HomeMy WebLinkAboutResolution - 2017-R0045 - Prochem Sales - 02/09/2017Resolution No.2017-R0045
Item No.5.18
February 9,2017
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayorof the Cityof Lubbock is herebyauthorizedand directedto executefor and on
behalf of the City of Lubbock,Contract No.13237 and related documents for pesticide and
herbicide supplies for various park property as per ITB 17-13142-KM,by and between the City
of Lubbock and ProChem Sales,of Lubbock, Texas. 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 Councilon February 9,2017
DANIEL M.POPE,MAYOR
ATTEST:
JLtlWSJ.,
Rebecca Garza, City Secret
APPROVED AS TO CONTENT:
Scott Snider,Assistant City Manager
APPROVED AS TO FORM:
Justin Assistant City Attorney
ccdocs/RES.Contract 13237 -ProChem Sales -Pesticide &Herbicide for Parks
January 23,2017
Resolution No. 2017-R0045
CONTRACT 13237
City of Lubbock, TX
Pesticide and Herbicide Supplies for Various Parkland Properties
THIS CONTRACT made and entered into this 9th day of February, 2017, by and between the City
of Lubbock ("City"), and Pro Chem Sales, ("Contractor").
WITNESSETH:
WHEREAS, the City of Lubbock duly advertised for bids for Pesticide and Herbicide Supplies for Various
Parkland Properties and bids were received and duly opened as required by law; and
WHEREAS, after careful consideration of the bid submitted by Contractor, the City of Lubbock has
heretofore adopted a resolution authorizing the acceptance of such bid, and the execution, in the name of the City
of Lubbock a contract with said Contractor covering the purchase and delivery of the said Pesticide and Herbicide
Supplies for Various Parkland Properties.
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 specifications and bid form
are attached hereto and made part hereof, Contractor will deliver to the City, Pesticide and Herbicide
Supplies for Various Parkland Properties, and more specifically referred to as items seven, eight, fifteen,
sixteen and seventeen on the bid submitted by the Contractor or in the bid form 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, with the option of four, one year extensions, said date of term
beginning upon formal approval. All stated annual quantities are approximations of usage during the time
period to be covered by pricing established by this bid. Actual usage may be more or less. Order quantities
will be determined by actual need. The City of Lubbock does not guarantee any specific amount of
compensation, volume, minimum, or maximum amount of services under this bid and resulting contract.
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 old 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. At any time during the term of the contract, or thereafter, the City,
or a duly authorized audit representative of the City, 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 the
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.
6. INSURANCE SECTION A. Prior to the approval of this contract by the City, the Contractor shall
furnish a completed Insurance Certificate to the City, which shall be completed by an agent authorized
to bind the named underwriter(s) to the coverages, limits, and termination provisions shown thereon,
and which shall furnish and contain all required information referenced or indicated thereon. THE
CITY SHALL HAVE NO DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL
SUCH CERTIFICATE SHALL HAVE BEEN DELIVERED TO THE CITY.
INSURANCE COVERAGE REQUIRED
SECTION B. The City reserves the right to review the insurance requirements of this section during the
effective period of the contract and to require adjustment of insurance coverages and their limits when
deemed necessary and prudent by the City based upon changes in statutory law, court decisions, or the
claims history of the industry as well as the Contractor.
SECTION C. The Contractor shall obtain and maintain in full force and effect for the duration of this
contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by companies
approved by the State of Texas and acceptable to the City, in the following type(s) and amount(s):
TYPE OF INSURANCE
GENERAL LIABILITY
® Commercial General Liability ❑ Other
❑ Claims Made ® Occurrence
❑ W/Heavy Equipment
❑ To Include Products of Complete Operation Endorsements
PROFESSIONAL LIABILITY
AUTOMOTIVE LIABILITY
® Any Auto
❑ Scheduled Autos
❑ Non -Owned Autos
EXCESS LIABILITY
❑ Umbrella Form
GARAGE LIABILITY
❑ Any Auto
❑ BUILDER'S RISK
❑ INSTALLATION FLOATER
® POLLUTION
❑ CARGO
❑ All Owned Autos
❑ Hired Autos
COMBINED SINGLE LIMIT
General Aggregate $1.000,000
Products-Comp/Op AGG X
Personal & Adv. Injury X
Contractual Liability X
Fire Damage (Any one Fire)
Med Exp (Any one Person)
General Aggregate
General Aggregate
Combined Single Limit $1,0 00,000
Aggregate
Each Occurrence
Aggregate
Auto Only - Each Accident
Each Accident Aggregate
❑ 100% of the Total Contract Price
❑ 100% of the Total Material Costs
$1.0 00,000
® WORKERS COMPENSATION — STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY
® EMPLOYERS' LIABILITY $1,000,000
OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED
® City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis.
® To include products of completed operations endorsement.
® Waiver of subrogation in favor of the City of Lubbock on all coverages, except
The City of Lubbock shall be named as an additional insured on a primary and non-contributory basis and
shall include waivers of subrogation in favor of the City on all coverage's. Copies of the Certificates of
Insurance and all applicable endorsements are required.
ADDITIONAL POLICY ENDORSEMENTS
The City shall be entitled, upon request, and without expense, to receive copies of the policies and all
endorsements thereto and may make any reasonable request for deletion, revision, or modification of
particular policy terms, conditions, limitations, or exclusions (except where policy provisions are
established by law or regulation binding upon either of the parties hereto or the underwriter of any of such
policies). Upon such request by the City, the Contractor shall exercise reasonable efforts to accomplish
such changes in policy coverages, and shall pay the cost thereof.
REQUIRED PROVISIONS
The Contractor agrees that with respect to the above required insurance, all insurance contracts and
certificate(s) of insurance will contain and state, in writing, on the certificate or its attachment, the
following required provisions:
a. Name the City of Lubbock and its officers, employees, and elected representatives as additional insureds,
(as the interest of each insured may appear) as to all applicable coverage;
b. Provide for thirty (30) days' notice to the City for cancellation, nonrenewal, or material change;
c. Provide for notice to the City at the address shown below by registered mail;
d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees, and
elected representatives for injuries, including death, property damage, or any other loss to the extent sane
may be covered by the proceeds of insurance;
e. Provide that all provisions of this contract concerning liability, duty, and standard of care together with
the indemnification provision, shall be underwritten by contractual liability coverage sufficient to include
such obligations within applicable policies.
NOTICES
The Contractor shall notify the City in the event of any change in coverage and shall give such notices
not less than 30 days prior the change, which notice must be accompanied by a replacement
CERTIFICATE OF INSURANCE.
All notices shall be given to the City at the following address:
Marta Alvarez, Director of Purchasing and Contract Management
City of Lubbock
1625 13`►' Street, Room 204
Lubbock, Texas 79401
SECTION D. Approval, disapproval, or failure to act by the City regarding any insurance supplied by
the Contractor shall not relieve the Contractor of full responsibility or liability for damages and accidents
as set forth in the contract documents. Neither shall the bankruptcy, insolvency, or denial of liability by
the insurance company exonerate the Contractor from liability.
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.
8. 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 thirty (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 of 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 17-13142-KM, Bid
Form and Specifications.
IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and year
first above written. Executed in triplicate.
CITY OF LUBBOCK:
Daniel M. Pope, Mayor
ATTEST:
Reb cca Garza, City Secret '
APPROVED AS TO_C
Faulkenberry, parks and Recreation
APPROVED AS TO FORM:
Justin Pruitt, As(
t City orney
CONTRACTOR:
BY AL
Authorized Representative's Signature
Ji ff�-Je mc' )�_CCX_
Print Name
1 -31 (.D) C f2- Z O 0
Address
o� j-c
City, State, Zip Code
-4 -
BID FORM
Pesticide and Herbicide Supplies for Various Parkland Properties
City of Lubbock, TX
ITS No. 17-13142-KM
In compliance with the Invitation to Bid 17-13142-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 17-13142-KM is by reference incorporated in this contract. The Bid Form roust be completed in blue or
black in or by ew 'ter.
ITEM
A.
QTY
(+/-)
B.
UNIT OF
MEASURE
C.
DESCRIPTION
D.
UNIT PRICE*
BID
E.
EXTENDED
COST
F=BxE
Delivery
Days
ARO**
1.
6
2'/2 Gallon
Prodiamine
I
Not. on mers
Brand Name:
Alternative Equal:
2.
4 12 Containers Deet
er --ase
Brand Name:
Alternative Equal:
Cn 7)
Brand Name:
Alternative Equal:
4. 48 2'/ Gallon Glyphosate
!!!!!!!!
Brand Name:
v
Alternative Equal:
5. 160 1 Gallon
Marker Dye
Brand Name:
Alternative Equal:
S: Purchase/Bid Docs/1TB 17-13142-KM, Pesticide and Herbicide Supplies for Various Parkland Properties
4
ITEM
A.
QTY
(+/-)
B.
UNIT OF
MEASURE
C.
DESCRIPTION
D.
UNIT PRICE*
BID
E.
EXTENDED
COST
F=BxE
Delivery
Days
ARO**
6.
10
2 '/2 Gallon
MSMA
on mers
Brand Name:
Alternative Equal:
7. 8
1 Galion
Containers
Taurus
'A -7
Brand Name:
Alternative Equal:
8. 2
2 '/2 Gallon
Containers
Reward
Brand Name:
Alternative Equal: 1-,-) r� Pr-r 2
1 5q ,'7 s
3 0g , -5 c
S
9. 2
12 Containers
Soap-N-Water
er a
Brand Name:
Alternative Equal:
10, 16
2'/Z Gallon
Surfactant
Brand Name:
Alternative Equal:
11. 1=4
12 Containers
Total Release
Is
Per Case
'
Brand Name:
Alternative Equal:
"12.5
12 Containers
Wasp Spray
r
Brand Name:
Alternative Equal:
S: Purchase/Bid Docs/ITB 17-13142-KM, Pesticide and Herbicide Supplies for Various Parkland Properties
QTY
UNIT OF
UNIT PRICE*
EXTENDED
Delivery
ITEM
(+I-)
MEASURE
DESCRIPTION
BID
COST
Days
A.
B.
C.
D.
E.
F=BxE
ARO**
13.
6
2 '/2 Gallon
Power Zone
on amers
Brand Name:
Alternative Equal:
Brand Name:
r.
Alternative Equal:
15. 10
2 '/Z Gallon
4-Speed XT
4 1 79Z 5
7 g 2 5 C
j
Brand Name:
Alternative Equal:
16. 6
2 '/2 Gallon
Parazone (Paraquat)�
Containers
Brand Name:
Alternative Equal:
17. I I
2 Gallon
Triplet
z ��
Brand Name:
Alternative Equal:
18. 20
Cases
Weevil-cide Tablets
Brand Name:
Alternative Equal:
Brand Name:
Alternative Equal:
S: Purchase/Bid Docs/ITB 17-13142-KM, Pesticide and Herbicide Supplies for Various Parkland Properties
ITEM
A.
QTY
(+/-)
B.
UNIT OF
MEASURE
C.
DESCRIPTION
D.
UNIT PRICE*
BID
E.
EXTENDED
COST
F=BxE
Delivery
Days
ARO**
20.
20
Cases
LV-6
Brand Name:
Alternative Equal:
Total Cost (Items 1-20)
$
*PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed
**Days After Receipt of Order (AR ) T
I Uldl �Py,UI-+
ALTERNATIVE EQUALS MUST INCLUDE LABELS AND MATERIALS SAFETY DATA SHEET (MSDS)
SHEETS.
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.
The City of Lubbock is seeking a contract for Pesticide and Herbicide Supplies for Various Parkland Properties with
one or more contractors. In order to assure adequate coverage, the City may make multiple awards, selecting multiple
vendors to provide the products desired, if multiple awards are in the best interest of the City. A decision to make a
multiple award of this Bid, however, is an option reserved by the City, based on the needs of the City.
PAYMENT TERMS AND DISCOUNTS - Bidder offers a prompt payment discount of %, 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.
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, L nn County, and City of Wolfforth.
YES NO
S; Purchas6Bid Docs/1TB 17-13142-KM, Pesticide and Herbicide Supplies for Various Parkland Properties
• 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 IS SUBMITTED BY Pa C t�Cfn SA US a corporation organized under the laws of the State of
, or a partnership consisting of
or individual trading as
of the City of
Firm: I�RC)_ C_l-��7►�1 S&LE:s
Address: _ _ 13101 C 12 j z Q C�
City:_ L L1 f� 43o 6_ State: T-,Y. Zip "7�i 4i 23
Bidder acknowledges receipt of the following addenda:
Addenda No. Date _
Addenda No. Date
Addenda No. Date
M/WBE Firm:
Woman Black American Native American
Hispanic American Asian Pacific Amerij Other (Specify)
By �Jr 1--� o f I
Authorized Representative - must sign by hand
Officer Name and Title: 3H A l Je (n LQ(.k_ 9 PA NcH M N (_✓ O
Please Print
Business Telephone Number �' _ `f 8 ` f�� FAX: ` T46 109
E-mail Address: S n E— Pp D C lleln Sce `-eS CX., ryl
FOR CITY USE ONLY
Bid Form Item Number(s) Awarded to Above Named Firm/Individual:
Date of Award by City Council (for bids over $50, 000): Date P.O./Contract Issued:
RETURN COMPLETED & SIGNED BID FORM ALONG WITH CITY OF LUBBOCK SPECIFICATIONS.
LABEL THE OUTSIDE OF YOUR SEALED BID WITH THE ITB NUMBER, THE CLOSING DATE AND
TIME, AND YOUR COMPANY NAME AND ADDRESS-
S: PurohaWBid DocsATB 17-13142-KM, Pesticide and Herbicide Supplies for Various Parkland Properties
8
City of Lubbock, TX
ITB 17-13142-KM
Pesticide and Herbicide Supplies for Various Parkland Properties
Specifications
Intent
The city of Lubbock is requesting bids for pesticides and herbicides supplies for use on various
parkland properties.
Statement of Needs
The city Parks and Recreation Department is requesting the chemicals and chemical supplies for park
use to be delivered to the Park Maintenance Shop by the vendor.
Follow the list of chemicals on the bid list, any deviation from the list please provide the chemical
name, cost, label and MSDS for the changed product.
It is at the discretion of parks and recreation to accept or deny the alternate chemical.
Contract Period
The contract shall be for a term of one year, with the option of four, one year extensions, said date of term
beginning upon formal approval. All stated annual quantities are approximations of usage during the time period
to be covered by pricing established by this bid. Actual usage may be more or less. Order quantities will be
determined by actual need. The City of Lubbock does not guarantee any specific amount of compensation, volume,
minimum, or maximum amount of services under this bid and resulting contract.
Delivery Location
City of Lubbock
Parks and Recreation — Park Maintenance
308 Municipal Dr.
Lubbock, TX 79403
S: Purchase/Bid Docs/ITB 17-13142-KM, Pesticide and Herbicide Supplies for Various Parkland Properties
32
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
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:
2016-143897
Date Filed:
12/07/2016
Date Acknowledged:
01/11/2017
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Pro Chem Sales
Lubbock, TX 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.
13142
chemical supplies
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
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277
LtK I IFIGATE OF INTERESTED PARTIES
FORM 1295
loll
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:
2016-143897
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Pro Chem Sales
Lubbock, TX 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.
13142
chemical supplies
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. ❑
6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
ELIZABETH MERCADO
Notary Pubkc, State of texas
Notary IR 1US4&-3
MY COffi<f i&kirl Ewes 10.07-2M Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP I SEAL ABOVE
Sworn tgand subscribed before me, by the said this the �_ day of 1
20� Y� , to certify which, witness my hand and seal of office.
Signatur of officer administering oath Printed name of officer administering oath Title of officer adrrfiNstering oath
runny Ntuvweu uy i exas ttnu;s �,ummtsston www.etnlcs.state.tx.us Version V1.0.277