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7117 - Formal Amendment 1 Executed DocuSign Transmittal Coversheet File Name Purchasing Contact Docusign Envelope ID: BFE737C9-DED9-4516-AF04-2E3818DCEBB5 Crystal Westbrook 7117-DIELECTRIC SAFETY GLOVE AND SLEEVE TESTING & REPLACEMENT 1 THE STATE OF TEXAS § § COUNTY OF DENTON § FIRST AMENDMENT TO CONTRACT BY AND BETWEEN THE CITY OF DENTON, TEXAS AND COTTON ELECTRIC SERVICES, INC. THIS FIRST AMENDMENT TO CONTRACT 7117 (this “Amendment”) by and between the City of Denton, Texas (“City”) and COTTON ELECTRIC SERVICES, INC. (“Contractor”) to that certain contract executed on November 5, 2019, in the original not-to-exceed amount of $275,000 (the “Agreement”); for services related to the Dielectric Safety Glove and Sleeve Testing Service and Replacement. WHEREAS, the City deems it necessary to further expand the services provided by Contractor to the City pursuant to the terms of the Agreement, and to provide an additional not-to-exceed amount $49,900 with this First Amendment for an aggregate not-to-exceed amount of $324,900; and WHEREAS, this amendment incorporates any previously executed documents between the parties including but not limited to pricing adjustments. WHEREAS, the City deems it necessary to further expand the goods/services provided by Contractor to the City; and WHEREAS, the original not-to-exceed amount may not be increased by more than 25.0% as provided in Texas Local Government Code Sec. 252.048; and NOW THEREFORE, the City and Contractor (hereafter collectively referred to as the “Parties”), in consideration of their mutual promises and covenants, as well as for other good and valuable considerations, do hereby AGREE to the following First Amendment, which amends the following terms and conditions of the said Agreement, to wit: 1. This Amendment modifies the Agreement amount to provide an additional $49,900 for additional services and materials to be provided in accordance with the terms of the Agreement with a revised aggregate not-to-exceed total of $324,900. The term of the Agreement is extended until April 5, 2025. The Parties hereto agree, that except as specifically provided for by this Amendment, that all of the terms, covenants, conditions, agreements, rights, responsibilities, and obligations of the Parties, set forth in the Agreement remain in full force and effect. IN WITNESS WHEREOF, the City and the Contractor, have each executed this Amendment, by and through their respective duly authorized representatives and officers on this date_______________________________________. Docusign Envelope ID: BFE737C9-DED9-4516-AF04-2E3818DCEBB5 10/10/2024 2 “CONTRACTOR” COTTON ELECTRIC SERVICES, INC. By: _____________________________ AUTHORIZED SIGNATURE, TITLE “CITY” CITY OF DENTON, TEXAS A Texas Municipal Corporation By: _____________________________ THIS AGREEMENT HAS BEEN BOTH REVIEWED AND APPROVED as to financial and operational obligations and business terms. _______________ ________________ SIGNATURE PRINTED NAME __________________________________ TITLE __________________________________ DEPARTMENT Docusign Envelope ID: BFE737C9-DED9-4516-AF04-2E3818DCEBB5 CESI Supervisor Antonio Puente, Jr. DME General Manager Electric 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. 1 Name of vendor who has a business relationship with local governmental entity. 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th 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 Docusign Envelope ID: BFE737C9-DED9-4516-AF04-2E3818DCEBB5 COTTON ELECTRIC SERVICES, INC. CIQ FORM X X X X 10/10/2024 X City of Denton Certificate Of Completion Envelope Id: BFE737C9DED94516AF042E3818DCEBB5 Status: Completed Subject: ***Purchasing Approval*** 7117 Dielectric Safety Glove Sleeve Testing and Replacement-Amendment 1 Source Envelope: Document Pages: 4 Signatures: 4 Envelope Originator: Certificate Pages: 5 Initials: 1 Crystal Westbrook AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 901B Texas Street Denton, TX 76209 crystal.westbrook@cityofdenton.com IP Address: 198.49.140.10 Record Tracking Status: Original 10/9/2024 2:35:38 PM Holder: Crystal Westbrook crystal.westbrook@cityofdenton.com Location: DocuSign Signer Events Signature Timestamp Crystal Westbrook crystal.westbrook@cityofdenton.com Senior Buyer City of Denton Security Level: Email, Account Authentication (None) Completed Using IP Address: 198.49.140.10 Sent: 10/9/2024 2:43:51 PM Viewed: 10/9/2024 2:44:00 PM Signed: 10/9/2024 2:45:05 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Lori Hewell lori.hewell@cityofdenton.com Purchasing Manager City of Denton Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 47.184.113.62 Sent: 10/9/2024 2:45:07 PM Viewed: 10/10/2024 8:40:51 AM Signed: 10/10/2024 8:41:09 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Eric Woods ewoods@cottonelectric.com CESI Supervisor Security Level: Email, Account Authentication (None)Signature Adoption: Pre-selected Style Using IP Address: 98.142.76.20 Sent: 10/10/2024 8:41:11 AM Viewed: 10/10/2024 8:47:17 AM Signed: 10/10/2024 9:03:01 AM Electronic Record and Signature Disclosure: Accepted: 2/1/2023 8:22:12 AM ID: 2a8588f4-227d-4c1d-a8fc-65cc37a1ec73 Antonio Puente, Jr. antonio.puente@cityofdenton.com DME General Manager Denton Municipal Electric Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.10 Sent: 10/10/2024 9:03:03 AM Viewed: 10/10/2024 4:05:56 PM Signed: 10/10/2024 4:06:11 PM Electronic Record and Signature Disclosure: Accepted: 10/10/2024 4:05:56 PM ID: c388bcd1-d6a9-447a-9829-98bcbfcbea91 Signer Events Signature Timestamp Crystal Westbrook crystal.westbrook@cityofdenton.com Senior Buyer City of Denton Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.104 Sent: 10/10/2024 4:06:13 PM Viewed: 10/10/2024 4:25:58 PM Signed: 10/10/2024 4:26:03 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Cheyenne Defee cheyenne.defee@cityofdenton.com Procurement Administration Supervisor City of Denton Security Level: Email, Account Authentication (None) Sent: 10/10/2024 4:26:05 PM Viewed: 10/10/2024 5:31:03 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Jeff Brown jeff.brown@cityofdenton.com Security Level: Email, Account Authentication (None) Sent: 10/10/2024 4:26:07 PM Viewed: 10/10/2024 5:20:04 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 10/9/2024 2:43:51 PM Certified Delivered Security Checked 10/10/2024 4:25:58 PM Signing Complete Security Checked 10/10/2024 4:26:03 PM Completed Security Checked 10/10/2024 4:26:07 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, City of Denton (we, us or Company) may be required by law to provide to you certain written notices or disclosures. 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