HomeMy WebLinkAboutResolution - 2019-R0242 - King Consultants - 07/09/2019Resolution No. 2019-RO242
Item No. 6.12
July 9, 2019 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, Service Contract No. 14613 for Mold Consulting
Services as per RFP 19-14613-FM, by and between the City of Lubbock and King
Consultants, Inc., 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 r July 9. 2019
i
1
JEFF IF I, MAY PRO TEM
ATTEST:
Re cca Garza, City Se`crett,,�
APPROVED AS TO CONTENT:
C-In -L /' ___j
Mark oo , A_ ssisiakt City Manager
APPROVED AS TO FORM:
c
K Ili Leisure, Assistant City Attorney
ccdocs/RES-Contract 14613 Mold Consulting Services
May 28, 2019
Resolution No. 2019-R0242
Contract 14613
City of Lubbock, TX
Mold Consulting Services
Agreement
This Service Agreement (this "Agreement") is entered into as of theq�day of , 2019
("Effective Date") by and between King Consultants, Inc., (the Contractor , nd the Cit ubbock (the
"City").
RECITALS
WHEREAS, the City has issued a Request for Proposals RFP 19-14613-FM, Mold Consulting
Services.
WHEREAS, the proposal submitted by the Contractor has been selected as the proposal which best
meets the needs of the City for this service; and
WHEREAS, Contractor desires to perform as an independent contractor to provide Mold Consulting
Services, upon terms and conditions maintained in this Agreement; and
NOW THEREFORE, for and in consideration of the mutual promises contained herein, the City and
Contractor agree as follows:
City and Contractor acknowledge the Agreement consists of the following exhibits which are
attached hereto and incorporated herein by reference, listed in their order of priority in the event of
inconsistent or contradictory provisions:
1. This Agreement
2. Exhibit A — General Requirements
3. Exhibit B Best and Final Offer
4. Exhibit C — Insurance
Scope of Work
Contractor shall provide the services that are specified in Exhibit A. The Contractor shall comply with all
the applicable requirements set forth in Exhibit B and C attached hereto.
Article 1
1.1 The contract shall be for a term of one year, with the option of four, one-year extensions, said
date of term beginning upon formal approval. The initial term of this Contract shall be from
August 28, 2019 through August 27, 2020. The subsequent periods covered by the optional,
one-year renewals shall be August 28 of the current year to August 27 of the next year. All
stated annual quantities are approximations of usage during the time period to be covered by
pricing established by this bid. Actual usage may be more or less. Order quantities will be
determined by actual need. The City of Lubbock does not guarantee any specific amount of
compensation, volume, minimum, or maximum amount of services under this bid and
resulting contract. The Contractor must maintain the insurance coverage required during the
term of this contract including any extensions. It is the responsibility of the Contractor to
ensure that valid insurance is on file with the Purchasing and Contract Management
Department as required by contract or contract may be terminated for non-compliance. The
rates may be adjusted upward or downward at this time at a percentage not to exceed the
effective change in the Consumer Price Index (CPI) or Product Price Index (PPI), whichever
is most appropriate for the specific contract for the previous 12-months. At the City's
discretion, the effective change rate shall be based on either the local or national index
average rate for all items. If agreement cannot be reached, the contract is terminated at the
end of the current contract period.
1.2 The Contractor shall not assign any interest in this Agreement and shall not transfer any
interest in the Agreement, whatsoever, without prior consent of the City.
1.3 All funds for payment by the City under this Agreement are subject to the availability of an
annual appropriation for this purpose by the City. In the event of non -appropriation of funds
by the City Council of the City of Lubbock for the goods or services provided under the
Agreement, the City will terminate the Agreement, 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 Agreement is spent, whichever
event occurs first. If at any time funds are not appropriated for the continuance of this
Agreement, cancellation shall be accepted by the contractor on 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 Agreement beyond the date of termination.
1.4 This contract shall remain in effect until the first of the following occurs: (1) the expiration
date, (2) performance of services ordered, or (3) termination of by either party with a 30 day
written notice. The City of Lubbock reserves the right to award the canceled contract to the
next lowest and best bidder as it deems to be in the best interest of the city.
Article 2 Miscellaneous.
2.1 This Agreement is made in the State of Texas and shall for all purposes be construed in
accordance with the laws of said State, without reference to choice of law provisions.
2.2 This Agreement is performable in, and venue of any action related or pertaining to this
Agreement shall lie in, Lubbock, Texas.
2.3 This Agreement and its Exhibits contains the entire agreement between the City and
Contractor and supersedes any and all previous agreements, written or oral, between the
parties relating to the subject matter hereof. No amendment or modification of the terms of
this Agreement shall be binding upon the parties unless reduced to writing and signed by
both parties.
2.4 This Agreement may be executed in counterparts, each of which shall be deemed an original.
2.5 In the event any provision of this Agreement is held illegal or invalid, the remaining
provisions of this Agreement shall not be affected thereby.
2.6 The waiver of a breach of any provision of this Agreement by any parties or the failure of
any parties otherwise to insist upon strict performance of any provision hereof shall not
constitute a waiver of any subsequent breach or of any subsequent failure to perform.
2.7 This Agreement shall be binding upon and inure to the benefit of the parties and their
respective heirs, representatives and successors and may be assigned by Contractor or the
City to any successor only on the written approval of the other party.
2.8 All claims, disputes, and other matters in question between the Parties arising out of or
relating to this Agreement or the breach thereof, shall be formally discussed and negotiated
between the Parties for resolution. In the event that the Parties are unable to resolve the
claims, disputes, or other matters in question within 30 days of written notification from the
aggrieved Party to the other Party, the aggrieved Party shall be free to pursue all remedies
available at law or in equity.
2.9 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 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.
2.10 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 do.
2.11 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 of insurance
from the Subcontractor that complies with all contract Insurance requirements document, this
provision shall control.
2.12 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 these terms
and conditions and any terms 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.
2.13 Pursuant to Section 2270.002 of the Texas Government Code, Respondent certifies that
either (i) it meets an exemption criteria under Section 2270.002; 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.
2.14 SB 252 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.
-----INTENTIONALLY LEFT BLANK-----
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
JEFF ., • . ..
ATTEST:
e ca Garza, City Secretary
APPROVED AS TO CONTENT:
Wesley Everett, Director of Facilities
Management
OVED AS O FORM
f
lli Leisure, Assistant City Attorney
CONTRAC --
Au zed Representative
]mac Axd w-t
Print Name
Address
City, State, Zip Code
Exhibit A
GENERAL REQUIREMENTS
1 INTENT
a) The City of Lubbock (hereinafter called "City") is seeking proposals from interested firms and individuals,
(hereinafter called "bidder") to provide Mold Consulting Services. Mold Consulting Services shall be
provided on an "as needed" basis without a minimum quality of work specified. The City is interested in
securing the most qualified firm/personnel to perform the required services.
b) Bidders are invited to submit demonstrated competence and qualifications of their firm for providing these
services.
c) The information contained within this document is intended to provide interested firms with the
requirements and criteria that will be used to make the selection.
d) The City of Lubbock is seeking a contract for mold consulting Services with one or more contractors. In
order to assure adequate coverage, the City may make multiple awards, selecting multiple vendors to
provide the services desired, if multiple awards are in the best interest of the City. A decision to make a
multiple award, however, is an option reserved by the City, based on the needs of the City.
2 PROJECT DESCRIPTION
Mold Consulting Services including but no limited to:
❑ Assessment of public facilities for the presence of mold
❑ Development of removal specifications for mold and mold contaminated material
0 Development of mold management plans
0 Management and monitoring of mold abatement jobs
0 Training
Other duties as requested.
Submittals. Submit a single copy of a sample of the following documents for review:
❑ Mold Assessment Report
❑ Mold Management Plan
❑ Mold Remediation Protocol (mold remediation work analysis)
❑ Mold Removal and Oversight Final Report
❑ Post - Remediation Assessment and Clearance Report and Final Status Report
❑ Indoor Environmental Quality Assessment Report
❑ Protocol to be used during Indoor an Environmental Quality Assessments
❑ Protocol to be used during a Mold Assessment
❑ Protocol to be used in creating a Mold Management Plan
❑ Protocol to be used in a Mold Post Remediation Assessment
3 FEE SCHEDULE
Fee Schedule should include, at a minimum, rates for the following personnel:
❑ Licensed Mold Assessment Consultant
0 Licensed Air Monitoring Technician
0 Technician
Records
a) Records shall be kept in the office of the Consultant for a period of not less than five (5) years and
shall be made available to the CITY for inspection and copying upon reasonable request.
b) Written and electronic copies of final documentation is required on all projects.
Ownership of Documents
a) All documents, including original drawings, estimates, specifications, field notes and data are
property of OWNER. CONSULTANT may retain reproducible copies of drawings and other
documents.
4 CONTRACT
a) This is a one year contract with the option to renew for four additional one year periods. The initial
term of this Contract shall be from August 28, 2019 through August 27, 2020. The subsequent periods
covered by the optional, one-year renewals shall be August 28 of the current year to August 27 of the
next year.
5 EXPERIENCE
A. The offeror shall provide the following information.
a) Experience evaluating and designing Mold Consulting projects.
b) The number of years in business.
c) Professional affiliations.
d) Recent examples of abatement projects.
B. Consultant(s) assigned by the offeror shall specialize in Mold Consulting. This experience
shall be documented in a resume for each staff member of the organization that will
The offeror shall briefly describe the firm's experience and qualifications to deliver the
requested services. The offerors' description shall also describe the proposed staffing level
required to perform the services and a list of all key members of the offeror's team (except
administrative support staff) and any consultant who will be committed to the project. Indicate
the level of effort and function of each member of the project, and the length of each staff
member's direct experiences. Prepare organization structure to show how the key members will
be involved.
C. Include resumes of these individuals. The resumes should include the following minimum
information:
a) Name
b) An explanation of the function they will perform and their title by classification.
c) Their relevant educational background.
d) Their relevant work experience.
e) Their work experience with local, state and federal government clients.
f) Any specialized skills, training, and/or credentials that is relevant to the required
services; (e.g., degrees, certificates, etc).
G REFERENCES
A. Include five (5) business references for which similar services have been provided. Include the
following:
a) The term (beginning and ending dates) of your contract agreement(s);
b) A brief description of the scope of work; and
c) Contact name, title, address, and telephone number.
The offeror(s) hereby authorize(s) and request(s) any person, firm, corporation and/or government entity
to furnish any information requested by the City in verification of the references provided and for
determining the quality and timeliness of providing the services.
7 EVALUATION CRITERIA
The following criteria will be used to evaluate and rank submittals:
Tab A) 50 Points — Qualifications/Experience
The following information shall be provided to allow the City to determine whether the
proponent is qualified to perform the work specified.
a. Provide a complete list of mold consulting projects within the past five years involving
your firm. Include the names of the participants as well as a contact person and his/her
phone number.
b. Identify any projects in which the respondent's contract was terminated for any reason;
c. Identify any claims or lawsuits that have been brought against your organization as a
result of any services provided within the last 5 years;
d. Provide an organization chart indicating the key personnel who will provide services
resulting from this RFP. All employees of the Contractor shall have knowledge and
experience including all applicable current licenses, certifications, and permits necessary
to perform assigned duties under the contract.
e. Provide a list of equipment available for this service. Contractor shall own or have
access to all equipment and instrumentation required for work performed under the
contract, and that equipment and instrumentation shall be available for the duration of
the contract.
f. Provide information regarding firm's safety record, and describe the specific safety
measures/plan to be used in this project to protect personnel, public, structures, and
infrastructure
Tab B) 20 Points — References
a. Please include in this section the names of five (5) organizations that have utilized your
services. Include the size and contract value of each project. Please include the name,
address, telephone number and contact person of the five organizations listed above.
(Do not use the City of Lubbock as a reference.)
Tab C) 30 Points — Cost
a. Respondents will submit the Proposal Price Sheet.
S PROPOSAL FORMAT
a) Proposals should provide a straightforward, concise description of the Offeror's capabilities to satisfy
the requirements of the RFP. Emphasis should be on completeness, clarity of content, and conveyance
of the information requested by the City.
b) The proposal should be bound in a single volume where practical. All documentation submitted with
the proposal should be bound in that single volume.
c) If the proposal includes any comment over and above the specific information requested in the RFP,
it is to be included as a separate appendix to the proposal.
d) The proposal must be organized into the following response item sections and submitted in an indexed
binder.
i) Cover letter addressed to the Honorable Mayor and City Council that states the Offeror's
understanding of the services to be provided. Include any additional information believed
necessary that is not requested elsewhere in the RFP.
ii) A description of the methodology to be used to complete the project to include, but not be limited
to, how recommendations will be formulated and commitment of adequate appropriate resources
to the project.
iii) Offeror's specific expertise in areas pertinent to the project to include a listing and brief description
of similar projects completed (with the dates of completion) or in progress and a list of references
by name, address, and telephone number for each project listed. This list of projects in progress
shall include the phase of work that each project is currently in (i.e. design, bid, construction), and
the estimated completion date.
iv) A brochure of past work, with emphasis on comparable projects.
v) List of principal(s) of the Proposer and amount of time that principal(s) will be involved in the
project.
vi) List of other professionals to be used, if applicable, with a record of experience in projects of this
nature. Identification of principal(s) and percentage of time the principal(s) will be involved in
the project.
vii) The organizational structure of the employees who will be assigned to this project along with
resumes of those individuals. If a joint venture is expected, then provide the organizational
structure of the sub -contractor and resumes of those persons who will be involved in the project.
viii) The Proposer must assure the City that he/she will to the best of his/her knowledge, information
and belief, be cognizant of, comply with, and enforce, where applicable and to the extent required,
all applicable federal or state statutes and local ordinances, but not limited to the City of Lubbock
Wage Determinations.
ix) Describe the Offeror's methodology for handling errors and omissions.
x) Disclosure of any obligations posing a potential conflict of interest, including service on City
boards and/or commissions and any current contracts with the City of Lubbock. This would apply
to the Proposer as well as consultants subcontracted by the Proposer.
xi) Any material which the proponent wishes to submit and which is not specifically requested in the
above categories.
xii) Offerors are strongly encouraged to explore and implement methods for the utilization of local
resources, and to outline how they would address outreach issues in their proposal.
(xiii) List your equipment available for this project.
(xiv) Provide resumes of key personnel who will be assigned to the contract, including photocopies of
all licenses and/or certifications.
(xv) Provide contact person who will be directly responsible for this contract and direct telephone
number.
(xvi) Have you ever failed to complete a project and/or defaulted on a contract? If so, specify when,
where and with whom.
Exhibit B
City of Lubbock, TX
RFP 19-14613-FM
RFP 19-14613-FM Mold Consulting Services
Best and Final Offer
Fee Schedule
Fee Schedule should include, at a minimum, rates a) Standard / Overtime HourlyRates
for the following personnel:
1) Licensed Mold Assessment Consultant
2) Licensed Air Monitoring Technician
3) Technician
4) Written Protocol
5) Bulk Samples
6) Phase 1 Site Assessment
,) $ 1 /JL/ <�, O L
3) $ L /
4)$ 1a:�p,00
5) $
6) $ -3z50,bC)
Name of Company:
Prepared By:C«
Title: C LX1 SL�J�Ctvi%
Date:
City of Lubbock, TX
RFP 19-14613-FM
Supplemental Price Sheet
Air Samples
Air Samples
Tape Lift
24 Hour TA
$
75.00
72 Hour TA $
60.00
24 Hour TA $
75.00
Ta a Lift
72 Hour TA
$
60.00
Bulk Samples
24 Hour TA
$
75.00
Bulk Samples
72 Hour TA
$
60.00
Culture Plates — Per Set (Fungus Plate
And Microbial Plate — Per Set
7 Day TA
$120.00
Exhibit C
City of Lubbock, TX
RFP 19-14613-FM
Mold Consulting Services
INSURANCE
SECTION A. Prior to the approval of this contract by the City, the Contractor shall furnish a completed Insurance Certificate to the
City, which shall be completed by an agent authorized to bind the named underwriter(s) to the coverages, limits, and termination
provisions shown thereon, and which shall furnish and contain all required information referenced or indicated thereon. THE CITY
SHALL HAVE NO DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL SUCH CERTIFICATE SHALL HAVE
BEEN DELIVERED TO THE CITY.
INSURANCE COVERAGE REQUIRED
SECTION B. The City reserves the right to review the insurance requirements of this section during the effective period of the contract
and to require adjustment of insurance coverages and their limits when deemed necessary and prudent by the City based upon changes
in statutory law, court decisions, or the claims history of the industry as well as the Contractor.
SECTION C. 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):
TYPE OF INSURANCE
GENERAL LIABILITY
® Commercial General Liability ❑ Other
❑ Claims Made ® Occurrence
❑ W/Heavy Equipment
® To Include Products of Complete Operation Endorsements
PROFESSIONAL LIABILITY
COMBINED SINGLE LIMIT
General Aggregate lS .000.000
Products-Comp/Op AGG X
Personal & Adv. Injury X
Contractual Liability X
Fire Damage (Any one Fire)
Med Exp (Any one Person)
General Aggregate
AUTOMOTIVE LIABILITY
® Any Auto ❑ All Owned Autos Combined Single Limit
❑ Scheduled Autos ❑ Hired Autos Each Occurrence $ I.000.000
❑ Non -Owned Autos
EXCESS LIABILITY
❑ Umbrella Form Each Occurrence
Aggregate
GARAGE LIABILITY
❑ Any Auto Auto Only - Each Accident
❑ Each Accident Aggregate
❑ BUILDER'S RISK ❑ 100% of the Total Contract Price
❑ INSTALLATION FLOATER ❑ 100% of the Total Material Costs
® POLLUTION 1 OS . 00,000
❑ CARGO
® WORKERS COMPENSATION — STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY
® EMPLOYERS' LIABILITY 50$0.000
OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED
® City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis
® To include products of completed operations endorsement.
® Waiver of subrogation in favor of the City of Lubbock on all coverages, except
The City of Lubbock shall be named as an additional insured on a primary and non-contributory basis and shall include waivers of
subrogation in favor of the City on all coverage's. Copies of the Certificates of Insurance and all applicable endorsements are required.
ADDITIONAL POLICY ENDORSEMENTS
The City shall be entitled, upon request, and without expense, to receive copies of the policies and all endorsements thereto and may
make any reasonable request for deletion, revision, or modification of particular policy terms, conditions, limitations, or exclusions
(except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwriter of any
of such policies). Upon such request by the City, the Contractor shall exercise reasonable efforts to accomplish such changes in policy
coverages, and shall pay the cost thereof.
REQUIRED PROVISIONS
The Contractor agrees that with respect to the above required insurance, all insurance contracts and certificate(s) of insurance will
contain and state, in writing, on the certificate or its attachment, the following required provisions:
a. Name the City of Lubbock and its officers, employees, and elected representatives as additional insureds, (as the interest of
each insured may appear) as to all applicable coverage;
b. Provide for thirty (30) days' notice to the City for cancellation, nonrenewal, or material change;
c. Provide for notice to the City at the address shown below by registered mail;
d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees, and elected representatives
for injuries, including death, property damage, or any other loss to the extent same may be covered by the proceeds of insurance;
e. Provide that all provisions of this contract concerning liability, duty, and standard of care together with the indemnification
provision, shall be underwritten by contractual liability coverage sufficient to include such obligations within applicable
policies.
NOTICES
The Contractor shall notify the City in the event of any change in coverage and shall give such notices not less than 30 days prior the
change, which notice must be accompanied by a replacement CERTIFICATE OF INSURANCE.
All notices shall be given to the City at the following address:
Marta Alvarez, Director of Purchasing and Contract Management
City of Lubbock
1625 131s Street, Room 204
Lubbock, Texas 79401
SECTION D. Approval, disapproval, or failure to act by the City regarding any insurance supplied by the Contractor shall not relieve
the Contractor of full responsibility or liability for damages and accidents as set forth in the contract documents. Neither shall the
bankruptcy, insolvency, or denial of liability by the insurance company exonerate the Contractor from liability.
LIM
CERTIFICATE OF INTERESTED PARTIES FORM 1295
Sofl
Complete Nos. 1 - 4 and 6 if there are interested parties
OFFICE USE ONLY
Complete Nos.1, 2, 3, S, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
2019-479974
1
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
King Consultants, Inc.
Lubbock, TX United States
Date Filed:
04/22/2019
2
Name of governmental entity or state agency t at is a party tot the contract for WENWhe form is
being filed.
City of Lubbock Texas
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 19-14613-FM
Enviornmental Consulting Mold Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5
Check only if there Is NO Interested Parry.
X
6
UNSWORN DECLARATION
)
My name is CE. P D and my date of birth is
My address is Z to O ;). ICF>FT
(street) {cityi (state) (zip code? (couNry.
I declare under penalty of perjury that the foregoing is true and correct.
rl
Executed in fL County, State of E sl ItS , on the ZZ day of _T. 204_
(month) (year)
r
Signature of authorized agent of contracting business entity
(Deaarant)
urn- Nruvrunri uy 1 tlRaS munus Commission www.etntes.state.mus Version V1.139f8039c
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:
12019-479974
i Name of business entity tiling form, and the city, state and country of the business entity's place
of business.
King Consultants, Inc.
Lubbock, TX United States
Date Filed:
04/22/2019
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 Texas
Date Acknowledged:
06/03/2019
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 19-14613-FM
Enviornmental Consulting Mold Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I 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 de u try
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County. State of on the day of 20
m nth yea
Signature of author zed agent of contracting business entity
+.Declarant)
t-orms provlaea ny I exas F-mics COrnmiSSion www.ethics.state.tx.us Version V1.1.39f8039c
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