HomeMy WebLinkAboutC2017-294 - 10/31/2017 - Approved ijj, F� SUPPLY AGREEMENT NO. 1266
Sodium Permanganate Solution
PPOR
THIS Sodium Permanganate Solution Supply Agreement ("Agreement") is entered
into by and between the City of Corpus Christi, a Texas home-rule municipal
corporation ("City") and Carus Corporation ("Supplier"), effective upon execution by
the City Manager or the City Manager's designee ("City Manager").
WHEREAS, Supplier has bid to provide Sodium Permanganate Solution in
response to Request for Bid No. 1266 ("RFB"), which RFB includes the required scope
of work and all specifications and which RFB and the Supplier'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 Supplier agree as follows:
1. Scope. Supplier will provide Sodium Permanganate Solution 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. This Agreement is for 24 months. The parties may mutually extend the term
of this Agreement for up to Iwo additional 24-month periods ("Option Period(s)"),
provided, the parties do so in writing and prior to the expiration of the original
term or the then-current Option Period. The City's extension authorization must
be executed by the City Manager or designee.
3. Compensation and Payment. The total value of this Agreement is not to exceed
$3,407,859.00, subject to approved extensions and changes. Payment will be
made for goods delivered 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.
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:
o ----- • Form
2017-294 /18/17 Page 1 of 7
10/31/17
M2017-172
Carus Corporation
INDEXED
Name: Diana Zertuche-Garza
Department: Utilities
Phone: (361) 826-1827
Email:dianaG@cctexas.com
5. Insurance. Before performance can begin under this Agreement, the Supplier
must deliver a certificate of insurance ("con, as proof of the required insurance
coverages, to the City's Risk Manager and the Contract Administrator.
Additionally, the 001 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.
6. Purchase Release Order. For multiple-release purchases of products to be
provided by the Supplier over a period of time, the City will exercise its right to
specify time, place and quantity of products to be delivered in the following
manner: any City department or division may send to Supplier a purchase
release order signed by an authorized agent of the department or division. The
purchase release order must refer to this Agreement, and products will remain
with the Supplier until such time as the products are delivered and accepted by
the City.
7. Inspection and 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
Supplier, 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 Supplier within 30 days of receipt of City's invoice.
8. Warranty. The Supplier 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 Supplier 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 Supplier 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
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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. Supplier 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 Supplier be considered an employee of the
City.
12. Subcontractors. Supplier may use subcontractors in connection with the work
performed under this Agreement. When using subcontractors, however, the
Supplier must obtain prior written approval from the Contract Administrator if the
subcontractors were not named at the time of bid. In using subcontractors, the
Supplier is responsible for all their acts and omissions to the same extent as if the
subcontractor and its employees were employees of the Supplier. 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 Supplier 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 Supplier 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
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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: Diana Zertuche-Garza
Title: Contracts/Fund Administrator
Address: 13101 Leopard Street,Corpus Christi, TX 78410
Fax: (361) 826-4488
IF TO SUPPLIER:
Carus Corporation
Attn: Susan Buchanan
Title: VP, CFO
Address: 315 Fifth Street, Peru , IL 61354
Fax: (815) 224-6697
17. SUPPLIER SHALL FULLY 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 WHATEVER
NATURE, CHARACTER, OR DESCRIPTION ON ACCOUNT OF PERSONAL
INJURIES, 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 A
BREACH OF THIS AGREEMENT OR THE PERFORMANCE OF THIS
AGREEMENT BY THE SUPPLIER OR RESULTS FROM THE NEGLIGENT ACT,
OMISSION, MISCONDUCT, OR FAULT OF THE SUPPLIER OR ITS
EMPLOYEES OR AGENTS. SUPPLIER 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 SUPPLIER UNDER THIS SECTION SHALL SURVIVE THE
EXPIRATION OR EARLIER TERMINATION OF THIS AGREEMENT.
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18. Termination.
(A) The City Manager may terminate this Agreement for Supplier'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 Supplier written notice of the breach and set out a
reasonable opportunity to cure. If the Supplier has not cured within the cure
period, the City Manager may terminate this Agreement immediately thereafter.
(B) Alternatively, the City Manager may terminate this Agreement for
convenience upon 30 days advance written notice to the Supplier. The City
Manager may also terminate this Agreement upon 24 hours written notice to the
Supplier 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 Supplier, 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 Supplier
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 (excluding attachments and exhibits);
B. its attachments;
C. the bid solicitation document including any addenda (Exhibit 1); then,
D. the Supplier's bid response (Exhibit 2).
22. Certificate of Interested Parties. Supplier 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
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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 all prior
negotiations, arrangements, agreements and understandings, either oral or
written, between the parties.
(SIGNATURE PAGE FOLLOWS)
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SUPPLIER
Signature: c/Vi I/li
Printed Name: David J l'y
Title: CEO
Date: September 27, 2017
CITY OF CORPUS CHRISTI
Signature: 1Y\-- p
Printed Name: fN-N.0.-r: e c 0..Z
Title: QCO -& Sc pr
Date: \ \ \ - 1'1
Attached and Incorporated by Reference:
Attachment A: Scope of Work ATTEST: �—
Attachment B: Bid/Pricing Schedule REB CCA HUERTA
CITY SECRETARY
Attachment C: Insurance Requirements
Attachment D: Warranty Requirements
Incorporated by Reference Only:
Exhibit 1: RFB No. 1266
Exhibit 2: Supplier's Bid Response
AU I R,
cOMcIi 1
�...... SECRETARY
Pi
Supply Agreement Standard Form Page 7 of 7
Approved as to Legal Form 9/18/17
Attachment A - Scope of Work
4.1 General Requirements
The Supplier shall provide Sodium Permanganate Solution as outlined in this
Scope of Work to be used at the City of Corpus Christi Water and
Wastewater Treatment Plants. This chemical is used for algae control in
water and must conform to all the requirements of this specification.
4.2 Scope of work
The Supplier shall provide with every delivery a chemical analysis for each
chemical shipment, and the chemical analysis must include the
percentage of assay, specific gravity and pH.
MATERIAL REQUIREMENTS:
The Sodium Permanganate Solution delivered under this agreement
will meet the following specifications:
Item Weight
Assay 39.5 - 41.0% as NaMn04
pH 5.0-8.0
Specific gravity 1.36 - 1 .39
Certified by the National Sanitation Foundation (NSF) to ANSI/NSF
Standard 60 for drinking water treatment chemicals-health effects.
The product should meet the AWWA Standard B603-03; EN: 15482-2007.
4.3 Delivery and Weighing Requirements
1 . The Supplier will be responsible for unloading the chemical. The Supplier
shall provide any special equipment necessary for unloading, up to and
including, hoses, connections, compressors, etc.
2. The Supplier must provide an affidavit of compliance to the City of
Corpus Christi stating that at the time of delivery the chemical furnished
I
under the release order complies with all applicable requirements of this
specification.
3. City of Corpus Christi Plant Supervisors, or their designee, may take a
sample of any chemical shipment for testing prior to unloading of the
chemical. In addition, approximately every three (3) months during the
supply agreement, the City will take a random sample of the chemical
upon delivery. This sample will be sent to an independent laboratory
chosen by the City, and tested for all items outlined in the product
specifications.
4. The Plant Supervisor may reject any chemical shipments that contain a
concentration of any component outside the allowable concentration
range as specified in the product specifications.
5. Deliveries of Sodium Permanganate solution must be by drivers
thoroughly trained and familiar with the related hazards, safety
measures, and spill cleanup procedures for sodium permanganate
solution. All spills and leakage, regardless of size must be properly and
immediately cleaned up by Supplier's personnel. The Supplier shall be
required to respond to any and all such emergencies within eight (8)
hours of being notified.
6. The Supplier shall allow two (2) hours "unloading time" for each
chemical shipment, starting from the time the load enters the plant site
to the time the unloading of the chemical shipment is completed.
Unloading of the chemical is complete when unloading apparatus is
disconnected from storage facilities and secured, and a designated
City of Corpus Christi representative has signed all delivery tickets for
each respective load. Any unloading time in excess of two (2) hours
which is directly attributable to the City will be paid for at the unit price
bid for "Unloading Delays," rounded and prorated to the nearest
quarter hour. This amount shall be included with the invoice for payment
--- ---- for that particular load of chemical.
7. Shipment(s) will be delivered in approximately 36,000 lb. lots. Each
chemical shipment must be weighed on a state certified truck scale
located within the city limits of Corpus Christi before delivery to and after
unloading at the water treatment plants.
8. The Supplier shall be responsible for mailing a legible copy of each
chemical shipment weight "ticket" to the respective City of Corpus
Christi Water Supervisor within 5 business days of delivery of the
chemical. Payments to the Supplier will not be processed unless this
requirement is met.
9. Deliveries shall be made between 8:00 a.m. and 5:00 p.m., Monday
through Sunday, excluding holidays, unless specific arrangements are
made otherwise.
10.Orders will be placed by telephone or email. The Supplier will deliver the
amount of Sodium Permanganate solution ordered within twenty-four
(24) hours of order placement. No minimum or maximum purchase of
Sodium Permanganate Solution is guaranteed by the City within the
duration of the contract.
4.4 Deliveries will be made to the following location:
O.N. Stevens Water Treatment Plant, 13101 Leopard St., Corpus Christi, TX
78410
4.5 Other Requirements
1 . All materials supplied must comply with all requirements and standards
of the Occupational Safety and Health Act (OSHA). All appropriate
markings shall be in place before delivery. Items not meeting OSHA
specifications will be refused.
2. The Supplier shall base its billing and quantity for each chemical
shipment on "local" certified weight tickets for the delivery of Sodium
Permanganate Solution.
3. The Supplier must submit the chemical analysis, weight ticket, and bill of
lading with each invoice.
4. Prior to initial use of the Sodium Permanganate solution, and annually
thereafter, the Supplier shall conduct a minimum of two (2) training
seminars for the City's operating personnel on the application and
control of the Sodium Permanganate solution, and shall include the
following:
a. Basic chemical properties of the Sodium Permanganate solution
b. Safety training
c. Equipment operation/set up
d. Safety Data Sheet
4.6 Supplier Quality Control and Superintendence
The Supplier 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 Supplier will also provide
supervision of the work to insure it complies with the contract requirements.
Attachment B - Bid Price/Schedule
oils
.c51Ad' CITY OF CORPUS CHRISTI
_Ii BID FORM
PURCHASING DIVISION
RFB No. 1266
M IOP SO
/852 Sodium Permanganate Solution
PAGE 1 OF 1
Date: September 18. 2017
Authorized
Bidder: Carus Corporation Signature: J. t.r
Susan BuchananNP, CFO
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
applicable governmental agencies.
d. Bidder acknowledges receipt and review of all addenda for this RFB.
4. Bidders must not write over or revise the bid form. Bidders will be considered Non-
Responsive if the bid form is modified.
Item Description UNIT QTY Unit Price Total Price
1 40% Solution Sodium
Permanganate Lbs. 1,456,350 $1.17 $1,703,929.50
2 Unloadin• Dela HR 25 N/A $0.00
Total
Attachment C - Insurance Requirements
SUPPLIER'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 Per occurrence - aggregate
change or termination required on all
certificates and policies.
Commercial General Liability including: $1,000,000 Per Occurrence
1. Commercial Broad Form $2,000,000 Aggregate
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
2. Hired & Non-owned
----
3. Rented & Leased
WORKERS' COMPENSATION Statutory and complies with Part II of
(All States Endorsement if Company is not This Exhibit
domiciled in Texas)
Employer's Liability $500,000 / $500,000 / $500,000
Pollution Liability $1,000,000 Per Incident Limit
(Including Cleanup and remediation $1,000,000 Aggregate
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 douse 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
payments) 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
Supply and Deliver Sodium Permanganate
06/28/2017 sw Risk Management
Attachment D-Warranty Requirements
No warranty requirements for this supply agreement; Section 8.
Warranty is null for this supply agreement.
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
I o' 1
Complete Nos. 1-4 and 6 if there are interested parties.
Complete Nos.1.2,3,5,and 6 if there are no interested parties. OFF
ICE I USE ONLY
CERT
2 Name of business entity filing form,and the city,state and country of the business entity's place ertifiicateNumber:
OF FILING
of business.
Carus Corporation 2017-264112
Peru. IL United States
Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 09/21/2017
being filed.
City of Corpus Christi
D1ate ckn hedged: yy--14
3 Provide the identification number used by the governmental entity or state agency to track or identify the co tract-2—V1.-On
�rovl
description of the services,goods,or other property to be provided under the contract. provide a
749
Manufacture and delivery sodium permanganate
4
Name of Interested Party Nature of interest
City,State,Country(place of business) (check applicable)
Controlling I Intermediary
K zy.David J. Peru,IL united States
X
Buchanan,Susan
Peru.It. Un.ted States
X
5 Check only if there is NO Interested Party.
EJ
6 AFFIDAVIT
I swear.or affirm,,.rider pe..atry of perjury,that the above d.sciosure is true and correct.
,..,- MMMN'Wi
OFFICIAL SEAL
SHELLEY A BURR !.
NOTARY PUBLIC-STATE OF ILLINOIS �;'uti) (�%l '7 /---
n MY C0MMiSSION EXPIRES:04/11/18 Signature of actt-orzec agent of contracting business entity
K.AFFIX NOTARY STAMP/SEAL ABOVE
porn to and subscribed before me.by the said j l\�J\Y *±
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201:a_,to certify which,witness my land and seal of office. ~� 1� this the �4� day of G� j l
Signature of dr administer n oath "�� '
4 Printed name of office',administering oath Title of officer ad inistering oath
Forms provided by Texas Ethics Commission
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