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HomeMy WebLinkAboutResolution - 2017-R0114 - Watermaster Irrigation Supply - 03_23_2017Resolution No. 2017-RO 114 Item No. 6.9 March 23, 2017 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Contract No. 13276 and related documents for irrigation parts and PVC supplies as per ITB 17-13141-KM, by and between the City of Lubbock and Watermaster Irrigation Supply, of Lubbock, Texas. Said Contract is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on March 23, 2017 DANIEL M. POPE, MAYOR ATTEST: l� Re cca Garza, City Secr t APPROVED AS TO CONTEN Scott Snider, Assistant City Manager APPROVED AS TO FORM: Justin P itt, Assista t City Attorney ccdocs/RES. Contract 13276 — Watermaster Irrigation Supply — Irrigation Parts & PVC Supplies February 2, 2017 Resolution No. 2017-RO 114 CONTRACT NO. 13276 CITY OF LUBBOCK, TX IRRIGATION PARTS AND PVC SUPPLIES THIS CONTRACT made and entered into this 23rd day of March, 2017, by and between the City of Lubbock ("City"), and Watermaster Irrigation Supply, ("Contractor"). WITNESSETH: WHEREAS, the City of Lubbock duly advertised for bids for Irrigation Parts and PVC Supplies and bids were received and duly opened as required by law; and WHEREAS, after careful consideration of the bid submitted by Contractor, the City of Lubbock has heretofore adopted a resolution authorizing the acceptance of such bid, and the execution, in the name of the City of Lubbock a contract with said Contractor covering the purchase and delivery of the said Irrigation Parts and PVC Supplies. NOW, THEREFORE, in consideration of the mutual agreement contained herein, as well as the financial consideration hereinafter referred to, the parties hereby covenant and agree as follows: 1. In accordance with City's specifications and Contractor's bid, copies of which specifications and bid are attached hereto and made part hereof, Contractor will deliver to the City, Irrigation Parts and PVC Supplies, and more specifically referred to as items one thru four, seven thru twelve, fifteen thru thirty-six and thirty- eight thru fifty-three on the bid submitted by the Contractor or in the bid form attached hereto. 2. The City promises and agrees to employ, and does employ, the Contractor to cause to be done the work provided for in this Contract and to complete and finish the same according to the attached specifications, offer, and terms and conditions contained herein. 3. The contract shall be for a term of one year, with the option of four, one year extensions, said date of tern beginning upon formal approval. The rates may be adjusted upward or downward every six (6) months at a percentage not to exceed the effective change in the Consumer Price Index (CPI) or Product Price Index (PPI), whichever is most appropriate for the specific contract for the previous six (6) months. Written consent from both parties is required for all price adjustments. At the City's discretion, the effective change rate shall be based on either the local or national index average rate for all items. If agreement cannot be reached, the contract is terminated at the end of the current contract period. All stated annual quantities are approximations of usage during the time period to be covered by pricing established by this bid. Actual usage may be more or less. Order quantities will be determined by actual need. 4. This contract shall remain in effect until the expiration date, performance of services ordered, or termination of by either party with a thirty (30) day written notice. Such written notice must state the reason for cancellation. The City of Lubbock reserves the right to award the canceled contract to the next lowest and best bidder as it deems to be in the best interest of the city. Contractor shall at all times be an independent contractor and not an agent or representative of City with regard to performance of the Services. Contractor shall not represent that it is, or old itself out as, an agent or representative of City. In no event shall Contractor be authorized to enter into any agreement or undertaking for or on behalf of City. At any time during the term of the contract, or thereafter, the City, or a duly authorized audit representative of the City, at its expense and at reasonable times, reserves the right to audit Contractor's records and books relevant to all services provided to the City under the Contract. In the event such an audit by the City reveals any errors or overpayments by the City, Contractor shall refund the City the frill amount of such overpayments within thirty (30) days of such audit findings, or the City, at its option, reserves the right to deduct such amounts owing the City from any payments due Contractor. INSURANCE SECTION A. Prior to the approval of this contract by the City, the Contractor shall furnish a completed Insurance Certificate to the City, which shall be completed by an agent authorized to bind the named underwriter(s) to the coverages, limits, and termination provisions shown thereon, and which shall furnish and contain all required information referenced or indicated thereon. THE CITY SHALL HAVE NO DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL SUCH CERTIFICATE SHALL HAVE BEEN DELIVERED TO THE CITY. INSURANCE COVERAGE REQUIRED SECTION B. The City reserves the right to review the insurance requirements of this section during the effective period of the contract and to require adjustment of insurance coverages and their limits when deemed necessary and prudent by the City based upon changes in statutory law, court decisions, or the claims history of the industry as well as the Contractor. SECTION C. The Contractor shall obtain and maintain in full force and effect for the duration of this contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by companies approved by the State of Texas and acceptable to the City, in the following type(s) and amount(s): TYPE OF INSURANCE GENERAL LIABILITY ® Commercial General Liability ❑ Other ❑ Claims Made ® Occurrence ❑ W/Heavy Equipment ❑ To Include Products of Complete Operation Endorsements PROFESSIONAL LIABILITY AUTOMOTIVE LIABILITY ® Any Auto ❑ Scheduled Autos ❑ Non -Owned Autos EXCESS LIABILITY ❑ Umbrella Form GARAGE LIABILITY ❑ Any Auto ❑ BUILDER'S RISK ❑ INSTALLATION FLOATER ❑ All Owned Autos ❑ Hired Autos COMBINED SINGLE LIMIT General Aggregate $1,000,000 Products-Comp/Op AGG X Personal & Adv. Injury X Contractual Liability X Fire Damage (Any one Fire) Med Exp (Any one Person) General Aggregate General Aggregate Combined Single Limit $I,000,000 Each Occurrence Aggregate Auto Only - Each Accident Each Accident Aggregate ❑ 100% of the Total Contract Price ❑ I00% of the Total Material Costs ❑ POLLUTION ❑ CARGO ® WORKERS COMPENSATION — STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY ® EMPLOYERS' LIABILITY $I,000,000 OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED ® City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis. ® To include products of completed operations endorsement. ® Waiver of subrogation in favor of the City of Lubbock on all coverages, except The City of Lubbock shall be named as an additional insured on a primary and non-contributory basts and snatt include waivers of subrogation in favor of the City on all coverage's. Copies of the Certificates of Insurance and all applicable endorsements are required. event such an audit by the City reveals any errors or overpayments by the City, Contractor shall refund the City the full amount of such overpayments within thirty (30) days of such audit findings, or the City, at its option, reserves the right to deduct such amounts owing the City from any payments due Contractor. 10. All funds for payment by the city under this contract are subject to the availability of an annual appropriation for this purpose by the City. In the event of nonappropriation of funds by the City Council of the city of Lubbock for the goods or services provided under the contract, the City will tenninate the contract, without termination charge or other liability, on the last day of the then -current fiscal year or when the appropriation made for the then -current year for the goods or services covered by this contract is spent, whichever event occurs first. If at any time funds are not appropriated for the continuance of this contract, cancellation shall be accepted by the Seller on thirty (30) days prior written notice, but failure to give such notice shall be of no effect and the City shall not be obligated under this contract beyond the date of termination. 11. The Contractor shall not assign or sublet the contract, or any portion of the contract, without written consent from the Director of Purchasing and Contract Management. Should consent be given, the Contractor shall insure the Subcontractor or shall provide proof of insurance from the Subcontractor that complies with all contract insurance requirements 12. This Contract consists of the following documents set forth herein; Invitation to Bid 17-13141-KM, the Bid Form and Specifications. IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and year first above written. Executed in triplicate. CITY OF LUBB K: ----- OF M. Pope, Mayor ATTEST: (Q 0 P'w Reblra Garza, City Secretary APPROVED AS TO CONTENT* Bridget Faulkenberry, Director, Parks and Re eation APPROVED AS TO FORM: ""'� Z�� Justin rui , Assistant City Attorney CONTRACTOR: FIR Autfized Representative'sture ex-(-) Print Name Address to b(` , , -a City, State, Zip Code ADDITIONAL POLICY ENDORSEMENTS The City shall be entitled, upon request, and without expense, to receive copies of the policies and all endorsements thereto and may make any reasonable request for deletion, revision, or modification of particular policy terms, conditions, limitations, or exclusions (except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwriter of any of such policies). Upon such request by the City, the Contractor shall exercise reasonable efforts to accomplish such changes in policy coverages, and shall pay the cost thereof. REQUIRED PROVISIONS The Contractor agrees that with respect to the above required insurance, all insurance contracts and certificate(s) of insurance will contain and state, in writing, on the certificate or its attachment, the following required provisions: a. Name the City of Lubbock and its officers, employees, and elected representatives as additional insureds, (as the interest of each insured may appear) as to all applicable coverage; b. Provide for 30 days notice to the City for cancellation, nonrenewal, or material change; c. Provide for notice to the City at the address shown below by registered mail; d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees, and elected representatives for injuries, including death, property damage, or any other loss to the extent same may be covered by the proceeds of insurance; e. Provide that all provisions of this contract concerning liability, duty, and standard of care together with the indemnification provision, shall be underwritten by contractual liability coverage sufficient to include such obligations within applicable policies. NOTICES The Contractor shall notify the City in the event of any change in coverage and shall give such notices not less than 30 days prior the change, which notice must be accompanied by a replacement CERTIFICATE OF INSURANCE. All notices shall be given to the City at the following address: Marta Alvarez, Director of Purchasing and Contract Management City of Lubbock 1625 131' Street, Room 204 Lubbock, Texas 79401 SECTION D. Approval, disapproval, or failure to act by the City regarding any insurance supplied by the Contractor shall not relieve the Contractor of full responsibility or liability for damages and accidents as set forth in the contract documents. Neither shall the bankruptcy, insolvency, or denial of liability by the insurance company exonerate the Contractor from liability. 7. Neither the City nor the Contractor shall assign, transfer or encumber any rights, duties or interests accruing from this Contract without the written consent of the other. 8. The City reserves the right to exercise any right or remedy available to it by law, contract, equity, or otherwise, including without limitation, the right to seek any and all forms of relief in a court of competent jurisdiction. Further, the City shall not be subject to any arbitration process prior to exercising its unrestricted right to seek judicial remedy. The remedies set forth herein are cumulative and not exclusive, and may be exercised concurrently. To the extent of any conflict between this provision and another provision in, or related to, this document, this provision shall control. 9. At any time during the term of the contract, or thereafter, the City, or a duly authorized audit representative of the City or the State of Texas, at its expense and at reasonable times, reserves the right to audit Contractor's records and books relevant to all services provided to the City under this Contract. In the City of Lubbock, TX ITB 17-13141-KM Irrigation Parts and PVC Supplies Specifications Intent The city of Lubbock intends to purchase irrigation parts, equipment, supplies, hardware, tools and materials for the use primarily for the repair, maintenance and up -keep of existing facilities at various sites across town. The City needs to have a proper source of supply that is responsive, readily available and able to meet the City's requirements with minimum delay in acquisition and/or delivery. Statement of Needs Bidder represents and warrants that all items are new and not used or reconditioned and are not of such age or so deteriorated as to impair their usefulness or safety and that the goods, materials, supplies or components offered are current production models of the respective manufacturer. This bid is for discount pricing on attached price list and will be awarded to multiple vendors. Bidders may bid on all or part of the list. Bidders may add irrigation, PVC, supplies and equipment showing the discounted pricing for materials not on the supplied list by providing a second sheet for such additions. Do not add items to the Bid Form. The City Parks and Recreation Department is requesting the irrigation and PVC supplies for park use to be either picked up by park staff or delivered to the park site by the vendor depending on quantities. Contract Period The contract shall be for a term of one (1) year with the option of four (4), one (1) year extensions. Delivery Location Deliveries will be made inside the city limits of Lubbock, TX or to the address below at the preference of the Parks and Recreation Department. City of Lubbock Parks and Recreation — Park Maintenance 308 Municipal Dr. Lubbock, TX 79403 Page 33 of 37 City of Lubbock, Tuts Purchasing and Contract Management BID FORM In cnmplismr with the Invitation to Bid 17-13141-KM, the undersigned Bidder having examined the Invitation to [aid and Specifications, and being rantiliar with the conditions to be met, hereby submits,the following Bid for furnishing the material. equipment. labor and everything necessary for providing the items listed below and agrees to deliver said items at the locations and for the prices set forth on this form. The Invitation to Bid 17-13141-KM is by reference incorporated in this contract. The Bid Form most be completed in blue or black ink or by typewriter. Item Description Discount Offered Off (RetsittCatalog) Please Ust Discount Delivery Fee* Restock Fee Delivery Days ARO 1. All Spears Wholegoods 'I X. �5 !O % S Q S — ) 2. All Spears Rc*r Parts 7 4D 00 O Q 1 _ 14- 3. All Lased Wholegoods -14 4. All Lasco Repair Parts All T)WV -- 7. All Febco Wholegoods (D 8. All Febco Repair Parts ( (q !p V ( T 9 All Rainbird Wholegoods % 10 All Rainbird Repair Parts 2 �p D O 1 !14- 11. All Hunter Wholegoods 55 1 1 B7 O Page 4 or37 Item 1?eteriplion Discount Offered Off (Retail/Cataing) Plense List Disenum Delivery fee* Re%mck fee Delivcn Days ARO*+ 12. All blunter Repair Puns 1 - 14 1 �. All Gaelc Wholeiwm)ds — 15, All ADS Wholegoods 16. All ADS Repair Parts 5 to O G ' - J4 17. All TORO Wholcgouds .22 IR, All TORO Repair Paris 10, All Bermad Wholc2oods 0 j'tj _ 14 20. All 13ermad Repair Paris lJ '1. All Irritml Whole�&cxxls� , 1 % I _'_'. :111 Irritrol Repair Parts 6D, l O I All Weathermatic Wholemids - �5D, 207o! L- 4111 pV�� V / /-! 4 24. All V�%eathermatic Repair Parts 4D(:/p C) ,s i :%If Rainklasier �Vholeg�xxls 'A'Pr;ce e-0dc -2D% TtGeCE D'� _ O ,^ U O 0 0 G I 'G. ,\II s i faster Repair tans f V io YGlM1. Description Discount Offered Off (Retail/Catalog) Discount Delivery Fee Restock Fee Delivery Days ARO*11 Y Please List 41 l Gmenlee %'Weepodss I V 6?0 0 -- I 43. All Midwest Vvholcs«xls O O /-� �J _ I 44. All Buckner Wholegoolegoo ds 45. All Buckner Repair Parts �] !0 n V V a 46 All Champion Wholegoods � C� O O 47 All Champion Repair Part, !�-1 4j tJ i. l LJ D 0 Q !1( — 1 T 4R. All Class 900 PVC Pipe and Fittings Pipe: � "� �O b O O ! _ 14 y Fittings: 170 � 4�' All Class 200 PVC Pipe and Fittings y( Pipe 110 Fittings; 62-''706 S t S0. All SCHAO PVC Pipe and Fittings Pipe: �6 02o _ Q Fittings: zt tr� (� O S I , All SCH_RO PVC Pipe and Fittings Pipe. �O O (— Fittings: All Irrigation Plumbing 52. Supplies, including but not limited to: PVC Cement, Primer, Teflon Ta , Wire Splice Kits. 53. Iipe and Fittings 4O C70,F j J Page 7 of 37 N , Ion Discount Offered Off (Retail/Catalog) Discount Delivery Fee" Restock Fee Delivery Days ARO** Please List Wholegoods Ugi able to provide b Check valve) 29.' All Netifirn Repair Parts All Valve Boxes 29. (various sizes, manufacturers, and lockable) 30. IS/ 13 quIti-Strand Iff igation Control Wire 14 31. 14 ga. Red Wire 6S61 0 32. 12 ga. Solid White Wire 33. All Hotboxcs (various sizes and manufacturers) A c,+LtA� 34. All Data Industrial Flow Sensors (to include wire) 35. All ADS Wholceoods 70 O 0 0 36. All ADS Repair Parts h17O 0 C) All Quaintarn Metal IS All Nelson Wholegoods 1-14 39, All Nelson Repair Parts 0 40, All Dig- Wholegoods 6� D C) 41. All Digs Repair Paris' 6"7 1 -4 (0 Page 6 of 37 Z! * Delmer fir shall he a Ilat rate for deli%Cry a ithin a _'�-mile radius of the C It% of Lubbock. **Days After Receipt ol'Order (AKO) In order to be considered for the ;m ard of this bid, bidders inti t meet the folloiN inr criteria: 1, dust he a stocking dealer of the items bid. 2. Distribution office tuns( be N itbin a 25-mile radius of' the Clt\ of Lubbock, 'I exas. Unless othem ise specified herein, the CiI\ nra) a1%and the bid eillter item -by —item or on :ut all -or -none basis for am item or group of items sho« n ou the bid. The City of Lubbock is seeking a contract for Irrigation Parts :uul N\'C Supplies ssith one or more contractors. In order to assure adequate coserage, the Cite nuts make multiple mards. selecting multiple vendors to pro\ide the products desired, if nrulliple aisards are in the hest interest of the C itN- -A decision to make a multiple :mard of this Bid, hoiseier, is an option reserNed by the Cil\, based on the needs of the Cite. The Cite of Lubbock reserves file right to reject anN or all bids, reject am particular itern on a quote, and to guise immaterial forntrtlities. PA)AIL-N f I-ERMS AND DISCC)11N fS - bidder 01'1Crs a prompt p;t%mcnt disruunt 01' � net-- calendar day,. Discount, will not br considered in dctcrminin�, log % hid. 1'nlc„ oillcr%'oile indirateii un Ihr Bid I -corm. mcr, (rent ll be NIT "1711IR FY DAYS. 'I lie Cir gill pay the successful bidder within shirts da}, after the receipt of a correct in"oice or ailer the date oI'acceptance. \\ lie he%cr rent Occurs later. I)1;Count, fur prompt payment requirim, pa-,mcnt b� the C m a ithin a Stipulated number ol"da%; a ill be intcrhrctekl as applyin , \k ithin the stipulatCd numhcr of calrnd.tr daN, alter the date of receipt by the City ola Correct ins wire or alier the date of aCCeptancc that meets runtract requirCntent,. a hiClte\ Ci event oCCurs later. DI;COttnl; fur pasnient in less than tell da%s will nut be ConSidCrCd. MOST FAVOURED PRICING: T he Bidder certilies that the price Cluolcd is not in csces, ofthC lone l price Char rJ ar%011C else, including its mini fawured cu>tumCr• liir like qualit% and quintit% of the prodUCt, NCI iCC,: due, nol inCIuLIC an CICmrnt of profit on the sale in ewes of that nCtnnally obtained b% the Bidder on the sale of produCts scricc, of like quality and quantith: and does not inCludC any provision lot discount, to selling agents. 11 at anN time during the contraet period. the supplier should sell or infer for sale to any other customer• an equal or leas quantity of similar Contract produCts of like or better quality, at a lower net price(;) than pro%ided herein. sul,hlier ❑grYe; to notilj the 01% and ;ell samC pruduCI(,) at the lower price(s) on all deliveries made during the period in which such lower priCC(S) is el'leCti\e. INTERLOC'AL PURCHASING (optional): The City desire; to make a\ailable to other local go%ernmental entities oI' the State of Teas. by mutual ith the sucCe:sful bidder. and properly authorized interlocal purcha:iIl2 aiarements ,u provided for by the Interlocal Cooperation Act (Chapter 7t) 1. Governmcm Code). the right to purhase the same ;er iccs, at the prices quoted, fir the period of this Cinrtract. Each bidder shall indicate on the Bid Bonn in the space prop Merl bCloa i f he she \ill honor Political Suhai\i;ion order, in additirIn to Orders Irum the Cit% ol' LubhuCk. Should the,e other g,mernmemal entities decide to participate in this contract, Mould kou (the bidder) aizree that all terms. cundinons. specifications, and pricing would apply? Other governmental entities that might have interests in this contract are Frenship Independent School District, Lubbock Housing Authority, Lubbock Count\, Lubbock County hospital District, Lubbock Independent School District, South Plains Association of Governments, City of'I'esarkan:i. ,re�as Tech University. West Texas Municipal Poser Agency, Lynn County, and City of Wolfforth. YES_/ I NO • II'Vou (thC bidder) checked YES. the folluaing %%ill apply: • Governmental entities utilizing Interlocal Agreements forCoopCrali�C PurChasint \\ith the C6 of Luhhuck \%ill be eligible, but not obligated. to purchase materials serviCC, under the Conn"aCt(S) aaarled as a result ofthis ;olicitatinn. All purchases by gmernmcntal cntitieS other than the City of Lubbock \ill be billed directly to that gcnernmental entity and paid by that gmernmental entity. City of Lubbock kcil) not be responsible for another governmental entitv's debts. Each caovernmental entitV %ill order their tan materialsservice as needed. MILS BID IS SLJF3hfllTED L31"✓ rY-*Q(t�,IY �S.li][],%� a corporation organized under the lams of the Stale of 'LeILQ�- or a partnership consisting of Firm: (� rtrl traclin as ti }e� ((� k� ufthe Cit) of 1� or all indivul akC.XrY10� Sher , A a i �5l �� I a -- P;w,c 8 u1'37 CitN: I lip Bidder acknowledges receipt of the llollo%% ing addenda: Addenda No. Date Addenda No. Date Addenda No. Date Addenda No. Date -N 1 AVB E Firm: Woman 111a,:k American Natke American I lispallic Americall A,;iall Piwil-Ic WIC r (specir\ Officer Name and I itle: PI -h I I BUsilles-; lelephone NUmLicr 66 E-Mail Addrcs�: ) cx C., r LLLk--LWl--(AJ(J-7tt�r ry FOR CITY USE ONLY Bid Fomi hem Numher(.-,)A% arded to Abow Named Firm 111di\ idUll: Date ot'A\%ard b\ Cil\ Council yor hid.., w-cr S25.000): Date P.O. Contract Issued: LABEL TIIF OUTSIDE OF YOUR SEALED BID NVITII TIIL IT13 NUMBER, THE CLOSING DATE :kNI) TIME, AND YOUR COMPANY NAME AND ADDRESS. Pa�c 9 ol'37 CERTIFICATE OF INTERESTED PARTIES FORM 1295 loll Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 2017-164371 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Watermaster Irrigation Lubbock, TX United States Date Filed: 02/09/2017 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a description of the services, goods, or other property to be provided under the contract. ITB 17-13141-KM Irrigation parts & PVC supplies 4 Name of Interested Party City, State, Country (place of business)(check Nature of interest applicable) Controllin97 Intermediary 5 Check only if there Is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. WLINDA CLIFTON Notary Public, State of Tws My CoWL,;§m boas 08..12.2019 Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said cz�11-,4u f S 1/l /(it %j�" this the 20 to certify which, witness my hand and seal of office. �._ day of Clr� �� / o-.-- / n Li cc / �n r✓' ire / /'�i [ � t/- Sign re of offcer adminis ing oath Printed name of officer admi tering oath Title of offi r administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2017-164371 Date Filed: 02109,2017 Date Acknowledged: 02/09/2017 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Watermaster Irrigation Lubbock, TX United States 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. ITB 17-13141-KM Irrigation parts & PVC supplies 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said this the day of 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277