HomeMy WebLinkAboutResolution - 2018-R0379 - PO - Tri County Equipments - 10/25/2018Resolution No. 2018-RO379
Item No. 6.9
October 25, 2018
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. 31041401 for the purchase of a
Remanufactured Al -Jon Landfill Compactor, by and between the City of Lubbock and Tri
County Equipment and Repair of Pierson, Michigan, 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 October 25, 2018
DANIEL M. POPE, MAYOR
ATTEST:
C)'o 04-4c-'( , )'-�
Rebe ca Garza, City Secreta
APPROVED AS TO CON
MTE
-SO6
Scott Snider, Assistant City Manager
APPROVED AS TO FORM:
a AA t -
Xlelli Leisure, Assistant City Attorney
ccdocs/RES.-Purchase Order 31041401 - Remanufactured AI -Jon Landfill Compactor
October 2, 2018
City of
,,►Lubbock PURCHASE ORDER
TO: TRI COUNTY EQUIPMENT & REPAI
PO BOX 196
PIERSON MI 49339
Page - 1
Date - 10/2/2018
Order Number 31041401 000 OP
Branch/Plant 3526
SHIP TO: CITY OF LUBBOCK
FLEET SERVICES
206 MUNICIPAL DRIVE
LUBBOCK TX 79404
INVOICE TO: CITY OF LUBBOCK
ACCOUNTSPAYABLE
P.O. BOX 2000
LUBBOCK, TX 79457 BY:
Marta Alkrez, Director of Purchasing & Contract Management
Ordered 10/1/2018 Freight
Requested 1/14/2019 Taken By S GONZALEZ
Delivery J LOERWALD REQ 52762 SOLE SOURCE
Description/Supplier Item Ordered Unit Cost UM
AI -Jon Compactor 1.000 689,500.0000 EA
CC 5815
Updated Seat 1.000 1.500.0000 EA
CC 5815
Automatic Grease System 1.000 7,500.0000 EA
CC 5815
Terms NET 30
Extension Request Date
689,500.00 1/14/2019
Total Order
1,500.00 1/14/2019
7,500.00 1/14/2019
698,500.00
INSURANCE REQUIRED:
Commercial General Liability, per occurrence- $1,000,000 Automotive Liability -Any Auto, Per Occurrence- $1,000,000
• GeneraI, Aggregate $1,000,000 Worker's Compensation -Statutory Amounts $500,000
• Contractual Liability -Products-Comp/Op AGG -Personal & Adv. Injury Employer's Liability $1,000,000
City of Lubbock is 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 coverage. Copies of endorsements required.
Wtw6pn order encumbers funds in the amount of $698,500 awarded to Tri County Equipment and Repair of Pierson, MI on
, 2018. The following is incorporated into and made part of this purchase order by reference: Sole Source
from Tri County Equipment and Repair of Pierson, MI. Resolution #P-0 I k-R03%y
CITY OF LUBBOCK
Daniel M. Pope, Mayor
ATTEST:
eb cca Garza, City Secretary
Seller and Buyer agree as
follows:
PURCHASE ORDER
TERMS AND CONDITIONS
IMPORTANT: REND CAREFULLY
STANDARD TERMS AND CONDITIONS
CITY OF LUBBOCK, TX
L 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 name and address,
(b) Consignee's name, address and purchase order or purchase release number and the supply agreement number
ifapplicable, (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 of a bill of lading will operate as a tender of 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 of delivery
4 NO REPL.ACENIENT OF DEFECTIVE TENDER Every render of delivery of goods must fully comply
withal[ provisions of this contract as to time of delivery, quality and the like If 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 my then make a conforming tender within the contract time but not afterward.
5 INVOICES & PAYMENTS a. S it 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 coached 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 of entertainment, 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 recoveror withhold the amount of the cosy incurred by Seller in providing such gratuities
7 SPECIAL TOOLS & TEST EQUIPNEENT If the price stated on the face 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 propertyof the Buyer
and to the extent feasible shall be identified by the Seller as such
8. N%'ARRANTY-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 pnee, or otherwise recover the full amount of such commission, percentage, brokerage
or contingent fee_
9 WARRANTY -PRODUCT. Seller shall not limit or exclude any implied warranties and anv attempt to do
so shall render this contract voidable at die option of the Buyer Seller warrants that the goods furnished will
conform to the specification, drawings, and descriptions listed in the bid in, cation, 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-ftee 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 comhmanon. 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 fails to make the appropriate correction within a
reasonable time, correction made by Buyer will be at the Seller's expense
I . NO WARRANTY BY BUYER AGAINST INFRINGEMENTS. As part 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 of 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 an 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 of 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 of nonappropnation of funds
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 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
lieu of any other remedies which Buyer may have in law or equity
15 TERyBNATION. The performance of work under this order may be terminated in whole• or in part 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 Id, herein
16. FORCE MAJEURE Neither party shall be held responsible for losses, resulting if 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 perfomance 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 Seiler 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.
19 WAIVER No claim or right arising out of a breach of this contract can be discharged in" hole or in part
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 grid intended also
as a complete and exclusive statement of the terns 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. Nhereever
the term "Uniform Commercial Code" is used, it shall be construed as meaning the Uniform Commercial
Code as adapted 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 party's intent to perform he may demand that the other party give written assurance of his intent to
perfonn 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 of the contract
22 INDENLNIFICATION. 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 of 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 subSeller or assignee or its
employees, of 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 any judgment
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 TVAE. 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 of 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 of race, color.
sex or natural onein in consideration for an award
25 NON -ARBITRATION The City reserves the right to exercise any right or remedy to it by law, corumct,
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 seekjudicial 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 anothei provision
in, or related to. this document. this provision shall control
26, RIGHT TO AUDIT. 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 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 thiny (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.
27. HOUSE BILL 2015, House Bill 2015, signed by the Governor on June 14. 2013 and effective on January
I, 2014, authorizes a penalty to be imposed on a person who contracts for certain services with a governmental
entity and who fails to properly classify their workers. This applies to subcontractors as well Contractors and
subcontractors who fail to properly classify individuals performing work under a governmental contract will be
penalized S200 for each individual that has been misclassified. (Texas Government Code Section 2155 001)
28 ASS IGNTNGOR 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 proof on
insurance front 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 '/www ci lubbock tic us!denartmental-websites.'departments/pvchasin-, 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 semis 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 ::rein are the final terms agreed
upon by the parties, and any prior conflicting terms shall be of no force or effect
31. By accepting this purchase order, the Vendor verifies that it does not Boycott Israel, and agrees that during
the term of this Agreement (Contract as applicable) will not Boycott Israel as that term is defined in Texas
14 CANCELLATION. Buyer shall have the right to cancel for default all or any pair of the undelivered
portion of this order if Seller breaches any of the terms hereof including warranties of Seller or if the Seller
becomes insolvent or commits acts of bankruptcy Such right of cancellation is in addition to mid not in
Rev 10,2017
%TR1NN
COUNTY
EQUIPMENT
AND REPAIR
September 12, 2018
City of Lubbock Landfill
17304 N FM 2526
Abermathy, TX 79311
Attention: Keith Markham
Your Great Lakes AI -Jon Distributor
Providing New Machine Sales, Parts, Service and
Certified Remanufactured & Refurbished Units
Quote- 14407
Sub ect: Quotation for AI -Jon Advantage ADV600 Certified Remanufactured Landfill Compactor
Thank you for giving us the opportunity to offer a proposal to supply a 2018R Aljon ADV 600 Factory
Authorized Certified Remanufactured landfill compactor.
Qualification
Tri County Equipment and Repair is the factory authorized Great Lakes Region Parts, Service,
Refurbishing and Certified Remanufacture Center for AI -Jon Manufacturing LLC. All work is performed by
factory trained technicians including all individual component rebuilding.
Outline of Remanufacturing Process
The machine is completely disassembled down to the bare main frame. The main frame is thoroughly
inspected, repaired as necessary and completely sandblasted, primed and painted to original factory
specifications. Any new factory main frame updates are incorporated.
The diesel engine is replaced with a New Caterpillar C18 engine with 5 year-10,000 hour warranty.
The pump drive gear box is completely disassembled and rebuilt with all new bearings & seals. Any parts
that do not meet Funk's original specifications are replaced during the rebuild.
All hydraulic pumps & motors including the pumps for the wheels, fan, steering and blade are completely
rebuilt by Danfoss. They are rebuilt to meet all Danfoss original specifications.
The four (4) Funk final drives are replaced with New Funk Final drives.
All coolers are cleaned, inspected and tested. Replaced as required.
All hydraulic valves and cylinders are inspected and resealed to new condition or replaced with new.
All hydraulic hoses are replaced with new Parker brand hoses.
All main electrical harnesses are replaced with new All other electrical components are carefully inspected
and replaced as required.
All new batteries and all new exhaust components are installed.
Steering pins and bushings are replaced with new.
Tri County Quotation for Remanufactured Mon ADV600
The machine's center joint and rear oscillating axle joint are completely disassembled and replaced with all
new pins and bushings.
The cab is reconditioned to like new condition.
The heating / air conditioner system is cleaned, inspected and tested. Air conditioning system is recharged.
The fire suppression system is serviced and recharged according to law by an authorized dealer and
service center,
All NEW fluids & filters are installed.
All systems are tested and calibrated. The unit is operated under load for several days. All systems are
rechecked and recalibrated or adjusted as necessary prior to shipment. A Tri County technician will
supervise assembly and commissioning. He will also conduct on -site training for operators and service
personnel.
Note: File photos not actual unit quoted.
Page 2
Commercial Proposal
We are pleased to present this quotation for one (1) 2018R Certified Remanufactured AI -Jon Advantage
600 landfill compactor.
Machine Description
Chassis
201SR AI -Jon Advantage 600 S/N 19R-14407-03 with a Caterpillar C18 Tier 3 diesel engine with
joystick style controls.
Wheels and Cleats
This unit will be equipped with 55 inch x 2" inch x 64 inch diameter refurbished I-beam wheels with
MacPactor Diamond traction and lateral cleats that average 9 inches (New measure 10"). Cleats
are installed with 5 x 8 all traction pattern. (40 cleats per wheel for a total of 160 cleats).
Blade
Refurbished Ali on style straight blade measures 17ft. 3in wide. Replaceable cutting edges will
have minimum of 75%+ wear life remaining.
Nominal Operating Weight
Approximately 125,0001b with above cleats.
Warrantv Summary (see optional warranty provisions
Total machine coverage ...... Six (6) months / unlimited hours from date of commissioning Parts &
Labor.
3 year 16,000 hour Power -train Parts & Labor warranty.
5 year 10,000 hour engine warranty.
(Note that all AI -Jon standard maintenance schedules including oil sampling must be followed to
keep warranties in force. These schedules can be found in the manuals.)
Training and Service
We will provide a Tri County Equipment serviceman to be on site for 3-4 days to assist in setup,
commissioning, and training of machine operators and service personnel.
On -site Equipment Requirement
Customer to provide adequate labor, tools and lifting device (usually a hydraulic excavator) capable
of lifting 12,000lbs to facilitate the assembly of the machine on -site. The blade & wheels may
arrive on site prior to the chassis arrives and will need to be unloaded.
Parts
Tri County Equipment and Repair maintains a large inventory of AI -Jon Compactor parts.
Page 3
Tri County Quotation for Remanufactured Mon ADV600
Pricing Summary
Selling Price of 2018R Certified Remanufactured ADV 600
S/N 1 BR-14407-03.............................................................................. $663,500.00
Freight.............................................................................. $21,000.00
Firesuppression...................................................................... Included
Total Delivered Price...................................................................... $689,500.00
OPTIONAL EQUIPMENT
UpdatedSeat.................................................................................ADD $1,500.00
Automatic Grease System............................................................ADD $7,500.00
Payment Terms
Net cash 15 days after delivery & setup.
Quote Validity & Machine Availability/Lead Time
Quote valid for 45 days from date of receiving. Delivery depends on timing of receiving P.O.# for machine.
QUOTED SUBJECT TO PRIOR SALE
Thank you for your interest in a Certified Remanufactured AI -Jon landfill compactor from Tri County
Equipment and Repair. If you have any questions or need further information please do not hesitate to
contact me at anytime I am always available to talk to you by phone or at your site for your convenience
We also always like to extend an invitation to visit us here in Pierson Michigan and see firsthand the
remanufacturing process.
Sincerely,
Todd Alcumbrack
Tri County Equipment and Repair
Sales Representative
616 835-2789 (My mobile number, best way to reach me)
616 636-5731 office number
Todd@tricountyeq.com
www.tricountyeg.com
"FIRST WE'D LIKE TO EARN YOUR TRUST; THEN WE'D LIKE TO EARN YOUR BUSINESS!"
21722 Cannonsville Road - P.O. Box 196 - Pierson, MI 49339 - Fax (616) 636-5288
Page 4
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:
2018-410458
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Tri County Equipment
Pierson, MI United States
Date Filed:
10/03/2018
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 gdirernmental 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.
31041401
Remanufactured AI -Jon Landfill Compactor
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Sanders, Chris
Pierson, MI United States
X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is
and my date of birth is
My address is f �7)/f 11 JF / Y/ i w r� Lab, ioa,4 take, i&I —11,q,5�0 �J .
(str et) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
/��f / /
Ezeeuted in " �'t' County, t to of / "` on the -3 day of U 20 /O
.� (month) (year)
Signature M a6thorized agent of contracting business entity
(Declarant) .
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711
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.
2018-410458
Tri County Equipment
Pierson, MI United States
Date Filed:
10/03/2018
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:
10/04/2018
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.
31041401
Remanufactured AI -Jon Landfill Compactor
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Sanders, Chris
Pierson, MI United States
X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of , 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711