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Home My WebLink AboutResolution - 2023-R0293 - Purchase Order 23105658, With Teledyne ISCO 6.13.23 - 06/13/2023Resolution No. 2023-RO293 Item No. 5.21 June 13, 2023 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Purchase Order No. 23105658 for the purchase of Samplers and Flow Meters, by and between the City of Lubbock and Teledyne ISCO of Lincoln, NE and related documents. Said Purchase Order is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on June 13, 2023 APPROVED AS TO CONTENT: w M Erik Rejino, Assistant City Manager APPROVED AS TO FORM: Amy VSirr)4, Deputy City RES.PurchaseOrd 23105658 PO for Samplers and Flow Meters 05,11,2023 City of Lubbock TEARS PURCHASE ORDER TO: TELEDYNE INSTRUMENTS INC 12497 COLLECTION CENTER DRIVE CHICAGO IL 60693-0124 Page - 2 Date - 5/10/2023 Order Number 23105658 000 OP Branch/Plant 231 SHIP TO: CITY OF LUBBOCK WATER RECLAMATION PLANT 3603 GUAVA AVENUE LUBBOCK TX 79403 INVOICE TO: CITY OF LUBBOCK ACCOUNTSPAYABLE P.O. BOX 2000 LUBBOCK, TX 79457 BY: Marta Alvarez, Du for of Purchasing & Contract Management Ordered 5/23/2023 Freight Requested 8/29/2023 Taken By K MORGAN Delivery PER C HENDERSON REQ 60180 SOLE SOURCE/ PUR 17351 Ifyou have any questions, please contact Craig Henderson at 806-775-3223 or via email at CHenderson@mylubbock.us Total Order Descri tion Supplier Item Ordered Unit Cost UM Extension Re uest Date Terms NET 30 139,745.00 This purchase order encumbers funds in the amount of $139,745.00 awarded to Teledyne ISCO, of Lincoln, NE, on June 13 , 2023. The following is incorporated into and made part of this purchase order by reference: Quote 00011700 V5 dated April 11, 2023, from Teledyne ISCO, of Lincoln, NE, as a sole source purchase. Resolution # 2023-RO293 ATTT AD Courtney Paz, City �" \ <: City of Lubbock PURCHASE ORDER TEXAS TO: TELEDYNE INSTRUMENTS INC 12497 COLLECTION CENTER DRIVE CHICAGO IL 60693-0124 Page - 1 Date - 5/10/2023 Order Number 23105658 000 OP Branch/Plant 231 SHIP TO: CITY OF LUBBOCK WATER RECLAMATION PLANT 3603 GUAVA AVENUE LUBBOCK TX 79403 INVOICE TO: CITY OF LUBBOCK ACCOUNTS PAYABLE P.O. BOX 2000 LUBBOCK, TX 79457 BY: d�f Marta Alvarez, Director oNPurchasing & Contract Management Ordered 5/23/2023 Freight Requested 8/29/2023 Taken By K MORGAN Delivery PER C HENDERSON REQ 60180 SOLE SOURCE/ PUR 17351 If you have any questions, please contact Craig Henderson at 806-775-3223 or via email at CHenderson@mylubbock.us Description/Supplier Item Ordered Unit Cost UM Extension Request Date Signature LaserFlow System 5.000 14,660.0000 EA 73,300.00 8 29 2023 360 LaserFlow sensor 684360060 8 Foot Power Cord 604304044 5.000 37.0000 EA 185.00 8/29/2023 TIENet 308 Analog Output 5.000 459.0000 EA 2,295.00 8/29/2023 option card 604304006 Wall Mount for 360 LaserFlow 5.000 1,053.0000 EA 5,265.00 8'29 2023 sensor604364003 Sensor Retrieval Tool 1.000 290.0000 EA 290.00 8.29 2023 604364033 TIENet 306 Interface with 3211 5.000 750.0000 EA 3,750.00 8 29'2023 cable 604304076 6712FR Refrigerated Sampler 5.000 10,214.0000 EA 51,070.00 8 29 2023 686710072 6712FR Adapter Kit for 1 5.000 42.0000 EA 210.00 8 29 2023 bottle 609004156 Freight 1.000 3,380.0000 EA 3,380.00 8!29:2023 Rev. 3/2022 Seller and Buyer agree as follows: PURCHASE ORDER TERMS AND CONDITIONS STANDARD TERMS AND CONDITIONS ACCEPTANCE OF THIS PURCHASE ORDER: CONTRACTOR ACKNOWLEDGES. by suimlvine any Goods or Services that the Contractor has read. fully understandsand 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 arrreed upon in writing by the parties. In the event of conflict between the City's terns and conditions and any terms and conditions provided by the Contractor. the reins and conditions provided herein shall prevail The terns and conditions provided herein are the final terns agreed upon by the parties. and any orior conflictine terns shall be of no force or effect. 1. SELLER TO PACKAGE GOODS. Seller will package goods in accordance with good commercial practice. Each shipping container shall be clearly and permanently marked as follows (a) Seller's name and address, (b) Consignee's name, address and purchase order or purchase release number and the supply agreement number if applicable, (c) Container number and total number of containers, e.g. box 1 of 4 boxes, and (d) the number of the container hearing the packing slip. Seller shall bear cost of packaging unless otherwise provided. Goods shall be suitably packed to secure lowest transportation costs and to conform with requirements of common carriers and any applicable specifications. Buyer's count or weight shall be final and conclusive on shipments not accompanied by packing lists. 2. SHIPMENT UNDER RESERVATION PROHIBITED Seller is not authorized to ship the goods under reservation and no tender of a bill of lading will operate as a tender of goods. 3. TITLE AND RISK OF LOSS. The title and risk of loss of the goods shall not pass to Buyer until Buyer actually receives and takes possession of the goods at the point or points of delivery. 4. NO REPLACEMENT OF DEFECTIVE TENDER Every tender of delivery of goods must fully comply with all provisions of this contract as to time of delivery, quality and the like. Ifa tender is made which does not fully conform, this shall constitute a breach and Seller shall not have the right to substitute a conforming tender, provided, where the time for performance has not yet expired, the Seller may reasonably notify Buyer of his intention to cure and may then make a conforming tender within the contract time but not aftenvard. 5. INVOICES & PAYMENTS. a. S e I I e r shall submit separate invoices, in duplicate, one each purchase order or purchase release after each delivery. Invoices shall indicate the purchase order or purchase release number and the supply agreement number if applicable. Invoices shall be itemized and transportation charges, if any, shall be listed separately. A copy of the bill of lading, and the freight waybill when applicable, should be attached to the invoice. Mail To: Accounts Payable, City of Lubbock, P O Box 2000, Lubbock, Texas 79457. Payment shall not be due until the above instruments are submitted after delivery 6. GRATUITIES. The Buyer may, by written notice to the Seller, cancel this contract without liability to Seller if it is determined by Buyer that gratuities, in the form of entertainment, gills or otherwise, were offered or given by the Seller, or any agent or representative of the Seller, to any officer or employee of the City of Lubbock with a view to securing a contract or securing favorable treatment with respect to the awarding or amending, or the making of any determinations with respect to the performing of such a contract. In the event this contract is canceled by Buyer pursuant to this provision, Buyer shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the tort incurred by Seller in providing such gratuities. 7. SPECIAL TOOLS & TEST EQUIPMENT. If the price stated on the face hereof includes the cost of any special Tooling or special test equipment fabricated or required by Seller for the purpose of filling this order, such special Tooling equipment and any process sheets related thereto shall become the property of the Buyer and to the extent feasible shall be identified by the Seller as such. 8. WARRANTY -PRICE. a The price to be paid by the Buyer shall be that contained in Seller's bid which Seller warrants to be no higher than Seller's current process on orders by others for products of the kind and specification covered by this agreement for similar quantities under similarof like conditions and methods of purchase. In the event Seller breaches this warranty, the prices of the items shall be reduced to the Seller's current prices on orders by others, or in the alternative. Buyer may cancel this contract without liability to Seller for breach or Seller's actual expense. b. The Seller warrants that no person or selling agency has been employed or retained to solicit or secure this contract upon an agreement or understanding for commission, percentage, brokerage, or contingent fee excepting bona fide employees of bona fide established commercial or selling agencies maintained by the Seller for the purpose of securing business. For breach of vitiation of this warranty the Buyer shall have the right in addition to any other right of rights to cancel this contract without liability and to deduct from the contract price, or otherwise recover without liability and to deduct from the contract price, or otherwise recover the full amount ofsuch commission, percentage, brokerage or contingent fee. 9. WARRANTY -PRODUCT. Seller shall not limit or exclude any implied warranties and any attempt to do so shall render this contract voidable at the option of the Buyer. Seller warrants that the goods furnished will conform to the specification, drawings, and descriptions listed in the bid invitation, and to the sample(s) furnished by the Seller, if any. In the event of a conflict or between the specifications, drawings, and descriptions, the specifications shall govern. Notwithstanding any provisions contained in the contractual agreement, the Seller represents and warrants fault -fame performanceand fault -free result in the processing date and date related data (including, but not limited to calculating, comparing and sequencing) of all hardware, software and firmware products delivered and services provided under this Contract, individually or in combination, as the case may be from the effective date of this Contract. The obligations contained herein apply to products and services provided by the Seller, its sub- Seller or any third party involved in the creation or development of the products and services to be delivered to the City of Lubbock under this Contract. Failure to comply with any of the obligations contained herein, may result in the City of Lubbock availing itself of any of its rights under the law and under this Contract including, but not limited to, its right pertaining to termination or default. The warranties contained herein are separate and discrete from any other warranties specified in this Contract, and are not subject to any disclaimer of warranty, implied or expressed, or limitation of the Seller's liability which may be specified in this Contract, its appendices, its schedules, its annexes or any document incorporated in this Contract by reference. 10. SAFETY WARRANTY. Seller warrants that the product sold to the Buyer shall conform to the standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970. In the event the product does not conform to OSHA standards, Buyer may return the product for correction or replacement at the Seller's expense. In the event Seller fails to make the appropriate correction within a reasonable time, correction made by Buyer will be at the Seller's expense. 11. NO WARRANTY BY BUYER AGAINST INFRINGEMENTS. As part of this contract for sale Seller agrees to ascertain whether goods manufactured in accordance with the specifications attached to this agreement will give rise to the rightful claim of any third person by way of infringement of the like. Buyer makes no warranty that the production of goods according to the specification will not give rise to such a claim, and in no event shall Buyer be liable to Seller for indemnification in the event that Seller issued on the grounds of infringement of the like. If Seller is of the opinion that an infringement or the like will result, he will notify the Buyer to this effect in writing within two weeks after the signing of this agreement. If Buyer does not receive notice and is subsequently held liable for the infringement or the like, Seller will save Buyer harmless If Seller in good faith ascertains the production of the goods in accordance with the specifications will result in infringement or the like, the contract shall be null and void. 12. NON APPROPRIATION. All funds for payment by the City under this contract 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 thirty (30) days prior written notice, but failure to give such notice shall be of no effect and the City shall not be obligated under this contract beyond the date of termination. 13. RIGHT OF INSPECTION. Buyer shall have the right to inspect the goods at delivery before accepting them 14. CANCELLATION. Buyer shall have the right to cancel for default all or any pan of the undelivered portion of this order if Seller breaches any of the terns hereof including warranties of Seller or if the Seller becomes insolvent or commits acts of bankruptcy. Such right ofcancellation is in addition to and not in lieu of any other remedies which Buyer may have in law or equity. in accordance with this provision. Termination of work hereunder shall be effected by the delivery of the Seller i a - Notice of Ternunauon" specifying the extent to which performance of work under the order is terminated and tl date upon which such termination becomes effective. Such right or termination is in addition to and not in lieu of it rights of Buyer set forth in Clause 14, herein. 16 FORCE MAJEURE. Neither party shall be held responsible for losses, resulting if the fulfillment of ar terns of provisions of this contract is delayed or prevented by any cause not within the control of the party who: performance is interfered with, and which by the exercise of reasonable diligence said party is unable to prevent. 17 ASSIGNMENT -DELEGATION No right or interest in this contract shall be assigned or delegation of at obligation made by Seller without the written permission of the Buyer. Any attempted assignment or delegation t Seller shall be wholly void and totally ineffective for all purpose unless made in conformity with this paragraph. 18. WAIV ER. No claim or right arising out of a breach of this contract can be discharged in whole or in pan by waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is i writing signed by the aggrieved party. 19. INTERPRETATION -PAROLE EVIDENCE. This writing, plus any specifications for bids and perfmarim( provided by Buyer in its advertisement for bids, and any other documents provided by Seller as part of his bu is intended by the parties as a final expression of their agreement and intended also as a complete and exclum statement of the terns of their agreement. Whenever a term defined by the Uniform Commercial Code is used in th agreement, the definition contained in the Code is to control. 20. APPLICABLE LAW. This agreement shall be governed by the Uniform Commercial Code. Wherever the ten "Uniform Commercial Code" is used, it shall be construed as meaning the Uniform Commercial Code as adopted the State of Texas as effective and in force on the date of this agreement. 21. RIGHT TO ASSURANCE. Whenever one party to this contract in good faith has reason to question the otht parry's intent to perform he may demand that the other party give written assurance of his intent to perform. In it event that a demand is made and no assurance is given within five (5) days, the demanding party may treat th failure as an anticipatory repudiation of the contract. 22. INDEMNIFICATION. Seller shall indemnify, keep and save harmless the Buyer, is agents, officials an employees, against all injuries, deaths, loss, damages, claims, patent claims, suits, liabilities, judgments, costs an expenses, which may in anywise accrue against the Buyer in consequence of the granting of this Contract or whit may anywise result therefrom, whether or not it shall be alleged or determined that the act was caused throug negligence or omission of the Seller or its employees, or of the subSeller or assignee or its employees, if any, and it Seller shall, at his own expense, appear, defend and pay all charges of attorneys and all costs and other expense arising therefrom of incurred in connection therewith, and, if any judgment shall be rendered against the Buyer in an such action, the Seller shall, at its own expenses, satisfy and discharge the same Seller expressly understands an agrees that any bond required by this contract, or otherwise provided by Seller, shall in no way limit th responsibility to indemnify, keep and save harmless and defend the Buyer as herein provided. 23. TIME. It is hereby expressly agreed and understood that time is of the essence for the performance of th contract, and failure by contract to meet the time specifications of this agreement will cause Seller to be in defau of this agreement. 24. MBE. The City of Lubbock hereby notifies all bidders that in regard to any contract entered into pursuant t this request, minority and women business enterprises will be afforded equal opportunities to submit bids in respom to this invitation and will not be discriminated against on the grounds of race, color, sex or natural origin i consideration for an award. 25. NON -ARBITRATION. The City reserves the right to exercise any right or remedy to it by law, contract, equity, < otherwise, including without limitation, the right to seek any and all forms of relief in a court of competes jurisdiction. Further, the City shall not be subject to any arbitration process prior to exercising its unrestricle right to seek judicial remedy. The remedies set forth herein are cumulative and not exclusive, and may be exercise concurrently. To the extent of any conflict between this provision and another provision in, or related to, this documen this provision shall control. 26. RIGHT TO AUDIT. At any time during the team of the contract, or thereafter, the City, or a duly authorize audit representative of the City or the State of Texas, at its expense and at reasonable times, reserves the right t audit Contractor's records and books relevant to all services provided to the City under this Contract. In the event suc an audit by the City meals any errors or overpayments by the City, Contractor shall refund the City the full amour ofsuch overpayments within thirty (30) days of such audit findings, or the City, at its option, reserves the right t deduct such amounts owing the City from any payments due Contractor. 27. The Contractor shall not assign or sublet the contract, or any portion of the contract, without written consent frot the Director of Purchasing and Contract Management. 28. Contracts with Companies Engaged in Business with Iran, Sudan, or Foreign Terrorist Organization Prohibitec Pursuant to Section 2252.152 of the Texas Government Code, prohibits the City from entering into a contract with vendor that s identified by The Comptroller as a company known to have contracts with or provide supplies or servmc with Iran, Sudan or a foreign terrorist organization 29, Texas Government Code. Section 2252.908 requires a business entity entering into certain contracts with governmental entity or state agency to file with the governmental entity or state agency a disclosure of interested panic at the time the business entity submits the signed contract to the governmental entity or state agency. Instructionsft completing Form 1295 are available at: bMWwww.cilsbbtxk.ixus departmcQI �bskrsdepartmcnfSDurc1N15ing vcndar_infilmulign 30. No Boycott of lmeL Pursuant to Section 2271.002 of the Texas Government Code, Respondent certifies that either (i) it meets an exemption criteria under Section 2271.002; or (ii) it does not boycott Israel and will not boycott Israel during the term of the contract resulting from this solicitation. Respondent shall state any facts that nuke it exempt from the boycott cenifiwtion in its Response. 31 No Boycott of Energy Companies. Pursuant to Section 2274 of the Texas Government Code, Respondent certifies that either (i) it meets an exemption criteria under Section 2274.002; or (ii) it does not boycott Energy Companies and will not boycott Energy Companies during the term of the contract resulting from this solicitation. Respondent shall state any facts that make it exempt from the boycott certification in its Response. 32 No Boycott of a Firearm Entity or Firearm Trade Association. Pursuant to Section 2274 of the Texas Government Code, Respondent certifies that either (i) it meets an exemption criteria under Section 2274.002; or (it) does not boycott a Firearm Entity or Firearm Trade Association and will not boycott a Firearm Entity or Firearm Trade Association during the term of the contract resulting from this solicitation. Respondent shall sate any facts tha make it exempt from the boycott certification in its Response. 33 Contracts with Companies Engaged in Business with Iran, Sudan, or Foreign Terrorist Organization Prohibited Pursuant to Section 2252.152 of the Texas Government Code, prohibits the City from entering into a contract with a vendor that is identified by The Comptroller as a company known to have contracts with or provide supplies or service with Iran, Sudan or a foreign terrorist organization 34. TEXAS PUBLIC INFORMATION ACT. The requirements of Subchapter 1, 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. 35. Pursuant to Section 552.301(c) of the Texas Government Code, the City of Lubbock has designated the followirl email address for which public information requests may be made by an entailed request: orlm my lubtsmLas. Please send this request to this email address for it to be processed 15. TERMINATION. The performance of work under this order may be terminated in whole, or in part by the Buyer REV. 3/2022 QUOTATION CO PRII. EyW?*w Ioyv W Quote # 00011700 V5 Date 4/11/2023 Bill To Name City of Lubbock Prepared By Ken Dillard Billing Address PO Box 2000 Email ken@cclynch.com Lubbock, TX 79457-0001 us Contact Name Craig Henderson Shipping Company City of Lubbock Est. Shipment 12-14 Weeks Name Shipping Terms F.O.B.: Origin PP&A Ship To 3603 Guava Ave SE Water Reclamation Plant Lubbock, TX 79404 ISCOID# 0022289 5.00 5.00 5.00 5.00 1.00 5.00 Isco Isco Isco Isco Isco Isco 5.00 Isco 5.00 Isco 684360060 604304044 604304006 604364003 604364033 604304076 686710072 609004156 Please address order: Teledyne ISCO 4700 Superior Lincoln, NE 68504 Signature LaserFlow System. Includes base station, 360 LaserFlow sensor with built-in ultrasonic level sensor and 32.8 it cable. Power cord, 8 foot for North America. Includes cord grip fitting (604304022). TIENet 308 analog 4-20 mA output option card, two independent channels. Max of 3 Permanent wall mount for TIENet 360 LaserFlow sensor. Sensor Retrieval Tool TIENet 306 Sampler Interface with 32.8 ft cable. Interface cable includes a TIENet plug. Supports flow pacing and sampler enabling. 6712FR Refrigerated Sampler (120 VAC, 60 Hz). Includes controller, refrigeration unit, distributor arm, and two pump tubes. Does not include bottle configuration kit. 6712FR refrigerator adapter kit for 1 bottle configuration. Kit contains mounting hardware for the controller. Bottle, caps, and discharge tubes must be ordered separately. Remit to: Teledyne Instruments 12497 Collection Center Drive Chicago, IL 60693 Important: Country of Origin: United States ISCO Minimum Order is $500; For orders less than $500, see https://store.teledyneisco.com/ All orders strictly limited to ISCO Terms & Conditions: http://isco.com/orderinfo/terms.asp Teledyne ISCO Representative: C.C. Lynch & Associates Subtotal Shipping and Handling Grand Total $14,660.00 $37.00 $459.00 $1,053.00 $290.00 $750.00 $73,300.00 $185.00 $2,295.00 $5,265.00 $290.00 $3,750.00 $10,214.00 $51,070.00 $42.00 $210.00 $136,365.00 $3,380.00 $139,745.00 • All freight will be Prepaid & Invoice Added unless specifically detailed otherwise. • Teledyne ISCO Federal ID # 95-488283 800-333-2252 228-452-2563 fax email: info@cclynch.com CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2023-1019401 Teledyne Instruments, Inc. dba Teledyne ISCO Lincoln, NE United States Date Filed: 05/11/2023 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 Stormwater Program 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. PUR-2023-17351 Lazerflow Systems and accessories 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 Patricia Bishop and my date of birth My address is 4736 Socialville Foster Road Mason OH 45040 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Warren County, State of Ohio on the11 day of May 20 23 . (month) (year) �C�iCJGGCiGC[i �LGlGdjA' Signature of authorized agent of contracting contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.7bd706d4 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2023-1019401 Teledyne Instruments, Inc. dba Teledyne ISCO Lincoln, NE United States Date Filed: 05/11/2023 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 Stormwater Ptogram Date Acknowledged: 05/11/2023 3 Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a description of the services, goods, or other property to be provided under the contract. PUR-2023-17351 Lazerflow Systems and accessories 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. ❑ 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 (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.7bd706d4