HomeMy WebLinkAboutContract 56307-R2LSL No 56307-R2
CITY OF FORT WORTH
CONTRACT RENEWAL NOTICE
June 23, 2023
Gulf Highway Equipment, LLC.
Attn: Travis McCain, Owner
600 Garden St.
Haltom City, TX 76117
Re: Contract Renewal Notice
Contract No. CSC No. 56307 (the "Contract")
Renewal Term No. 2: September 15.2023 to September 14.2024
The above referenced Contract with the City of Fort Worth expires on September 14, 2023
(the "Expiration Date"). Pursuant to the Contract, contract renewals are at the sole option of the
City. This letter is to inform you that the City is exercising its right to renew the Contract for an
additional one (1) year period, which will begin immediately after the Expiration Date. All other
terms and conditions of the Contract remain unchanged. Please return this signed
acknowledgement letter, along with a copy of your current insurance certificate, to the
address set forth below, acknowledging receipt of the Contract Renewal Notice. Failure to
provide a signed acknowledgment does not affect the renewal.
Please log onto PeopleSoft Purchasing at httn://fortworthtexas.aov/purchasing to ensure
that your company information is correct and up-to-date.
If you have any questions concerning this Contract Renewal Notice, please contact me at
the telephone number listed below.
Katya.Flores
Sincerely,
Katva Flores
Sr. Admin Assistant
(&fortworthtexas.2ov
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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ACCEPTED AND AGREED:
CITY OF FORT WORTH
LVJ
By:Valerie Washington (Jun 28, 202312:26 CDT)
Name: Valerie Washington
Title: Assistant Citv Manager
Date: J u n 28, 2023
APPROVAL RECOMMENDED:
By:J&fs Daviss (Jun 28, 2023 11:45 CDT)
Name: Jim Davis
Title: Fire Chief
ATTEST:
By:
Name: Jannette Goodall
Title: Citv Secretary
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and
administration of this contract, including
ensuring all performance and reporting
requirements.
By:BJun 28, 2023 09:02 CDT)
Name: Brenda Rav
Title: Fire Purchasina Manaaer
APPROVED AS TO FORM AND
LEGALITY:
By:
Name: Tavlor Paris
Title: Assistant Citv Attornev
CONTRACT AUTHORIZATION:
Me
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
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Gulf Hi2hwav Equipment, LLC.
By: / - -
Name: Travis McCain
Title: Owner
GULF HIGHWAY EQUIPMENT
ESTIMATE
6000 GARDEN ST #
Haltom City, TX. 76117 004699
Phone:682-708-8721 Fax:000
Estimate for Services
Estimate Date
: 6/26/2023
City of Fort Worth
0 -
200 Texas St
Lic # : -TX
Odom. In: 0
Fort Worth, TX 76102
Unit # : BLCKR '23 & '24
VIN #: BLOCKER56307R2
Part Description / Number
Oty
Sale
Ext
Labor Description
Hours
Extended
Blocker#1
1.00
0.00
0.00
Fab Parts
7.00
840.00
BLOCKER 1
Install Camera
8.00
960.00
Scorpion II Model "C" TL-3 TMA
1.00 27,628.57
27,628.57
,
Extend Frame on Apparatus
10.00
1,200.00
(MASH)
TMA-2 SERIAL #
Install TMA
14.00
1,680.00
VERTICALARROW BOARD MOUNT
1.00
2,334.29
2,334.29
Install Arrow Board w/ Lift
8.00
960.00
GHE:ABVM
Fab Parts
7.00
840.00
15 BULB ARROW BOARD
1.00
3,385.71
3,385.71
Install Camera
8.00
960.00
WB8-LSA-03
MDVR Syst. - (4) Cams, 128 GB, GPS &
1.00
2,495.00
2,495.00
Extend Frame on Apparatus
10.00
1,200.00
7" LCD
Install TMA
14.00
1,680.00
TDE #MDVR64GB3
Install Arrow Board w/ Lift
8.00
960.00
Power Kit
1.00
650.00
650.00
PWR kit
QUOTE FOR BLOCKER 1 AND BLOCKER 2
Slim Line LED Strobes - BLUE/RED
2.00
110.00
220.00
ELECTRICAL-2
Blocker #2
1.00
0.00
0.00
BLOCKER2
Scorpion II Model "C" , TL-3 TMA
1.00 27,628.57
27,628.57
(MASH)
TMA-2 SERIAL #
VERTICALARROW BOARD MOUNT
1.00
2,334.29
2,334.29
GHE:ABVM
15 BULB ARROW BOARD
1.00
3,385.71
3,385.71
WB8-LSA-03
MDVR Syst. - (4) Cams, 128 GB, GPS &
1.00
2,495.00
2,495.00
7" LCD
TDE #MDVR64GB3
Power Kit
1.00
650.00
650.00
PWR kit
Slim Line LED Strobes - BLUE/RED
2.00
110.00
220.00
ELECTRICAL-2
Parts/Supplies: 73,427.14 Labor: 11,280.00 Total : $ 84,707.14
I hereby authorize the above repair work to be done along with the necessary material and hereby grant you and /or your employees permission to operate
the vehicle described for testing and/or inspection. Express mechanic's lien is hereby acknowledged on above vehicle to secure the amount of repairs
thereto. SMOG: I understand that I can have emission service and/or adjustments done elsewhere. I hereby waive this right.
TEARDOWN ESTIMATE: I understand that my vehicle will be reassembled within_days of the date shown above if I choose not to authorize the service
recommended. All Parts removed will be discarded unless instructed otherwise: Save all Parts NOT RESPONSIBLE FOR LOSS OR DAMAGE TO CARS
OR ARTICLES LEFT IN CARS IN CASE OF FIRE, THEFT OR ANY OTHER CAUSE.
Signature Date Time
Page 1 of 1 Copyright (c) 2023 Mitchell Repair Information Company, LLC esthrs 4.06.2016kr
CSC No. 56307-Rl
CITY OF FORT WORTH
CONTRACT RENEWAL NOTICE
September 21, 2022
Gulf Highway Equipment, LLC.
Attn: Travis McCain, Owner
600 Garden St.
Haltom City, TX 76117
Re: Contract Renewal Notice
Contract No. CSC No. 56307-R1 (the "Contract')
Renewal Term No. 1: September 15, 2022 to September 14, 2023
The above referenced Contract with the City of Fort Worth expires on September 14, 2022
(the "Expiration Date"). Pursuant to the Contract, contract renewals are at the sole option of the
City. This letter is to inform you that the City is exercising its right to renew the Contract for an
additional one (1) year period, which will begin immediately after the Expiration Date. All other
terms and conditions of the Contract remain unchanged. Please return this signed
acknowledgement letter, along with a copy of your current insurance certificate, to the
address set forth below, acknowledging receipt of the Contract Renewal Notice. Failure to
provide a signed acknowledgment does not affect the renewal.
Please log onto PeopleSoft Purchasing at http:Hfortworthtexas.�zov/purchasing to ensure
that your company information is correct and up-to-date.
If you have any questions concerning this Contract Renewal Notice, please contact me at
the telephone number listed below.
Sincerely,
Brenda Rav
Sr. Contract Compliance Specialist
Brenda. ravafortworthtexas. Gov
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Contract Renewal
Page 1 of 3
CSC No. 56307-R1
ACCEPTED AND AGREED:
CITY OF FORT WORTH
VA11, kk-- .
By:Valerie,Washington (Oct 18, 2022 14:23 CDT)
Name: Valerie Washington
Title: Assistant City Manager
Date:
APPROVAL RECOMMENDED:
By J s Daviss� 18, 2022 13:52 CDT)
Name: Jim Davis
Title: Fire Chief
ATTEST:
Tannette S. Goodall
By Jannette S. Goodall (Oct 18, 2022 16:03 CDT)
Name: Jannette Goodall
Title: City Secretary
Contract Renewal
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.
ByMark Rauscher (Oct 18, 2022 13:46 CDT)
Name: Mark Rauscher
Title: Assistant Fire Director
APPROVED AS TO FORM AND
LEGALITY:
By:
Name: Tavlor Paris
Title: Assistant Citv Attornev
CONTRACT AUTHORIZATION:
N/A
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
CSC No. 56307-R1
Gulf HiAwav Equipment, LLC.
By:
Name: Travis McCain
Title: Owner
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Contract Renewal rage 3 01 3
CSC No. 56307
CITY OF FORT VMRTH
SOLE SOURCE PURCHASE AGREEMENT
Gulf I-DOway Equipment, LLC
This SOLE SOURCE PURCHASE AGREEMENT ('Agreein mt") is made and entered into by and
between the CITY OF FORT WORTH �'City'% a Texas home rule municipal corporation, acting by and through
its duly authorized Assistant City Manager, and Gulf Highway Equipment ("Vendor"), a LLC and acting by and
through its duly authorized representative, each individually referred to as a "party" and collectively referred to
as the "parfies,."
Vendor agrees dW this Sole Source Purchase Agreement includes the following documents which shall
be construed in the order of precedence in which they are listed:
1. This Sole Sou -me Poch Agreement;
I Exhibit A — Scope of Services
3. Exhibit B — Vendor's Quote
4, EXhibit C — Vendor's Sole Source Justification Letter;
5. ExItibit D � Sole Source Procurement Justification; and
6. EWbit E — Conflict of Triterest Questionwire.
Exhibits A, B, C, D, and E, which are aMched hereto and incorporated herein,, are made part of this Agreement
for A doses. In the event of any conflict between the terms and conditions of Exhibits A, B, C, or D and the
terms afid conditions set forth in the body of this Agreement, the terms and conditions of this Agreement shall
control.
1. Scope of Services. Purchase and installation of Two Truck Mounted Attenuators ("Services"),
which are set forth in more detail in Exhibit "A," atlaolied hereto and incorporated herein for all put"es.
2, Term. The initial team of this Agreement is for I ye-v(s), beginning on the date that this
Agrement is executed by the City's Assistant City Manager CEffective Date"), unless terminated earlier in
accordance with. this Agreement ("Initial Term"). City will have the option, in its sole discretion, to renew this
Agreement under the same terms and conditions, for up to 2 one-year renoml option(s) (each a "Renewal Term").
3. Compensation.
3.1 Total compermkon under this Agreement will not exceed Seventy -Five Thousand
Dollars and Zero Cents ($75,000.00) per year, including each renmal year.
1.2 City will pay Vendor in accordance with the Prompt Payment Act (Chapter 2251 of the
Texas Covemment Code) and provisions of this Agreement, including Exhibit "B," which is
adached hereto and incoqxxited herein for all purposes.
3.3 Vendor will not perform any additional services or bill for expenses incurred for City not
specified by this Agreement unless City requests and -approves in writing the additional costs for
such services. City will not be liable for any additional expenses of Vendor not specified by this
Agreement unless City first approves such expenses in writing.
4. Termination.
Sole Source Purchase Agreement - Gulf Highway Equipment OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
4.1. Written Notice. City or Vendor may terminate this Agreement at any time and for any
reason by providing the other party with 30 days' written notice of termination.
4.2 Non -appropriation of Funds. In the event no funds or insufficient funds are appropriated
by City in any fiscal period for any payments due hereunder, City will notify Vendor of such occurrence
and this Agreement will terminate on the last day of the fiscal period for which appropriations were
received without penalty or expense to City of any kind whatsoever, except as to the portions of the
payments herein agreed upon for which funds have been appropriated.
4.3 Duties and Obliaations of the Parties. In the event that this Agreement is terminated prior
to the Expiration Date, City will pay Vendor for services actually rendered up to the effective date of
termination and Vendor will continue to provide City with services requested by City and in accordance
with this Agreement up to the effective date of termination. Upon termination of this Agreement for any
reason, Vendor will provide City with copies of all completed or partially completed documents prepared
under this Agreement. In the event Vendor has received access to City Information or data as a
requirement to perform services hereunder, Vendor will return all City provided data to City in a machine
readable format or other format deemed acceptable to City.
5. Disclosure of Conflicts and Confidential Information.
5.1 Disclosure of Conflicts. Vendor hereby warrants to City that Vendor has made full
disclosure in writing of any existing or potential conflicts of interest related to Vendor's services under
this Agreement. In the event that any conflicts of interest arise after the Effective Date of this Agreement,
Vendor hereby agrees immediately to make full disclosure to City in writing.
5.2 Confidential Information. Vendor, for itself and its officers, agents and employees, agrees
that it will treat all information provided to it by City ("City Information") as confidential and will not
disclose any such information to a third party without the prior written approval of City.
5.3 Public Information Act. City is a government entity under the laws of the State of Texas
and all documents held or maintained by City are subject to disclosure under the Texas Public Information
Act. In the event there is a request for information marked Confidential or Proprietary, City will promptly
notify Vendor. It will be the responsibility of Vendor to submit reasons objecting to disclosure. A
determination on whether such reasons are sufficient will not be decided by City, but by the Office of the
Attorney General of the State of Texas or by a court of competent jurisdiction.
5.4 Unauthorized Access. Vendor must store and maintain City Information in a secure
manner and will not allow unauthorized users to access, modify, delete or otherwise corrupt City
Information in any way. Vendor must notify City immediately if the security or integrity of any City
Information has been compromised or is believed to have been compromised, in which event, Vendor
will, in good faith, use all commercially reasonable efforts to cooperate with City in identifying what
information has been accessed by unauthorized means and will fully cooperate with City to protect such
City Information from further unauthorized disclosure.
6. Right to Audit. Vendor agrees that City will, until the expiration of three (3) years after final
payment under this Agreement, or the final conclusion of any audit commenced during the said three years, have
access to and the right to examine at reasonable times any directly pertinent books, documents, papers and records,
including, but not limited to, all electronic records, of Vendor involving transactions relating to this Agreement at
no additional cost to City. Vendor agrees that City will have access during normal working hours to all necessary
Vendor facilities and will be provided adequate and appropriate work space in order to conduct audits in
compliance with the provisions ofthis section. City will give Vendor reasonable advance notice of intended audits.
Sole Source Purchase Agreement — Gulf Highway Equipment Page 2 of 20
7. Independent Contractor. It is expressly understood and agreed that Vendor will operate as an
independent contractor as to all rights and privileges and work performed under this Agreement, and not as agent,
representative or employee of City. Subject to and in accordance with the conditions and provisions of this
Agreement, Vendor will have the exclusive right to control the details of its operations and activities and be solely
responsible for the acts and omissions of its officers, agents, servants, employees, Vendors, and subcontractors,
Vendor acknowledges that the doctrine of respondeat superior will not apply as between City, its officers, agents,
servants and employees, and Vendor, its officers, agents, employees, servants, contractors, and subcontractors.
Vendor further agrees that nothing herein will be construed as the creation of a partnership or joint enterprise
between City and Vendor. It is further understood that City will in no way be considered a Co -employer or a Joint
employer of Vendor or any officers, agents, servants, employees, contractors, or subcontractors. Neither Vendor,
nor any officers, agents, servants, employees, contractors, or subcontractors of Vendor will be entitled to any
employment benefits from City. Vendor will be responsible and liable for any and all payment and reporting of
taxes on behalf of itself, and any of its officers, agents, servants, employees, or contractors.
Liabilitv and Indemnification.
8.1 LJABILITY - VENDOR WILL BE LIABLE AND RESPONSIBLE FOR ANY AND
ALL PROPERTY LOSS, PROPERTY DAMAGE AND PERSONAL INJURY, INCLUDING,
INCLUDING, BUTNOTLIMITED TO, DEATH, TOANYANDALL PERSONS, OFANYKIND OR
CHARACTER, WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED BY THE
NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR INTENTIONAL MISCONDUCT
OF VENDOR, ITS OFFICERS, REPRESENTATIVES, AGENTS, SERVANTS, EMPLOYEES,
CONTRACTORS, OR SUBCONTRACTORS,
8.2 GENERAL INDEMNIFICATION - VENDOR HEREBY COVENANTS AND
AGREES TO INDEMNIFY, HOLD HARMLESS, AND DEFEND CITY, ITS OFFICERS, AGENTS,
REPRESENTATIVES, SERVANTS, AND EMPLOYEES, FROM AND AGAINST ANY AND ALL
CLAIMS OR LAWSUITS OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED,
FOR EITHER PROPERTYDAMAGE OR LOSS (INCLUDINGALLEGED DAMAGE OR LOSS TO
VENDOR'S BUSINESS AND ANY RESULTING LOST PROFITS) AND PERSONAL INJURY,
INCLUDING, BUTNOT LIMITED TO, DEATH, TOANYANDALL PERSONS, ARISING OUT OF
OR IN CONNECTION WITH THIS AGREEMENT, TO THE EXTENT CAUSED BY THE
NEGLIGENT ACTS OR OMISSIONS OR MALFEASANCE OF VENDOR, ITS OFFICERS,
AGENTS, REPREENTATIVES, SERVANTS, EMPLOYEES, CONTRACTORS, OR
SUBCONTRACTORS.
8.3 INTELLECTUAL PROPERTY INDEMNIFICATION — Vendor agrees to defend,
settle, or pay, at its own cost and expense, any claim or action against City for infringement of any
patent, copyright, trade mark, trade secret, or similar property right arising from City's use of the
software or documentation in accordance with this Agreement, it being understood that this
agreement to defend, settle or pay will not apply if City modifies or misuses the software and/or
documentation. So long as Vendor bears the cost and expense of payment for claims or actions
against City pursuant to this section, Vendor will have the right to conduct the defense of any such
claim or action and all negotiations for its settlement or compromise and to settle or compromise
any such claim; however, City will have the right to fully participate in any and all such settlement,
negotiations, or lawsuit as necessary to protect City's interest, and City agrees to cooperate with
Vendor in doing so. In the event City, for whatever reason, assumes the responsibility for payment
of costs and expenses for any claim or action brought against City for infringement arising under
this Agreement, City will have the sole right to conduct the defense of any such claim or action and
all negotiations for its settlement or compromise and to settle or compromise any such claim;
however, Vendor will fully participate and cooperate with City in defense of such claim or action.
City agrees to give Vendor timely written notice of any such claim or action, with copies of all papers
City may receive relating thereto. Notwithstanding the foregoing, City's assumption of payment of
Sole Source Purchase Agreement —Gulf Highway Equipment Page 3 of 20
costs or expenses will not eliminate Vendor's duty to indemnify City under this Agreement. If the
software and/or documentation or any part thereof is held to infringe and the use thereof is enjoined
or restrained or, if as a result of a settlement or compromise, such use is materially adversely
restricted, Vendor will, at its own expense and as City's sole remedy, either: (a) procure for City the
right to continue to use the software and/or documentation; or (b) modify the software and/or
documentation to make it non -infringing, provided that such modification does not materially
adversely affect City's authorized use of the software and/or documentation; or (e) replace the
software and documentation with equally suitable, compatible, and functionally equivalent non -
infringing software and documentation at no additional charge to City; or (d) if none of the
foregoing alternatives is reasonably available to Vendor terminate this Agreement, and refund all
amounts paid to Vendor by City, subsequent to which termination City may seek any and all
remedies available to City under law.
Assignment and Subcontracting.
9.1 Assianment. Vendor will not assign or subcontract any of its duties, obligations or rights
under this Agreement without the prior written consent of City. If City grants consent to an assignment,
the assignee will execute a written agreement with City and Vendor under which the assignee agrees to
be bound by the duties and obligations of Vendor under this Agreement. Vendor will be liable for all
obligations of Vendor under this Agreement prior to the effective date of the assignment.
9.2 Subcontract. If City grants consent to a subcontract, the subcontractor will execute a
written agreement with Vendor referencing this Agreement under which subcontractor agrees to be bound
by the duties and obligations of Vendor under this Agreement as such duties and obligations may apply.
Vendor must provide City with a fully executed copy of any such subcontract.
10. Insurance. Vendor must provide City with certificate(s) of insurance documenting policies of
the following types and minimum coverage limits that are to be in effect prior to commencement of any Services
pursuant to this Agreement:
10.1 Coveraae and Limits
(a) Commercial General Liability:
$1,000,000 - Each Occurrence
$2,000,000 - Aggregate
(b) Automobile Liability:
$1,000,000 - Each occurrence on a combined single limit basis
Coverage will be on any vehicle used by Vendor, or its employees, agents, or
representatives in the course of providing Services under this Agreement. "Any vehicle"
will be any vehicle owned, hired and non -owned.
(c) Worker's Compensation:
Statutory limits according to the Texas Workers' Compensation Act or any other state
workers' compensation laws where the Services are being performed
Employers' liability
$100,000 - Bodily Injury by accident; each accident/occurrence
Sole Source Purchase Agreement — Guff Highway Equipment Page 4 of 20
$100,000 - Bodily Injury by disease; each employee
$500,000 - Bodily Injury by disease; policy limit
(d) Professional Liability (Errors & Omissions): ❑ Applicable ❑ N/A
$1,000,000 - Each Claim Limit
$1,000,000 - Aggregate Limit
Professional Liability coverage may be provided through an endorsement to the
Commercial General Liability (CGL) policy, or a separate policy specific to Professional
E&O. Either is acceptable if coverage meets all other requirements. Coverage must be
claims -made, and maintained for the duration of the contractual agreement and for two
(2) years following completion of services provided. An annual certificate of insurance
must be submitted to City to evidence coverage.
10.2 General Requirements
(a) The commercial general liability and automobile liability policies must name
City as an additional insured thereon, as its interests may appear. The term City includes
its employees, officers, officials, agents, and volunteers in respect to the contracted
services.
(b) The workers' compensation policy must include a Waiver of Subrogation (Right
of Recovery) in favor of City.
(c) A minimum of Thirty (30) days' notice of cancellation or reduction in limits of
coverage must be provided to City. Ten (10) days' notice will be acceptable in the event
of non-payment of premium. Notice must be sent to the City in accordance with the notice
provision of this Agreement.
(d) The insurers for all policies must be licensed and/or approved to do business in
the State of Texas. All insurers must have a minimum rating of A- VII in the current A.M.
Best Key Rating Guide, or have reasonably equivalent financial strength and solvency to
the satisfaction of Risk Management. If the rating is below that required, written approval
of Risk Management is required.
(e) Any failure on the part of City to request required insurance documentation will
not constitute a waiver of the insurance requirement.
(f) Certificates of Insurance evidencing that Vendor has obtained all required
insurance will be delivered to the City prior to Vendor proceeding with any work pursuant
to this Agreement.
11. Compliance with Laws, Ordinances, Rules and Reeulations. Vendor agrees that in the
performance of its obligations hereunder, it will comply with all applicable federal, state and local laws,
ordinances, rules and regulations and that any work it produces in connection with this Agreement will also
comply with all applicable federal, state and local laws, ordinances, rules and regulations. If City notifies Vendor
of any violation of such laws, ordinances, rules or regulations, Vendor must immediately desist from and correct
the violation.
12. Non -Discrimination Covenant. Vendor, for itself, its personal representatives, assigns,
contractors, subcontractors, and successors in interest, as part of the consideration herein, agrees that in the
performance of Vendor's duties and obligations hereunder, it will not discriminate in the treatment or employment
Sole Source Purchase Agreement — Gulf Highway Equipment Page 5 of 20
of any individual or group of individuals on any basis prohibited by law. IF ANY CLAIM ARISES FROM AN
ALLEGED VIOLATION OF THIS NON-DISCRIMINATION COVENANT BY VENDOR, ITS
PERSONAL REPRESENTATIVES, ASSIGNS, CONTRACTORS, SUBCONTRACTORS, OR
SUCCESSORS IN INTEREST, VENDOR AGREES TO ASSUME SUCH LIABILITY AND TO
INDEMNIFY AND DEFEND CITY AND HOLD CITY HARMLESS FROM SUCH CLAIM.
13. Notices. Notices required pursuant to the provisions of this Agreement will be conclusively
determined to have been delivered when (1) hand -delivered to the other parry, its agents, employees, servants or
representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3) received by the
other parry by United States Mail, registered, return receipt requested, addressed as follows:
To CITY:
City of Fort Worth
Attn: Assistant City Manager
200 Texas Street
Fort Worth, TX 76102-6314
Facsimile: (817) 392-8654
With copy to Fort Worth City Attorney's Office at
same address
To VENDOR:
GULF HIGHWAY EQUIPMENT, LLC.
Travis McCain, Owner
600 GARDEN ST
HALTOM CITY, TX 76117
PHONE: 682-708-8721
14. Solicitation of EmDlovees. Neither City nor Vendor will, during the term of this Agreement and
additionally for a period of one year after its termination, solicit for employment or employ, whether as employee
or independent contractor, any person who is or has been employed by the other during the term of this Agreement,
without the prior written consent of the person's employer. Notwithstanding the foregoing, this provision will not
apply to an employee of either party who responds to a general solicitation of advertisement of employment by
either party.
15. Governmental Powers. It is understood and agreed that by execution of this Agreement, City
does not waive or surrender any of its governmental powers or immunities.
16. No Waiver. The failure of City or Vendor to insist upon the performance of any term or provision
of this Agreement or to exercise any right granted herein does not constitute a waiver of City's or Vendor's
respective right to insist upon appropriate performance or to assert any such right on any future occasion.
17. Governine Law / Venue. This Agreement will be construed in accordance with the laws of the
State of Texas. If any action, whether real or asserted, at law or in equity, is brought pursuant to this Agreement,
venue for such action will lie in state courts located in Tarrant County, Texas or the United States District Court
for the Northern District of Texas, Fort Worth Division.
18. Severability. If any provision of this Agreement is held to be invalid, illegal or unenforceable,
the validity, legality and enforceability of the remaining provisions will not in any way be affected or impaired.
19. Force Majeure. City and Vendor will exercise their best efforts to meet their respective duties
and obligations as set forth in this Agreement, but will not be held liable for any delay or omission in performance
due to force majeure or other causes beyond their reasonable control, including, but not limited to, compliance
with any government law, ordinance, or regulation; acts of God; acts of the public enemy; fires; strikes; lockouts;
natural disasters; wars; riots; epidemics or pandemics; government action or inaction; orders of government;
material or labor restrictions by any governmental authority; transportation problems; restraints or prohibitions by
any court, board, department, commission, or agency of the United States or of any States; civil disturbances;
other national or regional emergencies; or any other similar cause not enumerated herein but which is beyond the
Sole Source Purchase Agreement —Gulf Highway Equipment Page 6 of 20
reasonable control of the Parry whose performance is affected (collectively, "Force Majeure Event"). The
performance of any such obligation is suspended during the period of, and only to the extent of, such prevention
or hindrance, provided the affected Party provides notice of the Force Majeure Event, and an explanation as to
how it prevents or hinders the Parry's performance, as soon as reasonably possible after the occurrence of the
Force Majeure Event, with the reasonableness of such notice to be determined by the City in its sole discretion.
The notice required by this section must be addressed and delivered in accordance with Section 13 of this
Agreement.
20. HeadinLys not Controlling. Headings and titles used in this Agreement are for reference purposes
only, will not be deemed a part of this Agreement, and are not intended to define or limit the scope of any provision
of this Agreement.
21. Review of Counsel. The parties acknowledge that each parry and its counsel have reviewed and
revised this Agreement and that the normal rules of construction to the effect that any ambiguities are to be
resolved against the drafting party will not be employed in the interpretation of this Agreement or Exhibits A, B,
and C.
22. Amendments / Modifications / Extensions. No amendment, modification, or extension of this
Agreement will be binding upon a party hereto unless set forth in a written instrument, which is executed by an
authorized representative of each parry.
23. Counterparts. This Agreement may be executed in one or more counterparts and each
counterpart will, for all purposes, be deemed an original, but all such counterparts will together constitute one and
the same instrument.
24. Warranty of Services. Vendor warrants that its services will be of a high quality and conform
to generally prevailing industry standards. City must give written notice of any breach of this warranty within
thirty (30) days from the date that the services are completed. In such event, at Vendor's option, Vendor will either
(a) use commercially reasonable efforts to re -perform the services in a manner that conforms with the warranty,
or (b) refund the fees paid by City to Vendor for the nonconforming services.
25. Immieration Nationalitv Act. Vendor must verify the identity and employment eligibility of its
employees who perform work under this Agreement, including completing the Employment Eligibility
Verification Form (I-9). Upon request by City, Vendor will provide City with copies of all I-9 forms and
supporting eligibility documentation for each employee who performs work under this Agreement. Vendor must
adhere to all Federal and State laws as well as establish appropriate procedures and controls so that no services
will be performed by any Vendor employee who is not legally eligible to perform such services. VENDOR WILL
INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES, LIABILITIES, OR
LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY VENDOR, VENDOR'S EMPLOYEES,
CONTRACTORS, SUBCONTRACTORS, OR AGENTS. City, upon written notice to Vendor, will have the
right to immediately terminate this Agreement for violations of this provision by Vendor.
26. Ownership of Work Product. City will be the sole and exclusive owner of all reports, work
papers, procedures, guides, and documentation that are created, published, displayed, or produced in conjunction
with the services provided under this Agreement (collectively, "Work Product"). Further, City will be the sole
and exclusive owner of all copyright, patent, trademark, trade secret and other proprietary rights in and to the
Work Product. Ownership of the Work Product will inure to the benefit of City from the date of conception,
creation or fixation of the Work Product in a tangible medium of expression (whichever occurs first). Each
copyrightable aspect of the Work Product will be considered a "work -made -for -hire" within the meaning of the
Copyright Act of 1976, as amended. If and to the extent such Work Product, or any part thereof, is not considered
a "work -made -for -hire" within the meaning of the Copyright Act of 1976, as amended, Vendor hereby expressly
assigns to City all exclusive right, title and interest in and to the Work Product, and all copies thereof, and in and
to the copyright, patent, trademark, trade secret, and all other proprietary rights therein, that City may have or
Sole Source Purchase Agreement — Gulf Highway Equipment Page 7 of 20
obtain, without further consideration, free from any claim, lien for balance due, or rights of retention thereto on
the part of City.
27. Sienature Authoritv. The person signing this Agreement hereby warrants that they have the
legal authority to execute this Agreement on behalf of the respective party, and that such binding authority has
been granted by proper order, resolution, ordinance or other authorization of the entity. This Agreement and any
amendment hereto, may be executed by any authorized representative of Vendor. Each parry is fully entitled to
rely on these warranties and representations in entering into this Agreement or any amendment hereto.
28. Change in Companv Name or Ownership. Vendor must notify City's Purchasing Manager, in
writing, of a company name, ownership, or address change for the purpose of maintaining updated City records.
The president of Vendor or authorized official must sign the letter. A letter indicating changes in a company name
or ownership must be accompanied with supporting legal documentation such as an updated W-9, documents filed
with the state indicating such change, copy of the board of director's resolution approving the action, or an
executed merger or acquisition agreement. Failure to provide the specified documentation so may adversely
impact future invoice payments.
29. No Bovcott of Israel. If Vendor has fewer than 10 employees or this Agreement is for less
than $100,000, this section does not apply. Vendor acknowledges that in accordance with Chapter 2271 of the
Texas Government Code, the City is prohibited from entering into a contract with a company for goods or services
unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2)
will not boycott Israel during the term of the contract. The terms "boycott Israel" and "company" has the meanings
ascribed to those terms in Section 2271 of the Texas Government Code. By signing this Agreement, Vendor
certifies that Vendor's signature provides written verification to the City that Vendor: (1) does not boycott
Israel; and (2) will not boycott Israel during the term of the Agreement.
30. Prohibition on Bovcotting Energv Companies. Vendor acknowledges that, in accordance with
Chapter 2274 of the Texas Government Code, as added by Acts 2021, 87th Leg., R.S., S.B. 13, § 2, the City is
prohibited from entering into a contract for goods or services that has a value of $100,000 or more that is to be
paid wholly or partly from public funds of the City with a company with 10 or more full-time employees unless
the contract contains a written verification from the company that it: (1) does not boycott energy companies; and
(2) will not boycott energy companies during the tern of the contract. The terms "boycott energy company" and
"company" have the meaning ascribed to those terms by Chapter 2274 of the Texas Government Code, as added
by Acts 2021, 87th Leg., R.S., S.B. 13, § 2. To the extent that Chapter 2274 of the Government Code is applicable
to this Agreement, by signing this Agreement, Vendor certifies that Vendor's signature provides written
verification to the City that Vendor: (1) does not boycott energy companies; and (2) will not boycott energy
companies during the term of this Agreement.
31. Prohibition on Discrimination Against Firearm and Ammunition Industries. Vendor
acknowledges that except as otherwise provided by Chapter 2274 of the Texas Government Code, as added by
Acts 2021, 87th Leg., R.S., S.B. 19, § 1, the City is prohibited from entering into a contract for goods or services
that has a value of $100,000 or more that is to be paid wholly or partly from public funds of the City with a
company with 10 or more full-time employees unless the contract contains a written verification from the company
that it: (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or
firearm trade association; and (2) will not discriminate during the term of the contract against a firearm entity or
firearm trade association. The terms "discriminate," "firearm entity" and "firearm trade association" have the
meaning ascribed to those terms by Chapter 2274 of the Texas Government Code, as added by Acts 2021, 87th
Leg., R.S., S.B. 19, § 1. To the extent that Chapter 2274 of the Government Code is applicable to this Agreement,
by signing this Agreement, Vendor certifies that Vendor's signature provides written verification to the City that
Vendor: (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or
firearm trade association; and (2) will not discriminate against a firearm entity or firearm trade association during
the term of this Agreement.
Sole Source Purchase Agreement — Gulf Highway Equipment Page 8 of 20
32. Electronic Signatures. This Agreement may be executed by electronic signature, which will be
considered as an original signature for all purposes and have the same force and effect as an original signature.
For these purposes, "electronic signature" means electronically scanned and transmitted versions (e.g. via pdf file
or facsimile transmission) of an original signature, or signatures electronically inserted via software such as Adobe
Sign.
33. Entirety of Agreement. This Agreement contains the entire understanding and agreement
between City and Vendor, their assigns and successors in interest, as to the matters contained herein. Any prior or
contemporaneous oral or written agreement is hereby declared null and void to the extent in conflict with any
provision of this Agreement.
(signature page follows)
Sole Source Purchase Agreement — Gulf Highway Equipment Page 9 of 20
IN WITNESS WHEREOF, the parties hereto have executed this Agreement in multiples.
City:
By: Valerie Washington S5,202116:07 CDT)
Name: VALERIE WASHINGTON
Title: Assistant City Manager
Date: Sep 15, 2021
Vendor:
By: "- 4"
Name: Travis McCain
Title: Owner
Date: 0(—/0--2n-?-1
FOR CITY OF FORT WORTH INTERNAL PROCESSES:
Approval Recommended:
By: zglts�. 14,202108:27 CDT)
Name: Jim Davis
Title: Fire Chief
Approved as to Form and Legality:
By:
Name: Christopher Austria
Title: Assistant City Attorney
Contract Authorization:
M&C: N/A
Form 1295: N/A
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.
1-j 1r
By: Josh Clam (Sep tj 202121:32 CDT)
Name: Joshua Clark
Title: Fire Lt.
City Secretary:
By:
?�
Name: Ronald P. Gonzales
Title: Acting City Secretary
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Sole Source Purchase Agreement - Gulf Highway Equipment OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
EXHIBIT A
The Scorpion 11 Truck Mounted Attenuator (TMA) is a mobile crash cushion attached to the rear
of a support vehicle's frame. The TMA may be used on moving shadow trucks, stationary block
vehicles, or advanced warning vehicles upstream of a moving or stationary operation. The TMA is
tested, passed and eligible to MASH TL-3 (62.5 mph / 100 kph). The TMA can be used on support
vehicles with a minimum actual/curb weight of 15,000 lbs (6,804 kg) with no upper weight limit
(infinite weight). Lighting consists of LED brake, directional, signal and running lights for
enhancement of advanced warning to drivers. The TL-3 TMA has an overall dimension of 12.94 ft.
(3.9 m) x 8.0 ft (2.4 m) x 2.0 ft (0.6 m) and has a ground clearance of 12" ± 1" (305 mm ± 25.4
mm) when deployed in the horizontal operating position. The Scorpion 11 TMA consists of three
(3) main components: Strut, Cartridge, and backup/diaphragm frames. The Strut and Cartridge
are the energy attenuation components. The Strut is positioned nearest to the support vehicle
and the Cartridge is positioned furthest away from the support vehicle. The Cartridge is typically
the first component impacted by an errant vehicle. The Strut consists of four (4) outboard convex
aluminum tubes (two on each side) forming an aluminum structural weldment. The aluminum
structural weldments bolt to a structural steel diaphragm/backup frame. The TMA can be rotated
in a double 900 fold position over the support vehicles bed with a stored height of less than 12' 5"
(3.8 m). An optional hydraulic powered vertical lift can be utilized with the TMA to deploy a
display panel when the TMA is lowered into the use position. The vertical lift is powered by the
same on -board hydraulic system that rotates the TMA into the travel/storage and deployed
positions. The vertical lift is sequenced to raise and lower a panel for displaying advanced
messages, directional indicators, or other notifications.
Sole Source Purchase Agreement — Gulf Highway Equipment Page 11 of 20
IEXHIBIT B
GULF HIGHWAY EQUIPMENT
6000 GARDEN ST ESTIMATE #
Haltom City, TX. 76117 002792
Phone:682-708-8721 Fax: 000- -
Estimate for Services
Estimate Date:
7121/2021
City of Fort Worth - Joshua Clark
0 -
200 Texas St
Lie # : -TX
Odom. In: 0
Fort Worth, TX 76102
Unit # : BLOCKER i
VIN # : BLOCKERI
Part Description I Number
City Sale
Ext
Labor Description
Hours
Extended
Scorpion 11 Model "C", TL-3 TMA
I.00 21,250.00
21,250.00
fab parts
7.00
805.00
(MASH)
Install camera
8.00
920.00
TMA(2) SERIAL#
Arrow. Board- R/TAssy-P46, 15Lt, LED,
1.00 2,836.20
2,836.20
Extend frame on truck
10.00
1,150.00
Seq., 48x96
Install TMA
14.00
1,610.00
WC #WB8-LSA-03
AS lift
1.00 2,175.00
2,175.00
install Arrow board
8.00
920.00
AS lift
fab parts
7.00
805.00
DVR camera
1.00 2,873.90
2,873.90
Install camera
8.00
920,00
DVR Camera
Extend frame on truck
10.00
1,150m
PWR kit
1.00 570.00
570.00
Install TMA
14.00
1,610.00
PWR kit
Slim line LED SIR
2.00 96.00
192.00
install Arrow board
8.00
920.00
Slim line
QUOTE FOR BLOCKER 1 AND BLOCKER 2
Scorpion 11 Model "C", TL-3 TMA
1.0021,250.00
21,250.00
(MASH)
TMA(2) SERIAL#
Arrow. Board- R1TAssy-P46, 15Lt, LED,
1.00 2,836,20
2,836.20
Seq., 48x96
WC #WBS-LSA-03
AB lift
1.00 2,175.00
2,175.00
AS lift
DVR camera
1.00 2,873.90
2,873.90
DVR Camera
PWR kit
1.00 570.00
570.00
PWR kit
Slim line LED B/R
2.00 96.00
192.00
Slim line
Parts/Supplies: 59,794.20 Labor: 10,810.00 HazMat/Fees: 0.00 Tax: 3.97422 Total: $ 74.578.42
I hereby authorize the above repair work to be done along with the necessary material and hereby grant you and /or your employees permission to operate
the vehicle described for testing and/or inspection. Express mechanic's lien is hereby acknowledged on above vehicle to secure the amount of repairs
thereto. SMOG: I understand that I can have emission service and/or adjustments done elsewhere. 1 hereby waive this right.
TEARDOWN ESTIMATE: I understand that my vehicle will be reassembled within days of the date shown above if I choose not to authorize the service
recommended. All Parts removed will be discarded unless instructed otherwise: Save all Parts NOT RESPONSIBLE FOR LOSS OR DAMAGE TO CARS
OR ARTICLES LEFT IN CARS IN CASE OF FIRE, THEFT OR ANY OTHER CAUSE.
Signature Date Time
Page 1 of 1 Copyright (02021 64lohell Report Inf(X-b n Company, LLC -fts 4.06.20I6kr
EXHIBIT C
"%�"s MIX
aW8' Vicesi Inc.
10/2/2020
To whom it may concern;
The structural aspect of installation of Scorpion TMA is unique for Fire
Engine installation, and special training is required to perform this
function safely. TrafFix Devices has one Distributor who has completed
factory training on the structural modification and installation of a
Scorpion TMA on a Fire Engine. That distributor is Gulf Highway
Equipment in Haltom City, Texas.
Sincerely,
. /4'// M a'Go'
Geoff Maus
Vice President of Engineering
TrafFix Devices
160 Ave. La Pata
San Clemente, California 92673
(949) 361-5663
FAX (949) 361-9205
www.traffixdevices.com
auie auuice ruicndae HgreernenL—uuu rngnwdy cquiNrneni rdge la ui eu
MUlf Highway Equipment
GHETX.CGM
6000 Garden St.
592o Lower Birdville Rd
Haltom City, Texas 76117
PH. 682.708.8721
August 19, 2021
To Whom it may concern,
Due the nature of the installation and risk associated with installation and performance
of a truck mounted crash attenuator, Gulf Highway Equipment will not warranty any TMA
device that is purchased thru any source other than GHE. Any customer supplied TMA
will be installed "as -is" and without warranty or guarantee. However, TMA's that are
purchased and installed thru GHE will include a 1-year parts and labor warranty from the
in-service date.
TMA's not purchased through GHE do not come with all the components necessary to
install a TMA on a Fire Apparatus. The components are fabricated in-house by GHE to fit
each individual truck. GHE is the only current distributor of Traffix Devices TMA that has
been authorized to fabricate these unique components used in the installation.
Sincerely,
Travis McCain
Sole Source Purchase Agreement — Gulf Highway Equipment Page 14 of 20
EXHIBIT D
FORT WORTH
CITY OF FORT WORTH
CHAPTER 252 EXEMPTION FORM
Instructions: Fill out the entire form with detailed information. Once you have completed this form,
provide it to the Purchasing attorney for review. The attorney will review the information you have
provided to determine whether an exemption to Chapter 252's biding requirements is defensible.
If you are printing this form to provide to Legal, please do not provide the Primer portion. Failure
to provide sufficient information may result in follow up questions and cause a delay in the
attorney's determination.
Section 1: General Information
Requesting Department:
Name of Contract Manager:
Department's Attorney:
Item or Service sought:
Goods:
Service:
Anticipated Amount:
Vendor:
Current/Prior Agreement for item/service:
CSC or Purchase Order #:
Amount:
Projected M&C Date:
[Fire Departmentl
rJosh Clark].
[Christopher Austrial
r$75,0001
[Gulf Highwav Equipment]
Yes ❑ No
L/AI
[$75,0001
CN/Al
How will this item or service be used? rWe have two older fire apparatus that will be used
as blocking trucks during freewav incidents. The Truck mounted attenuator will be a mobile
crash cushion attached to the rear of suuport fire truck frame which weighs about 45-50
thousand pounds. This will be used on moving fire trucks, stationary block/warning vehicles
upstream providing signal and advanced warning to drivers. This is a device to reduce the
damage to structures and vehicles resulting from a motor vehicle collision].
Page 1 of 7
Sole Source Purchase Agreement — Gulf Highway Equipment Page 15 of 20
Section 2: Claimed Exemption and Justification (Other than sole source)
NOTE - For a claimed sole -source exemption, complete Section 3.
Please indicate the non -sole -source exemption you believe applies to the purchase and provide
information to support its applicability. Please refer to the Exemption Primer for detailed
information about common exemptions:
M A procurement necessary to preserve or protect the public health or safety of the City
of Fort Worth's residents;
M A procurement necessary because of unforeseen danrage to public machinery,
equipment, or other property;
Q A procurement for personal, professional, or plannuig services;
Q A procurement for work that is perfonned and paid for by the day as the work
progresses;
n A purchase of land or a right-of-way;
❑ Paving drainage, street widening, and other public improvements, or related matters, if
at least one-third of the cost is to be paid by or through special assessments levied on
property that will benefit from the improvements;
Q A public improvement project, already in progress, authorized by the voters of the
municipality, for which there is a deficiency of funds for completing the project in
accordance with the plans and purposes authorized by the voters;
M A payment under a contract by which a developer participates in the construction of a
public improvement as provided by Subchapter C, Chapter 212;
❑ Personal property sold:
• at an auction by a state licensed auctioneer;
• at a going out of business sale held in compliance with Subchapter F,
Chapter 17, Business & Commerce Code;
• by a political subdivision of this state, a state agency of this state, or an
entity of the federal government; or
• under an interlocal contract for cooperative purchasing administered by a
regional planning commission established under Chapter 391;
n Services performed by blind or severely disabled persons;
F] Goods purchased by a municipality for subsequent retail sale by the municipality;
n Electricity, or
Page 2 of 7
Sole Source Purchase Agreement — Gulf Highway Equipment Page 16 of 20
El Advertising, other than legal notices.
Please provide details and facts to explain why you believe the exemption applies to the
purchase. You may also attach documentation to this form.
Section 3: Claimed Sole -Source Exemption and Justification
NOTE - For any non -sole -source exemption, complete Section 2.
Please indicate the sole -source exemption you believe applies to the purchase and provide
information to support its applicability. Please refer to the Exemption Primer for detailed
information about common exemptions
® *A procurement of items that are available from only one source, including:
• items that are available from only one source because of patents, copyrights,
secret processes, or natural monopolies;
• films, manuscripts, or books;
• gas, water, and other utility services;
• captive replacement parts or components for equipment;
• books, papers, and other library materials for a public library that are
available only from the persons holding exclusive distribution rights to the
materials; and
• management services provided by a nonprofit organization to a municipal
museum, park, zoo, or other- facility to which the organization has provided
significant financial or other benefits;
How did you detennine that the item or service is only available from one source?
Research was done on Buvboard. TX Smartbuv_ COOP, and GooQ_ le. Also, see sole source letter
from GHE.
Attach screenshots and provide an explanation of any independent research you conducted,
through inter net searches, searching cooperatives, or discussions with others knowledgeable on
the subject matter that corroborate that the item is available only from a single source.
After doing some research on Buvboard, TX Smartbuv COOP, and Goode (emails attached).
there was only one supplier that could meet our needs (quote attached). The type of truck -
mounted attentiator normally installed on fire trucks is the Scorpion TMA manufactured by
Traffrx. This is because it is designed for the weight of fire trucks and because it also folds into
the back of the truck like an accordion or "scomion" as opposed to folding in an upright position
which would create overhead clearance issues with parking them inside the fire stations that thev
will be based out of. Gulf Hiahwav Eauinment is the onlv authorized distributor and installer for
the Traffix Scorpion truck -mounted attenuators installation on fire apparatus.
Page 3 of 7
Sole Source Purchase Agreement — Gulf Highway Equipment Page 17 of 20
Section 4: Attornev Determination
With the facts provided by the department, is the use of the claimed exemption defensible if the
City were to be challenged on this purchase? ® Yes Q No.
Was there anything attached to this form that was relied on in making this determination?
M Yes Fi No.
If yes, please explain:GBE sole source letter (8/19/21), Traffix Devices Inc. letter
regarding installation
Was there anything not included on this form or attached hereto that was relied on in making this
determination? 0 Yes M No.
If yes, please explain:
Will the standard terms and conditions apply? Yes No.
Will the contract require special terms? [1 Yes No.
Will the contract require review by the department attorney? Eyes II No.
Approved By:
Date: 8l26/21
V
Page 4 of 7
Sole Source Purchase Agreement — Gulf Highway Equipment Page 18 of 20
Taylor Paris l 3essika Williams
Assistant City Attorney
Page 5 of 7
Sole Source Purchase Agreement — Gulf Highway Equipment Page 19 of 20
EXHIBIT E
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by KB. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordancewith Chapter 176, Local Government Code,
by a vendorwho has a business relationship as defined by Section 176.001(1-a) with a local
governmental entity and the vendor meets requirements under Section 176.006(a).
By law this questionnaire most be filedwith the records administrator of the local governmental
entity not later than the 7th business day after the date the vendor becomes aware of facts
that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.O46, Local
Government Code. An offense under this section is a misdemeanor.
!J Name of vendorwho has a business relationship with local governmental entity.
G)LAF
�J HCheck thlox Ifydu are filfPlg do update to a previously filed questionnaire.
OFFICE USE ONLY
Date R@CWGd
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not
11Y1later than the 7th business day after the date on which you became aware that the originally filed questionnaire was
4 incomplete or inaccurate.)
31- Name of local government officer about whom theinformation In this section is being disclosed.
N/A
Wame of Officer
This section (item 3 including subparts A, 9, C. & D) must be completed for each officer with whom the vendor has an
employment or other business relationship as defined by Section 176.001 (1 -a), Local Government Code. Attach additional
pages to this Form CIO as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment
income, from the vendor?
F-1 Yes F-1 No 0
13. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local
government officer named in this section AND the taxable income is not received from the local governmental entity?
= Yes = No A11A
C- Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local
government officer serves as an officer or director, or holds an ownership interest of one percent or more?
= Yes = No IVIA
D. Describe each employment or business and family relationship with the local government officer named in this section.
A 1
H0,2ozi
Signature of r doing twsiness With the governmental entity Date
Adopted 8.t7;20t5
Sole Source Purchase Agreement — Gulf Highway Equipment Page 20 of 20