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Home My WebLink AboutContract 59577CSC No. 59577 FORT WORTH CITY OF FORT WORTH COOPERATIVE PURCHASE AGREEMENT This Cooperative Purchase Agreement ("Agreement") is entered into by and between Lonestar Municipal Equipment, LLC ("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; 3. Exhibit B — BuyBoard Contract 676-22; 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 thirty-four thousand ($34,000.00). 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 September 30, 2023 in line with cooperative contract. Upon the expiration of this Term, the Agreement shall renew automatically under the same terms and conditions for up to two (2) one-year renewal periods (October 1, 2023 to September 30, 2024), unless City or Contractor provides the other party with notice of non -renewal at least 60 days before the expiration of the Initial Term or renewal period. However, if funds are not appropriated, the City may cancel the Agreement 30 calendar days after providing written notification to the Contractor. Vendor agrees that City shall, until the expiration of three (3) years after final payment under this Agreement, or the final conclusion of any audit commenced during the said three years, have access to and the right to examine at reasonable times any directly pertinent books, documents, papers and records, including, but not limited to, all electronic records, of Vendor involving transactions relating to this Agreement at no additional cost to City. Vendor agrees that City shall have access during normal working hours to all necessary Vendor facilities and shall be provided adequate and appropriate work space in order to conduct audits in compliance with the provisions of this section. City shall give Vendor reasonable advance notice of intended audits. Notices required pursuant to the provisions of this Agreement shall be conclusively determined to have been delivered when (1) hand -delivered to the other party, its agents, employees, servants or representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3) received by the other party by United States Mail, registered, return receipt requested, addressed as follows: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX To CITY: To VENDOR: City of Fort Worth Lonestar Municipal Equipment, LLC Attn: Dana Burghdoff, Assistant City Manager Lonestar Municipal Equipment, LLC 200 Texas Street Fort Worth, TX 76102-6314 Address: Facsimile: (817) 392-8654 1105 Friendship Road Weatherford, TX 76085 With copy to Fort Worth City Attorney's Office at same address Facsimile: 817-953-7099 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: L B A�uJc BY: Dana Burghdoff Chin 9, 20218:57 CDT) Name: Dana Burghdoff Title: Assistant City Manager Date: Jun 9, 2023 APPROVAL RECOMMENDED: CGt�i,tto�Gce� tfa��le� Christopher Hlyder (Jun 8, 2023 07:46 CDT) By: Name: Chris Harder Title: Water Director go.6vonp�� p �FORt/y ATTEST: 00 �o Ovo =4 °oa* * �d EXASoQ` U �nRR4449 By: Name: Jannette Goodall Title: City Secretary 0111W�1Z1JA Lonestar Municipal Equipment, LLC By: '00a d a. Name: Paul E. Folker, Jr. 0 Title: Owner / Managing Member Date: June 07, 2023 CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. By: ?— Name: Regina Jones Title: Contract Compliance Specialist APPROVED AS TO FORM AND LEGALITY: Gf%i�ia�rta- By: Name: Jessika Williams Title: Assistant City Attorney CONTRACT AUTHORIZATION: M&C: N/A OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Exhibit A Lonestar Municipal Equipment 1105 Friendship Road Weatherford, TX 76085 Paul@LonestarME.com https://www.lonestarmunicipalequipment.com ADDRESS City of Fort Worth, TX 1608 11th Avenue Fort Worth, TX 76102 SHIP TO City of Fort Worth, TX 1608 11th Avenue Fort Worth, TX 76102 LONESTAR MUNICIPAL EQUIPMENT Per BuyBoard Contract #676-22 ***PIPE WOLF TYPE NOZZLE W/ AN UPDATED DESIGN THAT GETS RID OF THE FINS THAT WEAR OUT AND MAKE THE NOZZLE STOP SPINNING 10321 SC RAPTOR NOZZLE - 1 ", w/ CERAMIC INSERTS 10321 SC RAPTOR NOZZLE - 3/4", w/ CERAMIC INSERTS (Will be a 1 " nozzle w/ a flush -mounted bushing) ***PRIMUS TYPE NOZZLE, MORE POWERFUL & W/ SEALED BEARINGS 10890SC TWISTER NOZZLE - 3/4", FOR 6" -12" LINES 10900SC TWISTER NOZZLE - 1 ", FOR 6" - 24" LINES ***FS NOZZLE EQUIVALENT Misc FJ PENETRATOR NOZZLE - 3/4" ***3D EXTREME NOZZLE EQUIVALENT - 1 PIECE BODY SO IT DOESN'T EVER SEPARATE 10121S PENETRATOR NOZZLE - 1", FOR 6" - 16" LINES 10121S PENETRATOR NOZZLE - 3/4", FOR 6" - 16" LINES (Will be a 1" nozzle w/ a flush -mounted bushing) ***ROTOR NOZZLE EQUIVALENT 10143SC TYPHOON NOZZLE - 1 ", FOR 6" - 16" LINES, w/ CERAMIC INSERTS ***ROCKET NOZZLE EQUIVALENT 10163S POWER PULL - 1 ", FOR 6" - 16" LINES 10162S POWER PULL - 3/4", FOR 6" - 16" LINES 4 2,045.00 8,180.00T 1 2,045.00 2,045.00T 3 3,375.00 10,125.00T 1 3,375.00 3,375.00T 1 790.00 790.00T 1 995.00 995.00T 4 995.00 3,980.00T 1 1 4 1,650.00 1,650.00T 1,025.00 1,025.00T 795.00 3,180.00T 'NOTE: Shipping is NOT included and will be charged per carrier charges SUBTOTAL 35,345.00 DISCOUNT 5%-1,767.25 TAX 0.00 M0 , $33,577.75 bmk Pr - Accepted By Accepted Date 5/15/23, 8:50 AM Exhibit B Power BI Host Menu WBoard- Vendor Contract Information Summary Vendor Lonestar Municipal Equipment, LLC Contact Paul Folker Phone 817-851-2243 Email paul@lonestarme.com Vendor Website www.lonestarmunicipalequipment.com TIN 81-4546554 Address Line 1 1105 Friendship Road Vendor City Weatherford Vendor Zip 76085 Vendor State TX Vendor Country USA Delivery Days 10 Freight Terms FOB Destination Payment Terms Net 30 Shipping Terms Freight prepaid by vendor and added to invoice Ship Via Prepaid & Add to Invoice Designated Dealer No EDGAR Received Yes Service -disabled Veteran Owned No Minority Owned No Women Owned No National No No Foreign Terrorist Orgs Yes No Israel Boycott Yes MWBE No ESCs All Texas Regions States All States Contract Name Sewer Inspection and Cleaning Products Contract No. 676-22 Effective 10/01/2022 Expiration 09/30/2025 Accepts RFQs Yes 5/15/2023 8:50 AM Paae 1 of 1 https://app.buyboard.com/report/20 1 /2 5/15/23, 8:50 AM Power BI Host https://app.buyboard.com/report/20 2/2 rM u U.yA i 1 1 14op_t�! 40 August 4, 2022 Sent Via Email: paul@lonestarme.com Paul Folker Lonestar Municipal Equipment, LLC 1105 Friendship Road Weatherford, TX 76085 Welcome to BuyBoard! P.O. Box 400, Austin, Texas 78767 800.695.2919 • info@buyboard.com • buyboard.com Re: Notice of The Local Government Purchasing Cooperative ContractAward; Proposal Invitation No. 676- 22, Sewer Inspection and Cleaning Products Congratulations, The Local Government Purchasing Cooperative (Cooperative) has awarded your company a BuyBoard® contract based on the above -referenced Proposal Invitation. The contract is effective for an initial one-year term of 10/01/2022 through 9/30/2023, and may be subject to two possible one-year renewals. Please refer to the Proposal Invitation for the contract documents, including the General Terms and Conditions of the Contract. To review the items your company has been awarded, please review Proposal Tabulation No. 676-22 at: www.buyboard.com/vendor. Only items marked as awarded to your company are included in this contract award, and only those awarded items may be sold through the BuyBoard contract. All sales must comply with the contract terms and must be at or below the awarded pricing as set forth in the General Terms and Conditions. The contract will be posted on the BuyBoard website as an online electronic catalog(s). You are reminded that, in accordance with the General Terms and Conditions, all purchase orders must be processed through the BuyBoard. Except as expressly authorized in writing by the Cooperative's administrator, you are not authorized to process a purchase order received directly from a Cooperative member that has not been processed through the BuyBoard or provided to the Cooperative. If you receive a purchase order directly from a Cooperative member that you have reason to believe has not been received by the Cooperative or processed through the BuyBoard, you must promptly forward a copy of the purchase order by email to info@buyboard.com. A list of Cooperative members is available on the buyboard.com website. The BuyBoard vendor relations staff will be contacting you to assist with the resources available and to provide any support you may need as an awarded BuyBoard vendor. On behalf of the Cooperative, we appreciate your interest in the Cooperative and we are looking forward to your participation in the program. If you have any questions, please contact Cooperative Procurement Staff at 800-695-2919 (select option "2"). Sincerely, Arturo Salinas Asst. Division Director, Cooperative Purchasing Texas Association of School Boards, Inc., Administrator for The Local Government Purchasing Cooperative v.02.01.2021 Endorsed by A TASAV VT Board® National Pumhasing Cooperative August 9, 2022 Sent Via Email: paul@lonestarme.com Paul Folker Lonestar Municipal Equipment, LLC 1105 Friendship Road Weatherford, TX 76085 Welcome to BuyBoard! Re: Notice of National Purchasing Cooperative Award; Proposal Invitation No. 676-22, Sewer Inspection and Cleaning Products Congratulations, The National Purchasing Cooperative (National Cooperative) has awarded your company a BuyBoard@ contract based on the above -referenced Proposal Invitation. The contract is effective for an initial one-year term of 10/01/2022 through 9/30/2023 and may be subject to two possible one-year renewals. Please refer to the Proposal Invitation for the contract documents, including the National Purchasing Cooperative Vendor Award Agreement and General Terms and Conditions of the Contract. To review the items your company has been awarded, please review Proposal Tabulation No. 676-22 at www.buvboard.com/vendor. Only items marked as awarded to your company are included in this contract award, and only those awarded items may be sold through the BuyBoard contract. All sales must comply with the contract terms and must be at or below the awarded pricing as set forth in the General Terms and Conditions. The contract will be posted on the BuyBoard website as an online electronic catalog(s). You are reminded that, in accordance with the General Terms and Conditions, all purchase orders from National Cooperative members must be processed through the BuyBoard. Except as expressly authorized in writing by the Cooperative's administrator, you are not authorized to process a purchase order received directly from a National Cooperative member that has not been processed through the BuyBoard or provided to the Cooperative. If you receive a purchase order directly from a National Cooperative member that you have reason to believe has not been received by the National Cooperative or processed through the BuyBoard, you must promptly forward a copy of the purchase order by e-mail to info@buyboard.com A list of National Cooperative members is available on the buyboard.com website. The BuyBoard vendor relations staff will be contacting you to assist with resources available and provide any support you may need as an awarded BuyBoard vendor. On behalf of the National Cooperative, we are looking forward to your participation in the program. If you have any questions, please contact Cooperative Procurement Staff at 800-695-2919 (select option "2'�. Arturo Salinas, Asst. Division Director, Cooperative Purchasing Texas Association of School Boards, Inc., Procurement Administrator for the National Purchasing Cooperative v.02.01.2021 '767-0400 toard.com •ti Boar d- PURCHASING C 0[7P�RA 7I YE 12007 Research Boulevard ' Austin, Texas 78759-2439 - PH: 800-695-2919 ' buvboard.com PROPOSER'S ACCEPTANCE AND AGREEMENT Proposal Invitation Name: Sewer Inspection and proposal Due Date/ODenina Date and Time: Cleaning Products March 24, 2022, at 4:00 PM Proposal Invitation Number: 676-22 Contract Term: October 1, 2022, through September 30, 2023, with two possible one-year renewals. Location of Proposal ODeninq: Texas Association of School Boards, Inc. BuyBoard Department 12007 Research Blvd. Austin, TX 78759 Anticipated Cooperative Board Meetinu Date: August 2022 By signature below, the undersigned acknowledges and agrees that you are authorized to submit this Proposal, including making all acknowledgements, consents, and certifications herein, on behalf of Proposer and, to the best of your knowledge, the information provided is true, accurate, and complete. Lonestar Municipal Equipment, LLC Name of Proposing Company 1105 Friendship Road Street Address Weatherford, TX 76085 City, State, Zip 817-851-2243 Telephone Number of Authorized Company Official 817-953-7099 March 20, 2022 Date Signature of Authorized Compan�)Dfficial Paul E. Folker, Jr Printed Name of Authorized Company Official Managing Member Position or Title of Authorized Company Official 81-4546554 Fax Number of Authorized Company Official Federal ID Number Page 10 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com PROPOSAL FORMS PART 1: COMPLIANCE FORMS INSTRUCTIONS: Proposer must review and complete all forms in this Proposal Forms Part 1: ■ Proposal Acknowledgements ■ Felony Conviction Disclosure ■ Resident/Nonresident Certification ■ Debarment Certification ■ Vendor Employment Certification ■ No Boycott Verification ■ No Excluded Nation or Foreign Terrorist Organization Certification ■ Historically Underutilized Business Certification ■ Acknowledgement of BuyBoard Technical Requirements ■ Construction -Related Goods and Services Affirmation ■ Deviation and Compliance ■ Vendor Consent for Name Brand Use ■ Confidential/Proprietary Information ■ EDGAR Vendor Certification ■ Compliance Forms Signature Page An authorized representative of Proposer must initial in the bottom riaht corner of each oaae where indicated and complete and sign the Compliance Forms Signature Page. Proposer's failure to fully complete, initial, and sign forms as required may result in your Proposal being rejected as non -responsive. PROPOSAL ACKNOWLEDGEMENTS The proposing company ("you" or "your' hereby acknowledges and agrees as follows: 1. You have carefully examined and understand all information and documentation associated with this Proposal Invitation, including the Instructions to Proposers, General Information, General Terms and Conditions, attachments/forms, appendices, item specifications, and line items (collectively "Requirements'; 2. By your response ("Proposal') to this Proposal Invitation, you propose to supply the products or services submitted at the pricing quoted in your Proposal and in strict compliance with the Requirements, unless specific deviations or exceptions are noted in the Proposal; 3. By your Proposal, you acknowledge and certify all items set forth in the General Terms and Conditions, Section B.12 (Certifications), including all non -collusion certifications and certifications regarding legal, ethical, and other matters set forth therein. 4. Any and all deviations and exceptions to the Requirements have been noted in your Proposal on the required form and no others will be claimed; Initial: Page 11 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com 5. If the Cooperative accepts any part of your Proposal and awards you a Contract, you will furnish all awarded products or services at the pricing quoted and in strict compliance with the Requirements (unless specific deviations or exceptions are noted on the required form and accepted by the Cooperative), including without limitation the Requirements related to: a. conducting business with Cooperative members, including offering pricing to members that is the best you offer compared to similarly situated customers in similar circumstances; b. payment of a service fee in the amount specified and as provided for in this Proposal Invitation; c. the possible award of a piggy -back contract by the National Purchasing Cooperative or nonprofit entity, in which event you will offer the awarded products and services in accordance with the Requirements; and d. submitting price sheets or catalogs in the proper format as required by the Cooperative as a prerequisite to activation of your Contract; 6. You have clearly identified on the included form any information in your Proposal that you believe to be confidential or proprietary or that you do not consider to be public information subject to public disclosure under the Texas Public Information Act or similar public information law; 7. The individual submitting this Proposal is duly authorized to enter into the contractual relationship represented by this Proposal Invitation on your behalf and bind you to the Requirements, and such individual (and any individual signing a form or Proposal document) is authorized and has the requisite knowledge to provide the information and make the representations and certifications required in the Requirements; 8. You have carefully reviewed your Proposal, and certify that all information provided is true, complete, and accurate to the best of your knowledge, and you authorize the Cooperative to take such action as it deems appropriate to verify such information; and 9. Any misstatement, falsification, or omission in your Proposal, whenever or however discovered, will be grounds for disqualifying you from consideration for a contract award under this Proposal Invitation, termination of a contract award, or any other remedy or action provided for in the General Terms and Conditions or by law. FELONY CONVICTION DISCLOSURE Subsection (a) of Section 44.034 of the Texas Education Code (Notification of Criminal History of Contractor) states: "A person or business entity that enters into a contract with a school district must give advance notice to the district if the person or an owner or operator has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony." Section 44.034 further states in Subsection (b): "A school district may terminate a contract with a person or business entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for services performed before the termination of the contract." Please check N) one of the followina: ❑ My company is a publicly -held corporation. (Advance notice requirement does not apply to publicly -held corporation.) 0 My company is not owned or operated by anyone who has been convicted of a felony. ❑ My company is owned/operated by the following individual(s) who has/have been convicted of a felony: Name of Felon(s): Details of Conviction(s): Initial: /) 'F�_ Page 12 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com RESIDENT/NONRESIDENT CERTIFICATION Chapter 2252, Subchapter A, of the Texas Government Code establishes certain requirements applicable to proposers who are not Texas residents. Under the statute, a "resident" proposer is a person whose principal place of business is in Texas, including a contractor whose ultimate parent company or majority owner has its principal place of business in Texas. A "nonresident" proposer is a person who is not a Texas resident. Please indicate the status of your company as a "resident" proposer or a "nonresident" proposer under these definitions. Please check W) one of the followina: ® I certify that my company is a Resident Proposer. ❑ I certify that my company is a Nonresident Proposer. If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in which your company's principal place of business is located): Company Name City Address State Zip Code A. Does your resident state require a proposer whose principal place of business is in Texas to under -price proposers whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract? ❑ Yes ❑ No B. What is the prescribed amount or percentage? $ or % DEBARMENT CERTIFICATION By signature on the Compliance Forms Signature Page, I certify that neither my company nor an owner or principal of my company has been debarred, suspended or otherwise made ineligible for participation in Federal Assistance programs under Executive Order 12549, "Debarment and Suspension," as described in the Federal Register and Rules and Regulations. Neither my company nor an owner or principal of my company is currently listed on the government -wide exclusions in SAM, debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory or regulatory authority. My company agrees to immediately notify the Cooperative and all Cooperative members with pending purchases or seeking to purchase from my company if my company or an owner or principal is later listed on the government -wide exclusions in SAM, or is debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory or regulatory authority. VENDOR EMPLOYMENT CERTIFICATION Section 44.031(b) of the Texas Education Code establishes certain criteria that a school district must consider when determining to whom to award a contract. Among the criteria for certain contracts is whether the vendor or the vendor's ultimate parent or majority owner (i) has its principal place of business in Texas; or (ii) employs at least 500 people in Texas. If neither your company nor the ultimate parent company or majority owner has its principal place of business in Texas, does your company, ultimate parent company, or majority owner employ at least 500 people in Texas? Please check N) one of the following: ❑ Yes ❑ No Initial: /a )X�_ Page 13 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASINGCOOPERATWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com NO BOYCOTT VERIFICATION A Texas governmental entity may not enter into a contract with a value of $100,000 or more that is to be paid wholly or partly from public funds with a company (excluding a sole proprietorship) that has 10 or more full-time employees for goods or services unless the contract contains a written verification from the company that it: (1) does not boycott Israel and will not boycott Israel during the term of the contract (TEx. Gov'T CODE Ch. 2271), (2) does not boycott energy companies and will not boycott energy companies during the term of the contract (TEx. Gov't CODE Ch. 2274 effective September 1, 2021), and (3) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and will not discriminate during the term of the contract against a firearm entity or firearm trade association (TEx. Gov'T CODE Ch. 2274 effective September 1, 2021). Accordingly, this certification form is included to the extent required by law. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes. TEx. Gov'T CODE §808.001(1). "Boycott energy company" means, without an ordinary business purpose, refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations with a company because the company: (A) engages in the exploration, production, utilization, transportation, sale, or manufacturing of fossil fuel -based energy and does not commit or pledge to meet environmental standards beyond applicable federal and state law; or (B) does business with a company described by Paragraph (A). TEx. Gov'T CODE §809.001(1) (effective September 1, 2021). "Discriminate against a firearm entity or firearm trade association" means, (A) with respect to the entity or association, to: (i) refuse to engage in the trade of any goods or services with the entity or association based solely on its status as a firearm entity or firearm trade association; (ii) refrain from continuing an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; or (iii) terminate an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; and (B) does not include: (i) the established policies of a merchant, retail seller, or platform that restrict or prohibit the listing or selling of ammunition, firearms, or firearm accessories; and (ii) a company's refusal to engage in the trade of any goods or services, decision to refrain from continuing an existing business relationship, or decision to terminate an existing business relationship: (aa) to comply with federal, state, or local law, policy, or regulations or a directive by a regulatory agency; or (bb) for any traditional business reason that is specific to the customer or potential customer and not based solely on an entity's or association's status as a firearm entity or firearm trade association. TEx. Gov'T CODE §2274.001(3) (effective September 1, 2021). By signature on the Compliance Forms Signature Page, to the extent applicable, I certify and verify that Vendor does not boycott Israel, boycott energy companies, or discriminate against a firearm entity or firearm trade association and will not do so during the term of any contract awarded under this Proposal Invitation, that this certification is true, complete and accurate, and that I am authorized by my company to make this certification. Initial: Page 14 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 - buvboard.com NO EXCLUDED NATION OR FOREIGN TERRORIST ORGANIZATION CERTIFICATION Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may not enter into a contract with a company engaged in active business operations with Sudan, Iran, or a foreign terrorist organization — specifically, any company identified on a list prepared and maintained by the Texas Comptroller under Texas Government Code §§806.051, 807.051, or 2252.153. (A company that the U.S. Government affirmatively declares to be excluded from its federal sanctions regime relating to Sudan, Iran, or any federal sanctions regime relating to a foreign terrorist organization is not subject to the contract prohibition.) By signature on the Compliance Forms Signature Page, I certify and verify that Vendor is not on the Texas Comptroller's list identified above; that this certification is true, complete and accurate; and that I am authorized by my company to make this certification. HISTORICALLY UNDERUTILIZED BUSINESS CERTIFICATION A Proposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women Business Enterprise or "MWBE" and all referred to in this form as a "HUB") is encouraged to indicate its HUB certification status when responding to this Proposal Invitation. The BuyBoard website will indicate HUB certifications for awarded Vendors that properly indicate and document their HUB certification on this form. Please check l-/l all that aaDly: ❑ I certify that my company has been certified as a HUB in the following categories: ❑ Minority Owned Business ❑ Women Owned Business ❑ Service -Disabled Veteran Owned Business (veteran defined by 38 U.S.C. §101(2), who has a service -connected disability as defined by 38 U.S.C. § 101(16), and who has a disability rating of 20% or more as determined by the U. S. Department of Veterans Affairs or Department of Defense) Certification Number: Name of Certifying Agency: ® My company has NOT been certified as a HUB. ACKNOWLEDGEMENT OF BUYBOARD TECHNICAL REQUIREMENTS Vendor shall review the BuyBoard Technical Requirements included in this Proposal Invitation. By signature on the Compliance Forms Signature Page, the undersigned affirms that Proposer has obtained a copy of the BuyBoard Technical Requirements, has read and understands the requirements, and certifies that Vendor is able to meet and will comply with those requirements except as follows: [List and explain BuyBoard Technical Requirements, if any, to which your company cannot or will not comply.] N/A Note: In accordance with the General Terms and Conditions of the Contract, to the extent Vendor is awarded a Contract under this Proposal Invitation but is unable or unwilling to meet the applicable BuyBoard Technical Requirements, the information available on the BuyBoard for Vendor's awarded products or services may be limited, potentially placing Vendor at a disadvantage and impacting the ability of Cooperative members to search, find, review, and purchase Vendor's awarded products and services on the BuyBoard website. Further, to the extent Vendor has acknowledged ability to meet and comply with the BuyBoard Technical Requirements, any subsequent failure or refusal by Vendor to promptly provide information upon request to the Cooperative administrator in accordance with those technical requirements may be deemed an event of default under the Contract. Initial: �o IF— Page 15 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com CONSTRUCTION -RELATED GOODS AND SERVICES AFFIRMATION The Cooperative issued the BuyBoard Procurement and Construction -Related Goods and Services Advisory for Texas Members ("Advisory"), which provides information specifically relevant to the procurement of construction -related goods and services by Texas Cooperative members. The Advisory, available at buvboard.com/Vendor/Resources.asi)x, provides an overview of certain legal requirements that are potentially relevant to a Cooperative member's procurement of construction or construction -related goods and services, including those for projects that may involve or require architecture, engineering or independent testing services. A copy of the Advisory can also be provided upon request. Because many BuyBoard contracts include goods or installation services that might be considered construction -related, Proposer must make this Construction Related -Goods and Services Affirmation regardless of type of goods or services associated with this Proposal Invitation. A contract awarded under this Proposal Invitation covers only the specific goods and/or services awarded by the Cooperative. As explained in the Advisory ("Advisory', Texas law prohibits the procurement of architecture or engineering services through a purchasing cooperative. This Proposal Invitation and any Contract awarded thereunder does not include such services. Architecture or engineering services must be procured by a Cooperative member separately, in accordance with the Professional Services Procurement Act (Chapter 2254 of the Texas Government Code) and other applicable law and local policy. By signature on the Compliance Forms Signature Page, Proposer affirms that Proposer has obtained a copy of the Advisory, has read and understands the Advisory, and is authorized by Proposer to make this affirmation. If Proposer sells construction - related goods or services to a Cooperative member under a Contract awarded under this Proposal Invitation, Proposer will comply with the Advisory and applicable legal requirements, make a good faith effort to make its Cooperative member customers or potential Cooperative member customers aware of such requirements, and provide a Cooperative member with a copy of the Advisory before accepting the member's Purchase Order or other agreement for construction -related goods or services. Initial: /V IF:-, Page 16 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com DEVIATION AND COMPLIANCE If your company intends to deviate from the General Terms and Conditions, Proposal Specifications or other requirements associated with this Proposal Invitation, you MUST list all such deviations on this form, and provide complete and detailed information regarding the deviations on this form or an attachment to this form. Prior to completing this form, Vendor shall review the General Terms and Conditions section B.4 (Deviations from Item Specifications and General Terms and Conditions). Please note that, as provided in section B.4, certain provisions of the General Terms and Conditions are NOT subject to deviation, and certain deviations will be deemed rejected without further action by the Cooperative. Any attempted deviation, whether directly or indirectly, to provisions identified in this Proposal Invitation as not subject to deviation shall be deemed rejected by the Cooperative and, unless otherwise withdrawn by Vendor, may result in Vendor's Proposal being rejected in its entirety. The Cooperative will consider any deviations in its contract award decision and reserves the right to accept or reject a proposal based upon any submitted deviation. In the absence of any deviation identified and described in accordance with the above, your company must fully comply with the General Terms and Conditions, Proposal Specifications and all other requirements associated with this Proposal Invitation if awarded a Contract under this Proposal Invitation. A deviation will not be effective unless accepted by the Cooperative. The Cooperative, by and through the Cooperative administrator, may, in its sole discretion, seek clarification from and/or communicate with Proposer(s) regarding any submitted deviation, consistent with general procurement principles of fair competition. The Cooperative reserves the right to accept or reject a Proposal based upon any submitted deviation. Please check W) one of the following: ❑■ NO; Deviations ❑ Yes; Deviations List and fully explain any deviations you are submitting: Initial: 110 � Page 17 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com VENDOR CONSENT FOR NAME BRAND USE BuyBoard members seeking to make purchases using a Contract awarded under this Proposal Invitation may view information regarding awarded Vendors, including but not limited to product catalogs, pricelists, pricing, and Proposals, through the BuyBoard website. To improve and enhance the experience of BuyBoard members seeking to procure goods and services under the Contract utilizing the BuyBoard website, any Vendor logo, product images, and similar brand and trademark information provided by Vendor for purposes of the Contract ("Vendor Information's may be posted on the BuyBoard website. You acknowledge that, by submitting your Proposal, unless you specifically opt out below, you consent to use of your company's Vendor Information on the BuyBoard website if awarded a Contract. You further acknowledge that whether, where, and when to include the Vendor Information on the BuyBoard website shall be at the sole discretion of the BuyBoard Administrator. Vendor retains, however, the right of general quality control over the BuyBoard Administrator's authorized display of proprietary Vendor Information. Neither the BuyBoard nor its administrator will be responsible for the use or distribution of Vendor Information by BuyBoard members or any other third party using the BuyBoard website. This Vendor Consent shall be effective for the full term of the Contract, including renewals, unless Vendor provides a signed, written notice revoking consent to contractadmin(&buvboard.com. BuyBoard shall have up to thirty days from the date of receipt of a termination or revocation of a Vendor Consent to remove Vendor information from the BuyBoard website. This Vendor Consent is subject to the Terms and Conditions of the Contract, including, but not limited to, those terms pertaining to Disclaimer of Warranty and Limitation of Liability, Indemnification, and Intellectual Property Infringement. Vendor logo files must be submitted in one of the formats set forth in the BuyBoard Technical Requirements. Proposers are requested to submit this information with Vendor's Proposal. (This consent shall not authorize use of your company's Vendor Information by BuyBoard if your company is not awarded a Contract.) OPT OUT: If your company wishes to opt out of the Vendor Consent for Name Brand Use, you must check the opt out box below. DO NOTselect this box unless your company is opting out of this Vendor Consent for Name Brand Use. ❑ By checking this box, Vendor hereby declines to provide consent for use of Vendor Information (as defined herein) on the BuyBoard website. By opting out, Vendor acknowledges and agrees that, if Vendor is awarded a Contract under this Proposal Invitation, information available on the BuyBoard for Vendor's awarded products or services may be limited, potentially placing Vendor at a disadvantage and impacting the ability of Cooperative members to search, find, review, and purchase Vendor's awarded products and services on the BuyBoard website. Initial: 10 IF:7- Page 18 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com CONFIDENTIAL/ PROPRIETARY INFORMATION A. Public Disclosure Laws All Proposals, forms, documentation, catalogs, pricelists, or other materials submitted by Vendor to the Cooperative in response to this Proposal Invitation, may be subject to the disclosure requirements of the Texas Public Information Act (Texas Government Code chapter 552.001, et, seq.) or similar disclosure law. Proposer must clearly identify on this form any information in its Proposal (including forms, documentation, or other materials submitted with the Proposal) that Proposer considers proprietary or confidential. If Proposer fails to properly identify the information, the Cooperative shall have no obligation to notify Vendor or seek protection of such information from public disclosure should a member of the public or other third party request access to the information under the Texas Public Information Act or similar disclosure law. When required by the Texas Public Information Act or other disclosure law, Proposer may be notified of any third -party request for information in a Proposal that Proposer has identified in this form as proprietary or confidential. Does your Proposal (including forms, documentation, catalogs, pricelists, or other materials submitted with the Proposal) contain information which Vendor considers proprietary or confidential? Please check (-%/) one of the followinq: ❑E NO, I certify that none of the information included with this Proposal is considered confidential or proprietary. ❑ YES, I certify that this Proposal contains information considered confidential or proprietary and all such information is specifically identified on this form. If you responded "YES", you must clearly identify below the specific information you consider confidential or proprietary. List each page number, form number, or other information sufficient to make the information readily identifiable. The Cooperative and Cooperative administrator shall not be responsible for a Proposer's failure to clearly identify information considered confidential or proprietary. Further, by submitting a Proposal, Proposer acknowledges that the Cooperative and Cooperative administrator will disclose information when required by law, even if such information has been identified herein as information Vendor considers confidential or proprietary. Confidential / Proprietary Information: (Attach additional sheets if needed.) Initial: Page 19 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com B. Coovriaht Information Does your Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal) contain copyright information? Please check W) one of the followina: ❑E NO, Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal) does not contain copyright information. ❑ YES, Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal) does contain copyright information. If you responded "YES", clearly identify below the specific documents or pages containing copyright information. Copyright Information: (Attach additional sheets if needed.) C. Consent to Release Confidential/Proprietary/Colavriaht Information to BuyBoard Members BuyBoard members (Cooperative and nonprofit members) seeking to make purchases through the BuyBoard may wish to view information included in the Proposals of awarded Vendors. If you identified information on this form as confidential, proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contract award constitutes your consent to the disclosure of such information to BuyBoard members, including posting of such information on the secure BuyBoard website for members. Note: Neither the Cooperative nor Cooperative administrator will be responsible for the use or distribution of information by BuyBoard members or any other party. D. Consent to Release Proposal Tabulation Notwithstanding anything in this Confidential/Proprietary Information form to the contrary, by submitting a Proposal, Vendor consents and agrees that, upon Contract award, the Cooperative may publicly release, including posting on the public BuyBoard website, a copy of the proposal tabulation and award information for the Contract including Vendor name; proposed catalog/pricelist name(s); proposed percentage discount(s), hourly labor rate(s), or other specified pricing; and Vendor award or non -award information. Initial: "D)� Page 20 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com EDGAR VENDOR CERTIFICATION (2 CFR Part 200 and Appendix II) When a Cooperative member seeks to procure goods and services using funds under a federal grant or contract, specific federal laws, regulations, and requirements may apply in addition to those under state law. This includes, but is not limited to, the procurement standards of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards, 2 CFR 200 (sometimes referred to as the "Uniform Guidance" or new "EDGAR"). All Vendors submitting a Proposal must complete this EDGAR Certification Form regarding Vendor's willingness and ability to comply with certain requirements which may be applicable to specific Cooperative member purchases using federal grant funds. Completed forms will be made available to Cooperative members for their use while considering their purchasing options when using federal grant funds. Cooperative members may also require Vendors to enter into ancillary agreements, in addition to the terms and conditions of the BuyBoard contract, to address the member's specific contractual needs, including contract requirements for a procurement using federal grants or contracts. For each of the items below, Vendor should certify Vendor's agreement and ability to comply, where applicable, by having Vendor's authorized representative check the applicable boxes, initial each page, and sign the Compliance Forms Signature Page. If you fail to complete any item in this form, the Cooperative will consider and may list the Vendor's response on the BuyBoard as "NO,"the Vendor is unable or unwilling to comply. A "NO" response to any of the items may, if applicable, impact the ability of a Cooperative member to purchase from the Vendor using federal funds. 1. Vendor Violation or Breach of Contract Terms: Contracts for more than the simplified acquisition threshold, which is the inflation adjusted amount determined by the Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 USC 1908, must address administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and penalties as appropriate. Provisions regarding Vendor default are included in the BuyBoard General Terms and Conditions, including Section E.18, Remedies for Default and Termination of Contract. Any Contract award will be subject to such BuyBoard General Terms and Conditions, as well as any additional terms and conditions in any Purchase Order or Cooperative member ancillary contract agreed upon by Vendor and the Cooperative member which must be consistent with and protect the Cooperative member at least to the same extent as the BuyBoard Terms and Conditions. The remedies under the Contract are in addition to any other remedies that may be available under law or in equity. By submitting a Proposal, you agree to these Vendor violation and breach of contract terms. ® YES, I agree. ❑ NO, I do not agree. 2. Termination for Cause or Convenience: For any Cooperative member purchase or contract in excess of $10,000 made using federal funds, you agree that the following term and condition shall apply: The Cooperative member may terminate or cancel any Purchase Order under this Contract at any time, with or without cause, by providing seven (7) business days advance written notice to the Vendor. If this Agreement is terminated in accordance with this Paragraph, the Cooperative member shall only be required to pay Vendor for goods or services delivered to the Cooperative member prior to the termination and not otherwise returned in accordance with Vendor's return policy. If the Cooperative member has paid Vendor for goods or services not yet provided as of the date of termination, Vendor shall immediately refund such payment(s). If an alternate provision for termination of a Cooperative member purchase for cause and convenience, including the manner by which it will be effected and the basis for settlement, is included in the Cooperative member's Purchase Order or ancillary agreement agreed to by the Vendor, the Cooperative member's provision shall control. ® YES, I agree. ❑ NO, I do not agree. Initial: Page 21 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com 3. Equal Employment Opportunity: Except as otherwise provided under 41 CFR Part 60, all Cooperative member purchases or contracts that meet the definition of "federally assisted construction contract" in 41 CFR Part 60-1.3 shall be deemed to include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, "Equal Employment Opportunity" (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, "Amending Executive Order 11246 Relating to Equal Employment Opportunity," and implementing regulations at 41 CFR Part 60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor." The equal opportunity clause provided under 41 CFR 60-1.4(b) is hereby incorporated by reference. Vendor agrees that such provision applies to any Cooperative member purchase or contract that meets the definition of "federally assisted construction contract" in 41 CFR Part 60-1.3 and Vendor agrees that it shall comply with such provision. ® YES, I agree. ❑ NO, I do not agree. 4. Davis -Bacon Act: When required by Federal program legislation, Vendor agrees that, for all Cooperative member prime construction contracts/purchases in excess of $2,000, Vendor shall comply with the Davis -Bacon Act (40 USC 3141-3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction"). In accordance with the statute, Vendor is required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determinate made by the Secretary of Labor. In addition, Vendor shall pay wages not less than once a week. Current prevailing wage determinations issued by the Department of Labor are available at beta.sam.gov. Vendor agrees that, for any purchase to which this requirement applies, the award of the purchase to the Vendor is conditioned upon Vendor's acceptance of the wage determination. Vendor further agrees that it shall also comply with the Copeland "Anti -Kickback" Act (40 USC 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States"). The Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. ® YES, I agree. ❑ NO, I do not agree. S. Contract Work Hours and Safety Standards Act: Where applicable, for all Cooperative member contracts or purchases in excess of $100,000 that involve the employment of mechanics or laborers, Vendor agrees to comply with 40 USC 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 USC 3702 of the Act, Vendor is required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 USC 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. ® YES, I agree. ❑ NO, I do not agree. Initial: 10 IF:7,- Page 22 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 - buvboard.com 6. Right to Inventions Made Under a Contract or Agreement: If the Cooperative member's Federal award meets the definition of "funding agreement" under 37 CFR 401.2(a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance or experimental, developmental, or research work under that "funding agreement," the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and any implementing regulations issued by the awarding agency. Vendor agrees to comply with the above requirements when applicable. ® YES, I agree. ❑ NO, I do not agree. 7. Clean Air Act and Federal Water Pollution Control Act: Clean Air Act (42 USC 7401-7671q.) and the Federal Water Pollution Control Act (33 USC 1251-1387), as amended — Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non -Federal award to agree to comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act (42 USC 7401-7671q.) and the Federal Water Pollution Control Act, as amended (33 USC 1251-1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). When required, Vendor agrees to comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act and the Federal Water Pollution Control Act. ® YES, I agree. ❑ NO, I do not agree. S. Debarment and Suspension: Debarment and Suspension (Executive Orders 12549 and 12689) — A contract award (see 2 CFR 180.220) must not be made to parties listed on the government -wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1966 Comp. p. 189) and 12689 (3 CFR Part 1989 Comp. p. 235), "Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. Vendor certifies that Vendor is not currently listed on the government -wide exclusions in SAM, is not debarred, suspended, or otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than Executive Order 12549. Vendor further agrees to immediately notify the Cooperative and all Cooperative members with pending purchases or seeking to purchase from Vendor if Vendor is later listed on the government -wide exclusions in SAM, or is debarred, suspended, or otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than Executive Order 12549. ® YES, I agree. ❑ NO, I do not agree. 9. Byrd Anti -Lobbying Amendment: Byrd Anti -Lobbying Amendment (31 USC 1352) - Vendors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 USC 1352. Each tier must also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non -Federal award. As applicable, Vendor agrees to file all certifications and disclosures required by, and otherwise comply with, the Byrd Anti -Lobbying Amendment (31 USC 1352). ® YES, I agree. ❑ NO, I do not agree. Initial: Page 23 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com 10. Procurement of Recovered Materials: For Cooperative member purchases utilizing Federal funds, Vendor agrees to comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act where applicable and provide such information and certifications as a Cooperative member may require to confirm estimates and otherwise comply. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR Part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery, and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. ® YES, I agree. ❑ NO, I do not agree. 11. Domestic Preferences for Procurements: Where appropriate and consistent with law, 2 CFR §200.322 contains certain considerations for domestic preferences for procurements which may be applicable to Cooperative members using federal funds. When required by a Cooperative member, Vendor agrees to provide such information or certification as may reasonably be requested by the Cooperative member regarding Vendor's products, including whether goods, products, or materials are produced in the United States. ® YES, I agree. ❑ NO, I do not agree. 12. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment 2 CFR §200.216 prohibits expending federal loan or grant funds to procure or obtain certain telecommunications and video surveillance services or equipment. To the extent applicable and when required by a Cooperative member, Vendor agrees to provide such information or certification as may reasonably be requested by the Cooperative member to confirm whether any telecommunications or video surveillance services or equipment provided by Vendor is covered equipment or covered services under 2 CFR §200.216. ® YES, I agree. ❑ NO, I do not agree. 13. Profit as a Separate Element of Price: For purchases using federal funds in excess of the Simplified Acquisition Threshold, a Cooperative member may be required to negotiate profit as a separate element of the price. See, 2 CFR 200.324(b). When required by a Cooperative member, Vendor agrees to provide information and negotiate with the Cooperative member regarding profit as a separate element of the price for a particular purchase. However, Vendor agrees that the total price, including profit, charged by Vendor to the Cooperative member shall not exceed the awarded pricing, including any applicable discount, under Vendor's Cooperative Contract. ® YES, I agree. ❑ NO, I do not agree. 14. General Compliance and Cooperation with Cooperative Members: In addition to the foregoing specific requirements, Vendor agrees, in accepting any Purchase Order from a Cooperative member, it shall make a good faith effort to work with Cooperative members to provide such information and to satisfy such requirements as may apply to a particular Cooperative member purchase or purchases including, but not limited to, applicable recordkeeping and record retention requirements. ® YES, I agree. ❑ NO, I do not agree. Initial: 1 Page 24 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com COMPLIANCE FORMS SIGNATURE PAGE By initialing pages and by signature below, I certify that I have reviewed the following forms; that the information provided therein is true, complete, and accurate; and that I am authorized by my company to make all certifications, consents, acknowledgements, and agreements contained herein: ■ Proposal Acknowledgements ■ Felony Conviction Disclosure ■ Debarment Certification ■ Resident/Nonresident Certification ■ Vendor Employment Certification ■ No Boycott Verification ■ No Excluded Nation or Foreign Terrorist Organization Certification ■ Historically Underutilized Business Certification ■ Construction -Related Goods and Services Affirmation ■ Acknowledgement of BuyBoard Technical Requirements ■ Deviation and Compliance ■ Vendor Consent for Name Brand Use ■ Confidential/Proprietary Information ■ EDGAR Vendor Certification Lonestar Municipal Equipment, LLC Company Name Signature of Authorized Compa(y Official Paul E. Folker, Jr. Printed Name and Title March 20, 2022 Date Page 25 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com PROPOSAL FORMS PART 2: VENDOR INFORMATION FORMS INSTRUCTIONS: Proposer must completely and accurately provide all information requested in the following Vendor Information Forms or your Proposal may be rejected as non -responsive: ■ Vendor Business Name ■ Vendor Contact Information ■ Federal and State/Purchasing Cooperative Experience ■ Governmental References ■ Company Profile ■ Texas Regional Service Designation ■ State Service Designation ■ National Purchasing Cooperative Vendor Award Agreement (vendors serving outside Texas only) ■ Local/Authorized Seller Listings ■ Manufacturer Dealer Designation ■ Proposal Invitation Questionnaire ■ Vendor Request to Self -Report BuyBoard Purchases (optional) To the extent any information requested is not applicable to your company, you must so indicate on the form. VENDOR BUSINESS NAME By submitting a Proposal, Vendor is seeking to enter into a legal contract with the Cooperative. As such, Vendor must be an individual or legal business entity capable of entering into a binding contract. Name of Pronosina Companv: LOneStar Municipal Equipment, LLC (List the legal name of the company seeking to contract with the Cooperative. Do NOT list an assumed name, dba, aka, etc. here. Such information may be provided below. If you are submitting a joint proposal with another entity to provide the same proposed goods or services, each submitting entity should complete a separate vendor information form. Separately operating legal business entities, even if affiliated entities, which propose to provide goods or services separately must submit their own Proposals.) Please check W) one of the following: Tvne of Business: ❑ Individual/Sole Proprietor ❑ Corporation ❑ Limited Liability Company ❑ Partnership ® Other (Specify: Limited Liabilitv Comoanv ) State of Incorporation (if applicable): Texas Federal Emalover Identification Number: 81-4546554 (Vendor must include a completed IRS W-9 form with their Proposal) Name by which Vendor, if awarded, wishes to be identified on the BuvBoard: (Note: Ifdifierentthan the Name of Proposing Company listed above, only valid trade names (dba, aka, etc.) of the Proposing Company may be used and a copy of your Assumed Name Certificate(s), if applicable, must be attached.) Lonestar Municipal Equipment Page 26 of 72 Proposal Forms COMM/SVCS v.08.11.2021 Form W=9 Request for Taxpayer Give Form to the (Rev. December Identification Number and Certification requester. not Department entoft20ea of the Treasury send to the IRS. I Internal Revenue Service 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Lonestar Municipal Equipment, LLC N 2 Business name/disregarded entity name, if different from above I Lonestar Municipal Equipment 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions (codes apply only to ° ❑ Individual/sole proprietor or ❑ C Corporation El Corporation El Partnership ❑ Trust/estate certain entities, not individuals; see on page 3): 0instructions m c a p ;,, single -member LLC ❑✓ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ► $ Exempt payee code (if any) v p 2 Note. For a single -member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for Exemption from FATCA reporting y the tax classification of the single -member owner. code (if any) c a ❑ Other (see instructions) ► Applies to accounts maintained outside the U.S.) — .v 5 Address (number, street, and apt. or suite no.) Requester's name and address (optional) a 1105 Friendship Road 6 City, state, and ZIP code c n Weatherford, TX 76085 7 List account number(s) here (optional) JUM Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, for a - m resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for Employer identification number guidelines on whose number to enter. M81 - 4 5 4 6 5 5 4 JIM Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Signature of n 614�/ , Here U.S. person ► ` 0Date ► 03//3/2-02,�-? General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following: • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled -out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. Cat. No. 10231 X Form W-9 (Rev. 12-2014) Boar d- PURCHASING C 0[7P�RA 7I YE 12007 Research Boulevard ' Austin, Texas 78759-2439 - PH: 800-695-2919 ' buvboard.com VENDOR CONTACT INFORMATION Vendor shall pro vide the requested Vendor Contact Information in the electronic proposal submission system including contract, purchase order, RFQ, and invoice contacts (or, if submitting a hard copy Proposal, timely request and complete the Vendor Contact Information form in accordance with the Instructions to Proposers). FEDERAL AND STATE/ PURCHASING COOPERATIVE EXPERIENCE The Cooperative strives to provide Cooperative members with the best services and products at the best prices available from Vendors with the technical resources and ability to serve Cooperative members. Please respond to the following questions. 1. Provide the dollar value of sales to or through purchasing cooperatives at or based on an established catalog or market price during the previous 12-month period or the last fiscal year: $ 128,231.07 . (The period of the 12-month period is 01/01/2021 / 12/31/2021 ). In the event that a dollar value is not an appropriate measure of the sales, provide and describe your own measure of the sales of the item(s). 2. By submitting a proposal, you agree that, based on your written discounting policies, the discounts you offer the Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items under equivalent circumstances. 3. Provide the information requested below for other purchasing cooperatives for which Proposer currently serves, or in the past has served, as an awarded vendor. Rows should be added to accommodate as many purchasing cooperatives as required. 1. Federal General Services Administration N N N/A 2. T-PASS (state of Texas) N N N/A 3. OMNIA Partners N N N/A 4. Sourcewell (NJPA) N N N/A 5. E&I Cooperative N N N/A 6. Houston -Galveston Area Council (HGAC) N N N/A 7. Choice Partners N N N/A 8. The Interlocal Purchasing System (TIPS) N N N/A 9. Other N/A N/A N/A ❑■ MY COMPANY DOES NOT CURRENTLY HAVE ANY OF THE ABOVE OR SIMILAR TYPE CONTRACTS. CURRENT BUYBOARD VENDORS If you are a current BuyBoard vendor in the same contract category as proposed in this Proposal Invitation, indicate the discount for your current BuyBoard contract and the proposed discount in this Proposal. Explain any difference between your current and proposed discounts. Current Discount (%): 5 Proposed Discount (%): 2-5 Explanation: All my products are at 5% except for 1 new manufacturer I'm adding at a 2% discount Page 27 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • buvboard.com GOVERNMENTAL REFERENCES For your Proposal to be considered, you must supply a minimum of five (5) individual governmental entity references. The Cooperative may contact any and all references provided as part of the Proposal evaluation. Provide the information requested below, including the existing pricing/discounts you offer each customer. The Cooperative may determine whether pricing/discounts are fair and reasonable by comparing pricing/discounts stated in your Proposal with the pricing/discounts you offer other governmental customers. Attach additional pages if necessary. Quantity/ Entitv Name Contact Phone# Email Address Discount Volume 1 City of Arlington Angelo Dupont 817-459-5913 angelo.dupont@arlingtontx.gov 5% $19,421.81 Z North Texas Municipal Water District Larry Gorum 972-442-5405 Igorum@ntmwd.com 5% $112,777.09 3 The Colony Joe Chase 972-624-4418 jchase@thecolonytx.gov 5% $10,480.04 4 Watauga, TX Taylor Alvarez 817-514-5846 talvarez@wataugatx.org 5% $90,900.28 5 Wichita Falls Nicki Lowery 940-723-5573 nicki.lowery@wichitafallstx.gov 5% $255,973.82 Do you ever modify your written policies or standard governmental sales practices as identified in the above chart to give better discounts (lower pricing) than indicated? YES ❑ NO 0 If YES, please explain: COMPANY PROFILE Information on awarded Cooperative Contracts is available to Cooperative Members on the BuyBoard website. If your company is awarded a Contract under this Proposal Invitation, please provide a brief company description that you would like to have included with your company profile on the BuyBoard website. Submit your company profile in a separate file, in Word format, with your Proposal. (Note: Vendor is solely responsible for any content provided for inclusion on the BuyBoard website. The Cooperative reserves the right to exclude or remove any content in its sole discretion, with or without prior notice, including but not limited to any content deemed by the Cooperative to be inappropriate, irrelevant to the Contract, inaccurate, or misleading.) Page 28 of 72 Proposal Forms COMM/SVCS v.08.11.2021 LONESTAR MUNICIPAL EQUIPMENT Located in Weatherford, TX, and with a service center in Haslet, TX, Lonestar Municipal Equipment serves as a distributor for Blue Star Nozzles, Jetter Depot Nozzles, MEC Equipment Nozzles, both Setcom and Sonetics wireless communications headsets, UEMSI parts and equipment, mainline and push camera systems, and Hydra -Flex sewer cleaning and hydro excavation nozzles. We are also the authorized GapVax dealer and the authorized dealer for VIR/Proteus CCTV Inspection Systems for the northern half of Texas. With over 20 years of municipal sales and service experience, LME has the experience and the expertise to handle your equipment needs. 1105 Friendship Road, Weatherford, TX 76085 www.lonestarmunicipalequipment.com Boar d- PURCHASING C 0[7P�RA 7I YE 12007 Research Boulevard ' Austin, Texas 78759-2439 - PH: 800-695-2919 ' buvboard.com TEXAS REGIONAL SERVICE DESIGNATION This form must be completed in the electronic proposal submission system (or, if submitting a hard copy Proposal, timely reouest and complete the form in accordance with the Instructions to Pr000sers). The Cooperative (referred to as "Texas Cooperative" in this form and in the State Service Designation form) offers vendors the opportunity to service its members throughout the entire State of Texas. In the electronic proposal submission system, you must indicate if you will service Texas Cooperative members statewide or, if you do not plan to service all Texas Cooperative members statewide, you must indicate the specific regions you will service. If you propose to serve different regions for different products or services included in your Proposal, you must complete and submit a separate Texas Regional Service Designation form for each group of products and clearly indicate the products or services to which the designation applies. (Additional forms can be obtained by contacting bids(a)buvboard.com at least five (5) business days prior to the Proposal Due Date.) By designating a region or regions, you are certifying that you are authorized and willing to provide the proposed products and services in those regions. Designating regions in which you are either unable or unwilling to provide the specified products and services shall be grounds for either rejection of your Proposal or, if awarded, termination of your Contract. Additionally, if you do not plan to service Texas Cooperative members (i.e., if you will service only states other than Texas), you must so indicate on the form in the electronic proposal submission system. Regional Education Service Centers Reaion and Headauarters 1 Edinburg 2 Corpus Christi 3 Victoria 4 Houston 5 Beaumont 6 Huntsville 7 Kilgore 8 Mount Pleasant w 9 Wichita Falls _ LL 10 Richardson 11 Fort Worth r ' 12 Waco 13 Austin ` 3 14 Abilene -- ,• 15 San Angelo _ 16 Amarillo -r 17 Lubbock 18 Midland - 19 ElPaso 20 San Antonio Page 29 of 72 Proposal Forms COMM/SVCS v.08.11.2021 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com STATE SERVICE DESIGNATION This form must be completed in the electronic proposal submission system (or, if submitting a hard copy Proposal, timely request and complete the in accordance with the Instructions to Proposers). As set forth in the Proposal Invitation, it is the Cooperative's intent that other governmental entities in the United States have the opportunity to purchase goods or services awarded under the Contract, subject to applicable state law, through a piggy- back award or similar agreement through the National Purchasing Cooperative BuyBoard. If you plan to service the entire United States or only specific states, you must complete the State Service Desianation information in the electronic proposal submission system. (Note: If you plan to service Texas Cooperative members, be sure that you complete the Texas Regional Service Designation form.) In addition to this form, to be considered for a piggy -back award by the National Purchasing Cooperative, you must have an authorized representative sign the National Purchasing Cooperative Vendor Award Agreement that follows this page. If you serve different states for different products or services included in your Proposal, you must complete and submit a separate State Service Designation form for each group of products and clearly indicate the products or services to which the designation applies. (Additional forms can be obtained by contacting bids buvboard.com at least five (5) business days prior to the Proposal Due Date.) By designating a state or states, you are certifying that you are authorized and willing to provide the proposed products and services in those states. Designating states in which you are either unable or unwilling to provide the specified products and services shall be grounds for either rejection of your Proposal or, if awarded, termination of your Contract. I will service all states in the United States. • I will not service all states in the United States. Alabama Alaska Nebraska Arizona Nevada Arkansas New Hampshire California (Public Contract Code 20118 & 20652) New Jersey Colorado New Mexico Connecticut New York Delaware North Carolina District of Columbia North Dakota Florida Ohio Georgia Oklahoma Hawaii Oregon Idaho Pennsylvania Illinois Rhode Island Indiana South Carolina Iowa South Dakota Kansas Tennessee Kentucky Texas Louisiana Utah Maine Vermont Maryland Virginia Massachusetts Washington Michigan West Virginia Minnesota Wisconsin Mississippi Wyoming Missouri Montana Proposal Forms COMM/SVCS v.08.11.2021 Page 30 of 72 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com NATIONAL PURCHASING COOPERATIVE VENDOR AWARD AGREEMENT In accordance with the Terms and Conditions associated with this Proposal Invitation, a contract awarded under this Proposal Invitation may be "piggy -backed" by another governmental entity. The National Purchasing Cooperative is an intergovernmental purchasing cooperative formed by certain school districts outside of Texas to serve its members throughout the United States. If you agree to be considered for a piggy -back award by the National Purchasing Cooperative, you agree to the following terms and agree to serve National Purchasing Cooperative members in the states you have indicated on the State Service Designation form, in your Proposal. By signing this form, Proposer (referred to in this Agreement as "Vendor") agrees as follows: 1. Vendor acknowledges that if The Local Government Purchasing Cooperative ("Texas Cooperative") awards Vendor a contract under this Proposal Invitation ("Underlying Award', the National Purchasing Cooperative ("National Cooperative") may - but is not required to - "piggy -back" on or re -award all or a portion of that Underlying Award ("Piggy -Back Award'). By signing this National Cooperative Vendor Award Agreement ("Agreement"), Vendor accepts and agrees to be bound by any such Piggy -Back Award as provided for herein. 2. In the event National Cooperative awards Vendor a Piggy -Back Award, the National Cooperative Administrator ("BuyBoard Administrator's will notify Vendor in writing of such Piggy -Back Award, which award shall commence on the effective date stated in the Notice and end on the expiration date of the Underlying Award, subject to annual renewals as authorized in writing by the BuyBoard Administrator. Vendor agrees that no further signature or other action is required of Vendor in order for the Piggy -Back Award and this Agreement to be binding upon Vendor. Vendor further agrees that no interlineations or changes to this Agreement by Vendor will be binding on National Cooperative, unless such changes are agreed to by its BuyBoard Administrator in writing. 3. Vendor agrees that it shall offer its goods and services to National Cooperative members at the same unit pricing and same general terms and conditions, subject to applicable state laws in the state of purchase, as required by the Underlying Award. However, nothing in this Agreement prevents Vendor from offering National Cooperative members better (i.e., lower) competitive pricing and more favorable terms and conditions than those in the Underlying Award. 4. Vendor hereby agrees and confirms that it will serve those states it has designated on the State Service Designation Form of this Proposal Invitation. Any changes to the states designated on the State Service Designation Form must be approved in writing by the BuyBoard Administrator. 5. Vendor agrees to pay National Cooperative the service fee provided for in the Underlying Award based on the amount of purchases generated from National Cooperative members through the Piggy -Back Award. Vendor shall remit payment to National Cooperative on such schedule as it specifies (which shall not be more often than monthly). Further, upon request, Vendor shall provide National Cooperative with copies of all purchase orders generated from National Cooperative members, vendor invoices, and/or such other documentation regarding those purchase orders as the Cooperative's administrators may require in their reasonable discretion for purposes of reviewing and verifying purchase activity. Vendor further agrees that National Cooperative shall have the right, upon reasonable written notice, to review Vendor's records pertaining to purchases made by National Cooperative members in order to verify the accuracy of service fees. 6. Vendor agrees that the Underlying Award, including its General Terms and Conditions, are adopted by reference to the fullest extent such provisions can reasonably apply to the post-proposal/contract award phase. The rights and responsibilities that would ordinarily inure to the Texas Cooperative pursuant to the Underlying Award shall inure to National Cooperative; and, conversely, the rights and responsibilities that would ordinarily inure to Vendor in the Underlying Award shall inure to Vendor in this Agreement. Vendor recognizes and agrees that Vendor and National Cooperative are the only parties to this Agreement, and that nothing in this Agreement has application to other third parties, including the Texas Cooperative. In the event of conflict between this Agreement and the terms of the Underlying Award, the terms of this Agreement shall control, and then only to the extent necessary to reconcile the conflict. Proposal Forms COMM/SVCS v.08.11.2021 Page 31 of 72 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com 7. This Agreement shall be governed and construed in accordance with the laws of the State of Rhode Island and venue for any dispute shall lie in the federal district court of Alexandria, Virginia. 8. Vendor acknowledges and agrees that the award of a Piggy -Back Award is within the sole discretion of National Cooperative, and that this Agreement does not take effect unless and until National Cooperative awards Vendor a Piggy -Back Award and the BuyBoard Administrator notifies Vendor in writing of such Piggy -Back Award as provided for herein. WHEREFORE, by signing below Vendor agrees to the foregoing and warrants that it has the authority to enter into this Agreement. Lonestar Municipal Equipment, LLC 676-22 Name of Vendor Proposal Invitation Number Paul E. Folker, Jr. Signature of Authorized CompV Official Printed Name of Authorized Company Official March 20, 2022 Date Proposal Forms COMM/SVCS v.08.11.2021 Page 32 of 72 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com LOCATION /AUTHORIZED SELLER LISTINGS If you have more than one location/authorized seller that will service a Contract awarded under this Proposal Invitation, please list each location/authorized seller below. If additional sheets are required, please duplicate this form as necessary. NOTE: Awarded Vendors shall remain responsible for all aspects of the Contract, including processing of Purchase Orders, and shall be responsible for the performance of all locations and authorized sellers under and in accordance with the Contract. If you are a product manufacturer and wish to designate Designated Dealers as defined in the General Terms and Conditions to receive Cooperative member Purchase Orders on your behalf, you must complete the Manufacturer Designated Dealer form. N/A N/A N/A Proposal Forms COMM/SVCS v.08.11.2021 Page 33 of 72 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com MANUFACTURER DEALER DESIGNATION If Vendor is a manufacturer that sells products through a dealer network and wishes to designate a dealer or multiple dealers ("Designated Dealers") to receive Cooperative member Purchase Orders on Vendor's behalf, you must complete this form for each dealer you wish to designate. Regardless of any Designated Dealers submitted by Vendor, Vendor specifically agrees and acknowledges that any such designations are for Vendor's convenience only and shall not, if Vendor is awarded a Contract, relieve Vendor of any obligations under the Contract, including payment of Cooperative service fees on all Purchase Orders submitted to Vendor or any Designated Dealer. In accordance with the General Terms and Conditions, an awarded Vendor shall remain responsible and liable for all of its obligations under the Contract and the performance of both Vendor and any of Vendor's Designated Dealers under and in accordance with the Contract and remain subject to all remedies for default thereunder, including, but not limited to suspension and termination of Vendor's Contract for nonpayment of service fees. If awarded, Vendor authorizes the Cooperative, in its sole discretion, to list any Vendor Designated Dealers in the BuyBoard system and to receive Purchase Orders directly from Cooperative members on behalf of Vendor. To the extent a Vendor with Designated Dealers receives a Purchase Order directly, it shall be the responsibility of Vendor to appropriately process such Purchase Order in accordance with the Contract, including but not limited to timely forwarding such Purchase Order to a Designated Dealer for processing. The Cooperative reserves the right, in its sole discretion, to refuse addition of, or request removal of, any Designated Dealer, and Vendor agrees to immediately require such Designated Dealer to cease accepting Purchase Orders or otherwise acting on Vendor's behalf under the Contract. Further, the Cooperative administrator shall be authorized to remove or suspend any or all Designated Dealers from the BuyBoard at any time in its sole discretion. If you wish to designate a dealer to service a contract awarded under this Proposal Invitation, please list the Designated Dealer below. If you wish to designate multiple dealers, please duplicate this form as necessary. N/A N/A Designated Dealer Name Designated Dealer Contact Person Designated Dealer Address City State Zip Phone Number Fax Number Email address Designated Dealer Tax ID Number* (*attach W-9) Proposal Forms COMM/SVCS v.08.11.2021 Page 34 of 72 oar d- PURChASING CGQPERALVE 12007 Research Boulevard ' Austin, Texas 78759-2439 - PH: 800-695-2919 ' FAX: 800-211-5454 ' buvboard.com PROPOSAL INVITATION QUESTIONNAIRE The Cooperative will use your responses to the questions below in evaluating your Proposal and technical and financial resources to provide the goods and perform the services ("Work") under the BuyBoard contract contemplated by this Proposal Invitation ("Contract"). Proposers must fully answer each question, numbering your responses to correspond to the questions/numbers below. Proposers must complete below or attach your responses to this questionnaire and submit in one document with your Proposal. You must submit the questionnaire and responses with your Proposal or the Proposal will not be considered. 1. List the number of years Proposer has been in business and former business names (if applicable). Note whether your company is currently for sale or involved in any transaction that would significantly alter its business or result in acquisition by another entity. 5 years, 3 months 2. Describe the resources Proposer has to manage staff and successfully perform the Work contemplated under this Contract. State the number and summarize the experience of company personnel who may be utilized for the Work, including those who will be available to Cooperative members for assistance with project development, technical issues, and product selection for Work associated with this Contract. Our company consists of the 2 owners, Jennifer and Paul Folker. We sell our equipment directly to our customers and do not require employees. Any service work that is beyond our capabilities is contracted through an outside company located in Haslet, TX. 3. Marketina Strateav: For your Proposal to be considered, you must submit the Marketing Strategy you will use if the Cooperative accepts all or part of your Proposal. (Example: Explain how your company will initially inform Cooperative members of your BuyBoard Contract, and how you will continue to support the BuyBoard for the duration of the Contract term.)Attach additional pages if necessary. We offer all cooperative members quotes/estimates with our BuyBoard contract number prominently displayed and we inform our customers that we are a BuyBoard Vender. We also display at the TML show and the TWUA regional schools where we display our BuyBoard signage on our equipment. Proposal Forms COMM/SVCS v.08.11.2021 Page 35 of 72 card PURCHASING COOPERA THE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com 4. Describe Proposer's financial capability to perform the Contract. State or describe the firm's financial strength and rating, bonding capacity, and insurance coverage limits. State whether the firm, or any of the firm's past or present owners, principal shareholders or stockholders, or officers, have been a debtor party to a bankruptcy, receivership, or insolvency proceeding in the last 7 years, and identify any such debtor party by name and relationship to or position with your firm. LME currently has not been rated, nor has a bond ever been required. We maintain $2,000,000 in Commercial General Liability Insurance. No owner has been party to a bankruptcy, receivership, or insolvency proceeding in the last 7 years. 5. Does your company have any outstanding financial judgments and/or is it currently in default on any loan or financing agreement? If so, provide detailed information on the nature of such items and prospects for resolution. WR 6. List all contracts, if any, in the last 10 years on which Proposer has defaulted, failed to complete or deliver the work, or that have been terminated for any reason. For each such contract, provide the project name, scope, value and date and the name of the procuring entity. Fully explain the circumstances of the default, failure to complete or deliver the work, or termination. 7. List all litigation or other legal proceedings (including arbitration proceedings), if any, in the last 10 years brought against your firm, or any of the firm's past or present owners, principal shareholders or stockholders, officers, agents or employees, that relate to or arise from a contract similar to this Contract or the Work contemplated under this Contract. Provide the style of the lawsuit or proceeding (name of parties and court or tribunal in which filed), nature of the claim, and resolution or current status. N/A Proposal Forms COMM/SVCS v.08.11.2021 Page 36 of 72 card PURCHASING COOPERA TWE 12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 - buvboard.com VENDOR REOUEST TO SELF -REPORT BUYBOARD PURCHASES The General Terms and Conditions require that all Purchase Orders generated by or under any Contract awarded under this Proposal Invitation be processed through the BuyBoard and, except as expressly authorized in writing by the Cooperative administrator, Vendors are not authorized to process Purchase Orders received directly from Cooperative members that have not been processed through the BuyBoard or provided to the Cooperative. In accordance with this provision, Vendor may request authorization of the Cooperative administrator to self -report Cooperative member purchases if awarded a Contract under this Proposal Invitation. By making such a request, Vendor acknowledges and agrees that self -reporting is specifically subject to and conditioned upon (1) Vendor's agreement to the Additional Terms and Conditions for BuyBoard Self -Reporting which are included in this Proposal Invitation and incorporated herein for all purposes and (2) approval of this request in writing by the Cooperative administrator. Note: This form is NOT required as part of your proposal. You should sign and return this form ONLY if you wish to request authorization to self -report BuyBoard purchases, Any request to self -report will not be effective, and Vendor shall not be authorized to self -report BuyBoard member purchases, unless and until (1) Vendor is awarded a Contract under this Proposal Invitation, and (2) the request has been approved in writing by the Cooperative administrator. By my signature below, I hereby request authorization from the Cooperative administrator to self -report BuyBoard purchases ifmy company is awarded a Contract. I certify that I am authorized by the above -named Vendor to approve this form, and I have received and read the Additional Terms and Conditions for BuyBoard Self -Reporting included in this Proposal Invitation and do hereby approve and agree to such terms and conditions on behalf of Vendor. NAME OF VENDOR: N/A Signature of Vendor Authorized Representative Printed Name: Title: Date: (For Cooperative Administrator Use Only) Approved by BuyBoard Administrator: Effective/Start Date for Self -Reporting: Proposal Forms COMM/SVCS v.08.11.2021 Page 37 of 72 oar d- PURChASWG CGQPERATWE 12007 Research Boulevard ' Austin, Texas 78759-2439 - PH: 800-695-2919 ' FAX: 800-211-5454 ' buvboard.com REQUIRED FORMS CHECKLIST (Please check (./) the following) ❑ Reviewed/Completed: Proposer's Acceptance and Agreement PROPOSAL FORMS PART 1: COMPLIANCE FORMS Reviewed/Completed: Proposal Acknowledgements Reviewed/Completed: Felony Conviction Disclosure Reviewed/Completed: Resident/Nonresident Certification Reviewed/Completed: Debarment Certification Reviewed/Completed: Vendor Employment Certification Reviewed/Completed: No Boycott Verification Reviewed/Completed: No Excluded Nation or Foreign Terrorist Organization Certification Reviewed/Completed: Historically Underutilized Business Certification Reviewed/Completed: Acknowledgement of BuyBoard Technical Requirements Reviewed/Completed: Construction -Related Goods and Services Affirmation Reviewed/Completed: Deviation and Compliance Reviewed/Completed: Vendor Consent for Name Brand Use Reviewed/Completed: Confidential/Proprietary Information Reviewed/Completed: EDGAR Vendor Certification Reviewed/Completed: Compliance Forms Signature Page PROPOSAL FORMS PART 2: VENDOR INFORMATION FORMS Reviewed/Completed: Vendor Business Name Reviewed/Completed: Vendor Contact Information(complete ineiectronicproposaisubmissionsystem) Reviewed/Completed: Federal and State/Purchasing Cooperative Experience Reviewed/Completed: Governmental References Reviewed/Completed: Company Profile Reviewed/Completed: Texas Regional Service Designation(complete ineiectronicproposaisubmission system) Reviewed/Completed: State Service Designation (complete in electronic proposal submission system) Reviewed/Completed: National Purchasing Cooperative Vendor Award Agreement (vendors serving outside Texas only) Reviewed/Completed: Local/Authorized Seller Listings Reviewed/Completed: Manufacturer Dealer Designation Reviewed/Completed: Proposal Invitation Questionnaire Reviewed/Completed: Vendor Request to Self -Report BuyBoard Purchases (optional) ❑ Reviewed/Completed: Proposal Specifications Discount (%) off Catalog/Pricelist and/or other required pricing information including Catalogs/Pricelists (or no bid response) must be submitted with the Proposal or the Proposal will not be considered. Proposal Forms COMM/SVCS v.08.11.2021 Page 40 of 72 oar d- PURChASWG CGQPERATWE 12007 Research Boulevard ' Austin, Texas 78759-2439 - PH: 800-695-2919 ' FAX: 800-211-5454 ' buvboard.com PROPOSAL SPECIFICATION SUMMARY The categories and items specified for this Proposal Invitation are summarized below. For full Proposal Specifications, you must review and complete the Proposal Specification information in the electronic proposal submission system in accordance with the Instructions to Proposers (or, if submitting a hard copy Proposal, timely request and complete the Proposal Specification Form in accordance with the Instructions to Proposers). PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response, or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accented. Section I: Sewer Cleaning Equipment, Products, and Supplies 1. Discount (%) off catalog/pricelist for Combination Sewer Cleaners, Single Engine, Attachments, Accessories, and related products. 2. Discount (%) off catalog/pricelist for Combination Sewer Cleaners, Dual Engine, Attachments, Accessories, and related products. 3. Discount (%) off catalog/pricelist for letter Units, Attachments, Accessories, and related products. 4. Discount (%) off catalog/pricelist for Trailer ]etter Units, Attachments, Accessories, and related products. 5. Discount (%) off catalog/pricelist for Vacuum Excavation Equipment and related products. 6. Discount (%) off catalog/pricelist for All Other Sewer Cleaning Equipment, Attachments, Accessories, and related products. Section II: Sewer Inspection Eauipment, Products, and Supplies 7. Discount (%) off catalog/pricelist for Portable Mini Sewer Inspection Systems, Attachments, Accessories and related products. 8. Discount (%) off catalog/pricelist for Mainline Portable Mini Sewer Inspection Systems, Attachments, Accessories, and related products. 9. Discount (%) off catalog/pricelist for Lateral and Mainline Sewer Inspection Systems, Attachments, Accessories, and related products. 10. Discount (%) off catalog/pricelist for Vehicle/Trailer Mounted TV Sewer Inspection and Rehabilitation Systems, Attachments, Accessories, and related products. 11. Discount (%) off catalog/pricelist for Sewer Inspection Cameras, Attachments, Accessories, and related products. 12. Discount (%) off catalog/pricelist for Sewer Inspection Camera Transporters, Attachments, Accessories, and related products. 13. Discount (%) off catalog/pricelist for Portable Video Inspection Cameras, Attachments, Accessories and related products. 14. Discount (%) off catalog/pricelist for Lateral Cleaning Systems, Attachments, Accessories, and related products. 15. Discount (%) off catalog/pricelist for Lateral Reinstatement Cutters, Attachments, Accessories, and related products. 16. Discount (%) off catalog/pricelist for Profiling Systems, Attachments, Accessories, and related products. 17. Discount (%) off catalog/pricelist for Gravity Pipeline Inspection Systems, Attachments, Accessories, and related products. 18. Discount (%) off catalog/pricelist for Pipeline Condition Assessment Software and related products. 19. Discount (%) off catalog/pricelist for All Other Sewer Inspection Systems, Attachments, Accessories, and related products. Proposal Forms COMM/SVCS v.08.11.2021 Page 38 of 72 oar d- PURChASWG CGQPERATWE 12007 Research Boulevard ' Austin, Texas 78759-2439 - PH: 800-695-2919 ' FAX: 800-211-5454 ' buvboard.com Section III: Repair and Replacement Parts 20.Discount (%) off catalog/pricelist for Repair/Replacement Parts for Sewer Cleaning and Inspection Equipment. Section IV: Installation and Repair Service 21. Hourly Labor Rate for Installation/Repair Service of Sewer Cleaning, Inspection Products, Equipment and Related Items-- Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products. 22. Hourly Labor Rate for Service of Pipeline Condition Assessments, Products, Equipment and Related Items- - Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products. Proposal Forms COMM/SVCS v.08.11.2021 Page 39 of 72 Lonestar Municipal Equipment, LLC Information Contact: Paul Folker Address: 1105 Friendship Road Weatherford, TX 76085 Phone: (817) 851-2243 Email: paul@lonestarme.com Web Address: lonestarmunicipalequipment.com By submitting your response, you certify that you are authorized to represent and bind your company. Paul Folker paul@lonestarme.com Signature Email Submitted at 3/23/2022 10:35:00 PM Requested Attachments BuyBoard Proposal Invitation No. 676-22 Sewer Inspection and Cleaning Proposal-No-676-22.pdf Products REQUIRED -In PDF format, upload all proposal invitation documents available for download at vendor.buyboard.com including any additional pages, as necessary. NOTICE: DO NOT complete proposal forms in internet browser. No data will be stored. Download file to computer and complete proposal forms prior to submitting. (Please DO NOT password protect uploaded files.) Catalog/Pricelist Blue Star Nozzles.pdf REQUIRED -In Excel or PDF format, upload catalog (s)/price Iist(s) in accordance with proposal invitation instructions. Vendors shall submit catalog (s)/pricelist(s) with their Proposal response or Proposal will not be considered. No paper catalogs or manufacturer/vendor websites will be accepted. File size must not exceed 250MB. (Please DO NOT password protect uploaded files.) Exceptions and/or Detailed Information Related to Discount % and/or Hourly Labor Rate No response Proposed In PDF format and if necessary, vendor shall attach detailed information regarding exceptions to pricing and/or discount percentage and define the services that are proposed to be provided. NOTE: IF DETAILED INFORMATION IS NOT SUBMITTED, PROPOSAL MAY NOT BE CONSIDERED. (Please DO NOT password protect uploaded files.) Company Profile LME Company Description.docx REQUIRED -Information on awarded Cooperative Contracts is available to Cooperative Members on the BuyBoard website. If your company is awarded a Contract under this Proposal Invitation, please provide a brief company description that you would like to have included with your company profile on the BuyBoard website. Submit your company profile in a separate file, in Word format, with your Proposal. (Note: Vendor is solely responsible for any content provided for inclusion on the BuyBoard website. The Cooperative reserves the right to exclude or remove any content in its sole discretion, with or without prior notice, including but not limited to any content deemed by the Cooperative to be inappropriate, irrelevant to the Contract, inaccurate, or misleading.) IRS Form W-9 Request for Taxpayer Identification Number and Certification REQUIRED -In PDF format, upload W-9 form. (Please DO NOT password protect uploaded files.) Response Attachments LME Assumed Name Certificate.PDF Assumed Name Certificate LME_logo_color Small.png Company Logo LME W9 03-2022.pdf Page 3 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 Insight Vision Pushcam Pricing.pdf Insight Vision Pushcam Pricing - Item 11 IRIS Mainline Camera Pricing.pdf IRIS Mainline Camera Pricing - Item 8 Jetter Depot Nozzles Pricing.pdf Jetter Depot Nozzles Pricing - Item 6 Jetters Northwest Price List.pdf Jetters Northwest Price List - Item 4 MEC Equipment Price List.pdf MEC Equipment Price List - Item 7 Predator System Pricing.pdf Predator System Pricing - Item 9 Setcom Price List.pdf Setcom Price List - Item 19 Sonetics Price List.pdf Sonetics Price List - Item 19 UEMSI JetCam Price List.pdf UEMSI JetCam Price List - Item 7 Reizler System Pricing.pdf Reizler Mainline Portable System Pricing Hydra Flex HX Nozzles.pdf Hydra Flex HX Nozzles - Item 5 Hydra Flex Sewer Nozzles.pdf Hydra Flex Sewer Nozzles - Item 6 Bid Attributes 1 Federal Identification Number Federal Identification Number 181-4546554 2 1 HUB/No Israel Boycott Certification/No Excluded Nation or Foreign Terrorist Certification HUB/No Israel Boycott Certification/No Excluded Nation or Foreign Terrorist Certification Page 4 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 3 No Israel Boycott Certification A Texas governmental entity may not enter into a contract with a value of $100,000 or more that is to be paid wholly or partly from public funds with a company (excluding a sole proprietorship) that has 10 or more full-time employees for goods or services unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. (TEX. GOV'T CODE Ch. 2270). Accordingly, this certification form is included to the extent required by law. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes. TEX. GOV'T CODE §808.001(1). By signature on the Compliance Forms Signature Page, to the extent applicable, I certify and verify that Vendor does not boycott Israel and will not boycott Israel during the term of any contract awarded under this Proposal Invitation, that this certification is true, complete and accurate, and that I am authorized by my company to make this certification. Yes 4 No Excluded Nation or Foreign Terrorist Organization Certification Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may not enter into a contract with a company engaged in active business operations with Sudan, Iran, or a foreign terrorist organization — specifically, any company identified on a list prepared and maintained by the Texas Comptroller under Texas Government Code §§806.051, 807.051, or 2252.153. (A company that the U.S. Government affirmatively declares to be excluded from its federal sanctions regime relating to Sudan, Iran, or any federal sanctions regime relating to a foreign terrorist organization is not subject to the contract prohibition.) By signature on the Compliance Forms Signature Page, I certify and verify that Vendor is not on the Texas Comptroller's list identified above; that this certification is true, complete and accurate; and that I am authorized by my company to make this certification. Yes I 5 MWBE/HUB Status Certification A Proposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women Business Enterprise or "MWBE" and all referred to in this form as a "HUB") is encouraged to indicate its HUB certification status when responding to this Proposal Invitation. The BuyBoard website will indicate HUB certifications for awarded Vendors that properly indicate and document their HUB certification on this form. certify that my company has been certified as a MWBE/HUB in the following categories: (Please check all that apply) 6 Minority Owned Business Minority Owned Business ❑ Minority Owned Business (Yes) 7 Women Owned Business Women Owned Business ❑ Women Owned Business (Yes) 8 Service -Disabled Veteran Owned Business Service -Disabled Veteran Owned Business (veteran defined by 38 U.S.C. §101(2), who has a service -connected disability as defined by 38 U.S.C. § 101(16), and who has a disability rating of 20% or more as determined by the U. S. Department of Veterans Affairs or Department of Defense) ❑ Service -Disabled Veteran Owned Business (Yes) Page 5 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 9 Certification Number Certification Number No response 1 Name of Certifying Agency U Certifying Agency No response 1 Non-MWBE/HUB 1 My company has NOT been certified as a MWBE/HUB ❑ Non -HUB (Yes) L12 Vendor General Contact Information Proposal/Contract General Contact Information 1 Vendor Proposal/Contract Contact Name 3 Vendor Proposal/Contract Contact Name Paul Folker 1 Vendor Proposal/Contract Contact E-mail Address 4 Vendor Proposal/Contract Contact E-mail Address paul@lonestarme.com 1 Vendor Proposal/Contract Mailing Address 5 Vendor Proposal/Contract Mailing Address 11105 Friendship Road 1 Vendor Proposal/Contact Mailing Address - City 6 Vendor Proposal/Contact Mailing Address - City Weatherford 1 Vendor Proposal/Contact Mailing Address - State 7 Vendor Proposal/Contact Mailing Address - State (Abbreviate State Name) ITX 1 Vendor Proposal/Contact Mailing Address - Zip Code 8 Vendor Proposal/Contact Mailing Address - Zip Code 176085 1 Vendor Proposal/Contact Phone Number 9 Vendor Proposal/Contact Phone Number (xoa-xoa-)o=) 1817-851-2243 2 Vendor Proposal/Contact Extension Number U Vendor Proposal/Contact Extension Number No response Page 6 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 2 Company Website Company Website (www.xxxxx.com) www.lonestarmunicipalequipment.com 2 2 Purchase Orders Contact Information All Purchase Orders from Cooperative members will be available through the Internet. Vendors need Internet access and at least one e-mail address so that notification of new orders can be sent to the Internet contact when a new purchase order arrives. An information guide will be provided to Vendors to assist them with retrieving their orders. Please select options below for receipt of Purchase Orders and provide the requested information: • I will use the internet to receive Purchase Orders at the following address Yes I 2 Purchase Order E-mail Address 3 Purchase Order E-mail Address paul@lonestarme.com 2 Purchase Order Contact Name 4 Purchase Order Contact Name Paul Folker 2 Purchase Order Contact Phone Number 5 Purchase Order Contact Phone Number (>oa-xoa-=(x) 1 817-851-2243 2 Purchase Order Contact Extension Number 6 Purchase Order Contact Extension Number No response 2 Alternate Purchase Order E-mail Address 7 Alternate Purchase Order E-mail Address Jen@lonestarme.com 2 Alternate Purchase Order Contact Name 8 Alternate Purchase Order Contact Name Jennifer Folker 2 Alternate Purchase Order Contact Phone Number 9 Alternate Purchase Order Contact Phone Number (xxx-xxx-xxxx) 1817-851-2034 3 Alternate Purchase Order Contact Extension Number U Alternate Purchase Order Contact Extension Number No response Page 7 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 3 Purchase Orders Contact Information All Purchase Orders from Cooperative members will be available through the Internet. Vendors need Internet access and at least one e-mail address so that notification of new orders can be sent to the Internet contact when a new purchase order arrives. An information guide will be provided to Vendors to assist them with retrieving their orders. Please select options below for receipt of Purchase Orders and provide the requested information: • Purchase Orders may be received by the Designated Dealer(s) identified on my company's Dealer Designation form as provided to the Cooperative administrator. I understand that my company shall remain responsible for the Contract and the performance of all Designated Dealers under and in accordance with the Contract. INo 3 Request for Quotes (5€ceRFQ5E) 2 Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses for the receipt of RFQs: 3 Request for Quote (RFQ) E-mail Address 3 Request for Quote (RFQ) E-mail Address paul@lonestarme.com 3 Request for Quote (RFQ) Contact Name 4 Request for Quote (RFQ) Contact Name Paul Folker 3 Request for Quote (RFQ) Contact Phone Number 5 Request for Quote (RFQ) Contact Phone Number (>oa-xxx-=oo 1 817-851-2243 3 Request for Quote (RFQ) Contact Extension Number 6 Request for Quote (RFQ) Contact Extension Number No response 3 Alternate Request for Quote (RFQ) E-mail Address 7 Alternate Request for Quote (RFQ) E-mail Address Jen@lonestarme.com 3 Alternate Request for Quote (RFQ) Contact Name 8 Alternate Request for Quote (RFQ) Contact Name Jennifer Folker 3 Alternate Request for Quote (RFQ) Contact Phone Number 9 Alternate Request for Quote (RFQ) Contact Phone Number (xxx-xxx-xxxx) 1 817-851-2034 4 Alternate Request for Quote (RFQ) Contact Extension Number U Alternate Request for Quote (RFQ) Contact Extension Number W I No response Page 8 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 4 Invoices Your company will be billed monthly for the service fee due under a Contract awarded under this Proposal Invitation. All invoices are available on the BuyBoard website and e-mail notifications will be sent when they are ready to be retrieved. 4 Invoices 2 Please choose only one (11 of the following options for receipt of invoices and provide the requested information: (a) Service fee invoices and related communications should be provided directly to my company at: or (b) In lieu of my company, I request and authorize all service fee invoices to be provided directly to the following billing agent: If Vendor authorizes a billing agent to receive and process service fee invoices, in accordance with the General Terms and Conditions of the Contract, Vendor specifically acknowledges and agrees that nothing in that designation shall relieve Vendor of its responsibilities and obligations under the Contract including, but not limited to, payment of all service fees under any Contract awarded Vendor. Service fee invoices and notices direct to company I 4 Invoice Company Name 3 Invoice Company Name Lonestar Municipal Equipment 4 Invoice Company Department Name 4 Invoice Company Department Name Accounts Payable 4 Invoice Contact Name 5 Invoice Contact Name IJennfer Folker 4 Invoice Mailing Address 6 Invoice Mailing Address (P.O. Box or Street Address) 11105 Friendship Road 4 Invoice Mailing Address - City 7 Invoice Mailing Address - City Weatherford 4 Invoice Mailing Address - State 8 Invoice Mailing Address - State (Abbreviate State Name) I-rx 4 Invoice Mailing Address - Zip Code 9 Invoice Mailing Address (Zip Code) 176085 Page 9 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 5 Invoice Contact Phone Number U Invoice Contact Phone Number (xxx-xxx-xxxx) 1817-851-2034 5 Invoice Contact Extension Number Invoice Contact Extension Number No response 5 Invoice Contact Fax Number 2 Invoice Contact Fax Number (xxx-xxx-xxxx) No response 5 Invoice Contact E-mail Address 3 Invoice Contact E-mail Ijen@lonestarme.com 5 Invoice Contact Alternate E-mail Address 4 Invoice Contact Alternate E-mail Address paul@lonestarme.com 5 Billing Agent Company Name 5 Billing Agent Company Name No response 5 Billing Agent Department Name 6 Billing Agent Department Name No response 5 Billing Agent Contact Name 7 Billing Agent Contact Name No response 5 Billing Agent Mailing Address 8 Billing Agent Mailing Address (P.O. Box or Street Address) No response 5 Billing Agent Mailing Address - City 9 Billing Agent Mailing Address - City No response 6 Billing Agent Mailing Address - State U Billing Agent Mailing Address - State (Abbreviate State Name) No response 6 Billing Agent Mailing Address - Zip Code Billing Agent Mailing Address - Zip Code 176085 Page 10 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 6 Billing Agent Contact Phone Number 2 Billing Agent Contact Phone Number (xxx-xxx-xxxx) 18178512243 6 Billing Agent Contact Extension Number 3 Billing Agent Contact Extension Number No response 6 Billing Agent Fax Number 4 Billing Agent Fax Number No response 6 Billing Agent Contact E-mail Address 5 Billing Agent Contact E-mail Address paul@lonestarme.com 6 Billing Agent Alternative E-mail Address 6 Billing Agent Alternative E-mail Address No response 6 Shipping Via 7 Common Carrier, Company Truck, Prepaid and Add to Invoice, or Other Prepaid and Add to Invoice I 6 Payment Terms 8 Note: Vendor payment terms must comply with the BuyBoard General Terms and Conditions and the Texas Prompt Payment Act (Texas Government Code Ch. 2251). 1 Net 30 6 Vendor's Internal/Assigned Reference/Quote Number 9 Vendor's Internal/Assigned Reference/Quote Number No response 7 State or Attach Return Policy U Note: Only return requirements and processes will be deemed part of Vendor's return policy. Any unrelated contract terms, terms of sale, or other information not specifically related to return requirements and processes included in Vendor's return policy shall not apply to any awarded Contract unless specifically included as a deviation in the Deviation and Compliance Form and accepted by the Cooperative. Returns are not accepted after cooperative member has received and accepted products, other than warrantied item returns 7 Electronic Payments Are electronic payments acceptable to your company? Yes I 7 Credit Card Payments 2 Are credit card payments acceptable to your company? Yes I Page 11 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 7 3 Texas Regional Service Designation Texas Regional Service Designation - Refer to Form in Proposal Invitation The Cooperative (referred to as "Texas Cooperative" in this form and in the State Service Designation form) offers vendors the opportunity to service its members throughout the entire State of Texas. If you do not plan to service all Texas Cooperative members statewide, you must indicate the specific regions you will service on this form. If you propose to serve different regions for different products or services included in your Proposal, you must complete and submit a separate Texas Regional Service Designation form for each group of products and clearly indicate the products or services to which the designation applies. By designating a region or regions, you are certifying that you are authorized and willing to provide the proposed products and services in those regions. Designating regions in which you are either unable or unwilling to provide the specified products and services shall be grounds for either rejection of your Proposal or, if awarded, termination of your Contract. Additionally, if you do not plan to service Texas Cooperative members (i.e., if you will service only states other than Texas), you must so indicate on this form. 7 Company Name 4 Company Name Lonestar Municipal Equipment 7 Texas Regional Service Designation 5 Select only one of the following options. If you select "I will NOT serve all Regions of Texas", you must then check the individual Regions you wish to serve. JAII Regions 7 Region 1 6 Region 1 - Edinburg ❑ Region 1 (1) 7 Region 2 7 Region 2 - Corpus Christi ❑ Region 2 (2) 7 Region 3 8 Region 3 - Victoria ❑ Region 3 (3) 7 Region 4 9 Region 4 - Houston ❑ Region 4 (4) 8 Region 5 U Region 5 - Beaumont ❑ Region 5 (5) 8 Region 6 1 Region 6 - Huntsville ❑ Region 6 (6) 8 Region 7 2 Region 7 - Kilgore ❑ Region 7 (7) Page 12 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 8 Region 8 3 Region 8 - Mount Pleasant ❑ Region 8 (8) 8 Region 9 4 Region 9 - Wichita Falls ❑ Region 9 (9) 8 Region 10 5 Region 10 - Richardson ❑ Region 10 (10) 8 Region 11 6 Region 11 - Fort Worth ❑ Region 11 (11) 8 Region 12 7 Region 12 - Waco ❑ Region 12 (12) 8 Region 13 8 Region 13 - Austin ❑ Region 13 (13) 8 Region 14 9 Region 14 - Abilene ❑ Region 14 (14) 9 Region 15 0 Region 15 - San Angelo ❑ Region 15 (15) 9 Region 16 Region 16 - Amarillo ❑ Region 16 (16) 9 Region 17 2 Region 17 - Lubbock ❑ Region 17 (17) 9 Region 18 3 Region 18 - Midland ❑ Region 18 (18) 9 Region 19 4 Region 19 - El Paso ❑ Region 19 (19) Page 13 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 9 Region 20 5 Region 20 - San Antonio ❑ Region 20 (20) 9 6 State Service Designation State Service Designation - Refer to Form in Proposal Invitation. As set forth in the Proposal Invitation, it is the Cooperative's intent that other governmental entities in the United States have the opportunity to purchase goods or services awarded under the Contract, subject to applicable state law, through a piggy -back award or similar agreement through the National Purchasing Cooperative BuyBoard. If you plan to service the entire United States or only specific states, you must complete this form accordingly. (Note: If you plan to service Texas Cooperative members, be sure that you complete the Texas Regional Service Designation form.) In addition to this form, to be considered for a piggy -back award by the National Purchasing Cooperative, you must have an authorized representative sign the National Purchasing Cooperative Vendor Award Agreement that follows this form. If you serve different states for different products or services included in your Proposal, you must complete and submit a separate State Service Designation form for each group of products and clearly indicate the products or services to which the designation applies. By designating a state or states, you are certifying that you are authorized and willing to provide the proposed products and services in those states. Designating states in which you are either unable or unwilling to provide the specified products and services shall be grounds for either rejection of your Proposal or, if awarded, termination of your Contract. 9 Company Name 7 Company Name Lonestar Municipal Equipment 9 State Service Designation 8 Select only one of the following options the individual States you wish to serve. All States 9 Alabama 9 Alabama ❑ Alabama (AL) 1 Alaska 0 6 Alaska ❑ Alaska (AK) 1 Arizona 10 Arizona ❑ Arizona (AZ) If you select "I will NOT serve all States", you must then check 1 Arkansas 2 Arkansas ❑ Arkansas (AR) 1 California 0 California (Public Contract Code 20118 & 20652) 3 ❑ California (CA) Page 14 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 1 Colorado U Colorado 4 ❑ Colorado (CO) 1 Connecticut 5 Connecticut ❑ Connecticut (CT) 1 Delaware 6 Delaware ❑ Delaware (DE) 1 District of Columbia U District of Columbia 7 ❑ District of Columbia (DC) 1 Florida U Florida 8 ❑ Florida (FL) 1 Georgia 9 Georgia ❑ Georgia (GA) 1 Hawaii 1 Hawaii ❑ Hawaii (HI) 1 Idaho 1 Idaho 1 ❑ Idaho (ID) 1 Illinois 1 Illinois 2 ❑ Illinois (IL) 1 Indiana 1 Indiana ❑ Indiana (IN) 1 Iowa 4 Iowa ❑ Iowa (IA) 1 Kansas 5 Kansas ❑ Kansas (KS) Page 15 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 1 Kentucky 6 Kentucky ❑ Kentucky (KY) 1 Louisiana 1 Louisiana ❑ Louisiana (LA) 1 Maine 1 Maine ❑ Maine (ME) 1 Maryland 9 Maryland ❑ Maryland (ME) 1 Massachusetts UMassachusetts ❑ Massachusetts (MA) 1 Michigan Michigan ❑ Michigan (MI) 1 Minnesota 2 Minnesota ❑ Minnesota (MN) 1 Mississippi 2 3 Mississippi ❑ Mississippi (MS) 1 Missouri 4 Missouri ❑ Missouri (MO) 1 Montana 5 Montana ❑ Montana (MT) 1 Nebraska 6 Nebraska ❑ Nebraska (NE) 1 Nevada 7 Nevada ❑ Nevada (NV) Page 16 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 1 New Hampshire 8 New Hampshire ❑ New Hampshire (NH) 1 New Jersey 9 New Jersey ❑ New Jersey (NJ) 1 New Mexico UNew Mexico ❑ New Mexico (NM) 1 New York New York ❑ New York (NY) 1 North Carolina 2 North Carolina ❑ North Carolina (NC) 1 North Dakota 3 North Dakota ❑ North Dakota (ND) 1 Ohio 4 Ohio ❑ Ohio (OH) 1 Oklahoma 5 Oklahoma ❑ Oklahoma (OK) 1 Oregon 6 Oregon ❑ Oregon (OR) 1 Pennsylvania 7 Pennsylvania ❑ Pennsylvania (PA) 1 Rhode Island 8 Rhode Island ❑ Rhode Island (RI) 1 South Carolina 9 South Carolina ❑ South Carolina (SC) Page 17 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 1 South Dakota USouth Dakota ❑ South Dakota (SD) 1 Tennessee Tennessee ❑ Tennessee (TN) 1 Texas 2 Texas ❑ Texas (TX) 1 Utah 3 Utah ❑ Utah (UT) 1 Vermont 4 Vermont ❑ Vermont (VT) 1 Virginia 5 Virginia ❑ Virginia (VA) 1 Washington 6 Washington ❑ Washington (WA) 1 West Virginia 7 West Virginia ❑ West Virginia (WV) 1 Wisconsin 8 Wisconsin ❑ Wisconsin (WI) 4 Wyoming 9 Wyoming ❑ Wyoming (WY) Bid Lines Page 18 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 2 Section I: Sewer Cleanina Eauipment. Products. and Supplies - Discount (%) off catalog/pricelist for Combination Sewer Cleaners, Single Engine, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Section (:Sewer Cleanina Eauiament. Products. and Suplalies - Discount (%) off catalog/pricelist for Combination Sewer Cleaners, Dual Engine, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Page 19 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 3 Section I:Sewer Cleanina Eauiament. Products. and SuaDlies - Discount (%) off catalog/pricelist for Jetter Units, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response 4 Section (:Sewer Cleanina Eauiament. Products. and SuDDlies - Discount (%) off catalog/pricelist for Trailer Jetter Units, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. Total: 1 5% 1 Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Jetters Northwest Price List Page 20 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 5 Section (:Sewer Cleanina Eauipment. Products. and SuaDlies - Discount (%) off catalog/pricelist for Vacuum Excavation Equipment and related products. Catalog/Pricelist MUST be included or proposal will not be considered. Total: 1 5% 1 Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Hydra Flex HX Nozzles 6 Section I:Sewer Cleanina Eauipment. Products, and SUDDlies - Discount (%) off catalog/pricelist for All Other Sewer Cleaning Equipment, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. Total: 5% 1 Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Blue Star Nozzles Price List Alternate 1 Section (:Sewer Cleanina Eauipment. Products, and Supplies - Discount (%) off cataloa/Dricelist for All Other Sewer Cleanina Eauipment. Attachments. Accessories, and related products. Cataloa_/Pricelist MUST be included or Droaosal will not be considered. Total: 1 5% 1 Page 21 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NO E: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". T Jetter Depot Nozzles Pricing Alternate 2 Section I:Sewer Cleanina Eauiament. Products, and Supplies - Discount (%) off cataloa_/Dricelist for All Other Sewer Cleanina Eauiament. Attachments. Accessories. and related products. Cataloa_/Pricelist MUST be included or DrODosal will not be considered. Total: 1 5% 1 Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NO E: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". T Hydra Flex Sewer Nozzles 7 Section II: Sewer Inspection Eauiament. Products and Supplies - Discount (%) off catalog/pricelist for Portable Mini Sewer Inspection Systems, Attachments, Accessories and related products. Catalog/Pricelist MUST be included or proposal will not be considered. Total: I 5% 1 Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NO E: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". T MEC Equipment Price List Alternate 1 Section II: Sewer Inspection Eauiament. Products and Supplies - Discount (%) off cataloa/Dricelist for Portable Mini Sewer Inspection Svstems. Attachments. Accessories and related products. Cataloa/Pricelist MUST be included or DrODosal will not be considered. Total: 1 5% 1 Page 22 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 Item Attributes 0 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NO E: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". T UEMSI JetCam Price List Section II: Sewer Insaection Eauiament. Products and SUDDlies - Discount (%) off catalog/pricelist for Mainline Portable Mini Sewer Inspection Systems, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. Total: 2% 1 Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NO E: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". T IRIS Mainline Camera Pricing Alternate 1 Section II: Sewer Insaection Eauiament. Products and SUDDIieS - Discount (%1 off cataloa/pricelist for Mainline Portable Mini Sewer Insaection Svstems. Attachments. Accessories. and related Droducts. Cataloa/Pricelist MUST be included or Dr000sal will not be considered. Total: 1 5% 1 Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NO E: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". T Reizler System Pricing Page 23 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 0 1 0 Section II: Sewer Inspection Eauiament. Products and SUDDlieS - Discount (%) off catalog/pricelist for Lateral and Mainline Sewer Inspection Systems, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. Total: 5% 1 Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Predator System Pricing Section II: Sewer Inspection Eauiament. Products and Supplies - Discount (%) off catalog/pricelist for Vehicle/Trailer Mounted TV Sewer Inspection and Rehabilitation Systems, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Page 24 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 Section II: Sewer Inspection Eauipment. Products and SUDDlieS - Discount (%) off catalog/pricelist for Sewer Inspection Cameras, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. Total: 1 2% 1 Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Insight Vision Pushcam Pricing 1 Section II: Sewer Inspection EauiDment. Products and Supplies - Discount (%) off catalog/pricelist for 2 Sewer Inspection Camera Transporters, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Page 25 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 1 3 1 4 Section II: Sewer Inspection Eauiament. Products and Supplies - Discount (%) off catalog/pricelist for Portable Video Inspection Cameras, Attachments, Accessories and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Section II: Sewer Inspection Eauiament. Products and Supplies - Discount (%) off catalog/pricelist for Lateral Cleaning Systems, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Page 26 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 1 5 1 6 Section II: Sewer Inspection Eauiament. Products and Supplies - Discount (%) off catalog/pricelist for Lateral Reinstatement Cutters, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Section II: Sewer Inspection Eauipment. Products and Supplies - Discount (%) off catalog/pricelist for Profiling Systems, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Page 27 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 1 Section II: Sewer Inspection Eauiament. Products and Supplies - Discount (%) off catalog/pricelist for 7 Gravity Pipeline Inspection Systems, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response 1 Section II: Sewer Inspection Eauiament. Products and Supplies - Discount (%) off catalog/pricelist for 8 Pipeline Condition Assessment Software and related products. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Page 28 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 1 9 2 0 Section II: Sewer Inspection Eauipment. Products and SUDDlieS - Discount (%) off catalog/pricelist for All Other Sewer Inspection Systems, Attachments, Accessories, and related products. Catalog/Pricelist MUST be included or proposal will not be considered. Total: 1 5% 1 Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Setcom Price List Alternate 1 Section II: Sewer Inspection Eauipment. Products and Supplies - Discount (%) off cataloa/Dricelist for All Other Sewer Inspection Svstems. Attachments. Accessories. and related products. Cataloa_/Pricelist MUST be included or DrODosal will not be considered. Total: 1 5% 1 Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". i Sonetics Price List Section III: Repair and Replacement Parts - Discount (%) off catalog/pricelist for Repair/Replacement Parts for Sewer Cleaning and Inspection Equipment. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes: Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: • Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed • Vendor's must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Page 29 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 Item Attributes 1. State Name of Catalog/Pricelist Proposed with Discount Percentage NO E: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". T No response 2 Section IV: Installation and Repair Service - Hourly Labor Rate for Installation/Repair Service of Sewer Cleaning, Inspection Products, Equipment and Related Items -- Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products. Quantity: 1 UOM: Hourly Labor Rate Price: $145.00 1 Total: $145.00 1 2 Section IV: Installation and Reaair Service - Hourly Labor Rate for Service of Pipeline Condition 2 Assessments, Products, Equipment and Related Items -- Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products. Quantity: 1 UOM: Hourly Labor Rate Price: $145.00 1 Total: $145.00 1 Response Total: $290.00 Page 30 of 30 pages Vendor: Lonestar Municipal Equipment, LLC 676-22 Form 503 (Revised 09/13) Return in duplicate to: Secretary of State P.O. Box 13697 Austin, TX 78711-3697 512 463-5555 FAX: 512 463-5709 Filing Fee: S25 .-assumed Name Certificate Assumed Name This space resented for office use. 1. The assumed name under which the business or professional service is, or is to be, conducted or rendered is: Lonestar Municipal Equipment Entity information 2. The legal name of the entity filing the assumed naive is: Lonestar Municipal Equipment LLC, Dealership 1 Series State the name of the entity as currenrlr shown nt the records of the secr2tan' t fsrante or on its organizational documenes. if not filed with the secreiatj• of state. 3- The entity filing the assumed name is a: (select the appropriate entity typr below) ❑ For -profit Corporation El Nonprofit Corporation ❑ Professional Corporation ❑ Professional Association M Limited Liability Company ❑ Limited Partnership ❑ Limited Liability Partnership ❑ Cooperative Association ❑ Other Sjxeci& tkpe of emit),. For c,xvample, foreign real eslute investment trust, .state hank, iirsurance company, elc. 4. The file number, if any, issued to the entity by the secretary of state is: go R5- t I-/ l q 7 5. The state. country, or other jurisdiction of formation of the entity is: Texas 6. The entity s principal office address is: 13233 Alyssum Drive ,Street at- Hading Adtkess Fort Worth _ TX USA 7.6244 ;fur S7ar C.'ourrtn Postal oo, bp Code Period of Duration ✓❑ 7a. The period during which the assumed name will be used is 10 years from the date of filing with the secretary of state. OR ❑ 7b. The period during which the assumed name xvill he used is years from the date of' -filing with the secretai}= of state (not to exceed 10 years). OR ❑ 7c. The assumed name will be used until (not to exceed 10 years). tiirr elctz�� I�Oml 503 4 County or Counties in which Assumed Name Used 8. The county or counties where business or professional services are being or are to be conducted or rendered under the assumed name are: Q All counties ❑ All counties with the exception of the following counties: ❑ Only the following counties: Execution The undersigned signs this document subject to the penalties imposed by law for the submission of a materially false or fraudulent instrument and also certifies that the person is authorized to sign on behalf of the identified entity. If the undersigned is acting in the capacity of an attorney in fact for the entity, the undersigned certifies that the entity has duly authorized the undersigned in writing to execute this document. Date: 1 � IM116 l Signature of a person authorized by law to sign on behalf of the identified entity (see instructions) Pone 503 ASSUMED NAME CERTIFICATE FOR .AN UNINCORPORA"I'ED BUSINESS OR PROFESSION NOTICE: "CERTIFICATES" ARE VALID ONLY FOR A PERIOD NOT TO EXCEED 10 YEARS FROM THE DATE FILED IN THE COUNTY CLERK'S OFFICE. (Chapter 36, Title 4 Business and Cornrnerce Codei This certificate properly executed is to be filed immediately with the County Clerk (PRINT OR TYPE) NAME UNDER WHICH BUSINESS OR PROFESSIONAL pal Equipment LOnestar Municipal SERVICES IS OR WILL BE CONDUCTED: Address: 13233 Alyssum Drive city: Fort Worth _......__ state: Texas Zip Code: 76244 Period (not to exceed ten years) during which the assumed name will be used is: 10 Years Business is to be conducted as (Check one): ❑ Sole Proprietorship ❑ Sole Practitioner ❑ Joint Venture ❑ General Partnership ❑ Limited Partnership ❑ Real Estate Investment Trust ❑ Joint Stock Company p Other (name type): Limited Liability Company CERTIFICATE OF OWNERSHIP I'We, the undersigned, are the owner(s) of the above business and my/our name(s) and address(es) are given is/are true and correct, and there islare no ownership(s) in said business other than those listed herein below. — NAMES OF OWNERS — NAME Lonestar Municipal Equipment LLC, Dealership 1 Series SIGNATURE (Proll or I yp@) _ Address 13233 Alyssum Drive, Fort Worth, TX zip Code 7624 NAME_ SIGNATURE Address Zip Code NAME Address NAME Address NAME Address THE STATE OF TEXAS COUNTY OF TARRANT SIGNATURE Zip Code SIGNATURE Zip Code SIGNATURE Zip Code BEFORE ME, THE UNDERSIGNED AUTHORITY, on this day personally appeared tJ -",-r ,der> %,� ,-• Known to me to be the person(s) whose name(s) is/are subscribed to the foregoing instrument and unr oath, acknowledged to me thal they are the owner(s) of the above -named business and that they signed the same for the purpose and consideration therein expressed, GIVEN UNDER MY HAND AND SEAL OF OFFICE, on t 01 'U 1? j 1A 6 _r > CD .a'7,, �'} �,4 L�K.5IMPSONNb ary#O 130177 0NJ Notary Public in and for <' ,�iC* rr County My Commission Expires MARY LOUISE GARCIA, COUNTY CLERK \��April 2, 2019 cc-sGN,-103. BY , Deputy Exhibit 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. CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing busimss with local governmental entity This questionnaire reflects changes made to the law by H,f3. 23, a4ih Leg., Regular Session. his questionnaire is being liled it accordance with Chapter 176. Local Gavemmant Code, by a vendor who has a business relationship as dahned by Section 176-001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a)- fay law this questionnaire must be liled with the records administrator of the local gmammenlal entity not later than the 7th business day after the date the vendor becomes aware of facts that require the slatement to be filed. Sap Section 1 76-0o6(a-1), Local Goaemment Code. A vendor commits an offense if the vendor knowingly violates Section 176.U06, Loral Government Code- An oflerne under this section is a misdemeanor. J N ame of vendor who has a business relationship with lo-cal governmental entity. Lonestar Municipal Equipment, LLC FORA CIO OFFICE USEONLY Date Rece.-.ec J El Cheek ih is box Ifyou are fill ng an update to a previously filed quasfiormdre. (The law requires that you file an updates completeci a jestionnaire with the appropriate filing auth wity not later than the 7th business day after the date on wh is h you became aware that the originally filed questionnaire was incomplete Or inaccurate.) J Name of local governrrmant officer about whom the information is being disclosed. None Na-ne 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 176.00.2(a)(2)(A). Also descri6eany familyrelationshipwith the local govern mont off icer. Complete subparts A and B ioreach employment or business relationship described. Attach additional pages to this Form CIO as necessary. 61 71 A- Is the local government officer or a family member of the officer receiving or likely to r9caive taxable income, other than irvestment income. from the vendor? Yes VNo B- Is thevendor receiving or likely to receive taxable income, other than investment i-icome. from or at the direction of the local gOwemment officer Or a family mernbarof the OffkMF AND the taxable income is not received from the local governmental entity? Yes �/No Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership inlerest of one percent or more. None ❑ Check this boat if the vendor has given the local government officer or a family member of the Officer one or more gifts as described in Section 178.OU3(a}(P}(Bj, excluding gifts described in section 176-003(a-1). &4.'-Z,� , L l2. June 7. 2023 ature o vier r Signing Business govenmental entry uau Form provided by Texas Ethics Commission wenw.athics.stato.Ix. us ReAsed 111 2021 Revised 6.9.22cc Signature: Saves Email: allison.tidwell@fortworthtexas.gov CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity A complete copy of Chapter 176 of the Local Government Cade may be found at http Avww. statutes_legis_state.tx_usF Docs+L +htrNLG_ 17B.tOm. For easy reference. below are some of the sections cited on this farm. Local Government Code 6176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity ofone of the parties. The germ does not include a connection based on: (A) a tran saction that is s ubject 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 pu rchase or lease of goods or services from a person that is ch artered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Cade § 176.DD3(a)(2)(Al and ( B), (a) A local govern ment officer sh all fi le a confI icts disclo sure statement with respect to a vendor if: (2) thevendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than irnrestmerd 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 govern mental entity and vendor has been executed; or (i i) the local governmental entity is considering entering into a contract with the vendor, (B) h as given to the lccaJ government officer or a family mem ber of the off icer one or more gifts that have an aggregate value of more than 3 100 in the 12-month period preceding the date the officer becomes aware that: (i) a oontract 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- Loca I Gove rnme nt Code 61 76.006(a) and (a-1) {a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a fam ily member of the officer. descri bed by Section 176-003(a)(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 giftswith the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1)1 or (3) has a famity relationship with a local government officer of that local governmental entity- {a- f ) The completed confI ict of interest questionnaire must be fi led with the appropriate records admin istrator 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) subm its 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 ven dor has given one or mare gifts described by Subsection (a), or (G) of a family relationship with a local government officer - Form provided by Texas Dhics Commission rrnw. othi cs.stato.lx. u s Reuised 1112021 Revised 6.9.22cc