HomeMy WebLinkAboutContract 56039-R1Contract Renewal Page 1 of 3
CITY OF FORT WORTH
CONTRACT RENEWAL NOTICE
September 14, 2022
Delta Industrial Service & Supply
Attn: Eric Currie, President
3159 Summit Dr.
Port Neches, Texas 77651
Re: Contract Renewal Notice
Contract No. CSC No. 56039-R1 (the “Contract”)
Renewal Term No. 1: July 20, 2022 to July 19, 2023
The above referenced Contract with the City of Fort Worth expires on July 19, 2022 (the
“Expiration Date”). Pursuant to the Contract, contract renewals are at the sole option of the City.
This letter is to inform you that the City is exercising its right to renew the Contract for an
additional one (1) year period, which will begin immediately after the Expiration Date. All other
terms and conditions of the Contract 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 Contract Renewal Notice. Failure to
provide a signed acknowledgment does not affect the renewal.
Please log onto PeopleSoft Purchasing at http://fortworthtexas.gov/purchasing to ensure
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,
Brenda Ray
Sr. Contract Compliance Specialist
Brenda.ray@fortworthtexas.gov
CSC No. 56039
Contract Renewal Page 2 of 3
ACCEPTED AND AGREED:
CITY OF FORT WORTH
By: ___________________________
Name: Valerie Washington
Title: Assistant City Manager
Date:
APPROVAL RECOMMENDED:
: Jim Davis
Title: Fire Chief
ATTEST:
By: ______________________________
Name: Jannette Goodall
Title: City Secretary
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and
administration of this contract, including
ensuring all performance and reporting
requirements.
By:______________________________
Name: Mark Rauscher
Title: Assistant Fire Director
APPROVED AS TO FORM AND
LEGALITY:
By: ______________________________
Name: Taylor Paris
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
N/A
CSC No. 56039
Contract Renewal Page 3 of 3
Delta Industrial Service & Supply
By:
Name: Eric Currie
Title: President
Delta Fire & Safety TX �� O��
3159 Summit Dr.
�ELTA Port Neches TX 77651 #EST2476
United States
� , ..- -, 7/14/2022
Bill To
JAMES CONNER
Fort Worth Fire Department
2900 W Bolt St
Fort Worth TX 76110
United States
Expires
8/13/2022
Quantity
Exp. Close Terms
7/14/2022 Net 30
Item
Description
Contract
HGAC-
Contract #:
EP11-20
Ship To
JAMES CONNER
Fort Worth Fire Department
2900 W Bolt St
Fort Worth TX 76110
United States
Sales Rep Partner
Chris Young
4 KAPPLER: D2H634HY2X3X9212CP16-DuraChem 200
D2H634HY2X3X9212 Multi-Piece Configuration Certified to NFPA
1992 and NFPA 2112. Includes Jacket with CP
CP16 Cuff (D2H680CP), Bib Overall with 2 cargo
pockets (D2H662), Glove Cone Inserts
(AGOAR). Heat Sealed/Taped Seams - Size
2X/3X
16 D2H634HYLGXL9212 D2H634HYLGXL9212CP16-DuraChem 200
CP16 Multi-Piece Configuration Certified to NFPA
1992 and NFPA 2112. Includes Jacket with CP
Cuff (D2H680CP), Bib Overall with 2 cargo
pockets (D2H662), Glove Cone Inserts
(AGOAR). Heat Sealed/Taped Seams - Size LG/
XL
Shipping & Handling charges, Pre-Pay and
Add; Charges to be added to final invoice.
HGAC - CONTRACT #: EP11-20
Shipping Method
Rate
$1,480.47
$1,382.90
Subtotal
Shipping Cost
Tax Total (%)
Tota I
Amount
$5,921.88
$22,126.40
$28,048.28
$0.00
$28,048.28
1 of 1
CSC NO.
CSC No. 56039
ORT ORTH�
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and between Delta Industrial
Service & Supply ("Vendor") and the City of Fort Worth, ("City"), a Texas home rule municipality.
The Cooperative Purchase Agreement includes tbe following documents which shall be construed inthe
order of precedence in which they arelisted:
1. This Cooperative Purchase Agreement;
2. Exhibit A- Seller's Quote, Scope of Services or Purchase Order;
3. Exhibit B- Cooperative Agency Contract (e.g., NJPA, DiR, BuyBoard);and
4. Exhibit C- Conflict of interest Questionnaire.
Exhibits A, B, and C which are attached hereto and incorporated herein, are made a part of
this Agreement for all purposes. Vendor agrees to provide City with the services and goods included
in Exhibit A pursuant to the terms and conditions of this Cooperative Purchase Agreement, including
all exhibits thereto.
City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance
with the provisions of this Agreement. Total estimated payments made under this Agreement for the
each year by City shall be in the amount up to FiftyThousandDollatsandZeroCents($50,000.00). Vendor
shall not provide any additional items or services or bill for expenses incurred for City not specified
by this Agreement unless City requests and approves in writing the additional costs for such services.
City shall not be liable for any additional expenses of Vendor not specified by this Agreement unless
City first approves such expenses in writing.
The term ofthis Agreement shall be for one year beginning on the date signed by the Assistant
City Manager below ("Effective Date") and shall expire one year from effective date. City shall be
able to renew this agreement for two one-year renewal options by written agreement of the parties.
Vendor agrees that City shall, until the expiration of three (3) years after final payment under
this Agreement, or the final conclusion of any audit commenced during the said three years, have
access to and the right to exam ine at reasonable times any directly pertinent books, documents, papers
and records, including, but not limited to, all electronic records, of Vendor involving transactions
relating to this Agreement at no additional cost to City. Vendor agrees that City shall have access
during normal working hours to all necessary Vendor facilities and shall be provided adequate and
appropriate work space in order to conduct audits in compliance with theprovisions ofthis section. City
shall give Vendor reasonable advance notice of intended audits.
Notices required pursuant to the provisions of this Agreement shall be conclusively
COOP AGREEMENT-DELTA
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:
City of Fort Worth
Attn: Assistant City Manager
200 Texas Street
Fort Worth TX 76102
Facsimile: (817) 392-8564
With Copy to the City Attorney
at same address
TO VENDOR:
Delta Industrial Service & Supply
Attn: Eric Currie, President
Address: 3159 Summit Dr.
Port Neches, Texas 77651
Phone: (409)724-1055
The undersigned represents and warrants that he or she has the power and authority to execute
this Agreement and the Cooperative Documents and bind the Vendor.
(signature page follows)
COOP AGREEMENT-DELTA 2
ACCEPTED AND AGREED:
CITY OF FORT WORTH:
By• Valerie Was�igt� u� 20211727 CDT)
Name: Valerie Washington
Title: Assistant Citv Mana�er
Date: J u l 20, 2021
APPROVAL RECOMMENDED:
J� s Davis (Jul 19, 2021 2L48 CDT)
Name: Jim Davis
Title: Fire Chief
���, .���
Name
Title:
ATTEST:
By:
�� �
Christopher Austria
Assistant Citv Attorney
CONTRACT AUTHORIZATION:
M&C: N/A
1295: N/A
Name: Ronald Gonzalez
Title: Acting Cltv SecretarX
VENDOR: DELTA INSUTRIAL SERVICE & SUPPLY
Eric Currie
Eric Currie (Jul 19, 2�2119:44 CDT)
Name: Eric Currie, President
Date: 7/19/2021
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract, including ensuring all performance
and reporting requirements.
By: � ..��, _
Mark Rauscher (Jul 19, 2021 22:L7 CDT)
Name: Mark Rauscher
Title: Fire Assistant Director
APPROVED AS TO FORM AND LEGALITY:
COOP AGREEMENT-DELTA 3
EXHIBIT A
�.. ��LTA
' - y 1+*Yu.kru'� Sarvl..�r,�5u:p�} : Fire�&saTe�Y
f�[ame / Address
Firestation � 8
99D6 CarEeton
Fort Worth, TX 78'107
Part Number _ Description
KAPPLER KAPI'LER D2H634-92-12CP-UPL-CAP, DuraChem 2D0
Multi-Piece Config�ration Certified to iVFPA 4992 and P[FPA
2Z12. Includes Jacket with CP CufF (D2H88DCP}, Bib
Ovetall wifh 2 cargo pocKets {�2H662j, G[ove Cone Inserts
(AGOAR). Heat Sealed/Taped Seams, SIZES = LGlXL
KAPPLER KAPPLER D2H634-92�2CP-UPL-CAP, DuraChem 200
Mutti-Piace Configura6on Certified io t�[FPA 1992 and NFPA
2't'12. Inclttdes Jacket with CP Cuff (D2H68DCP), Bih
Overall with 2 cargo packets (a2HS62), Glove Cone Inserts
(AG0.4R). Heat SealedlTaped Seams, SIZES = 2Xl3X _
FREIGHT- To Shipping & Handling Cost Pre Pay & Add
Invoice
expir'es : next price increase
Quote
6aLe Estimate #
Hlay-27-2029 CY0527202i G
Praject
F�re DepartmenY
Qiy Cost Total
16 $�,383.588 $22,137.41 Non
'13
4 $'1,46'1.212 $5,924_85 Non
5
'I $O_00 $0.00 Non
0.00% $O.DO
TO�1 $28,062.26
EXHIBIT B
� Board �
Cooperative Pu�chasiag
12007 Research Boulevard � Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
PROPOSER'S AGREEMENT AND SIGNATURE
Pronosal Name: Boats, Trailers, Marine and
Waterway Equipment
Pronosal Number: 578-18
Pr000sal Due Date{Onenina Date and Time:
May 24, 2018 at 4:0� PM
Location of Proposal Ouenina:
Texas Association of School Boards, Inc.
BuyBoard Department
12007 Research Blvd.
Austin, TX 78759
Contract Time Period: December 1, 2018
through November 30, 2019 with two (2) possible
one-year renewals.
Antici�ated Coonerative Board Meetina Date:
October 2018
Delta Industrial Service & Supply
Name of Proposing Company
May 23, 2018
Date
3159 Summit Dr
Street Address
Port Neches, Texas, 77651
City, State, Zip
409-724-1055
Telephone Number of Authorized Company Official
409-722-8062
Fax Number of Authorized Company Official
Signature�horized Company Official
Eric Currie
Printed Name of Authorized Company Official
President
Position or Title of Authorized Company Official
76-0696202
Federal ID Number
Pa9e 9 of 69
Proposal Forms COMM/SVCS v_01.12.2018
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78i59-2439 • PH: 800-695-2919 • buvboard.com
The proposing company (`�you" or "your") hereby acknowledges and agrees as follows:
1. You have carefully examined and understand all Cooperative information and documentation associated with this
Proposal Invitation, incluciing the Instructians to Proposers, General Terms and Conditions, attachments/forms, item
specifications, and line items (collectively "Requirements");
2. By your response ("Proposal") to this Proposal Invitation, you propose to supply the products or services subrnitted at
the prices quoted in your Proposal and in strict compliance with the Requirements, unless specific deviations or
exceptions are noted in the Proposal;
3. Any and all deviations and exceptions to the Requirements have been noted in your Proposal and no others will be
claimed;
4. If the Coaperative accepts any part of your Proposal and awards you a contract, you will furnish all awarded products
or services at the prices quoted and in strict compliance with the Requirements (unless specific exceptions are noted in
the Proposal and accepted by the Cooperative), including without limitation the Requirements related to:
a, conducting business with Cooperative members, includi�g ofFering pricing to members that is the best you affer
cornpared to similar customers;
b. payrnent of a service fee in the amount specified and as provided for in this Proposal Invitation;
c. the possible award of a piggy-back contract by another governmental entity or nonprofit entity, in which event
you will offer the awarded goods and services ir� accordance with the Requirements; and
d. submitting price sheets or catalogs in the proper format as required by the Cooperative as a prerequisite to
acti�ation of your contract;
S. You have [learly identified on the included form any infQrmation in your Proposal that you believe to be confidential or
proprietary or that you do not consider to be public information subject to public disclosure under a Texas Public
Infarmatian Act request or similar public information law;
6. The individual signing this Agreement is duly authorized to enter into the contractual relationship represented by this
Proposal Invitation on your behalf and bind you to the Requirements, and such individual (and any individual signing a
form) is authorized and has the requisite knowledge to provide the information and make the representations and
certifications required in the Requirements;
7. You have carefuliy reviewed your Proposal, and certify that all information provided is true, complete and accurate,
and you authorize the Cooperative to take such action as it deems appropriate to verify such informatian; and
8. A�y misstatement, falsification, or omission in your Proposal, whenever or however discovered, may disqualify you
from consideration for a contract award under this Proposal Invitation or result in termination of an award or any other
remedy or action provided for in the General Terms and Conditions or by law.
Page 10 of 69
Proposal Forms COMM/SVCS v.01.12.2018
� Board�
Cooperative Purchasinq
12007 Research Boulevard • Austin, Texas i8759-2439 • PH: 800-695-2919 • buvboard.com
VENDOR CONTACT INFORMATION
co,,.,pany: Delta Industrial Service & Supply
vendor Contact Name and Mailing pddress For Notices: 3159 Sur711'Tllt DC'. POI't N2Ch2S, Texas 77651
Company Website: WWW•de�talSS.001'71
Purchase Orders: Purchase orders from Cooperative members will be available through the Internet or by facsimile.
Option 1: Internet. Vendors need Internet access and at least one e-rnail address so that notification of new
orders can be sent to the Internet contact when a new purchase order arrives. An information guide will be
provided to vendors that choose this option to assist them with retrieving their orders.
Option 2: Fax. Vendors need a designated fax line available at all times to receive purchase orders.
Please choose onlv one (1) of the following options for receipt of purchase orders and provide the requested
information:
�
❑
I will use the INTERNET to receive purchase orders.
E-mail Address: erlC p�C�2�taISS.001'71
Internet Contact: ErIC CUI'I'12
Alternate E-mail Address: �arlSSa p�C�2�taISS.COC71
Alternate Internet Contact: M a rl SSa G U@ I"I"a
I wili receive purchase orders via FAX.
Fax Number:
Fax Cankact:
Phone: 409-724-1055
Phone: 409-724-1055
Phone:
❑ Purchase orders may be received by any Designated Dealer identified on my company's Dealer Designatian
form as provided to the Cooperative administratar. I understand that my company shall remain responsible for the
Contract and the performance of all Designated Dealers under and in accordance with the Contract.
Request for Quotes ("RFQ"): Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses
for the receipt of RFQs:
E-mail Address: erlC p�C�@�taISS.COC71
Alternate E-rnail Address: marlSSa@C�@�taISS.C�f71
Page 11 of 69
Proposal Forms COMM/SVCS v.01.12.2018
� Board �
Cnoperative Purchasing
12007 Research 6oulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
Invoices: Your company wil! be billed monthly for the service fee due under a contract awarded under this Proposal
Invitatian. All invoices are available on the BuyBoard website and e-mail notificatians will be sent when they
are ready to he retrieved. Please provide the following address, contact and e-mail information for receipt of servEce fee
invoices and related communications:
Please choose onlv one (11 of the following options for receipt of invoices and provide the requested
infarmation:
❑■ Service fee invoices and related communications should be provided directly to my company at:
Mailing address: 3159 SUI'711'711t DI'. Department: Accounts Payable
�;�,: Port Neches State: Texas Zip Code: 77651
Contact Name: Jacqui Currie Phone: 409-724-1055
Fax: E-mail Address: Jax@deltaiss.com
Alternative E-mail Address: marissa@deltaiss.com
❑ In lieu of my company, I request and authorize all serv�ce fee invoices to be provided directly ko �he following billing
agent**:
Mailing address:
Department:
City: State: Zip Code:
Contact Name:
Phone:
Fax: E-mail Address:
Alternative E-mail Address:
❑ In lieu of my company, I request and authorize service fee invoices to be provided to the Designated Dealer(s)
receiving the purchase order(s) to which the invoiced service fees relate at the address and contact information designated
on my company's Dealer Designaiion form as provided to the Cooperative administrator.**
** If Vendor authorizes a 6i//ing agent or Designated Dea/er(s) to receive and process service fee rnvoices,
in accordance with the Genera/ Terms and Conditions of the Cont�act, Vendor specifica/ty acknow/edges and
agrees that nothing in that designatron sha// re/ieve Vendor of its responsibi/ities and o6/igations under the
Contract inc/uding, 6ut not /imited to, payment of a// service fees under any Contract awarded Vendor,
Page 12 of 69
Proposal Forms COMM/SVCS v.61.12.2018
= Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-Z919 • buyboard.com
FELONY CONVICTION DISCLOSURE AND DEBARMENT CERTIFICATION
FELONY CONVICTION DISCLOSURE
Subsection (a) of Section 44.034 of the Texas Education Code (Notification of Criminal History of Contractor)
states: `�A persan or business entity that enters into a contract with a school district must give advance notice to the district
if the person or an owner or operator has been convicted of a felony. The notice must include a ger�eral description of the
conduct resulting in the conviction of a Felony."
Section 44.U34 further states in Subsection (b): "A school district may terminate a contract with a person or
business entity if the district determines that the person or business entity failed to give notice as required by Subsection
(a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity
for services performed befqre the termination of the contract."
Please check (� one of the following:
❑■ My company is a publicly-held corporation. (Advance notice requirement does not apply to publidy-held corporation.)
❑■ My company is not owned or aperated by anyone who has been convicted of a felony.
❑ My company is owned/aperated by the following individual(s) who has/have been convicted of a felony:
Name of Felon(s):
Details of Conviction(s):
By signature below, I certify that the above information is true, complete and accurate and that I am authorized by my
company to make this cerf�ification.
Delta Industrial Service & Supply
Company Name
�� Eric Currie
Sign�ture of Authorized Company Offici�l Printed N�me
DEBARMENT CERTIFICATION
Neither my company nor an owner or principal of my company has been debarred, suspended or otherwise made ineligible
for participation in Federal Assis�ance pragrams under Executive Order 12549, "Debarment and Suspension," as described
in the Federal Register and Rules and Regulations. Neither my company nor an owner or principal of my company is
currently listed on the government-wide exclusians in SAM, debarred, suspended, or otherwise excluded by agencies or
cleclared ineligible under any statutory or regulatory authority. My company agrees to immediately notify the Caoperative
and all Cooperative members with pending purehases or seeking to purchase frorn my company if my company or an
owner or principal is later listed on the government-wide exclusions in SAM, or is debarred, suspended, or otherwise
excluded by agencies or declared ineligible under any statutory or regulatory authority.
By signature below, I certify that the above is true, complete and accurate and that I am authorized by my company to
make this certification.
Delta Industrial Service & Supply
Company Name
G� Eric Currie
Signature of Authorized Company OfFicial Printed Name
Page 13 of 69
Proposal Forms COMM/SVCS v.01.iZ.2018
� Board�
Cooperative Purahasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 80Q-695-2919 • buvboard.com
RESIDENT/ NONRESIDENT CERTIFICATION
Chapter Z25Z, Subchapter A, af' the Texas Government Code establishes certain requirements applicable to proposers who
are not Texas residents. Llnder the statute, a"resident" proposer is a person whase principal place of business is in Texas,
including a contractar whose ultimate parent company or rr�ajarity owner has its principal place of business in Texas. A
"nonresident" proposer is a person who is not a Texas resident. Please indicate the status of your company as a"resident"
proposer or a'�nonresident" proposer under these definitions.
Please check (�) one of the followinca:
■❑ I certify that my company is a Resident Proposer.
❑ I certify that my company is a Nonresident Proposer.
If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in
which your cornpany's principal place of business is located):
Delta Industrial Service & Supply
Company Name
Port Neches
City
3159 Summit Dr.
Add ress
TX
State
77651
Zip Code
A. Does your resident state require a proposer whose principal place of business is in Texas to under-price proposers
whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?
❑ Yes 0 No
B. What is the prescribed amount or percentage? $ or %
VENDOR EMPLOYMENT CERTIFICATION
Section 44.031(b) of the Texas Education Code establishes certain criteria that a school district must consider when
determining to whom to award a contract. Among the criteria for certain contracts is whether the vendor or the vendor's
ultimate parent or majority owner (i) has its principal place of business in Texas; or (ii) employs at least S00 people in
Texas.
Tf neither your company nor the ultimate parent company or majority owner hes its principal place of business in i"exas,
does your company, ultimate parent company, or majority owner employ at least 500 people in Texas?
Please check {�/� one of the followincL
❑ Yes � No
By signature below, I certify that the information in Sections 1(Resident/Nonresrdent Certification) and 2(Vendor
Emp/oyment Certification) above is true, complete and accurate and that I am authorized by my company to make this
certification.
Delta Industrial Service & Supply
Company Narr�e
G�� Eric Currie
Signature o Authorized CQmpany Official Printed Name
Page 14 of 69
Proposal Forms COMM/SVCS v.01.12.2018
� Board�
Gaoperative Purchasinq
12007 Ftesearch Boulevard • Austin, Texas 78i59-2439 • PH: 800-695-2919 • buvboard.com
NO ISRAEL BOYCOTT CERTIFICATION
Effective September 1, 2017, a Texas governmental entity may not enter into a contract with a company for goods or
services unless the contract contains a written verification from the company that it: (1) cioes not boycott Israel; and (2)
will not boycott Israel during the term of the contract. (TEx. Gov'T CODE Ch. 2270)
"Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is
intended to penalize, inFlict economic harm on, or limit commercial relations specifically with Israel, or with a person or
entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business
purposes. Tex. GOV'T CODE §808.001(1).
By signature below, T certify and verify that Vendor does not boycott Tsrael and will not boycott Israel during the term of
any contract awarded under this Proposal Invitation, that this certification is true, complete and accurate, and that I am
authorized by my campany to make this certification.
Delta Industrial Service & Supply
Company Name
G� Eric Currie
SignaturP of A��th�rizPd ��mpany Official Printed Name
NO EXCLUDED NATION OR FOREIGN TERRORIST ORGANIZATION CERTIFICATION
Effective September 1, 2017, Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may
not enter into a contract with a company engaged in active business operations with Sudan, Iran, or a foreign terrorist
organization — specifically, any company identified on a list prepared and maintained by the Texas Comptroller under Texas
Government Code §§806.051, 807.d51, or 2252.153. (A company that the U.S. Government affirmatively dedares to be
excluded from its federal sanctions regime relating to Sudan, Iran, or any federal sanctions regime relating to a foreign
terrorist organization is not subject to the contract prohibition.)
By signature below, I certify and verify that Vendor is not on the Texas Comptroller's list identified above; that this
certification is true, complete and accurate; and that I am authorized by my company to make this certification.
Delta Industrial Service & Supply
Company Name
�� Eric Currie
Signature �f Authorized Company Official Printed Name
Page 15 of 69
Proposal Forms COMMJSVCS v.0i.12.2018
� Bo�rd�
Cooperative Purchasiag
12007 Research Boulevard • Austin, 7exas 78759-2439 • PH: 800-695-2919 • buyboard.com
HISTORICALLY UNDERUTILIZED BUSINESS CERTIFICATION
A proposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women Business
Enterprise or "MWBE" and all referred tp in this form as a"HUB") is encour�ged to indicate its HUB certification status
when responding to this Proposal Invitation. The electronic catalogs will indicate HUB certifications for vendors that
properly indicate and document their HUB certification on this forrr�.
Please check (�) all that a�plv:
❑ I certify that my company has been certified as a HUB in the following categories:
❑ Minority Owned Business
❑ Women Owned Business
❑ Service-Disabled Veteran Owned Business (veteran defined by 38 U.S.C. §101(2), who has a
service-connected disability as defined by 38 U.S.C. § 101(16), and who has a disability rating
of 2D% or more as determined by the U. S. Department of Veterans AfFairs or Department of
Defense)
Certification Number:
Name of Certifying Agency:
0 Niy company has NOT been certified as a HUB.
By signature belaw, I certify that the above is true, complete and accurate and that I am authorized by my
company to make this certification.
Delta Industrial Service & Supply
Company Name
Eric Currie
Printed Name
Signature of A�thori
pany Official
Page 16 of 69
Proposal Forms COMMJSVCS v.01.12.2018
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
CONSTRUCTION-RELATED GOODS AND SERVICES AFFIRMATION
A contract awarded under this Proposal Invitation covers only the specifiic goods and services awarded by the BuyBoard. As
explained in the BuyBoard Pracurement and Construction Related Goods and Services Advisory for Texas Members
("Advisory"), Texas law prohibits the procurement of architecture or engineering services through a
purchasing cooperative. This BuyBoard contract does not include such services. Architecture or engineering
services must be procured by a Cooperative member separately, in accordance with the Professional
Services Procurement Act (Chapter 2254 of the Texas Government Code} and other applicable law and local
pol icy.
The Advisory, available at buybaard.com/Vendor/Resaurces.aspx, provides an overview of certain legal requirements that
are potentially relevant to a Cooperative member's procuremen� of construction or construction-related goods and services,
including those for projects that may involve or require architecture, engineering or independent testing services. A copy
ofi' the Advisory can also be provided upon request.
By signature below, the undersigned affirms that Proposer has obtained a copy of the Advisory, has read and understands
the Advisory, and is authorized by Proposer to rr�ake this affirmation. If Proposer sells construction-related goods or
services to a Cooperative member under a BuyBoard contract awarded under this Praposal Invitation, Proposer will comply
with the Advisory and applicable legal requirements, make a good faith effort to make its Cooperat€ve member customers
or potential Cooperative member customers aware of such requirernents, and provide a Cooperative member with a copy
of the Acivisory before executing a Member Construction Cnntract with the member or accepting the member's purchase
order for ConStruCtion-related goqd5 or 5erviCes, whiChever Comes firSt.
Delta Industrial Service & Supply
Company Name
Eric Currie
Signature o .i-z�dCompany Official Printed Name
May 23, 2018
Date
Page 17 of 69
Proposal Forms COMM/SVCS v.01.12.Z018
� Board �
Cooperative Purchasinq
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
DEVIATION AND COMPLIANCE
If your company intends to deviate from the General Terms and Conditions, Proposal Specifications or other requirements
associated with this Proposal Invitation, you MUST list all such deviations on this form, and provide complete and detailed
information regarding the deviations on this form or an attachment to this form. The Caoperative will consider any
deviations in its contract award decision, and reserves the right to accept or reject a proposal based upon any submitted
deviation.
In the absence of any deviation identified and described in accordance with the above, your company must fully comply
with the General Terms and Conditions, Proposal Specifications and all other requirements associated with this Proposal
Invitation if awarded a contract under this Pr4posal Invitation. A deviation will not be effective unless accepted by the
Cooperative. The Cooperative may, in its sole discretion, seelc clarification from and/or communicate with Proposer(s)
regarding any submitted deviation, consistent with general procurement principles of fair competition. The Cooperative
reserves the right to accept or reject a proposal based upan any submitted deviation.
Please check (�/) one of the followinp:
❑■ NO; Deviations
❑ Yes; Deviations
List and fully explain any deviations you are submitting:
PLEASE PROVIDE THE FOLLOWING INFORMATION:
1. Shipping Via: ❑ Gommon Carrier ❑ Gompany Truck ❑■ Prepaid and Add to Invoice ❑ Other:
Z. Paym�nt Terms: ■❑ Net 30 days ❑ 1% in 10/Net 30 days ❑ Other:
3. Number of Days for Delivery: 60-120 ARO
4. Vendor Reference/Quote Number:
5. St�te your return �or�y: No Retu rns
6. Are electronic payments acceptable? ❑■ Yes ❑ No
7. Are credit card payments acceptable? ❑Yes ❑■ No
Delta Industrial Service & Supply
Company Name
c -/
Signature of Authorized Company Official
Eric Currie
Printed iVarne
Page 18 of 69
Proposal Forms COMM/SVCS v.01.12.2018
� Board �
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
TEXAS REGIONAL SERVICE DESIGNATION
The Cooperative {referred to as "Texas Cnoperative" in this Porrri and in the State Service Designation fnrm) offers vendors
the opportunity to service its members throughout the entire State of Texas. If you do no� plan to service all Texas
Caoperative members statewide, you must indicate the specific regions you will service on this form. If you propose to
serve different regions for different products or services inc/uded in your p�oposa/, you must comp/ete and
su6mit a separate Texas Reyiona/ Service Designation form for each group of products and c%ar/y indicate
the products or services to which the designation app/ies in the space provided at the end of this form. By
designating a region or regions, you are certifying that yau are authorized and wi//ing to provide the
proposed products and services in thase regions. Designating regions in which you are either unad/e or
unwi//ing to provide the specified praducts and services sha// 6e g�aunds for either �ejectian of your
proposa/ or, if awarded, termination of your Contract. Additionally, if you do not plan to service Texas Cooperative
members (i.e., if you will service only states other than Texas), you must so indicate on this form.
Regional Education Ser�ice Centers
0 I will service Texas
Cooperative members
statewide.
❑ I will not service Texas
Cooperative members
statewide. I will only
service members in the
regions checked below:
Company Name
Signature of Au horized Company Official
Eric Currie
Printed Name
a
❑
❑
❑
❑
❑
❑
❑
❑
❑
a
❑
a
❑
❑
❑
❑
0
❑
❑
Repion
1
2
3
4
5
6
7
8
4
10
11
1Z
13
14
15
1b
17
18
19
20
Headauarters
Edinburg
Corpus Christi
Victoria
Houston
Beaumont
Huntsville
Kilgore
Mount Pleasant
Wichita Falls
Richardso�
Fort Worth
Waco
Austi n
Abilene
San Angelo
Ama ri I lo
Lubbock
Midland
EI Paso
San Antonio
❑ I will not service members
of the Texas Cooperati�e.
Page Zl of 69
Proposal Forms COMM/SVCS v.01.1Z.2018
-,:°;- - '
Delta Industria[ Service & Supply
� Board�
Cooperative Purchasinq
12007 Research Boulevard • Austin, Texas 78759-2439 • PN: 800-695-2919 • buvboard.com
This form will be used to ensure �hat you cen service other governmental entities throughout the United States as
indicated. Your signature below confirms that you understand your service commitments during the terrn of a
contract awarded under this proposal.
Delta Industrial Service & Supply
Company Name
��/ Eric Currie
Signature of Au orized Company Official Printed Name
If this State Service Designation form applies to only one or some of the products and services proposed by Vendor,
list the products and services to which this form applies here:
Page Z4 of 69
Proposal Forms COMM/SVCS v.01.1Z.2018
� Board�
Caoperaiive Purchasing
12007 Research Boulevard • Austin, Texas 78759-Z439 • PH: 800-695-2919 • buyboard.com
NATIONAL PURCHASING COOPERATIVE VENDOR AWARD AGREEMENT
In accordance with the Terms and Conditions associated with this Proposal Invitatinn, a contract awarded under this
Propos�l Invitetion may be ��p€ggy-backed" by enother government�l entity. The National Purchasing Cooperative is �n
intergovernmental purchasing cooperative formed by certain school districts outside of Texas to serve its members
throughout the United States. If you agree to be considered for a piggy-bacic award by the National Purchasing
Cooperative, you agree to the following terms and agree to serve National Purchasing Cooperative members in the states
you have indicated on the State Service Designation form, in your Proposal.
By signing this form, Proposer (referred to in this Agreement as "Vendor") agrees as follows:
1. Vendor acknowledges that if The Local Government Purchasing Cooperative ("Texas Cooperative") awards Vendor a
contract under this Proposal Invitation ("Underlying Award"), the National Purchasing Cooperative ("National Cooperative"}
may - but is not required ta -"piggy-back" on or re-award all or a portion of that Underlying Award ("Piggy-Back Award").
By signing th€s National Cooperative Vendor Award Agreement ("Agreement"), Vendor accepts and agrees to be bound by
any such Piggy-Sack Award as provided for herein.
2. In the event National Cooperative awards Vendor a Piggy-Back Award, the National Cooperative Administrator
("BuyBoard Administrator") will notify Vendor in writing of such Piggy-Bacic Award, which award shall commence on the
effective date stateci in the Notice and end on the expiration date of the Underlying Award, subject to annual renewals as
authorized in writing by the BuyBoard Administrator. Vendor agrees that no further signature or other action is required of
Vendor in order for the Piggy-Back Award and this Agreement to be binding upon Vendor. Vendor further agrees that no
interlineations or changes to this Agreement by Vendor wili be binding on National Cooperative, unless such changes are
agreed to by its BuyBoard Administratar in writing.
3. Vendor agrees that it shall ofFer its goods and services to National Cooperative members at the same unit pricing and
same general terms and conditions, subject to applicable state laws in the state of purchase, as required by the Underlying
Award. However, nothing in this Agreement prevents Vendor frorn offering National Cooperative members better (i.e.,
lower) competitive pricing and more favorable terms and conditions than those in the Underlying Award.
4. Vendor hereby agrees and confirms that it will serve those states it has designated on the State Service Designation
Form of this Proposal Invitation. Any changes to the states designated on the State Service Designation Form must be
approved in writing by the BuyBoard Administrator.
5. Vendor agrees to pay National Cooperative the service fee provided for in the Underlying Award based on the amount of
purchases generated from National Cooperative members through the Piggy-Back Award. Vendor shall remit payrnent to
National Cooperative on such schedule as it specifies (which shall not be more often than monthly). Further, upon
request, Vendor shall provide National Cooperative with copies of all purchase orders generated from National Cooperative
members for purposes of reviewing and verifying purchase activity. Vencior further agrees that National Cooperative shall
have the right, upon reasonable written notice, to review Vendor's records pertaining to purchases made by Na�ional
Cooperative members in order to verify the accuracy of service fees.
6. Vendor agrees that the Underlying Award, including its General Terms and Conditions, are adopted by reference to the
fullest extent such provisions can reasonably apply to the post-proposal/contract award phase. The rights and
responsibilities that would ordinarily inure ta the Texas Caoperative pursuant to the Underlying Award shall inure to
National Cooperative; and, conversely, the rights and responsibilities that would ordinarily inure to Vendor in the Underlying
Award shall inure to Vendor in this Agreement. Vendor recognizes and agrees that Vendor and National Cooperative are the
only parties to this Agreement, and that nothing in this Agreement has application to other third parties, including the
Texas Cooperative. In the event of conflict between this Agreerr�ent and the terms of the iJnderlying Award, the terms of
this Agreement shall control, and then only to the extent necessary to reconcile the conflict.
Proposal Forms COMM/SVCS v.0i.12.2018
Paqe 25 of 69
� Board�
Coaperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
7. This Agreement shall be gaverned and construed in accordance with the laws of the State of Rhode Island and venue
for any dispute shali lie in the federal district court of Alexandria, Virginia.
8. Vendor acknowledges and agrees that the award of a Piggy-Back Award is within the sole discretior� of National
Cooperative, and that this Agreerr�ent does not take effect unless and until National Cooperative awards Vendor a Piggy-
B�Ck Aw�rd and khe BuyBo�rd Admini5kr�tpr notifies Vendor in writing of suth Piggy-B�Ck Aw�rd �s provided for herein.
WHEREFORE, by signing below Vendor agrees to the foregoing and warrants that it has the authority to enter into this
Agreement.
Delta Industrial Service & Supply
Name of Vendor
�/
5ignature uthorized Compariy Official
578-18
Proposal Invitation Number
Eric Currie
Printed Name of Authorized Company Offic€al
May 23, 2018
Date
Proposal Forms COMM/SVCS v.O1.1Z.2018
Page Z6 oF 69
� Board �'
Coaperative Purchasing
1Z007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
FEDERALAND SYATE/PURCHASING COOPERATNE EXPERIENCE
The Cooperative strives to provide its members with the best services and products at the best prices available from
vendars with the technical resources and ability to serve Coaperative members. Please respond to the following questions.
Provide the dallar value of sales to or through purchasing cooperatives at or based on an established catalog or
market price during the previous 12-month period or the last fiscal year: $ .(The p�riod of the 12
month period is / ). In the event that a dollar value is not an appropriate measure of the sales,
provide and describe your own measure of the sales of the item(s).
2. By submitting a proposal, you agree that, based on your written discounting policies, the discounts you offer the
Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items
under equivalent circumstances.
3. Provide the information requested below for other purchasing cooperatives for which Proposer currently serves, or in
the past has served, as an awarded vendor. Rows should be added to aceommodate as many purchasing
cooperatives as required.
�• ��• •� �
��• • •�
•• ��• •�
1. Federal General Services Administration
2. T-PASS (State of Texas)
3. �J.S. Communities Purchasing Alliance
4. National IPA/TCPN
5. Houston-Galveston Area Council (H�ac} Y
Emeyenc� Preparedness &Safety Equipment EP I'I-1�
6. National Joint Powers Alliance (NJPA)
7. E&I Cooperative
8. The Interlocal Purchasing System (TIPS)
9. Other
❑ MY COMPANY DOES NOT CURRENTLY HAVE ANY OF THE ABOVE OR SIMILAR TYPE CONTRACTS.
CURRENT BUYBOARD VENDORS
If you are a current BuyBoard vendor in the same contract category as proposed in this Proposal Invitation, indicate the
discount for your current BuyBoard contract and the proposed discount in this Proposal. Explain any difference between
your current and proposed discounts.
Current Discount (%): Proposed Discount (%):
Explanation :
Proposal Forms COMM/SVCS v.0i.12.2018
Page Z7 of 69
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PN: 800-695-2919 • buvboard.com
By signature below, I certify that the above is true, complete and accurate and that I am authorized by my company to
maKe this certification.
Delta Industrial Service & Supply
Company Narne
G� Eric Currie
SI�f1BtUE'e nf Ai ithnri�arl C'r�mnanv OffICIdI Printed Name
Proposal Forms COMM/SVCS v.01.12.2018
Page 28 of 69
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PN: 80Q-695-2919 • buvboard.com
GOVERNMENTAL REFERENCES
For yaur Proposal tn be considered, you must supply a minimum of five (5) individual governmental entity references. The
Cooperative may contact any and all references provided as part of the Proposal evaluation. Provide the information
requested below, including the existing price/discounts you ofFer each customer. The Cooperative may determine whether
prices/discounts are fair and reasonable by comparing prices/discounts stated in your Proposal with the prices/discounts
you offer other governmental customers. Attach additional pages if necessary.
Quantity/
Entitv Name Contact Phone# Email Address Discount Volume
1. CyFair VFD Eliu Hernandez 281-541-8989 EIiu.Hernandez@cyfairvfd.org
Z. Spring FD Keith Tapper 281-951-7013 keith.topper@springfd.org
3. Harris County ESD 48 Lou Fabricant 281-578-2518 lou.fabricant@hcesd48.org
4. Nederland Fire Dept. Terry Morton 409-723-1535 tmorton@ci.nederland.tx.us
5. Wylie Fire Dept Andrew Johnson 972-429-8072 andrew.johnson@wylietexas.gov
Do you ever modify your written policies or standard governmental sales practices as identified in the above chart to give
better discounts (lower prices} than indicated? YES ❑ NO ■❑ If YES, please explain:
By signature below, I certify that the above is true and correct and that I am authorized by my company to make this
certification.
Delta Industrial Service & Supply
Company Name
��'/ . _�
C� �
Signature af Authorized Company Official
Eric Currie
Printed Name
Proposal Forms COMM/SVCS v.O1.1Z.2018
Page 29 of 69
� Board�
Cauperative Purchasirtg
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
MARKETING STRATEGY
For your Proposal to be considered, you must submit the Marketing Strategy you will use if the Cooperative accepts all or
part of your Proposal. (Examp/e: Exp/ain hoyv your company wrl/ initia//y inform Cooperative mem6ers of your BuyBoard
contract, and how you wil/ continue to support the BuyBoard for the duration of the contract period.)
Attach additional pages if necessary.
Our company will market the Buyboard program to current and po�ential members.
We plan to advertise the buyboard logo on our website and Facebook page. We
also plan to advertise at tradeshows we attend {with approval by Buyboard)
Delta Industrial Service & Supply
Company Narne
�
Signature of Autharized Company �fficial
Eric Currie
Printed Name
Proposal Forms COMM/SVCS v.01.12.2018
Page 30 of 69
� Board�
Caoperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PM: 800-695-2919 • buyboard.com
CUNFIDENTIAL/ PROPRIETARY INFORMATION
A. Public Disclosure Laws
All Proposals, forms, documentation, or other materials submitted by Vendor to the Cooperative in response to this
Proposal Invitatian, including catalags and pricelists, may be subject to the disclosure requirements of the Texas Public
Information Act (Texas Government Code chapter 552A01, et. seq.) or similar disclosure law. Proposer must clearly
identify on this form any infprmatipn in its Prpposal (including form5, documentation, or pther m�terials submitked wikh the
Proposal) that Proposer considers proprietary or confidential. If Proposer fails to properly identify the infarmation, the
Cooperative 5hall have no obligation to notify Vendor or seek protection of su�h information from publiC di5closure should a
member of the public or other third party request access to the information ur�der the Texas Public Information Act or
similar disclosure law. Propaser will be notified of any third party request for information in a Proposal that Proposer has
identified in this form as proprietary or confidential.
Does your Proposal (inclucfing forms, documentation, or other materials submitted with the Proposal) contain information
which Vendar considers proprietary or confidential?
Please check [,/] one af the followinp;
� NO, I certify that none of the information included with this Proposal is considered confidential or proprietary.
� YES, I certify that this Proposal contains information considered confidential or proprietary and all such information is
specifically identified on this form.
If you responded "YES", you must identify below the specific information you consider confidential or proprietary. List each
page number, form number, or other information sufficient to make the information readily identifiable. The Cooperative
and its Administrator will not be respo�sible for a Proposer's failure to clearly identify inforrnatian considered confidential or
proprietary. Further, by suf�mitting a Proposal, Prnposer acknowledges that the Cooperative and its Administrator will
disclose information when required by law, even if such information has been identified herein as information the vendor
considers confidential or proprietary.
Confidential / Proprietary Information:
(Attach additional sheets if needed.)
Proposal Forms COMM/SVCS v.0i.12.2018
Page 31 oF 69
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 80Q-695-2919 • buvboard.com
B. Copvriqht Information
�oes your Proposal (including forms, documentation, or other materials submitted with the Proposal) contain copyright
information?
� NO� Proposal (including forms, documentation, or other materials submitted with the Proposal) does not
contain copyright information.
❑� YES, Proposal (induding forms, documentation, or other materials submitted with khe Proposal} does
contain copyright information.
If you responded "YES", identify below the specific documents or pages containing copyright information.
copyr�gnt I�format�o�; Sealegs Price List - all photographs and text are copyright of Sealegs
(Attach additional sheets if needed.)
C. Consent to Release Confidential/Proprietary/Copyright Information to BuyBoard Members
BuyBoard merr�bers (Cooperative and nonprofit members) seeking to make purchases through the BuyBoard may wish to
view information included in the Proposals of awarded Vendors. If you identified information on this form as confidential,
proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contract
award constitutes your consent to the disclosure of such information to BuyBoard members, including posting of such
information on the secure BuyBoard website for members. Nate: Neither the Cooperative nor its Administrator wil! be
responsible for the use or distribution of information by BuyBoard members or any other party.
D. Consent to Release Propasal Tabulation
Notwithstandir�g anything in this Confidential/Proprietary Information form ta the contrary, by submitting a Proposal,
Vendor consents and agrees that, upon Contract award, the Cooperative may publically release, including posting on the
public BuyBoard website, a copy of the proposal tabulation for the Contract including Vendor name; proposed
catalog/pricelist name(s); proposed percentage discount(s), hourly labor rate{s), or other specified pricing; and Vendor
award or non-award information.
By signature below, I certify that the information in this form is true, complete, and accurate and that I am authorized by
my company to make this certification and ail consents and agreernents contained herein.
Delta Industrial Service & Supply
Company Name
�
Signature �f Auth�rized Cor�pany Official
Eric Currie
Printed Name
May 23, 2018
Date
Proposal Forms COMM/SVCS v.01.12.2018
Page 32 of 69
� Board �
Caoperative Purchasing
12007 Research Boulevard • Austin, 7exas 78759-2439 • PH: 800-695-Z919 • buvboarcf.com
VENDOR BUSINESS NAME
By submitting a Proposal, Proposer is seeking to enter into a legal cantract with the Cooperative. As such, a Proposer must
be an individual or legal business entity capable of entering into a binding contract. Proposers, must completely and
accurately provide the information requested belnw or your Proposal may be deemed n�n-responsive.
Name of Proposing Company: JETS Fire & Safety
(List the /eaa/ name of the company seeking to contract with the Cooperative. Do NOT list an assumed name, d6a, aka, etc. here. Such information may
be provrded 6e%w, If yau are submitting a joint proposa/ with another entity to prouide the same proposed goods or services, each submitting entr£y
shou/d comp/ete a separaie vendo� information form. Separate/y operating legal business entitres, even rf affiliated entities, which propose to provrde
gaods or services separatety must su6mit their own Proposals )
Please check (�} one of the followinq:
Tvne of Business:
Individual/Sole Proprietor
Corporatian X
Limited Liability Company
Partnership
Other If other, identify
State of Incorporation (if applica6le): TeXaS
Federal Employer ldentification Number: 76-0696202
(I/ertdor must inc/ude a cpmp/eted IRS W-9 form with their proppsa/)
List the Name(s) by which Vendor, if awarded, wishes to be itlentified on the BuySoard: (Nore: rf d;fferent than the Name of
Proposrng Company listed a6ove, on/y va/rd trade names (dba, aka, etc.) of the Proposmg Company may be used and a copy of your Assumed Name
Certificate(sJ, if app/icab/e, must 6e attached.)
Delta Industrial Service & Supply
Proposal Forms COMM/SVCS v.01.12.2018
Page 33 of 69
Form ���
(Rev. November2017)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer Give Form to the
Identification Number and Certification requester. Do not
send to the IRS.
► Go to
for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not
Jets Fire & Safety
ness name/disregarded entity name, if different from above
Delta Industrial Service & Supply
�
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a>
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y
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m
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
following seven boxes. certain entities, not individuals; see
ry instructions on page 3):
❑ Individual/sole proprietor or L� C Corporation ❑ S Coryoration ❑ Partnership ❑ TrusVestate
single-member LLC Exempt payee code (if any)
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner. �
U Other (see instructions) ►
5 Address (number, street, and apt. or suite no.) See instructions.
3159 Summit Drive
6 City, state, and ZIP code
Port Neches, TX 77651
7 List account number(s) here (optiona�
(Applles to accounfs malnfafned outslde fhe U.S.)
Requester's name and address
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid � Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a �- m -�
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later. or
Note: If the account is in more than one name, see the instructions for line i. Also see What Name and Employer �dentification number
NumberTo Give the Requesterfor guidelines on whose number to enter.
7 6 - 0 6 9 6 2 0 2
� Certification
Under penalties of perjury, 1 certify that:
�. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the lnternal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has no#ified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generalfy, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign Signawre of
Here U.S.person►
�ate► 04/17/2018
General Instructions
Section references are to the Intemal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (fIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third parry network transactions)
• Form 1098 (home mortgage interest), �098-E (student loan interest),
1098-T (tuition)
• Form '1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
lf you do not return Form W-9 to the requester with a TIN, you might
be subject to backup wifhholding. See What is backup withholding,
late�.
Cat. No. 1023�X Form W-9 (Rev. 77-20�7)
� aBQ�1'd�
Caaperative PurChasing
120Q7 Research Baule�ard • Auskin, Texas 78759-2439 • PH: BOQ-695-2919 • buyboard.Com
EDGAR VENDOR �ERTIFICATI�N
(2 CFR Part 20D and Appendix II)
When a Cvoperati�e member seeks ta procure goods and services using funds under a federal grant vr contract, specific
federal laws, regulations, and requirements may apply in additian ta those under state law. This includes, buC is not limited
ta, the procurement standards of the Uniform Adrninistrative Requirernents, Cost Principles and Audit Requirements for
Fed�ral Awards, 2 CFR Z�fl (sometimes referred to as the "iJnifarm Guidance" or new "EDGAR"). All Vendars subrnitting
proposals must complete this EDGAR Certification Farm regarding Vendor's willingness and ability to comply with cer�ain
requirements which m�y be applicable to spe�ific Cooperative mem�er purchases using �ederal grant funds. This
corrspleted forrn will be made a�ailable to Cooperati�e members far their use while considering their purchasing options
when using federal grant funds. Cooperati�e mernbers may alsv req�ire Vendors ta enter into ancillary agreements, in
additian to the BuySoard contract's general terms and cvnditions, to address the mernber's specific �ontractual needs,
includ'€ng contract requirements for a procurement using federal gran�.5 or eontracts.
For each of the items below, Vendor should certify Vendor`s agreement and a6ility to comply, where
applica6le, 6y having Vendar's authorized representative complete and initial the applicable 6oxes and sign
the acknowled�ment at the end of this form. If you fail to complete any item in this form, the Cooperative
wi11 consider and may Iist the 1/endor's response on the BuyBaard as "N�,'� the Vendar is una6le ar unwilling
ta comply. A"NQ" response ta any of the ikems rr:ay, if �pplie�ble� irnpact the ability of a Caoperative member ta
purchase from ti�e Vendor using federal funas.
1. Vendor Vialation ar Breach of Cantract Terms:
Contracts for more than the simplified acquisitian threshold currently set at $150,fl00, which is the inflation adjusted
am��nt determined hy the Ci�ilian Agency Acquisitian Council and the Defense Acquisiki�n Regulations Couneil (Councils}
as authorized by 41 U5C 1908, m�ast address administrati�e, contractual, or legal remedies in instances where contractars
�i�late or breach cor�tract terms, ar�d pra�ide for such sanctions and penalties as appropriate.
Provisions regarding Vendor default are includec� in the BuyBoard General Terms and Canditions, ir�cluding Section E.18,
Rernedies for Default and Termir�ation af Contract As�y Cantract award will be subject to such BuyBaard General Terms
and Conditians, as well as any addi�ional terms and conditions in any Purchase �rder, Caaperati�e member ancillary
contract, ar Member Construction Conkract agreed upon by Vendor ar�d the Cooperati�e member which must be consistent
with and protect the Coaperati�e member at least to the same extent as the BuyBoard Terms and Conditians.
The remedies under the Contract are in addition to any other remedies that may be a�ailable under law or in equity. By
subrr3itting � Proposal, you agree to the5e Vend�r viol�tion and breach pf contract terms.
2. Terminatian for Cause ar Con�enience:
For �ny Caaperati�e member purchase or contract in �xC�55 Df �1Q,OflQ made using federal funds, you agree th�t the
following term ar�d condition shall apply:
The Cooperatiue mem6er may terminate ar cancel any purchase order under this Contract at any time, with or �+rithouf
cause, 6y providing seven (7J 6usiness days aduance written notice to the l�endar. If this Agreement is terminated m
�cc�rdanCe uvith thi5 Paragraph, the Cooperative mem6er shall only 6e required to p�y l/endor for goods or serviCes
delivered to the Cooperative mem6er priar to the termination and not �therwise returned in accardance �ith l/endor's
return policy, If the Cooperative mem6er has pard I/endor for goods or services nat yet provided as af the date of
iermination, l/endar shall immediately refund such payment(sJ.
If an alternate pr��isidn for termination of a Coaperati�e member purchase for cause and con�enience, including the
manner by which it will be effecked and the basis for setklement, is included in the Cooperati�e mem�er's purchase order,
ancillary agreement, or Memi�er Construction Contract agreed to by the Vendor, the Cooperati�e member's pro�ision shall
�o ntral .
Proposal Forms COMM/SVCS v,0i,12,2018
Page 34 oP 59
s �B���d �
C�operative Purchasing
12pp7 ResearCh B�ule�ard ' Auskin, TExas 78759-2�39 • PE�: 8Q�-695-2919 ' buyboard.com
3. Equal Employment Upportunity:
Except as atherwise pro�icied under 41 CFR Part 50, all Caoperati�e member purchases ar contracts that meet the
definition of "federally assisted canstructian contract" in 4i CFR Part 60-1.3 shall be deemed ta include the equal
opportunity clause pra�ided under 41 CFR 60-1.4(b}, in accordance with Executi�e Order 11245, "Equal Ernployment
�pportunity" (3Q FR 12319, 12935, 3 CFR Part, 1964-19b5 Camp., p. 339), as amended by Executi�e Order 11375,
"Amending Executi�e �rder 11246 Relating to Equal Employrnent Dpportunity," and implementing regulations at 41 CFR
Part bQ, "�ffice of Federal Conkra�t Compli�n�e Progr�ms, Equal Employment Dpportunity, Department of L�bor."
The equal opportunity clause pro�ided under 41 CFR 50-1.4(b} is hereby incorparated by reference. Vendor agrees that
such provisior� �pplies ta �ny Cooper�ti�e mernber purch�se or Contract kh�t meets the definition of "feder�lly �ssisted
construction cantract" in 41 CFR Part 5D-1.3 and Vendor aarees that it shalf cornol� with such ❑ravision.
4. Da�is-Bacan Act:
When r�quireci by Federal program legislation, Vendor agrees that, for all Cooperati�e member prime construction
contracts�purchases in exeess of �2,040, Vendor shall comply with the Da�is-Bacon Ac'� {40 U5C 3141-3144, and 3146-
3148) as supplemented by Depa�ment of Labor regulations (29 CFR Part 5, "Labar Standards Pro�isions Applicable to
Contracts Co��ring Federafiy Financed and Assisteci Canstructian"). In accordance with the statute, Vendar is required to
pay wages to lahorers and mechanics at a rate not less than the pre�ailing wages specifiied in a wage determinate made hy
the Secretary of Labor. In addition, Vendar shail pay wages nat less tha� ance a week.
Current pre�ailing wage determinatians issued by the beparkment af Lat�or are available at wdol.go�. Vendar agrees that,
for any purchase to which this requirement applies, the award of the purchase tfl the Vendor is conditioned upon Vendor's
acceptance of the wage determination.
Vendar further agrees that it shall also camply with the Copeland '�Anti-Kickback" Act (4Q L15C 3145), as supplemented t�y
Departrnent of Labor regulatians (29 CFR Part 3, "Cantractors and Subcontrattors on Public 8uilding or Public Work
Financed in Whole or in Part by Loans or Grants from the United SCates"). The Act provides that each contractor or
subrecipient must be prohibited fram inducing� by any means, any person employed in the cvnstruction, completion, or
repair of publsC work, to gi�e up �ny p�rt of the Compens�ti0n ta whiCh he or She is ptherwise entitled.
5. Contract Work Haurs and Safety Stanciards Act:
Where applicable, for all Coaperative member contra�t5 or purchase5 in ex�e55 of $100,DOQ that in�ol�e the employment of
mechanics or labarers, Vendor agrees to comply with 4� L15C 3702 and 3704, as supplementeci hy Department of Labor
regulations {Z9 CFR Part 5). Llnder 40 USC 370Z of the Act, Vendor is required to compute the wages of e�ery mechanic
�nd I�borer on the b�sis of � st�nd�rd wprk week pf 40 hours. Work in ex�ess of the st�nd�rd work week is permissible
pro�icfed that the worker is eompensated at a rate of not less than one and a half kimes the basic rate of pay for all haurs
worked in excess of 40 hours in the work week. The requirements of 40 U5C 3704 are applicable to canstruction wark and
pro�ide that na laborer ar mechanic must be required to wark in surroundings ar under working conditians which are
unsanitary, hazardous ar c4angerous. These requirements do nflt apply to the purchases of supplies or rr�aterials or articles
ordinarily a�aila�le on the apen market, ar corstracts far �ransportatian or transmissifln of intelligence.
6. Right to In�entians Made Under a Cantract or Agreement:
If the Cooperati�e member's Federal award meets the defin�tion of "funding agreement" under 37 CFR 4p1.2(a} and the
recipient or subrecipient wishes to enter into a contract with a small business firm ar nanprofit organization regarding the
substitution of parties, assignment or performance �r experimental, de�elapmental, or research work under �hat "funding
agreement," the recipienC or subrecipient must carr�ply wi�h the requirements of 37 CFR ParC 4D1, "Rights to In�entions
Made t�y NonprofiY Organizations and 5mall 6usiness Firms Under Ga�ernment Grants, Contra�ts and Coaperati�e
Agreements," and any implementing regulations issued by the awarding agency.
Vendor agrees to camply with the abo�e requirements when applicable.
Proposal Forms COMM�SVCS �.01.12.2018
Page 35 of 59
� Board �
C�uper�tive PurChasing
12a07 ResearCh B4ule�ard ' Austin, Texas 78759-2439 • PFi: 80Q-695-2919 ' buvbQard.Corn
7. Clean Air Act and Federal Water Pollution Control Act:
Clean Air Act (42 U5C 7401-7b71q.) anri the Federal Water Pallution Control Act (33 USC 1251-�387), as amended —
Contracts and subgrants of amaunts in excess af $f50,f304 must contain a pro�isian that requires the non-Federal award to
agree to comply with all applicat�le standards, orders, or regulations issued pursuant to the Clean Air Act (4� L15C 7401-
7671q.} and the Federal Water Poilutian Control Act, as amended (33 USC 125i-1387). Violatians must be reported to the
Federal awarding agency and the Regional OfFice of the En�iranmental Protection Agency (EPA).
When required, Vendor agrees to comply with a!I applicable standards, orders, or regulations issued pursuant to the Clean
Air Act and the Federal Water Pal[ution Cantrol Act.
8. Debarment and Suspensian:
Debarmen� and 5uspensivn (Executive �rders 1Z549 and 1�689] — A contract award (see 2 CFR 18a.224) must nat be
made ta parties listed an the go�ernment-wide exclusions in the System far Award Management (SAM}, in accordance with
the OMB guidelines at Z CFR 180 that impl�ment Executi�e �rders 1�549 (3 CFR Part 1965 Comp. p. 189) and �Z689 (3
CFR Part 1989 Comp. p. �35}, "Debarment and Suspensi�n." 5AM Exclusians cantains the names of parties debarred,
suspended, ar otherwise exeluded by agencies, as well as par-ties declared ineligible under statutory or regulatory authority
ather than Executive Order 1Z549.
Vendar certifies that Vendor is not currently listed on the go�ernrryent-wide exclusions in SAM, is nat debarred, suspended,
or otherwise exclucied by agencies or cieclared ineligible uncEer statutory or regulatory authority ather than Executi�e �rder
12549. Vendar furkher agrees to immediately notify the Cooperati�e and all Cooperati�e members with pending purchases
or seeking to purchase from Vendar if Venelor is later listed an the go�ernment-wide exclusions in SAM, or is debarred,
suspended, ar otherwise excluded f�y agencies or declared ineligible under statutory or regulatary authority ather than
ExeCuti�e Qrder 12549.
9. Byrd Anti-Lohhying Amendment:
Byrd Anti-Lobbying Amendment {31 I�SC 1352) -- Vendors that apply or bid for an award exceeding $1�O,Oaa must file the
required certificatian. Each tier certifies to the tier abo�e that it will not and has not used Federal apprapriated funds to
p�y �ny per5on or org�niz�tian for influencing or �ttempting to influenCe �n offiCer or err�pl�yee of �ny �genCy, a member
of Congress, �fficer ar emplayee af Congress, or an emplQyee af a member of Congress in connection with obtaining any
Federal contract, grant or any other award co�ered by 3f USC 1352. Each tier �-nust also disclose any lobbying with non-
Feder�l funds th�t t�kes plate in tonnection with obt�ining �ny Fecieral award. Such disclosures are forwarded from tier to
tier up to the non-Federal award. As applicable, Ves�dor agrees to file all certifications and disclasures req�aired by, and
vtherwise comply with, the Byrd Anti-Labbying Arnendment (31 USC 1352).
10. Pracurement af Reca�ered Materials:
For Cooperati�e member purchases utilizing Federal funds, Vendor agrees to comply with 5ection 6002 of the Solid Waste
Dispasal Act, as amer�ded by the Resaurce Conser�ation and Reco�ery Act where applicable and provide s�sch information
and certifications as a Coaperati�e member may require to confirm estimates anci otherwise comply. The requirements of
Section 6D02 include procuring only items designated in guidelines of the En�ironmental Protection Agency (�PA) at 40 CFR
Part 247 that contain the highest percentage of recovered rrtaterials practicable, consistent with main�aining a satisfactory
le�el af competition, where the purchase price of the item exceeds $1d,000 ar the �alue of the quantity acquired during the
prececling fiscal year exceecfed �1a,0�Q; prflc�ring salid waste management ser�ices in a manner that maximizes energy
and resource recovery, �nd eSt�E]lishing an �ffirm�ti�e procurement prDgram For proCurement of reco�ered m�teri�l5
identified in the EPA guidelines.
11, Profit as a Separate Element vf Price;
For purchases usi�g fetferal funds in excess aF $15fl�00D, a Cooperati�e merrsber may be required to negotiate profit as a
separate element of the price. See, � CFR ZdD.323�b). Wher� required by a Cooperati�e member, Vendor agrees to
pro�ide information and negatiate with the Coflperati�e mem6er regarding profit as a separate element of the price for a
particular purchase. Howe�er, Vendor agrees that the total price, including profit, charged by Vendar to the Caaperati�e
mernber shall not exceed the awarded pricing, including any applicable discaunt, under Ver�dor's Cooperati�e Contract.
Proposal Forms COMM�5VC5 v.62.12.2018
Page 3fi of 59
, Y �����
Conperative PurChasirty
120p7 ResearCh B4ulevard ' Austin, Texas 7$759-Z439 • PH: 8�p-595-2919 • buvboard.com
12. General Compliance and Cooperatian with Cooperati�e Members:
In addition to the foregoing specific requirements, Vendor agrees, in accepting any PurGhase Order from a CQoperati�e
member, it shall make a good faith effort to work with Cooperati�e me�nbers to pra�ide such information and to satisfy
5uCh requirements �5 m�y �pply to a p�rtiCul�r Co4perati�e member purCh85e or purch�5es inCluding, but not limited �o,
applicable recordkeeping and re�ard retention requirements.
Vendar Certificatian:
YES, I agree or
Vendor Certification Item No. NO I do NOT a ree Initial
1. Vendo� vialation or Breach of Contract Terms � ES E C
z. Termination for Cause ar Convenience �� E�
3. Equal Employment Oppvrtunity YES EC
�. Da�is-Bacon Act Y E� E�
5. Cvntract Work Haurs and Safety 5tandards Act �E� EC
5. Right Co Inventions Made Under a Contract or Agreement �ES EC
7. Clean Air Act and Federal Water Pollution Control Act �ES E�
8. Debarment and Suspensian �ES EC
9. Byrd Anti-L�bbying Amendment �ES EC
10. Procurement of Reca�ered Materials �ES E�
11. Profit as a Separate Element af Price YES EC
12. General Compliance and Cooperation with Coop�rati�e Members �ES E�
By signature below, I certify that the informatian in this fprm is true, �omplete, and aGturate and that I am authorized by
my company to make this certifi�ation and all cansents and agreements contained herein.
Delta Industrial Ser�ice & Suppfy
Company Name
l� ��
��_
5ignature of Authorized Campany OfFicial
Eric Currie
Printed EVame
Proposal Forms COMM/SVCSv.Of.12.2018
Page 37 of 59
� Baa►�d �
Cooperative Purchasinyr
12Q�7 Research Baule�ard ' Austin, Texas 78759-2439 • PH: 500-695-2914 ' buyboard.com
PROPOSAL INVITATI�N QUESTIONNAIRE
The Cooperati�e wifl use your responses to the questions below in e�aluating your Prvposal and technical and financial
resources to pra�ide the goods and perform the services {"Woric") under the BuyBoard contract con�emplated by this
Proposal In�itation ("Contract"). Proposers must fully answer each question, numb�ring your r�sponses to correspond ta
the questions/numbers below. Proposers must complete below or a�tach your responses to this questionnaire, sign whsere
incficated below, and submit the signed questiannafre and your responses ta all questions in one dotument with your
Proposal. Yau must suhmit the signed questionnaire and responses with your Propasai or the Proposal will
nnt be considered.
1. List the number of years Proposer has been in business and farmer business names (if applicable). Nate whether your
company is currently far sale or invol�ed in any transaction that would significantly alter its business or result in
acquisitian by another entity.
17 years in business
2. Describe the resources Praposer has to manage staff and suecessfully perform the Wark contemplated �nder this
Cantrack. Stake the nurr�ber and summarize khe experienee of campany persannel w�o may be utilized for the Woric,
including those who will b� available �o Cooperati�e members far assistance with project de�elopment, technical issues,
and product selection for Work asso�iated with this Contract.
We have many resvurces to manage our staff and successfully perForm the work contempiated
under this contract. Our customer ser�ice reps and sales reps will be a�ailable to pro�ide
assistance with project de�elopment, technical issues, anci product selection for work associated
with this contract.
3. Describe Rroposer's financial capability to perfarm the Contract. State or describe the firm's financial strength and
rating, bonding capa�ity, and insuran[e �o�erage limits. State whether the firm, or any af the firm's past or �resent
owners, principal sharehalders ar stockholders, or afficers, ha�e been a debtar parry to a bankruptcy, recei�ership, or
insol�ency proceeding in the last 7 years, and identify any such debtor party by name and relationship to or posi�ion
with your firm.
Delta Industrial Ser�ice & Supply is an established business with a great financial
background. VIle ha�e $1 million general liability insurance co�erage. The firm
has ne�er been a debtor for bankruptcy.
Proposal Forms COMM�SVCS v,0i,12,2018
Page 38 of b9
= Board�
Cooperative Purchasirtg
12007 ReSearCh Baule�ard • Austin, Texas 78759-2439 • PH: $pQ-695-2919 • buybvard.com
4. Does your company ha�e any outstanding financial judgments andlor is it currently in default on any Ioan or financing
agreement? If so, pravide detailed infarmation on the nature af such items and prospects for resolution.
No
5. List all contracts, if any, in the last 10 years on which Propaser has defaulted, failed ta complete or deliver the work, or
that have been terminated for ar�y reason. For each such contract, pro�ide the project name, scope, �alue and date
d�d the n�me pf the proCuring entity. Fully expl�in the GirCumst�nCes of khe def�ult, f�ilure to Complete or deli�er khe
work, ar termination.
not applicable
List all litigation ar other legal proceedings (including arbitration proceedings}, if any, in the last 10 years brought
against your firm, or any af the firm's past or present owners, principal shareholders ar stockholders, afficers, agents or
employees, that relates to or arises from a cantract similar to this Contract or the work conternplated under this
Contract. Pro�ide the style af the lawsuit or pro�eeding (name of parties and caurt or tribunal in which filed), nature of
the claim, and resolution or current status.
not applicable.
By signature hetow, I certify that the information contained in and�or attached to this Prapasal Invitatian
Questionnaire in response to the aba�e questions is true and correct and that I am authorized by my
company to make this certificatian.
Defta Industriaf Ser�ice & Supply
Company Name
���
Signature �f : :u�t�o. �ze� Company Official
Proposal Forms COP1MISVCS v.Of.12.2018
Page 34 of 59
� Board �
Cauperative Purchasing
12a�7 Research 8oule�ard ' Austin, Texas 78759-2439 • PFf: 80Q-695-2919 ' buyboard.cam
REQUIRED F�RMS CHECKLIST
(Please check {d} the foliowing)
0 Completed: Proposer`s Agreement and Signatura
0
�
0
0
Campleted: Vendar Cnntact Information
Completed: Felony Canviction Disclosure and De6arment Certificatian
Campleted: Resident�Monresiden# Cer#ification
Completed: Na Israel Boycott Certificatian
0 Campleted: No Excluded Natian ar Foreign Terrorist Organization Certification
0 Campleted: Histarically Underutilized Business (HUB} Certification)
0 Comr�leted: Construction Related Goods and Serrrices Affirmatian
0
❑
❑
0
0
0
�
0
0
0
0
0
0
0
0
Campleted: De�iation�Compfiance
Campleted: Locatian�Autharized Seller Listings
Campleted: Manufacturer Dealer Designation
Comaleted: Texas Regianal Ser�ice Designation
Completed: 5tate Ser�ice Dasignation
Completed: Nationai Purchasing Cooperati�e Vendor Award Agreement
Camaleted: Federal and State/Purchasing Cooperati�e Experience
Campleted: Governmentai References
Campleted: Marketing Strategy
Campleted: ConfidentialJPraprietary Information
Completed: Vendor Business Name with IRS Form W-9
Completed: EDGAR Vendor Certificatian
Completed: Proposal In►►itatian Questionnaire
Completed: Required Forms Checklist
Comt�leted: Proposal Specifica#ion Form with Catalvgs/Pricelists and
Manufacturer Authorization Letters
*Ca[alog5/Pric�lists must 6e su6mitted ivith proposal response or response avi/I not tre mnsider�
Proposal Forms COMM/SVCS �.Oi.iZ.2018
Page 4a of 69
�Board�
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
�`ALL CdLUMNS MUST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERED*
NOTE 1: All fees to be charged for any purchase from this contract with the exceptian of delivery fees (i.e. pre de/ivery inspection, make ready, applicable state
inspection or/icense fee, manufacture� destination fees, etc.) are to be included in the 6ase price(s). Fees not included in the 6ase price(s) will not be allowed.
NOTE 2: An awarded Vendor must be approved 6y the manufacturer to sell, install, and service the 6rand of equipment submitted. Proposers responding to this
Proposal Invitation should submit an approval letter from each manufacturer. Manufacturer authorization letters must include the regions and/or states in which
equipment may be sold.
Section I: Boats
Item State Brand of
No, Short Description Full Description Base Modef Price Boat Manufacturer Options
10 Foot Boat -- 10 Foot Boat, outboard/inboard �Ia
1 10 Foot BoaY propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
11 Foot Boat -- ll Faot Boat, outboard/inboard n/a
Z 11 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
12 Foot Boat -- 12 Foot Boat, outboard/in6oard n/a
3 12 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufadurer's standard equipment.
13 Foot Boat -- 13 Foot Boat, outboard/inboard
4 13 Foat Bwt propulsion, fiberglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
14 Foot Boat — 14 Foot Boat, outboard/inboard
5 14 Faot Boat propulsion, fiberglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 41 of 69
�: f , f
Praposal Invitation No. 578-18 Baats, Traiiers, Marine and Waterway Equipment
"ALL COLUMNS MUST B� COMPLETED OR PROPOSAL WILL NOT BE CONSIQEREt7"
Item State Brand of
No. Short Description Full Description Base Model Price Boat Manufacturer Options
15 Foot Boat -- 15 Fnot Boat, outboarcf/inboard n/a
6 15 Foot Boat propulsion, fiberglass or aluminum, complete witfi all $
manufacturer's standard equipment.
16 Foot Boat -- 16 Foot Boat, outboard/inboard n/a
7 16 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
17 Foot Boat -- 17 Foot Boat, outboard/inboard n/a
8 17 Fppt Boat propulsion, fiberglass pr aluminum, complete with all $
manufacturer's standard equipment.
19 Foot Boat -- 19 Foot Boat, outboard/inbnard
9 19 Foot Boat propulsion, fi6erglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
21 Foot Boat -- 21 Foot Boat, outboard/inboard $99�900 SEALEGS 6_1 m Sport RIB"
10 21 Foot Boat propulsion, fiberglass or aluminum, mmplete with all $104,9f1(l SEALEGS 6_1 m Sport D-Tube "
manufacturer's standard equipment.
22 Foot Boat -- 22 Foot Boat, outboard/in6oard n/a
11 22 Foot Boat propulsion, fiberglass, complete with all $
manufacturer's standard equipment.
23 Foot Boat-- 23 Foot Boat, outboard/inboard 119,900 SEALEGS 7.1m Sport RIB�
12 Z3 Foot 6oat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 4� of 69 �other custom options available.
POA. Same discount applies
�Baard�
Proposal In�itation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
yALL COl UMIVS MUST BE COMPLETEp OR PROPOSAL WILI NOT BE CONSI6ERED'�
Item State Brand of
No. Short Description Full Description Base Model Price Boat Manufacturer Options
24 Foot Boat -- 24 Foot Boat, outboard/inboard
13 24 Foot Boat propulsion, fiberglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
25 Foot Boat -- 25 Foot Boat, outboard/inboard $132,90a SEALEGS 7.7m Sport D-Tube'
14 25 Foot Boat propulsion, fiberglass or aluminum, complete with all $ 134.900 SEALEGS 7.7m Wide Console RIB*
manufacturer's standard equipment. $149,90Q SEALEGS 7.7m Cabin RIB'
26 Foot Boat -- 26 Foot Boat, outboard/inboard n/a
15 26 Foot 6oat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
27 Foot Boat -- 27 Foot Boat, outboard/inbnard n/a
16 27 Foot Boat propulsion, fiberglass nr aluminum, complete with all $
manufacturer's standard equipment.
28 Foot Boat -- 28 Foot Boat, outboard/inboard n/a
17 28 Foot Boat propulsion, fiberglass or aluminum, complete witfi all $
manufacturer's standard equipment.
30 Foot Boat -- 30 Foot Boat, outboard/inboard n/a
18 30 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
32 Foot Boat -- 32 Foot Boat, outboard/inboard n/a
19 32 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted w9th Proposal Page 43 of 69 �other custom options available. POA.
Same discount applies
�Bvard"
ro�„�.�,.
Proposa! Invitation No. 578-f8 Boats, Trailers, Marine and Waterway Equipment
�ALL COLUMNS MUST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERE�"
Item State Brand af
No. Short Description Full Description Base MocEel Price Boat Manufacturer Options
33 Foot Boat -- 33 Fnot Boat, outboard/inboard n/a
2fl 33 Foot Soat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
34 Foot Boat -- 34 Foot Boat, outboard/in6oard n/a
21 34 Foot Soat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
35 Foot Boat-- 35 Foot Boat, outboard/inboard 189,0�� SEALEGS 9.flm Hydrasol RIB `
2z 35 Foot Soat propulsion, fiberglass or aluminum, complete with ail $
manufacturer's standard equipment.
36 Foot Boat -- 36 Foot Boat, outboard/inboard
23 36 Foot Boat propulsion, fi6erglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
37 Foot Boat -- 37 Foot Boat, outboard/inbaard
24 37 Foot Boat propulsion, fiberglass or aluminum, complete witfi a!I $ n�a
manufacturer's standard equipment.
38 Foot Boat -- 38 Faot Boat, outboard/in6oard n/a
25 38 Foot Soat propulsion, Fiberglass or aluminum, complete with a31 $
manufacturer's standard equipment.
40 Foot Boat -- 40 Foot Boat, outboard/inboard
2b 40 Fnot 8oat propulsinn, fiberglass nr aluminum, complete with all $ n�a
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are reguired to be submitted with Proposal Page 44 of 69 *other custom options available.
POA. Same discount applies
�Board�°
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
*ALL COLUMNS MUST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERED*
Item 5tate Brand of
No. Short Description Full Description Base Model Price Boat Manufacturer Options
41 Foot Boat -- 41 Foot Baat, outboard/inboard
Z7 41 Foot Boat prapulsion, fiherglass or aluminum, complete with all � n/a
manufacturer's standard equipment.
44 Foot Boat -- 44 Foot Boat, out6oard/inboard
28 44 Foot Boat propulsion, fiberglass or aluminurr�, complete with all � n/a
manufacturer's standard equipment.
46 Foot Boat -- 46 Foot Boat, outboard/inboard
29 46 Foot Boat propulsion, fiberglass or aluminum, complete with all � n/a
manufacturer's standard equipment.
48 Foot Boat -- 48 FooC Boat, outboard/inboard n/a
30 48 Foot Boat prapulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
52 Foot Boat -- 52 Foot Boat, outboard/inboard
31 52 Foot Boat propulsion, fiberglass or aluminum, complete wifh all � n/a
manufacturer's standard equipment.
54 Foot Boat -- 54 Foot Boat, outboard/inboard
32 54 Foot Boat propulsion, fiberglass or aluminum, complete with all $ nl�
manufacturer's standard equipment.
60 Foot Boat -- 60 Foot Boat, out6oard/inboard n/a
33 5Q Foot Boat prapulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIF7CATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal �age as oF 69
�Bvard `
Proposal In�itation Na. 578-18 Baats, Trailers, Marine and Waterway Equipment
*ALL COLUMNS NEElST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERED*
Item
I�o. Short
Fuil Descri
State Brand of
Base Model Price Boat Manufactur
65 Foot Boat -- 65 Foot Boat, outhoard/inboard
34 55 Foot Boat propulsion, fiberglass or aluminurr�, complete with all � n/a
manufacturer's standard equipment.
Boat Motors
State Percent (%)
Item of Discount off State Name of
I�o. Shart Description Full Description Cataloq/Pricekist Cataloq/Pricelist
�iscount (%) Off Please state the discount (%} off catalog/pricel€st for
35 �atalog/Pricelist for Alf All Types Boat Motors and Accessories. �
Typ25 Of BOdt MOtO!'S Catalag/Pricelist MUST be included or propasal will not be —
and Accessories wesidered.
ection III: 6oat Marine and Waterwa E ui ment and Products
Discount (%) Off DiscounY (%) OfF Catalog/Pricelist for Lake, River
Catalog/Pricelist for and Waterway Equipment (dock floats, decking, O
36 waterway 6arriers, buoys, markers, and similar
Lake, River and —
Waterway �quipment related equipment). Catalog/Pricelist MUST be included
or proposal will not be considered.
Discount (%) Off
Catalog/Pricelist for Discount (%) Off Catalog/Pricelist for Anchors,
37 Anchors, Docking Docking Equipment, Accessories and Related �
Equipment, PI'OdllCtS. Catalog JPricelist MUST 6e included or —
ACCessories and proposal will not be considered.
Related Products
o�o I SEALEGS
��° I SEALEGS
% I SEALEGS
�tions to Discaunt
PROPOSALNdTE
PROPOSALSPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 46 of 69
Bnard�
�.�,,,...�..,�
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
*ALL COLUMNS MUST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERED*
State Percent (%)
Item of Discount off State Name of
Na. Short Descri #ion Full Description Catalog/Pricelist Cataiog/Pricelist Exceptions to Discount
DiScount (%) Off
Catalag/Pricelist for p€scount (%) �ff Catalo9/Pricelist for Life Vests,
38 Life Vests, Jackets, �ackets, Accessories and Related Products. 0 0�o SEALEGS
AccessOri25 dnd Catalog/PricelisE MUST be included or proposal will not be
considered.
Related Products
Di5C0unt (%) Off
Catalog/Pricelist for p�ease state the discount (%) off catalog/pricelist for
39 Boat Seats, Boat Seats, Accessories and Related Products. O o�o SEALEGS
Accessories and �atalog/Pricelist MUST be included or propasal will not be
considered.
Related Products
DISCOunt (%) Off
Catalog/Pricelist for P�ease state the discount (%j off catalog/pricelist for
40 Marine Electranics, Marine Electronics, Accessories and Related O % SEALEGS
Accessories and p�0[IIIC#5. Catalog/Pricelist MUST be incfuded or
proposal will not be considered.
Related Products
Discount {%) Off
Ca�alog/Pricelist for P�ease state the disco�nt (%) off catalog/pricelist for
41 Niarine BatYerfes, Marine Batteries, Chargers, Accessories and � % SEALEGS
Chargers, Accessories �eldted P�OdlJCfS. Cataiag/Pricelist MUSTbe included
afld Relat2d PI'OdUCtS or proposal will not be considered,
Section IV: Boat Trailers
Discount (%) Off Catalog/Pricelist for All Types of
Discount (%) Off Boat Trailers (Load capacity rated at 60 MPH, DOT
42 Catalog/Pricelist for All appraved lights and standard manufacturer's O % SEALEGS
Types nf 8oat Trailers equipment.) Catalog/Pricelist MUST be included or
propasal will not be considered.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 47 of 69
�Board'°
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
*ALL COWMNS MUST 6E COMPLETE� OR PROPOSAL WILL NOT BE CONSIDERED*
Section V: OPTIONA! EOUIPMENT and PARTS- Options will be selected by the Cooperative member at the time of order. A COMPLETE LIST OF ALL OPTIONAL
EQUIPNiENT AND PAR75 MU57 BE SUBMI77ED WifH PROPOSAL FOR PROPOSAL 70 BE CONSIDERED.
5tate Percent (%)
Item of Discount off State Name of
No. 5hort Description Full Description Catalog/Pricelist Catalog/Pricelist Options
Discount (%) OFF
Catalog/Pricelist for all �iscount (%) off all Original Equipment � o
43 Original EquipmenC Manufacturer (OEM) Options. �0
Manufacturer (OEM)
Options
D'IS[ount {%) Off
Catalog/Pricelist for
44 Third Party Options Discount (%) off Third Party Options (not OEM) � %
(not OEM) and and Unpublished Options and Equipment.
Unpublished Optior�s
and Equipment
Discount {%) OfF
Catalog/PriceGst for o
Discount (/o) off Original Equipment � o
45 Original Eguipment Manufacutrer (OEM) Parts. �0
Manufacutrer (OEM)
Parts
Discount {a/o) Off
Catalog/Pricelist for piscount (%) off Extended Service Maintenance n/a
45 E�ended Service %
Maintenance Agreements.
Agreements
Discount {%) off Floor �iscount (%) off Floor Plan Insurance and Lot n/a
47 Plan Insurance and Insurance. °/o
LotInsurance
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal �age a8 of 69
�Board `
�,.���..�
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
*ALL COLUMNS MUST BE COMPLETE� OR PROPOSAL WILL NOT BE CONSIDER�D*
Section VI: Delivery Fees And La6or Rate For Insiallation and Repair Service Of Boats
Detailed
Information on
Item Hourly Labor Rate Hourly Labor Rate Exceptions #a Hourly Labor Rate
No. Short Descripiion Full Description and Delivery Fee and Delivery Fee and Delivery Fee
Nat to Exceed Hourly Hourly Labor Rate for Installation and Repair
Labor Rate for Service of Boat Equipment and Products -- State
48 Installation and Repair the Not to Exceed hourly labor rate for $ nla /Hour
Service and of �oat �nstallatian/R2pair Service of Equipment and
Equipment and products.
Praducts
49 Per Mile Delivery Fee Per Mile Delivery Fee for Boats- State the per 2.��
for Boats mile delivery fee for Boats. � /Mile
PROPOSAL NOTE PROPOSAL SPECiFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 49 of 69
EXHIBIT C
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg.. Regular Session.
FORM CIQ
OFFlCE USE ONLY
This questionnaire is being filed in accordancewith Chapter 176, Local Govemment Code. �,,,a R�e����
by a vendorwho 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 lacal govemmental
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 Govemment Code.
A vendor commits an offense if the vendor knowingly violates Section 176.00B. Local
Govemment Code. An offense under this section is a misdemeanor.
Name of vendorwho has a busfness relatlonship wlth local governmenal entity.
Check thls box if you are flling an update to a previously ftled questionnai�.
(The law requires that you file an updated completed questionnaire with the appropriate filing authoriry not
later than the 7th business day after the date on which you became aware that the originally filed questionnaire was
incomplete or inaccurate.)
Name of local government officer aboutwhom the information in this section is being disclosed.
Name of Officer
This section (item 3 including subparts A, B, C, & D) must be completed for each officer with whom the vendor has an
employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional
pages to this Fortn CIQ 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?
� Yes � No
B. Is the vendor receiving or likety 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 o�cer 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.
Signature of vendor doing business wdh the governmental entity
Date
Adopted 8!7;2015
Signature:
Email:
CSC NO.
CSC No. 56039
ORT ORTH�
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and between Delta Industrial
Service & Supply ("Vendor") and the City of Fort Worth, ("City"), a Texas home rule municipality.
The Cooperative Purchase Agreement includes tbe following documents which shall be construed inthe
order of precedence in which they arelisted:
1. This Cooperative Purchase Agreement;
2. Exhibit A- Seller's Quote, Scope of Services or Purchase Order;
3. Exhibit B- Cooperative Agency Contract (e.g., NJPA, DiR, BuyBoard);and
4. Exhibit C- Conflict of interest Questionnaire.
Exhibits A, B, and C which are attached hereto and incorporated herein, are made a part of
this Agreement for all purposes. Vendor agrees to provide City with the services and goods included
in Exhibit A pursuant to the terms and conditions of this Cooperative Purchase Agreement, including
all exhibits thereto.
City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance
with the provisions of this Agreement. Total estimated payments made under this Agreement for the
each year by City shall be in the amount up to FiftyThousandDollatsandZeroCents($50,000.00). Vendor
shall not provide any additional items or services or bill for expenses incurred for City not specified
by this Agreement unless City requests and approves in writing the additional costs for such services.
City shall not be liable for any additional expenses of Vendor not specified by this Agreement unless
City first approves such expenses in writing.
The term ofthis Agreement shall be for one year beginning on the date signed by the Assistant
City Manager below ("Effective Date") and shall expire one year from effective date. City shall be
able to renew this agreement for two one-year renewal options by written agreement of the parties.
Vendor agrees that City shall, until the expiration of three (3) years after final payment under
this Agreement, or the final conclusion of any audit commenced during the said three years, have
access to and the right to exam ine at reasonable times any directly pertinent books, documents, papers
and records, including, but not limited to, all electronic records, of Vendor involving transactions
relating to this Agreement at no additional cost to City. Vendor agrees that City shall have access
during normal working hours to all necessary Vendor facilities and shall be provided adequate and
appropriate work space in order to conduct audits in compliance with theprovisions ofthis section. City
shall give Vendor reasonable advance notice of intended audits.
Notices required pursuant to the provisions of this Agreement shall be conclusively
COOP AGREEMENT-DELTA
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:
City of Fort Worth
Attn: Assistant City Manager
200 Texas Street
Fort Worth TX 76102
Facsimile: (817) 392-8564
With Copy to the City Attorney
at same address
TO VENDOR:
Delta Industrial Service & Supply
Attn: Eric Currie, President
Address: 3159 Summit Dr.
Port Neches, Texas 77651
Phone: (409)724-1055
The undersigned represents and warrants that he or she has the power and authority to execute
this Agreement and the Cooperative Documents and bind the Vendor.
(signature page follows)
COOP AGREEMENT-DELTA 2
ACCEPTED AND AGREED:
CITY OF FORT WORTH:
By• Valerie Was�igt� u� 20211727 CDT)
Name: Valerie Washington
Title: Assistant Citv Mana�er
Date: J u l 20, 2021
APPROVAL RECOMMENDED:
J� s Davis (Jul 19, 2021 2L48 CDT)
Name: Jim Davis
Title: Fire Chief
���, .���
Name
Title:
ATTEST:
By:
�� �
Christopher Austria
Assistant Citv Attorney
CONTRACT AUTHORIZATION:
M&C: N/A
1295: N/A
Name: Ronald Gonzalez
Title: Acting Cltv SecretarX
VENDOR: DELTA INSUTRIAL SERVICE & SUPPLY
Eric Currie
Eric Currie (Jul 19, 2�2119:44 CDT)
Name: Eric Currie, President
Date: 7/19/2021
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract, including ensuring all performance
and reporting requirements.
By: � ..��, _
Mark Rauscher (Jul 19, 2021 22:L7 CDT)
Name: Mark Rauscher
Title: Fire Assistant Director
APPROVED AS TO FORM AND LEGALITY:
COOP AGREEMENT-DELTA 3
EXHIBIT A
�.. ��LTA
' - y 1+*Yu.kru'� Sarvl..�r,�5u:p�} : Fire�&saTe�Y
f�[ame / Address
Firestation � 8
99D6 CarEeton
Fort Worth, TX 78'107
Part Number _ Description
KAPPLER KAPI'LER D2H634-92-12CP-UPL-CAP, DuraChem 2D0
Multi-Piece Config�ration Certified to iVFPA 4992 and P[FPA
2Z12. Includes Jacket with CP CufF (D2H88DCP}, Bib
Ovetall wifh 2 cargo pocKets {�2H662j, G[ove Cone Inserts
(AGOAR). Heat Sealed/Taped Seams, SIZES = LGlXL
KAPPLER KAPPLER D2H634-92�2CP-UPL-CAP, DuraChem 200
Mutti-Piace Configura6on Certified io t�[FPA 1992 and NFPA
2't'12. Inclttdes Jacket with CP Cuff (D2H68DCP), Bih
Overall with 2 cargo packets (a2HS62), Glove Cone Inserts
(AG0.4R). Heat SealedlTaped Seams, SIZES = 2Xl3X _
FREIGHT- To Shipping & Handling Cost Pre Pay & Add
Invoice
expir'es : next price increase
Quote
6aLe Estimate #
Hlay-27-2029 CY0527202i G
Praject
F�re DepartmenY
Qiy Cost Total
16 $�,383.588 $22,137.41 Non
'13
4 $'1,46'1.212 $5,924_85 Non
5
'I $O_00 $0.00 Non
0.00% $O.DO
TO�1 $28,062.26
EXHIBIT B
� Board �
Cooperative Pu�chasiag
12007 Research Boulevard � Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
PROPOSER'S AGREEMENT AND SIGNATURE
Pronosal Name: Boats, Trailers, Marine and
Waterway Equipment
Pronosal Number: 578-18
Pr000sal Due Date{Onenina Date and Time:
May 24, 2018 at 4:0� PM
Location of Proposal Ouenina:
Texas Association of School Boards, Inc.
BuyBoard Department
12007 Research Blvd.
Austin, TX 78759
Contract Time Period: December 1, 2018
through November 30, 2019 with two (2) possible
one-year renewals.
Antici�ated Coonerative Board Meetina Date:
October 2018
Delta Industrial Service & Supply
Name of Proposing Company
May 23, 2018
Date
3159 Summit Dr
Street Address
Port Neches, Texas, 77651
City, State, Zip
409-724-1055
Telephone Number of Authorized Company Official
409-722-8062
Fax Number of Authorized Company Official
Signature�horized Company Official
Eric Currie
Printed Name of Authorized Company Official
President
Position or Title of Authorized Company Official
76-0696202
Federal ID Number
Pa9e 9 of 69
Proposal Forms COMM/SVCS v_01.12.2018
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78i59-2439 • PH: 800-695-2919 • buvboard.com
The proposing company (`�you" or "your") hereby acknowledges and agrees as follows:
1. You have carefully examined and understand all Cooperative information and documentation associated with this
Proposal Invitation, incluciing the Instructians to Proposers, General Terms and Conditions, attachments/forms, item
specifications, and line items (collectively "Requirements");
2. By your response ("Proposal") to this Proposal Invitation, you propose to supply the products or services subrnitted at
the prices quoted in your Proposal and in strict compliance with the Requirements, unless specific deviations or
exceptions are noted in the Proposal;
3. Any and all deviations and exceptions to the Requirements have been noted in your Proposal and no others will be
claimed;
4. If the Coaperative accepts any part of your Proposal and awards you a contract, you will furnish all awarded products
or services at the prices quoted and in strict compliance with the Requirements (unless specific exceptions are noted in
the Proposal and accepted by the Cooperative), including without limitation the Requirements related to:
a, conducting business with Cooperative members, includi�g ofFering pricing to members that is the best you affer
cornpared to similar customers;
b. payrnent of a service fee in the amount specified and as provided for in this Proposal Invitation;
c. the possible award of a piggy-back contract by another governmental entity or nonprofit entity, in which event
you will offer the awarded goods and services ir� accordance with the Requirements; and
d. submitting price sheets or catalogs in the proper format as required by the Cooperative as a prerequisite to
acti�ation of your contract;
S. You have [learly identified on the included form any infQrmation in your Proposal that you believe to be confidential or
proprietary or that you do not consider to be public information subject to public disclosure under a Texas Public
Infarmatian Act request or similar public information law;
6. The individual signing this Agreement is duly authorized to enter into the contractual relationship represented by this
Proposal Invitation on your behalf and bind you to the Requirements, and such individual (and any individual signing a
form) is authorized and has the requisite knowledge to provide the information and make the representations and
certifications required in the Requirements;
7. You have carefuliy reviewed your Proposal, and certify that all information provided is true, complete and accurate,
and you authorize the Cooperative to take such action as it deems appropriate to verify such informatian; and
8. A�y misstatement, falsification, or omission in your Proposal, whenever or however discovered, may disqualify you
from consideration for a contract award under this Proposal Invitation or result in termination of an award or any other
remedy or action provided for in the General Terms and Conditions or by law.
Page 10 of 69
Proposal Forms COMM/SVCS v.01.12.2018
� Board�
Cooperative Purchasinq
12007 Research Boulevard • Austin, Texas i8759-2439 • PH: 800-695-2919 • buvboard.com
VENDOR CONTACT INFORMATION
co,,.,pany: Delta Industrial Service & Supply
vendor Contact Name and Mailing pddress For Notices: 3159 Sur711'Tllt DC'. POI't N2Ch2S, Texas 77651
Company Website: WWW•de�talSS.001'71
Purchase Orders: Purchase orders from Cooperative members will be available through the Internet or by facsimile.
Option 1: Internet. Vendors need Internet access and at least one e-rnail address so that notification of new
orders can be sent to the Internet contact when a new purchase order arrives. An information guide will be
provided to vendors that choose this option to assist them with retrieving their orders.
Option 2: Fax. Vendors need a designated fax line available at all times to receive purchase orders.
Please choose onlv one (1) of the following options for receipt of purchase orders and provide the requested
information:
�
❑
I will use the INTERNET to receive purchase orders.
E-mail Address: erlC p�C�2�taISS.001'71
Internet Contact: ErIC CUI'I'12
Alternate E-mail Address: �arlSSa p�C�2�taISS.COC71
Alternate Internet Contact: M a rl SSa G U@ I"I"a
I wili receive purchase orders via FAX.
Fax Number:
Fax Cankact:
Phone: 409-724-1055
Phone: 409-724-1055
Phone:
❑ Purchase orders may be received by any Designated Dealer identified on my company's Dealer Designatian
form as provided to the Cooperative administratar. I understand that my company shall remain responsible for the
Contract and the performance of all Designated Dealers under and in accordance with the Contract.
Request for Quotes ("RFQ"): Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses
for the receipt of RFQs:
E-mail Address: erlC p�C�@�taISS.COC71
Alternate E-rnail Address: marlSSa@C�@�taISS.C�f71
Page 11 of 69
Proposal Forms COMM/SVCS v.01.12.2018
� Board �
Cnoperative Purchasing
12007 Research 6oulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
Invoices: Your company wil! be billed monthly for the service fee due under a contract awarded under this Proposal
Invitatian. All invoices are available on the BuyBoard website and e-mail notificatians will be sent when they
are ready to he retrieved. Please provide the following address, contact and e-mail information for receipt of servEce fee
invoices and related communications:
Please choose onlv one (11 of the following options for receipt of invoices and provide the requested
infarmation:
❑■ Service fee invoices and related communications should be provided directly to my company at:
Mailing address: 3159 SUI'711'711t DI'. Department: Accounts Payable
�;�,: Port Neches State: Texas Zip Code: 77651
Contact Name: Jacqui Currie Phone: 409-724-1055
Fax: E-mail Address: Jax@deltaiss.com
Alternative E-mail Address: marissa@deltaiss.com
❑ In lieu of my company, I request and authorize all serv�ce fee invoices to be provided directly ko �he following billing
agent**:
Mailing address:
Department:
City: State: Zip Code:
Contact Name:
Phone:
Fax: E-mail Address:
Alternative E-mail Address:
❑ In lieu of my company, I request and authorize service fee invoices to be provided to the Designated Dealer(s)
receiving the purchase order(s) to which the invoiced service fees relate at the address and contact information designated
on my company's Dealer Designaiion form as provided to the Cooperative administrator.**
** If Vendor authorizes a 6i//ing agent or Designated Dea/er(s) to receive and process service fee rnvoices,
in accordance with the Genera/ Terms and Conditions of the Cont�act, Vendor specifica/ty acknow/edges and
agrees that nothing in that designatron sha// re/ieve Vendor of its responsibi/ities and o6/igations under the
Contract inc/uding, 6ut not /imited to, payment of a// service fees under any Contract awarded Vendor,
Page 12 of 69
Proposal Forms COMM/SVCS v.61.12.2018
= Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-Z919 • buyboard.com
FELONY CONVICTION DISCLOSURE AND DEBARMENT CERTIFICATION
FELONY CONVICTION DISCLOSURE
Subsection (a) of Section 44.034 of the Texas Education Code (Notification of Criminal History of Contractor)
states: `�A persan or business entity that enters into a contract with a school district must give advance notice to the district
if the person or an owner or operator has been convicted of a felony. The notice must include a ger�eral description of the
conduct resulting in the conviction of a Felony."
Section 44.U34 further states in Subsection (b): "A school district may terminate a contract with a person or
business entity if the district determines that the person or business entity failed to give notice as required by Subsection
(a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity
for services performed befqre the termination of the contract."
Please check (� one of the following:
❑■ My company is a publicly-held corporation. (Advance notice requirement does not apply to publidy-held corporation.)
❑■ My company is not owned or aperated by anyone who has been convicted of a felony.
❑ My company is owned/aperated by the following individual(s) who has/have been convicted of a felony:
Name of Felon(s):
Details of Conviction(s):
By signature below, I certify that the above information is true, complete and accurate and that I am authorized by my
company to make this cerf�ification.
Delta Industrial Service & Supply
Company Name
�� Eric Currie
Sign�ture of Authorized Company Offici�l Printed N�me
DEBARMENT CERTIFICATION
Neither my company nor an owner or principal of my company has been debarred, suspended or otherwise made ineligible
for participation in Federal Assis�ance pragrams under Executive Order 12549, "Debarment and Suspension," as described
in the Federal Register and Rules and Regulations. Neither my company nor an owner or principal of my company is
currently listed on the government-wide exclusians in SAM, debarred, suspended, or otherwise excluded by agencies or
cleclared ineligible under any statutory or regulatory authority. My company agrees to immediately notify the Caoperative
and all Cooperative members with pending purehases or seeking to purchase frorn my company if my company or an
owner or principal is later listed on the government-wide exclusions in SAM, or is debarred, suspended, or otherwise
excluded by agencies or declared ineligible under any statutory or regulatory authority.
By signature below, I certify that the above is true, complete and accurate and that I am authorized by my company to
make this certification.
Delta Industrial Service & Supply
Company Name
G� Eric Currie
Signature of Authorized Company OfFicial Printed Name
Page 13 of 69
Proposal Forms COMM/SVCS v.01.iZ.2018
� Board�
Cooperative Purahasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 80Q-695-2919 • buvboard.com
RESIDENT/ NONRESIDENT CERTIFICATION
Chapter Z25Z, Subchapter A, af' the Texas Government Code establishes certain requirements applicable to proposers who
are not Texas residents. Llnder the statute, a"resident" proposer is a person whase principal place of business is in Texas,
including a contractar whose ultimate parent company or rr�ajarity owner has its principal place of business in Texas. A
"nonresident" proposer is a person who is not a Texas resident. Please indicate the status of your company as a"resident"
proposer or a'�nonresident" proposer under these definitions.
Please check (�) one of the followinca:
■❑ I certify that my company is a Resident Proposer.
❑ I certify that my company is a Nonresident Proposer.
If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in
which your cornpany's principal place of business is located):
Delta Industrial Service & Supply
Company Name
Port Neches
City
3159 Summit Dr.
Add ress
TX
State
77651
Zip Code
A. Does your resident state require a proposer whose principal place of business is in Texas to under-price proposers
whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?
❑ Yes 0 No
B. What is the prescribed amount or percentage? $ or %
VENDOR EMPLOYMENT CERTIFICATION
Section 44.031(b) of the Texas Education Code establishes certain criteria that a school district must consider when
determining to whom to award a contract. Among the criteria for certain contracts is whether the vendor or the vendor's
ultimate parent or majority owner (i) has its principal place of business in Texas; or (ii) employs at least S00 people in
Texas.
Tf neither your company nor the ultimate parent company or majority owner hes its principal place of business in i"exas,
does your company, ultimate parent company, or majority owner employ at least 500 people in Texas?
Please check {�/� one of the followincL
❑ Yes � No
By signature below, I certify that the information in Sections 1(Resident/Nonresrdent Certification) and 2(Vendor
Emp/oyment Certification) above is true, complete and accurate and that I am authorized by my company to make this
certification.
Delta Industrial Service & Supply
Company Narr�e
G�� Eric Currie
Signature o Authorized CQmpany Official Printed Name
Page 14 of 69
Proposal Forms COMM/SVCS v.01.12.2018
� Board�
Gaoperative Purchasinq
12007 Ftesearch Boulevard • Austin, Texas 78i59-2439 • PH: 800-695-2919 • buvboard.com
NO ISRAEL BOYCOTT CERTIFICATION
Effective September 1, 2017, a Texas governmental entity may not enter into a contract with a company for goods or
services unless the contract contains a written verification from the company that it: (1) cioes not boycott Israel; and (2)
will not boycott Israel during the term of the contract. (TEx. Gov'T CODE Ch. 2270)
"Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is
intended to penalize, inFlict economic harm on, or limit commercial relations specifically with Israel, or with a person or
entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business
purposes. Tex. GOV'T CODE §808.001(1).
By signature below, T certify and verify that Vendor does not boycott Tsrael and will not boycott Israel during the term of
any contract awarded under this Proposal Invitation, that this certification is true, complete and accurate, and that I am
authorized by my campany to make this certification.
Delta Industrial Service & Supply
Company Name
G� Eric Currie
SignaturP of A��th�rizPd ��mpany Official Printed Name
NO EXCLUDED NATION OR FOREIGN TERRORIST ORGANIZATION CERTIFICATION
Effective September 1, 2017, Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may
not enter into a contract with a company engaged in active business operations with Sudan, Iran, or a foreign terrorist
organization — specifically, any company identified on a list prepared and maintained by the Texas Comptroller under Texas
Government Code §§806.051, 807.d51, or 2252.153. (A company that the U.S. Government affirmatively dedares to be
excluded from its federal sanctions regime relating to Sudan, Iran, or any federal sanctions regime relating to a foreign
terrorist organization is not subject to the contract prohibition.)
By signature below, I certify and verify that Vendor is not on the Texas Comptroller's list identified above; that this
certification is true, complete and accurate; and that I am authorized by my company to make this certification.
Delta Industrial Service & Supply
Company Name
�� Eric Currie
Signature �f Authorized Company Official Printed Name
Page 15 of 69
Proposal Forms COMMJSVCS v.0i.12.2018
� Bo�rd�
Cooperative Purchasiag
12007 Research Boulevard • Austin, 7exas 78759-2439 • PH: 800-695-2919 • buyboard.com
HISTORICALLY UNDERUTILIZED BUSINESS CERTIFICATION
A proposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women Business
Enterprise or "MWBE" and all referred tp in this form as a"HUB") is encour�ged to indicate its HUB certification status
when responding to this Proposal Invitation. The electronic catalogs will indicate HUB certifications for vendors that
properly indicate and document their HUB certification on this forrr�.
Please check (�) all that a�plv:
❑ I certify that my company has been certified as a HUB in the following categories:
❑ Minority Owned Business
❑ Women Owned Business
❑ Service-Disabled Veteran Owned Business (veteran defined by 38 U.S.C. §101(2), who has a
service-connected disability as defined by 38 U.S.C. § 101(16), and who has a disability rating
of 2D% or more as determined by the U. S. Department of Veterans AfFairs or Department of
Defense)
Certification Number:
Name of Certifying Agency:
0 Niy company has NOT been certified as a HUB.
By signature belaw, I certify that the above is true, complete and accurate and that I am authorized by my
company to make this certification.
Delta Industrial Service & Supply
Company Name
Eric Currie
Printed Name
Signature of A�thori
pany Official
Page 16 of 69
Proposal Forms COMMJSVCS v.01.12.2018
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
CONSTRUCTION-RELATED GOODS AND SERVICES AFFIRMATION
A contract awarded under this Proposal Invitation covers only the specifiic goods and services awarded by the BuyBoard. As
explained in the BuyBoard Pracurement and Construction Related Goods and Services Advisory for Texas Members
("Advisory"), Texas law prohibits the procurement of architecture or engineering services through a
purchasing cooperative. This BuyBoard contract does not include such services. Architecture or engineering
services must be procured by a Cooperative member separately, in accordance with the Professional
Services Procurement Act (Chapter 2254 of the Texas Government Code} and other applicable law and local
pol icy.
The Advisory, available at buybaard.com/Vendor/Resaurces.aspx, provides an overview of certain legal requirements that
are potentially relevant to a Cooperative member's procuremen� of construction or construction-related goods and services,
including those for projects that may involve or require architecture, engineering or independent testing services. A copy
ofi' the Advisory can also be provided upon request.
By signature below, the undersigned affirms that Proposer has obtained a copy of the Advisory, has read and understands
the Advisory, and is authorized by Proposer to rr�ake this affirmation. If Proposer sells construction-related goods or
services to a Cooperative member under a BuyBoard contract awarded under this Praposal Invitation, Proposer will comply
with the Advisory and applicable legal requirements, make a good faith effort to make its Cooperat€ve member customers
or potential Cooperative member customers aware of such requirernents, and provide a Cooperative member with a copy
of the Acivisory before executing a Member Construction Cnntract with the member or accepting the member's purchase
order for ConStruCtion-related goqd5 or 5erviCes, whiChever Comes firSt.
Delta Industrial Service & Supply
Company Name
Eric Currie
Signature o .i-z�dCompany Official Printed Name
May 23, 2018
Date
Page 17 of 69
Proposal Forms COMM/SVCS v.01.12.Z018
� Board �
Cooperative Purchasinq
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
DEVIATION AND COMPLIANCE
If your company intends to deviate from the General Terms and Conditions, Proposal Specifications or other requirements
associated with this Proposal Invitation, you MUST list all such deviations on this form, and provide complete and detailed
information regarding the deviations on this form or an attachment to this form. The Caoperative will consider any
deviations in its contract award decision, and reserves the right to accept or reject a proposal based upon any submitted
deviation.
In the absence of any deviation identified and described in accordance with the above, your company must fully comply
with the General Terms and Conditions, Proposal Specifications and all other requirements associated with this Proposal
Invitation if awarded a contract under this Pr4posal Invitation. A deviation will not be effective unless accepted by the
Cooperative. The Cooperative may, in its sole discretion, seelc clarification from and/or communicate with Proposer(s)
regarding any submitted deviation, consistent with general procurement principles of fair competition. The Cooperative
reserves the right to accept or reject a proposal based upan any submitted deviation.
Please check (�/) one of the followinp:
❑■ NO; Deviations
❑ Yes; Deviations
List and fully explain any deviations you are submitting:
PLEASE PROVIDE THE FOLLOWING INFORMATION:
1. Shipping Via: ❑ Gommon Carrier ❑ Gompany Truck ❑■ Prepaid and Add to Invoice ❑ Other:
Z. Paym�nt Terms: ■❑ Net 30 days ❑ 1% in 10/Net 30 days ❑ Other:
3. Number of Days for Delivery: 60-120 ARO
4. Vendor Reference/Quote Number:
5. St�te your return �or�y: No Retu rns
6. Are electronic payments acceptable? ❑■ Yes ❑ No
7. Are credit card payments acceptable? ❑Yes ❑■ No
Delta Industrial Service & Supply
Company Name
c -/
Signature of Authorized Company Official
Eric Currie
Printed iVarne
Page 18 of 69
Proposal Forms COMM/SVCS v.01.12.2018
� Board �
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
TEXAS REGIONAL SERVICE DESIGNATION
The Cooperative {referred to as "Texas Cnoperative" in this Porrri and in the State Service Designation fnrm) offers vendors
the opportunity to service its members throughout the entire State of Texas. If you do no� plan to service all Texas
Caoperative members statewide, you must indicate the specific regions you will service on this form. If you propose to
serve different regions for different products or services inc/uded in your p�oposa/, you must comp/ete and
su6mit a separate Texas Reyiona/ Service Designation form for each group of products and c%ar/y indicate
the products or services to which the designation app/ies in the space provided at the end of this form. By
designating a region or regions, you are certifying that yau are authorized and wi//ing to provide the
proposed products and services in thase regions. Designating regions in which you are either unad/e or
unwi//ing to provide the specified praducts and services sha// 6e g�aunds for either �ejectian of your
proposa/ or, if awarded, termination of your Contract. Additionally, if you do not plan to service Texas Cooperative
members (i.e., if you will service only states other than Texas), you must so indicate on this form.
Regional Education Ser�ice Centers
0 I will service Texas
Cooperative members
statewide.
❑ I will not service Texas
Cooperative members
statewide. I will only
service members in the
regions checked below:
Company Name
Signature of Au horized Company Official
Eric Currie
Printed Name
a
❑
❑
❑
❑
❑
❑
❑
❑
❑
a
❑
a
❑
❑
❑
❑
0
❑
❑
Repion
1
2
3
4
5
6
7
8
4
10
11
1Z
13
14
15
1b
17
18
19
20
Headauarters
Edinburg
Corpus Christi
Victoria
Houston
Beaumont
Huntsville
Kilgore
Mount Pleasant
Wichita Falls
Richardso�
Fort Worth
Waco
Austi n
Abilene
San Angelo
Ama ri I lo
Lubbock
Midland
EI Paso
San Antonio
❑ I will not service members
of the Texas Cooperati�e.
Page Zl of 69
Proposal Forms COMM/SVCS v.01.1Z.2018
-,:°;- - '
Delta Industria[ Service & Supply
� Board�
Cooperative Purchasinq
12007 Research Boulevard • Austin, Texas 78759-2439 • PN: 800-695-2919 • buvboard.com
This form will be used to ensure �hat you cen service other governmental entities throughout the United States as
indicated. Your signature below confirms that you understand your service commitments during the terrn of a
contract awarded under this proposal.
Delta Industrial Service & Supply
Company Name
��/ Eric Currie
Signature of Au orized Company Official Printed Name
If this State Service Designation form applies to only one or some of the products and services proposed by Vendor,
list the products and services to which this form applies here:
Page Z4 of 69
Proposal Forms COMM/SVCS v.01.1Z.2018
� Board�
Caoperaiive Purchasing
12007 Research Boulevard • Austin, Texas 78759-Z439 • PH: 800-695-2919 • buyboard.com
NATIONAL PURCHASING COOPERATIVE VENDOR AWARD AGREEMENT
In accordance with the Terms and Conditions associated with this Proposal Invitatinn, a contract awarded under this
Propos�l Invitetion may be ��p€ggy-backed" by enother government�l entity. The National Purchasing Cooperative is �n
intergovernmental purchasing cooperative formed by certain school districts outside of Texas to serve its members
throughout the United States. If you agree to be considered for a piggy-bacic award by the National Purchasing
Cooperative, you agree to the following terms and agree to serve National Purchasing Cooperative members in the states
you have indicated on the State Service Designation form, in your Proposal.
By signing this form, Proposer (referred to in this Agreement as "Vendor") agrees as follows:
1. Vendor acknowledges that if The Local Government Purchasing Cooperative ("Texas Cooperative") awards Vendor a
contract under this Proposal Invitation ("Underlying Award"), the National Purchasing Cooperative ("National Cooperative"}
may - but is not required ta -"piggy-back" on or re-award all or a portion of that Underlying Award ("Piggy-Back Award").
By signing th€s National Cooperative Vendor Award Agreement ("Agreement"), Vendor accepts and agrees to be bound by
any such Piggy-Sack Award as provided for herein.
2. In the event National Cooperative awards Vendor a Piggy-Back Award, the National Cooperative Administrator
("BuyBoard Administrator") will notify Vendor in writing of such Piggy-Bacic Award, which award shall commence on the
effective date stateci in the Notice and end on the expiration date of the Underlying Award, subject to annual renewals as
authorized in writing by the BuyBoard Administrator. Vendor agrees that no further signature or other action is required of
Vendor in order for the Piggy-Back Award and this Agreement to be binding upon Vendor. Vendor further agrees that no
interlineations or changes to this Agreement by Vendor wili be binding on National Cooperative, unless such changes are
agreed to by its BuyBoard Administratar in writing.
3. Vendor agrees that it shall ofFer its goods and services to National Cooperative members at the same unit pricing and
same general terms and conditions, subject to applicable state laws in the state of purchase, as required by the Underlying
Award. However, nothing in this Agreement prevents Vendor frorn offering National Cooperative members better (i.e.,
lower) competitive pricing and more favorable terms and conditions than those in the Underlying Award.
4. Vendor hereby agrees and confirms that it will serve those states it has designated on the State Service Designation
Form of this Proposal Invitation. Any changes to the states designated on the State Service Designation Form must be
approved in writing by the BuyBoard Administrator.
5. Vendor agrees to pay National Cooperative the service fee provided for in the Underlying Award based on the amount of
purchases generated from National Cooperative members through the Piggy-Back Award. Vendor shall remit payrnent to
National Cooperative on such schedule as it specifies (which shall not be more often than monthly). Further, upon
request, Vendor shall provide National Cooperative with copies of all purchase orders generated from National Cooperative
members for purposes of reviewing and verifying purchase activity. Vencior further agrees that National Cooperative shall
have the right, upon reasonable written notice, to review Vendor's records pertaining to purchases made by Na�ional
Cooperative members in order to verify the accuracy of service fees.
6. Vendor agrees that the Underlying Award, including its General Terms and Conditions, are adopted by reference to the
fullest extent such provisions can reasonably apply to the post-proposal/contract award phase. The rights and
responsibilities that would ordinarily inure ta the Texas Caoperative pursuant to the Underlying Award shall inure to
National Cooperative; and, conversely, the rights and responsibilities that would ordinarily inure to Vendor in the Underlying
Award shall inure to Vendor in this Agreement. Vendor recognizes and agrees that Vendor and National Cooperative are the
only parties to this Agreement, and that nothing in this Agreement has application to other third parties, including the
Texas Cooperative. In the event of conflict between this Agreerr�ent and the terms of the iJnderlying Award, the terms of
this Agreement shall control, and then only to the extent necessary to reconcile the conflict.
Proposal Forms COMM/SVCS v.0i.12.2018
Paqe 25 of 69
� Board�
Coaperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
7. This Agreement shall be gaverned and construed in accordance with the laws of the State of Rhode Island and venue
for any dispute shali lie in the federal district court of Alexandria, Virginia.
8. Vendor acknowledges and agrees that the award of a Piggy-Back Award is within the sole discretior� of National
Cooperative, and that this Agreerr�ent does not take effect unless and until National Cooperative awards Vendor a Piggy-
B�Ck Aw�rd and khe BuyBo�rd Admini5kr�tpr notifies Vendor in writing of suth Piggy-B�Ck Aw�rd �s provided for herein.
WHEREFORE, by signing below Vendor agrees to the foregoing and warrants that it has the authority to enter into this
Agreement.
Delta Industrial Service & Supply
Name of Vendor
�/
5ignature uthorized Compariy Official
578-18
Proposal Invitation Number
Eric Currie
Printed Name of Authorized Company Offic€al
May 23, 2018
Date
Proposal Forms COMM/SVCS v.O1.1Z.2018
Page Z6 oF 69
� Board �'
Coaperative Purchasing
1Z007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
FEDERALAND SYATE/PURCHASING COOPERATNE EXPERIENCE
The Cooperative strives to provide its members with the best services and products at the best prices available from
vendars with the technical resources and ability to serve Coaperative members. Please respond to the following questions.
Provide the dallar value of sales to or through purchasing cooperatives at or based on an established catalog or
market price during the previous 12-month period or the last fiscal year: $ .(The p�riod of the 12
month period is / ). In the event that a dollar value is not an appropriate measure of the sales,
provide and describe your own measure of the sales of the item(s).
2. By submitting a proposal, you agree that, based on your written discounting policies, the discounts you offer the
Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items
under equivalent circumstances.
3. Provide the information requested below for other purchasing cooperatives for which Proposer currently serves, or in
the past has served, as an awarded vendor. Rows should be added to aceommodate as many purchasing
cooperatives as required.
�• ��• •� �
��• • •�
•• ��• •�
1. Federal General Services Administration
2. T-PASS (State of Texas)
3. �J.S. Communities Purchasing Alliance
4. National IPA/TCPN
5. Houston-Galveston Area Council (H�ac} Y
Emeyenc� Preparedness &Safety Equipment EP I'I-1�
6. National Joint Powers Alliance (NJPA)
7. E&I Cooperative
8. The Interlocal Purchasing System (TIPS)
9. Other
❑ MY COMPANY DOES NOT CURRENTLY HAVE ANY OF THE ABOVE OR SIMILAR TYPE CONTRACTS.
CURRENT BUYBOARD VENDORS
If you are a current BuyBoard vendor in the same contract category as proposed in this Proposal Invitation, indicate the
discount for your current BuyBoard contract and the proposed discount in this Proposal. Explain any difference between
your current and proposed discounts.
Current Discount (%): Proposed Discount (%):
Explanation :
Proposal Forms COMM/SVCS v.0i.12.2018
Page Z7 of 69
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PN: 800-695-2919 • buvboard.com
By signature below, I certify that the above is true, complete and accurate and that I am authorized by my company to
maKe this certification.
Delta Industrial Service & Supply
Company Narne
G� Eric Currie
SI�f1BtUE'e nf Ai ithnri�arl C'r�mnanv OffICIdI Printed Name
Proposal Forms COMM/SVCS v.01.12.2018
Page 28 of 69
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PN: 80Q-695-2919 • buvboard.com
GOVERNMENTAL REFERENCES
For yaur Proposal tn be considered, you must supply a minimum of five (5) individual governmental entity references. The
Cooperative may contact any and all references provided as part of the Proposal evaluation. Provide the information
requested below, including the existing price/discounts you ofFer each customer. The Cooperative may determine whether
prices/discounts are fair and reasonable by comparing prices/discounts stated in your Proposal with the prices/discounts
you offer other governmental customers. Attach additional pages if necessary.
Quantity/
Entitv Name Contact Phone# Email Address Discount Volume
1. CyFair VFD Eliu Hernandez 281-541-8989 EIiu.Hernandez@cyfairvfd.org
Z. Spring FD Keith Tapper 281-951-7013 keith.topper@springfd.org
3. Harris County ESD 48 Lou Fabricant 281-578-2518 lou.fabricant@hcesd48.org
4. Nederland Fire Dept. Terry Morton 409-723-1535 tmorton@ci.nederland.tx.us
5. Wylie Fire Dept Andrew Johnson 972-429-8072 andrew.johnson@wylietexas.gov
Do you ever modify your written policies or standard governmental sales practices as identified in the above chart to give
better discounts (lower prices} than indicated? YES ❑ NO ■❑ If YES, please explain:
By signature below, I certify that the above is true and correct and that I am authorized by my company to make this
certification.
Delta Industrial Service & Supply
Company Name
��'/ . _�
C� �
Signature af Authorized Company Official
Eric Currie
Printed Name
Proposal Forms COMM/SVCS v.O1.1Z.2018
Page 29 of 69
� Board�
Cauperative Purchasirtg
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com
MARKETING STRATEGY
For your Proposal to be considered, you must submit the Marketing Strategy you will use if the Cooperative accepts all or
part of your Proposal. (Examp/e: Exp/ain hoyv your company wrl/ initia//y inform Cooperative mem6ers of your BuyBoard
contract, and how you wil/ continue to support the BuyBoard for the duration of the contract period.)
Attach additional pages if necessary.
Our company will market the Buyboard program to current and po�ential members.
We plan to advertise the buyboard logo on our website and Facebook page. We
also plan to advertise at tradeshows we attend {with approval by Buyboard)
Delta Industrial Service & Supply
Company Narne
�
Signature of Autharized Company �fficial
Eric Currie
Printed Name
Proposal Forms COMM/SVCS v.01.12.2018
Page 30 of 69
� Board�
Caoperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PM: 800-695-2919 • buyboard.com
CUNFIDENTIAL/ PROPRIETARY INFORMATION
A. Public Disclosure Laws
All Proposals, forms, documentation, or other materials submitted by Vendor to the Cooperative in response to this
Proposal Invitatian, including catalags and pricelists, may be subject to the disclosure requirements of the Texas Public
Information Act (Texas Government Code chapter 552A01, et. seq.) or similar disclosure law. Proposer must clearly
identify on this form any infprmatipn in its Prpposal (including form5, documentation, or pther m�terials submitked wikh the
Proposal) that Proposer considers proprietary or confidential. If Proposer fails to properly identify the infarmation, the
Cooperative 5hall have no obligation to notify Vendor or seek protection of su�h information from publiC di5closure should a
member of the public or other third party request access to the information ur�der the Texas Public Information Act or
similar disclosure law. Propaser will be notified of any third party request for information in a Proposal that Proposer has
identified in this form as proprietary or confidential.
Does your Proposal (inclucfing forms, documentation, or other materials submitted with the Proposal) contain information
which Vendar considers proprietary or confidential?
Please check [,/] one af the followinp;
� NO, I certify that none of the information included with this Proposal is considered confidential or proprietary.
� YES, I certify that this Proposal contains information considered confidential or proprietary and all such information is
specifically identified on this form.
If you responded "YES", you must identify below the specific information you consider confidential or proprietary. List each
page number, form number, or other information sufficient to make the information readily identifiable. The Cooperative
and its Administrator will not be respo�sible for a Proposer's failure to clearly identify inforrnatian considered confidential or
proprietary. Further, by suf�mitting a Proposal, Prnposer acknowledges that the Cooperative and its Administrator will
disclose information when required by law, even if such information has been identified herein as information the vendor
considers confidential or proprietary.
Confidential / Proprietary Information:
(Attach additional sheets if needed.)
Proposal Forms COMM/SVCS v.0i.12.2018
Page 31 oF 69
� Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 80Q-695-2919 • buvboard.com
B. Copvriqht Information
�oes your Proposal (including forms, documentation, or other materials submitted with the Proposal) contain copyright
information?
� NO� Proposal (including forms, documentation, or other materials submitted with the Proposal) does not
contain copyright information.
❑� YES, Proposal (induding forms, documentation, or other materials submitted with khe Proposal} does
contain copyright information.
If you responded "YES", identify below the specific documents or pages containing copyright information.
copyr�gnt I�format�o�; Sealegs Price List - all photographs and text are copyright of Sealegs
(Attach additional sheets if needed.)
C. Consent to Release Confidential/Proprietary/Copyright Information to BuyBoard Members
BuyBoard merr�bers (Cooperative and nonprofit members) seeking to make purchases through the BuyBoard may wish to
view information included in the Proposals of awarded Vendors. If you identified information on this form as confidential,
proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contract
award constitutes your consent to the disclosure of such information to BuyBoard members, including posting of such
information on the secure BuyBoard website for members. Nate: Neither the Cooperative nor its Administrator wil! be
responsible for the use or distribution of information by BuyBoard members or any other party.
D. Consent to Release Propasal Tabulation
Notwithstandir�g anything in this Confidential/Proprietary Information form ta the contrary, by submitting a Proposal,
Vendor consents and agrees that, upon Contract award, the Cooperative may publically release, including posting on the
public BuyBoard website, a copy of the proposal tabulation for the Contract including Vendor name; proposed
catalog/pricelist name(s); proposed percentage discount(s), hourly labor rate{s), or other specified pricing; and Vendor
award or non-award information.
By signature below, I certify that the information in this form is true, complete, and accurate and that I am authorized by
my company to make this certification and ail consents and agreernents contained herein.
Delta Industrial Service & Supply
Company Name
�
Signature �f Auth�rized Cor�pany Official
Eric Currie
Printed Name
May 23, 2018
Date
Proposal Forms COMM/SVCS v.01.12.2018
Page 32 of 69
� Board �
Caoperative Purchasing
12007 Research Boulevard • Austin, 7exas 78759-2439 • PH: 800-695-Z919 • buvboarcf.com
VENDOR BUSINESS NAME
By submitting a Proposal, Proposer is seeking to enter into a legal cantract with the Cooperative. As such, a Proposer must
be an individual or legal business entity capable of entering into a binding contract. Proposers, must completely and
accurately provide the information requested belnw or your Proposal may be deemed n�n-responsive.
Name of Proposing Company: JETS Fire & Safety
(List the /eaa/ name of the company seeking to contract with the Cooperative. Do NOT list an assumed name, d6a, aka, etc. here. Such information may
be provrded 6e%w, If yau are submitting a joint proposa/ with another entity to prouide the same proposed goods or services, each submitting entr£y
shou/d comp/ete a separaie vendo� information form. Separate/y operating legal business entitres, even rf affiliated entities, which propose to provrde
gaods or services separatety must su6mit their own Proposals )
Please check (�} one of the followinq:
Tvne of Business:
Individual/Sole Proprietor
Corporatian X
Limited Liability Company
Partnership
Other If other, identify
State of Incorporation (if applica6le): TeXaS
Federal Employer ldentification Number: 76-0696202
(I/ertdor must inc/ude a cpmp/eted IRS W-9 form with their proppsa/)
List the Name(s) by which Vendor, if awarded, wishes to be itlentified on the BuySoard: (Nore: rf d;fferent than the Name of
Proposrng Company listed a6ove, on/y va/rd trade names (dba, aka, etc.) of the Proposmg Company may be used and a copy of your Assumed Name
Certificate(sJ, if app/icab/e, must 6e attached.)
Delta Industrial Service & Supply
Proposal Forms COMM/SVCS v.01.12.2018
Page 33 of 69
Form ���
(Rev. November2017)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer Give Form to the
Identification Number and Certification requester. Do not
send to the IRS.
► Go to
for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not
Jets Fire & Safety
ness name/disregarded entity name, if different from above
Delta Industrial Service & Supply
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3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
following seven boxes. certain entities, not individuals; see
ry instructions on page 3):
❑ Individual/sole proprietor or L� C Corporation ❑ S Coryoration ❑ Partnership ❑ TrusVestate
single-member LLC Exempt payee code (if any)
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner. �
U Other (see instructions) ►
5 Address (number, street, and apt. or suite no.) See instructions.
3159 Summit Drive
6 City, state, and ZIP code
Port Neches, TX 77651
7 List account number(s) here (optiona�
(Applles to accounfs malnfafned outslde fhe U.S.)
Requester's name and address
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid � Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a �- m -�
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later. or
Note: If the account is in more than one name, see the instructions for line i. Also see What Name and Employer �dentification number
NumberTo Give the Requesterfor guidelines on whose number to enter.
7 6 - 0 6 9 6 2 0 2
� Certification
Under penalties of perjury, 1 certify that:
�. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the lnternal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has no#ified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generalfy, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign Signawre of
Here U.S.person►
�ate► 04/17/2018
General Instructions
Section references are to the Intemal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (fIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third parry network transactions)
• Form 1098 (home mortgage interest), �098-E (student loan interest),
1098-T (tuition)
• Form '1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
lf you do not return Form W-9 to the requester with a TIN, you might
be subject to backup wifhholding. See What is backup withholding,
late�.
Cat. No. 1023�X Form W-9 (Rev. 77-20�7)
� aBQ�1'd�
Caaperative PurChasing
120Q7 Research Baule�ard • Auskin, Texas 78759-2439 • PH: BOQ-695-2919 • buyboard.Com
EDGAR VENDOR �ERTIFICATI�N
(2 CFR Part 20D and Appendix II)
When a Cvoperati�e member seeks ta procure goods and services using funds under a federal grant vr contract, specific
federal laws, regulations, and requirements may apply in additian ta those under state law. This includes, buC is not limited
ta, the procurement standards of the Uniform Adrninistrative Requirernents, Cost Principles and Audit Requirements for
Fed�ral Awards, 2 CFR Z�fl (sometimes referred to as the "iJnifarm Guidance" or new "EDGAR"). All Vendars subrnitting
proposals must complete this EDGAR Certification Farm regarding Vendor's willingness and ability to comply with cer�ain
requirements which m�y be applicable to spe�ific Cooperative mem�er purchases using �ederal grant funds. This
corrspleted forrn will be made a�ailable to Cooperati�e members far their use while considering their purchasing options
when using federal grant funds. Cooperati�e mernbers may alsv req�ire Vendors ta enter into ancillary agreements, in
additian to the BuySoard contract's general terms and cvnditions, to address the mernber's specific �ontractual needs,
includ'€ng contract requirements for a procurement using federal gran�.5 or eontracts.
For each of the items below, Vendor should certify Vendor`s agreement and a6ility to comply, where
applica6le, 6y having Vendar's authorized representative complete and initial the applicable 6oxes and sign
the acknowled�ment at the end of this form. If you fail to complete any item in this form, the Cooperative
wi11 consider and may Iist the 1/endor's response on the BuyBaard as "N�,'� the Vendar is una6le ar unwilling
ta comply. A"NQ" response ta any of the ikems rr:ay, if �pplie�ble� irnpact the ability of a Caoperative member ta
purchase from ti�e Vendor using federal funas.
1. Vendor Vialation ar Breach of Cantract Terms:
Contracts for more than the simplified acquisitian threshold currently set at $150,fl00, which is the inflation adjusted
am��nt determined hy the Ci�ilian Agency Acquisitian Council and the Defense Acquisiki�n Regulations Couneil (Councils}
as authorized by 41 U5C 1908, m�ast address administrati�e, contractual, or legal remedies in instances where contractars
�i�late or breach cor�tract terms, ar�d pra�ide for such sanctions and penalties as appropriate.
Provisions regarding Vendor default are includec� in the BuyBoard General Terms and Canditions, ir�cluding Section E.18,
Rernedies for Default and Termir�ation af Contract As�y Cantract award will be subject to such BuyBaard General Terms
and Conditians, as well as any addi�ional terms and conditions in any Purchase �rder, Caaperati�e member ancillary
contract, ar Member Construction Conkract agreed upon by Vendor ar�d the Cooperati�e member which must be consistent
with and protect the Coaperati�e member at least to the same extent as the BuyBoard Terms and Conditians.
The remedies under the Contract are in addition to any other remedies that may be a�ailable under law or in equity. By
subrr3itting � Proposal, you agree to the5e Vend�r viol�tion and breach pf contract terms.
2. Terminatian for Cause ar Con�enience:
For �ny Caaperati�e member purchase or contract in �xC�55 Df �1Q,OflQ made using federal funds, you agree th�t the
following term ar�d condition shall apply:
The Cooperatiue mem6er may terminate ar cancel any purchase order under this Contract at any time, with or �+rithouf
cause, 6y providing seven (7J 6usiness days aduance written notice to the l�endar. If this Agreement is terminated m
�cc�rdanCe uvith thi5 Paragraph, the Cooperative mem6er shall only 6e required to p�y l/endor for goods or serviCes
delivered to the Cooperative mem6er priar to the termination and not �therwise returned in accardance �ith l/endor's
return policy, If the Cooperative mem6er has pard I/endor for goods or services nat yet provided as af the date of
iermination, l/endar shall immediately refund such payment(sJ.
If an alternate pr��isidn for termination of a Coaperati�e member purchase for cause and con�enience, including the
manner by which it will be effecked and the basis for setklement, is included in the Cooperati�e mem�er's purchase order,
ancillary agreement, or Memi�er Construction Contract agreed to by the Vendor, the Cooperati�e member's pro�ision shall
�o ntral .
Proposal Forms COMM/SVCS v,0i,12,2018
Page 34 oP 59
s �B���d �
C�operative Purchasing
12pp7 ResearCh B�ule�ard ' Auskin, TExas 78759-2�39 • PE�: 8Q�-695-2919 ' buyboard.com
3. Equal Employment Upportunity:
Except as atherwise pro�icied under 41 CFR Part 50, all Caoperati�e member purchases ar contracts that meet the
definition of "federally assisted canstructian contract" in 4i CFR Part 60-1.3 shall be deemed ta include the equal
opportunity clause pra�ided under 41 CFR 60-1.4(b}, in accordance with Executi�e Order 11245, "Equal Ernployment
�pportunity" (3Q FR 12319, 12935, 3 CFR Part, 1964-19b5 Camp., p. 339), as amended by Executi�e Order 11375,
"Amending Executi�e �rder 11246 Relating to Equal Employrnent Dpportunity," and implementing regulations at 41 CFR
Part bQ, "�ffice of Federal Conkra�t Compli�n�e Progr�ms, Equal Employment Dpportunity, Department of L�bor."
The equal opportunity clause pro�ided under 41 CFR 50-1.4(b} is hereby incorparated by reference. Vendor agrees that
such provisior� �pplies ta �ny Cooper�ti�e mernber purch�se or Contract kh�t meets the definition of "feder�lly �ssisted
construction cantract" in 41 CFR Part 5D-1.3 and Vendor aarees that it shalf cornol� with such ❑ravision.
4. Da�is-Bacan Act:
When r�quireci by Federal program legislation, Vendor agrees that, for all Cooperati�e member prime construction
contracts�purchases in exeess of �2,040, Vendor shall comply with the Da�is-Bacon Ac'� {40 U5C 3141-3144, and 3146-
3148) as supplemented by Depa�ment of Labor regulations (29 CFR Part 5, "Labar Standards Pro�isions Applicable to
Contracts Co��ring Federafiy Financed and Assisteci Canstructian"). In accordance with the statute, Vendar is required to
pay wages to lahorers and mechanics at a rate not less than the pre�ailing wages specifiied in a wage determinate made hy
the Secretary of Labor. In addition, Vendar shail pay wages nat less tha� ance a week.
Current pre�ailing wage determinatians issued by the beparkment af Lat�or are available at wdol.go�. Vendar agrees that,
for any purchase to which this requirement applies, the award of the purchase tfl the Vendor is conditioned upon Vendor's
acceptance of the wage determination.
Vendar further agrees that it shall also camply with the Copeland '�Anti-Kickback" Act (4Q L15C 3145), as supplemented t�y
Departrnent of Labor regulatians (29 CFR Part 3, "Cantractors and Subcontrattors on Public 8uilding or Public Work
Financed in Whole or in Part by Loans or Grants from the United SCates"). The Act provides that each contractor or
subrecipient must be prohibited fram inducing� by any means, any person employed in the cvnstruction, completion, or
repair of publsC work, to gi�e up �ny p�rt of the Compens�ti0n ta whiCh he or She is ptherwise entitled.
5. Contract Work Haurs and Safety Stanciards Act:
Where applicable, for all Coaperative member contra�t5 or purchase5 in ex�e55 of $100,DOQ that in�ol�e the employment of
mechanics or labarers, Vendor agrees to comply with 4� L15C 3702 and 3704, as supplementeci hy Department of Labor
regulations {Z9 CFR Part 5). Llnder 40 USC 370Z of the Act, Vendor is required to compute the wages of e�ery mechanic
�nd I�borer on the b�sis of � st�nd�rd wprk week pf 40 hours. Work in ex�ess of the st�nd�rd work week is permissible
pro�icfed that the worker is eompensated at a rate of not less than one and a half kimes the basic rate of pay for all haurs
worked in excess of 40 hours in the work week. The requirements of 40 U5C 3704 are applicable to canstruction wark and
pro�ide that na laborer ar mechanic must be required to wark in surroundings ar under working conditians which are
unsanitary, hazardous ar c4angerous. These requirements do nflt apply to the purchases of supplies or rr�aterials or articles
ordinarily a�aila�le on the apen market, ar corstracts far �ransportatian or transmissifln of intelligence.
6. Right to In�entians Made Under a Cantract or Agreement:
If the Cooperati�e member's Federal award meets the defin�tion of "funding agreement" under 37 CFR 4p1.2(a} and the
recipient or subrecipient wishes to enter into a contract with a small business firm ar nanprofit organization regarding the
substitution of parties, assignment or performance �r experimental, de�elapmental, or research work under �hat "funding
agreement," the recipienC or subrecipient must carr�ply wi�h the requirements of 37 CFR ParC 4D1, "Rights to In�entions
Made t�y NonprofiY Organizations and 5mall 6usiness Firms Under Ga�ernment Grants, Contra�ts and Coaperati�e
Agreements," and any implementing regulations issued by the awarding agency.
Vendor agrees to camply with the abo�e requirements when applicable.
Proposal Forms COMM�SVCS �.01.12.2018
Page 35 of 59
� Board �
C�uper�tive PurChasing
12a07 ResearCh B4ule�ard ' Austin, Texas 78759-2439 • PFi: 80Q-695-2919 ' buvbQard.Corn
7. Clean Air Act and Federal Water Pollution Control Act:
Clean Air Act (42 U5C 7401-7b71q.) anri the Federal Water Pallution Control Act (33 USC 1251-�387), as amended —
Contracts and subgrants of amaunts in excess af $f50,f304 must contain a pro�isian that requires the non-Federal award to
agree to comply with all applicat�le standards, orders, or regulations issued pursuant to the Clean Air Act (4� L15C 7401-
7671q.} and the Federal Water Poilutian Control Act, as amended (33 USC 125i-1387). Violatians must be reported to the
Federal awarding agency and the Regional OfFice of the En�iranmental Protection Agency (EPA).
When required, Vendor agrees to comply with a!I applicable standards, orders, or regulations issued pursuant to the Clean
Air Act and the Federal Water Pal[ution Cantrol Act.
8. Debarment and Suspensian:
Debarmen� and 5uspensivn (Executive �rders 1Z549 and 1�689] — A contract award (see 2 CFR 18a.224) must nat be
made ta parties listed an the go�ernment-wide exclusions in the System far Award Management (SAM}, in accordance with
the OMB guidelines at Z CFR 180 that impl�ment Executi�e �rders 1�549 (3 CFR Part 1965 Comp. p. 189) and �Z689 (3
CFR Part 1989 Comp. p. �35}, "Debarment and Suspensi�n." 5AM Exclusians cantains the names of parties debarred,
suspended, ar otherwise exeluded by agencies, as well as par-ties declared ineligible under statutory or regulatory authority
ather than Executive Order 1Z549.
Vendar certifies that Vendor is not currently listed on the go�ernrryent-wide exclusions in SAM, is nat debarred, suspended,
or otherwise exclucied by agencies or cieclared ineligible uncEer statutory or regulatory authority ather than Executi�e �rder
12549. Vendar furkher agrees to immediately notify the Cooperati�e and all Cooperati�e members with pending purchases
or seeking to purchase from Vendar if Venelor is later listed an the go�ernment-wide exclusions in SAM, or is debarred,
suspended, ar otherwise excluded f�y agencies or declared ineligible under statutory or regulatary authority ather than
ExeCuti�e Qrder 12549.
9. Byrd Anti-Lohhying Amendment:
Byrd Anti-Lobbying Amendment {31 I�SC 1352) -- Vendors that apply or bid for an award exceeding $1�O,Oaa must file the
required certificatian. Each tier certifies to the tier abo�e that it will not and has not used Federal apprapriated funds to
p�y �ny per5on or org�niz�tian for influencing or �ttempting to influenCe �n offiCer or err�pl�yee of �ny �genCy, a member
of Congress, �fficer ar emplayee af Congress, or an emplQyee af a member of Congress in connection with obtaining any
Federal contract, grant or any other award co�ered by 3f USC 1352. Each tier �-nust also disclose any lobbying with non-
Feder�l funds th�t t�kes plate in tonnection with obt�ining �ny Fecieral award. Such disclosures are forwarded from tier to
tier up to the non-Federal award. As applicable, Ves�dor agrees to file all certifications and disclasures req�aired by, and
vtherwise comply with, the Byrd Anti-Labbying Arnendment (31 USC 1352).
10. Pracurement af Reca�ered Materials:
For Cooperati�e member purchases utilizing Federal funds, Vendor agrees to comply with 5ection 6002 of the Solid Waste
Dispasal Act, as amer�ded by the Resaurce Conser�ation and Reco�ery Act where applicable and provide s�sch information
and certifications as a Coaperati�e member may require to confirm estimates anci otherwise comply. The requirements of
Section 6D02 include procuring only items designated in guidelines of the En�ironmental Protection Agency (�PA) at 40 CFR
Part 247 that contain the highest percentage of recovered rrtaterials practicable, consistent with main�aining a satisfactory
le�el af competition, where the purchase price of the item exceeds $1d,000 ar the �alue of the quantity acquired during the
prececling fiscal year exceecfed �1a,0�Q; prflc�ring salid waste management ser�ices in a manner that maximizes energy
and resource recovery, �nd eSt�E]lishing an �ffirm�ti�e procurement prDgram For proCurement of reco�ered m�teri�l5
identified in the EPA guidelines.
11, Profit as a Separate Element vf Price;
For purchases usi�g fetferal funds in excess aF $15fl�00D, a Cooperati�e merrsber may be required to negotiate profit as a
separate element of the price. See, � CFR ZdD.323�b). Wher� required by a Cooperati�e member, Vendor agrees to
pro�ide information and negatiate with the Coflperati�e mem6er regarding profit as a separate element of the price for a
particular purchase. Howe�er, Vendor agrees that the total price, including profit, charged by Vendar to the Caaperati�e
mernber shall not exceed the awarded pricing, including any applicable discaunt, under Ver�dor's Cooperati�e Contract.
Proposal Forms COMM�5VC5 v.62.12.2018
Page 3fi of 59
, Y �����
Conperative PurChasirty
120p7 ResearCh B4ulevard ' Austin, Texas 7$759-Z439 • PH: 8�p-595-2919 • buvboard.com
12. General Compliance and Cooperatian with Cooperati�e Members:
In addition to the foregoing specific requirements, Vendor agrees, in accepting any PurGhase Order from a CQoperati�e
member, it shall make a good faith effort to work with Cooperati�e me�nbers to pra�ide such information and to satisfy
5uCh requirements �5 m�y �pply to a p�rtiCul�r Co4perati�e member purCh85e or purch�5es inCluding, but not limited �o,
applicable recordkeeping and re�ard retention requirements.
Vendar Certificatian:
YES, I agree or
Vendor Certification Item No. NO I do NOT a ree Initial
1. Vendo� vialation or Breach of Contract Terms � ES E C
z. Termination for Cause ar Convenience �� E�
3. Equal Employment Oppvrtunity YES EC
�. Da�is-Bacon Act Y E� E�
5. Cvntract Work Haurs and Safety 5tandards Act �E� EC
5. Right Co Inventions Made Under a Contract or Agreement �ES EC
7. Clean Air Act and Federal Water Pollution Control Act �ES E�
8. Debarment and Suspensian �ES EC
9. Byrd Anti-L�bbying Amendment �ES EC
10. Procurement of Reca�ered Materials �ES E�
11. Profit as a Separate Element af Price YES EC
12. General Compliance and Cooperation with Coop�rati�e Members �ES E�
By signature below, I certify that the informatian in this fprm is true, �omplete, and aGturate and that I am authorized by
my company to make this certifi�ation and all cansents and agreements contained herein.
Delta Industrial Ser�ice & Suppfy
Company Name
l� ��
��_
5ignature of Authorized Campany OfFicial
Eric Currie
Printed EVame
Proposal Forms COMM/SVCSv.Of.12.2018
Page 37 of 59
� Baa►�d �
Cooperative Purchasinyr
12Q�7 Research Baule�ard ' Austin, Texas 78759-2439 • PH: 500-695-2914 ' buyboard.com
PROPOSAL INVITATI�N QUESTIONNAIRE
The Cooperati�e wifl use your responses to the questions below in e�aluating your Prvposal and technical and financial
resources to pra�ide the goods and perform the services {"Woric") under the BuyBoard contract con�emplated by this
Proposal In�itation ("Contract"). Proposers must fully answer each question, numb�ring your r�sponses to correspond ta
the questions/numbers below. Proposers must complete below or a�tach your responses to this questionnaire, sign whsere
incficated below, and submit the signed questiannafre and your responses ta all questions in one dotument with your
Proposal. Yau must suhmit the signed questionnaire and responses with your Propasai or the Proposal will
nnt be considered.
1. List the number of years Proposer has been in business and farmer business names (if applicable). Nate whether your
company is currently far sale or invol�ed in any transaction that would significantly alter its business or result in
acquisitian by another entity.
17 years in business
2. Describe the resources Praposer has to manage staff and suecessfully perform the Wark contemplated �nder this
Cantrack. Stake the nurr�ber and summarize khe experienee of campany persannel w�o may be utilized for the Woric,
including those who will b� available �o Cooperati�e members far assistance with project de�elopment, technical issues,
and product selection for Work asso�iated with this Contract.
We have many resvurces to manage our staff and successfully perForm the work contempiated
under this contract. Our customer ser�ice reps and sales reps will be a�ailable to pro�ide
assistance with project de�elopment, technical issues, anci product selection for work associated
with this contract.
3. Describe Rroposer's financial capability to perfarm the Contract. State or describe the firm's financial strength and
rating, bonding capa�ity, and insuran[e �o�erage limits. State whether the firm, or any af the firm's past or �resent
owners, principal sharehalders ar stockholders, or afficers, ha�e been a debtar parry to a bankruptcy, recei�ership, or
insol�ency proceeding in the last 7 years, and identify any such debtor party by name and relationship to or posi�ion
with your firm.
Delta Industrial Ser�ice & Supply is an established business with a great financial
background. VIle ha�e $1 million general liability insurance co�erage. The firm
has ne�er been a debtor for bankruptcy.
Proposal Forms COMM�SVCS v,0i,12,2018
Page 38 of b9
= Board�
Cooperative Purchasirtg
12007 ReSearCh Baule�ard • Austin, Texas 78759-2439 • PH: $pQ-695-2919 • buybvard.com
4. Does your company ha�e any outstanding financial judgments andlor is it currently in default on any Ioan or financing
agreement? If so, pravide detailed infarmation on the nature af such items and prospects for resolution.
No
5. List all contracts, if any, in the last 10 years on which Propaser has defaulted, failed ta complete or deliver the work, or
that have been terminated for ar�y reason. For each such contract, pro�ide the project name, scope, �alue and date
d�d the n�me pf the proCuring entity. Fully expl�in the GirCumst�nCes of khe def�ult, f�ilure to Complete or deli�er khe
work, ar termination.
not applicable
List all litigation ar other legal proceedings (including arbitration proceedings}, if any, in the last 10 years brought
against your firm, or any af the firm's past or present owners, principal shareholders ar stockholders, afficers, agents or
employees, that relates to or arises from a cantract similar to this Contract or the work conternplated under this
Contract. Pro�ide the style af the lawsuit or pro�eeding (name of parties and caurt or tribunal in which filed), nature of
the claim, and resolution or current status.
not applicable.
By signature hetow, I certify that the information contained in and�or attached to this Prapasal Invitatian
Questionnaire in response to the aba�e questions is true and correct and that I am authorized by my
company to make this certificatian.
Defta Industriaf Ser�ice & Supply
Company Name
���
Signature �f : :u�t�o. �ze� Company Official
Proposal Forms COP1MISVCS v.Of.12.2018
Page 34 of 59
� Board �
Cauperative Purchasing
12a�7 Research 8oule�ard ' Austin, Texas 78759-2439 • PFf: 80Q-695-2919 ' buyboard.cam
REQUIRED F�RMS CHECKLIST
(Please check {d} the foliowing)
0 Completed: Proposer`s Agreement and Signatura
0
�
0
0
Campleted: Vendar Cnntact Information
Completed: Felony Canviction Disclosure and De6arment Certificatian
Campleted: Resident�Monresiden# Cer#ification
Completed: Na Israel Boycott Certificatian
0 Campleted: No Excluded Natian ar Foreign Terrorist Organization Certification
0 Campleted: Histarically Underutilized Business (HUB} Certification)
0 Comr�leted: Construction Related Goods and Serrrices Affirmatian
0
❑
❑
0
0
0
�
0
0
0
0
0
0
0
0
Campleted: De�iation�Compfiance
Campleted: Locatian�Autharized Seller Listings
Campleted: Manufacturer Dealer Designation
Comaleted: Texas Regianal Ser�ice Designation
Completed: 5tate Ser�ice Dasignation
Completed: Nationai Purchasing Cooperati�e Vendor Award Agreement
Camaleted: Federal and State/Purchasing Cooperati�e Experience
Campleted: Governmentai References
Campleted: Marketing Strategy
Campleted: ConfidentialJPraprietary Information
Completed: Vendor Business Name with IRS Form W-9
Completed: EDGAR Vendor Certificatian
Completed: Proposal In►►itatian Questionnaire
Completed: Required Forms Checklist
Comt�leted: Proposal Specifica#ion Form with Catalvgs/Pricelists and
Manufacturer Authorization Letters
*Ca[alog5/Pric�lists must 6e su6mitted ivith proposal response or response avi/I not tre mnsider�
Proposal Forms COMM/SVCS �.Oi.iZ.2018
Page 4a of 69
�Board�
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
�`ALL CdLUMNS MUST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERED*
NOTE 1: All fees to be charged for any purchase from this contract with the exceptian of delivery fees (i.e. pre de/ivery inspection, make ready, applicable state
inspection or/icense fee, manufacture� destination fees, etc.) are to be included in the 6ase price(s). Fees not included in the 6ase price(s) will not be allowed.
NOTE 2: An awarded Vendor must be approved 6y the manufacturer to sell, install, and service the 6rand of equipment submitted. Proposers responding to this
Proposal Invitation should submit an approval letter from each manufacturer. Manufacturer authorization letters must include the regions and/or states in which
equipment may be sold.
Section I: Boats
Item State Brand of
No, Short Description Full Description Base Modef Price Boat Manufacturer Options
10 Foot Boat -- 10 Foot Boat, outboard/inboard �Ia
1 10 Foot BoaY propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
11 Foot Boat -- ll Faot Boat, outboard/inboard n/a
Z 11 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
12 Foot Boat -- 12 Foot Boat, outboard/in6oard n/a
3 12 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufadurer's standard equipment.
13 Foot Boat -- 13 Foot Boat, outboard/inboard
4 13 Foat Bwt propulsion, fiberglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
14 Foot Boat — 14 Foot Boat, outboard/inboard
5 14 Faot Boat propulsion, fiberglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 41 of 69
�: f , f
Praposal Invitation No. 578-18 Baats, Traiiers, Marine and Waterway Equipment
"ALL COLUMNS MUST B� COMPLETED OR PROPOSAL WILL NOT BE CONSIQEREt7"
Item State Brand of
No. Short Description Full Description Base Model Price Boat Manufacturer Options
15 Foot Boat -- 15 Fnot Boat, outboarcf/inboard n/a
6 15 Foot Boat propulsion, fiberglass or aluminum, complete witfi all $
manufacturer's standard equipment.
16 Foot Boat -- 16 Foot Boat, outboard/inboard n/a
7 16 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
17 Foot Boat -- 17 Foot Boat, outboard/inboard n/a
8 17 Fppt Boat propulsion, fiberglass pr aluminum, complete with all $
manufacturer's standard equipment.
19 Foot Boat -- 19 Foot Boat, outboard/inbnard
9 19 Foot Boat propulsion, fi6erglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
21 Foot Boat -- 21 Foot Boat, outboard/inboard $99�900 SEALEGS 6_1 m Sport RIB"
10 21 Foot Boat propulsion, fiberglass or aluminum, mmplete with all $104,9f1(l SEALEGS 6_1 m Sport D-Tube "
manufacturer's standard equipment.
22 Foot Boat -- 22 Foot Boat, outboard/in6oard n/a
11 22 Foot Boat propulsion, fiberglass, complete with all $
manufacturer's standard equipment.
23 Foot Boat-- 23 Foot Boat, outboard/inboard 119,900 SEALEGS 7.1m Sport RIB�
12 Z3 Foot 6oat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 4� of 69 �other custom options available.
POA. Same discount applies
�Baard�
Proposal In�itation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
yALL COl UMIVS MUST BE COMPLETEp OR PROPOSAL WILI NOT BE CONSI6ERED'�
Item State Brand of
No. Short Description Full Description Base Model Price Boat Manufacturer Options
24 Foot Boat -- 24 Foot Boat, outboard/inboard
13 24 Foot Boat propulsion, fiberglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
25 Foot Boat -- 25 Foot Boat, outboard/inboard $132,90a SEALEGS 7.7m Sport D-Tube'
14 25 Foot Boat propulsion, fiberglass or aluminum, complete with all $ 134.900 SEALEGS 7.7m Wide Console RIB*
manufacturer's standard equipment. $149,90Q SEALEGS 7.7m Cabin RIB'
26 Foot Boat -- 26 Foot Boat, outboard/inboard n/a
15 26 Foot 6oat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
27 Foot Boat -- 27 Foot Boat, outboard/inbnard n/a
16 27 Foot Boat propulsion, fiberglass nr aluminum, complete with all $
manufacturer's standard equipment.
28 Foot Boat -- 28 Foot Boat, outboard/inboard n/a
17 28 Foot Boat propulsion, fiberglass or aluminum, complete witfi all $
manufacturer's standard equipment.
30 Foot Boat -- 30 Foot Boat, outboard/inboard n/a
18 30 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
32 Foot Boat -- 32 Foot Boat, outboard/inboard n/a
19 32 Foot Boat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted w9th Proposal Page 43 of 69 �other custom options available. POA.
Same discount applies
�Bvard"
ro�„�.�,.
Proposa! Invitation No. 578-f8 Boats, Trailers, Marine and Waterway Equipment
�ALL COLUMNS MUST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERE�"
Item State Brand af
No. Short Description Full Description Base MocEel Price Boat Manufacturer Options
33 Foot Boat -- 33 Fnot Boat, outboard/inboard n/a
2fl 33 Foot Soat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
34 Foot Boat -- 34 Foot Boat, outboard/in6oard n/a
21 34 Foot Soat propulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
35 Foot Boat-- 35 Foot Boat, outboard/inboard 189,0�� SEALEGS 9.flm Hydrasol RIB `
2z 35 Foot Soat propulsion, fiberglass or aluminum, complete with ail $
manufacturer's standard equipment.
36 Foot Boat -- 36 Foot Boat, outboard/inboard
23 36 Foot Boat propulsion, fi6erglass or aluminum, complete with all $ n�a
manufacturer's standard equipment.
37 Foot Boat -- 37 Foot Boat, outboard/inbaard
24 37 Foot Boat propulsion, fiberglass or aluminum, complete witfi a!I $ n�a
manufacturer's standard equipment.
38 Foot Boat -- 38 Faot Boat, outboard/in6oard n/a
25 38 Foot Soat propulsion, Fiberglass or aluminum, complete with a31 $
manufacturer's standard equipment.
40 Foot Boat -- 40 Foot Boat, outboard/inboard
2b 40 Fnot 8oat propulsinn, fiberglass nr aluminum, complete with all $ n�a
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are reguired to be submitted with Proposal Page 44 of 69 *other custom options available.
POA. Same discount applies
�Board�°
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
*ALL COLUMNS MUST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERED*
Item 5tate Brand of
No. Short Description Full Description Base Model Price Boat Manufacturer Options
41 Foot Boat -- 41 Foot Baat, outboard/inboard
Z7 41 Foot Boat prapulsion, fiherglass or aluminum, complete with all � n/a
manufacturer's standard equipment.
44 Foot Boat -- 44 Foot Boat, out6oard/inboard
28 44 Foot Boat propulsion, fiberglass or aluminurr�, complete with all � n/a
manufacturer's standard equipment.
46 Foot Boat -- 46 Foot Boat, outboard/inboard
29 46 Foot Boat propulsion, fiberglass or aluminum, complete with all � n/a
manufacturer's standard equipment.
48 Foot Boat -- 48 FooC Boat, outboard/inboard n/a
30 48 Foot Boat prapulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
52 Foot Boat -- 52 Foot Boat, outboard/inboard
31 52 Foot Boat propulsion, fiberglass or aluminum, complete wifh all � n/a
manufacturer's standard equipment.
54 Foot Boat -- 54 Foot Boat, outboard/inboard
32 54 Foot Boat propulsion, fiberglass or aluminum, complete with all $ nl�
manufacturer's standard equipment.
60 Foot Boat -- 60 Foot Boat, out6oard/inboard n/a
33 5Q Foot Boat prapulsion, fiberglass or aluminum, complete with all $
manufacturer's standard equipment.
PROPOSAL NOTE PROPOSAL SPECIF7CATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal �age as oF 69
�Bvard `
Proposal In�itation Na. 578-18 Baats, Trailers, Marine and Waterway Equipment
*ALL COLUMNS NEElST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERED*
Item
I�o. Short
Fuil Descri
State Brand of
Base Model Price Boat Manufactur
65 Foot Boat -- 65 Foot Boat, outhoard/inboard
34 55 Foot Boat propulsion, fiberglass or aluminurr�, complete with all � n/a
manufacturer's standard equipment.
Boat Motors
State Percent (%)
Item of Discount off State Name of
I�o. Shart Description Full Description Cataloq/Pricekist Cataloq/Pricelist
�iscount (%) Off Please state the discount (%} off catalog/pricel€st for
35 �atalog/Pricelist for Alf All Types Boat Motors and Accessories. �
Typ25 Of BOdt MOtO!'S Catalag/Pricelist MUST be included or propasal will not be —
and Accessories wesidered.
ection III: 6oat Marine and Waterwa E ui ment and Products
Discount (%) Off DiscounY (%) OfF Catalog/Pricelist for Lake, River
Catalog/Pricelist for and Waterway Equipment (dock floats, decking, O
36 waterway 6arriers, buoys, markers, and similar
Lake, River and —
Waterway �quipment related equipment). Catalog/Pricelist MUST be included
or proposal will not be considered.
Discount (%) Off
Catalog/Pricelist for Discount (%) Off Catalog/Pricelist for Anchors,
37 Anchors, Docking Docking Equipment, Accessories and Related �
Equipment, PI'OdllCtS. Catalog JPricelist MUST 6e included or —
ACCessories and proposal will not be considered.
Related Products
o�o I SEALEGS
��° I SEALEGS
% I SEALEGS
�tions to Discaunt
PROPOSALNdTE
PROPOSALSPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 46 of 69
Bnard�
�.�,,,...�..,�
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
*ALL COLUMNS MUST BE COMPLETED OR PROPOSAL WILL NOT BE CONSIDERED*
State Percent (%)
Item of Discount off State Name of
Na. Short Descri #ion Full Description Catalog/Pricelist Cataiog/Pricelist Exceptions to Discount
DiScount (%) Off
Catalag/Pricelist for p€scount (%) �ff Catalo9/Pricelist for Life Vests,
38 Life Vests, Jackets, �ackets, Accessories and Related Products. 0 0�o SEALEGS
AccessOri25 dnd Catalog/PricelisE MUST be included or proposal will not be
considered.
Related Products
Di5C0unt (%) Off
Catalog/Pricelist for p�ease state the discount (%) off catalog/pricelist for
39 Boat Seats, Boat Seats, Accessories and Related Products. O o�o SEALEGS
Accessories and �atalog/Pricelist MUST be included or propasal will not be
considered.
Related Products
DISCOunt (%) Off
Catalog/Pricelist for P�ease state the discount (%j off catalog/pricelist for
40 Marine Electranics, Marine Electronics, Accessories and Related O % SEALEGS
Accessories and p�0[IIIC#5. Catalog/Pricelist MUST be incfuded or
proposal will not be considered.
Related Products
Discount {%) Off
Ca�alog/Pricelist for P�ease state the disco�nt (%) off catalog/pricelist for
41 Niarine BatYerfes, Marine Batteries, Chargers, Accessories and � % SEALEGS
Chargers, Accessories �eldted P�OdlJCfS. Cataiag/Pricelist MUSTbe included
afld Relat2d PI'OdUCtS or proposal will not be considered,
Section IV: Boat Trailers
Discount (%) Off Catalog/Pricelist for All Types of
Discount (%) Off Boat Trailers (Load capacity rated at 60 MPH, DOT
42 Catalog/Pricelist for All appraved lights and standard manufacturer's O % SEALEGS
Types nf 8oat Trailers equipment.) Catalog/Pricelist MUST be included or
propasal will not be considered.
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 47 of 69
�Board'°
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
*ALL COWMNS MUST 6E COMPLETE� OR PROPOSAL WILL NOT BE CONSIDERED*
Section V: OPTIONA! EOUIPMENT and PARTS- Options will be selected by the Cooperative member at the time of order. A COMPLETE LIST OF ALL OPTIONAL
EQUIPNiENT AND PAR75 MU57 BE SUBMI77ED WifH PROPOSAL FOR PROPOSAL 70 BE CONSIDERED.
5tate Percent (%)
Item of Discount off State Name of
No. 5hort Description Full Description Catalog/Pricelist Catalog/Pricelist Options
Discount (%) OFF
Catalog/Pricelist for all �iscount (%) off all Original Equipment � o
43 Original EquipmenC Manufacturer (OEM) Options. �0
Manufacturer (OEM)
Options
D'IS[ount {%) Off
Catalog/Pricelist for
44 Third Party Options Discount (%) off Third Party Options (not OEM) � %
(not OEM) and and Unpublished Options and Equipment.
Unpublished Optior�s
and Equipment
Discount {%) OfF
Catalog/PriceGst for o
Discount (/o) off Original Equipment � o
45 Original Eguipment Manufacutrer (OEM) Parts. �0
Manufacutrer (OEM)
Parts
Discount {a/o) Off
Catalog/Pricelist for piscount (%) off Extended Service Maintenance n/a
45 E�ended Service %
Maintenance Agreements.
Agreements
Discount {%) off Floor �iscount (%) off Floor Plan Insurance and Lot n/a
47 Plan Insurance and Insurance. °/o
LotInsurance
PROPOSAL NOTE PROPOSAL SPECIFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal �age a8 of 69
�Board `
�,.���..�
Proposal Invitation No. 578-18 Boats, Trailers, Marine and Waterway Equipment
*ALL COLUMNS MUST BE COMPLETE� OR PROPOSAL WILL NOT BE CONSIDER�D*
Section VI: Delivery Fees And La6or Rate For Insiallation and Repair Service Of Boats
Detailed
Information on
Item Hourly Labor Rate Hourly Labor Rate Exceptions #a Hourly Labor Rate
No. Short Descripiion Full Description and Delivery Fee and Delivery Fee and Delivery Fee
Nat to Exceed Hourly Hourly Labor Rate for Installation and Repair
Labor Rate for Service of Boat Equipment and Products -- State
48 Installation and Repair the Not to Exceed hourly labor rate for $ nla /Hour
Service and of �oat �nstallatian/R2pair Service of Equipment and
Equipment and products.
Praducts
49 Per Mile Delivery Fee Per Mile Delivery Fee for Boats- State the per 2.��
for Boats mile delivery fee for Boats. � /Mile
PROPOSAL NOTE PROPOSAL SPECiFICATION FORM
1. Catalogs/Pricelists are required to be submitted with Proposal Page 49 of 69
EXHIBIT C
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg.. Regular Session.
FORM CIQ
OFFlCE USE ONLY
This questionnaire is being filed in accordancewith Chapter 176, Local Govemment Code. �,,,a R�e����
by a vendorwho 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 lacal govemmental
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 Govemment Code.
A vendor commits an offense if the vendor knowingly violates Section 176.00B. Local
Govemment Code. An offense under this section is a misdemeanor.
Name of vendorwho has a busfness relatlonship wlth local governmenal entity.
Check thls box if you are flling an update to a previously ftled questionnai�.
(The law requires that you file an updated completed questionnaire with the appropriate filing authoriry not
later than the 7th business day after the date on which you became aware that the originally filed questionnaire was
incomplete or inaccurate.)
Name of local government officer aboutwhom the information in this section is being disclosed.
Name of Officer
This section (item 3 including subparts A, B, C, & D) must be completed for each officer with whom the vendor has an
employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional
pages to this Fortn CIQ 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?
� Yes � No
B. Is the vendor receiving or likety 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 o�cer 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.
Signature of vendor doing business wdh the governmental entity
Date
A dopted 8: 7+20 t 5