HomeMy WebLinkAboutResolution - 2016-R0092 - Contract - Utility Contractors Of America Inc. - Pump Station - 03/10/2016 Resolution No. 2016-R0092
Item No. 5.10
March 10, 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 12670 for Pump Station No. 16
and Storage Tank, by and between the City of Lubbock and Utility Contractors of
America, Inc., and any 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 March 10, 2016
GLE RTSON, MAYOR
ATTEST:
Rebe ca Garza, City Secretary
APP VED AS TO NTENT:
Woo Ira lin, P.E., Director of Public Works
APPROVED AS TO FORM:
my ims, e t i y A r
RES.Contract-Nbr 12670,Utility Contractors of America, Inc
2.15.16
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
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2016-30680
Utility Contractors of America, Inc.
Lubbock,TX United States Rate Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/24/2016
being filed.
City of Lubbock Date Acknowledged:
03/29/2016
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 goods or services to be provided under the contract.
12670
Pump Station 16 and Storage Tank
4 Nature of interest(check applicable)
Name of Interested Party City,State,Country(place of business)
Controlling Intermediary
Ziegner,Jonathan Lubbock,TX United States X
Lane,Ty 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 Texas Ethics Commission www.ethics.state.tx.us Version V1.0.312
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1of1
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
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business.
Utility Contractors of America, Inc. 2016-30680
Lubbock,TX United States Date Filed:
2 Name of governmental entity or state agency that is a parry to the contract for which the form is 03/2412016
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.
12670
Pump Station 16 and Storage Tank
4 Nature of interest(check applicable)
Name of Interested Party City,State,Country(place of business)
Controlling Intermediary
Ziegner,Jonathan Lubbock,TX United States X
Lane,Ty 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.
;a;.or A•an Tammy VanBulen
Notary Public,State of Texas r
My Commission Expires
Seplember27,2016 ;
i. Signature of authorized agent of contracting business entity
t
AFFIX NOTARY STAMP 1 SEAL ABOVE \J
Sworn to and subscribed before me,by the said this the- a� day of 01Q
20 /6 to rtify 'ch,witness my hand and seal of office.
\,L�� We/A
Signaturo fficer administering nth Printed name o officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.312
To see a copy of the contract please contact the
City Secretary Office.