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HomeMy WebLinkAboutResolution - 2019-R0254 - High Sierra Electronics - 07/23/2019 Resolution No. 2019-RO254 Item No. 6.16 July 23, 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. 14683 for High Water Detection Warning System as per RFP 19-14683-FM, by and between the City of Lubbock and High Sierra Electronics, Inc., of Grass Valley, California, 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 July 23, 2019 DANIEL M. POPE, MAYOR ATTEST: Reb Ic ca Garza, City Secret ry APPROVED AS TO CONTENT: ;eslc:a McEachern, Assistant City Manager APPROVED AS "1'0 FORM: --I& Aox� Ke li Leisure, Assistant City Attorney ccdocs/RES.Contract 14683— High Water Detection System June 25, 2019 Resolution No. 2019-R0254 Contract 14683 City of Lubbock,TX High Water Detection Warning System Agreement This Service Agreement (this"Agreement") is entered into as of the rday of July 2019 ("Effective Date")by and between High Sierra Electronics,Inc.,(the Contractor),and the City of Lubbock (the "City"). RECITALS WHEREAS, the City has issued a Request for Proposals 19-14683-FM, High Water Detection Warning System. 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 High Water Detection Warning System; 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 —Proposal Price Sheet 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 four months, said date of term beginning upon formal approval. 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. 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 h•an, Sudan or a foreign terrorist organization. -----INTENTIONALLY LEFT BLANK----- IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the clay and year first above written. Executed in triplicate. CITY OF LUBB CI: CONTRACTOR High Sierra Electronics, Inc. BY: ( jNn'14- Daniel M. Pope. Mayor Authorized Representative ATTEST: Christopher Acevedo Print 1amc c'-Q155 Spring Hill Dr, Suite 106 Rebe ca Garza. City Seere ary Address APPROVED AS TO CONTENT: Grass Valley, CA 95945 Cit%. State. Zip Code Mike Keenum, Division Director of Engineering City Engineer 27 June 2019 APPMS TO FORM Kel i Leisure. Assistant City Attorney City of Lubbock,TX Exhibit A RFP 19-14683-FM High Water Detection Warning System GENERAL REQUIREMENTS 1 INTENT a) The City of Lubbock (hereinafter called "City") is seeking proposals from interested firms and individuals, (hereinafter called "Proposer") to provide a high water detection warning system. b) Offerors 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. 2 BACKGROUND Multiple streets in Mackenzie Park are subject to high water crossings. These roads can experience occasional flooding and become dangerous to cross. Installing a high water detection warning system on these streets will attempt to minimize future incidents and safety concerns in these areas.Underlying safety hazards associated with the high water crossings necessitate a solution for these areas.This service contract will provide the opportunity to have a contractor identified that can respond quickly and is capable of installing the necessary system. 3 SCOPE OF WORK The contractor shall have the ability to install a high water detection warning system. This system shall advise motorists of a flooded roadway by activating flashing lights and an automatic road crossing-arm. Materials such as, solar powered flashing LEDs, reflective "High Water" signs, high water sensor, automated drop down arms/gates, drill shaft, and any and all tools and labor for proper installation of the high water detection warning system. Specific direction will be provided by the CIP & Design Engineer as to where the system will be installed; see attached drawings. An example of the desired system can be seen in Exhibit A. For both sites, "Mackenzie Park North"and"Mackenzie Park South", two warning signs are to be placed at each site to alert both northbound and southbound traffic. Detailed Scope: 1. Provide all labor, materials, tools, supervision and equipment to fully analyze site locations and perform the installation of a high water detection system.The methods of construction shall conform to the requirements of all applicable American Society of Testing Materials (ASTM) Standards as well as all the American National Standards Institute(ANSI) and NSF International Standards. 2. It is not necessary for this system to provide remote access nor any alerts or reports when activated. 3. Furnish cleanup and restoration of the site to pre-construction conditions or better. 4. Carry out operations in accordance with local,state, federal and OSHA safety regulations. 4 CONTRACT TERMS AND DURATION The Contract will be in the form of Contract for Installation. Payment for work is as described in the provided bid sheets. Payment will be based on time at the site only; mobilization/demobilization costs are to be included in the proposed rates. City of Lubbock, TX RFP 19-14683-FM High Water Detection Warning System 5 CONTRACTOR'S RESPONSIBILITIES Contractor will be required to perform installation at the City's high water crossings. Contractor is responsible for all means and methods used to complete the installation, as directed by the City. Contractor shall be responsible for providing the following at levels adequate to complete installation in a timely manner as outlined below: • Qualified Labor • Tools • Equipment • Transportation • Services (including fuel, electricity, water, and communications) • Permits The Contractor shall be responsible for notifying the Engineering department for each of the working days of this contract. The Contractor is responsible for damage resulting from performing repair and clean-up of effected area. The City has adopted the City of Lubbock wage rates for use in and in accordance with the Texas Government Code, Section 2258.022. A copy of the wage rates is attached to this RFP. The Contractor is responsible for meeting all Contract conditions and City Standards & Details for all work performed. Substandard work, as determined solely by the City, shall be redone at the expense of the Contractor. Contractor will be required, at Contractor's expense, to furnish a payment bond in accordance with Chapter 2253, Government Code, in the amount of 100% of the total work or job price in the event that said work or job price assigned exceeds$50,000 and will also be required to furnish a performance bond in accordance with Chapter 2253, Government Code, in the amount of 100% of the total work or job price in the event that said contract work or job assigned exceeds$100,000. Said statutory bonds should be issued by a company carrying a current Best Rating of"A" or better. 6 PROTECTION OF EXISTING FACILITIES 6.1 GENERAL A. The Contractor shall protect all existing utilities and improvements not designated for removal and shall restore damaged or temporarily relocated utilities and improvements to a condition equal to our better than they were prior to such damage or temporary relocation. B. The Contractor shall verify the exact locations and depths of all utilities shown and the Contractor shall make exploratory excavations of all utilities that may interfere with the Work. C. The number-of exploratory excavations required shall be that number which is sufficient to determine conflicts with installation of the equipment. City of Lubbock,TX RFP 19-14683-FM High Water Detection Warning System 6.2 RIGHTS-OF WAY A. The Contractor shall not do any work that would affect any oil, gas, sewer, or water pipeline; any telephone, communication cable, fiber optic transmission line, or electric transmission line; any fence; or any other structure, nor shall the Contractor enter upon the right-of-way involved until notified by the Engineer that the City has secured authority therefore from the proper party. After authority has been obtained, the Contractor shall give said party due notice of its intention to begin work, and shall give said party convenient access and every facility for installation of equipment. When two (2) or more contracts are being executed at one time, on the same or adjacent land in such manner that work on one contract may interfere.with that on another, the City shall determine the sequence and order of the Work. When the territory of one contract is the necessary or convenient means of access for the execution of another contract, such privilege of access or any other reasonable privilege may be granted by the City to the Contractor so desiring, to the extent, amount, in the manner, and at the times permitted. 6.3 RESTORATION OF PAVEMENT A. General: All paved areas, including asphalt concrete berms, cut or damaged during construction, shall be replaced with similar materials of equal thickness to match the existing adjacent undisturbed areas. Exceptions would be specific resurfacing requirements of the permit-issuing agency. All temporary and permanent pavement shall conform to the requirements of the City. All pavement, which is subject to partial removal, shall be neatly saw cut in straight lines per City specifications. The Contractor shall be responsible for the repair of all trenches and paved areas that settle or fail within one year of construction. B. Temporary Resurfacing_ Wherever required by the public authorities having jurisdiction, the Contractor shall place temporary surfacing promptly after backfilling and shall maintain such surfacing for the period of time fixed by said authorities before proceeding with the final restoration of improvements. C. Permanent Resurfacing: In order to adhere to the City of Lubbock Standard Specifications&Details regarding adjacent surfaces, the Contractor shall saw cut back and trim the edge so as to provide a clean, sound, vertical joint before permanent replacement of an excavated or damaged portion of pavement. D. Restoration of Sidewalks or Private Driveways: Wherever sidewalks or private roads have been removed for purposes of construction, the Contractor shall place suitable temporary sidewalks or roadways promptly after back-filling and shall maintain them in satisfactory condition for the period of time fixed by the authorities having jurisdiction over the affected portions before proceeding with the final restoration or, if no such period of times is so fixed, the Contractor shall maintain said temporary sidewalks or roadways until the final restoration thereof has been made. City of Lubbock, TX RFP 19-14683-FM High Water Detection Warning System 7 EVALUATION CRITERIA The following criteria will be used to evaluate and rank submittals: a) 40 Points—Price a. Contractor will complete the Proposal Price Sheet. b) 30 Points—Qualifications/Experience a. Contractor will complete the Statement of Qualifications. C) 20 Points—Adherence to General Requirements a. Contractor must submit high water detection warning system information, including manufacturer, description of the system,product information, specification, etc. d) 5 Points—Safety a. Contractor will complete the Safety Record Questionnaire. C) 5 Points—Time a. Contractor will provide the proposed amount of consecutive calendar days required to complete the project. 8 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. The proposal shall not exceed a page limit of 27 pages. Proposals that exceed the maximum number of pages will be refected without review and will not be considered further. 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 City of Lubbock,TX RFP 19-14683-FM High Water Detection Warning System 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. 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. Exhibit B REVISED City of Lubbock,TX RFP 14-14683-FM High Water Detection Warning System Proposal Price Sheet (To be completed and returned with Proposal) ITEM DESCRIPTION �+Y U0 UNIT COST EXTENDED COST Mackenzie Park North&South General Items Mobilization- Including Contractor I mobilization, insurance,payment bond, 1 LS $6,236.00 $8,236.00 erformance bond and demobilization. Storm Water Pollution Prevention Plan - 2 (SWPPP)- Including preparation,NOT, 1 LS implementation,NOT and all other work Included in Insta ation Cost considered incidental to this item. _ Traffic Control-Including Traffic Control Plan - 3 (TCP),signage,cones,barrels,temporary I LS $2,480.00 $2,480.00 paving,detours, phasing and all other work considered incidental to this item. General Items Extended Total $ Site Specific Items Mackenzie Park North&South Fully Automated System-Including materials, equipment and labor to perform installation, installation,programming, instrumentation, embedment,testing and all other work considered incidental to this item,This system can include water level sensors that are monitored and controlled by base station so are to automatically ac iva a flashing beacons and lower crossing arms/gates.The system allows for remote access to activate system and may also include software to produce reports for water levels and notification alerts that the system has been activated.The system also has the option to be activated manually on location. Mackenzie Park North&South Semi- Automated System- Including materials, equipment and labor to perform installation, installation,programming,instrumentation, embedment,testing and all other work considered incidental to this item,This system (tj Or OAA nf) CIQAQArnA does not include any water level sensors nor base I Ila station software,but would have the ability for remote access to activate the system at anytime without the need to be on location.The system also has the option to be activated manually on location. REVISED City of Lubbock,TX RFP 19-14683-FM High Water Detection Warning System Proposal Price Sheet To be completed and returnTwithsaS Mackenzie Park North&South Manual System -Including materials,equipment and labor to perform installation, installation,programming, 6 instrumentation,embedment,testing and all other $83,402.00 $83,402.00 work considered incidental to this item.This system only has the option to manually activate the flashing beacons and lower crossing arms/gates with the need to be on location. Manual System+General Items Extended Total: ��5r,9a8 $ 94 , 118 Proposed Time for Completion: 90 to 120 Consecutive Calendar Days After Receipt of Order Exhibit C City of Lubbock, TX RFP 19-14683-FM High Water Detection Warning System 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 COMBINED SINGLE LIMIT GENERAL LIABILITY ® Commercial General Liability ❑ Other General Aggregate $1.000,000 ❑ Claims Made ® Occurrence Products-Comp/Op AGG X ❑ W/Heavy Equipment Personal&Adv. Injury X ❑ To Include Products of Complete Operation Endorsements Contractual Liability X Fire Damage(Any one Fire) Med Exp(Any one Person) PROFESSIONAL LIABILITY ❑ General Aggregate S AUTOMOTIVE LIABILITY ® Any Auto ❑ All Owned Autos Combined Single Limit ❑ Scheduled Autos ❑ Hired Autos Each Occurrence 51,000.000 ❑ 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 ❑ CARGO ® WORKERS COMPENSATION—STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY ® EMPLOYERS- LIABILITY 51,000,000 OTHER:COPIES OF ENDOSEMENTS ARE REQUIRED ® Ci{v of Lubbock named cis actclitional irtstu er!art halo/Getterctl Liability on a primary and trot-contr ibutai-basis. ® To iiicbide prortircts of conipletec!opercitions eudo•semeul. ® 6f aiver 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 13`x' 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. CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f1 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. 2019-509188 High Sierra Electronics, Inc. Grass Valley,CA United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 06/24/2019 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. 19-14683-FM MacKenzie Park North&South Remote MANUAL High Water Detection System 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Logan,James Longmont,CO United States X Gayl, Ilse Longmont,CO United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is_ Sue SWenOr and my date of birth is.--- My address is_ HSE, Inc. 155 Spring Hill Dr, Suite 106 Grass Valley CA 95945 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in-Nevada Count State of an the�da of__ 20 -- Y, SallfOLlllcl__-.� Y ,�.Ufit3—• _1_2— (month) (year) signauue of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.39f8039c �Gl%�(GViv&4S& M '0 �( ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Aj&-/A7 i i On /8y, before me, l� c (insert name and title of the officer) personally appeared who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s)is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s)acted, executed the instrument. 1 certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. y PATMCCOLLOCH "''; Notary Public-California ` :r:`fr Nevada County ¢ g a Commission#2275160 9 rvs'.,. My Comm.Expires Jan 14,2023 Signature _% (Seal) _ CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f1 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. 2019-509188 High Sierra Electronics, Inc. Grass Valley, CA United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 06124/2019 being filed. City of Lubbock Date Acknowledged: 07/09/2019 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. 19-14683-FM MacKenzie Park North&South Remote MANUAL High Water Detection System 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Logan,James Longmont, CO United States X Gayi, Ilse Longmont, CO United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is and my date of birth is My address is , (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of on the day of ,20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.39f8039c