HomeMy WebLinkAboutContract 48192 CITY SECRETARY
CONTRACT NO
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To PROFESSIONAL IONA SERVICES AGRF. , .NT
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This PROFESSIONAL SERVICES AGREEMENT("Agreement")is made and entered into by
and between the CITY OF FORT WORTH (the "City"), a Texas home rule municipal corporation,
acting by and through Jesus J. Chapa, its duly authorized Assistant City Manager, and S L-S e r c o,
I n c. ("Contractor" and"ALC"), a Minnesota Corporation, and acting by and through Laurie Allen, its
duly authorized Chief Financial Officer,each individually referred to as a"party"and collectively referred
to as the"parties."
The City has approximately 250,000 water meters that are currently read manually with handheld
devices throughout its 350 square-mile service area. Residential meters are read monthly by a contracted
third-party service provider. Commercial and industrial customer meters are read in-house by City staff
through a combination of meter reading systems. Meter registers are in cubic feet(CuFt.),and customers are
billed in hundreds of CuFt. The City desires to automate meter reading activities through the development
and implementation of an Advanced Metering Infrastructure (AMI) program. In association with the new
AMI program, the City recognizes that additional process efficiencies, operational cost savings, revenue
enhancement,database integrations and improved customer service activities shall occur.
The Fort Worth Water Department (FWWD) conducted internal staff workshops to define existing
utility issues and opportunities for a new meter reading technology to mitigate existing problems through the
AMI solution.A Request for Qualifications (RFQ),was released on August 12, 2015 to identify a qualified
System Integrator.The City's desire was to identify a fully integrated system and its components to complete
the project.
1. SCOPE OF SERVICES.
Contractor hereby agrees to provide the City with professional services in the successful completion of the
City's five phased AMI program for the design,planning and full implementation of the AMI system.
The Contractor shall provide technical assistance supporting the planning, design,purchase and full
deployment of a City-Wide AMI system. This will include advanced metering technical features in the
support to the FWWD leadership, as well as preparation and evaluating program components design and
functionality.
Task 1—Operations Oversight and Project Management
Contractor shall support the City with the following:
• Coordinate staff resources to complete project objectives as necessary;
• Discuss with management prior to system integrator meetings;
• Supply weekly status updates to management concerning program progress;
• Schedule management of installation of water meters with registers and Meter Interface Unit
(MIU)devices;
• Assist with inventory support.
1-FPC0AL RECORD
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Task 2—Transition Assistance(Project to Operations)
Contractor shall provide assistance moving from project planning and deployment mode to operations mode.
Contractor shall assist with the following responsibilities:
• Complete systems acceptance plan;
• Coordinate resources for operations roles;
• Onsite meeting with management for role definition;
• Onsite preparation for system training;
• Participate in system training;
• Validate if operational instructions are clear and acceptable;
• Conduct follow-up meetings with resources,for preparation of subsequent training;
• Participate in follow-up training;
• Document operations level checklist and best practices documentation;
• Meter right sizing survey;
• Marketing and customer presentation;
• Review and make recommendations on the system operational and maintenance plan.
Task 3—Acceptance Testing/Final Acceptance
Contractor shall support the City with the following during Acceptance Testing:
• Monitor system integrity daily and weekly;
• Alert and document all issues;
• Review of system acceptance documents;
• Validation of punch list items and completion tracking;
• Contract management;
• Installation validation;
• Achieving the system performance measures as requested;
• Validation of the leak detection system.
Task 4—Post Project
Contractor shall provide the following Post Project solutions and long term assistance to the FWWD:
Completion of a Data Utilization Plan Including the following:
• Contractor shall meet-with key staff to determine data usefulness;
• Contractor shall meet with key staff to define reporting requests;
• Contractor shall build data management and utilization plan;
• Contractor shall assist FWWD with reporting;
• Contractor shall build data utilization processes for departments
• Contractor shall be able to review meter to cash process review and optimization reports;
• Contractor shall review of current data system processes;
• Contractor shall be able to analyze data utilization;
• Contractor shall be able to use process refinement and document;
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• Contractor shall be able to use training and system utilization review;
• Contractor shall update system documentation as necessary;
• Contractor shall provide integration support.
City's Responsibilities
• Provide the Contractor with adequate work space throughout the engagement.
• Advising Contractor of City Purchasing Procedures.
• Assist in communication between Contractor and FWWD subject matter experts as needed.
• Provide System Integrator Coordination Data
• Determine magnitude and location of leak detection system
2. TERM.
This term of this Agreement shall commence on September 26, 2016 (Effective Date) and shall
expire on September 25, 2017, unless terminated earlier in accordance with the provisions of this
Agreement. The City shall have the option, in its sole discretion, to renew this Agreement under the
same terms and conditions, for up to five (5) one-year options, unless terminated in accordance with
the provisions of the Agreement.
3. COMPENSATION.
The City shall pay Contractor an amount not to exceed $175,000.00 in accordance with the
provisions of this Agreement. The Contractor will invoice the City not more than once a month itemizing
work performed under this Agreement. Contractor shall not perform any additional services for the City
not specified by this Agreement unless the City requests and approves in writing the additional costs for
such services. The City shall not be liable for any additional expenses of Contractor not specified by this
Agreement unless the City first approves such expenses in writing. Contractor agrees that it can provide the
services described in Agreement for the not to exceed amount.
4. TERMINATION.
4.1. Written Notice.
The City or Contractor may terminate this Agreement at any time and for any reason by
providing the other party with fifteen (15)days written notice of termination. The City may also
issue notice of termination for Contractor's failure to perform in accordance with Section 1.
Contractor shall respond and correct any failure to perform five(5)business days of such notice
of termination, otherwise the Agreement shall be terminated at the end of the 5`business day.
4.2 Non-appropriation of Funds.
In the event no funds or insufficient funds are appropriated by the City period for any
payments due hereunder, City will notify Contractor of such occurrence and this Agreement shall
terminate on the last day for which appropriations were received without penalty or expense to the
City of any kind whatsoever, except as to the portions of the payments herein agreed upon for
which funds shall have been appropriated.
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The award of this Agreement is contingent upon release of funds from the Texas Water
Development Board, TWDB. Any sub-contract(s) awarded as a result of this Agreement that are
expected to be funded in part by the loan from the TWDB is also contingent upon the release of
funds from the TWDB. Neither the State of Texas, nor any of its departments, agencies, or
employees are or will be part of any resulting contracts.
4.3 Duties and Obligations of the Parties.
In the event that this Agreement is terminated prior to the Expiration Date, the City
shall pay Contractor for services actually rendered up to the effective date of termination and
Contractor shall continue to provide the City with services requested by the City and in accordance
with this Agreement up to the effective date of termination.
5. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION.
Contractor hereby warrants to the City that Contractor has made full disclosure in writing of any
existing or potential conflicts of interest related to Contractor's services under this Agreement. In the
event that any conflicts of interest arise after the Effective Date of this Agreement, Contractor hereby
agrees immediately to make full disclosure to the City in writing. Contractor, for itself and its officers,
agents and employees, further agrees that it shall treat all information provided to it by the City as
confidential and shall not disclose any such information to a third party without the prior written
approval of the City. Contractor shall store and maintain City Information in a secure manner and shall
not allow unauthorized users to access, modify, delete or otherwise corrupt City Information in any way.
Contractor shall notify the City immediately if the security or integrity of any City information has been
compromised or is believed to have been compromised.
6. RIGHT TO AUDIT.
Contractor agrees that the City shall, until the expiration of three (3) years after final payment
under this contract, have access to and the right to examine at reasonable times any directly pertinent
books, documents, papers and records of the Contractor involving transactions relating to this Contract
at no additional cost to the City. Contractor agrees that the City shall have access during normal
working hours to all necessary Contractor facilities and shall be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. The City shall give
Contractor reasonable advance notice of intended audits.
Contractor further agrees to include in all its subcontractor agreements hereunder a provision to the
effect that the subcontractor agrees that the City shall, until expiration of three(3)years after final payment
of the subcontract, have access to and the right to examine at reasonable times any directly pertinent books,
documents, papers and records of such subcontractor involving transactions related to the subcontract, and
further that City shall have access during normal working hours to all subcontractor facilities and shall be
provided adequate and appropriate work space in order to conduct audits in compliance with the provisions
of this paragraph. City shall give subcontractor reasonable notice of intended audits.
The Contractor further agrees to accept the authority of the State of Texas Auditor's office authority
to conduct audits and investigations under the State Water Infrastructure Reserve Fund Texas, SWIRFT, in
connection with state funds received pursuant to this Agreement. The Contractor shall comply with the
directives from the City and the Texas State Auditor and shall cooperate in any such audit or investigation.
The Contractor agrees to provide the State of Texas Auditor with access to any information the City or Texas
state Auditor considers relevant to the audit or investigation. The Contractor agrees to include the same
provision in any contract or subcontract used in connection with this agreement.
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7. INDEPENDENT CONTRACTOR.
It is expressly understood and agreed that Contractor shall operate as an independent contractor
as to all rights and privileges granted herein, and not as agent, representative or employee of the City.
Subject to and in accordance with the conditions and provisions of this Agreement, Contractor shall
have the exclusive right to control the details of its operations and activities and be solely responsible
for the acts and omissions of its officers, agents, servants, employees, contractors and subcontractors.
Contractor acknowledges that the doctrine of respondeat superior shall not apply as between the City,
its officers, agents, servants and employees, and Contractor, its officers, agents, employees, servants,
contractors and subcontractors. Contractor further agrees that nothing herein shall be construed as the
creation of a partnership or joint enterprise between City and Contractor.
8. LIABILITY AND INDENMIFICATTON.
CONTRACTOR SHALL BE LIABLE AND RESPONSIBLE FOR ANYAND ALL PROPERTY
LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY, INCL UDING DEATH, TO ANY AND
ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, TO THE
EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR
INTENTIONAL MISCONDUCT OF CONTRACTOR, ITS OFFICERS, AGENTS, SERVANTS OR
EMPLOYEES.
CONTRACTOR COVENANTS AND AGREES TO, AND DOES HEREBY, INDEMNIFY,
HOLD HARMLESS AND DEFEND THE CITY, ITS OFFICERS, AGENTS, SERVANTS AND
EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR LAWSUITS FOR EITHER
PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO
CONTRACTOR'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL
INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER,
WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH THIS
AGREEMENT, TO THE EXTENT CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OR
MALFEASANCE OF CONTRACTOR,ITS OFFICERS,AGENTS,SERVANTS OR EMPLOYEES.
9. ASSIGNMENT AND SUBCONTRACTING.
Contractor shall not assign or subcontract any of its duties, obligations or rights under this
Agreement without the prior written consent of the City. If the City grants consent to an assignment, the
assignee shall execute a written agreement with the City and the Contractor under which the assignee
agrees to be bound by the duties and obligations of Contractor under this Agreement. The Contractor and
Assignee shall be jointly liable for all obligations under this Agreement prior to the assignment. If the
City grants consent to a subcontract,the subcontractor shall execute a written agreement with the Contractor
referencing this Agreement under which the subcontractor shall agree to be bound by the duties and
obligations of the Contractor under this Agreement as such duties and obligations may apply.The Contractor
shall provide the City with a fully executed copy of any such subcontract.
10. INSURANCE.
Contractor shall provide the City with certificate(s) of insurance documenting policies of the
following minimum coverage limits that are to be in effect prior to commencement of any work pursuant
to this Agreement:
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10.1 Coverage and Limits
(a) Commercial General Liability
$1,000,000 Each Occurrence
$2,000,000 Aggregate
(b) Automobile Liability
$1,000,000 Each accident on a combined single limit basis or
$250,000 Bodily injury per person
$500,000 Bodily injury per occurrence
$100,000 Property damage
Coverage shall be on any vehicle used by the Contractor, its employees, agents,
representatives in the course of the providing services under this Agreement. "Any
vehicle"shall be any vehicle owned, hired and non-owned
(c) Worker's Compensation
Statutory limits Employer's
liability
$100,000 Each accident/occurrence
$100,000 Disease-per each employee
$500,000 Disease-policy limit
This coverage may be written as follows:
Workers' Compensation and Employers' Liability coverage with limits consistent with
statutory benefits outlined in the Texas workers' Compensation Act (Art. 8308 — 1.01 et seq.
Tex. Rev. Civ. Stat.) and minimum policy limits for Employers' Liability of$100,000 each
accident/occurrence, $500,000 bodily injury disease policy limit and $100,000 per disease per
employee
(d) Professional Liability(Errors&Omissions)
$1,000,000 Each Claim Limit
$1,000,000 Aggregate Limit
Professional Liability coverage may be provided through an endorsement to the
Commercial General Liability (CGL) policy, or a separate policy specific to
Professional E&O. Either is acceptable if coverage meets all other requirements.
Coverage shall be claims-made, and maintained for the duration of the
contractual agreement and for two(2)years following completion of services provided.
An annual certificate of insurance shall be submitted to the City to evidence coverage.
10.2 Certificates.
Certificates of Insurance evidencing that the Contractor has obtained all required
insurance shall be delivered to the City prior to Contractor proceeding with any work
pursuant to this Agreement. All policies except Workers' Compensation and
Professional Liability shall be endorsed to name the City as an additional insured
thereon, as its interests may appear. All policies shall contain a Waiver of Subrogation for
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the benefit of the City of Fort Worth. The term City shall include its employees, officers,
officials, agent, and volunteers in respect to the contracted services. Any failure on the part of
the City to request required insurance documentation shall not constitute a waiver of the
insurance requirement. A minimum of thirty(30) days' notice of cancellation or reduction in
limits of coverage shall be provided to the City. Ten (10) days' notice shall be acceptable
in the event of non-payment of premium. Such terms shall be endorsed onto Contractor's
insurance policies. Notice shall be sent to the Risk Manager, City of Fort Worth, 1000
Throckmorton, Fort Worth, Texas 76102, with copies to the City Attorney at the same
address.
11. COMPLIANCE WITH LAWS. ORDINANCES.R AND REGULATIONS.
Contractor agrees to comply with all applicable federal, state and local laws, ordinances, rules
and regulations. If the City notifies Contractor of any violation of such laws, ordinances, rules or
regulations, Contractor shall immediately desist fi•om and correct the violation.
12. NON-DISCRIMINATION COVENANT.
Contractor,for itself, its personal representatives,assigns, subcontractors and successors in interest,
as part of the consideration herein, agrees that in the performance of Contractor's duties and obligations
hereunder, it shall not discriminate in the treatment or employment of any individual or group of individuals
on any basis prohibited by law including Chapter 17, Article III of the Code of the City of Fort Worth. If
any claim arises from an alleged violation of this non-discrimination covenant by Contractor, its personal
representatives, assigns, subcontractors or successors in interest, Contractor agrees to assume such
liability and to indemnify and defend the City and hold the City harmless from such claim.
13. NOTICES.
Notices required pursuant to the provisions of this Agreement shall be conclusively determined to
have been delivered when (1) hand-delivered to the other party, its agents, employees, servants or
representatives,(2)delivered by facsimile with electronic confirmation of the transmission,or(3)received
by the other parry by United States Mail,registered,return receipt requested, addressed as follows:
To CITY: To CONTRACTOR:
City of Fort Worth SL-Serco, Inc.
Attn: Jesus Chapa Attn: Laurie Allen
1000 Throckmorton Street 2817 Anthony Lane S
Fort Worth, TX 76102-6311 Suite# 104
Facsimile: (817)392-8654 St. Anthony, MN 55418
Phone: 612-709-6107 or 912-618-4747
Fax: 612-782-9782
14. SOLICITATION OF EMPLOYEES.
Neither the City nor Contractor shall, during the term of this agreement and additionally for a
period of one year after its termination, solicit for employment or employ, whether as employee or
independent contractor, any person who is or has been employed by the other during the term of this
agreement,without the prior written consent of the person's employer.
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15. GOVERNMENTAL POWERS.
It is understood and agreed that by execution of this Agreement, the City does not waive or
surrender any of its governmental powers.
16. NO WAIVER.
The failure of the City or Contractor to insist upon the performance of any term or provision of
this Agreement or to exercise any right granted herein shall not constitute a waiver of the City's or
Contractor's respective right to insist upon appropriate performance or to assert any such right on any future
occasion.
17. GOVERNING LAW/VENUE
This Agreement shall be construed in accordance with the internal laws of the State of Texas. If
any action, whether real or asserted, at law or in equity, is brought on the basis of this Agreement, venue
for such action shall lie in state courts located in Tarrant County, Texas or the United States District Court
for the Northern District of Texas, Fort Worth Division.
18. SF.VERABIL.ITY.
If any provision of this Agreement is held to be invalid, illegal or unenforceable, the validity,
legality and enforceability of the remaining provisions shall not in any way be affected or impaired.
19. FORCE MAJEURE.
The City and Contractor shall exercise their best efforts to meet their respective duties and
obligations as set forth in this Agreement, but shall not be held liable for any delay or omission in
performance due to force majeure or other causes beyond their reasonable control (force majeure),
including, but not limited to, compliance with any government law, ordinance or regulation, acts of God,
acts of the public enemy, fires, strikes, lockouts, natural disasters, wars, riots, material or labor
restrictions by any governmental authority,transportation problems and/or any other similar causes.
20. HEADINGS NOT CONTROLLING.
Headings and titles used in this Agreement are for reference purposes only and shall not be
deemed a part of this Agreement.
21. AMENDMENTS/MODIFICATIONS/EXTENSIONS.
No extension, modification or amendment of this Agreement shall be binding upon a party hereto
unless such extension,modification,or amendment is set forth in a written instrument,which is executed by
an authorized representative and delivered on behalf of such party.
22. ENTIRETY OF AGRFTMENT.
This Agreement, including the schedule of exhibits attached hereto and any documents
incorporated herein by reference, contains the entire understanding and agreement between the City and
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Contractor, their assigns and successors in interest, as to the matters contained herein. Any prior or
contemporaneous oral or written agreement is hereby declared null and void to the extent in conflict
with any provision of this Agreement.
24. SIGNATURE AUTHORITY.
The person signing this agreement hereby warrants that he/she has the legal authority to execute
this agreement on behalf of the respective party, and that such binding authority has been granted by proper
order, resolution, ordinance or other authorization of the entity. The other party is fully entitled to rely on
this warranty and representation in entering into this Agreement.
[SIGNATURE PAGE FOLLOWS]
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IN ITNESS WHEREOF, the parties hereto have executed this Agreement in multiples thij, y of
16.
ACCEPTED AND AGREED:
CITY OF FORT WORTH: SL-SERCO,INC.
By: ��.•�6J C��
Jesus J. Chapa % By:
Assistant City Manager rie Allen, CFO
Date:
A4
Date. l
APPROVAL RECOMMENDED:
WITNESS:
By:
-44a&,—
Joyn Robert Carman
By:
Water Director Name: -C7A1`yL> 141,1
Title:
Date: 9 . Z f
APPROVED AS TO FORM AND
LEGALITY:
By:"-
Christa opez-Reynolds
Senior Assistant City Attorney
Date:
l
ATTEST: � .
$o S
By: aryU � ;a
City Secr6fary 7 �`�
Date:
1
M&C:
Date: 0o -colt
it
Professional Services Agreement r,
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M&C Review Page 1 of 2
Official site of the City of Fort Worth,Texas
CITY COUNCIL AGENDA FORTTII
COUNCIL ACTION: Approved on 9/20/2016
DATE: 9/20/2016 REFERENCE NO.: **C-27936 LOG NAME: 60SL SERCO
CODE: C TYPE: CONSENT PUBLIC HEARING: NO
SUBJECT: Authorize Professional Services Agreement with SL-serco, Inc., in the Amount of
$175,000.00 Annually to Support the City's My H2O Advanced Metering Infrastructure
Program (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council authorize execution of a Professional Services Agreement with SL-
serco, Inc. in the amount of$175,000.00 annually for services to support the City's My H2O Advanced
Metering Infrastructure Program with up to five annual contract renewals (six years total).
DISCUSSION:
In 2015, an Professional Services Agreement was executed with SL-serco, Inc., for services related to the
preparation and review of a Request for Qualifications (RFQ) for a system integrator for the program. On
January 4, 2016, a subsequent Professional Services Agreement was administratively approved with SL-
serco, Inc. in the amount of$48,500.00 annually (City Secretary Contract No. 47446). The Agreement
included up to five annual renewals. The contract provided for technical assistance related to the My H2O
Program a city-wide Advanced Metering Infrastructure project . The program is being implemented in multiple
phases including planning and design, pilot implementation, full deployment (2 phases) and final assessment.
Through the term of the initial Agreement, SL-serco, Inc., has served as a valuable partner assisting the City
with vendor procurement, negotiating the final scope of work for the selected program integrator, and
identifying areas of risk. This Agreement provides additional funding to support the Utility's efforts throughout
implementation. The consultant brings strong technical and systems operations expertise to the overall
project team. Through this Agreement, SL-serco, Inc., will provide support for business process
transformation activities and system implementation oversight. The consultant will also provide technical
expertise related to multiple system integrations, identifying ongoing efficiencies in Utility operations, facilitate
system testing, and other related services.
M/WBE Office: A waiver of the goal for MBE/SBE subcontracting requirements was requested by the
Department and approved by the M/WBE Office, in accordance with the BIDE Ordinance, because the
purchase of goods or services from source(s)where subcontracting or supplier opportunities are negligible.
This proposed term of this Agreement supports the My H2O Program's anticipated schedule:
2016 Phase 1 Planning and Design
2017 Phase 2 Pilot Implementation
2018—2019 Phases 3 & 4 Full Implementation
2020 Phase 5 Evaluation/Assessment/Program Close-out
This project is located in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
http://apps.foi-twol-thtexas.gov/council_packet/mc_review.asp?ID... 9/21/2016
M&C Review Page 2 of 2
The Director of Finance certifies that the appropriations are available as directed by M&C G-18625 in the
TWDB SWIRFT Fund for Phases 1 and 2 of the Advanced Metering Infrastructure Project. Appropriations for
this project by fund will consist of the following:
Current Future
FUND Appropriations Appropriations Project Total"
Water Capital Fund 59601 $24,500.00 $0.00 IF $24,500.00
TWDB SWIRFT Fund $12,301,421.00
57005 $o.00 $12,301 ,421 .00
Future TWDB SWIRFT ---$O--00]$60,140,207.00 $60,140,207.00
Project $12,325,921 .00 $60,140,207.00 $72,466,128.00
Total
TO
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year Chartfield 2)
FROM
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year (Chartfield 2
Submitted for City Manager's Office by: Jay Chapa (5804)
Originatinq Department Head: John Carman (8246)
Additional Information Contact: Madelene Rafalko (5467)
ATTACHMENTS
60SLserco Form 1295.pdf
http://apps.foi-twoi-thtexas.gov/council—Packet/mc_review.asp?ID... 9/21/2016
CERTIFICATE OF INTERLSTED PARTIES
FORM 1295
10f1
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. 2016-88800
SL-serco, Inc.
St.Anthony, MN United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 07/21/2016
being filed.
City of Fort Worth 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.
47446
Project SWIFT, Project#51014,Advanced Metering Infrastructure Project
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
Allen, Laurie St.Anthony, MN United States X
Allen, David St.Anthony, MN 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.
<*°Eb*,,� CAROLE LOIS ART
-� Notary Public
State of Minnesota
My Commission Expires
January 31, 2019 _ r—
Signature of au horized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said this the day of J \
20- 1(, to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer ad inistering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277
City of Fort Worth
Departmental Request for Waiver
Of MBE/SBE Subcontracting/Supplier goal
Water Department $175,000.00 N/A
DEPARTMENT NAME: ESTIMATED COST / PROPOSAL DATE
City of Fort Worth Advanced Metering Infrastructure Project(AMI) SWIFT/#51014
ME OF PROJECT/BID: DOE/PROJECT NO.
\AAkhr��J�
5467 08/19/2016 285.01
SIGNATURE OF/PROJECT MANAGER EXTENSION DATE NIGP CODE
Prior to advertisement the contracting/managing department shall determine whether the bid/proposal is one which MBE/SEB
requirements should not be applied. MBEMBE requirements may be waived upon written approval of the M/WBE Manager,.If one
of the conditions listed below exists,the oontracting/managing department shall notify the Manager via this form,stating the specific
reason(s)for requesting a waiver.
If the contracting/managing department and the Manager are in conflict over the granting of a waiver, either
may appeal to the City Manager, or designee, and his/her decision is final.
Please Check Applicable Reason:
A. MWBE Office: A waiver of the goal for MBE/SBE subcontracting requirements was requested
by the Department and approved by the MWBE Office, in accordance with the M/WBE or BDE
Ordinance, because the public or administrative emergency exists which requires the goods or
services to be provided with unusual immediacy; or
X B. MWBE Office, A waiver of the goal for MBE/SBE subcontracting requirements was requested
by the Department and approved by the MWBE Office,in accordance with the M/WBE or BDE
Ordinance, because the purchase of goods or services from source(s)where subcontracting or
supplier opportunities are negligible; or
C. MWBE Office: A waiver of the goal for MBE/SBE subcontracting requirements was requested
by the Department and approved by the MWBE Office, in accordance with the M/WBE or BDE
Ordinance, because the application of the provisions of this ordinance will impose an economic
risk on the City or unduly delay acquisition of the goods or services; or
D. MWBE Office: A waiver of the goal for MBE/SBE subcontracting requirements was requested
by the Department and approved by the MWBE Office, in accordance with the M/WBE or BDE
Ordinance, because the MWBE Waiver is solicited based on the sole source information
provided to the MWBE Office by the managing department's project manager,
Justify Coinmodity or Service Waiver Request:
The Consultant shall provide technical assistance supporting the planning,design,purchase and full deployment of the City-Wide AMI System.
This will Include advanced metering technology features In the support of the FWWD leadership,as well as preparation and evaluating program
component design and functionalliy. The prime consultant will utilize Its own employees to perform these services. Therefore,subcontracting opportunities are Negligible.
Please use additional sheets,if napded
M/W E OFFICE USE ONLY: !�
Approved Signature fO/W Authorize Personnel Date
Not Approved Signature of M/WBE Authorized Personnel Date
3
Roy,2.20.1