HomeMy WebLinkAboutResolution - 2018-R0438 - Utility Contractors Of America. - 12/17/2018Resolution No. 2018-RO438
Item No. 6.7
December 17, 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 fol
and on behalf of the City of Lubbock, Contract No. 14368 for FM 179 Waterline Extension a�
per RFP 19-14368-FM, by and between the City of Lubbock and Utility Contractors of America.
Inc., of Lubbock, Texas, and related documents. Said Contract is attached hereto anc
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 December 17, 201
DANIEL M. POPE, MAYOR
ATTEST:
Reb k
ca Garza, City Sec tar
APPROVED AS TO CO NT:
-- Jesica McEachern, Assistant City Manager
APPROVED AS TO FORM:
elli Leisure, Assistant City Attorney
ccdocs/RES.CONTRACT 14368 — FM 179 Waterline Extension
November 30, 2018
Contract is viewable in the
Office of the City Secretary
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.
2018-430593
Utility Contractors of America, Inc.
Lubbock, TX United States
Date Filed:
12/04/2018
2 Name of governmental entity or state agency that is a parry 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.
RFP 19-14368-FM
FM 179 Waterline Extension
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling I
Intermediary
Ziegner, Jonathan
Lubbock, TX United States
X
Lane, Ty
Lubbock, TX United States
X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is Ty Lane and my date of birth is
My address is _ 5805 CR 7700 Lubbock , TX 79424 USA
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Texas_ on the 5th day of December, 2018
`- (month) (year)
Executed in Lubbock c*S�ii
i
`of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission w \Pth" s.state.tx.l.ls Version V.1 .0.6711
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
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.
2018-430593
Utility Contractors of America, Inc.
Lubbock, TX United States
Date Filed:
12/04/2018
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:
12/05/2018
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.
RFP 19-14368-FM
FM 179 Waterline Extension
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Ziegner, Jonathan
Lubbock, TX United States
X
Lane, Ty
Lubbock, TX 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