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Home My WebLink AboutResolution - 2010-R0070 - Contract 9405 Circle R Lawn And Sprinkler Application Of Fertilizer On Parkland - 02/09/2010Resolution No. 2010-R0070 February 9, 2010 Item No. 5.15 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock BE and is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Contract No. 9405 for granular fertilization for various parkland properties per ITB 10- 038 -DT, by and between the City of Lubbock and Circle R Lawn & Sprinkler of Lubbock, 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 February 9, 2010 TOM MA TIN, MAYOR ATTEST: Re Garza, City Secretary APPROVED AS TO CONTE T. Scott Snider, Assistant City Manager Community Development APPROVED AS TO FORM: Chad Weaver, Assistant City Attorney vwxcdocs RES.Contract-Circle R Lawn & Sprinkler January 27, 2010 Resolution No. 2010-R0070 CITY OF LUBBOCK CONTRACT FOR SERVICES Granular Fertilization for Various Parkland Properties Bid No.10-038-DT Contract No. 9405 THIS CONTRACT, made and entered into this 9th day of February 2010 pursuant to a resolution heretofore adopted by the City of Lubbock, Texas, by and between the City of Lubbock ("City"), and Circle R Lawn & Sprinkler, ("Contractor"). WITNESSETH: WHEREAS, the City of Lubbock duly advertised for bids for Granular Fertilization for Various Parkland Properties 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 Granular Fertilization for Various Parkland Properties . 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 the Granular Fertilization for Various Parkland Properties specifically shown on Exhibit A and B and referred to as Item(s) Sprayed Applications 1 thru 3 and Item(s) Manual Applications 1 thru 3 more particularly described in 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 City agrees to pay the Contractor according to the payment schedule attached; said payment schedule does not include any applicable sales or use tax. 3. The Contractor shall perform the work according to the procedure outlined in the specifications and Invitation to Bid attached hereto and incorporated herein. 4. 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 hold 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. 5. 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 B or better. The policies will be written on an occurrence basis, subject to the following minimum limits of liability: ITB #010-038-13T. Granular Fertilization Page 1 of 7 Worker's Compensation - The Contractor shall elect to obtain worker's compensation coverage pursuant to Section 406.002 of the Texas Labor Code. Further, Contractor shall maintain said coverage throughout the term of this Contract and shall comply with all provisions of Title 5 of the Texas Labor Code to ensure that the Contractor maintains said coverage. Any termination of worker's compensation insurance coverage by contractor or any cancellation or non -renewal of worker's compensation insurance coverage for the Contractor shall be a material breach of this Contract. The contractor may maintain Occupational Accident and Disability Insurance in lieu of Workers' Compensation. In either event, the policy must be endorsed to include a wavier of subrogation in favor of the CITY OF LUBBOCK. The Contractor shall also provide to the CITY OF LUBBOCK proof of Employers' Liability in an amount no less than $500,000. Commercial General (public) Liability insurance, per occurrence, in an amount not less than $500,000 including coverage for the following: Products /completed operations Personal & Advertising injury Contractual Liability Automotive Liability insurance, per occurrence, in an amount not less than $300,000 combined single limit including coverage for the following: Any Auto The City of Lubbock shall be named a primary additional insured on auto, general liability and to include products of completed operations with a waiver of subrogation in favor on all coverage's. The contractor will provide a Certificate of Insurance to the City as evidence of coverage. The certificate will provide 30 days notice of cancellation, and under the cancellation section, the wording "endeavor to" and "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives" will be crossed out. A copy of the additional insured endorsement attached to the policy will be included with the certificate. Contractor's insurance policies through policy endorsement must include wording, which states that the policy shall be primary and non-contributing with respect to any insurance carried by the City of Lubbock. The certificate of insurance described below must reflect that the above working is included in evidenced policies. If at any time during the life of the contract or any extension, the contractor fails to maintain the required insurance in full force and effect; all work under the contract shall be discontinued immediately. Any failure to maintain the required insurance may be sufficient cause for the City to terminate the contract. 6. 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. 7. This Contract consists of the following documents set forth herein; Invitation to Bid #10 -038 -DT, General Conditions, Insurance Requirements, Specifications, and the Bid Form. ITB 0010 -038 -DT. Granular Fertilization Page 2 of 7 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 CONTRACTOR BY Tom Martin, Mayor Authori esen Address: 3511 57th Street Lubbock, TX 79413 ATTEST: 'p, --�' �'� Rebe a Garza, City Secretary APPROVED AS TO CONTE V v\ Scott Snider, Assistant City Manager Community Services APPROVED S T FORM: Assistant City Attorney ITB #010 -038 -DT, Granular Fertilization Page 3 of 7 CITY OF LUBBOCE, TEXAS Resolution No. 2010-R0070 Granular Fertilization for Various City Properties ITB 10 -038 -DT 2010 City Turf Program Application Date Applied Product Application Rate 1 May 1 to June 30 Granular Fertilizer 141 lbs/acre 38-0-0, 4% Sulphur, 3% Iron 2 June 1 to July 31 Granular Fertilzer 141 lbs/acre 38-0-0, 4% Sulphur, 3% Iron 3 Aug 1 to Aug 31 Granular Fertilizer 141 lbs/acre 38-0-0,4% Sulphur, 3% Iron and 50% Sulphur coated urea ITB 0010 -038 -DT, Granular Fertilization Page 4 of 7 EXHIBIT A Resolution No. 2010-R0070 CITY OF LUBBOCK, TEXAS Granular Fertilization for Various City Properties ITB 10 -038 -DT DAY 1 PROPERTY ACRES 1. HOOD 14.3 2. HUFFMAN 114 3. HODGES 13 4. NW LITTLE LEAGUE 8.42 5. FIESTA PLAZA 12 &ROGERS 8.3 7. MAEDGEN 4.51 8. HOLLINS 6.4 9. PIONEER 4.2 10. CMC CENTER 16 11. GUADALUPE 3 12. GUADALUPE STRIP 7 13. ATZLAN 28 14. ATZLAN CORRIDOR 2 15. CANYON RIM 2.3 16. DAVIES 6 17. SIMS 4.96 18. CARTER 10 19. MACKENZIE B.FIELDS 11.7 20. WOODS 11.7 21. RAEGAN 4.48 22. PATTERSON- 5.28 23. BUTLER 6 24. SEDBERRY- 5 25. MAE SIMMONS- 98.3 26. MLX COMPLEX 8.6 DAY 2 PROPERTY ACRES 27. LUSK 24 28. CHATMAN- 3 29. WASHINGTON 3.5 30. BERRY 9.1 31. RAWLINGS 2.5 32. LEWIS 8.4 33. STUBBS 8 34. BURNS 3 35.OVERTON 1.9 36. HAMILTON 6.6 37. CARLISLE 4.5 38. CLAPP 102.95 39. UNDERWOOD 8 40. STRONG 7.75 41. CROW 10.17 42. RIBBLE 18.02 ITB #010 -038 -DT. Granular Fertiliz: Turf Fertilizing Properties ADDRESS 23RD & P LANDMARK DRIVE N. UNIV. & MARSHALL 903 N. UNIVERSITY 911 N. UNIVERSITY AMHERST & G I ST & BOSTON 1 ST & VERNON 6TH & T 6TH & O 2ND&P 1ST&O IST&K MACK. UNDER 1-27 BAYLOR & AVE K N. AVE. N & CLEMSON MARLBORO & KING N. GLOBE & LOOP 289 Municipal & Skyline ERSKINE & ZENITH COLGATE & OLIVE PARKWAY & WALNUT E. 4TH & ZENITH E. 10TH & GUAVA E. 23 RD & OAK E. 19TH & ASPEN ADDRESS E. 25TH & OAK E. 29TH & JUNIPER E. 22ND & CEDAR 36TH & CEDAR 40TH & B 54TH & AVE. J 36TH & AVE. N 23RD & K 14TH U 22ND & X 28TH & X 46TH & AVE. U 74TH & CEDAR 81ST & U 91ST & BELTON 62ND & TEMPLE tion PROPERTY DAY 3 43. CASEY 44. LEFTWICH/f. CENTER 45. KASTMAN 46. ELMORE 47. DUPREE 48. LONG - 49. RATLIFF 50. MCCULLOUGH 51, GUY 52. HUNEKE 53, ANDREWS 54. MILLER 55. JENNINGS 56. STEVENS 57. REMINGTON DAY 4 58. YOUTH SPORTS COMPLEX 59. HOEL 60.NEUGEBAUER 61. MCALISTER FIELDS 62. DURAN 63. COOKE 64. HINOJOSA 65. REMOTE CONTROL AIRFIELD. 66. LOPEZ 67. HIGGINBOTHAM 68. MAHON 69. GROVES 70. SMITH 71. WHISPERWOOD 72. SLIDE ROAD MEDIANS 73. MAXEY 74. DAVIS 75. WHEELOCK- 76. WAGNER 77. TECH TERRACE Page 5 of 7 ACRES 8.1 59.63 14.45 43.13 32.56 21.1 6.26 23.33 20.3 15.54 35.5 31.43 34.58 16.66 22.25 41.75 11.33 3.3 11.5 8.37 7.01 9 3.01 7.91 23.42 15.1 2 4.3 5 3.75 70.89 8.5 2 9 18 ADDRESS 66TH & W 60TH & ELGIN JOLIET & S. LOOP 66TH & QUAKER 59TH & TOLEDO 56TH & ABERDEEN 50TH & CHICAGO 88TH & FLINT 93RD & NASHVILLE 82ND & NASHVILLE 76TH & .MEMPHIS MEMPHIS & LOOP 73RD & WINSTON 75TH & SLIDE 73RD & ALBANY FM 1585 & Milwaukee Ave 91 ST &CHICAGO 83RD & GROVER 5610 FRANKFORD 26TH & KEWANEE 18TH & KIRBY 7336 22ND 15TH & INLER AUBURN & CHICAGO. 19TH & VICKSBURG 29TH & CHICAGO 19TH & DOVER 15TH & CHICAGO 4TH & WHISPERWOOD DR. 4TH & SLIDE TO ACCESS R 30TH & NASHVILLE 40TH &NASHVILLE 40TH & ELGIN 26TH & ELGIN 23RD & FLINT EXHIBIT B Resolution No. 2010—ROO70 CITY OF LUBBOCK, TEXAS Granular Fertilization for Various City Properties ITB 10 -038 -DT Manual Fertilizing Properties UNIT ADDRESS APPROX. ACREAGE BERL HUFFMAN SOFTBALL FIELDS N. LOOP 289 & LANDMARK .64 ROGERS PARK AND POOL 3200 BATES 1.27 DETROIT STRIP ERSKINE TO DUKE AVE .56 COLISEUM/AUDITORIUM 4TH & BOSTON 1.43 AVE X & 16TH ST 16TH & AVE X .37 UNIVERSITY MEDIANS 4TH ST THROUGH 19TH ST 1.0 UNIVERSITY 19TH THROUGH 34TH ST 3.0 UNIVERSITY MEDIANS 34TH THROUGH 50TH 2.0 CLAPP PARK AREAS 46TH & AVE U 4.3 INDIANA MEDIANS 19TH THROUGH 34TH ST .80 MAXEY PARK 30TH & NASHVILLE AVE 1.58 WHISPERWOOD PARK 4TH & WHISPERWOOD AVE 1.23 GROVESI CARLISLE CEMETERY 7308 19TH 1.1 CAVAZOS BALLFIELDS BROWNFIELD RD. & MILWAUKEE 3.1 QUINCY MEDIANS 82ND & QUINCY AVE GODEKE LIBRARY 66TH & QUAKER .69 ANDREWSPARK NORTHWEST LITTLE LEAGUE 903 N. UNIVERSITY .79 YOUTH 120TH 15 MACKENZIE BALLFIELDS MUNICIPAL DR & SKYLINE .93 MACKENZIE AMPHITHEATRE 423 E. BROADWAY .76 ITB #010 -038 -DT, Granular Fertilization Page 6 of 7 UNIT ADDRESS APPDX ACREAGE GUADALUPE PARK 2ND & AVE P .14 GUADALUPE ENTRANCE IST & AVE J .25 CIVIC CENTER GAZEBO 9TH & AVE L .25 CIVIC CENTER SOUTH. PARKING LOT 9TH & AVE K .25 CIVIC CENTER LIBRARY & ADJACENT SITES 9TH & AVE O 3.16 CIVIC CENTER AVF. Q MEDIANS AVE 0 & MAC DAVIS LANE 15 CIVIC CENTER COOLING TOWERS AREA AVE 0 & MAC DAVIS LANE .44 WALK OF FAME PLAZA 8TH & AVE Q .25 GATEWAYV BROADWAY ANNEX SE CORNER OF BROADWAY & AVE Q .34 BROADWAY MEDIANS (3 TOTAL) BROADWAY & Q & BROADWAY & MLK BLVD .25 MARTIN LUTHER KING MEDIANS 19TH & MLK BLVD. .50 MAE SIMMONS COMMUNITY CENTER E. 23RD & OAK .91 MARTIN LUTHER KING BASEBALL FIELD E. 24TH & MLK BLVD. .50 MARTIN LUTHER KING COMPLEX E. 19TH & ASPEN AVE .45 CHATMAN ENTRANCE MCCRUMMEN SENIOR CENTER 2001 19TH .61 LEWIS BALLFIELDS 54TH & AVE TENNIST 1.71 CASEY PARK 66TH & AVE W .73 GUY PARK 87TH & MEMPHIS .11 WHEELOCK PARK 40TH I WAGNER PARK 26TH & ELGIN 35 MAEDGEN IST & BOSTON .30 BUDDY HOLLY RECREATION AREA 2525 CANYON LAKE DR 5 FIESTA PLAZA 911 N. UNIVERSITY 1.64 TOTAL ACRES 69.54 ITB #010 -038 -DT. Granular Fertilization Page 7 of 7 Resolution No. 2010—R0070 ITS 10 -038 -DT, Granular Fertilization for Various City Properties BID FORM Granular Fertilization for Various City Properties CITY OF LUBBOCK, TEXAS ITB 10 -038 -DT In compliance with the Invitation to Bid 10 -038 -DT, the undersigned Bidder having examined the Invitation to Bid and Specifications, and being familiar 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 10 -038 -DT is by reference incorporated in this contract. The Bid Form must be completed in blue or black ink or by typewriter. ITEM APPLICATION ACRES PRODUCT APPLICA TION COST PER EXTENDED (dates may vary) (approx.) RATE ACRE COSTRATE 1 IS` Application May 1 30 1,356 Granular Fertilizer 38-0-0, 4% Sulphur, 3% Iron 141 lbs/acre aq a CC —June 4% Sulphur, J 2 2 "d Application 1,356 Granular Fertilizer 38-0-0, 4% Sulphur, 3% Iron 141 lbs/acre a°t I AO, S'1 G6 June 15 —July 31 3 3d Application 1,356 Granular Fertilizer 38-0-10, 141 /1 "-1 /1 �J1 �j�J��•-/1-1 50% Sulphur Coated Urea Aug 1— Aug 31 4% Sulphur, 3% Iron, lbs/acre 50% Sulph Coated Urea TOTAL ITEM MANUAL ACRES APPLICA COST PER EXTENDED APPLICATION (approx.) PRODUCT TION ACRE COST dates may vary)RATE 1 I" Application 70 Granular Fertilizer 38-0-0 141 May 1 — June 30 4% Sulphur, 3% Iron lbs/acre 3$ C-\` a,9a.3 no 2 2 nd Application 70 Granular Fertilizer 38-0-0 141 0 June 15 — July 31 4% Sulphur, 3% Iron lbs/acre 2.Qt� \ aJ�]a� 9 3 3 Application Aug 1 — Aug 31 70 Granular Fertilizer 38-0-10 4% Sulphur, 3% Iron 141 lbs/acre , �y quo 6 .80 50% Sulphur Coated Urea TOTAL 010.038-DT.doc 11 APPLICATION ACRES PRODUCT TION COST PER ACRE EXTEN ST dates may v . (approx.) RATE 1 I" Application 160 Granular Fertilizer 38-0-0, 3% Iron 141 lbs/ 931 May 1 —June 30 4% Sulphur, I30Z 2 2 nd Application June 15 — July 31 160 Granular Fertilize -1-'0—, 4% Sul o Iron 141 lbs/acre y3 q� '7,0x5 3 3rd Application Aug I — Au Granular Fertilizer 38-0-10, 141 4% Sulphur, 3% Iron, lbs/acre 50% Sulphur Coated Urea TQTAF 010.038-DT.doc 11 ITB 10 -038 -DT, Granular Fertilization for Various City Properties *PRICE: F.O.B. City of Lubbock **Days After Receipt of Order (ARO) PAYMENT TERMS AND DISCOUNTS - Bidder offers a prompt payment discount of %, net —calendar days. Discounts will not be considered in determining low bid. Unless otherwise indicated on the Bid 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 after 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 contract requirements, 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/services; does not include an element of profit on the sale in excess of that normally obtained by the Bidder on the sale of products/services of like quality and quantity; and does not include any provision for discounts to selling agents. If at any time during the contract period, the supplier should sell or offer for sale to any other customer, an equal or less quantity of similar contract 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 interlocal purchasing agreements as provided for by the Interlocal Cooperation Act (Chapter 791, Government Code), the right to purchase the same services, at the prices quoted, for the period of this contract. Each bidder shall indicate on the Bid Form in the space provided below if he/she will honor Political Subdivision orders in addition to orders from the City of Lubbock. Should these other governmental entities decide to participate in this contract, would you (the bidder) agree that all terms, conditions, specifications, and pricing would apply? Other governmental entities that might have interests In this contract are Frenship Independent School District, Lubbock Housing Authority, Lubbock County, Lubbock County Hospital District, Lubbock Independent School District, South Plains Association of Governments, City of Texarkana, Texas Tech University, West Texas Municipal Power Agency, Lynn County, and City of Woltforth. YES_ 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, but not obligated, to purchase materials/services under the contract(s) awarded as a result of this solicitation. All purchases by governmental entities other than the City of Lubbock will be 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 needed. 010-038-DT.doc T PER EXTEND APPLICATION (approx.) PRODUCT ION RATE ACRE dates may v 1 I" Application 15.68 Granular Fertilizer 38-0-0, 141 May I – June 30 4% Sulphur, 3% Iron lbs/ 01 �,�j� •� 1 2 2nd Application June 15 31 15.68 Granular Fertilizer - , 4% Sul o Iron 141 lbs/acre –July 141 I 3 3 Application Granular Fertilizer 38-0-10, �g Aug I – Au 4% Sulphur, 3% Iron, Ibs/acre . -A�L1 50% Sulphur Coated Urea TOTAL $At *PRICE: F.O.B. City of Lubbock **Days After Receipt of Order (ARO) PAYMENT TERMS AND DISCOUNTS - Bidder offers a prompt payment discount of %, net —calendar days. Discounts will not be considered in determining low bid. Unless otherwise indicated on the Bid 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 after 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 contract requirements, 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/services; does not include an element of profit on the sale in excess of that normally obtained by the Bidder on the sale of products/services of like quality and quantity; and does not include any provision for discounts to selling agents. If at any time during the contract period, the supplier should sell or offer for sale to any other customer, an equal or less quantity of similar contract 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 interlocal purchasing agreements as provided for by the Interlocal Cooperation Act (Chapter 791, Government Code), the right to purchase the same services, at the prices quoted, for the period of this contract. Each bidder shall indicate on the Bid Form in the space provided below if he/she will honor Political Subdivision orders in addition to orders from the City of Lubbock. Should these other governmental entities decide to participate in this contract, would you (the bidder) agree that all terms, conditions, specifications, and pricing would apply? Other governmental entities that might have interests In this contract are Frenship Independent School District, Lubbock Housing Authority, Lubbock County, Lubbock County Hospital District, Lubbock Independent School District, South Plains Association of Governments, City of Texarkana, Texas Tech University, West Texas Municipal Power Agency, Lynn County, and City of Woltforth. YES_ 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, but not obligated, to purchase materials/services under the contract(s) awarded as a result of this solicitation. All purchases by governmental entities other than the City of Lubbock will be 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 needed. 010-038-DT.doc ITB 10 -038 -DT, Granular FerNlizatlon for Various City Properties THIS BID IS SUBMITTED BY a corporation organized under the laws of the State of , or a partnership consisting of or an individual trading as G 1 c k '*'� �� +� pc��Y of the City of I -AN) eO�k Firm: �, c�\e tr,. wrn 41ir 5 w- \ Address: 351 ' � City: Stater X Zip aq 1 DBE Firm: By Woman Black American Native American Hispanic American Asian Pacific Other (Specify) American Date: \ 1 \� I \� Officer Name and Title: Please Print Business Telephone Number Fax:C566�76-0gEmail: C LST— Arn lsqALABEL THE OUTSIDE OF YOUR SEALED BID WITH THE ITB NUMBER, THE CLOSING DATE AND TIME, AND YOUR COMPANY NAME AND ADDRESS. 010-038•DT.doc