HomeMy WebLinkAboutResolution - 2022-R0442 - PO 31069475 with Doggett Freightliner 10.25.22Resolution No. 2022-RO442
Item No. 5.19
October 25, 2022
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 fo>;
and on behalf of the City of Lubbock, Purchase Order No. 31069556 in accordance with TIPJ
Contract No. 200206 for the purchase of Six 2024 Freightliner Chassis, by and between the City
of Lubbock and Doggett Freightliner of South Texas, LLC of Austin, TX 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
APPROVED AS TO CONTENT:
October 25, 2022
Brooke Witcher, Assistant City Manager
APPROVED AS TO FORM:
K lli Leisure, Assistant City Attorney
ccdocs/RES.PurchaseOrd 31069556 Six 2024 Freightliner Chassis
10.18.22
Page - 1
`= City of PURCHASE ORDER Date - 10/ 17/2022
Lubbock Order Number 31069556 000 OP
TEXAS Branch/Plant 3526
DOGGETT FREIGHTLINER OF
TO: SOUTH TEXAS LLC
1701 SMITH RD
AUSTIN TX 78721
CITY OF LUBBOCK
SHIP TO: FLEET SERVICES
206 MUNICIPAL DRIVE
LUBBOCK TX 79404
INVOICE TO: CITY OF LUBBOCK
ACCOUNTS PAYABLE
P.O. BOX 2000
LUBBOCK, TX 79457 4BY:Y
Marta ANQrez, Director of Purchasing & Contract Management
Ordered 10/10/2022 Freight
Requested 10/20/2023 Taken By YBUSBY
Delivery PER B RODRIGUEZ REQ 59424 TIPS CONTRACT 200-206
If you have any questions, please contact Breana Rodriguez: BRodriguez@mylubbock.us or 806-775-2374
Description/Supplier Item Ordered Unit Cost UM Extension Request Date
2024 Freightliner Chassis 6.000 114,130.8000 EA 684,784.80 10/20/2023
Total Order
Terms NET 30
684,784.80
This purchase order encumbers funds in the amount of $684,784.80 awarded to Doggett Freightliner of South Texas
LLC of Austin, TX, on October 25 , 2022. The following is incorporated into and made part of this purchase order
by reference: Quote dated August 23, 2022, Doggett Freightliner of South Texas LLC of Austin, TX, and TIPS Contract 200206.
Resolution # 2022-RO442
CITY OF LUBBOCK
WE
Tra ne or
ATTEST:
Rebelcfa Garza, City Secrete,67
Rev. 3/2022
Seller and Buyer agree as
follows:
PURCHASE ORDER
TERMS AND CONDITIONS
STANDARD TERMS AND CONDITIONS
ACCEPTANCE OF THIS PURCHASE ORDER:
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 the City's terms and
conditions and any terms and conditions provided by the Contractor, the terms and conditions provided henem shall
prevail. The terms and conditions provided herein are the final terms agreed upon by the parries, and anv.vnor
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 name and address, (b)
Consignee's name, address and purchase order or purchase release number and the supply agreement number if
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 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 ofdelivery.
4. NO REPLACEMENT OF DEFECTIVE TENDER Every tender of delivery of goods must fully comply with all
provisions of this contract as to time ofdelivery, 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 fbr 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. O. 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 recover or withhold
the amount of the cost incurred by Seller in providing such gratuities.
7. SPECIAL TOOLS & TEST EQUIPMENT. 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 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 amountofsuch 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 samples) furnished by the Seller, ifany.
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
performanceandfcult-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 confbrm 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 confbrn to OSHA standards, Buyer may mum 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.
11. 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 issued 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 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 an: subject to the availability of an
annual appropriation for this purpose by the City. In the event of nonappropriation 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.
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 part of the undelivered portion of
this order if Seller breaches any of the temes hereof including warranties of Seller or if the Seiler becomes insolvent or
commits acts of bankruptcy. Such right ofcancellation is in addition to and riot in lieu of any other remedies which
Buyer may have in law or equity.
in accordance with this provision. Termination of work hereunder shall be effected by the delivery of the Seller of
a "Nonce 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 tp and not in ticiu of ncC
rights of Buyer set forth in Clause 14, 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
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. Nee claim tar right arising out of a breach of this contract can be discharged in whole 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 patty.
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 part 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 them agreement. Whenever a tern defined by the Umfotm 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. Wherever the term
'Uniforrn 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 tfus 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 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 mpur ationof the contract.
22. 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 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, 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 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. 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
of this agreement
14. 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 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 lbrms 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 arc cumulative and not exclusive, and may be exercised
concurrently. To the extent ofany conflict between this provision and another provision in, or related to, this docu enr,
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 f I I amount
ofsuch 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.
27. 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.
28. Contracts with Companies Engaged in Business with Iran, Sudan, or Foreign Terrorist Organization Prohibited.
Pursuant to Section 2252.152 of the Texas Government Code, 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
29. 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. linowww,a.lubbock.tx.us departmental-
websitesrdcpartmenm up rchasmy vender-informauon
30. No Boycott of Israel. Pursuant to Section 2271.002 of the Texas Government Code, Respondent certifies that
either (i) it meets an exemption criteria under Section 2271.002; or (ii) it does not boycott Israel and will not boycott
Israel during the term of the contract resulting from this solicitation. Respondent shall state any facts that make it
exempt from the boycott certification in its Response.
31. No Boycott of Energy Companies. Pursuant to Section 2274 of the Texas Government Code, Respondent
certifies that either (i) it meets an exemption criteria under Section 2274.002; or (ii) it does not boycott Energy
Companies and will not boycott Energy Companies during the term of the contract resulting from this solicitation.
Respondent shall state any facts that make it exempt from the boycott certification in its Response.
32. No Boycott of a Firearm Entity or Firearm Trade Association. Pursuant to Section 2274 of the Texas
Government Code. Respondent ratifies that either (i) it meets an exemption criteria under Section 2274.002; or (ii) it
does not boycott a Firearm Entity or Firearm Trade Association and will not boycott a Firearm Entity or Firearm
Trade Association during the term of the contract resulting from this solicitation. Respondent shall state any facts that
make it exempt from the boycott certification in its Response.
33. Contracts with Companies Engaged in Business with Iran, Sudan, or Foreign Terrorist Organization Prohibited.
Pursuant to Section 2252.152 ofthe Texas Government Code, 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 a r
service with Iran, Sudan or a foreign terrorist organization
34. TEXAS PUBLIC INFORMATION ACT. The requirements of Subchapter J. Chapter 552, Government Code,
may apply to this contract and the contractor or vendor agrees that the contract can be terminated if the contractor or
vendor knowingly or intentionally fails to comply with a requirement of that subchapter.
35. Pursuant to Section 552.301(c) of the Texas Government Code. the City of Lubbock has designated the fol low ing
email address for which public information requests may be made by an entailed request: oar+ms Iubbcxk us. Please
send this request to this email address Por it to be processed
15. TERMINATION. The performance of work under this order may be terminated in whole, or in part by the Buyer
REV. 3 :022
DOGGETT FREIGHTLINER OF SOUTH TEXAS LLC - AUSTIN INV #:
1701 Smith Rd. Bus: 512-389-0000 DATE: 8/23/2022
Austin, Texas 78721 Fax: 512-389-2663 INVOICE / BUYER'S ORDER
BUYER's NAME
CITY OF LUBBOCK
TELEPHONE
806-775-2167
ADDRESS
206 MUNICIPAL DRIVE
CI Y
LUBBOCK
VATE
TX
ZIP CODE
YEAR
2024
MAKE MODEL/BODY
FREIGHTLINER 108SD
VIN
TBD
LICENSE PLATE
A DOCUMENTARY FEE IS NOT AN OFFICIAL
FEE. A DOCUMENTARY FEE IS NOT
REQUIRED BY LAW, BUT MAY CHARGED
TO BUYER FOR HANDLING DOCUMENTS
RELATING TO THE SALE. A DOCUMENTARY
FEE MAY NOT EXCEED A REASONABLE
AMOUNT AGREED TO BY THE PARTIES.
THIS NOTICE IS REQUIRED BY LAW.
MILEAGE:
TIPS CONTRACT 200206
CHASSIS BASE MODEL PRICE
$88,463.20
OPTION CONTENT
$25,667.60
TOTAL
$114,130.80
UN PAGO DOCUMENTAL NO ES UN CARGO
OFFICIAL. LA LEYNO EXIGUE SE IMPONGA
UN CARGO DOCUMENTAL. PERO ESTE
PODRIA COBRARSE A LOS COMPRADORES
POR EL MANEJO DE LA DOCUMENTACION
EN RELACION CON LE VENTA. UN CARGO
DOCMENTAL NO PUEDI EXCEDER UNA
CANIDAD PAZONABLE ACORDADA POR
LAS PARTIES. ESTA NOTIFICACION SE
EXIGUE POR LA LEY.
X 6
$684,784.80
Disclaimer of Warranties
The above decribed vehicle sold by Freightliner of Ausitn is sold
as is, without either express or implied warranties of any kind
by Freightliner of Austin, including warranties of merchantability
or fitness, and Buyer will bear the entire expense of repairing or
correcting any defects that presently exist or that may occur in
the vehicle, unless a "He warranty by, or service contract with
Freightliner of Austin covering the describe vehicle is delivered to
Buyer in conjunction with or within 90 days following the time of
sale,but such vehicle or any of its component parts maybe subject
to warranty by the manufacuter thereof.
9WVN'W91=M_VV0
0
MILEAGE
YEAR
MAKE
IMODEUBODY
VIN
MILEAGE
TRADE-IN
YEAR
MAKE
MODEUBODY VIN
TOTAL
$684,784.80
PAYOFF TO:
(Trade Allowance)
$.00
ADDRESS:
TRADING DIFFERENCE
$684,784.80
TELEPHONE: FAX:
SALES TAX
$0.00
GOOD UNTIL:
DEALER'S INVENTORY TAX
$0.00
QUOTED BY:
LICENSE FEE
$0.00
SHOW LIEN TO:
Body Type:
DOCUMENTARY FEE
$0.00
ADDRESS:
License WL:
FEDERAL EXCISE TAX
$0.00
State Insp.:
TOTAL SALE, PRICE
DATED: LIEN AMOUNT $
License:
PAYOFF ON TRADE
$0.00
DRAFT FOR $
Title:
EXT. WARRANTY
0,00
DRAFT THRU:
Transfer:
LESS DEPOSITI
$0.00
ADDRESS:
Total Balance Due
684,784.80
the dealers Inventory Tax charge is intended to reimburse the dealer for ad valorem taxes on its motor vehicle Inventory. I ne charge, wnicn is paid ny me Ueaier to the
The information you see on the window form for this vehicle is part of this contract. Information on the window form overrides any contrary provisions on the contract of sale.
La informacion que aparece en Is ventanilla de este vehiculo forma pate de este contrato. La informacon contenida en of formulario de Is ventanilla anula cualquler prevision que establezca
contrado y guy aparezca on el contrato de vents. If a credit purchase, this is an offer to purchase only. Buyer offers to purchase vehicle on credit terms described herein and no contractual
relationship is created. This order does not constitute an agreement for the extension of credit. Manufacturer/Distributor reserves the right to change the price of new vehicles to Seller without notice.
In the event that the price to Seller of the new vehicle ordered hereunder is changed prior to delivery to Buyer, Buyer agrees and accepts that the cash delivered price will be changed accordingly.
If the Buyer's used vehicle trade-in is not delivered to the Seller until delivery of the new vehicle, the trade-in will be reappraised at that time and Buyer agrees that such reappraised value shall
determine the allowance, if any, made for the trade-in. Buyer agrees to deliver the original bill of sale and the title to an trade-in along with the delivery of the trade-in and further agrees to execute
and all documents necessary or required to transfer legal title and ownership to Seller or its assigns. Buyer warrants the trade-in to be his property and free and clear of all liens and encumbrances
except as otherwise noted herein. Buyer further warrants that the trade-in has not been declared rebuilt salvage, reconditioned, nonrrpairable, or flood damaged and that the emission systems have
not been tampered with and are in the condition as originally manufactured, except for ordinary wear, unless so disclosed. Seller makes no representations, concerning fuel economy of the sale unit
and any information posted on the sale unit or contained in literature relating to the same reflect the results of tests performed, required or prescribed by govemment agency, upon which Seller has
relied.It is expressly agreed to and understood by Buyer and Seller that is the event of a non-credit transaction, Seller retains a security interest in the purchased vehicle until such time as Buyer has
paid the Seller for the vehicle. Buyer agrees to all the above listed charges.
BUYER'S SIGNATURE: SELLER'S SIGNATURE: DATE
CERTIFICATE OF INTERESTED PARTIES
FORM Z29'J
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.
2022-945873
Freightliner of Austin
AUSTIN, TX United States
Date Filed:
10/18/2022
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:
10/19/2022
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.
TIPS 200802
108SD
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Hempel, Carlton
Austin, 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 V3.5.1.8b4250f1
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
1 Name of business entity filing form, and the city, state and country of the business entity's place Certificate Number:
of business. 2022-945873
Freightliner of Austin
AUSTIN, TX United States Date Filed:
2 Name of governmental entity or state agency that is a parry to the contract for which the form is 10/18/2022
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.
TIPS 200802
108SD
4 Nature of interest
Name of Interested Party City, State, Country (place of business) (check applicable)
Controlling Intermediary
Hempel, Carlton Austin, TX United States X
5 Check only if there is NO Interested Party.
6 UNSWORN DECLAR ON
My name is /
r / and my date of birth is
My address is %O fly t �. L `�X '%� 72 Os /¢^
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct. T
Executed in ��`�� S County, State of on the lB day of 0 -1'-(rt , 20 Z—Z—
(month) (year)
ignature of auth ed agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission .ethics.state.tx.us Version V3.5.1.8b4250f1