Loading...
HomeMy WebLinkAboutContract 61377 (2)FORT WORTH CSC No. 61377 CITY OF FORT WORTH COOPERATIVE PURCHASE AGREEMENT This Cooperative Purchase Agreement ("Agreement") is entered into by and between CEC Facilities Group, LLC ("Vendor") and the City of Fort Worth, ("City"), a Texas home rule municipality. The Cooperative Purchase Agreement includes the following documents which shall be construed in the order of precedence in which they are listed: 1. This Cooperative Purchase Agreement; 2. Exhibit A — Seller's Quote; 3. Exhibit B — Purchasing Cooperative of America OD-355-21 and OFFICIAL RECORD 4. Exhibit C — Conflict of Interest Questionnaire. CITY SECRETARY FT. WORTH, TX The Exhibits referenced above, 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. If any provisions of the attached documents, conflict with the terms herein, are prohibited by applicable law, conflict with any applicable rule, regulation or ordinance of City, the terms in this Agreement shall control City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance with the provisions of this Agreement. Total payment made under this Agreement for the first year by City shall not exceed Seventeen Thousand Dollars ($17,000.00). 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 be effective beginning on the date signed by the Assistant City Manager below ("Effective Date") and ending on October 10, 2025, City shall be able to renew this agreement for One (1) one-year 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: To CITY: To VENDOR: City of Fort Worth CEC Facilities Group, LLC Attn: Mark McDaniel, Assistant City Manager 1275 Valley View Ln. 200 Texas Street Irving, TX. 75061 Fort Worth, TX 76102-6314 Facsimile: N/A Facsimile: (817) 392-8654 With copy to Fort Worth City Attorney's Office at same address IP Indemnification. Vendor agrees to indemnify, defend, settle, or pay, at its own cost and expense, including the payment of attorney's fees, any claim or action against the City for infringement of any patent, copyright, trade mark, service mark, trade secret, or other intellectual property right arising from City's use of the Deliverable(s), or any part thereof, in accordance with the Agreement, it being understood that the agreement to indemnify, defend, settle or pay shall not apply if City modifies or misuses the Deliverable(s). So long as Vendor bears the cost and expense of payment for claims or actions against the City pursuant to this section, Vendor shall 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 shall have the right to fully participate in any and all such settlement, negotiations, or lawsuit as necessary to protect the 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 the City for infringement arising under the Agreement, the City shall 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 shall fully participate and cooperate with the 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, the City's assumption of payment of costs or expenses shall not eliminate Vendor's duty to indemnify the City under the Agreement. If the Deliverable(s), 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 shall, at its own expense and as City's sole remedy, either: (a) procure for City the right to continue to use the Deliverable(s); or (b) modify the Deliverable(s) to make them/it non -infringing, provided that such modification does not materially adversely affect City's authorized use of the Deliverable(s); or (c) replace the Deliverable(s) with equally suitable, compatible, and functionally equivalent non -infringing Deliverable(s) at no additional charge to City; or (d) if none of the foregoing alternatives is reasonably available to Vendor, terminate the Agreement, and refund all amounts paid to Vendor by the City, subsequent to which termination City may seek any and all remedies available to City under law. VENDOR'S OBLIGATIONS HEREUNDER SHALL BE SECURED BY THE REQUISITE INSURANCE COVERAGE REQUIRED BY CITY. Data Breach. Vendor further agrees that it will monitor and test its data safeguards from time to time, and further agrees to adjust its data safeguards from time to time in light of relevant circumstances or the results of any relevant testing or monitoring. If Vendor suspects or becomes aware of any unauthorized access to any financial or personal identifiable information ("Personal Data") by any unauthorized person or third party, or becomes aware of any other security breach relating to Personal Data held or stored by Vendor under the Agreement or in connection with the performance of any services performed under the Agreement or any Statement(s) of Work ("Data Breach"), Vendor shall immediately notify City in writing and shall fully cooperate with City at Vendor's expense to prevent or stop such Data Breach. In the event of such Data Breach, Vendor shall fully and immediately comply with applicable laws, and shall take the appropriate steps to remedy such Data Breach. Vendor will defend, indemnify and hold City, its Affiliates, and their respective officers, directors, employees and agents, harmless from and against any and all claims, suits, causes of action, liability, loss, costs and damages, including reasonable attorney fees, arising out of or relating to any third party claim arising from breach by Vendor of its obligations contained in this Section, except to the extent resulting from the acts or omissions of City. All Personal Data to which Vendor has access under the Agreement, as between Vendor and City, will remain the property of City. City hereby consents to the use, processing and/or disclosure of Personal Data only for the purposes described herein and to the extent such use or processing is necessary for Vendor to carry out its duties and responsibilities under the Agreement, any applicable Statement(s) of Work, or as required by law. Vendor will not transfer Personal Data to third parties other than through its underlying network provider to perform its obligations under the Agreement, unless authorized in writing by City. Vendor's obligation to defend, hold harmless and indemnify City shall remain in full effect if the Data Breach is the result of the actions of a third party. All Personal Data delivered to Vendor shall be stored in the United States or other jurisdictions approved by City in writing and shall not be transferred to any other countries or jurisdictions without the prior written consent of City. [Signature Page Follows] 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: By: �-449 e `l4 i Name: Mark McDaniel Title: Deputy City Manager Date: May 6, 2024 APPROVAL RECOMMENDED: By: Name: Kevin Gunn Title: Director, IT Solutions 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: Dom iniav 3, 202415:02 CDT) Name: Dominic Casagrande Title: Sr. IT Solutions Manager APPROVED AS TO FORM AND LEGALITY: ATTEST: Apo FORri& By: - ° od Name: Taylor Paris � Title: Assistant City Attorney 4 ..�CTy....� aaCu nEX 4Sobp By: CONTRACT AUTHORIZATION: Name: Jannette Goodall M&C: N/A Title: City Secretary VENDOR: CEC Facilities GrooulD, LLC By: Name: Travis Rowe Title: Director Service Sales Date: 05/03/2024 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Exhibit A FORT 0 RT HP) "I"Ir City of Forth Worth IR Scan and Report April 16, 2024 City Hall Computer Room 200 Texas Street Fort Worth, TX 911 300D W. Bolt Street Fort Worth, TX DR Site 6801 Bowman Roberts Rd. Fort Worth, TX CEC I heproposed power systemstudy will include an Infrared thermography scan From these scans and reports C ay of fort Worth will be able to mitigate risk associated with existing electrical components T he information provided because of thisstudy will help protect City of Fort Worth employees/customersaswell as anyservicevendorswho might come in contaciwith theseelectrical systems. Perform infrared inspectiononelectncalequipmentshowndunngthe walk through IR inspection shall be performed by a cenifiedThermographer I hermographer shall usean infrared camera to photograph allelectrical panel equipment Ihermographershall beaccompaniedbytwo Journeymen Electricianswhowill assist inremwingpanel covers J Personnel Protective Equipment(PPE) shall be worn by all members of IR survey team Providea detailed Inspection Report andAnalysisof each piece ofequipmentsurveyed Inspection Report shall highlight any anomaly's or potentialissues Provide a corrective action plan based upon Inspection finding The client shall provide the(ollowing: Existing electrical one lire diagram Of Applicable) Accessto sac andeilearical rooms J R Scan of any equipment or gear not listed on this proposal J ARC Flash Study, labels, and short circuit calculations Sheet work patchrWpaintng New CAD DrawingVedting of existing CAD drawings V Proposal is valid for 30 days CEC ;��_•s ;•cx,a Perform Infrared Scan and Provide report the following locations with Panels Listed: 200 Texas Street Annually Performed (Saturday Work) I UPS A- Panel CPA 1,2.3.4. 2 Panel UPS3A 3. Panel 3-1 4. UPS B 2-2. 2-1 5. UPS BPanel UPS4 6. Main Distribution panel in basement 7. EP-1 8. ATS 9. M90CFF12XX 10. EP-2 11. LKA 12. M90CFFIXX 13. disconnects feeding abovegear 14. 4 - disconnects in batteryroom 3000 W. Bolt Street Annually Performed (Night Work) 1. Panel LC 2. Panel A 1, A2, A3 3. FDUPS2B 4. UPIA 1 &2 5. Panel DP 6. UP16 7 Main Distribution Panel 8. Main Disconnect 9. ATS 10 Panel C section 1 &2 11. UP3 section 1 &2 12 UP2 13 C1 14. UP26 15 UPSB 1 & 2 16 R1, B2.63 6801 Bowman Robert% Annually Performed (Normal liours) 1. Main Disconnect 2. UMDP 3 PMDP 4 UPI 5. PLP1 6 P1 7. P2 - 2 Sections 8. P3 - 2 Sections 9 Unlabeled panel next to Panel P3 10. P4 - 2 Sections 11. P5 - 2 Sections 12. Lighting Tower box 1 Q 13. CLP3 14. CLP2-2Sections 15. CLPI - 2Sections 16. Inspect wire ways above racks. �, C E C IR Scanand ReportCity of Forth City Hall Computer Room 200 Texas Street Fort Worth, TX .............................................. S6,620.00 9113000 W. Bolt Street Fort worth, TX..................................................................... S3,311 DO DR Site6801 Bowman Roberts Rd. Fort Worth, TX .............. ....................................... __. S2,230.00 Pricing: Totalcostforall workoutlinedabove is S17,161.00 Price does not include sales tax. Price is valid for thirty(30)days from date ofproposat T his Statementof Work or Proposal incorporates the Terms and Conditions attached hereto as fuly set forth herein As an authorized representatim cfCity of Forth Worthor Client', I hereby acknowledge and agree with the Terms and Conditions by signature hereto. Submitted by. Approved by. 114A� k�4>11' Travis Rove Title Deputy Citv Manaaer Director Service Sales/CEC Facilities Group City of Fort Worth ',:VCEC facilities group Exhibit B CEC Facilities Group, LLC I Purchasing Cooperative of America (ocamerica.org) 615 8th Street • O'Donnell, TX 79351 October 11, 2021 CEC Facilities Group, LLC Travis Rowe, Service Sales Manager 1275 Valley View Lane Irving, TX 75061 trowe(ocecfg com Ofc:806-428-3239 9 Fax:806-428-3440 Subject: PURCHASING COOPERATIVE OF AMERICA CONTRACT AWARD LETTER PCA OD-355-21 HVAC/MEP for Installs, Repair, & Maintenance Dear Mr. Rowe, Congratulations! The City of O'Donnell has awarded your company a contract for the above -referenced solicitation. Your contract number will be the same as the solicitation number: PCA OD-355 21. The contract number is to be on all Invoices for proper reporting. You are responsible for keeping PCA up to date with your current contact information and for submitting monthly reports. For months with inactivity, complete the company/contact information and simply input 'No Activity'. We send out the Members list monthly, in response to your organization emailing the monthly report. The contract is effective for the dates on the Contract Acceptance and Signatures Page and may be renewed up to four (4) additional years; unless notified otherwise, the renewal will be automatic. For any inquiries about your contract, please contact gcamerigA camenca.orq & we will assist you! We will contact you for an orientation meeting and for content for your vendor paKe on the PCA web site. PCA looks forward to working with you! Sincerely, D Ki Parker, Mayor City of O'Donnell The award packet includes: • Award Letter • Signed Contract Acceptance and Signatures Page • Instructions for Monthly Report and Administrative Fee Tab 3 • Monthly Report Form & Instructions RFP OD•355-21 HVACIMEP for Instals. Repair. & Maintenance Form B — Contract Acceptance and Signatures ,fined at S--nission of Proposal Acceptance and Exceptions The undersigned Vendor acknowledges t'tat helshe has examined this solicitatior, the accompanying forms and contract terms and conditions, and scope and specrfications associated witr this solictation. The undersigned Vendor hereby agrees to furnish products and/or services in strict compliance with the terms, specifications, and conditions of the solicitation, the Contract and the Vendor's response. he undersigned certifies that he or she is an officer of the company and has authority to negotiate and contract for the company named below and meets,'agrees with all of the teens and conditions of this "ontract and the solicitation. Q No Exceptions. in the absence cf any exception entry on this form, the Vendor assures Awarding Agency of their full complianco with the solicitation, the accompanying forms and contract terms and conditions. scope and specifications associated with this solicitation. --1 Exceptions as Listed on Attached Page(s). ANY AND ALL EXCEPTIONS TO THE CONTRACT TERMS AND CONDITIONS OF THIS CONTRACT MUST BE NOTED ON THE COMPLIANCE AND EXCEPTIONS FORM AND REFERENCE THE SPECIFIC TERMlCONDITION. NO OTHER EXCEPTIONS TO THE CONTRACT TERMS AND CONDITIONS WILL BE CLAIMED. Awarding Agency will consider any exceptions during contract award evalua5or and reserves the right to accept or reject any and all , based on any exception indicated. Company Na CEC Facilities Group Address 1275 Valley View Lane City,,State;Zip Code. Irving, TX 75061 Phone 817-734-0040 trowe@cec'g.com Sep* 14 2021 AuM►onzed Company Sign^ •t Printed Na—e T2Ie Travis Rowe, Service Sales Manager A,,,; .., by Awardino Aoencv Term of Contract 10 - // 'v2 i to /D A ,2.Z Unless otherwise stated, this Contract is for a period of one (') year with an oplan to renew annually for an .41x.11Wf idl fuui (4) yeai 5 i(dyr aed upur i by Awa i dit iy Ayr. i ..y of id Vei is y . U • t:uss it dui n led ullis wse, Use ieritrwdl shall be automatic on annhersary date. Vendor shall honor all administrative fees for any sales resulting from t Contract whether Vandor is awarded a renewal or not. /P"44 /D - l( ---,2-j Awalrding Agency Ikxhorued Sgnati re Printed Name: J6 fyi PURCHASING COOPERATIVE OF AMERICA Page 35 of 70 PURCHASING COOPERATIVE OF AMERICA PCA OD-355-21 HVAC/MEP for Installs, Repair, & Maintenance Monthly Vendor Reporting Vendor shall provide PCA with a detailed monthly report and pro forma showing the total dollar volume of all sales under this Contract for the previous month in Microsoft Excel, in the format and with the information specified by PCA. Reports are due on the fifteenth (15) day of the month, after the close of the previous month and shall provide information regarding Purchase Orders and Job Orders during the previous month. Vendor is responsible for collecting and compiling all sales under this Contract from all Members and submitting one (1) consolidated monthly report. The monthly report shall include, at a minimum, the date of each Purchase Order with scheduled start and completion date, Purchase Order number, Member name, citytown, and Purchase Order total dollar amount. The monthly report shall also include an overview of pending projects and purchase/job orders. After a PCA Member signs a Purchase Order, the awarded Vendor shall submit a copy of the Purchase Order and/or supplemental agreement, if any, to PCA along with the mandatory monthly report with any change orders made prior to protect completion. Reports shall be submitted in Excel format to Purchasing Cooperative of America at P 0 Box 604 Hico. Texas 76457. or electronical;y to Reports@pcamerica.org. The Monthly Report Form is at w%wv.pcamerica.org on the Forms Tab Copies of signed purchase orders and supplemental contracts shall be turned into PCA along with the Monthly Report Administration Fee • The PCA Administrative Fee stated in the solicitation will be based on total sales made through this Contract • Vendor shall honor and pay the Administration Fee for any sales resulting from this Contract that occirred within thirty (30) days at the completion of on -going work. • Vendor shall pay PCA the contracted fee for monthly progress payments and/or at project completion within thirty (30) days. • Failure to pay the Administrative Fee in a timely manner may result in Vendor's breach of this Contract and may result in suspension or termination of this Contract. • In the event that Vendor's contract expires or is terminated Verdor agrees to pay the Administrative Fee for any projects extending beyond the expiration or termination date as those Purchase/ Delivery/Job Orders received prior to the expiration or termination are completed within thirty (30) days of the pro;ect or purchase order close out. • Vendor must maintain a good record for compliance under the contract, timely reporting. and prompt payment of Administrative Fees. • Vendor shall make the check payable to 'Purchasing Cooperative of America": and send check to Purchasing Cooperative of America, P O Box 604, Hico, TX 76457. • if convenient for the Vendor. the check may be mailed with the monthly report The Administrative Fee for this solicitation is three (3) percent, unless otherwise stated in Tab 6 Pricing. Additional Foos and Reporting Information Some states and other government/non-profit agencies require an additional fee to use another state's or agency's contracts in their jurisdiction. If an additional fee is requested and Vendor agrees, Vendor shall submit copies of the purchase orders involved and pay the additional fee to PCA who will then pay the entity involved Additional fees must be discussed with PCA prior to acceptance of additicnal fee charges Awarded Contractors may not use PCA contract to request a contract from another agency or purchasing cooperative without the written approval of PCA as a requirement under Section 791 of the Texas Government Code To do so without PCA wntten approval will automatically violate the provisions of this contract resulting in its immediate cancellation. Other cooperatives desiring to utilize PCA contracts must sign an Interlocal Agreement or contract with PCA defining the contracts use and PCA payment requirements. Some non -Texas Governmental Jurisdictions do not require an Interlocal Governmental Contract and may join PCA without one by signing up on line If this contract is adopted by another cooperative or entity, the Awarded Contractor (Vendor) for this contract is still responsible for PCA fees based on the work performed for that entity, cooperative and/or that cooperative's Members. All such work shall be reported on the PCA Monthly Report and fees paid accordingly MONTHLY REPORT ?CA Namo-Awarded Cont acicc Ccolract Number ReDw. No.lYr AWN FFF CURRENT PROJECT TOTALS: * PROJECT MEMBER! DESCRIPTION CUSTOMER NAME 7 2 3 4 S. 6 7. PFNDINGIFI)TORE PROJECT`: 0 PROJECT NENBErb' DESCRIPTION CUSTOMER NAME 1 3 4 '• Attach copies of Purchase OrdMs). Please use additional pages as necessary Please complete all aside. Contact Name: Phone Number. email CITY •• PURCHASE PROJECT DATES INVOICE TOTAL EST. FEE PER VENDOR CHECK TO PCA STATE ORDER 0 P.O. AMOUNT AMOUNT ADMAN FEE INVOICE START END DATE AMOUNT Would you like a confirtnatigqn of receipt of PICA fpayment) Yes No ESTMATED A lk6 t ftes N) Ovinvoiebt 51 bylo tZPrgects a Pw crwx In ma I io CITYPR3JECT EST. PRQIFCT DATF3 NOTES PCA PO Box Address Wow 6 PDF RewttiPO&1 nvo,0eS t0 STATE TOTAL START ENO woen j.forms Send CHECKS to PICA, PO Box 604, Hied, TX 76M Questions? Call 644-722-6374 Rev 2+21 I ill In the CURRENT PROJECT section with h1ONTHLY REPORT WL&AWLi RVIORT active approved P.O.s. If None, report NO „�yyr ACTIVITY. Cantaaar NC Ca7a�. ?c ^sns^ /pry atxa Bares Copies of purchase orders are Camaatamtwr PCA naectc•nte, rtslna») ROWWOM oaumwr)B,o Trot .e_ea�,;_;=. _ supplemental to your contract and may eAW41itt +• be attached to the Monthly Report or sent to PCA separately ALL POs / Invoices ;-JMNT ►RO.IIJ�T TOTALS: _ acsww �,.. .,tesee•ea,ea .o .wes oouucar r Vga ,yu�atc.u•ror. should reference contract number. CC&C111"" pbantl RAW 71AIT M11111 IBM AWMW aatv,rr aerw iK BIYfs.1 [MR Yap.Yl gd.W't-GD i4mb,'x 11011,76) ,.WMIS ,Ya7019 )ream )20"M ' For purchase orders that have r++...w.... s >,mu s )e000e ,a,•� s spew s+w.rttnt to � .*I *19=0 ,ama,a commun mobilization (project start-up) or .saaory,+wttt� t.•,a„•„ s scco s )000 s tBooa s xcm s 110010 progress payments, list these payments on separate lines and pay the PCA fee as wwo s s,asw ta360oo cott�a instructed in the contract. ) Z%&u twmii WN.tN icNN o.r. Tx 7r1V •ytcl» mr,sww $ n000 s is we ) socx $ unco 111VIG s s MD40 N— W COMIrR $ S.%c a F"t»aarruTutte nto leer: anataao -es, vouo rou IBt a c fp'�1 ■!.� 1rtAA�y� o+ s\ r.oJecr "C"am CM�M a sr reta♦�7 Dues cote a rca th w cr«.,, t.w. a ror a.aatara►wee, OCKGrnor cuslaw tt■cra sswtt '111111I aaw oo \ x \\ t awoemgr-r atwocNv t,a...Tx ) It,= V%W9 W10:o9J „*Wewro •• atYca cores as Mcbmw Cysopl- MaeMMC"ww:�a���r1 :r,.••.•.. P - ut• sO+IMs, Nss Bas Mcaaaw t�ft� 9: PCA, PO Bloc BQa, srco. Tx 76a51 Pending or possible future projects or purchase orders shall be llsto signed P.O is received, rnove to the Current Project section. If purchase order is not received or project is cancelled, remove'rom list. There is no reason to continue to report. Add any P.O. changes, additional work or items that qualify to be added to the P 0 on additional lines Send copy of P.O. extension to PCA Include DATE of check approval- PCA understands that accounting may take several more days to process a request for payment Add COMPLETE if project or P.O. has been completed. All Admrn Fees shall tie paid upon receipt of vendor payment. Use the notes section to convey any important or informational items. I The Monthly Report;orm is located:''t•j ;, I t v a .; 1 'f r_t, for download I Exhibit C CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23. 84th Leg.. Regular Session. OFFICE USE ONLY -his questionnaire is being filed in accordance with Chapter 176, Local Govemment Code, by a vendor who Jxe Reco ea 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 govemmental 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 Sedan 176.006(a-1). Local Government Code. Avendor commits an offense d the vendor knowingly violates Section 176.006. Local Govemment Code. An _.ffen.5e under N ,s ;echon is a r-i sderreanor J Name of vendor who has a business relationship with local governmental entity. JEl Check this box if you are filing an update, to a previously filed questionnaire. (The law requires that you file an updated completed ques:iorr3.•e with the appropriate filirg au:honty 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. Name of Officer 41 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(ax2)(A). Also describe any family relationship with the local government officer. Complete subparts 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 allo B 's the vendor receiving or likely to receive taxable income. other than investment income, from or at the direction of the local govemment officer or a family member of the officer AND the taxable income is not received from the local governmental ertity? Yes 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 it 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 descnbed in Section 176.003(a-1). J Signature of vendor doing business with the govemmental entry pate Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11i30e2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity A complete 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 & 176.001(1-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 Goverr)me(1t Code § 176.093(a)((A) and (B): (a) A local government officers all file a conflicts disclosure statement with respect to a vendor if: (2) thevendor. (A) has an employment or other business relationshipwith 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 aggregatevalue 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 Governmept Code � 176.006(a) and (a-1) (a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer. described by Section 176.003(a)(2)(A): (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specrfied 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 uniting related to a potential contract with the local governmental entity: or (2) the date the vendor becomes avrare: (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. Form provided by'exas Ethics commission worn.ethics-state.tx us Revised 11 s k2C15