HomeMy WebLinkAboutResolution - 2017-R0437 - Kann Manufacturing Corporation - 11_16_2017Resolution No. 2017-RO437
Item No. 6.23
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, Purchase Order No. 31035825 for the purchase of Kann
Packer Bodies as per BuyBoard 516-16, by and between the City of Lubbock and Kann
Manufacturing Corporation of Guttenberg, Iowa, and related documents. Said Purchase Order 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
Ll _
DANIEL M. POPE, MAYOR
ATTEST:
Q,0
Reb kcca Garza, City Secr tar
APPROVED AS TO CONT NT:
—Scott Snider, Assistant City Manager
APPROVED AS TO FORM:
K lli Leisure, Assistant City Attorney
ccdocs!'RES.Purchase Order Contract 31035825.Kann Packer Bodies
10.12.2017
Lubboc
PURCHASE ORDER
Wr k
TEXAS
TO: KANN MANUFACTURING CO
PO BOX 400
GUTTENBERG Iowa 52052
Page -
Date -
Order Number
Branch/Plant
1
10/31/2017
31035825 000 OP
3526
TO: CITY OF LUBBOCK
FLEET SERVICES
206 MUNICIPAL DRIVE
LUBBOCK Texas 79404
INVOICE TO: CITY OF LUBBOCK
ACCOUNTS PAYABLE
P.O. BOX 2000
LUBBOCK, TX 79457 BY:
Marta Al z, Director of Purchasing & Contract Management
Ordered 10/12/2017 Freight
Requested 03/30/2018 Taken By
Delivery J LOERWALD REQ 51014
BUYBOARD 516-16
Description/Supplier Item Ordered
Kann Packer Bodies 4.000
CC 5511
Freight 4.000
CC 5511
Terms NET 30
SGONZALEZ
Unit Cost UM Extension Request Date
97,480.0000 EA 389,920.00 03/30/2018
2,665.0000 EA 10,660.00 03/30/2018
Total Order
400,580.00
This purchase order encumbers funds in the amount of $400,580.00 awarded to Kann Manufacturing Corporation of Guttenberg,
Iowa, on November 16 2017. The following is incorporated into and made part of this purchase order by reference:
Quote Number 6097 dated October 10, 2017 from Kann Manufacturing Corporation of Guttenberg, Iowa and BuyBoard 4516-16.
Resolution # 2017-RO437
CITY OF LUBBOCK ATTEST:
LAI--- I X-1 _r_ V
Daniel M. Pope, Mayor f Reb' ca Garza, City Secreta
Seller and Buyer agree as
follows:
PURCHASE ORDER
TERMS AND CONDITIONS
IMPORTANT: READ CAREFULLY
STANDARD TERMS AND CONDITIONS
CITY OF LUBBOCII, TX
I. SELLER TO PACKAGE GOODS. Seller will package goods in accordance with good commercial practice.
Each shipping container shall be clearly and permanently marked as follows (a) Seller's time and address,
(b) Consignee's name, address and purchase order or purchase release number and the supply agreement number
i(applicable, (c) Container number and total number of containers, e.g. box I of 4 boxes, and (d) the number
of the container bearing the packing slip. Seller shall bear cost of packaging unless otherwise provided. Goods
shall be suitably packed to secure lowest transportation costs and to conform with requirements of common
carriers and any applicable specifications. Buyer's count or weight shall be final and conclusive on shipments
not accompanied by packing lists.
2. SHIPMENT UNDER RESERVATION PROHIBITED. Seller is not authorized to ship the goods under
reservation and no tender o(a bill of lading will operate as a tender o(goods.
3. TITLE AND RISK OF LOSS. The title and risk of loss of the goods shall not pass to Buyer until Buyer
actually receives and takes possession of the goods at the point or points ofdelivery.
4, NO REPLACEMENT OF DEFECTIVE TENDER. Every tender of delivery of goods must fully comply
with all provisions o(this contract as to time ofdelivery, quality and the like. 1(a tender is made which does not
fully conform, this shall constitute a breach and Seller shall not have the right to substitute a conforming tender,
provided, where the time for performance has not yet expired, the Seller may reasonably notify Buyer of his
intention to cure and may then make a conforming tender within the contract time but not afterward.
5. INVOICES & PAYMENTS. a. S e I I e r shall submit separate invoices, in duplicate, one each purchase
order or purchase release after each delivery. Invoices shall indicate the purchase order or purchase release
number and the supply agreement number if applicable. Invoices shall be itemized and transportation charges,
if any, shall be listed separately. A copy of the bill of lading, and the freight waybill when applicable, should
be attached to the invoice. Mail To: Accounts Payable, City of Lubbock, P. 0. Box 2000, Lubbock. Texas
79457. Payment shall not be due until the above instruments are submitted after delivery.
6. GRATUITIES. The Buyer may, by written notice to the Seller, cancel this contract without liability to
Seller if it is determined by Buyer that gratuities, in the form ofentertainment, gifts or otherwise, were offered
or given by the Seller, or any agent or representative of the Seller, to any officer or employee of the City of
Lubbock with a view to securing a contract or securing favorable treatment with respect to the awarding or
amending, or the making of any determinations with respect to the performing of such a contract. In the event
this contract is canceled by Buyer pursuant to this provision. Buyer shall be entitled, in addition to any other
rights and remedies, to recover or withhold the amount o(the cost incurred by Seller in providing such gratuities.
7. SPECIAL TOOLS & TEST EQUIPMENT. If the price stated on the (ace hereof includes the cost of any
special tooling or special test equipment fabricated or required by Seller for the purpose of filling this order,
such special tooling equipment and any process sheets related thereto shall become the property of the Buyer
and to the extent feasible shall be identified by the Seller as such.
8. WARRANTY -PRICE. a. The price to be paid by the Buyer shall be that contained in Seller's bid
which Seller warrants to be no higher than Seller's current process on orders by others for products of the kind
and specification covered by this agreement for similar quantities under similar of like conditions and methods
of purchase. In the event Seller breaches this warranty, the prices of the items shall be reduced to the
Seller's current prices on orders by others, or in the alternative. Buyer may cancel this contract without
liability to Seller for breach or Seller's actual expense. b. The Seller warrants that no person or selling agency
has been employed or retained to solicit or secure this contract upon an agreement or understanding for
commission, percentage, brokerage, or contingent fee excepting bona fide employees of bona fide established
commercial or selling agencies maintained by the Seller for the purpose of securing business. For breach of
vitiation of this warranty the Buyer shall have the right in addition to any other right of rights to cancel this
contract without liability and to deduct from the contract price, or otherwise recover without liability and to
deduct from the contract price, or otherwise recover the full amount o(such commission, percentage, brokerage
or contingent fee.
9. WARRANTY -PRODUCT. Seller shall not limit or exclude any implied warranties and any attempt to do
so shall render this contract voidable at the option of the Buyer. Seller warrants that the goods furnished will
conform to the specification, drawings, and descriptions listed in the bid invitation, and to the sample(s) furnished
by the Seller, if any. In the event of a conflict or between the specifications, drawings, and descriptions, the
specifications shall govern. Notwithstanding any provisions contained in the contractual agreement, the Seller
represents and warrants fault -free performance and fault -free result in the processing date and date related data
(including, but not limited to calculating, comparing and sequencing) of all hardware, software and firmware
products delivered and services provided under this Contract, individually or in combination, as the case may
be from the effective date of this Contract. The obligations contained herein apply to products and services
provided by the Seller, its sub- Seller or any third party involved in the creation or development of the products
and services to be delivered to the City of Lubbock under this Contract. Failure to comply with any of the
obligations contained herein, may result in the City of Lubbock availing itself of any of its rights under the
law and under this Contract including, but not limited to, its right pertaining to termination or default. The
warranties contained herein are separate and discrete from any other warranties specified in this Contract,
and are not subject to any disclaimer of warranty, implied or expressed, or limitation of the Seller's liability
which may be specified in this Contract, its appendices, its schedules, its annexes or any document incorporated
in this Contract by reference.
10. SAFETY WARRANTY. Seller warrants that the product sold to the Buyer shall conform to the standards
promulgated by the U. S. Department of Labor under the Occupational Safety and Health Act of 1970. In the
event the product does not conform to OSHA standards, Buyer may return the product for correction or
replacement at the Seller's expense. In the event Seller (ails to make the appropriate correction within a
reasonable time, correction made by Buyer will be at the Seller's expense.
11. NO WARRANTY BY BUYER AGAINST INFRINGEMENTS. As pan of this contract for sale Seller
agrees to ascertain whether goods manufactured in accordance with the specifications attached to this agreement
will give rise to the rightful claim of any third person by way of infringement of the like. Buyer makes no
warranty that the production o(goods according to the specification will not give rise to such a claim, and in no
event shall Buyer be liable to Seller for indemnification in the event that Seller is sued on the grounds of
infringement of the like. If Seller is of the opinion that an infringement or the like will result, he will notify the
Buyer to this effect in writing within two weeks after the signing o(this agreement. If Buyer does not receive
notice and is subsequently held liable for the infringement or the like, Seller will save Buyer harmless. If
Seller in good faith ascertains the production of the goods in accordance with the specifications will result in
infringement or the like, the contract shall be null and void.
12. NON APPROPRIATION. 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 o(nonappropriation of funds
by the City Council o(the City o(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 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.
13. RIGHT OF INSPECTION. Buyer shall have the right to inspect the goods at delivery before accepting
them.
14. CANCELLATION. Buyer shall have the right to cancel for default all or any pan of the undelivered
portion of this order if Seller breaches any of the terns hereof including warranties of Seller or if the Seller
becomes insolvent or commits acts of bankruptcy. Such right of cancellation is in addition to and not in
lieu of any other remedies which Buyer may have in law or equity
15. TERMINATION. The performance o(work under this order may be terminated in whole, or in pan by the
Buyer in accordance with this provision. Termination of work hereunder shall be effected by the delivery
of the Seller of a "Notice of Termination" specifying the extent to which performance of work under the
order is terminated and the date upon which such termination becomes effective. Such right or termination is
in addition to and not in lieu of the rights of Buyer set forth in Clause 14. herein.
16. FORCE MAJEURE. Neither party shall be held responsible for losses, resulting i(the fulfillment
of any terms of provisions of this contract is delayed or prevented by any cause not within the control of the
party whose performance is interfered with, and which by the exercise of reasonable diligence said party is
unable to prevent.
17. ASSIGNMENT -DELEGATION. No right or interest in this contract shall be assigned or delegation of
any obligation made by Seller without the written permission of the Buyer. Any attempted assignment or
delegation by Seller shall be wholly void and totally ineffective for all purpose unless made in conformity with
this paragraph.
18. WAIVER. No claim or right arising out o(a breach o(this contract can be discharged in whole or in pan
by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by
consideration and is in writing signed by the aggrieved party.
19. INTERPRETATION -PAROLE EVIDENCE. This writing, plus any specifications for bids and
performance provided by Buyer in its advertisement for bids, and any other documents provided by
Seller as pan of his bid, is intended by the parties as a final expression of their agreement and intended also
as a complete and exclusive statement of the terms of their agreement. Whenever a term defined by the
Uniform Commercial Code is used in this agreement, the definition contained in the Code is to control.
20. APPLICABLE LAW. This agreement shall be governed by the Uniform Commercial Code. Whereever
the term "Uniform Commercial Code" is used, it shall be construed as meaning the Uniform Commercial
Code as adopted in the State of Texas as effective and in force on the date of this agreement.
21. RIGHT TO ASSURANCE. Whenever one party to this contract in good faith has reason to question
the other parry's intent to perform he may demand that the other party give written assurance of his intent to
perform. In the event that a demand is made and no assurance is given within five (5) days, the demanding
party may treat this failure as an anticipatory repudiation o(the contract.
r_r_. INDEMNIFICATION. Seller shall indemnify, keep and save harmless the Buyer, its agents, officials and
employees, against all injuries, deaths, loss, damages, claims, patent claims, suits, liabilities, judgments, costs
and expenses, which may in anywise accrue against the Buyer in consequence of the granting o(this Contract
or which may anywise result therefrom, whether or not it shall be alleged or determined that the act was
caused through negligence or omission of the Seller or its employees, or of the sub5eller or assignee or its
employees, if any, and the Seller shall, at his own expense, appear, defend and pay all charges of attorneys
and all costs and other expenses arising therefrom of incurred in connection therewith, and, if anyjudgment
shall be rendered against the Buyer in any such action, the Seller shall, at its own expenses, satisfy and
discharge the same Seller expressly understands and agrees that any bond required by this contract, or
otherwise provided by Seller, shall in no way limit the responsibility to indemnify, keep and save harmless
and defend the Buyer as herein provided.
23. TIME. It is hereby expressly agreed and understood that time is of the essence for the performance of
this contract, and failure by contract to meet the time specifications of this agreement will cause Seller to
be in default o(this agreement.
24. MBE. The City of Lubbock hereby notifies all bidders that in regard to any contract entered into
pursuant to this request, minority and women business enterprises will be afforded equal opportunities to
submit bids in response to this invitation and will not be discriminated against on the grounds o(race, color,
sex or natural origin in consideration for an award.
25. NON -ARBITRATION. The City reserves the right to exercise any right or remedy 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 o(any conflict between this provision and another provision
in, or related to, this document, this provision shall control.
26. RIGHT TO AUDIT. At any time during the tern 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 event such an audit by the City reveals any errors or overpayments by the City,
Contractor shall refund the City the full amount o(such overpayments within thirty (30) days of such
audit findings, or the City, at its option, rams the right to deduct such amounts owing the City from any
payments due Contractor.
27. HOUSE BILL 2015. House Bill 2015, signed by the Governor on June 14, 2013 and effective on January
1, 2014, authorizes a penalty to be imposed on a person who contracts for certain services with a governmental
entity and who (ails to properly classify their workers. This applies to subcontractors as well. Contractors and
subcontractors who (ail to properly classify individuals performing work under a governmental contract will be
penalized $200 for each individual that has been misclassified. (Texas Government Code Section'_ 155.001).
28. ASSIGNING OR SUBLETTING THE CONTRACT. 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 proo(on
insurance from the Subcontractor that complies with all contract Insurance requirements.
29. HOUSE BILL 1295 DISCLOSURE OF INTERESTED PARTIES. House Bill 1295. adopted by the 84th
Legislature, created §2252,908, Texas Government Code. Section 2252.908 requires a business entity entering
into certain contracts with a governmental entity or state agency to file with the governmental entity or state
agency a disclosure of interested parties at the time the business entity submits the signed contract to the
governmental entity or state agency. Instructions for completing Form 1295 are available at
http:l/awlv.ci.lubbock.tx.us/depanmental-websites departments purchasing. vendor -information
30. CONTRACTOR ACKNOWLEDGES, by supplying any Goods or Services that the Contractor has read,
fully understands, and will be in full compliance with all terms and conditions and the descriptive material
contained herein and any additional associated documents and Amendments. The City disclaims any terms and
conditions provided by the Contractor unless agreed upon in writing by the parties. In the event of conflict
between these terms and conditions and any terms and conditions provided by the Contractor, the terms and
conditions provided herein shall prevail. The terms and conditions provided herein are the final terms agreed
upon by the parties, and any prior conflicting terms shall be o(no force or effect.
31. By accepting this purchase order, the Vendor t erifies that it does not Boycott Israel, and agrees that during
the tern of this Agreement (Contract as applicable) will not Boycott Israel as that tern is defined in Texas
Government Code Section 808.001. as amended.
IKANNI
Kann Manufacturing Corporation
P.O. Box 400 — 210 Regent Street — Guttenberg, Iowa 52052
Phone: 563-252-2035 — Fax: 563-252-3069 — Email: sales@kannmfg.com
Quote To:
CITY OF LUBBOCK
PO BOX 2000
LUBBOCK, TX 79457-
Contact
ISAAC
Customer
0012068
Telephone
806-775-2376 Fax 806-775-3085
QUOTE
Date Quote #
10/ 10/17 6097
Ship To: BUYBOARD
Terms
Expiry Date
Salesperson
Ship Via
NET 30 DAYS
11/30/17
RT
DELIVER
Qh'
Part #
Description
Unit Price
Ext. Price
BUYBOARD CONTRACT #516-16
BUYBOARD ITEM#10: CURB MASTER SERIES, SLEC
SERIES 27-YD: COMMERCIAL SIDE -LOADER, EJECT
UNLOADING,ROUND TOP
4.0
3531062
BODY ASSY 26YD SSL XS SLEC RR
53,054.00
212,216.00
4.0
3531068
TAILGATE ASSY 1YD, SLEC RR
2,785.00
11,140.00
4.0
3530709
PAINT, MISC MATL PPG#FDGH SLC
2,945.00
11,780.00
24.0
1800306-18
PPG#FDGH 90604 INC, INT WHT
115.00
2,760.00
4.0
4530098
SNGL HOOK LOAD OPT SLEC
2,725.00
10,900.00
4.0
3530937
ROOF DECK ASSY, SLEC 26 RR
720.00
2,880.00
4.0
3531115
LIGHTS, 1YD TG LED T/B SLEC RR
1,250.00
5,000.00
4.0
4530093
STROBE WHEELEN M6A, 1YD TG SLE
275.00
1,100.00
4.0
4530092
BEACON WHEELEN L360, LWR 1Y TG
560.00
2,240.00
4.0
4530094
7" RND AMB ARROW LIGHTS SLEC
328.00
1,312.00
4.0
4530006
LIGHTS, SIDE WORK OPTION SLC
165.00
660.00
4.0
4530050
LOADING WORK LIGHTS, SLEC
97.00
388.00
4.0
4530091
CAMERA, (3) CONVOY 7" LCD 33'
1,906.00
7,624.00
4.0
4530102
REAR WORK LIGHTS, BTM LT BAR
85.00
340.00
4.0
4530107
OPTION, CMPCTR REV PRESS SWTCH
95.00
380.00
4.0
5530013
SLEC27YD SSL PTO/T PMP FRTLNR
29,800,00
119,200.00
OPTIONS (ALL ARE EACH PRICES)
4530003 GRABBER - ADD $5,200
4530011 20# FIRE EXTINGUISHER - ADD $350
3530515 TOOL BOX - ADD $375
4530007 FRONT STROBE - ADD $295
4530056 CARRIAGE AUTO LIFT - ADD $545
4530098 SINGLE HOOK LOAD OPTION -DEDUCT $650
($3375-$2725=$650)
4.0 FREIGHT
2,665.00 10,660.00
Page 1 of 2
JKANN
Kann Manufacturing Corporation
P.O. Box 400 - 210 Regent Street - Guttenberg, Iowa 52052
Phone: 563-252-2035 - Fax: 563-252-3069 - Email: sales@kannmfg.com
QUOTE
Date Quote #
10/ 10/ 17 6097
Sub Total: 400,580.00
Federal Excise Tax: 0.00
Freight Total: 0.00
Total: 400, 580.00
-Customer is responsible for throttle advance programming if required.
- F.O.B. Kann Manufacturing Corporation. Freight charge is estimated based upon fuel cost at the time of quotation. The
charge is subject to change at the time of delivery.
- Modifications to customer supplied chassis will be at the customer's expense and will be added to the customer's
invoice. Customers will be notified prior to any modifications.
- If Kann Manufacturing Corporation facilitates the customer purchase of a chassis, C.O.D. terms on both chassis and
body will supercede all other specified terms found in this agreement.
"' Ordering Information:
Order date: Number of Units Ordered: Customer's P.O. #:
Customer Order Authorization Signature,
Kann Manager Authorization:
Page 2 of 2
580.00 SHEET 1 OF 1
CURB SIDE ,9.oa I I
MAX --- t02.30--'--'-�'-j
STREET SIDE
INI MANUFACTURING CORP.
ROGER TAAKE
SALEWSLRVICE
.I U Regent tit. CELL. 563.581-1`1766
1t0. Box -100 YI 1. 563 252-2035
Guttenberg. IA 52052-04DO f•AX 561 :.52.3069
www.katinmfg.com E-mail: suIc%@ kannmfp.enm
KANN CURB SIDE
CLEAR FRAME
KANN STREET SIDE t
CLEAR FRAME
2600 1Z4.50
MAX
MAX
17200
CHASSIS MOUNTED PARI'S ALLOWED
ABOVE 7OP OF FRAME RAIL
I90 GO C T 90.M MIN AF7EP-FRAME J
LLOIW RF.VISUNS WE .a.
EK,'— '" YJIWANUFACTURING CORP.
MIKE LAHMAN
C LL:405-R26-1342
210 Regent St. P11. 561.252.21135
Y.O. Box AM KNX 503-252 :1(90
GuIre0 rg, IA 52052•04IN) Li -mail: salcsB+kannnlfg.rtlnl
www.kammnfg.enm Honk Office: mikc.IahmanCMgmail.enm
I7t5S oo
w d.
it YD SLEC SS LOAD
CONVENTIONAL CAD
io
10:35 AM-9130/2015
CERTIFICATE OF INTERESTED PARTIES FORM 12955
lofl
Complete Nos. ? - 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos. 1, 2, 3, 5, and 6 if there are no ntetested part es.
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.
2017-279164
KANN MANUFACTURING CORPORATION
GUTTENBERG, IA United States
Date Filed:
11/01/2017
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.
PO 31035825
(4) Kann Packer Bodies
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
TAAKE, ROGER
GUTTENBERG, IA United States
X
KANN, WILLIAM
GUTTENBERG, IA United States
X
5 Check only if there is NO Interested Party. O
6 AFFIDAVIT I swear. or affirm, under penalty of perjury, that the above disclosure is true and correct.
=N.KAINCmy co"60-an
PCL+,
Signature o a horized agent of contracting business entity
AFFIX NOTARY STAMP 1 SEAL ABOVE
o/1 t
Sworn to and subscribed before me by the said f 9 ) TO � E s this the 172 nd day of V Q Lff-.
20 19 , to certify which, witness my hand and seal of office.
kAM k�� L,14,56V� N Nnl o
Signature of officer admrrnsteriny oath Printed name of officer adminrstenng oath Title of officer administering oath
FortnS provided by Texas Ethics Commission vAvw.ethics.state.tx.us Version V1.0.3337
CERTIFICATE OF INTERESTED PARTIES FORM 1295
lofl
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.
2017-279164
KANN MANUFACTURING CORPORATION
GUTTENBERG, IA United States
Date Filed:
11/01/2017
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:
11/02/2017
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.
PO 31035825
(4) Kann Packer Bodies
4
Name of Interested Parry
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
TAAKE, ROGER
GUTTENBERG, IA United States
X
KANN, WILLIAM
GUTTENBERG, IA 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