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Home My WebLink AboutContract 57328-R1CSC No. 57328-R1 CITY OF FORT WORTH CONTRACT RENEWAL NOTICE June 29, 2023 Safeware Inc. Kenneth Crawford 4403 Forbes Blvd. Lanham, MD 20706 Re: Contract Renewal Notice Contract No. CSC No. 57328 (the "Contract") Renewal Term No. 1: October 01, 2023 to September 30, 2024 The above referenced Contract with the City of Fort Worth expires on September 30, 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 http://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 (a,fortworthtexas. 2ov OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Contract Renewal 57328-R1 Page 1 of 3 ACCEPTED AND AGREED: CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including Byyale s'h-igton(Jul 17,202313:17CDT) ensuring all performance and reporting requirements. Name: Valerie Washington Title: Assistant Citv Manager Date: Jul 17, 2023 By:Br�rRay (Jul 14, 2023 09:09 CDT) APPROVAL RECOMMENDED: Name: Brenda Rav Byr sl avis(Ju114,202309:17CDT) Title: Fire Purchasina Manaaer Name: Jim Davis Title: Fire Chief APPROVED AS TO FORM AND LEGALITY: go44ann�� ATTEST: per. °°°° op�� 0~° °mod ��- °° ° °o °o*g° By: BEd454gpl:/ By: �/J� Name: Tavlor Paris Name: Jannette Goodall Title: Assistant Citv Attornev Title: Citv Secretary CONTRACT AUTHORIZATION: Me OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Contract Renewal 57328-R1 Page 2 of 3 Safeware Inc. By. d =" , )M. O Name: Jessica M. Faulkner Title: Assistant Secretary Contract Renewal 57328-R1 Page 3 of 3 v SAFEWARE ORDER ACKNOWLEDGEMENT 801 W. 116th Avenue Ste #400 Westminster, CO 80234 303-322-3577 www.safewareinc.com Bill To: Customer ID: Fort Worth Fire Department 505 West Felix Fort Worth, TX 76105 817-392-6589 PO Number FW036-5105 Freight Terms Freight Paid Sales Representative Kenneth Crawford Quantities Item ID Ordered Allocated Remaining UOM Unit Size I R q 1.00 0.00 0.00 EA C 1.0 1.00 0.00 0.00 EA C 1.0 1.00 0.00 1.00 EA D 1.0 1.00 0.00 1.00 EA D 1.0 2.00 0.00 2.00 EA D 1.0 1.00 0.00 1.00 EA D 1.0 Item Descrintion K_CRAWFORD For questions concerning this proposal please contact your local Safeware territory Manager Kenneth Crawford Direct line-281-755-3692 Safeware Office: 1-800-282-4782 Email- Kcrawford@safewareinc.com OMNIA OMNIA Contract #4400008468 Lead Agency: Fairfax County, VA Public Safety and Emergency Preparedness Standard freight within continental US is paid, all HAZMAT or expedited freight will be billed. *Register with OMNIA at www.onmiapartners.com/publicsector DRA 6406330 CMS CHIP, ACETIC ACID, 2.0-50 PPM DRA 6406440 CMS Chip Hydrogen Peroxide 0.2-2ppm DRA 6406400 PHOSPHINE -1, 0.10 - 2.5 PPM CHIP DRA 6406410 CMS Chip Phosphine 1.0-25ppm Order Number 10015252 Order Date Page 06/06/2023 16:13:33 1 of 3 Contract No: OMNIA Contract #4400008468 60368 Ship To: Fort Worth Fire Department 1000 Cherry Street Fort Worth, TX 76102 Ordered By: Captain Joseph Otey Taker Email Vicky Garcia vgarcia@safewareinc.com Phone Fax Pricing UOM Unit Size EA 1.0 EA 1.0 EA 1.0 EA 1.0 EA 1.0 EA 1.0 Unit Price 0.00 0.00 94.56 117.12 84.00 84.00 Extended Price 0.00 0.00 94.56 117.12 168.00 84.00 v SAFEWARE ORDER ACKNOWLEDGEMENT 801 W. 116th Avenue Order Number Ste #400 10015252 Westminster, CO 80234 Order Date Page 303-322-3577 06/06/2023 16:13:33 2 of 3 www.safewareinc.com Contract No: ONINIA Contract #4400008468 Quantities Pricing Item ID UOM Unit Extended Ordered Allocated Remainind UOM ° Item Description Price Price Unit Size q Unit Size 1.00 0.00 1.00 EA D DRA 6406420 EA 94.56 94.56 1.0 CMS Chip Phosphine 20-500ppm 1.0 1.00 0.00 1.00 EA D DRA 6406560 EA 94.56 94.56 1.0 CMS Chip Styrene 2.0-40ppm 1.0 1.00 0.00 1.00 BX D SEN 216S BX 72.80 72.80 10.0 Detector Tube, Acetic Acid, 1-5ppm 10.0 Ordered As: 216S 1.00 0.00 1.00 BX D SEN 102SC BX 72.80 72.80 1.0 Acetone (0.01-4.0 %v) 1.0 1.00 0.00 1.00 BX D SEN 140SA BX 72.80 72.80 1.0 Arsine (5-160 ppm) 1.0 1.00 0.00 1.00 BX D SEN 126SA BX 72.80 72.80 1.0 Tubes Carbon Dioxide 0.1-2.6pcty 1.0 1.00 0.00 1.00 BX D SEN 141 SB BX 72.80 72.80 1.0 Carbon Disulfide (0.8-50 ppm) 1.0 1.00 0.00 1.00 BX D SEN 147S BX 72.80 72.80 1.0 Carbon Tetrachloride (0.5-60 ppm) 1.0 1.00 0.00 1.00 BX D SEN 109SB BX 72.80 72.80 1.0 Tubes, Chlorine 1.0 1.00 0.00 1.00 EA D SEN 111U EA 83.07 83.07 1.0 Tubes, Isopropyl & Ethyl Acetate (10- 1.0 1000 ppm). One box 1.00 0.00 1.00 BX D SEN 171 SC BX 72.80 72.80 1.0 Formaldehyde Tube 1.0 1.00 0.00 1.00 BX D SEN 171 SB BX 72.80 72.80 1.0 Tubes, Formaldehyde 1.0 1.00 0.00 1.00 EA D SEN 137U EA 83.07 83.07 1.0 Tubes, Hydrogen (0.05-0.8 %v), One box 1.0 1.00 0.00 1.00 BX D SEN 112SB BX 72.80 72.80 1.0 Hydrogen Cyanide 0.5-100ppm 1.0 1.00 0.00 1.00 BX D SEN 156S BX 72.80 72.80 1.0 Tubes, Hydrogen Fluoride 1.0 1.00 0.00 1.00 BX D SEN 120SB BX 72.80 72.80 1.0 DETECTION TUBE .75-300 PPM 1.0 HYDROGEN SULFIDE 3.00 0.00 3.00 BX D SEN 131 BX 83.07 249.21 1.0 INORGANIC GASES 1.0 v SAFEWARE ORDER ACKNOWLEDGEMENT 801 W. 116th Avenue Order Number Ste #400 10015252 Westminster, CO 80234 Order Date Page 303-322-3577 06/06/2023 16:13:33 3 of 3 www.safewareinc.com Contract No: ONINIA Contract #4400008468 Quantities Pricing Item ID UOM Unit Extended Ordered Allocated Remaining UOM ° Item Description Price Price Unit Size q Unit Size 2.00 0.00 2.00 BX D SEN 142S BX 72.80 145.60 1.0 TUBE 1.0 TUBE, MERCURY VAPOR 1.00 0.00 1.00 BX D SEN 157SB BX 72.80 72.80 1.0 Methyl Bromide 0.4-80 ppm 1.0 1.00 0.00 1.00 BX D SEN 117SD BX 72.80 72.80 10.0 Nitrogen Dioxide range 0.1 - 1.0 ppm 10.0 1.00 0.00 1.00 BX D SEN 174A BX 72.80 72.80 1.0 NITRIC OXIDE 10-300 ppm 1.0 3.00 0.00 3.00 BX D SEN 186B BX 83.07 249.21 1.0 Organic gases (qualitative) 1.0 1.00 0.00 1.00 BX D SEN 121U BX 83.07 83.07 1.0 Phosphine (Range: 0.05 2.Oppm) 1.0 2.00 0.00 2.00 BX D SEN 134SB BX 83.07 166.14 1.0 Trichloroethylene (0.2-16 ppm)bx 1.0 Total Lines: 30 SUB -TOTAL: 2,804.17 TAX. 0.00 AMOUNT TENDERED: 0.00 AMOUNT DUE: 2,804.17 Actual freight added per freight terms v SAFEWARE ORDER ACKNOWLEDGEMENT 801 W. 116th Avenue Ste #400 Westminster, CO 80234 303-322-3577 www.safewareinc.com Bill To: Customer ID: Fort Worth Fire Department 505 West Felix Fort Worth, TX 76105 817-392-6589 PO Number FW036-5146 Freight Terms Freight Paid Sales Representative Kenneth Crawford Quantities Item ID Ordered Allocated Remainine UOM Unit Size q Item Description 1.00 0.00 0.00 EA C K CRAWFORD 1.0 For questions concerning this proposal please contact your local Safeware territory Manager Kenneth Crawford Direct line-281-755-3692 Safeware Office: 1-800-282-4782 Email- Kcrawford@safewareinc.com 1.00 0.00 0.00 EA C OMNIA 1.0 OMNIA Contract #4400008468 Lead Agency: Fairfax County, VA Public Safety and Emergency Preparedness Standard freight within continental US is paid, all HAZMAT or expedited freight will be billed. *Register with OMNIA at www.omniapartners.com/publicsector 1.00 0.00 1.00 EA D DRA 8610470 1.0 Acetone 25 - 5,000 ppm TBD 1.00 0.00 1.00 EA D DRA 8610380 1.0 Alcohol 10 - 5,000 ppm 1.00 0.00 1.00 EA D DRA 8610130 1.0 Ammonia 1 - 100 ppm 1.00 0.00 1.00 EA D DRA 8610020 1.0 Ammonia 100 - 2500 ppm Order Number 10022090 Order Date Page 06/21/2023 14:11:57 1 of 3 Contract No: OMNIA Contract #4400008468 60368 Ship To: Fort Worth Fire Department #2 1000 Cherry Street Fort Worth, TX 76102 Ordered By: Captain Joseph Otey Taker Email Vicky Garcia vgarcia@safewareinc.com Phone Fax Pricing UOM Unit Size EA 1.0 EA 1.0 EA 1.0 EA 1.0 EA 1.0 EA 1.0 Unit Price 0.00 0.00 86.16 96.96 86.16 86.16 Extended Price 0.00 0.00 86.16 96.96 86.16 86.16 v SAFEWARE ORDER ACKNOWLEDGEMENT 801 W. 116th Avenue Order Number Ste #400 10022090 Westminster, CO 80234 Order Date Page 303-322-3577 06/21/2023 14:11:57 2 of 3 www.safewareinc.com Contract No: OMNIA Contract #4400008468 Quantities Pricing Item ID UOM Unit Extended Ordered Allocated Remainind UOM ° Item Description Price Price Unit Size q Unit Size 1.00 0.00 1.00 EA D DRA 8610600 EA 176.64 176.64 1.0 MT Benzene 1-150 ppb 1.0 1.00 0.00 1.00 EA D DRA 8610030 EA 160.32 160.32 1.0 MT Benzene 0.15-10 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610280 EA 77.11 77.11 1.0 MT Benzene 10 - 100 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610460 EA 142.08 142.08 1.0 MT1,3-Butadiene 25-500 ppb 1.0 1.00 0.00 1.00 EA D DRA 8610300 EA 106.56 106.56 1.0 MT 1,3-Butadiene 0.5-25 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610190 EA 86.16 86.16 1.0 Carbon Dioxide 200 - 50000 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610080 EA 86.16 86.16 1.0 Carbon Monoxide 10 - 1000 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610010 EA 86.16 86.16 1.0 Chlorine 50 - 5000 ppb 1.0 1.00 0.00 1.00 EA D DRA 8610290 EA 22.89 22.89 1.0 Demo, for Training, NA 1.0 1.00 0.00 1.00 EA D DRA 8610200 EA 156.48 156.48 1.0 MT Ethylene Oxide 25-250 ppb 1.0 1.00 0.00 1.00 EA D DRA 8610580 EA 176.64 176.64 1.0 MT Ethylene Oxide 0.25-10 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610540 EA 176.64 176.64 1.0 MT Formaldehyde 5-150 ppb 1.0 1.00 0.00 1.00 EA D DRA 8610100 EA 89.52 89.52 1.0 MT Formaldehyde 0.15-3 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610090 EA 89.52 89.52 1.0 Hydrochloric Acid 0.5 - 25 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610520 EA 86.16 86.16 1.0 Hydrocyanic Acid 0.5 - 50 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610050 EA 86.16 86.16 1.0 MT HydrogenSulfide 0.1-50 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610220 EA 77.11 77.11 1.0 MT Hydrogen Sulfide 100 - 2,000 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610360 EA 120.00 120.00 1.0 Mercaptan 50 - 6,000 ppb 1.0 1.00 0.00 1.00 EA D DRA 8610350 EA 176.64 176.64 v SAFEWARE ORDER ACKNOWLEDGEMENT 801 W. 116th Avenue Order Number Ste #400 10022090 Westminster, CO 80234 Order Date Page 303-322-3577 06/21/2023 14:11:57 3 of 3 www.safewareinc.com Contract No: ONINIA Contract #4400008468 Quantities Pricing Item ID UOM Unit Extended Ordered Allocated Remaining UOM a Item Description price Price Unit Size q Unit Size 1.0 MT Mercury 0.005-0.25 mg/m 1.0 1.00 0.00 1.00 EA D DRA 8610530 EA 77.11 77.11 1.0 MTBE 2-200 ppm - Methyl tert-butyl ether 1.0 1.00 0.00 1.00 EA D DRA 8610120 EA 86.16 86.16 1.0 Nitrogen Dioxide 0.25 - 50 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610060 EA 86.16 86.16 1.0 Nitrous Fumes 0.25 - 50 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610430 EA 86.44 86.44 1.0 MT Ozone 10-1000 ppb 1.0 1.00 0.00 1.00 EA D DRA 8610040 EA 86.16 86.16 1.0 Perchloroethylene 1 - 500 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610270 EA 96.96 96.96 1.0 MT Petroleum Hydrocarbons 10-3000 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610340 EA 156.48 156.48 1.0 Phosgene 2 - 1,000 ppb 1.0 1.00 0.00 1.00 EA D DRA 8610110 EA 86.16 86.16 1.0 Sulphur Dioxide 0.05 - 5 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610250 EA 86.16 86.16 1.0 MT Toluene 10-1000 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610320 EA 81.56 81.56 1.0 MT Trichlorethylene 0.25-50 ppm 1.0 1.00 0.00 1.00 EA D DRA 8610260 EA 86.16 86.16 1.0 MT Xylene 10-1000 ppm 1.0 Total Lines: 36 SUB -TOTAL: 3,549.90 TAX. 0.00 AMOUNT TENDERED: 0.00 AMOUNT DUE: 3,549.90 Actual freight added per freight terms CSC No. 57328-Al FIRST AMENDMENT TO FORT WORTH CITY SECRETARY CONTRACT NO. 57328 This FIRST AMENDMENT to Fort Worth City Secretary Contract No. 57328 ("Amendment") is made and entered into by and between the City of Fort Worth, a home -rule municipal corporation of the State of Texas ("City"), acting herein by and through Fernando Costa, its duly authorized Assistant City Manager, and Safeware, Inc. ("Vendor"), acting herein by and through Jessica M. Faulkner, its duly authorized Assistant Secretary. City and Vendor are individually referred to as a "party" and collectively referred to as the "parties". WHEREAS, City and Vendor are currently parties to an agreement for Vendor to provide safety supplies, the same being Fort Worth City Secretary Contract No. 57328 (the "Agreement"); WHEREAS, the Agreement provides for a 6-month initial term with five (5) one-year renewal terms; WHEREAS, the parties now wish to amend the Agreement to increase the maximum amount to be expended under the contract, for the initial term or any following renewal term, to a total not to exceed $254,000.00. NOW THEREFORE, known by all these present, Fort Worth and Vendor, acting herein by the through their duly authorized representatives, agree to the following terms, which amend the Agreement as follows: 1_ The Agreement is hereby amended by deleting the second paragraph, section regarding "Compensation" and replacing it with the following: 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 the initial term or any following renewal term under this Agreement by City shall be in an amount not to exceed Two Hundred Fifty -Four Thousand Dollars ($254,000.00) per year. Vendor shall 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 shall not be liable for any additional expenses of Vendor not specified by this Agreement unless City first approves such expenses in writing. 2 Except as expressly modified in this Amendment, all other terms and conditions of the Agreement shall remain in full force and effect. OFFICIAL RECORD ACCEPTED AND AGREED: CITY SECRETARY FT. WORTH, TX First Amendment to Fort Worth City Secretary Contract No. 57328 Page 1 of 2 City of Fort Worth By: Name: Fernando Costa Oct 23, 2022 Title: Assistant City Manager Approval Recommended: By: Neil Nett 23, 20)2�56 CDT) Name: Neil Noakes Title: Chief of Police Attest: By: � ;111�11 S. Goodall (Oct 24, 2022�09: CDT) T) Name: Jannette S. Goodall a.��,d4FvOn�n� a °°o0o0o00Ti le: City Secretary XYo0 0 o° 0o 0g ° °�s d� VENDOR: °O000000°*�d d �� EXp?gAp Imf SAFEWARE, INC. Name: JAsica M. Faulkner Title: Assistant 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: Sasha Kane (Oct 20, 2022 14:59 CDT) Name: Sasha Kane Title: Senior Contract Compliance Specialist Approved as to Form and Legality Nicc Arias ( c 20,�2 13:30 CDT) By: Name: Nico Arias Title: Assistant City Attorney CONTRACT AUTHORIZATION: M&C: 21-0237 Date Approved: 4/6/2021 Form 1295 Certification No.: 2021-713519 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX First Amendment to Fort Worth City Secretary Contract No. 57328 Page 2 of 2 CSC No. 57328 FORT WORTH CITY OF FORT WORTH COOPERATIVE PURCHASE AGREEMENT This Cooperative Purchase Agreement ("Agreement") is entered into by and between Safeware Inc. ("Vendor") and the City of Fort Worth, ("City"), a Texas home rule municipality. The Cooperative Purchase Agreement includes the following documents which shall be construed in the order of precedence in which they are listed: 1. This Cooperative Purchase Agreement; 2. Exhibit A — Safeware Inc Quote #1867125 3. Exhibit B — Cooperative Agency Contract OMNIA #4400008468; 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 the initial term of this Agreement by City shall be up to the amount of Fifty Thousand Dollars ($50,000.00). 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 shall begin upon execution by the Assistant City Manager for the City and end on September 30, 2022. The City shall be able to renew this agreement for five (5) one- year renewal options by written agreement of the parties. 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: City of Fort Worth and Safeware Inc. Page 1 of 14 Cooperative Agency Contract OMNIA #4400008468 To CITY: City of Fort Worth Attn: Valerie Washington, Assistant City Manager 200 Texas Street Fort Worth, TX 76102-6314 Facsimile: (817) 392-6192 With copy to Fort Worth City Attorney's Office at same address To VENDOR: Safeware Inc. Kenneth Crawford 4403 Forbes Blvd. Lanham, MD 20706 Facsimile: N/A kcrawford@safewareinc.com 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: klgGeni hwhl ne By: Valerie Washington (Mar 31, 26-f211:18 CDT) Name: Valerie Washington Title: Assistant City Manager Date: M a r 31, 2022 APPROVAL RECOMMENDED: By: J s Davis (Mar 30, 2022 16:08 CDT) Name: James E. Davis Title: Fire Chief ATTEST: Jannol1'e S. Goodall By: Jannette S. Goodall (Mar 31, 2022 12:42 CDT) Name: Jannette Goodall Title: City Secretary VENDOR: Safeware Inc. By: • �U UXJI�YIP/l— ame: Jessica M. Faulkner Title: Assistant Secretary Date: 3/29/2022 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: BV a Ra`y (Mar 30, 202211:40 CDT) Name: Brenda Ray Title: Sr. Contract Compliance Specialist APPROVED AS TO FORM AND LEGALITY: By: Name: Taylor Paris Title: Assistant City Attorney CONTRACT AUTHORIZATION: M&C: N/A City of Fort Worth and Safeware Inc. Page 2 of 14 Cooperative Agency Contract OMNIA #4400008468 v SAFEWARE EXHIBIT A QUOTATION 801 W. 116th Avenue Ste #400 Westminster, CO 80234 303-322-3577 www.safewareinc.com Bill To: Customer ID: Fort Worth Fire Department 505 West Felix Fort Worth, TX 76105 817-392-6589 PO Number Draeger-2022-02-0 8 13 :09: 5 9 Freight Terms Freight Paid Sales Representative Kenneth Crawford Quantities Order Number 1867125 Order Date Page 02/08/2022 13:07:46 1 of 5 Quote Expires On: 04/15/2022 60368 Ship To: Fort Worth Fire Department 1000 Cherry Street Fort Worth, TX 76102 Requested By: Captain Joseph Otey Taker Email Vicky Garcia vgarcia@safewareinc.com Phone Fax Item ID Ordered Allocated Remaining UOM ° Unit Size 9j Item Description 1.00 0.00 1.00 EA K CRAWFORD 1.0 For questions concerning this proposal please contact your local Safeware territory Manager Kenneth Crawford Direct line- 281-755-3692 Safeware Office: 1-800-282-4782 Email- Krrawford@safewareinc.com 3.00 0.00 3.00 EA DRA 8610800 Safeware Catalog Price: 5,613.56 Contract Discount: 41 % 1.0 X- act 7000 3.00 0.00 3.00 EA DRA 8327115 Safeware Catalog Price: 595.53 Contract Discount: 41 % 1.0 Drager X-am pump incl. USB charger and shoulder strap 3.00 0.00 3.00 EA DRA 3701985 Safeware Catalog Price: 74.85 Contract Discount: 41 % 1.0 Pre Tube Holder X-act 7000 3.00 0.00 3.00 PK DRA 3702013 Safeware Catalog Price: 76.47 Contract Discount: 41 % 10.0 Tube ppb-Booster Basic, Pack of 10 3.00 0.00 3.00 EA DRA 6401200 Safeware Catalog Price: 72.41 Contract Discount: 41 % 1.0 TUBE OPENER 7000 Pricing UOM Unit Price Unit Size EA 0.00 1.0 EA 3,312.00 Your Discount: 41.00% 1.0 EA 351.36 Your Discount: 41.00% 1.0 EA 44.16 Your Discount: 41.00% 1.0 PK 45.12 Your Discount: 41.00% 10.0 EA 42.72 Your Discount: 41.00% 1.0 Extended Price 0.00 9,936.00 1,054.08 132.48 135.36 128.16 City of Fort Worth and Safeware Inc. Page 3 of 14 Cooperative Agency Contract OMNIA #4400008468 v SAFEWARE QUOTATION 801 W. 116th Avenue Order Number Ste #400 1867125 Westminster, CO 80234 Order Date Page 303-322-3577 02/08/2022 13:07:46 2 of 5 www.safewareinc.com Quote Expires On: 04/15/2022 Quantities Pricing Item ID UOM Unit Extended Ordered Allocated RemainineI UOM Unit Size ° q Item Descrintion Unit Size Price Price 3.00 0.00 3.00 EA DRA 3703690 EA 313.92 941.76 Safeware Catalog Price: 532.07 Contract Discount: 41 % Your Discount: 41.00% 1.0 Case, X-act 7000 with insert 1.0 3.00 0.00 3.00 EA DRA 8610810 EA 150.72 452.16 Safeware Catalog Price: 255.46 Contract Discount: 41 % Your Discount: 41.00% 1.0 Coupler X-act 7000 1.0 3.00 0.00 3.00 KT DRA 3705997 KT 93.12 279.36 Safeware Catalog Price: 157.83 Contract Discount: 41 % Your Discount: 41.00% 1.0 Filter Kit, 20 pcs 1.0 3.00 0.00 3.00 EA DRA 8325706 EA 235.20 705.60 Safeware Catalog Price: 398.64 Contract Discount: 41 % Your Discount: 41.00% 1.0 Hose 10 m, cpl. with adapters 1.0 3.00 0.00 3.00 EA DRA 8316533 EA 240.00 720.00 Safeware Catalog Price: 406.78 Contract Discount: 41 % Your Discount: 41.00% 1.0 Telescopic probe ES 1501.5M(5 FT) 1.0 2.00 0.00 2.00 EA DRA 8610470 EA 81.36 162.72 Safeware Catalog Price: 137.90 Contract Discount: 41 % Your Discount: 41.00% 1.0 Acetone 25 - 5,000 ppm TBD 1.0 2.00 0.00 2.00 EA DRA 8610380 EA 91.20 182.40 Safeware Catalog Price: 154.58 Contract Discount: 41 % Your Discount: 41.00% 1.0 Alcohol 10 - 5,000 ppm 1.0 2.00 0.00 2.00 EA DRA 8610130 EA 79.68 159.36 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 Ammonia 1 - 100 ppm 1.0 2.00 0.00 2.00 EA DRA 8610020 EA 79.68 159.36 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 Ammonia 100 - 2500 ppm 1.0 2.00 0.00 2.00 EA DRA 8610600 EA 164.16 328.32 Safeware Catalog Price: 278.24 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT Benzene 1-150 ppb 1.0 2.00 0.00 2.00 EA DRA 8610030 EA 148.80 297.60 Safeware Catalog Price: 252.20 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT Benzene 0.15-10 ppm 1.0 1.00 0.00 1.00 EA DRA 8610460 EA 131.52 131.52 Safeware Catalog Price: 222.92 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT1,3-Butadiene 25-500 ppb 1.0 1.00 0.00 1.00 EA DRA 8610300 EA 98.88 98.88 City of Fort Worth and Safeware Inc. Page 4 of 14 Cooperative Agency Contract OMNIA #4400008468 v SAFEWARE QUOTATION 801 W. 116th Avenue Order Number Ste #400 1867125 Westminster, CO 80234 Order Date Page 303-322-3577 02/08/2022 13:07:46 3 of 5 www.safewareinc.com Quote Expires On: 04/15/2022 Quantities Pricing Item ID UOM Unit Extended Ordered Allocated Remainke UOM Unit Size q Item Descrintion Unit Size Price Price Safeware Catalog Price: 167.59 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT 1,3-Butadiene 0.5-25 ppm 1.0 2.00 0.00 2.00 EA DRA 8610190 EA 79.68 159.36 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 Carbon Dioxide 200 - 50000 ppm 1.0 2.00 0.00 2.00 EA DRA 8610080 EA 79.68 159.36 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 Carbon Monoxide 10 - 1000 ppm 1.0 2.00 0.00 2.00 EA DRA 8610010 EA 81.36 162.72 Safeware Catalog Price: 137.90 Contract Discount: 41 % Your Discount: 41.00% 1.0 Chlorine 50 - 5000 ppb 1.0 1.00 0.00 1.00 EA DRA 8610200 EA 144.96 144.96 Safeware Catalog Price: 245.69 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT Ethylene Oxide 25-250 ppb 1.0 1.00 0.00 1.00 EA DRA 8610580 EA 164.16 164.16 Safeware Catalog Price: 278.24 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT Ethylene Oxide 0.25-10 ppm 1.0 2.00 0.00 2.00 EA DRA 8610540 EA 164.16 328.32 Safeware Catalog Price: 278.24 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT Formaldehyde 5-150 ppb 1.0 2.00 0.00 2.00 EA DRA 8610100 EA 82.56 165.12 Safeware Catalog Price: 139.93 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT Formaldehyde 0.15-3 ppm 1.0 2.00 0.00 2.00 EA DRA 8610090 EA 82.56 165.12 Safeware Catalog Price: 139.93 Contract Discount: 41 % Your Discount: 41.00% 1.0 Hydrochloric Acid 0.5 - 25 ppm 1.0 2.00 0.00 2.00 EA DRA 8610520 EA 79.68 159.36 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 Hydrocyanic Acid 0.5 - 50 ppm 1.0 2.00 0.00 2.00 EA DRA 8610050 EA 79.68 159.36 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT HydrogenSulfide 0.1-50 ppm 1.0 2.00 0.00 2.00 EA DRA 8610360 EA 113.28 226.56 Safeware Catalog Price: 192.00 Contract Discount: 41 % Your Discount: 41.00% 1.0 Mercaptan 50 - 6,000 ppb 1.0 2.00 0.00 2.00 EA DRA 8610350 EA 164.16 328.32 Safeware Catalog Price: 278.24 Contract Discount: 41 % Your Discount: 41.00% City of Fort Worth and Safeware Inc. Page 5 of 14 Cooperative Agency Contract OMNIA #4400008468 v SAFEWARE QUOTATION 801 W. 116th Avenue Order Number Ste #400 1867125 Westminster, CO 80234 Order Date Page 303-322-3577 02/08/2022 13:07:46 4 of 5 www.safewareinc.com Quote Expires On: 04/15/2022 Quantities Pricing Item ID UOM Unit Extended Ordered Allocated Remaining UOM ° Unit Size q Item Descrintion Unit Size Price Price 1.0 MT Mercury 0.005-0.25 mg/m 1.0 1.00 0.00 1.00 EA DRA 8610120 EA 79.68 79.68 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 Nitrogen Dioxide 0.25 - 50 ppm 1.0 1.00 0.00 1.00 EA DRA 8610060 EA 79.68 79.68 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 Nitrous Fumes 0.25 - 50 ppm 1.0 1.00 0.00 1.00 EA DRA 8610040 EA 81.36 81.36 Safeware Catalog Price: 137.90 Contract Discount: 41 % Your Discount: 41.00% 1.0 Perchloroethylene 1 - 500 ppm 1.0 2.00 0.00 2.00 EA DRA 8610270 EA 89.28 178.56 Safeware Catalog Price: 151.32 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT Petroleum Hydrocarbons 10-3000 ppm 1.0 1.00 0.00 1.00 EA DRA 8610340 EA 147.84 147.84 Safeware Catalog Price: 250.58 Contract Discount: 41 % Your Discount: 41.00% 1.0 Phosgene 2 - 1,000 ppb 1.0 1.00 0.00 1.00 EA DRA 8610110 EA 79.68 79.68 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 Sulphur Dioxide 0.05 - 5 ppm 1.0 2.00 0.00 2.00 EA DRA 8610250 EA 79.68 159.36 Safeware Catalog Price: 135.05 Contract Discount: 41% Your Discount: 41.00% 1.0 MT Toluene 10-1000 ppm 1.0 2.00 0.00 2.00 EA DRA 8610260 EA 79.68 159.36 Safeware Catalog Price: 135.05 Contract Discount: 41 % Your Discount: 41.00% 1.0 MT Xylene 10-1000 ppm 1.0 1.00 0.00 1.00 EA OMNIA EA 0.00 0.00 1.0 OMNIA Contract #4400008468 1.0 Lead Agency: Fairfax County, VA Public Safety and Emergency Preparedness Standard freight within continental US is paid, all HAZMAT or expedited freight will be billed. *Register with OMNIA at www.omniapartners.com/publicsector City of Fort Worth and Safeware Inc. Page 6 of 14 Cooperative Agency Contract OMNIA #4400008468 v SAFEWARE QUOTATION 801 W. 116th Avenue Ste #400 Westminster, CO 80234 303-322-3577 www.safewareinc.com Quantities Item ID Ordered Allocated Remaining UOM Item Descrit7tion Unit Size q Total Lines: 40 Order Number 1867125 Order Date Page 02/08/2022 13:07:46 5 of 5 Quote Expires On: 04/15/2022 Pricing UOM Unit Extended Price Price Unit Size SUB -TOTAL: 19,293.36 TAX. 0.00 AMOUNT DUE: 19,293.36 Actual freight added per freight terms City of Fort Worth and Safeware Inc. Cooperative Agency Contract OMNIA #4400008468 Page 7 of 14 EXHIBIT B -j OF FAl� 9 County of Fairfax, Virginia To protect and enrich the quality of life for the people, neighborhoods and diverse communities of Fairfax 1742 County IR GnAl Date of Award: JUN ` 7 2018 Safeware, Inc. 4403 Forbes Blvd Lanham, MD 20706 Attention: Rick Bond, Vice President of Sales Reference: RFP2000002547; Public Safety and Emergency Preparedness Equipment and Related Services Dear Mr. Bond: Acceptance Aareemenj Contract Number: 4400008468 This acceptance agreement signifies a contract award for Public Safety and Emergency Preparedness Equipment and Related Services. The period of the contract shall be from October 1, 2018 through September 30, 2023 with renewals of five (5) additional years, one (1) year at a time or a combination of the years, by mutual agreement of both parties. The contract award shall be in accordance with: 1) This Acceptance Agreement; and 2) The Attached Memorandum of Negotiations. Please note that this is not an order to proceed. A Purchase Order, which constitutes your notice to proceed, will be issued to your firm. Please provide your Insurance Certificate according to Fairfax County Special Provisions, Section 1 (Insurance) within ten (10) days after receipt of this letter. Sincerely, Cathy A. Muje, CPPO Director/County Purchasing Agent Department of Procurement & Material Management 12000 Government Center Parkway, Suite 427 Fairfax, VA 22035-0013 Website: «,ww.fairfaxcountv.eov/donun Phone 703-324-3201, TTY: 1-800-828-1140, Fax: 703-324-3228 City of Fort Worth and Safeware Inc. Page 8 of 14 Cooperative Agency Contract OMNIA #4400008468 Ol' F� County of Fairfax, Virginia To protect and enrich the quality of life for the people, neighborhoods and diverse communities of Fairfax 1742 County GL 'IA MEMORANDUM OF NEGOTIATIONS RFP 2000002547 Public Safety and Emergency Preparedness Equipment and Related Services The County of Fairfax (hereinafter called the County) and Safeware, Inc. and Mallory Safety and Supply, LLC. (hereinafter called the Contractor) hereby agree to the following in the execution of Contract 4400008468 with Safeware, Inc. and Contract 4400008495 with Mallory Safety and Supply, LLC. (hereinafter called the Contract) for the provision of public safety and emergency preparedness equipment and related services. The final Contract contains the following documents: a. The County's Request for Proposal RFP 2000002547 and all Addenda; b. The Contractor's Technical Proposal and Cost Proposal dated March 8, 2018; C. The Contractor's response to clarification questions dated March 28, 2018. d. The Contractor's response to items for negotiation dated April 12, 2018. e. This Memorandum of Negotiations; f. County's purchase order; g. Any subsequent amendments to the Contract. In addition, the County and the Contractor agree to the following: The parties to this Contract acknowledge that Safeware, Inc. submitted a proposal, on behalf of Safeware, Inc. and Mallory Safety and Supply, LLC., in response to RFP2000002547. Mallory Safety and Supply, LLC. acknowledges and agrees to provide public safety and emergency preparedness equipment and related services to Participating Public Agencies of the states of Alaska, Hawaii, Washington, Oregon, California, Arizona, Nevada, New Mexico, Wyoming, Idaho, Montana, and Utah and to assume all responsibilities and obligations under this Contract for its designated territory. Safeware, Inc. acknowledges and agrees to provide public safety and emergency preparedness equipment and related services to Participating Public Agencies located in all other states of the United States, not identified above and to assume all responsibilities and obligations under this Contract for its designated territory. Contract number 4400008468 has been assigned to Safeware, Inc. and Contract number 4400008495 has been assigned to Mallory Safety and Supply LLC. to facilitate ordering. 2. The Contractor shall provide ecommerce rebates as outlined below: If 30%-69.99% of total invoiced sales are received by website orders at the conclusion of each contract year, a 0.5% rebate will be provided on purchases made through ecommerce. If 70% or greater of total invoiced sales are received by website orders at the conclusion of each contract year, a 1 % rebate will be provided on purchases made through ecommerce. o Conditions: The agency total purchases for the annual contract period must be greater than $20,000. Ecommerce is defined as any order placed through Safeware or Mallory's website or fully integrated third party marketplace where the Participating Public Agency's orders and Safeware-Mallory's invoices are transacted via EMI, XML or cXML. Ecommerce rebates cannot be combined with other rebates, early payment discounts, or where the buying agency or procurement platform charges an administrative or transaction fee. Department of Procurement&.. Material Management 12000 Government Center Parkway, Suite 427 Fairfax, VA 22035-0013 Website: www.fairfaxcountv.eovldumm Phone 703-324-3201, TTY: 1-800-828-1140, Fax: 703-324-3228 City of Fort Worth and Safeware Inc. Page 9 of 14 Cooperative Agency Contract OMNIA #4400008468 Memorandum of Negotiations RFP2000002547 Page 2 3. Large sales greater than $20,000 maybe eligible for additional price discounts from manufacturers and will be automatically flagged in the Contractor's system to seek additional price concessions from manufacturers. 4. For purchase of services under this Contract, the Contractor shall provide a minimum of 10% discount from Safeware and Mallory's list price. The pricing for services may be negotiated to a lower price. 5. The Contractor acknowledges and agrees that the County and the Participating Public Agencies reserve the right to review and negotiate the license and maintenance terms and conditions prior to any purchase of software under this Contract and that the Contractor will provide full support for executing the negotiated license/maintenance agreement(s) by the County/Participating Public Agencies and the software publisher. The Contractor also agrees to obtain agreement from its software publishers that their shrink wrap, browse wrap, click through, or similar processes are for access purposes only, and any terms and conditions offered in or referenced by those procedures will have no force or effect. 6. The Contractor shall hold the discount rate of 41 % for equipment and 10% for services firm for the entire contract term including renewal periods. 7. The parties mutually agree that the first sentence of Paragraph 1.3 of Section 1 titled Insurance (Fairfax County Special Provisions) is deleted and is replaced with the following language: No change, cancellation, or non -renewal shall be made in any insurance coverage without a thirty -day written notice to the County Purchasing Agent and/or Risk Manager. 8. The parties mutually agree that the Paragraph 1.2 b. of Section 1 titled Insurance (Fairfax County Special Provisions) is deleted and is replaced with the following language: The contractor agrees to maintain Commercial General Liability insurance in the amount of $1,000,000 per occurrence/aggregate, to protect the contractor, its subcontractors, and the interest of the County, against any and all injuries to third parties, including bodily injury and personal injury, wherever located, resulting from any action or operation under the contract or in connection with contracted work. ACCEPTED BY: Safeware, Inc. Date 51& �6A1rig Mallory Safety and Sp�Y ply, !_LC. Date 617,116 Cathy A. Mus fu CPPO Date Director/County Purchasing Agent City of Fort Worth and Safeware Inc. Page 10 of 14 Cooperative Agency Contract OMNIA #4400008468 OMNIA P A R T N E R S PUBLIC SAFETY AND EMERGENCY PREPAREDNESS EQUIPMENT AND RELATED SERVICES Executive Summary Lead Agency: County of Fairfax, VA RFP Issued: February 6, 2018 Response Due Date: March 13, 2018 Awarded to: Safeware, Inc.: Contract #4400008468 Solicitation: 2000002547 Pre -Proposal Date: February 22, 2018 Proposals Received: #10 Fairfax County, Virginia Department of Procurement & Material Management (DPMM) issued RFP #2000002547 on February 6, 2018, to establish a national cooperative contract for Public Safety and Emergency Preparedness Equipment and Related Services. The solicitation included cooperative purchasing in No.1. Master Agreement: Fairfax County, VA (herein 'lead Public Agency" on behalf of itself and all states, local governments, school districts, and higher education institutions in the United States of America, and other government agencies and nonprofit organizations (herein "Participating Public Agencies") is soliciting proposals from qualified suppliers to enter into a Master Agreement for a complete line of Public Safety and Emergency Preparedness Equipment and Related Services (herein 'Products and Services"). And No.4. U.S. Communities: U.S. Communities Government Purchasing Alliance (herein "U.S. Communities") helps Participating Public Agencies to reduce the cost of purchased goods through strategic sourcing that combines the purchasing power of public agencies nationwide. This is accomplished through an award of competitively solicited contracts for high quality products and services by large and well recognized public agencies (herein 'lead Public Agencies"). The contracts are available for use by the respective Lead Public Agency and, also, by other Participating Public Agencies. Notice of the solicitation was sent to potential offerors, as well as advertised in the following: • The Buy Line Blog, Seattle.gov • The Honolulu Star, HI • Merx.com • The New York State Contract Reporter, NYSCR.ny.gov • ONVIA Page 1 of 2 • Pamplin Media Group - Portland, OR, legals@commnewspapers.com • U.S. Communities — Website • The ADVOCATE, LA • The Daily Journal of Commerce, WA City of Fort Worth and Safeware Inc. Cooperative Agency Contract OMNIA #4400008468 Page 11 of 14 On March 13, 2018 proposals were received from the following offerors: • Federal Resources • Safeware, Inc. • Tactical & Survival Specialties, Inc. (TSSI) • WatchGuard, Inc. • STRACK, Inc. • Atlantic Emergency Solutions • L.N. Curtis & Sons • Digital Ally, Inc. • Moser Training Solutions, LLC • Products Unlimited, Inc. Ten (10) Proposal were received. Using the evaluation criteria established in the RFP, five (5) were disqualified (Atlantic Emergency Solutions, L.N. Curtis & Sons, Digital Ally, Inc., Moser Training Solutions, LLC and Products Unlimited, Inc.) and the other Five (5) proposals (Federal Resources, Safeware, Inc., TSSI, WatchGuard, Inc. and STRACK, Inc.) were deemed responsive and upon evaluation, the committee elected to award to Safeware, Inc. and Mallory Safety and Supply, LLC. as the top Offerors for public safety and emergency preparedness equipment and related services. Contract includes: Safeware, Inc. offers a robust selection of products in public safety and emergency preparedness equipment and related services. Solution benefits include: • Comprehensive website offering related public safety and emergency preparedness • No minimum quantity required and no freight charges for non-hazmat shipments Term: Contract period from October 1, 2018 through September 30, 2023 with the option to renew to a maximum of five (5) additional (1) year periods, through September 30, 2028. Pricing/Discount: • Discount rate of 41% for equipment and 10% for services • Larges sales may be eligible for additional price discounts • Offering eCommerce rebates OMNIA Partners, Public Sector Landing Pages: https://public.omniMartners.com/suppliers/safeware- mallorv/contract-documentation Page 2 of 2 City of Fort Worth and Safeware Inc. Page 12 of 14 Cooperative Agency Contract OMNIA #4400008468 EXHIBIT C CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity FORM CIQ This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. jJ Name of vendor who has a business relationship with local governmental entity. Safeware, Inc. J ❑ Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) J Name of local government officer about whom the information is being disclosed. NONE Name of Officer J Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes F-1 No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? 71 Yes F1 No J Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. J ❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). J AQ.u.Qkn� 3/25/2022 Sj nature o vendor doing business with the governmental entity Date City of Fort Worth and Safeware Inc. Cooperative Agency Contract OMNIA #4400008468 Form provided by Texas Ethics Commission www.ethics.state.tx.us Page 13 of 14 Revised 1/1/2021 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code § 176.0010-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code § 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code § 176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. City of Fort Worth and Safeware Inc. Cooperative Agency Contract OMNIA #4400008468 Form provided by Texas Ethics Commission www.ethics.state.tx.us Page 14 of 14 Revised 1/1/2021