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HomeMy WebLinkAboutResolution - 2018-R0450 - PO With CXT Restrooms - 12_17_2018Resolution No. 2018-RO450 Item No. 6.13 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 for and on behalf of the City of Lubbock, Purchase Order No. 90500050 for the purchase of Pre -Fab CXT Restrooms, by and between the City of Lubbock and CXT, Inc., of Spokane Valley, Washington, 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 Deremher 17 ant 9 DANIEL M. POPE, MAYOR ATTEST: Reb cca Garza, City Secret ry APPROVED AS TO C Snider, Assistant City APPROVED AS TO FORM: Ry B oke, A st nt City Attorney ccdocs/RES.PurchaseOrd. 90500050 — Pre -Fab CXT Restrooms November 14, 2018 .�' City of Lubb o ck TEXAS PURCHASE ORDER Page - I Date - 11/14/2018 Order Number 90500050 000 OP 607 TO: CXT INCORPORATED AN L.B. FOSTER COMPANY 3808 N. SULLIVAN RD BLDG #7 SPOKANE VALLEY WA 99216 SHIP TO: CITY OF LUBBOCK 916 TEXAS AVE LUBBOCK TX 79401 INVOICE TO: CITY OF LUBBOCK ACCOUNTSPAYABLE P.O. BOX 2000 LUBBOCK, TX 79457 4BY:W Marta varez, Director of Purchasing & Contract Management Ordered 11/14/2018 Freight Requested 3/14/2019 Taken By J MONTES Delivery A STAINFIELD REQ 53018 SOURCEWELL CONTRACT 030117-CXT Description/Supplier Item Ordered Unit Cost UM Extension Request Date Santiago Building 1 1.000 219,164.0000 EA 219,164.00 3/14/2019 (13-246P) Santiago Building 2 1.000 206,464.0000 EA 206,464.00 3/14/2019 (13-246P) Total Order Terms NET 30 425,628.00 The Contractor shall obtain and maintain in full force and effect for the duration of this contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by companies approved by the State of Texas and acceptable to the City, in the following type(s) and amount(s) here to as Exhibit A and incorporated herein by reference. This purchase order encumbers funds in the amount of $425,628.00 awarded to CXT Incorporated of Spokane Valley, WA on December 17, 2018. The following is incorporated into and made part of this purchase order by reference: Sourcewell Contract 030117-CXT from CXT Incorporated. Spokane Valley, VA. Resolution #?0'I R-R0450 City of Lub k ATTEST: -01 Daniel M. Pope, Mayor eb cca Garza, City Secreta Seller and Buyer agree as follows: PURCHASE ORDER TERMS AND CONDITIONS IMPORTANT: READ 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) Consignees 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 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 may then make a conforming tender within the contract time but not afterward. 5. INVOICES & PAYMENTS. a. S e 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. 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 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 Wee conditions and methods of purchase. In the event Seller breaches this warranty, the prices of the items shall be reduced to the Sellers current prices on orders by others, or in the altemative. 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 wananty 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 amount of such 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 famished will conform to the specification, drawings, and descriptions listed in the bid invitation, and to the sample(s) fumished 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 -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 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 par 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 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 are subject to the availability of an annual appropriation for this purpose by the City. In the event of nomppropriation of finds by the City Council of the City of Lubbock for the goods or selyiees 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 terns hereof including warranties of Seller or if the Seller becomes insolvent or commits acts of batilwptcy. Such right of cancellation is in addition to and not in lieu of any other remedies which Buyer may have in law or equity. 15. TERMINATION. The performance of work under this order may be terminated in whole, or in pan 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 14, herein. 16. FORCE MAJEURE. Neither parry shall be held responsible for losses, resulting if the fulfillment of any terns 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 conformitywith 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 for bids, and any other documents provided by Seller as par 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. Whereever the term "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 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 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 lire 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 anyjudgment 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. 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 tight 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 confict 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. 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 $200 for each individual that has been misclassifted. (Texas Government Code Section 2155.0011. 28. ASSIGNING OR 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 from 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: bM,//wow.ci.lubbock.tx.us/doartmental-websites/dgpartmentsbp rchasing/vendor-infortnatior 30. CONTRACTOR ACKNOWLEDGES, by supplying any Goods or Services that the Contractor has read, fully understands, and will be in full compliance with all terns and conditions and the descriptive material contained herein and any additional associated documents and Amendments. The City disclaims any tems 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 tears and conditions provided by the Contractor, the terms and conditions provided herein shall prevail. The terms and conditions provided herein 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 tern of this Agreement (Contract m applicable) will not Boycott Israel as that term is defined in Texas Government Code Section 808.001, as amended. Rev. 10,2017 Exhibit A City of Lubbock, TX Purchasing & Contract Management INSURANCE COVERAGE REQUIRED TYPE OF INSURANCE COMBINED SINGLE LIMIT GENERAL LIABILITY ❑■ Commercial General Liability General Aggregate ❑ Claims Made ❑ Other _ Products-Comp/Op AGG x ❑ W/Heavy Equipment ❑■ Occurrence Personal & Adv. Injury x ❑ XCU Contractual Liability x ❑■ To Include Products of Complete Operation Endorsements Fire Damage (Any one Fire) Med Exp (Any one Person) ❑ PROFESSIONAL LIABILITY ❑ Occurrence General Aggregate ❑ or Technical Errors and Omissions ❑ CYBER LIABILITY ❑ Occurrence General Aggregate OTHER: ❑ ❑ Occurrence General Aggregate AUTOMOTIVE LIABILITY El Any Auto ❑ All Owned Autos Per Occurrence ❑ Scheduled Autos ❑ Hired Autos ❑ Non -Owned Autos Aggregate EXCESS LIABILITY ❑ Umbrella Form Each Occurrence Aggregate GARAGE LIABILITY ❑ Any Auto Auto Only - Each Accident ❑ Other than Auto Only: Each Accident Aggregate ❑ BUILDER'S RISK ❑ 100% of the Total Contract Price ❑ INSTALLATION FLOATER ❑ 100% of the Total Material Costs ❑ POLLUTION ❑ CARGO ❑■ WORKERS COMPENSATION or OCCUPATONAL MEDICAL AND DISABILITY 500,000 ❑■ EMPLOYERS' LIABILITY lffi ° OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED ❑� City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis. ❑E To include Products and Completed Operations Endorsements N Waiver of subrogation in favor of the City of Lubbock on all coverages ❑ No insurance required. Additional Comments: Quote #: KMEE800971.1 Mailing Address: CXT Incorporated: an LBFoster Co. CAT, inc. an L.B. Foster Company 3808 North Sullivan Road Bldg. #7 Spokane Valley. WA99216 Phone: (800) 696-5766 To: City of Lubbock Fax: (509) 928-8270 1625 13th Street. Room L-04 Date: 11/07/2018 Lubbock. TX 79401 Attention: Abbey Stainfield Phone: (806) 775-2665 Our quotation for the Taos Flush Building building is as follows: Per Building Santiago Building 1 (13-246P) multi-user flush building with standard simulated cedar $219.164.00 shake roof and stone with lap siding wall texture. three 16-gauge galvanized steel doors and frames. stainless steel plumbing fixtures (4-lavatories, 6-water closets, 2-urinal). Electric hand dryers. electronic flush valves. 4 gallon HW heater. Exterior ADA drinking fountain. Defense Shield Grafitti sealer. exterior hose bib. five 3-roll toilet paper holders. two exhaust fans. five GFI outlets. five floor drains. four s/s mirrors. ADA grab bars. ADA signs, one hose bib in chase area. and motion controlled interior lights and photo cell controlled exterior lights. Price includes delivery to Berl Huffman Sports complex near Lubbock TX. Price also includes crane and crew to set the building on the customers supplied foundation and stubbed utilities. Price also includes CXT installer to connect final utilities to customers provided stubs. CXT installer will also charge up utilities if customer has them ready. Crew will flush out the lines and confirm that everything is working prior to departure If customer is not ready to charge utilities and CXT crew needs to return, then additional costs will be incurred. Site must be accessible to a standard semi and trailer. Site must allow the crane to set within 2-3' of the pad and the semi has access to pull next to the crane. Price also includes stamped plans and TX inspections and tags. Sourceweil Contract # 030117 Freight FOB: Freight FOB Plant Prepaid and Add. Terms: Net 30 with Credit Approval. Notes: Sales tax not included Number of Units: This quotation is subject to the conditions on the attached sheet and the terms hereof shall constitute the exclusive agreement of the parties and all conflicting or additional terms in Buyer's purchase order or any other such documents of Buyer shall have no force or effect. By Accepted this By: day of _ L.B. FOSTER COMPANY Kurt Mee 20 KMee@lbfoster.com (Customer Name) $219,164.00 Quote #: KPdEE80098k 5 Mailing Address: CXT Incorporated. an LBFoster Co. CAT,Q Inc. an L.B. Foster Company 3808 North Sullivan Road Bldg. #7 Spokane Valley. WA99216 Phone: (800) 696-5766 To: City of Lubbock Fax: (509) 928-8270 1625 13th Street, Room L-04 Date: 11/07/2018 Lubbock, TX 79401 Attention: Abbey Stainfield Re: Phone: (806) 775-2665 Our quotation for the Taos Flush Building building is as follows: Per Building Santiago Building 2 (13-246P) multi-user flush building with standard simulated cedar $206.464.00 shake roof and stone with lap siding wall texture, three 16-gauge galvanized steel doors and frames. stainless steel plumbing fixtures (4-lavatories. 6-water closets. 2-urinal). Electric hand dryers, electronic flush valves. 4 gallon HW heater. Exterior ADA drinking fountain. Defense Shield Grafitti sealer; exterior hose bib. five 3-roll toilet paper holders. two exhaust fans, five GFI outlets. five floor drains, four s/s mirrors. ADA grab bars, ADA signs. one hose bib in chase area, and motion controlled interior lights and photo cell controlled exterior lights. Price includes delivery to Burl Huffman Sports Complex in Lubbock TX. Price also includes crane and crew to set the building on the customers supplied foundation and stubbed utilities. Price also includes CXT installer to connect final utilities to customers provided stubs. CXT installer will also charge up utilities if customer has them ready. Crew will flush out the lines and confirm that everything is working prior to departure. If customer is not ready to charge utilities and CXT crew needs to return. then additional costs will be incurred. Site must be accessible to a standard semi and trailer. Site must allow the crane to set within 2-3' of the pad and the semi has access to pull next to the crane. Price also includes TX inspections and tags. Discount applied to building #2 because 2 buildings are being orderd. Sourcewell Contract # 030117 $206, 464.00 FOB: Freight FOB Plant Prepaid and Add. Terms: Net 30 with Credit Approval. Shipment: Motes: Sales tax not included Number of Units: 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. 2018-426160 CXT Incorporated Spokane, WA United States Date Filed: 11/15/2018 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: 11/15/2018 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. Berl Huffman Sports Complex Precast Concrete Building 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. ❑ X 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 (Declai3nt) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711 CERTIFICATE OF INTERESTED PARTIES FORM 3.295 1 of 1 Complete Nos. 1- 4 and 6 it 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. 2018-426160 CXT Incorporated Spokane, WA United States Date Filed: 11/15/2018 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. Berl Huffman Sports Complex Precast Concrete Building 4 Name of Interested PartY City, State Count lace of business ty, � Country iP ) Nature of interest check applicable) ( PP 1 Controlling Intermediary 5 Check only if there is NO Interested Party. ❑ X 6 UNSWORN DECLARATION My name is J and my date of birth Is My address is (street) c� (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in C+wnty, State of on the /- day of20. 1,C— (month) (year) /v Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www. ethics. state.tx. Lis Version V1.0.6711