7054 - Concrete Crushing Service, 0.Main Solicitation
Materials Management Department
901-B Texas Street
Denton, Texas 76209
INVITATION FOR BIDS
IFB 7054
CONCRETE CRUSHING SERVICE
FOR THE CITY OF DENTON
NIGP CLASS and ITEM
968 28
Issue Date: April 25, 2019
Response due Date and Time (Central Time):
Thursday, May 23, 2019 at 11:00 A.M.
The City highly recommends that respondents do not wait until minutes before the
due date and time to email a submission.
It can take significant time for the submissions to reach the City.
City of Denton
IFB 7054
Table of Contents
1. INTRODUCTION................................................................................................................................................. 3
2. COMMODITY OR SERVICE DESCRIPTION ..................................................................................................... 3
3. MINIMUM QUALIFICATIONS........................................................................................................................... 3
4. SCHEDULE OF EVENTS .................................................................................................................................... 4
5. PRE-SUBMITTAL CONFERENCE AND WALKTHROUGH.............................................................................. 4
6. CONTRACT TERM ............................................................................................................................................. 4
7. PRICING .............................................................................................................................................................. 5
8. PRICE ADJUSTMENTS....................................................................................................................................... 5
9. COOPERATIVE PURCHASING / PIGGYBACK OPTION .................................................................................. 6
10. ADDENDA .......................................................................................................................................................... 6
11. BUSINESS OVERVIEW ...................................................................................................................................... 6
12. EXCEPTIONS ...................................................................................................................................................... 6
13. SAFETY RECORD............................................................................................................................................... 6
14. DISCLOSURES .................................................................................................................................................... 6
15. ACKNOWLEDGEMENT ..................................................................................................................................... 7
16. SUBMITTAL INSTRUCTIONS ........................................................................................................................... 7
a. Submission Format ................................................................................................................................................ 7
b. Electronic Submission Requirements ..................................................................................................................... 8
17. EVALUATION PROCEDURES ........................................................................................................................... 8
18. CONTACT BETWEEN RESPONDENT AND THE CITY ................................................................................... 9
SOLICITATION CHECKLIST .............................................................................................................................. 10
ATTACHMENT A-BUSINESS OVERVIEW QUESTIONNAIRE AND FORMS ..... Error! Bookmark not defined.
ATTACHMENT B-SUBMISSION EXCEPTIONS ................................................................................................ 14
ATTACHMENT C-SAFETY RECORD QUESTIONNAIRE ................................................................................. 15
ATTACHMENT D-REFERENCES ....................................................................................................................... 17
ATTACHMENT E-CONFLICT OF INTEREST QUESTIONNAIRE ..................................................................... 18
ATTACHMENT F-ACKNOWLEDGEMENT ........................................................................................................ 18
Exhibit 1 Pricing Sheet
Exhibit 2 General Provisions, Standard Terms and Conditions and Appendices
Exhibit 3 Scope of Work or Technical Specifications
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City of Denton
IFB 7054
1. INTRODUCTION
In accordance with the provisions of Texas Local Government Code, Chapter 252 and 271, the City
of Denton (the City) is requesting submissions to contract with an individual or business with
considerable experience in providing goods or services of this solicitation. The responses and the
cost solutions shall be submitted to the City of Denton in a sealed submission.
The awarded individual or business shall possess a proven track record of using innovative
approaches to providing goods and services that represent the best value to their clients. The awarded
individual or business shall have the ability to accomplish all aspects of the requested services. The
selected individual or firm should be able to provide innovative methods to deal with municipal
challenges, and cost effective solutions.
A firm may submit a solicitation response for one or more of the categories of product or services
requested in this solicitation.
2. COMMODITY OR SERVICE DESCRIPTION
The City is seeking a term contract for the SUPPLY OF CONCRETE CRUSHING SERVICE as
needed over the contract term. The City will issue Purchase Orders for specific needs.
The products and services shall be accomplished per all exhibits identified in the table of
contents.
3. MINIMUM QUALIFICATIONS
The following minimum requirements must be demonstrated in order for the submission to be
considered responsive to the City of Denton. Any submission received, which is determined to not
meet these mandatory requirements shall be immediately disqualified and rejected as non-
responsive.
Three (3) years experience providing similar products or services.
Three (3) references from governmental entities for the products or services requested. The
City prefers references from municipalities of similar size.
Must have valid air permit and supply copy of with bid package submission.
The responding individual or business must be registered in the State of Texas, or the County
of Denton, to provide the products or services required in the solicitation, and the individual
or business must have all licensure required by the State to provide any services required
under this contact.
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IFB 7054
To learn how to obtain information about filing with the State of Texas, or obtaining copies
or certificates from the Secretary of State visit Webpage:
http://www.sos.state.tx.us/corp/copies.shtml; Phone 512-463-5578; or email
corpcert@sos.state.tx.us.
Meet the specifications per Exhibit 3.
Submittal documents including a cover sheet, Solicitation Checklist, Attachments A -F and
Exhibit 1, per the method described in Error! Reference source not found.SUBMITTAL
INSTRUCTIONS.
4. SCHEDULE OF EVENTS
The City of Denton reserves the right to change the dates indicated below:
Solicitation Schedule:
Pre-submittal conference 5/7/2019 at 11:00 AM CST
Deadline for Submission of Questions: 5/17/2019 at 11:00 AM CST
Deadline for Submission of Responses: 5/23/2019 at 11:00 AM CST
The City of Denton is using the solicitation ‘Issue Date’ as noted in the Schedule of Events above as
the official 30 day notification requirement for an interview with a firm.
5. PRE-SUBMITTAL CONFERENCE
A non-mandatory, pre-solicitation conference and walkthrough will be available to interested
contractors. Attendance at the pre-solicitation conference and walkthrough is strongly
encouraged prior to submission of a response. The conference will be held on Tuesday May, 7
2019 at 11:00 AM CST at the City of Denton Landfill, Solid Waste Training Room 1527 S
Mayhill Rd, Denton, Texas 76208.
Internet link to meeting location:
https://www.google.com/maps/place/Denton+Landfill/@33.1931058,-
97.0858035,17z/data=!3m1!4b1!4m5!3m4!1s0x864c34d63240d7d5:0x8a296262642f08df!8m
2!3d33.1931013!4d-97.0836148?hl=en
6. CONTRACT TERM
It is the intention of the City of Denton to award a contract for a three (3) year period.
The Contract shall commence upon the issuance of a Notice of Award/Issuance of Purchase Order
by the City of Denton. At the sole option of the City of Denton, the Contract may be further
extended as needed, not to exceed a total of six (6) months.
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IFB 7054
7. PRICING
Unit Pricing in Exhibit 1 shall include all fees and costs to provide the goods and services to the
City. Unit pricing for goods shall include delivery costs, F.O.B. Destination
Firm Price
Pricing and discounts submitted are firm for the initial one-year period specified in the solicitation.
Price decreases are allowed at any time. Price increases shall only be considered as stipulated below
in “PRICE ADJUSTMENTS”.
Price Decreases/Discount Increases
Respondents are required to immediately implement any price decrease or discount increase that may
become available. The City of Denton must be notified in writing for updating the contract.
8. PRICE ADJUSTMENTS
Prices quoted for the commodities or services described in the solicitation must be firm for a period
of one year from date of contract award. Any request for price adjustment must be based on the, U.S
Department of Labor, Bureau of Labor Statistics, Producer Price Index (PPI). The price will be
increased or decreased based upon the annual percentage change in the PPI. The maximum escalation
will not exceed +/- 8% for any individual year. The escalation will be determined annually at the
renewal date. Should the PPI change exceed a minimum threshold value of +/-1%, then the stated
eligible bid prices shall be adjusted in accordance with the PPI change not to exceed the 8% limit per
year. The supplier should provide documentation as percentage of each cost associated with the unit
prices quoted for consideration.
Request must be submitted in writing with supporting evidence for need of such increase to the
Purchasing Manager at least 60 days prior to contract expiration of each year. Respondent must also
provide supporting documentation as justification for the request.
Upon receipt of such request, the City of Denton reserves the right to either: accept the escalation as
competitive with the general market price at the time, and become effective upon the renewal date
of the contract award or reject the increases within 30 calendar days after receipt of a properly
submitted request. If a properly submitted increase is rejected, the Contractor may request
cancellation of such items from the Contract by giving the City of Denton written notice.
Cancellation will not go into effect for 15 calendar days after a determination has been issued. Pre-
price increase prices must be honored on orders dated up to the official date of the City of Denton
approval and/or cancellation.
The request can be sent by e-mail to: purchasing@cityofdenton.com noting the solicitation number.
The City of Denton reserves the right to accept, reject, or negotiate the proposed price changes.
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IFB 7054
9. COOPERATIVE PURCHASING / PIGGYBACK OPTION
The contract resulting from this solicitation will be available for use by all governmental entities,
providing there is no conflict with any applicable statutes, rules, policies, or procedures. The
governmental entities will have the option to use the pricing as agreed to within the resulting contract.
Governmental entities will issue their internal purchase orders directly to the contractor(s).
10. ADDENDA
Respondents are required to acknowledge addenda with their submission. Respondents will be
responsible for monitoring the City of Denton Purchasing website at www.dentonpurchasing.com to
ensure they have downloaded and signed all addenda required for submission with their submission.
Respondents should acknowledge each individual addendum on Attachment F.
11. BUSINESS OVERVIEW
Respondent shall complete the Business Overview Questionnaire, Project Information Form &
Schedule Compliance Form as applicable per Attachment A.
12. EXCEPTIONS
The respondent shall note any exceptions to the solicitation document, on Attachment B. The
exceptions will be reviewed to ensure they meet the minimum specifications. The City reserves the
right to accept or reject the exceptions provided.
Do not mark or change the text of the solicitation document, exceptions shall be noted only on
Attachment B.
If no exceptions are taken, the respondent shall sign and return Attachment B in the appropriate
signature block.
13. SAFETY RECORD
The City of Denton desires to avail itself of the benefits of Section 252.0435 of the Local Government
Code, and consider the safety records of potential contractors prior to awarding City contracts.
Pursuant to Section 252.0435 of the Local Government Code, the City of Denton has adopted the
written definition and criteria as shown in the Safety Record Questionnaire (Attachment C) for
accurately determining the safety record of a respondent prior to awarding City contracts.
14. DISCLOSURES
The individual or business must disclose any business relationship that would have an effect, of a
conflict of interest. A conflict of interest statement must be signed as part of the contract negotiated
with the awardee(s). (Attachment E)
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IFB 7054
15. ACKNOWLEDGEMENT
Submit a signed acknowledgement by authorized agent of the responding firm (Attachment F).
16. SUBMITTAL INSTRUCTIONS
The City of Denton will accept electronic or hard copy submittals until the date and time on the cover
sheet of this solicitation. Any submission received after the date and/or hour set for solicitation
opening will be returned unopened.
Electronic submittals may be emailed to ebids@cityofdenton.com with the solicitation number and
name in the subject line. Please consolidate attachments as much as possible, and do not exceed
35MB total for attachments. Emails received by the City will remain unopened until after the due
date and time. Only authorized Materials Management Staff will have access to the e-bid email
inbox. Please do not email the buyer directly to ensure security of the proposal. Electronic proposals
must be received by the City before the due date and time. The date and time used by the City
shall be the official time. It is highly recommended that respondents do not wait until minutes
before the due date and time to email their submission. It can take significant time for the
email to reach the City.
Hard copy submissions may be hand delivered (by firm or express courier) to the address listed
below:
City of Denton
Materials Management
SOLICITATION NUMBER AND NAME
901B Texas Street
Denton, TX 76209
The City of Denton reserves the right to accept or reject in part or in whole any submission, and to
waive technicalities of the submission, in the best interest of obtaining best value for the City.
Each respondent is responsible for taking the necessary steps to ensure their submission is received
by the date and time noted herein. The City is not responsible for missing, lost or late mail or any
mail or email delays, internal or external, that may result in the submission arriving after the set time.
a. Submission Format
Respondents shall provide detailed information to allow the City to properly evaluate the
submission. The City requests the following format be used:
1. Hard copy submissions shall be bound only utilizing a staple or binder clip. Do not submit
responses in a binder or file folder.
2. Submission shall be no more than 200 pages in length
3. Utilize tabs to identify exhibits and attachments
4. The submission shall be in the following order:
a) Coversheet – including Solicitation number and name, firm name, address, contact
name, phone, fax, website and email address.
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IFB 7054
b) Pricing Sheet – Exhibit 1 (EXCEL FORMATTED)
c) Completed Solicitation Checklist
d) Valid Air Permit copy
e) Attachment A- Business Questionnaire
f) Attachment B- Exception Form
g) Attachment C -Safety Record (if applicable form will be attached)
h) Attachment D -References
i) Attachment E -Conflict of Interest Questionnaire Form
j) Attachment F -Signed Acknowledgement form
k) Appendices may be used for additional documentation or clarification at the
respondent’s option.
5. Hard Copy submittals shall include one (1) original signed by an officer authorized to bind
the firm, and two (2) copies of the completed response.
6. Submit response, before the published due date. Hard copy submittals must be in a sealed
envelope with the solicitation number and name.
b. Electronic Submission Requirements
All respondents shall submit their pricing sheet (Exhibit 1) in Microsoft Excel format for
quick tabulation of results. The electronic pricing sheet must be received regardless of the method
chosen by the proposer to submit (hard copy or electronic). If a respondent is only submitting a hard
copy, they shall provide a flash drive, containing a complete copy of the response to this solicitation,
or submit electronically to ebids@cityofdenton.com. Please consolidate attachments as much as
possible, and do not exceed 35MB total for attachments. Please do not email the buyer directly to
ensure security of the proposal
17. EVALUATION PROCEDURES
Selection of a firm(s) to provide the aforementioned materials and services shall be in accordance
with the City of Denton Purchasing Policies and procedures and the State of Texas Local
Government Code Chapter 252.043. The City of Denton shall evaluate each submission utilizing the
following process:
Step 1: A public opening will be conducted. Responses will be read aloud thirty minutes after
the opening time and date published on the coversheet.
Step 2: The City of Denton will evaluate the submissions in accordance with the minimum
qualifications and adherence to the specifications.
Step 3: Upon selection of the lowest responsible respondent meeting the specifications, a written
recommendation will be presented to the appropriate approving authority for the City of
Denton (the City Manager, Public Utility Board, City Council) requesting authorization
to proceed with contract execution for the proposed services.
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IFB 7054
18. CONTACT BETWEEN RESPONDENT AND THE CITY
Respondents shall direct all inquiries and communications concerning this solicitation to the Point
of Contact(s) listed below:
Jamie Cogdell, CTPM
Senior Buyer
901-B Texas Street
Denton, TX 76209
(940) 349-7100
Fax: (940) 293-1837
jamie.cogdell@cityofdenton.com
*** Please do not email the buyer the final proposal unless requested after the due date and time
published on the coversheet. A proposal should be emailed to ebids@cityofdenton.com
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IFB 7054
SOLICITATION CHECKLIST
Check
when Task to be Completed by Respondent
Completed
Exhibit 1 – Pricing sheet
Review Exhibit 2 – General Provisions and Terms and Conditions
Review Exhibit 3 – Scope of Work/Technical Specifications
Cover sheet
Solicitation number
Solicitation name
Firm name
Firm address
Contact name
Contact phone
Contact fax
Website address
Contact email address
Solicitation Checklist
Attachment A- Business Overview Questionnaire
Document how firm meets minimum qualifications in Section 3
Attachment B – Exception Form
Attachment C – Safety Record Questionnaire (if applicable)
Attachment D – Reference Form
Attachment E – Conflict of Interest Questionnaire Form- with signature
Attachment F - Acknowledgment
Acknowledgment of Addenda
Submission signed by authorized officer, in the order specified below
Hard Copy Submission: If submitting a hard copy, the City requires one (1) original and
two (2) copies, with the pricing sheet submitted electronically in excel or emailed in excel
to Ebids@cityofdenton.com with the solicitation # and name in the subject line.
Electronic Submission: If submitting an electronic proposal only, email to
Ebids@cityofdenton.com with the solicitation # and name in the subject line. The pricing
sheet (Exhibit 1) must be in excel format.
Submit response, with tabs marking each section, in the following order:
Order for
Document
Submission
1 Cover Sheet
2 Pricing Sheet – Exhibit 1
3 Solicitation Checklist
4 Attachment A- Business Overview Questionnaire
5 Attachment B – Exception Form
6 Attachment C – Safety Record Questionnaire (if applicable)
7 Attachment D – Reference Form
8 Attachment E – Conflict of Questionnaire Form
9 Attachment F - Acknowledgment
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IFB 7054
ATTACHMENT A-BUSINESS OVERVIEW QUESTIONNAIRE AND FORMS
1. Contract Information (for formal contracting purposes):
The following information will be used to write a contract, should your firm be selected for
award.
Firm’s Legal Name:
Address:
Agent Authorized to sign contract (Name):
Agent’s email address:
2. Subsidiary of:
3. Check the appropriate Organization Class and provide proof of registration as indicated below:
______ Sole Proprietorship – County Assumed Name Certificate
______ General Partnership – County Assumed Name Certificate
______Corporation – Secretary of State Certificate of Registration
______Limited Liability Companies (LLC) – Secretary of State Certificate of Registration
______ Limited Partnership (LP) – Secretary of State Certificate of Registration
______ Limited Liability Partnership (LLP) – Secretary of State Certificate of Registration
______ Foreign Entity – Secretary of State Certificate of Registration
4. Tax Payer ID#:
5. Date Established:
6. Historically Underutilized Business: Yes or No
7. Does your company have an established physical presence in the State of Texas, or the City of
Denton? Yes or No, in which?
8. Please provide a detailed listing of all products and/or services that your company provides.
9. Has your company filed or been named in any litigation involving your company and the
Owner on a contract within the last five years under your current company name or any other
company name? If so provide details of the issues and resolution if available. Include lawsuits
where Owner was involved. (Notice: Failure to disclose this information during proposal
submission, and later discovered, may result in contract termination at the Owner’s option.)
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10. Have you ever defaulted on or failed to complete a contract under your current company
name or any other company name? If so, where and why? Give name and telephone number
of Owner.
11. Have you ever had a contract terminated by the Owner? If so, where and why? Give name
and telephone number (s) of Owner (s).
12. Has your company implemented an Employee Health and Safety Program compliant with 29
CFR 1910 “General Industry Standards” and/or 29 CFR 1926 “General Construction
Standards” as they apply to your Company’s customary activities?
http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc
_level=1&p_keyvalue=1926
13. Resident/Non-Resident Bidder Determination:
Texas Government Code Section 2252.002: Non-resident bidders. Texas law prohibits cities
and other governmental units from awarding contracts to a non-resident firm unless the
amount of such a bid is lower than the lowest bid by a Texas resident by the amount the Texas
resident would be required to underbid in the non-resident bidders’ state. In order to make
this determination, please provide the name, address and phone number of:
a. Responding firms principle place of business:
b. Company’s majority owner principle place of business:
c. Ultimate Parent Company’s principle place of business:
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14. Provide details on how firm meets the minimum qualifications stated in this Main
document Section 3.
a. The details must be completed on this form, and shall not point to another document
in the respondent’s proposal.
b. Sign below and return form with final submission.
I certify that our firm meets the minimum qualifications as stated in this Main document, section 3.
_______________________ _____________________ _____________________
Signature Company Date
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IFB 7054
ATTACHMENT B-SUBMISSION EXCEPTIONS
Any exceptions or clarifications taken to this solicitation (including terms and conditions in Exhibit
2, the General Provisions and Terms and Conditions) must be itemized on the lines below.
Additional pages may be added as needed. If there are no exceptions or clarifications, please sign
where indicated at the bottom of the page.
Item # Description
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
_________ __________________________________________________________________________________
The above exceptions or clarifications (and any additional pages identified) are the ONLY exceptions
to the specifications, General Provisions and Terms and Conditions in Exhibit 2, and sample contract
to this solicitation. I understand that the City may not accept additional exceptions produced after
final submission of this proposal.
_______________________ _____________________ _____________________
Signature Company Date
No Exceptions are taken to this solicitation or the General Provisions and Terms
and Conditions in Exhibit 2.
_______________________ _____________________ _____________________
Signature Company Date
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ATTACHMENT C-SAFETY RECORD QUESTIONNAIRE
The City of Denton desires to avail itself of the benefits of Section 252.0435 of the Local Government Code,
and consider the safety records of potential contractors prior to award of City contracts. Pursuant to Section
252.0435 of the Local Government Code, the City of Denton has adopted the following written definition and
criteria for accurately determining the safety record of a respondent prior to awarding City contracts.
The definition and criteria for determining the safety record of a respondent for this consideration shall be:
The City of Denton shall consider the safety record of the respondent in determining the responsibility
thereof. The City may consider any incidence involving worker safety or safety of the citizens of the
City of Denton, be it related or caused by environmental, mechanical, operational, supervision or any
other cause or factor. Specifically, the City may consider, among other things:
a. Complaints to, or final orders entered by, the Occupational Safety and Health Review
Commission (OSHRC), against the respondent for violations of OSHA regulations
within the past three (3) years.
b. Citations (as defined below) from an Environmental Protection Agency (as defined
below) for violations within the past five (5) years. Environmental Protection
Agencies include, but are not necessarily limited to, the U.S. Army Corps of
Engineers (USACOE), the U.S. Fish and Wildlife Service (USFWS), the
Environmental Protection Agency (EPA), the Texas Commission on Environmental
Quality (TCEQ), the Texas Natural Resource Conservation Commission (TNRCC)
(predecessor to the TCEQ), the Texas Department of Health (TDH), the Texas Parks
and Wildlife Department (TPWD), the Structural Pest Control Board (SPCB),
agencies of local governments responsible for enforcing environmental protection or
worker safety related laws or regulations, and similar regulatory agencies of other
states of the United States. Citations include notices of violation, notices of
enforcement, suspension/revocations of state or federal licenses or registrations, fines
assessed, pending criminal complaints, indictments, or convictions, administrative
orders, draft orders, final orders, and judicial final judgments.
c. Convictions of a criminal offense within the past ten (10) years, which resulted in
bodily harm or death.
d. Any other safety related matter deemed by the City Council to be material in
determining the responsibility of the respondent and his or her ability to perform the
services or goods required by the solicitation documents in a safe environment, both
for the workers and other employees of respondent and the citizens of the City of
Denton.
In order to obtain proper information from respondents so that City of Denton may consider the safety
records of potential contractors prior to awarding bids on City contracts, City of Denton requires that
respondents answer the following three (3) questions and submit them with their submissions:
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QUESTION ONE
Has the respondent, or the firm, corporation, partnership, or institution represented by the respondent, or
anyone acting for such firm, corporation, partnership or institution, received citations for violations of OSHA
within the past three (3) years?
YES NO
If the respondent has indicated YES for question number one above, the respondent must provide to City of
Denton, with its submission, the following information with respect to each such citation:
Date of offense, location of establishment inspected, category of offense, final disposition of offense, if any,
and penalty assessed.
QUESTION TWO
Has the respondent, or the firm, corporation, partnership, or institution represented by the respondent, or
anyone acting for such firm, corporation, partnership or institution, received citations for violations of
environmental protection laws or regulations, of any kind or type, within the past five years? Citations include
notice of violation, notice of enforcement, suspension/revocations of state or federal licenses, or registrations,
fines assessed, pending criminal complaints, indictments, or convictions, administrative orders, draft orders,
final orders, and judicial final judgments.
YES NO
If the respondent has indicated YES for question number two above, the respondent must provide to City of
Denton, with its submission, the following information with respect to each such conviction:
Date of offense or occurrence, location where offense occurred, type of offense, final disposition of offense, if
any, and penalty assessed.
QUESTION THREE
Has the respondent, or the firm, corporation, partnership, or institution represented by respondent, or anyone
acting for such firm, corporation, partnership, or institution, ever been convicted, within the past ten (10) years,
of a criminal offense which resulted in serious bodily injury or death?
YES NO
If the respondent has indicated YES for question number three above, the respondent must provide to City of
Denton, with its submission, the following information with respect to each such conviction:
Date of offense, location where offense occurred, type of offense, final disposition of offense, if any, and
penalty assessed.
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ATTACHMENT D-REFERENCES
Please list three (3) Government references, other than the City of Denton, who can verify the quality of service
your company provides. The City prefers customers of similar size and scope of work to this solicitation.
REFERENCE ONE
GOVERNMENT/COMPANY NAME:
LOCATION:
CONTACT PERSON AND TITLE:
TELEPHONE NUMBER:
SCOPE OF WORK:
CONTRACT PERIOD:
REFERENCE TWO
GOVERNMENT/COMPANY NAME:
LOCATION:
CONTACT PERSON AND TITLE:
TELEPHONE NUMBER:
SCOPE OF WORK:
CONTRACT PERIOD:
REFERENCE THREE
GOVERNMENT/COMPANY NAME:
LOCATION:
CONTACT PERSON AND TITLE:
TELEPHONE NUMBER:
SCOPE OF WORK:
CONTRACT PERIOD:
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ATTACHMENT E-CONFLICT OF INTEREST QUESTIONNAIRE
CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as
defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after
the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a
misdemeanor.
Name of vendor who has a business relationship with local governmental entity.
1
2
Check this box if you are filing an update to a previously filed questionnaire.
th
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7 business day after the
date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information in this section is being disclosed.
Name of Officer
This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the vendor has an employment or other business relationship
as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer
named in this section AND the taxable income is not received from the local governmental entity?
Yes No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an
officer or director, or holds an ownership of one percent or more?
Yes No
D. Describe each employment or business and family relationship with the local government officer named in this section.
4
I have no Conflict of Interest to disclose.
5
Signature of vendor doing business with the governmental entity Date
IFB 7054 - Main Document Page 18 of 19
City of Denton
IFB 7054
ATTACHMENT F-ACKNOWLEDGEMENT
The undersigned agrees this submission becomes the property of the City of Denton after the official opening.
The undersigned affirms he has familiarized himself with the specification, drawings, exhibits and other documents; the
local conditions under which the work is to be performed; satisfied himself of the conditions of delivery, handling and
storage of materials and equipment; and all other matters that will be required for the work before submitting a response.
The undersigned agrees, if this submission is accepted, to furnish any and all items/services upon which prices are offered,
at the price(s) and upon the terms and conditions contained in the specification. The period for acceptance of this
submission will be 120 calendar days unless a different period is noted.
The undersigned affirms that they are duly authorized to execute this contract, that this submission has not been prepared
in collusion with any other respondent, nor any employee of the City of Denton, and that the contents of this submission
have not been communicated to any other respondent or to any employee of the City of Denton prior to the acceptance of
this submission.
Respondent hereby assigns to the City any and all claims for overcharges associated with this contract which arise under
the antitrust laws of the United States, 15 USCA Section 1 et seq., and which arise under the antitrust laws of the State of
Texas, Tex. Bus. & Com. Code, Section 15.01, et seq.
The undersigned affirms that they have read and do understand the specifications, all exhibits and attachments contained
in this solicitation package.
The undersigned agrees that the solicitation package posted on the website are the official specifications and shall not alter
the electronic copy of the specifications and/or pricing sheet (Exhibit 1), without clearly identifying changes.
The undersigned understands they will be responsible for monitoring the City of Denton Purchasing Website at:
http://www.cityofdenton.com/index.aspx?page=397 to ensure they have downloaded and signed all addendum(s) required
for submission with their response.
I certify that I have made no willful misrepresentations in this submission, nor have I withheld information in my statements
and answers to questions. I am aware that the information given by me in this submission will be investigated, with my
full permission, and that any misrepresentations or omissions may cause my submission to be rejected.
Acknowledge receipt of following addenda to the solicitation:
Addendum No 1 Dated _______________________ Received _________________
Addendum No 2 Dated _______________________ Received _________________
Addendum No 3 Dated _______________________ Received _________________
NAME AND ADDRESS OF COMPANY: AUTHORIZED REPRESENTATIVE:
___________________________________ Signature
___________________________________ Date
___________________________________ Name
___________________________________ Title ___________________________
Tel. No. ____________________________ Fax No. ________________________
Email. _____________________________
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