HomeMy WebLinkAboutC2017-242 - 8/15/2017 - Approved GO. US
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SERVICE AGREEMENT NO. 1036
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85e Emergency Spill Response and Remediation Services
THIS Emergency Spill Response and Remediation Services Agreement
(`'Agreement") is-entered into by and between the City.of Corpus Christi, a Texas
home-rule municipal corporation ("City") and Horizon Environmental
("Contractor"), effective upon execution by the City Manager or the City
Manager's designee ("City Manager").
WHEREAS, Contractor.has bid to provide Emergency Spill Response and
Remediation Services in response to Request for Bid/Proposal No. 1036
("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 Emergency Spill Response and Remediation
Services ("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 $22,762.30, 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
Attachment B, the content of which is incorporated by reference into this
Agreement as if fully set out here in its entirety.
City of Corpus Christi Page 1 of 8
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2017-242
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Horizon Environmental
INDEXED
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:
Crystal Ybanez
• Water Department ••
361-826-1289
CrystalY@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
Services will not be rendered until the Contractor receives the signed
purchase release order.
City of Corpus Christi Page 2 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
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.
12. Subcontractors. Contractor may use subcontractors in connection with the
work performed under this Agreement. When using subcontractors,
City of Corpus Christi Page 3 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
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: Crystal Ybanez
Environmental Services Superintendent
13101 Leopard St., P.O. Box 9277, Corpus Christi, TX 78410
Fax:(361) 826-4550
IF TO CONTRACTOR:
Horizon Environmental
Attn: Jack Ostermaier
Title: Vice- President, Sales and Marketing
Address: 2407 Albright Drive, Houston, Texas 77017
Fax (713) 378-0717
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
Signature: ��7 624,4'
Printed Name: Davin M.Pioder
• Title: President
Date: 7/7/2017
CITY OF CORPUS CHRISTI
Signature: 1\CN.OVti
Printed Name:1 -,-
Title: --(:)r u c:c.4.-6'• e
Date: / ! y 1. 7
Rue_
(ort
REBECCA HUERTA
CITY SECRETARY
Attached and Incorporated by Reference:
Attachment A: Scope of Work
Attachment B: Bid/Pricing Schedule
Attachment C: Insurance/Bond Requirements
Attachment D: Warranty Requirements
Incorporated by Reference Only: k2_o -j -
A I Kh LL.rt
Exhibit 1: RFB/RFP No. 1036 0 COUNCIL I
Exhibit 2: Contractor's Bid/Proposal Response
SECRETARY
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
1.1 General Requirements/Background Information
A. The Contractor shall provide emergency spill response and
remediation services as outlined in this Scope of Work.
1.2 Scope of Work
A. Service Requirements for the Contractor:
1. Shall be able to provide specified services twenty-four (24)
hours a day, three hundred and sixty-five (365) days per year,
on an as needed basis.
2. Will receive work order requests and shall respond by phone
within 30 minutes of a call being placed by the Utilities
Department.
3. Must be on site within two hours of receipt of work order of a
request for services.
4. Shall begin spill response and/or remediation within 2 hours of
arrival on site unless otherwise approved by Utilities
Department.
5. Must have a sufficient number of certified/trained personnel
to fulfill work demands.
6. Shall have HAZWOPER, RCRA and any other training required
by OSHA, Federal, State or local regulations.
7. Will have the capability and capacity to respond to on-site,
highway, in water, or on shoreline incidents.
8. Shall have the facilities and equipment to meet the response
time dictated in this specification.
9. Shall have the experience to meet this specification for
chemical and/or petroleum spills.
10. Shall have experience and training to respond to land and
water remediation.
11. Shall have the ability to mitigate any or all spill incidents, for
example gas, oil, sugar water and other types of spills.
12. Shall have multiple vacuum trucks available for immediate
response to eliminate and/or mitigate pollutant loading
and/or contamination to the Municipal Separate Storm Sewer
System (MS4) and/or waters of the state.
13. Shall have the ability to perform hydro-excavation.
14. Will have the capability to perform work in confined spaces
and have the safety equipment and training required to
support.
15. Must have the capacity to collect analytical samples
according to State standards. All samples taken shall have a
copy sent to the City Contract Administrator or their
designee.
16. Shall have the capability and equipment to hydro-jet
infrastructure lines blocked by a material or hazard. •
17. Responsible for any or all decontamination of personnel and
equipment.
B. Spill remediation shall include any and all affected areas.
C. All items used for spill response and remediation shall be free from
the threat of cross contamination.
D. Contractor shall provide status updates to City throughout the
duration of the response.
E. At time of completion of services, the Contractor shall report back
to the City.
F. All response and remediation services provided shall be
documented by the Contractor. A copy of the work order shall be
provided to the City with the following information:
• Site location
• Description of response and/or remediation services provided
• List of materials used
• Log of timeline, from time of City request to departure from
the scene.
G. The Contractor shall provide follow up services in the event
additional remediation is required.
1.3 Work Site and Conditions
A. The work shall be performed at any location within the City of Corpus
Christi's jurisdictional boundary and/or any location deemed
affected by incidents occurring within the City of Corpus Christi's
jurisdictional boundary, which shall include incidents occurring
and/or threatening navigable waterways and/or waters of the state
for which the City has the responsibility to protect through state issued
permits. The work may be required on land, roadways, infrastructure,
ditches, waterways, structures, objects, and other items that are
determined to be affected by the incident.
1.4 Contractor Quality Control and Superintendence
A. 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.
•
1.5 Payment
Work will be paid for on a Time and Material basis. Documentation
including time records, receipts purchase or lease records for
materials and equipment will be required to demonstrate charges.
Attachment B - Bid Pricing/Schedule
"4;'
viihoore
CITY OF CORPUS CHRISTI
RR RI V
1852 BID FORM
PURCHASING DIVISION
RFB No. 1036, Emergency Spill Response and Remediation Services
Date: AkKe_ 19, to/ 7 PAGE 1 OF 1
Bidder: [Iona), EI/i�^o► He•e Authorized ,
Signature: i / _
.1117
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.
Item Description Unit Qty. Total Price
Labor Fees
- Unit Price
1 1 Labor Fees HRS. 145 X30.oo $ 6{35-0, vc
Materials/ Equipment Markup % Total Price
2 Materials Markup Est. $6,705.00 / $ W,-77Z,6 S-
3 Equipment Markup Est. $11,525.00 / /l, 6,4'0
Total -
$ZZ, 762,36
Example: Item 2 calculation is $6,705.00 X % markup + $6,705.00 = Total Price
$6,705.00 X 5% = $335.25 + $6,705.00 = $7,0480.25
Same mathematical formula applies for Item 3 as above.
Attachment C- Insurance Requirements
CONTRACTOR'S LIABILITY INSURANCE
1. Contractor must not commence work under this agreement until all
insurance required herein has been obtained and approved by the City's
Risk Manager or designee. Contractor must not allow any subcontractor to
commence work until all similar insurance required of the subcontractor has
been so obtained.
2. Contractor must furnish to the Risk Manager and Assistant Director, Office
of Strategic Management, two (2) copies of Certificates of Insurance with
applicable policy endorsements showing the following minimum coverage
by an insurance company(s) acceptable to the Risk Manager or designee.
The City must be listed as an additional insured for the General Liability and
Auto Liability policies, and a waiver of subrogation is required on all
applicable policies. 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
change or termination required on all Per occurrence - aggregate
certificates and policies.
Commercial General Liability including: $1,000,000 Per Occurrence
1. Commercial Broad Form
2. Premises- Operations
3. Products/ Completed Operations
4. Contractual Liability
5. Independent Contractors
6. Personal Injury- Advertising Injury
BUSINESS AUTOMOBILE LIABILITY $1,000,000 Combined Single Limit
1. Owned Or State of Texas Minimum Limits for
2. Hired & Non-owned personal or rental autos.
3. Rented & Leased
PROFESSIONAL LIABILITY $1,000,000 Per Claim
(Errors and Omissions) (Defense costs not included in face
value of the policy)
•
If claims made policy, retro date must
be prior to inception of agreement,
have extended reporting period
provisions and identify any limitations
regarding who is insured.
WORKERS' COMPENSATION Statutory
(All States Endorsement if Company is not
domiciled in Texas)
Employer's Liability $500,000 / $500,000 / $500,000
3. In the event of accidents of any kind related to this project, Consultant must
furnish the Risk Manager with copies of all reports of such accidents within 10
days of the accident.
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 an amount sufficient to assure that all workers'
compensation obligations incurred by the Contractor will be promptly met.
An All States endorsement shall be required if consultant 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 replacement Certificate of
Insurance to City at the address provided below within 10 days of any
change made by the Contractor or as requested by the City. Contractor
shall pay any costs incurred resulting from said changes. All notices under
this Article shall be given to City at the following address:
City of Corpus Christi
Attn: Risk Management
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 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 calendar days advance written notice for
nonpayment of premium.
5. Within five 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 Consultant 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 agreement.
2017 Insurance Requirements
Utilities
Emergency Response and Remediation Services
01/17/2017 cg Risk Management
Attachment C - Bond Requirements
No bond requirements necessary for this supply agreement; Section
5. (8) is null for this service agreement.
ATTACHMENT D: WARRANTY REQUIREMENTS
No warranty requirements necessary for this supply agreement; Section 8.
Warranty is null for this service agreement.
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1of1
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. 2017-232245 •
Horizon Environmental
Houston,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 07/05/2017
being filed.
City of Corpus Christi • Date cknowl aged:+?►`�
g Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
230-5:RFB1036
Emergency Spill Response and Remediation
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
Horizon Environmental Victoria,TX United States X
•
5 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
"""% HALEY SANFORD
11,,s=o: 40aNotary Publi ,State of Texas 747_ at,
. o- Comm.Expires 05-10-2020 �
!%n°,"„��` Notary ID 130656002 Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE n
•
sworn to and subscribed before me,by the said (A.f I(M` ?1:1 ,this the Oa' day of _,
20 11 ,to certify which,witness my hand and seal of office. - f
Signet of officer administering oath Printed name of officer administering oath Title of off er administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx,us Version V1.0.883