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Contract 58398
CSC No. 58398 FORT WORTH CITY OF FORT WORTH COOPERATIVE PURCHASE AGREEMENT This Cooperative Purchase Agreement ("Agreement") is entered into by and between PETRA CHEMICAL ACQUISITION LLC dba DCC, Inc. ("Vendor") and the City of Fort Worth, ("City"), a Texas home rule municipality. The Cooperative Purchase Agreement includes the following documents which shall be construed in the order of precedence in which they are listed: 1. This Cooperative Purchase Agreement; 2. Exhibit A—Seller's Quote, Scope of Services or Purchase Order; 3. Exhibit B—Cooperative Agency Contract BuyBoard 613-20; and 4. Exhibit C—Conflict of Interest Questionnaire. Exhibits A, B, and C which are attached hereto and incorporated herein, are made a part of this Agreement for all purposes. Vendor agrees to provide City with the services and goods included in Exhibit A pursuant to the terms and conditions of this Cooperative Purchase Agreement, including all exhibits thereto. City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance with the provisions of this Agreement. Total payment made under this Agreement for the first year by City shall be an amount not to exceed One Hundred Thousand Dollars and Zero Cents ($100,000.00).Vendor shall not provide any additional items or services or bill for expenses incurred for City not specified by this Agreement unless City requests and approves in writing the additional costs for such services. City shall not be liable for any additional expenses of Vendor not specified by this Agreement unless City first approves such expenses in writing. The term of this Agreement is effective beginning on the date signed by the Assistant City Manager below ("Effective Date") and expires on May 31, 2023 in line with the cooperative contract. Vendor agrees that City shall,until the expiration of three(3)years after final payment under this Agreement, or the final conclusion of any audit commenced during the said three years, have access to and the right to examine at reasonable times any directly pertinent books,documents,papers and records, including, but not limited to, all electronic records, of Vendor involving transactions relating to this Agreement at no additional cost to City. Vendor agrees that City shall have access during normal working hours to all necessary Vendor facilities and shall be provided adequate and appropriate work space in order to conduct audits in compliance with the provisions of this section. City shall give Vendor reasonable advance notice of intended audits. Notices required pursuant to the provisions of this Agreement shall be conclusively determined to have been delivered when (1) hand-delivered to the other party, its agents, employees, servants or representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3) received by the other party by United States Mail, registered, return receipt requested, addressed as follows: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX To CITY: To VENDOR: City of Fort Worth PETRA CHEMICAL ACQUISITION LLC Attn: Jesica McEachern, Assistant City Manager Attn.: Doug Dean, Regional Account Manager 200 Texas Street 2929 Storey Lane Fort Worth, TX 76102-6314 Dallas, TX 75220 Facsimile: (817) 392-8654 Facsimile: 214-352-1049 With copy to Fort Worth City Attorney's Office at same address The undersigned represents and warrants that he or she has the power and authority to execute this Agreement and bind the respective Vendor. CITY OF FORT WORTH: CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person By: responsible for the monitoring and administration Name: Jesica McEachern of this contract,including ensuring all performance Title: Assistant City Manager and reporting requirements. Date: Nov 4, 2022 APPROVAL RECOMMENDED: By: Name: Brittney Huff Title: Management Analyst II By: 49v APPROVED AS TO FORM AND LEGALITY: Name: Dave Lewis Title: Park and Recreation Director 4.a�vvapIl� ATTEST: ��FEORT�oddd By. o. P�0 09=°o Name: Jessika Williams P*0000 oo* Title: Assistant City Attorney 7GI�l�l2tt2 cl C7000t��G pd4�nEXASo�p By. Jan netteS.Gooda U(Nov 4,202216:01 CDT) CONTRACT AUTHORIZATION• Name: Jannette S. Goodall M&C: N/A Title: City Secretary VENDOR: PETRA CHEMICAL ACQUISITION LLC OFFICIAL RECORD By. Tie T� Name: boug Dean CITY SECRETARY Title: Regional Account Manager FT. WORTH, TX Date: 10-20-22 EXHIBIT A Stock Items List-10%off listed pricing DCC-Inc July 1,2022 Petra Chemical Company Item DescriptioPock Items Price List Price 100-100 Sodium Hypochlorite 10.5%Solution-Delivered in Mini-Bulk-Per Gallon* $3.31 100-105 Sodium Bisulfate 50#Bag-Globular $86.43 100-120 Hydrochloric Acid 30 Gallon-290# $141.08 100-130 Hydrochloric Acid 15 Gallon-150# $70.53 371-307 Hydrochloric Acid 4 x 1 Gallon Case-20b $42.59 100-160 Sodium Bicarbonate 50#Bag-Industrial Grade $48.40 100-180 Calcium Chloride 50#Bag-96%Anhydrous Pellets $56.65 100-190 Isocyanuric Acid 100#Drum $175.12 100-200 Calcium Hypochlorite 100#Drum-Granular $324.50 100-220 Sodium Carbonate 50#Bag-Soda Ash-Powder $45.13 100-235 Diatomaceous Earth 25#Bag-Powder $24.09 100-240 Sodium Thiosulfate 50#Bag-Prismatic Rice $96.38 100-265 Non-Chlorine Shock Oxy-Klear 25#Pail $132.00 100-275 Trichloroisocyanuric Acid 25#Pail-1"Tabs $127.60 100-280 Trichloroisocyanuric Acid 25#Pail-3"Tabs $105.60 100-290 Trichloroisocyanuric Acid 50#Pail-3"Tabs $188.32 100-300 Bromine Dimethylhadation-25#Pail Tablets $133.06 100-310 113romine Dimethylhadation-50#Pail Tablets $281.39 Drum Deposit Refundable Deposit-15,30&55 Gallon Drum $44.00 *ADDITIONAL DISCOUNTS AVAILABLE ON SODIUM HYPOCHLORITE-DELIVERED IN MINI-BULK(Over 300 Gallons) Stock Items List-10%off listed pricing DCC-Inc Buyboard Contract 613-20 July 1,2022 Petra Chemical Company Swimming Pool Chemicals,Supplies Equipment Stock Items Price List CHEMICALS/MISC 100-137 Jacks Magic-The Clean Stuff 1 Quart Bottle $40.46 100-185 Zeobrite 50#Bag Filter Media $74.03 200-075 Sea Klear-2 Gallon Kit Stage 1&Stage 2-1 Gallon ea. $127.58 200-085 Regal Algaecide 60 1 Quart Bottle $32.43 200-095 Algaezone Plus 1 Quart Bottle $19.25 200-105 Black Algaetrine Plus 1 Quart Bottle $43.14 200-110 Super Blue-Clarifier 1 Quart Bottle $25.85 200-120 Pool Perfect 2 Liter Bottle $57.35 200-131 Jacks Magic-Seacluest Test $131.25 200-132 Jacks Magic-The Deck Stuff Plus 1 Quart Bottle $14.37 200-133 Clear View-Poly Clear 1 Gallon $37.49 200-134 Jacks Magic-All Fixed Up Stuff 1 Quart Bottle $34.74 200-135 Jacks Magic-Yellow Stuff 25#Pail-Algaecide $473.00 200-136 Jacks Magic-The Tile Plus Stuff 1 Quart Bottle $24.75 200-139 Jacks Magic-The Emerald Stuff 1 Quart Bottle $22.40 200-145 De-Foamer Pint Bottle $13.77 200-150 EZ Chlor Enhanced Filter Cleaner-1 Quart Bottle $15.22 200-155 UC Pool Stain Treatment 1 Quart Bottle $27.50 200-160 Bio Dex#300 Tile Cleaner 1 Quart Bottle $40.52 200-185 Jacks Magic-The Blue Stuff 1 Quart Bottle $39.38 200-190 Jacks Magic-Stain Kit 1 $23.63 200-195 Magic Lube 1#615 Red $22.09 200-196 IMagic Lube 1#631 Blue $10.52 Stock Items List-10%off listed pricing DCC-Inc Buyboard Contract 613-20 July 1,2022 Petra Chemical Company Swimming Pool Chemicals,Supplies Equipment Stock Items Price List PARTS 900-005 Bung Wrench $53.94 900-159 Victor-Carbon Dioxide Regulator $1,029.16 900-163 Pressure Gauge Back Mount $12.45 900-165 Pressure Gauge Bottom Mount $6.71 900-166 Pressure Switch Switch Only $150.70 900-245 lCO2 Check Valve Carbon Dioxide Check Valve $33.00 900-300 1/4"Blue White Pool Rope Per Foot $0.09 900-305 3/4"Blue White Pool Rope Per Foot $0.77 900-336 Ceramic Weight w/3/8 Clip $10.33 900-338 Chemical Strainer w/Weight 1/4" $35.49 900-339 Chemical Strainer w/Weight 3/8" $67.96 900-340 Black Poly Chemical Tubing 1/4"-per foot $0.68 900-341 MOM Check Valve 3/8" $35.35 900-345 Black Poly Chemical Tubing 3/8"-per foot $0.85 900-350 Pool Putty Black $39.71 900-355 Pool Putty White $22.90 900-361 Quick Connect Valve 3/8"-Poly $9.82 900-362 Quick Connect Valve 1/4"-Poly $9.30 900-363 Quick Connect Tee 3/8"-Poly $5.21 900-364 Quick Connect Tee 1/4"-Poly $4.26 900-365 Quick Connect Coupling 3/8"-Poly $4.02 900-366 Quick Connect Coupling 1/4"Poly $2.96 900-367 Quick Connect Coupling 3/8"x 1/4"NPT-Poly $3.48 900-368 Quick Connect Coupling 3/8"x 3/8"NPT-Poly $3.82 900-369 Quick Connect Coupling 3/8"x 1/2"NPT-Poly $5.93 900-370 Quick Connect Coupling Z 1/4"x 1/4"NPT-Poly 1 $2.19 900-371 Quick Connect Coupling 1/4"x 3/8"NPT Poly $3.03 900-372 lQuick Connect Bleach Valve/RH/HD 1/4"NPT x 1/4"NPT-Poly $61.36 Stock Items List-10%off listed pricing DCC-Inc Buyboard Contract 613-20 July 1,2022 Petra Chemical Company Swimming Pool Chemicals,Supplies Equipment Stock Items Price List PUMPS/PARTS 900-105 Mec-O-Matic Injector 1/4"Chemical Injector $45.87 900-169 Blue White Pump 24 GPD Peristaltic Pump-24 Gallon Per Day-A1N20E-6T $523.63 900-170 Blue White Pump 95 GPD Peristaltic Pump-95 Gallon Per Day-A1N30E-7T $523.63 900-171 Blue White Pump 52 GPD Peristaltic pump-52 Gallon Per Day-A1N10E-7T $523.63 900-172 Blue White Pump 8 GPD Peristaltic Pump-8 Gallon Per Day- A1N20E-4T $523.63 900-210 Mec-O-Matic KOP Kit Replacement Kit $85.00 900-251 Blue White Injector 3/8"Chemical Injector $37.14 900-252 Blue White Injector 1/4"Chemical Injector $37.14 900-255 MOM Check Valve 1/4"Check Valve $29.73 900-265 Dolphin D-50 Pump Peristaltic Pump-50 Gallon Per Day $285.41 900-266 Dolphin D-10 Pump Peristaltic Pump-10 Gallon Per Day $285.41 900-267 Dolphin D-75 Pump Peristaltic Pump-75 Gallon Per Day $285.41 900-315 MOM 7070 Pump Tube 1/4"Replacement Pump Tube $28.71 900-376 2016/Blue White Pump Tube 96/52(7T) 7/16"Tube 13.3(Al-7T)2016 Style $30.50 900-377 2016/Blue White Pump Tube BGPD(4T) 1/4"Tube(8.7)(Al-4T)2016 Style $30.50 900-378 2016/Blue White Pump Tube 24 GPD(6T) 3/8"Tube(9.5)(Al-6T)2016 Style $30.50 900-400 Blue White-Spider Gear Spider Gear-1/4" $66.81 900-401 IBlue White-Spider Gear I Spider Gear-3/8" $66.81 Stock Items List-10%off listed pricing DCC-Inc Buyboard Contract 613-20 July 1,2022 Petra Chemical Company Swimming Pool Chemicals,Supplies Equipment Stock Items Price List FLOW METERS 900-188 Blue White 1/2 Flow Meter 1/2"Horizontal Flow Meter $82.50 900-189 Blue White 2"Flow Meter 2"Horizontal Flow Meter $111.54 900-190 Blue White 3"Flow Meter 3"Horizontal Flow Meter $59.14 900-191 Blue White 4"Flow Meter 4"Horizontal Flow Meter $154.99 900-192 Blue White 6"Flow Meter 6"Horizontal Flow Meter $245.17 900-193 Blue White 8"Flow Meter 8"Horizontal Flow Meter $286.62 900-194 IBlue White 1"Flow Meter 1"Horizontal Flow Meter $85.52 CHEMICAL CONTAINMENT TANKS-High Density Polyethylene 1.9 Specific Gravity 200SW 200 Gallon Chemical Container Single Wall Tank $565.00 300SW 300 Gallon Chemical Container Single Wall Tank $773.00 150DW 150 Gallon Chemical Container Dual Wall Tank $1,038.05 275DW 275 Gallon Chemical Container Dual Wall Tank $1,586.11 360DW 360 Gallon Chemical Container Dual Wall Tank $1,937.63 550DW 1550 Gallon Chemical Container Dual Wall Tank 1 $2,364.38 Factory Shipping Charges from MFR. Freight based on Tank Size and Destination SWIMMING POOL COATINGS&COMPOUNDS Plaster/Tile/Renovations DCC to Provide Pricing based on RFQ RFQ Hourly Labor Rate-Per Man Hour Coatings/Compounds/Renovations $75.00 LABOR Repair&Installation Labor for Equipment Hourly Rate-per man hour $75.00 Emergency/After Hour Labor Hourly Rate-per man hour/4 Hour Minimum $90.03 Stock Items List-10%off listed pricing DCC-Inc Buyboard Contract 613-20 July 1,2022 Petra Chemical Company Swimming Pool Chemicals,Supplies Equipment Stock Items Price List SWIMMING POOL CHEMICAL FEED SYSTEMS PP2000/CAT 2000 Pro Package Controller/Sensors/Rotary Flow Switch/Flow Cell/PVC $2,617.95 CAT-4000-WIFI-Standard Cat 4000 Controller w/WIFI Transceiver $3,537.72 CAT-4000075-WIFI-Pro Pack CAT 4000 w/WIFI Machined Flow Cell&RFS $3,927.70 CAT-5000075-WIFI Pro Pack CAT 5000 w/WIFI Machined Flow Cell&RFS $4,890.00 CAT5000075DS100-Pro Pack CAT 5000 w/Satellite RCVR/Machined Flow Cell&RFS $4,848.99 900-040 PRO-15-24 CAT pH Probe 24"Lead $340.96 900-025 PRO-25-24 ICAT ORP Probe 24"Lead $340.96 900-060 CAX-20203 jPaddle Wheel Flow Sensor/Socket/CAT $356.22 AUTOMATIC POOL CLEANERS Dura-Max Duo 120ft Cable/Double Body/w Remote&Ultra Kart $6,195.00 Dura-Max Duo Jr. 120ft Cable/Single Body/w Remote&Ultra Kart $5,180.00 Gemini Cleaner 150ft Cale/Double Body/w/Remote&Ultra Kart $6,405.00 Magnum/Black 120ft Cable/Large Body/w Remote&Trolley Kart $4,200.00 DuraMax RC 120ft swivel cable/Large Body/w Remote&Ultra Kart $3,430.00 Magnum Jr 1100ft cable/floor&wall/w Remote&Trolley Kart $3,262.00 UNDERWATER LIGHTING Pentair Amerlite 50OW 120V 500w/50ft Cord $359.33 Pentair Amerlite 50OW 120V 500w/100ft cord $437.97 Pentair Intellebrite LED-5G 55W 120Volt White LED/50ft Cord $739.93 Pentair Intellebrite LED-5G 55W 120Volt White LED/100ft Cord $799.73 MAIN DRAIN COVERS AQUASTAR 18x18 MOFLOW VGB Frame&Grate/White/18MF101 $340.44 2424 White Flat Suction Cover/VGB/ 24NF101 $885.36 24 x 24 White WAVE Frame&Cover/WAV24101 $885.36 12x12 MOFLOW VGB Frame&Grate/12MF101 $83.41 LAWSON/NEPTUNE BENSON 18x18 Domed Drain Cover/White MLD-FGD-1818-2W $1,120.77 24 x 24 White Main Drain Grate-MD-FG-2424 1 $1,012.27 EXHIBIT B Cooperative Purchasing P.O.Box 490 Austin, TX 78767-0400 809.695.2919 / 512.467.0222 / Fax:800.211.5454 buyboard.com April 29, 2020 Sent Via Email: ddean@petrachem.com Doug Dean DCC, Inc. 2929 Storey Ln. Dallas,TX 75220 Welcome to BuyBoard! Re: Nobbe of The Local Government Purchasing Cooperative Award Proposal Name and Number: Swimming Pool Chemicals, Supplies and Equipment, Proposal No. 613-20 Congratulations, The Local Government Purchasing Cooperative (Cooperative) has awarded your company a BuyBoard@ contract based on the above-referenced Proposal.The contract is effective 6/1/2020 through 5/31/2021,with two possible one-year renewals. The contract documents are those identified in Section 3 of the General Terms and Conditions of the specifications. To view the items your company has been awarded, please review the proposal tabulation No. 613-20 on the following web-site: www.buyboard.com/vendor. Only items marked as awarded to your company can be sold through the BuyBoard contract. In addition, on this website you will find the membership list which will provide you with the names of all entities with membership in our purchasing cooperative. Enclosed with this letter you will find the following documents: 1. Vendor Quick Reference Guide 2. BuyBoard License and Identity Standards You are advised that receipt of a purchase order directly from a Cooperative member is not within the guidelines of the Cooperative.Accepting purchase orders directly from Cooperative members may result in a violation of the State of Texas competitive bid statute and termination of this Cooperative BuyBoard contract. Therefore, all purchase orders must be processed through the BuyBoard in order to comply. Please forward by email to info@buyboard.com any order received directly from a Cooperative member. If you inadvertently process a purchase order sent directly to you by a Cooperative member, please email the order info@buyboard.com and note it as RECORD ONLY to prevent duplication. As an awarded vendor a BuyBoard user id and password will be sent via e-mail 2 to 3 business days prior to the start of your contract. On behalf of the Texas Association of School Boards, we appreciate your interest in the Cooperative and we are looking forward to your participation in the program. If you have any questions, please contact Cooperative Procurement Staff at 800-695-2919. Sincerely, Arturo Salinas Department Director, Cooperative Procurement v.6.5 The Local Government Purchasing Cooperative is endorsed by the Texas Association of School Boards, ME -Alwl� =F TC2E�"C3 Texas Municipal League, Texas Association of Counties,and the Texas Association of School Administrators. PVBoard C00per.0tWe Parchas/ng 12007 Research Boulevard 'Austin,Texas 78759-2439 • PH: 800-695-2919 , FAX: 800-211-5454 • buvboard.com PROPOSER'S AGREEMENT AND SIGNATURE Proposal Name: Swimming Pool Chemicals, Qroposal Due Date/Opening Date and Time: Supplies and Equipment December 19, 2019 at 4:00 PM Location of Proposal Opening: Texas Association of School Boards, Inc. BuyBoard Department Proposal Number: 613-20 12007 Research Blvd. Austin,TX 78759 Anticipated Cooperative Board Meeting Date: Contract Time Period:June 1, 2020 through May April 2020 31, 2021 with two (2) possible one-year renewals. 2 ("-� 1S c Name of Proposing Company Date i 1'�j :§tre&Ad ress Signature of a any Official City, State, Zip Printed Name of Authorized Company Official I 1't-V/4 -16 V'] 16�K- A-a d U N r M Telephone Number of Authorized Company Official Position or Title of Authorized Company Official q'i ,/MZ. 10g9 15 ' ILit o Fax Number of Authorized Company Official Federal ID Number Page 9 of 64 Proposal Forms COMM/SVCS v.09.05.2019 Board® W ooperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 ' buvboard.com VENDOR CONTACT INFORMATION Name of Company: Vendor Proposal/Contract Contact Name: (( f Vendor Proposal/Contract Contact E-mail Address: l d.�f� p l�u.�Ctl°I/� C M CC S S &L( WJS,£UM Vendor Contact Mailing Address for Proposal/Contract Notices: H W� ZaoV Company Website: in f l 0 0 Purchase Orders: All purchase orders from Cooperative members will be available through the Internet. Vendors need Internet access and at least one e-mail address so that notification of new orders can be sent to the Internet contact when a new purchase order arrives. An information guide will be provided to vendors to assist them with retrieving their orders. Please sale options below for receipt of purchase orders and provide the requested information: I will use the internet to receive purchase orders at the following address: Purchase Order E-mail Address: d�I e-a ) j2 p e-frek- —e W CCU VA p Purchase Order Contact: <�J U y De-a-� Phone: q 1.I Z-�,-14 b - I� Alternate Purchase Order E-mail Address: U C[-SCII C-5 e C, 120 0�S� �om Alternate Purchase Order Contact: Phone: Z_z Z�_ I p Purchase orders may be received by the Designated Dealer(s)identified on my company's Dealer Designation form as provided to the Cooperative administrator. I understand that my company shall remain responsible for the Contract and the performance of all Designated Dealers under and in accordance with the Contract. bequest for Quotes("RFO"): Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses for the receipt of RFQs: R f RFQ E-mail Address: �(." oo 5. CC)V0 RFQ Contact: t 0 d l�1-e aa" Phone: Alternate RFQ E-mail Address: dcc Sal e5 d a-pv61s, Cy v►, Alternate RFQ Contact: Phone: Page 11 of 64 Proposal Forms COMM/SVCS v.09.05.2019 PVBoard® C00perative Purchasing 12007 Research Boulevard ,Austin,Texas 78759-2439 - PH: 800-695-2919 • FAX: 800-211-5454 - buyboarclxom Invoices: Your company will be billed monthly for the service fee due under a contract awarded under this Proposal Invitation. All invoices are available on the BuyBoard website and e-mail notifications will be sent when they are ready to be retrieved. Please provide the following address, contact and e-mail information for receipt of service fee invoices and related communications: Please choose only one (1) of the following options for receipt of invoices and provide the requested information: EV'Service fee invoices and related communications should be provided directly to my company at: Invoice Mailing address: IA 7A ISTb ' Department: A//_,0L `0 PAz-,-y Ikj'?LE City: (State: / Zip Code:-� -1 5 L 2 0 Contact Name: � �A �+ '7 Phone: 1��� �y"l Cl Invoice Fax: q' Invoice E-mail Address: M[ ' u l (f Alternative Invoice E-mail Address: ) N Y1 n I V)&I S /� o e-�rO�.�_ 1'�t04. C.o m ti ❑ In lieu of my company, I request and authorize all service fee invoices to be provided directly to the following billing agent": Billing agent Mailing address: Department: City: State: Zip Code: Billing Agent Contact Name: Phone: Billing Agent Fax: Billing Agent E-mail Address: Alternative Billing Agent E-mail Address: **If Vendor author/zes a b1111ng agent to recelve and process service fee Invo%s, In accordance with the General Terms and Condition of the Contract, Vendor spectflcally acknowledges and agrees that nothing In that deslgnat/on shall relieve Vendor of Its respons/blllt/es and obligations under the Contract Including, but not limited to,payment of all service fees under any Contract awarded Vendor. Page 12 of 64 Proposal Forms COMM/SVCS v.09.05.2019 Board® Cooperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 ' PH: 800-695-2919 ' FAX: 800-211-5454 ' buybaard.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 person or business entity that enters into a contract with a school district must give advance notice to the district if the person or an owner or operator has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony." Section 44.034 further states in Subsection (b): "A school district may terminate a contract with a person or business entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for services performed before the termination of the contract." Please check(d)one of the fallowing: ❑ My company is a publicly-held corporation. (Advance notice requirement does not apply to publicly-held corporation.) y company is not owned or operated by anyone who has been convicted of a felony. My company is owned/operated by the following individual(s) who has/have been convicted of a felony: Name of 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 certification. 17)C6 _ ompany Name Deg 0 Signa h ompany Official Printed Name DEBARMENT CERTIFICATION Neither my company nor an owner or principal of my company has been debarred, suspended or otherwise made ineligible for participation in Federal Assistance programs under Executive Order 12549,"Debarment and Suspension,"as described in the Federal Register and Rules and Regulations. Neither my company nor an owner or principal of my company is currently listed on the government-wide exclusions in SAM, debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory or regulatory authority. My company agrees to immediately notify the Cooperative and all Cooperative members with pending purchases or seeking to purchase from my company if my company or an owner or principal is later listed on the government-wide exclusions in SAM, or is debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory or regulatory authority. By signature below, I certify that the above is true,complete and accurate and that I am authorized by my company to make this certification. ` X,Lam• Company Name Signat f h ompany Official Printed Name Page 13 of 64 Proposal Forms COMM/SVCS v.09.05.2019 Board Cooperative Purchasing 12007 Research Boulevard . Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 .buvboard.com RESIDENT/NONRESIDENT CERTIFICATION Chapter 2252, Subchapter A, of the Texas Government Code establishes certain requirements applicable to proposers who are not Texas residents. Under the statute, a"resident"proposer is a person whose principal place of business is in Texas, including a contractor whose ultimate parent company or majority owner has its principal place of business in Texas. A "nonresident"proposer is a person who is not a Texas resident. Please indicate the status of your company as a"resident" proposer or a"nonresident"proposer under these definitions. Please check one of the following: I certify that my company is a Resident Proposer. ❑ I certify that my company is a Nonresident Proposer. If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in which your company's principal place of business is located): / Company Name Address city State Zip Code A. Does your resident state require a proposer whose principal place of business is in Texas to under-price proposers whose resident st t s the same as yours by a prescribed amount or percentage to receive a comparable contract? ❑ Yes 9ff No B. What is the prescribed amount or percentage? $ or °Io VENDOR EMPLOYMENT CERTIFICATION Section 44.031(b) of the Texas Education Code establishes certain criteria that a school district must consider when determining to whom to award a contract. Among the criteria for certain contracts is whether the vendor or the vendor's ultimate parent or majority owner(i) has its principal place of business in Texas; or(ii)employs at least 500 people in Texas. If neither your company nor the ultimate parent company or majority owner has its principal place of business in Texas,does your company, ultimate parent company, or majority owner employ at least 500 people in Texas? Please check W)one of the followinn: pool Yes ❑ No By signature below, I certify that the information in Sections 1 (Resident/Nonresident Certification) and 2 (Vendor Employment Certification) above is true, complete and accurate and that I am authorized by my company to make this certification. C& Company Name �d y 4i Sign r �odzed Company Official Printed Name Page 14 of 64 Proposal Forms COMM/SVCS v.09.05.2019 Board Cooperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 , buyboard.corn NO ISRAEL BOYCOTT CERTIFICATION Effective September 1, 2017, as amended effective May 7, 2019 (H.B. 793), a Texas governmental entity may not enter into a contract with a value of$100,000 or more that is to be paid wholly or partly from public funds with a company(excluding a sole proprietorship) that has 10 or more full-time employees for goods or services unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. (TEx. Govt CODE Ch. 2270). Accordingly, this certification form is included to the extent required by law. "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. Govt CODE§808.001(1). By signature below, I certify and verify that Vendor does not boycott Israel and will not boycott Israel during the term of any contract awarded under this Proposal Invitation,that this certification is true,complete and accurate,and that I am authorized by my company to make this certification. .0 orripany Name Sig , e of Authoriz ompany Official Printed Name Note: If Vendor does not wish to make this certlflcatlon,return the blank form In Ileu of a completed certlflcatlon. NO EXCLUDED NATION OR FOREIGN TERRORIST ORGANIZATION CERTIFICATION Effective September 1, 2017, Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may not enter into a contract with a company engaged in active business operations with Sudan, Iran, or a foreign terrorist organization—specifically, any company identified on a list prepared and maintained by the Texas Comptroller under Texas Government Code §§806.051, 807.051, or 2252.153. (A company that the U.S. Government affirmatively declares to be excluded from its federal sanctions regime relating to Sudan, Iran, or any federal sanctions regime relating to a foreign terrorist organization is not subject to the contract prohibition.) By signature below,I certify and verify that Vendor is not on the Texas Comptroller's list identified above;that this certification is true, complete and accurate; and that I am authorized by my company to make this certification. Company Name Signatu of A ronzed Company Official Printed Name Page 15 of 64 Proposal Forms COMM/SVCS v.09.05.2019 Board Cooperative Purchasing 12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 ' buvboard.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 to in this form as a"HUB' is encouraged 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 form. Please check(A all that apply: ❑ I certify that my company has been certified as a HUB in the following categories: ❑ Minority Owned Business ❑ Women Owned Business ❑ Service-Disabled Veteran Owned Business(veteran defined by 38 U.S.C. §101(2),who has a service-connected disability as defined by 38 U.S.C. § 101(16),and who has a disability rating of 20% or more as determined by the U. S. Department of Veterans Affairs or Department of Defense) Certification Number: Name of Certifying Agency: My company has NOT been certified as a HUB. By signature below, I certify that the above is true, complete and accurate and that I am authorized by my company to make this certification. Company Name Printed_yam C Signature o Authorized 1ompany Official Page 16 of 64 Proposal Forms COMM/SVCS v.09.05.2019 Board e7 Cooperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 - PH: 800-695-2919 ' FAX: 800-211-5454 ' buvboard.com CONSTRUCTION-RELATED GOODS AND SERVICES AFFIRMATION A contract awarded under this Proposal Invitation covers only the specific goods and services awarded by the BuyBoard. As explained in the BuyBoard Procurement and Construction Related Goods and Services Advisory for Texas Members ("Advisory',Texas law prohibits the procurement of architecture or engineering services through a purchasing cooperative.This BuyBoard contract does not include such services.Architecture or engineering services must be procured by a Cooperative member separately, in accordance with the Professional Services Procurement Act(Chapter 2254 of the Texas Government Code)and other applicable law and local policy. The Advisory, available at buyboard.com/)4endor Resource s.as x, provides an overview of certain legal requirements that are potentially relevant to a Cooperative member's procurement of construction or construction-related goods and services, including those for projects that may involve or require architecture, engineering or independent testing services. A copy of the Advisory can also be provided upon request. By signature below, the undersigned affirms that Proposer has obtained a copy of the Advisory, has read and understands the Advisory,and is authorized by Proposer to make this affirmation. If Proposer sells construction-related goods or services to a Cooperative member under a BuyBoard contract awarded under this Proposal Invitation, Proposer will comply with the Advisory and applicable legal requirements, make a good faith effort to make its Cooperative member customers or potential Cooperative member customers aware of such requirements, and provide a Cooperative member with a copy of the Advisory before executing a Member Construction Contract with the member or accepting the member's purchase order for construction-related goods or services, whichever comes first. IX- ompany Name Si e A . z d Company Official Printed Name to Page 17 of 64 Proposal Forms COMMIMS v.09.05.2019 PWBoard CooPe,r,:1tF-F,&Purcha /ng 12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 • buvboard.com DEVIATION AND COMPLIANCE If your company intends to deviate from the General Terms and Conditions, Proposal Specifications or other requirements associated with this Proposal Invitation, you MUST list all such deviations on this form, and provide complete and detailed information regarding the deviations on this form or an attachment to this form. The Cooperative will consider any deviations in its contract award decision, and reserves the right to accept or reject a proposal based upon any submitted deviation. In the absence of any deviation identified and described in accordance with the above,your company must fully comply with the General Terms and Conditions, Proposal Specifications and all other requirements associated with this Proposal Invitation if awarded a contract under this Proposal Invitation. A deviation will not be effective unless accepted by the Cooperative. The Cooperative may, in its sole discretion, seek clarification from and/or communicate with Proposer(s) regarding any submitted deviation, consistent with general procurement principles of fair competition. The Cooperative reserves the right to accept or reject a proposal based upon any submitted deviation. Please check ()n one of the following: Information presented by the vendor has been accepted by BuyBoard. ❑ NO; Deviations Connie W Burkett, CTSBO iz(es; Deviations BuyBoard Contract Administrator List and fully explain any deviations you are submitting: CM IcA� PE�IA�� 517x D STI14A-f-10N . SpAaDKD 12W,5 -t-V �f aft HIf1PINC, -PU1Nr PLEASE PROVIDE THE FOLLOWING INFORMATION: 1. Shipping Via: P"Common Carrier C9"C"Ompany Truck ❑ Prepaid and Add to Invoice ❑ Other: 2. Payment Terms: UONet 30 days ❑ 1% in 10/Net 30 days ❑ Other: 3. Number of Days for Delivery: __ARO 4. Vendor Reference/Quote rN�u�mber: 5. State your return policy: 40 RE-S j OCK {PAA15 `3 Sep u V-:lj / N C) a I� M1! 4AkCOt'1)'-> 00CF, Df-�1dr-::Ry A-CGCIOMD 6. Are electronic payments acceptable? ®Yes ❑ No 7. Are credit card payments acceptable? Egy'es ❑ No Company Name �© L) Signature u on `any Official Printed Name Page 18 of 64 Proposal Forms COMM/SVCS v.09.05.2019 PFBoard® Cooperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 'buyboard.com LOCATION / AUTHORIZED SELLER LISTINGS If you have more than one location/authorized seller that will service a contract awarded under this Proposal Invitation, please list each location/authorized seller below. If additional sheets are required, please duplicate this form as necessary. NOTE: Awarded Vendors shall remain responsible for all aspects of the Contract, including processing of Purchase Orders, and shall be responsible for the performance of all locations and authorized sellers under and in accordance with the Contract. If you are a product manufacturer and wish to designate Designated Dealers as defined in the General Terms and Conditions to receive Cooperative member P rchase Orders on your behalf, you must complete the Manufacturer Designated Dealer form. Company Name Address City State Zip Phone Number Fax Number Contact Person Iv P Company Name Address City State Zip Phone Number Fax Number Contact Person Page 19 of 64 Proposal Forms COMM/SVCS v.09.05.2019 Board® Cooperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 ' PH: 800-695-2919 ' FAX: 800-211-5454 ' buvboard.com MANUFACTURER DEALER DESIGNATION If Vendor is a manufacturer that sells products through a dealer network and wishes to designate a dealer or multiple dealers ("Designated Dealers' to receive Cooperative member Purchase Orders on Vendor's behalf,you must complete this form for each dealer you wish to designate. Regardless of any Designated Dealers submitted by Vendor, Vendor specifically agrees and acknowledges that any such designations are for Vendor's convenience only and shall not, if Vendor is awarded a Contract, relieve Vendor of any obligations under the Contract, including payment of Cooperative service fees on all Purchase Orders submitted to Vendor or any Designated Dealer. In accordance with the General Terms and Conditions, an awarded Vendor shall remain responsible and liable for all of its obligations under the Contract and the performance of both Vendor and any of Vendor's Designated Dealers under and in accordance with the Contract and remain subject to all remedies for default thereunder, including, but not limited to suspension and termination of Vendor's Contract for nonpayment of service fees. If awarded, Vendor authorizes the Cooperative, in its sole discretion, to list any Vendor Designated Dealers in the BuyBoard system and to receive Purchase Orders directly from Cooperative members on behalf of Vendor. To the extent a Vendor with Designated Dealers receives a Purchase Order directly, it shall be the responsibility of Vendor to appropriately process such Purchase Order in accordance with the Contract, including but not limited to timely forwarding such Purchase Order to a Designated Dealer for processing. The Cooperative reserves the right, in its sole discretion,to refuse addition of,or request removal of,any Designated Dealer, and Vendor agrees to immediately require such Designated Dealer to cease accepting Purchase Orders or otherwise acting on Vendor's behalf under the Contract. Further, the Cooperative's administrator shall be authorized to remove or suspend any or all Designated Dealers from the BuyBoard at any time in its sole discretion. If you wish to designate a dealer to service a contract awarded under this Proposal Invitation, please list the Designated Dealer below and have this form signed by an official of your company authorized to make such designation. If you wish to designate multiple dealers, please duplicate this form as necessary. N/A Design ted Dealer Name Designated Dealer Address City State Zip Phone Number Fax Number Email address Designated Dealer Tax ID Number* (*attach W-9) Designated Dealer Contact Person DCC Your Company Name S1gnat7k'Ad1(r!ze&6mpany Official Page 20 of 64 Proposal Forms COMM/SVCS v.09.05.2019 DuBoard capperadve Purchasing 12007 Research Boulevard I Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com TEXAS REGIONAL SERVICE DESIGNATION The Cooperative (referred to as"Texas Cooperative"in this form and in the State Service Designation form) offers vendors the opportunity to service its members throughout the entire State of Texas. If you do not plan to service all Texas Cooperative members statewide, you must indicate the specific regions you will service on this form. Ifyou propose to serve d/fferent regions for d/fferent products or sere/ces Included In your proposal,you must complete and subm/t a separate Texas Region/Service Des/gnatlon form for each group of products and clearly Ind/cate the products or services to which the designation applies In the space provided at the end of this form. By designating a region orreglons,you are certifying that you are authorized and w1111ng to provide the proposed products and services In those regions. Deslynat/ng regions In which you are elther unable or unwllling to provide the speclf/ed products and services shall be grounds for either rejection of your proposal or, If awarded, terminatlon ofyour Contract. Additionally, if you do not plan to service Texas Cooperative members (i.e., if you will service only states other than Texas), you must so indicate on this form. Regional Education Service Centers ❑ I will service Texas •yiY �-�_a Cooperative members statewide. I will not service Texas Cooperative members WYf.. 4.r M'fit statewide. I will only service members in the ~' °~ regions checked below: Region Headauarters °»- I h a -'t ❑ 1 Edinburg L ❑ 2 Corpus Christi - t1 ❑ 3 Victoria ❑ 4 Houston ❑ 5 Beaumont ❑ 6 Huntsville ❑ 7 Kilgore ❑ 8 Mount Pleasant 9 Wichita Falls 10 Richardson 11 Fort Worth JRr 12 Waco Rr 13 Austin ❑ 14 Abilene •- ❑ 15 San Angelo ❑ 16 Amarillo ❑ 17 Lubbock ❑ 18 Midland Company Na ❑ 19 El Paso .-' �A ❑ 20 San Antonio Signature,pf"AuttCr ompany Official C, ❑ I will not service members of Print d Name the Texas Cooperative. Page 21 of 64 Proposal Forms COMM/SVCS v.09.05.2019 Board® Cooperative Frrrchasing 12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 . buyboard.com STATE SERVICE DESIGNATION The Cooperative offers vendors the opportunity to service other governmental entities in the United States, including intergovernmental purchasing cooperatives such as the National Purchasing Cooperative BuyBoard. You must complete this form if you plan to service the entire United States, or will service only the specific states indicated. (Note:If you plan to service Texas Cooperative members, be sure that you complete the Texas Regional Service Designation form.) If you serve different states for d/fferent products or services Included In your proposal,you must complete and submit a separate State Service Designatlon form for each group of products and clearly indicate the products or services to which the designatlon applies In the space provided at the end of this form. By des/gnat/ng a state or states,you are cert/fying that you are authorized and w/lling to prov/de the proposed products and services In those states. Deslgnat/ng states In which you are ether unable or unwilling to provide the specified products and services shall be grounds for either rejection of your proposal or, if awarded, terminatlon of your Contract. Please check(37 all that apply: ❑ I will service all states in the United States. I will not service all states in the United States. I will service only the states checked below: ❑ Alabama ❑ Alaska ❑ Nebraska ❑ Arizona ❑ Nevada ❑ Arkansas ❑ New Hampshire ❑ California (Public Contract Code 20118 &20652) ❑ New Jersey ❑ Colorado ❑ New Mexico ❑ Connecticut ❑ New York ❑ Delaware ❑ North Carolina ❑ District of Columbia ❑ North Dakota ❑ Florida ❑ Ohio ❑ Georgia Oklahoma ❑ Hawaii ❑ Oregon ❑ Idaho ❑ Pennsylvania ❑ Illinois ❑ Rhode Island ❑ Indiana ❑ South Carolina ❑ Iowa ❑ South Dakota ❑ Kansas ❑Tennessee ❑ Kentucky ®Texas ❑ Louisiana ❑ Utah ❑ Maine ❑ Vermont ❑ Maryland ❑ Virginia ❑ Massachusetts ❑ Washington ❑ Michigan ❑ West Virginia ❑ Minnesota ❑ Wisconsin ❑ Mississippi ❑ Wyoming ❑ Missouri ❑ Montana Page 23 of 64 Proposal Forms COMM/SVCS v.09.05.2019 DuBoard® Capperative Purchasing 12007 Research Boulevard ' Austin,Texas 78759-2439 - PH: 800-695-2919 ' FAX: 800-211-5454 'buvboard.com This form will be used to ensure that you can service other governmental entities throughout the United States as indicated. Your signature below confirms that you understand your service commitments during the term of a contract awarded under this proposal. /T)CC- Company Name Signatu of u on ompany 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 24 of 64 Proposal Forms COMM/SVCS v.09.05.2019 DwBoard® Couperative Purchasing 12007 Research Boulevard • Austin,Texas 78759-2439 PH: 800-695-2919 • FAX: 800-211-5454 ' buyhoard.cM 7. This Agreement shall be governed and construed in accordance with the laws of the State of Rhode Island and venue for any dispute shall lie in the federal district court of Alexandria,Virginia. 8. Vendor acknowledges and agrees that the award of a Piggy-Back Award is within the sole discretion of National Cooperative,and that this Agreement does not take effect unless and until National Cooperative awards Vendor a Piggy-Back Award and the BuyBoard Administrator notifies Vendor in writing of such Piggy-Back Award as provided for herein. WHEREFORE, by signing below Vendor agrees to the foregoing and warrants that it has the authority to enter into this Agreement. T? (QI3 —zy Name of Ven2for Proposal Invitation Number U(,- tom Signature of oriz pany Official Printed Name of Authorized Company Official Date Proposal Forms COMM/SVCS v.09.05.2019 Page 26 of 64 Board® Cooperative Purchasing 12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 • buyboard.com FEDERAL AND STATE/PURCHASING COOPERATIVE EXPERIENCE The Cooperative strives to provide its members with the best services and products at the best prices available from vendors with the technical resources and ability to serve Cooperative members. Please respond to the following questions. 1. Provide the dollar value of sales to or through purchasing cooperatives at or based on an established catalog or market price during the previous 12-month period or the last fiscal year: $ 'Y P 3 . (The period of the 12 month period is�2 l"I I / ►L 1 -lci). In the event that a dollar value is n t an appropriate measure of the sales, provide and describe your own measure of the safes of the item(s). 2. By submitting a proposal, you agree that, based on your written discounting policies, the discounts you offer the Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items under equivalent circumstances. 3. Provide the information requested below for other purchasing cooperatives for which Proposer currently serves, or in the past has served, as an awarded vendor. Rows should be added to accommodate as many purchasing cooperatives as required. CURRENT FORMER VENDOR (Y/N)?— AWARDED PURCHASING VENDOR? • •D GROUPD•. •. 1. Federal General Services Administration 2. T-PASS (state of Texas) 3. OMNIA Partners 4. Sourcewell (NJPA) 5. E&I Cooperative 6. Houston-Galveston Area Council 7. Choice Partners 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.09.05.2019 Page 27 of 64 wBoard ouperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • 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. T" ompany ame ^-� Signat ompany Official Printed Name Proposal Forms COMM/SVCS v.09.05.2019 Page 28 of 64 Board Cooperative Purchasing 12007 Research Boulevard .Austin,Texas 78759-2439 - PH: 800-695-2919 ' FAX: 800-211-5454 ' buvboard.com GOVERNMENTAL REFERENCES For your Proposal to be considered, you must supply a minimum of five (5) individual governmental entity references. The Cooperative may contact any and all references provided as part of the Proposal evaluation. Provide the information requested below, including the existing 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/ Entiltv Name Contact Phone# Email Address Discount Volumes 4 • �?Z-�9N�e2�3 � �� T2�AC14Wawj LlArmtr brao�n Z73-551� IM? aL) nAJ' At t -W- fI ClUJIC& rc O �I'1-T�{3•�355 fir u. 4. t�If Act je4jt( evLvw C l o f(t.cpm C Cady Bi"VA4 l 1 (( i o% 5L e Do you ever modify your written policies or standard goArnmental sales practices as identified in the above chart to give better discounts(lower prices)than indicated? YESEVNOEI If YES, please explain: firI I4w y~ Avomopi" nsivmr3 oa- Poart) Pe-noo wan Coyi�tr R(L W XF fM' FAT C M IC�s l ��D 1-r o rJPrt� 0- WK G[� y1 I C ASS By signature below, I certify that the above is true and correct and that I am authorized by my company to make this certificatio n. Qc/ Company Name Sign o utho ed Company official 'Do UCH �r Printed Name Proposal Forms COMM/SVCS v.09.05.2019 Page 29 of 64 Board Cooperative Purchasing 12007 Research Boulevard •Austin,Texas 78759-2439 - PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com MARKETING STRATEGY For your Proposal to be considered, you must submit the Marketing Strategy you will use if the Cooperative accepts all or part of your Proposal. (Exam le: Explain how your company will initially inform Cooperative members of your BuyBoard contract, and how you will continue to support the BuyBoard for the duration of the contract period.) Attach additional pages if necessary. A-6 M , (C Company N` e r` Sign e ' ed Company Official Printed Name Proposal Forms COMM/SVCS v.09.05.2019 Page 30 of 64 PVBoard C00perative Purchasing 12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 . FAX: 800-211-5454 • uuyhoard.com CONFIDENTIAL/PROPRIETARY INFORMATION A. Public Disclosure Laws All Proposals,forms, documentation, or other materials submitted by Vendor to the Cooperative in response to this Proposal Invitation, including catalogs and pricelists, may be subject to the disclosure requirements of the Texas Public Information Act(Texas Government Code chapter 552.001, et seq.)or similar disclosure law. Proposer must clearly identify on this form any information in its Proposal(including forms,documentation,or other materials submitted with the Proposal)that Proposer considers proprietary or confidential. If Proposer fails to properly identify the information, the Cooperative shall have no obligation to notify Vendor or seek protection of such information from public disclosure should a member of the public or other third party request access to the information under the Texas Public Information Act or similar disclosure law. Proposer will be notified of any third party request for information in a Proposal that Proposer has identified in this form as proprietary or confidential. Does your Proposal (including forms, documentation, or other materials submitted with the Proposal) contain information which Vendor considers proprietary or confidential? Please check M one of the following: [SfNO,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 responsible for a Proposer's failure to clearly identify information considered confidential or proprietary. Further, by submitting a Proposal,Proposer acknowledges that the Cooperative and its Administrator will disclose information when required by law, even if such information has been identified herein as information the vendor considers confidential or proprietary. Confidential/ Proprietary Information: (Attach additional sheets if needed.) Proposal Forms COMM/SVCS v.09.05.2019 Page 31 of 64 oard Cooperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 • PH: 800-695-2919 . FAX: 800-211-5454 .buyboard.com B. Copyright Information Does your Proposal (including forms, documentation, or other materials submitted with the Proposal) contain copyright information? Please check f d]one of the following: NO, Proposal (including forms,documentation,or other materials submitted with the Proposal)does not contain copyright information. ❑ YES, Proposal (including forms,documentation,or other materials submitted with the Proposal)does contain copyright information. If you responded "YES", identify below the specific documents or pages containing copyright information. Copyright Information: (Attach additional sheets if needed.) C.Consent to Release Confidential/Proprietary/Copyright Information to BuyBoard Members BuyBoard members (Cooperative and nonprofit members) seeking to make purchases through the BuyBoard may wish to view information included in the Proposals of awarded Vendors. If you identified information on this form as confidential, proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contract award constitutes your consent to the disclosure of such information to BuyBoard members, including posting of such information on the secure BuyBoard website for members. Note: Neither the Cooperative nor its Administrator will be responsible for the use or distribution of information by BuyBoard members or any other party. D.Consent to Release Proposal Tabulation Notwithstanding anything in this Confidential/Proprietary Information form to the contrary, by submitting a Proposal,Vendor consents and agrees that, upon Contract award, the Cooperative may publically release, including posting on the public BuyBoard website, a copy of the proposal tabulation for the Contract including Vendor name; proposed catalog/pricelist name(s); proposed percentage 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 all consents and agreements contained herein. �') C-C., Company Name r Signat of t ampany Official C Printed Name Date Proposal Forms COMM/SVCS v.09.05.2019 Page 32 of 64 Board Cooperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 •buyboard.corn VENDOR BUSINESS NAME By submitting a Proposal, Proposer is seeking to enter into a legal contract with the Cooperative. As such, a Proposer must be an individual or legal business entity capable of entering into a binding contract. Proposers, must completely and accurately provide the information requested below or your Proposal may be deemed non-responsive. Name of Proposing Company: fl�Gl���Sl^{�4=-S li � 'F(Rj�CtI�{t'��kt j'�tS,Sj(.erJ(c, (tC Abs, (List the LWAJ name of the company seeking to contract with the Cooperative. Do NOT list an assumed name,dba,aka,etc,here. Such information may be provided below. If you are submitting a joint proposal with another entity to provide the same proposed goods or services,each submitting entity should complete a separate vendor information form. separately operating legal business entities, even if affrllated entities, which propose to provide goods or services separately must submit their own Proposals.) lease check one of the following: Tyne of Business: Individual/Sole Proprietor Corporation ✓ Limited Liability Company _ Partnership Other If other, identify State of Incorporation (if applicable): TAX�4's Federal Employer Identification Number: 1 0 1 0 (Vendor must include a completed IRS W-9 form with their proposal) List the Name(s) by which Vendor, if awarded,wishes to be identified on the BuyBoard: (Note: Ifdifferentthan the Name ofProposing Company listed above,only valid trade names(dba,aka,etc.)of the Proposing Company may be used and a copy of your Assumed Name Certifiicate(s),/f applicable,must be attached.) Proposal Forms COMM/SVCS v.09.05.2019 Page 33 of 64 Form Request for Taxpayer Give Form to the (Rev.October 2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service 0,Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name(as shown on your income tax return).Name is required on this tine;do not leave this line blank. DPC INDUSTRIES, INC 2 Business name/disregarded entity name,if different from above PETRA CHEMICAL ACQUISITION COMPANYr LLC dba DCC INC. 03-0584710 Sin ie-member LLC, Disregarded Entity) `6 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 � P Y P� { PPY Y ro following seven boxes. certain entities,not individuals;see a instructions on page 3): o ❑ Individual/sole proprietor or C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate single-member LLC Exempt payee code(if any) ,ay u ❑ Limited liability company.Enter the tax classification(C—C corporation,S=S corporation,P=Partnership)0- 0 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(f any) a U 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. m ❑ Other(see instructions)► {Applies to accounts U.SJ rn 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional) m 300 JACKSON HILL ST 6 City,state,and ZIP code HOUSTON,TX 77007 7 List account number(s)here(optional) MOM Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid social security number backup withholding. For individuals,this is generally yoursocial security number(S However,for a —m resident alien,sole proprietor,or disregarded entity,seeee the instructions for Part I,later. .For other entities,it is your employer identification number(EIN).If you do not have a number,see Now to get a TIN, later. or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter. M75 - 1 4 8 1 M08 Certification Under penalties of perjury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2. 1 am not subject to backup withholding because,(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3. 1 am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions,You must cross out item 2 above if you have been 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 generally,payments other than interest and dividend re not required to sign the certification,but you must provide your correct TIN.See the instructions for Part 11,later. Sign Signature of Here U.S.person► Late► Q, 0 IF General Instr Ions •Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code in otherwise .Form 1099-NIISC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments e Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to wvvw.irs.gov1FormW9. .Form 1099-S(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest), 1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number a Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption .Form 1099-A(acquisition or abandonment of secured property) taxpayer identification number(ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return. Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat,No.10231X Form W-9(Rev.10-2018) Board® Cooperative Purchasing 12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 •buvboard.com 12. General Compliance and Cooperation with Cooperative Members: In addition to the foregoing specific requirements, Vendor agrees, in accepting any Purchase Order from a Cooperative member, it shall make a good faith effort to work with Cooperative members to provide such information and to satisfy such requirements as may apply to a particular Cooperative member purchase or purchases including,but not limited to,applicable recordkeeping and record retention requirements. Vendor Certification: YES, I agree or Vendor Certlflcatinn-Item No. NOJ I do NOT agree Initial — 1. Vendor Violation or Breach of Contract Terms 2. Termination for Cause or Convenience ,� r 3. Equal Employment Opportunity77, S 4. Davis-Bacon Act �j(� 5. Contract Work Hours and Safety Standards Act 6. Right to Inventions Made Under a Contract or Agreement t r r 7. Clean Air Act and Federal Water Pollution Control Act e,s v 8. Debarment and Suspension 9. Byrd Anti-Lobbying Amendment 10. Procurement of Recovered Materials C 11. Profit as a Separate Element of Price r 12. General Compliance and Cooperation with Cooperative Members `r S By signature below, I certify that the information in this form is true,complete, and accurate and that I am authorized by my company to make this certification and all consents and agreements contained herein. — D c Company Na Signature Autho z Company Official 00 6 Dr, pro Printed Name Proposal Forms COMM/SVCS v.09.05.2019 Page 37 of 64 Board® Cooperative Purchasing 12007 Research Boulevard 'Austin,Texas 78759-2439 ' PH: 800-695-2919 ' FAX: 800-211-5454 'buyboard.com PROPOSAL INVITATION QUESTIONNAIRE The Cooperative will use your responses to the questions below in evaluating your Proposal and technical and financial resources to provide the goods and perform the services("Work'D under the BuyBoard contract contemplated by this Proposal Invitation ("Contract'. Proposers must fully answer each question, numbering your responses to correspond to the questions/numbers below. Proposers must complete below or attach your responses to this questionnaire, sign where indicated below,and submit the signed questionnaire and your responses to all questions in one document with your Proposal. You must submit the signed questionnaire and responses with your Proposal or the Proposal will not be considered. 1. List the number of years Proposer has been in business and former business names (if applicable). Note whether your company is currently for sale or involved in any transaction that would significantly alter its business or result in acquisition by another entity. a. s-., r S 2. Describe the resources Proposer has to manage staff and successfully perform the Work contemplated under this Contract. State the number and summarize the experience of company personnel who may be utilized for the Work, including those who will be available to Cooperative members for assistance with project development,technical issues, and product selection for Work associated with this Contract. uS co wC'4Uoti, c � I C 4; vL C w GX-re- c- - �l b U ok.Pl C v , M e Lt 3. Describe Proposer's financial capability to perform the Contract. State or describe the firm's financial strength and rating, bonding capacity, and insurance coverage limits. State whether the firm, or any of the firm's past or present owners, principal shareholders or stockholders, or officers, have been a debtor party to a bankruptcy, receivership, or insolvency proceeding in the last 7 years, and itify any such debtorJ-e�6rpp,� p irty by name and relationship to or position with your firm. N I's. F—C`�S Dt 'ACC c,,,Tn ""3 �2e.1.. G- Gxyt �'jr,n K id p p C( kit� 0 erLrvv e J aiA d< (t u c l b o cC 1 c� J , cl li I ,� Gc av4 C o\rlr" C S a,(1 41 09 0 Jr'C A- �e . Ow rA" CC f e J C ek- Q e Otfi c,c q CC o r4 of I n S') r U„c C&Jefa.C\-91 Proposal Forms COMM/SKS v.09.05.2019 Page 38 of 64 ard� Cooperative Purchasing 12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 •buvboard.com 4. Does your company have any outstanding financial judgments and/or is it currently in default on any loan or financing agreement? If so, provide detailed information on the nature of such items and prospects for resolution. TD 5. List all contracts, if any, in the last 10 years on which Proposer has defaulted, failed to complete or deliver the work, or that have been terminated for any reason. For each such contract, provide the project name, scope,value and date and the name of the procuring entity. Fully explain the circumstances of the default,failure to complete or deliver the work, or term nation. A 6. List all litigation or other legal proceedings(including arbitration proceedings), if any, in the last 10 years brought against your firm, or any of the firm's past or present owners, principal shareholders or stockholders, officers, agents or employees,that relates to or arises from a contract similar to this Contract or the work contemplated under this Contract. Provide the style of the lawsuit or proceeding (name of parties and court or tribunal in which filed), nature of the claim, and resolution or current status. By signature below, I certify that the information contained in and/or attached to this Proposal Invitation Questionnaire in response to the above questions is true and correct and that I am authorized by my company to make this certification. -�)CC Company Name Signature uthori 17 d omppanyy Official Proposal Forms COMM/SVCS v.09.05.2019 Page 39 of 64 wBoard ouperative Purchasing 12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 ' buyhoard.coin REQUIRED FORMS CHECKLIST (Please check(v' the following) ©' Completed: Proposers Agreement and Signature Completed: Vendor Contact Information [� Completed: Felony Conviction Disclosure and Debarment Certification Q� Completed: Resident/Nonresident Certification Completed: No Israel Boycott Certification Completed: No Excluded Nation or Foreign Terrorist Organization Certification Completed: Historically Underutilized Business(HUB) Certification) Uf Completed: Construction Related Goods and Services Affirmation Completed: Deviation/Compliance Completed: Location/Authorized Seller Listings [—/ Completed: Manufacturer Dealer Designation Lid Completed: Texas Regional Service Designation {� Completed: State Service Designation Completed: National Purchasing Cooperative Vendor Award Agreement Completed: Federal and State/Purchasing Cooperative Experience Completed: Governmental References Completed: Marketing Strategy Completed: Confidential/Proprietary Information Completed: Vendor Business Name with IRS Form W-9 Completed: EDGAR Vendor Certification Ell Completed: Proposal Invitation Questionnaire Completed: Required Forms Checklist Completed: Proposal Specification Form with Catalogs/Pricelists 'nilafogs/Pntehsts must toe submided with ptoposai response or response wiv not h-e mnsldead Proposal Forms COMM/SVCS v.09.05.2019 Page 40 of 64 C? � yam. i� O 0 O �p OJ Q :� LL o y E w c w , u a°i \ � _ a Lb Ql— W c a w of o o +�+ c o 0 0tt 0 0 E m u ° u � C L r� a) au U. 7 0 y u tn 0 - �A ° w > 4) 1 E U u � � E � � E M o ° ai of of s L = c E I aU � c c _c _ � 1c '0 vI 0 CL E ar v CD a a) N1 C -p u (A c (!� ro w o G1a 41 m t 0 0 0 .3 d .3 m a 0 d 0 � � v g C t c = u 4- of a u1 „ w ° w � c, } o m E � a 4 4. 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OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code.An offense under this section is a misdemeanor. Name of vendor who has a business relationship with local governmental entity. Petra Chemical Acquisition Company LLC dba DCC 2 Check this box if you are filing an update to a previously filed questionnaire.(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 Name of local government officer about whom the information is being disclosed. None Name of Officer 4j Describe each employment or other business relationship with the local government officer,or a family member of the officer,as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes F-x--] No B. Is the vendor receiving or likely to receive taxable income,other than investment income,from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes Fx---] No 5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director,or holds an ownership interest of one percent or more. 6 ❑ Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). 7 Brett C.Clapsaddle,CFO,Petra Chemical Acquisition Company LLC dba DCC 10-19-2022 Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code§176.001(1-a):"Business relationship"means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal,state,or local governmental entity or an agency of a federal,state,or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public;or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to,that agency. Local Government Code§176.003(a)(2)(A)and(B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than$100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code$176.006(a)and(a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity,or a family member of the officer,described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity,or a family member of the officer,one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B),excluding any gift described by Section 176.003(a-1);or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application,response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity;or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer,described by Subsection(a); (B) that the vendor has given one or more gifts described by Subsection (a);or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015