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Home My WebLink AboutResolution - 2016-R0403 - Purchase Order - Scoggin-Dickey Chevrolet - Pickup Trucks - 11/03/2016Resolution No.2016-R0403 Item No.6.13 November 3.2016 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.Purchase Order No.31029886,ITB 16-13065-KM for the purchase of Pick-up Trucks, by and between the City of Lubbock and Scoggin-Dickey Chevrolet of Lubbock,Texas,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;and THAT,in reference to this purchase,the Council finds that this local bidder offers the municipality the best combination of contract price and additional economic development opportunities for the municipality created by the award of the contract to the local bidder, including the employment of residents of the municipality and increased tax revenues to the municipality. Passed by the City Council on November 3. 2016 . DANIEL M.POPE,MAYOR ATTEST: \Ut€t Rebecca Garza.City Secretary Scott Snider,Assistant City Manager APPROVED AS,TO FORM: \\JLU {J^JoiA^ Kelli Leisure.Assistant City Attorney RES. PO #31029886-Local Bidder-Scoggin-Dickey Chevrolet 11.01.16 City of Lubbock aW PURCHASE ORDER SCOGGIN-DICKEY CHEVY BUICK 5901 SPUR 327 PO BOX 64910 LUBBOCK Texas 79464 4910 SHIP TO: Page - 1 Date - 11/04/2016 Order Number 31029886 000 OP CITY OF LUBBOCK FLEET SERVICES 206 MUNICIPAL DRIVE LUBBOCK Texas 79404 INVOICE TO: CITY OF LUBBOCK ACCOUNTSPAYABLE P.O. BOX 2000 LUBBOCK, TX 79457 BY: Ma lvar irect of Purchasing & Contract Management Ordered 10/20/2016 Freight Requested 02/20/2017 Taken By Delivery PER D GAMBOA REQ #47588 Description/Supplier Item__ 1 Ton Pick-up 4x4 Specification No. 1541 1.2 Ton Pick-up Truck 4x4 Specification No. 1525-4 Terms NET DUE ON RECEIPT ITB 16-13065-KM Ordered 1.000 1.000 S SUMMERS Unit Cost UM Extension Request Date 28,916.9600 EA 28,916.96 02/20/2017 28,747.3300 EA Total Order 28,747.33 02/20/2017 57,664.29 This purchase order encumbers funds in the amount of $57,664.20 awarded Scoggin Dickey Chevrolet of Lubbock, TX on November 3, 2016. The following is incorporated into and made part of this purchase order by reference ITB 16-13065-KM dated October 6, 2016 Scoggin Dickey Chevrolet of Lubbock, TX Resolution # 2016-RO403 CITY OF LUBBOCK (1�3_'W Daniel M. Pope, Mayor ATTEST: 0 A-7) Reb ca Garza, City Secretary Bid Form Pick -Up Trucks City of Lubbock, TX ITB 16-13065-KM In compliance with the Invitation to Bid 16-13065-KM, 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 16-13065-KM is by reference incorporated in this contract. The Bid Form must be completed in blue or black ink or by typewriter. Unit Delivery ITEM QTY of DESCRIPTION UNIT PRICE* EXTENDED (Days) Measure BID COST ARO** 1 Ton Pick -Up Truck, Extended Cab, - F - - - - t- - - -Each- - Slmrt-Bed; 4X4; per Specification -No.- - - g- 1542-Water Reservoir - - - Model Year, -Brand Name-and_Madel_ i nber- I Ton Pick -Up Truck, Extended Cab, - -? - - - r - - i?aclr- - 3pecificatfion No.-1348=FNt 2 - - `�� S� CC6347r Model Year, Brand Name and Model Number: l '/, Ton Pick -Up Truck, Extended Cab, J.- - - 4 - - - Each - -Sho*Bed,-4X4,-perSpecifteatiorrNo-. - - 41� $�� / /✓ 1526-4 / - - Model Yea, -Brad Nxnie and-lvludeM mlier- - - jy % --�- - - - - - - - - - - - - - - - (//�CrJ��y vf1 4. 1 Each I Ton Pick -Up Truck, Regular Cab, Bed $ el Delete, 4X4, per Specification No. 1541 $ G / 67! Model Year, Brand Name and Model Number: �O/'7 Each - I Ton Pic k-U-_fruck,IteguJar Cab,�ed Delete, 4X4, Specification No. NV41 t per Ap --- Modet Year, ----------------------------- - - - - - - I on Pick -Up Truck, Regular Cab, Bed - 6- - - -1- - - Each - Iete,-4X.2,-per-4ecificatiorr Nor. 64-13— _$;W_9M -$ � 5y (e - - - - - - W 0-10" Model Year, Brand Name and Model Number: b /7 CZv4o f C� - �.- - - -1- - - Eirch - I Ton Pick -Up Truck, Regular Cab, Bed Mete,-4X2,-p-er-Specification N(. 6a13=zv NV-41 _-- Model Year, Brand.Nameand-Model -Number:------------------------------------ S Purchasc/Bid DocsM B 16-13065-KM Pick -Up Trucks Unit Delivery ITEM QTY of DESCRIPTION UNIT PRICE* EXTENDED (Days) (+/-) Measure BID COST ARO** 8. I Each V=Ton Pick -Up Truck, Crew Cab, Short Bed, 4X4, Specification No. 15254 $�g/�� per , Total: : $57,664.29 Model Year, Brand Name and Model Number: A/ 7 .t�p D 0� �T _ +� *PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed **ARO — After Receipt of Order 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. PAYMENT TERMS AND DISCOUNTS - Bidder offers a prompt payment discount of %, net calendar days. 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 ofcalendar 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 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 1S SUBMITTED BY _a&sa , jotion organized under the laws of the State of or a partner gip consisting of or individual trading as of the City of t Bidder acknowledges receipt of the following addenda: Addenda No. Date 164 -1794 Addenda No. Date S Purchase/Bid Docstrr6 16-13065-KM Pick -Up Trucks PAGE 1 OF 3 DATED: 10-15-13 Specification Reviewed by: Department requesting vehicle/equipment. Signature of Department Head/Date: CITY OF LUBBOCK, TX MINIMUM SPECIFICATIONS: ONE TON PICK-UP, REGULAR CAB, BED DELETE, 4X4, SINGLE REAR WHEEL TO HAVE A GENERAL PURPOSE FLATBED INSTALLED UPON IT //�� -7 SPEC: 154411 1tiV-e11-e"4_) YEAR / (�MAKE 'LDZ� MODEL 1 IT IS THE INTENT OF THIS SPECIFICATION, REFERENCED DOCUMENTS, REQUIREMENTS AND CONDITIONS SECTIONS TO DESCRIBE MINIMUM PERFORMANCE REQUIREMENTS. THE VEHICLE OR PRODUCT MUST MEET OR EXCEED THE PERFORMANCE OR CONSTRUCTION DESCRIBED HEREIN. THE VENDOR SHALL BE REQUIRED TO MARK COMPLIANCE OR NON-COMPLIANCE TO EACH ITEM DESCRIPTION IN THE SPACE PROVIDED. ALL EQUIPMENT FURNISHED AS STANDARD TO THE GENERAL PUBLIC ON THE PRODUCT BY THE MANUFACTURER SHALL BE INCLUDED, ENEN WHEN NOT SPECIFICALLY IDENTIFIED IN THIS SPECIFICATION. ANY DEVIATIONS FROM THE WRITTEN SPECIFICATION WITH DATE AS SHOWN IN THE INVITATION TO BID (ITB) SHALL BE NOTED ON THE ATTACHED EXCEPTIONS TO THE SPECIFICATION IN ORDER TO RECEIVE FULL CONSIDERATION, ITB RESPONSE QUOTATION MUST FOLLOW THIS SPECIFICATION AND THE INVITATION TO BID'S TERMS AND CONDITIONS. VENDOR NAME: 1Wy PHONE: NO. ITEM MINIMUM REQUIREMENTS SELLER COMPLIANCE YES NO ONE TON PICK-UP, REGULAR CAB, BED DELETE, 4X4, WITH SINGLE REAR WHEELS. TO HAVE A GENERAL PURPOSE FLATBED INSTALLED UPON IT. UNLESS OTHERWISE SPECIFIED, ALL UNITS SHALL BE FURNISHED COMPLETE WITH STANDARD EQUIPMENT GENERAL AND FACTORY- INSTALLED ACCESSORIES AS LISTED BY THE MANUFACTURER'S PRINTED LITERATURE AND AS STATED IN THE STATE OF TEXAS FLEET AUTOMOBILES AND TRUCKS TEXAS SPECIFICATIONS. SEE: STATE OF TEXAS FLEET AUTOMOBILES AND TRUCKS http://«w%v.window.state.tr.us/r)rocurement/r)ub/speci fications- library/071-072-AT 2010 2011.pdf 1. GVWR 9,800 POUNDS 2. WHEEL BASE 133.7 INCHES 3. CAB TO AXLE 56 INCHES 4 PAYLOAD 4,320 POUNDS / ALLOWANCE 5. ENGINE A. GASOLINE, V8 6.OL B. 316 NET HP C. 380 FT LBS. TORQUE 6. TRANSMISSION OEM AUTOMATIC ALL WEATHER STEEL BELTED TUBELESS RADIALS 7. TIRES WITH CRANK -UP SPARE TIRE WINCH AND SPARE TIRE / LT235/80/R 17 (/ 8. RIM SIZE 6.5 INCHES S: Purchase/Bid Docs/ITB 16-13065-KM Pick -Up Trucks NO. ITEM MINIMUM REQUIREMENTS SELLER COMPLIANCE YES NO OEM 40/20/40 CLOTH FABRIC, WITH CHARCOAL, GRAY, 9. SEATS OR TAN COLOR 10. COLOR OEM FLEET WHITE ALL ITEMS ARE TO BE HEAVIEST OEM EQUIPMENT FOR THE VEHICLE SERIES AND INSTALLED BY THE MANUFACTURER AND SHALL INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING: A TRANSMISSION OIL COOLER, HEAVY-DUTY RADIATOR, AND TRAILER WIRING HARNESS. HARNESS SHALL BE PROVIDED AS AN INTEGRAL PART OF THE VEHICLE WIRING SYSTEM 11. TOWING PACKAGE TO PROVIDE POWER TO TRAILER TURN SIGNALS, BRAKES, BRAKE LIGHTS, AND RUNNING LIGHTS. EACH WIRE SHALL BE LABELED ACCORDING TO ITS FUNCTION, I.E., BRAKES, TURN, ETC. A 7-PIN, RV STYLE, FLAT (SPADE) ELECTRICAL CONNECTOR TO CONNECT TRAILER WIRING CIRCUITRY TO THE WRING HARNESS SHALL BE PROVIDED. SHALL INCLUDE OEM FACTORY V INSTALLED BRAKE CONTROLLER. TO INCLUDE FRONT TOW HOOKS. A HEAVY-DUTY GRILLE GUARD DESIGNED TO PROTECT THE HEADLAMPS AND GRILLE OF A VEHICLE SHALL BE MOUNTED ON THE FRONT OF VEHICLE. PUSH BAR PADS SHALL BE INCLUDED. THIS GUARD SHALL BE MADE OF A MINIMUM OF 14 GAUGE STEEL TUBING. THIS GUARD SHALL BE BOLTED TO THE FRAME AND AFFIXED TO 12. BRUSH GUARD THE BUMPER IN ACCORDANCE WITH MANUFACTURER'S SPECIFICATIONS. THREAD - FORMING BOLTS OR SCREWS ARE NOT ACCEPTABLE. IT SHALL BE TREATED FOR RUST PREVENTION PRIOR TO APPLICATION OF FINAL FINISH. THE FINAL FINISH WILL BE POWDER COATED BLACK COLOR. RUST -PROOFING SHALL BE WARRANTED FOR A MINIMUM OF 12 MONTHS FROM VEHICLE ACCEPTANCE BY CITY OF LUBBOCK. REPLACEMENT SHALL INCLUDE COST OF SHIPPING CHARGES, TO AND FROM THE ORIGINAL FOB POINT. OEM BLACK BARS WITH BRACES AND NO DRILL FOR 13. NERF BARS STANDARD CAB TO BE INSTALLED ON BOTH SIDES OF / TRUCK TO ALLOW SUFFICIENT ACCESS FOR USERS V INCLUDES POWER WINDOWS, POWER LOCKS, POWER 14. POWER PACKAGE MIRRORS, CRUISE CONTROL AND TILT STEERING WHEEL. 15. REAR AXLE LIMITED SLIP WITH RATIO 410 CAB AND CHASSIS VENDOR SHALL NOTIFY THE CITY OF LUBBOCK WHEN CAB AND CHASSIS IS COMPLETED AT MANUFACTURER. VENDOR AND CITY OF LUBBOCK SHALL INSPECT FOR COMPLIANCE. IF CAB AND CHASSIS MEETS COMPLIANCE, VENDOR SHALL TRANSPORT CAB AND CHASSIS TO BODY BUILDER FOR 16. CAB CHASSIS COMPLETION. IF CAB AND CHASSIS FAILS TO MEET INSPECTION COMPLIANCE, VENDOR SHALL ENSURE THAT REPAIRS ARE COMPLETED WITHIN 24 HOURS. REPAIRS THAT CANNOT BE COMPLETED DURING INSPECTION MUST BE RE -INSPECTED TO MEET COMPLIANCE BY VENDOR AND CITY OF LUBBOCK PRIOR TO RELEASING TO BODY BUILDER. S: Purchase/Bid Docs/ITB 16-13065-KM Pick -Up Trucks THE SECONDARY VENDOR SHALL NOTIFY CITY OF LUBBOCK WHEN THE BODY INSTALLATION IS COMPLETE. SECOND STAGE VENDOR SHALL DELIVER 17. SECOND STAGE THE COMPLETED UNIT FOR COMPLIANCE INSPECTION TO THE CITY OF LUBBOCK 206 MUNICIPAL DRIVE, LUBBOCK, TEXAS, CLEANED, WITH AT LEAST''/4 TANK OF FUEL. AFTER THE BODY INSTALLATION, THE CAB AND CHASSIS WILL BE RETURNED TO THE CITY, 206 MUNICIPAL DRIVE, LUBBOCK TEXAS. THE CAB AND CHASSIS VENDOR SHALL PROVIDE THE PRE -DELIVERY 18. PRE -DELIVERY SERVICE AND FIRST STATE SAFETY INSPECTION AND INSTALL THE WINDSHIELD STICKER. CAB AND CHASSIS WITH BODY SHALL BE READY TO BE PLACED IN SERVICE UPON DELIVERY TO THE CITY. PROVIDE BUILD DATES IN SPACE PROVIDED MSO AND PAPERWORK VEHICLE/EQUIPMENT WILL NOT BE ACCEPTED BY THE CITY OF LUBBOCK WITHOUT THE MSO, BILL OF SALE, WARRANTY, ALL KEYS, AND ALL PAPERWORK GENERAL REQUIREMENT AND INFORMATION BIDDER SHALL SUBMIT WITH EACH BID, CURRENT PRINTED LITERATURE AND SPECIFICATION SHEETS ON THE UNIT OFFERED IN THE RESPONSE TO SOLICITATION. EXCEPTIONS TO THE SPECIFICATIONS OF ANY ITEMS STATED HEREIN SHALL BE FULLY DESCRIBED IN WRITING BY THE BIDDING VENDOR IN THE SPACE PROVIDED BELOW. LIST ITEMS BY ITEM NUMBERS. 8 // S: Purchase/Bid Docs/ITB 16-13065-KM Pick -Up Trucks PAGE I OF 2 DATED: 11/4/2013 Specification Reviewed by: Department requesting vehicle/equipment: Signature of Department Head/Date: CITY OF LUBBOCK, TX MINIMUM SPECIFICATIONS 1/2 TON CREW CAB, SHORTBED, 4X4 SPEC: 1525-4 YEAR � D/ / MAKE MODEL IT IS THE INTENT OF THIS SPECIFICATION, REFERENCED DOCUMENTS, REQUIREMENTS AND CONDITIONS SECTIONS TO DESCRIBE MINIMUM PERFORMANCE REQUIREMENTS THE VEHICLE OR PRODUCT MUST MEET OR EXCEED THE PERFORMANCE OR CONSTRUCTION DESCRIBED HEREIN. THE VENDOR SHALL BE REQUIRED TO MARK COMPLIANCE OR NON-COMPLIANCE TO EACH ITEM DESCRIPTION IN THE SPACE PROVIDED. ALL EQUIPMENT FURNISHED AS STANDARD TO THE GENERAL PUBLIC ON THE PRODUCT BY THE MANUFACTURER SHALL BE INCLUDED, ENEN WHEN NOT SPECIFICALLY IDENTIFIED IN THIS SPECIFICATION ANY DEVIATIONS FROM THE WRITTEN SPECIFICATION WITH DATE AS SHOWN IN THE INVITATION TO BID (ITB) SHALL BE NOTED ON THE ATTACHED EXCEPTIONS TO THE SPECIFICATIONS IN ORDER TO RECEIVE FULL CONSIDERATION, ITB RESPONSE QUOTATION MUST FOLLOW THIS SPECIFICATION AND THE INVITATION TO BID'S TERMS AND CONDITIONS. / �/ p �` VENDOR NAME: �� PHONE: j (�d6 _ ! � — 4 DAy NO. ITEM MINIMUM REQUIREMENTS SELLER COMPLIANCE YES NO 1/2 ton pick-up, Crew Cab, Shortbed, 4x4. Unless otherwise specified, all units shall be furnished complete with GENERAL standard equipment and factory- installed accessories as listed by the manufacturer's printed literature and as stated in the State of Texas Fleet Automobiles and trucks Texas specifications. 1. GVWR 6,800 Pounds 2. WHEEL BASE 139.8 Inches 3. OVERALL LENGTH 224.6 Inches / v 4 PAYLOAD ALLOWANCE 1,550 Pounds 5. ENGINE A. Gasoline, V-8, 4.6 L ✓ B. 302 Net HP C. 305 Ft lbs. torque 6. TRANSMISSION OEM Automatic 7 CARGO BOX 66.7 Inches / LENGTH All weather steel belted tubeless radials with crank -up spare tire 8. TIRES winch and spare tire. Tire size: P235 75/R17 9. RIM SIZE 17 x 7 Inches 10. SEATS AND OEM 40/20/40 cloth fabric, with charcoal, gray, or tan color. INTERIOR Rear bench type seat. 11. EXTERIOR COLORS OEM Fleet White S: Purchase/Bid Docs/ITB 16-13065-KM Pick -Up Trucks NO. ITEM MINIMUM REQUIREMENTS SELLER COMPLIANCE YES NO 12. POWER PACKAGE Includes power windows, power locks, power mirrors, cruise control and tilt steering wheel. // PROVIDE BUILD DATES IN SPACE PROVIDED MSO AND PAPERWORK VEHICLE/EQUIPMENT WILL NOT BE ACCEPTED BY THE CITY OF LUBBOCK WITHOUT THE MSO, BILL OF SALE, WARRANTY, ALL KEYS AND ALL PAPERWORK GENERAL REQUIREMENT AND INFORMATION BIDDER SHALL SUBMIT WITH EACH BID, CURRENT PRINTED LITERATURE AND SPECIFICATION SHEETS ON THE UNIT OFFERED IN THE RESPONSE TO SOLICITATION EXCEPTIONS TO THE SPECIFICATIONS OF ANY ITEMS STATED HEREIN SHALL BE FULLY DESCRIBED IN WRITING BY THE BIDDING VENDOR IN THE SPACE PROVIDED BELOW. LIST ITEMS BY ITEM NUMBERS. S: Purchase/Bid Docs/ITB 16-13065-KM Pick -Up Trucks 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: 2016-133042 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. SCOGGIN DICKEY CHEVROLET LUBBOCK, TX United States Date Filed: 11/04/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. CITY OF LUBBOCCK Date Acknowledged: 11/04/2016 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. ITB 16-13065-KM VEHICLES 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary SCOGGIN DICKEY CHEVROLET 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 / 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 i exas tthics commission www.ethics.state.tx.us Version V1.0.2, , 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. 2016-133042 SCOGGIN DICKEY CHEVROLET LUBBOCK, TX United States Date Filed: 11/04/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. CITY OF LUBBOCCK 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. ITB 16-13065-KM VEHICLES 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary SCOGGIN DICKEY CHEVROLET Lubbock, TX United States X 5 Check only if there is NO Interested Parry. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. JENNIFER SOWDER CLEMENTS Notary Public, State of Texas ECcn., Notary IDp 12497068.3 My Commission Expires 06-28.2020 Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE I Sworn to and subscribed before me, by the said ,this the 2011, to certify which, witness my hand and se o office. day of ig ature of officer a6lofnistering oath Printed name of officer administering oath Title of officer ad imstering oath Form"rovided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277