HomeMy WebLinkAboutC2025-044 - 4/8/2025 - Approved CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
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
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.
ji Name of vendor who has a business relationship with local governmental entity.
PVS DX, Inc.
2
Check this box If you are tiling 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.)
3 Name of local government officer about whom the Information Is being disclosed.
None
Name of Officer
4 Describe each employment or other business relationship with the local government officer,or a family member of the
off leer,as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government off leer.
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 ® 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?
Yes No
-5J 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 off leer serves as an officer or director,or holds an
ownership Interest of one percent or more.
i
j
1'
6
❑ 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)(6), excluding gifts described in Section 176.003(a-1).
7 Connie O'Guynn
Assistant Secretary
PVS DX I 04/07/2025
Signature of vendor doing business with the governmental enilfy 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
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§176r001(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(1:3):
(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)(S),excluding any
gift described by Section 1 76.003(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
c SUPPLY AGREEMENT NO. 6331
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Liquid Chlorine One-Ton Cylinders
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THIS Liquid Chlorine One-Ton Cylinders Supply Agreement ("Agreement") is
entered into by and between the City of Corpus Christi, a Texas home-rule municipal
corporation ("City") and PVS DX Inc. ("Contractor"), effective upon execution by the
City Manager or the City Manager's designee ("City Manager").
WHEREAS, Contractor has bid to provide Liquid Chlorine One-Ton Cylinders
in response to Request for Bid No. Exempt-6331 ("RFB"), which RFB includes the
required scope of work and all specifications and which RFB and the Contractor's
bid response are incorporated by reference in this Agreement as Exhibits 1 and 2,
respectively, as if each were fully set out here in its entirety.
NOW, THEREFORE, City and Contractor agree as follows:
1. Scope. Contractor will provide Liquid Chlorine One-Ton Cylinders in accordance
with the attached Scope of Work, as shown in Attachment A, the content of which
is incorporated by reference into this Agreement as if fully set out here in its
entirety. "Goods," "products", and "supplies", as used in this Agreement, refer to
and have the same meaning.
2. Term.
(A) The Term of this Agreement is one year beginning on the date provided in
the Notice to Proceed from the Contract Administrator or the City's Procurement
Division. The parties may mutually extend the term of this Agreement for up to two
additional one-year periods ("Option Periods)"), provided, the parties do so in
writing prior to the expiration of the original term or the then-current Option Period.
(B) At the end of the Term of this Agreement or the final Option Period, the
Agreement may, at the request of the City prior to expiration of the Term or final
Option Period, continue on a month-to-month basis for up to six months with
compensation set based on the amount listed in Attachment B for the Term or the
final Option Period. The Contractor may opt out of this continuing term by
providing notice to the City at least 30 days prior to the expiration of the Term or
final Option Period. During the month-to-month term, either Party may terminate
the Agreement upon 30 days' written notice to the other Party.
3. Compensation and Payment. This Agreement is for an amount not to exceed
$167,100.00, subject to approved extensions and changes. Payment will be made
Supply Agreement Standard Form Page 1 of 7
Approved as to Legal Form October 29, 2021
7. Inspection and Acceptance. City may inspect all products supplied before
acceptance. Any products that are delivered but not accepted by the City must
be corrected or replaced immediately at no charge to the City. If immediate
correction or replacement at no charge cannot be made by the Contractor, a
replacement product may be bought by the City on the open market and any
costs incurred, including additional costs over the item's bid price, must be paid
by the Contractor within 30 days of receipt of City's invoice.
8. Warranty.
(A) The Contractor warrants that all products supplied under this Agreement
are new, quality items that are free from defects, fit for their intended purpose,
and of good material and workmanship. The Contractor warrants that it has clear
title to the products and that the products are free of liens or encumbrances.
(B) In addition, the products purchased under this Agreement shall be
warranted by the Contractor or, if indicated in Attachment D by the
manufacturer, for the period stated in Attachment D. Attachment D is attached
to this Agreement and is incorporated by reference into this Agreement as if fully
set out here in its entirety.
9. Quality/Quantity Adjustments. Any quantities indicated on the Bid/Pricing
Schedule are estimates only and do not obligate the City to order or accept more
than the City's actual requirements nor do the estimates restrict the City from
ordering less than its actual needs during the term of the Agreement and including
any Option Period. Substitutions and deviations from the City's product
requirements or specifications are prohibited without the prior written approval of
the Contract Administrator
10. Non-Appropriation. The continuation of this Agreement after the close of any
fiscal year of the City,which fiscal year ends on September 30th annually, is subject
to appropriations and budget approval specifically covering this Agreement as
an expenditure in said budget, and it is within the sole discretion of the City's City
Council to determine whether or not to fund this Agreement. The City does not
represent that this budget item will be adopted, as said determination is within the
City Council's sole discretion when adopting each budget.
11. Independent Contractor. Contractor will perform the work required by this
Agreement as an independent contractor and will furnish such products in its own
manner and method, and under no circumstances or conditions will any agent,
servant or employee of the Contractor be considered an employee of the City.
12. Subcontractors. In providing the Goods, Contractor will not enter into
subcontracts or utilize the services of subcontractors.
Supply Agreement Standard Form Page 3 of 7
Approved as to Legal Form October 29, 2021
AGREEMENT BY THE CONTRACTOR OR RESULTS FROM THE NEGLIGENT
ACT, OMISSION, MISCONDUCT, OR FAULT OF THE CONTRACTOR OR ITS
EMPLOYEES OR AGENTS. CONTRACTOR MUST, AT ITS OWN EXPENSE,
INVESTIGATE ALL CLAIMS AND DEMANDS, ATTEND TO THEIR SETTLEMENT
OR OTHER DISPOSITION, DEFEND ALL ACTIONS BASED THEREON WITH
COUNSEL SATISFACTORY TO THE CITY ATTORNEY, AND PAY ALL
CHARGES OF ATTORNEYS AND ALL OTHER COSTS AND EXPENSES OF
ANY KIND ARISING OR RESULTING FROM ANY SAID LIABILITY, DAMAGE,
LOSS, CLAIMS, DEMANDS, SUITS, OR ACTIONS. THE INDEMNIFICATION
OBLIGATIONS OF CONTRACTOR UNDER THIS SECTION SHALL SURVIVE
THE EXPIRATION OR EARLIER TERMINATION OF THIS AGREEMENT.
18. Termination.
(A) The City may terminate this Agreement for Contractor's failure to comply with
any of the terms of this Agreement. The City must give the Contractor written
notice of the breach and set out a reasonable opportunity to cure. If the
Contractor has not cured within the cure period, the City may terminate this
Agreement immediately thereafter.
(B) Alternatively, the City may terminate this Agreement for convenience upon
30 days advance written notice to the Contractor. The City may also terminate
this Agreement upon 24 hours written notice to the Contractor for failure to pay or
provide proof of payment of taxes as set out in this Agreement.
19. Owner's Manual and Preventative Maintenance. Contractor agrees to provide a
copy of the owner's manual and/or preventative maintenance guidelines or
instructions if available for any equipment purchased by the City pursuant to this
Agreement. Contractor must provide such documentation upon delivery of such
equipment and prior to receipt of the final payment by the City.
20. Limitation of Liability. The City's maximum liability under this Agreement is limited
to the total amount of compensation listed in Section 3 of this Agreement. In no
event shall the City be liable for incidental, consequential or special damages.
21. Assignment. No assignment of this Agreement by the Contractor, or of any right
or interest contained herein, is effective unless the City Manager first gives written
consent to such assignment. The performance of this Agreement by the
Contractor is of the essence of this Agreement, and the City Manager's right to
withhold consent to such assignment is within the sole discretion of the City
Manager on any ground whatsoever.
Supply Agreement Standard Form Page 5 of 7
Approved as to Legal Form October 29, 2021
CONTRACTOR
Signature: lennyleal rApr7,202510:36CDT)
Printed Name: Jenny teal
Title: Regional Sales Manager
Date: 04/07/2024
Res.033617 � ir11crizecl p�
CITY OF CORPUS CHRISTI 4/8/2025
Council
Sergio V' asana(Apr 13,2025 07:33 CDT) R�SS
Sergio Villasana
Director, Finance & Procurement
Date: 04/13/2025
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Stwhairie 50,� �oY
Attached and Incorporated by Reference: Stephani Box for(Apr 14,2025 10: 9CDT)
Attachment A: Scope of Work Rebecca Wuerta
Attachment B: Bid/Pricing Schedule City Secretary
Attachment C: Insurance Requirements
Attachment D: Warranty Requirements
Incorporated by Reference Only:
Exhibit 1 : RFB No. Exempt-6331
Exhibit 2: Contractor's Bid Response
Supply Agreement Standard Form Page 7 of 7
Approved as to Legal Form October 29, 2021
furnished under the release order, complies with all applicable
requirements of ANSI/AWWA B301-18 and ANSI/NSF 60 must be provided to
the City of Corpus Christi, Plant Manager, 13101 Leopard Street, Corpus
Christi, TX 78410.
4. Ownership
The City's ownership of the liquid chlorine in one-ton cylinders must begin, and
Contractor's ownership must cease, upon arrival of the cylinders at the
unloading rack at the O.N. Stevens Water Treatment Plant.
5. Testing
The City reserves the right to have the product supplied tested at any time
during the Contract period. An independent laboratory would do such
testing. Failure to meet specifications must result in the testing rate costs to be
borne by the Contractor.
6. Containers
A. The Contractor must supply liquid chlorine in one-ton cylinders.
B. The Contractors' shipping containers for liquid chlorine must conform to
applicable regulations of the federal, state, and Interstate Commerce
Commission.
C. The Contractor must send containers that are reconditioned and
maintained in accordance with the latest edition of "Container Procedure
at Chlorine Packaging Plants" issued by the Chlorine Institute Inc. The
Contractor must carefully examine the container for leakage, damage,
and corrosion before delivery.
D. All chlorine containers must have legible tags securely attached which, in
additional to the information routinely furnished, must indicate the following
container history:
a. Date of last visual inspection in accordance with Compressed Gas
Association, Inc. standards.
b. Date the valves were overhauled.
c. Date the fuse plugs were tested and/or renewed.
d. Date the container was last cleaned.
7. Inspection
The City reserves the right to make unannounced inspections of the
Contractor's plant and facilities at any time, in order to ensure proper cleaning
Page 2 of 3
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0 0 �� ATTACHMENT B: QUOTE/PRICING SCHEDULE
CITY OF CORPUS CHRISTI
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1. Refer to "Sample Service Agreement" Contract Terms and Conditions before completing
quote.
2. Quote your best price, including freight, for each item.
3. In submitting this quote, vendor certifies that the prices in this quote have been arrived at
independently,without consultation,communication,or agreement with any othervendor
or competitor, for the purpose of restricting competition with regard to prices.
Invitation to quote, FOB Destination, Freight Included, on the following:
DESCRIPTION QTY UNIT UNIT PRICE PRICE TOTAL
Liquid Chlorine-One-ton Cylinders 60 EA $2,635.00 $158,100.00
Rental Fee per one-ton Cylinder
(per ton, per month, cylinders to 120 EA $75.00 $9,000.00
be turned every six months)
`OAt $167,100.00
COMPANY: PVS DX Inc.
NAME OF PERSON AUTHORIZED TO SIGN:
ADDRESS: 5245 Sunbelt CITY /STATE/ZIP: Corpus Christi, TX 78408
PHONE: 361-289-6947 EMAIL: emanzano@pvschemicals.com
FAX: 361-289-7709 DATE:
SIGNATURE: TITLE:
THE CITY RESERVES THE RIGHT TO REJECT OR CANCEL ANY OR ALL QUOTES. TO WAIVE
ANY INFORMALITIES OR IRREGULARITIES IN THE QUOTES RECEIVED AND TO CANCEL
OR POSTPONE THIS PROJECT UNTIL A LATER DATE.
B. ADDITIONAL REQUIREMENTS
1 . Applicable for paid employees, Contractor must obtain workers' compensation
coverage through a licensed insurance company. The coverage must be written on a
policy and endorsements approved by the Texas Department of Insurance. The
workers' compensation coverage provided must be in statutory amounts according to
the Texas Department of Insurance, Division of Workers' Compensation. An All States
Endorsement shall be required if Contractor is not domiciled in the State of Texas.
2. Contractor shall obtain and maintain in full force and effect for the duration of this
Contract, and any extension hereof, at Contractor's sole expense, insurance coverage
written on an occurrence basis by companies authorized and admitted to do business
in the State of Texas and with an A.M. Best's rating of no less than A- VII.
3. Contractor shall be required to submit renewal certificates of insurance throughout the
term of this contract and any extensions within 10 days of the policy expiration dates.
All notices under this Exhibit shall be given to City at the following address:
City of Corpus Christi
Attn: Risk Manager
P.O. Box 9277
Corpus Christi, TX 78469-9277
4. Contractor agrees that, with respect to the above required insurance; all insurance
policies are to contain or be endorsed to contain the following required provisions:
• List the City and its officers, officials, employees, and volunteers, as additional insured's
by endorsement with regard to operations, completed operations, and activities of or
on behalf of the named insured performed under contract with the City, with the
exception of the workers' compensation policy;
• Provide for an endorsement that the "other insurance" clause shall not apply to the City
of Corpus Christi where the City is an additional insured shown on the policy;
• Workers' compensation and employers' liability policies will provide a waiver of
subrogation in favor of the City; and
• Provide 30 calendar days advance written notice directly to City of any, cancellation,
non-renewal, material change or termination in coverage and not less than 10 calendar
days advance written notice for nonpayment of premium.
5. Within 5 calendar days of a cancellation, non-renewal, material change or termination
of coverage, Contractor shall provide a replacement Certificate of Insurance and
applicable endorsements to City. City shall have the option to suspend Contractor's
performance should there be a lapse in coverage at any time during this contract.
Failure to provide and to maintain the required insurance shall constitute a material
breach of this contract.
Attachment D: Warranty Requirements
No warranty is required for this service agreement.
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