HomeMy WebLinkAboutContract 56994 CSC No. 56994
FORT WORTH
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and between MoboTrex,
Inc ("Vendor") and the City of Fort Worth, ("City"), a Texas home rule municipality.
The Cooperative Purchase Agreement includes the following documents which shall be construed in the
order of precedence in which they are listed:
1. This Cooperative Purchase Agreement;
2. Exhibit A— Seller's Quote, Scope of Services or Purchase Order;
3. Exhibit B—Cooperative Agency Contract(e.g.,NJPA, DIR, BuyBoard); and
4. Exhibit C—Conflict of Interest Questionnaire
Exhibits A, B, and C,which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes. Vendor agrees to provide City with the services and goods included in
Exhibit A pursuant to the terms and conditions of this Cooperative Purchase Agreement, including all
exhibits thereto.
City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance with
the provisions of this Agreement. Total payment made under this Agreement for the first year by City
shall be in the amount of Two Hundred and Three Thousand Dollars ($203,000.00). Vendor shall not
provide any additional items or services or bill for expenses incurred for City not specified by this
Agreement unless City requests and approves in writing the additional costs for such services. City shall
not be liable for any additional expenses of Vendor not specified by this Agreement unless City first
approves such expenses in writing.
The term of this Agreement shall be for one year beginning on January 11, 2022 and ending on
May 31, 2022. The City shall be able to renew this agreement for one (1) one-year renewal options by
written agreement of the parties.
Vendor agrees that City shall,until the expiration of three(3)years after final payment under this
Agreement, or the final conclusion of any audit commenced during the said three years, have access to
and the right to examine at reasonable times any directly pertinent books,documents,papers and records,
including, but not limited to, all electronic records, of Vendor involving transactions relating to this
Agreement at no additional cost to City. Vendor agrees that City shall have access during normal
working hours to all necessary Vendor facilities and shall be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. City shall give Vendor
reasonable advance notice of intended audits.
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 party by United States Mail, registered, return receipt requested, addressed as
follows: OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
To CITY: To VENDOR:
City of Fort Worth
Attn: Reginald Zeno, Interim Asst. City Manager MoboTrex, Inc
200 Texas Street Vincent Holdridge, Inside Sales Rep
Fort Worth, TX 76102-6314
Facsimile: (817) 392-8654 Address:
109 West 55th Street
With copy to Fort Worth City Attorney's Office Davenport, IA 52806
at same address
Facsimile: N/A
The undersigned represents and warrants that he or she has the power and authority to execute this
Agreement and bind the respective Vendor.
CITY OF FORT WORTH:
CONTRACT COMPLIANCE MANAGER:
'znwq� �Gt�IC By signing I acknowledge that I am the person
By: Dana Burghd off(Jan 13,20221 :T� responsible for the monitoring and administration
Name: Dana Burghdoff of this contract,including ensuring all performance
Title: Assistant City Manager and reporting requirements.
Date: Jan 13, 2022
lire i l ajwm
APPROVAL RECOMMENDED: By: Aziz Rahman(Jan 13,202210:34 CST)
Name: Aziz Rahman
Title: Engineering Manager
By: WJ(Jan 13.20 13:37 CST) APPROVED AS TO FORM AND LEGALITY:
Name: William Johnson
Title: Transportation/Public Works Director
ATTEST: 0o4�FWWQ � By:
Al °°000000
P�o° °°'0 Name: Taylor Paris
1. °o9�d Title: Assistant City Attorney
Tahheffe S. Goodall v o o=�
By: Jannette S.Goodall(Jan 14,2022 07:45 CST) .*o° �e ad CONTRACT AUTHORIZATION:
Name: Jannette Goodall �aa4� EXAS�a� M&C: 22-0007
Title: City Secretary
VENDOR:
MoboTrex, Inc
By:
Name: Vincent Holdridge
Title: Inside Sales Rep
OFFICIAL RECORD
Date: 01/13/2022 CITY SECRETARY
FT. WORTH, TX
mobotrey,,TM Exhibit A .
MOBILITY 8 TRAFFIC EXPERTS Quote Number: 1907669
109 West 55th Street I Davenport, IA 52806 1(563)323-0009
Date: 10/07/2021
Customer: FORT Expire Date: 12/31/2021
YANG JIN Prepared By: Holdridge, Vincent V.
Fort Worth TX, City of
Transportation & public Works
200 Texas St
Fort Worth TX 76102-6314
United States
Contact: YANG JIN
Description: CONTRACT QUOTE
Part# Description Quantity Price Extended
PXX11215-001 MIOVISION DETECTION SYSTEM 8 $15,500.00 $124,000.00
MBV18114-003 KIT, LED INTERSECTION DISP, S2,S3, S1/C5 3 $1,790.00 $5,370.00
PXX10598-001 UPSTEALTH 2:CNTRLR,1000W 8 $2,250.00 $18,000.00
PXX10598-002 UPSTEALTH 2:13ATTERY PANEL,500W 16 $2,402.00 $38,432.00
PXX10598-004 UPSTEALTH 2:PWR INTERFACE MOD,REQUIRED 8 $450.00 $3,600.00
PPS08255-003 POE INJECTOR,70W 50 $128.00 $6,400.00
EKI-25281-BE Advantech 8 port unmanaged switch 40 $170.00 $6,800.00
Sale Amount: $202,602.00
Sales Tax: 0.00
Misc Charges: 0.00
Total Amount: $202,602.00
Notes:
SHIPPING INCLUDED
ALL ITEMS ON BUYBOARD CONTRACT#608-20
Mobotrex, Inc Thursday,October 7,2021 11:57 AM Page 1 of 2
mobotrey�TM
MOBILITY a TRar_c ;,ERTS Quote Number: 1907669
109 West 55th Street I Davenport, IA 52806 1(563)323-0009
Terms:
THIS QUOTE IS BASED ON THE ENTIRE VALUE AND VOLUME OF ALL LINE ITEMS- Prices listed on this quote are valid only in the
event of purchase of all line items in the quantities listed, in their entirety. Purchases of individual line items will require a new quote
prior to acceptance of any purchase orders.
Shipment of the material will be approximately 90 days after receipt of both an acceptable purchase order and approved submittal data
if required. PAYMENT TERMS ARE NET 30 DAYS with prior approved credit. MoboTrex, Inc. retains title to material until paid in full.
A service charge of 1.5% per month (18%annual rate)will be assessed against all past due accounts. Prices and delivery quoted are
firm for 30 days from the data of bid. The above quote does not include installation of the products quoted. On-Site technical
assistance is available and will be quoted upon request.
Quotation does not include sales tax. Sales tax will be added at time of invoice unless a valid Sales Tax Exempt certificate has been
provided. Sales tax exempt certificate should accompany customer Purchase Order.
Limited Warranty: MoboTrex, Inc. only obligations shall be to replace such quantity of the product proven to be defective.
Warranty Period: The length of warranty manufacturers have conveyed to the seller and which can be passed on to the buyer.
Additional terms and conditions apply-See MoboTrex, Inc. Terms &Conditions document at our website: www.mobotrex.com.
Thank you for the opportunity to provide this quote.
Mobotrex, Inc Thursday,October 7,2021 11:57 AM Page 2 of 2
PFBoard® Exhibit B
Capperative Purchasing
P.O. Box 400
Austin, TX 78767-0400
609.695.2919 / 512.467.0222 / Fax:800.211.5454
buyhoard.com
April 29, 2020
Sent Via Email: vholdridge@mobotrex.com
Vincent Holdridge
MoboTrex, Inc.
109 W. 55th Street
Davenport, IA 52806
Welcome to BuyBoard!
Re: Notice of The Local Government Purchasing Cooperative Award
Proposal Name and Number: Highway Safety and Traffic Control Products, Proposal No. 608-20
Congratulations, The Local Government Purchasing Cooperative (Cooperative) has awarded your company a BuyBoard®
contract based on the above-referenced Proposal. The contract is effective 6/1/2020 through 5/31/2021, with two possible
one-year renewals. The contract documents are those identified in Section 3 of the General Terms and Conditions of the
specifications.
To view the items your company has been awarded, please review the proposal tabulation No. 608-20 on the following
web-site: www.buyboard.com/vendor. Only items marked as awarded to your company can be sold through the BuyBoard
contract. In addition, on this website you will find the membership list which will provide you with the names of all entities
with membership in our purchasing cooperative.
Enclosed with this letter you will find the following documents:
1. Vendor Quick Reference Guide 2. BuyBoard License and Identity Standards
You are advised that receipt of a purchase order directly from a Cooperative member is not within the
guidelines of the Cooperative.Accepting purchase orders directly from Cooperative members may result in a violation
of the State of Texas competitive bid statute and termination of this Cooperative BuyBoard contract. Therefore, all
purchase orders must be processed through the BuyBoard in order to comply. Please forward by email to
info@buyboard.com any order received directly from a Cooperative member. If you inadvertently process a purchase
order sent directly to you by a Cooperative member, please email the order info@buyboard.com and note it as RECORD
ONLY to prevent duplication.
As an awarded vendor a BuyBoard user id and password will be sent via e-mail 2 to 3 business days prior to
the start of your contract.
On behalf of the Texas Association of School Boards, we appreciate your interest in the Cooperative and we are looking
forward to your participation in the program. If you have any questions, please contact Cooperative Procurement Staff
at 800-695-2919.
Sincerely,
Arturo Salinas
Department Director, Cooperative Procurement
v.6.5
The Local Government Purchasing Cooperative is endorsed by the Texas Association of School Boards,
N = `T�a Texas Municipal League, Texas Association of Counties,and the Texas Association of School Administrators.W.'
i Bna�d®
%National School
Endorsed by 'NSBA' Boards Association
April 29, 2020
Sent Via Email: vholdridge@mobotrex.com
Vincent Holdridge
MoboTrex, Inc.
109 W. 55th Street
Davenport, IA 52806
Welcome to BuyBoard!
Re: Notice of Nation/Purchasing Cooperative Award
Proposal Name and Number: Highway Safety and Traffic Control Products, Proposal No. 608-20
Congratulations, The National Purchasing Cooperative (National Cooperative) has awarded your company a BuyBoard®
contract based on the above-referenced Proposal. As provided for in the Proposal and your National Purchasing
Cooperative Vendor Award Agreement, you are authorized to sell the goods and services awarded under the Proposal to
National Cooperative members in states other than Texas through the BuyBoard. The contract is effective 6/1/2020
through 5/31/2021, with two possible one-year renewals.
The National Cooperative membership list is available at our website www.buyboard.com/vendor. The list identifies the
current members that may purchase awarded goods and services under your National Cooperative BuyBoard contract.
You are advised that receipt of a purchase order directly from a National Cooperative member is not within
BuyBoard guidelines. Accepting purchase orders directly from Cooperative members may result in a violation of
applicable competitive procurement law and termination of this National Cooperative BuyBoard contract. Therefore, all
purchase orders from National Cooperative members must be processed through the BuyBoard. Please
forward by e-mail to info@buyboard.com any order received directly from a National Cooperative member. If you
inadvertently process a purchase order sent directly to you by a National Cooperative member, please fax the order to the
above number and note it as RECORD ONLY to prevent duplication.
As an awarded vendor a BuyBoard user id and password will be sent via e-mail 2 to 3 business
days prior to the start of your contract.
On behalf of the National Cooperative, we are looking forward to your participation in the program. If you have any
questions, please contact Cooperative Procurement Staff at 800-695-2919.
Sincerely,
Arturo Salinas
Department Director, Cooperative Procurement
v.6.5
P.O.Box 400,Austin, Texas 78767-0400
800.695.2919•buyboard.com
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wCouperative Pura hasfag
12007 Research Boulevard ' Austiri,Texas 78759-2439 PH: 800-595-2919 ' FAX: 800-211-5454 ' buvhoard,com
PROPOSER'S AGREEMENT AND SIGNATURE
Proposal Name: Highway Safety and Traffic Proposal Due DatelDnening Date and Time:
Control Products November 7, 2019 at 4:00 PM
Location of Proposal Ooening:
Texas Association of School Boards, Inc.
BuyBoard Department
Proposal Number: 608-20 12007 Research Blvd.
Austin,TX 78759
Anticipated_ Cooperative Board Meeting Date:
Contract Time Period: June 1, 2020 through May April 2020
31, 2021 with two (2) possible one-year renewals.
MoboTrex, Inc 11 -5-2019
Name of Proposing Company Date
109 W 55th ST
Street Address Signature of Authorized- any Qu
Davenport, IA 52806 Vincent Holdridge
City, State, Zip Printed Name of Authorized Company Official
512-521 -3337 Inside Sales Rep
Telephone Number of Authorized Company Official Position or Title of Authorized Company Official
5633238256 36-2656899
Fax Number of Authorized Company Official Federal I❑ Number
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The proposing company["you"or"your'} hereby acknowledges and agrees as follows:
I. You have carefully examined and understand all Cooperative information and documentation associated with this
Proposal Invitation, including the Instructions to Proposers, General Terms and Conditions, attachments forms, item
specifications, and line items(collectively"Requirements'};
2. By your response ("Proposal") to this Proposal Invitation, you propose to supply the products or services submitted at
the prices quoted in your Proposal and in strict compliance with the Requirements, unless specific deviations or
exceptions are noted In the Proposal;
3. Any and all deviations and exceptions to the Requirements have been noted in your Proposal and no others will be
claimed;
4. If the Cooperative accepts any part of your Proposal and awards you a contract, you will furnish all awarded products
or services at the prices quoted and in strict compliance with the Requirements(unless specific exceptions are noted in
the Proposal and accepted by the Cooperative), including without limitation the Requirements related to:
a. conducting business with Cooperative members, including offering pricing to members that is the best you offer
compared to similar customers;
b. payment of a service fee in the amount specified and as provided for in this Proposal Invitation;
c, the possible award of a piggy-hack contract by another governmental entity or nonprofit entity, in which event
you will offer the awarded goods and services in accordance with the Requirements; and
d. submitting price sheets or catalogs in the proper format as required by the Cooperative as a prerequisite to
activation of your contract;
S. You have clearly identified on the included farm any information in your Proposal that you believe to be confidential or
proprietary or that you do not consider to be public information subject to public disclosure under a Texas Public
Information Act request or similar public information law;
6. The individual signing this Agreement is duly authorized to enter into the contractual relationship represented by this
Proposal Invitation on your behalf and bind you to the Requirements, and such individual (and any individual signing a
Form) is authorized and has the requisite knowledge to provide the information and make the representations and
certifications required in the Requirements;
7. You have carefully reviewed your Proposal, and certify that all information provided is true, complete and accurate, and
you authorize the Cooperative to take such action as it deems appropriate to verify such information; and
8. Any misstatement, falsification, or omission in your Proposal, whenever or however discovered, may disqualify you
from consideration for a contract award under this Proposal Invitation or result in termination of an award or any other
remedy or action provided for in the General Terms and Conditions or by law.
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VENDOR CONTACT INFORMATION
Name of Company: MoboTrex, Inc
Vendor Proposal/Contract Contact Name: Vincent Holdridge
Vendor Proposal/Contract Contact E-mail Address: vholdridge@mobotrex.com
Vendor Contact Mailing Address for Proposal/Contract Notices: 169 W 55th St, Davenport, IA 52806
Company Website: www.mobotrex.com
Purchase Orders: All purchase orders from Cooperative members will be available through the Internet. Vendors need
Internet access and at least one e-mail address so that notification of new orders can be sent to the Internet contact when
a new purchase order arrives. An information guide will be provided to vendors to assist them with retrieving their orders.
Please select options below for receipt of purchase orders and provide the requested information:
I will use the internet to receive purchase orders at the Following address:
Purchase Order E-mail Address: vholdridge@mobotrex.com
Purchase order Contact: Vincent Holdridge Phone: 512-521-3337
Alternate Purchase Order E-mail Address: ccooper@mobotrex.com
Alternate Purchase Order Contact: Cameron Cooper Phone: 512-496-3611
❑ Purchase orders may be received by the Designated Dealer(s) identified on my company's Deater
Designation form as provided to the Cooperative administrator, I understand that my company shall
remain responsible for the Contract and the performance of all Designated Dealers under and in
accordance with the Contract.
Request for Quotes("RFQ"): Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses
for the receipt of RFQs:
RFQ E-mail Address: vholdridgellmobotrex.com
RFQ Contact: Vincent Holdridge Phone: 512-521-3337
Alternate RFQ E-mail Address: ccooper@mobotrex.com
Alternate RFQ Contact: Cameron Cooper Phone: 512-496-3611
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Invoices: Your company will be billed monthly for the service fee due under a contract awarded under this Proposal
Invitation. All invoices are available on the BuyBoard website and e-mail notifications will be sent when they
are ready to be retrieved. Please provide the following address, contact and e-mail Information for receipt of service fee
Invoices and related communications:
Please choose ants on_e__(1) of the following options for receipt of invoices and provide the requested
information:
9 Service fee invoices and related communications should be provided directly to my company at:
Invoice Mailing address: 109 W 55th 5T Department:
city: Davenport state: A Zip code: 52806
Contact Name: Eydie Petersen Phone: 563-328-4476
Invoice Fax: Invoice E-mail Address: ap@mobotrex.Com
Alternative Invoice E-mail Address: Vholdrldge%CllobotCEx.Cam
71 In lieu of my company, I request and authorize all service fee invoices to be provided directly to the following billing
agent":
Billing agent Mailing address: Department:
City; State: Zip Code:
Billing Agent Contact Name: Phone:
Billing Agent Fax; Billing Agent E-mail Address:
Alternative Billing Agent E-mail Address:
**If Vendor authorizes a bllling agent to receive and process service fee Invoices, In accordance with the
General Terms and Conditions of the Contract, Vendor speclflcally acknowledges and agrees that nothing In
that designation shall relleve Vendor of Its responslbllltles and obligations under the Contract Including, but
not limited to,payment of all service fees under any Contract awarded Vendor.
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FELONY CONVICTION DISCLOSURE AND DEBARMENT CERTIFICATION
FELONY CONVICTION DISCLOSURE
Subsection (a)of Section 44.034 of the Texas Education Code (Notification of Criminal History of Contractor)
states: "A person or business entity that enters into a contract with a school district must give advance notice to the district
if the person or an owner or operator has been convicted of a felony. The notice must include a general description of the
conduct resulting in the conviction of a felony."
Section 44.034 further states in Subsection (b): "A school district may terminate a contract with a person or business
entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or
misrepresented the conduct resulting in the conviction. The district must compensate the person or lousiness entity for
services performed before the termination of the contract,"
Please check NI one of the Following:
❑■ My company is a publicly-held corporation, (Advance notice requirement does not apply to publicly-held corporation.)
❑ My company is not owned or operated by anyone who has been convicted of a felony.
❑ My company is owned/operated by the following individual(s)who has/have been convicted of a felony:
Name of Felons):
Details of Conviction(s):
By signature below, I certify that the above information is true, complete and accurate and that I am authorized by my
company to make this certification.
MoboTrex, Inc
Company Name
Vincent Holdridge
Signature of Authorized Company official Printed Name
DEBARMENT CERTIFICATION
Neither my company nor an owner or principal of my company has been debarred, suspended or otherwise made ineligible
for participation in Federal Assistance programs under Executive Order 12549, "Debarment and Suspension," as described
in the Federal Register and Rules and Regulations. Neither my company nor an owner or principal of my company is
currently listed on the government-wide exclusions in SAM, debarred, suspended, or otherwise excluded by agencies or
declared ineligible under any statutory or regulatory authority. My company agrees to immediately notify the Cooperative
and all Cooperative members with pending purchases or seeking to purchase from my company if my company or an
owner or principal is later listed on the government-wide exclusions in SAM, or is debarred, suspended, or otherwise
excluded by agencies or declared ineligible under any statutory or regulatory authority.
By signature below, I certify that the above is true, complete and accurate and that I am authorized by my company to
make this certification.
MoboTrex, Inc
Company Name
Vincent Holdridge
Signature of Authorized Co ffciai Printed Name
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RESIDENT/NONRESIDENT CERTIFICATION
Chapter 2252, Subchapter A, of the Texas Government Code establishes certain requirements applicable to proposers who
are not Texas residents, Linder the statute, a"resident"proposer is a person whose principal place of business is in Texas,
including a contractor whose ultimate parent company or majority owner has its principal place of business in Texas. A
"nonresident" proposer is a person who is not a Texas resident. Please indicate the states of your company as a"resident"
proposer or a"nonresident"proposer under these definitions.
Please check M one of the following
❑ I certify that my company is a Resident Proposer.
❑■ I certify that my company is a Nonresident Proposer.
If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in
which your company's principal place of business is located):
MoboTrex, Inc 109 W 55th St
Company Name Address
Davenport IA 52806
City State Zip Code
A. ❑oes your resident state require a proposer whose principal place of business is in Texas to under-price proposers
whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?
❑ Yes 7 No
B. What is the prescribed amount or percentage? $ or %
VENDOR EMPLOYMENT CERTIFICATION
Section 44,031(b) of the Texas Education Code establishes certain criteria that a school district must consider when
determining to whom to award a contract. Among the criteria for certain contracts is whether the vendor or the vendor's
ultimate parent or majority owner (i) has its principal place of business in Texas; or (ii) employs at least 500 people in
Texas.
If neither your company nor the ultimate parent company or majority owner has its principal place of business in Texas,
does your company, ultimate parent company, or majority owner employ at least 500 people in Texas?
Please check N)one of the following
n Yes ❑ No
By signature below, I certify that the information in Sections 1 (Res1denVNonres1denr Certification) and 2 (Vendor
Employment Certification) above is true, complete and accurate and that I am authorized by my company to mace this
certification.
MoboTrex, Inc
Company Name
- Vincent Holdridge
Signature of Authorized Corn lcial Printed Name
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NO ISRAEL BOYCOTT CERTIFICATION
Effective September 1, 2017, as amended effective May 7, 2019 (H.B. 793), a Texas governmental entity may not enter
into a contract with a value of $100,000 or more that is to be paid wholly or partly from public funds with a company
(excluding a sole proprietorship)that has 10 or more Full-time employees 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. (TEX.Gav`r CODE Ch. 2270). Accordingly, this certification form is included to the extent required by law.
"Boycott Israei" means refusing to deal with, terminating business activities with, or otherwise taking any action that is
intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or
entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business
purposes. TEx. Gov T CODE §808.001(1).
By signature below, I certify and verify that Vendor does not boycott Israel and will not boycott Israel during the term of
any contract awarded under this Proposal Invitation, that this certification is true, complete and accurate, and that I am
authorized by my company to make this certification.
MoboTrex, Inc
Company Name
Vincent Holdridge
Signature of Authorized Company Official Printed Name
Note. If Vendor does not wish to make this certlflcatlon, return the blank form In Ileu of a completed
certlflcatlon.
NO EXCLUDED NATION OR FOREIGN TERRORIST ORGANIZATION CERTIFICATION
Effective September 1, 2017, Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may
not enter into a contract with a company engaged in active business operations with Sudan, Iran, or a foreign terrorist
organization —specifically, any company identified on a list prepared and maintained by the Texas Comptroller under Texas
Government Code §§805.051, 807.051, or 2252.153. (A company that the U.S. Government affirmatively declares to be
excluded from its federal sanctions regime relating to Sudan, Iran, or any federal sanctions regime relating to a Foreign
terrorist organization is not subject to the contract prohibition.)
By signature below, I certify and verify that Vendor is not on the Texas Comptroller's list identified above; that this
certification is true, complete and accurate; and that I am authorized by my company to make this certification.
MoboTrex, Inc
Company Name
Vincent Holdridge
Signature of Authorized Company Official Printed Name
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HISTORICALLY UNDERUTILIZED BUSINESS CERTIFICATION
A proposer that has been certified as a Historically Underutilized Business {also known as a Minority/Women Business
Enterprise or "MWBE" and all referred to in this Form as a "HUB'7 is encouraged to indicate its HUB certification status
when responding to this Proposaf Invitation. The electronic catalogs will indicate HUB certifications for vendors that
properly indicate and document their HUB certification on this form.
Please check M all that apply:
❑ I certify that my company has been certified as a HUB in the following categories:
❑ Minority Owned Business
❑ Women Owned Business
❑ Service-Disabled Veteran Owned Business (veteran defined by 38 U.S.C. §101(2), who has a
service-connected disability as defined by 38 U.S.C.§ 101(16), and who has a disability rating
of 20% or more as determined by the U. S. Department of Veterans Affairs or Department of
Defense)
Certification Number:
Name of Certifying Agency:
❑ My company has NOT been certified as a HUB.
By signature below, I certify that the above is true, complete and accurate and that I am authorized by my
company to make this certification.
MoboTrex, Inc
Company Name
Vincent Holdridge
Printed Name
Signature of Authorized Com clal
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CONSTRUCTION-RELINED GOODS AND SERVICES AFFIRMATION
A contract awarded under this Proposal Invitation covers only the specific goods and services awarded by the BuyBoard. As
explained in the BuyBoard Procurement and Construction Related Goods and Services Advisory for Texas Members
["Advisory'% Texas law prohibits the procurement of architecture or engineering services through a
purchasing cooperative. This BuyBoard contract does not include such services. Architecture or engineering
services must be procured by a Cooperative member separately, in accordance with the Professional
Services Procurement Act(Chapter 2254 of the Texas Government Code) and other applicable law and local
policy.
The Advisory, available at buyboard.com/vendor/Resources.aspx, provides an overview of certain legal requirements that
are potentially relevant to a Cooperative member's procurement of construction or construction-related goods and services,
including those for projects that may involve or require architecture, engineering or independent testing services. A copy
of the Advisory can also be provided upon request.
By signature below, the undersigned affirms that Proposer has obtained a copy of the Advisory, has read and understands
the Advisory, and is authorized by Proposer to make this affirmation. If Proposer sells construction-related goods or
services to a Cooperative member under a BuyBoard contract awarded under this Proposal Invitation, Proposer will comply
with the Advisory and applicable legal requirements, make a good faith effort to make its Cooperative member customers
or potential Cooperative member customers aware of such requirements, and provide a Cooperative member with a copy
of the Advisory before executing a Member Construction Contract with the member or accepting the member's purchase
order For construction-related goads or services, whichever comes first.
MoboTrex, Inc
Company Name
Vincent Holdridge
Signature of Authorized Company Official Printed Name
11 -5-2019
Da to
Page 16 of 63
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wCoopetativeft ,11 ,1fog
12007 Research Boulevard •Austin, "texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
DEVIATION AND COMPLIANCE
If your company intends to deviate from the General Terms and Conditions, Proposal Specifications or other requirements
associated with this Proposal Invitation, you MUST list all such deviations on this form, and provide complete and detailed
information regarding the deviations on this form or an attachment to this form. The Cooperative will consider any
deviations in its contract award decision, and reserves the right to accept or reject a proposal based upon any submitted
deviation.
In the absence of any deviation identified and described in accordance with the above, your company must Fully comply
with the General Terms and Conditions, Proposal Specifications and all other requirements associated with this Proposal
Invitation if awarded a contract under this Proposal Invitation. A deviation will not be effective unless accepted by the
Cooperative. The Cooperative may, in its sole discretion, seek clarification from and/or communicate with Proposer(s)
regarding any submitted deviation, consistent with general procurement principles of fair competition. The Cooperative
reserves the right to accept or reject a proposal based upon any submitted deviation.
Please check_()Z]_one of the following
❑ NO; Deviations
❑ YeS; Deviations
List and fully explain any deviations you are submitting:
PLEASE PROVIDE THE FALLOWING INFORMATION:
1. Shipping Via: ■❑ Common Carrier ❑ Company Truck ❑ Prepaid and Add to Invoice ❑ Other:
2, Payment Terms: ❑■ Net 30 days ❑ 1%in 10/Net 30 days ❑ Other:
3. Number of Days for Delivery: 45-60 ARO
4. Vendor Reference/Quote Number: 608-20
5. State your return policy: Restocking fee of up to 20% may apply
b. Are electronic payments acceptable? ®Yes ❑ No
7. Are credit card payments acceptable? *Yes ❑ No
MoboTrex, Inc
Company Name
Vincent Holdridge
Signature of Authorized Company official _ Printed Name
Page 17 of 63
Proposal Forms COMM/SVCS V.05.31,2019
Du�aard
Cepperative Purchasing
12007 Research Boulevard ' Austin,Texas 78759-2439 - PH; 800-695-2919 ' FAX.- 800-211-5454 ' buyboard.conl
LOCATION / AUTHORIZED SELLER LISTINGS
If you have more than one location/authorized seller that will service a contract awarded under this Proposal Invitation,
please list each location/authorized seller below. If additional sheets are required, please duplicate this form as necessary.
NOTE! Awarded vendors shall remain responsible for all aspects of the Contract, including processing of Purchase Orders,
and shall be responsible for the performance of all locations and authorized sellers under and in accordance with the
Contract. If you are a product manufacturer and wish to designate Designated Dealers as defined in the General Terms
and Conditions to receive Cooperative member Purchase Orders on your behalf, you must complete the Manufacturer
Designated Dealer forrn.
MoboTrex, Inc
Company Name
301 W Howard Lane
Address
Austin TX 78753
City State Zip
512-521-3337
Phone Number Fax Number
Vincent Holdridge
Contact Person
Company Name
Address
City State Zip
Phone Number Fax Number
Contact Person
Page 18 of 63
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Cooperative Purchasing
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 ' huyboard.com
MANUFACTURER DEALER DESIGNATION
If Vendor is a manufacturer that sells products through a dealer network and wishes to designate a dealer or multiple
dealers ("Designated Dealers") to receive Cooperative member Purchase Orders on Vendor's behalf, you must complete
this form for each dealer you wish to designate.
Regardless of any Designated Dealers submitted by Vendor, Vendor specifically agrees and acknowledges that any such
designations are for Vendor's convenience only and shall not, if Vendor is awarded a Contract, relieve Vendor of any
obligations under the Contract, including payment of Cooperative service fees on all Purchase Orders submitted to Vendor
or any Designated Dealer. In accordance with the Generai Terms and Conditions, an awarded Vendor shall remain
responsible and liable for all of its obligations under the Contract and the performance of both Vendor and any of Vendor's
Designated Dealers under and in accordance with the Contract and remain subject to all remedies for default thereunder,
including, but not limited to suspension and termination of Vendor's Contract for nonpayment of service fees.
If awarded, Vendor authorizes the Cooperative, in its sole discretion, to list any Vendor Designated Dealers in the BuyBoard
system and to receive Purchase Orders directly from Cooperative members on behalf of Vendor. To the extent a Vendor
with Designated Dealers receives a Purchase Order directly, it shall be the responsibility of Vendor to appropriately process
such Purchase Order in accordance with the Contract, including but not limited to timely forwarding such Purchase Order to
a Designated Dealer for processing.
The Cooperative reserves the right, in its sole discretion, to refuse addition of, or request removal of, any Designated
Dealer, and Vendor agrees to immediately require such Designated Dealer to cease accepting Purchase Orders or otherwise
acting on Vendor's behalf under the Contract. Further, the Cooperative's administrator shall be authorized to remove or
suspend any or all Designated Dealers from the BuyBoard at any time in its sole discretion.
If you wish to designate a dealer to service a contract awarded under this Proposal Invitation, please list the Designated
Dealer below and have this form signed by an official of your company authorized to make such designation. If you wish
to designate multiple dealers, please duplicate this form as necessary.
NONE
Designated Dealer Name
Designated Dealer Address
City State Zip
Phone Number Fax Number
Email address Designated Dealer Tax ID Number* (*attach W-9)
Designated Dealer Contact Person
MoboTrex, Inc
Your Company Name Signature of Authorized Co Official
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12007 Research Boulevard ' Austin,Texas 78759-2439 ' PH 800-695-2919 ' FAX: 800-211-5454 • buyboard.conn
TEXAS REGIONAL SERVICE DESIGNATION
The Cooperative(referred to as"Texas Cooperative" in this form and in the State Service Designation form) offers vendors
the opportunity to service its members throughout the entire State of Texas. If you do not plan to service all Texas
Cooperative members statewide, you must indicate the specific regions you will service on this form. ff you propose to
serve different regions for different products or services included In your proposal, you must complete and
submit a separate Texas Reglonal Service Designation form for each group of products and clearly Indicate
the products or services to which the deslgnatlon applles In the space provided at the end of this form. By
designating a region or regions, you are certifying that you are authorized and willing to provide the
proposed products and services In those regions. Deslgnating regions In which you are elther unable or
unwllling to provide the speclfled products and services shall be grounds for elther rejection of your
proposal or, If awarded, termination of your Contract. Additionally, if you do not plan to service Texas Cooperative
members (i.e., if you will service only states other than Texas), you must so indicate on this form.
Regional Education Service Centers I will service Texas
Cooperative members
_ - statewide.
i ❑ I will not service Texas
Cooperative members
statewide. I will only
service members in the
regions checked below:
Region Headtluar#ers
� ; 4 •_..
-- - i_ ; r,__ ❑ 1 Edinburg
-# - i ❑ 2 Corpus Christi
? ❑ 3 Victoria
�� i. ;- - =ALL` ❑ 4 Houston
5 Beaumont
�' — ❑ 6 Huntsville
_ -- ,� •- ;�, ❑ 7 Kilgore
-1 ❑ 8 Mount Pleasant
0 • ,3'�_. TF ❑ 9 Wichita Falls
�'•: :i:. `, ❑ to Richardson
} ❑ 11 Fort Worth
:`" ❑ 12 Waco
❑ 13 Austin
❑ 14 Abilene
`Y ❑ 15 San Angelo
❑ 16 Amarillo
MoboTrex, Inc ❑ 17 Lubbock
❑ 18 Midland
Company Name ❑ 19 El Paso
���- ❑ 20 San Antonio
Signature of Authorized Company Official
Vincent Holdridge ❑ 1 will not service members
Printed Name of the Texas Cooperative.
Page 20 of 63
Proposal Forms CaMM/SICS v.05.31.2019
DCooperative Purchasing
12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-595-2919 ' FAX: 800-211-5454 • buyboard.com
If this Texas Regional Service Designation form applies to only one or some of the products and services proposed by
Vendor, list the products and services to which this form applies here:
Page 21 of 63
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Csoperstive PnrGhaslrig
12007 Research Boulevard ' Austin,Texas 78759-2439 , PH: 800-695-2919 ' FAX: 800-211-5454 • buyboard.com
STATE SERVICE DESIGNATION
The Cooperative offers vendors the opportunity to service other governmental entities in the United States, including
intergovernmental purchasing cooperatives such as the National Purchasing Cooperative 8UyBoard. You must complete
this form if you plan to service the entire united States, or will service only the specific states indicated. (Note:If you plan
to service Texas Cooperative members, be sure that you complete the Texas Regional Service Designation form.)
If you serve different states for different products or services Included In your proposal, you must complete
and submit a separate State Service Deslgnadon form for each group of products and clearly Indicate the
products or services to which the designation applies In the space provided at the end of this form. By
designating a state or states, you are certifying that you are authorized and w1111ng to provide the proposed
products and services In those states. Deslgnating states In which you are elther unable or unw1111ng to
provide the speclfled products and services shall be grounds for elther refectlon of your proposal or, If
awarded, terminatlon of your Contract.
Please check(A all that aody:
❑ I will service all states in the United States.
0 I will not service all states in the United States. I will service only the states checked below:
❑ Alabama
❑ Alaska ❑ Nebraska
❑ Arizona ❑ Nevada
❑ Arkansas ❑ New Hampshire
❑ California (Public Contract Code 20118 &20652) ❑ New Jersey
❑ Colorado ❑ New Mexico
❑ Connecticut ❑ New York
❑ Delaware ❑ North Carolina
❑ District of Columbia ❑ North Dakota
❑ Florida ❑ Ohio
❑ Georgia ❑■ Oklahoma
❑ Hawaii ❑ Oregon
❑ Idaho ❑ Pennsylvania
❑ Illinois ❑ Rhode Island
❑ Indiana ❑ South Carolina
❑ Iowa ❑ South Dakota
❑ Kansas ❑Tennessee
❑ Kentucky ❑■ Texas
❑ Louisiana ❑ Utah
❑ Maine ❑ Vermont
❑ Maryland ❑ Virginia
❑ Massachusetts ❑ Washington
❑ Michigan ❑ West Virginia
❑ Minnesota ❑ Wisconsin
❑ Mississippi ❑ Wyoming
❑ Missouri
❑ Montana
Page 22 of 63
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Cooperative Purchasing
12007 Research Boulevard •Austin, Texas 78759-2439 PH: 800-695-2919 • FAX: 800-211-5454 •buyboard.com
This form will be used to ensure that you can service other governmental entities throughout the United States as
indicated. Your signature below confirms that you understand your service commitments during the term of a
contract awarded under this proposal.
MoboTrex, Inc
Company Name
Vincent Holdridge
Signature of Authorized Company Offcial Printed Name
If this State Service Designation Form applies to only one or some of the products and services proposed by Vendor,
list the products and services to which this form applies here:
Page 23 of 63
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Cooperative Purchasing
12007 Research Boulevard 'Austin,Texas 78759-2439 - PH; 800-695-2919 ' FAX: 800-211-5454 • buvboard.com
NATIONAL PURCHASING COOPERATIVE VENDOR AWARD AGREEMENT
In accordance with the Terms and Conditions associated with this Proposal Invitation, a contract awarded under this
Proposal Invitation may be "piggy-backed" by another governmental entity. The National Purchasing Cooperative is an
intergovernmentaf purchasing cooperative formed by certain school districts outside of Texas to serve its members
throughout the United States. If you agree to be considered for a piggy-back award by the National Purchasing
Cooperative, you agree to the following terms and agree to serve National Purchasing Cooperative members in the states
you have indicated on the State Service Designation form, in your Proposal.
By signing this form, Proposer(referred to in this Agreement as"Vendor")agrees as follows:
1. Vendor acknowledges that if The Local Government Purchasing Cooperative ("Texas Cooperative") awards Vendor a
contract under this Proposal Invitation ("Underlying Award), the National Purchasing Cooperative ("National Cooperative")
may - but is not required to - "piggy-back"on or re-award all or a portion of that Underlying Award ("Piggy-Back Award").
By signing this National Cooperative Vendor Award Agreement ('Agreement"), Vendor accepts and agrees to be bound by
any such Piggy-Back Award as provided for herein.
2. In the event National Cooperative awards Vendor a Piggy-Back Award, the National Cooperative Administrator
("BuyBoard Administrator) will notify Vendor in writing of such Piggy-Back Award, which award shall commence on the
effective date stated in the Notice and end on the expiration date of the Underlying Award, subject to annual renewals as
authorized in writing by the BuyBoard Administrator. Vendor agrees that no further signature or other action is required of
Vendor in order for the Piggy-Back Award and this Agreement to be binding upon Vendor. Vendor further agrees that no
interlineations or changes to this Agreement by Vendor will be binding on National Cooperative, unless such changes are
agreed to by its BuyBoard Administrator in writing.
3. Vendor agrees that it shall offer its goods and services to National Cooperative members at the same unit pricing and
same general terms and conditions, subject to applicable state laws in the state of purchase, as required by the Underlying
Award. However, nothing in this Agreement prevents Vendor from offering National Cooperative members better (i.e.,
lower) competitive pricing and more favorable terms and conditions than those in the Underlying Award.
4. Vendor hereby agrees and confirms that it will serve those states it has designated on the State Service Designation
Form of this Proposal Invitation. Any changes to the states designated on the State Service Designation Form must be
approved in writing by the BuyBoard Administrator.
5. Vendor agrees to pay National Cooperative the service fee provided for in the Underlyinq Award based on the amount of
purchases generated from National Cooperative members through the Piggy-Back Award. Vendor shall remit payment to
National Cooperative on such schedule as it specifies (which shall not be more often than monthly). Further, upon
request, Vendor shall provide National Cooperative with copies of all purchase orders generated from National Cooperative
members for purposes of reviewing and verifying purchase activity. Vendor further agrees that National Cooperative shall
have the right, upon reasonable written notice, to review Vendor's records pertaining to purchases made by National
Cooperative members in order to verify the accuracy of service fees.
6. Vendor agrees that the underlying Award, including its General Terms and Conditions, are adopted by reference to the
fullest extent such provisions can reasonably apply to the post-proposal/contract award phase. The rights and
responsibilities that would ordinarily inure to the Texas Cooperative pursuant to the Underlying Award shall inure to
National Cooperative; and, conversely, the rights and responsibilities that would ordinarily inure to Vendor in the Underlying
Award shall inure to Vendor in this Agreement. Vendor recognizes and agrees that Vendor and National Cooperative are the
only parties to this Agreement, and that nothing in this Agreement has application to other third parties, including the
Texas Cooperative. In the event of conflict between this Agreement and the terms of the Underlying Award, the terms of
this Agreement shall control,and then only to the extent necessary to reconcile the conflict.
Proposal Forms COMM/SVCS v.05.33.2019
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7, This Agreement shall be governed and construed in accordance with the laws of the State of Rhode Island and venue
for any dispute shall lie in the federal district court of Alexandria, Virginia.
8. Vendor acknowledges and agrees that the award of a Piggy-Back Award is within the sole discretion of National
Cooperative, and that this Agreement does not take effect unless and until National Cooperative awards Vendor a Piggy-
Back Award and the BuyBoard Administrator notifies Vendor in writing of such Piggy-Back Award as provided for herein.
WHEREFORE, by signing below Vendor agrees to the foregoing and warrants that it has the authority to enter into this
Agreement.
MoboTrex, Inc 608-20
Name of Vendor Proposal Invitation Number
Vincent Holdridge
Signature of Aut orized C any Official Printed Name of Authorized Company Official
11-5-2019
Date
Proposal Forms COMM/Svcs v.65.31,2019
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12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 ' bu bo_ X , ard.com
FEDERAL AND STATE/PURCHASING COOPERATIVE EXPERIENCE
The Cooperative strives to provide its members with the best services and products at the best prices available from
vendors with the technical resources and ability to serve Cooperative members. Please respond to the following questions.
1. Provide the dollar value of sales to or through purchasing cooperatives at or based on an established catalog or
market price during the previous 12-month period or the last fiscal year: $3,550,000.00 . (The period of the 12
month period is Nov /Oct ). In the event that a dollar value is not an appropriate measure of the sales,
provide and describe your own measure of the sales of the item(s).
2. By submitting a proposal, you agree that, based on your written discounting policies, the discounts you offer the
Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items
under equivalent circumstances.
3. Provide the information requested below for other purchasing cooperatives for which Proposer currently serves, or in
the past has served, as an awarded vendor, Rows should be added to accommodate as many purchasing
cooperatives as required,
CURRENT FORMER VENDOR (Y/N)? — AWARDED
PURCHASING VENDOR? IF YES, LIST YEARS
GROUP �Y/N) AS VENDOR CATEGORY(IES�
1. Federal General Services Administration N
2. T-PASS(State of Texas) y Traffic Signal Equipment
3. OMNIA Partners N
4, Sourcewell (N]PA) N
S. E&I Cooperative N
6. Houston-Galveston Area Council(HGAQ Y Traffic Signal Equipment
7. Choice Partners N
8. The Interlocal Purchasing System (TIPS) N
9. Other
❑ MY COMPANY DOES NOT CURRENTLY HAVE ANY OF THE ABOVE OR SIMILAR TYPE CONTRACTS.
CURRENT BLIYBOARD VENDORS
If you are a current BuyBoard vendor in the same contract category as proposed in this Proposal Invitation, indicate the
discount for your current BuyBoard contract and the proposed discount in this Proposal. Explain any difference between
your current and proposed discounts,
Current Discount(0/6): Avg 20% Proposed Discount(a/o): Avg 20%
x Ian ion; Our intent is to hold our discounts from contract 534-17
Proposal Farms COMM/SVCs v.05.3L2019
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DBeard
Cooperative Purch=1179
12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 • huyhoard.corn
By signature below, I certify that the above is true, complete and accurate and that I am authorized by my company to
make this Certification.
MoboTrex, Inc
Company Name
Vincent Holdridge
Signature of Authorized Ca y official Printed Name
Proposal Forms COMMISVCS v.05.31.2019
Page 27 of 63
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Cooperative Purchasing
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 • duYbowd.com
GOVERNMENTAL REFERENCES
For your Proposal to be considered, you must supply a minimum of five (5) individual governmental entity references, The
Cooperative may contact any and all references provided as part of the Proposal evaluation. Provide the information
requested below, including the existing pnce/discounts you offer each customer. The Cooperative may determine whether
prices/dscounts are fair and reasonable by comparing prices/discounts stated in your Proposal with the prices/discounts
you offer other governmental customers. Attach additional pages if necessary.
Quantity/
Entity Name Contact Phone# Email Address Discount Volume
See attached sheet
2.
3.
4.
5.
Do you ever modify your written policies or standard governmental sales practices as identified in the above chart to give
better discounts (lower prices)than indicated? YES ❑ NO ❑■ If YES, please explain'.
By signature below, I certify that the above is true and correct and that I am authorized by my company to make this
certification,
MoboTrex, Inc
Company Name
_
Signature of Authorized Company official
Vincent Holdridge
Printed Name
Proposal Forms CaMM/SKS v.05.31.2019
Page 28 of 63
BIDDER REFERENCES
Please list three(3) references, preferably a Government(local,county,state)or Educational Agency that
may be contacted:
1. COMPANY NAME: San Antonio, City of
ADDRESS: 223 S. Cherry Street
CITY 1 STATE 1 ZIP: San Antonio,TX 78203
PHONE NO.: 210-207-4048
NAME OF CONTACT: Jorge Garcia
2. COMPANY NAME: Dallas, City of
ADDRESS: 3204 Canton Street
CITY/STATE 1 ZIP: Dallas,TX 75226
PHONE NO.: 214-671-9249
NAME OF CONTACT: Dana Driggars
3. COMPANY NAME: Austin, City of
ADDRESS: 1501 Toomey Rd
CITY 1 STATE 1 ZIP: Austin,TX 78704
PHONE NO.: 512-974-7050
NAME OF CONTACT: Ramona Aguilar
BIDDER REFERENCES
Please list three (3) references, preferably a Government(local, county, state)or Educational Agency that
may be contacted:
t COMPANY NAME: New Braunfels, City of
ADDRESS: 424 S Castell Ave
CITY I STATE I ZIP: New Braunfels, TX 78130
PHONE NO.: 830-221-4049
NAME OF CONTACT: Chris Nowak
2. COMPANY TAME: Harlingen, City of
ADDRESS: 404 54th Street
CITY 1 STATE 1 ZIP' Harlingen, TX 78550
PHONE NO.: 956-216-5234
NAME ❑F CONTACT: Eli Cruz
3. COMPANY NAME: Duncanville. City of
ADDRESS: 330 Shady Trail Dr
CITY 1 STATE 1 Zlp' Duncanville, TX 75137
PHONE NO.: 972-780-5D59
NAME OF CONTACT. John Borchardt
P0 Baird®
Cooperative Purchasing
12007 Research Boulevard ' Austin,Texas 78759-2439 - PH: 800-695-2919 ' FAX: 800-211-5454 ' buyboard.com
MARKETING STRATEGY
For your Proposal to be considered, you must submit the Marketing Strategy you will use if the Cooperative accepts all or
part of your Proposal, (Exam le: Explain how your company will initially inform Cooperative members of your BuyBoard
contract, and how you will continue to support the BuyBoard for the duration of the contract period)
Attach additional pages if necessary.
We plan to continue to market our buyboard contract through customer visits, trade shows, trainings, and email.
Mobotrex, Inc
Company Name
Signature of Authorize Company Official
Vincent Holdridge
Printed Name
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CONFIDENTIAL/PROPRIETARY INFORMATION
A.Public Disdgsure LaLws
All Proposals, forms, documentation, or other materials submitted by Vendor to the Cooperative in response to this
Proposal Invitation, including catalogs and priceiists, may be subject to the disclosure requirements of the Texas Public
Information Act (Texas Government Code chapter 552.001, et. seq.) or similar disclosure law. Proposer must clearly
identify on this form any information in its Proposal (including forms, documentation, or other materials submitted with the
Proposal) that Proposer considers proprietary or confidential. If Proposer fails to properly identify the information, the
Cooperative shall have no obligation to notify Vendor or seek protection of such information from public disclosure should a
member of the public or other third party request access to the information under the Texas Public Information Act or
similar disclosure law. Proposer will be notified of any third party request for information in a Proposal that Proposer has
identified in this form as proprietary or confidential.
Does your Proposal (including forms, documentation, or other materials submitted with the Proposal) contain information
which Vendor considers proprietary or confidential?
Please check(V)one of the following:
NNO, I certify that none of the information included with this Proposal is considered confidential or proprietary,
YES, I certify that this Proposal contains information considered confidential or proprietary and all such information is
specifically identified on this form.
If you responded"YES", you must identify below the specific information you consider confidential or proprietary. List each
page number, form number, or other information sufficient to make the information readily identiflable. The Cooperative
and its Administrator will not be responsible for a Proposer's failure to clearly identify information considered confidential or
proprietary. Further, by submitting a Proposal, Proposer acknowledges that the Cooperative and its Administrator will
disclose information when required by law, even if such information has been identified herein as information the vendor
considers confidential or proprietary.
Confidential / Proprietary Information:
(Attach additional sheets if needed.)
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12007 Research Boulevard • Austin,Texas 78759-2439 , PH: 800-695-2919 ' FAX: 800-211-5454 ' buyboard,com
S. Copyright Information
Does your Proposal (including forms, documentation, or other materials submitted with the Proposal) contain copyright
information?
Please_check M one of the fotlowina;
FMJ NO, Proposal (including forms,documentation, or other materials submitted with the Proposat)sloes not
contain copyright information.
YES, Proposal(including Forms,documentation,or other materials submitted with the Proposal)does
contain copyright information.
If you responded"YES", identify below the specific documents or pages containing copyright information.
Copyright Information:
(Attach additional sheety if needed.)
C.Consent to Release Confidential/Proprietary/CoaYright Information to BuyBoard Members
BuyBoard members (Cooperative and nonprofit members) seeking to make purchases through the BuyBoard may wish to
view information included in the Proposals of awarded Vendors. If you identified information on this form as confidential,
proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contract
award constitutes your consent to the disclosure of such information to BuyBoard members, including posting of such
Information on the secure BuyBoard website for members. Note: Neither the Cooperative nor its Administrator will be
responsible for the use or distribution of information by BuyBoard members or,any other parry.
D.Consent_to Release-Proposal Tabulation
Notwithstanding anything in this Confidential/Proprietary Information form to the contrary, by submitting a Proposal,
Vendor consents and agrees that, upon Contract award, the Cooperative may publically release, including posting on the
public BuyBoard website, a copy of the proposal tabulation for the Contract including Vendor name; proposed
catalog/pricelist name(s); proposed percentage discounts), hourly labor rate(s), or other specified pricing; and Vendor
award or non-award information.
By signature below, I certify that the information in this form is true, complete, and accurate and that I am authorized by
my company to make this certification and all consents and agreements contained herein.
MoboTrex, Inc
Company Name
Signature of Authorized Comp
Vincent Hoidridge
Printed Name
11 -5-2019
Date
Proposal Forms COMMISWS v.05.31.2014
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VENDOR BUSINESS NAME
By submitting a Proposal, Proposer is seeking to enter into a legal contract with the Cooperative. As such, a Proposer must
be an individual or legal business entity capable of entering into a binding contract. Proposers, must completely and
accurately provide the information requested b0ow or your Proposal may be deemed non-responsive.
Name of Proposing Company: MoboTrex, Inc
(List the&g&1 name of the company seeking to contract with the Cooperative. Do NOT list an assumed name, oba,aka,etc.here. Suor information may
be provided below. If you are submitting a joint proposal with anodrer entity to provide the same proposed goods or services, each submthng entity
should complete a separate vendor information form separately operating legal business entities, even if alYliated entities, which propose to provide
goods or services separately must submit their own Proposals.)
Please check(y)Qnn_of the following:
Type of Business:
Individual/Sole Proprietor
Corporation x
Limited Liability Company
Partnership
Other If other, identify
State of Incorporation (if applicable): I O WA
Federal Employer Identification Number: 35-2656899
(Vendor must include a completed IRS W-9 form with their proposal)
List the Name(s) by which Vendor, if awarded, wishes to be identified on the BuyBoard: (Note: Jf different than the Name of
Proposing Company listed above, only valid trade names(aba, aka, etc)of the Proposrn_g Company may be used and a copy of your Assumed Name
Certiricate(s),if applicable,must be attached.)
Proposal Forms COMM/SVCS v.a5.31,2019
Page 32 of 63
Farm Request for Taxpayer Give Form to the
(Rev.October2018) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revehue Service ►Go to www.1rs.gov1FormW9 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.
MoboTrex,Inc _
2 Susiness 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. I certain entities,not Individuals;see
a + instructions on page 3):
a
individual1sole proprietor or ❑ C Corporation ❑✓ S.Corporation ❑ Partnership ❑Trustlestate
e single-member LLC Exempt payee code(if any)
a
-s [ 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 (If any)
e another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC th code at
afJis disregarded from the owner should check the appropriate box for the tax classification of its owner.
w=
❑I Other(see instructions)► (4pph s to a moda melnterned outside roe us)
0 5 Address(number,sheet,and apt.or suite no.)See instructions. Requester's name and address(optional)
109 West 55th Street
B City,state,and ZIP code
DavenPort,IA 52806
7 List account number's)here(optionaQ
Taxpayer 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.For individuals,this is generally your social security number(S However,for a -m -
resident alien,sole proprietor,or disregarded entity,see the instructions for Part 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 line 1.Also see What Name and I EmploYer Identification number
Number Tc Give the Requester for guidelines on whose number to enter.
F
- 2 6 5 6 8 9 9
IF-.TRVF 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 I 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 noted 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 11,later.
Sign U.S.
: of/ ` �,�, 9
Here U U.S.person► Date► O
� � /
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 a Form 1099-8(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/FcrmUJ9.
•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 file an a Form 1098(home mortgage interest),1098-E(student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-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 9imited to,the following. lfyou 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.10231X Form W-9(Rev.10-2018)
Couparatlre Purchasi►►g
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX; 800-211-5454 ' buvboard.com
EDGAR VENDOR CERTIFICATION
(2 CFR Part 200 and Appendix II)
When a Cooperative member seeks to procure goods and services using funds under a Federal grant or contract, specific
federal laws, regulations, and requirements may apply in addition to those under state law. This includes, but is not limited
to, the procurement standards of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for
Federal Awards, 2 CFR 200 [sometimes referred to as the "Uniform Guidance" or new "EDGAR'�- All Vendors submitting
proposals must complete this EDGAR Certification Form regarding Vendor's willingness and ability to comply with certain
requirements which may be applicable to specific Cooperative member purchases using federal grant Funds. This
completed form will be made available to Cooperative members for their use while considering their purchasing options
when using federal grant funds. Cooperative members may also require Vendors to enter into ancillary agreements, in
addition to the BuyBoard contract's general terms and conditions, to address the member's specific contractual needs,
Including contract requirements for a procurement using federal grants or contracts.
For each of the Items below, Vendor should certify Vendor's agreement and ablllty to comply, where
applicable, by having Vendor's authorized representative complete and Initial the applicable boxes and sign
the acknowledgment at the end of this form. If you fall to complete any Item In this form, the Cooperative
will consider and may list the Vendor's response on the BuyBoard as "NO,"the Vendor Is unable or unw1111ng
to comply. A "NO" response to any of the items may, if applicable, impact the ability of a Cooperative member to
purchase from the Vendor using federal funds.
I. Vendor Violation or Breach of Contract Terms:
Contracts for more than the Simplified Acquisition Threshold, which is the inflation adjusted amount determined by the
Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 USC
1908, must address administrative, contractual, or legal remedies in instances where contractors violate or breach contract
terms, and provide for such sanctions and penalties as appropriate.
Provisions regarding Vendor default are included in the BuyBoard General Terms and Conditions, including Section E.18,
Remedies for Default and Termination of Contract. Any Contract award will be subject to such BuyBoard General Terms
and Conditions, as well as any additional terms and conditions in any Purchase Order, Cooperative member ancillary
contract, or Member Construction Contract agreed upon by Vendor and the Cooperative member which must be consistent
with and protect the Cooperative member at least to the same extent as the BuyBoard Terms and Conditions.
The remedies under the Contract are in addition to any other remedies that may be available under law or in equity. By
submitting a Proposal, you agree to these Vendor violation and breach of contract terms,
2. Termination for Cause or Convenience:
For any Cooperative member purchase or contract in excess of $10,000 made using federal Funds, you agree that the
Following term and condition shall apply:
The Cooperative member may terminate or cancel any purchase order under this Contract at any time, with or without
cause, by providing seven (7) business days advance written notice to the Vendor, If this Agreement is terminated in
accordance with this Paragraph, the Cooperative member shall only be required to pay Vendor for goods or services
delivered to the Cooperative member prior to the termination and not otherwise returned in accordance with Vendor`s
return policy. If the Cooperative member has paid Vendor for goods or services not yet provided as of the date of
termination, Vendor shall immediately refund such payments).
If an alternate provision for termination of a Cooperative member purchase for cause and convenience, including the
manner by which it will be effected and the basis for settlement, is included in the Cooperative member's purchase order,
ancillary agreement, or Member Construction Contract agreed to by the Vendor, the Cooperative member's provision shall
control.
Proposal Forms COMMiSVCS v.0&31.2019
Page 33 of 63
P 0 a
wCapperative Purchasing
12007 Research Boulevard . Austin,Texas 78759-2439 PH. 800-695-2919 • FAX: 800-211-5454 • huyhoand.corn
3. Equal Employment Opportunity:
Except as otherwise provided under 41 CFR Part 60, all Cooperative member purchases or contracts that meet the
definition of "federally assisted construction contract" in 41 CFR Part 60-1.3 shall be deemed to include the equal
opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, "Equal Employment
Opportunity" (30 FIR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375,
"Amending Executive Order 11246 Relating to Equal Employment Opportunity," and implementing regulations at 41 CFR
Part 60,"Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor."
The equal opportunity clause provided under 41 CFR 60-1.4(b) Is hereby incorporated by reference. Vendor agrees that
such provision applies to any Cooperative member purchase or contract that meets the definition of "federally assisted
construction contract"in 41 CFR Part 60-1.3 and Vendor agrees that it shall comply with such provision.
4. Davis-Baton Act:
When required by Federal program legislation, Vendor agrees that, for all Cooperative member prime construction
contracts/purchases in excess of $2,000, Vendor shall comply with the. Davis-Bacon Act (40 USC 3141-3144, and 3146-
3148) as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to
Contracts Covering Federally Financed and Assisted Construction']- In accordance with the statute, Vendor is required to
pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determinate made by
the Secretary of Labor. In addition, Vendor shall pay wages not less than once a week.
Current prevailing wage determinations issued by the Department of Labor are available at wdol.raov. Vendor agrees that,
for any purchase to which this requirement applies, the award of the purchase to the Vendor is conditioned upon Vendor's
acceptance of the wage determination.
Vendor further agrees that it shall also comply with the Copeland "Anti-Kickback" Act (40 USC 3145), as supplemented by
Department of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work
Financed in Whole or in Part by Loans or Grants from the United States"). The Act provides that each contractor or
subrecipient must be prohibited from inducing, by any means, any person employed in the Construction, completion, or
repair of public work, to give up any part of the compensation to which he or she is otherwise entitled.
5. Contract Work Hours and Safety Standards Act:
where applicable, for all Cooperative member contracts or purchases in excess of$100,000 that involve the employment of
mechanics or laborers, Vendor agrees to comply with 40 USC 3702 and 3704, as supplemented by Department of Labor
regulations (29 CFR Part 5). Under 40 USC 3702 of the Act, Vendor is required to compute the wages of every mechanic
and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible
provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours
worked in excess of 40 hours in the work week. The requirements of 40 USC 3704 are applicable to construction work and
provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are
unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles
ordinarily available on the open market, or contracts for transportation or transmission of intelligence.
6. Right to Inventions Made Under a Contract or Agreement:
If the Cooperative member's Federal award meets the definition of"funding agreement" under 37 CFR 401.2(a) and the
recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the
substitution of parties, assignment or performance or experimental, developmental, or research work under that"funding
agreement," the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions
Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative
Agreements,"and any implementing regulations issued by the awarding agency.
Vendor agrees to comply with the above requirements when applicable.
Proposal Forms COMM/5VC5 v.05.31.2019
Page 34 of 63
P 0 a
Wcapperative Purchmdfig
12007 Research Boulevard •Austin,Texas 78759-2439 - PH: 800-695-2919 • FAX: 800-211-5454 • buyboard,corn
7. Clean Air Act and Federal Water Pollution Control Act:
Clean Air Act (42 USC 7401-7671q.) and the Federal Water Pollution Control Act (33 USC 1251-1387), as amended —
Contracts and subgrants of amounts in excess of$150,000 must contain a provision that requires the non-Federal award to
agree to comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act (42 USC 7401-
7671q.) and the Federal Water Pollution Control Act, as amended (33 USC 1251-1387). Violations must be reported to the
Federal awarding agency and the Regional Office of the Environmental Protection Agency(EPA).
When required, Vendor agrees to comply with all applicable standards, orders, or regulations issued pursuant to the Clean
Air Act and the Federal Water Pollution Control Act.
8. Debarment and Suspension:
Debarment and Suspension (Executive Orders 12549 and 12689) — A contract award (see 2 CFR 180.220) must not be
made to parties listed on the government-wide exclusions in the System for Award Management(SAM), in accordance with
the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1966 Comp. p. 189) and 12689 (3
CFR Part 1989 Comp. p. 235), "Debarment and Suspension." SAM Exclusions contains the names of parties debarred,
suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority
other than Executive Order 12549.
Vendor certifies that Vendor is not currently listed on the government-wide exclusions in SAM, is not debarred, suspended,
or otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than Executive Order
12549. Vendor further agrees to immediately notify the Cooperative and all Cooperative members with pending purchases
or seeking to purchase from Vendor if Vendor is later listed on the government-wide exclusions in SAM, or is debarred,
suspended, or otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than
Executive Order 12549.
9. Byrd Anti-Lobbying Amendment:
Byrd Anti-Lobbying Amendment(31 USC 1352) -- Vendors that apply or bid for an award exceeding $100,000 must file the
required certification. Each tier certifies to the tier above that It will not and has not used Federal appropriated funds to
pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member
of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any
Federal contract, grant or any other award covered by 31 USC 1352. Each tier must also disclose any lobbying with non-
Federai funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to
tier up to the non-Federal award. As applicable, Vendor agrees to file all certifications and disclosures required by, and
otherwise comply with, the Byrd Anti-Lobbying Amendment(31 USC 1352).
10. Procurement of Recovered Materials:
For Cooperative member purchases utilizing Federal funds, Vendor agrees to comply with Section 6002 of the Solid Waste
Disposal Act, as amended by the Resource Conservation and Recovery Act where applicable and provide such information
and certifications as a Cooperative member may require to confirm estimates and otherwise comply. The requirements of
Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR
Part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory
level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the
preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy
and resource recovery, and establishing an affirmative procurement program for procurement of recovered materials
Identified in the EPA guidelines.
11. Profit as a Separate Element of Price:
For purchases using federal funds in excess of the Simplified Acquisition Threshold, a Cooperative member may be required
to negotiate profit as a separate element of the price. See, 2 CFR 200.323(b). When required by a Cooperative member,
Vendor agrees to provide information and negotiate with the Cooperative member regarding profit as a separate element
of the price for a particular purchase. However, Vendor agrees that the total price, including profit, charged by Vendor to
the Cooperative member shall not exceed the awarded pricing, including any applicable discount, under Vendor's
Cooperative Contract,
Proposal Forms COMM/SVCS v.05.31.2019
Page 35 of 63
buyboard.com
oard
Cooperative Pmclras/ng
12007 Research Boulevard •Austin,Texas 78759-2439 PH:800 695 2919 FAX:800-211-5454
12. General Compliance and Cooperation with Cooperative Members:
In addition to the foregoing specific requirements, Vendor agrees, in accepting any Purchase Order from a Cooperative
member, it shall make a good faith effort to work with Cooperative members to provide such information and to satisfy _
such requirements as may apply to a paFtiGulap C.99peFative FnepplaeF purchase or purchases iRd ding, but not limited to,
applicable recordkeeping and record retention requirements. j
Vendor Certification: f
YES,I agre
Vendor Certification Item No. NO I do NOT agree Initial
I. Vpnrinr Vinlatinn nr Rraarh of('nntra�+ rormc
YES -
2. Termination for Cause or Convenience YES —T —
3. Equal Employment Opportunity YES
4. Davis-Bacon Act YES /1
5. Contract Work Hours and Safety Standards Act YES
6. Right to Inventions Made Under a Contract or Agr
YES
7. Cl,-an air Art anri Federal Water Pollution Control Act
YES
8. Debarment and Suspension YES / f d
9. Byrd Anti-Lobbying Amendment YES . in
10. Procurement of Recovered Materials YES
11. Profit as a Separate Element of Price
YES f..
12. General Compliance and Cooperation with Cooperative Members YES ,1
By signature below, I certify that the information in this form is true, complete,and accurate and that I am authorized by
my company to make this certification and all consents and agreements contained herein.
MoboTrex, Inc
Company Name
Signature of Authorized Company Official
Vincent Holdridge
Printed Name
Proposal Forms COMMISVCS v.05.31.2019
Page 36 of 63
BaqPurc�N,d�
Cooperative
t2007 Research Boulevard 'Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 •bu boy ard.com
PROPOSAL INVITATION QUESTIONNAIRE
The Cooperative will use your responses to the questions below in evaluating your Proposal and technical and financial
resources to provide the goods and perform the services C'Work'} under the 8uyBoard contract contemplated by this
Proposal Invitation ['Contract"}. Proposers must fully answer each question, numbering your responses to correspond to
the questions numbers below. Proposers must complete below or attach your responses to this questionnaire, sign where
indicated below, and submit the signed questionnaire and your responses to all questions in one document with your
Proposal. You must submit the signed questionnaire and responses with your Proposal or the Proposal will
not be considered.
1. List the number of years Proposer has been in business and former business names(if applicable). Note whether your
company is currently for sale or involved in any transaction that would significantly alter its business or result in
acquisition by another entity.
We have been in business for 50 years this year.
2. Describe the resources Proposer has to manage staff and successfully perform the Work contemplated under this
Contract. State the number and summarize the experience of company personnel who may be utilized For the Work,
including those who will be available to Cooperative members for assistance with project development, technical issues,
and product selection for Work associated with this Contract.
We have facilities in Austin, TX. We have 4 sales people for Texas and Oklahoma.
3. Describe Proposers financial capability to perform the Contract. State or describe the firm's financial strength and
rating, bonding capacity, and insurance coverage limits. State whether the firm, or any of the firm's past or present
owners, principal shareholders or stockholders, or officers, have been a debtor party to a bankruptcy, receivership, or
insolvency proceeding in the last 7 years, and identify any such debtor party by name and relationship to or position
with your firm.
We have a strong financial performance history and have never been party to bankruptcy.
Proposal forms COMM/SVCS v.05.31.2019
Page 37 of 63
P 0 0
Beard
Cooperative Purchasing
12007 Research Boulevard •Austin,Texas 78759-2439 ' PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com
4. Roes your company have any outstanding financial judgments and/or is it currently in default on any loan or financing
agreement's If so, provide detailed information on the nature of such items and prospects for resolution.
NONE
5. List all contracts, if any, in the last 14 years on which Proposer has defaulted, failed to complete or deliver the work, or
that have been terminated for any reason. For each such contract, provide the project name, scope, value and date
and the name of the procuring entity. Fully explain the circumstances of the default, failure to complete or deliver the
work, or termination.
NONE
& List all litigation or other legal proceedings (including arbitration proceedings), if any, in the fast 10 years brought
against your firm, or any of the firm's past or present owners, principal shareholders or stockholders, officers, agents or
employees, that relates to or arises from a contract similar to this Contract or the work contemplated under this
Contract. Provide the style of the lawsuit or proceeding (name of parties and court or tribunal in which filed), nature of
the claim, and resolution or current status.
NONE
By signature below, I certify that the information contained in and/or attached to this Proposal Invitation
Questionnaire in response to the above questions is true and correct and that I am authorized by my
company to make this certification.
MoboTrex, Inc
Company Name
Signature of Authorized Company Official
Proposal Forms CQMM/SVCS v.05.31.2019
Page 33 of 63
Board'
cooperative Purchasing
12007 Research Boulevard • Austin,Texas 78759-2439 , PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com
REQUIRED FORMS CHECKLIST
(Please check(d)the Following)
Completed: Proposer's Agreement and Signature
Completed: Vendor Contact Information
Completed: Felony Conviction Disclosure and Debarment Certification
dCompleted: Resident/Nonresident Certification
Completed: No Israel Boycott Certification
[� Completed- No Excluded Nation or Foreign Terrorist Organization Certification
Completed: Historically Underutilized Business (HUB)Certification)
Completed: Construction Related Goods and Services Affirmation
Completed: Deviation/Compliance
Completed: Location/Authorized Seller Listings
Ed Comolleted: Manufacturer Dealer Designation
L� Com ! d: Texas Regional Service Designation
Completed: State Service Designation
Completed: National Purchasing Cooperative Vendor Award Agreement
dCompleted: Federal and State/Purchasing Cooperative Experience
Completed: Governmental References
Completed: Marketing Strategy
Completed: Confidential/Proprietary Information
EZ Completed: Vendor Business Name with IRS Form W-9
Completed: EDGAR Vendor Certification
Completed: Proposal Invitation Questionnaire
Completed: Required Forms Checklist
Completed: Proposal Specification Form with Catalogs/Pricelists
*Dt;alogs/Prtre115ts must be submitted with proposal response or respanse will not oe rorwaered.
Proposal Furms COMMJSVCS v.05.31.20 19
Page 39 of 63
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Exhibit C
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, by a vendor who Date Received
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 governmental entity.
MoboTrex, Inc
2
Check 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 government officer about whom the information is being disclosed.
N/A
Name of Officer
4J Describe each employment or other business relationship with the local government officer, or a family member of the
officer,as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.
Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form
CIO as necessary.
A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income,
other than investment income, from the vendor?
Yes F-1 No
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 or a family member of the officer AND the taxable income is not received from the
local governmental entity?
Yes F-1 No
5 Describe each employment or business relationship that the vendor named in Section 1 maintains with 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.
s
❑ Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts
as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).
7
01/13/2022
Signature of vendor doing busin66s with the governmental entity Date
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
A complete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.Iegis.state.tx.us/
Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.
Local Government Code§176.001(1-a):"Business relationship"means a connection between two or more parties
based on commercial activity of one of the parties. The term does not include a connection based on:
(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an
agency of a federal, state, or local governmental entity;
(B) a transaction conducted at a price and subject to terms available to the public; or
(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and
that is subject to regular examination by, and reporting to, that agency.
Local Government Code§176.003(a)(2)(A)and(B):
(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
(2) the vendor:
(A) has an employment or other business relationship with the local government officer or a
family member of the officer that results in the officer or family member receiving taxable
income, other than investment income, that exceeds $2,500 during the 12-month period
preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
vendor;
(B) has given to the local government officer or a family member of the officer one or more gifts
that have an aggregate value of more than$100 in the 12-month period preceding the date the
officer becomes aware that:
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contract with the vendor.
Local Government Code§ 176.006(a)and (a-1)
(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship
with a local governmental entity and:
(1) has an employment or other business relationship with a local government officer of that local
governmental entity,or a family member of the officer,described by Section 176.003(a)(2)(A);
(2) has given a local government officer of that local governmental entity, or a family member of the
officer,one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B),excluding any
gift described by Section 176.003(a-1);or
(3) has a family relationship with a local government officer of that local governmental entity.
(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator
not later than the seventh business day after the later of:
(1) the date that the vendor:
(A) begins discussions or negotiations to enter into a contract with the local governmental
entity; or
(B) submits to the local governmental entity an application,response to a request for proposals
or bids, correspondence, or another writing related to a potential contract with the local
governmental entity;or
(2) the date the vendor becomes aware:
(A) of an employment or other business relationship with a local government officer, or a
family member of the officer,described by Subsection(a);
(B) that the vendor has given one or more gifts described by Subsection (a);or
(C) of a family relationship with a local government officer.
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021
Official site of the City of Fort Worth,Texas
CITY COUNCIL AGENDA FbR Wo
rm
Create New From This M&C
DATE: 1/11/2022 REFERENCE**M&C 22- LOG 13PCOOP BB 608-20 MIOVISION
NO.: 0007 NAME: DETECTION SYSTEM TPW TD
CODE: P TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT: (ALL)Authorize the Execution of a Purchase Agreement in an Amount of
$203,000.00 with MoboTrex, Inc., Utilizing Buyboard Cooperative Contract 608-20, for a
MioVision Traffic Detection System for the Transportation & Public Works Department
(2018 Bond Program)
RECOMMENDATION:
It is recommended that the City Council authorize the execution of a purchase agreement in an
amount of$203,000.00 with MoboTrex, Inc., utilizing Buyboard Cooperative Contract 608-20, for a
MioVision traffic detection system for the Transportation & Public Works Department.
DISCUSSION:
The Transportation &Public Works Department(TPW)approached the Purchasing Division for
assistance in buying a new traffic detection system. The current detection system is an intelligent
transportation system (ITS)to detect vehicles, pedestrians, and cyclists with a single camera at the
intersection. Traffic engineers utilize the detection system to minimize traffic delay and distribute the
unused timing to the major street to move the traffic more efficiently.
The City of Fort Worth (City) is replacing the old detection technology with MioVision. This system will
provide detailed traffic data to the traffic engineers for timing adjustment and traffic pattern analysis.
The vendor will help the City to program the system, which detects the traffic and can send the signal
to the traffic controller for signal timing operation. The City traffic staff can monitor the traffic through
cameras and adjust the timing remotely. TPW obtained a quote from MoboTrex, Inc. using BuyBoard
Contract 608-20.
COOPERATIVE PURCHASE-State law provides that a local government purchasing an item under
a cooperative purchase agreement satisfies any state law requiring that the local government seek
competitive bids for purchase of the item. BuyBoard Contracts are competitively bid to increase and
simplify the purchasing power of government entities across the State of Texas. BuyBoard conducted
competitive bidding for the contract 608-20 during November 2019.
BUSINESS EQUITY-A Minority/Women Business Enterprise (M/WBE) goal is not assigned when
purchasing from an approved purchasing cooperative or public entity.
AGREEMENT TERM - Upon City Council's approval, this agreement will commence upon execution
by both parties and will run through May 31, 2022.
This project is included in the 2018 Bond Program. Available resources within the General Fund will
be used to provide interim financing until debt is issued. Once debt associated with the project is
sold, bond proceeds will reimburse the General Fund in accordance with the statement expressing
official Intent to Reimburse that was adopted as part of the ordinance canvassing the bond election
(Ordinance No. 23209-05-2018)and subsequent actions taken by the Mayor and Council.
This project will serve ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that funds are available in the current capital budget, as previously
appropriated, in the 2018 Bond Program Fund for the 2018 Traffic Mods and Upgrades project to
support the approval of the above recommendation and execution of the purchase agreement. Prior
to any expenditure being incurred, the Transportation & Public Works Department has the
responsibility to validate the availability of funds.
BQN\\
TO
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year Chartfield 2
FROM
Fund Department Accouroject Program Activity Budget Reference# Amount
nt P
ID ID I Year (Chartfield 2)
Submitted for City Manager's Office by_ Jay Chapa (5804)
Dana Burghdoff (8018)
Originating Department Head: Reginald Zeno(8517)
—g g—P William Johnson (7801)
Additional Information Contact: Cynthia Garcia(8338)
Taylor Dean (7648)
ATTACHMENTS
13PCOOP BB 608-20 MIOVISION DETECTION SYSTEM TPW TD funds availability.docx (CFW Internal)
FIDS table MioVision.xlsx (CFW Internal)
MoboTrex, Inc. 1295 Form.pdf (CFW Internal)
SAMS MoboTrex, Inc..pdf (CFW Internal)