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HomeMy WebLinkAboutResolution - 2017-R0250 - Provine Helicopter Service - 07/27/2017Resolution No.2017-R0250 Item No.6.12 27,2017 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,a Professional Service Contract No. 13452 by and between the City of Lubbock and Provine Helicopter Service, Inc., for Brush Control Management in the Lake Alan Henry Watershed,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 July 27 ATTEST: JUjl^.. Rebecca Garza,City Secret APPROVED AS TO CONTENT: Snj; Mark YearwooVa,Assistant City Manager APPROVED AS TO FORM: RES.PSContract-Nbr 13452-Provine Helicopter Service,Inc. (7-11-17) ,2017. DANIEL M.POPE,MAYOR Resolution No. 2017-R0250 Contract 13452 City of Lubbock, TX Brush Control Management in the Lake Alan Henry Watershed Service Agreement This Service Agreement (this "Agreement') is entered into as of the 27th day of July, 2017 ("Effective Date") by and between Proving Helicopter Service Inc. (the Contractor), and the City of Lubbock, TX (the "City"). RECITALS WHEREAS, the City has issued a Request for Proposal 17-13452-SS Brush Control Management in the Lake Alan Henry Watershed WHEREAS, the proposal submitted by the Contractor has been selected as the proposal which best meets the needs of the City for this service; and WHEREAS, Contractor desires to perform as an independent Contractor to provide Brush Control Management in the Lake Alan Henry Watershed, upon terms and conditions maintained in this Agreement; and NOW THEREFORE, for and in consideration of the mutual promises contained herein, the City and Consultant agree as follows: City and Contractor acknowledge the Agreement consists of the following exhibits which are attached hereto and incorporated herein by reference, listed in their order of priority in the event of inconsistent or contradictory provisions: 1. This Agreement 2. Exhibit A — General Requirements 3. Exhibit B — Price Proposal Sheets 4. Exhibit C — Insurance Scope of Work Contractor shall provide the services that are specified in Exhibits A - B. The Contractor shall comply with all the applicable requirements set forth in Exhibits A - C attached hereto. Article 1 Services 1.1 This agreement shall be a term of five years, said date of term beginning upon formal approval. This contract shall remain in effect until the expiration date, performance of services ordered, or termination by either party with a thirty (30) date written notice. Such written notice must state the reason for cancellation. The City of Lubbock does not guarantee any specific amount of compensation, volume, minimum, or maximum amount of services under this proposal and resulting contract. The Contractor must maintain the insurance coverage required during the term of this contract including any extensions. It is the responsibility of the Contractor to ensure that valid insurance is on file with the Purchasing and Contract Management Department as required by contract or contract may be terminated for non-compliance. 1.2 This agreement shall remain in effect until the first of the following occurs: (1) the expiration date, (2) performance of services ordered, or (3) termination of by either party with a 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. 1.3 The Contractor shall not assign any interest in this Agreement and shall not transfer any interest in the Agreement, whatsoever, without prior consent of the City. 1.4 All funds for payment by the City under this Agreement are subject to the availability of an annual appropriation for this purpose by the City. In the event of non -appropriation of funds by the City Council of the City of Lubbock for the goods or services provided under the Agreement, the City will terminate the Agreement, 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 Agreement is spent, whichever event occurs first. If at any time funds are not appropriated for the continuance of this Agreement, cancellation shall be accepted by the Contractor on 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 Agreement beyond the date of termination. Article 2 Miscellaneous. 2.1 This Agreement is made in the State of Texas and shall for all purposes be construed in accordance with the laws of said State, without reference to choice of law provisions. This Agreement is performable in, and venue of any action related or pertaining to this Agreement shall lie in, Lubbock, Texas. 2.2 This Agreement and its Exhibits contains the entire agreement between the City and Contractor and supersedes any and all previous agreements, written or oral, between the parties relating to the subject matter hereof. No amendment or modification of the terms of this Agreement shall be binding upon the parties unless reduced to writing and signed by both parties. 2.3 This Agreement may be executed in counterparts, each of which shall be deemed an original. 2.4 In the event any provision of this Agreement is held illegal or invalid, the remaining provisions of this Agreement shall not be affected thereby. 2.5 The waiver of a breach of any provision of this Agreement by any parties or the failure of any parties otherwise to insist upon strict performance of any provision hereof shall not constitute a waiver of any subsequent breach or of any subsequent failure to perform. 2.6 This Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, representatives and successors and may be assigned by Contractor or the City to any successor only on the written approval of the other party. 2.7 All claims, disputes, and other matters in question between the Parties arising out of or relating to this Agreement or the breach thereof, shall be formally discussed and negotiated between the Parties for resolution. In the event that the Parties are unable to resolve the claims, disputes, or other matters in question within 30 days of written notification from the aggrieved Party to the other Party, the aggrieved Party shall be free to pursue all remedies available at law or in equity. 2.8 At any time during the term of the agreement, 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 Agreement. 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 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. 2.9 The City reserves the right to exercise any right or remedy 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 do. 2.10 The Contractor shall not assign or sublet the agreement, or any portion of the agreement, 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 agreement Insurance requirements document, this provision shall control. IN WITNESS WHEREOF, this Agreement is executed as of the Effective Date. CITY OF LUBBO , TX: CONTRACTOR: Daniel M. Pope, Mayolq Contractor's Signature ATTEST: Do 14,e� -- RebIca Garza, City Sccretar�) APPROVED AS TO Spear APPROVP AS TO FORM: Amy Sims, Dep orney Water Utilities 1+ 7-7,4,An t) Printed Name Title City of Lubbock, TX RFP 17-13452-SS Brush Control Management in the Lake Alan Henry Watershed II. GENERAL REQUIREMENTS 1 INTENT Exhibit A 1.1 The City of Lubbock (hereinafter called "City") is seeking proposals from interested firms and individuals to provide application of herbicide to manage brush (including saltcedar (Tamarix ramosissima), and mesquite (Prosopis glandulosa), in the Lake Alan Henry Watershed. 1.2 Offerors are invited to submit demonstrated competence and qualifications of their firm for providing these services. 1.3 The information contained in this document is intended to provide interested firms with the requirements and criteria that will be used to make the selection. 2 PROJECT DESCRIPTION The City owns and operates Lake Alan Henry, which provides the City with approximately 20% of its annual water supply. Lake Alan Henry is on the South Fork of the Double Mountain Fork of the Brazos River located 15 miles southeast of Post, Texas. The City in partnership with the U.S. Geological Survey (USGS) has evaluated the effects of water supply enhancement from the management of invasive brush species in this watershed. Saltcedar, mesquite, juniper, and other phreatophytes consume water to a degree that is detrimental to water conservation. The selective control, removal, or reduction of these species should increase water yields to Lake Alan Henry. The City initiated a saltcedar control program that began in 2013, and is expanding the scope of work to include other invasive species. 3 SCOPE OF WORK 3.1 Target Area The scope of work includes herbicidal treatment of approximately 700 acres of saltcedar and/or mesquite, located on the watershed of the South Fork of the Double Mountain Fork of the Brazos River 15 miles southeast of Post, Texas. The applicator will treat species only in the designated areas with landowner and City approval. Please see the attached map for better reference. The City will provide more detailed information, regarding the area to be treated, to the successful Offeror. 3.2 Landowner Consent Agreements The City will obtain easements or consents from the landowners for entry to the property, and for application of the herbicide. The application shall be accomplished by spraying, using a helicopter, fixed -wing aircraft, or ground vehicle application where appropriate. The Offeror's personnel shall exercise due precautions in operations on private property, and shall close all gates and repair any fences damaged due to the spraying operations. 3.3 Preliminary Flight The Offeror shall conduct a preliminary survey allowing one or two city personnel an opportunity to observe the watershed to document the effectiveness of the herbicide from the previous year(s) and to show the operator the location(s) to be sprayed. 3.4 Treatment Schedule The optimum time to spray saltcedar is soon after the flowering stage, which normally occurs during August to early September in this area. The Offeror shall verbally respond to service requests within 2 days to schedule the service with the City. The optimum time to spray mesquite is late spring after the foliage has turned to a dark green or after the beans have elongated fully in late August into September. Generally, the peak spraying should be done 42 to 63 days after bud break, or 72 to 90 days after bud break. 3.5 Type of Herbicide Usage For saltcedar, the Offeror must apply the herbicide (Arsenal) with a surfactant labeled for aquatic application at rates specified by the label to control saltcedar, by helicopter. The total mixture rate must be at least 15 gallons per acre. Any spray adjuvant added to the chemical must be mixed according to chemical label for optimum herbicide performance. For mesquite, the Offeror must apply the herbicide mixture of (Sendero plus Remedy Ultra) with a surfactant or adjuvant at the rates prescribed by the label. The total tank mixture rate must be at least 5 gallons per acre. The application can be by a fixed -wing aircraft, or helicopter. 3.6 Herbicide Application a. The targeted plants may be in clusters/patches in the watershed, and not covering the entire targeted area to be treated. The chemical application will be charged on a per acre application of the chemical to the target species. b. Special consideration for the volume of spray, spray height and spray drift minimization should be followed as specified by chemical label. All application shall be in strict accord with USDA label requirements and State of Texas rules and regulations. The Offeror must follow all federal, state, local laws and regulations, while performing the above -mentioned operations, including FAA, DOT, and Department of Agriculture. c. The Offeror shall be responsible for observing all limitations on spraying based on wind speed, humidity, temperature, inversions, and other conditions affecting the application of herbicide, so that the herbicide can be applied safely, efficiently, and with a minimum of waste, and drift. The Offeror is solely responsible for the safe application of the herbicide. d. The Offeror shall be responsible for cleanup of any spills and/or damages resulting from the above -mentioned operations. 4 QUALIFICATIONS / SPECIFICATIONS 4.1 Type of Aircraft For the spraying of saltcedar, the only type of aircraft that the Offeror is allowed to use for herbicide application of arsenal is a helicopter. The helicopter must be equipped with precision boom and nozzles divided into two or three individually controlled sections for variable swath width with 1,000-micron droplet nozzles. For the spraying of mesquite, the Offeror is allowed to use a fixed wing aircraft or helicopter to apply Sendero plus Remedy Ultra. The boom must not exceed 75% of wingspan or 85% of rotor diameter. The nozzles should be pointed backward parallel with the air stream and not pointed downwards more than 45 degrees. 4.2 Licenses and Permits The Offeror must possess the following licenses and permits (Please provide copies): a. FAA Part 137 Operating Certificate b. Department of Agriculture Licenses 4.3 Guidance System The Offeror must own/possess a Guidance System such as a GPS capable of providing maps and .Shp files, with variable rate flow control linked to GPS. The Offeror's operators must be capable of avoiding individual non -target plants such as cottonwood, willow, plum thickets, and hackberry trees among others. 4.4 Trucks and Equipment The Offeror must own/possess trucks that are equipped to haul and pre -batch chemicals, water, and surfactant and be able to triple rinse on site. All tanks shall be DOT -approved meeting 406 specifications or newer. ��K1Z.T1tW '11W11T." 5.1 The unit and total prices included in Exhibit B shall include all Offeror's costs including travel required to and from the respective site and all other associated direct and indirect overhead costs. 5.2 The contract shall be a term of five years, said date of term beginning upon formal approval. This contract shall remain in effect until the expiration date, performance of services ordered, or termination by either party with a thirty (30) date written notice. Such written notice must state the reason for cancellation. The City of Lubbock does not guarantee any specific amount of compensation, volume, minimum, or maximum amount of services under this proposal and resulting contract. The Contractor must maintain the insurance coverage required during the term of this contract including any extensions. It is the responsibility of the Contractor to ensure that valid insurance is on file with the Purchasing and Contract Management Department as required by contract or contract may be terminated for non-compliance. 6 REPORTING REQUIREMENTS The Offeror shall provide documentation of the flight operations and herbicide coverage. The documentation shall include: a) An area map of application b) Total acres applied c) Chemical(s) used d) Rate of application and percent of formulation (active ingredient) e) Environmental factors during application (wind speed/direction, temperature, etc.) f) Name of applicator g) Date and time of application h) Spray Reports that meet Department of Agriculture requirements i) GPS-generated Spray Maps 7 EVALUATION CRITERIA The following criteria will be used to evaluate and rank submittals: a) Experience — The Offeror's experience in providing the services as requested in the specifications. (20%) b) Responsibility — The Offeror who has the capability, in all respects, to perform fully the contract requirements and the moral and business integrity and reliability that will assure good faith performance as required by these specifications. (20%) c) Capability and Skill — Offeror's capability, flexibility, and skill to perform the services stated in the specifications. (20%) d) Responsiveness — The degree to which the Offeror has responded to the purpose and scope of work. (5%) e) Record of performance based on previous work with the City and/or other client references. (10%) f) Cost (25%) 8 PROPOSAL FORMAT 8.1 Proposals should provide a straightforward, concise description of the Offeror's capabilities to satisfy the requirements of the RFP. Emphasis should be on completeness, clarity of content, and conveyance of the information requested by the City. 8.2 The proposal should be bound in a single volume where practical. All documentation submitted with the proposal should be bound in that single volume. No spiral binding. 8.3 If the proposal includes any comment(s) over and above the specific information requested in the RFP, it is to be included as a separate appendix to the proposal. 8.4 The proposal must be organized into the following response item sections and submitted in an indexed binder. TAB A Qualifications and Experience a) Briefly introduce your firm, providing a summary of the administration, organization and staffing of your firm, including multiple offices, if applicable. Provide an organizational chart indicating the positions and naives of the core management team, which will undertake this engagement. b) A list of aircraft by N number and how each one is equipped (Including Spray Equipment, GPS, etc.). c) A list of support trucks (Batch Trucks, Chemical Support Trucks, etc.). d) A list of additional equipment that will be used. e) Qualification using GIS and GPS systems, including capability of shape file format data transfer capability of uploading avoidance zones. f) Names of pilots (Copy of Licenses — FAA & Department of Agriculture). g) Names of support crew (CDL licenses with hazardous material endorsements). h) Names of additional personnel that may work on this project. TAB B Price Proposal Sheet a) The price sheet (Exhibit B) must be completed and returned with proposal. The unit of measure pricing requested is per acre. TAB C References Provide three references. Please include the name of the agency, contact name, telephone, fax, and email address. Performance should include goods or services, similar to those in this proposal, within the last twenty-four (24) months a. Name of the contact person; b. Name of the company or governmental entity; c. Address of the contact person; d. Telephone number of contact person; e. Email address of the contact person; f. A description of the services provided and dates the services were provided Exhibit B City of Lubbock, TX RFP 17-13452-SS Brush Control Management in the Lake Alan Henry Watershed (To be completed and returned with Proposal) Proposal Pricing Sheet for Saltceder ITEM DESCRIPTION RATE/PRICE La Price for aerial application of the herbicide (Arsenal 32 $ i O S , o b oz/acre with a surfactant labeled for use in water at a rate Per Acre of 15 gallons per acre) on 101 to 200 acres of saltcedar Alternate Price for aerial application of the herbicide (Arsenal 32 $ 1 05 bo Lb oz/acre with a surfactant labeled for use in water at a rate Per Acre of 15 gallons per acre) on 201 to 500 acres of saltcedar Alternate Price for aerial application of the herbicide (Arsenal 32 $ r7 S o 0 Lc oz/acre with a surfactant labeled for use in water at a rate Per Acre of 15 gallons per acre) for greater than 500 acres of saltcedar 2 Preliminary flight over the watershed to allow city staff to $ 0 document the saltcedar kill rates from previous year and Per Hour o cur to direct the pilot to the current area to apply herbicide 1 ime required for performance of work = L 5 Days <weather permitting Offeror shall mobilize and begin treatment within a 1 day notification_ Offeror shall guarantee that their herbicide application will provide control of the treated areas measured by the lack of regrowth for at least three (3) years after the treatment on at least 85% of the treated area. For purposes of this guarantee, each contiguous area shall be considered individually, and the guarantee shall be considered met if 85% of that contiguous area is controlled. For areas not meeting this requirement, the Offeror agrees to provide re -treatment at no cost to the City. Offeror accepts this stipulation Yes K No Prepared by: pJAM I�"r-U AA + Title: .M6,2JctF-f-T7NG MI}AfAdcR .4 Cover - Date: 7151/-7 IeSS �tG� I hou An � tdC[, */Onc- f'vin� U Ii he s loco Per { o,,r Exhibit B City of Lubbock, TX RFP 17-133452-SS Brush Control Management in the Lake Alan Henry Watershed (To be completed and returned with Proposal) Proposal Pricing Sheet for Mesquite ITEM DESCRIPTION RATE/PRICE 1.a Price for aerial application of the herbicide (Sendero 28 $ (D . 0 ° oz/acre + Remedy Ultra 8 oz/acre at a minimum of 5 Per Acre gallons per acre total spray volume with a surfactant specified by the labeled for use on mesquite) for 101 to 200 acres Alternate Price for aerial application of the herbicide (Sendero 28 $ (p, 0 0 l.b oz/acre + Remedy Ultra 8 oz/acre at a minimum of 5 per Acre gallons per acre total spray volume with a surfactant specified by the labeled for use on mesquite) for 201 to 500 acres Alternate Price for aerial application of the herbicide (Sendero 28 $ 5o,00 l.c oz/acre + Remedy Ultra 8 oz/acre at a minimum of 5 Per Acre gallons per acre total spray volume with a surfactant specified by the labeled for use on mesquite) for over 500 acres 2 Preliminary flight over the watershed to allow city staff to $` document the noxious kill rates for following years and to per Hour direct the pilot to the area to apply herbicide Time required for performance of work = 2 - Days�e_ a_th_er_ erm [ti'n� Offeror shall mobilize and begin treatment within a 10 day notification_ Offeror shall guarantee that their herbicide application will provide control of the treated areas measured by the lack of regrowth for at least three (3) years after the treatment on at least 85% of the treated area. For purposes of this guarantee, each contiguous area shall be considered individually, and the guarantee shall be considered met if 85% of that contiguous area is controlled. For areas not meeting this requirement, the Or agrees to provide re -treatment at no cost to the City. Offeror accepts this stipulation Yes « No ii / no t CY►U jc e-- Prepared by: fA DAAA ! (4/�A 4-he, f"C-s -)L hO'r qddi'��Dn�t Title: M AA OI 6 AALGZE-A2 , 0 6 e, 1 ,ti w � Date: 7 S l i -'jj 10 C) 0 P or- kv qr- � AAe syiA1'�� 4- be- �n Jc©mod GOnGtr� Exhibit C City of Lubbock, TX Brush Control Management in the Lake Alan Henry Watershed Insurance Requirements 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): INSURANCE (Copies of Endorsements will be Required) TYPE OF INSURANCE AIRCRAFT LIABILITY ® Commercial General Liability ❑ Other ❑ Claims Made ® Occurrence ❑ W/Heavy Equipment ❑ XCU ❑ To Include Products of Complete Operation Endorsements CRIME POLICY ❑ Crime Policy AUTOMOTIVE LIABILITY ® Any Auto per Occurrence EXCESS LIABILITY ❑ Umbrella Form GARAGE LIABILITY ❑ Any Auto ❑ BUILDER'S RISK ❑ INSTALLATION FLOATER ❑ POLLUTION ❑ CARGO COMBINED SINGLE LIMIT General Aggregate $5,000,000 Products-Comp/Op AGG X Personal & Adv. Injury X Contractual Liability X Fire Damage (Any one Fire) Med Exp (Any one Person) General Aggregate Aggregate Each Occurrence Aggregate Auto Only - Each Accident Each Accident Aggregate ❑ 100% of the Total Contract Price ❑ 100% of the Total Material Costs $1,000,000 ® WORKERS COMPENSATION 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 on ALL coverages except Professional Liability. All Copies of the Certificates of Insurance and all applicable endorsements are required. ADDITIONAL POLICY ENDORSEMENTS The City shall been, 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 30 day 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 same 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 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1041 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: 2017-236441 Date Filed: 07/13/2017 Date Acknowledged: 07/17/2017 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Provine Helicopter Service, Inc. Greenwood, MS 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. 13452 Aerial Application 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. 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 Ethics Commission www.ethics.state.tx.us Version V1.0.883 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1041 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. 2017-236441 Provine Helicopter Service, Inc, Greenwood, MS United States Date Filed: 07/13/2017 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 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. 13452 Aerial Application 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. . /,T -. 0..'!Y .... . '•lC O�PP Usk i a. cio• :,tQ ID N 84280 JEANNIE HADDON Signature of authorize gent of contracting business entity ��,„, Expires;• AFFIX b.trgq Qy� p ��S*.iBOVE G� 1, Mardi Sworn to �m��jtred;h\e?e me, by the saidfQ�(lV>a �Gt this the day of a. 20 to certify which, witness my hand and seal of office. gnature of officer administering oath Printed name of officer administering oath Title of officer Jdministering oath r1 r , UA"a 11103 �umlrl �� U1, www.CuuUS,State.tx•US Version V1,0,883