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HomeMy WebLinkAboutResolution - 2016-R0148 - Allison Enterprises Dba Kleen Air Filter Service & Sales - 04/28/2016Resolution No.2016-R0148 Item No.6.28 April 28,2016 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 a Service Agreement for HVAC Filter Service at Lubbock Preston Smith International Airport, by and between the City of Lubbock and Allison Enterprises dba Kleen Air Filter Service & Sales, and related documents. Said Agreement 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 bytheCity Council on April 28.2016 • ATTEST: a £ey&**-<Rebecca Garza,City Secretary APPRO\I'D AS lOOATEYI: (WpW, Kelly Campbell.Director of Aviation APPROVED AS TO FORM: GLEN it.ROBERTSON,MAYOR atterwhite,First Assistant City Attorney RES.Service Agrmnt-Allison Enterprises dba Kleen Air Filter Serv & Sales 2.29.16 Resolution No. 2016-R0148 Contract 12744 City of Lubbock, TX Contract for HVAC Air Filter Service for Lubbock Preston Smith International Airport THIS CONTRACT made and entered into this 28th day of April• 2016, by and between the City of Lubbock ("City"), and Allison Enterprises dba Meen Air Filter Service & Sales, ("Contractor"). WITNESSETH: WHEREAS, the City of Lubbock duly advertised for bids for HVAC Air Filter Service for Lubbock Preston Smith International Airport and bids were received and duly opened as required by law; and WHEREAS, after careful consideration of the bid submitted by Contractor, the City authorized the execution, in the name of the City of Lubbock a contract with said Contractor covering the purchase and delivery of the said HVAC Air Filter Service for Lubbock Preston Smith International Airport. NOW, THEREFORE, in consideration of the mutual agreement contained herein, as well as the financial consideration hereinafter referred to, the parties hereby covenant and agree as follows: 1. In accordance with City's specifications and Contractor's bid, copies of which are attached hereto and made part hereof, Contractor will deliver to the City, HVAC Air Filter Service for Lubbock Preston Smith International Airport and more specifically referred to as Items One through Nine on the bid submitted by the Contractor or in the specifications attached hereto. 2. The City promises and agrees to employ, and does employ, the Contractor to cause to be done the work provided for in this Contract and to complete and finish the same according to the attached specifications, offer, and terms and conditions contained herein. 3. The contract shall be for a term of one year, with the option of three, one year extensions, 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. 4. This contract shall remain in effect until the expiration date, performance of services ordered, or termination of by either party with a 30 day written notice. Such written notice must state the reason for cancellation. 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. 5. Contractor shall at all times be an independent contractor and not an agent or representative of City with regard to performance of the Services. Contractor shall not represent that it is, or hold itself out as, an agent or representative of City. In no event shall Contractor be authorized to enter into any agreement or undertaking for or on behalf of City. 6. The contractor shall obtain and maintain in full force and effect during the term of the contract, commercial general liability coverage with insurance carriers admitted to do business in the State of Texas. The insurance companies must carry a Best's Rating of A- VII or better. The policies will be written on an occurrence basis, subject to the following minimum limits of liability: TYPE AMOUNT General Liability Commercial General Liability General Aggregate/Per Occurrence $1,000,000 Products-Comp/Op AGG Contractual Liability Automotive Liability Combined Single Limit — Per Occurrence $1,000,000 Any Auto Workers Compensation Statutory Or Occupational Medical and Disability Employer's Liability $500,000 The City of Lubbock shall be named as additional insured on a primary and Non -Contributory basis on Auto/General Liability, with a waiver of subrogation in favor of the City of Lubbock on all coverages. Copies of all endorsements are required. The contractor will provide a Certificate of Insurance to the City as evidence of coverage. The certificate will provide 30 days notice of cancellation, and under the cancellation section, the wording "endeavor to" and "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives" will be crossed out. A copy of the additional insured endorsement attached to the policy will be included with the certificate. The contractor shall also maintain workers compensation insurance in the statutory amount If at any time during the life of the contract or any extension, the contractor fails to maintain the required insurance in full force and effect, all work under the contract shall be discontinued immediately. Any failure to maintain the required insurance may be sufficient cause for the City to terminate the contract. Neither the City nor the Contractor shall assign, transfer or encumber any rights, duties or interests accruing from this Contract without the written consent of the other. 9. 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. 10. 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. 11. 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 non -appropriation of funds by the City Council of the City of Lubbock for the goods or services provided under the contract, the City City of Lubbock Bid ITB 16-12744-TF 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 fast. If at any time funds are not appropriated for the continuance of this contract, cancellation shall be accepted by the Seller 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 contract beyond the date of termination. 12. The Contractor shall not assign or sublet the contract, or any portion of the contract, without written consent from the Director of Purchasing and Contract Management. Should consent be given, the Contractor shall insure the Subcontractor or shall provide proof on insurance from the Subcontractor that complies with all contract Insurance requirements. 13. This Contract consists of the following documents set forth herein; Invitation to Bid No. 16- 12744-TF, Specifications, and the Bid Form. IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and year first above written. Executed in triplicate. CITY OF LUBBOCK i Glen C. Ro rtson, Wayor ATTEST: Reb cca Garza, City Secret APPROVED AS TO CONTENT: Kelly Campbell, Director of Aviation /,n 'l1�us /✓le�Z�l Print Name / 0 Z 5, 7 e at �z tJci.. J' -- Address (�;'Iry %x . i 4 (� YL City, State, Zip C6de 2/18/2016 2:05 PM p. 40 REVISED City of Lubbock, TX ITB 16-12744-TF HVAC Air Filter Service for Lubbock Preston Smith International Airport Specifications 1. The contractor shall provide and install all air filters indicated for the following facilities at LPSIA. The Main Passenger Terminal Building Parking Lot Gate Houses (4) Airport Operations Computer Room East Terminal (Chaparral Jet Center, US Customs, FCWOS) West Terminal (FAA-FSDO) Airfield Maintenance facility The Cooling Tower (West of the terminal building) 2. Framed filters, fan coil filters and pre -filters will be installed on a bi-monthly, monthly quarterly and 6 month basis according specifications. Filter replacement will take place during the first week of the month according to the following schedule: Bi Monthly First week of April, June August, October, December and February Quarterly First weeks of April, July, October and January 6 Month First weeks of April and October 3. Filters shall be sized to fill the entire cross section of the units to prevent blow -by and eliminate filter spaces in the units. 4. Filter media shall have a synthetic dust weight resistance of 89.1% and a dust holding capacity of 194 grams (23.5%). 5. Contractor shall schedule filter change during working hours (8 a.m.-5 p.m. Monday -Friday) and coordinate with maintenance department the day before showing up. 6. Contractor will remove all filter media for offsite disposal. Contractor's employees assigned to work at the airport will be required to submit to a fingerprint - based criminal history records check (CHRC). Each CHRC will cost $29. Once the employee's CHRC has been cleared, the employee will attend a training class. A badge will be issued after the completion of the appropriate training class. The badge will then be held in the Airport Operations Office for check -in and check-out. The contractor will allow 3 weeks for processing of all CHRCs, training classes, and badging. 8. If the contractor notices any discrepancies with the HVAC equipment while performing their work they will report their findings to the Facilities Maintenance Supervisor. UNIT LOCATION QUANTITY SIZE TYPE ITLK�ti Bid Item #1 - Chance every 6 Months _Wall filters- Back Draft **AHU's 1, 2, &3 30 20x25x2 18 16x25x2 --Maintenance Shop filters 3 45xl3xl --Wall filters —Back Draft 20 24x24x2 --Wall filters —Back Draft 17 16x25x2 **AHU's 11 & 12 12 20x25x2 1 16x20x2 Bid Item #2 — Chance Bi-Monthly AHU#1 14 16x25x2 AHU#2 21 16x20x2 AHU#3 21 16x25x2 12 24x24x2 3 12x24x2 AHU#1 9 24x24x2 AHU#2 12 24x24x2 AHU#4 6 24x24x2 5 12x24x2 AHU#5 12 12x24x2 3 12x24x2 AHU#6 6 12x24x2 6 12x24x2 AHU#7 20 24x24x2 AHU#8 4 16x25x2 AHU#9 20 24x24x2 AHU#10 6 24x24x2 3 12x24x2 AHU# I l 21 16x20x2 Pre -filters 12 24x24x2 AHU#12 14 16x25x2 AHU #24 Low Roof East 16 24x24x2 AHU#25 High Roof East to West 6 24x24x2 AHU#26 6 24x24x2 AHU#27 Low Roof Middle 6 24x24x2 AHU#28 High Roof East to West 4 24x24x2 AHU#29 12 24x24x2 AHU#30 1 20x25x2 AHU#31 9 24x24x2 AHU#32 Low Roof West end 6 24x24x2 Wall Filters Generator Room 12 24x24x2 FP200 FP200 FP200 FP200 FP200 FP200 FP200 Pleated BID ITEM #3 — Change Bi-Monthly AHU#13 4 16x25x2 Pleated AHY#14 4 16x25x2 AHU#15 4 16x25x2 AHU#16 4 16x25x2 AHU#17 4 16x25x2 AHU#18 4 16x25x2 AHU#19 4 16x25x2 AHU#20 4 16x25x2 AHU#23 4 16x25x2 BID ITEM #4 — Chance Monthl AHU#18 4 16x25x2 Pleated AHY#19 4 16x25x2 AHY#20 4 16x25x2 AHY#21 4 16x25x2 AHY#22 4 16x25x2 AHY#23 4 16x25x2 BID ITEM #5 — Change Quarterly PARKING LOT GATEHOUSES GATE #1 1 14x20x1 Pleated GATE #2 1 12x20x 1 GATE #3 1 14x20x 1 GATE #4 1 12x 16x 1 AIRPORT OPERATIONS COMPUTER ROOM 4 25x25xl BID ITEM #6 - Change Ouarterly EAST TERMINAL AHU #52 Equip. Room 13 20x20x2 Pleated Equip Room 4 20x25x2 Rest Room I 39x26xl BID ITEM #7 — Change Yearly WEST TERMINAL AHU #54 4 20x25x2 Pleated 6 16x25x2 RTU 962 Roof 2 14x22xl RTU #63 Roof I 14x25xl Roof I 14x20xl Roof 1 16x20xl RTU #64 Roof 2 16x24xl RTU #65 Roof I 16x20x1 Roof 1 16x24xl RTU #67 Roof 2 20x30x2 FAA Computer room Drop Vent I 20x20x1 BID ITEM #8 — Chance Quarterly AIRFIELD MAINTENANCE AHU#1 Equip. Room 7 20x20xl Pleated 3 24x24xl 3 12x24xl BED ITEM #9 — Change Semi -Annually COOLING TOWER FILTERS Tower#1 2 16x20x2 FP200 Tower#2 2 18x24x2 FP200 Tower#3 2 18x24x2 FP200 City of Lubbock Bid ITB 16-12744-TF BID FORM HVAC Air Filter Service for Lubbock Preston Smith International Airport City of Lubbock, TX ITB No.16-12744-TF In compliance with the Invitation to Bid 16-12744-TF, the undersigned Bidder having examined the Invitation to Bid and Specifications, and being familiar with the conditions to be met, hereby submits the following Bid for furnishing the material, equipment, labor and everything necessary forproviding the items listed below and agrees to deliver said items at the locations and for the prices set forth on this form. A bid will be subject to being considered irregular and may be rejected if it shows omissions, alterations of form, conditional alternate bids, additions or alternates in lieu of the items specified, if the unit prices are obviously unbalanced (either in excess of or below reasonably expected values), or irregularities of any kind. The Invitation to Bid 16-12744-TF is by reference incorporated in this contract. The Bid Form must be completed in blue or black ink or by typewriter. ITEM SERVICE LOCATION Contract Rate Annual Contract Rate 1 Passenger Terminal Building, (Semi -Annual) as specified herein. $ 5-v5 O n x z $ / 0/0, OD 2. Passenger Terminal Building, (Quarterly), as specified herein. S 2 OD?_ O X 6 $ / 2 012,00 3 Passenger Terminal Building (Bi-Monthly) as specified herein $ 23Y.00 X 6 S / �t 1 `7U L . oo 4. Passenger Terminal Building (Monthly) as specified herein $ / UD X12 S 5' Parking Lot Gate Houses & Airport Operations Computer (Q y), as specified herein. Room (Quarterly), $ Q Q X 4 S 208,00 6. East Terminal (Quarterly), specified herein. .00 7. West Terminal (Annually), as specified herein. $ y3, oo X 1 $ N3, 00 g. Airfield Maintenance Bldg. (Quarterly), as specified herein. $ 8q. So X° $ 338. oo 9' Cooling Tower west of the Terminal Building, (Semi -Annual) as specified herein. $ 30. oo X 2 $ 0, TOTAL BID: Items 1 through 9 (TOTAL ANNUAL CONTRACT PRICE) $ / 7,516,00 *PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed "Days After Receipt of Order (ARO) Unless otherwise specified herein, the City may award the bid either item -by —item or on an all -or -none basis for any item or group of items shown on the bid. The City of Lubbock is seeking a contract for ITVAC Air Filter Service for Lubbock Preston Smith International Airport with one or more contractors. In order to assure adequate coverage, the City may make multiple awards, selecting multiple vendors to provide the products desired, if multiple awards are in the best interest of the City. A decision to make a multiple award of this Bid, however, is an option reserved by the City, based on the needs of the City. S:PurchaseBid Docs/ITB I6-12744-TF, Construction and Installation of Bus Shelters for Citibus 2/18/2016 2:05 PM p. 7 City of Lubbock Bid ITB 16-12744-TF PAYMENT TERMS AND DISCOUNTS -Bidder offers a prompt payment discount of _0__%,ncLj0caIendar days. Discounts will not be considered in determining low bid. Unless otherwise indicated on the Bid Form, payment terms will be NET THIRTY DAYS. The City will pay the successful bidder within thirty days after the receipt of a correct invoice or after the date of acceptance, whichever event occurs later. Discounts for prompt payment requiring payment by the City within a stipulated number of days will be interpreted as applying within the stipulated number of calendar days after the date of receipt by the City of a correct invoice or after the date of acceptance that meets contract requirements, whichever event occurs later. Discounts for payment in less than ten days will not be considered. MOST FAVOURED PRICING: The Bidder certifies that the price quoted is not in excess of the lowest price charged anyone else, including its most favoured customer, for like quality and quantity of the products/services; does not include an element of profit on the sale in excess of that normally obtained by the Bidder on the sale of products/services of like quality and quantity; and does not include any provision for discounts to selling agents. If at any time during the contract period, the supplier should sell or offer for sale to any other customer, an equal or less quantity of similar contract products of like or better quality, at a lower net price(s) than provided herein, supplier agrees to notify the City and sell same product(s) at the lower price(s) on all deliveries made during the period in which such lower price(s) is effective. INTERLOCAL PURCHASING (optional): The City desires to make available to other local governmental entities of the State of Texas, by mutual agreement with the successful bidder, and properly authorized interlocal purchasing agreements as provided for by the Interlocal Cooperation Act (Chapter 791, Government Code), the right to purchase the same services, at the prices quoted, for the period of this contract. Each bidder shall indicate on the Bid Form in the space provided below if he/she will honor Political Subdivision orders in addition to orders from the City of Lubbock. Should these other governmental entities decide to participate in this contract, would you (the bidder) agree that all terms, conditions, specifications, and pricing would apply? Other governmental entities that might have interests in this contract are Frenship Independent School District, Lubbock Housing Authority, Lubbock County, Lubbock County Hospital District, Lubbock Independent School District, South Plains Association of Governments, City of Texarkana, Texas Tech University, West Texas Municipal Power Agency, Lynn County, and City of Wolfforth. YES .X NO • If you (the bidder) checked YES, the following will apply: • Governmental entities utilizing Interlocal Agreements for Cooperative Purchasing with the City of Lubbock will be eligible, but not obligated, to purchase materials/services under the contract(s) awarded as a result of this solicitation. All purchases by governmental entities other than the City of Lubbock will be billed directly to that governmental entity and paid by that governmental entity. City of Lubbock will not be responsible for another governmental entity's debts. Each governmental entity will order their own materials/service as needed. THIS BID IS SUBMITTED BY // O/ P /'/sea corporation organized under the laws of the State of Te xllS or a partnership consisting of or individual trading as of the City of 6,eOCS CC, Tt' Bidder acknowledges receipt of the following addenda: Addenda No. Date 2 -Ar, /(a Addenda No. �— Date Addenda No. Date Addenda No. Date M/WBE STurchase/Bid Docs/rrB 16-12744-TF, Construction and Installation of Bus Shelters for Cidbus Native American Other (Soecifv) 2/18/2016 2:05 PM p, 8 City of Lubbock Bid ITB 16-12744-TF by hand Officer Name and Please Print .Z el - Business Telephone Number r2J ! — ?.� 9— 0,2 / FAX: ,). _y- 17 Z % 113— E-mail Address: / : fus ® eleen % 1 f C!j FOR CITY USE ONLY Bid Form Item Number(s) Awarded to Above Named Firm/Individual: Date of Award by City Council (for bids over $50,000): Date P.O./Contract Issued: RETURN COMPLETED & SIGNED BID FORM ALONG WITH CITY OF LUBBOCK SPECIFICATIONS. LABEL THE OUTSIDE OF YOUR SEALED BID WITH THE ITB NUMBER, THE CLOSING DATE AND TIME, AND YOUR COMPANY NAME AND ADDRESS. 2/18/2016 2:05 PM P. 9 City of Lubbock, TX Lubbock Preston Smith International Airport Bid Tabulation April 28, 2016 ITB 16-12744-TF HVAC Filter Service for Lubbock Preston Smith International Airport Item Qty U/M Description/Vendor Location Unit Cost Extended Cost 1 2 EA Passenger Terminal Building, (Semi -Annual), as specified. Advanced Environmental, IAQ, LLC Lubbock, TX $ 352 NR Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX 505 1,010 Hub City Plumbing Lubbock, TX 1,563 3,126 2 6 EA Passenger Terminal Building, (Bi-Monthly), as specified. Advanced Environmental, IAQ, LLC Lubbock, TX 1,650 NR Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX 2,002 12,012 Hub City Plumbing Lubbock, TX 5,760 34,560 3 6 EA Passenger Terminal Building (Bi-Monthly), as specified. Advanced Environmental, IAQ, LLC Lubbock, TX 167 NR Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX 234 1,404 Hub City Plumbing Lubbock, TX 632 3,792 4 12 EA Passenger Terminal Building (Monthly), as specified. Advanced Environmental, IAQ, LLC Lubbock, TX III NR Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX 156 1,872 Hub City Plumbing Lubbock, TX 416 4,992 5 4 EA Parking Lot Gate Houses & Airport Operations Computer Room (Quarterly), as specified. Advanced Environmental, IAQ, LLC Lubbock, TX 38 NR Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX 52 208 Hub City Plumbing Lubbock, TX 255 1,020 6 4 EA East Terminal (Quarterly), as specified. Advanced Environmental, IAQ, LLC Lubbock, TX 91 NR Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX 117 468 Hub City Plumbing Lubbock, TX 330 1,320 7 1 EA West Terminal (Annually), as specified. Advanced Environmental, IAQ, LLC Lubbock, TX 104 NR Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX 143 143 Hub City Plumbing Lubbock, TX 630 630 8 4 EA Airfield Maintenance Bldg. (Quarterly), as specified. Advanced Environmental, IAQ, LLC Lubbock, TX 60 NR Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX 85 338 Hub City Plumbing Lubbock, TX 267 1,068 9 2 EA Cooling Tower west of the Terminal Building, (Semi -Annual), as specified. Advanced Environmental, IAQ, LLC Lubbock, TX 21 NR Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX 30 60 Hub City Plumbing Lubbock, TX 403 806 OVERALL TOTAL(Items I - 9) Allison Enterprises dba Kleen Air Filter Service & Sales Groesbeck, TX $ 17,515 Hub City Plumbing Lubbock, TX 51,314 Advanced Environmental, IAQ, LLC Lubbock, TX NR* Air Filtration Products & Service Co. Odessa, TX NQAS** *NR - Non -Responsive **NQAS - Not Quoted As Specified t S:hvcha MufflocsIM 16-12744-TFmVACArt FOWSmicefor Lubbock heron Smhh Inlmationo]Avon CERTIFICATE OF INTERESTED PARTIES FORM 1295 1af1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2016-21448 Date Filed: 03/03/2016 Date Acknowledged: 03/09/2016 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Allison Enterprises Groesbeck, TX United States 2 Name of governmental entity or state agency that is a parry to the contract for which the form is being filed. City of Lubbock 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 goods or services to be provided under the contract. 12744 HVAC Air Filtration Installation Service 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Allison, Carla Groesbeck, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm. under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said , this the day of 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.312 CERTIFICATE OF INTERESTED PARTIES FORM 1295 l of l Complete Nos. 1.4 and 6 if mere are interested parries. OFFICE USE ONLY Complete Nos. 1, 2, 3. 5. and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 2016.21448 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Allison Enterprises Groesbeck, TX United States Date Filed: 2 m Name of govemen ent ty or state agency that s a party to the contract for which the form is being filed. 03/03/2016 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 goods or services to be provided under the contract. 12744 HVAC Air Filtration Installation Service 4 Name of Interested Party Cfty, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary Allison, Carla Groesbeck, TX United States X 5 Check only if there Is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is We and correct. ..�-•,. TAYLOR GONZALES NogPublic STATE OF TEXAS signature of authorized agent of contracting business entity Comm. Feb 6, 2019 AFFIX Swom to and subscribed before me, by the said ��.� . Y I r I I' ISC Y1 , this the day of 20 1(0 , f0 certify which, witness my hand and seal of office. i t re of officer dministering oath Prin d name of officer administering oath Title of officer administering oath Forms proviaea by I exas unite c:ommission www.ethics.state.tx.us Version V1.0.312