HomeMy WebLinkAboutResolution - 2016-R0443 - Contract For RFP - Ace Pipe Cleaning Inc - Canyon Lakes Sewer - 12/15/2016Resolution No.2016-R0443
Item No.6.12
December 15,2016
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 behalfof the Cityof Lubbock,RFP 17-13037-TF,Contract No.13037 for Canyon Lakes
Sanitary Sewer Interceptor Rehabilitation - Phase 1A,by and between the City of Lubbock and
Ace Pipe Cleaning,Inc.,of Kansas City, MO, 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 December 15,2016
DANIEL M.POPE,MAYOR
ATTEST:
a Garza,C
APPROVED
Director of Public Works
APPROVED AS TO FORM:
\$m<Aj^
Kelli Leisure,Assistant City Attorney
ccdocs/RES.Contract-Nbr 13037-Ace Pipe Cleaning, Inc.
November 28,2016
CERTIFICATE OF INTERESTED PARTIES
FORM 129rJ
1 of 1
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:
2016-143722
Date Filed:
12/07/2016
Date Acknowledged:
12/07/2016
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Ace Pipe Cleaning, Inc.
Kansas City, MO United States
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
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.
13037
Canyon Lakes Sanitary Sewer Interceptor Rehabilitation
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. ❑
X
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
I-orms provlaea ny I exas unics Uommisslon www.ethics.state.tx.us Version V1.0.277
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 0f 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.
2016-143722
Ace Pipe Cleaning, Inc.
Kansas City, MO United States
Date Filed:
12/07/2016
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of 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 services, goods, or other property to be provided under the contract.
13037
Canyon Lakes Sanitary Sewer Interceptor Rehabilitation
4
Nature of interest
Name of Interested Party
City, State, Country (place of business
(check applicable)
Controlling
I Intermediary
5 Check only if there is NO Interested Party.
❑ ���'' X
A.
6 AFFIDAVtT�.��� ....
�¢ "� ExP r0.p •, Lam'- I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
NOTARY s
PUBLIC _
l NOTARY -
SEAL
:.�'• �dpr Cj �4
KsOn G......
`
�� � Signature of authorized Agent of c ntracting business entity
Op Mrs ruceIvantine
,.•�'
AFFIX NOTARY STA l " tg�Al- ABOVE Secretary / Treasurer
Sworn ��f7�j
to and subscribed before me, by the said t( this the day of,itGL/
20f_(pto certify which, witness my hand and seal of office.
Theresa Caiyan
-_ Theresa Calvert Contract Manager
Signatur of officer administering oath Printed nPWMAWHOWring oath Title of officer administering oath
rumia piuv,ueu by i exas cuucs t.omrnisslon www.etnics.state,tx.us Version V1.0.277