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HomeMy WebLinkAboutResolution - 2017-R0422 - Brenntag Southwest - 11_16_2017Resolution No. 2017-RO422 Item No. 6.8 November 16, 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. 13817 for Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant as per ITB 18-13668-KW, by and between the City of Lubbock and Brenntag Southwest, Inc., of Longview, Texas, and related documents. 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 November 16, 2017 ATTEST: I; �I Reb cca Garza, City Secretai ks DANIEL M. POPE, MAYOR vw:ccdocs/RES.Contract 13817.Aluminum Sulfate Polymer Blend for the North Water Treatment Plant 11.07.2017 Resolution No. 2017-RO422 Contract 13817 City of Lubbock, TX Contract for Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant THIS CONTRACT, made and entered into this 16"' day of November, 2017, pursuant to a resolution heretofore adopted by the City of Lubbock, Texas, by and between the City of Lubbock ("City"), and Brennta2 Southwest, Inc. ("Contractor"). WITNESSETH: WHEREAS, the City of Lubbock duly advertised for bids Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant and bids were received and duly opened as required by law; and WHEREAS, after careful consideration of the bid submitted by Contractor, the City bid, and authorized the execution, in the name of the City of Lubbock a secondary contract with said Contractor covering the purchase and delivery of the said Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant 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 provide to the City Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant, and more specifically referred to as item four on the bid submitted by the Contractor or in the specifications 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. The contract shall be for a term of three years, said date of term beginning upon formal approval. 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. The City of Lubbock does not guarantee any specific amount of compensation, volume, minimum, or maximum amount of services under this bid and resulting contract. The Contractor must maintain the insurance coverage required during the term of this contract including any extensions. It is the responsibility of the Contractor to ensure that valid insurance is on file with the Purchasing and Contract Management Department as required by contract or contract may be terminated for non-compliance. 4. This contract shall remain in effect until the first of the following occurs: (1) the expiration date, (2) performance of services ordered, or (3) termination of by either party with a 30 day written notice. 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. 5. Contractor shall at all times be an independent contractor and not an agent or representative of the City with regard to performance of the Services. Contractor shall not represent that it is, or hold itself out as, an agent or representative of the City. In no event shall Contractor be authorized to enter into any agreement or undertaking for or on behalf of the City. 6. The contractor shall obtain and maintain in full force and effect during the term of the contract, commercial general liability coverage with insurance carriers admitted to do business in the State of Texas. The insurance companies must carry a Best's Rating of A- VII or better. The policies will be written on an occurrence basis, subject to the following minimum limits of liability: 7. INSURANCE COVERAGE REQUIRED 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. 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. Subject to the Contractor's right to maintain reasonable deductibles in such amounts as are approved by the City, 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 amottnt(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 El 1AUTOMOTIVE LIABILITY 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 ® Any Auto ❑ All Owned Autos Combined Single Limit ❑ Scheduled Autos ❑ Hired Autos Per Occurrence $1,000,000 ❑ Non -Owned Autos EXCESS LIABILITY ❑ Umbrella Form Each Occurrence _ Aggregate GARAGE LIABILITY ❑ Any Auto Auto Only - Each Accident ❑ Each Accident Aggregate _ ❑ BUILDER'S RISK ❑ 100% of the Total Contract Price ❑ INSTALLATION FLOATER ❑ 100% of the Total Material Costs ❑ POLLUTION ❑ CARGO ® WORKERS COMPENSATION —OR OCCUPATIONAL MEDICAL AND DISABILITY $1,000,000 ® EMPLOYERS' LIABILITY OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED ® City of Lubbock named as additional insured on Auto/Genera( 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 IMPORTANT: POLICY ENDORSEMENTS The Contractor will provide copies of the policies without expense, to the City 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. Any costs will be paid by the Contractor. 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. L All copies of the Certificates of Insurance shall reference the project name or bid number for which the insurance is beine supplied. 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 & Contract Management City of Lubbock 1625 131h 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. S. 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 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. 9. 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. 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 fiinds by the City Council of the City of Lubbock for the goods or services provided under the contract, the City will terminate 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 finds are not appropriated for the continuance of this contract, cancellation shall be accepted by the Seller on 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 insurance requirements 12. Neither the City nor the Contractor shall assign, transfer or encumber any rights, duties or interests accruing frorn this Contract without the written consent of the other. 13. The Contractor warrants that it complies with Chapter 2270, Subtitle F, Title 10 of the Texas Government Code by verifying that: (1) The Contractor does not boycott Israel; and (2) The Contractor will not boycott Israel during the term of the Agreement. 14. SB 252 prohibits the City from entering into a contract with a vendor that is identified by The Comptroller as a company known to have contracts with or provide supplies or service with Iran, Sudan or a foreign terrorist organization. 15. This Contract consists of the following documents set forth herein; Invitation to Bid No. 18-13668-KW, Specifications, and the Bid Form. [Signatures on Next Page] 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 LUBBOCK: Daniel M. Pope, ayor ATTEST: D - ov Reb up Garza, City Secretary APP OVED AS TO ONTENT: Aubr S , P. ., Director of Water Utilites APPRO AS RM: Amy , epuFCiVALkCom CONTRACTOR: h � I BY Authorized Representative's Signature W - �h Print Name (. Address it), State, and Zip Code City of Lubbock, TX Bid 18-13668-KW Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant SPECIFICATIONS 1. INTENT It is the intent of these specifications to describe the aluminum sulfate/polymer blends to be used as a coagulant at the City of Lubbock North Water Treatment Plant. 2. PRODUCT SPECIFICATION The aluminum sulfate/polymer blend purchased for use at the City of Lubbock Water Treatment Plant shall contain no soluble inorganic or organic substances capable of producing deleterious or injurious effects upon the health of those consuming the water, or that would otherwise render it unfit for public consumption. The aluminum sulfate/polymer blend must have NSF/ANSI Certification for use in potable water treatment plants. Bidder shall submit a certificate of analysis which will include the specific gravity and pH. The City will require the product to have a pH in the range of 1.3 to 2.8 (slightly more stringent than AWWA Standard). The material safety data sheets (MSDS) for the product shall also be submitted with the bid. Due to the fact that successful aluminum sulfate/polymer blends are 90% or more aluminum sulfate by weight, it is preferable that the bidders be a manufacturer of liquid aluminum sulfate. If the successful bidder is not a manufacturer of aluminum sulfate, bidder must provide a copy of a legal contract between the bidder and the aluminum sulfate manufacturer that will be used to produce the blend. In any event, all products used must have NSF/ANSI certification for use in drinking water treatment plants. The same aluminum sulfate manufacturer must be used throughout the term of the contract. Throughout the term of the contract, the successful bidder may not change the formulation of the aluminum sulfate/polymer blend in any way without the express written consent of the Water Production & Treatment Superintendent. No exceptions, an unauthorized change in the formulation of the product will result in contract termination. 3. PRODUCT PERFORMANCE Products to be considered for bid will be tested by the manufacturer using standard jar testing methods at the City's site. The test results must include settled water and final water turbidities, pH and temperature. A sample of the product being tested will be left at the facility for additional jar testing by Operations personnel, if additional pilot plant testing is necessary an additional amount of sample will be required. At the City's discretion full plant testing will be required based on results of previous tests; the City will pay for a full delivery (approximately 48,000 lbs.) at the price submitted in the bid document to conduct full plant testing. Water Treatment Operations personnel will evaluate product performance based on settled water quality, pH, filter effluent turbidities, and cost effectiveness. Bidders must submit a list with a minimum of three (3) potable water treatment plants with phone numbers and contact persons that are currently using the product. References will be thoroughly checked and will figure prominently into the selection of a successful bidder. 4. PRODUCT QUALITY PER LOAD Upon delivery of each load of product, the transport driver must present a certificate of analysis containing specific gravity and pH. As stated in the product specifications, the pH must be within the range of 1.3 to 2.8. Plant operations staff will also perform specific gravity and pH analyses on the product in the presence of the transport driver. A delivered product that exhibits any unusual color or appearance compared to previous acceptable deliveries will be refused, as will deliveries containing any form of foreign material. If the product meets the required minimum standards, the product may then be off loaded into the storage tanks. If desired, the vendor may provide their own hydrometer and perform an additional specific gravity analysis in the presence of the plant operations staff. In the event the product does not meet the required minimum standards, the load will be refused and the vendor must provide another acceptable load within forty eight (48) hours. No additional freight or shipping charges shall be assessed by vendor. 5. TECHNICAL SUPPORT Vendor shall provide acceptable technical support and response time whenever problems are encountered relating to product use and/or performance. Acceptable technical support will include routine site visits at least every three (3) months to perform jar testing and consulting with operations staff on any questions or problems with the product. A telephone response time of one (1) business day is required of vendor in cases of product performance problems. A site visit by the vendor may be requested by the owner if owner feels it is necessary to solve any significant problem related to product performance. If a non -routine site visit is requested, the vendor will have five (5) business days to respond and arrive on -site. If at any time during the duration of the contract a significant change in the source water is experienced, including major changes related to the ground water to surface water ratio of the owners blended raw water source, vendor will have five (5) business days to respond and arrive on -site to test and evaluate current process and recommend changes in the product if needed. All technical support will be at no cost to the owner. 6. BID ACCEPTANCE Product performance will be required to meet optimum quality results for settled and effluent water. The evaluation of bids will include a set of water quality parameters that must be met through the above outlined testing procedures. The bid will be awarded based on water quality and overall visual plant performance, cost effectiveness, and reference checks. 7. QUANTITIES AND PRICING The anticipated annual consumption of an aluminum sulfate/polymer blend for coagulant use is 949 tons more or less. Prices quoted for product shall be FOB North Lubbock Water Plant, 6001 North Guava, Lubbock, Texas. Pricing shall be firm for a period of three years. Written consent from both parties is required for all price adjustments. Listed quantities are estimates only for pricing purposes. Actual usage may vary. 8. DELIVERY / SECURITY Successful vendor shall be required to deliver the product to the Lubbock Water Treatment Plant in bulk tank truck within five (5) days after order is placed. Unloading to plant storage tanks is to be performed by the driver under the direction of operations personnel. Successful vendor shall provide any and all special equipment necessary to perform unloading at no cost to the City of Lubbock. All deliveries will be unloaded between the hours of 8:00 A.M. and 4:00 P.M., Monday through Friday. No exceptions will be made unless prior approval is agreed upon with the water treatment plant's operations personnel. The transporter is required to furnish certified, dated, and stamped weight tickets with each load of product, before and after unloading. All delivery people will display photo security ID upon arrival at the site. All delivery vehicles shall meet OSHA and DOT regulations and be operated in a safe manner while on site. All delivery personnel will be identified by the vendor before arrival at the site; preferably at the time an order is placed. Upon arrival at the Water Treatment Plant, delivery personnel will check in at the main building before proceeding to the unloading site. The driver will be met at the security gate by plant personnel and must present photo identification. All shipments shall be sealed and the seal will be broken only in the presence of the plant representative. If any of the security measures are violated, the shipment will be refused. 9. SUPPLEMENTAL ADDITIVE SPECIFICATION Buyer requests the option of having copper sulfate, containing at least 99% CuSO4.5H2O, added to the Aluminum Sulfate/Polymer blend. The copper sulfate must have NSF Certification for use in potable water treatment plants. The copper sulfate would be added per load at the buyer's request to control algae growth. Algae growth occurs when the water reaches a temperature of 72°F. The yearly average of this temperature is between the middle of April to the end of September. The amount of additive will be based on the coagulant feed rate at the time the load was ordered and would be determined by the operations staff, a 2.0% copper sulfate additive is to be expected. 10. TERM AND CONDITIONS The contract shall be for a term of three years, said date of term beginning upon formal approval. 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. The City of Lubbock does not guarantee any specific amount of compensation, volume, minimum, or maximum amount of services under this bid and resulting contract. The Contractor must maintain the insurance coverage required during the term of this contract including any extensions. It is the responsibility of the Contractor to ensure that valid insurance is on file with the Purchasing and Contract Management Department as required by contract or contract may be terminated for non- compliance. This contract shall remain in effect until the first of the following occurs: (1) the expiration date, (2) performance of services ordered, or (3) termination of by either party with a 30 day written notice. 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. BID FORM Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant City of Lubbock, TX ITB 18-13"9-KW In compliance with the Invitation to Bid 18-13668-KW, the undersigned Bidder having examined the Invitation to Bid and Specifications, and being familiar with the conditions to be met, herehy submits the following Bid for fiunishing 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. A bid will be subject to being considered irregular and may be rejected if it shows omissions, alterations of form, conditional alternate bids, additions or alternates in lieu of the items specified, if the unit prices are obviously unbalanced (either in excess of or below reasonably expected values), or irregularities of any kind. The invitation to Bid 18-13668-KW is by reference incorporated in this contract. The Bid Form must be completed in blue or black ink or by typewriter. Q.FY UNIT OFUNI'I� PRICE' EXTENDED DELNERY ITEM DESCRIPTION W-) MFASURE B COST DAYS A A x B = ARO•• 1 Hydrate Aluminum $ al1U ' 2. Hydrate Aluminum 949 TON Sulfate/Polymer Blend with 1"/0 49n— $394594.20 3-5 Days Copper Sulfate Additive, as perAl ' s ecific do _ 3. Hydrate Aluminum 949 TON Sulfate/Polymer Blend with 2% Copper S ate Additive, as per ' specifications. 4 Hydrate Aluminum 949 TON Sulfate/Polymer Blond with 3% $477.60fron $453,242.40 3-5 Days Copper Sulfate Additive, as per specifications. 5 Bauxite Aluminum 949 TON s ecifications. 6. Bauxite Aluminum 949 '1 ON Sulfate/Polymer Blend with 1% Copper Sulfate Additive, as per specifications. - 7. Bauxite Aluminum 949 TON Sultite/Pol mer Blend with 2% Copper Sullitc Additive. as per ecifications. 8 Bauxite Aluminum 949 TON Sullite/Polymer Blend with 3% $463,242.40 3 6 Days Copper Sulfate Additivr, as per ____r'�_GOITen specifications. Total 1-8 Total S453,242.40 *PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed "Days After Receipt of Order (ARO) The City of Lubbock is seeking an agreement for aluminum sulfate/polymer blend with one or more contractors. In order to assure adequate coverage, the City may make multiple awards, selecting multiple vendors to provide the products desired, If multiple awards are in the best interest of the City. A decision to make a multiple award or this Bid, however, is an option reserved by the City, based on the needs of the City. ffB 18-13669-KW Aluminum Sulfaldi Wrna Bicnd for NWTP PAYMENY1-11 "S AND DISCOUNTS - Bidder oli'crs a prompt payment discount of 0 °!a, ne13O calendar days. Discounts will not be considered in determining low bid. Unless otherwise indicated on the Rid Form, payment terms will be NET THIRTY DAYS. The City will pay the successful bidder within thirty days after the receipt of a correct invoice or alkr the date of acceptance, whichever event occurs later. Discounts for prompt payment requiring payment by the City within a stipulated number of days will be interpreted as applying within the stipulated number of calendar days after the date of receipt by the City of a correct invoice or after the date of acceptance that meets agremmeni requi vmcnts. whichever event occurs later_ Discounts for payment in less than ten days will not be considered_ MOST FAVOURED PRICING: The Bidder certifies that the price quoted is not in excess of the lowest price charged anyone else, including its most favoured customer, for like quality and quantity of the products/scrvices, does not include an element of profit on the sale in excess of that normally obtained by the Bidder on the sale of productslserviecs of like quality and quantity; and does no include any provision for discounts to selling agents. If at any time doming the agreement period, the supplier should sell or offer for sale to any other customer, an equal or less quantity of similar agreement products of like or better quality, at a lower net price(s) than provided herein, supplier agrees to notify the City and sell same product(s) at the lower price(s) on all deliveries made during the period in which such lower price(s) is effective. INTERLOCAL PURCHASING (optional): The City desires to make available to other local governmental entities of the State of Texas, by mutual agreement with the successful bidder, and properly authorized interloral purchasing agreements as provided for by the Interiocal Cooperation Act (Chapter 791, Government Code), the right to purchase the same services, at the prices quoted, for the period of this agreement_ Each bidder shall indicate on the Bid Dorm in the space provided below if he/she will honor Political Subdivision orders in addition to orders kom the City of Lubbock. Should these other governmental entities decide to participate in this agreement, would you (the bidder) agree that all terms, conditions, specifications, and pricing would apply`' Other governmental eadiks that might have Interests In t><is agreement an Freaship independent School District, Lubbock Housing Authority, Lubbock County, Lubbock County Hospital District, Lubbock Independent School Dlatrkt, South Plains Association of Governments, City of Texarkana, Tesns Tech University, Wert Tee Municipal Powvr Ageaey, Lynn County, and City of W nine. YE. S NO • If you (the bidder) checked YES, the following will apply: Governmental entities utilizing Interlocal Agreements for Cooperative Purchasing with the City of Lubbock will be eligible, bnt ant obligated, to purchase m 4crialstservices under the agreement(s) awarded as a remit of this solicitation. All purchases by governmental entities other than the City of Lubbock will he billed directly to that governmental entity and paid by that governmental entity. City of Lubbock will not be responsible for another governmental entity's debts. Each governmental entity will order their own materials/service as heeded_ THIS BID iS SUBMITTED BY B3renntag SouthwW, inc. a corporation orftanized under the laws of the State of Texas , or a partnership consisting of of the City of Firm: Brenntag Southwest, Inc. 610 Fisher Road or individual trading as City--lo tayiew Stage: TgMs _ "Lip 75604 Bidder acknowledges receipt of the fallowing addenda: Addenda No_ Date Addenda No. Dane Addenda No_ Date Addenda No. Date M/WBE Firm:1 I Woman Black American Native American Hispanic American Asian Pacific Americ Other (Specify) rrB 18-13668-KW AhwMav SwIlWaotyma Mad Soc NwtY 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: 2017-279979 Date Filed: 11/03/2017 Date Acknowledged: 11/07/2017 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Brenntag Southwest, Inc. Longview, 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. 13817 Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary Brenntag North America, Inc. Reading, PA United States X 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 V1.0.3337 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 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: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2017-279979 Brenntag Southwest, Inc. Longview, TX United States Date Filed: 11/03/2017 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 identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 13817 Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling I Intermediary Brenntag North America, Inc. Reading, PA United States X 5 Check only if there is NO Interested Parry. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. KRISL.A CADENHEAD NOTARY PUBLIC I i *i 041130800221 1 "� . P• State of Texas .9lF K�+ Goitnn-Exp.08-29-2020 , OF Signature of authorize age o c ntracting business entity AFFIX NOTARY STAMP / SEAL ABOVE A Y before by the f! I this the ,/ C/ / day of I�IQ l Sworn to and sub ribed me, said 20_, to e ify which, witn s my hand and seal of office. Sig t e f officer adminhtp ring oath P rated name of officer administering oath Title of off er administerib oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337