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HomeMy WebLinkAboutContract 47486-R2 r% ;r CSC No.47486 ,4. CITY OF FORT WORTH ci� rFo <�?EJB CONTRACT RENEWAL NOTICE CITY SECRETARY I I n �� SFCA9'oY r�, CONTRACT NO. 41 Kemira Water Solution,Inc. 4321 W 6"'St Lawrence,KS 66049 Re. NOTICE OF CONTRACT RENEWAL Odor Control Services Contract No.CSC No.47486 Renewal Term No.2:January 26,2018 to January 25,2019 The above referenced Contract will expire on January 25,2018.Pursuant to the Contract,contract renewals are at the sole option ofthe City.This letter is to inform you that the City is exercising its right to renew CSC No.47486 for an additional one yearperiod,which will begin immediately upon the expiration ofthe currentterm and will end onJanuary 25,2019 or expenditure of funding,whichever occurs first.All other terms and conditions of CSC No.47486 remain unchanged. Please return this signed acknowledgement letter, along with a copy of your current insurance certificate, to the address set forth below, acknowledging receipt of the Notice of Contract Renewal. Please log onto BuySpeed Online at http://fortworihtexas.eov/purchasine to insure that your company information is correct and up-to-date. If you have any questions concerning this Contract Renewal Notice,please contact me at the telephone number listed below. Sincerely yours, Darla Morales Parts Material Supervisor Village Creek Water Reclamation and Reuse Division 817-392-4932 By: f�r t +l/t �h'l �Vi _1/0 (�fL"rcl 4-' Date: � � lie CP " e Na nd Title ignature CITY O�T WORTH: ATTEST: OF... Jesus J.Chapa,Asststa it City Manager ar 4 r, ity rePary Date Q M&C No. P-11830 ' .►c .� APPROVED.. FORM AND ALI'fX , C. Asslstant`G ty Corney T^ , I„ r CSCO No.47486 CITY OF FORT WORTH CONTRACT RENEWAL NOTICE Kemira Water Solution, Inc. 4321 W 611 St Lawrence, KS 66049 Re. NOTICE OF CONTRACT RENEWAL Odor Control Services Contract No. CSC No.47486 Renewal Term NO. 2:January 26,2018 to January 25,2019 Contract compliance Manager: By signing I acknowledge that I am the person responsible For the monitoring and administration of the contract, including ensuring all performance and reporting requirements. 4;x� Name of Employee G;c.Go ��vr Title City of Fort Worth, Texas Mayor and Council Communication COUNCIL ACTION: Approved on 1/26/2016 DATE: Tuesday,January 26,2016 REFERENCE NO.: P-11830 LOG NAME: 13P16-0006 ODOR CONTROL MJR SUBJECT: Authorize Execution of Contracts with D3W Industries,NRP Group,Inc.,U.S. Peroxide,LLC d/b/a USP Technologies,Premier Magnesia,LLC,Kemira Water Solutions,Inc.,and Chemtrade Chemicals US,LLC,in the Amount Up to $3,960,000.00 for the Initial Term for Odor Control Services for the Water Department(ALL COUNCIL DISTRICTS) RECOMMENDATION: It is recommended that the City Council authorize the execution of contracts with D3W Industries,NRP Group,Inc.,U.S.Peroxide,LLC d/b/a USP Technologies,Premier Magnesia,LLC,Kemira Water Solutions,Inc.,and Chemtrade Chemicals US,LLC,in the amount up to$3,960,000.00 for the initial term for odor control services for the Water Department. DISCUSSION: The Water Department will use these contracts to provide odor control products and services in Field Operations wastewater collection systems and the Village Creek Reclamation Facility(Village Creek Wastewater Treatment Plant)on an as needed basis. RFP ADVERTISEMENT-A Request for Proposals(RFP)was advertised in the Fort Worth Star-Telegram every Wednesday from October 21,2015 through November 18,2015. The evaluation factors consisted of customer service, product quality and performance,monitoring systems or data availability and proposed contract price. Sixteen vendors were solicited from the purchasing vendor database system; seven responses were received. The proposals were reviewed by an evaluation committee consisting of staff from the Water Department Field Operations and Village Creek Wastewater Treatment Plant. The proposals from D3W Industries,NRP Group,Inc.,U.S. Peroxide,LLC d/b/a USP Technologies,Premier Magnesia,LLC,Kemira Water Solutions,Inc.,and Chemtrade Chemicals US,LLC,were determined to present the best value to the City. PRICE ANALYSIS-Prices under these contracts present an overall 1.24 percent increase than previously awarded on November 15,2011 (M&C P-11325). No guarantee was made that a specific amount of goods and services would be purchased. However,Water Department may spend up to $3,960,000.00 with the contractors during the initial term of this Agreement. ADMINISTRATIVE CHANGE ORDER-An administrative change order or increase may be made by the City Manager in the amount of up to$50,000.00 and does not require specific City Council approval as long as sufficient funds have been appropriated. CONTRACT TERMS -Upon City Council's approval,the contracts will begin upon complete execution and expire on January 25,2017. RENEWAL OPTIONS-These contracts may be renewed for up to four successive one-year periods under the same terms and conditions. The renewals will not require City Council approval provided that the City Council has appropriated sufficient funds to satisfy the City's obligations during the renewal term. M/WBE OFFICE-A waiver of the goal for MBE/SBE subcontracting requirements was requested by the Purchasing Division and approved by the M/WBE office, in accordance with the BDE ordinance,because the purchase of goods or services is from sources where subcontracting or supplier opportunities are negligible. FISCAL_INFORMATION/CERTIFICATION: The approval of this action provides purchasing authority up to $3,960,000.00. The Financial Management Services Director certifies that funds are available in the current operating budget,as appropriated,of the Water Department and that prior to an expenditure being made,the participating Department has the responsibility to validate the availability of funds. BQN\\ FUND IDENTIFIERS (FIDs): ID Fund Department Account Project program Activity Budget Reference# Amount ID ID Year (Chartfield 2) FROM Department Account Project Program Activity Budget Reference# Amount Fund ID ID Year (Chartfield 2) CERTIFICATIONS: Submitted for City Manager's Office by: Jay Chapa (5804) Originating Department Head: Aaron Bovos (8517) Additional Information Contact: Jane Rogers (8385) Jack Dale (8357) ATTACHMENTS 1. 16-0006 MWBE Waiver.pdf (CFW Internal) 2. Form 1295 (13P 16-0006).ndf (Public) 3. Odor Control EPLS 15 l.ndf (CFW Int mal) 4. Odor Control EPLS 15 2.ndf (CFW Internal) 5. Requisition 16-00325168.pdf (CFW Internal) been appropriated. CONTRACT TERMS-Upon City Council's approval,the contracts will begin upon complete execution and expire on January 25,2017. RENEWAL OPTIONS-These contracts may be renewed for up to four successive one-year periods under the same terms and conditions. The renewals will not require City Council approval provided that the City Council has appropriated sufficient funds to satisfy the City's obligations during the renewal term. M/WBE OFFICE-A waiver of the goal for MBE/SBE subcontracting requirements was requested by the Purchasing Division and approved by the M/WBE office, in accordance with the BDE ordinance,because the purchase of goods or services is from sources where subcontracting or supplier opportunities are negligible. FISCAL INFORMATION/CERTIFICATION: The approval of this action provides purchasing authority up to $3,960,000.00. The Financial Management Services Director certifies that funds are available in the current operating budget,as appropriated,of the Water Department and that prior to an expenditure being made,the participating Department has the responsibility to validate the availability of funds. BQN\\ FUND IDENTIFIERS (FIDs): TD Department Account Project Program Activity Budget Reference# Amount Fund ID ID year (Chartfield 2) FROM Department Account Project Program Activity Budget Reference# Amount Fund ID ID year (Chartfield 2) CERTIFICATIONS: Submitted for City Manager's Office by: Jay Chapa (5804) Originating Department Head: Aaron Bovos (8517) Additional Information Contact: Jane Rogers (8385) Jack Dale (8357) ATTACHMENTS 1. 16-0006 MWBE Waiver.pdf (CFW Intemal) 2. Form 1295 (13P16-0006).pdf (Public) 3. Odor Control EPLS 15 l.pdf (CFW Internal) 4. Odor Control EPLS 15 2,12df (CFW int mal) 5. Requisition 16-00325168.pdf (CFW Internal) CITY SECRETARY CONTRACT RIO. AGREEMENT This AGREEMENT(°Agreement")is made and entered into by and between the CITY OF FORT WORTH(the"City'), a home rule municipal corporation situated in portions of Tarrant, Denton and Wise Counties, Texas, acting by and through Susan Alanis, its duty authorized Assistant City Manager, and Kemira Water Solutions, Inc. ("Agency"), a global chemistry company and acting by and through Christina M. Imbrogno, its duly authorized Customer Service Manager, each individually referred to as a "party"and collectively referred to as the"parties." CONTRACT DOCUMENTS: The Contract documents shall include the following: 1. This Agreement for Product and Services 2. Exhibit A—Statement of Work plus any amendments to the Statement of Work 3. Exhibit B—Payment Schedule All Exhibits attached hereto are incorporated herein and made a part of this Agreement for all purposes. In the event of any conflict between the documents,the terms and conditions of this Agreement shall control. 1. SCOPE OF SERVICES. Agency hereby agrees to provide the City with product and services for the purpose of odor control products and services. Attached hereto and incorporated for all purposes incident to this Agreement is Exhibit"A,"Statement of Work,,more specifically describing the product and services to be provided hereunder. 2. TERM. This Agreement shall commence upon execution of contract and shall expire on January 25, 2017 unless terminated earlier In accordance with the provisions of this Agreement. Subject to mutual agreement, the period covered by the ensuing contract, under the same terms and conditions stated therein can be extended for up to four successive one year terms at the agreed to pricing for each extension year, 3. COMPENSATION. The City shall pay Agency in accordance to the Bid Sheet Attached on an as needed basis of Agency personnel who provide product and perform services under this Agreement in accordance with the provisions of this Agreement and the Payment Schedule attached as Exhibit "B," which is incorporated for all purposes herein; however, total payment made under this Agreement by the City for all product and services shall not exceed requesting department's fund amount for odor control products and services. Agency shall not provide any additional product or perform any additional services for the City not specified by this Agreement unless the City requests the additional product and services and approves in writing the additional costs for such product and services. The City shall not be liable for any additional expenses of Agency not specified by this Agreement unless the City first approves such expenses in writing. 4. TERMINATION. 4.1 Convenience. The City or Agency may terminate this Agreement at any time and for any reason by providing the other party with 30 days'written notice of termination. Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX 4.2 Non-appropriation of Funds. In the event no funds or insufficient funds are appropriated by the City in any fiscal period for any payments due hereunder, City will notify Agency of such occurrence and this Agreement shall terminate on the last day of the fiscal period 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 have been appropriated. 4.3 Breach. Either party may terminate this Agreement for breach of duty, obligation or warranty with then (10)days written notice and reasonable time to cure. 4.4 Duties and Obligations of the Parties. In the event that this Agreement is terminated prior to the Expiration Date, the City shall pay Agency for product and services actually rendered up to the effective date of termination and Agency shall continue to provide the City with product and services requested by the City and in accordance with this Agreement up to the effective date of termination. Upon termination of this Agreement for any reason, Agency shall provide the City with copies of all completed or partially completed documents prepared under this Agreement. In the event Agency has received access to City information or data as a requirement to perform services hereunder, Agency shall return all City provided data to the City in a machine readable format or other format deemed acceptable to the City. 5. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION. 5.1 Disclosure of Conflicts. Agency hereby warrants to the City that Agency has made full disclosure in writing of any existing or potential conflicts of interest related to Agency's services under this Agreement. In the event that any conflicts of interest arise after the Effective Date of this Agreement, Agency hereby agrees immediately to make full disclosure to the City in writing. 5.2 Confidential Information. Agency, for itself and its officers, agents and employees, 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. 5.3 Unauthorized Access. Agency 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. Agency shall notify the City immediately if the security or integrity of any City Information has been compromised or Is believed to have been compromised, in which event, Agency shall, in good faith, use all commercially reasonable efforts to cooperate with the City in identifying what information has been accessed by unauthorized means and shall fully cooperate with the City to protect such information from further unauthorized disclosure. 6. RIGHT TO AUDIT. Agency agrees that the City shall, until the expiration of three (3)years after final payment under this contract, 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 of the Agency involving transactions relating to this Contract at no additional cost to the City. Agency agrees that the City shall have access during normal working hours to all necessary Agency 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 Agency reasonable advance notice of intended audits. Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. Agency 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, 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 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. 7. INDEPENDENT CONTRACTOR. It is expressly understood and agreed that Agency shall operate as an independent contractor as to all rights and privileges and work performed under this agreement, and not as agent, representative or employee of the City. Subject to and in accordance with the conditions and provisions of this Agreement, Agency 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. Agency acknowledges that the doctrine of respondeat superior shall not apply as between the City, its officers, agents, servants and employees, and Agency, its officers, agents, employees, servants, contractors and subcontractors. Agency further agrees that nothing herein shall be construed as the creation of a partnership or joint enterprise between City and Agency. It is further understood that the City shall in no way be considered a Co-employer or a Joint employer of Agency or any officers, agents, servants, employees or subcontractors of Agency. Neither Agency, nor any officers, agents, servants, employees or subcontractors of Agency shall be entitled to any employment benefits from the City.Agency shall be responsible and liable for any and all payment and reporting of taxes on behalf of itself, and any of its officers, agents, servants, employees or subcontractors. 8. LIABILITY AND INDEMNIFICATION. A. LIABILITY- AGENCY SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY LOSS, PROPERTY DAMAGE ANDIOR PERSONAL INJURY, INCLUDING DEATH,TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF AGENCY, ITS OFFICERS,AGENTS,SERVANTS OR EMPLOYEES. B. INDEMNIFICATION - AGENCY HEREBY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS AND DEFEND THE CITY, ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR LAWSUITS OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, FOR EITHER PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS TO AGENCY'S BUSINESS AND ANY RESULTING LOST PROFITS) ANDIOR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE NEGLIGENT ACTS OR OMISSIONS OR MALFEASANCE OF AGENCY, ITS OFFICERS, AGENTS, SERVANTS OR EMPLOYEES. 9. ASSIGNMENT AND SUBCONTRACTING. Agency 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 Agency under which the assignee agrees to be bound by the duties and obligations of Agency under this Agreement. The Agency and Assignee shall be jointly liable for all obligations of the Agency under this Agreement prior to the effective date of the assignment. If the City grants consent to a subcontract, the subcontractor shall execute a written agreement with the Agency referencing this Agreement under which the subcontractor shall agree to be bound by the duties and obligations of the Agency under this Agreement as such duties and Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. obligations may apply. The Agency shall provide the City with a fully executed copy of any such subcontract. 10. INSURANCE. Agency 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 $1,000,000 Aggregate (b) Automobile Liability $1,000,000 Each occurrence on a combined single limit basis Coverage shall be on any vehicle used by the Agency, 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 General Requirements (a) The commercial general liability and automobile liability policies shall name the City as an additional insured thereon,as its interests may appear. The term City shall include its employees, officers,officials,agents,and volunteers in respect to the contracted services. (b) The workers' compensation policy shall include a Waiver of Subrogation (Right of Recovery) in favor of the City of Fort Worth. Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. (c) 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. 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. (d) The insurers for all policies must be licensed and/or approved to do business in the State of Texas. All insurers must have a minimum rating of A- VII in the current A.M. Best Key Rating Guide, or have reasonably equivalent financial strength and solvency to the satisfaction of Risk Management. If the rating is below that required, written approval of Risk Management is required. (e) Any failure on the part of the City to request required insurance documentation shall not constitute a waiver of the insurance requirement. (f) Certificates of Insurance evidencing that the Agency has obtained all required insurance shall be delivered to the City prior to Agency proceeding with any work pursuant to this Agreement. 11. COMPLIANCE WITH LAWS ORDINANCES RULES AND REGULATIONS. Agency agrees that in the performance of its obligations hereunder, it will comply with all applicable federal, state and local laws, ordinances, rules and regulations and that any work it produces in connection with this agreement will also comply with all applicable federal, state and local laws, ordinances, rules and regulations. If the City notifies Agency of any violation of such laws, ordinances, rules or regulations,Agency shall immediately desist from and correct the violation. 12. NON-DISCRIMINATION COVENANT. Agency,for itself, its personal representatives,assigns,subcontractors and successors in interest, as part of the consideration herein, agrees that in the performance of Agency'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. If any claim arises from an alleged violation of this non-discrimination covenant by Agency, its personal representatives, assigns, subcontractors or successors in interest, Agency 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 the CITY: To Agency: City of Fort Worth Kemira Water Solutions Attn:Fernando Costa,Assistant City Manager Attn: Christina M. Imbrogno, Customer Service 1000 Throckmorton Manager Fort Worth TX 76102-6311 4321 W.61 St. Facsimile:(817)392-8654 Lawrence,KS 66049 Phone: (800)879-4353 With Copy to the City Attorney E-mail: kwsna.bids@kemira.com At same address Professional Service Agreement Revised January 2016 Kemira Water Solutions.Inc_ 14. GOVERNMENTAL POWERS/IMMUNITIES It is understood and agreed that by execution of this Agreement, the City does not waive or surrender any of its governmental powers or immunities. 1s. NO WAIVER. The failure of the City or Agency 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 Agency's respective right to insist upon appropriate performance or to assert any such right on any future occasion. 16. GOVERNING LAW/VENUE. This Agreement shall be construed in accordance with the laws of the State of Texas. If any action,whether real or asserted, at law or in equity, is brought pursuant to 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. 17. SEVERABILITY. 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. 18. FORCE MAJEURE. The City and Agency 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, 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. 19. HEADINGS NOT CONTROLLING. Headings and titles used in this Agreement are for reference purposes only, shall not be deemed a part of this Agreement, and are not intended to define or limit the scope of any provision of this Agreement. 20. REVIEW OF COUNSEL. The parties acknowledge that each patty and its counsel have reviewed and revised this Agreement and that the normal rules of construction to the effect that any ambiguities are to be resolved against the drafting party shall not be employed in the interpretation of this Agreement or exhibits hereto. 21. AMENDMENTS. No amendment of this Agreement shall be binding upon a party hereto unless such amendment is set forth in a written instrument,which is executed by an authorized representative of each 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 Agency, 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. Professional Service Agreement Revised January 2016 Kemlra Water Solutions,Inc. 23. COUNTERPARTS. This Agreement may be executed in one or more counterparts and each counterpart shall, for all purposes, be deemed an original, but all such counterparts shall together constitute one and the same instrument. 24. WARRANTY OF SERVICES. Agency warrants that its services will be of a professional quality and conform to generally prevailing industry standards. City must give written notice of any breach of this warranty within thirty(30) days from the date that the services are completed. In such event,at Agency's option,Agency shall either (a) use commercially reasonable efforts to re-perform the services in a manner that conforms with the warranty,or(b)refund the fees paid by the City to Agency for the nonconforming services. 25. IMMIGRATION NATIONALITY ACT. The City of Fort Worth actively supports the Immigration & Nationality Act (INA) which includes provisions addressing employment eligibility, employment verification, and nondiscrimination.Agency shall verify the identity and employment eligibility of all employees who perform work under this Agreement. Agency shall complete the Employment Eligibility Verification Form (1-9), maintain photocopies of all supporting employment eligibility and identity documentation for all employees, and upon request, provide City with copies of all 1-9 forms and supporting eligibility documentation for each employee who performs work under this Agreement. Agency shall establish appropriate procedures and controls so that no services will be performed by any employee who is not legally eligible to perform such services.Agency shall provide City with a certification letter that it has complied with the verification requirements required by this Agreement. Agency shall indemnify City from any penalties or liabilities due to violations of this provision. City shall have the right to immediately terminate this Agreement for violations of this provision by Agency. 26. 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. This Agreement and any amendment hereto, may be executed by any authorized representative of Agency whose name, title and signature is affixed on the Verification of Signature Authority Form, which is attached hereto as Exhibit "D" and incorporate herein by reference. Each party is fully entitled to rely on these warranties and representations in entering into this Agreement or any amendment hereto. 27. OWNERSHIP OF WORK PRODUCT. City shall be the sole and exclusive owner of all reports, work papers, procedures, guides, and documentation, created, published, displayed, and/or produced exclusively for City in conjunction with the services provided under this Agreement, collectively, 'Work Product". Agency's proprietary technology and intellectual property and prior, current, or future data, iteration, reports, work papers, procedures, guides, and documentation, based on Agency's activity relating to Agency's technology and intellectual property, created outside the Agreement and/or not created exclusively for City, are excluded from the Scope of Work Product hereunder, and shall remain the sole and exclusive property of Agency. Further, City shall be the sole and exclusive owner of all copyright, patent, trademark, trade secret and other proprietary rights in and to the Work Product. Ownership of the Work Product shall inure to the benefit of the City from the date of conception, creation or fixation of the Work Product in a tangible medium of expression (whichever occurs first). Each copyrightable aspect of the Work Product shall be considered a "work-made-for-hire"within the meaning of the Copyright Act of 1976, as amended. If and to the extent such Work Product, or any part thereof, is not considered a "work-made-for-hire" within the meaning of the Copyright Act of 1976, as amended, Agency hereby expressly assigns to City all exclusive right, title Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. and interest in and to the Work Product, and all copies thereof, and in and to the copyright, patent, trademark, trade secret, and all other proprietary rights therein, that the City may have or.obtain, without further consideration, free from any claim, lien for balance due, or rights of retention thereto on the part of the City. [Signature page follows] Professional Service Agreement Revised January 2026 Kemlra Water Solutions,Inc. IN WITNESS WH EOF,the parties hereto have executed this Agreement in multiples this � A�—day of ,2016. ACCEPTED AND AGREED: CITY OF FORT WORTH: ORGANIZATION: V'C + Name: �snar Assistant City Manager Title: !Fj''A Date: '3t_3 —/40 Date: T - 11 APPROVAL RECOMMENDED: ,orT APPROVAL RECOMMENDED: Y t Name: 1 a Name:--Tf„L.rn� Title: Title: 1NY.r�r�t ATTE7, �� � y � �>1 TTEST: glary Ka seer City Sectary,; Title {~1 + ca APPROVED AS TO FORM AND LEGALITY: By. ►ltY��at�j IJQ. Yi..� ►?( Christa R. L F%pAds���. Sr.Assistant City Attomey CONTRACT AUTHORIZATION: P-M&C: - f"II'7 -3io Date Approved: _ '' OFFICIAL RECORD IT,WORTH,VE Professional Service Agreement Revised January 2016 Kemlra Water Solutions,Inc. EXHIBIT A STATEMENT OF WORK Kemira Water Solutions, Inc. Odor Control Services. 1.0 Contractors to provide multiple odor control products and services in Field Operations wastewater collection systems and the Village Creek Wastewater Treatment Plant. Magnesium hydroxide, ferric sulfate, ferric chloride, ferrous chloride, hydrogen peroxide, and biocatalyst liquid that stimulates endogenous bacteria to control odors in wastewater collection systems are some of the required products and services to be provided. 2.0 The Contractor(s) shall provide all necessary materials and supplies on an as-needed basis,as requested by the City. 3.0 The Contractor shall conduct detailed baseline H2S sampling. 4.0 The Contractor shall prove the underlying concept,the cost and operational efficacy of the Contract period for controlling H2S odors and corrosion within the collection system. 5.0 The treatment targets for sulfide levels will be agreed prior to starting the Contract period by all parties. 6.0 In addition, the sampling frequency and schedule will be determined and agreed by all parties prior to the starting of the Contract period. 7.0 The Contractor shall optimize feed rates as well as performance throughout M00292 and M00253 line. 8.0 Each week: Additional line segments within the wastewater collection systems shall be selected, data shall be collected in electronic format, then forwarded to the City representative for review. 9.0 Each month: Data shall be collected in electronic format, recommended treatment approach shall be provided and an annualized budgetary estimate for full service annual Contract,which will be forwarded to the City representative for review. 10.0 Each quarter: Data shall be collected in electronic format, and recommended treatment approach shall be provided and an annualized budgetary estimate for full service annual Contract,which will be forwarded to the City representative for review. 11.0 The Contractor shall provide a final report in electronic format that provides: 1) an executive summary of the Contract period, it's findings, results, cost, and recommendation; 2) an analysis of any impact on the Field Operations wastewater collection systems and Village Creek Wastewater Treatment operations, and related systems cost impacts; and 3)charts and tables containing detailed data and observations collected during the Contract period. 12.0 Scope of Work will be delivered as a full service project conducted over a one year period. 13.0 The Contract period is conducted during the City's higher sulfide months and under the worst case conditions and evaluates the maximum performance benefits. Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. 14.0 The Contract period may be seasonal contingent on the performance of the Contractor or the levels of sulfide during winter months. 15.0 The project delivery scope includes the odor and corrosion product, storage, dosing equipment system, analytical instrumentation, and all of the labor associated for the project management,operating and maintenance services and reporting. 16.0 The actual project costs will be based on the final volume consumed during the Contract period and are structured on a not-to-exceed basis. 17.0 Contractor shall provide service to all equipment utilized during the annual Contract, including installation,safety training, and maintenance. 18.0 Product safety training will be provided to all designated personnel and for anyone that works with or near the product during the annual Contract. The training should consist of first exposure to the product, required personal protective equipment, feed system materials and"what to do"if there is a spill. 19.0 The technical approach is based on the sulfide data collected and information provided by the City. 20.0 A simplified model of the technical approach, including a schematic of approximate application points and monitoring points, is shown below under "System Schematic M00292. 21.0 A variety of test conditions will be evaluated and provided to the City within the first 30 days for review. 22.0 Contractor shall respond to and repair any equipment failures at each supply application site within 24 hours. 23.0 Contractor shall have at least two local technicians within 60 minutes of each site to respond to any issue that may occur. 24.0 The Village Creek Wastewater Treatment Plant requires a variety of chemicals to mitigate odors and corrosion throughout the plant and in various treatment processes. 24.1 The following chemicals listed shall be required for The Village Creek Wastewater Treatment Plant but not limited to: ferric chloride, ferric sulfate, magnesium hydroxide slurry (technical grade), hydrogen peroxide (technical grade). 24.2 Contractor shall provide unit price including all associated cost for each chemical listed above for each option described below: a. Chemical only -Contractor shall deliver chemicals to site and offload in City owned/operated storage tanks and/or facilities. Contractor shall provide all equipment necessary to affect delivery. b. Chemical and equipment costs — Contractor shall deliver chemical and provide "turnkey" services including: storage tank(s) and ancillary equipment(level sensors, meters, dosage control system(s) providing for optimal dosage rates in real time), technical support, and mobilization/demobilization. Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. 25.0 In order to ensure that the City's odor control objectives are met; Contractor shall install devices to monitor atmospheric 112S data and collect dissolved H2S data on a weekly basis. The Owner and System shall mutually agree during the service Contract to modify the monitoring program as needed to ensure that the chemical feed is being optimized before any changes in monitoring are implemented. 26.0 The Contractor shall provide various Odor Control Programs to various Field Operations wastewater collection systems and Village Creek Wastewater Treatment Plant that includes but not limited to: 26.1 Biocatalyst liquid - a natural organic solution, that stimulates endogenous bacteria, biological activity, within the sewer system to prevent or reduce the formation of fats,oils and greases,H2S, and ammonia. 26.2 Ferric Chloride - Supply ferric chloride for post digestion treatment of an aerobically digested sludge. Product must be 30-40% ferric chloride and contain minimal sulfur-bearing compounds. Ferric chloride will be added to reduce ortho-phosophate levels in the liquid sludge, minimize struvite buildup after digestion and improve overall biosolids dewaterability in an effort to minimize odor potential at land application sites. 26.3 Ferric Sulfate — Supply ferric sulfate for control of odors associated with raw wastewater. Product must be 60%ferric sulfate, and 10-13%ferric iron(Fe+3) 26.4 Magnesium Hydroxide Slurry, Technical Grade — Supply 90,0% Mg(OH)2 dry weight percent purity,for use in treatment of raw wastewater for odors. 26.5 Hydrogen Peroxide, Technical Grade — Supply 50% solution of Hydrogen Peroxide for use in treatment of raw wastewater for odors. 27.0 The Contractor shall be responsible for furnishing the necessary personnel, equipment, materials, supplies, transportation, services and otherwise do all things necessary to provide odor control services of the monitoring and services programs for odor control. 28.0 During the Service Contract, the City may desire to install additional supply storage and feed systems at other locations.The City will request a price proposal from the Contractor to furnish and install the new system(s)with consideration given to any adjustment in the supply unit prices to account for the additional supplies used and program management services required. 29.0 It is expressly understood and agreed that the foregoing RFP is based on the total bid amount for the service Contract which is inclusive of all work, equipment, and supplies and management for one year period as specified in the reference RFP documents. 30.0 The program goals will include minimizing the occurrence/frequency of odor complaints. In addition, the following specific targets levels of H28 treatment will be used to evaluate the effectiveness of the odor control services provided: 30.1 Vapor H2S daily average at all locations target levels is 25 ppm. 30.2 Contractor shall review the monitoring results on a quarterly basis with the City to confirm the average monthly vapor levels are within 10 percent of the target levels and the average dissolved sulfide levels are no greater than 0.5mg/L. Changes to the program goals shall not be implemented without approval from the City. Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. 31.0 Contractor shall provide all equipment maintenance and repair during the 12 month operating period. All materials required for routine maintenance (diaphragms, filters, etc...) are to be provided by Contractor as part of this service contract at no additional cost to the City. 32.0 Contractor shall provide and manage all supply deliveries and supply feed systems operations for the life of the service Contract to meet the established goals of the odor control program as described below. Management shall include adjustment and control of the metering pumps to optimize chemical usage for 1-12S control,with City's prior approval of dosing changes. Hourly dosage profiles are to be development by Contractor through frequent liquid and vapor sampling at all times of the day in order to optimize supply use. Unique profiles shall be developed to adjust for seasonal variation and sulfide loading. 33.0 Contractor shall provide a cellular based remote telemetry control computer for continuous monitoring by Contractor of each of the City's feed systems with the following capabilities: 33.1 Tank Level monitoring for inventory monitoring, scheduling deliveries and usage verification. 33.2 Dosage Control - Shall be capable of programming a different dosage for each hour or the day with a different 24 hour profile for each day of the week. 33.3 Real Time Alarms - Shall have the ability to monitor leak detection in the pump enclosure and the tank secondary containment in addition to flow rate variation, pump failure, excess flow cut off alarm, high tank level, low tank level and loss of source power. 33.4 Excess Flow Cut Off- Each system shall be equipped with an excess flow cut off valve. When the system detects excess flow the tank valve shall close. This prevents chemical from spilling on the ground in the event a pipe breaks or pump diaphragm breaks. This valve also shall close when there is a power outage.The control system shall be capable monitoring and opening the valve remotely. 33.5 Flow Detection - Each system shall be equipped with a pressure sensor to measure the system or pumping pressure. If there is no pumping pressure, there shall be chemical flow.The control system shall monitor the pressure. 33.6 Notification The system shall be capable of sending text messages and emails to key personnel of Contractor and selected City personnel to notify them of all high priority alarms. 33.7 Data Storage/Recall-Critical data such as tank level shall be kept internally in the programmable logic controller(PLC) memory with the level recorded every fifteen minutes for the past 10 days. Accessing the Contractor provided website page with color graphical user interface, the level can be viewed on an x-y chart showing the values and also downloaded in a '.csv or '.txt format to maintain weekly histories. The same shall be accomplished with other measurements (such as flow if a meter is incorporated into the system). 33.8 Device shall have the flexibility to incorporate other communication protocols such as Modicon Communication Bus (MODBUS) or Process Field Bus (PROFIBUS). 34.0 Contractor shall provide the City with access to web based daily tank inventories for each site. Professional Service Agreement Revised January 2018 Kemira Water Solutions,lnc. 35.0 Contractor shall provide a sampling program during the 12 month operating period to include weekly gathering of dissolved and atmospheric H2S data and iron analysis using portable and fixed devices at key monitoring points. The sampling program shall include all devices,installation,calibration,and local labor. 36.0 Contractor shall provide quarterly reports to the City showing sulfide and H2S levels at the monitoring locations and chemical usage at each dosing site and an annual report providing data on monitoring,chemical usage,and equipment maintenance. 36.1 QUARTERLY. Quarterly reports shall provide graphic representation of the sulfide and H2S levels at monitoring locations on a daily basis throughout the quarter with a summary of the target levels and whether they were met. The report shall also provide the results of all grab samples taken during the month in tabular format with a discussion of any changes that may affect the feed rates at the various locations and a discussion of the graphical results presented in the reports. The report shall also provide descriptions of system performance, chemical usage, key observations, and any problems. Reports shall also provide information on seasonal trends in both H2S and chemical feed and recommendations for changes in the dosing rate at each chemical application point. Reports shall provide a summary of the budget through the end of the quarter. 37.0 Contractor shall control the environment of the work site during on-site operations. All precautions shall be taken by the Contractor to protect the workers, public and City staff from any exposure to harmful or hazardous substances. 38.0 Contractor shall conform to any and all requirements regarding handling and hauling of chemicals for the odor control services provided at each site in accordance with Occupational Safety and Health Administration(OSHA)regulations and those that may be mandated by Federal or State Governments. 39.0 Contractor shall provide safety training to all designated personnel annually.Training shall include leak detection and clean-ups chemical handling, emergency response, and shut down procedures for short term and extended periods for each system. 40.0 Contractor is required to have a detailed spill response plan for each chemical feed site that can be accessed by the City personnel in the event of a spill or leak. 41..0 In addition to having a minimum of four (4) Contractor personnel familiar with the City program that can be contacted in case of an emergency, Contractor shall provide a 24 hour toll free hotline phone number. 42.0 H2S data loggers shall be provided by the Contractor. Instruments shall be calibrated in the manner prescribed by the instrument Contractor. Instruments shall be maintained in accordance with manufacturer's recommendations. 43.0 Supplies required for the odor control program shall be provided by the Contractor. 44.0 Estimated supply dosages are provided to assist the Contractor with bidding the project. 45.0 System Contractor will be paid based on actual supply used as described in the Measurement and Payment section. 46.0 Any product lost as a result of leakage or metering pump malfunction resulting in overdosing,will be replaced at Contractor's expense. Professional Service Agreement Revised January 2016 Kemira Water Solutions,Ina 47.0' Contractor shall provide a Certificate of Analysis stating that the chemical complies with the product specifications with each chemical delivery. Contractor shall provide a certificate of weight for each shipment. 48.0 Contractor shall comply with all federal, state, and local regulations regarding product labeling,packaging,and safety including providing Material Safety Data Sheets(MSDS). 49.0 Contractor must obtain pre-approval from the City prior to changing any supply Contractor and provide a certificate of analysis. Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. EXHIBIT B PAYMENT SCHEDULE Agency will be compensated according to the Bid Sheet attached herein for authorized product and services provided pursuant to the scope of work(Exhibit A)and properly invoiced, not exceed requesting department's fund amount for odor control products and services for the contract term. Prices from Kemira Water Solutions, Inc.stated on the current Bid Sheet attached herein shall remain in effect for the first year. Kemira Water Solutions, Inc. has options to renew for four(4) consecutive years. Upon each renewal,a price increase with justification statement shall be submitted in writing sixty(60)days prior to the renewal date. The requesting department will approve or disprove price increase upon that notification. The remainder of this page is left intentionally blank Professional Service Agreement Revised January 2016 Kemira Water Solutions,Inc. ExhlbitA ODOR CONTROL PROGRAM SCOPEOF SERVICES BID SHEET TECHNICAL&FUNCTIONAL REOUIREMENTS:ODOR CONTROL PROGRAM SCOPE of SERVICES WD SHEET:Contraccorshall provide all labor,materials, supplies and equipment to perform the following: B. Liquid Fenic Chlori de-solution of 30.40%Fe CM Specific Estimated Item Motion Gravity %FeCI3 Quanti UOM Unit Cost Total Cost 1 la,�a,FerrrsChloride.deli very included.Estimated quantityis based L41 39.5096 7,610,250 Dry lbs $ 0.32 $ 2,435280.00 on feeding 25 ppm of FeQ3(dry weight)at 100 MGD for 365 days. Fed w anon cetm Fee-!umkev cast to set u�a<M;t T-jeaT.: Indud Ig equipment x:picg,aPP.111-.C.,1161 r. . mon-'or]r.g/alarmint;'te:eme:��umume� ti On,sooregetankand 10,000 gallon IspiE d,citywllt a It fencing and slte tanksystem`. 1 EA $ 20,127 $ 20,127.00 concrete pa a,obtain easements,build access roads,obtain property owner permissions,and provide water and electricity. CiWs—ed feed sion m mod fi=1en Setuo Fee-cost to set up Zb cellular btsed remcte tele vycan^rol aom on.(KC)slang wish PLC menitoringd-ice%),cahles a.1c ef,. V ... nathm**lvwmon 2 FA $ 8,667 $ 17,334.00 each of the Qty°s rod systems(per sit.) •Vendorma bidon any or all ofthe differently sized s stems [gd Station M,mhiv Fee-Monthly feeper vendor insmIled{eed 3a station(does rot iWudetratment products).Dom now apply ifthe Sites: 1 32. EA $ 2,700-$ 32,40000 feed station is prodded and maintained by Qty(per site) arrentlydnesite Et�d SgtipbKOffth�•Monthlyfee per vendor insta lied 3b equipment on C ty Owned feed station(does notlndodetreaument Sites: 2 12 EA $ 7„350 $ 27,600,00 Products).(persitO Currently two sites 4 m222Smon litid eSiteMonthlvFe -month lyfee per hydrogen sulfide Sites: 3 12 EA $ 2,210 $ nS60.00 monitoring site I currently three sites 5 odorrenrnigcnftMaMhivManaternerrcfe..Including 12 EA S 3,530 S 42,360.00 administration,web service,and reportinit Atte;vendor mdlnmtns cwnemhlp ofvendorsupppWequtpment Total $ 2,637,327.00 �YriTraum_ai�as..gtUtlntfip!is�8ptfgalloas;�45�Opge6lbs). a, FxhibiLA Village Creek WastewaterTreatment Plant Sludge mnditipNng and dewatering program scope of service bid sheet(ret:32.2.2of RFP) TECHNICAL&FUNCTIONAL REQ IRE14ENTS:ODOR CONTROL PROGRAM SCOPEof SERVICES BID SHEET:tontractorshall provide all labor,materials, supplies and equipment to perform the following: G Lluld Ferric Chloride-solution of 3440%FeCi3 Specific Estimated. Item DescrloNon %Fe q3 UOM Unit Cost Total Cost Gravity Quantity UnuidFerricchlorid delivery included.Fsdmated quantity is based on feeding ZSOG-3000 gallons per day of FeO3 for 365 days. 1 143 39.509: 12.013,312 wctibs 5 0.3192- 5 1,433,417.19 tiouid Fertk alkide-def"veryinduded.Estimated quantity is based on feeding 25003000 gationsper day of fe63 for 365 days. 2 lr lads vmdarsupplied seA—ndeguip—t:smragXt (10,000 1.41 39.50% 12,025,312 wetlbs $ MUM $ 1,433,417-19 gal lonl un th cantai nmem,fi II stadan,nmtering pumps,level fiow instrumentation Note.yendormalntohts ownership of vendorsuppkedequipmmt ExhlbltA t' ' ODOR CONTROL PROGRAM SCOPE OF SERVICES BID SHEET TECHNICAL,&FUN MON AL REQUIREMENTS.DOOR CONTROL PROGRAM SCOPE of SERVICES 810$HEFT:Contractorshall provide an labor,materials, supplies and equipment to perform the following. F. Uquid Ferrous Chloride-solution of 19-32%FeC12 Item DesMotinn Specific %FQd2 t3timated I1QM UnitCort Total Cost Gravity QuarrG Linuid Ferrous ChkwW detivayincluded.Estimatedquantity-m 1 based on feeding 15.65 ppm of Fe02(dry a fight)at 1DO MGD for 365 L3 27.SD% I 4,763,980 Drylb $ 0"275 $, 1,37.0,212.34 da _ Feed station Set—Fre-turnkey costta setup a feed station, incl udi ng equi pmeng piping appurtenances,labor, 2a monitoring/alarming/tdemetryinstrumentation,stroragetankand 10,000 gallon 1 EA $ 20,327 S 20,127.00 spill containmertect.As needed,city xnll install fencing had site tanks'.rn concrete pad,obtain easements,build access toads,obtain property owner ermissions and rovtdewater and electrici , CkVs erased feed system modification setup Fan-costto setup ' 2b cellular based remoteteierr*"cwnroicomputer(PLC)along vAth PLC 2 EA $ 9,667 $ 17,334.00 inonitorirtgdevice(s),cables and connecttng(tesdng thesystem on each of the 0tv1s feed systems(per site) `Vendor may bid on any or all of the differently sized systems " Feed Station htpnthhr EyeMonthlyfee per vendor installed feed 3a station(does not include tratmeutproducb)•Does not apply if the Sites: 1 12 EA -$ 2,700 '$ 32,400.00 fed station is provided and maintained byGty(per site) currently one site F dsrn��k+n snynthly F«...Monthlyfeepervendorinstelled 3b equipment on City Owned feed station(dow not i ncl ude treatment Sites:, 2 12 FA $ 1,350 $ 27,600.00 productsb(persite) Currently two sites 4 H2S Monhorinr Site rbMhHFee-Monthly fee per hydrogen sulfide Sites: 3 12 EA $ 2,210 $, 79,560.00 mpnitaring site currently three sites S odors»yLseceMrnrthlyManaerm n�tFrr�inciuding 12 EA $ 3,330 $ 42,360.00 administration,v b service,and reporting Note:Vendormalntnins ownership ofvendarsupplied equipment Total $ L529.593.34 relnTmnm t;�dere_jgtI.tS;41VO B? 1Saatviet1 eKhibitA Special Studies:Houdydosage profiles Scope of service bid sheet(ref.32.8 of RFP) TECHNICAL&FUNCTIONAL RECLUIREMENM ODOR COMROI,PROGRAM SCOPE of SERVICES BID SHEET:Contractor shall provide all lahmt,materials, supplies and equipmerltto perform the following: Numberof Estimated Oescriotien UOM Unit Cost Total Cost Events QuantitySpecial swdies requested bythe QtyofFmi Worth duringthelnitial con7actyear requiring hourly dosageprotiles atall times ofdteday TBD persfte 24 H[ S 125.00.,$ 3,000.00 to develop uniquep�les will needm beagreed uPoo Prior tostirt of comrart Example:once a month running a 24-11hrdiumal at five(5)locations would Cost$180,000 The number of locations,duration,frequency of sampling ect can have greatimpaet on H25 Monitoring monthly fee.We separated itas a single line item CERTIFICATE OF INTERESTED PARTIES FORM 1295 l of l Complete Nos.1-4 and 6 fi there are interested parties. OFFICE USE ONLY Complete Nos.1,2,3,5,and 6 If there are no Interested parties, CERTIFICATION OF FILING 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2016-1230 Kemira Water Solutions,Inc, Lawrence,KS United States Date Filed: 2 Name of governmental entity or state agency that Is a party to the contract for which the form is 01/05/2016 being filed. City of Fort Worth Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a description of the goods or services to be provided under the contract. 16-0006 Odor Control Services 4 Nature of interest(check applicable) Name of Interested Party City,State,Country(place of business) Controlling intermediary Kemira Specialty Chemicals,Inc. Atlanta,GA United States X 5 Check only it there is NO Interested Party. ❑ 6 AFFIDAVIT I swear,or affirm,under pen � ally of perjury,that the above disclosure is true and correct. _Iq NOTARY P -State of Kansas M bfARCIA 1A D t3lAfd QORE My AppL ` � Signature of authorized agent of cont usiness entity AFFIX NOTARY STAMP!SEAL ABOVE Swornto and subscribed before me,by the said �u$"(bA4 r �irVit4... W M AU✓' ,this the day of 4 20 I U .to certify which,witness my hand and seal of office. 0���A Ck ristina M.Imbrogno Customer Service Manager Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Farms provided by Texas Ethics Commission vrww.ethics.state.tx,us Version V1.0.33598