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Contract 53755
h CS\V,C,-'D CI YSECRETARY MPg 2110 CONMACT N®. _-77 Fova WORTH March 8,2019 CLS Sewer Equipment Co Inc 726 S.Sherman St. Richardson,TX 75081 Attention:Jennifer Sonnier cissewerequipmentco@sbcglobal.net Re:Renewal of Bid CLS Sewer Equipment Co Inc OEM CUES CCTV SEWER INSPECTION EQUIPMENT,PARTS AND REPAIR Po No:PO-18-00103467;SS:16-0456 On 3/7/2019,the agreement between CLS Sewer Equipment Co Inc.and the City of Fort Worth will expire with 3 option(s)to renew. If you agree to extend the existing agreement for an additional 12-month period,please mark the appropriate box,sign below and return to this letter,your current certificate of insurance and your current signed IRS W-9 form within 48 hours. Final approval of a new purchase order is dependent on fund availability. if approved,a new purchase-order wilI be e-mailed to you. Please note that the former supplier site,auySpeed Online,will no longer be available for use.The City of Fort Worth has implemented a new system for procurements of goods and services.This will include bidding and direct purchases of goods and services. Business partners will able to access their City-related business information through the City's new PeopleSoft Supplier portal. To access your information in the new system,businesses need to register as a "User"using the link provided below. htt s: su lier.fortworthtexas. ov se fin rd/SUPPLIER ERP c NUI FRAMEWORK.PT LAND]NGPAGE.GBL?& You will need the following to complete registration: Your Vendor number:XXXX and your company's T N'identification number. "In the description field please put the position you hold within your company.EX:owner,office manager, accounts payable.** If you have any questions concerning this correspondence,please call 817-392-2462. Thank you for your prompt attention and foryour continued interest in doing business with the City of Fort Worth. Sincerely, Ashley Kadva Purchasing Division, Financial Management Services Department New Agreement Term.,3 8 19 thra kh 3 7 ZQ Vendor:CLS Sewer Equipment Co Inc. City, f Fort W A Yes,renew this agreement ❑ No do not renew this agreement Steven Rathe ennlf annier Purchasing Manager �� � � CCI SECRETARY t'��Slttt City Attora+dy FT WORTH,�9, 2-C PURCHASING DIVISION REQUEST FOR PROPOSALS(RFP) for OEM AUTHORIZED SERVICE FACILITIES AGREEMENT RFP No, 17-•0362 l Issued: May 30,2017 PROPOSAL SUBMISSION DEADLINE: *******June 29,2017 by 1:30PM Local Time jVO LATE PROPOSALS WILL BEACCEPTED RESPONSES SHALL BE DELIVERED TO: RESPONSES SHALL BE MAILED TO: CITY OF FORT WORTH CITY OF FORT WORTH PURCHASING DIVISION PURCHASING DIVISION LOWER LEVEL LOWER LEVEL 200 TEXAS STREET 200 TEXAS STREET FORT WORTH,TEXAS 76102 FORT WORTH,TEXAS 76102 Pre-Proposal Conference will be held: NAME AND ADDRESS OF COMPANY SUBMITTING PROPOSAL: 9:00 AM to 10:30 AM (local time)June 8,2017 at Training Room at 5021 James Ave.Service Center,Fort Worth,Texas 76115 FOR ADDITIONAL INFORMATION ao REGARDING THIS RFP PLEASE CONTACT: ,� �r - � John PadinjaraviIa Baby, Buyer Contact Person:,Jf fri I n'i john.padinjaravilababyQfortworthtexas.gov Title: RETURN THIS COVER SHEET WITH RESPONSE TO: Phone: ( 7g1355Fax:(a7�,)� Email; ( John Padinjaravila Baby, Buyer Signature. Purchasing Division, Lower Level, Financial Management Services Department Printed ame: !f c S r 200 Texas Street, Fort Worth,Texas 76102 Will contract be available far Cooperative Agreement use? (See Section 27,page 10)Yes No__�- Acknowledgment of Addenda:#1.2F 92 #3 #4 #5 j 'The Standard of the Industry" lli- I VIA EMAIL: JemCasewertools.com 3600 Rio Vista Avenue Orlando, Florida 32805 (407) 849-0190 October 14, 2011 (407)425--1569(Fax) (800)327-7791 RE: CLS Sewer Egui.nment Corrinarly,,T To Whom It May Concern: This letter is for the purpose of confirming that CLS Sewer Equipment Company is the sole CUES factory authorized dealership for the State of Texas for CUES spare parts, service, repairs,trouble shooting, and major unit equipment purchases. Contact information is as follows: CLS Sewer Equipment Company--North Texas Contact: Jerry Sonnier 726 S. Sherman St, Richardson, TX 75081 972.479,1336 Office 972.479,1336 Fax le.rry@sewertools.com CLS Sewer Equipment Company-South Texas Contact: Mark Wardlaw 15103 Mintz Ln Houston, TX 77014 281.440,1881 Office 281,440,1879 Fax rrt a r kfa?sewe rto o l s.com CLS Sewer Equipment Company is the sole authorized facility in the states of Texas to supply loaner equipment to operate on CUES systems. CUES spare parts are stocked at their facility. CLS service and parts personnel have received training on parts and repairs related to CUES equipment. I can be reached at 800-327-7791 for further information. Sincerely, Paul Stenzier Vice President, Sales CUES CC: Sales File; Mr. Jerry Sonnier, Mr. Mark Wardlaw, Mitch Windham, Jamie Arnold Corporate Office: 3600 Rio Vista Avenue, Orlando,FL 32805 • Telephone(407)849-0190 1 (800)327-7791 . Fax(407) 425-W l 569 Purchasing Division City of Fort North REQUEST FOR SOLE SOURCE PROCUREMENT TO: Purchasing Manager FROM: or Designee �� -- &r 1. Request approval for Sole Source Procurement of goods and/or services for the reasons described in sections 3 and 4 below. 2. Describe item(s) or service(s) to be purchased. Include cost, name and telephone number of vendor and other descriptive information. S r 1k ipc s o-A VIP ti 0 oD 3. Definition of Sole Source Procurement Condition(check one or more applicable items). This sole source procurement is necessary because: Items are available from only one source because of patents,copyrights, secret processes, or natural monopolies I This is a procurement of electricity, gas, water,or other utility services 4 These are captive replacement parts or components for equipment are of paramount consideration or use of other than OEM parts jeopardizes warranty and/or insurance coverage These are films, manuscripts, books,papers,or other materials that are available only from the persons holding exclusive distribution rights to the materials These are management services provided by a nonprofit organization of municipal museum,park, zoo, or other facility to which the organization has provided significant financial or other benefits 4. Detail of Sole Source Procurement Condition(reason(s) the item requested is the only product that will meet the need): Sa re- for _C�►es �r � s ,�� --L e t�l Page I of 2 i S• Solicitations and Products Evaluated (Required) (add additional pages, if needed): Product Name of Veaador _ ` Bid Amount Person Contacted Telephone Number M/7 B Status B. Product $ Name of Vendor Bid Amount Person Contacted Telephone Number M/WB SStatus C. Product Narrae of'Vendor Bid Amount Person Contacted Telephone Number MJW13C Status 6. T certify that a sole source condition exists for item( that normally bid competitively. Please forward this request to the P cha ' ivision, 2-1 Division Manager Department S gnature (Printed Name) Date 7, Purchasing Division Comments: kZA LS lr_ r✓.r.� e fs�„r 4 t JC<S rs r r`h fdr _ C� eS �s s V . der/Senior Buyer/Supe or: Date APPROVED. l ing Manager or Designee Date DENTED: Purchasing Manager or Designee Date Revised 3/17/2011 Page 2 of 2 CLS SEWER EQUIPMENT CO„INC. www.Sewerl'ools.com C LS NORTH SERVICE CENTER CLS SOUTH SERVICE CENTER 726 S.SHERMAN STREET 1 51 03 MINTZ LANE RICHARDSON,TEXAS 75081 HOUSTON,TEXAS 77014 OFFICE: 972-479.1 335 OFFICE: 281-44&1881 FAx: 972-479-1 336 FAX: 261-440.1879 CLS Sewer Equipment Co. Inc. July 25"-2017 726 S Sherman St. Richardson,TX. 75081 City of Fort Worth Mr. John Padinjaravila Baby Purchasing Division , 200 Texas Street Fort Worth,TX. 76102 CLS Sewer Equipment Co. Inc, will extend a 10% discount on parts purchased through RFP No. 17-0362, however shipping/freight charges will be added to corresponding invoices. Please contact me directly if you have any questions Sincerely, Irry Sonnier President/CEO CLS Sewer Equipment 726 S Sherman St. Richardson,TX. 75081 972-479-1335- Office 214-878-7380- Cell jerry@scwertools.com www.SewerTools.com 'The Standard of the Industq' 3600 Rio Vista Avenge January 3,2017 Orlando,Florida 32805 (407)849-0190 (407)425-1569(Fax) (800)327-7791 RE: CLS Sewer Ecluipmgqt Company To Whom It May Concern: This letter is for the purpose of confirming that CLS Sewer Equipment is the sole CUES factory authorized dealership for the State of Texas for CUES spare parts,service,repairs,trouble shooting,and major unit equipment purchases. Contact information is as follows, CLS Sewer Equipment Company—North Texas Contact: Jerry Sonnier 726 S.Sherman Street Richardson,TX 75081 Office: 972-479-1335 Fax: 972-479-1336 jerr a sewertools.com CLS Sewer Equipment Company--South Texas Contact:Paul Baumy 800 N.Loop East Houston,TX 77028 Office: 281-440-I 881 Fax: 281-440-1879 pawl a,sewertools.com' CLS Sewer Equipment Company is the sole authorized facility in the State of Texas to supply loaner equipment to operate on CUES systems. CUES spare parts are stocked at their facility. CLS service and parts personnel have received training on parts and'repairs related to CUES equipment. This letter is valid through December 31,2017. I can be reached at 800-327-7791,for further information. Sincerely, David Doolittle Vice President Corporate Office: 3600 Rio Vista Avenue,Orlando,Ft.32805 Telephone(407)849-0190/(800)'327-7791 Fax(407) 425-1 569 V1 G 75 MR TI-5)�Zo 9 969 Nail Park Rd., Green Cove Springs, FL 32043 Tel: 904-284-4200 o Fax: 904-284--3305 January 3, 2017 To Whom It May Concern: This letter will confirm that: CLS Sewer Equipment Co., Inc. 726 S. Sherman Street Richardson, Texas 75081 Tel: 972-479-1335 Fax: 972-479-1336 Email: ,Ierry@sewertools.com www.sewertools.corn is the only authorized Vac-Con dealer in North Texas for sales, genuine parts and service. Vac-Con, Inc. is the manufacturer of this equipment and there are no other authorized distributors in North Texas. This letter is good for one year from this date. If you have any questions, please do not hesitate to contact me. Sincerely, Todd Masley Sales Manager MORE POWER TO YOU ATTACHMENT C--CONTRACTOR(S)'S CONTACT INFORMATION Contractor(s)'s Name: L5 Contractor(s)'s local Address: 7LQ cri Y}a ,, a. . 'l Phone: q]09- 4-7q" 1836 _. Fax: � r a- `�-)q 133(.0 Email: Q�Ylfl IX c�' S - � � 32uxfC' S-wn Name of persons to contact when placing an order-. Name/Title kr ( �C�'L � I l✓� Qf� S J�' � Phone: I -/ 3 67 � _ _ Fax: Email: 1 �i)�� �s,�1 Name/Title 3 brUn Phone: Fax Email: .r� U'"~>�O� 5 •COfY1 Name/Titlq��, �J1'1rLG4 Phone:_Q7� -��� 1 ]�f3 Fax: q—47J 9-193(g Email: ()a td A "[Tewxrh nis wnt -- gnature Printed Name Date RFP No. 17-0362,OEM Authorized Service Facilities Agreement,Page 26 of 38 cc L2 LLLC L 0.9 �LgCca List of Certified technicians for CLS Sewer Equipment Co. Inc. Manufactures only issue a certificate, no numbers or expiration dates. VAC-CON: Jerry Sonnier 1998 Jeremy Rednour 2010 . Jr. Chapman 2014 Aaron Morris 2014 Terry Ginn 2014 CUES: Paul Baumy 2000 Kelly Guy 2016 00 6? 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L N 5 U m fixx-. xrx w F- p W W w z Q Q 2 2Q o ¢ CO2i C, ¢ ¢ J rn to 0 c � W !U W x LL' ~ m Q ¢ J w w W W z W Z .r Ei w m z w LL r z v w v � ovE2vN v `AL) C) - a m Q Q Q z w w U z z c) 'tu w ❑ ❑ v aNi 2 yo al 2 ¢ 2 2 2 C) 0 0 n D W W x W W w w z ❑ m W Ica 1r5 I z I I I I I U) U)i ¢ 01 wj U U > > °' > > > ¢ Q U > Q n �n co r� oa m p N r) m co � Co m o v v v •V• v LO ui U'i LO iii �i Lo ua [b I-A r WOR1,11-U. i REQUEST FOR QUOTATIONS Purchasing Division 200 Texas Street Fort Worth,Texas 76102 Phone: 817-392-8385 Fax: 817-392-8440 RFQ NO: 16-0456 CLOSING DATE: WEDNESDAY, FEBRUARY S, 2017 @ 1:30 PM COMMODITY: OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR SUYER: JANE ROGERS,SR. BUYER EMAIL. JANE,ROGERS@FORTWORTMTEXAS.GOV INSTRUCTIONS TO BIDDERS Quotes are solicited for furnishing the merchandise, supplies, services and/or equipment set forth. Completed Quote must be received in the Purchasing Division, 200 Texas Street, Fort Werth, Texas 76102 by the above quote deadline. Quotes must be faxed to 817-392-8440 or emailed addressed to the above Buyer, CitV of Fort Worth and have the bid number and o eninq date clearly marked on the fax cover, Late quotes will not be considered for award unless bidders are notified otherwise. Quotes may be withdrawn at any time prior to the official opening by written notification. Quotes may not be altered, amended or Withdrawn after the official opening e Your quote must be submitted on this form a Freight and all other delivery charges shall be included in the unit price(s) bid. s The City is exempt from Federal Excise and State Sales Tax-, therefore, tax must not be included in the quote price. Items quoted must meet or exceed City of Fort Worth Specifications: however, The City of Fort Worth may consider and accept alternate bids if specified herein when most advantageous to the City. The City reserves the right, however, to hold to City Specifications and to determine "or equal' status. The City reserves the right to accept or reject in part or whole any quote submitted, and to waive any technicalities for the best interest of the City. The undersigned agrees, if the quote is accepted,to furnish any and all items upon which prices are offered,at the price(s) and upon the terms and conditions contained in the specifications. The period for acceptance of this proposal will be 90 calendar days(unless the bidder inserts a different period) after opening date. f Will Agreement be available for Cooperative Agreement use? (See Section 21, page 9) Yes V 'No- City of Fort Worth Standard Terms and Conditions Shall Apply Company Name&Address QUOTE EVALUATION The quote award shall be based on, but not necessarily limited to,the following factors; 1,; WEk F_QUIPMr--nJ_rd •-Aj0UnitPrice Z Total Quote Price 72LL / 1yj I Terms and Discounts 4, Delivery Date 5. Results of Testing Samples 6. Special Needs and Requirements of the City . past experience with productlservice 8. Vendor`s past:performance Telephone nor. (ACI:?A 9. City's evaluation of the Vendor's responsibility Fax no.(�J i-F70-� 16&- 10. Derraurrage charges, freight costs and mileage 11. Estimated cast of supplies, maintenance, storage ` 12. Estimated Surplus value Signature E-mail Addr COMFl CT OF 11MI'Vl EST ClUES °IONNAIRE FORM CIO For vendor doing business with Kcal governmental entity This questionnaire reflects changes made to the law by 11.8, 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176,Local Government Code nape by a vendor who has a business relationship as defined by Section 176.001(1-a)with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1),Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.O06, Local Government Code.An offense under this section is a misdemeanor. 1 Name of vendor who has a business relationship with local governmental entity. +`', Check this br►x if you are filing a pda#e a a previously tiled questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 _ Name of local government officer about whom the information in this section is being disclosed. W� ,me of Officer This section (item 3 including subparts A, 6, C, & D) must be completed for each officer with whore the vendor has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code, Attach additional pages to this Form CIO as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor? 71 Yes No D. Is the vendor receiving or likely to receive taxable income,other than investment income,from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? = Yes = No C. is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more? = Yes = No D. Describe each employment or business and family relationship with the local government officer named in this section, 4 Win atu vendor doing business with the governmental entity pate Adopted &.71201 6 Rage 1 of 6 WHICITATIOW _ Printed: 02/03/2017 BID OPENING BATE AND TIME: 210/2017 1:30:00 PM UID NUUIBER: 16-0466 BUYER Jane Rogers PHONE#: (817)392-8385 ❑Et IVERY REOUfREt]:2/8!2017 V Vendor Name- li_, S City of Ft Worth IN IN Address: t� I 1508 11 TH AVENUE ! _ILIY � ���� _ p FORT WORTH TX 76102 G City State Zip Cod - t c� T O Item Class-Item Quantity Unit Unit Price Total 53 000 The City of Fort Worth is seeking quote for an annual Agreement for OEM Cues CCTV 5evrer Inspection Equipment.Parts and Repair.The Agreement will be for one(1) one-year perFod with options to renew for up to four(4) additional one-year periods All items shall bi�bid per attached specifications Pr ce 1.000 HUB.IDLER SPROCKET ITEM CU-MC269 10 EA 2.000 COUPLING,TRANSMISSION,FWC ITEM CU-MC273 10 EA 3 000 SPINDLE, DRIVE SP-ROCKET COUPLING ITEM CU-MC272 10 EA � 4.000 CONNECTOR ASSEMBLY, REAR CAMERA MINI ITEM CO-MZ304 20 EA 5-000 GEAR, ROTATE;CLUTCH,30TI48P,SST ITEM CU-CZ032 10 EA 6.000 PCS ASSEMBLY,POWER, LINE DRIVER,MICITEM CU-CL002 20 EA 7.000 HOUSING,GEAR ITEM CU-MC277 14 EA TT 8.000 FILTER ASSEMBLY,MULTI PAN&TILT OZII ITEM CU-730146-1 10 EA _ i 9-000 CABLE ASSEMBLY, 1200'GOLD W!5+4 ITEM CU-0300526 5 EA - 55,000 CABLE ASSEMBLY MIC GOLD W6+4 1500'ITEM CU-0305497 2 EA _ Page 2 of 6 "10 SOLICITAT 101'1 Printed. 02/03/2017 F31D OPENING DATE AND Tl,',n.E: ?1812017 1:30,00 Por; 311) PlMMER: 16-0456 BUYER ,lane Rogers PHONE# i817j392-8335 DELIVERY REQUIRED!21812017 V Vendor Name: l S City of Ft Worth E C L S .5 t<;�./fi t c�7 t I�' i"n' ''> ► C H 1608 11 TH AVENUE N Address, 7 2) .� D _ _ .�r� S i P FORT WORTH TX 76102 0 City, State Zip Cade. R 1 Co A1zb50 c T R O Item Class-Item Quantity Unit Unit Price Total 10 000 CONNECTOR, BLKHD. READ 5 PIN MIC ITEM C'U-CZ002 10 EA 11000 SEAL,OIL,.5ID X.875 OD X.252THK. ITEM 042-130305 20 EA 12.000 GEAR,MODIFIED. ITEM 042-299981 2 EA �----- --- 13.000 GEARJANDEM, ITEM 042-300407 2 EA 14.000 SPROCKET, ITEM 042-300432 10 EA -- --'— 15,000 VALVE,PURGE,P&T,ITEM 042-CP063 20 EA �T 16.o00 CONNECTOR, BLKHD.REAR. 5 PIN,MIC ITEM 042-CZ002 2 FA — 17.000 LENS,PLANOCON,LGHTHD INDOW, OZII. ITEM 042-CZ003 6 FA 18,000 GEAR,SPUR,54Tl48P,ALUM ITEM 042-CZ031 2 EA —19000 FORK.PAN DRIVE SIDE,OZII ITEM 042-CZ042 2 EA 20 000 FORK. CONNECTOR.SIDE,OZII ITEM 042-CZ043 2 EA J — 21 000 PCB ASSY MICROPROCESSOR OZII ZOOM ITEM 042-CZ409-1 3 EA _�,� Page 3 of 6 H310 S .-ICITA 101" Printed:02/03/2017 BID OPENING DA EI AND`DIME: 21812017 1:30M NO BID N#JNGER; 16-0456 BUYER Jane Rogers PHONE#. (8171392-8385 DELIVERY REOUIRED 2/8/201.7 V Vendor Name S City of Ft Worth 1608 11 TH AVENUE D Address 7 2, 5/) t r" � p FORT WORTH TX 76102 O City State Zip Code: 1 40`a1��L / R T -75V F1 1 O Item Class-Item Ouantity Unit Unit Price Total 22 000 GEAR DRIVE.SPUR. 12T/24P TEARDROP 2 ITEM 042-HW552 2 EA 23 000 CRADLE, CAMERA BODY 10.50 INCH, ITEM 042-MC203-1 2 EA 24.000 ADAPTER.SINGLE WITH SHORTY Il. ITEM 042-MC222 16 EA 25.000 MOUNT_MOTOR&XMSM, ULTRA. ITEM 042-MC238 ? EA -- _- - 26 000 RACE BALL TRIPLE.CLUTCH, F/N/R, ITEM 042-MC244 2 EA 27 000 SHAFT.DRIVE,CLUTCH. ULTRA. ITEM 042-MG245 2 EA 28 000 COVER,TRANSMISSION,ULTRA,ITEM 042-MC246 2 EA 29,000 GEAR,WORM. HS. BBCL, ULTRA SHORTY ITEM 042-MC247 2 EA 30.000 SPINDLE, IDLER SPROCKET, ITEM 042-MC267 10 EA 31.000 HOUSING,GEAR. ITEM 042-MC277 2 EA 32.000 SPRlJGKET ASSY FRONT U-SHORTY 8 21, ITEM 042-MC907 10 EA 33 000 DRIVE ASSY_REAR,U-SHORTY&21. ITEM 042-MC908 10 EA — Page 4 of 6 31D 801-I ITAT10ol Printed; 02103/20/7 BIB OPJ1 KING DATE AND TIAAE: DID NUMBER: 16-6466 BUYER,Jane Rogers PHONE# (817)392-8385 DELIVERY REQUIRED.2/8/2017 V Vendor Name 1 ), S City of Ft Worth N Address: t 1608 11TH AVENUE Q s p FORT WORTH TX 76102 O City State Zip Code -,1 , 'L� L« 1 R T _. ? 0 CJ Item Class-4em Quantity Ursit Unit Price Total 34 000 BRUSH. MOTOR F.'TRANS MTR TL050, ITEM 042-T L041 20 EA 35 000 MOTOR 115VDC. 12HP. bV/STANDOFF TRANS ITEM 042-TLO50 A EA 36.000 MOTOR CAN GONE.USIII,WTR-US21JWS405. ITEM 042-TX023 6 EA 3.7.000 2 INCH TIGER TALES W/ROPE CLAMPS AND CUFFS ITEM 056-TAIL2 20 EA 38,000 JAKE SEWER VAULT LID EXTRACTOR 8 LB. ITEM 098-I]MJAKE 8 10 EA 39.000 SPROCKET, ITEM CU-300432 10 EA 40.000 BRUSH,MOTOR,FITRANS MTR TL050. CU-TL041 10 EA 41.000. MOTOR, 1 f5VQC, 12HP WISTANDOFF, TRANS, ITEM CU-TLO50 2 EA 42.000 PCB ASSY. FILTER, NON-FUSED, ITEM CU-WS406 6 EA 43 000 CARLP ASSY,MOTOR&XSM, ULTRA SHORTY, ITEM 042-MC236 50 EA 44.000 SHAFT. EXTENDER. DRIVE,8 INCH PIPE. ITEM 042-MC220.1 6 EA 45.000 SHAFT, EXTENUER DRIVE. F112 INCH PIPE, ITEM 042-MC220-5 6 EA Page 5 of 6 BID 501-IGH'AT100 Printed. 02103/2017 BID C?1yC-NINO DATE AND I lME: 218120111�:MOO j[�IVI BID 466 BUYER: .iaoc Rogers PHONE#_ (817)392-8385 DELIVERY REQUIRED:2/812017 1f Vendor Name t , S City of Ft Worth N Address 1 1608 11TH AVENUE D p FORT WORTH TX 76102 Oi City, State Zip Cade RPS7t T item Class-Itern Quantity Unit Unit Price . Total 45 000 SHIFT EXTENDER, DRIVE, 15 INCH PIPE ITEM 042-MC220-7 6 EA 47.000 ADAPTER TRIPLE WITH SHORTY 11, ITEM 042-MC266 12 EA 48.000 CONNECTOR, THREADED CHAIN 114 SST. ITEM 042-712849 t0 EA 49-000 TOW CABLE ASSY, FOR CAMERA SKIDS 27 INCH, ITEM 042-120502 20 EA 50.000 CUES CAMERA REPAIR SERVICE HOURLY RATE REGULAR HOURS. 10 HR M-F, B-00 AM-5�00 PM 51.000 CUES CAMERA REPAIR SERVICE HOURLY RATE OVERTIME HOURS, 10 HR 1(77 $!T�0�lc M-F, 5:01 PM•7:59 AM,WEEKENDS AND HOLIDAYS JCC' 54.000 MISCELLANEOUS ITEMS @ MANUFACTURER LIST PRICE LESS 50044 EA � 5 %DISCOUNT The quantity listed is the estimated total cast.The amount to be entered on this line item for example,$50,000 -$5000(10%discount)W$45,000 56.000 VEHICLE.DIAGNOSTIC FLAT FEE(excluding repairs associated with the 10 EA Cues camera system) 57,000 VEHICLE MAINTENANCE,SERVICE OR REPAIR NON-WARRANTY 50 EA 0511, HOURLY RATE REGULAR HOURS,M-F.8:00 AM-5=.PM(excluding repairs associated with the Cues camera system) 58.000 VEHICLE MAINTENANCE.SERVICE CAR REPAIR WARRANTY HOURLY 1 EA 4�( RATE REGULAR HOURS,M-F,8:00 AM-5:00 PM(excluding repairs — associated with the Cues camera system) Page 6 of 6 MD SOUCITAT1010 Printed:02/03/2017 BID OPENING DATE AND TIME: 2!$12017 1:30:00 rPjw 811) NUMD R: 96-0456 BUYER Jane Rogers PHONE#' (817)392-8385 DELIVERY REQUIRED.2/8J2017 EV Vendor Name'O�S 5F-Lt l ! fN rr u"" ' f rtr(n S City of F#Worth H N Address 1 160E 1 1TH AVENUE © .off ✓�.''Vtf7'j S'r p FORT WORTH TX 76102 ❑ City. State Zip Code R c rUtr , 7-' T Item Ctass-Item: Quantity lJnit Unit Price Total 55 000 VEHICLE MAINTENANCE. SERVICE OR REPAIR NON-WARRANTY 5 EA IUlf V ?� � �(? HOURLY RATE OVERTIME HOURS,10-F 5:01 PM-7 59 AM WEEKENDS AND HOLIDAYS(excluding repairs associated with the Cues camera system) 60.000 VEHICLE MAINTENANCE,SERVICE OR REPAIR WARRANTY HOURLY 20 EA RATE OVERTIME HOURS,M-F,5 01 PM-7 59 AM.WEEKENDS AND HOLIDAYS(excluding repairs associated with the Cues camera system) 61.000 ADDITIONAL VEHICLE MAINTENANCE,SERVICE. OR REPAIR FEES 1 EA � 0 such as shop fees.environmental. transportation disposal,hazardous material,freight or miscellaneous fee shall be detailed on each estimate and invoice provided to the City(excluding repairs associated with the Cues camera system) 62.000 VEHICLE EQUIPMENT PARTS(excluding repairs associated with the 1 EA Cues camera system). A. Discount 0 %off MSRP or B Manufacturer Cast plus % TOTAL: WE AGREE TO FURNISH ANY OR ALL OF THE ITEMS QUOTED AT THE PRICES SHOWN QUOTE MUST BE HELD FIRM FOR PERIOD OF 90 DAYS, ERM OF PAYMENT: )VE" 7 �_;19 COMPANY: e L-S_Saw�kn E�i t�11�9��U% (?�o /la ELIVERY: -a Ps. SIGNATURE: 7LEPHONE NUMBER: 1-4`7 C1 —1 35 NAME AND TITLE: DETAILED SPECIFICATIONS FOR OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR 1,Q SCOPF 1.1 The City of Fart Worth (City) is accepting quote(s) for an annual Agreement for Original Equipment Manufacturer (OEM) Cues closed circuit television video (CCTV) sewer inspection equipment, parts and repair service for the Water Department and Property Management/Fleet Division in accordance with the descriptions and specifications listed in this solicitation. 1.2 OEM Cues CCTV sewer inspection equipment is used for wastewater fine and storm sewer pipeline profiling and inspection throughout the City. 1.3 The Vendor shall provide OEM Cues CCTV sewer inspection equipment, parts and repair service on an as needed basis, as requested by the City 1 A The term of the Agreement shall be for an initial one-year(1) period, with four (4) options to renew for additional one-year periods. However, if funds are not appropriated, the City of Fort Worth (City) may cancel the agreement 30 calendar days after providing written notification to the Vendor. 1.5 Vendor shall respond to a purchase request within twenty-four (24) hours verbally or via email and supply requested materials or services required during regular business hours within a maximum of five(5)business days or less including shipment by mutual agreement from the time original request is made. 1.6 The Vendor shall provide unit prices for listed items required on the bid solicitation page. 1.7 Unit prices shall include all associated costs, not limited to delivery, fuel and handling charges. No additional charges will be accepted or paid by the City. All charges must be stated on each line item. No miscellaneous charges will be accepted by the City. 1.8 Vendor shall state manufacturer list price less percentage discount on Bid Solicitation Page. 1.9 Vendor shall quote hourly rate for repair service on Bid Solicitation Page. 1.10 Following the award, additional services of the same general category that could have been encompassed in the award of this Agreement, and that are not already on the Agreement, may be added. 1.11 Because the Water Department performs emergency services, as well as functions during public safety incidents, it requires all of its applicable Vendors to be available twenty-four (24) hours a day, seven (7) days a week, if necessary, for an emergent repair or part. Therefore, the vendor shall provide.an on-call person or staff member and direct telephone number that can be distributed to the operators of the equipment involved in this RFQ. 1.12 The City expects the OEM service facility to continually stay up-to-date on the Cues CCTV Sewer Inspection System so that the workmanship and quality of knowledge, training, repairs, maintenance and service to the City is always maintained at the highest level possible. 1.13 With the•high number and value of Cues CCTV Systems the City has acquired and plans to acquire, coupled with the knowledge that the Water Department has standardized on the system, the City requires that the awarded OEM authorized service facility of this RFQ provide three (3) days of free (no charge) product training on the system annually to-two (2) City personnel. The City personnel will consist of one (1) from the Water Department and one (1) from Property Management Department/Fleet Division. This required product RFQ No.16-0456, OEM CUES CCTV.SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 3 of 20 training should be one of the formal on-site product training courses offered and by Cues CCTV Systems personnel and not on-line training. 2.0 GENERAL REQUIREMENTS 2A The Vendor shall provide but not limited to all items listed on Bid Solicitation Page. 2.2 Vendor shall provide OEM Cues CCTV sewer inspection equipment repair services and additional vehicle (and generator) maintenance, and repair services they are capable of providing at an hourly rate. Any units sent to an OEM authorized service facility that are recognized by that facility to be outside their scope of specialization and capabilities for the Cues CCTV System Services or the vehicle it is mounted within, will be sent back to the City for issuance to the appropriate vendor for that repair. The City does not consent the OEM authorized service facility to send the unit to another vendor for third party repairs or service without prior documented and written consent. Repairs which exceed 20 percent of the total cost for new equipment or parts must be called in and authorized by the warehouse personnel. 3.0 METHOD OIL AWARD 3.1 Bids will be evaluated based on the lowest responsive and responsible bidder complying with all of the provisions of the solicitation, provided the bid price is reasonable, and it is in the best interest of the City to accept it. 3.1.1 A responsive bidder is defined to be one who submits a completed bid packet within the stated time deadline and in accordance with the bid specification. 3.1.2 A responsible bidder is defined to be one who demonstrates via responses to the selection criteria his/her ability to successfully deliver the supplies, equipment, or services being procured. 3.2 In order for the City to receive adequate coverage on its requirements as specified in the solicitation, the City reserves the right to make multiple awards. 3.3 The City reserves the right to accept or reject in whole or in part any or all bids received and to make an award on the basis of individual item, combination of items, or overall bid, as it is deemed in the best interest of the City. 3.4 The City also reserves the right to reject the bid of a bidder who has previously failed to perform properly or complete on time agreements of a similar nature. 4.0 INVOICING REQUIREMENTS 4.1 All invoices should be submitted directly to the requesting department. It is the responsibility of the Vendor to get the name of the responsible person, telephone numbers and address of the department at the time the service is requested. The requesting department is required to issue a release purchase order number to the Vendor during the process. 4.2 A properly prepared invoice shall be typewritten or computer printed and shall include the Vendor's name and federal tax identification number, invoice number, address, date, service or item description, unit price, extended cost, City issued purchase order and release number. incomplete or inaccurate invoices may result in delayed payments, as they shall be returned to the Vendor for correction and re-submittal. All freight costs shall be included in the unit prices bid. The City of Fort Worth will not pay shipping costs, off- loading or handling charges associated with orders. 4.3 All invoices shall include a written description of the work performed and the dates when the work was performed. Hourly rates for field work will commence from the time the Vendor arrives on site and continue until the Vendor departs the site. The Vendor's employee(s) will inform the City when he/she arrives on site and report his/her hours worked though completion of a work summary sheet. Where appropriate, invoices shall RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 4 of 20 include mileage required for pickup and delivery of equipment. Depending on the work performed, City may hold invoices until required reports are received by the City. 4.3.1 . Hourly rates shall be invoiced to the nearest% hour. 6.0 WARRANTY 5.1 All items installed under this contract shall carry the standard manufacturer warranty. Warranties shall be effective on the date the items are accepted by the City. 5.2 No repair or service work provided on any existing equipment shall void the existing warranty on the equipment. 5.3 The Vendor shall warranty all equipment that is appropriate for the intended service and shall be free of manufacturing and installation defects in materials and workmanship for a period of not less than the manufacturer's standard warranty. Should equipment fail during the warranty period, it shall be repaired/replaced at no expense to the city. 6.0 DELIVERY 6.2 Delivery shall be F.O.B. Destination and all delivery charges shall be included in the unit prices. The person placing the order will provide delivery and billing information. No additional charges for expenses, freight, mileage, time, or similar items will be accepted or paid by the City. 6.3 There may be instances when the Vendor may be asked to accelerate delivery of an order(s)due to extenuating circumstances. When this occurs,the Vendor will be expected to provide this service at no additional cost 6.4 In the event the Vendor is unable to meet the original delivery date(s), the City must be contacted immediately, but prior to the due date, and seek an extension of delivery time. Failure to comply with the delivery terms may be legal grounds for canceling an order(s), or the entire Agreement in accordance with the Termination Clause shown elsewhere in the solicitation. 6.5 Delivery tickets must include the City's Blanket Order Number and the ordering department's Release Number. 7.0 UNIT PRICE ADJUSTMENT 7.1 The unit prices may be adjusted for increases or decreases in Vendor's cost during the renewal period but before the effective date of the renewal upon written request from the Vendor. 7.2 At the time the City exercise the renewal options,the Vendor may request a rate adjustment in an amount not to exceed the current Producer Price Index (PPI) rate of the original contract rate price or subsequent renewal rate price. 7.3 The Vendor must submit its price adjustment request, in writing, at least 60 days before the renewal effective period. The Vendor shall provide written proof of cost increases with price adjustment request. 7.4 If the City concludes that the rate increase being requested is exorbitant, the City reserves the right to adjust the rate request, or reject the rate request in its entirety and allow the contract to expire at the end of the contract term. If the City elects not to exercise the renewal option, the Purchasing Division will issue a new solicitation. 7.5 Prices bid shall remain firm for each one-year term of the Agreement and shall include all associated freight and delivery costs. RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 5 of 20 7.6 Prices offered shall be used for bid analysis and for Agreement pricing. In cases of errors in extensions or totals, the unit prices offered will govern. 7.7 Upon expiration of the Agreement term the successful bidder, agrees to hold over under the terms and conditions of this Agreement for a reasonable period of time to allow the city to re-let an agreement, not to exceed ninety (90) days. Vendor will be reimbursed for this service at the prior agreement rate(s). Vendor shall remain obligated to the City under all clauses of this Agreement that expressly or by their nature extends beyond and survives the expiration or termination of this contract. 7.8 Goods and/or services shall not be suspended by the Vendor without a 30 day prior written notice to the Purchasing Manager. 8.0 INSURANCE REQUIREMENTS 8.1 The Vendor shall assume all risk and liability for accidents and damages that may occur to persons or property during the prosecution of work under this Agreement.The Vendor shall file with the City of Fort Worth Purchasing Division, prior to the commencement of services, a certificate of insurance documenting the following required insurance within five (5) calendar days of notification. 8.2 Policies shall have no exclusions by endorsements which nullify the required lines of coverage, nor decrease the limits of said coverage unless such endorsements are approved by the City. In the event a contract has been bid or executed and the exclusions are determined to be unacceptable or the City desires additional insurance coverage, and the City desires the Vendor to obtain such coverage, the contract price shall be adjusted by the cost of the premium for such additional coverage plus 10%. 8.2.1 Statutory Workers' Compensation Insurance and Employer's Liability Insurance at the following limits: $100,000 Each Accident $500,000 Disease— Policy limit $100,000 Disease—Each Employee 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 accidentloccurrence, $500,000 bodily injury disease policy limit and $100,000 per disease per employee. 8.2.2 Commercial General Liability Insurance including Explosion, Collapse, and Underground Coverage shall be provided as follows: $1,000,000 Each Occurrence $2,000,000 Annual Aggregate Coverage shall include but not be limited to the following: premises/operations, independent Vendors, productslcompleted operations, personal injury, and contractual liability. Insurance shall be provided on an occurrence basis, and as comprehensive as the current Insurance Services Office (ISO) policy. 8.2.3 Auto Liability Insurance shall be provided as follows: $1,000,000 Combined Single Limit Each Accident A commercial business policy shall provide coverage on "Any Auto", defined as autos owned, hired and non-owned. 8.2.4 The Vendor shall furnish the Purchasing Manager, with a certificate of insurance RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 6 of 20 documenting the required insurance prior to the commencement of services. 8.2.5 Policies shall be endorsed to provide the City of Fort Worth a thirty-(30)day notice of cancellation, material change in coverage, or non-renewal of coverage. 8.2.6 Applicable policies shall also be endorsed to name the City of Fort Worth as an additional insured, as its interests may appear(ATIMA). 9.0 ADDITIONAL INSURANCE REQUIREMENTS 9.1 The City, its officers, employees and servants shall be endorsed as an additional insured on Vendor's insurance policies excepting employer's liability insurance coverage under Vendor's workers' compensation insurance policy. 9.2 Certificates of insurance satisfactory to the City and Worker's Compensation Affidavit must be received before Vendor can begin work. Failure to supply and maintain such insurance shall be a breach of contract. Vendor shall provide complete copies of all insurance policies required by this Agreement. Certificates of insurance must be supplied to: Financial Management Services Department Attention: Purchasing Division 200 Texas Street Fort Worth, Texas 76102 9.3 Any failure on part of the City to request required insurance documentation shall not constitute a waiver of the insurance requirements specified herein. Each insurance policy shall be endorsed to provide the City a minimum 30 days notice of cancellation, non renewal, and/or material change in policy terms or coverage. A ten (10) day notice shall be acceptable in the event of non-payment of premium. 9.4 Insurers must be authorized to do business in the State of Texas and have a current A.M. Best rating of A: VII or equivalent measure of financial strength and solvency. 9.5 Deductible limits, or self-funded retention limits, on each policy must not exceed $10,000.00 per occurrence unless otherwise approved by the City. 9.6 Other than worker's compensation insurance, in lieu of traditional insurance, City may consider alternative coverage or risk treatment measures through insurance pools or risk retention groups. The City must approve in writing any alternative coverage. 9.7 Workers' compensation insurance policy(s) covering employees of the Vendor shall be endorsed with a waiver of subrogation providing rights of recovery in favor of the City. 9.8 City shall not be responsible for the direct payment of insurance premium costs for Vendor's insurance. 9.9 Vendor's insurance policies shall each be endorsed to provide that such insurance is primary protection and any self-funded or commercial coverage maintained by City shall not be called upon to contribute to loss recovery. . 9.10 While the purchase order is in effect, Vendor shall report, in a timely manner, to the Purchasing Department any known loss occurrence that could give rise to a liability claim or lawsuit or which could result in a property loss. 9.11 Vendor's liability shall not be limited to the specified amounts of =insurance required herein. 10.0 SAFETY — The Vendor shall be responsible for meeting all Federal: laws, ordinances and regulations; State: laws, ordinance and regulations; County: laws, ordinances and regulations; and City: laws, ordinances, and regulations for safety of people, environment, and property. This includes, but is not limited to, all licenses, all Federal, State, County, and City Agencies, RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 7 of 20 Administrations and Commissions such as the Environmental Protection Agency (EPA), Occupational Safety and Health Administration (OSHA), and the Texas Commission on Environmental Quality (TCEQ). 11.0 PERFORMANCE - Failure of the City to insist in any one or more instances upon performance of any of the terms and conditions of this Agreement shall not be construed as a waiver or relinquishment of the future performance of any terms and conditions, but the Vendor's obligation with respect to such performance shall continue in full force and effect. 12.0 COMPLAINTS - Complaints processed through the City Purchasing Division are to be corrected within fourteen (14)days of formal notice of complaint. Written response to the Purchasing Division is required. Failure to properly resolve complaints within the fourteen (14)calendar day time period may result in the cancellation of the applicable fine item(s) in the price agreement. 13.0 HAZARDOUS CONDITIONS - The Vendor is required to notify the City immediately of any hazardous conditions and/or damage to City property. 14.0 CONTRACT ADMINISTRATION 14.1 Contract administration will be performed by the Water Department. In the event the Vendor fails to perform according to the terms of the agreement, the Department head or his/her designee will notify the Vendor, in writing, of its failures.A meeting may be arranged to discuss the Vendor's deficiencies. A written cure notice may be prepared giving the Vendor 14 calendar days to cure any deficiency. 14.2 In the event the Vendor continues with unsatisfactory performance, the department will promptly notify the Purchasing Manager who will take appropriate action to cure the performance problem(s), which could include cancellation, termination for convenience or default. If the agreement is terminated for default, the Vendor may be held liable for excess cost and/or liquidated damages. 14.3 The Vendor will be paid only those sums due and owing under the agreement for services satisfactorily rendered, subject to offset for damages and other amounts which are, or which may become, due and owing to the City. 14.4 The City reserves the right to terminate this agreement, or any part hereof, for its sole convenience. In the event of such termination, the Vendor shall immediately stop all work hereunder and shall immediately cause any and all of its suppliers and subVendors to cease work. Subject to the terms of this agreement, the Vendor shall be paid a percentage of the agreement price reflecting the percentage of the work performed prior to the notice of termination, plus reasonable charges the Vendor can demonstrate to the satisfaction of the City using its standard record keeping system, have resulted from the termination. However, in no event shall the total of all amounts paid to the Vendor exceed the agreement price. The Vendor shall not be reimbursed for any profits which may have been anticipated, but which have not been earned up to the date of termination. 15.0 OPTION TO EXTENDIRENEW THE TERM OF THE AGREEMENT 15.1 The term of the agreement shall be for a period of one (1) year, with options to renew annually for up to four (4) additional one year terms. The City may extend the term of this agreement by written notice to the Vendor within 30 calendar days; provided,the City gives the Vendor a preliminary written notice of its intent to extend at least 60 calendar days before the agreement expires, and the renewal/extension is mutually agreed upon by both parties to the agreement. 15.2 The preliminary notice does not commit the City to an extension. If the City exercises this option, the extended agreement shall be considered to include this option clause. RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 8 of 20 16.0 EXCEPTIONS TO SPECIFICATIONS Any conditions of exceptions to specification must be in writing and attached to this bid. The City reserves the right at its sole option to accept or reject such bid. 17.0 QUANTITIES The quantities listed on the bid solicitation are only estimates based on previous usage and do not. indicate intent to purchase or a guarantee of future business. The City of Fort Worth is obligated to pay for only those materials and services actually ordered by an authorized City employee providing a purchase order number and a release number and then received as required and accepted by the City. 18.0 PERFORMANCE Failure of the City to insist in any one or more instances upon performance of any of the terms and conditions of this Agreement shall not be construed as a waiver or relinquishment of the future performance of any terms and conditions, but the Vendor's obligation with respect to such performance shall continue in full force and effect. 19.0 COMPLAINTS Complaints processed through the City Purchasing Division are to be corrected within fourteen(14) days of formal notice of complaint. Written response to the Purchasing Division is required. Failure to properly resolve complaints within the fourteen (14) calendar day time period may result in the cancellation of the applicable line item(s) in the price agreement. 20.0 SUBCONTRACTING No subcontracting of the work under this Agreement will be allowed without written permission. 21.0 COOPERATIVE PURCHASING 21.1 Should other governmental entities decide to participate in this Agreement, Bidders, shall indicate in their bid response whether they agree that all terms, conditions, specification, and pricing would apply. 21.2 If the successful Bidder agrees to extend the resulting Agreement to other governmental entities, the following will apply: Governmental entities within utilizing Agreements with the City of Fort Worth will be eligible, but not obligated, to purchase materiallservices under this Agreement(s) awarded as a result of this solicitation. All purchases by governmental entities other than the City of Fort Worth will be billed directly to that governmental entity and paid by that governmental entity. The City of Fort Worth will not be responsible for another governmental entity's debts. Each governmental entity will order its own materiallservices as needed. 22.0 CHANGE IN COMPANY NAME OR OWNERSHIP The Contractor shall notify the City's Purchasing Manager, in writing, of a company name, ownership, or address change for the purpose of maintaining updated City records. The president of the company or authorized official must sign the letter.A letter indicating changes in a company name or ownership must be accompanied with supporting legal documentation such as an updated W-9, documents filed with the state indicating such change, copy of the board of director's resolution approving the action, or an executed merger or acquisition agreement. Failure to do so may adversely impact future invoice payments. RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 9 of 20 23.0 QUESTIONS—Questions, explanations or clarifications desired by a Vendor regarding any part of the RFQ must be requested in writing from the Purchasing Division. Request can be send to the following. Jane Rogers, Sr. Buyer, Lane.rogersP-fortworthtexas.gov Reference RFQ 16-0456 City of Fort Worth Purchasing Division Attention: Jane Rogers 200 Texas Street Fort Worth, Texas 76102 Facsimile: (817) 392-8440, Attention: Jane Rogers 24.0 BIDS 24.1 Vendor shall submit the following items with their bid: 24.1:1 A completed and signed original Request for Quotations cover page; 24.1.2 A completed and signed original Bid Solicitation form; 24.1.3 A completed and signed original Conflict of Interest Questionnaire, Attachment A. RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 10 of 20 CITY OF FORT WORTH, TEXAS STANDARD PURCHASING TERMS AND CONDITIONS 1.0 DEFINITION OF BUYER The City of Fort Worth, its officers, agents, servants, authorized employees, Vendors and subVendors who act on behalf of various City departments, bodies or agencies. 2.0 DEFINITION OF SELLER The consultant, Vendor, supplier, Vendor or other provider of goods and/or services, its officers, agents, servants, employees, Vendors and subVendors who act on behalf of the entity under a contract with the City of Fort Worth. 3.0 PUBLIC INFORMATION Any information submitted to the City of Fort Worth (the"City") may be requested by a member of the public under the Texas Public Information Act. See TEX. GOV'T CODE ANN. §§ 552.002, 552.128(c) (West Supp. 2006). If the City receives a request for a Seller's proprietary information, the Seller listed in the request will be notified and given an opportunity to make arguments to the Texas Attorney General's Office (the "AG") regarding reasons the Seller believes that its information may not lawfully be released. If Seller does not make arguments or the AG rejects the arguments Seller makes, Seller's information will be released without penalty to the City. 4.0 PROHIBITION AGAINST PERSONAL INTEREST IN CONTRACTS No officer or employee of Buyer shall have a financial interest, direct or indirect, in any contract with Buyer or be financially interested, directly or indirectly, in the sale to Buyer of any land, materials, supplies or services, except.on behalf of Buyer as an officer or employee. Any willful violation of this section shall constitute malfeasance in office, and any officer or employee found guilty thereof shall thereby forfeit his office or position. Any violation of this section with the knowledge, expressed or implied, of the person or corporation contracting with the City Council shall render the contract invalid by the City Manager or the City Council. (Chapter XXVII, Section 16, City of Fort Worth Charter) 5.0 ORDERS 5.1 No employees of the Buyer or its officers, agents, servants, Vendors or subVendors who act on behalf of various City departments, bodies or agencies are authorized to place orders for goods and/or services without providing approved contract numbers, purchase order numbers, or release numbers issued by the Buyer. The only only exceptions are Purchasing Card orders and emergencies pursuant to Texas Local Government Code Section 252.022(a)(1), (2), or (3). In the case of emergencies, the Buyer's Purchasing Division will place such orders. 5.2 Acceptance of an order and delivery on the part of the Seller without an approved contract number, purchase order number, or release number issued by the Buyer may result in rejection of delivery, return of goods at the Seller's cost and/or non-payment. 6.0 SELLER TO PACKAGE GOODS Seller will package goods in accordance with good commercial practice. Each shipping container, shall be clearly and permanently marked as follows: (a)Seller's name and address: (b)Consignee's name, address and purchase order or purchase change order number; (c) Container number and total number of containers, e.g., box 1 of 4 boxes; and (d) Number of the container bearing the packing slip. Seller shall bear the cost of packaging unless otherwise provided. Goods shall be suitably packed to secure lowest transportation costs and to 'conform to requirements of common carriers and any applicable specifications. Buyer's count or weight shall be final and conclusive on shipments not accompanied by packing lists. 7.0 SHIPMENT UNDER RESERVATION PROHIBITED Seller is not authorized to ship the goods under reservation, and no tender of a bill of lading will operate as a tender of goods. RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 11.of 20 8.0 TITLE AND RISK OF LOSS The title and risk of loss of the goods shall not pass to Buyer until Buyer actually receives and takes possession of the goods at the point or points of delivery after inspection and acceptance of the goods. 9.0 DELIVERY TERMS AND TRANSPORTATION CHARGES Freight terms shall be F.O.B. Destination, Freight Prepaid and Allowed,unless delivery terms are specified otherwise in Seller's bid. Buyer agrees to reimburse Seller for transportation costs in the amount specified in Seller's bid or actual costs, whichever is lower, if the quoted delivery terms do not include transportation costs; provided, Buyer shall have the right to designate what method of transportation shall be used to ship the goods. 10.0 PLACE OF DELIVERY The place of delivery shall be set forth in the"Ship to"block of the purchase order, purchase change order, or release order. 11.0 RIGHT OF INSPECTION Buyer shall have the right to inspect the goods upon delivery before accepting them. Seller shall be responsible for all charges for the return to Seller of any goods rejected as being nonconforming under the specifications. 12.0 INVOICES 12.1 Seller shall submit separate invoices in duplicate, on each purchase order or purchase change order after each delivery. Invoices shall indicate the purchase order or purchase change order number. Invoices shall be itemized and transportation charges, if any, shall be listed separately, A copy of the bill of lading and the freight waybill, when applicable, should be attached to the invoice. Seller shall mail or deliver invoices to Buyer's Department and address as set forth in the block of the purchase order, purchase change order or release order entitled "Ship to." Payment shall not be made until the above instruments have been submitted after delivery and acceptance'of the goods and/or services. 12.2 Seller shall not include Federal Excise, State or City Sales Tax in its invoices. The Buyer shall furnish a tax exemption certificate upon Seller's request. 13.0 PRICE WARRANTY 13.1 The price to be paid by Buyer shall be that contained in Seller's bid which Seller warrants to be no higher than Seller's current prices on orders by others for products and services of the kind and specification covered by this agreement for similar quantities under like conditions and methods of purchase. In the event Seller breaches this warranty,the prices of the items shall be reduced to the prices contained in Seller's bid, or in the alternative upon Buyer's option, Buyer shall have the right to cancel this contract without any liability to Seller for breach or for Seller's actual expense. Such remedies are in addition to and not in lieu of any other remedies which Buyer may have in law or equity. 13.2 Seller warrants that no person or selling agency has been employed or retained to solicit or secure this contract upon an agreement or understanding for commission, percentage, brokerage or contingent fee, excepting employees of an established commercial or selling agency that is maintained by Seller for the purpose of securing business. For breach or violation of this warranty, Buyer shall have the right, in addition to any other right or rights arising pursuant to said purchase(s), to cancel this contract without liability and to deduct from the contract price such commission percentage, brokerage or contingent fee, or otherwise to recover the full amount thereof. 14.0 PRODUCT WARRANTY Seller shall not limit or exclude any express or implied warranties and any attempt to do so shall render this contract voidable at the option of Buyer. Seller warrants that the goods furnished will conform to Buyer's specifications, drawings and descriptions listed in the bid invitation, and the sample(s) furnished by Seller, if any. In the event of a conflict between Buyer's specifications, drawings, and descriptions, Buyer's specifications shall govern. RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 12 of 20 15.0 SAFETY WARRANTY Seller warrants that the product sold to Buyer shall conform to the standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act (OSHA) of 1970, as amended. In the event the product does not conform to OSHA standards, Buyer may return the product for correction or replacement at Seller's expense. In the event Seller fails to make appropriate correction within a reasonable time, any correction made by Buyer will be at Seller's expense. Where no correction is or can be made, Seller shall refund all monies received for such goods within thirty(30)days after request is made by Buyer in writing and received by Seller. Notice is considered to have been received upon hand delivery, or otherwise in accordance with Section 29.0 of these terms and conditions. Failure to make such refund shall constitute breach and cause this contract to terminate immediately. 16.0 SOFTWARE LICENSE TO SELLER If this purchase is for the license of software products and/or services, and unless otherwise agreed, Seller hereby grants to Buyer, a perpetual, irrevocable, non-exclusive, nontransferable, royalty free license to use the software. This software is"proprietary"to Seller, and is licensed and provided to the Buyer for its sole use for purposes under this Agreement and any attached work orders or invoices. The City may not use or share this software without permission of the Seller; however Buyer may make copies of the software expressly for backup purposes. 17.0 WARRANTY AGAINST INFRINGEMENT OF INTELLECTUAL PROPERTY 17.1 The SELLER warrants that all Deliverables, or any part thereof, furnished hereunder, including but not limited to: programs, documentation, software, analyses, applications, methods, ways, and processes (in this Section each individually referred to as a "Deliverable" and collectively as the "Deliverables,") do not infringe upon or violate any patent, copyrights, trademarks, service marks, trade secrets, or any intellectual property rights or other third party proprietary rights, in the performance of services under this Agreement. 17.2 SELLER shall be liable and responsible for any and all claims made against the City for infringement of any patent, copyright,trademark,service mark,trade secret, or other intellectual property rights by the use of or supplying of any Deliverable(s) in the course of performance or completion of,or in any way connected with providing the services, or the City's continued use of the Deliverable(s) hereunder. 17.3 SELLER agrees to indemnify, defend, settle, or pay, at its own cost and expense, including the payment of attorney's fees, any claim or action against the City for infringement of any patent, copyright, trade mark, service mark, trade secret, or other intellectual property right arising from City's use of the Deliverable(s), or any part thereof, in accordance with this Agreement, it being understood that this agreement to indemnify, defend, settle or pay shall not apply if the City modifies or misuses the Deliverable(s).So long as SELLER bears the cost and expense of payment for claims or actions against the City pursuant to this section S, SELLER shall have the right to conduct the defense of any such claim or action and all negotiations for its settlement or compromise and to settle or compromise any such claim; however, City shall have the right to fully participate in any and all such settlement, negotiations, or lawsuit as necessary to protect the City's interest, and City agrees to cooperate with SELLER in doing so. In the event City, for whatever reason,assumes the responsibility for payment of costs and expenses for any claim or action brought against the City for infringement arising under this Agreement,the City shall have the sole right to conduct the defense of any such claim or action and all negotiations for its settlement or compromise and to settle or compromise any such claim; however, SELLER shall fully participate and cooperate with the City in defense of such claim or action. City agrees to give SELLER timely written notice of any such claim or action,with copies of all papers City may receive relating thereto. Notwithstanding the foregoing, the City's assumption of payment of costs or expenses shall not eliminate SELLER's duty to indemnify the City under this Agreement. If the Deliverable(s), or any part thereof, is held to infringe and the use thereof is enjoined or restrained or, if as a result of a settlement or compromise, such use is materially adversely restricted,SELLER shall, at its own expense and as RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAfR Page 13 of 20 City's sole remedy, either; (a) procure for City the right to continue to use the Deliverable(s); or (b) modify the Deliverable(s) to make them/it non-infringing, provided that such modification does not materially adversely affect City's authorized use of the Deliverable(s); or (c) replace the Deliverables) with equally suitable, compatible, and functionally equivalent non-infringing Deliverable(s) at no additional charge to City; or (d) if none of the foregoing alternatives is reasonably available to SELLER, terminate this Agreement, and refund all amounts paid to SELLER by the City, subsequent to which termination City may seek any and all remedies available to City under law. 18.0 OWNERSHIP OF WORK PRODUCE' Seller agrees that any and all analyses, evaluations, reports,"memoranda, letters, ideas, processes, methods, programs, and manuals that were developed, prepared, conceived, made or suggested by the Seiler for the City pursuant to a Work Order, including all such developments as are originated or conceived during the term of the Contract and that are completed or reduced to writing thereafter (the "Work Product") and Seller acknowledges that such Work Product may be considered "work(s) made for hire" and will be and remain the exclusive property of the City. To the extent that the Work Product, under applicable law, may not be considered work(s) made for hire, Seller hereby agrees that this Agreement effectively transfers, grants, conveys, and assigns exclusively to Buyer, all rights, title and ownership interests, including copyright, which Seller may have in any Work Product or any tangible media embodying such Work Product,without the necessity of any further consideration, and Buyer shall be entitled to obtain and hold in its own name, all Intellectual Property rights in and to the Work Product. Seller for itself and on behalf of its Vendors hereby waives any property interest in such Work Product. 19.0 NETWORK ACCESS The:City owns and operates a computing environment and network(collectively the"Network"). If Seller requires access, whether onsite or remote, to the City's network to provide services hereunder, and the Seller is required to utilize the Internet, Intranet, email, City database, or other network application, Seller shall separately execute the City's Network Access Agreement prior to providing such services. A copy of the City's standard Network Access Agreement can be provided upon request. 20.0 CANCELLATION Buyer shall have the right to cancel this contract immediately for default on all or any part of the undelivered portion of this order if Seller breaches any of the terms hereof, including warranties of Seller. Such right of cancellation is in addition to and not in lieu of any other remedies,which Buyer may have in law or equity. 21.0 TERMINATION The performance of work or purchase of goods under this order may be terminated in whole or in part by Buyer, with or without cause, at any time upon the delivery to Seller of a written "Notice of Termination" specifying the extent to which performance of work or the goods to be purchased under the order is terminated and the date upon which such termination becomes effective. Such right of termination is in addition to and not in lieu of any other termination rights of Buyer as set forth herein. 22.0 ASSIGNMENT/DELEGATION No interest, obligation or right of Seller, including the right to receive payment, under this contract shall be assigned or delegated to another entity without the express written consent of Buyer. Any attempted assignment or delegation of Seller shall be wholly void and totally ineffective for all purposes unless made in conformity with this paragraph. Prior to Buyer giving its consent, Seller agrees that Seller shall provide, at no additional cost to Buyer, all documents, as determined by Buyer, that are reasonable and necessary to verify Seller's legal status and transfer of rights, interests, or obligations to another entity. The documents that may be requested include, but are not limited to, Articles of incorporation and related amendments, Certificate of Merger, IRS Form W 9 to verify tax identification number, etc. Buyer reserves the right to withhold all payments to any entity other than Seller, if Seller is not in compliance with this provision. If Seller fails to provide necessary information in accordance with this section, Buyer shall not be liable for any penalties, fees or interest resulting therefrom. RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 14 of 20 23.0 WAIVER No claim or right arising out of a breach of this contract can be discharged in whole or in-part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration in writing and is signed by the aggrieved party. 24.0 MODIFICATIONS This contract can be modified or rescinded only by a written agreement signed by both parties. 25.0 THE AGREEMENT In the absence of an otherwise negotiated contract, or unless stated otherwise, the Agreement between Buyer and Seller shall consist of these Standard Terms and Conditions together with any applicable bid documents published by the Buyer and Seller's Response to such bid (the"contract documents"). This Agreement is intended by the parties as a final expression of their agreement and is intended also as a complete and exclusive statement of the terms of their agreement. No course of prior dealings between the parties and no usage of trade shall be relevant to supplement or explain any term used in this Agreement. Acceptance of or acquiescence in a course of performance under this Agreement shall not be relevant to determine the meaning of this Agreement even though the accepting or acquiescing party has knowledge of the performance and opportunity for objection. Whenever a term defined by the Uniform Commercial Code (UCC) is used in this Agreement, the definition contained in the UCC shall control. In the event of a conflict between the contract documents, the order of precedence shall be these Standard Terms and Conditions, the Buyer's published bid documents and the Seller's response. if Buyer and Seller have otherwise negotiated a contract, this Agreement shall not apply. 26.0 APPLICABLE LAW/VENUE This agreement shall be governed by the Uniform Commercial Code wherever the term "Uniform Commercial Code" or"UCC" is used. It shall be construed as meaning the Uniform Commercial Code as adopted and amended in the State of Texas. Both parties agree that venue for any litigation arising from this contract shall be in Fort Worth, Tarrant County, Texas. This contract shall be governed, construed and enforced under the laws of the State of Texas. 27.0 INDEPENDENT VENDOR Seller shall operate hereunder as an independent Vendor and not as an officer, agent, servant or employee of Buyer. Seller shall have exclusive control of, and the exclusive right to control, the details of its operations hereunder, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers, agents, employees, Vendors and sub- Vendors. The doctrine of respondeat superior shall not apply as between Buyer and Seller, its officers, agents, employees, Vendors and subVendors. Nothing herein shall be construed as creating a partnership orjoint enterprise between Buyer and Seiler, its officers, agents, employees, Vendors and subVendors. 28.0 LIABILITY AND INDEMNIFICATION. 28.1 LIABILITY - SELLER SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR 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 OIL SELLER, ITS OFFICERS,,AGENTS, SERVANTS OR EMPLOYEES. 28.2 INDEMNIFICATION-SELLER HEREBY COVENANTS AND AGREES TO INDEMNIFY, HOLD HARMLESS AND DEFEND THE CITY(ALSO REFERRED TO AS BUYER), 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 SELLER'S BUSINESS, AND ANY RESULTING LOST PROFITS) PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, AND DAMAGES FOR CLAIMS OF INTELLECTUAL PROPERTY INFRINGEMENT, ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE ACTS OR OMISSIONS OF SELLER, ITS OFFICERS, AGENTS, SUBVENDORS, SERVANTS OR EMPLOYEES. RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 15 of 20 29.0 SEVERABILITY In case any one or-more of the provisions contained'in this agreement shall for any reason, be held to be invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision of this agreement, which agreement shall be construed as if such invalid, illegal or unenforceable provision had never been contained herein. 30.0 FISCAL FUNDING LIMITATION In the event no funds or insufficient funds are appropriated and budgeted in any fiscal period for payments due under this contract,then Buyer will immediately notify Seller of such occurrence and this contract shall be terminated on the last day of the fiscal period for which funds have been appropriated without penalty or expense to Buyer of any kind whatsoever, except to the portions of annual payments herein agreed upon for which funds shall-have been appropriated and budgeted or are otherwise available. 31.0 NOTICES TO PARTIES Notices addressed to Buyer pursuant to the provisions hereof shall be conclusively determined to have been delivered three(3)business days following the day such notice is deposited in the United States mail, in a sealed envelope with sufficient postage attached, addressed to Purchasing Manager, City of Fort Worth, Purchasing Division, 200 Texas Street, Fort Worth, Texas 76102. Notices to Seller shall be conclusively determined to have been delivered three (3) business days following the day such notice is deposited 'in the United States mail, in a sealed envelope with sufficient postage attached, addressed to the address given by Seller in its response to Buyer's invitation to bid. Or if sent via express courier or hand delivery, notice is considered received upon delivery. 32.0 NON-DISCRIMINATION This contract is made and entered into with reference specifically to Chapter 17, Article III, Division 3 ("Employment Practices"), of the City Code of the City of Fort Worth (1986), as amended, and Seller hereby covenants and agrees that Seller, its employees, officers, agents, Vendors or subVendors, have fully complied with all provisions of same and that no employee, participant, applicant, Vendor or subVendor has been discriminated against according to the terms of such Ordinance by Seller, its employees, officers, agents, Vendor or subVendors herein. 33.0 IMMIGRATION NATIONALITY ACT The City of Fort Worth actively supports the Immigration & Nationality Act (IN A) which includes provisions addressing employment eligibility, employment verification, and nondiscrimination. Seller shall verify the identity and employment eligibility of all employees who perform work under this Agreement. Seller shall complete the Employment Eligibility Verification Form (1-9), maintain photocopies of all supporting employment eligibility and identify documentation for all employees, and upon request, provide Sellerwith copies of all 1-9 forms and supporting eligibility documentation for each employee who performs work under this Agreement. Seller shall establish appropriate procedures and controls so that no services will be performed by any worker who is not legally eligible to perform such services. Seller shall provide Buyer with a certification letter that it has complied with the verification requirements required by this Agreement. Seller shall indemnify Buyer from any penalties or liabilities due to violations of this provision. Buyer shall have the right to immediately terminate this Agreement for violations of this provision by Seller. 34.0 HEALTH SAFETY AND ENVIRONMENTAL REQUIREMENTS Services, products, materials, and supplies provided by the Seller must meet or exceed all applicable health, safety, and the environmental laws, requirements., and standards. In addition, Seller agrees to obtain and pay, at its own expense, for all licenses, permits, certificates, and inspections necessary to provide the products or to perform the services hereunder. Seller shall indemnify Buyer from any penalties or liabilities due to violations of this provision. Buyer shall have the right to immediately terminate this Agreement for violations of this provision by Seller. 35.0 RIGHT TO AUDIT Seller agrees that the Buyer,or Buyer's authorized representative,shall, until the expiration of three (3)years after final payment under this contract, and at no additional cost to Buyer, have access to and the right to examine and copy any directly pertinent books, computer disks, digital files, RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 16 of 20 documents, papers and records of the Seller involving transactions relating to this contract, including any and all records maintained pursuant to Section 31 of this Agreement. Seller agrees that the Buyer shall have access, during normal working hours, to all necessary Seller facilities, and shall be provided adequate and appropriate workspace, in order to conduct audits in compliance with the provisions of this section. Buyer shall pay Seller for reasonable costs of any copying in accordance with the standards set forth in the Texas Administrative Code. The Buyer shall give Seller reasonable advance written notice of intended audits, but no less than ten (10) business days. 36.0 DISABILITY In accordance with the provisions of the Americans With Disabilities Act of 1990(ADA),Sellerwarrants that it and any and all of its subVendors will not unlawfully discriminate on the basis of disability in the provision of services to general public, nor in the availability, terms and/or conditions of employment for applicants for employment with, or employees of Seller or any of its subVendors. Seller warrants it will fully comply with ADA's provisions and any other applicable federal, state.and local laws concerning disability and will defend, indemnify and hold Buyer harmless against any claims or allegations asserted by third parties or subVendors against Buyer arising out of Seller's and/or its subVendors alleged failure to comply with the above-referenced laws concerning disability discrimination in the performance of this agreement. 37.0 DISPUTE RESOLUTION If either Buyer or Seiler has a claim, dispute, or other matter in question for breach of duty, obligations, services rendered or any warranty that arises under this Agreement, the parties shall first attempt to resolve the matter through this dispute resolution process. The disputing party shall notify the other party in writing as soon as practicable after discovering the claim, dispute, or breach. The notice shall state the nature of the dispute and fist the party's specific reasons for such dispute. Within ten (10) business days of receipt of the notice, both parties shall make a good faith effort, either through email, mail, phone conference, in person meetings, or other reasonable means to resolve any claim, dispute, breach or other matter in question that may arise out of, or in connection with this Agreement. If the parties fail to resolve the dispute within sixty(60)days of the date of receipt of the notice of the dispute, then the parties may submit the matter to non-binding mediation upon written consent of authorized representatives of both parties in accordance with the Industry Arbitration Rules of the American Arbitration Association or other applicable rules governing mediation then in effect. If the parties cannot resolve the dispute through mediation, then either party shall have the right to exercise any and all remedies available under law regarding the dispute. Revised November 20, 2014 RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 17 of 20 ATTACHMENT A 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 Forms CIQ ("Questionnaire") the person's affiliation or business relationship that might cause a conflict of interest with the local governmental entity. By law, the Questionnaire must be filed with the Fort Worth City Secretary no later than seven days after the date the person begins contract discussions or negotiations with the City, or submits an application or response to a request for proposals or bids, correspondence, or another writing related to potential agreement with the City. Updated Questionnaires must be filed in conformance with Chapter 176. A copy of the Questionnaires Form CIQ is enclosed with submittal documents. The form is also available at http://www.ethics,state.tx.us/forms/CIQ.pdf. If you have any questions about compliance, please consult your own legal counsel. Compliance is the individual responsibility of each person or agent of a person who is subject to the filing requirement. An offense under Chapter 176 is a Class C misdemeanor. RFQ No.16-0466, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 18 of 20 CONFLICT OF IN i ERA T tUESTIONHARE For vendor doing business with local govr?mmental entity Tltls quotmotinairo r'efloctx ctiatigaoo rrtaai10 ttr the laa by RB, 21 84VI leg- Hagvlar 5.#49511ort. _ OFRCE USE ONLY -- f i�i;a uesti+�nna{re to in€�file i in accord trig eyv.th Chas#er 17G, Lecal Clovennrnent Cade. Catc r:e •� by a vanour who has a but3iraos5 relalionship as dofirtod by Son on 176.001 d 1-a)with s a local goverampantal emit and tha venOor meets requver ilantq under SePwion 17£.OQGi ai By law this gtreslionnaire niu l be f lodwilh the records adtniniztratorciffhe local_gmtgrnmental en5ity not later than iha 7th business day after the Gate the vendor k comes aware of ta'is thal require(be statement to be hIedL qE,-Section 17E-006i a-1 1,LocalGovl-rnmont Corse A vedid f commites an orerise if the vendor knoe ingly violaPo8 Soclion 176.O0& Le-cal i3o ernmew Code—An often,i2 under this sent€on is a masdeme;tncr t - aan e-of vendorwvho has a bttsinass relatfcrn hip wvith Isrcai c a�verrarnerrtal errtiiy. ____. Check this box ifyou are filing an update to a previously flt2d questionnalre_ ;The law requires that you the an grpttated completed que-,5tirannaire with the appropriate Filing �iulhority not lattor than the-th busiaass day after iha date on which you bocanita awar'v 1-rat the o6qirt€rlty filed questionnaire yeas mcGrr:ple to air inam curate) 31 Name of local govilmirl:rit offIcer about`dIlo i the infatrin Itlon in tuts se tlon is ITaing disclosed, .�._._......�...___..__._._._ N E1Rle Siii OtllFver _.-.—.._--------_--- This section (item 3 itdil ling subparls A 2.1 C. 9 D) must bc- coratp-fed fair Bath offieLlr witty wwt,rbrr3 vendor has all employrnerr; or other Lusute9s relationship as d=_Mined by SA ct€jn 1:&•.Hest-al. Leas-at Gnvernrnenl Code. A'ttoch additi nal tees to this Font~ CIO as necessary. A, to ih€r local goyornrnont off ice+r:tamed in this suction recojwng or ts'rcely to j-ocOv,,taxobae inoorno other than inveFtment rnGome. from the.venrdo3" - Yes No B. Is that wonclor receiving or likoly to rccove taxablo incomo,other than investment inwA7*,from or at the direction of the local governinent offi-Gov named in this section AND the taxable incortte is not received from lie local governmental enfi 7 EJ Yes O No C. Is the filer of this €fues.tiennaire employed by a corporation ear other bushiess entity with respect to which the local govveri ient officer r etvcs as ail OffiCQr or director, or holds an vvnffshi�p interest of One percent of mare? Yes E-1 No D. bescnbe each ernplaynienl or business .and family relalbons,hip wvith Ike iical governmenl officer named in this se€Iron —----------._---.---- ILI i na:lurE- C-t vyrxier durEx# (user sgs tiw-lfr 'h4 Ouveiriar�rrial yndi q � .Cate Adopted a-12015 RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 19 of 20 NO BID SHEET—REQUEST FOR QUOTES NO. 16-0456 FOR OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR CLOSING DATE: FESRUARY 8, 2017 Jane Rogers, Sr. Buyer Purchasing Division Fax No. 817-392-8440 E-mail address: jane.rogers@fortworthtexas.gov If your firm has chosen not to submit a bid for this procurement, please complete this form and submit to: City of Fort Worth, Purchasing Division 200 Texas Street Fort Worth, Texas 76102 {or fax to above address} Please check the items that apply: E] Do not sell the item(s) required. Cannot be competitive. Cannot meet the Specifications highlighted in the attached Bid. 0 Cannot provide Insurance required. Cannot provide Bonding required. Cannot comply with Indemnification requirements. Job too large. Job too small. ElDo not wish to do business with the City. Other reason. Company Name: Authorized Officer or Agent Signature: Telephone: (e) FAX Number: ( ) RFQ No.16-0456, OEM CUES CCTV SEWER INSPECTION EQUIPMENT, PARTS AND REPAIR Page 20 of 20