HomeMy WebLinkAbout064772 - General - Contract - G4 Geomatic Resources, LLCCSC No. 64772
FORT WORTH
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and G4 Geomatic Resources,
LLC ("Vendor") and the City of Fort Worth ("City"), a Texas home-rule municipality individually
referred to as "party" and collectively as the "parties".
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— Pricing Index;
3. Exhibit B— Cooperative Agency Contract DIR-CPO-6013; 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 E�ibits 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 payment terms in Exhibit A and in accordance with
the provisions of this Agreement. Total payment made under this Agreement by City shall not exceed
Fifty Thousand Dollars ($50,000.00) annually. 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 Parties will engage in multiple transactions to purchase goods and/or services under this
Agreement. For each purchase made pursuant to this Agreement, Vendor must supply a quote for the
subject goods and/or services and the quote must conform with the then-current pricing under the
underlying cooperative agreement. If the City accepts the quote and places an order for the goods and/or
services, that quote shall be considered an addendum to this agreement but is not required to be filed in
the City records. The Parties will maintain all quotes for the 3- year Audit period included herein.
The term of this Agreement is effective beginning on the date signed by the Assistant City
Manager ("Effective Date") and expires on December 1, 2026, with four (4) one-year renewal options.
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. oFFicia� RecoR�
CITY SECRETARY
FT. WORTH, TX
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 or (2) received by the other party by United States Mail, registered, return receipt
requested, addressed as follows:
To CITY:
City of Fort Worth
Attn: Assistant City Manager
100 Fort Worth Trail
Fort Worth, TX 76102
With copy to Fort Worth City Attorney's Office at the
same address
To VENDOR:
G4 Geomatic Resources, LLC
Rodney Walsh, President
2914 Story Rd W
Irving, TX 75038
City is a government entity under the laws of the State of Texas and all documents held or
maintained by City are subject to disclosure under the Texas Public Information Act. To the eXtent the
Agreement requires that City maintain records in violation of the Act, City hereby objects to such
provisions and such provisions are hereby deleted from the Agreement and shall have no force or effect.
In the event there is a request for information marked Confidential or Proprietary, City shall promptly
notify Vendor. It will be the responsibility of Vendor to submit reasons objecting to disclosure. A
determination on whether such reasons are sufiicient will not be decided by City, but by the Office of
the Attorney General of the State of Texas or by a court of competent jurisdiction.
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
law 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.
Nothing herein constitutes a waiver of City's sovereign immunity. To the extent the Agreement
requires City to waive its rights or immunities as a government entity; such provisions are hereby deleted
and shall have no force or effect.
To the extent the Agreement, in any way, limits the liability of Vendor or requires City to
indemnify or hold Vendor or any third party harmless from damages of any kind or character, City
objects to these terms and any such terms are hereby deleted from the Agreement and shall have no force
or effect.
If Vendar has fewer than 10 employees or this Agreement is for less than $100,000, this section does not
apply. Vendar acknowledges that in accordance with Chapter 2271 of the Texas Government Code, the City is
prohibited from entering into a contract with a company for goods or services unless the contract contains a written
verifcation from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term
of the contract. The terms "boycott Israel" and "company" has the meanings ascribed to those terms in Chapter
2271 of the Texas Government Code. By signing this Agreement, Vendor certifies that Vendor's signature
provides written verification to the City that Vendor. (1) does not boycott Israel; and (2) will not boycott Israel
during the term of the Agreement.
If Vendor has fewer than 10 employees or this Agreement is for less than $100,000, this section does not
apply. Vendor acknowledges that in accardance with Chapter 2276 of the Texas Government Code, the City is
prohibited from entering into a contract for goods or services that has a value of $100,000 or more that is to be
paid wholly or partly from public funds of the City with a company with 10 or more full-time employees unless
the contract contains a written verification from the Vendor that it: (1) does not boycott energy companies; and
(2) will not boycott energy companies during the term of this Agreement. To the extent that Chapter 2276 of the
Government Code is applicable to this Agreement, by signing this Agreement, Vendor certifies that Vendor's
signature provides written verification to the City that Vendor: (1) does not boycott energy companies; and (2)
will not boycott energy companies during the term of this Agreement.
If Vendor has fewer than 10 employees or this Agreement is for less than $100,000, this section does not
apply. Vendor acknowledges that except as otherwise provided by Chapter 2274 of the Texas Government Code,
the City is prohibited from entering into a contract for goods or services that has a value of $100,000 or more that
is to be paid wholly or partly from public funds of the City with a company with 10 or more full-time employees
unless the contract contains a written verification from the Vendor that it: (1) does not have a practice, policy,
guidance, or directive that discriminates against a iirearm entity or iirearm trade association; and (2) will not
discriminate during the term of the contract against a firearm entity or firearm trade association. To the extent
that Chapter 2274 of the Government Code is applicable to this Agreement, by signing this Agreement, Vendor
certifes that Vendor's signature provides written verifcation to the City that Vendor: (1) does not have apractice,
policy, guidance, or directive that discriminates against a firearm entity or frearm trade association; and (2) will
not discriminate against a firearm entiry or firearm trade association during the term of this Agreement.
(signature page follows)
(remainder of this page intentionally left blank)
The undersigned represents and warrants that he or she has the power and authority to execute
this Agreement and bind the respective party.
CITY OF FORT WORTH:
� �� 4�
I By' —
Name: William Johnson
Title: Assistant City Manager
, Date: 02�24�2026
APPROVAL RECOMMENDED:
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the inonitoring and administration of
this contract, including ensuring all performance and
reporting requirements.
�,���,,,� ��_
By. Ka�hryn �yee (�eb .�0�6 14 �� � CSTJ
Naine: Kathryn Agee
Title: Sr Management Analyst
APPROVED AS TO FORM AND LEGALITY:
By: DaWd C�arCab�ajaT(�b 24, 2026 10:49:06 EST)
Na�ne: David Carabajal
Title: Executive Assistant Chief
Ao9Foe>°�a
Feo� h.aa
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OVeo a°=F
By: (� oQA,e ee*Pa
Name: Jannette Goodall ��a° °aXp564�
Title: City Secretary
VENDOR:
� G4 Geomatic Resources, LLC
� B : ?� �,�/
y �" � ""1 !`
Namc: Rodncy Walsh
I Title: President
Date: � � � � ��- �
�exc%Git .A�irc�,ty
gy: O �
Name: Jordan P. Alvarez
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
i�I&C: N/A
Date Approved: N/A
1295 Form: N/A
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Exhibit A
G4 Geamatic Resources, LLC
APPENDIx � - PRICING INDEx
DI R-CPD-6�'I 3
Leica Geosystems - Lei�a Geomatics - SmartNet
Leica Geosystems - Lei�a Geomatics - Customer Care Plan
Leica Geosystems - Lei�a Reality Capture - Hardware � 5oftware
Leica Geosystems - Lei�a Reality Capture — BLK
Leica Geosystems - Lei�a Reality Capture - Custamer Care Plan
Carlsan 5oftware
MicroSurvey 5oftware
5eco Manufacturing
Topcon Pasitianing 5ystems
❑ata Acti�atian Center
Carlsan Saftware - Training
MicroSurvey 5aftware - Training
Seca Manufa�turing - Training
Tapcon Pasitianing Systems - Training
Data Activatian Center - Training
End af Appendix C
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Geagraphic Infarmatian Systems {GIS] & Digital Land Surveying Produ�ts and Services RFO DIR-CPD-TMP-596
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MASTER C��PERATIVE CONTRACT
G4 Geomatic Resources. LLC
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1.� Parties
This �antra�t for Geagraphi� Information 5ystems [GIS} & Digital Land 5urveying
Products and 5ervi�es [this "Contra�t"} is entered into k�etween the 5tate of Texas, acting
by and through the Department of Information Resour�es (hereinafter "DIR"7 with its
prin�ipal place ❑f business at 30a West 15t�, 5treet, Suite 13D0, Austin, Texas 787a1, and
G4 Geomati� Resour�es, LLC a Texas Limited Liability Company [LLC] [hereinafter
"Successful Respandent"], with its principal place of business at 2914 5tory Rd W, Irving,
TX 75a38. This Cantra�t k�e�omes effe�ti�e on the date on whi�h the last party to sign
affixes its signature.
�.2 Complianre with Procurement Laws
This Contract is the result of compliance with appli�able pro�urement laws ❑f the 5tate
of Texas. �IR issued a solicitation on the Camptraller of Publi� A��aunts' Ele�tronic 5tate
Business �aily, Request for �ffer [RFO] DIR-CPO-TMP-5g5, on May 7, 2025, for
Geagraphic Information 5ystems [G15} & Digital Land 5urveying Produ�ts and 5ervices
[the "RFO"}. Llpon execution of all Cantra�ts, a noti�e of award for DIR-CP�-TMP-596,
shall be posted by DIR on the Ele�tronic 5tate Business Daily.
� .3 �rder vf Precedence
Far transactions under this Contra�t, the order of pre�eden�e shall be as fallows:
1. This Master Cooperative Cantra�t;
2. Appendix A, Standard Terms and Conditians;
3. Appendix B, 5uccessful Respandent's Historically Underutilized Businesses
5ub�ontracting Plan;
4. Appendix C, Pricing I�ndex;
5. Exhibit 1, RFD DIR-CPO-TMP-5g5, including all Addenc�a; and
�IR Contract No. DIR-CPO-6013
G4 Geomatic Resources, LLC — 87-190628D
5. Exhibit 2, 5u��essful Respandent's Response to RFD DIR-CPO-TMP-5g5,
in�luding all Addenda.
1.4 Definitions
Capitalized terms used but nat defined herein have the meanings given to them in
Appendix A, Standard Terms and Condi�ians.
� TERM �F C�NTRACT
The initial term of this Cantra�t shall be up to two (2] years commencing on the date of
the last signature heret❑ [the "Initial Term"}, with one �1} optional two-year renewa�l and
one [1 } optional one-year renewal (ea�h, a"Renewal Term" and tagether with the "Inrtial
Term," the "Term"}, Prior t❑ expiration of the Initial Term and ea�h Renewal Term
[excluding the final Renewal Term}, this Contract will renew automatically under the
same terms and �onditions unless either party prv�ides written notice to the other party
at least sixty (5D} days in ad�an�e of the renewal date stating that the party wishes to
discuss amendment ❑r non-renewal. Additionally, DIR, in its sole discretion, may extend
the final Renewal Term by up to ninety (9D} days under the then-�urrent terms and
conditions upon thirty (3D} days written noti�e to Successful Respondent.
f�� �:Zf] �1�I� r_1► I��7 �:��1 C�1 ��] y y�:� 1► C��
The produ�ts and services a�ailable under this Contract are limited to the praducts and
servi�es provided in Appendix C, Pri�ing Index. At DIR's sale dis�retion, Successful
Respondent may rnake changes t❑ its praduct and service offerings by a mutually
agreed amendment to Appendix C, Pricing Index, provided that any changes must be
within the s�ape af the RFO.
4 PRICING
4.9 Pricing Index
Pri�ing to Customers shall be as set forth in Appendix C, Pri�ing Index, and shall
in�lude the DIR Administrati�e Fee �as defined below].
4.2 Customer Discount
A. The minimum Customer dis�aunt for all products and services will be the
percentage off List Price [as defined below} or MSRP [as defined below}, as
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appli�able, as specified in Appendix C, Pricing Index. Successful Respandent
shall not establish a List Pri�e or MSRP for this Contract ❑r a parti�ular soli�itation.
Far purposes ❑f this 5e�tion, "List Pri�e" is the pri�e for a prvdu�t or service
published in 5uccessful Respondent's price �atalog (or similar do�ument} before
any discounts or pri�e allowan�es are applied. For purposes ❑f this Section,
"MSRP", or manufa�turer's suggested retail pri�e, is the price list published by the
manufa�turer or publisher of a prvdu�t and available to and re�agnized by the
trade.
B. Customers pur�hasing prvdu�ts or services under this Contract may negotiate
additional discounts with Successful Respandent. 5uccessful Respondent and
Customer shall pra�ide the details of su�h additional dis�aunts to �IR upon
request.
C. If products or servi�es available under this Contract are pro�ided by Successful
Respandent at a lower price to: [i7 an Eligible Customer who is not pur�hasing
those praducts ❑r ser�i�es under this Contra�t, or (ii} to any other �ustomer under
the same terms and �anditions provided for the same produ�ts and services
under this Cantra�t, then the pri�e of su�h praducts and services under this
Contract shall be adjusted to that lower pri�e. This requirement does nat apply to
�olume ❑r spe�ial pri�ing pur�hases. Successful Respondent shall natify DIR
within ten �1D} days of pro�iding a lower price as des�ribed in this 5ection, and
this Contract shall be amended within ten (1D} days to reflect such Ivwer price.
4.3 Changes t❑ Prices
A. 5ubje�t to the requirements of this 5e�tian, 5u��essful Respondent may �hange
the price ❑f any product ❑r ser�i�e upan changes to the List Price or MSRP, as
appli�able. Discount le�els shall not be subject to su�h changes, and will remain
consistent with the dis�ount levels specified in this Contra�t.
B. 5uccessful Respondent may re�ise its pri�ing by publishing a revised pri�ing list,
subject to re�iew and approval by DIR. If �IR, in its sole dis�retion, finds that the
price of a produ�t or servi�e has been increased unreasonably, DIR may request
that 5u��essful Respondent reduce the pri�ing for the produ�t or service to the
le�el published befare su�h re�isian. LJpon such request, Successful Respandent
shall either redu�e the pricing as requested, or shall remo�e the product ❑r
servi�e fram the pri�ing list for this Cantra�t. Failure to do so will constitute an a�t
of default k�y Successful Respondent.
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�����:�,���1�1��1 ��'��:7_r��������
A. 5uccessful Respondent shall pay an administrati�e fee to DIR based ❑n the dallar
�alue of all sales to Customers pursuant to this Contract (the "DIR Administrative
Fee"}, The amount ❑f the DIR Administrati�e Fee shall be seventy-fi�e hundredths
vf a per�ent �0.75°/0] of all sales, net of returns and credits. For example, the
administrative fee for sales totaling $10D,DOD shall be $750.
B. All prices quated to Customers shall in�lude the DIR Administrative Fee.
5uccessful Respondent shall not in�oice Customers for the �IR Administrative Fee
as a separate item or �harge on any Invoi�e.
C. DIR reserves the right to change the DIR Administrative Fee during the Term,
upon written noti�e to 5uccessful Respondent without amending this Contract.
Any increase or de�rease in the DIR Administrati�e Fee shall be incorporated in
the price to Customers.
D. The DIR Administrati�e Fee for any Customer pur�hase shall be the rate in effect
vn the date vf the Pur�hase Agreement.
5 CONTRACT WEBPAGE REQLJIREMENTS
In addition to the requirements listed in Appendix A, 5ection 8.4, Internet Access to
Cantract and Pri�ing Infarmation, 5u��essful Respandent shall include the following
with its webpage:
A. Warranty policies; and
B. Return palicies.
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7.'I Authorizativn to Use Designated Resellers
5ubje�t to the conditians in this 5ection, 5u�cessful Respondent may designate resellers
to provide the products and servi�es available under this Contra�t to Customers (such
resellers, "Designated Resellers"} under the terms and �onditions ❑f this Contract.
Designated Resellers may enter into Purchase Agreements with Customers on behalf of
5uccessful Respondent and perform Successful Respondent's obligations thereunder.
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Far the a�oidan�e of doubt, 5uccessful Respondent shall remain responsible for
obligations t❑ DIR arising under the Cantract.
7.2 Responsibility for Designated Resellers
A. 5uccessful Respondent shall be responsible for its Designated Reseller's
performan�e of and �omplian�e with the Contract and all Purchase Agreements
issued thereunder to the same extent as if 5uc�essful Respondent had dire�tly
entered into such Purchase Agreements.
B. 5uccessful Respondent shall enter into agreements with its �esignated Resellers
that are consistent with the terms of this Contra�t. The terms of this Cantra�t take
precedence o�er any �onfli�ting terms in the agreements between Su��essful
Respandent and Designated Resellers to the extent such terms relate to the
performan�e of this Contra�t.
C. 5uccessful Respondent shall not contractually prahibit ❑r otherwise attempt to
prevent its Designated Resellers fram participating directly in DIR or Eligible
Customer pro�urements or salicitatian oppartunities.
7.3 Designation and Remv►►al Procedures
A. 5uccessful Respondent may add Designated Resellers vnly upon written
authorization by DIR.
B. Far ea�h Designated Reseller, 5u�cessful Respondent shall provide DIR with the
entity`s:
1. Legal name and assumed name, if applicable;
2. Business address;
3. Camptroller of Public Accounts identifi�ation number;
4. Cantact email address and phone number; and
5. Any other information reasonably requested by DIR.
C. DIR, in its sole dis�retion, may reje�t the additian or require the immediate
rema�al of any Designated Reseller. �IR will make a gaod faith effort t❑ pra�ide
reasonable noti�e to 5uccessful Respondent of the remo�al ❑f any Designated
Reseller.
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D. 5uccessful Respondent may submit a request to DIR to rema�e a �esignated
Reseller. 5u��essful Respondent shall provide DIR with any infarmation
reasonably requested by �IR related t❑ such removal request, and the parties will
�oaperate to remove the Designated Reseller as soon as reasonably practi�able.
E. LJpon remo�al ❑f a Designated Reseller, any Pur�hase Agreements entered into
with su�h Designated Resellers will survive in a��ardance with the terms of su�h
Purchase Agreement and 5e�tian 4.5, Appendix A, 5tandard Terms and
Conditions. Successful Respandent wiil remain responsik�le far the performance
vf such Purchase Agreement in a��ordance with 5e�tian 7.2 above.
F. LJpon designatian or rema�al of Designated Resellers, 5uccessful Respondent
shall �omply with the requirements of the state's Historically LJnderutilized
Business �"HL1B"} program and revise its HUB 5ub�ontracting Plan a��ordingly.
E��►C���ly[�1_��C�7►1
All natices, demands, designatians, certificates, requests, offers, consents, approvals, a�d
othe� instruments given pursuant to this Contra�t shall be in writing and shall k�e validly
gi�en on: [i} the date of delivery if deli�ered by email, facsimile transmissian, mailed by
registered or certified mail, or hand deli�ered, or �ii7 three �3} Business Days after being
mailed �ia United 5tates Postal 5ervice. All notices under this Contra�t shall be sent to a
party at the respecti�e address indicated belaw or to another address as the party shall
ha�e nvtified the other party in writing.
If sent to the State:
Lisa Massack or 5uccessor in �ffice
Chief Pro�urement �fficer
Department ❑f Infarmatian Resour�es
3a0 W. 15th 5t., 5uite 130a
Austin, Texas 78701
Phane: (512} 475-47D0
Email: dir�antra�tmanaqementafficeC�dir.texas.aov
With �apy to the DIR Contra�t Manager. 5ee Appendix A at Se�tion 10.2.1.
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If sent to Successful Respondent:
Christina Lucas
G4 Geomati� Resour�es, LLC
2g14 5tary Rd W
Irving, TX 75�38
Phane: (714] 925-6345
Email: Christina.Lu�as@g4gr.com
Notices issued pursuant to a Purchase Agreement between 5u��essful Respondent and
Customer shall be made in accordan�e with the Pur�hase Agreement.
�'�,1�7�1��C�7►1_l�_[�f:���►►►1�►���
9.9 Definition vf Additivnal Agreements
"Additional Agreements" include any terms and conditions governing produ�ts or
servi�es purchased under this Contra�t that are in�arporated into or made appli�able t❑
a Purchase Agreement but are not in�luded in the list of documents in 5e�tian 1.3,
�rder of Pre�edence, hereaf. Additianal Agreements may be in�luded in, but are not
limited to, a Statement of Wark, fis�al pur�hase orders, software li�ensing agreements,
servi�e agreements, leasing agreements, or any linked, �li�k-through, supplemental, ❑r
affixed terms or �anditions, regardless of when su�h additional terms and conditians are
in�orporated into ❑r made appli�able to a Pur�hase Agreement. For the avoidance ❑f
doubt, Additianal Agreements include terms and �onditions go�erning products or
servi�es purchased under this Contra�t that are in�arporated by the publisher or
manufacturer of the product ❑r ser�i�e.
9.2 Authority t❑ Enter Into Additional Agreements
A. 5ubje�t to the conditions in this Se�tion, 5u��essful Respvndent and a Customer
may enter into Additional Agreements. The terms and �onditions of su�h
Additional Agreements will be re�iewed, negatiated, and agreed upan between
the Custamer and Successful Respandent. DIR has not reviewed and will not
re�iew any Additional Agreements, and is nvt a party to any Additional
Agreements.
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a. Amendments ❑r updates to Additional Agreements shall nat be made
without Customer's express consent, unless Customer has expressly
agreed otherwise.
9.3 Precedence vf Contract
A. All Additianal Agreements are subje�t t❑ the Contract. The terms and �onditions
vf the Cantra�t shall take pre�eden�e v�er any �onflicting terms and conditions
vf any Additianal Agreement. 5u��essful Respondent and Customers may not
alter this order of pre�edence.
B. If any Additional Agreement purpvrts to take precedence over or supersede the
terms and conditians of the Contract, the confli�ting terms and �onditions will be
�oid and inapplicable to the Contract and the Purchase Agreement. Successful
Respandent will be nonetheless obligated to perform the appli�able Pur�hase
Agreement without regard to the �onflicting terms and �onditions, unless
Customer elects instead t❑ terminate such Purchase Agreement, which may be
considered a termination for �ause in a��ardance with 5ection 12.5.3, Appendix
A, Standard Terms and Conditions.
1� AUTHORIZED ExCEPTI�NS TO APPENDIx A, STANDARD TERMS AND
CONDITIDNS
No ex�eptions ha�e been agreed to by DIR and 5uccessful Respondent.
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�IR Contract No. DIR-CPO-6013
G4 Geomatic Resources, LLC — 87-190628D
This Contract is exe�uted to be effe�ti�e as of the date of last signature.
G4 Geamatic Resour�es, LLC
Autharized By: 5iqnature on File
Name: Rodne� Walsh
Title: President
Date: 111141�D25
The 5tate vf Texas, acting hy and through the Department of Information Resvurces
Autharized By: 5ignature on File
Name: Lisa Masso�k
Title: Chief Procurement �fficer
Date: 121112d25
❑fFice af General Counsel: Siqnature on File
Date: 1112d1�D25
DIR-CPfl-TMP-596 Page 9 of 9
Version 7.1
Re�. 03�12�25
Exhib�t C
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor dang bu:sin�ss with locaf governmental entity
This questionnaire reflects changes macie to the law hy H.B. 23, $4th Leg., Regular Session.
FORM CIQ
QFFICE US� ONL.Y
This questionnaire is being filed in accordance with Chapter i 76, Local Government Code, by a vendor who oaie Received
has a busine5s relationship as tlefined by Section 176.Ofl1(1-a) with a local governmental entity and the
vendor meets requirements under Section i7B.006(a}.
By law this questlannaEre m�st be filed with the records administrator of the local governmental entity not later
than ihe 7th b�siness day after ihe date the �endor becomes aware o# facts lhat require the statement to be
filed. See Sectian i76.OD6(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates 5ection 176.D06, Local Government Gode. An
offense under this seciion is a misdemeanor.
J Name of vendor who has a business relationship wiih local gp�ernmental entity.
�
�� Ca�Or�a'hc ��SnUrC'��S , � -
❑ Check this box if you are filing an update to a pre�iously #iled quesfionnaire. {The law requires that you file an updated
completed questiannaire with the apprapriate fiiing autt�ority not later than t�e 7th business day after the date ort which
you became aware that the originally fifed questionnaire was incomplete or inaccurate.)
J Name of local gnvernment officer a6out whom the information is being disc[asecf.
� ��
Name of Of�icer
� Describe each err�ployrnent or other business relationship with the local go�ernment officer, or a family member of the
officer, as described by Section 176.003(a)(2)(AJ. A�sa describ� any family relationship with the Eocal government officer.
Corrtple#e subparis A and B for each employment or business relationship described. Attach additional pages to this Form
CIQ as necessary.
A. Is the local government officer ar a family member of Yhe officer receiving or likely to rec�ive taxable income;
other than investment income, from tne vendor?
� Yes � iVo
B. is the vendor receiving or likely to f�eceive taxable income, ather than investment income, from or at the direction
of the lacal government officer or a family member of the officer AND the taxable income is not received irom the
local go�ernmental entiiy?
� Yes � {�o
� Describe each emplqymenf or business relationship tha# ihe vendor named in Section 1 maintains with a corporatian or
other business enti#y with respect to which the Ipcal go��rnment officer serves as an officer or director, or hoids an
ownership interest of one percent or more.
J
� Check this box if the vendor has gi�en the lacal government officer or a family memf�er of the afficer ane or more gifts
as described in Section 176.003{a}(2)(B), excluding gifts described in Section 17fi.003(a-1}.
�
ignature o ven'dor prng�[t� h the overnme �L�� f��6;/��l)
g ntal entity �a#e
Form provided by Texas �Yhics Commission www.ethics.state.tx.us Revised 1/�l2021