HomeMy WebLinkAboutContract 47565 CITY SECRETAW, N6�_,
PROFESSIONAL SERVICES AGREEMENT CONTRACT NO.
This PROFESSIONAL SERVICES AGREEMENT("Agreement")is made and entered into by
and between the CITY OF FORT WORTH (the "City"), a Texas home rule municipal corporation,
acting by and through Jay Chapa,its duly authorized Assistant City Manager,and Thirkettle Corporation
dba A q u a M e t r i c, I n c. ("Contractor"),a California Corporation,and acting by and through Chris
Thirkettle, its duly authorized President, each individually referred to as a "party" and collectively
referred to as the "parties."
The Contract documents shall include the following:
1. This Agreement for Professional Services
2. Scope of Services plus any amendments to the Scope of Services
3. Exhibit —Completion of Certificate of Interested Parties(Form 1295)
4. Exhibit-Conflict of Interest Disclosure Requirement
The Contractor shall provide a solid foundation for success by conducting workshop with the City's AMI
Program Manager and the City's AMI team members in order to establish a common understanding of the
City's project goals,drivers, success factors and risks. This approach is designed to stimulate discussion
around the City's goals and objectives that otherwise may have not been considered. This task will serve as
the foundation for future work to develop Key Performance Indicators(KPIs).
1. SCOPE OF SERVICES.
Contractor hereby agrees to provide the City with professional services during the design and planning phase
of the City's five phased Advanced Metering Infrastructure AMI program for the design, planning and full
implementation of the AMI system.
The Contractor shall provide technical workshops supporting the design and planning during Phase I of a
City-wide AMI system.This will include advanced metering technical features to support the FWWD
leadership, as well as preparation and evaluating program components design and functionality.
Purpose
The Advanced Metering Infrastructure(AMI)workshops aids in the identification of the underlying
business reasons that are motivating the effort and reveals the critical success factors. The fundamentals
include planning workshops, identification of project objectives,and the recommended implementation
strategy. In addition,the Contractor shall assist in determining which technologies are best suited for the
City of Fort Worth's unique environment and identify the associated business process and operational
changes that must occur to realize the maximum benefits of an AMI deployment.
Assumptions
•Aqua Metric and Fort Worth will provide a single point of contact to address any inquiries related
the design and planning sessions.
•Aqua Metric and Fort Worth will answer all inquiries related to the project in a timely fashion.
• Work will be performed by Fort Worth and Aqua Metric resources on-site or off-site, when
needed, in the completion of these planning sessions.
OFRECORD
CITY SECRETARY Page 1 of 15
FT. WORTH,TX
• Aqua Metrics and Fort Worth will assign a project manager to participate in regularly scheduled
status calls with the Aqua Metrics and its partner's project manager to review open issues and
remove barriers.
• The Contractor will provide the City a written assessment report of the planning sessions.
Task 1 —City of Fort Worth Project Design and Planning
Contractor shall support the City with the following:
Prior to launching the overall AMI project, Contractor shall work with Fort Worth to compile their internal
project team organization chart which will facilitate effective communications and schedule working
sessions. The Contractor shall hold an on-site design and planning meeting with the stakeholders and project
team members to review the project scope,timeline,communications plan and housekeeping items.
During the design and planning sessions, Aqua Metric shall initiate the discovery effort to compile the
necessary data and information to assess the current state of utility operations and develop an analysis and
provide recommendations. The Contractor shall provide Fort Worth with a comprehensive list of data and
information requests including, but not limited to: financial reports, labor costs, meter information, usage
data, asset value, and losses. The City will provide a single point of contact to facilitate this activity.
Task 2—AMI Design and Planning Option Session
The Contractor shall conduct a half-day technology overview training session on-site between the
Contractor and City. The Contractor shall detail key developments and concepts underlying the current state
of the industry and important design considerations when embarking on an AMI program. Included in this
working session will an explanations of how the selected Sensus and MeterSense product and system
characteristics could impact Fort Worth. It will clarify any specific features that Fort Worth may want to
include in future project development as well as an opportunity for asking questions that will raise the
overall education of AMI deployment as it pertains to the City
Typical topics covered in this workshop may include:
• State of the market
• Core elements of AMI project implementation planning
• Material requirements: configuration, storage, controls
• Field service requirements: safety standards, Work Order Management(WOM), material controls, and
quality control on system performance
• Software system integration requirements
• Customer engagement and call center requirements
• Utility business change requirements
• Benefits verification process
Task 3—Project Goals & Objectives
Our team forms a solid foundation for success by conducting planning and design sessions with executives,
stakeholders and key users in order to establish a common understanding of Fort Worth design and planning
goals, drivers, success factors and risks. This approach is designed to stimulate discussion around Fort
Worth's design and planning objectives that otherwise may have not been considered. This task will serve as
the foundation for future work to develop Key Performance Indicators(KPIs).
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Task 4—Current State Development
We will examine the utility's current business processes, practices, and personnel to establish a baseline for
assessing Fort Worth's AMI readiness. Our team will identify and schedule the necessary working sessions
with Fort Worth to assess the following processes/functions:
• Business processes,policies and procedures(meter reading, customer service, billing, etc.)
•Application/communications systems and physical infrastructure
• Utility operations and organization
2. TERM.
The initial term of this Agreement shall commence on March 7, 2016 and shall expire on August
31, 2016, unless terminated earlier in accordance with the provisions of this Agreement. The parties
may renew this Agreement for up to two additional one-year periods by signed mutual consent under
the same terms and conditions.
3. COMPENSATION.
The City shall pay Contractor an amount not to exceed $41,750.00 in accordance with the
provisions of this Agreement. The Contractor will invoice the City at the completion of the services
provided itemizing work performed under this Agreement. Contractor shall not perform any additional
services for the City not specified by this Agreement unless the City requests and approves in writing the
additional costs for such services. The City shall not be liable for any additional expenses of Contractor
not specified by this Agreement unless the City first approves such expenses in writing. Contractor agrees
that it can provide the services described in Agreement for the not to exceed amount.
4. TERMINATION.
4.1. Written Notice.
The City or Contractor may terminate this Agreement at any time and for any reason by
providing the other party with fifteen(15)days written notice of termination. The City may also
issue notice of termination for Contractor's failure to perform in accordance with Section 1.
Contractor shall respond and correct any failure to perform five (5) business days of such notice
of termination, otherwise the Agreement shall be terminated at the end of the 5`h business day.
4.2 Non-appropriation of Funds.
In the event no funds or insufficient funds are appropriated by the City period for any
payments due hereunder, City will notify Contractor of such occurrence and this Agreement shall
terminate on the last day for which appropriations were received without penalty or expense to the
City of any kind whatsoever, except as to the portions of the payments herein agreed upon for
which funds shall have been appropriated.
The award of this Agreement is contingent upon release of funds from the Texas Water
Development Board, TWDB. Any sub-contract(s) awarded as a result of this Agreement that are
expected to be funded in part by the loan from the TWDB is also contingent upon the release of
funds from the TWDB. Neither the State of Texas, nor any of its departments, agencies, or
employees are or will be part of any resulting contracts.
4.3 Duties and Obligations of the Parties.
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Task 4—Current State Development
We will examine the utility's current business processes, practices, and personnel to establish a baseline for
assessing Fort Worth's AMI readiness. Our team will identify and schedule the necessary working sessions
with Fort Worth to assess the following processes/functions:
• Business processes, policies and procedures(meter reading, customer service, billing, etc.)
• Application/communications systems and physical infrastructure
• Utility operations and organization
2. TERM.
The initial term of this Agreement shall commence on March 7, 2016 and shall expire on August
31, 2016, unless terminated earlier in accordance with the provisions of this Agreement. The parties
may renew this Agreement for up to two additional one-year periods by signed mutual consent under
the terms of same terms and conditions.
3. COMPENSATION.
The City shall pay Contractor an amount not to exceed $41,750.00 in accordance with the
provisions of this Agreement. The Contractor will invoice the City at the completion of the services
provided itemizing work performed under this Agreement. Contractor shall not perform any additional
services for the City not specified by this Agreement unless the City requests and approves in writing the
additional costs for such services. The City shall not be liable for any additional expenses of Contractor
not specified by this Agreement unless the City first approves such expenses in writing. Contractor agrees
that it can provide the services described in Agreement for the not to exceed amount.
4. TERMINATION.
4.1. Written Notice.
The City or Contractor may terminate this Agreement at any time and for any reason by
providing the other party with fifteen (15) days written notice of termination. The City may also
issue notice of termination for Contractor's failure to perform in accordance with Section 1.
Contractor shall respond and correct any failure to perform five(5) business days of such notice
of termination, otherwise the Agreement shall be terminated at the end of the 5" business day.
4.2 Non-appropriation of Funds.
In the event no funds or insufficient funds are appropriated by the City period for any
payments due hereunder, City will notify Contractor of such occurrence and this Agreement shall
terminate on the last day for which appropriations were received without penalty or expense to the
City of any kind whatsoever, except as to the portions of the payments herein agreed upon for
which funds shall have been appropriated.
The award of this Agreement is contingent upon release of funds from the Texas Water
Development Board, TWDB. Any sub-contract(s) awarded as a result of this Agreement that are
expected to be funded in part by the loan from the TWDB is also contingent upon the release of
funds from the TWDB. Neither the State of Texas, nor any of its departments, agencies, or
employees are or will be part of any resulting contracts.
4.3 Duties and Obligations of the Parties.
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In the event that this Agreement is terminated prior to the Expiration Date, the City
shall pay Contractor for services actually rendered up to the effective date of termination and
Contractor shall continue to provide the City with services requested by the City and in accordance
with this Agreement up to the effective date of termination.
5. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION.
Contractor hereby warrants to the City that Contractor has made full disclosure in writing of any
existing or potential conflicts of interest related to Contractor's services under this Agreement. In the
event that any conflicts of interest arise after the Effective Date of this Agreement, Contractor hereby
agrees immediately to make full disclosure to the City in writing. Contractor, for itself and its officers,
agents and employees, further agrees that it shall treat all information provided to it by the City as
confidential and shall not disclose any such information to a third party without the prior written
approval of the City. Contractor shall store and maintain City Information in a secure manner and shall
not allow unauthorized users to access, modify, delete or otherwise corrupt City Information in any way.
Contractor shall notify the City immediately if the security or integrity of any City information has been
compromised or is believed to have been compromised.
6. RIGHT TO AUDIT.
Contractor agrees that the City shall, until the expiration of three (3) years after final payment
under this contract, have access to and the right to examine at reasonable times any directly pertinent
books, documents, papers and records of the Contractor involving transactions relating to this Contract
at no additional cost to the City. Contractor agrees that the City shall have access during normal
working hours to all necessary Contractor facilities and shall be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. The City shall give
Contractor reasonable advance notice of intended audits.
Contractor further agrees to include in all its subcontractor agreements hereunder a provision to the
effect that the subcontractor agrees that the City shall, until expiration of three(3)years after final payment
of the subcontract, have access to and the right to examine at reasonable times any directly pertinent books,
documents, papers and records of such subcontractor involving transactions related to the subcontract, and
further that City shall have access during normal working hours to all subcontractor facilities and shall be
provided adequate and appropriate work space in order to conduct audits in compliance with the provisions
of this paragraph. City shall give subcontractor reasonable notice of intended audits.
The Contractor further agrees to accept the authority of the State of Texas Auditor's office authority
to conduct audits and investigations under the State Water Infrastructure Reserve Fund Texas, SWIRFT, in
connection with state funds received pursuant to this Agreement. The Contractor shall comply with the
directives from the City and the Texas State Auditor and shall cooperate in any such audit or investigation.
The Contractor agrees to provide the State of Texas Auditor with access to any information the City or Texas
state Auditor considers relevant to the audit or investigation. The Contractor agrees to include the same
provision in any contract or subcontract used in connection with this agreement.
7. INDEPENDENT CONTRACTOR.
It is expressly understood and agreed that Contractor shall operate as an independent contractor
as to all rights and privileges granted herein, and not as agent, representative or employee of the City.
Subject to and in accordance with the conditions and provisions of this Agreement, Contractor shall
have the exclusive right to control the details of its operations and activities and be solely responsible
for the acts and omissions of its officers, agents, servants, employees, contractors and subcontractors.
Contractor acknowledges that the doctrine of respondeat superior shall not apply as between the City,
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its officers, agents, servants and employees, and Contractor, its officers, agents, employees, servants,
contractors and subcontractors. Contractor further agrees that nothing herein shall be construed as the
creation of a partnership or joint enterprise between City and Contractor.
8. LIABLIATY AND INDEMNIFICATION.
CONTRACTOR SHALL BE LIABLE AND RESPONSIBLE FOR ANYAND ALL PROPERTY
LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANYAND
ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, TO THE
EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR
INTENTIONAL MISCONDUCT OF CONTRACTOR, ITS OFFICERS, AGENTS, SERVANTS OR
EMPLOYEES.
CONTRACTOR COVENANTS AND AGREES TO, AND DOES HEREBY, INDEMNIFY,
HOLD HARMLESS AND DEFEND THE CITY, ITS OFFICERS, AGENTS, SERVANTS AND
EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR LAWSUITS FOR EITHER
PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO
CONTRACTOR'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL
INJURY, INCLUDING DEATH, TO ANYAND ALL PERSONS, OF ANY KIND OR CHARACTER,
WHETHER REAL OR ASSERTED, ARISING OUT OF OR IN CONNECTION WITH THIS
AGREEMENT, TO THE EXTENT CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OR
MALFEASANCE OF CONTRACTOR,ITS OFFICERS,AGENTS, SERVANTS OR EMPLOYEES.
9. ASSIGNMENT AND SUBCONTRACTING.
Contractor shall not assign or subcontract any of its duties, obligations or rights under this
Agreement without the prior written consent of the City. If the City grants consent to an assignment, the
assignee shall execute a written agreement with the City and the Contractor under which the assignee
agrees to be bound by the duties and obligations of Contractor under this Agreement. The Contractor and
Assignee shall be jointly liable for all obligations under this Agreement prior to the assignment. If the
City grants consent to a subcontract,the subcontractor shall execute a written agreement with the Contractor
referencing this Agreement under which the subcontractor shall agree to be bound by the duties and
obligations of the Contractor under this Agreement as such duties and obligations may apply.The Contractor
shall provide the City with a fully executed copy of any such subcontract.
10. INSURANCE.
Contractor shall provide the City with certificate(s) of insurance documenting policies of the
following minimum coverage limits that are to be in effect prior to commencement of any work pursuant
to this Agreement:
10.1 Coverage and Limits
(a) Commercial General Liability
$1,000,000 Each Occurrence
$2,000,000 Aggregate
(b) Automobile Liability
$1,000,000 Each accident on a combined single limit basis or
$250,000 Bodily injury per person
$500,000 Bodily injury per occurrence
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$100,000 Property damage
Coverage shall be on any vehicle used by the Contractor, its employees, agents,
representatives in the course of the providing services under this Agreement. "Any
vehicle" shall be any vehicle owned, hired and non-owned
(c) Worker's Compensation
Statutory limits Employer's
liability
$100,000 Each accident/occurrence
$100,000 Disease-per each employee
$500,000 Disease-policy limit
This coverage may be written as follows:
Workers' Compensation and Employers' Liability coverage with limits consistent with
statutory benefits outlined in the Texas workers' Compensation Act (Art. 8308 — 1.01 et seq.
Tex. Rev. Civ. Stat.) and minimum policy limits for Employers' Liability of $100,000 each
accident/occurrence, $500,000 bodily injury disease policy limit and $100,000 per disease per
employee
(d) Professional Liability(Errors & Omissions)
$1,000,000 Each Claim Limit
$1,000,000 Aggregate Limit
Professional Liability coverage may be provided through an endorsement to the
Commercial General Liability (CGL) policy, or a separate policy specific to
Professional E&O. Either is acceptable if coverage meets all other requirements.
Coverage shall be claims-made, and maintained for the duration of the
contractual agreement and for two(2)years following completion of services provided.
An annual certificate of insurance shall be submitted to the City to evidence coverage.
10.2 Certificates.
Certificates of Insurance evidencing that the Contractor has obtained all required
insurance shall be delivered to the City prior to Contractor proceeding with any work
pursuant to this Agreement. All policies except Workers' Compensation and
Professional Liability shall be endorsed to name the City as an additional insured
thereon, as its interests may appear. All policies shall contain a Waiver of Subrogation for
the benefit of the City of Fort Worth. The term City shall include its employees, officers,
officials, agent, and volunteers in respect to the contracted services. Any failure on the part of
the City to request required insurance documentation shall not constitute a waiver of the
insurance requirement. A minimum of thirty(30) days' notice of cancellation or reduction in
limits of coverage shall be provided to the City. Ten (10) days' notice shall be acceptable
in the event of non-payment of premium. Such terms shall be endorsed onto Contractor's
insurance policies. Notice shall be sent to the Risk Manager, City of Fort Worth, 1000
Throckmorton, Fort Worth, Texas 76102, with copies to the City Attorney at the same
address.
11. COMPLIANCE. WITH LAWS. ORDINANCES.RULES AND REGULATIONS.
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Contractor agrees to comply with all applicable federal, state and local laws, ordinances, rules
and regulations. If the City notifies Contractor of any violation of such laws, ordinances, rules or
regulations, Contractor shall immediately desist from and correct the violation.
12. NON-DISCRIMINATION COVENANT.
Contractor,for itself, its personal representatives, assigns, subcontractors and successors in interest,
as part of the consideration herein, agrees that in the performance of Contractor's duties and obligations
hereunder, it shall not discriminate in the treatment or employment of any individual or group of individuals
on any basis prohibited by law including Chapter 17, Article III of the Code of the City of Fort Worth. If
any claim arises from an alleged violation of this non-discrimination covenant by Contractor, its personal
representatives, assigns, subcontractors or successors in interest, Contractor agrees to assume such
liability and to indemnify and defend the City and hold the City harmless from such claim.
13. NOTICES.
Notices required pursuant to the provisions of this Agreement shall be conclusively determined to
have been delivered when (1) hand-delivered to the other party, its agents, employees, servants or
representatives,(2)delivered by facsimile with electronic confirmation of the transmission,or(3)received
by the other party by United States Mail, registered, return receipt requested, addressed as follows:
To CITY: To CONTRACTOR:
City of Fort Worth Thirkettle Corporation
dba Aqua Metric Inc.
Attn: Jay Chapa Attn: Clint Arnold
1000 Throckmorton Street National Manager
Fort Worth,TX 76102-6311 Phone: 214.663.6831 Cell
Facsimile: (817) 392-8654 FAX:
14. SOLICITATION OF EMPLOYEES.
Neither the City nor Contractor shall, during the term of this agreement and additionally for a
period of one year after its termination, solicit for employment or employ, whether as employee or
independent contractor, any person who is or has been employed by the other during the term of this
agreement, without the prior written consent of the person's employer.
15. GOVERNMENTAL.POWERS.
It is understood and agreed that by execution of this Agreement, the City does not waive or
surrender any of its governmental powers.
16. NO WAIVER.
The failure of the City or Contractor to insist upon the performance of any term or provision of
this Agreement or to exercise any right granted herein shall not constitute a waiver of the City's or
Contractor's respective right to insist upon appropriate performance or to assert any such right on any future
occasion.
17. GOVERNING LAW/VENUE.
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This Agreement shall be construed in accordance with the internal laws of the State of Texas. If
any action, whether real or asserted, at law or in equity, is brought on the basis of this Agreement, venue
for such action shall lie in state courts located in Tarrant County, Texas or the United States District Court
for the Northern District of Texas, Fort Worth Division.
18. SF,VERARILITY.
If any provision of this Agreement is held to be invalid, illegal or unenforceable, the validity,
legality and enforceability of the remaining provisions shall not in any way be affected or impaired.
19. FORCE MAJEURF,.
The City and Contractor shall exercise their best efforts to meet their respective duties and
obligations as set forth in this Agreement, but shall not be held liable for any delay or omission in
performance due to force majeure or other causes beyond their reasonable control (force majeure),
including, but not limited to, compliance with any government law, ordinance or regulation, acts of God,
acts of the public enemy, fires, strikes, lockouts, natural disasters, wars, riots, material or labor
restrictions by any governmental authority, transportation problems and/or any other similar causes.
20. HEADINGS NOT CONTROL.L.ING.
Headings and titles used in this Agreement are for reference purposes only and shall not be
deemed a part of this Agreement.
21. AMENDMENTS/MODIFICATIONS/EXTENSIONS.
No extension, modification or amendment of this Agreement shall be binding upon a party hereto
unless such extension, modification,or amendment is set forth in a written instrument,which is executed by
an authorized representative and delivered on behalf of such party.
22. ENTIRETY OF AGREEMENT.
This Agreement, including the schedule of exhibits attached hereto and any documents
incorporated herein by reference, contains the entire understanding and agreement between the City and
Contractor, their assigns and successors in interest, as to the matters contained herein. Any prior or
contemporaneous oral or written agreement is hereby declared null and void to the extent in conflict
with any provision of this Agreement.
24. SIGNATURE AUTHORITY.
The person signing this agreement hereby warrants that he/she has the legal authority to execute
this agreement on behalf of the respective party,and that such binding authority has been granted by proper
order, resolution, ordinance or other authorization of the entity. The other party is fully entitled to rely on
this warranty and representation in entering into this Agreement.
[SIGNATURE PAGE FOLLOWS]
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IN TNESS WHEREOF, the parties hereto have executed this Agreement in multiples this*&ay of
X816.
ACCEPTED AND AGREED:
CITY OF FORT WORTH: Thirkettle Corporation dba A q u a M e t r i c,
Inc.
By:
Jay Chapa By:
Assistant City Manager Chris Thirkettle, President
Date:
Date:
APPROVAL RECOMMENDED:
WITNESS:
By:
J n Robert Carman
ater Director By.
Name:
Title: Q-.12—
Date:
szDate: 3 /-4
APPROVED AS TO FORM AND
LEGALITY:N'
�j
By: 1` I It ,114
Christa lYopez-Reyno
Senior Assistant City Attorney
Date: S-7 - 119 7 - `19
ATTEST:
of F®�
By. ary l{ .�8 X
City Se etary
Date: -7 l ���
M&C: N/A
Date: NIA
OFFICIAL RECORD
CITY S►ECRE°AIW9 of is
FT.WORTH,TX
Exhibit A
Completion of Certificate of Interested Parties (Form 1295)
HB 1295 Certificate of Interested Parties
Ethics Commission Rules,Chapter 46.Disclosure of Interested Parties
(effective December 24,2015)
Text of Adopted Rule
The adopted new language is indicated by underlined text.
Chanter 46. DISCLOSURE OF INTERESTED PARTIES
§46.1.Application_
(a)This chapter applies to section 2252.908 of the Government Code.
(b)Section 2252.908 of the Government Code applies only to a contract of agovernmental entity or state
agency entered into after December 31, 2015,that meets either of the following conditions:
(1)The contract requires an action or vote bathe governing body of the entity or agency; or
(2)The value of the contract is at least$1 million.
(c)A contract does not require an action or vote by the governing body of a governmental entity or state
agency if:
(1)The governing body has legal authority to delegate to its staff the authority to execute the contract;
(2)TheovgL erning body has delegated to its staff the authority to execute the contract; and
(3)The governing body does not participate in the selection of the business entity with which the contract
is entered into.
§46.3.Definitions
(a)"Contract"includes an amended,extended, or renewed contract.
(b)"Business entity"includes an entily through which business is conducted with a governmental entity-
or state agency,regardless of whether the entity is a for-profit or nonprofit entity.The term does not
include a governmental entity or state agency-
(c)"Controlling interest"means: (1)an ownership interest or participating interest in a business entitYbY
virtue of units,percentage,shares, stock,or otherwise that exceeds 10 percent;(2)membership on the
board of directors or other governing body of a business entity of which the board or other governing
body is composed of not more than 10 members; or(_3)service as an officer of a business entity that has
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four or fewer officers,or service as one of the four officers most highly compensated by a business entity
that has more than four officers.
(d)"Interested party"means: (1)aperson who has a controlling interest in a business entity with whom a
governmental entityor state agency contracts,• or(2)a person who actively participates in facilitating a
contract or negotiating the terms of a contract with a governmental entity or state agency, including a
broker, intermediary,adviser, or attorney for the business entity.
(ee)"Intermediary"for purposes of this rule means a person who actively participates in the facilitation of
the contract or negotiating_ the contract, including a broker, adviser,attorney, or representative of or agent
for the business entity who:
(1)receives compensation from the business entity for the person's participation;
(2)communicates directly with the governmental entity or state agency on behalf of the business entity
regarding the contract; and
(3)is not an employee of the business entity
§46.5. Disclosure of Interested Parties Form
(a)A disclosure of interested parties form required by section 2252.908 of the Government Code must be
filed on an electronic form prescribed by the commission that contains the following_
(1)The name of the business entity filing the form and the city, state,and country of the business entity's
place of business;
(2)The name of the overnmental entity or state agency that is a partes to the contract for which the form
is being filed;
(3)The name of each interested party and the city, state,and country of the place of business of each
interested party;
(4)The identification number used by the governmental entity or state agency to track or identify the
contract for which the form is being filed and a short description of the goods or services used by the
governmental entity or state agency provided under the contract; and
(5)An indication of whether each interested party has a controlling interest in the business enti1y, is an
intermediary in the contract for which the disclosure is being filed,or both.
(b)The certification of filing and the completed disclosure of interested parties form generated by the
commission's electronic filing_application must be printed, signed by an authorized agent of the
contracting business entity,and submitted to the governmental entity or state agency that is the party to
the contract for which the form is being filed
(c)Agovernmental entityor state agency that receives a completed disclosure of interested parties form
and certification of filing,shall notify the commission, in an electronic format prescribed by the
commission,of the receipt of those documents not later than the 30th day after the date the contract for
which the form was filed binds all parties to the contract.
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(d)The commission shall make each disclosure of interested parties form filed with the commission under
section 2252.908(f)of the Government Code available to the public on the commission's Internet website
not later than the seventh business day after the date the commission receives the notice required under
subsection (c)of this section.
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Exhibit B
CONFLICT OF INTEREST DISCLOSURE REQUIREMENT
Pursuant to Chapter 176 of the Local Government Code, any person or agent of a person who
contracts or seeks to contract for the sale or purchase of property, goods,or services with a local
governmental entity(i.e. The City of Fort Worth) must disclose in the Questionnaire Form CIQ
("Questionnaire")the person's affiliation or business relationship that might cause a conflict of
interest with the local governmental entity. Bylaw,the Questionnaire must be filed with the Fort
Worth City Secretary no later than seven days after the date the person begins contract
discussions or negotiations with the City, or submits an application or response to a request for
proposals or bids, correspondence, or another writing related to a potential agreement with the
City. Updated Questionnaires must be filed in conformance with Chapter 176.
A copy of the Questionnaire Form CIO is enclosed with the submittal documents. The
form is also available at http://www.ethics.state.tx.us/forms/CIO.12dE
If you have any questions about compliance, please consult your own legal counsel.
Compliance is the individual responsibility of each person or agent of a person who is
subject to the filing requirement. An offense under Chapter 176 is a Class C
misdemeanor.
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CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2016-20489
Aqua Metric Sales Company
Schertz,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/01/2016
being filed.
City of Fort Worth Texas Date Acknowledged:
—Icop
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the goods or services to be provided under the contract.
Project#1
Fixed Based Water Metering System
4 Nature of interest(check applicable)
Name of Interested Party City,State,Country(place of business)
Controlling Intermediary
Lancon,Jeremy Schertz,TX United States X
Segarra,Kristy Schertz,TX United States X
Aqua Metric Safes Company Schertz,TX United States X
Wood,Mike Schertz,TX United States X
Cartwright,Michael Schertz,TX United States X
Arnold,Clint Schertz,TX United States X
5 Check only if there is NO Interested Party. O
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
00.11....... ,; CORALEE ROXANNE BROOKS
Notary Public.State of Texas
My Commiulon Expites
July 07, 2019
Signature of authorized agent f contracting business entity
AFFIX NOTARY STAMP;SEAL ABOVE / +_ , ( �1 ` ,n
Sworn to and subscribed before me,by the said /'t t o kae 1 l *P-&e;9 this the l day of ,
20 Z4 to certify which,witness my hand and seal of office.
4az - oe &OAS Aotoy
Signature of officer administering oath Printed name of officer administering oath Tide of officer admini tering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.312
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor or other person doing business with local governmental entity Pa e 2
5. Name of local government officer with whom filer has affiliation or business relationship.
(Complete this section only if the answer to A,B,or C is YES.)
This section, item 5 including subparts A, B,C& D, must be completed for each officer with whom
the filer has affiliation or business relationship. Attach additional pages to this Form CIQ as necessary.
A. is the local government officer named in this section receiving or likely to receive taxable
income from the filer of the questionnaire?
❑ Yes [�I- No
B. Is the filer of the questionnaire receiving or likely to receive taxable income from or at the
direction of the local government officer named in this section AND the taxable income is not
from the local governmental entity?
❑ Yes M No
C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local
government officer serves as an officer or director,or holds an ownership of 10 percent or more?
❑ Yes ,Z No
D. Describe each affiliation or business relationship.
6. Describe any other affiliation or business relationship that might cause a conflict of interest.
7.
Signature of person doing business with the governmental entity Date
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