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HomeMy WebLinkAboutC2011-015 - 1/25/2011 - ApprovedSERVICE CONTRACT Storm Water Improved ROW Strip Mowing Service Agreement No. SA11 -031 THIS Storm Water Improved ROW Strip Mowing CONTRACT (this "Agreement ") is entered into by and between Dat A Boy Env Service (the "Contractor ") and the City of Corpus Christi, a Texas home -rule municipal corporation (the "City "), by and through its duly authorized City Manager or designee, effective for all purposes upon execution by the City Manager or his designee. WHEREAS Contractor has proposed to provide Storm Water Improved ROW Strip Mowing, for Group 1, for an estimated annual expenditure of $30,660.00, in response to Bid Invitation No. BI- 0012 -11 in accordance with Specification 1104, dated 08/24/10 which is incorporated and attached as Exhibit A; WHEREAS the City has determined Contractor to be the best value bidder; NOW, THEREFORE, Contractor and City enter into this Agreement and agree as follows: 1. Services. Contractor will perform Improved ROW Strip Mowing in accordance with Specification 1104. 2. Term. This Agreement is for twelve (12) months commencing on February 1, 2011 and continuing through January 31, 2012. The term includes an option to extend for up to two (2) additional twelve -month (12) periods subject to the approval of the Contractor and the City Manager or his designee ( "City Manager "). 3. Contract Administrator. The Contract Administrator designated by the City is responsible for approval of all phases of performance and operations under this Agreement including deductions for non - performance and authorizations for payment. All of the Contractor's notices or communications regarding this Agreement must be directed to the Contract Administrator, who is the Storm Water Contract Administrator. 4. Independent Contractor. Contractor will perform the services hereunder as an independent contractor and will furnish such services in its own manner and method, and under no circumstances or conditions may any agent, servant or employee of the Contractor be considered an employee of the City. 2011 -015 M2011 -024 01/25/11 Dat A Boy Env Svc INDEM 5. Insurance. Before activities can begin under this Agreement, the Contractor's insurance company(ies) must deliver a Certificate of Insurance, as proof of the required insurance coverages and the performance bond to the Contract Administrator. Additionally, the Certificate must state that the Storm Water Contract Administrator will be given at least thirty (30) days notice, by certified mail, of cancellation, material change in the coverages, or intent not to renew any of the policies. The City must be named as an Additional Insured. The City Attorney must be given copies of all insurance policies within 15 days of the City Manager's written request. 6. Assignment. No assignment of this Agreement or any right or interest therein by the Contractor is effective unless the City first gives its written consent to such assignment. The performance of this Agreement by the Contractor is of the essence of this Agreement and the City's right to withhold consent to such assignment is within the sole discretion of the City on any ground whatsoever. 7. Fiscal Year. All parties recognize that the continuation of any contract after the close of any fiscal year of the City (the City's fiscal year ends on July 31St), is subject to appropriations and budget approval providing for covering such contract item as an expenditure in said budget. The City does not represent that said budget item will be actually adopted as that determination is within the sole discretion of the City Council at the time of adoption of each budget. 8. Waiver. No waiver of any breach of any term or condition of this Agreement, or Specification 1104, or the Contractor's bid offer to Bid Invitation No. BI- 0012 -11 waives any subsequent breach of the same. 9. Compliance with Laws. This Agreement is subject to all Federal laws and laws of the State of Texas. All duties of the parties will be performed in the City of Corpus Christi, Texas. The applicable law for any legal disputes arising out of this Agreement is the law of Texas and such form and venue for such disputes is the appropriate district, county or justice court in and for Nueces County, Texas. 10. Subcontractors. The Contractor may use subcontractors in connection with the work performed under this Agreement. When using subcontractors, however, the Contractor must obtain prior written approval from the Storm Water Contract Administrator. In using subcontractors, the Contractor is responsible for all their acts and omissions to the same extent as if the subcontractor and its employees were employees of the Contractor. All requirements set forth as part of this Agreement are applicable to all subcontractors and their employees to the same extent as if the Contractor and its employees had performed the services. 11. Amendments. This Agreement may be amended only by written Agreement duly authorized by the parties hereto and signed by the parties. 12. Termination. The City Manager may terminate this Agreement for Contractor's failure to perform the services specified in Bid Invitation No. BI- 0012 -11 or Specification No. 1104. Failure to keep all insurance policies and performance bonds in force for the entire term of this Agreement is grounds for termination. The Contract Administrator must give the Contractor five (5) work days 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 Manager may terminate this Agreement immediately thereafter. Alternatively, the City may terminate this Agreement upon twenty (20) days written notice to the Contractor. However, the City may terminate this Agreement on twenty -four (24) hours written notice to the Contractor for failure to pay or provide proof of payment of taxes as set out herein. 13. Taxes. The Contractor covenants to pay payroll taxes, Medicare taxes, FICA taxes, unemployment taxes and all other related taxes according to Circular E Employer's Tax Guide, Publication 15, as it may be amended. Upon his request, the City Manager shall be provided proof of payment of these taxes within fifteen (15) days of such request. Failure to pay or provide proof of payment is grounds for the City Manager to immediately terminate this Agreement. 14. Drug Policy. The Contractor must adopt a Drug Free Workplace and drug testing policy that substantially conforms to the City's policy. The City has a zero - tolerance drug policy. 15. Violence Policy. The Contractor must adopt a Violence in the Workplace and related hiring policy that substantially conforms to the City's policy. The City has a zero - tolerance violence in the workplace policy. 16. Notice. Notice may be given by fax, hand delivery or certified mail, postage prepaid, and is received on the day faxed or hand - delivered and on the third day after deposit if sent certified mail. Notice shall be sent as follows: IF TO CITY: City of Corpus Christi Attention: Storm Water Contract Administrator P.O. Box 9277 Corpus Christi, Texas 78469 -9277 Fax No.: (361) 826 -4352 IF TO CONTRACTOR: Contractor D4-1- 4 B 09 uson i e4 /a Contact 44 k1 s R `e. `f) Address: ? ", Rd, '< " 1 City, State, .54 4P7 gaol` o '%'( Fax No.: 7 ira zt) 17. Month -to -Month Extension. If the City has not completed the procurement process and awarded a new Agreement upon expiration of the original contract period or any extension period, the Contractor shall continue to provide goods /services under this Agreement, at the most current price under the terms of this Agreement or extension, on a month -to -month basis, not to exceed six months. This Agreement automatically expires on the effective date of a new contract. 18. Severability. Each provision of the Agreement shall be considered to be severable and, if, for any reason, any such provision or any part thereof, is determined to be invalid and contrary to any existing or future applicable law, such invalidity shall not impair the operation of or affect those portions of this Agreement that are valid, but this Agreement shall be construed and enforced in all respects as if the invalid or unenforceable provision or part thereof had been omitted. CONTRACTOR SHALL INDEMNIFY, HOLD HARMLESS AND DEFEND THE CITY OF CORPUS CHRISTI AND ITS OFFICERS, EMPLOYEES AND AGENTS (INDEMNITEES) FROM AND AGAINST ANY AND ALL LIABILITY, LOSS, CLAIMS, DEMANDS, SUITS AND CAUSES OF ACTION OF ANY NATURE ON ACCOUNT OF DEATH, PERSONAL INJURIES, PROPERTY LOSS OR DAMAGE OR ANY OTHER KIND OF DAMAGE, INCLUDING ALL EXPENSES OF LITIGATION, COURT COSTS, ATTORNEYS' FEES AND EXPERT WITNESS FEES WHICH ARISE OR ARE CLAIMED TO ARISE OUT OF OR IN CONNECTION WITH THIS CONTRACT OR THE PERFORMANCE OF THIS CONTRACT, REGARDLESS OF WHETHER THE INJURIES, DEATH OR DAMAGES ARE CAUSED OR ARE CLAIMED TO BE CAUSED BY THE CONCURRENT OR CONTRIBUTING NEGLIGENCE OF INDEMNITEES, BUT NOT BY THE SOLE NEGLIGENCE OF INDEMNITEES UNMIXED WITH THE FAULT OF ANY OTHER PERSON OR GROUP. 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 INDEMNITEES AND PAY ALL CHARGES OF ATTORNEY AND ALL OTHER COSTS AND EXPENSES OF ANY KIND ARISING FROM ANY OF SAID LIABILITY, DAMAGE, LOSS, CLAIMS, DEMANDS OR ACTIONS. THE INDEMNIFICATION OBLIGATIONS OF CONTRACTOR UNDER THIS SECTION SHALL SURVIVE THE EXPIRATION OR SOONER TERMINATION OF THIS AGREEMENT. SIGNED this 7 day of , 20 / / . CITY 0 Michael!:. era STI ( "CITY ") Contractor )6 4 73c `- 6cvL02-1 Title: Assistant Director of Financial Services APPROVED THIS / 3 DAY OF -3-r vvA+L,es CARLOS VALDEZ, CITY ATTORNEY By: Assistant City Attorney Exhibit A: Specification No. 1104 dated 08/24/10 Exhibit B: Bid Invitation No. BI- 0012 -11 Exhibit C: Insurance Requirements ATTEST: ARMANDO CHAPA Crry SECRr TAR" eteel ,20 rT . 4LE ` ®, . AUTHORILED BY COUNCIL .24- ,5."11( SECRETARY Y /k'. Revised 10/14/10 CITY OF CORPUS CHRISTI PURCHASING DIVISION P. O. BOX 9277 CORPUS CHRISTI, TEXAS 78469 BID INVITATION INVITATION TO: This invitation includes these forms: *Bid Invitation Notice to All Bidders Instructions to Bidders Std. Purchase Terms & Conditions *Bid Sheet *Storm Water Improved ROW Strip Mowing Statement *Reference Sheet Service Agreement Standard Provisions *Service Contract Specification No. 1104 Insurance Requirements Qi pplemental Terms & Conditions, Storm Water mproved ROW Strip Mowing Storm Water Strip Mowing — Groups 1 - 7 Property Lists Property location maps Additional Instructions to Bidders *Disclosure of Interest *Minority Business Enterprise Information Form INVITATION NO.: BI- 0012 -11 (Must appear on Bidder's return envelope) COMMODITY: Storm Water Improved ROW Strip Mowing REQUISITION NO.(S) 004985 BID CLOSING TIME: October 27, 2010, 11:00 a.m. (By Purchasing Division Time Stamp) For ityformation on contract: Elisa Covington Senior Buyer e -mail: elisac @cctexas.com Telephone: (361) 826 -3161 'hese documents must be +ro. erI com.leted and returned as must our bid. BID (Refer to "Instructions to Bidders" before completing) he undersigned, by his/her signature, represents that he /she is authorized to bind the bidder to fully comply with the terms and conditions of e attached Bid Invitation, Specifications, and Special Provisions for the amount (s) shown on the accompanying bid sheet(s), if the offer is ;cepted within calendar days (90 days unless a different period is inserted) after date of bid opening. Firm Name: address: b - Q 8j Env Secth'c.e aox Ao 1'? t s f� Il 1t"� n 4-0y) D State: TX( Zip:q y -l2, o 64,4 ature of Person Authorized to Sign Bid Signer's Name: e h/frl es sQ- (Please print or type) Title: Telephone: S02-7 415 Ext. /UM- Fax: E -mail: Date: low ?re5/a&e�y —& 4. In order to provide interested parties sufficient time to formulate and submit their bids, the City of Corpus Christi hereby revises the due date for bids from 11:00 a.m. on October 20, 2010 to 11:00 a.m. on October 27, 2010. Attached is the revised bid invitation sheet which supersedes the original. "ALL OTHER ITEMS AND CONDITIONS, AS AMENDED, REMAIN UNCHANGED" Elisa Covington Senior Buyer ACKNOWLEDGED BY: '21) (-Ow dActax), 4-?,,Q.,0. 0 FIRM NAME AUTHORIZED SIGNATURE DATE ONE (1) COPY AND FIVE (5) SIGNED AND DATED ORIGINAL ADDENDUM NO. 1 MUST BE RETURNED TO =THE PURCHASING DIVISION WITH YOUR BID. CITY OF CORPUS CHRISTI PURCHASING DIVISION BID SHEET BID INVITATION NO. BI- 0012 -11 DATE: ( 0 – BIDDER Revised 10/14/10 0-1)10,4-11-12,1 kr2Q-L2.__ AUTHORIZED SIGNATURE PAGE 1 OF 2 1. Refer to "Instructions to Bidders" and Standard Purchase Terms and Conditions before completing bid. 2. Quote your best price, F.O.B. Destination, on each item. 3. In submitting this bid, I certify: a. That the prices in this bid have been arrived at independently, without consultation, communication, or agreement with any other bidder or competitor, for the purpose of restricting competition with regard to prices; b. That I am an Equal Opportunity Employer; and c. That the disclosure of Interest information on file with City purchasing pursuant to the Code of Ordinance is current and true. ITEM DESCRIPTION QTY UNIT UNIT PRICE TOTAL PRICE Twelve month service agreement with an option to extend for up to two (2) additional twelve (12) month periods, subject to the approval of the City Manager or his designee for the Storm Water Improved Rights-of-Way Strip Mowing in accordance with Specification No. 1104 and the attached Supplemental Terms and Conditions (Items 1 through 7). 1. Group 1 – mowing, trimming, edging and litter pickup, 27.83 acres, 25 strips. 27.83 Acres r y 6, p v17,7110 2. Group 2 – mowing, trimming, edging and litter pickup, 14.02 acres, 17 strips. 14.02 Acres 01, I r/ 9 d/ 3. Group 3 – mowing, trimming, edging and litter pickup, 14.39 acres, 18 strips. 14.39 Acres #9, , 1 4 9 al 4. Group 4 -- mowing, trimming, edging and litter pickup, 34.98 acres, 17 strips. 34.98 Acres 3,5-00 5A. Group 5A – mowing, trimming, edging and litter 37.11 Acres 3 70 (a / 7ri/ 300 pickup 37.11 acres, 5 strips. 5B. Group 5B – mowing, trimming, edging and litter pickup, 19.2 acres, 3 strips. 19.2 Acres .2 , oo 0 3 a'i Q° 6. Group 6 -- Ocean Drive Medians, mowing, trimming, 6.5 Acres 7' edging and litter pickup, 6.5 acres. 3V)-- 1 g, 2 3 7 CITY OF CORPUS CHRISTI PURCHASING DIVISION BID SHEET BID INVITATION NO. BI- 0012 -11 DATE: / - -/2. W- « /c' J4./ /4 , c)v the,' BIDDER ef/k AUTHORIZED SIGNATURE PAGE 2 OF 2 ITEM D DESCRIPTION Q QTY U UNIT P UNIT T TOTAL 7. G Group 7 — Calallen minor ditches, mowing, trimming, 2 2.32 A Acres r r Revised 10/14/10 REFERENCE SHEET a. CURRENT CLIENT Reference 1 Organization name: L rl Y °F 5a n AIrk*I° tig65.1'3 f Ne yhr boo P 5 e r 1 Dep. v Contact and title: Pri5p -&-/Mr.pdor Address: p° 0, enC r1€ 2 z O 3 9764 5-et4 k te r;( ,prk- Phone number: cuO) ,A67 - qog ? Effective date of contract: 3 - Of? Number of acres mowed: , cool, in i LLO •fg.c„.74? tai 0 P t 0 rd,E,r.) Description of services provided: 2/4 CAA(/ /04 C A/ op maw- -z 6r4n si, , e d 5 ,1� r .e 0 All ',0,--e-e- s do ^/ A-A/ c' f ? . Tv e tom, ecf , b. CURRENT CLIENT Reference 2 Organization name: G �,1 o -eyiks e,„'1--s Contact and title: Sh `lA s tadevi ezorcD AA loi." Address: a 2.g- s'4 -' vG 7I rPieligz5A brAtotr2.,®� Phone number: (i?)i3-573) xAsCAI riC a 7759 z_ Effective date of contract: L -. „261O Number of acres mowed: d5iArt d 4 °'frt 2Ot j Description of services provided: 7v5k 7*/07 l.'-'ork' frn 61'1-'1 f'rl h f /714., xi y .¢mod eaiif'`er / c, CURRENT CLIENT Reference 3 Organization name: Dr'ertM /14/4 /idiR Contact and title: 73e1Af 4 bow /eivAti:R.-- Address: '3 7 /1 H• A-H -' Bfadk Si 5 /" ,7 Phone number: (?/3) 51 "'i - 10 V 2 b Effective date of contract: 5' - 007 Number of acres mowed: //4 /,I- 64, Description of services provided: 5' C td r-'e r w5id e N 141 ,Arpme cl FORMER CLIENT Reverence 1 Organization name: 1- 'ri Contact and title: \D'(oio Cratf iQu4iN Address: e-02 Al 4.0 r- ikr't l i f - o ►o ( > `?C2Z0 Phone number: 6 1 0) '310-30 9- Effective date of contract: C --a?D ©l Number of acres mowed: %/ Description of services provided: rvwku ,1 inl W+ , e do re Reason for termination: iz b-e.,r , Ao ; -k- no j e. FORMER CLIENT Reference 2 Organization name: �7 c + t- Lk, c �7 k iiW o l i) Contact and title: h' e r`e C- rtI,G rC C1 l�f \odv/.v1 Address: (of i 'S Phone number: ( (2 /0); o7- (e (0 Z7 Effective date of contract: `.-/ -2 00 7 Number of acres mowed: %/ Description of services provided: Reason for termination: -F re-5-4w FORMER CLIENT Reference 3 Organization name: I c: rrSA.,/ ��! } /4 6,..-L? Contact and title: S. y&ei+ /7x-t-%ice /,) [...�C / 106� Address: F 10 ,os Phone number: o/c) 20 -W34/ Effective date of contract: Number of acres mowed: Description of services provided: Reason for terming on: Page 3 of 3 -'od 51,0 Storm Water Improved ROW Strip Mowing Statement By submitting and signing this statement, the Contractor indicates its intention to adhere to the provisions described in this bid. Company Name: 'DA f ,4 &al ii v 57e,04., Telephone: Address: I 1 /7e 62)x 20 /7 /4 Fax: City: �j/Y-11 Ail 14) State: ` X Zip Code: e /' 627 -'8's -o "282X.) E M il:�� Signature of Person Authorized to Sign: Signer's Name: (Please Print or Type) Date: je9 1C)0)7./\ Title: eit;/v1e g/ A-"c/ - "- List description and condition of equipment to be used on the job for this project. .1,-,:ate f--- 5 Z---{_e2) /9 Z, persons /employees assigned as their sole dedicated job 2 'J'4i . e.`0 to i ■r 0 Vie, /eA- Z/ // Qxl cixr t 7 9zio d oc)q / 10 ` f 0 c di.. vC1.-4 ocinPl -Qc(-- 2 e, ? o `re a,,,`i'{�i Z 30 ,2 OJ I 2 o $' f ( /0 in/Tx/ 1� %l.- /`4i/ /vr� -rev's l? /3 r 7 en d ,,z)o 7 ,x X 4/ 4-)11A-/ 91iiV1 ✓ A r _glair Z 54 . o • a P. zfi-,a. )`Ji,-!, 2_3e , - -<:' Pr) r✓ oC'Fr XC 2 List how many perform this work for this project. - persons /employees assigned as their sole dedicated job 2 'J'4i . e.`0 to i ■r 0 Vie, /eA- Z/ // Qxl cixr t 7 4 (7,-- - or e'At -Drift) e., - er r, ` f 0 c di.. vC1.-4 ocinPl -Qc(-- lo AlEA.-/' 6-- v L /0 in/Tx/ 1� %l.- /`4i/ - ii Z'G, Ci ', ,11 4-)11A-/ 91iiV1 ✓ Past Performance �/I A i; ('C) IAA p CO 3 r) 4 1.7-6k. /Gz(2 /c>ork ore-40i— /tor /11-t( o 6l II 4 /0) w.e. w .r _ i4-4 (,Q Q c1 ..k V_. L) vC1.-4 ocinPl -Qc(-- 4-n ,.5c.0 p,e (p word Page I of 2 Contractor's experience in performing work of the type specified. 12 t ,_ 0e_ 15�.r- 0 r / ice . � a- r ro' eel- ni A ki ar -C rr- 1 0 6 v - ,Q.1, i t fs n. 01,1,e. , ir) 0 '-6, 0I' b--e r-- i.,c.,7 % / /YC> t)'io'r ';'t e. L , i& ',''j1 4A( c/ i) ,e ,7 0 i,--4, i rr % i3.ir a`° 1 0 / ern, t L. . -- o/e.4 fez.- I rod,' to s A.r1 c/ t-0 (.2._, A ti • In the last five years, has the City terminated any agreement with your organization, either for or not for cause, breach or default? Is your organization currently involved in litigation with the City or, in the last five years, has your organization been involved in litigation with the City? If so, please provide cause numbers, dates and final disposition of each. Page 2 of 2 Storm Water Improved ROW Strip Mowing Statement By submitting and signing this statement, the Contractor indicates its intention to adhere to the provisions described in this bid. Company Name: l A.4- a o u Address: 'P ,O , O ), 2_0 /7- /67 Fax: Telephone: c2 j 0") (L? - q 8S5 0 City: 5 /1-n A n k et►`U State: TX Zip Code: PAS, -qsae Signature of Person Authorized to Sign: `22O E -Mail: q2 vw-t11,C0 Date: Signer's Name: �, �W �`�C s ��[ St' Title: r�S � AL (Please Print or Type) List description and condition of equipment to be used on the job for this project. `po 4 -t50 79, ln C--/ ,,J '. 2 /tF /N,+ e,1 � . � ewejs /Iv .5-01,r.)5- 5-c Ai- o cl f 0 C., he v 1 Tod/ ) (...a boo d -• F(A+ b0.d 9 °(SIDCI _ } Tr A.10 y--- t' / `l on d Zr,(i r L 44, 1 P,c9a -1 List how many persons /employees assigned to perform this work as their sole dedicated job for this project. C--/ ,,J '. 2 /tF /N,+ e,1 � . � ewejs /Iv .5-01,r.)5- 5-c Ai- .2. G Z 1 ;p-r C' mlii/ ,4-17 zeave &w e, c'--j' oN7 xt7i1i�i 3 i a-3 I mAiK e o vvialtt' 4( 2y c 4P 0 At-- 4/ - lo 3m ' :dAy e!om/0 4-/( at cirvVe 30 k �pet 5-- - -7 a &tow1d,y. eo L 6 2V kr- Past Performance Page 1 of 2 Contractor's experience in performing work of the type specified. In the last five years, has the City terminated any agreement with your organization, either for or not for cause, breach or default? Is your organization currently involved in litigation with the City or, in the last five years, has your organization been involved in litigation with the City? If so, please provide cause numbers, dates and final disposition of each. Page 2 of 2 CITY OF CORPUS CHRISTI FINANCE ,DEPARTMENT / PURCHASING Di , ISION MINORITY BUSINESS ENTERPRISE INFORMATION FORM THIS FORM MUST BE SUBMITTED ALONG WITH BID PLEASE INDICATE WHETHER THE COMPANY IS A CERTIFIED MINORITY BUSINESS. EXAMPLES OF CERTIFICATIONS RECOGNIZED BY THE CITY INCLUDE: ❑ YES - CERTIFIED HISTORICALLY UNDERUTILIZED BUSINESS (HUB) Select all that are appropriate: ❑ ASIAN PACIFIC ❑ .BLACK ❑ HISPANIC ❑ NATIVE AMERICAN ❑ WOMAN Please visit the following website for information on becoming a Certified HUB: http: / /www. window. state .tx.us /nrocurementlprog/hub/ ❑ YES 0 - LOCAL SMALL BUSINESS (LSB) A for- profit entity employing less than 49 employees located within the City limits of Corpus Christi, Texas EYE S O OTHER (PLEASE SPECIFY): HIS COMPANY IS NOT A CERTIFIED HUB or LSB THE ABOVE MINORITY BUSINESS INFORMATION IS REQUESTED FOR STATISTICAL AND TRACKING PURPOSES AND WILL NOT INFLUENCE THE AMOUNT OF EXPENDITURES THE CITY WILL MAKE WITH ANY GIVEN COMPANY. BID INVITATION NO: BI -OOIZ I Firm Name B o C 1 -1', Di ?max ZO l? lco Address: City: Si4vt / n 400rPa State: 7 �( Zip: 78 2 Signature of Person Authorized to Sign Form Signer's Name: [I„- IIAr j.p, (Please print or type) c2iv) 62.7 -.if O Telephone. - - Ext. Fax: E -mail: Date: Title: 2.a -'._{2 -gaff (J,41t 4,_ 1003 6) iryi A-; f. ctm 10 _ 10 - Z.v / (� Ucv�r � /5-5, ° r( City of Corpus Christi SUPPLIER NUMBER TO BE ASSIGNED BY UI Y PURCHASING DIVISION CITY OF CORPUS CHRISTI DISCLOSURE OF INTEREST city of Corpus Christi Ordinance 17112, as amended, requires all persons or firms seeking to do business with the City to provide the following information. Every question must be answered. If the question is not applicable, answer with "NA ". See reverse side for Filing Requirements, Certifications and definitions. COMPANY NAME: D-$ A STREET P. O. BOX: Zp VI 1 (p ADDRESS CITY: S ti irk n t/i - 6,r : 0 STATE: -r-x ZIP: 7 rzto FIRM IS: 1. Corporation B 2. Partnership 8 3. Sole Owner El---- 4. Association 5. Other DISCLOSURE QUESTIONS If additional space is necessary, please use the reverse side of this page or attach separate sheet. 1. State the names of each "employee" of the City of Corpus Christi having an `ownership interest" constituting 3% or more of the ownership in the above named "firm." Name Job Title and City Department (if known) /DO c 2. State the names of each "official" of the City of Corpus Christi having an "ownership interest" constituting 3% or more of the ownership in the above named "firm. Name Title NU,v 3. State the names of each "board member" of the Cit of Corpus Christi having an "ownership interest" constituting 3% or more of the ownership in the above named "firm." Name Board, Commission or Committee {Li vfur 4. State the names of each employee or officer of a "consultant" for the City of Corpus Christi who worked on any matter related to the subject of this contract and has an "ownership interest" constituting 3% or more of the ownership in the above named "firm." Name f Consultant Non) FILING REQUIREMENTS If a person who requests official action on a matter knows that the requested action will confer an economic benefit on any City official or employee that is distinguishable from the effect that the action will have on members of the public in general or a substantial segment thereof, you shall disclose that fact in a signed writing to the City official, employee or ody that has been requested to act in the matter, unless the interest of the City official or employee in the matter is parent. The disclosure shall also be made in a signed writing filed with the City Secretary. [Ethics Ordinance Section z -349 (d)] CERTIFICATION I certify that all information provided is true and correct as of the date of this statement, that I have not knowingly withheld disclosure of any information requested; and that supplemental statements will be promptly submitted to the City 'f Corpus Christi, Texas as changes occur. Certifying Person: 031APIQS Pew Ste. Title: 0 62i N6--g ( ir 'eS/ jm 6 (Type or Print) Signature of Certifying Person: Q..tOE1&.QQ\ DEFINITIONS Date: 10- (D- •,7& /0 a. "Board member." A member of any board, commission, or committee appointed by the City Council of the City of Corpus Christi, Texas. b. "Economic benefit ". An action that is likely to affect an economic interest if it is likely to have an effect on that interest that is distinguishable from its effect on members of the public in general or a substantial segment thereof. c. "Employee." Any person employed by the City of Corpus Christi, Texas either on a full or part -time basis, but not as an independent contractor. d. "Firm." Any entity operated for economic gain, whether professional, industrial or commercial, and whether established to produce or deal with a product or service, including but not limited to, entities operated in the form of sole proprietorship, as self - employed person, partnership, corporation, joint stock company, joint venture, receivership or trust, and entities which for purposes of taxation are treated as non - profit organizations. "Official:" The Mayor, members of the City Council, City Manager, Deputy City Manager, Assistant City Managers, Department and Division Heads, and Municipal Court Judges of the City of Corpus Christi, Texas. f. "Ownership Interest." Legal or equitable interest, whether actually or constructively held, in a firm, including when such interest is held through an agent, trust, estate, or holding entity. "Constructively held" refers to holdings or control established through voting trusts, proxies, or special terms of venture or partnership agreements." g. "Consultant." Any person or firm, such as engineers and architects, hired by the City of Corpus Christi for the purpose of professional consultation and recommendation. CORD" CERTIFICATE OF LIABILITY INSURANCE r---- DATE (MM$DDIYYYY) 02/09!11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may requlre an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Kris Billy Insurance 3100 W. Slaughter Lane, Suite A -104 Austin, TX 78748 Phone .1512)292 -3650 INSURED Reese, Charles dba Dat A Boy PO Box201716 San Antonio, TX 78220- Fax (512)292 -4512 CONTACT NAME: ((PHONE 512 E AIL: { 292 -3650 } ADMDRESS; Ibillydimi�eusl(n,R.com FAX rc. Not (512)292 -4512 INSURER(S) AFFORDING COVERAGE INSURER A ; Westem Heritage NAIC # COVERAGES (210) 290.3091 CERTIFICATE NUMBER: INSURER 5: Progresslte INSURER c: Texas Mutual INSURER D : INSURER E tNSUR F THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE IAN' SR i UND POLICY NUMBER IN MIOD�YYY 1MMIDCNY EXP LIMITS A GENERAL LIABILITY in COMMERCIAL GENERAL LIABILITY Y SCP0824919 02/07/2011 02/07/2012 EACH OCCURRENCE s 5013,000.00 S 100,000.00 DAMAGE (Ea RENTED ❑ ❑ CLAIMS -MADE n OCCUR MED EXP (Any one person) s 5,000.00 0 PERSONAL 8 ADV INJURY s 500,000.00 ❑ GENERAL AGGREGATE f 500,000.00 GENII_ AGGREGATE LIMIT APPUES PER ❑ POLICY ❑ kl ❑ LOC PRODUCTS - COMP/OP AGG $ 500,000.00 S 8 AUTOMOBILE LIABILITY ❑ ANY AUTO ALlLTg5 NED SCHEDULED ❑ AUTOS Y 07818973-0 02/07/2011 02/07/2012 C9 SAWED SINGILE UMrr s 500,000.00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) 5 WNED © HIRED AUTOS i� AUTOS FA? ���772/y po IPe�etieldent)AMAGE $ ❑ 0 S C ❑ UMBRELLA LIAB ❑ OCCUR NIA y Q001137051 20101124 02/15/2011 02/15/2012 EACH OCCURRENCE s ❑ EXCESS LAB • CLAIMS -MADE AGGREGATE ❑ DED ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER,EXECIRIVE OFFICER/MEMBER EXCLUDED? 1 J (Mandatory In NH) WC si 'ni. r �H. TORY LIMITS I�I E.L. EACH ACCIDENT $ 900 000.00 ' E.L. DISEASE. EA EMPLOYE $ 500,000.00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY UMIT $ 500 000.00 ch ACORD 101, Additional Remarks Schedule, if more space Is required) 3ertificare holder is listed as an additional Insured on the GL policy and a waiver of subrogation on the commercial auto and work comp policy, CERTIFICATE HOLDER CANCELLATION City of Corpus Christi PO Box 9277 Corpus Christi, TX 78469 Attn: Eilsa Covington Fax 361- 826 -3174 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A H, - IZEDREPRESENTATIVE •; 11 WORD 25 (2010105) OF © 19B8 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD