HomeMy WebLinkAboutResolution - 2017-R0041 - Archer Western Construction - 02/09/2017Resolution No.2017-R0041
Item No.5.13
February 9,2017
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, RFP 17-12834-TF Contract No. 12834 for Pump Station
No. 10, by and between the City of Lubbock and Archer Western Construction, LLC,of Irving,
Texas, 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 February 9.7.017 •
DANIEL M.POPE,MAYOR
ATTEST:
-*Alc^
Rebecjca Garza, City Secretary
APPROVED AS TO CONTENT:
tor of Public Works
APPROVED AS TO FORM:
Kelli Leisure,Assistant City Attorney
RES.Contract 12834-Archer Western Construction,LLC
December 12,2016
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 0f 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:
2017-159236
Date Filed:
01/27/2017
Date Acknowledged:
01/27/2017
1
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Archer Western Construction, LLC
Irving, 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 Water Utilities
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.
12834
Construction service for Pump Station No. 10
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I 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
ruiiiia NiuviuCu uy I exds cuucs uummission www.etnics.state.tx.us Version V1.0.277
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
Certificate Number:
1
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2017-159236
Archer Western Construction, LLC
Irving, TX United States
Date Filed:
01/27/2017
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 Water Utilities
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.
12834
Construction service for Pump Station No. 10
4
Nature of interest
Name of Interested Party
City, State, Country (place of business)
(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.
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Signature of business
authorized agent of contracting entity
AFFIX N0TARIS3Tkv11PdPq EALOVOF
:SPIRE`; '• �� %
I
Sworn to and subscilbp�d I S'ne,` ie said � Y f i) ( �. ( W&IS this the 1 day of aet
20�2, to certify w 1601110 s my hand and seal of office;
w-P�ril` sn" Ili^L/
4��
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by I exas Ltnlcs commission www.ethics.state.tx.us Version V1.0.277