HomeMy WebLinkAboutC2017-051 - 3/28/2017 - Approved 4'as 'll\
o�
v rY SERVICE AGREEMENT NO. 816
MOR R 1
:�2 Rental and Servicing of Portable
Toilets for Beach Operations
THIS Rental and Servicing of Portable Toilets for Beach Operations Agreement
("Agreement") is entered into by and between the City of Corpus Christi, a Texas
home-rule municipal corporation ("City") and Progressive Waste Solutions of TX,
Inc., dba Skid-o-Kan ("Contractor"), effective upon execution by the City
Manager or the City Manager's designee ("City Manager").
WHEREAS, Contractor has bid to provide Rental and Servicing of Portable
Toilets for Beach Operations in response to Request for Bid/Proposal No. 816
("RFB/RFP"), which RFB/RFP includes the required scope of work and all
specifications and which RFB/RFP and the Contractor's bid or proposal response,
as applicable, 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 Rental and Servicing of Portable Toilets for
Beach Operations ("Services") 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, and in
accordance with Exhibit 2.
2. Term. This Agreement is for 12 months,with performance commencing upon
the date of issuance of a notice to proceed from the Contract Administrator
or Purchasing Division. This Agreement includes an option to extend the term
for up to two additional 12-month periods ("Option Period"), provided, the
parties do so prior to expiration of the original term or the then-current Option
Period. The decision to exercise the option to extend the term of this
Agreement is, at all times, within the sole discretion of the City and is
conditioned upon the prior written agreement of the Contractor and the City
Manager.
3. Compensation and Payment. The total value of this Agreement is not to
exceed $22,600.00, subject to approved extensions and changes. Payment
will be made for Services completed and accepted by the City within 30
days of acceptance, subject to receipt of an acceptable invoice. All pricing
must be in accordance with the attached Bid/Pricing Schedule, as shown in
City of Corpus Christi Page 1 of 8
2017-051
3/28/17
M2017-043
Progressive Waste Solutions
INDEXED
Attachment B, the content of which is incorporated by reference into this
Agreement as if fully set out here in its entirety.
4. 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. The City's Contract Administrator for this
Agreement is as follows:
Russell Armstrong
Park and Recreation-Beach Operations
Phone: 361-826-4168
Email: RussellA@cctexas.com
5. Insurance; Bonds.
(A) Before performance can begin under this Agreement, the Contractor
must deliver a certificate of insurance ("COI"), as proof of the required
insurance coverages, to the City's Risk Manager and the Contract
Administrator. Additionally, the COI must state that the City will be given at
least 30 days' advance written notice of cancellation, material change in
coverage, 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 10 days of the City Manager's written request.
Insurance requirements are as stated in Attachment C, the content of which
is incorporated by reference into this Agreement as if fully set out here in its
entirety.
(B) In the event a payment bond, a performance bond, or both, are
required of the Contractor to be provided to the City under this Agreement
before performance can commence, the terms, conditions, and amounts
required in the bonds and appropriate surety information are as included in
the RFB/RFP or as may be added to Attachment C, and such content is
incorporated here in this Agreement by reference as if each bond's terms,
conditions, and amounts were fully set out here in its entirety.
6. Purchase Release Order. For multiple-release purchases of Services to be
provided by the Contractor over a period of time, the City will exercise its
right to specify time, place and quantity of Services to be delivered in the
following manner: any City department or division may send to Contractor
a purchase release order signed by an authorized agent of the department
or division. The purchase release order must refer to this Agreement, and
City of Corpus Christi Page 2 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
Services will not be rendered until the Contractor receives the signed
purchase release order.
7. Inspection and Acceptance. Any Services that are provided but not
accepted by the City must be corrected or re-worked immediately at no
charge to the City. If immediate correction or re-working at no charge
cannot be made by the Contractor, a replacement service may be
procured by the City on the open market and any costs incurred, including
additional costs over the item's bid/proposal price, must be paid by the
Contractor within 30 days of receipt of City's invoice.
8. Warranty. 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. 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 Service 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 Services 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.
City of Corpus Christi Page 3 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
12. Subcontractors. 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
Contract Administrator if the subcontractors were not named at the time of
bid or proposal, as applicable. 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, including the necessity of
providing a COI in advance to the City, are applicable to all subcontractors
and their employees to the same extent as if the Contractor and its
employees had performed the work.
13. Amendments. This Agreement may be amended or modified only by written
change order signed by both parties. Change orders may be used to modify
quantities as deemed necessary by the City.
14. Waiver. No waiver by either party of any breach of any term or condition of
this Agreement waives any subsequent breach of the same.
15. Taxes. The Contractor covenants to pay payroll taxes, Medicare taxes, FICA
taxes, unemployment taxes and all other related taxes. Upon request, the
• City Manager shall be provided proof of payment of these taxes within 15
days of such request.
16. Notice. Any notice required under this Agreement must be given by fax,
hand delivery, or certified mail, postage prepaid, and is deemed received
on the day faxed or hand-delivered or on the third day after postmark if sent
by certified mail. Notice must be sent as follows:
IF TO CITY:
City of Corpus Christi
Attn: Russell Armstrong
Title: Beach and Special Event Superintendent
Address: 1201 Leopard St., Corpus Christi, Texas 78401
Fax: 361-826-4168
IF TO CONTRACTOR:
Progressive Waste Solutions of TX, Inc. dba Skid-o-Kan
Attn: William Puryear
Title: Office Manager/Accts Payable
Address: 622 McBride Ln., Corpus Christi, Texas 78408
Fax: 361-882-5351
City of Corpus Christi Page 4 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
17. CONTRACTOR AGREES TO 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 WHATSOEVER ON ACCOUNT
OF PERSONAL INJURIES (INCLUDING DEATH AND WORKERS'
COMPENSATION CLAIMS), PROPERTY LOSS OR DAMAGE, OR ANY
OTHER KIND OF INJURY, LOSS, OR 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 AGREEEMENT OR THE
PERFORMANCE OF THIS AGREEMENT, REGARDLESS OF WHETHER THE -
INJURIES, DEATH OR DAMAGES ARE CAUSED OR ARE CLAIMED TO
BE CAUSED BY THE CONCURRENT OR CONTRIBUTORY NEGLIGENCE
OF INDEMNITEES, BUT NOT IF BY THE SOLE NEGLIGENCE OF
INDEMNITEES UNMIXED WITH THE FAULT OF ANY OTHER PERSON.
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 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 Manager may terminate this Agreement for Contractor's failure
to perform the work specified in this Agreement or to keep any required
insurance policies in force during the entire term of this Agreement. The
Contract Administrator 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 Manager may terminate this
Agreement immediately thereafter.
City of Corpus Christi Page 5 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
(B) Alternatively, the City Manager may terminate this Agreement for
convenience upon 30 days advance written notice to the Contractor. The
City Manager 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. 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.
20. Severability. Each provision of this Agreement is considered to be severable
and, if, for any reason, any provision or part of this Agreement is determined
to be invalid and contrary to applicable law, such invalidity shall not impair
the operation of nor 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 had been omitted.
21. Order of Precedence. In the event of any conflicts or inconsistencies
between this Agreement, its attachments, and exhibits, such conflicts and
inconsistencies will be resolved by reference to the documents in the
following order of priority:
A. this Agreement and its attachments
B. the bid solicitation document, including addenda (Exhibit 1)
C. the Contractor's bid response (Exhibit 2)
22. Certificate of Interested Parties. Contractor agrees to comply with Texas
Government Code Section 2252.908, as it may be amended, and to
complete Form 1295 "Certificate of Interested Parties" as part of this
Agreement.
23. Governing Law. This Agreement is subject to all federal, State, and local laws,
rules, and regulations. The applicable law for any legal disputes arising out
of this Agreement is the law of the State of Texas, and such form and venue
for such disputes is the appropriate district, county, or justice court in and for
Nueces County, Texas.
24. Entire Agreement. This Agreement constitutes the entire agreement between
the parties concerning the subject matter of this Agreement and supersedes
City of Corpus Christi Page 6 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
all prior negotiations, arrangements, agreements and understandings, either
oral or written, between the parties.
(SIGNATURE PAGE FOLLOWS)
City of Corpus Christi Page 7 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
CONTRACTOR
(11,,,
Signature: ( v�---
Printed Name: (A),/l fUrgerA•r• Jt
Title: OF/c(4- /�RNgs cr /4c silts yR,6/t'
Date: Z-2-0 'Za/
CITY OF CORPUS CHRISTI
Signature:
Printed Name: rr\ck,--:. • P Y c. Cy
Title: Pr-cc,'r _
Date: 3/ a� � i �
ATTEST: R'Q--- A—Htit-e/r- ----
REBECCA HUERTA
CITY SECRETARY
Attached.and Incorporated by Reference:
Attachment A: Scope of Work
Attachment B: Bid/Pricing Schedule ed2:0_
Attachment C: Insurance/Bond Requirements .,�„
Attachment D:. Warranty Requirements
Y COUNCIL.. 7i0
Incorporated by Reference Only: A
Exhibit 1: RFB/RFP No. 816
Exhibit 2: Contractor's Bid/Proposal Response
City of Corpus Christi Page 8 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
Attachment A: Scope of Work
1. General Requirements
The City of Corpus Christi is seeking an annual service contract for the rental,
delivery, cleaning, maintenance, and services of chemical portable toilets,
both regular units and ADA wheelchair accessible. The chemical portable
toilets will be rented on a monthly, weekly, or daily basis including holidays,
weekends, and special events around the City.
2. Scope of work
A. Contractor shall comply with all sanitary conditions set forth in the City
Codes and Ordinances as administered by the City-County Health
Department.
B. Contractor shall comply with all applicable certifications and licensing for
operating equipment appropriate for the rental, delivery, cleaning,
maintenance and service of units and provide them with the bid.
C. Contractor shall provide all equipment and supplies required to place,
pickup, clean, service, repair and/or relocate units.
D. Contractor shall provide portable chemical toilet units fabricated from
fiberglass, PVC plastic, or polyethylene. Each unit shall bear its own
identification system of numbers, letters, or combination.
E. Contractor shall provide and maintain a written Service Log affixed to the
inside of each portable unit. The service log shall lists the date(s) of each
maintenance service visit and initials of the individual(s) whom performed
the service.
F. Contractor shall provide units with doors that are self-closing, tight fitting,
and shall have an inside lock. The exterior of the door shall include an
occupancy meter to indicate when unit is occupied and unoccupied.
G. Contractor shall remove all tank waste, clean and disinfect the inside,
including but not limited to, the waste tank, walls, door, toilet seat, and
floor, at no additional cost to City.
H. Contractor shall properly dispose of all waste products removed from the
portable toilets during the servicing and sanitizing.
I. Contractor shall remove damaged or non-functional rental unit when
found, either during cleaning procedure, or within 24 hours after
notification from the Contract Administrator of the using department.
3. Special Instructions
In-Season Months
A. The Contractor will supply Beach Operations with ten regular portable
toilet units and ten ADA portable toilet units. In-Season Months are April
through October.
B. Contractor shall service and sanitize all units three times a week during the
in-season months. Service days will be Tuesday, Friday, and Sunday.
Off-Season Months
A. The Contractor will supply Beach Operations with ten ADA portable toilet
units. Off-season months are November through February.
B. Contractor shall service and sanitize all units three times a week during the
off-season months. Service days will be Tuesday, Friday, and Sunday.
Spring Break/Holidays
A. Contractor shall service and sanitize all units six times a week in the month of
March.
B. Contractor will be notified of extra services during spring break and holidays by
Beach Operations.
C. In the event of short term rentals of a week or less, the Contractor shall provide
more frequent servicing and sanitation as required by Beach Operations.
D. Contractor shall provide extra ADA units and emergency services within 12 hours
after vendor receives request.
E. Contractor shall move units from place to place on various job sites as requested
by the Contract Administrator. Units are to be moved within 12 hours after
Contractor receives request.
4. Contractor Quality Control and Superintendence
The Contractor shall establish and maintain a complete Quality Control
Program that is acceptable to the Contract Administrator to assure that the
requirements of the Contract are provided as specified. The Contractor will
also provide supervision of the work to insure it complies with the contract
requirements.
Attachment B: Bid/Pricing Schedule
.mus
4Cr; CITY OF CORPUS CHRISTI
BID FORM
� PURCHASING DIVISION
/ RFB No. 816
:
1852 Rental and Servicing of Portable Toilets for Beach Operations
Date: 02/06/2017
Progressive Waste Solutions of TX, Authorized T�
Inc.dba, Skid-o-Kan /
Bidder: ._ Signature:
1. Refer to "Instructions to Bidders" and Contract Terms and Conditions before
completing bid.
2. Quote your best price for each item.
3. In submitting this bid, Bidder certifies that:
a. 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. Bidder is an Equal Opportunity Employer; and the Disclosure of Interest information
on file with City's purchasing office, pursuant to the Code of Ordinances, is current
and true.
c. Bidder is current with all taxes due and company is in good standing with all
required governmental agencies.
d. Bidder acknowledges receipt and review of all addenda for this RFB.
Scheduled
Item Description Unit QTY Unit Total Months Extended
Price Cost
Standard Portable
Toilets
Rental and
1 Services three EA 10 x $ 80.00 = $ 800.00 x 7 = $ 5,600.00
times per week
Rental and
2 Services six times EA 10 x $ 150.00 = $1,500.0.0 x 1 = $ 1,500.00
per week
ADA Portable
Toilets
Rental and •
3 Services three EA 10 x $105.00 = $1,050.00 x 11 = $ 11,550.00
times per week
Rental and
4 Services six times EA 10 x $175.00 = $1,750.00 x 1 = $ 1,750.00
per week
Non-Scheduled
Item Description Unit QTY Unit Total Daily Extended Cost
Price
ADA Portable 1 $1,400.00
5 Toilets Rental and EA 40 x $35.00 - $1,400.00 x 40 - $56,000.00
Service
6 ADA Portable EA 40 x $20.00 1 =
Toilets Service - S 800.00 x 48 $800.00
$32,000.00
*Items 5 and 6 Daily number is 1 and not 40 as released in RFB. No. Total $22,600.00
816. The totals above are the totals that will be awarded under the
contract.
ATTACHMENT C - INSURANCE REQUIREMENTS
A. CONTRACTOR'S LIABILITY INSURANCE
1. Contractor must not commence work under this contract until all insurance required has
been obtained_and such insurance has been approved by the City. Contractor must
not allow any subcontractor, to commence work until all similar insurance required of
any subcontractor has been obtained.
2. Contractor must furnish to the City's Risk Manager and Contract Administrator one (1)
copy of Certificates of Insurance with applicable policy endorsements showing the
following minimum coverage by an insurance company(s) acceptable to the City's Risk
Manager. The City must be listed as an additional insured on the General liability and
Auto Liability policies by endorsement, and a waiver of subrogation endorsement is
required on GL, AL and WC if applicable. Endorsements must be provided with
Certificate of Insurance. Project name and/or number must be listed in Description Box
of Certificate of Insurance.
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-day advance written notice of Bodily Injury and Property Damage
cancellation, non-renewal, material Per occurrence - aggregate
change or termination required on all
certificates and policies.
COMMERCIAL GENERAL LIABILITY $1,000,000 Per Occurrence
including: $2,000,000 Aggregate
1 . Commercial Broad Form
2. Premises - Operations
3. Products/Completed Operations
4. Contractual Liability
5. Independent Contractors
6. Personal Injury- Advertising Injury
AUTO LIABILITY (including) $1,000,000 Combined Single Limit
1.Owned
2. Hired and Non-Owned
3. Rented/Leased
WORKERS'S COMPENSATION Statutory and complies with Part II of
(All States Endorsement if Company is this Exhibit.
not domiciled in Texas)
Employers Liability $500,000/$500,000/$500,000
3. In the event of accidents of any kind related to this contract, Contractor must furnish
the Risk Manager with copies of all reports of any accidents within 10 days of the
accident.
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 insureds
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 thirty (30) calendar days advance written notice directly to City of any,
cancellation, non-renewal, material change or termination in coverage and not less
than ten (10) calendar days advance written notice for nonpayment of premium.
5. Within five (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.
6. In addition to any other remedies the City may have upon Contractor's failure to provide
and maintain any insurance or policy endorsements to the extent and within the time
herein required, the City shall have the right to order Contractor to stop work hereunder,
and/or withhold any payment(s) which become due to Contractor hereunder until
Contractor demonstrates compliance with the requirements hereof.
7. Nothing herein contained shall be construed as limiting in any way the extent to which
Contractor may be held responsible for payments of damages to persons or property
resulting from Contractor's or its subcontractor's performance of the work covered
under this contract.
8. It is agreed that Contractor's insurance shall be deemed primary and non-contributory
with respect to any insurance or self insurance carried by the City of Corpus Christi for
liability arising out of operations under this contract.
9. It is understood and agreed that the insurance required is in addition to and separate
from any other obligation contained in this contract.
2016 Insurance Requirements
Purchasing
Portable Toilet Rental and Service
12/16/2016 cg Risk Management
Attachment D: Warranty Requirements
No warranty requirement needed for the Service Agreement.
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2017-176412
Progressive Waste Solutions of Texas Inc.dba Skidokan
Corpus Christi,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/08/2017
being filed. r,{
City of Corpus Christi Beach Operations Dat Adm wledged: Y
3 Provide the identification number used by the governmental entity or state agency to track or identify ntract,and provide a
description of the services,goods,or other property to be provided under the contract.
Event:201-RFB 816
Portable toilets
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
•
5 Check only if there is NO Interested Party.
X
6 AFFIDAVIT I swear,or affirm,and nalty of perjury,that the above disclosure is true and correct.
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`' TIFzP,IaY P'"
_; i.‘ ',' My Notal)•.:.•
•
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... S' nature of authorized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE 'W,` (� �_f�^
Sworn to and subscribed before me,by the said l,LL ex E fte.. ,this the day of t aCCX1 ,
20 � ,to certify which,witness my hand and seal of office.
Signal e f offi ministering oath • Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277