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HomeMy WebLinkAboutContract 59442CSC No. 59442 FORT WORTH CITY OF FORT WORTH COOPERATIVE PURCHASE AGREEMENT This Cooperative Purchase Agreement ("Agreement") is entered into by and between RDO Equipment Co ("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 (Sourcewell #032119-JDC); 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 not exceed ONE -HUNDRED THOUSAND DOLLARS WITH 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 13, 2024 with no renewals. 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: City of Fort Worth Attn: Dana Burghdoff, Assistant City Manager 200 Texas Street Fort Worth, TX 76102-6314 With copy to Fort Worth City Attorney's Office at same address Hns kNAOIL1163A RDO Equipment Co Austin Walker, Government Fleet Sales Address: 1396 Hwy 327 E. Silsbee, TX 77656 Facsimile: N/A 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: ,Darla EwgG 6rf By: Dana Burghdoff(MK19,2021P:40 CDT) Name: Dana Burghdoff Title: Assistant City Manager Date: APPROVAL RECOMMENDED: By: Name: Steve Cooke Title: Asst Property Management Director apvoagn ATTEST: vim°'' �9dC Pvo a=d � s opP* 000 oo*gip Qaa� nEop544p By: Name: Jannette Goodall Title: City Secretary VENDOR: RDO Equipment Co Ausfin R walller Austin R Walker (May 12, 202312:50 CDT) By: Name: Austin Walker Title: Government Fleet Sales CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. T��vaude�r� By: Denise GarciEd4ay 18, 202310:24 CDT) Name: Denise Garcia Title: Contract Compliance Specialist APPROVED AS TO FORM AND LEGALITY: By: Name: Jessika Williams/Jeremy Anato- Mensah Title: Assistant City Attorney CONTRACT AUTHORIZATION: M&C: N/A OFFICIAL RECORD Date: CITY SECRETARY FT. WORTH, TX ATTACHMENT A Retail Purchase Order JOHN DEERE RDO Equipment Co. 5301 Mark IV Parkway Fort Worth TX, 76131 Phone: (817) 232-8094 - Fax: (817) 847-0398 Bill To: Purchase Order Date: CITY OF FORT WORTH Purchase Order* 4100 COL U MB US TRL Purchaser Account #: FORT WORTH, TX, 761337578 TARRANT () Customer Purchaser Type: (817) 392-8500 Customer Market Use: Location of First Working Use: Dealer Account Number. Govemmentaf Sales F ui::.: a.r •:1: Phone: Fax: Email: Comments QUOTE VALID UNTIL 6/25/2023 (60 DAYS) - CURRENT EST. DELIVERY: JUNE - JULY 2023 Equipment Information Quantity Serial Number Stock Number 1 TBD TBD Purchase Order Totals Hours Status 1 Year! Make 1 Model (approx.) Additional Items 0 New 2023 JOHN DEERE 210G 22'4*04 4 4/26/2023 1653890 8560001 Governmental - City/Town/Village Road Building - Highways & Sts. Const. FORT WORTH, TX, 761337578 177417 Austin Walker (817) 566-1541 awalker@rdoequipment.com Customer Discount Sourcewell Discount 1 #032119-JDC 1 39% Freight in FREIGHT TO STORE Freight Out FREIGHT TO CUSTOMER Prep 1 Reconditioning PDI Customer Discount VALUED CUSTOMER DISCOUNT Warranty -John Deere Power Train & Hyd.-60 Months, 2500 Hours, Deductible: 0 Item Subtotal: Equipment Subtotal: Balance: Total Taxable Amount: TX STATE TAX: TX CITY TAX: TX SPECIAL TAX: Sales Tax Total: Sub Total: Cash with Order. Balance Due: Cash Price $151,617.00 (S59,130.63) $2.000.00 $1,000.00 $2,500.00 (S2,000.00) $4,000.00 $99,986.37 $99, 986.37 $99,986.37 S0.00 S0.00 $0.00 $0.00 $0.00 $99,986.37 S 0.00 $99,986.37 D1653890 Page 1 of 7 Sourcewell Contract 032119-JDC John Deere Construction Retail Sales List Price Discounts Note: Discounts will be calculated based on current pricing at the time an agency requests the quote and will be valid for 30 days. Please contact your local dealer for a contract quote: httos://dealerlocator.deere.com/servlet/ Product Family Model List Price Discount Articulated Dump Trucks 260E 33% Articulated Dump Trucks 260 P-Tier 28% Articulated Dump Trucks 310E 33% Articulated Dump Trucks 310 P-Tier 28% Articulated Dump Trucks 410E-II 32% Articulated Dump Trucks 410 P-Tier 28% Articulated Dump Trucks 460E-II 30% Articulated Dump Trucks 460 P-Tier 28% Product Family Model List Price Discount Backhoes 310LEP 45% Backhoes 310L 46% Backhoes 310 G-Tier 43% Backhoes 310 P-Tier 43% Backhoes 310SL 46% Backhoes 310SL HL 46% Backhoes 315SL 46% Backhoes 320 P-Tier 43% Backhoes 410L 44% Backhoes 410 P-Tier 41% Backhoes 710L 43% Backhoes 710 P-Tier 43% Product Family Model List Price Discount Compact Track Loaders 317G 32% Company Use Compact Track Loaders 325G 32% Compact Track Loaders 331G 32% Compact Track Loaders 333G 32% Product Family Model List Price Discount Dozers 450K 29% Dozers 450 P-Tier 27% Dozers 550K 29% Dozers 550 P-Tier 27% Dozers 650K 29% Dozers 650 P-Tier 28% Dozers 700L 26% Dozers 750L 25% Dozers 850L 28% Dozers 950K 33% Dozers 1050K 33% Product Family Model List Price Discount Crawler Loaders 655K 28% Crawler Loaders 755K 28% Product Family Model List Price Discount Excavators 75G/ZX75US-5 34% Excavators 75 P-Tier 32% Excavators 85G/ZX85USB-5 34% Excavators 85 P-Tier 32% Excavators 130G/ZX130-6 36% Excavators 130 P-Tier 32% Excavators 135G/ZX135US-6 36% Excavators 135 P-Tier 32% Excavators 160G LC/ZX160LC-6 36% Excavators 160 P-Tier 32% Company Use Excavators 190GW/ZX190W-6 44% Excavators 20OG LC 36% Excavators 200 G-Tier 32% Excavators 21OG LC/ZX210LC-6 36% Excavators 210 P-Tier 32% Excavators 245G LC/ZX245LC-6 36% Excavators 245 P-Tier 32% Excavators 250G LC/ZX250LC-6 35% Excavators 250 P-Tier 32% Excavators 30OG LC/ZX300LC-6 35% Excavators 300 P-Tier 32% Excavators 345G LC/ZX345USLC-6 31% Excavators 345 P-Tier 32% Excavators 350G LC/ZX350LC-6 36% Excavators 350P P-Tier 31% Excavators 380G LC/ZX380LC-6 36% Excavators 380 P-Tier 31% Excavators 470G LC/ZX470LC-6 39% Excavators 470 P-Tier 31% Excavators 670G LC/ZX670LC-6 39% Excavators 670 P-Tier 31% Excavators 870G LC/ZX870LC-6 39% Excavators 870 P-Tier 31% Product Family Model List Price Discount Compact Excavators 17G/ZX17U-5 29% Compact Excavators 17 P-Tier 27% Compact Excavators 26G/ZX26U-5 29% Compact Excavators 26 P-Tier 27% Compact Excavators 30G/ZX30U-5 29% Compact Excavators 30 P-Tier 27% Compact Excavators 35G/ZX35U-5 29% Company Use Compact Excavators 35 P-Tier 27% Compact Excavators 50G/ZX50U-5 29% Compact Excavators 50 P-Tier 27% Compact Excavators 60G/ZX60U-5 29% Compact Excavators 60 P-Tier 27% Product Family Model List Price Discount Feller Buncher 859M 22% Product Family Model List Price Discount Forwarder 191OG 27% Product Family Model List Price Discount Motor Graders 620G 43% Motor Graders 622G 43% Motor Graders 670G 44% Motor Graders 672G 44% Motor Graders 770G 45% Motor Graders 772G 45% Motor Graders 870G 45% Motor Graders 872G 45% Product Family Model List Price Discount Skid Steers 316GR 32% Skid Steers 318G 32% Skid Steers 320G 32% Skid Steers 324G 32% Skid Steers 330G 32% Skid Steers 332G 32% Company Use Product Family Model List Price Discount Skidder 640L II 25% Skidder 648L II 23% Product Family Model List Price Discount Swing Machine 2156G 29% Swing Machine 2654G 31% Swing Machine 2656G 31% Product Family Model List Price Discount Tractor Loaders 210 G-Tier 39% Tractor Loaders 210 P-Tier 39% Product Family Model List Price Discount Wheel Loaders 444 P-Tier 37% Wheel Loaders 524 P-Tier 40% Wheel Loaders 544 G-Tier 36% Wheel Loaders 544 P-Tier 41% Wheel Loaders 544 G (Only Available in Canada) 36% Wheel Loaders 624 P-Tier 40% Wheel Loaders 644 G-Tier 33% Wheel Loaders 644 P-Tier 37% Wheel Loaders 644 G (Only Available in Canada) 36% Wheel Loaders 644 X-Tier 37% Wheel Loaders 724 P-Tier 39% Wheel Loaders 744L 38% Wheel Loaders 744 P-Tier 30% Wheel Loaders 824L 38% Wheel Loaders 824 P-Tier 30% Wheel Loaders 844L 38% Wheel Loaders 844 P-Tier 30% Wheel Loaders 844L AH 38% Company Use Wheel Loaders 904 P-Tier 30% Wheel Loaders 944K 39% Wheel Loaders 944 X-Tier 35% Product Family Model List Price Discount Compact Wheel Loaders 184 G-Tier 26% Compact Wheel Loaders 204L 28% Compact Wheel Loaders 204 G-Tier 26% Compact Wheel Loaders 244L 28% Compact Wheel Loaders 244 P-Tier 26% Compact Wheel Loaders 304L 28% Compact Wheel Loaders 304 G-Tier 26% Compact Wheel Loaders 324L 28% Compact Wheel Loaders 324 P-Tier 26% Compact Wheel Loaders 344L 28% Compact Wheel Loaders 344 P-Tier 26% Product Family Model List Price Discount Knuckleboom Loader 437E 27% Product Family Model List Price Discount Worksite Pro Attachments Various 20% Company Use Additional Volume Discounts if Ordered on One Purchase Order Quantity 5-7 Machines 8-14 Machines 15+ Machines For Contract questions, contact: Brooke L. DeVol Contract Administrator John Deere Construction Retail Sales 309-207-0431 ForsberaBrooke LCd)JohnDeere. com Additional Volume Discount 1% 2% 3% Company Use DocuSign Envelope ID: B986BB43-5AB0-4207-86D3-05B9F5D54A03 ATTACHMENT B SourcewellW. CONTRACT EXTENSION Contract Number: #032119-JDC Sourcewell, 202 12th Street Northeast, P.O. Box 219, Staples, MN 56479 (Sourcewell) and John Deere Construction Retail Sales a Division of John Deere Shared Services, Inc., 1515 5th Ave., Moline, IL 61265 have entered into Contract #032119-JDC for the procurement of Heavy Construction Equipment with Related Accessories, Attachments and Supplies. The Contract has an expiration date of May 13, 2023, but the parties may extend the Contract by mutual consent. Sourcewell and Vendor acknowledge that extending the Contract benefits the Vendor, Sourcewell and Sourcewell's Members. Vendor and Sourcewell agree to extend the Contract listed above for an additional period, with a new Contract expiration date of May 13, 2024. All other terms and conditions of the Contract remain in full force and effect. Sourcewell DocuSigned by,r . , ,t Vt,tM� �GI,I,Wr�Aj gy: COFD2A139D06489... Jeremy Schwartz Title: Chief Procurement Officer 12/1/2022 1 1:47 PM CST Date: John Deere Construction Retail Sales a Division of John Deere Shared Services, Inc. DocuSigned by: By; 2.1'9c6B5FD143D... Brooke (Forsberg) DeVol Title: Contract Administrator 12/13/2022 1 2:23 PM PST Date: Rev. 7/2022 1 Form C mil" EXCEPTIONS TO PROPOSAL, TERMS, CONDITIONS, x t AND SOLUTIONS REQUEST Sourcewell Company Name: John Deere Construction Retail Sales (JDCRS) Any exceptions to the terms, conditions, specifications, or proposal forms contained in this RFP must be noted in writing and included with the Proposer's response. The Proposer acknowledges that the exceptions listed may or may not be accepted by Sourcewell or included in the final contract. Sourcewell will make reasonable efforts to accommodate the listed exceptions and may clarify the exceptions in the appropriate section below. Section/page Term, Condition, or Specification Unless stated otherwise, a manufacturer or wholesale distributor Proposer is assumed to have a documented relationship with their dealer network where that dealer network is informed of, and authorized to accept, purchase orders pursuant to any Contract resulting from this RFP on behalf of the manufacturer or wholesale distributor Proposer. Any such dealer will be considered a sub- 3.14/6 contractor of the Proposer/Vendor. Proposers are assumed to have sub -contractor relationships with all organizations and individuals whom are external to the Proposer and are involved in providing or delivering the equipment/products/services being proposed. Vendor assumes all responsibility for the equipment/products/services and actions of any such Sub- 3.23.2/8 Contractor. With respect to Members within the Commonwealth of Virginia, this RFP is intended to be a "joint procurement agreement" as 3.28.1/10 described in Vir. Code § 2.2- Sourcewell Exception ACCEPTS JDCRS approves dealer groups to sell direct under this contract upon their acceptance of the Sourcewell Sourcewell T&Cs. JDCRS -will sell direct where a dealer group has yet to accepts accept the contract terms. JDCRS and U.S. dealer sales reporting and admin fee payment functions will be processed by our JDCRS office. "Sub -contractor" does not apply to our dealer network. Our network is comprised of independently owned dealer groups that are bound by a dealer agreement. John Deere is not responsible for the acts or omissions of the dealer network. We request all sub -contractor verbiage/reference be stricken. Sourcewell accepts "Sub -contractor" does not apply to our dealer network. Our network is comprised of independently owned dealer groups that are bound by a dealer agreement. John Deere is not responsible for the acts or omissions of the dealer network. We request all sub -contractor verbiage/reference be stricken. We offer our contract to all eligible member agencies. Should any state, governing body, or Sourcewell buying agency impose or require accepts any additional administrative or transaction fee of any kind, said 44 4304(A), and those Virginia fee will reduce the list discounts Members identified in accordingly. Appendix C must be allowed to use this Contract as a Joint Purchaser. Proposal pricing is to be established as a ceiling price. We offer our contract to all At no time may the proposed eligible member agencies. Should products or services be any state, governing body, or offered under this Contract buying agency impose or require at prices above this ceiling any additional administrative or price without a specific transaction fee of any kind, said request and approval by fee will reduce the List discounts 5.18/16 Sourcewell. accordingly. Throughout the term of the Contract, Proposer agrees to pay for return shipment on products that arrive in a defective or inoperable condition. Proposer must Standard warranty defines arrange for the return covered items and services. 5.51/18 shipment of the damaged Freight and transport to and from 5.54/18 products. dealership are not covered items. "Subcontractor" does not apply to Subcontractors: Vendors' our dealer network. Our network certificate(s) must include all is comprised of independently subcontractors as additional owned dealer groups that are insureds under its policies, or the bound by a dealer agreement. Vendor must furnish to Sourcewell John Deere is not responsible for separate certificates for each the acts or omissions of the dealer subcontractor. All coverage for network. subcontractors are be subject to the minimum requirements identified We request all subcontractor 6.26/23 above. verbiage/reference be stricken. The Vendor must Unless a dealer stock unit is being immediately notify offered, retail machines are made Sourcewell Members when to order. 90 day lead time or less they order an out -of -stock is the general guidance, but there 7.13/27 item. may be exceptions. As was clarified in the pre - proposal conference, what needs to be advised is any major scenario that would impact the vendor's financial standing and their ability to uphold the contract agreement. JDCRS is not at The Vendor must disclose to liberty to share all litigation Sourcewell any litigation, scenarios that may arise. bankruptcy, or suspensions / 7.16/27- disbarments that occur during the We request the "litigation" 28 Contract period. verbiage be stricken. No delegation of any duty of We request permission to approve the Vendor under this dealer groups to sell direct. Contract may be made Dealer groups must first agree to without prior written abide by the Sourcewell Terms & 8.11/29 permission of Sourcewell. Conditions as agreed by JDCRS. Sourcewell accepts Sourcewell accepts Sourcewell accepts Sourcewell accepts Sourcewell accepts the removal of "litigation;" however, all other requirements remain. Sourcewell accepts 45 JDCRS will include U.S. dealer sales in our reporting and admin fee processing. Allowing so on the previous contract has proven value-added as it has; allowed dealers to fully embrace the contract, streamlined the sales process, and continued to increase sales each year. Procurements by Sourcewell or Sourcewell Members utilizing funds under a federal grant or contract may be subject to specific federal laws, regulations, and requirements in addition to those under state and local laws. Applicable law may include, but is not limited to, the procurement standards of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards, 2 CFR Part 200 (also referred to as the "Uniform Guidance" or " EDGAR" ). The terms included in this section While JDCRS endeavors to express supply all equipment requests, we Proposers willingness and ability to cannot commit to all unknown comply with certain requirements requirements ahead of time. We which may be applicable to specific will gladly review each request at Sourcewell Member time of inquiry for feasibility and purchases using federal follow-through as may be 8.31/32 grant or contract dollars. applicable. "Subcontractor" does not apply to The Proposer further our dealer network. Our network understands that it accepts is comprised of independently the full responsibility as the owned dealer groups that are sole source of solutions bound by a dealer agreement. proposed in this RFP John Deere is not responsible for response and that the the acts or omissions of the dealer Proposer accepts network. responsibility for any Form subcontractors used to fulfill We request all subcontractor D/48 this proposal. verbiage/reference be stricken. Procurements by Sourcewellsm (Formerly NJPA) or Sourcewell Members utilizing funds under a federal grant or contract funded all or in part by the Federal Emergency Management While JDCRS endeavors to Agency (FEMA) may be subject to supply all equipment requests, we specific federal laws, regulations, and cannot commit to all unknown requirements in addition to those under requirements ahead of time. We Appendix other federal, state and local laws. This will gladly review each request at D/69 may time of inquiry for feasibility and (PDF include, but is not limited to, the follow-through as may be copy) procurement standards of the Uniform applicable. Sourcewell accepts Sourcewell accepts Sourcewell accepts 46 Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments, Title 44 of the Code of Federal Regulations, Part 13 (44 CFR Part 13). The terms included in this section express Vendors willingness and ability to comply with certain requirements which may be applicable to specific Sourcewell Member purchases using FEMA grant or contract dollars. Proposer's Signature: Date: Sourcewell's clarification on exceptions listed above: 47 Contract Award W #032010 FORM D Sourcewell►� Formal Offering of Proposal (To be completed only by the Proposer) HEAVY CONSTRUCTION EQUIPMENT WITH RELATED ACCESSORIES, ATTACHMENTS, AND SUPPLIES In compliance with the Request for Proposal (RFP) for [HEAVY CONSTRUCTION EQUIPMENT WITH RELATED ACCESSORIES, ATTACHMENTS, AND SUPPLIES, Ithe undersigned warrants that the Proposer has examined this RFP and, being familiar with all of the instructions, terms and conditions, general and technical specifications, sales and service expectations, and any special terms, agrees to furnish the defined products and related services in full compliance with all terms and conditions of this RFP, any applicable amendments of this RFP, and all Proposer's response documentation. The Proposer further understands that it accepts the full responsibility as the sole source of solutions proposed in this RFP response 1.1'tl:ia trapesal. Exception is noted in our RFP response, asking for this text to be stricken as we do not use subcontractors. Our dealer network is independently owned. Company Name: _ John Deere Construction Retail Sales Company Address: _ 1515 51 Avenue City:_Moline CAGE Code/DUNS: 3 PSD7/ 142124762 Contact Person: _Richard Murga Authorized Signature: Date: State: _11 Zip: _61265 Title: Contract Administrator Mark Oliver (Name printed or typed) 48 DocuSign Envelope ID: F71579A7-EF16-49C5-BABC-4D9BBC37120C FORM E CONTRACT ACCEPTANCE AND AWARD aERµMk M i q^,U t� O Y Sourcewell , (Top portion of this form will be completed by Sourcewell if the vendor is awarded a contract. The vendor should complete the vendor authorized signatures as part of the RFP response.' Sourcewell Contract #: 032119-JDC Proposer's full legal name: John Deere Construction Retail Sales Based on Sourcewell's evaluation of your proposal, you have been awarded a contract. As an awarded vendor, you agree to provide the products and services contained In your proposal and to meet all the terms and conditions set forth In this RFP, In any amendments to this RFP, and in any exceptions that are accepted by Sourcewell. The effective date of the Contract will be May 13, 2019 and will expire on May 13, 2023 (no later than the later of four years from the expiration date of the currently awarded contract or four years from the date that the Sourcewell Chief Procurement Officer awards the Contract). This Contract may be extended for a fifth year at Sourcewell's discretion. Sourcewell Authorized Signatures: ooeuswn.a W. - . SCTWaVR"RECTOR OF OPERATIONS AND P�J �.T/CPPOSIGNATURE tJ�+t7� (AAWL y — rt4ZU"l rwoanc:... SOURCEWELL EXECUTIVE DIRECTOR/CEO SIGNATURE Awarded on May 10, 2019 Vendor Authorized Signatures: Jeremy Schwartz (NAME PRINTED OR TYPED) Chad Coauette (NAME PRINTED OR TYPED) Sourcewell Contract # 032119-JDC The Vendor hereby accepts this Contract award, including all accepted exceptions and amendments. Vendor Name - c n ee f l' l Authorized Signatory's Title f"A`1c'r VENDOR AUTHORIZED SIGNATURE l Executed on ! �`� , 20 J 1 l rCiy(C 1 1 sK f C U t T4' ) C ifrAt: r -�lz✓ - (NAME PRINTED OR TYPED) Sourcewell Contract # 032119-JDC Form F PROPOSER ASSURANCE OF COMPLIANCE Proposal Affidavit Signature Page PROPOSER'S AFFIDAVIT Sourcewell s The undersigned, authorized representative of the entity submitting the foregoing proposal (the "Proposer"), swears that the following statements are true to the best of his or her knowledge. 1. The Proposer is submitting its proposal under its true and correct name, the Proposer has been properly originated and legally exists in good standing in its state of residence, the Proposer possesses, or will possess before delivering any products and related services, all applicable licenses necessary for such delivery to Sourcewell members agencies. The undersigned affirms that he or she is authorized to act on behalf of, and to legally bind the Proposer to the terms in this Contract. 2. The Proposer, or any person representing the Proposer, has not directly or indirectly entered into any agreement or arrangement with any other vendor or supplier, any official or employee of Sourcewell, or any person, firm, or corporation under contract with Sourcewell, in an effort to influence the pricing, terms, or conditions relating to this RFP in any way that adversely affects the free and open competition for a Contract award under this RFP. 3. The Proposer has examined and understands the terms, conditions, scope, contract opportunity, specifications request, and other documents in this solicitation and affirms that any and all exceptions have been noted in writing and have been included with the Proposer's RFP response. 4. The Proposer will, if awarded a Contract, provide to Sourcewell Members the /products and services in accordance with the terms, conditions, and scope of this RFP, with the Proposer -offered specifications, and with the other documents in this solicitation. 5. The Proposer agrees to deliver products and services through valid contracts, purchase orders, or means that are acceptable to Sourcewell Members. Unless otherwise agreed to, the Proposer must provide only new and first - quality products and related services to Sourcewell Members under an awarded Contract. 6. The Proposer will comply with all applicable provisions of federal, state, and local laws, regulations, rules, and orders. 7. The Proposer understands that Sourcewell will reject RFP proposals that are marked "confidential" (or "nonpublic," etc.), either substantially or in their entirety. Under Minnesota Statute §13.591, Subd. 4, all proposals are considered nonpublic data until the evaluation is complete and a Contract is awarded. At that point, proposals generally become public data. Minnesota Statute § 13.37 permits only certain narrowly defined data to be considered a "trade secret," and thus nonpublic data under Minnesota's Data Practices Act. 8. The Proposer understands that it is the Proposer's duty to protect information that it considers nonpublic, and it agrees to defend and indemnify Sourcewell for reasonable measures that Sourcewell takes to uphold such a data designation. [The rest of this page has been left intentionally blank. Signature page below] W11 BY signing be and conditions OWY Spec r d ser is act Company N above. owledg'ng that he or she a has read unders Address.._,,,,.,— John here Co Cl�'/Stat Slh Avenue nscti°n Reel �a ids' and aees to co TejePhon %Zlp. �M©lines l� �,l I es Inp/�y with �e terms e 6S IV, R'mail '30 9'748-3418 `9ddress',Cliverl�,lar� Au�on2ed Sibfia ,�. R�JOhnD tu,.. ee re e: co Authonz ed 7itl ,Ma Nafie (Printed). —Mak r Date: 8J Contract Sales Oliver Nota"Zed Subscribed and Sworn No Public in and f to before r this 11'ly commission e or the County o f L% Si xpires: �. day of Q- )KJi' 20 State 51 ��xucnr,4,e Sourcewell Form P PROPOSER QUESTIONNAIRE Payment Terms, Warranty, Products and Services, Pricing and Delivery, and Industry -Specific Questions Proposer Name: _John Deere Construction Retail Sales Questionnaire completed by: _Richard Murga Pavment Terms and Financinv Ontions 1) What are your payment terms (e.g., net 10, net 30)? JDCRS' only option for payment terms is Net 30 Days. 2) Do you provide leasing or financing options, especially those options that schools and governmental entities may need to use in order to make certain acquisitions? JDCRS (contract vendor) does not play a role in leasing, financing or payment terms other than Net 30 Days. John Deere Financial offers leasing/financing options. The John Deere Municipal Lease Purchase Plan is a special low -rate financing plan that is designed to provide flexibility of leasing while building equity toward ownership of the John Deere equipment. Any state or local government body, or their political subdivisions, having the power to tax may be eligible for the John Deere Municipal Lease Purchase Plan, subject to approval. John Deere Financial also offers other leasing and financing options for governmental, educational, and non-profit entities, subject to approval. All leasing and financing options are handled through the local dealer and John Deere Financial. The lease/finance provider funds the contract sales invoice within 30 days. 3) Briefly describe your proposed order process. Please include enough detail to support your ability to report quarterly sales to Sourcewell. For example, indicate whether your dealer network is included in your response and whether each dealer (or some other entity) will process the Sourcewell Members' purchase orders. JDCRS authorizes U.S. dealer groups to sell direct after they agree to uphold Sourcewell's T&Cs in writing. Sourcewell members will contact their local dealer for assistance with machine and option selection. httns://dealerlocator.deere.com/servlet/countrv=US The local dealer will provide the contract quote. Sourcewell members will submit their purchase orders to the authorized quoting party noted on their contract quote. The quote number and the Sourcewell contract number must be noted on the PO. If a municipal lease is involved, that too must be made known on the PO. JDCRS will ship the unit to the selling U.S. dealer. For sales outside of the U.S., the local selling dealer will quote and arrange the freight move from factory to dealer and from dealer to customer. Setup, installs, inspection and final delivery are handled by the local dealer. Authorized seller will invoice Sourcewell member upon receipt of product delivery acceptance notice. 53 U.S. sales reports will be processed and submitted by JDCRS on a quarterly basis. Canada sales reports will be processed and submitted by John Deere Limited on a quarterly basis. Per our previous Sourcewell addendum to expand into Canada, John Deere Limited is the Canada -based sales branch office that owns the relationship with the Canadian dealer groups. 4) Do you accept the P-card procurement and payment process? If so, is there any additional cost to Sourcewell Members for using this process? P-card payments are accepted with a 3% processing fee added to the contract quote. P-card usage is to be made known at time of quote request. Customer PO must cover the added fee. Warrantv 5) Describe in detail your manufacturer warranty program, including conditions and requirements to qualify, claims procedure, and overall structure. You may include in your response a copy of your warranties, but at a minimum please also answer the following questions. Copy of standard warranty is attached in addition to the below responses. rpd Standard Warranty.pdf • Do your warranties cover all products, parts, and labor? 12 months full machine standard warranty is provided, as outlined in the standard warranty document. • Do your warranties impose usage restrictions or other limitations that adversely affect coverage? Full-size machines receive 12 months of coverage with no hour limit. Compact machines (Commercial Worksite) receive 24 months of coverage with 2,000-hour limit. Limitations on usage behavior are in place for all goods. • Do your warranties cover the expense of technicians' travel time and mileage to perform warranty repairs? No • Are there any geographic regions of the United States for which you cannot provide a certified technician to perform warranty repairs? No How will Sourcewell Members in these regions be provided service for warranty repair? Dealers are assigned for coverage of the entire U.S. • Will you cover warranty service for items made by other manufacturers that are part of your proposal, or are these warranties issues typically passed on to the original equipment manufacturer? As outlined in the standard warranty document, non -Deere items are handled by original OEM. • What are your proposed exchange and return programs and policies? As noted in the standard warranty document, "John Deere will repair or replace, at its option, any parts... of a new John Deere product that, as delivered to the original retail purchaser(s), are defective in material or workmanship." See full text for detailed explanation. 6) Describe any service contract options for the items included in your proposal. No service contracts are made part of this RFP response or resultant award. Local dealers are allowed to quote service contracts and extended warranties at time of machine quote for buying agency's consideration. Pricing, Deliverv. Audits, and Administrative Fee 7) Provide a general narrative description of the equipment/products and related services you are offering in your proposal. 54 Customer solutions offered in response to this RFP are John Deere's Construction Equipment (CE) and Compact Construction Equipment (CCE) product lines. Heavy, medium and compact machines are available to meet the Sourcewell members' needs. Specifically, there are 15 categories of 90 plus machines, each with their own factory options and attachments. Additionally, there are 120 plus attachment offerings to be used in conjunction with the compact line of machines. Many of these attachments are functional on a variety of the four compact machine categories, adding great versatility to the end -user. Further, local dealers will have the ability to provide customer requested goods and services to complete the desired machine functionality. 8) Describe your pricing model (e.g., line -item discounts or product -category discounts). Provide detailed pricing data (including standard or list pricing and the Sourcewell discounted price) on all of the items that you want Sourcewell to consider as part of your RFP response. If applicable, provide a SKU for each item in your proposal. (Keep in mind that reasonable price and product adjustments can be made during the term of an awarded Contract. See the body of the RFP and the Price and Product Change Request Form for more detail.) As in previous contracts, we will use a discount off current List price for each product model. Complete commercial price pages as well as a discount matrix are included with our bid response. Base machine and four -digit factory build codes will receive the machine discount. Non -factory items will be quoted by the dealer. 9) Please quantify the discount range presented in this response. For example, indicate that the pricing in your response represents is a 50% percent discount from the MSRP or your published list. The discount range varies from 20% to 44% off our published List prices. 10) The pricing offered in this proposal is a. the same as the Proposer typically offers to an individual municipality, university, or school district. b. the same as the Proposer typically offers to GPOs, cooperative procurement organizations, or state purchasing departments. X c. better than the Proposer typically offers to GPOs, cooperative procurement organizations, or state purchasing departments. d. other than what the Proposer typically offers (please describe). 11) Describe any quantity or volume discounts or rebate programs that you offer. 5-7 machines receive 1 % additional discount 8-14 machines receive 2% additional discount 15-30 machines receive 3% additional discount No rebates are offered. 12) Propose a method of facilitating "sourced" products or related services, which may be referred to as "open market" items or "nonstandard options". For example, you may supply such items "at cost" or "at cost plus a percentage," or you may supply a quote for each such request. JDCRS can certainly offer "Sourced Goods". "Sourced Goods" are also referred to by John Deere as non -contract items, allied items, referral attachments, dealer provided goods/services... We define non -contract as John Deere non - factory items, such as Field Kits and Parts for dealer installation that appear in the price pages. Allied equipment is defined as other OEM equipment (ex. Bradco Rock Saw). Dealer provided goods/services are items such as; Attachments, Parts, Setup, Installs, Inspection, Preventative Maintenance services, Extended Warranty... Non -contract, allied, and dealer provided goods/services would be sold as sourced goods and the price of the item or service is quoted by the John Deere dealer. Sourced goods will appear on the quote along with the contract item and would be listed as "Dealer provide..." 55 For example, a Sourcewell Member could purchase a John Deere Skid Steer Loader, an extra fuel tank cap (non- contract part) and a Bradco Rock Saw (allied) by utilizing the Sourcewell contract, but the price of the fuel tank cap and rock saw would be determined by the John Deere dealer and both would be listed on the PO as "Dealer provided fuel cap and Dealer provided Bradco Rock Saw". We successfully use this process on other contracts. 13) Identify any total cost of acquisition costs that are NOT included in the pricing submitted with your response. This cost includes all additional charges that are not directly identified as freight or shipping charges. For example, list costs for items like installation, set up, mandatory training, or initial/pre-delivery inspection. Identify any parties that impose such costs and their relationship to the Proposer. Dealer provided goods and services: Customer requested non -factory goods/services will be quoted by dealer. Set-up and installation fees: Dealer applied charges that cover their costs for installing and ensuring the proper operation of sourced goods and field attachments. The set-up and installation fees are quoted by the dealer. Pre -Delivery Inspection (PDI): A PDI is performed on all new machine purchases to ensure proper fluid levels, check system pressures, verify accurate system operation, and cleaning of the unit prior to delivery. The cost of the PDI is quoted by the dealer and will vary by machine model and complexity. Taxes: Local taxes, if applicable, will be assessed. 14) If travel expense, delivery or shipping is an additional cost to the Sourcewell Member, describe in detail the complete travel expense, shipping and delivery program. JDCRS believes that charging the corporate contracted freight rates for each and every sale is most equitable due to the known sizes & weights and unknown distances that goods will travel to reach the Sourcewell member's local John Deere dealership. All shipments in the continental U.S. (CONUS) region will therefore be FOB Destination, Pre - Paid and Added. Factory to dealer freight will be quoted. Local delivery by dealer to customer location will also be quoted. Prospective buying agency must supply the full address for the end -user's delivery location at time of quote request. Should buying agency choose not to use their nearest compact equipment dealer, the preferred dealer needs to be clearly stated on the Purchase Order accordingly. Full-size equipment dealers have a defined coverage area and are not selectable by the customer. JDCRS will make every effort to deliver ordered items in as timely a fashion as possible. Actual delivery cannot be defined ahead of time as warehouse dates are assigned based on number of orders placed on the factory, logistics assignment, transit time to local dealer, installs/setuphnspection by local dealer and final delivery to end user. In most cases, goods are delivered within 90 days, but there may be exceptions from time to time. 15) Specifically describe those travel expense, shipping and delivery programs for Alaska, Hawaii, Canada, or any offshore delivery. As is the case for the continental U.S., factory to dealer freight as well as local delivery by dealer to end -user will be quoted and invoiced. Location specific constraints related to moves by; ocean, barge, inland... may affect final delivery time. 16) Describe any unique distribution and/or delivery methods or options offered in your proposal. None noted that vary from what has previously been described. Should a request come in that requires further consideration, we will be happy to review for applicability. 56 17) Please specifically describe any self -audit process or program that you plan to employ to verify compliance with your proposed Contract with Sourcewell. This process includes ensuring that Sourcewell Members obtain the proper pricing, that the Vendor reports all sales under the Contract each quarter, and that the Vendor remits the proper administrative fee to Sourcewell. For sales that are processed through our office, the quote and purchase order are reviewed by the in-house Account manager for accuracy. If the purchase order needs to be modified, the change request is submitted prior to commencing the factory ordering process. Monthly spot checks are performed by our accounting department to ensure the department is compliant with published pricing and contract discounts. Additionally, the accuracy of the contract sales reporting and administrative fee paying are also audited. For sales that are processed through the dealer network, the quote and purchase order are reviewed by the selling dealer. Dealers acquire the machines at a discount when selling through this contract. A program code has been established for use at time of dealer settlement to claim their discount. On a quarterly basis, JDCRS receives a dealer settlement report from which the dealer sales are retrieved and added to the in-house sales noted above. Together, the full report is reviewed, approved and processed for sales reporting to Sourcewell and for payment of admin fees. 18) Identify a proposed administrative fee that you will pay to Sourcewell for facilitating, managing, and promoting the Sourcewell Contract in the event that you are awarded a Contract. This fee is typically calculated as a percentage of Vendor's sales under the Contract or as a per -unit fee; it is not a line -item addition to the Member's cost of goods. (See RFP Section 6.29 and following for details.) We propose a 1% admin fee applicable only to the equipment's contract selling price (List price of equipment on contract reduced by the contract discount percentage). The incidental, non -factory items and dealer provided goods and services (all items not priced/discounted by contract), will be excluded from the calculation. This process has proven functional in the past to accurately report sales activity stemming from dealers across the nation and for paying admin fees in a timely fashion. Industry -Specific Ouestions 19) Describe any industry -specific quality management system certifications obtained by your organization. John Deere is registered with the International Standards Organization 9001 for quality management. 20) Describe any environmental management system certifications obtained by your organization. For more information on John Deere's Environmental Stewardship visit: http://www.deere.com/en US/corporate/our company_/citizenship/environmental_ stewardship/environmental stewa rdshin.paue? 21) Describe any preventive maintenance programs that your organization offers for the solutions you are proposing in your response. Preventative maintenance services are dealer -provided. Please review Form P item 12 above. 7 Signature: Date: 57 DocuSign Envelope ID: FCE16DED-FE51-4A90-B857-7E46D1B0844E AMENDMENT TO Sourcewell Contract #032119-JDC This AMENDMENT ("Amendment") to Sourcewell Contract # 032119-JDC ("Agreement") is effective on the date hereof, by and between Sourcewell® and John Deere Construction Retail Sales ("Vendor") WHEREAS, Vendor was awarded a Sourcewell Contract for Heavy Construction Equipment with Related Accessories, Attachments and Supplies effective May 13, 2019 until May 13, 2023 relating to the provision of products and services to Sourcewell and its members; WHEREAS, John Deere Construction Retail Sales and Wirtgen America, Inc. have historically held separate Sourcewell contracts, it was errantly assumed separate submittals was the most appropriate response for RFP 032119. It has been since determined that the most effective way to serve Sourcewell members is to provide both John Deere and Wirtgen America offerings in tandem through contract award, 032119-JDC. John Deere Construction Retail Sales will remain the contract holder and Wirtgen America, Inc.'s products, ordering process, and sales/administration contacts will be included in John Deere's portfolio for direct purchase and processing through the Wirtgen America, Inc. dealer channel. To summarize; John Deere offerings will only be sold through John Deere Construction Retail Sales and its authorized dealer channel, Wirtgen America, Inc. offerings will only be sold through Wirtgen America, Inc. and its authorized dealer channel. Those wishing to engage either product line must do so through the appropriate dealer channel; WHEREAS, Vendor and Sourcewell desire to add Wirtgen America, Inc.'s product line (Wirtgen, Hamm and Vogele brands) under the Agreement (all sold by Wirtgen America, Inc. dealers); WHEREAS, Vendor and Sourcewell acknowledge that Wirtgen America, Inc. shall be supporting sales of Wirtgen America offerings to Sourcewell members within the U.S. and Canada as well as responsible for related sales reporting and administrative fee paying; WHEREAS, Vendor and Sourcewell acknowledge that Wirtgen America, Inc. failure to perform to contract terms and conditions may result in termination of contract; WHEREAS, all parties agree that certain terms within the Agreement shall be updated and amended; and only to the extent as hereunder provided. NOW, THEREFORE, in consideration of the mutual covenants and agreements described in this Amendment, the parties hereby agree as follows: 1. Form P Question 4 response is amended as follows: After the first paragraph, insert: "Wirtaen America, Inc. does not accent the P-card procurement and navment process." DocuSign Envelope ID: FCE16DED-FE51-4A90-B857-7E46D1B0844E 2. Form P Question 5 response is amended as follows: After the first paragraph, insert: "Wirteen America, Inc. also offers 12 months of standard warranty but with a 1,000-hour limit." 3. Form P Question 7 response is amended as follows: After the first paragraph, insert: "Wirtaen America, Inc.'s product line (Wirteen, Hamm and Voeele) is being offered to provide 130+ eauinment variations in the followine catee_ ories: Milline, Recvclina, Stabilizine, Pavine, Sareadine, Comnactine and Rollers. Further, local dealers will be allowed to provide customer rea_uested izoods and services to complete the desired machine functionalitv. John Deere Construction Retail Sales will also be offering Program Eligible machines to Sourcewell members in both the U.S. and Canada. "Program Eligible" opens the contract's machine eligibility to include Demonstration machines, Training Center machines and Marketing machines as defined below. Program Eligible Criteria: Never retailed, Less than three years old for compact and mid -size machines, Less than four years old for Production Class Equipment (Articulated Dump Trucks, 950 and larger size Dozers, 470 and larger size Excavators, 744 and larger size 4WD Loaders). Program Eligible Pricing Model: Original List - Contract Discount = Standard Contract Selling Price Standard Contract Selling Price - Depreciation = Program Eligible Selling Price. Depreciation varies based on age, hours, and machine type. Depreciation is negotiated between dealer and customer. Sourcewell Administration Fee will be paid on Standard Contract Selling Price." 4. Form P Question 9 response is amended as follows: Replace the initial response with the following verbiage: "The discount range varies from 17% to 44% off the manufacturer's published List prices." - - 5. Lastly, Form P Question 3 and Form A question 32 identify the John Deere sales branch in Canada as "John Deere Limited", the proper business name is "John Deere Canada ULC." DocuSign Envelope ID: FCE16DED-FE51-4A90-B857-7E46D1B0844E Except as amended by this Amendment, the Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties have executed this Agreement as of the date hereof. Sourcewell® DocuSigned by: X iignature — Signed By Jeremv Schwartz Name — Printed Title Director of Operations & Procurement/CPO Date 3/12/2020 1 1:59 PM CDT APPROVED: Sourcewell® L occuSSigneedby, �y ature — Signed By Chad Coauette Name — Printed Title Executive Director / CEO Date 3/12/2020 1 2:08 PM CDT John Deere Construction Retail Sales LDocuSigned by: X tt on d"ignature — Signed By Richard Muraa Name Printed Title Account Manager, Fed & State Date 3/12/2020 1 1:43 PM CDT DocuSign Envelope ID:4DEF6B38-AC85-49FC-90D4-B19FBD91B13A AMENDMENT#2 TO SOURCEWELL CONTRACT #032119-JDC This Amendment is by and between Sourcewell (Sourcewell) and John Deere Construction Retail Sales, a division of John Deere Shared Services, Inc. (Vendor). Vendor was awarded a Sourcewell contract for Heavy Construction Equipment with Related Accessories, Attachments, and Supplies #032119-JDC (Original Contract). The parties agree that certain terms within the Original Contract will be amended as hereunder provided. In consideration of the mutual covenants and agreements described in this Amendment, the parties agree as follows: 1. This Amendment is effective upon the date of the last signature below. 2. Form P, Question 18, is modified to read that Vendor's Administrative Fee will be 0.50%. Except as amended by this Amendment, the Original Agreement remains in full force and effect. Sourcewell DocuSigned by, " By. �,yti,aty �(,u. AyfAj Authc __ COFD2A739DO6489 . Jeremy Schwartz Name — Printed John Deere Construction Retail Sales, a division of John Deere Shared Services, Inc. DocuSigned by: zB:� ��.thc BSFDSEFBEF6045A.. Richard Murga Name — Printed Title: Director of Operations & Procurement/CPO Title: Contract Administrator Date: 3/18/2020 1 3:25 PM CDT APPROVED: DocuSigned by: By. r,I7E4288Ft A� C,6AItt,{ft, Authc 817A64CC.- Chad Coauette Name — Printed Title: Executive Director/CEO Date: 3/18/2020 1 12:27 PM CDT Date: 3/18/2020 1 5:05 PM CDT DocuSign Envelope ID: A73FA430-23DD-4AAA-808C-004C3B4AF1A5 AMENDMENT #3 TO CONTRACT #032119-J DC THIS AMENDMENT is effective upon the date of the last signature below by and between Sourcewell and John Deere Construction Retail Sales, a division of John Deere Shared Services, Inc. (Vendor). Sourcewell awarded a contract to Vendor to provide Heavy Construction Equipment with Related Accessories, Attachments, and Supplies, effective May 13, 2019, through May 13, 2023 (Contract). Vendor has notified Sourcewell that its name changed on October 31, 2022, from John Deere Shared Services, Inc., to John Deere Shared Services LLC, with an address of 400 East Court Avenue, Des Moines, Iowa 50309. Vendor is now requesting to change the name of the contract holder, and Sourcewell agrees to this change. Except as amended above, the Contract remains in full force and effect. Sourcewell John Deere Construction Retail Sales, a division of John Deere Shared Services, Inc. I�`/ E DocuSigned by: By. C0FD2A139 S64�� Jeremy Schwartz, Chief Procurement Officer Date: 12/20/2022 1 3:21 PM CST Approved: ay:—EDocuSigned by: 7E42B8F817A64CC... Chad Coauette, Executive Director/CEO Date: 12/20/2022 1 3:22 PM CST DocuSigned by: By ItiLa mvk r 1CAF73242BB647F... Mark Oliver Manager, Contract Sales Title: Date: 12/20/2022 1 3:08 PM CST Sourcewell Contract # 032119-JDC I Amendment #3 Page 1 of 1 ATTACHMENT - C CONFLICT OF INTEREST DISCLOSURE REQUIREMENT Pursuant to Chapter 176 of the Local Government Code, any person or agent of a person who contracts or seeks to contract for the sale or purchase of property, goods, or services with a local governmental entity (i.e. The City of Fort Worth) must disclose in the Questionnaire Forms CIQ ("Questionnaire") the person's affiliation or business relationship that might cause a conflict of interest with the local governmental entity. By law, the Questionnaire must be filed with the Fort Worth City Secretary no later than seven days after the date the person begins contract discussions or negotiations with the City, or submits an application or response to a request for proposals or bids, correspondence, or another writing related to potential agreement with the City. Updated Questionnaires must be filed in conformance with Chapter 176. A copy of the Questionnaires Form CIQ is enclosed with submittal documents. The form is also available at http://www.ethics.state.tx.us/forms/CIQ.pdf. If you have any questions about compliance, please consult your own legal counsel. Compliance is the individual responsibility of each person or agent of a person who is subject to the filing requirement. An offense under Chapter 176 is a Class C misdemeanor. NOTE: If you are not aware of a Conflict of Interest in any business relationship that you might have with the City, state Contractor name in the # 1, use N/A in each of the areas on the form. However, a signature is required in the #7 box in all cases. Revised 6.9.2021 cc CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity •: rt K93W4 This questionnaire reflects changes made io the law by H.B. 23. 941h Leg., Regular Session. OFFICE ISEONLY This questionnaire is being liled in accordance with Ghaptw 176. Laval Government Code, by a vendor who DaW peceiwed has a business relationship as defined by Section 176-0010-at with a local gouernmen-al en0k and the vendor meats requirements under Section 175.U06(a)- fay law this questlonnaire must be liled with the records adminhaalor of the local gouen-rental entity not laser than the 7th business day after the dale the vendor becomes arras of facts tha-, require the am-.ement io be filed. Sap Section 176-aob(a-1), LocaJ Goaemmoni Coda. A vendor commits an olfanse if the vendor knowingly violates Section 176A06, Loral Givemment Code- An coarse under this section is a misdemeanor. -11 Name of vendor who has a business relationship with local governmental entity. J ❑ Check this box if you arm tilt ng an ups is a previously fi IE}d q uesfiannaire. (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 arare that the originally filed questionnaire was incomplete or inaccurate.) J Name of local government officerabout whom the information is being disclosed,. Name of Off cer J describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.002(a)(2)(A). Also describe any family relationship with tlhelocal governrnentoff icer. Complete subparts A and B for each employment or business miationship described. Attach additional pages to this Form CIO as necessary. A- Is the local government officer or a family member of the offioer receiving or likely to rOreive taxable income, other than investment income. from the vendor? Yes =No B- Is the vendor receiving or likely to rareive taorable income, other than investment income, from or at the direction of the local government officer or a family rrembw of the officer AND the taxable income is not reaeived tram the local governmental entity? Yes = No f?escribeeach employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect towhich the local government officer serves asan officer ordirector, or holds an ownership inierest of one percent or more. 61 ❑ Check this boot if the vendor has given the local govern ment officer or a fam ily member of the officer one or more gifts as described in Section 176.00S(a)(2)(B), excluding gifts described in Section 176-003(a.-1 ). 71 Signature of vendor doing business with the governmental entity pate Form provided by Tmas Ethics Commission wrm. athi cs.stata.lz. u s Re Ased 11113021 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governnnental entity A complete copy of Chapter 176 of the Local Government Cade may be found at http Awww.statutes_legis_state_tx_us! Docs+L +htm+LCL 176.htm. For easy reference, below are some of the sections cited on this farm. Local Government Code Q 176.001(1-a): "Business relationship" means a connection between two or more parties based on commeroia avtivity ofone of the parties. The term does not include a connection based on: (A) atransaction that is subject to rate or fee regulation by afederal, state, or local governmental entity or an agency of afederal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a pu rchase or lease of goads or services from a person that is ch artered by a state or federal agency and that is subject to regular exam i nation by, and reporting to, that agency. Local Government Code 4176A03(a)(2)(A) and (B): {a) A local government officer shall file a conflicts disclosure statement with respect to avendor if: (2) thevendor: (A) has an em ployment or other business relation ship 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 irnrestment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware th at (i) a contract between the local govern mental 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 orafamily memberofthe off icerone ormore 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 (i i) the local governmental entity is considering entering into a contract with the vendor_ Local Government Code § 176.006(a) and (a-1I f a) A vendor shal I 1 ile a compl eted confI ict of i nterest questia nnaire if the vendor has a bus iness rel ationshi p 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 fam ily member of the officer, desori bed by Section 176_00ja)(2) (A); (2) h as given a local government officer of that I oval govern mental 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 govemmental 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 arequest 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 kcal government officer, or a family member of the officer, described by Subsection (a); (B) that the ven dor has given one or mare gifts described by Subsection (a); or (C) of a family relationship with a local government officer_ Farm provided by Texas Ethics CammISSiDn www.othics.state.lx.us Revised 111fi2021