HomeMy WebLinkAboutContract 56630-R1 CSC No. 56630-RI
CITY OF FORT WORTH
CONTRACT RENEWAL NOTICE
November 9, 2022
Firehouse Hydrostat Services LLC
Attn: Scott Evans, CEO
200 Hillside Ln
Lindsay, TX 76250
Re: Contract Renewal Notice
Contract No. CSC No. 56630-R1 (the "Contract")
Renewal Term No. 1: November 9, 2022 to November 8, 2023
The above referenced Contract with the City of Fort Worth expires on November 08, 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
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
Contract Renewal Page 1 of 3
CSC No. 56630-R1
ACCEPTED AND AGREED:
CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and
administration of this contract, including
Vitls.l —'By;Va IeriQ Washington(Nov 11,202213:03 CST) ensuring all performance and reporting
requirements.
Name: Valerie Washington
Title: Assistant City Manager
Date:
By;Mark Rauscher(Nov 9,202215:28 CST)
APPROVAL RECOMMENDED: Name: Mark Rauscher
Title: Assistant Fire Director
By:J s Davis(Nov 9,202216:17 CST)
Name: Jim Davis APPROVED AS TO FORM AND
Title: Fire Chief LEGALITY:
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Name: Taylor Paris
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Tannetl-e S. Gaada// Title: Assistant City AttorneX
ByJannette S.Goodall(Nov 14,202213:37 CST)
Name: Jannette Goodall
Title: City SecretarX
CONTRACT AUTHORIZATION:
N/A
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
Contract Renewal Page 2 of 3
CSC No. 56630-Rl
Firehous dro t S is LLC
By:
Name: Scott Evans
Title: CEO
Contract Renewal Page 3 of 3
CSC No.56630
FORTWORTH.
VENDOR SERVICES AGREEMENT
Firehouse Hydrostat Services
This VENDOR SERVICES AGREEMENT ("Agreement") is made and entered into by and
between the CITY OF FORT WORTH("City"),a Texas home rule municipal corporation,acting by and
through its duly authorized Assistant City Manager, and Fire Hydrostat Services ("Vendor"), a Texas
Limited Liability Company and acting by and through its duly authorized representative,each individually
referred to as a"party"and collectively referred to as the "parties."
AGREEMENT DOCUMENTS:
The Agreement documents shall include the following:
1. This Vendor Services Agreement;
2. Exhibit A—Scope of Services;
3. Exhibit B—Price Schedule;
4. Exhibit C— City's RFP No.21-0179
5. Exhibit D— Vendor's Bid Response to City's RFP No. 21-0179; and
6. Exhibit E—Verification of Signature Authority Form.
Exhibits A, B, C, D, and E, which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes.In the event of any conflict between the terms and conditions of Exhibits A,B,
C, or D and the terms and conditions set forth in the body of this Agreement,the terms and conditions of
this Agreement shall control.
I. Scope of Services.Vendor is to supply the City with hydrostatic testing services for SCBA,
SCUBA,oxygen cylinders,and large D.O.T.cylinders for the Fire Department. ("Services"),which are set
forth in more detail in Exhibit"A," attached hereto and incorporated herein for all purposes..
2. Term. This Agreement shall begin on the date signed by the Assistant City Manager below
("Effective Date") and expires one year after("Expiration Date"),unless terminated earlier in accordance
with this Agreement ("Initial Term"). City will have the option, in its sole discretion, to renew this
Agreement under the same terms and conditions, for up to four (4) one-year renewal option(s) (each a
"Renewal Term").
3. Compensation. City will pay Vendor in accordance with the provisions of this Agreement,
including Exhibit "B," which is attached hereto and incorporated herein for all purposes. Total annual
compensation under this Agreement will not exceed Nineteen Thousand and Nine Hundred and
Seventy-Five Dollars and Zero Cents Dollars($19,975.00). The City makes no promise or guarantee of
the total amount of work that will be assigned to Vendor under this Agreement. Vendor will not perform
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OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
4. any additional 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 will not be liable
for any additional expenses of Vendor not specified by this Agreement unless City first approves such
expenses in writing.
4. Termination.
4.1. Written Notice. City or Vendor may terminate this Agreement at any time and for
any reason by providing the other party with 30 days' written notice of termination.
4.2 Non-appropriation of Funds. In the event no funds or insufficient funds are
appropriated by City in any fiscal period for any payments due hereunder,City will notify Vendor
of such occurrence and this Agreement will terminate on the last day of the fiscal period for which
appropriations were received without penalty or expense to City of any kind whatsoever,except as
to the portions of the payments herein agreed upon for which funds have been appropriated.
4.3 Duties and Obligations of the Parties. In the event that this Agreement is
terminated prior to the Expiration Date, City will pay Vendor for services actually rendered up to
the effective date of termination and Vendor will continue to provide City with services requested
by City and in accordance with this Agreement up to the effective date of termination. Upon
termination of this Agreement for any reason, Vendor will provide City with copies of all
completed or partially completed documents prepared under this Agreement. In the event Vendor
has received access to City Information or data as a requirement to perform services hereunder,
Vendor will return all City provided data to City in a machine readable format or other format
deemed acceptable to City.
5. Disclosure of Conflicts and Confidential Information.
5.1 Disclosure of Conflicts.Vendor hereby warrants to City that Vendor has made full
disclosure in writing of any existing or potential conflicts of interest related to Vendor's services
under this Agreement.In the event that any conflicts of interest arise after the Effective Date of this
Agreement,Vendor hereby agrees immediately to make full disclosure to City in writing.
5.2 Confidential Information.Vendor,for itself and its officers,agents and employees,
agrees that it will treat all information provided to it by City ("City Information") as confidential
and will not disclose any such information to a third party without the prior written approval of
City.
5.3 Public Information Act. City is a government entity under the laws of the State of
Texas and all documents held or maintained by City are subject to disclosure under the Texas Public
Information Act.In the event there is a request for information marked Confidential or Proprietary,
City will promptly notify Vendor.It will be the responsibility of Vendor to submit reasons objecting
to disclosure. A determination on whether such reasons are sufficient will not be decided by City,
but by the Office of the Attorney General of the State of Texas or by a court of competent
jurisdiction.
5.4 Unauthorized Access.Vendor must store and maintain City Information in a secure
manner and will not allow unauthorized users to access, modify, delete or otherwise corrupt City
Information in any way. Vendor must notify City immediately if the security or integrity of any
City Information has been compromised or is believed to have been compromised,in which event,
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Vendor will, in good faith, use all commercially reasonable efforts to cooperate with City in
identifying what information has been accessed by unauthorized means and will fully cooperate
with City to protect such City Information from further unauthorized disclosure.
6. Rieht to Audit. Vendor agrees that City will,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 will have access during
normal working hours to all necessary Vendor facilities and will be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. City will give Vendor
reasonable advance notice of intended audits.
7. Independent Contractor. It is expressly understood and agreed that Vendor will operate
as an independent contractor as to all rights and privileges and work performed under this Agreement, and
not as agent, representative or employee of City. Subject to and in accordance with the conditions and
provisions of this Agreement, Vendor will have the exclusive right to control the details of its operations
and activities and be solely responsible for the acts and omissions of its officers, agents, servants,
employees, Vendors, and subcontractors. Vendor acknowledges that the doctrine of respondeat superior
will not apply as between City,its officers,agents,servants and employees,and Vendor,its officers,agents,
employees, servants, contractors, and subcontractors. Vendor further agrees that nothing herein will be
construed as the creation of a partnership or joint enterprise between City and Vendor. It is further
understood that City will in no way be considered a Co-employer or a Joint employer of Vendor or any
officers, agents, servants, employees, contractors, or subcontractors. Neither Vendor, nor any officers,
agents, servants, employees, contractors, or subcontractors of Vendor will be entitled to any employment
benefits from City.Vendor will be responsible and liable for any and all payment and reporting of taxes on
behalf of itself, and any of its officers, agents, servants,employees,contractors,or contractors.
8. Liability and Indemnification.
8.1 LIABILITY- VENDOR WILL BE LIABLE AND RESPONSIBLE FOR ANY
AND ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY KIND OR CHARACTER,
WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT
ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT OF
VENDOR, ITS OFFICERS, AGENTS, SERVANTS, EMPLOYEES, CONTRACTORS, OR
SUBCONTRACTORS.
8.2 GENERAL INDEMNIFICATION- VENDOR HEREBY COVENANTS AND
AGREES TO INDEMNIFY, HOLD HARMLESS AND DEFEND CITY, ITS OFFICERS,
AGENTS,SERVANTSAND EMPLOYEES,FROMAND AGAINSTANYAND ALL CLAIMS
OR LAWSUITS OFANYKIND OR CHARACTER, WHETHER REAL OR ASSERTED,FOR
EITHER PROPERTYDAMAGE OR LOSS(INCLUDING ALLEGED DAMAGE OR LOSS TO
VENDOR'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL
INJURY, INCLUDING DEATH, TO ANY AND ALL PERSONS, ARISING OUT OF OR IN
CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE
NEGLIGENT ACTS OR OMISSIONS OR MALFEASANCE OF VENDOR,ITS OFFICERS,
AGENTS,SERVANTS,EMPLOYEES, CONTRACTORS, OR SUBCONTRACTORS.
8.3 INTELLECTUAL PROPERTY INDEMNIFICATION — Vendor agrees to
defend, settle, or pay, at its own cost and expense, any claim or action against City for
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infringement of any patent, copyright, trade mark, trade secret, or similar property right
arising from City's use of the software and/or documentation in accordance with this
Agreement, it being understood that this agreement to defend, settle or pay will not apply if
City modifies or misuses the software and/or documentation. So long as Vendor bears the
cost and expense of payment for claims or actions against City pursuant to this section,
Vendor will have the right to conduct the defense of any such claim or action and all
negotiations for its settlement or compromise and to settle or compromise any such claim;
however, City will have the right to fully participate in any and all such settlement,
negotiations, or lawsuit as necessary to protect City's interest, and City agrees to cooperate
with Vendor in doing so. In the event City, for whatever reason, assumes the responsibility
for payment of costs and expenses for any claim or action brought against City for
infringement arising under this Agreement, City will have the sole right to conduct the
defense of any such claim or action and all negotiations for its settlement or compromise and
to settle or compromise any such claim; however,Vendor will fully participate and cooperate
with City in defense of such claim or action.City agrees to give Vendor timely written notice
of any such claim or action, with copies of all papers City may receive relating thereto.
Notwithstanding the foregoing, City's assumption of payment of costs or expenses will not
eliminate Vendor's duty to indemnify City under this Agreement. If the software and/or
documentation or any part thereof is held to infringe and the use thereof is enjoined or
restrained or, if as a result of a settlement or compromise, such use is materially adversely
restricted,Vendor will, at its own expense and as City's sole remedy, either: (a) procure for
City the right to continue to use the software and/or documentation; or (b) modify the
software and/or documentation to make it non-infringing, provided that such modification
does not materially adversely affect City's authorized use of the software and/or
documentation; or (c) replace the software and/or documentation with equally suitable,
compatible,and functionally equivalent non-infringing software and/or documentation at no
additional charge to City; or (d)if none of the foregoing alternatives is reasonably available
to Vendor terminate this Agreement, and refund all amounts paid to Vendor by City,
subsequent to which termination City may seek any and all remedies available to City under
law.
9. Assignment and Subcontracting.
9.1 Assignment. Vendor will not assign or subcontract any of its duties, obligations
or rights under this Agreement without the prior written consent of City. If City grants consent to
an assignment, the assignee will execute a written agreement with City and Vendor under which
the assignee agrees to be bound by the duties and obligations of Vendor under this Agreement.
Vendor will be liable for all obligations of Vendor under this Agreement prior to the effective date
of the assignment.
9.2 Subcontract. If City grants consent to a subcontract,the subcontractor will execute
a written agreement with Vendor referencing this Agreement under which subcontractor agrees to
be bound by the duties and obligations of Vendor under this Agreement as such duties and
obligations may apply. Vendor must provide City with a fully executed copy of any such
subcontract.
10. Insurance. Vendor must provide City with certificate(s) of insurance documenting
policies of the following types and minimum coverage limits that are to be in effect prior to commencement
of any Services pursuant to this Agreement:
10.1 Coverage and Limits
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(a) Commercial General Liability:
$1,000,000- Each Occurrence
$2,000,000- Aggregate
(b) Automobile Liability:
$1,000,000- Each occurrence on a combined single limit basis
Coverage will be on any vehicle used by Vendor, or its employees, agents, or
representatives in the course of providing Services under this Agreement. "Any
vehicle"will be any vehicle owned,hired and non-owned.
(c) Worker's Compensation:
Statutory limits according to the Texas Workers' Compensation Act or any other
state workers' compensation laws where the Services are being performed
Employers' liability
$100,000- Bodily Injury by accident; each accident/occurrence
$100,000- Bodily Injury by disease; each employee
$500,000- Bodily Injury by disease;policy limit
(d) Professional Liability(Errors& Omissions):
$1,000,000- Each Claim Limit
$1,000,000- Aggregate Limit
Professional Liability coverage may be provided through an endorsement to the
Commercial General Liability (CGL) policy, or a separate policy specific to
Professional E&O. Either is acceptable if coverage meets all other requirements.
Coverage must be claims-made,and maintained for the duration of the contractual
agreement and for two (2) years following completion of services provided. An
annual certificate of insurance must be submitted to City to evidence coverage.
10.2 General Requirements
(a) The commercial general liability and automobile liability policies must
name City as an additional insured thereon, as its interests may appear. The term
City includes its employees,officers,officials,agents,and volunteers in respect to
the contracted services.
(b) The workers' compensation policy must include a Waiver of Subrogation
(Right of Recovery)in favor of City.
(c) A minimum of Thirty (30) days' notice of cancellation or reduction in
limits of coverage must be provided to City.Ten (10) days' notice will be
acceptable in the event of non-payment of premium.Notice must be sent to the
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Risk Manager, City of Fort Worth, 200 Texas Street, Fort Worth, Texas 76102,
with copies to the Fort Worth City Attorney at the same address.
(d) The insurers for all policies must be licensed and/or approved to do
business in the State of Texas.All insurers must have a minimum rating of A-VII
in the current A.M.Best Key Rating Guide,or have reasonably equivalent financial
strength and solvency to the satisfaction of Risk Management.If the rating is
below that required,written approval of Risk Management is required.
(e) Any failure on the part of City to request required insurance
documentation will not constitute a waiver of the insurance requirement.
(fl Certificates of Insurance evidencing that Vendor has obtained all required
insurance will be delivered to the City prior to Vendor proceeding with any work
pursuant to this Agreement.
11. Compliance with Laws,Ordinances,Rules and Regulations. Vendor agrees that in the
performance of its obligations hereunder, it will comply with all applicable federal, state and local laws,
ordinances,rules and regulations and that any work it produces in connection with this Agreement will also
comply with all applicable federal, state and local laws, ordinances,rules and regulations. If City notifies
Vendor of any violation of such laws, ordinances, rules or regulations, Vendor must immediately desist
from and correct the violation.
12. Non-Discrimination Covenant. Vendor, for itself, its personal representatives, assigns,
contractors,subcontractors,and successors in interest,as part of the consideration herein,agrees that in the
performance of Vendor's duties and obligations hereunder, it will not discriminate in the treatment or
employment of any individual or group of individuals on any basis prohibited by law. IF ANY CLAIM
ARISES FROM AN ALLEGED VIOLATION OF THIS NON-DISCRIMINATION COVENANT
BY VENDOR, ITS PERSONAL REPRESENTATIVES, ASSIGNS, CONTRACTORS,
SUBCONTRACTORS, OR SUCCESSORS IN INTEREST, VENDOR AGREES TO ASSUME
SUCH LIABILITY AND TO INDEMNIFY AND DEFEND CITY AND HOLD CITY HARMLESS
FROM SUCH CLAIM.
13. Notices. Notices required pursuant to the provisions of this Agreement will be
conclusively determined to have been delivered when (1) hand-delivered to the other party, its agents,
employees, servants or representatives, (2) delivered by facsimile with electronic confirmation of the
transmission,or(3)received by the other party by United States Mail,registered,return receipt requested,
addressed as follows:
To CITY: To VENDOR:
City of Fort Worth Firehouse Hydrostat Services
Attn: Assistant City Manager 200 Hillside Ln
200 Texas Street Lindsay Texas
Fort Worth,TX 76102-6314 76250
Facsimile: (817) 392-8654 sevanskfirehousehydro.com
Phone: 817 948 6177
With copy to Fort Worth City Attorney's Office
at same address
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14. Solicitation of Employees. Neither City nor Vendor will, during the term of this
Agreement and additionally for a period of one year after its termination,solicit for employment or employ,
whether as employee or independent contractor, any person who is or has been employed by the other
during the term of this Agreement, without the prior written consent of the person's employer.
Notwithstanding the foregoing,this provision will not apply to an employee of either party who responds
to a general solicitation of advertisement of employment by either parry.
15. Governmental Powers. It is understood and agreed that by execution of this Agreement,
City does not waive or surrender any of its governmental powers or immunities.
16. No Waiver. The failure of City or Vendor to insist upon the performance of any term or
provision of this Agreement or to exercise any right granted herein does not constitute a waiver of City's or
Vendor's respective right to insist upon appropriate performance or to assert any such right on any future
occasion.
17. Governing Law/Venue. This Agreement will be construed in accordance with the laws
of the State of Texas. If any action,whether real or asserted,at law or in equity,is brought pursuant to this
Agreement, venue for such action will lie in state courts located in Tarrant County, Texas or the United
States District Court for the Northern District of Texas,Fort Worth Division.
18. Severability. If any provision of this Agreement is held to be invalid, illegal or
unenforceable,the validity, legality and enforceability of the remaining provisions will not in any way be
affected or impaired.
19. Force Maieure. City and Vendor will exercise their best efforts to meet their respective
duties and obligations as set forth in this Agreement,but will not be held liable for any delay or omission
in performance due to force majeure or other causes beyond their reasonable control, including, but not
limited to, compliance with any government law, ordinance, or regulation; acts of God; acts of the public
enemy; fires; strikes; lockouts; natural disasters; wars; riots; epidemics or pandemics; government action
or inaction; orders of government; material or labor restrictions by any governmental authority;
transportation problems;restraints or prohibitions by any court,board,department,commission,or agency
of the United States or of any States;civil disturbances;other national or regional emergencies;or any other
similar cause not enumerated herein but which is beyond the reasonable control of the Party whose
performance is affected (collectively, "Force Majeure Event"). The performance of any such obligation is
suspended during the period of, and only to the extent of, such prevention or hindrance, provided the
affected Party provides notice of the Force Majeure Event, and an explanation as to how it prevents or
hinders the Parry's performance, as soon as reasonably possible after the occurrence of the Force Majeure
Event,with the reasonableness of such notice to be determined by the City in its sole discretion.The notice
required by this section must be addressed and delivered in accordance with Section 13 of this Agreement.
20. Headings not Controlling. Headings and titles used in this Agreement are for reference
purposes only,will not be deemed a part of this Agreement,and are not intended to define or limit the scope
of any provision of this Agreement.
21. Review of Counsel. The parties acknowledge that each party and its counsel have
reviewed and revised this Agreement and that the normal rules of construction to the effect that any
ambiguities are to be resolved against the drafting party will not be employed in the interpretation of this
Agreement or Exhibits A,B, and C.
22. Amendments/Modifications/Extensions. No amendment, modification, or extension
of this Agreement will be binding upon a parry hereto unless set forth in a written instrument, which is
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executed by an authorized representative of each party.
23. Counterparts. This Agreement may be executed in one or more counterparts and each
counterpart will, for all purposes,be deemed an original,but all such counterparts will together constitute
one and the same instrument.
24. Warranty of Services. Vendor warrants that its services will be of a high quality and
conform to generally prevailing industry standards. City must give written notice of any breach of this
warranty within thirty (30) days from the date that the services are completed. In such event, at Vendor's
option, Vendor will either (a) use commercially reasonable efforts to re-perform the services in a manner
that conforms with the warranty, or (b) refund the fees paid by City to Vendor for the nonconforming
services.
25. Immigration Nationality Act. Vendor must verify the identity and employment eligibility
of its employees who perform work under this Agreement, including completing the Employment
Eligibility Verification Form (I-9). Upon request by City,Vendor will provide City with copies of all I-9
forms and supporting eligibility documentation for each employee who performs work under this
Agreement. Vendor must adhere to all Federal and State laws as well as establish appropriate procedures
and controls so that no services will be performed by any Vendor employee who is not legally eligible to
perform such services.VENDOR WILL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM
ANY PENALTIES,LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH
BY VENDOR, VENDOR'S EMPLOYEES, CONTRACTORS, SUBCONTRACTORS, OR
AGENTS.City,upon written notice to Vendor,will have the right to immediately terminate this Agreement
for violations of this provision by Vendor.
26. Ownership of Work Product. City will be the sole and exclusive owner of all reports,
work papers,procedures,guides, and documentation that are created,published,displayed,or produced in
conjunction with the services provided under this Agreement(collectively,"Work Product"). Further,City
will be the sole and exclusive owner of all copyright,patent,trademark,trade secret and other proprietary
rights in and to the Work Product. Ownership of the Work Product will inure to the benefit of City from
the date of conception, creation or fixation of the Work Product in a tangible medium of expression
(whichever occurs first).Each copyrightable aspect of the Work Product will be considered a"work-made-
for-hire" within the meaning of the Copyright Act of 1976, as amended. If and to the extent such Work
Product,or any part thereof,is not considered a"work-made-for-hire"within the meaning of the Copyright
Act of 1976, as amended,Vendor hereby expressly assigns to City all exclusive right,title and interest in
and to the Work Product,and all copies thereof,and in and to the copyright,patent,trademark,trade secret,
and all other proprietary rights therein, that City may have or obtain, without further consideration, free
from any claim,lien for balance due,or rights of retention thereto on the part of City.
27. Signature Authority. The person signing this Agreement hereby warrants that they have
the legal authority to execute this Agreement on behalf of the respective party, and that such binding
authority has been granted by proper order,resolution,ordinance or other authorization of the entity. This
Agreement and any amendment hereto,may be executed by any authorized representative of Vendor.Each
party is fully entitled to rely on these warranties and representations in entering into this Agreement or any
amendment hereto.
28. Change in Company Name or Ownership. Vendor must notify City's Purchasing
Manager, in writing, of a company name, ownership, or address change for the purpose of maintaining
updated City records.The president of Vendor or authorized official must sign the letter.A letter indicating
changes in a company name or ownership must be accompanied with supporting legal documentation such
as an updated W-9, documents filed with the state indicating such change, copy of the board of director's
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resolution approving the action, or an executed merger or acquisition agreement. Failure to provide the
specified documentation so may adversely impact future invoice payments.
29. No Boycott of Israel. If Vendor has fewer than 10 employees or this Agreement is for
less than $100,000, this section does not apply. Vendor acknowledges that in accordance with Chapter
2271 of the Texas Government Code,the City is prohibited from entering into a contract with a company
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. The terms"boycott Israel"
and "company"has the meanings ascribed to those terms in Section 2271 of the Texas Government Code.
By signing this Agreement,Vendor certifies that Vendor's signature provides written verification to
the City that Vendor: (1) does not boycott Israel; and (2)will not boycott Israel during the term of
the Agreement.
30. Prohibition on Boycotting Energy Companies. Vendor acknowledges that, in
accordance with Chapter 2274 of the Texas Government Code, as added by Acts 2021, 87th Leg., R.S.,
S.B. 13, § 2, the City is prohibited from entering into a contract for goods or services that has a value of
$100,000 or more that is to be paid wholly or partly from public funds of the City with a company with 10
or more full-time employees unless the contract contains a written verification from the company that it:
(1) does not boycott energy companies; and (2) will not boycott energy companies during the term of the
contract. The terms"boycott energy company" and"company"have the meaning ascribed to those terms
by Chapter 2274 of the Texas Government Code, as added by Acts 2021, 87th Leg.,R.S., S.B. 13, § 2. To
the extent that Chapter 2274 of the Government Code is applicable to this Agreement, by signing this
Agreement,Vendor certifies that Vendor's signature provides written verification to the City that Vendor:
(1) does not boycott energy companies; and(2)will not boycott energy companies during the term of this
Agreement.
31. Prohibition on Discrimination Aeainst Firearm and Ammunition Industries. Vendor
acknowledges that except as otherwise provided by Chapter 2274 of the Texas Government Code,as added
by Acts 2021, 87th Leg.,R.S., S.B. 19, § 1,the City is prohibited from entering into a contract for goods or
services that has a value of$100,000 or more that is to be paid wholly or partly from public funds of the
City with a company with 10 or more full-time employees unless the contract contains a written verification
from the company that it: (1) does not have a practice, policy, guidance, or directive that discriminates
against a firearm entity or firearm trade association; and (2) will not discriminate during the term of the
contract against a firearm entity or firearm trade association. The terms "discriminate," "firearm entity"
and "firearm trade association" have the meaning ascribed to those terms by Chapter 2274 of the Texas
Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 19, § 1. To the extent that Chapter 2274
of the Government Code is applicable to this Agreement,by signing this Agreement,Vendor certifies that
Vendor's signature provides written verification to the City that Vendor:(1)does not have a practice,policy,
guidance, or directive that discriminates against a firearm entity or firearm trade association; and (2) will
not discriminate against a firearm entity or firearm trade association during the term of this Agreement.
32. Electronic Signatures. This Agreement may be executed by electronic signature, which
will be considered as an original signature for all purposes and have the same force and effect as an original
signature.For these purposes,"electronic signature"means electronically scanned and transmitted versions
(e.g.via pdf file or facsimile transmission)of an original signature,or signatures electronically inserted via
software such as Adobe Sign.
33. Entirety of Agreement. This Agreement,including all attachments and exhibits,contains
the entire understanding and agreement between City and Vendor,their assigns and successors in interest,
as to the matters contained herein. Any prior or contemporaneous oral or written agreement is hereby
declared null and void to the extent in conflict with any provision of this Agreement.
9
IN WITNESS WHEREOF,the parties hereto have executed this Agreement in multiples.
CITY OF FORT WORTH:
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration of
By:ValerielNashington(Nov 9,202115:18 CST) this contract,including ensuring all performance and
Name: Valerie Washington reporting requirements.
Title: Assistant City Manager
Date: Nov 9,2021 20 -sn-
B'�'; Mark Rauscher(Nov 2,202122:37 CDT)
Name: Mark Rauscher
APPROVAL RECOMMENDED: Title: Assistant Fire Director
APPROVED AS TO FORM AND LEGALITY:
By: J s Davis(Nov 7,202110:18 CST)
Name: Jim Davis
Title: Fire Chief o44�FpRr�'Qa BY � a Apt
X000�°°°°°°°°°°�'0-a Name: Christopher Austria
ATTEST: g?�01 Title: Assistant City Attorney
ova =d
d��*o �d CONTRACT AUTHORIZATION:°°
000005 �d M&C: N/A
By: / " ��nEXAoo Form 1295: NIA
Name: Ronald P. Gonzales
Title: Acting City Secretary
VENDOR:
Firehouse Hydrostat Services
By:
Name: �+l
Title:
Date: A f , 20 Zr
OFFICIAL RECORD
CITY SECRETARY
10
FT.WORTH, TX
EXHIBIT A
SCOPE OF SERVICES
SPECIFICATIONS
The vendor shall be D.O.T. certified as a cylinder requalification facility and must provide a copy of its
D.O.T. letter with Requalified Identification Number to the Fort Worth Fire SCBA Air Shop to keep
on record.
The vendor shall have mobile testing capability to test cylinders on location at various sites
throughout the City.
The vendor shall be able to hydrostatically test SCBA breathing air cylinders, SCUBA breathing air
cylinders, medical grade oxygen cylinders, and large D.O.T cylinders on an as needed basis per
D.O.T. 49 CFR 180 subpart C guidelines and in accordance with any and all other local, state and
Federal regulations.
The vendor shall provide the Fort Worth Fire SCBA Air Shop a spreadsheet, PDF or
printed list of all cylinders tested with the results including the pressures and expansions recorded
for the SCBA cylinders within 5 business days of testing.
CYLINDER TESTING SHALL MEET REQUIREMENTS
Cylinder shall be examined to ensure it can safely hold it pressure.
Cylinder shall be filled with a nearly incompressible liquid, in most cases water, pressurizing
the cylinder and examined for leaks or permanent changes in shape. A visual inspection shall be performed
each time a cylinder goes through the pressure testing
process. The cylinder must be given an internal and external inspection in accordance with
Compressed Gas Association (CGA) pamphlets, D.O.T CFR 49 requirements and any local, state,
and federal laws. Each Cylinder tested must be legibly labeled or stamped as applicable with the new
hydrostatic test date in a manner that remain legible until the next test date or end of service
of the cylinder.
CYLINDER REJECTION The Vendor shall reject a cylinder when, after a visual inspection, it meets a
condition for rejection under the visual inspection requirements stated in the D.O.T CFR 49.
The Vendor shall notify the City that the cylinder is being rejected and provide further
requalification instructions. Be able to go and check Cylinder Locations
11
EXHIBIT B
PAYMENT SCHEDULE
FORT WORTH.
BID SOLICITATION
Event ID Page Invited: PUBLIC EVENT DETAILS
7 ai-21_019
Event Round Version
1 1 i
Event Name
RFQt s dress a Testing far 1'x1 s _ _ Submit To: City df Fort Worth
Start Tlme Finish Time FINANCIAL MANAGEMENT SERVICES
09 io za2 & 0 ao cvr 202> o FINANCE-Purehasing
200 Texas St-(Lower Level,South}
Fort Worth TX 76102
United States
Email: FMSPurchasingResponses@fortworthtexas.gov
Line: 1
Deacr i Ion _ O Unit UnitPriee Total
4500 PSI SC5A High Pressure Hydrotast,per 300-00 EA
cylinder
Line:. 2
Desert 69n: 9N Unit UnitPripq Total
SCUBA High Pressure Hydrotest,per cylinder 50.00 EA _
Line: 3
Description: Qty Unit UnitPrlce Total
02 Hydro(D)Slze 02 High Pressure Hydrotest, 150-00 EA
per cylinder
Lino: 4
Description: __ Qty Unit UnitPrlce TOW
Teflon O-ring 150-00 EA
Line: 5
Description: City Unit UnitPriee Tafal
Rubber O-ring 30D.00 EA
Line: 6
Description: Qtv Unit UnNIMM Total
4500 PSI Hydrostatic test,DOT(K)Size or 25.00 - EA
similar,per cylindee kxkl /�.
Line: 7 `nf
Description: OtV Molt UnitPr€ce Total
600D PSI Hydrostatic test.DOT(K)Size or 25,00 EA
similar,par cylinder
Line: 8
Description: City Unit UnftPrkp T®tat
Eddy Current Inspection,per cylinder 100-00 EA
LLB—J I-C,LLJ
Total Sid hmoasrt:!
A laid of"0"(zero)will be interpreted by the City as a no-charge(free)item and the City will not expect 407rx�
to pay For that Rem.A bld of"no bid"ar no response(space left blank)will be interpreted by the City
that the Offeror does not wish to bid on that item-Be advised,a"no bid"or no response may be
considered as non-responsive and may result 6 disqualihcati on of the bid.
RFOt 21-0179 Hydrostatic Testing for Cylinders
Page 3 of 18
12
EXHIBIT C
CITY'S RFP NO.
FORT WORTH
�•" ' COVER PAGE
Event I Page- Invited: PUBLIC EVENT DETAILS
CFW01-21-0179 _
Event Round Version
1 1
Event Name
." ayarast.tic Testing for cylinazrs Submit To: City of Fort Worth
Stan Time Finish Time FINANCIAL MANAGEMENT SERVICES
o9110/2021 0600 00 cm 0/1712021 060000 CDT FINANCE-Purchasingq
200 Texas St.(Lower Cevel,South)
Fort Worth TX 76102
United States
Email: FMSPurchasingResponses@fortworthtexas.gov
Event Descritrtinn
The City of Fort Worth seeks bids to finalize an Agreement for Hydrostatic Testing for SC BA,SCUBA and Oxygen
�yli ride r for the Fire Department on an as needed basis.
Submission Requirements and Deadlines
All companieslindividuals wishing to do business with the City of Fort Worth must register as a Bidder on the
PeopleSoft Supplier Portal.Please visit
https:/hvww.fortworthtexas.gov/departmenWfinance/purehasinglregister for more information.
Assigned Buyer:Rya Robertson
There is no a Pre-Bid Conference for this bid.
Completed Quote must be received in the Purchasing Division,200 Texas Street,Fort Worth,Texas 76102 by the
above"Finish TimelEnd Date Time".Quotes must be submitted via email to:
fmspurchasingresponses(gfortworthtexas.gov or faxed to 817-392-B440,addressed to the Buyer,,and have the RFQt
Number and"Finish TimelEnd Date Tme"clearly marked on the email subject and/or fax cover page.
Late quotes will not be considered for award unless bidders are notified otherwise.Late quotes will be
returned or destroyed.Quotes may be withdrawn at any time prior to the official apeTng by written notification.
Quotes may not be altered,amended or withdrawn after the"Finish TimelEnd Date Time".Quote must be submitted
on this form.Freight and all other delivery charges shall be included in the unit price(s).The City is exempt from
Federal Excise and State Sales Tax,therefore,tax must not be included in the quote price.
Items quoted must meet or exceed City of Fort Worth Specifications;.however,The City of Fort Worth may
consider and accept alternate quotes if specified herein when most advantageous to the City.The City reserves the
right,however,to hold to City Specifications and to determine"or equal"status.The City reserves the
right to accept or reject in part or whole any quote submitted,and to waive any technicalities
for the best interest of the City.
Solicitation Documents:
Cover Page
Bid Submission Signature Page"
Bid Solicitation"
Part I Purchasing Agreement Specif cations
Part II-Scope of Se rvices)Specifications
Attachment A-Conflict of Interest Disclosure Requirement"
Attachment B-No Quote Sheet
Attachment C-Reference Sheet
Attachment D-Bidder's Qualification Questionnaire
Attachment E-Draft Service Agreement,attached as a separate
document
"Required to be completed and submitted.See Section 17.0,Quotations of Part 1 for list of all required
documents that shall be submitted with quote.Failure to submit all items will be grounds for rejection of a bid as non-
responsive to the specifications.
13
Fax,WaxrH.
�tr BID SOLICITATION
Event ID Page Invited: PUBLIC EVENT DETAILS
CPWa1.21-0174 3
Event Round Version
i 1
Event Name
tic Testing for c- _r:l'.._r< Submit To: City of Fort Worth
Start Time Finish Tirne FINANCIAL MANAGEMENT SERVICES
9 10 zd21 oe:3c:oa CDT as 7 o 0$: o:oo MT FINANCE-Purchasing
200 Texas St.(Lower Level,South)
Fort Worth TX 76102
United States
ErnaN: FMSPurcha sing Responsesgfortworthtexas.goy
Line: 1
Description: City Unit UnitPrice Total
4500 PSI SCBA High Pressure Hydrotest,per 300.00 EA
cylinder
Line: 2
Description: Qty Unit UnitPrice Total
SCUBA High Pressure Hydrotest,per cylinder 50.00 EA
O
Line: 3
Description: City Unit UnitPrice Total
02 Hydro(D)Size 02 High Pressure Hydrotest, 150.00 EA
per cylinder
Line: 4
Description: Qri Unit UnitPrice Total
Teflon C-ring 150.00 EA
Line:. 5
Description: City Unit UnitPrice Total
Rubber 0-ring 300.00 EA.
Line: 6
Description: QW Unit UnitPrice Total
4500 PSI Hydrostatic test,DOT(K)Size or 25.00 EA
similar,per cylinder 0
Line: 7
Description: Qty Unit UnitPrice Total
6000 PSI Hydrostatic test,DOT(K)Size or 25.00 EA
similar,per cylinder
Line: 8
Description: Sty Unit UnitPrice Total
Eddy Current Inspection,per cylinder 100.00 EA
Total laid Arnountc
A bid of'0'(zero)will be interpreted by the City as a no-charge(free)item and the City will not expect
to pay for that item.A bid of-no bid"or no response(space left blank)will be interpreted by the City
that the Offeror does not wish to bid on that item.Be advised,a"no bid"or no response may be
considered as non-responsive and may result in disqualification of the bid.
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 3 of 18
14
PART—1
PURCHASING AGREEMENT SPECIFICATIONS
1.0 SCOPE
1.1 The Cityof FortWorth(City)seeks bids to finalize an Agreement to provide hydrostatic
testing for SCBA,SCUBA,oxygen cylinders,and large D.O.T cylinders for the Fire
Department.The successful bidder(s),known hereafteras°Contractor'P'Vendor.°
1.2 The term of this Agreement shall begin on the date stated in the signed Contract
("Effective Date")and shall expire one year from the effective date,unless terminated
earlier in accordance with the provisions of this Agreement.This Agreement may be
renewed under the same terms and conditions for four additional one year periods,
unless City of Vendor provides the other party with notice of non-renewal at least 60
days before the expiration of the initial term or renewal period.
1.3 Following the award,additional services of the same general category that could have been
encompassed in the award of this Agreement,and that are not already on the Agreement,
maybe added based on the discount bid and price sheet provided with the bid.
1.4 Unit prices shall include all costs associated with the specified work,including but
not limited to handling,delivery,fuel charges,fees and certification fees.No
additional charges will be accepted or paid by the City.
1.5 The submission of a quote by the bidder shall be considered evidence of
compliance with these requirements.
2.0 DFTAILFD SCOPE OF SERVICESlSPECIFICATIONS
2.1 The Vendor hereby agrees to provide the City with requirements attached hereto and
incorporated for all purposes incident to this Agreement in Part - 2, Scope of
Services/Specifications and Attachment E, Draft Vender Service Agreement, more
specifically describing the services to be provided hereunder.
3.0 CHANGE IN COMPANY NAME OROWNE IRS HIP
3.1 The Vendor shall notify the City's Purchasing Manager,in writing,of a company name,
ownership,or address change for the purpose of maintaining updated City records.The
president of the company or authorized official must sign the letter.A letter indicating
changes in a company name or ownership must be accompanied with supporting legal
documentation such as an updated W-9,documents filed with the state indicatingsuch
change,copy of the board of director's resolution approving the action,or an executed
merger or acquisition agreement. Failure to do so may adversely impact future invoice
payments.
4.0 LAWS.REGULATIONS,AND ORDINANCES
4.1 The Vendor shall be responsible for meeting all Federal:laws,ordinances and regulations;
State:laws,ordinance and regulations,County:laws,ordinances and regulations,and City:
laws,ordinances,and regulations for safety of people,environment,and property.This
includes,but is not limited to,all Federal,State,County,and City Agencies,
Administrations and Commissions such as the Environmental Protection Agency(EPA),
0ccupationaI Safety and Health Administration(OSHA),and the Texas Commission on
Environmental Quality(TCEQ)-In the event any law,regulation or ordinance becomes
effective after the start of this Agreement,the Vendor is required to comply with new policy.
Any mandates requiring the City to comply with new guidelines will also require the Vendor
to comply.
RFQt 21-4179 Hydrostatic Testing for Cylinders
Page 4 of 18
15
6.0 UNIT PRICE ADJUSTMENT
6.1 The unit prices may be adjusted for increases or decreases in Vendor's cost during the
renewal period but before the effective date of the renewal upon written request from the
Vendor.
6.2 The Vendor must submit its price adjustment request,in writing,at least 60 days before
the renewal effective period.The Vendor shall provide written proof of cost increases with
price adjustment request.
6.3 If the City concludes that the rate increase being requested is exorbitant,the Cityreserves
the right to adjust the rate request,or reject the rate request in its entirety and allow the
contract to expire at the end of the contract term.If the City elects not to exercise the
renewal option,the Purchasing Division will issue a newsolicitation.
6.4 Prices bid shall remain firm for each one-year term of the Agreement and shall include
all associated freight and deliverycosts.
6.5 Prices offered shall be used for bid analysis and for Agreement pricing.In cases of errors in
extensions or totals,the unit prices offered willgovern.
6.6 Upon expiration of the Agreement term the successful bidder,agrees to hold over under
the terms and conditions of this Agreement for a reasonable period of time to allow the city
to re-bid an agreement,not to exceed ninety(90)days.Vendor will be reimbursed for this
service at the prior agreement rate(s).Vendor shall remain obligated to the City under all
clauses of this Agreement that expressly or by their nature extends beyond and survives
the expiration or termination of this Agreement.
6.7 Goods and/or services shall not be suspended by the Vendor without a 30 day prior written
notice to the City.
7.0 QUANTITIES
7.1 The quantities listed on the bid solicitation are only estimates based on previous usage
and do not indicate intent to purchase or a guarantee of future business.The City of Fort
Worth is obligated to pay for only those materials and services actually ordered by an
authorized City employee and then received as required and accepted by the City-
8 n INSURANCE REQUIREMENTS
8.1 The Vendor shall carry insurance in the types and amounts for the duration of this contract
as listed in the draft service agreement,Attachment_to this solicitation,and furnish
certificates of insurance along with copies of policy declaration pages and policy
endorsements as evidence thereof.
9.0 PERFORMANCE
9.1 Failure of the Cityto insist in anyone or more instances upon performance of anyofthe
terms and conditions of this Agreement shall not be construed as a waiver or
relinquishment of the future performance of any terms and conditions,but the Vendor's
obligation with respect to such performance shall continue in full force andeffect.
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 6 of 18
16
100 COMPLAINTS
10.1 Complaints processed through the City Purchasing Division are to be corrected within
fourteen(14)days of formal notice of complaint.Written response to the Purchasing
Division is required.Failure to properly resolve complaints within the fourteen(14)
calendar day time period may result in the cancellation of the applicable line items)in
the price agreement.
11.0 COOPERATIVE PURCHASING
11.1 Should other governmental entities decide to participate in this Agreement,Bidders,shall
indicate in their bid response whether they agree that all terms,conditions,specification,
and pricing would apply.
112 If the successful Bidder agrees to extend the resulting Agreement to other governmental
entities,the following will apply:Governmental entities within utilizing agreements with the
City of Fort Worth will be eligible,but not obligated,to purchase material/services under this
Agreement(s)awarded as a result of this solicitation.All purchases bygovernmental entities
other than the City of Fort Worth will be billed directly to that governmental entity and paid
by that governmental entity.The City of Fort Worth will not be responsible for another
governmental entity's debts. Each governmental entity will order its own material/services
asneeded.
12.❑ NO BOYCOTT OF ISRAEL
12.1 It Vendor has fewer than 10 employees or this Agreement is for less than$100,000,
this section does not apply.Vendor acknowledges that in accordance with Chapter 2271
of the Texas Government Code,the City is prohibited from entering into a contract with a
company 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.The terms"boycott Israel'and"company"has the meanings ascribed to those
terms in Section 2271 of the Texas Government Code. By signing this Agreement,
Vendor certifies that Vendor's signature provides written verification to the City that
Vendor: (1)does not boycott Israel;and(2)will not boycott Israel during the term of
the Agreement.
13.0 PROHIBITION ON BOYCOTTING ENERGY COMPANIES
13.1 Vendor acknowledges that in accordance with Chapter 2274 of the Texas Government
Code,as added by Acts 2021,87th Leg.,R.S., S.B.13,§2,the City is prohibited from
entering into a contract for goods or services that has a value of$100,000 or more that is to
be paid wholly or partly from public funds of the City with a company with 10 or more full-
time employees unless the contract contains a written verification from the company that it:
does not boycott energy companies;and(2)will not boycott energy companies during the
term of the contract.The terms"boycott energy company" and"company"have the
meaning ascribed to those terms by Chapter 2274 of the Texas Government Code,as
added by Acts 2021,87th Leg., R.S.,S.B. 13,§2. To the extent that Chapter 2274 of the
Government Code is applicable to this Agreement,by signing this Agreement,Vendor
certifies that Vendor's signature provides written verification to the City that Vendor:(1)does
not boycott energy companies,and(2)will not boycott energy companies during the term of
this Agreement.
14.0 PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND AMMUNITION INDUSTRIES
14.1 Vendor acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code,as added by Acts 2021,87th Leg.,R.S., S.B.19,§1,the City is
prohibited from entering into a contract for goods or services that has a value of$100,000 or
more that is to be paid wholly or partly from public funds of the City with a company with 10
or more full-time employees unless the contract contains a written verification from the
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 7 of 1$
17
company that it:(1)does not have a practice,policy,guidance,or directive that discriminates
against a firearm entity or firearm trade association;and(2)will not discriminate during the
term of the contract against a firearm entity or firearm trade association. The terms
"discriminate,""firearm entity"and"firearm trade association"have the meaning ascribed to
those terms by Chapter 2274 of the Texas Government Code,as added by Acts 2021,87th
Leg.,R.S.,S.B. 19,§1. To the extent that Chapter 2274 of the Government Code is
applicable to this Agreement,by signing this Agreement,Vendor certifies that Vendor's
signature provides written verification to the City that Vendor.(1)does not have a practice,
policy,guidance,or directive that discriminates against a firearm entity or firearm trade
association;and(2)will not discriminate against a firearm entity or firearm trade association
during the term of this Agreement.
15.❑ BIDDER QUALIFICATIONS
15.1 The following Information must be submitted as part of the bid package and shall be
supplied In the following order.Failure to provide the information below will deem the bid as
non-responsive.
15.1.1 Numberofyearsinbusiness(i.eSecretaryofState)
15.12 Bidders shall provide evidence that they are duly qualified and capable to fulfill
and abide by the requirements listed herein with the bid.The bidder shall
demonstrate its ability to secure and perform the services within the delivery
requirements specified herein.
15.1.3 Detailed explanation of methodology Vendor will use to provide all necessary
labor,material,personnel and equipment to perform the hydrostatic testing
service
15.1.4 Documentation showing the Vendor D.C.T.certified as a cylinderrequalification
facility and a copy of their D.C.T.letter with Requalifier Identification Number.
15.1.5 In order to receive bid award consideration,the bidder shall maintainsufficient
resources to fulfill normal City of Fort Worth requirements.
15.0 METHOD OF AWARD
16.1 Bids will be evaluated based on the bidder who offers represents the"best value"tothe
City.A responsible bidder is defined as a bidder that
16.1.1 Meets all the requirements listed in Section 15.0.
16.1.2 Submits a completed bid within the stated deadline and in accordance with
the bid specifications.
16.2 Bids that do not receive 50%or more of the total available points excluding the points for
price will be deemed nonresponsive.The following criteria will be considered to
determine the best value:
16.2.1 Cost of service—up to 50 pointsavailable
162.2 Bidder's qualification,experience,and references-up to 20 points available
162.3 Bidder's availability of resources to provide services(equipment,personnel)—up to
15 pointsavailable
162.4 Bidder's approach to perform services—up to 15 pointsavailable
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 8 of 18
18
16.3 In order for the City to receive adequate coverage on its requirements as specified in the
solicitation,the Cityreserves the right to make muIt i pleawards.
16.4 The City also reserves the right to reject the bid of a bidder who has previouslyfai led
to perform properlyor complete on time agreements of a similar nature.
16.5 The evaluation factors listed above will be applied in a comparative manner to all
eligible,responsive bids.Award may be made without discussion with Bidders
after bids are received.Bids should,therefore, be submitted on the most favorable
terms.
16.6 The City reserves and shall be free to exercise the right to evaluate bid in relation to
performance record of bidder with the City itself,another municipal corporation of like size,
or private corporations during the past two-year period.Such precautions are deemed to be
in the public interest inasmuch as Vendor failure or inability to furnish items within the
prescribed time can create emergency situations and impose unnecessary hardship on
both the City as a municipal corporation and the public at large.
16.7 Tentative Schedule of Events:
RFQt Release Date September 10,2021
Deadline for Questions September 14,2021 at 5PM Local Time
Answer Deadline September 15,2021
RFQt Due Date September 17,2021 at 8:30AM Local Time
Bid Evaluations September 20—September 27,2021
Recommended Vendor5election September 2021
Contract Execution October 2021
17.0 QUOTATIONS
17.1 Bidders shall submitthe fallowing items with their quote.Failure to provide all
the information will deem the bid non-responsive.
17.1.1 A completed and signed Bid Submission Signature Page;
17.1.2 A completed Bid Solicitation Page;
17.1.3 A completed and signed original Conflict of Interest Questionnaire,Attachment A;
17.1.4 A completed Reference Sheet,Attachment C
17.1.5 Acompleted Bidder Qualification Questionnaire,Attachment D;
17.1.6 Documentation showing the Vendor D.O.T.certified as a cylinder requalification
facility and a copy of their D.O.T. letter with Requalifier Identification Number.
17.1.7 Detailed explanation of methodology Vendor will use to provide all necessary labor„
material,personnel and equipment to perform the hydrostatic testing services;
17.1.8 Documentation showing companyhas been in the marketplaceforaminimumoftwe
(2)years(i.e. Secretary of State).
17.1.9 Scanned copy of all documents listed in paragraph 17.1 in flash drive.
17.2 Failure to submit the items listed in Section 17.1 will be grounds for rejection of a bid as
non-responsive to thespecifications.
18.0 QUESTIONS
18.1 Questions,explanations or clarifications desired by a Vendor regarding any part of the
bid must be requested in writing from the Purchasing Division by 5:00 PM on
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 9 of 18
19
September 14,2021.Request can be send to the following:
A'ja Robertson,Buyer,FMSPurchasingResponses@fortworthtexas.gov
Reference RFQt 21.0179
City of Fort Worth Purchasing Divis[on
Attention:A'ja Robertson
200 Texas Street
Fort Worth,Texas 76102
Facsimile:(817)392-8440,Attention:A'ja Robertson
RFQt 21-D179 Hydrostatic Testing foe Cylinders
Page to of 18
20
PART 2-SCOPE OF SERVICES/SPECIFICATIONS
1.0 VENDOR SHALL MEET THE FOLLOWING REQUIREMENTS
1.1 The vendor shall be D.O.T. certified as a cylinder requalification facility and must provide a copy of
its D.O.T. letter with Requalifier Identification Number to the Fort Worth Fire SCBA Air Shop to keep
on record.
1.2 The vendor shall have mobile testing capability to test cylinders on location at various sites
throughout the City.
1.3 The vendor shall be able to hydrostatically test SCBA breathing air cylinders, SCUBA breathing air
cylinders, medical grade oxygen cylinders, and large D.O.T cylinders on an as needed basis per
D.O.T.49 CFR 180 subpart C guidelines and in accordance with any and all other local, state and
federal regulations.
1.4 The vendor shall provide the Fort Worth Fire SCBA Air Shop an electronical spreadsheet, PDF or
printed list of all cylinders tested with the results including the pressures and expansions recorded
for the SCBA cylinders within 5 business days oftesting.
1.5 Vendor shall perform hydrostatic testing Monday-Friday 8:00AM-5:00PM, excluding holidays.
2.0 CYLINDER TESTING SHALL MEET THE FOLLOWING REQUIREMENTS
2.1 Cylinder shall be examined to ensure it can safely hold it pressure.
2.2 Cylinder shall be filled with a nearly incompressible liquid, in most cases water, pressurizing
the cylinder and examined for leaks or permanent changes in shape.
2.3 A visual inspection shall be performed each time a cylinder goes through the pressure testing
process.The cylinder must be given an internal and external inspection in accordance with
Compressed Gas Association (CGA)pamphlets, D.O.T CFR 49 requirements and any local,state,
and federal laws.
2.4 Each Cylinder tested must be legibly labeled or stamped as applicable with the new
hydrostatic test date in a manner that remain legible until the next test date or end of service
of the cylinder.
3.0 CYLINDER REJECTION
3.1 The Vendor shall reject a cylinder when,after a visual inspection, it meets a condition for rejection
under the visual inspection requirements stated in the D.O.T CFR 49.
3.1.1 The Vendor shall notify the City that the cylinder is being rejected and provide further
requalification instructions
4.0 CYLINDER LOCATIONS
4.1 Hydrostatic testing may be performed at the locations listed below:
4.1.1 FW FD Air Shop-400 Grand Ave. Fort Worth,Texas 76164
4.1.2 Bob Bolen Public Safety Fire Training-505 W Felix St. Fort Worth,Texas76115
4.1.3 FW FD Equipment Services Shop-2930 W. Bolt St.Fort Worth,Texas 76110
4.1.4 FWFD Station 32- 10201 White Settlement Rd. Fort Worth,Texas76108
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 11 of 18
21
ATTACHMENT-A
CONFLICT OF INTEREST DISCLOSURE REQUIREMENT
Pursuant to Chapter 176 of the Local Government Code,any person or agent of a person who contracts or
seeks to contract for the sale or purchase of property,goads,or services with a local governmental entity(i.e.
The City of Fort Worth)must disclose in the Questionnaire Forms CIQ("Questionnaire")the person's affiliation
or business relationship that might cause a conflict of interest with the local governmental entity. By law,the
Questionnaire must be filed with the Fort Worth City Secretary no later than seven days after the date the
person begins contract discussions or negotiations with the City,or submits an application or response to a
request for proposals or bids,correspondence,or another writing related to potential agreement with the City.
Updated Questionnaires must be filed in conformance with Chapter 176.
A copy of the questionnaires Form CIQ is enclosed with submittal documents.The form is also available at
h ttps:llwww.eth i c s.state.tx.usld atalform slco of I ict/C I Q.pd f
If you have any questions about compliance, please consult your own legal counsel- Compliance is the
individual responsibility of each person or agent of a person who is subject to the filing requirement. An
offense under Chapter 176 is a Class C misdemeanor.
NOTE: If you are not aware of a Conflict of Interest in any business relationship that you might have
with the City, state Vendor name in the# 1, use NIA in each of the areas on the form. However, a
signature is required in the#7 box in all cases.
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 12 of 18
22
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B.23,84th Leg.,Regular Session. 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-
2J Name of vendor who has a business relationshin with local governmental entity.
® check this box It you are tiling an update to a previously tiled questionnaire.(I ne law requires that you Tile 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 belna disclosed.
Name of Officer
a Describe each emplovment or other business relationshin with the local government officer.or a family member of the
officer,as described by Section 176.003(a)(2)(A).Also describe anyfamily relationship with the local government officer.
Complete subparts Aand B for each employmentor business relationship described.Attach additional pages to this Form
CIQ as necessary.
A. Is the Vocal 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-1No
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 F__]No
5 Describe each emolovment 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
Signature of vendor doing business with the governmental entity Date
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 13 of 18
23
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
Acomplete copy of Chapter 176 of the Local Government Code maybe found at http:/Iwww.statutes.legis.state.tx.us/
DOcs/LGlh1miLG.176.htm.For easy reference,below are some of the sections cited on this form.
Local Government Code§I M001(1-al:"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:
(N 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.
LocaI Government Code§176.003(a)l21(A)and t81:
(a) A local government officer shall file a conflicts disclosure statementwith respect to a vendor if.
(2) thevendor:
0) 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-1I
(a) A vendor 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 conflictof interestquestionnaire 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.
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 14 of 18
24
ATTACH M ENT—B
NO QUOTE SHEET
(Please complete this form,only if,your firm has chosen not to submit a bid)
A'ja Rohertson,Buyer
Purchasing Division
Fax No.817-392-8440
E-mail address.FMSPurchasingResoonses(a)fortworthtexas.gov
If your firm has chosen not to submit a bid for this procurement.,please complete this form and submit to:
City of Fort Worth,Purchasing Division
200 Texas Street
Fort Worth,Texas 76102
for fax to above address}
Please check the items that apply:
1-1 Do not sell the items)required.
Cannot be competitive.
Cannot meet the Specifications highlighted in the attached Bid.
Cannot provide Insurance required.
Cannot provide Bonding required.
Cannot comply with Indemnification requirements.
Job too large.
Q Job too small.
Do not wish to do business with the City.
0 Other reason.
Company Name:
Authorized Officer or Agent Signature:
Telephone:L _] _ FAX Number:
RFQt 21-0178 Hydrostatic Testing for Cylinders
Page 15 of 18
25
ATTACHMENT-C
REFERENCE SHEET
Bidders shall provide a reference list of a minimum of three(3)current customers(comparable in size)
who the bidder has recently supplied subject item(s)land or services on a continuing basis over a recent
twelve(12)month period.The City will be the sole judge of references.Please use additional sheets if
necessary.
1. Company's Name
Name of Contact
Title of Contact
Present Address
City,State,Zip Code
Telephone Number ( 7 Fax Number{ )
Email
2. Company's Name
Name of Contact
Title of Contact
Present Address
City,State,Zip Code
Telephone Number { 7 Fax Number{ )
Email
3. Company's Name
Name of Contact
Title of Contact
Present Address
City,State,Zip Code
Telephone Number { j Fax Number( )
Email
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 16 of 18
26
ATTACHMENT-D
BIDDER'S
QUALIFICATION
QUESTIONNAIRE
1. Date your companywas established?
2. How many years has your organization been in business under its present name?
a. List anyformer names your organization has operated under and the timefrarne[s].
3. Have you ever defaulted on a contract?If so,whywere you unable to fulfill the obligation?
4. Please provide in a separate attachment documentation showing yourcompany has been in
the marketplace for a minimum of two(2)years(i.e.Secretary of State).
5. Can your company fulfil the specifications listed in sections 1.0-3.0 on page 11?Please provide
a detailed explanation of methodology Vendor will use to provide all necessary labor,
material,personnel and equipment for the hydrostatic testing.
Yes No
6. Is your companya D.O.T.certified as a cylinder requalification facility?If so,please provide a
copy of your D.O.T.letter with Requalifier Identification Number with your bid response.
Yes No
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 17 of 18
27
ATTACHMENT E-
DRAFT SERVICE AGREEMENT
The draft service agreement is attached as a separate document.
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 18 of 18
28
EXHIBIT D
VENDOR'S RESPONSE TO CITY RFP NO.
TORT WORTH
BID SUBMISSION SIGNATURE PAGE
Event ID Page Invited: PUBLIC EVENT DETAILS
Event
Event Roouu dt7$ 2
nd Version
1 1
Event Name
r rt arostatic xa "n far ii Submit To- City of Fort Worth
start Tarn® Finish Time FINANCIAL MANAGEMENT SERVICES
a io aeai oa: o:• 2h21 0 _ cnx FINANCE-Purchasing
200 Texas St"(Lower Level,South)
Fort Worth TX 76102
United States
Email: FMSPurchasingResponses@fortworlhtexas,gov
The undersigned,by his/her signature,represents that helshe is submitting a binding offer and is authorized
to bind the respondent to fully comply with the solicitation document contained herein..The Respondent,by
submtfing and signing below,acknowledges that helshe has received and read the entire document packet
sections defined above including all documents incorporated by reference,and agrees to be bound by the terms
therein,
Legal Company Name �c.'SG
Company Address: a:) f
City,State,Zip: ! S Ac
Vendor Registration No. �S T
Printed Name of Officer or Authorized Representative:
Title:<122
Sign
Signature of OfficeriorAulhoriz>ed Represenfali "
Date: /
Email Address: [.
Phone Number:
Federal Identification Number(FID):
Wit agreement be available for Cooperative Agreement use? Yes/' Na
RF4t 21-0179 Hydrostatic Testing for Cylinders
Page 2 0118
29
FORT WORTH,..
BID SOLICITATION
Event ID - Page. Invited: PUBLIC EVENT DETAILS
CPWdl-71-Oi?9 3.
Event Round Version
1 1
Event
Name
RF r. Hydrostatic Testinq for cylinders — Submit To: City of Fort Worth
start Time Finish Tlme FINANCIAL MANAGEMENT SERVICES
D9 111 .1 B._3o:a0 CBT os la 2021 rsa:sd:o T FINANCE-Purchasing
200 Texas St.(Lower Level,South)
Fort Worth TX 76102
United States
Email: FMSPurchasingResponses@rortworthtexas.gov
Line. 1
Description; Unii _ UnitPrice Total
4500 PSI SCBA High Pressure Hydrotest,per 300.00 EA
cylinder 3
So
Line: 2
Description: Unit UnILPrire Total
SCUBA High Pressure Hydrotest,per cylinder 50.00 EA
I�7s
Line: 3
Description: 6dty _ Unit UnitPrice Total
02 Hydro(D)Size 02 High Pressure Hydrotest, 150,00 EA
PEW cylinder
Line: 4
Description: Qty Unit UnitPrice Total
Teflon 0-4ing 150,00 EA
Line: 5
Descri ion: QtY Unit UnitPrice Total
Rubber 0-ring - 300.00 EA !!_
O FGG J
Line: 6
Descript on: QW Unit UnitPrice __ Total
4500 PSI Hydrostatic test,DDT(K)Size or 25.00 EA
similar,per cylinder
Line. 7 �f�J
Uescrlptlon: __ Qty _ Unit UnitPrice Total
6000 PSI Hydrostatic test,DOT(K)Size or 25.00 EA
similar,per cylinder
Line- 8
Description: Qty Unit UnitPrice Total
Eddy Current Inspection,per cylinder 100.00 EA _
Total sid Amauat-
A bid of"0'(zero)w41 be interpreted by the City as a no-charge(free)item and the City yell not expect
to pay for that item.A bid of'nn bid"or no response(space left blank)will be interpreted by the City
that the Offeror does not wish to bid on that item.Be advised,a"no bid"or no response may be
considered as non-responsive and may result in disqualification of the bid.
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 3 of 18
30
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B.23,84th Leg.,Regular Session. OFFICE USE ONLY
This questionnaire is being riled in accordance with Chapter 176.Local Government Code,by a vendor who Pete Reccved
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 entily 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 176.006,Local Government Code.An
offense under this section is a misdemeanor.
.1J Name of vendor who has a business relationship with local ciovernmental�entiitty-
2 ❑ check this box it you are riling an update to a previously}lied questtannaire.(I he law requires tna[you The an Optla[Bd
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 novernment officer about whom the infnrmatinn is beino disclosed.
Name of Officer
4 Describe each emotovmant 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 anyfamily 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?
El Yee E]No
B. Is the vendor receiving or likely to receive taxable inooma,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?
DY-
5 Describe each emolovment 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
❑ Gheck this box if the vend has given the local government officer or a family member of the officer one or more gifts
a ri a Section 003(a)(2)(B),a lulling gifts described in Section 176.003(a-1).
7 f
V
Signalure of vendor doing bu ness with the governmental entity ` Date
RFQt 21.0179 Hydrostatic Testing forCylinders
Pave 13 of 1 a
31
ATTACHMENT-C
REFERENCE SHEET
Bidders shall provide a reference list of a minimum of three(3)current customers(comparable in size)
who the bidder has recently supplied subject item(s)land or services on a continuing basis over a recent
twelve(12)month period.The City will be the sole judge of references.Please use additional sheets if
necessary.
1. Company's Name rlir f.1 BLS I j�ip�
Name of Contact u
Title of Contact
Present Address toj�� r2G
City,State,Zip Code
Telephone Number �+ ] _ Fax Number( }
Email ' t12
2. Company's Name
Name of Contact4�f t.
Title of Contact u L
Present Address
City,State,Zip Code
Telephone Number [ ] Fax Number( )
Email -Dice,
3. Company's Name [ ti
Name of Contact l
Title of ContactS&RA
Present Address
City,State,Zip Code —nC —15001,
Telephone Number { ) t_ Irl q-70 Fax Number( ]
Email lIli I1.ark r Wk,�&(h A j114 'R 041aOt
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 16 of 18
32
ATTACHMENT-D
BIDDER'S
QUALIFICATION
QUESTIONNAIRE
1.. Date your companywas established?
2. Howmanyyears has your organization been in business under its presentname?
a. List anyformer names your organization has operated under and the timeframe(s).
3. Have you ever defaulted on a contract?If so,whywere you unable to fulfill the obligation?
- - —
4. Please provide in a separate attachment documentation showing yourcompany has been in
the marketplace fora minimum of two(2)years(i.e.Secretary ofstate).
5. Can your company Fulfil the specifications listed in sections 1.0-3.0 on page f 1?Please provide
a detailed explanation of methodology Vendor will use to provide all necessary labor,
material,personnel and equipment for the hydrostatic testing.
Yes No
G. Is your companya D.O.T.oortiFod as a cylinder requaffication facility?If so,pl—p-provide a
copy of your D.O.T.letter with Requalifier Identification Numberwith your bad response.
Yes � No
RFQt 21-0179 Hydrostatic Testing for Cylinders
Page 17 of 18
33
Corporations Soclion SCE OF David Whitley
P.Q.Box 13697 Gto.� Secretary of Statc
Austin,Texas 7871 1-3 697 r"
Office of the Secretary of State
CERTIFICATE OF FILING
OF
Firehouse Hydrostat Services,LLC
File Number'803322502
The undersigned, as Secretary of State of Texas, hereby certifies that a Certificate of Formation for the
above named Domestic Limited Liability Company(LLC)has been received in this office and has been
found to conform to the applicable provisions of law.
ACCORDINGLY, the undersigned, as Secretary of State, and by virtue of the authority vested in the
secretary by law,hereby issues this certificate evidencing filing effective on the date shown below.
The issuance of this certificate does not authorize the use of a name in this state in violation of the rights
of another under the federal Trademark Act of 1946,the Texas trademark law,the Assumed Business or
Professional Name Act,or the common law.
ram.
Dated:05/20/2019
EfFective:05/2012019
tin
�?
L
David Whitley
Secretary of State
Come visit us on the intermt at stare.tx.uV
Phone:(5t2)463-5555 Fax:(512)463-5708 Dual:7-1-1 for Relay Services
Prepared by:Carol Cb ey T1D:10306 Document:990773120002
34
a
U-S-Department Earl Building,PHH-33
of Transportation 12OG Now Jgf y AW ua_%NAhMM
Wsslnngwn.PC 205'W
Pipeline and Hazardous
Materials Safety Administration
July 29,2019
Expiration Date:June 30,2022
Revision:Address update
Mr.Scott Evans
Owner
Firehouse Hydrostat Services LLC(Mobile Unit)
200 Hillside LN
Lindsay,TX 76250 United States
Dear Mr.Evans:
The Pipeline and Hazardous Materials Safety Administration (PHMSA) has reviewed your
application for approval as a cylinder requalification facility under Section 107.805 of Title 49
Code of Federal Regulations(49 CFR).At the recommendation of Steigerwalt Associates, Inc.,
this office is re-issuing the requalifier identification number(RIN)1208 to your facility located at
200 Hillside LN, Lindsay, TX for DOT cylinder specification(s): 3A,3AA,3AL and Special
Permit(s): 7277,11194,10915,10945,10947,14,387,14339,11005, 14003, 10869,15136 and
13583. This number authorizes requalification of the authorized cylinder specifications by the
"hydrostatic"test method,applies to this location only,and is valid until the pasted expiration
date above or until terminated by the Associate Administrator for I lazardous Materials Safety.
This number applies to mobile unit vehicles garaged at this location only. The vehicle
identification number(s) authorized under the provisions of this approval are as follows:
1GC4K1EY2HF124886. The mobile unit(s) can only travel within the following geographical
regions: Arkansas, New Mexico, Oklahoma, Louisiana and Texas. The cylinder sizes
authorized to be tested are as follows:The smallest cylinder is 3"X 12".The largest cylinder is
10"X 66".
The RIN is valid until the posted expiration date above or until terminated by the Associate
Administrator for Hazardous Materials Safety. Failure to comply with the provisions of this
approval may result in the suspension or termination of this RIN authorization.
In addition to the requirements for requalification of cylinders under the relevant provisions of
Sections 180.205 through 180.215 of 49 CFR,the following conditions must be met:
Tracking'No: 2019075101 Page I of 3
35
l. You must notify this office in writing of any change in company name,address,ownership,
testing equipment and approved mobile unit used, management,or testing personnel within
twenty days or the change.
2. Additional mobile units, not identified above, are not authorized under this RIN approval
without prior approval from The Office of hazardous Materials Safety, Approvals and
Permits Division in accordance with the provisions of 49 CFR 107.805.
3. If more than one mobile unit is approved under this RIN authorization,in addition to the RIN
number,the specific mobile unit where cylinder requalification is being conducted must be
clearly identified on the requalifier test records and calibration records, as required by 49
CFR 180.215.
4_ This approval is renewable every five years. If you wish to renew this approval, please
ensure that your application for renewal is received by PHMSA at least 60 days prior to the
expiration date posted above,in accordance with 49 CFR 107.705(c).
5. Renewal applications or enquiries should be sent to a approvals(ddot.gov.
6. Testing must be performed by, or in the presence of,a designated hydrostatic test operator
who has been observed by the authorized independent inspection agency inspector during the
onsite audit of the mobile unit under the provisions of 49 CFR 107.805, or who has been
certified as meeting the training requirements of 49 CFR 171 700 through 49 CFR 172.704
and has been added to your file by addition under condition number one(1)above.
7. A copy of this approval must be maintained onboard and adjacent to the mobile testing
unit(s)and at the stationary facility at the authorized address identified above.
8. The approved stationary address, where the mobile unit(s) is garaged, must be manned,
during normal business hours,and accessible to unannounced onsite inspection by PHMSA
inspectors. This location must maintain a daily log that identifies the date of inspection,the
specific mobile unit authorized under the provisions of this approval, and the
location/address where testing is being performed each day.
9. Testing under this RIN approval is authorized only on the authorized cylinder specifications
and testing method listed above. Additional special permits (not meeting approved testing
method above), DOT cylinder specifications, including UN ISO specifications may be
requested only after inspection and recommendation by an approved Independent Inspection
Agency and only after additional approval is granted by PHMSA in accordance with the
requirements of 107.705 and 107.805.
10.Copies of your RIN application and all supporting documentation must be retained and made
available to DOT upon request.
11.Each"Hazmat employee",as defined in Section 171.8, who performs a function subject to
this approval,must receive appropriate training;in accordance with Section 172.704.
12.All correspondence with PHMSA relating to your approval must include the R1N.
Tracking No: 2019075101 Page 2 of
36
13.This approval as revised supersedes all previous versions.
for William Schoonover
Associate Administrator for Hazardous Materials Safety
Tracking No: 2019075101 Page 3 of 3
37
A
f IRRHOUSIG
Hy0aOSTAT
City of Fort Worth,
Firehouse Hydrostatic Services LLC, has a 24 ft mobile testing lad ratory.We can test onsite,limiting the
out of service time of the cylinders_We can test as many as 150 per day.We employee all off duty
firefighters.The employees have meet all DOT test requirements for testing.While maintaung any
updated tranning as well.All employees are cover with Texas Workmans Comp Insurance.Along with f L
Polices.
The epuipment we used is the 500-HP-14S-M Hydrostatic Water Jacket testing System.This is a
manually operated sytem with a testung rang from 2000-10,000 psi.It meets US DOT requerments-
Equipted with a calibrated pressurre gauge ranging from 0-11,000 psi x20 psi increments.Class 3A-1/4%
full range accuracy.Water jacket is safe under pressure with a 35 psi burst disk.
Scot Evans CEO
817-948-6177
seva ns@firehousehydro:com
38
EXHIBIT E
VERIFICATION OF SIGNATURE AUTHORITY
FIREHOUSE HYDROST SERVICES
200 HILLSIDE LN
LINDSAY,TX 76250
Execution of this Signature Verification Form ("Form") hereby certifies that the following
individuals and/or positions have the authority to legally bind Vendor and to execute any agreement,
amendment or change order on behalf of Vendor. Such binding authority has been granted by proper order,
resolution, ordinance or other authorization of Vendor. City is fully entitled to rely on the warranty and
representation set forth in this Form in entering into any agreement or amendment with Vendor. Vendor
will submit an updated Form within ten (10) business days if there are any changes to the signatory
authority.City is entitled to rely on any current executed Form until it receives a revised Form that has been
properly executed by Vendor.
1. Name:
Position:
Signature
2. Name:
Position:
Signature
3. Name:
Position:
Signature
Name:
Signature of President/CEO
Other Title:
Date:
39