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HomeMy WebLinkAboutResolution - 2022-R0450 - PO 25101489 with ADB Safegate Americas, LLC - Airport 11.1.22Resolution No. 2022-RO450 Item No. 5.6 November 1, 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 for and on behalf of the City of Lubbock, Purchase Order No. 25101489/PUR16933 by and between the City of Lubbock and ADB SafeGate Americas, LLC for the purchase of Airfield Lighting Systems at the Lubbock Preston Smith International Airport, 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 ATTEST: Re cca Garza, City Secret APPROVED AS TO CONTENT: November 1, 2022 Kelly Campbell, Executive Director of Aviation .- . ' - elm:] Assistant City Attorney ccdocs/RES.ADB SafeGate-PurchaseOrd October 24, 2022 !wx City of Lubbock PURCHASE ORDER TEXAS TO: ADB SAFEGATE AMERICAS, LLC 977 GAHANNA PARKWAY COLUMBUS OH 43230 Page - 1 of 2 Date - 10/21 /2022 Order Number 25101489 000 OP Branch/Plant 4613 SHIP TO: CITY OF LUBBOCK LUBBOCK PRESTON SMITH INTERNATIONAL AIRPORT 5401 N. MARTIN L KING BLVD LUBBOCK TX 79403 INVOICE TO: CITY OF LUBBOCK ACCOUNTSPAYABLE P.O. BOX 2000 LUBBOCK, TX 79457 BY: _d�f Marta Alvare vector of Purchasing & Contract Management Ordered 10/21 /2022 Freight Requested 11/3/2022 Taken By D HEATH Delivery PER C FARINA REQ 59447 SOLE SOURCE/PUR 16933 If you have any questions please feel free to reach out to Charles Farina at 8067752036 or CFarinaC�mylubbockus Description/Supplier Item Ordered _ Unit Cost UM_ Extension Request Date L858,LED,SZ2,4M,DBL-F,6P,P-L,W 4.000 4,493.3900 EA 17,973.56 11/3/2022 /SW,2-T SR24-7263220 L858,LED,SZ2,3M,DBL-F,4P,P-L,W 3.000 3,530.8400 EA 10,592.52 113/2022 SW,2-T SR23-7243220 L858,LED,SZ2,3M,SGL-F,4P,P-L,W 5.000 3,102.6100 EA 15,513.05 11/3/2022 'SW,2-TE SR23-7143220 L858,LED,SZ2,2M,SF,2P,P-L,W; SW 7.000 2,321.3100 EA 16,249.17 113/2022 IT SR22-7123210 L858,LED,SZ2,IM,DBL-F,2P,P-L,W 3.000 1,726.9500 EA 5,180.85 11/3/2022 'SW,I-TE SR21-7223210 ISOL TX L830-18 15OW 6.6. 6.E 4.000 161.1700 EA 644.68 11 3/2022 60HZ 35AO650 ISOL TX 100W 6.6:6.6 L-830-4 15.000 119.3400 EA 1,790.10 11 '3/2022 IST100666010 ISOL TX 65 W 6.6:6.6 L-830-3 3.000 107.1600 EA 321.48 11 Y2022 IST065666010 City of Lubbock PURCHASE ORDER TEXAS TO: ADB SAFEGATE AMERICAS, LLC 977 GAHANNA PARKWAY COLUMBUS OH 43230 Page - 2 of 2 Date - 10/21 /2022 Order Number 25101489 000 OP Branch/Plant 4613 SHIP TO: CITY OF LUBBOCK LUBBOCK PRESTON SMITH INTERNATIONAL AIRPORT 5401 N. MARTIN L KING BLVD LUBBOCK TX 79403 INVOICE TO: CITY OF LUBBOCK ACCOUNTS PAYABLE P.O. BOX 2000 LUBBOCK, TX 79457 BY: 4f Marta Alvarez, vector of Purchasing & Contract Management Ordered 10/21/2022 Freight Requested 11/3/2022 Taken By Delivery PER C FARINA REQ 59447 Description/Supplier Item CONN PRIMARYCOMPLETE KIT#8 L823 11805-01 70A0012/CK Terms NET 30 DAYS D HEATH SOLE SOURCE/ PUR 16933 Ordered _ Unit Cost UM Extension Request Date 22.000 27.3700 EA 602.14 11/3/2022 Total Order 68,867.55 This purchase order encumbers funds in the amount of $68,867.55 awarded to ADB SafeGate Americas, LLC. of Columbus, OH, on November 1 , 2022. The following is incorporated into and made part of this purchase order by reference: Quote dated September 27, 2022, from ADB SafeGate Americas, LLC. of Columbus, OH, as a Sole Source. Resolution # 2022-RO450 C BOCK: Tra a , Mayor ATTEST: AP Rebe Garza, City Secretary Rev. 3/2022 Seller and Buyer agree as follows: ACCEPTANCE OF THIS PURCHASE ORDER CONTRACTOR ACKNOWLEDGES. by -- PURCHASE ORDER TERMS AND CONDITIONS STANDARD TERMS AND CONDITIONS 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 term and conditions provided herein shall prevail. The terms and conditions movided herein are the final terms agreed upon by the parties and any prior conflictine terms shall be of no force or effect. 1. 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 of delivery. 4. NO REPLACEMENT OF DEFECTIVE TENDER Every tender of delivery of goods must fully comply with all provisions ofthis contract as to time ofdelivery, quality and the like. Ifa 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 conforrning 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 Porn 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 Por 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 Por 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 lability 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 ofsuch 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, 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 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, se ftware and firmware products delivered and services provided under this Contract, individually or in combination, as the case may be from the effective dale 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. 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 arc subject to the availability of an annual appropriation Por this purpose by the City. In the event of nonappropriation of funds by the City Council of the City of Lubbock Por 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 ten nination 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 Por default all or any part 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 ofcancellation is in addition to and not in lieu of any other remedies which Buyer may have in haw or equity. 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 Iicu of the 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 contbrmity with this paragraph. 18. WAIVER. No claim or 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 party 19. INTERPRETATION -PAROLE EVIDENCE. This writing, plus any specifications for bids and performance provided by Buyer in its advertisement Por 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 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. Wherever the tern "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 Porce 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 of 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 tendered 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. 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 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 of 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 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 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 Goverment 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 Goverment 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: lino. www.a.lubbock.mu"Illartmental- Nrhsimesdeparmcros.A rchasins; esndor-infarnation 30. No Boycott of Israel. Pursuant to Section 2271.002 of the Texas Goverment 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 Goverment 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 certifies 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 of the Texas Goverment Code, prohibits the City from entering into a contact with a vendor that is identified by The Comptroller as a company known to have contacts with or provide supplies or service with Itan, Sudan or a foreign terrorist organization 34. TEXAS PUBLIC INFORMATION ACT. The requirements of Subchapter J, Chapter 552, Government Code, may apply to this contact 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 following email address for which public inPormation requests may be made by an entailed request: 4Tam�lubbhxk.e;. Please send this request to this email address Por it to be processed IS.TERMINATION. The perPormance of work under this order may be terminated in whole, or in pan by the Buyer REV. 3•2022 ADB SAFEGATE Americas LLC Tel: +1(614) 8611304 Page 1 of 4 ADB 977 Gehenna Parkway Fax. +1(614) 864 2069 SAFEGATE Columbus, OH 43230 qo b Quote Confirmation Sold To -Party: 1002653 CITY OF LUBBOCK ACCOUNTS PAYABLE PO BOX 2000 LUBBOCK TX 79457 Cust.Tax ID: 1-75-600059 Contact Person: RAYMOND ARMENTA Phone: 806-241-9490 Ship -To -Party: 2002257 CITY OF LUBBOCK (LBB) Raymond Trejo LUBBOCK INT'L AIRPORT 5900 N. Walnut St. LUBBOCK TX 79403 Cust.Tax ID: 1-75-600059 Contact Person: KIRBY HURTA Project No.: Terms of Delivery: EXW - PLANT Quote No: 20032236 Terms of Payment: Credit Card Payment Quote Date: September 27, 2022 FOB: Origin Airport Code: LBB-LUBBOCK PRESTON SMITH Valid From: September 27, 2022 INTL ADB Contact Person: Wilson Degeo Valid To: November 11, 2022 Pay Item Line Part No./ Quantity/Uollll Unit Price Amount 100 SR24-7263220 4 EA 4,493.39 17,973.56 L858,LED,SZ2,4M,DBL-F,6P, P-L,W/SW,2-T 200 SR23-7243220 3 EA 3,530.84 10,592.62 L858,LED,SZ2,3M,DBL-F,4P, P-L,W/SW„ 2-T 300 SR23-7143220 5 EA 3,102.61 15,513.05 LW8,LED,SZ2,3M,SGL-F,4P, P-L,W/SW,2-TE 400 SR22-7123210 7 EA 2,321.31 16,249.17 L858,LED,SZ2,2M,SF,2P,P-L W/SW,1T 500 SR21-7223210 3 EA 1.726.95 5,180.85 LS5B,LED,SZ2,1 M,DBL-F,2P,P-L,W/SW,1-TE 600 35A0650 4 EA 161.17 644.68 ISOL TX 1-830-1815OW 6.6/6.6 60HZ 700 1ST100666010 15 EA 119.34 1,790.10 ISOL TX 100W 6.6:6.6 L-830-4 800 1ST065666010 3 EA 107.16 321.48 ISOL TX 65W 6.6:6.6 L-830-3 ADB SAFEGATE C:U ADB SAFEGATE Americas LLC Tel. +1(614) 8611304 Page 2 of 4 977 Gehenna Parkway Fax: +1(614) 864 2069 Columbus, OH 43230 Quote Confirmation Quote:20032236 900 70A0012/CK 22 EA 27.37 602.14 CONN PRIMARYCOMPLETE KIT#8 L82311806-01 Quote Total: 68,667.55 Final Quote Amount (USD): 68,867.55 Additional Notes: ADB SAFEGATE PAYS FREIGHT ON ORDERS OVER $3600.00 IN CONTENENTAL US ADB SAFEGATE MINIMUM ORDER: $150.00 TAX NOT INCLUDED —IF APPLICABLE We accept Visa, Master card and American Express. N30 accounts available upon approval. RESERVATION CLAUSE' Pultlysar ea Oul AOB SAfEQATE Amakae k b aampty � a�at appi�M laws ane repulaaons ndetllq fo aw ads, aspartatlon .trarrrar .aaipnmeM, ana a( dr EqulpnnntpoSrid•d uMar ou Contact hdWUp any expa�t faanw lapuGamanLL Redisser aproea dust slldl EWllpnaM aha0lgt at dma dYaclly Or bbiedly Oa wad. �xpabd. tq0. tmaffarnd. ae(ei7�� W or oaaiwlas dsposad o�tn a manner whkA wBl mW[ In nalcomep�apmpo(s wM weh a�ha9eabla a�oA lawn and INiala. It aaW b a oaMidon of IM o0n�ynFpYp�rfpmanca S/1PEOATE Amafws WIRMLESS FROM ANY � ALL COSTSnwLI�LRI�E3. pENAL�TIE�S,aSAFCTI�ON3�AND FlNES «EL�A O I�N�COM NICE Wlhi APDPL 11CASLE DEPORT YSAND REOUlATIONS. To Reorder Call: 800-545-4157 ADB SAFEGATE 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. 2022-953230 ADB Safegate Columbus, OH United States Date Filed: 11/08/2022 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: 11/14/2022 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. 20032236 Airfield guidance Signs 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Roser, Gary Columbus, OH United States X Pokoj, Joe Columbus, OH 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.dlb92728 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. 2022-953230 ADB Safegate Columbus, OH United States Date Filed: 11/08/2022 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: 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. 20032236 Airfield guidance Signs 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary Roser, Gary Columbus, OH United States X Pokoj, Joe Columbus, OH United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION �p My name is 61 1 v 5 61 — and my date of birth is _ My address is 3S11 Cr1571-L AD , AL&Y,1tVV1?l,1' , OIi , q3c-.�` (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Ip Executed in Vf,,4NViLA County, State of ©ijj�.jj , on the)m day of A119y 20+L�, (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms Drovided by Texas Ethics Commission www-ethics_ state_tx_iv; \/ercinn VI 5 1 r11 hQ979R