HomeMy WebLinkAboutContract 52987 F.D.605
FORT WORTH FIRE DEPARTMENT
F 505 W. Felix Street* Fort Worth, Texas 76115
Phone: (817)392-6800*Fax: 817.392.6859
ROUTING AND TRANSMITTAL FORM
(For Contracts or Other Documents requiring ACM Signature)
FROM: Sherry Carter I DATE: 10/22/2019
EMAIL: sherry.carter@fortworthttexas.gov _
FSUBJECT: Urgent: Texas Commission on Fire Protection CSCO
Brief Description of Contract:
Contract with TCFP for testing and certification for state license on fire.
Please review and sign. PSK is currently expired, fire certifications are due to be renewed by Oct
31 so, we need to get a contract in place ASAP.
Thank you,
Sherry Carter
Routing SIGNATURE DEPARTMENT DATE
Ste
hiy�e` b2t�toh
1. Homer9obe„—(0,o&,,,M,9, Assistant Fire Chief Oct 22,2019
2. M"k K""�Clwr Assistant Fire Director Oct 23,2019
V ark Rauscher(Oct 23,2019)
3. L�- Financial Verification Oct 25,2019
.c Y6—s I ,2019)
4. Fire Chief Oct 26,2019
ss s(0ct 26,2019)
5. L,vQual�s Law Department Oct 28,2019
Qualls(Oct 28,2019)
6. Assistant City Manager's Office Oct 28,2019
h'xre Was n0p n
7• ,. y9er(Oct28, 19) City Secretary's Office Oct 28,2019
Note: Return Original Contract to Ori_gainator
RECEIVED LOFFICIAL
OCT 2 g 2019CORDC1TYOFFORTWORTH TARYCRY SECRETARYH,Tx
CITY SECRETARY
CONTRACT NO 09- 9 7
FORT WORTH
CITY OF FORT WORTH
SOLE SOURCE PURCHASE VENDOR AGREEMENT
This Sole Source Purchase Vendor Agreement ("Agreement") is entered into by and between
Texas Commission on Fire Protection("Vendor")and the City of Fort Worth,("Customer" or
"Authorized Customer"), a Texas local government entity.
The Sole Source Purchase Vendor Agreement includes the following documents which shall be
construed in the order of precedence in which they are listed:
1. This Sole Source Vendor Purchase Agreement;
2. Exhibit A—Terms and Conditions;
3. Exhibit B—Sole Source Procurement Justification; and
4. Exhibit C—Conflict of Interest Questionnaire.
5. Exhibit D—Vendor Contact Information
6. Exhibit E—Verification of Signature Authority.
The Vendor agrees to the Terms and Conditions which are attached. Exhibits A,B,C,D,E which
are attached hereto and incorporated herein, are made part of this agreement for all purposes. The
Amount of this contract shall not exceed$90,000.00
The undersigned represents and warrants that he or she has the power and authority to execute this
Agreement and bind the respective Vendor.
Vendor and Customer have caused this Agreement to be executed by their duly authorized
representatives to be effective as of the date signed below.
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH,TX
IN WITNESS WHEREOF,the parties hereto have executed this Agreement in multiples this 15th day
of October,2019.
ACCEPTED AND AGREED:
CITY:
City of Fort Worth Contract Compliance Manager:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
gam_ of this contract, including ensuring all
By: ValerleWashin8ton(Oct28,2019) performance and reporting requirements.
Name: Valerie Washington
Title: Assistant City Manager
Oct 28 2019 /YO/ff 1y1hA9 0-&
Date: By Homer Robertson(Oct 22,20191
Name:
Approval Recommended: Title: Assistant Fire Chief
Approved as to Form and Legality:
By: Ja es (Oct 26,2019)
Name: James Davis fray i9aalls
Title: Fire Chief By: Trey ualls(Oct 28,2019)
Name: Trey Qualls
Attest: = -F :.. Title: Assistant City Attorney
o r Q d ,� Contract Authorization:
M&C: IJ/A
Mary J. yser(Oct 28, 19)
Name: Mary Kayser t!
Title: City Secretary
VENDOR:
"fi�►s Zo %sso•. at:ro h ATTEST:
By: By: _
Name: 0-ile Name:
Title: ''��n/mac' o� _ Title:
Date: !:212I '}dVI
OFFICIAL RECORD
CITY SECRETARY
,T. WORTH,TX
CSC No.52987
EXHIBIT A
CITY OF FORT WORTH, TEXAS
STANDARD PURCHASING TERMS AND CONDITIONS
1.0 DEFINITION OF BUYER
The City of Fort Worth, its officers, agents, servants, authorized employees,vendors and
subvendors who act on behalf of various City departments,bodies or agencies.
2.0 DEFINITION OF SELLER
The consultant,Vendor(s), supplier,Vendor(s)or other provider of goods and/or services,
its officers, agents, servants, employees,vendors and subvendors who act on behalf of the
entity under a contract with the City of Fort Worth.
3.0 TERM
3.1 The term of this Agreement will commence upon 15`h of October,2019 or the last
date that both the Buyer and the Seller have executed this Agreement(the
"Effective Date") and shall continue in full force and effect until September 30,
2020 . (This will be a maximum of 1 year- follow M&C date or agreed to date),
unless terminated earlier in accordance with the Provision of this Agreement.
4.0 PUBLIC INFORMATION
Any information submitted to the City of Fort Worth(the"City")may be requested by a
member of the public under the Texas Public Informatio Act. See TEX. GOV'T CODE
ANN. §§ 552.002, 552.128(c)(West Supp. 2006). If the ity receives a request for a
Seller's proprietary information,the Seller listed in the request will be notified and given
an opportunity to make arguments to the Texas Attorney General's Office(the"AG")
regarding reasons the Seller believes that its information may not lawfully be released. If
Seller does not make arguments or the AG rejects the arguments Seller makes, Seller's
information will be released without penalty to the City,
5.0 PROHIBITION AGAINST PERSONAL INTEREST IN CONTRACTS
No officer or employee of Buyer shall have a financial interest, direct or indirect,in any
contract with Buyer or be financially interested, directly or indirectly, in the sale to Buyer
of any land, materials, supplies or services, except on behalf of Buyer as an officer or
employee.Any willful violation of this section shall constitute malfeasance in office, and
any officer or employee found guilty thereof shall thereby forfeit his office or position
Any violation of this section with the knowledge, expressed or implied, of the person or
corporation contracting with the City Council shall render the contract invalid by the City
Manager or the City Council. (Chapter XXVII, Section 16, City of Fort Worth Charter)
6.0 ORDERS
No employees of the Buyer or its officers, agents, servants,vendors or subvendors who
act on behalf of various City departments,bodies or agencies are authorized to place
orders for goods and/or services without providing approved contract numbers,purchase
order numbers, or release numbers issued by the Buyer. The only exceptions are
Purchasing Card orders and emergencies pursuant to Texas Local Government Code
Section 252.022(a)(1), (2), or(3). In the case of emergencies, the Buyer's Purchasing
Division will place such orders.
7.0 INVOICES
7.1 Seller shall not include Federal Excise, State or City Sales Tax in its invoices.
The Buyer shall furnish a tax exemption certificate upon Seller's request.
7.2 Payment. All payment due upon receipt.
8.0 PRICE WARRANTY
Seller warrants that no person or selling agency has been employed or retained to solicit
or secure this contract upon an agreement or understanding for commission,percentage,
brokerage or contingent fee, excepting employees of an established commercial or selling
agency that is maintained by Seller for the purpose of securing business. For breach or
violation of this warranty, Buyer shall have the right, in addition to any other right or
rights arising pursuant to said purchase(s),to cancel this contract without liability and to
deduct from the contract price such commission percentage,brokerage or contingent fee,
or otherwise to recover the full amount thereof.
9.0 NETWORK ACCESS
The City owns and operates a computing environment and network(collectively the
"Network"). If Seller requires access,whether onsite or remote, to the City's network to
provide services hereunder, and the Seller is required to utilize the Internet, Intranet,
email, City database, or other network application, Seller shall separately execute the
City's Network Access Agreement prior to providing such services.A copy of the City's
standard Network Access Agreement can be provided upon request.
10.0 CANCELLATION
Buyer shall have the right to cancel this contract immediately for default on all or any
part of the undelivered portion of this order if Seller breaches any of the terms hereof,
including warranties of Seller. Such right of cancellation is in addition to and not in lieu
of any other remedies,which Buyer may have in law or equity.
11.0 TERMINATION
The performance of work or purchase of goods under this order may be terminated in
whole or in part by Buyer,with or without cause, at any time upon the delivery to Seller
of a written"Notice of Termination" specifying the extent to which performance of work
or the goods to be purchased under the order is terminated and the date upon which such
termination becomes effective. Such right of termination is in addition to and not in lieu
of any other termination rights of Buyer as set forth herein.
12.0 WAIVER
No claim or right arising out of a breach of this contract can be discharged in whole or in
part by a waiver or renunciation of the claim or right unless the waiver or renunciation is
supported by consideration in writing and is signed by the aggrieved party.
13.0 MODIFICATIONS
This contract can be modified or rescinded only by a written agreement signed by both
parties.
14.0 THE AGREEMENT
In the absence of an otherwise negotiated contract, or unless stated otherwise,the
Agreement between Buyer and Seller shall consist of these Standard Terms and
Conditions together with any attachments and exhibits. This Agreement is intended by
the parties as a final expression of their agreement and is intended also as a complete and
exclusive statement of the terms of their agreement.No c urse of prior dealings between
the parties and no usage of trade shall be relevant to supplement or explain any term used
in this Agreement.Acceptance of or acquiescence in a course of performance under this
Agreement shall not be relevant to determine the meaning of this Agreement even though
the accepting or acquiescing party has knowledge of the performance and opportunity for
objection. Whenever a term defined by the Uniform Commercial Code (UCC) is used in
this Agreement, the definition contained in the UCC shall control. In the event of a
conflict between the contract documents,the order of precedence shall be these Standard
Terms and Conditions, and the Seller's Quote.
15.0 APPLICABLE LAW/VENUE
This agreement shall be governed by the Uniform Commercial Code wherever the term
"Uniform Commercial Code" or"UCC"is used. It shall be construed as meaning the
Uniform Commercial Code as adopted and amended in the State of Texas. This contract
shall be governed, construed and enforced under the laws of the State of Texas.
16.0 INDEPENDENT VENDOR(S)
Seller shall operate hereunder as an independent Vendor(s) and not as an officer, agent,
servant or employee of Buyer. Seller shall have exclusive control of,and the exclusive
right to control,the details of its operations hereunder, and all persons performing same,
and shall be solely responsible for the acts and omissions of its officers, agents,
employees,vendors and sub-vendors. The doctrine of res ondent superior shall not apply
as between Buyer and Seller, its officers, agents,employes,vendors and subvendors.
Nothing herein shall be construed as creating a partnership or joint enterprise between
Buyer and Seller, its officers, agents, employees, vendors and subvendors.
17.0 SEVERABILITY
In case any one or more of the provisions contained in this agreement shall for any
reason,be held to be invalid,illegal or unenforceable in any respect,such invalidity,
illegality or unenforceability shall not affect any other provision of this agreement,which
agreement shall be construed as if such invalid, illegal or unenforceable provision had
never been contained herein.
18.0 FISCAL FUNDING LIMITATION
In the event no funds or insufficient funds are appropriated and budgeted in any fiscal
period for payments due under this contract, then Buyer will immediately notify Seller of
such occurrence and this contract shall be terminated on the last day of the fiscal period
for which funds have been appropriated without penalty or expense to Buyer of any kind
whatsoever, except to the portions of annual payments herein agreed upon for which
funds shall have been appropriated and budgeted or are otherwise available.
19.0 NOTICES TO PARTIES
Notices addressed to Buyer pursuant to the provisions hereof shall be conclusively
determined to have been delivered three(3)business days following the day such notice
is deposited in the United States mail, in a sealed envelope with sufficient postage
attached, addressed to Purchasing Manager,City of Fort Worth,Purchasing Division,200
Texas Street,Fort Worth, Texas 76102.Notices to Seller shall be conclusively
determined to have been delivered three(3)business days following the day such notice
is deposited in the United States mail, in a sealed envelope with sufficient postage
attached, addressed to the address given by Seller in its response to Buyer's invitation to
proposals. Or if sent via express courier or hand delivery,notice is considered received
upon delivery.
20.0 NON-DISCRIMINATION
This contract is made and entered into with reference specifically to Chapter 17,Article
III, Division 3 ("Employment Practices"), of the City Code of the City of Fort Worth
(1986), as amended, and Seller hereby covenants and agrees that Seller, its employees,
officers, agents,vendors or subvendors,have fully complied with all provisions of same
and that no employee,participant, applicant,Vendor(s)or subVendor(s)has been
discriminated against according to the terms of such Ordinance by Seller, its employees,
officers, agents,Vendor(s)or subvendors herein.
21.0 IMMIGRATION NATIONALITY ACT
City actively supports the Immigration&Nationality Act(INA) which includes
provisions addressing employment eligibility, employment verification, and
nondiscrimination. Vendor shall verify the identity and employment eligibility of all
employees who perform work under this Agreement..Vendor shall establish appropriate
procedures and controls so that no services will be performed by any employee who is
not legally eligible to perform such services. Vendor shall indemnify City from any
penalties or liabilities due to violations of this provision. City shall have the right to
immediately terminate this Agreement for violations of this provision by Vendor.
22.0 HEALTH, SAFETY,AND ENVIRONMENTAL REQUIREMENTS
Services,products, materials, and supplies provided by the Seller must meet or exceed all
applicable health, safety, and the environmental laws, requirements, and standards. Seller
shall indemnify Buyer from any penalties or liabilities clue to violations of this provision.
Buyer shall have the right to immediately terminate this Agreement for violations of this
provision by Seller.
23.0 RIGHT TO AUDIT
Seller agrees that the Buyer, or Buyer's authorized representative, shall,until the
expiration of three(3)years after final payment under this contract, and at no additional
cost to Buyer,have access to and the right to examine and copy any directly pertinent
books, computer disks,digital files, documents,papers and records of the Seller
involving transactions relating to this contract, including any and all records maintained
pursuant to this Agreement. Buyer shall pay Seller for reasonable costs of any copying in
accordance with the standards set forth in the Texas Administrative Code. The Buyer
shall give Seller reasonable advance written notice of intended audits, but no less than ten
(10)business days.
24.0 DISABILITY
In accordance with the provisions of the Americans With Disabilities Act of 1990
(ADA), Seller warrants that it and any and all of its subvendors will not unlawfully
discriminate on the basis of disability in the provision of services to general public, nor in
the availability,terms and/or conditions of employment for applicants for employment
with, or employees of Seller or any of its subvendors. Seller warrants it will fully comply
with ADA's provisions and any other applicable federal, state and local laws concerning
disability and will defend, indemnify and hold Buyer harmless against any claims or
allegations asserted by third parties or subvendors against Buyer arising out of Seller's
and/or its subvendor's alleged failure to comply with the above-referenced laws
concerning disability discrimination in the performance of this agreement.
25.0 DISPUTE RESOLUTION
If either Buyer or Seller has a claim, dispute,or other matter in question for breach of
duty, obligations, services rendered or any warranty that arises under this Agreement,
either party shall have the right to exercise any and all remedies available under law
regarding the dispute.
26.0 PROHIBITION ON CONTRACTING WITH COMPANIES THAT BOYCOTT ISRAEL
Seller acknowledges that in accordance with Chapter 22�0 of the Texas Government
Code,the City is prohibited from entering into a contrac with a company for goods or
services unless the contract contains a written verification from the company that it: (1)
does not boycott Israel; and(2)will not boycott Israel during the term of the contract.
The terms"boycott Israel"and"company"shall have the meanings ascribed to those
terms in Section 808.001 of the Texas Government Cod . By signing this contract, Seller
certifies that Seller's signature provides written verification to the City that Seller: (1)
does not boycott Israel; and(2)will not boycott Israel during the term of the contract
EXHIBIT B
SOLE SOURCE PROCUREMENT JUSTIFICATION
FORT WORTH
CITY OF FORT WORTH
CHAPTER 252 EXE3iPTION FORM
This form must be provided when requesting to make a purchase over$50,000 without following
public bidding requirements.
Instructions:Fill out the entire form with detailed information.Once you have completed this
form,provide it to the Purchasing attorney for review.The attorney will review the information
you have provided and determine whether using an exemption to Chapter 252's biding
requirements would be defensible.If you are printing this form to provide to Legal,please do not
provide the Primer portion. Failure to provide sufficient niformation may result in follow up
questions and cause a delay in the attorney's determination.
Section 1:General Information
Requesting Department: Fire RTLO rterrt
Name of Contract Manager: Chief Homer Robertson
Department's Attorney: Trey Qualls
Item or Service sought: Fire CeOwtions and Exams
Vendor: Texas Commission on Fire Protection
Current Agreement for itemiservice:Yes ✓ No
CSC#:
How will this item or service be used: The Fort Worth Fire Department is required to pay annual
fees for the administration of exams and professional certifications for FWFD firefighters.
TCFP,the goveminq agency,certifies and renews certificates for firefighters who have completed the
minimum standards for basic and higher levels of fire suppression as well as firefighters who have
received advanced training in specialized areas which require additional exams and certifications.
Section 2:Exemption Justificatio,:
Please indicate which exemption you believe applies to the punch=w and prvt ide 1"IL formation to
support its applicability_Please refer to the Exemption Primer fo:detailed information about
common exMRttions.
a procurement made because of a public calamity that requires the immediate appropriation
of money to relieve the necessity of the municipality's residents or to preserve the property of the
municipality;
V/ a procurement necessary to preserve or protect the public health or safety of the
municipality's residents;
a procurement necessary because of unforeseen damage to public machinery,equipment,or
other property;
a procurement for personal,professional,or planning seniees,
a procurement for work that is performed and paid for by the hy as the work progresses,-
purchase of land or a right-of-way;
procurement of items that are available from only one source,including:
a purchase of ran books,papers,and other library materials i r a public tibtrary;
___paving drainage,street widening,and other public improvements,or related matters,if at
least one-third of the cost is to be paid by or through special asses srnents levied on property that
trill benefit from the improvements;
a;jublic improvement project,already in progress,authorized by the voters of the
municipality,for which there is a deficiency of funds for completing the project in accordance
with the plans and purposes authorized by the voters;
a payment under a contract by which a developer participaw-3 in the construction of a public
improvement as provided by Subchapter C,Chapter 212;
_personal property sold:
(A)at an auction by a state licensed auctioneer;
(B)at a going out of business sale held in compliance with Subchapter F,Chapter 17,
Business&Commerce Code;
(C)by a political subdivision of this starve,a state agency of 1tis state,or an entity of the
federal government:or
(D)under an interlocal contract for cooperative purchasinf a iministered by a regional
planning commission established under Chapter 391;
—services performed by blind or severely disabled persons;
goods purchased by a municipality for subsequent retail sale try-,-the municipalAy;
electricity;or
advertising,other than legal notices.
Please provide details and facts to explain why you believe the exemption applies to the purchase.
You may also attach documentation to this form.
The Texas Commission on Fire Protection is a Texas state governmental agency tasked with
otwseeing and regulating all paid fire departments,,and firefu ttnz! standards within Texas.The
agency provides a variety of services including the writing atd publication of curriculum
manuals,standard manuals, and miury reports.This is the only a zenc v that provides State license
for firefighters and instructors for fire training, without State license a fire department can not
lega Ly operate-
PO should be renewed LnM year d_-e to TX Gov't Code C'heter 41
Sectim 3:Agorngy Demermination
With the facts provided by the department:is the use of the claimed exemption de£msible if the
City wen to be challenged on this purchase? a Yes or No
Was there anything not included an this form or attached hereto that was relied am is making this
determination? Yes or a No
Ifym,p
Approved by:
Ao,Aim Pabe,ACA I
EXEMPTION FORM PRMLL
Below are explanations and examples of common exemption that apply to municipal purchases.
If you have questions about the information provided or need additional information,please
contact your department's assigned attorney.
1. A procurement made because of a public calamity that requires the immediate
appropriation of money to relieve the necessity of the municipality's residents or to preserve the
property of the municipality.This is generally used in cases of public emergency.
2_ A procurement necessary to preserve or protect the public health or safety of the
municipality's residents.This is a factual determination that will be used when the purchase directly
impacts public health and safety.Please note,this is generally a very narrow exception.
3_ A procurement necessary because of unforeseen damage to public machinery,equipmem
or other property_Damage or immediately foreseeable damage that is caused by an unexpected
event.This will generally be used when a natural disaster or unforeseen failure occurs that impacts
other property.
4. A procurement for personal,professional,or planning services;
Professional services are not defined under Chapter 252,so there is no precise definition to
follow.However,the Texas Attorney General has suggested that a professional service
comprehends labor and skill that is`predominately mental or intellectual.rather than physical or
manual.— Tex.Atty Gen Op.]M-940(1988)(quoting Maryland Casualty Co.v.Qay Rater
Co., 160 S.W.2d 102(Tex.Civ.App.--Eastland 1942,no writ). The Texas Attorney General
has also opined that'professional services"no longer includes only the services of lawyers,
physicians,or theologians.but also those members of disciplines requiring special knowledge or
attaitunent and a high order of learning,skill,and intelligence_ Id.
Facts needed to support a professional service exemption include the specialized requirements of
that profession and the mental and mtellectual skill required by the person while performing the
service.Purchases of goods are not professional services-
5- A procurement of items that are available from only one source_
This exemption is commonly referred to as the sole source exemption.In determining whether a
purchase is of a good or service that is available from one source,you should not consider price
or time to receive the good or service.The information needed to support this exemption,is that
no other provider can provide the service or category of good except for the vendor you are
proposing.Some examples of sole source purchases include service agreements when only one
vendor is authorized to work on the equipment by the manufacturer and allowing another vendor
would void the warranty;purchase of a good that is copyrighted or trademarked and only
provided by one vendor.
EXHIBIT C
CONFLICT OF INTEREST QUESTIONNAIRE
Pursuant to Chapter 176 of the Local Government Code, any person or agent of a person
who contracts or seeks to contract for the sale or purchase of property, goods, or services
with a local governmental entity (i.e. The City of Fort Worth) must disclose in the
Questionnaire Form CIQ ("Questionnaire")the person's affiliation or business relationship
that might cause a conflict of interest with the local governmental entity. By law, the
Questionnaire must be filed with the Fort Worth City Secretary no later than seven days
after the date the person begins contract discussions or negotiations with the City,or submits
an application or response to a request for proposals or bids, correspondence, or another
writing related to a potential agreement with the City.Updated Questionnaires must be filed
in conformance with Chapter 176.
A copy of the Questionnaire Form CIQ is enclosed with the submittal documents. The
form is also available at http://www.ethics.state.tx.us/forms/CIQ.pdf.
If you have any questions about compliance,please consult your own legal counsel.
Compliance is the individual responsibility of each person or agent of a person who is
subject to the filing requirement. An offense under Chapter 176 is a Class C misdemeanor.
NOTE: If you are not aware of a Conflict of Interest in any business relationship
that you might have with the City,state Vendor name in the# 1,use N/A in each of
the areas on the form. However,a signature is required in the#4 box in all cases.
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO
For vendor doing business with local governmental entity
This questtonmire reflects changes made to the law by KB. 23,84th Leg.,Fleguisr Session. OFFICE USE ONLY
This questionnaire is being filed in accordancewith Chapter 176,Local Government Code, 4m P""a
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.
Name of vendor who has a business relationship with local govemmemal entity.
2 L_jCheck this box if 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 govemment officer about whom the Information In this section is being disclosed.
Name of Officer
This section(dem 3 including subparts A,13,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 Nicety to receive taxable income,other than investment
income,from the vendor?
Yes � No
S. is the vendor receiving or Nicely 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?
Yes No
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?
F] Yes a No
D. Describe each employment or business and family relationship with the local government officer named in this section.
4
Signature of vendor doing business with the governmental entity Date
Adopted 817/2015
EXHIBIT D
VENDOR CONTACT INFORMATION
Vendor's Name: Texas Commission on fire Protection
Vendor's Local Address: 1701 N. Congress #1-105, Austin, TX 78701
Phone: 512-936-3825 Fax:
Email:
Name of persons to contact when placing an order or invoice questions:
Name/Title Sylvia Miller—Certifications Manager
Phone: 512-936-3825 Fax:
Email: Sylvia.Millercgrtcfp.Texas.gov
Name/Title Denise Alvarez—Accountant
Phone: 512-936-3844 Fax:
Email:Denise.Alvarez(i tcfp.Texas.gov
Name/Title
Phone: Fax:
Email:
Signature Printed Name Date
EXHIBIT E
VERIFICATION OF SIGNATURE AUTHORITY
TEXAS COMMISSION ON FIRE PROTECTION
PO BOX 2286
AUSTIN,TX 78768
Vendor hereby agrees to provide City with the fair presentation of the financial statements of individual
funds.
Execution of this Signature Verification Form ("Form") hereby certifies that the following individuals
and/or positions have the authority to legally bind Vendor and to execute any agreement, amendment or
change order on behalf of Vendor. Such binding authority has been ranted by proper order, resolution,
ordinance or other authorization of Vendor.City is fully entitled to rel�+on the warranty and representation
set forth in this Form in entering into any agreement or amendment with Vendor. Vendor will submit an
updated Form within ten (10) business days if there are any changed to the signatory authority. City is
entitled to rely on any current executed Form until it receives a revised Form that has been properly executed
by Vendor.
I. Name
Position:�1+�+4✓`�-� '��'-ya^r
Signature
2. Name:
Position:
Signature
zwaace4e
Signature of President/C,EO'V-Managging PrLner
Title. ��r/ �t ��h�t' ✓1r Date ��—��--