The URL can be used to link to this page

Home My WebLink AboutResolution - 2024-R0075 - Contract 17753, Pavement Restoration, Inc., Asphalt Pavement Rejuvenation Prog. - 02/13/2024Resolution No. 2024-R0075 Item No. 5.21 February 13, 2024 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, the Sole Source Service Contract No. 17753 for Asphalt Rejuvenation Program, by and between the City of Lubbock and Pavement Restoration, Inc. of Boerne, TX, 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 February 13, 2024 TRAY PAY ;, AYOR AT' ' � ST: Courtney Paz, Ci Secreta APPROVED AS TO CONTENT� �� G� Erik Rejino, Assistant City Manager APPROVED AS TO FORM: _ r elli Leisure, Senior Assistant City Attorney ccdocs/RES.SoIe Source Scrvice Contract 17753 Asphalt Rejuvenation Program 1.10.24 Resolution No. 2024-R0075 City of Lubbock, TX Asphalt Rejuvenation Program STATE OF TEXAS COUNTY OF LUBBOCK Contract 17753 This contract, (the "Contract"), effective as of the 13th day of February , 2024, (the "Effective Date"), is by and between the City of Lubbock, (the "City"), a Texas municipal corporation, and Pavement Restoration, Inc. ("CONTRACTOR") of Boerne, TX. WITNESSETH WHEREAS, the City desires to obtain an Asphalt Reiuvenation Pro�ram in Lubbock, Texas; and WHEREAS, CONTRACTOR has a professional experienced staff and is qualified to provide Asphalt Reiuvenation Prosram; and WHEREAS, the City desires to contract with CONTRACTOR to provide an Asphalt Rejuvenation Pro�ram in Lubbock, Texas. NOW THEREFORE, for and in consideration of the terms, covenants and conditions set forth in this Contract, the City and CONTRACTOR hereby agree as follows: ARTICLE I. TERM The contract shall be for a term of one year with the option of four one-year renewals. The term of this Contract commences on a date to be specified for each year in a written "Notice to Proceed" of the Owner. The Contractor is to substantially complete the project within 85 consecutive calendar days and the liquidated damages amount is $1,204.28 each consecutive calendar day thereafter as stipulated in the specifications and other contract documents. The Contractor is to finally complete the project within 90 consecutive calendar days and the liquidated damages amount is $1,204.28 each consecutive calendar day thereafter as stipulated in the specifications and other contract documents. All stated annual quantities are approximations of usage during the time period to be covered by pricing established. 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 contract. ARTICLE II. COMPENSATION CONTRACTOR shall be compensated by the City $1.20 per square yard for the first year, $1.25 per square yard for the second year, $1.30 per square yard for the third year, $1.35 per square yard for the fourth year, and $1.40 per square yard for the fifth year. The estimated quantity of Reclamite Preservative Seal to be applied under this contract per year is 1,000,000 square yards for a total contract price not to exceed $1,400,000 per year. Contractor shall submit a monthly request for payment to the Owner's Representative for approval. The Owner shall pay the Contractor on or before the fifteenth day of the current month the total amount of the Owner's Representative's Certificate of Partial Payment, less 5% of the amount thereof, which 5% shall be retained until final payment, and further, less all previous payments and all further sums that may be retained by Owner under the terms of the contract documents. ARTICLE III. TERMINATION A. General. City may terminate this Contract, for any reason, upon 30 days written notice to CONTRACTOR. B. Termination and Remedies. In the event CONTRACTOR breaches any term and/or provision of this Contract the City shall be entitled to exercise any right or remedy available to it at law or equity, including without limitation, termination of this Contract and assertion of action for damages and/or injunctive relief. The exercise of any right or remedy shall not preclude the concurrent or subsequent exercise of any other right or remedy and all other rights and remedies shall be cumulative. City or CONTItACTOR may, in its sole discretion, terminate this Agreement at any time, with or without cause upon 30 days written notice. C. 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. ARTICLE IV. REPRESENTATIONS AND WARRANTIES A. Existence. CONTRACTOR is a corporation duly organized, validly existing, and in good standing under the laws of the State of Texas and is qualified to carry on its business in the State of Texas. B. Corporate Power. CONTRACTOR has the corporate power to enter into and perform this Contract and all other activities contemplated hereby. C. Authorization. Execution, delivery, and performance of this Contract and the activities contemplated hereby have been duly and validly authorized by all the requisite corporate action on the part of CONTRACTOR. This Contract constitutes legal, valid, and binding obligations of the CONTRACTOR and is enforceable in accordance with the terms therof. D. CONTRACTOR. CONTRACTOR maintains a professional staff and employs, as needed, other qualified specialists experienced in providing Asphalt Reiuvenation Pro�ram, and are familiar with all laws, rules, and regulations, both state and federal, including, without limitation the applicable laws, regarding the activities contemplated hereby. E. Performance. CONTRACTOR will and shall conduct all activities contemplated by this Contract in a good and workmanlike manner, and comply with all laws, rules, and regulations, both state and federal, relating to predictive maintenance services, as contemplated hereby. If any of the activities of CONTRACTOR, or omissions of the activities required herein, shall cause, in whole or in part, liability or loss on the part of the City, it shall be deemed that CONTRACTOR did not perform said activities (or omitted the performance of said activities) in a good and workmanlike manner. F. Use of Copyrighted Material. CONTRACTOR warrants that any materials provided by CONTRACTOR for use by City pursuant to this Contract shall not contain any proprietary material owned by any other party that is protected under the Copyright Act or any other similar law. CONTRACTOR shall be solely responsible for ensuring that any materials provided by CONTRACTOR pursuant to this Contract satisfy this requirement and CONTRACTOR agrees to hold City harmless from all liability or loss to which City is exposed on account of CONTRACTOR's failure to perform this duty. ARTICLE V. SCOPE OF WORK CONTRACTOR shall accomplish the following: The contractor shall furnish all labor, material, and equipment necessary to perform all operations for the application of an asphalt rejuvenating agent to asphaltic surfaces at various locations. All Traffic Control shall conform to the Texas Manual on Uniform Traffic Control Devices in accordance with the City of Lubbock Public Works Engineering Standard Paving Specifications, Section 10.1, BARRICADES. A map of streets selected for application, labelled ATTACHMENT A, is hereto attached and incorporated by reference. The contractor shall be responsible for sweeping and cleaning of the streets prior to, and after treatment when required. Prior to treatment, the street will be cleaned of all debris (dirt, leaves, foreign materials, etc.) This work shall be accomplished by brooming, power blowing, or other approved methods. All sand used during the treatment must be removed no later than 48 hours after treatment of the street. This shall be accomplished by mechanical sweeping. All turnouts, cul-de-sacs, etc. must be cleaned of any material to the satisfaction of the Street Superintendent. If the cleanup process falls behind or the cleanup is not satisfactory to the Street Superintendent the application process will be halted until the sweeping crew has caught up, or until the street and surrounding right of way has been cleaned. Street sweeping and clean up shall be included in the price per square yard for the asphalt-rejuvenating agent. The asphalt-rejuvenating agent shall be applied by a distributor truck at the temperature recommended by the manufacturer and at the pressure required for the proper distribution. The emulsion shall be applied so that uniform distribution is obtained at all points of the areas treated. Areas inadvertently missed shall receive additional treatment. Application of asphalt rejuvenating agent shall be on one-half width of the pavement at a time. When the second half of the surface is treated, the distributor nozzle nearest the center of the road shall overlap the previous application by at least one-half the width of the nozzle spray. In any event the centerline construction joint of the pavement shall be treated in both application passes of the distributor truck. The asphalt- rejuvenating agent shall be blended with water at the rate of two (2) parts rejuvenating agent to one (1) part water, by volume or as specified by the manufacturer. The combined mixture of asphalt rejuvenating agent and water shall be spread at the rate of 0.05 to 0.10 gallons per square yard, or as approved by the Street Superintendent following field testing. After the street has been treated, the area within one foot of the curb line on both sides of the road shall receive an additional treahnent of the asphalt rejuvenating agent. The treatment shall be uniformly applied by a method acceptable to the Street Superintendent. After the rejuvenating agent has penetrated the surface, a coating of dry sand shall be applied to the surface to protect the traveling public. The asphalt-rejuvenating agent shall not be placed when the ambient temperature is below 40 degrees F as determined by the National Weather Service continuous broadcast, 748-1071 selection 2. The asphalt-rejuvenating agent shall be applied only when the existing surface to be treated is thoroughly dry and when it is not threatening to rain. ARTICLE VI. INDEPENDENT CONTRACTOR STATUS CONTRACTOR and City agree that CONTRACTOR shall perform the duties under this Contract as an independent contractor. CONTRACTOR has the sole discretion to determine the manner in which the services are to be performed. ARTICLE VII. INSURANCE A. General. CONTRACTOR shall procure and carry, at its sole cost and expense through the life of this Contract insurance protection hereinafter specified, in form and substance satisfactory to the City. City must approve all policies prior to the commencement of any activities whether performed by CONTRACTOR, subcontractor, agents, or third parties. The insurance carrier must be an insurance company authorized to transact business in the State of Texas and have a Best's Financial rating of "A" or better. A Certificate of Insurance specifying each and all coverage shall be submitted to City prior to the execution of this Contract. All insurance shall be prepared and executed by the insurance company or its authorized agents and shall contain an endorsement naming the City of Lubbock as additional insured on Auto/General Liability on a primary and non-contributory basis to include products of complete operations endorsement. All insurance shall provide a waiver of subrogation in favor of the City of Lubbock. Written notice of cancellation or any material change will be provided thirty (30) days in advance of cancellation or change. B. Required Coverage. CONTRACTOR shall obtain and maintain policies of insurance throughout the Contract term in limits specified below. Commercial General Liability Requirements: $1 M occurrence /$2M aggregate (can be combined with an Excess Liability to meet requirement). CGL is required in ALL contracts. It is perhaps the most important of all insurance policies in a contractual relationship. It insures the Contractor has broad liability coverage for contractual activities and for completed operations. Commercial General Liability to include Products — Completion/OP, Personal and Advertising Injury, Contractual Liability, Fire Damage (any one fire), and Medical Expenses (any one person). Automatically add an excess liability of $4M. Commercial General LiabiliTy Heavy Equipment Endorsement: Heavy equipment endorsement is required Automobile Liability Requirements: $1M/occurrence is needed Workers Compensation Requirements: Statutory. If the vendor is an independent contractor with no employees and are exempt from providing Workers' Compensation coverage, they must sign a waiver (obtained from COL Purchasing) and include a copy of their driver's license.. Employer Liability ($1M) is required with Workers Compensation. * The City of Lubbock (including its officials, employees and volunteers) shall be afforded additional insured status on a primary and non-contributory basis on all liability policies except professional liabilities and workers' comp. * Waivers of Subrogation are required for CGL, AL, and WC. * To Include Products of Completed Operations endorsement. * Carrier will provide a 30-day written notice of cancellation, 10-day written notice for non-payment. * Carriers must meet a A.M. Best rating of A- or better. * Subcontractors must carry same limits as listed above C. Subcontractors. CONTRACTOR shall require each subcontractor with whom it contracts to provide activities as contemplated by this Contract, to obtain proof of insurance coverage as set forth herein, and to provide to CONTRACTOR, prior to such person performing any such activities, a Certifcate of Insurance establishing such coverage. ARTICLE VIII. EMPLOYMENT OF AGENTS CONTRACTOR may employ or retain agents, consultants, contractors, or third parties, to perform certain duties of CONTRACTOR under this Contract provided that CONTRACTOR is in no event relieved of any obligation under this Contract. Any such agents, contractors, or third parties retained and/or employed by CONTI�.ACTOR shall be required to carry, for the protection and benefit of the City and CONTRACTOR and naming said third parties as additional insureds, insurance as described above in this Contract. ARTICLE IX. CONFIDENTIALITY CONTRACTOR shall retain all information received from or concerning the City and the City's business in strictest confidence and shall not reveal such information to third parties without prior written consent of the City, unless otherwise required by law. ARTICLE X. INDEMNITY CONTRACTOR shall indemnify and save harmless the City of Lubbock and its officers, agents, and employees from all suits, actions, losses, damages, claims, or liability of any character, type, or description, including without limiting the generality of the foregoing all expenses of litigation, court costs, and attorney's fees for injury or death to any person, or injury to any property, received or sustained by any person or persons or property, arising out of, or occasioned by, the acts of CONTRACTOR, its agents or employees, in the execution of this Contract. ARTICLE XI. COMPLIANCE WITH APPLICABLE LAWS CONTRACTOR shall comply with all applicable federal, state and local laws, statutes, ordinances, rules and regulations relating, in any way, manner or form, to the activities under this Contract, and any amendments thereto. AHTICLE XII. NON-ARBITRATION The City reserves the right to exercise any right or remedy available to it by law, contract, equity, or otherwise, including without limitation, the right to seek any and all forms of relief in a court of competent jurisdiction. Further, the City shall not be subject to any arbitration process prior to exercising its unrestricted right to seek judicial remedy. The remedies set forth herein are cumulative and not exclusive, and may be exercised concurrently. To the extent of any conflict between this provision and another provision in, or related to, this document, this provision shall control. ARTICLE XIIL 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 nonappropriation of funds by the City Council of the City of Lubbock for the goods or services provided under the contract, the City will terminate the contract, without termination charge or other liability, on the last day of the then-current fiscal year or when the appropriation made for the then-current year for the goods or services covered by this contract is spent, whichever event occurs first. If at any time funds are not appropriated for the continuance of this contract, cancellation shall be accepted by the Seller on thiriy (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. ARTICLE XIV. NOTICE A. General. Whenever notice from CONTRACTOR to City or City to CONTRACTOR is required or permitted by this Contract and no other method of notice is provided, such notice shall be given by (1) actual delivery of the written notice to the other party by hand. (2) facsimile, or other reasonable means (in which case such notice shall be effective upon delivery). or (3) by depositing the written notice in the United States mail, properly addressed to the other party at the address provided in this article, registered or certified mail, return receipt requested, in which case such notice shall be effective on the third business day after such notice is so deposited. B. CONTRACTOR's Address. CONTRACTOR's address and numbers for the purposes of notice are: Pavement Restoration, Inc. Arin: Robert Wiggins - President P.O. Box 1532 Boerne, Texas 78006 Telephone: (813) 323-2710 Facsimile: (830) 336-3484 C. City's Address. The City's address and numbers for the purposes of notice are: City of Lubbock Attn: Mike Gilliland — Director of Public Utilities P. O. Box 2000 Lubbock, Texas 79457 Telephone: �806) 775 - 2600 Facsimile: (806) 775 - 2744 D. Change of Address. Either party may change its address or numbers for purposes of notice by giving written notice to the other party, referring specifically to this Contract, and setting forth such new address or numbers. The address or numbers shall become effective on the 15th day after such notice is effective. ARTICLE XV. MISCELLANEOUS A. Captions. The captions for the articles and sections in this Contract are inserted in this Contract strictly for the parties' convenience in identifying the provisions to this Contract and shall not be given any effect in construing this Contract. B. Audit. CONTRACTOR shall provide access to its corporate books and records to the City. The City may audit, at its expense and during normal business hours, CONTRACTOR's books and records with respect to this Contract between CONTRACTOR and City. C. Records. CONTRACTOR shall maintain records that are necessary to substantiate the services provided by CONTRACTOR D. Assignability. 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. E. Successor and Assigns. This Contract binds and inures to the beneft of the City, CONTRACTOR, and their respective successors, legal representatives, and assigns. F. Construction and Venue. THIS CONTRACT SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF TEXAS. THE PARTIES HERETO HEREBY IRREVOCABLY CONSENT TO THE EXCLUSIVE JURISDICTION AND VENUE OF THE COURTS OF THE STATE OF TEXAS, COUNTY OF LC]13BOCK, FOR THE PURPOSES OF ALL LEGAL PROCEEDINGS ARISING OUT OF OR RELATING TO THIS CONTkACT OR THE ACTIONS THAT ARE CONTEMPLATED HEKEBY. G. Severability. If any provision of this Contract is ever held to be invalid or ineffective by any court of competent Jurisdiction with respect to any person or circumstances, the remainder of this Contract and the application of such provision to persons andlor circumstances other than those with respect to which it is held invalid or ineffective shall not be affected thereby. H. Amendment. No amendment, modification, or alteration of the terms of this Contract shall be binding unless such amendment, modification, or alteration is in writing, dated subsequent to this Contract, and duly executed by CONTRACTOR and City. I. 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. J. House Bill 2015. House Bill 2015, signed by the Governor on June 14, 2013 and effective on January 1, 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 misclassified (Texas Government Code Section 2155.001). K. 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. Section 2252.908 requires the disclosure form to be signed by the authorized agent of the contracting business entity, acknowledging that the disclosure is made under oath and under penalty of perjury. Section 2252.908 applies only to a contract that requires an action or vote by the governing body of the governmental entity or state agency before the contract may be signed or has a value of at least $1 million. Instructions for completing Form 1295 are available at: http://www.ci.lubbock.tx.us/departments/purchasin�/vendor-informatiari L. 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. M. HB 89 states the Contractor warrants that it complies with Chapter 2270, Subtitle F, Title 10 of the Texas Government Code by verifying that: (1) The Contractor does not boycott Israel; and (2) The Contractor will not boycott Israel during the term of the Agreement. N. Texas Government Code 2274. By entering into this Agreement, Contractor verifies that: (1) it does not, and will not for the duration of the contract, have a practice, policy, guidance, or directive that discriminates against a frearm entity or firearm trade association or (2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract. If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and will not discriminate during the term of the contract against a firearm entity or firearm trade association. O. Texas Government Code 2274 Contractor represents and warrants that: (1) it does not, and will not for the duration of the contract, boycott energy companies or (2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract. If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not boycott energy companies; and will not boycott energy companies during the term of the Agreement. This verifcation is not required for an agreement where a governmental entity determines that these requirements are inconsistent with the governmental entity's constitutional or statutory duties related to the issuance, incurrence, or management of debt obligations or the deposit, custody, management, borrowing, or investment of funds. P. Texas Public Information Act. The requirements of Subchapter J, Chapter 552, Government Code, may apply to this contract and the contractor or vendor agrees that the contract can be terminated if the contractor or vendor knowingly or intentionally fails to comply with a requirement of that subchapter. To the extent Subchapter J, Chapter 552, Government Code applies to this agreement, Contractor agrees to: (1) preserve all contracting information related to the contract as provided by the records retention requirements applicable to the governmental body for the duration of the contract; (2) promptly provide to the governmental body any contracting information related to the contract that is in the custody or possession of the entity on request of the governmental body; and (3) on completion of the contract, either: (A) provide at no cost to the governmental body all contracting information related to the contract that is in the custody or possession of the entity; or (B) preserve the contracting information related to the contract as provided by the records retention requirements applicable to the governmental body. Q. Professional Responsibility. All architectural or engineering services to be performed shall be done with the professional skill and care ordinarily provided by competent architects or engineers practicing under the same or similar circumstances and professional license. R. Bonds. The Contractor is required to furnish a performance bond in accordance with Chapter 2253, Government Code, in the amount of 100% of the total contract price in the event that said contract price exceeds $100,000 and the Contractor is required to furnish a payment bond in accordance with Chapter 2253, Government Code, in the amount of 100% of the total contract price in the event that said contract price exceeds $50,000. All bonds shall be submitted on forms supplied by the Owner, and executed by an approved Surety Company authorized to do business in the State of Texas. It is Fiarther agreed that this contract shall not be in effect until such bonds are so furnished. S. Entire Agreement. This Contract contains the Entire Contract between the City and CONTI7ACTOR, and there are no other written or oral promises, conditions, warranties, or representations relating to or affecting the matters contemplated herein. EXECUTED as of the Effective Date hereof. CONTRACTOR: Pavement RestoratiQn Inc. By: --- Printed Nam : oti�RT W�4s�� Title: ��,,j � � �-r' COMPLETE ADDRESS: Pavement Restoration Inc. PO Box 1532 Boerne, TX 78006 ATTEST: ��y Corporate Secretary CITY OF LUBBOCK, TEXAS (OWNER): By: Tray Payn , or ATTEST: Courtney az, City Secretary TO CONT� Director �ublic Utilities L. Woo� F lin,�'. ., Division Director of Public W ks VED AS TO FORM: elli Leisure, Senior Assistant City Attorney Z � � ►s� . . �,�. i nvauva er � es a� �nw nv wou � � W �a� ^� r"�.'_ �� a�v � � U� �O U� �` � � � 0 w m � c � c � � 'ai a�i �� C � - '�p � � � c L m N � � a � � N � O IN ATTACHMENT A C � e� aoor � � � � n� �n1`►c w� anrto �j_,�„ � �r aerw � ra��om �� `�R' a�,� .. � � �c�=� �cv�r�mo � • !�` � ��. �v.i ..�P� s. `� � s - � u� r � • � �.� �' � � ~ $ �tt �� ,� �� 6 �� C�C �..�� '' .. � s � 1wv �no � ; g � = C�,. � � � � � n� a� �� , �� arwv5 , k►atw � g ,� w��n� n��aw�r � �-+1�. >� ra�►r � J � ""�r.� e�r as w� � k'Si+�� °Ar a�'►� j a� � ` �r- �Q � �+: ru � �': . • ib :. � 3nv "'ta�w' � N tA NiAY�tO A� O�r �+� �'F�� L' �� dillr •Hl1r O BAY � B aA� e� �� .e � M CI �� e ser o�r �a � C n an� � �, '' �"r q �0 � �0 � �' e anv � �° � eA� �� A� �i��xanv��,M�►r � � � e_ � _ � � � � � � �e'+ �+r� �� .� � rw,c„� � .�.�� e �'� $ � � er roaaoa � d . � • & Ar 1MI�i A �N�9�� (lr � � � � � �� rl Mllil'101` � ri � ... � � � � � � � �� I � �� .��.�� '� � s �� ' � � � � �► � u � r a�r� �Frotw � � S �� D :o` �e �► M �rMoaan �0 p� � � � � �� @ 4 � suoeao �,�� . � � � � � ��, � � � � � � � .n�a�uvr t �e .' � � � � � � mr oom�w�' i �� eoo�nq � � � � � � $ ' ' S� � �e � � E A er ulw3r� ��'j0��' � i�C � � � � � v auo�whu � -�pp �� AMrONBU �7} __ � t�. \ A11ld�Ij .�/ � � k �ArrWl � ow u� � � r�a � � � ' w . h.€ ooc� aa ' � � T � � � � �`� ti e� a�mrMvw � � � i �e � ' � �� a � �a� �s[; �`� � �� AYYMYNII � C � � � .� �w � . �� f � � p�e € �� rwiY�c " � � o � a . G � e� �noarr � �' � nr anoan � � � �r iB1N1 � � Ar N'NF H:i u�ns�' oa �awarsr a� xa�nasas � � CERTIFICATE OF INTERESTED PARTIES FORnn 1295 1of1 Complete Nos. l- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. l, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entiry filing form, and the ciry, state and country of the business entity's place Certificate Number: of business. 2024-1108922 PAVEMENT RESTORATION INC Boerne, TX United States Date Filed: 2 Name of governmenta entiry or state agency that is a party to the contract for which the form is 01/05/2024 being filed. CITY OF LUBBOCK Date Acknowledged: g 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. 17753 ASPHALT REJUVENATION PROGRAM IN LUBBOCK TX Nature ofinterest 4 Name of Interested P Ci State, Count lace of business check a licable �Y tY, rY �P ) � PP ) Controlling Intermediary 5 Check only if there is NO Interested Party. � X 6 UNSWORN DECLARATION My name is 1��g�T W�S� � n� , and my date of birth is � _. My address is � � � V�tl.l�.`( �CV�01..1.. 11 a? i?i�� , ` � , �� C� , �1Jn► . (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in ��O�P►I.�— County, State of �� , on the 5 day of 'T�t� . 20 ��} (month) (year) Signature of authorize agent contracting business entiry eclara Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.f1b8c3f1 CERTIFICATE OF INTERESTED PARTIES FORnn 1295 lofl Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos, l, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entity filing form, and the ciry, state and country of the business entity's place Certificate Number: of business. 2024-1108922 PAVEMENT RESTORATION INC Boerne, TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 01/05/2024 being filed. CITY OF LUBBOCK Date Acknowledged: 01/05/2024 g 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. 17753 ASPHALT REJUVENATION PROGRAM IN LUBBOCK TX Nature of interest 4 Name of Interested Party City, State, Country (place of business) (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 penalry of perjury that the foregoing is true and correct. Executed in Counry, 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.ethlcs.state.tx.us version v:�.5.l.rla�c�rl