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Home My WebLink AboutContract 61525FORT WORTH CSC No. 61525 CITY OF FORT WORTH COOPERATIVE PURCHASE AGREEMENT This Cooperative Purchase Agreement ("Agreement") is entered into by and between ICOR Technology, 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 — Seller's Quote, Scope of Services or Purchase Order; 3. Exhibit B — Cooperative Agency Contract GSA GS-07F-0430V; 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. If any provisions of the attached Exhibits conflict with the terms herein, are prohibited by applicable law, conflict with any applicable rule, regulation or ordinance of City, the terms in this Cooperative Purchase 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 Two -Hundred and Fifty Thousand Dollars ($250,000.00). Vendor shall not provide any additional items or services or bill for expenses incurred for City not specified by this Agreement unless City requests and approves in writing the additional costs for such services. City shall not be liable for any additional expenses of Vendor not specified by this Agreement unless City first approves such expenses in writing. The term of this Agreement is effective beginning on the date signed by the Assistant City Manager below ("Effective Date") and expires on July 31, 2024. The City shall be able to renew this agreement for five (5) one-year renewal options by written agreement of the parties. Vendor will confer with the City's Fire Department to determine any applicable federal restrictions associated with the grant funding for this Agreement and shall comply with all such terms. 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 parry by United States Mail, registered, return receipt requested, addressed as follows: OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX To CITY: City of Fort Worth Attn: Dana Burghdoff, Assistant City Manager 200 Texas Street Fort Worth, TX 76102-6314 Facsimile: (817) 392-8654 With copy to Fort Worth City Attorney's Office at same address To VENDOR: ICOR Technology, Inc. Address: 935 Ages DR Ottawa, ON K I G 6L3, Canada The Agreement and the rights and obligations of the parties hereto shall be governed by, and construed in accordance with the laws of the United States and state of Texas, exclusive of conflicts of laws provisions. Venue for any suit brought under the Agreement shall be in a court of competent jurisdiction in Tarrant County, Texas. To the extent the Agreement is required to be governed by any state law other than Texas or venue in Tarrant County, City objects to such terms and any such terms are hereby deleted from the Agreement and shall have no force or effect. 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: 15 gap# By: Dana Burghdoff (Jun 20241'S: 6 CDT) Name: Dana Burghdoff Title: Assistant City Manager Date: APPROVAL RECOMMENDED: By: Jhpfs Davis 6, 202414:30 CDT) Name: Jim Davis Title: Fire Chief pp'04UO4gIl ATTEST:of > �oRT9..$ o dd �o Ova W. pQa d /7 4� �'EXA5o40 By: ; Name: Jannette Goodall Title: City 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: Breq?a Ray (Jun 6, 202412:48 CDT) Name: Brenda Ray Title: Purchasing Manager APPROVED AS TO FORM AND LEGALITY: By: Name: Jeremy Anato-Mensah Title: Assistant City Attorney CONTRACT AUTHORIZATION: M&C: N/A OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX VENDOR: ICOR Technology, Inc. By: f �J x Name: Jack Vongdouangchanh Title: Commercial Manager ICOR TECHNOLOGY INC. GSA Contract Number: GS-07F-0430V Valid to JULY 31, 2024 (as amended) COMPANY INFORMATION Name: Address Phone Number: NA Toll Free: Fax Number: URL: Point of Contact: UEI (Formerly DUNS): SAM Registration: CONTRACT INFORMATION Contract Number: Contract Period Schedule Number / Description: SIN Numbers/Description: Labor Category/Description: ICOR Technology Inc. 935 Ages Drive, Ottawa, ON K1G 61_3 CANADA +1 613 745 3600 +1 877 483 7978 +1 613 745 3590 www.icortechnologv.com Mr. Jack Vongdouangchanh, sales icortechnologv.com EGDNEF4N3NL4 Activation Date — 02/12/2015 GS-07F-0430V August 1, 2019 — July 31, 2024 084: Total Solutions for Law Enforcement, Security, Facilities Management, Fire, Rescue, Clothing, Marine Craft and Emergency/Disaster Response, FSC Group 84 — Law Enforcement and Security Equipment Supplies and Services 334519 — Bomb and Hazardous Material Disposal; Metal and Bomb Detection 334220 — Surveillance Systems, Wearable Body Cameras, and Vehicular Video OLM — Order Level Materials N/A TERMS AND CONDITIONS 1. GEOGRAPHIC COVERAGE: Domestic, 50 states, Washington, DC, Puerto Rico, US Territories and to a CONUS port or consolidation point for orders received from overseas activities 2. POINT(S) OF PRODUCTION: 935 Ages Drive, Ottawa, ON K1G 61_3 CANADA, check with Contractor at time of order. 3. DISCOUNT FROM LIST PRICES: 3% on Robots; 10% on Hook & Line products; 15% on Mirrors from the accepted pricelist. For calculation of the GSA Schedule price (price paid by customers ordering from the GSA Schedule, and the price to be loaded in to GSA Advantage), the contractor should deduct the appropriate basic discount from the list price and add the prevailing IFF rate to the negotiated discounted price (Net GSA price). Current IFF rate is 0. 75%. 4. QUANTITY DISCOUNT(S): 10% on single orders of $600,000.00 or more for SIN 334519; 20% on single orders of $100,000 or more for SIN 334220. 5. PROMPT PAYMENT TERMS: 1%/10 Days/Net 30 6. Government Purchase Cards must be accepted at or below the micro -purchase threshold. 7. Government Purchase Cards are accepted above the micro -purchase threshold. 8. FOREIGN ITEMS: Canada 9. TIME OF DELIVERY: Shipped 120 Days after receipt of order for SIN 334519; shipped 42 Days after receipt of order for SIN 334220. 10. EXPEDITED DELIVERY: Contact Contractor for details 11. OVERNIGHT AND 2-DAY DELIVERY: Overnight and 2-day delivery are available. Contact the Contractor for rates. 12. URGENT REQUIRMENTS: Agencies can contact the Contractor's representative to affect a faster delivery. Customers are encouraged to contact the contractor for the purpose of requesting accelerated delivery. 13. FOB POINT: Origin 14. ORDERING ADDRESS: ICOR Technology, Inc., 935 Ages Drive, Ottawa, ON K1G 61-3, Canada 15. ORDERING PROCEDURES: For supplies and services, the ordering procedures, information on Blanket Purchase Agreements (BPA's) are found in Federal Acquisition Regulation (FAR) 8.405-3 16. PAYMENT ADDRESS: Same as ordering address 17. WARRANTY PROVISION: Standard Commercial Warranty 18. EXPORT PACKING CHARGES: Not applicable 19. TERMS AND CONDITIONS OF GOVERNMENT PURCHASE CARD ACCEPTANCE: (any thresholds above the micro -purchase level) 20. TERMS AND CONDITIONS OF RENTAL, MAINTENANCE, AND REPAIR (IF APPLICABLE): N/A 21. TERMS AND CONDITIONS OF INSTALLATION (IF APPLICABLE): N/A 22. TERMS AND CONDITIONS OF REPAIR PARTS INDICATING DATE OF PARTS PRICE LISTS AND ANY DISCOUNTS FROM LIST PRICES (IF AVAILABLE): N/A 23. TERMS AND CONDITIONS FOR ANY OTHER SERVICES (IF APPLICABLE): N/A 24. LIST OF SERVICE AND DISTRIBUTION POINTS (IF APPLICABLE): N/A 25. LIST OF PARTICIPATING DEALERS (IF APPLICABLE): N/A 26. PREVENTIVE MAINTENANCE (IF APPLICABLE): N/A 27. SPECIAL ATTRIBUTES SUCH AS ENVIRONMENTAL ATTRIBUTES (e.g. recycled content, energy efficiency, and/or reduced pollutants): None COMMERCIAL PRICELIST GSA OFFER SIN PART NO PRODUCT NAME PRICE (inclusive of the .75% IFF) 334519 10001 MINI arm Picatinny Rail Assembly $400.68 334519 10002 K3150 Robot Disrupter Sleeve $3,225.01 334519 10003 Mini Claw Kit - 2ND Generation $4,930.35 334519 10004 MK3/ T5 Claw Kit - 2ND Generation $5,335.92 334519 10255 T5 Universal Disruptor Mount Kit $3,567.05 334519 10257 MK3 Universal Disuptor Mount Kit $3,567.05 334519 10458 Claw Auxiliary Camera - Mini $1,583.19 334519 10478 Extended Warranty - Mini $5,941.83 334519 10785 168001 - Remote Firing Devices Controller $2,462.73 334519 10786 168002 - Remote Firing Devices Remote $2,462.73 334519 10787 A700-900-00 - 900 MHz 1680 Antenna $48.86 334519 10788 B168-092-00 - Ultimate AAA Lithium Battery $1.71 334519 10789 168003 - Shock Tube Firing Adapter $36.16 334519 10790 C799-800-00 - MK4 Igniter Tip 1680 $53.75 334519 10791 168004 - Carry Case (Holds up to 9 Units) $464.21 334519 10792 168050 - Pairing Cable $86.00 334519 10793 166412-A - ShieldTenna (shield w/antenna) $825.80 334519 10927 MK4 CLAW KIT - 3RD GENERATION $5,375.01 334519 11044 MK3 Single Duke Pro Bracket Assy $293.18 334519 11048 T5 Single Duke Pro Bracket Assy $293.18 334519 11134 24V DC Battery Pack - FLEX $1,641.82 334519 11181 K100PL - PAN Disrupter (Push Lock) Unit (Fine Thread) $3,625.69 334519 11237 Claw Auxiliary Camera —T5 / MK3 $2,037.62 334519 11298 MK4 Claw Auxiliary Camera $2,438.30 334519 11704 MK3/T5 Quick Release Colour IR Camera $1,079.89 334519 11998 MK3/T5 32FT (10M) BULKHEAD TRUCK KIT $3,308.08 334519 12627 MINI Quick Release Color IR Camera $1,079.89 334519 13153 Mini -CALIBER RF Range Extender (Video/Data) $5,814.79 334519 13355 FLEX - CCU Power Pack $2,980.69 334519 13365 Claw Auxiliary Camera - FLEX $2,150.01 334519 13371 DUKE PRO- FOR FLEX $1,754.21 334519 13895 SOO' Tether Reel kit - Mini RF Range Extender $4,475.92 334519 13899 FLEX Basic Spare Parts Kit $5,927.17 334519 13900 FLEX Quick Release FLIR Camera $8,961.61 334519 13901 FLEX Auxillary Pole Camera $2,003.41 334519 13902 FLEX Bulkhead Truck Kit $2,135.35 334519 13903 FLEX - Arm Extension Kit $7,891.50 334519 13908 FLEX Fiber -Optic Tether $9,039.79 334519 13910 RF Extender - CALIBER° FLEX $3,650.12 334519 13968 MK3/T5 64FT(20M) BULKHEAD TRUCK KIT $3,444.89 334519 14058 MINI Portable Handheld Screen (COFDM) $6,738.31 334519 14096 Mini -CALIBER RF Range Extender (COFDM Video/Data) $8,429.00 334220 06A0645 CUTABINEER $81.61 334519 ABP.DM-MK4 AB Precision Disruptor Mount - MK4 $3,420.46 334519 CAL-ALO Aluminum Ramps (foldable, lightweight) $586.37 334519 CAL-APC Auxiliary Pole Camera for MK3 or T5 $1,138.53 334519 CAL-BCO Extra Caliber 24 V Battery Charger $415.34 334519 CAL-BC1 CALIBER Command Station Battery Charger $327.39 334519 CAL-BC2 CCU Battery Charger - Mini $337.16 334519 CAL-BC3 Robot Battery Charger - Mini $219.89 334519 CAL-BC4 48V DC Battery Charger - MK4 $2,575.12 334519 CAL-BC4-110V Spare 48V DC Battery Charger - MK4 North America $2,575.12 334519 CAL-BMO MK3 BENELLI M4 SUPER SHOTGUN MOUNT (SHOTGUN NOT INCLUDED) $2,917.17 334519 CAL-BM1 T5 BENELLI M4 SUPER SHOTGUN MOUNT (SHOTGUN NOT INCLUDED) $2,917.17 334519 CAL-CCU15 MK3 CCU Upgrade $34,018.94 334519 CAL-CCUPP CCU POWER PACK $2,980.69 334519 CAL-CCUST Folding CCU Stand $415.34 334519 CAL-CPV Command Post Video Transmitter $5,814.79 334519 CAL-DCPP MK4 14V DC CCU Power Pack $2,941.60 334519 CAL-DVR Digital Video Recorder (DVR) $2,325.91 334519 CAL-DVU1 Digital COFDM Video System Upgrade $32,831.55 334519 CAL-EBO MK3 EXTRA ROBOT BATTERY PACK 24VDC (RECHARGEABLE) $1,353.53 334519 CAL-EB1 T5 EXTRA ROBOT BATTERY PACK 24VDC (RECHARGEABLE) $1,353.53 334519 CAL-EB2 24V DC Battery Pack - Mini $708.52 334519 CAL-EB3 CCU Battery - Mini $185.68 334519 CAL-EB4 48V DC Battery Pack - MK4 $5,941.83 334519 CAL-EXA T5 - Arm Extension Kit $5,624.22 334519 CAL-EXT CCU RF EXTENSION CABLE 15 FT SET $307.84 334519 CAL-EXWAR CALIBER Robot Extended Warranty (3rd Year) $7,691.15 334519 CAL-EXWAR.MK4 MK4 Extended Warranty $23,078.35 334519 CAL-FLMK4 FLIR Thermal Camera - MK4 $11,937.41 334519 CAL -FRO 1000' (305m) milspec fiber-optic tether $15,831.86 334519 CAL-FR1 Fiber -Optic Tether - MK4 $16,960.61 334519 CAL-HCU CALIBER Hand Held Control Unit $1,866.60 334519 CAL-HCUb CALIBER Wireless Hand Held Control Unit (Bluetooth) $3,342.28 334519 CAL-K100 K100 — PAN DISRUPTER UNIT (Fine thread) $3,298.30 334519 CAL-K1000 K1000 — RECOIL REDUCTION ADAPTER KIT (Fine thread) $2,834.10 334519 CAL-K1090 K1090 — ELECTRIC BREECH KIT -PAN (Fine thread) $2,663.07 334519 CAL-K4300-121C K4300-12 — Tactical -Swat Disrupter Kit $5,091.60 334519 CAL-MAFB Motorized Anti -Flip Bar $5,291.94 334519 CAL-MDVR Digital Video Recorder (DVR) for Mini -CALIBER° $2,213.53 334519 CAL -MINI Mini -CALIBER° Robot SWAT Robot $57,483.32 334519 CAL-MK3 MK3 - CALIBER° EOD $83,557.01 334519 CAL-MK4 MK4 CALIBER Robot and Standard Accessories $326,532.01 334519 CAL-MPTZ Motorized, Telescoping Pan -Tilt -Zoom Camera $5,291.94 334519 CAL-OP001 24V DC Firing Circuit for Mini -CALIBER° Robot $1,192.28 334519 CAL-OP002 24V DC Firing Circuit AND Duke Pro Single Channel Shock Tube Initiator $2,560.46 334519 CAL-OP009 Motorized PTZ Mast and Camera $11,878.78 334519 CAL-OP014 Mini -CALIBER case $1,778.64 334519 CAL-OP015 Quick Release PTZ Upgrade $4,031.26 334519 CAL-OP016 Quick Release FUR Camera for CALIBER° Robot $10,984.57 334519 CAL -PIP Quad Screen Picture -in -Picture Functionality $4,163.19 334519 CAL-PSA The CALIBER°'s Portable Handheld Screen for Analog RF System $4,148.53 334519 CAL-PSD The CALIBER°'s Portable Handheld Screen for Digital COFDM RF System $5,765.92 334519 CAL-SLO MK3 Power Switch Lock $210.11 334519 CAL-SL1 T5 Power Switch Lock $210.11 334519 CAL-SPO MK3 CALIBER BASIC SPARE PARTS KIT $2,692.39 334519 CAL-SP1 T5 CALIBER BASIC SPARE PARTS KIT $2,692.39 334519 CAL-SP2 Mini -CALIBER SPARE PARTS $1,783.53 334519 CAL-SP3 MK4 Basic Spare Parts Kit $13,295.83 334519 CAL-T5 CALIBER° T5 $85,511.56 334519 CAL -TKO External truck brackets for RF system (Client installs) $874.66 334519 CAL-TK1 Truck Brackets Kit - MK4 $918.64 334519 CAL-TRC Heavy Duty Hard Shell Transit Case (set of 2) $5,003.65 334519 CAL-TTC CALIBER ROBOT ONSITE TRAINING at Customer Location (MK3/T5) $3,396.03 334519 CAL-TTC-FLEX CALIBER° FLEX ROBOT ONSITE TRAINING at Customer Location $5,541.15 334519 CAL-TTC-MINI Mini -CALIBER° Training $3,396.03 334519 CAL-TTC-MK4 CALIBER ROBOT ONSITE TRAINING (MK4) $5,541.15 334519 CAL -VEX Video Rf Range Extender for CALIBER Robot (for Analog Video System) $2,448.07 334519 CAL-XR1 X-ray mounting bracket for Vidisco XR-200 OR XR-300. $1,338.87 334220 ESHL01 Hook & Line ESSENTIAL $5,191.14 334220 ESHL03 Hook & Line ESSENTIAL with Backpack $5,191.14 334519 ESI-RM2 Duke Pro 2-Channel Shock Tube Initiator with Mount $1,754.21 334519 ESI-RM2-MK4C MK4 ST Initiator Claw Arm Assembly $1,754.21 334519 ESI-RM2-MK4W MK4 ST Initiator Weapon Arm Assembly $1,754.21 334519 EXWAR-FLEX Extended Warranty - CALIBER° FLEX $15,729.24 334519 FLEX-111 CALIBER° FLEX w/ COFDM IP Radios & Dual PAN Disrupter Mount $202,100.47 334519 FR300 300m Firing Line $1,373.07 334220 M1000 M1000 - Under -Vehicle Search Mirror $770.74 334220 M2000 M2000 - 5-Section Search Mirror $569.49 334220 M3000 M3000 - 3-Section Search Mirror $226.08 334220 M4000 M4000 - Carbon Fiber Tactical Search Mirror $586.62 334519 MK3-DSO MK3 CALIBER° Robot w/ Digital COFDM Video $101,768.53 334220 PSM-H&L Pocket Search Mirror $239.79 334519 RFD1678-1 8-Position Controller $5,028.08 334519 RFD1678-10 Smart Charger, 3 Position $1,026.14 334519 RFD1678-13 Tactical Case w/insert $693.87 334519 RFD1678-18 Full Case $1,021.25 334519 RFD1678-2 Electric Remote Initiator $4,837.51 334519 RFD1678-3 Remote Shock Tube Initiator (RSTI) $5,389.67 334519 RFD1678-4 Test Box (Optional) $2,951.37 334519 RFD1678-6 Mini Controller $5,277.29 334519 RFD1678-8 Conditioning Charger, 5 position $2,907.39 334519 RFD1678-KIT01 System w/ 1 Electric & 1 RSTI Remote $19,995.05 334519 RFD1678-KIT02 System with 2 Electric & 2 RSTI Remotes $30,911.21 334519 RFD1678-KIT03 System with 4 Electric Remotes $29,210.75 334519 RFD1678-KIT04 System with 4 RSTI Shock Tube Remotes $31,991.10 334519 RFDC930-400-00 Orange Cover (remotes only) $83.07 334519 T5-DSO CALIBER° T5 Robot w/ Digital COFDM Video $101,768.53 334220 TSPC-BasePkg TSPC with Quick Disc and Audio Out Port $4,686.03 334220 TSPC-Batt TSPC - Backup Battery $346.93 334220 TSPC-DualCam TSPC - Dual Camera for UDC $3,694.10 334220 TSPC-Shield TSPC - Sunshield $50.77 334220 TSPC-Sling TSPC - Tactical Rifle Sling $156.36 334220 TSPC-UDC-IR TSPC - Under Door Camera with IR $5,541.15 334220 TSPC-War3 TSPC - 3 Year Parts/ Labor Warranty (Depot) $669.43 334220 ULHL02 Hook & Line ULTIMATE $8,147.15 Exhibit B - GSA GS-07F-0430V The Cooperative Agency Contract GSA #GS-07F-0430V is incorporated into this agreement as Exhibit B. The entire text of Exhibit B is omitted for conciseness and is available at the link below: https://www.gsaelibrary.gsa.gov/ElibMainlhome.dohttp:/www. gsaelibrary. %20gsa. gov/ElibMain/contractClauses.do? scheduleNumber=MAS&contractNumber=GS-07F- 0430V&contractorName=ICOR+TECHNOLOGY+INC&duns=EGDNEF4N3NL4 &source=ci&view=clauses Exhibit C - Conflict of Interest Questionnaire 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. J Name of vendor who has a business relationship with local governmental entity. ICOR Technology Inc. 21 ❑ 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. N/A 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. N/A 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? F]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? F1 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. N/A 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 Jun 6, 2024 ignature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021 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 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. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021