HomeMy WebLinkAboutResolution - 2016-R0147 - CEC Services - 04/28/2016Resolution No.2016-R0147
Item No.6.27
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.Contract No. 12761 for landscape maintenance services at
Lubbock Preston Smith International Airport, by and between the City of Lubbock and CEC
Services, Inc., 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 April 28.2016 •
GLEN OROB'ERTSON,MAYOR
ATTEST:
Rebecca Garza,City Secretary
APPROVED AS TO CONTEN"
Kelly Campbell.Executive Director of Aviation
APPROVED AS TO FORM:
Thirst Assistant City Attorney
Rl-S.Contract-CEC Services,Inc.
4.4.2016
Resolution No. 2016-RO147
City of Lubbock, TX
Contract for Services
Landscape Maintenance Services at LPSIA
Contract 12761
THIS CONTRACT made and entered into this 28th day of April, 2016, by and between the City of
Lubbock ("City"), and CEC Services. Inc., ("Contractor").
WITNESSETH:
WHEREAS, the City of Lubbock duly advertised for bids for landscape maintenance services at
LPSIA 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 landscape maintenance services at LPSIA.
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, fertilization for various parkland
properties and more specifically referred to as Items 1 thru 7 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, said date of term beginning upon City Council date
of formal approval. The City and Contractor may, upon written mutual consent, extend the
contract for three (3) additional one-year periods.
4. This contract shall remain in effect until the expiration date, performance of services ordered, or
termination of by either party with a thirty (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.
The contractor shall obtain and maintain in full force and effect during the term of the contract,
commercial general liability coverage with insurance carvers 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 1,000,000
Commercial General Liability
General Aggregate
Products-Comp/Op AGG
Contractual Liability
Automotive Liability 1,000,000
Any Auto
Pollution 1,000,000
Workers Compensation Statutory Amounts
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.
7. 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.
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.
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 thirty
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.
10. 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 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.
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 on insurance from the
Subcontractor that complies with all contract insurance requirements
12. This Contract consists of the following documents set forth herein; Invitation to Bid 16-12761-
KK, Specifications, and the Bid Form.
IN WITNESS WHEREOF, the parties hereto have caused thict to be executed the day and
year first above written. Executed in triplicate.
CITY OF LUBBOG/CK /J
Glen C. Ro6ertson, Mayor
ATTEST:
Reb cca Garza,,City Secret y
APPROVED.AS TO CONTENT:
C2 � �A
Kelly Campbell, Executive Director of Aviation
Aullforized Representative
PostO}V
Print ame
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ddress
h�YY T ��1 �23
City, State, Zip Code
REVISED
City of Lubbock, TX
ITB 16-12761-KK
Landscape Maintenance Services at LPSIA
Specifications
MAINTENANCE STANDARDS
General: The Owner's Representative will inform the contractor when to commence maintenance
activities. The decision to end the maintenance season shall be made by the Owner's
Representative. The Contractor shall be notified of the City's decision by letter or email. The
designated Owner's Representative for contract oversight and coordination is the Airfield
Maintenance Supervisor.
The areas to be serviced for each site include all right of ways adjoining the site and to the
centerline of all alleys adjoining the site, and extending 2 feet from back of curb into all streets.
Contractor is responsible for safe and careful operation of mowing equipment around plant
material and structures to prevent damage and to prevent clipping from contaminating plant beds.
Contractor shall provide all equipment, trained personnel, and materials for the performance of
this contract. This includes but is not limited to vehicles, mowers, edgers, cutters, clippers, hose,
irrigation equipment (fixed & portable), plants, fertilizer, sprays, etc. Contractor shall be
responsible for any damage resulting from his work. This might include vehicle damage (such
as damaged glass or paint) from thrown rocks, damage to airport terminal building window glass
or damage to vegetation (trees, plans, shrubs) that is damaged during the performance of this
contract.
Mowing: The Owner's Representative will inform the contractor when to commence mowing
activities for the season. The mowing frequency is the same day every week. Turf shall be cut
at a height of 1 1/2", and will increase to 2" at the discretion of the Owner's Representative and
last through the remainder of the season. Clippings will not be bagged, and all hardscapes shall
be cleaned after each mowing. The mowers shall leave no clumps or windrows of grass. Mowing
equipment shall be reel mowers or turf type full flotation rotary mowers and shall be approved
by the Owner's Representative.
Mowing Schedules: The Contractor shall furnish the Owner's representative a mowing schedule
5 working days prior to the start of every month. A copy shall be faxed or e-mailed to the Airfield
Maintenance department. Identified properties shall be mowed in the order they are listed on the
monthly schedule, unless prior notice is given before the start of the working day.
Litter Control: Litter will be picked up by 10:00 a.m. daily, Monday - Saturday; holidays are
excluded. Note: The operator of the paid parking lot and parking structure is responsible for litter
control in those areas. In the west side area, generally adjacent to Cedar Street, litter control will
be performed bi-weekly (every other week).
Edgine: All sidewalks, curbed plant material beds, shall be edged to a depth of one inch and all
non -curbed plant beds shall be edged to a depth necessary to achieve appropriate results. All
edging shall be performed concurrently with mowing at each site. String trimmer or curb dresser
may not be used for these tasks. Chemical edging is not permitted.
Trimming: All string trimming must be done to achieve a height uniform with the mowing
height. Trimming must be performed around trees, plant beds, buildings, signs, fences, and any
other plants or structures. All trimming will be accomplished so as not to damage trees, shrubs,
window glass, etc. All surfaces, streets, and parking areas must be kept free of grass, weeds, and
debris. This task must be completed within 24 hours of mowing.
Flowering Plants & Beds: Flower beds around airport signage at the main airport entrance sign
at Regis and MLK will be planted with plants that provide a colorful and attractive appearance.
The Owner's Representative will pre -approve planting materials with the Contractor prior to
planting. This appearance can be provided by a single variety or multiple varieties. These beds
will be planted as frequently as necessary, but not less than four times a year to ensure a full
appearance. The contractor will ensure that all plants are healthy and that unhealthy plants are
removed and replaced within 24 hours of identification. Responsibility for other required
maintenance of all beds will also rest with the contractor.
Irri atg ion: It will be the Contractor's responsibility to repair any damage to the irrigation system
caused by Contractor's activities, such as damage by mowers. It will be the Contractor's
responsibility to ensure that all turf, foliage, and plants are adequately irrigated by either
automated systems or by hand. Changes to the irrigation system will be coordinated between the
contractor and the Department of Aviation. All operational problems with the irrigation system
will be promptly reported to the Owner's Representative.
Pruning: The contractor will maintain all foliage, trees, shrubs, and plants that require pruning.
Pruning will be at a minimum of one time per year, as appropriate for the plant type. Pruning will
be coordinated in advance with the Owner's Representative.
Contractor Contact: The contractor and or contractor appointee shall be accessible via cell phone,
pager or any other means of communication during regular business hours. Those numbers shall
be furnished to the Airfield Maintenance Supervisor.
Payment: The Contractor shall receive compensation provided for in the contract on a per cycle
basis. Payment shall be made at the first of each month based on the previous month's completed
cycles for each maintenance area.
Contract Term: The contract shall be for a term of one year, said date of term beginning upon
City Council date of formal approval. The City and Contractor may, upon written mutual consent,
extend the contract for three (3) additional one-year periods.
EXHIBITS A, B, C, D & WEST SIDE AREA
General Grounds Maintenance: The contractor shall maintain all grounds identified in Exhibits
A, B, C, D & West Side Area. These areas will be maintained free of litter, irrigated, mowed,
edged and have applied as required weed and pest control. No litter, weeds, or other materials
will be thrown over the airfield perimeter fence. Foliage in these areas will be maintained with a
preventative maintenance program of weed and pest control with applications at a minimum of
three times per year. Foliage in these areas will be fertilized as required (minimum of three times
per year).
REVISED
Exhibit A Area: The parking lot operator is responsible for litter control in the paid parking lot
and the parking structure.
Exhibit B Area: During the term of the contract the Department of Aviation may add additional
plantings, shrubs, or trees along MLK.
Exhibit C Area: The area immediately in front of the former Flight Standards District Office
(FSDO) area of the old terminal building is included in this contract. The trees and turf along
Independence Street (west of Cedar Street), including the median, are included in this contract.
Exhibit D Area: Shelter Park — All turf and trees maintained as Exhibit A & B areas. Litter control
included.
West Side Area - Description:
The western fence perimeter beginning at the north-west corner of the Armed Services Center
(Armory) at Regis and Cedar Street and proceeding north along the east side of Cedar Street to
the south-west corner of the FedEx facility. The cross -hatched area marked `D' on the attached
drawing delineates the area in front of the Silent Wings Museum. The West Side area also
includes the public side of the Hangar 20 area.
West Side Area - Special Conditions:
In the West Side area only, mowing/trimming will be performed on a minimum bi-weekly (every
other week) basis, unless the Airfield Maintenance Supervisor approves a less frequent schedule
due to weather or insufficient growth conditions. Litter control will be performed bi-weekly
(every other week).
Payment: The Contractor shall receive compensation provided for in the contract on a per cycle
basis. Payment shall be made at the end of each month on completed cycles for each maintenance
group.
REVISED
�p
Lubbock International Airport
Landscape Maintenance Services
Exhibit A
Contractor shall pick up all trash along the sidewalk
in front of the terminal
REVISED
L
REVISED
O
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I wll�
Lubbock Intamntianal Aipue(
Landscape Unintrnnnte `aeNus
Exhibit C
REVISED
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BID FORM
Landscape Maintenance Services at LPSIA
City of Lubbock, TX
ITB 16-12761-KK
In compliance with the Invitation to Bid 16-12761-KK, 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 for providing 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 16-12761-KK is by reference incorporated in this contract. The Bid Form
must be completed in blue or black ink or by typewriter.
ITEM
Annual
Maintenance
DESCRIPTION
a ntenance
Cycle Unit Cost
Extended
Cost
Cycles
a.
(Approx.)
C.
d.
&=bxd
b.
1
29
roun s Maintenance for areas covered under Exhibit
A B and C & D. Maintenance to include mowing, edging, and trimming. (As specified herein)
(%s
Monthly Cost for Litter Control for areas covered under
2.
12
Exhibit A, B, C, D, & West Side Area (As specified
73O
7(00
herein)
3.
4
Flowering Beds. (As specified herein)
��SS
H2O
4.
3
Weed & Pest Control for areas covered under Exhibit A,
B, C & D. (As specified herein)
5.
3
Fertilizer for areas covered under Exhibit A, B, C & D.
(As specified herein)
�j
—lno
2i17t7
6.
1
Pruning for areas covered under Exhibit A, B, C & D.
(As specified herein)
'boo
7
26
West Side: Landscape alntenance or area covert
under Exhibit C. Bi-Weekly Maintenance. (As specified
�I-
herein)
7K
Total Annual Contract Price
S 69�%�S
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 or items shown on the bid.
The City of Lubbock reserves the right to reject any or all bids, reject any particular item on a quote, and to waive
immaterial formalities.
PAYMENT TERMS AND DISCOUNTS - Bidder offers a prompt payment discount of a/a, net --calendar 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.
S PurclmsdBid Dacslrn3 16-12761-KK Landscape Maintemnce Services at LPSIA
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 some 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 entitles 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 CI or Wolfforth.
YES 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 govemmental 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 a corporation organized under the laws of the State of
or a partnership consisting of
or individual trading as
of the City of
Firm: C-VL SrfV.teS Tyvc.
Address: iOkE"
City: L" 66c Lk �} -0. State: 1X Zip 'W14.13
Bidder acknowledges receipt of the following addenda:
Addenda No. Date
Addenda No. Date
M/WBE
L— I Woman Black American Native American
Hispanic American Asian Pacific America Other (Soecifvl
- must sign by hand
S PurchavAid Docs/r M 16.12761-KK Inndscape Maintenance Services at LPSIA
5
City of Lubbock, TX
Bid Tabulation
Landscape Maintenance Services at LPSIA
April 28, 2016
ITB 16-12761-KK
Landscape Maintenance Services at LPSIA
Maintenance Extended
Item QTY U/M DescriptionNendor
Location
Cycle Unit Cost
Cost
1 29 Annual Cycles Grounds Maintenance
CEC Services, Inc.
Lubbock, TX
$ 1,125
32,625
Hardy Trees, Inc.
Lubbock, TX
1,600
46,400
Reeder Landscape
Lubbock, TX
1,600
46,400
Pevey Lawn & Landscape, Inc.
Lubbock, TX
4,700
136,300
2 12 Annual Cycles Monthly Cost for Litter Control
CEC Services, Inc.
Lubbock, TX
730
8,760
Hardy Trees, Inc.
Lubbock, TX
1,100
13,200
Reeder Landscape
Lubbock, TX
1,500
18,000
Pevey Lawn & Landscape, Inc.
Lubbock, TX
1,950
23,400
3 4 Annual Cycles
Flowering Beds
Hardy Trees, Inc.
Lubbock, TX
i 00
400
Pevey Lawn & Landscape, Inc.
Lubbock, TX
795
3,180
CEC Services, Inc.
Lubbock, TX
1,855
7,420
Reeder Landscape
Lubbock, TX
2,500
10,000
4 3 Annual Cycles
Weed & Pest Control
Hardy Trees, Inc.
Lubbock, TX
600
1,800
CEC Services, Inc.
Lubbock, TX
900
2,700
Pevey Lawn & Landscape, Inc.
Lubbock, TX
2,500
7,500
Reeder Landscape
Lubbock, TX
6,000
18,000
5 3 Annual Cycles
Fertilizer
Hardy Trees, Inc.
Lubbock, TX
600
1,800
CEC Services, Inc.
Lubbock, TX
900
2,700
Pevey Lawn & Landscape, Inc.
Lubbock, TX
2,500
7,500
Reeder Landscape
Lubbock, TX
10,500
31,500
6 1 Annual Cycles
Pruning
Hardy Trees, Inc.
Lubbock, TX
2,000
2,000
CEC Services, Inc.
Lubbock, TX
2,700
2,700
Pevey Lawn & Landscape, Inc.
Lubbock, TX
3,750
3,750
Reeder Landscape
Lubbock, TX
5,200
5,200
7 26 Annual Cycles
West Side: Landscape Maintenance
CEC Services, Inc.
Lubbock, TX
265
6,890
Hardy Trees, Inc.
Lubbock, TX
500
13,000
Reeder Landscape
Lubbock, TX
500
13,000
Pevey Lawn & Landscape, Inc.
Lubbock, TX
1,500
39,000
All or None
CEC Services, Inc.
Lubbock, TX
$ 63,795
Hardy Trees, Inc.
Lubbock, TX
78,600
Reeder Landscape
Lubbock, TX
142,100
Pevey Lawn & Landscape, Inc.
Lubbock, TX
220,630
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
l of l
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.
2016-39511
Cutting Edge Landscape
Lubbock, TX United States
Date Filed:
04/13/2016
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
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.
ITB 16-12761-KK
Lawn Services
4
Nature of interest (check applicable)
Name of Interested Party
City, Stale, Country (place of business)
Controlling
Intermediary
Moore, Matt
Lubbock, TX United States
X
5
Check only if there is NO Interested Party.
❑
6
AFFIDAVIT 1 ar, or affirm, un r penal of perjury, that the above disclosure is true and correct.
•. AMY SLAUGHTER
:.tee �.....s
:; �,1[� •`b� Notary Public. State of Texas
. '; Comm. Expires 02.23-2020
� Notary ID 128/93534 Signature of authorized agent of contra siness entity
AFFIX NOTARY STAMP I SEAL ABOVE
�,� `
Sworn to and subscribed before me, by the said Ylzil'i3G �vW , this the
,,
�3 ` day of APM____.
20__1_6_, to certify which, witness my hand and seal of office.
wkmln. Ate" s l;r� ;;�,
, ►tom
Signature of offidW administering oath Printed name o fficer adminnWering oath Title of officeWrnmistering oath
umis pruvmeu by Texas Ethics Commission www.etmcs.state.tx.us Version V1.0.645
CERTIFICATE OF INTERESTED PARTIES FORM 1295
loft
Complete Nos. i - 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:
2016-39511
Date Filed:
13/2016
e Acknowledged:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Cutting Edge Landscape
Lubbock, TX United States
being filed.
2 Name of governmental entity or state agency that is a party to the contract for which the fo7404/13/2016
City of Lubbock
3 Provide the identification number used by the governmental entity or state agency to track or dentify the contract, an ovide a
description of the goods or services to be provided under the contract.
ITB 16-12761-KK
Lawn Services
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest (check applicable)
Controlling
Intermediary
Moore, Matt
Lubbock, 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 I 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 V1.0.645