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HomeMy WebLinkAboutContract 52893 Purchase No. SS-PO-101978-R3 CITY OF FORT WORTH CITY SECRETARY REQUEST TO EXERCISE RENEWAL OPTION CONTRACT N0. 5 September 26, 2019 Environmental Improvements Inc. Attn: Michael Carpenter 517 N. Kealy Lewisville, TX 75057 Re: Contract Renewal Notice Purchase No. SS-PO-10 1 978-R3 (the "Contract") Renewal Term No. 3: October 12, 2019 to October 11, 2020 The above referenced Contract with the City of Fort Worth expires on October 11, 2019 (the "Expiration Date"). Pursuant to the Contract, contract renewals are at the mutual agreement of the parties. This letter is to inform you that the City is requesting to renew the Contract, inclusive of the terms and conditions as set forth in the original ITB, 16-0372, for an additional one (1) year period, which will begin immediately after the Expiration Date. All other terms and conditions of the Contract remain unchanged. To agree to renew the Contract for an additional one(1)year period, please sign and return this request to exercise renewal option, along with a copy of your current insurance certificate, to the address set forth below. Please log onto PeopleSoft Purchasing at http://fortworthtexas.gov/purchasing to insure that your company information is correct and up-to-date. If you have any questions concerning this Contract Renewal Notice, please contact me at the telephone number listed below. Sincerely, V&W Saes Monica Saenz/Admin Assistant 817-392-8267 OCT " OFFICIAL RECORD CITY SECRETARY FT. WORTH,TX Contract Renewal Page 1 of 2 Purchase No, SS-PO-10 1 978-R3 ACCEPTED AND AGREED: CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract,including By: _ ensuring all perfonnance and reporting Name: Dana Burgooffy requirements. Title: Interim Assistant City Manager By: APPROVAL RECOMMENDED: Name: Ma to Phillips �� I�/ Title: Engineering Manager By: (_ Name: Chris Harder APPROVED AS TO FORM AND Title: Water Director LEGALITY: By: Name: Charly Angadicheril By: Title: Assistant Water Director Name: Doug Black Title: Assistant City Attorney ATTEST: CONTRACT AUTHORIZATION: M&C: f_�8 Ld;55 IORT Ali , Date Approved: By: 1 Name tylec*rearry� l .Form 1295 Certification No.: ,¢ Title: Ci U By. Name: Title: _,,y�nu����u.-��s /fr.✓. OFFICIAL RECOR-1 CITY SECRETARY Contract Renewal Page 2 of 2 Form Request for Taxpayer Give Form to the (Rev.October2o18) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service ►Go to www.irs.gov/FormW9 for instructions and the latest Information. t Name(as shown on your Income tax return).Name is required on this line;do not leave this line blank. ENVIRONMENTAL IMPROVEMENTS, INC, _ 2 Business name/disregarded entity name,if different from above M 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to following seven boxes. certain entities,not individuals;see n instructions on page 3): p ❑ Individual/sole proprietor or 0 C Corporation ❑ S Corporation ❑ Partnership ❑Trust/estate yr single-member LLC Exempt payee code(if any) �. o 0 ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)► p` Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting a LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is ( y) C i another LLC that is not disregarded from the owner for U.S,federal tax purposes.Otherwise,a single-member LLC that code f an tl ,� is disregarded from the owner should check the appropriate box for the tax classification of its owner. ❑ Other(see instructions)► � (Apples to xcawa mYnfunsd wlvde IM U 5 rn 5 Address(number,street,and apt,or suite no.)See Instructions. Requester's name and address(optional) 1183 13RITTMOORE RD., STE. 100 MAILING: PO BOX 79266 6 City,state,and ZIP code HOUSTON,TX 77043 HOUSTON,TX 77279 7 List account numbers)here(optional) Tax ayer Identification Number(TiN Enter your TiN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup withholding,sole .For individuals,this is generally your social security number(SSNr.However,for a —M —� resident alien,sole proprietor,or disregarded entity,see the instructions for Para I,later.For other entities,it Is your employer'identification number(EIN),If you do not have a number,see How to get a TIN, later, or Note:If the account is in more than one name,see the instructions for fine 1.Also see What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter. 7 4 - 1 5 4 6 8 Z 3 Certification Under penalties of perjury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that 1 am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3.1 am a U.S.citizen or other U.S,person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting Is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part II,later, Sign signature of1� ./�•'��� L Here U.S.person► �(/L( r�' r Date► General Instructions - Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise -Form 1099-MISC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments .Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and Its instructions,such as legislation enacted transactions by brokers) after they were published,go to www.irs.gov/FormW9. .Form 1099-S(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An Individual or entity(Form W-9 requester)who is required to rile an - Form 1098(home mortgage interest), 1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1096-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption .Form 1099•A(acquisition or abandonment of secured property) taxpayer identification number(ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an Information return.Examples of Information alien),to provide your correct TIN. returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat.No.10231 X Form W-9(Rev.10-2016) City of Fort Worth, Texas Mayor and Council Communication COUNCIL ACTION: Approved on 10/11/2016 DATE: Tuesday, October 11, 2016 REFERENCE NO.: **P-11948 LOG NAME: 13P16-0372 CHLORINATOR PARTS MJR WATER SUBJECT: Authorize Sole Source Purchase Agreement with Environmental Improvements, Inc. d/b/a El 2, for a Total Amount Up to $65,000.00 for the First Year for OEM Wallace and Tiernan Chlorinator and Ammonia System Parts for the Water Department(ALL COUNCIL DISTRICTS) RECOMMENDATION: It is recommended that the City Council authorize a Sole Source Purchase Agreement with Environmental Improvements, Inc. d/b/a El 2, for a total amount up to $65,000.00 for the first year for OEM Wallace and Tiernan chlorinator and ammonia system parts for the Water Department. DISCUSSION: The Water Department will use this Agreement to purchase Original Equipment Manufacturer(OEM)Wallace Tiernan chlorinator and ammonia feed system replacement parts for the Eagle Mountain Water Treatment Plant(EMWTP). Environmental Improvements, Inc., is the documented Sole Source provider for OEM Wallace and Tiernan replacement parts in the Texas region. The Agreement includes detailed specifications describing the OEM Wallace and Tiernan chlorinator and ammonia feed systems located at EMWTP requiring replacement parts. No guarantees were made that a specific amount of required items would be purchased. Items will be ordered on an as-needed basis. PRICE ANALYSIS - There is no previous comparable pricing awarded. Water Department staff reviewed the proposed pricing and certified that the prices offered are fair and reasonable. ADMINISTRATIVE CHANGE ORDER-An administrative change order or increase may be made by the City Manager in the amount up to $16,250.00 and does not require specific City Council approval as long as sufficient funds have been appropriated. M/WBE OFFICE -A waiver of the goal for MBE/SBE subcontracting requirements was requested by the Purchasing Division and approved by the M/WBE Office, in accordance with the BDE Ordinance,because the M/WBE Waiver is based on the Sole Source information provided to the M/WBE Office by the Purchasing Division Buyer. AGREEMENT TERMS -Upon City Council approval,this Agreement shall begin on October 12, 2016 and end on October 11,2017. RENEWAL OPTIONS -This Agreement may be renewed for up to four successive one-year terms at the City's option. This action does not require specific City Council approval provided that the City Council has appropriated sufficient funds to satisfy the City's obligations during the renewal term. FISCAL INFORMATION/CERTIFICATION: The approval of this action provides purchasing authority up to$65,000.00, as specified. The Director of Finance certifies that funds are available in the current operating budget, as appropriated, of the Water and Sewer Fund and that prior to an expenditure being made, the Water Department has the responsibility to validate the availability of funds. BQN\\ FUND IDENTIFIERS (FIDs): 19 Department Account Project Program Activity Budget Reference# Amount Fund ID ID year (Chartfield 2) FR M Department Account Project Program Activity Budget Reference# Amount Fund ID ID year (Chartfield 2) CERTIFICATIONS: Submitted for City Manager's Office by: Jay Chapa (5804) Originating Department Head: Aaron Bovos (8517) Additional Information Contact: Jack Dale (8357) Jane Rogers (8385) ATTACHMENTS 1. 16-0372 MWBE Waiver. f (CFw Internal) 2. Environmental Imp 1295 Form.pdf (Pubiiol 3. Environmental Imp EPLS 16.12df (CFw Internal) 4. Environmental Imp SS 16.pdf (CFw internal) 5. Water-16-00354113.pdf (CFwinternal) FORT WORTH. CITY OF FORT WORTH/PURCHASING DIVISION INVITATION TO BID NO. 16-0372 OEM WALLACE AND TIERNAN CHLORINATOR AND AMMONIA SYSTEM REBUILD BID CLOSING DATE: AUGUST 25,2016 For further information contact: Jane Rogers, Sr. Buyer (817)392-8385 FAX(817)392-8440 jane.rogers@fortworthtexas.gov INSTRUCTIONS TO BIDDERS Bids are solicited for furnishing the merchandise, supplies, services and/or equipment set forth in this solicitation. Completed Bids (one (1) executed original and two (2) copies) must be received in the Purchasing Office by 1:30 P.M.,August 25,2016,and then publicly opened and read aloud at 2:00 P.M. in the Council Chambers. Bids must be returned in a sealed envelope, addressed to the Purchasing Manager, City of Fort Worth, and have the bid number, closing date, and company name clearly marked on the outside envelope. Bids should be mailed or hand delivered to the following address: Purchasing Division, Lower Level, Municipal Building 1000 Throckmorton Street Fort Worth,Texas 76102 Bids to be delivered by special courier(i.e. Federal Express, Special Delivery, etc.)are to be marked "BID MUST BE DELIVERED TO PURCHASING DIVISION BEFORE 1:30 P.M."in order to be considered. Late bids will be returned; they will not be opened nor considered in the evaluation of the bid. Bids may be withdrawn at any time prior to the official opening. Bids may not be altered, amended or withdrawn after the official opening. The undersigned agrees, if the bid is accepted, to furnish any and all items upon which prices are offered, at the price(s) and upon the terms and conditions contained in the specifications. The period for acceptance of this bid will be 90 calendar days after the bid opening date unless the bidder submits a different date. ( days). I have read and agreed with the attached Terms and Conditions, Instruction to Bidders and the Invitation to Bid requirements. Failure to complete the requested information below may result in resection of your bid. Principal Place of Business (Defined as at least having one permanent active business office and employee located in Texas). Company Name and Address Company's Authorized Agent Signature: Federal ID Number(TIN) Name and Title(Typ6d Printed) (,-,q ro t*t 0— Social Security Number and Legal: Company Name: vtrc rnrt� 1-rn lGtJLr»err inc.. Date: Telephone Number: 9-la-9 36,-JLS-3 Fax Number: Email address: S,c Cooperative Purchasing: Should other Governmental Entities decide to participate in this contract,w you, the Vendor, agree that all terms, conditions, specifications, and pricing would apply? Yes No If you, the Vendor checked "Yes," the following will apply: Governmental entities within utilizing Inter-Governmental Contracts with the City of Fort Worth will be eligible, but not obligated, to purchase material/services under this contract(s)awarded as a result of this solicitation. All purchases by Governmental Entities other than the City of Fort Worth will be billed directly to that Governmental Entity and paid by that Governmental Entity. The City of Fort Worth will not be responsible for another Governmental Entity's debts. Each Governmental Entity will order its own material/services as needed. Jack Dale, JD, CPPO Purchasing Manager Page 1 of 17 BID SOLICITATION Printed:08/0212016 BID OPENING DATE AND TIME: 8126120161:30:00 PM BID NUMBER: 16-0372 BUYER:Jane Rogers PHONE C (817)392-8385 DELIVERY REQUIRED:8/25/2016 V Vendor Name: S City of Ft Worth En rcar�rn eK re1 F L e 1' f ' H N Address: tA,t! 1 6801 BOWMAN ROBERTS ROAD A;D j E 7 t,4t, P FORT WORTH TX 76179 R City,State Zip Code: ti� 11 e 1)X '751'Y7 T Item Class-Item Quantity Unit Unit Price Total 188.000 The City of Fort Worth is seeking bids from qualified Vendors for an annual Agreement for OEM Wallace and Tiernan Chlorinator and Ammonia System Rebuild.The Agreement will be for one(1),one-year period with options to renew for up to four(4)additional one-year periods. All items shall be bid per attached specifications. 1.000 10,000 LB.V2000 CHLORINATOR WITH 3 INCH INJECTORS REBUILD 4 EA t,63 REPAIR PARTS,O-RING 012 BUNA-N P/N W2T376757 2.000 O-RING HYPALON P/N W2T37592y V 24 EA Z­ ISO 14 3.7�_ 3.000 GASKET,KOROSEAL PIN W2T19811 4 EA Sam A3. 4 Li 4.000 GASKET,KOROSEAL 4 EA Ll 0-1 PIN W2T17286 5,000 O-RING 119 VITON 4 EA PIN W2T16731 6.000 GASKET TEFLON P/N W2T19780 20 EA C4J 7,000 SPRINGS P/N W2T17195 4 EA 8.000 SHAFT SEAL PIN W2T160507 4 EA � 9.000 GASKET P/N W2T13189 4 EA Page 2 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8125120161:30:00 PM BID NUMBER: 1"372 BUYER:Jane Rogers PHONE#: (817)392-8385 DELIVERY REQUIRED:8/25/2016 V Vendor Name: S City of Ft Worth E H N Address: i 6801 BOWMAN ROBERTS ROAD D P FORT WORTH TX 76179 0 City,State Zip Code: R T Item Class-Item Quantity Unit Unil Price Total 10.000 O-RING 170 HYPALON P/N W2T14248 4 EA •J I ��j4� N 11.000 DIAPHRAGM ASSY P/N W3T110042 4 EA 12.000 GASKET P/N W2T19780 4 EA 13.000 DIAPHRAGM ASSY P/N W3T107679 4 EA a`$ (c 11gg. 14.000 0-RING 170 HYPALON P/N W2T14248 4 EA 115 15.000 0-RING 113 VITON P/N W2T11777 4 EA A 16.000 SPRING P/N W2T375973 4 EA 35. 17.000 GASKET P/N W2T19780 8 EA '5(c Ss • (p 18.000 RING GASKET PIN W2T376066 8 EA 11." r y_O. ' (� 19.000 GASKET P/N W2T17266 4 EA y_q1 19.g$ 20.000 GASKET PIN W2T19808 8 EA1-103 21.000 SPRING P/N W2T17900 4 EA a .$y1. i Page 3 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8/26/20161:30:00 PM BID NUMBER:16-0372 BUYER:Jane Rogers PHONE#: (817)392-8385 DELIVERY REQUIRED:8/26/2016 V Vendor Name: S City of Ft Worth E H N Address: 1 6801 BOWMAN ROBERTS ROAD D P FORT WORTH TX 76179 City,State Zip Code: R T Item Class-Item Quantity Unit Unit Price Total 22.000 STEM UNIT P/N W2T8122 4 EA 7 j:, � w4 23.000 SEAT,TEFLON PIN W2T12138 4 EA 419y ,l�.5.A 24.000 O-RING 156 HYPALON P/N W2T15623 4 EA MAO �j-7,$Li 25.000 DIAPHRAGM PIN W3T107827 4 EA 00,OLA 4 oo, tlp 26.000 SPRING PIN W2T17594 4 EA 40A,(cs 1 10+ Go 27,000 STEM,PVC PIN W2T12140 4 EA oa-i s , 28.000 SEAL,TEFLON PIN W2T19743 4 EA ,,,,(p (a.w4 29.000 GASKET P/N W2T375791 3 EA 1)1 a 30.000 RING GASKET P/N W2T16104 6 EA S1 , 16 31..000 3,000 I.B.V2000 CHLORINATOR WITH 2 INCH INJECTORS REBUILD 4 EA CS �3.t REPAIR PARTS,RING,ROTAMETER SEAL P/N W2T375962 32.000 O-RING HYPALON PIN W2T16760 7 EA c • �p�,�� 33.000 SPRING,VACUUM VALVE PIN W2T375957 4 EA Page 4 of 17 BID SOLICITATION _ Printed:08/02/2016 BID OPENING DATE AND TIME: 8126/2016 1:30:00 PM BID NUMBER: 16-03T2 BUYER:Jane Rogers PHONE#: (817)392-8385 DELIVERY REQUIRED:8/26/2016 V Vendor Name: IPFORT ity of Ft Worth E N Address: 01 BOWMAN ROBERTS ROAD D WORTH TX 76179 O City,State Zip Code: R Item Class-Item Quantinit Unit Price Total 34.000 GASKET PIN W2T16755 4 EA ,a 1(9.Cl(c 35.000 O-RING 318 HYPALON PIN W2T19365 4 EA LI,SaQ � 36.000 SHAFT SEAL P/N W2T16507 4 EA .a 37.000 0-RING 222 HYPALON PIN W2T12130 4 EA 38,000 0-RING 324 HYPALON PIN W2T19038 4 EA I.t�J 40c) LIiJ 39.000 O-RING 025 HYPALON P/N W2T11660 4 EA 4(p i-7 40.000 ROTAMETER GASKET PIN W2T16760 8 EA �_� -73,7(0 41,000 ROTAMETER GASKET PIN W2Ti6151 8 EA a,lOD ply 4 y 42.000 GASKET,V-NOTCH PLUG PIN W2T16509 4 EA 43.000 0-RING,V-NOTCH PLUG P/N W2T19028 4 EA -1 19.6 o 44,000 O-RING P/N W2T12130 4 EA IT..34 (1�1 (0 45,000 BIAS SPRING P/N W2T376136 4 EA IO-0\ 44 0.C). Page 5 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8125/20161:30:00 PM BID NUMBER-16.0372 BUYER:Jane Rogers PHONE* (817)392-8385 DELIVERY REQUIRED:8l2512016 V Vendor Name: S City of Ft Worth E H N Address: 1 6801 BOWMAN ROBERTS ROAD D p FORT WORTH TX 76179 City,State Zip Code: R T 101 Item Class-Item Quantity Unit Unit Price Total 46.000 RETURN SPRING PIN W2T13688 4 EA tp�,(^ a 0.3 a 47.000 DIAPHRAGM HYPALON P/N W2T15239 4 EA D 48.000 GASKET PIN W2T9795 4 EA 49.000 DIAPHRAGM FOR CHLORINE PIN W2T15240 4 EA � ]� �� 0() 50,000 O-RING 010 HYPALON PIN W2T15233 4 EA ^(0 W, 51.000 0-RING 122TFE PIN W2T17172 4 EA ,,�g al 52.000 STEM UNIT FOR CHLORINE PIN W2T8124 4 EA , $ --�)a• -3a 53,000 MAIN SPRING PIN W2T14909 4 EA 54,000 STRAINER PIN W2T376041 4 EA 55,000 BUSHING GUIDE PIN W2T18787 4 EA 56.000 LEAD GASKET PIN W2T376042 4 EA 57.000 O-RING 170 HYPALON PIN W2T14248 4 EA _ �, y Page 6 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8/25120161:30:00 PM BID NUMBER: 1"372 BUYER:Jane Rogers PHONE#: (817)392-8385 DELIVERY REQUIRED:8/25/2016 V Vendor Name: S City of Ft Worth E H N Address: i 6801 BOWMAN ROBERTS ROAD O P FORT WORTH TX 76179 0 City,State Zip Code: R T 0 Item Class-Item Quantity Unit Unit Price T Total 58.000 DIAPHRAGM P/N W2T12161 4 EA 14(o,93 G 7, '7 59.000 GASKET,SEAL PIN W2T16497 12 EA UA_ 131 3a _ 60.000 DISC,SEALING PIN W2T19734 4 EA 6S-1 1q 360 76 61.000 DISC,STEM P/N W2T19735 4 EA Q3.99 qs,. 9 a 62.000 O-RING 232 VITON PIN W2T13588 4 EA ,ga 63.000 0-RING 5-457 HYPALON PIN W2T14062 4 EA 1 .00 69,00 64.000 RELIEF SPRING PIN W2T15252 4 EA 2(00.4S So 0 65.000 RING GASKET P/N W2T375928 4 EA J. Ig ca3.9(e 66.000 GASKET PIN W2T15255 4 EA , %o.ocj 67.000 DIAPHRAGM P/N W2T14904 4 EA I&I 1ol 195. (og 68.000 O-RING 013 VITON P/N W2T376717 4 EA Q,% 0 �j�_ 69,000 SPRING PIN W2T376141 4 EA ag_._9 9 21 9(0 Page 7 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8125120161:30:00 PM BID NUMBER: 16-0372 BUYER:Jane Rogers PHONE#: (817)392-8385 DELIVERY REQUIRED:8/25/2016 V Vendor Name: S City of Ft Worth E H N Address: i 6801 BOWMAN ROBERTS ROAD D P FORT WORTH TX 76179 0 City,State Zip Code: R T Item Class-ttem Quantity Unit Unit Price Total 70.000 O-RING 228 BUNA-N 11 EA l a IS -9-7 P/N W2T19274 71.000 O-RING 110 BUNA-N PIN W2T16578 11 EA 0-1g _.4�_ 72.000 O-RING 148 BUNA-N P/N W2T17502 11 EA 1 .19 11 .52 73.000 SPRING P/N W2T15244 11 EA 1 1_G!!��_I 74.000 O-RING 210 TEFLON P/N W2T13555 11 EA L4 G4 S1otj � 75.000 RING GASKET P/N W2T15623 11 EA 76.000 GASKET SEAL P/N W2T375955 11 EA 77.000 DIAPHRAGM P/N W2T11991 11 EA a9.99 a7y• �q 78.000 GASKET PIN W2T16384 4 EA �p• Jp( as,�� 79.000 GASKET P/N W2T18054 4 EA 80.000 O-RING VITON 012 P/N W2T11775 8 EA 81.000 GASKET P/N W2T11775 8 EA Page 8 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8126120161,30,00 PM BID NUMBER:164372 BUYER:Jane Rogers PHONE* (817)392-8385 DELIVERY REQUIRED:8/25/2016 V Vendor Name: S City of Ft Worth E H N Address: 1 6801 BOWMAN ROBERTS ROAD D p FORT WORTH TX 76179 City,State Zip Code; R T Item Class-Item Quantity Unit Unit Price Total 82.000 LEVEL PROBE P/N W3T109321 4 EA GS_.w _ qv go 83.000 LEVEL PROBE PIN W3T109324 4 EA 79.2-1 84.000 LEVEL PROBE PIN W3T109328 4 EA 771al all ( 85.000 LEVEL PROBE PIN W3T109331 4 EA 'I I. < }'s6,a 86.000 TEMPERATURE PROBE PIN W3T107903 4 EA Q0,5 104171, 87.000 GASKET PIN W2T15004 4 EA 3,51 88.000 RUPTURE DISK PIN W2T15213 4 EA t e cm _ 7•q� 89.000 AMMONIA FEED SYSTEM REBUILD REPAIR PARTS,SPRING SEAT 5 EA (Q H GLI-1 70 PIN W2T14134 90.000 SPRING PIN W2T375808 5 EA 41.S7 at(,,$S 91.000 SEGMENT HOLDER PIN W2T14136 5 EA 11" 9000,10 92.000 SEGMENT PIN W2T14135 128 EA a,2� SQ, Page 9 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8125120161:30:00 PM BID NUMBER: 164372 BUYER:Jane Rogers PHONE#: (817)392-8385 DELIVERY REQUIRED:8/25/2016 V Vendor Name: S City of Ft Worth E H N Address: 1 6801 BOWMAN ROBERTS ROAD D P FORT WORTH TX 76179 O City,State Zip Code: R T Item Class-Item Quantity Unit Unit Price Total 93.000 OUTER DIAPHRAM PIN W2T14892 8 EA �3 3! }$ 94.000 INNER DIAPHRAM PIN W2T14137 8 EA 5140 441 95.000 O-RING PIN W2T 18580 8 EA O,S3 -7,0 y 96.000 VACUUM SUPPORT PLATE PIN W2T14888 5 EA 113.00 715 100 97.000 O-RING 259 BUNA PIN W2T14891 8 EA .. S .Li3 98.000 GUIDE BUSHING PIN W2718787 5 EA ag.o5 190, as 99.000 LEAD GASKET PIN W2T376042 8 EA 91110 '73,a$ 100.000 SPRING PIN W2T376003 5 EA u y 3 63a.t s 101,000 STEM UNIT PIN W2T8124 5 EA 178.08 9cla,y0 102.000 STEM UNIT CARTRIDGE PIN W2T19453 5 EA a93,$� 103,000 O-RING 122 TFFI ON PIN W2T17172 8 EA 71-)fi ✓1 SH S.L 104.000 STRAINER PIN W2T376041 8 EA L±1a 35-a (P Page 10 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: W2W20151:30:00 PM BID NUMBER: 16-0372 BUYER:Jane Rogers PHONE* (817)392-8385 DELIVERY REQUIRED:8/25/2016 V Vendor Name: S City of Ft Worth E H N Address: 1 6801 BOWMAN ROBERTS ROAD D P FORT WORTH TX 76179 0 City,State Zip Code: R T Item Class-Item Quantity Unit Unit Price Total 105.000 VAREA-METER TUBE,CONN,P/N W2T10361 2 EA ' DAIS t. 3(1-1 106.000 STEM SPACER P/N W2T10374 7 EA 63- 1 �-t 7.39 107.000 MANIFOLD P/N W2T9698 2 EA iluo 7 y a,ab 108.000 HOLDER,ORIFICE P/N W2T15672 2 EA 3' ,31 I"A, 7 109.000 O-RING#014 BUNA P/N W2T11975 14 EA OAS 110.000 VENT TUBE P/N W2T8961 2 EA 111.000 POSITIONER DISC KNOB P/N W2T10345 2 EA ��OJ 112.000 GAUGE TUBE(VENT)P/N W2T8960 2 EA 113.000 CLAMP P/N W3T107671 7 EA ,744 114,000 NUT,PLASTIC P/N W2T16511 7 EA J I 1 115.000 COUPI ING,SCREW,STEM P/N W2T16503 7 EA .30 �� Q 116,000 DISC P/N W2T11485 7 EA q 'c2!3 &a. Page 11 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8125120161:30:00 PM BID NUMBER: 16-0372 BUYER:Jane Rogers PHONE* (817)392-8385 DELIVERY REQUIRED:8/25/2016 V Vendor Name: S City of Ft Worth E H N Address: 1 6801 BOWMAN ROBERTS ROAD p p FORT WORTH TX 76179 0 City,State Zip Code: R T Item Class-Item Quantity Unit Unit Price Total 117.000 BALL&SCREW PIN W2T11457 7 EA 7a 149 118.000 CLAMP NUT P/N W2T11456 7 EA t$,o `M, 10 119,000 GAS PRESSURE GAUGE P/N W2T10323 7 EA 120.000 CONTROL VALVE SHAFT PIN W3T100153 3 EA BLT. l its, (0a, 121.000 CONTROL VALVE SHAFT U)(A P/N W3T100187 4 EA ILiO,yO (p)tQ 122.000 CONTROL VALVE SHAFT UXE PIN W3T98195 2 EA 123.000 ORIFICE PLATE 100 PPD PIN W2T16700 3 EA sea. 3 124.000 ORIFICE PLATE 500 PPD PIN W2T15710 4 EA b1 9y 6,69, 76 125,000 ORIFICE PLATE 1000 PPD PIN W2T15713 2 EA 161-yy 339 . 98 126.000 LEAD GASKET P/N W2T15571 7 EA oN. f I a©,5 127.000 RETAINING GUIDE P!N W2T14669 7 EA S) ,6Dry (p , 83 128.000 STEM SPRING PIN W2T17900 7 EA ag.S--i 191. 78 Page 12 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8/26/20161:30:00 PM BID NUMBER-164372 BUYER:Jane Rogers PHONE* (817)392-8385 DELIVERY REQUIRED:$12512016 V Vendor Name: S City of Ft Worth E H N Address: I 6801 BOWMAN ROBERTS ROAD D P FORT WORTH TX 76179 O City,State Zip Code: R T Item Class-Item Quantity Unit Unit Price Total 129.000 VALVE STEM P/N W2T8123 7 EA C{ ,W ao 130.000 SEAT(U28191)PIN W2T15696 3 EA '`% ,39 35-5-, 131.000 SEAT(U28196)PIN W2T15697 5 EA lq E3 132.000 CLAMPING SCREW(U28191)PIN W2T15686 3 EA V)'uy _31\ .$p 133.000 CLAMPING SCREW(U28196)PIN W2T15665 5 EA 51 7 ;a gd',70 134.000 GASKET PIN W2T17604 7 EA Ll,,7j 30,(pip 135.000 DIAPHRAGM(FEP)PIN W2T14111 7 EA t1.09 M 1% 136.000 DIAPHRAGM(HYPALON)PIN W2T17686 7 EA 'tp,y `,y• 9y 137.000 SPOOL PIN W2T15664 7 EA QL^lo 98,�o 138.000 SPRING(U28191)PIN W2T16779 3 EA 131 0a 4 139.000 SPRING(U28196)PIN W2T15694 5 EA lP .�1 30 55 140,000 VALVE STEM(KYNAR)PIN WZT8123 7 EA 96,60 6-V aQ Page 13 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8125120161:30:00 PM BID NUMBER: 16-0372 BUYER:Jane Rogers PHONE#: (817)392-8385 DELIVERY REQUIRED 8/25/2016 V Vendor Name: S City of Ft Worth E H N Address: 1 6801 BOWMAN ROBERTS ROAD D P FORT WORTH TX 76179 City,State Zip Code: R T O Item Class-Item Quantity Unit Unit Price T Total 141.000 DIAPHRAGM NUT P/N W2T15691 7 EA 79,w 5S 3 , 30 142.000 CLAMP P/N W2T15693 7 EA 49,35 3145,yS 143.000 DIAPHRAGM DRIVE CAP P/N W2T15690 7 EA ('09,5S 'i O'g(O 144.000 DIAPHRAGM(HYPALON)P/N W2T17686 7 EA 145.000 DIAPHRAGM(FEP)P/N W2T14111 7 EA ,( -7,S(p 146.000 CLAMPING SCREW(U28170)P/N W2T15686 3 EA 3)11 147.000 CLAMPING SCREW(U28180)W2T15665 5 EA � 7y a. � 148.000 SEAT(U28170)P/N W2T15696 3 EA 15 3J J , QJ� 149.000 SEAT(U28180)P/N W2T15697 5 EA 7 ,S 37A A.(,off 150.000 GASKET P/N W2T15571 7 EA ��` a ,S 151.000 STFM SPRING P/N W2T17900 7 EA I R9.7�3 152,000 GUIDE RETAINER P/N W2T14669 7 EA 3(ol, 9 Page 14 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8125/20161:30:00 PM BID NUMBER- 16-0372 BUYER:Jane Rogers PHONE#: (817)392.8385 DELIVERY REQUIRED:8/25/2016 V Vendor Name: S City of Ft Worth E H N Address: 1 6801 BOWMAN ROBERTS ROAD D P FORT WORTH TX 76179 Q City,State Zip Code: R T Item Class-Item Quantity Unit Unit Price Total 153.000 GASKET PIN W2T17604 7 EA 4, 3 '�O'COL'� 154.000 LEAD GASKET W2T15571 7 EA 155.000 SEAT(TFE)PIN W2T15688 7 EA (,� �, 491 lei 156.000 GUIDE P/N W2T15692 EA LAI 'alto 157.000 SPRING P/N W2T15689 7 EA 31 14 AOLO n 158.000 SPOOL P/N W2T15664 7 EA 159.000 SUPPORT WASHER PIN W2T15666 7 EA III 11. l(0_ 160.000 DIAPHRAGM(HYPALON)P/N W2T17686 7 EA 161.000 DIAPHRAGM(FEP)PIN W2T14111 Y EA 1-0-2 , S� 162.000 CLAMPING SCREW PIN W2T15665 7 EA 163.000 VALVE STEM PIN W2T15682 7 EA a 1 a('`Il 39 164.000 GUIDE RETAINER P/N W2T18254 7 EA y l 106 1 ,`i3 Page 15 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8126/20161:30:00 PM BID NUMBER: 1"372 BUYER:Jane Rogers PHONE#: (817)392-8385 DELIVERY REQUIRED:8/2 512 0 1 6 V Vendor Name: S City of Ft Worth E H N Address I 6801 BOWMAN ROBERTS ROAD D P FORT WORTH TX 76179 0 City,State Zip Code: R T Item Class-item Quantity Unit Unit Price Total 165,000 SPRING STEM PIN W2T17900 7 EA al"3-1 1q 9, '�g 166.000 GASKET PIN W2T17604 7 EA ,3$ 30,{a 167,000 O-RING(114)PIN W2T16169 18 EA 168.000 FLOAT 100 PPD PIN W2T11949 3 EAa 169.000 SCALE 100 PPD PIN W3T109246 3 EA 170.000 TUBE 100 PPD PIN W2T12887 1 EA i*3Q. V 1 13�, 171.000 O-RING(010)PIN W2T11990 6 EA .50 172.000 STOP PIN W2T375604 3 EA �r S 1 3 173.000 O-RING(114)PIN W2T16169 20 EA t O ' 174,000 LOWER RETAINER(KYNAR)PIN W2T17560 5 EA M ,f 110 175.000 TUBE 500 PPD PIN W2T18225 2 EA -M5,03 176.000 TUBE 1000 PPD PIN W2T18227 1 EA 031L.,4 S j?, q:S Page 16 of 17 BID SOLICITATION Printed:08/02/2016 BID OPENING DATE AND TIME: 8125120161:30:00 PM BID NUMBER: 164372 BUYER:Jane Rogers PHONE#: (817)392-8385 DELIVERY REQUIRED:8/26/2016 V Vendor Name: S City of Ft Worth E H N Address: l 6801 BOWMAN ROBERTS ROAD D p FORT WORTH TX 76179 City,State Zip Code: R T Item Class-Item Quantity Unit Unit Price Total 177.000 FLOAT 500 PPD P/N W3T99979 3 EA 32U1 10.7.7 ,571 178.000 FLOAT 1000 PPD PIN W3T99976 2 EA 411,77 9 SS,j 4 179.000 SCALE 500 PPD P/N W3T109252 1 EA qlls L49 .19_ 180.000 SCALE 1000 PPD P/N W3T109254 1 EA 51,31 181.000 RETAINER 8 STOP UNIT P/N W3T107606 5 EA aai�3s 7S 182.000 GREASE(O-RING)P/N W2T11142 4 EA 70-1 ag,ag 183.000 PHENOPTHALEIN PAPER 100 COUNT PIN W2T17076 4 EA 09,O() J(c•00 184.000 SPARE CL2 SPECIALITIES FILTER PADS P/N W2T12217 7 EA 101,11 �Q� 185.000 LEAD GASKET FOR CL2 FILTER PIN W2T12205 7 EA w ,gg 4 x, 1(,a 186,000 RUPTURE DISC PIN U24910 5 EA 'SS , W U9, 75 187.000 DIF.PRESS-TRANS(U28363)P/N W2T10181 1 EA 3 � ( (}Q ,oa TOTAL: WE AGREE TO FURNISH ANY OR ALL OF THE ITEMS QUOTED AT THE PRICES SHOWN,QUOTE MUST BE HELD FIRM FOR PERIOD OF 90 DAYS. C`� Page 17 of 17 TERM OF PAYMENT: �� 30 COMPANY: GNd IPONMF,NT'A V '1`9p1 O04W1 s,b DELIVERY: - wc. SIGNATURE: TELEPHONE NUMBER: NAME AND TITLE: �RtG 6 r' eS11 6A7r CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176,Local Government Code, Date Received by a vendor who has a business relationship as defined by Section 176.001(1-a)with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1),Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code.An offense under this section is a misdemeanor. 1 Name of vendor who has a business relationship with local governmental entity. /f /A 2 Check this box it you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information in this section is being disclosed. Name of Officer This section (item 3 including subparts A, B, C, & D) must be completed for each officer with whom the vendor has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIO as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor? Yes a No A/A B. is the vendor receiving or likely to receive taxable income,other than investment income,from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? F7 Yes a No 4r/� C. is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership Interest of one percent or more? aYes allo / f} D. Describe each employment or business and family relationship with the local government officer named in this section. 4 dl l i Signature of vep4or doing business with the governmental entity J Date Adopted 8/7/2015 FORTWORTH. ATTACHMENT B-REFERENCE SHEET Please Complete and Return This Form with your bid. The Bidder shall furnish, with the bid, the following information, for at least three (3) recent customers to whom products and/or services have been provided that are similar to those required by this solicitation. ANY NEGATIVE VERIFICATIONS, FAILURE TO VERIFY, OR OTHER PUBLIC INFORMATION MAY RENDER BID NON-AWARDABLE.The City will be the sole judge of references. 1. Project Name Description/Scope of Work(what roduct/service did youprovide: Completion Date: Was work subcontracted? Yes No #of Days worked Subcontractor's name: Project Location(s) Project Manager/Superintendent: Phone: A Email: h,,' Aer- , cl ,ial„�� l�,h Contract Amount: 2. Project Namel, �a •, f ti ;rs, Description/Scope of Work(what product/service did youprovide: Y cJV-m,!eJ (ecd we'—e-1 Completion Date: Was work subcontracted? Yes No #of Days worked Subcontractor's name: Project Location(s) Project Manager/Superintendent: Phone: Email: �� rr�� It T ,/r\ Contract Amount: 3. Project Name r I' A Description/Scope of Work(what roduct/service did youprovide: k° PT C.h�icJ �ecc Completion Date: Was work subcontracted? Yes No #of Days worked Subcontractor's name: Project Location(s) Project Manager/Superintendent: Phone: q7a, yJQ_20 Email: C.Aatc tq l v[ r Cap. Contract Amount: 1TB No. 16-0372, OEM Wallace and Tiernan Chlorinator and Ammonia System Rebuild Bid Opening Date: August 25,2016 Page 25 of 28 FORT WORTH. Attachment C-Vendor Contact Information Vendor's Name: Yl�J i�+'�f�i r,ti t it' 'Irv) -L, . Vendor's Local Address: -7 Phone: 9 'a_9 3.3�-, Fax: 1 - Yo ' _ (G C, Email: ()I LcirFe �) ('_ia c AI,�S,c-ym Name of persons to contact when placing an order:}� {� Name/Title Ii~�u.c-� �i�r�r'r� ey / ay)w r -Ac Y'e.ls Phone: a1�_�� d (cac� Fax: �?c� Email:- rA L c,vv�e�- (L, EC'_i r� a���S, cosy) Name/Title Phone: Fax: Email: Name/Title Phone: Fax: Email: Signature ,:' Printed Name Date s ITB No. 16-0372, OEM Wallace and Tiernan Chlorinator and Ammonia System Rebuild Bid Opening Date: August 25, 2016 Page 26 of 28 ATTACHMENT D CONSIDERATION OF LOCATION OF BIDDER'S PRINCIPAL PLACE OF BUSINESS Section 2-14 of the Fort Worth Code of Ordinances authorizes the City Council, when considering competitive sealed bids, to enter into a contract for certain purchases with a bidder whose principal place of business is in the corporate limits of the City of Fort Worth and whose bid is within 3 or 5 percent of the lowest bid,depending on the value of the request and goods or services requested,if the lowest bid is from a business outside the municipality and contracting with the local bidder would provide the best combination of price and other economic benefits to the municipality. Requests to be considered a local business must be submitted on this form with bid packages to be considered by the City of Fort Worth, Questions should be addressed to the Purchasing staff listed in the bid or request package. The Fort Worth City Council requires the following information for consideration of location of a bidder's principal place of business. Add additional sheets if needed to provide this information. 1. Locational Eligibility: Principal Place of Business in Fort Worth, Texas. a. Do you have a Fort Worth office? If yes, identify address: A//A b_ What percentage of estimated gross company sales (worldwide) are sales originating in Fort Worth? "Originatil in F rt Worth" shall mean payable at the Fort Worth office. [must exceed 50%] ��. 2. Economic Development opportunities resulting from contract. l a. Number of Fort Worth resident-employees? b. Amount of City of Fort Worth ad valorem taxes (real and business personal property) paid by company(for prior tax year— Fort Worth office or former location, if Fort Worth office is newly- established)? Certification of information: The undersigned does hereby affirm that the information supplied is true and correct as of the date hereof, under penalty of perjury. �t1(1 C11t)M e4A 1 C,i` -.1-v✓I r!�Iuv'�s)'7C�V( > -#--c-n C... t) G�� �! ' Com any Name} (Date) (Si ature) (Printed Name and Title ) ITB No, 16-0372, OEM Wallace and Tiernan Chlorinator and Ammonia System Rebuild Bid Opening Date:August 25,2016 Page 27 of 28