Tropical Snow Agreement-4959-Renewal Pricing (2)V-.
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CONTRACT BY AND BETWEEN
CITY OF DENTON, TEXAS AND
FILE NO. 4959 SNOW CONE VENDOR FOR AQUATIC CENTER
5/6/2016
THIS CONTRACT is made and entered into this day of A.D., 2016,
by and between Q's Tropical Sno a corporation, whose address is PO Box 2132, Lake Dallas,
TX 75065, hereinafter referred to as "Contractor," and the CITY OF DENTON, TEXAS, a
home rule municipal corporation, hereinafter referred to as "City," to be effective upon approval
of the Denton City Council and subsequent execution of this Contract by the Denton City
Manager or his duly authorized designee.
For and in consideration of the covenants and agreements contained herein, and for the
mutual benefits to be obtained hereby, the parties agree as follows:
I.
SCOPE OF SERVICES
Contractor shall provide all labor, supervision, materials and equipment necessary for
Snow Cone Vendor for the Aquatics Park. These products and services shall be provided in
accordance with the Contractor's proposal in response thereto, a copy of which is attached hereto
and incorporated herein for all purposes as Exhibit "A". The Contract consists of this written
agreement and the following items which are attached hereto and incorporated herein by
reference:
(a) Contractor's Proposal. (Exhibit "A");
(b) Insurance Requirements. (Exhibit "B");
(c) Form CIQ —Conflict of Interest Questionnaire (Exhibit "C").
These documents make up the Contract documents and what is called for by one shall be
as binding as if called for by all. In the event of an inconsistency or conflict in any of the
provisions of the Contract documents, the inconsistency or conflict shall be resolved by giving
precedence first to the written agreement then to the contract documents in the order in which
they are listed above. These documents shall be referred to collectively as "Contract
Documents."
IL
TIME OF COMPLETION
Contractor agrees and covenants that all work hereunder shall be complete by September
169 2016 - (131) days following notice to proceed from City.
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Coil
III.
TERM OF CONTRACT
The initial term of this Contract shall be one year from date of contract execution unless
otherwise stated. The TERM OF CONTRACT will be from May 9, 2016 through September 16,
2016. CONTRACTOR must be onsite and open during posted operational hours for Water
Works Park. CONTRACTOR will abide by the following rules:
• CONTRACTOR will be punctual with regards to opening and closing the snow cone
stand during designated hours listed above.
• CONTRACTOR will display COD Health Permit in snow cone stand.
• CONTRACTOR will keep area clean and clear of trash within 15 feet of the snow cone
stand.
• CONTRACTOR must empty trash in snow cone stand and dispose of it by placing it in
Water Works Park (WWP) dumpster at the end of each day.
• CONTRACTOR and employees of CONTRACTOR will provide quality customer
service to patrons of WWP.
• CONTRACTOR must close the snow cone stand anytime WWP is closed during
inclement weather. CONTRACTOR must reopen the stand if WWP reopens on the same
day after inclement weather has passed. CONTRACTOR may request permission from
the Manager on Duty (MOD) to close the stand for the remainder of the day due to
abnormal weather conditions.
Failure to open and provide service on a scheduled business day will result in the following:
• First Day — Failure to show constitutes a material breach of contract. CONTRACTOR
will owe The City $100. Amount must be paid to The City the next business day.
• Second day — Failure to show constitutes a material breach of contract. CONTRACTOR
will owe The City $150. Amount must be paid to The City the next business day.
• Third Day - — Failure to show constitutes a material breach of contract. CONTRACTOR
will owe The City $200. Amount must be paid to The City the next business day. The
City reserves the right, at our sole discretion, to terminate the contract.
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IV.
WARRANTY
Contractor warrants and covenants to City that all goods and services provided by
Contractor, Contractor's subcontractors, and agents under the Agreement shall be free of defects
and produced and performed in a skillful and workmanlike manner and shall comply with the
specifications for said goods and services as set forth in this Agreement and the Contractor's
proposal attached hereto and incorporated herein as Exhibit "A". Contractor warrants that the
goods and services provided to City under this Agreement shall be free from defects in material
and workmanship, for a period of one (1) year commencing on the date that City issues final
written acceptance of the project.
V.
PAYMENT
Payments hereunder shall be made to Contractor following city's acceptance of the work
and within thirty (30) days of receiving Contractor's invoice for the products and services
delivered. Total compensation under this contract shall not exceed the sum of N/A.
Contractor recognizes that this Contract shall commence upon the effective date herein
and continue in full force and effect until termination in accordance with its provisions.
Contractor and City herein recognize that the continuation of any contract after,the_close of any
given fiscal year of the City of Denton, which fiscal year ends on September 30th of each year,
shall be subject to Denton City Council approval. In the event that the Denton City Council does
not approve the appropriation of funds for this contract, the Contract shall terminate at the end of
the fiscal year for which funds were appropriated and the parties shall have no further obligations
hereunder.
VI.
PROTECTION AGAINST ACCIDENT TO EMPLOYEES AND THE PUBLIC
Contractor shall at all times exercise reasonable precautions for the safety of employees
and others on or near the work and shall comply with all applicable provisions of Federal, State,
and Municipal safety laws. The safety precautions actually taken and the adequacy thereof shall
be the sole responsibility of the Contractor. Contractor shall indemnify City for any and all losses
arising out of or related to a breach of this duty by Contractor pursuant to paragraph
VIL
INDEMNIFICATION and paragraph IX. COMPLIANCE, WITH APPLICABLE LAWS set
forth herein.
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VII.
LOSSES FROM NATURAL CAUSES
Unless otherwise specified, all loss or damage to Contractor arising out of the nature of
the work to be done, or from the action of the elements, or from any unforeseen circumstances in
the prosecution of the same, or from unusual obstructions or difficulties which may be
encountered in the prosecution of the work, shall be sustained and borne by the Contractor at its
own cost and expense.
VIII.
INDEMNIFICATION
Contractor shall release, defend, indemnify and hold the City, its elected officials, officers
and employees harmless from and against all claims, damages, injuries (including death),
property damages (including loss of use), losses, demands, suits, judgments and costs, including
attorney's fees and expenses, in any way arising out of, related to, or resulting from the services
provided by Contractor under this Agreement or caused by the negligent act or omission or the
intentional act or omission of Contractor, its officers, agents, employees, subcontractors,
licensees, invitees or any other third parties for whom Contractor is legally responsible
(hereinafter "Claims"). Contractor is expressly required to defend City against all such Claims.
In the event the City is a named party to a suit arising out of the subject matter of this
Contract, the City shall have reasonable input into the selection of defense counsel to be retained
by Contractor in fulfilling its obligation hereunder to defend and indemnify City. City reserves
the right to provide a portion or all of its own defense; however, City is under no obligation to do
so. Any such action by City is not to be construed as a waiver of Contractor's obligation to
defend City or as a waiver of Contractor's obligation to indemnify City. pursuant to this Contract.
Contractor shall retain defense counsel within seven (7) business days of City's written notice
that City is invoking its right to indemnification under this Contract. If Contractor fails to retain
counsel within such time period, City shall have the right to retain defense counsel on its own
behalf, and Contractor shall be liable for all costs incurred by City.
IX.
COMPLIANCE WITH APPLICABLE LAWS
Contractor shall at all times observe and comply with all Federal, State and local laws,
ordinances and regulations including all amendments and revisions thereto, which in any manner
affect Contractor or the work, and shall indemnify and save harmless City against any claim
related to or arising from the violation of any such laws, ordinances and regulations
whether by Contractor, its employees, officers, agents, subcontractors, or representatives.
If Contractor observes that the work is at variance therewith, Contractor shall promptly notify
City in writing.
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X.
VENUE
The laws of the State of Texas shall govern the interpretation, validity, performance and
enforcement of this Contract. The parties agree that this Contract is performable in Denton
County, Texas, and that exclusive venue shall lie in Denton County, Texas.
XL
ASSIGNMENT AND SUBLETTING
Contractor agrees to retain control and to give full attention to the fulfillment of this
Contract, that this Contract shall not be assigned or sublet without the prior written consent of
City, and that no part or feature of the work will be sublet to anyone objectionable to City.
Contractor further agrees that the subletting of any portion or feature of the work, or materials
required in the performance of this Contract, shall not relieve Contractor from its full obligations
to City as provided by this Contract.
XII.
INDEPENDENT CONTRACTOR
Contractor covenants and agrees that Contractor is an independent contractor and not an
officer, agent, servant or employee of City; that Contractor shall have exclusive control of and
exclusive right to control the details of the work performed hereunder and all persons performing
same, and shall be responsible for the acts and omissions of its officers, agents; employees,
contractors, subcontractors and consultants; that the doctrine of respondent superior shall not
apply as between City and Contractor, its officers, agents, employees, contractors, subcontractors
and consultants, and nothing herein shall be construed as creating a partnership or joint enterprise
between City and Contractor.
XIII.
INSURANCE AND CERTIFICATES OF INSURANCE
Contractor shall procure and maintain for the duration of the contract insurance coverage
as set forth in the Insurance Requirements marked Exhibit "C" attached hereto and incorporated
herein by reference. Contractor shall provide a signed insurance certificate verifying that they
have obtained the required insurance coverage prior to the effective date of this Contract.
XIV. l
HINDRANCES AND DELAYS
No claims shall be made by Contractor for damages resulting from hindrances or delays
from any cause during the progress of any portion of the work embraced in this Contract.
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XV.
AFFIDAVIT OF NO PROHIBITED INTEREST
Contractor acknowledges and represents it is aware of all applicable laws, City Charter,
and City Code of Conduct regarding prohibited interests and that the existence of a prohibited
interest at any time will render the Contract voidable. Contractor has executed the Affidavit of
No Prohibited Interest, attached and incorporated herein as Exhibit "C".
XVI.
SEVERABILITY
The provisions of this Contract are severable. If any paragraph, section, subdivision,
sentence, clause, or phrase of this Contract is for any reason held to be contrary to the law or
contrary to any rule or regulation having the force and effect of the law, such decisions shall not
affect the remaining portions of the Contract. However, upon the occurrence of such event,
either party may terminate this Contract by giving the other party thirty (30) days written notice.
XVIL
TERMINATION
City may, at its option, with or without cause, and without penalty -or prejudice to any
other remedy it may be entitled to at law, or in equity or otherwise under this Contract, terminate
further work under this contract, in whole or in part by giving at least thirty (30) days prior
written notice thereof to Contractor with the understanding that all services being terminated
shall cease upon the date such notice is received.
XVIII.
ENTIRE AGREEMENT
This Contract and its attachments embody the entire agreement between the parties and
may only be modified in writing if executed by both parties.
XIX.
CONTRACT INTERPRETATION
Although this Contract is drafted by City, should any part be in dispute, the parties agree
that the Contract shall not be construed more favorably for either party.
XX.
SUCCESSORS AND ASSIGNS
This Contract shall be binding upon the parties hereto, their successors, heirs, personal
representatives and assigns.
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XXI.
HEADINGS
The headings of this Contract are for the convenience of reference only and shall not
affect in any manner any of the terms and conditions hereof.
XXII.
RIGHT TO AUDIT
The CITY shall have the right to audit and make copies of the books, records and computations
pertaining to this agreement. The CONTRACTOR shall retain such books, records, documents
and other evidence pertaining to this agreement during the contract period and five years
thereafter, except if an audit is in progress or audit findings are yet unresolved, in which case
records shall be kept until all audit tasks are completed and resolved. These books, records,
documents and other evidence shall be available, within 10 business days of written request.
Further, the CONTRACTOR shall also require all Subcontractors, material suppliers, and other
payees to retain all books, records, documents and other evidence pertaining to this agreement,
and to allow the CITY similar access to those documents. All books and records will be made
available within a 50 mile radius of the City of Denton. The cost of the audit will be borne by
the CITY unless the audit reveals an overpayment of 1% or greater. If an overpayment of 1% or
greater occurs, the reasonable cost of the audit, including any travel costs, must be borne by the
CONTRACTOR which must be payable within five business days of receipt of an invoice.
Failure to comply with the provisions of this section shall be a material breach of this contract
and shall constitute, in the CITY'S sole discretion, grounds for termination thereof. Each of the
terms "books" "records" "documents" and "other evidence" as used above shall be construed to
include drafts and electronic files, even if such drafts or electronic files are subsequently used to
generate or prepare a final printed document.
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IN WITNESS WHEREOF, .the parties of these presents have executed this agreement in
the year and day first above written.
CONTRACTOR
DocuSigned by:
BY:
O ER (I 6NATURE)
5/5/2016
Date:
Q's tropical sno
Name:
Title: Owner
1523 Nightingale Lane, Corinth, Tx 76210
MAILING ADDRESS
972-816-1116
PHONE NUMBER
940-498-0652
FAX NUMBER
LaQuita R. Harmon
PRINTED NAME
CITY OF DE Q2j6 j&XAS
V)"4
BY.
PURCHASING AGENT
5/6/2016
DATE:
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EXHIBIT B
CITY OF DENTON
INSURANCE REQUIREMENTS FOR CONTRACTORS
Bidder's attention is directed to the insurance requirements below. It is highly recommended
that bidders confer with their respective insurance carriers or brokers to determine in advance
of Bid submission the availability of insurance certificates and endorsements as prescribed
and provided herein. If an apparent low bidder fails to comply strictly with the insurance
requirements, that bidder may be disqualifled from award of the contract. Upon bid award, all
insurance requirements shall become contractual obligations, which the successful bidder
shall have a duty to maintain throughout the course of this contract.
STANDARD PROVISIONS:
Without limiting any of the other obligations or liabilities of the Contractor, the Contractor shall
provide and maintain until the contracted work has been completed and accepted by the City of
Denton, Owner, the minimum insurance coverage as indicated hereinafter.
As soon as practicable after notification of bid award, Contractor shall file with the Purchasing
Department satisfactory certificates of insurance, containing the bid number and title of the
project. Contractor. may, upon written request to the Purchasing Department, ask for
clarification of any insurance requirements at any time; however, Contractors are strongly
advised to make such requests prior to bid opening, since the insurance requirements may not be
modified or waived after bid opening unless a written exception has been submitted with the bid.
Contractor shall not commence any work or deliver any material until he or she receives
notification that the contract has been accepted, approved, and signed by the City of Denton.
All insurance policies proposed or obtained in satisfaction of these requirements shall comply
with the following general specifications, and shall be maintained in compliance with these
general specifications throughout the duration of the Contract, or longer, if so noted.•
• Each policy .shall be issued by a company authorized to do business in the State of
Texas with an A.M. Best Company rating of at least A- VII or better.
• Any deductibles or self-insured retentions shall be declared in the bid proposal. If
requested by the City, the insurer shall reduce or eliminate such deductibles or
self-insured retentions with respect to the City, its officials, agents, employees and
volunteers; or, the contractor shall procure a bond guaranteeing payment of losses and
related investigations, claim administration and defense expenses.
• Liability policies shall be endorsed to provide the following:
• Name as additional insured the City of Denton, its Officials, Agents,
Employees and volunteers.
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• That such insurance is primary to any other insurance available to the
additional insured with respect to claims covered under the policy and that this
insurance applies separately to each insured against whom claim is made or suit
is brought. The inclusion of more than one insured shall not operate to increase
the insurer's limit of liability.
• Cancellation. The City requires 30 day written notice should any of the
policies described on the certificate be cancelled or materially changed
before the expiration date.
• Should any of the required insurance be provided under a claims -made form,
Contractor shall maintain such coverage continuously throughout the term of
this contract and, without lapse, for a period of three years beyond the contract
expiration, such that occurrences arising during the contract term which give
rise to claims made after expiration of the contract shall be covered.
• Should any of the required insurance be provided under a form of coverage that
includes a general annual aggregate limit providing for claims investigation or
legal defense costs to be included in the general annual aggregate limit, the
Contractor shall either double the occurrence limits or obtain Owners and
Contractors Protective Liability Insurance.
• Should any required insurance lapse during the contract term, requests for
payments originating after such lapse shall not be processed until the City
receives satisfactory evidence of reinstated coverage as required by this contract,
effective as of the lapse date. If insurance is not reinstated, City may, at its sole
option, terminate this agreement effective on the date of the lapse.
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EXHIBIT B
SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS:
All insurance policies proposed or obtained in satisfaction of this Contract shall additionally
comply with the following marked specifications, and shall be maintained in compliance with
these additional specifications throughout the duration of the Contract, or longer, if so noted.•
[X] A. General Liability Insurance:
General Liability insurance with combined single limits of not less than $500,000.00
shall be provided and maintained by the Contractor. The policy shall be written on
an occurrence basis either in a single policy or in a combination of underlying and
umbrella or excess policies.
If the Commercial General Liability form (ISO Form CG 0001 current edition) is used:
• Coverage A shall include premises, operations, products, and completed
operations, independent contractors, contractual liability covering this
contract and broad form property damage coverage.
• Coverage B shall include personal injury.
• Coverage C, medical payments, is not required.
If the Comprehensive General Liability form (ISO Form GL 0002 Current Edition and ISO
Form GL 0404) is used, it shall include at least;
• Bodily injury and Property Damage Liability for premises, operations,
products and completed operations, independent contractors and property
damage resulting from explosion, collapse or underground (XCU) exposures.
• Broad form contractual liability (preferably by endorsement) covering this
contract, personal injury liability and broad form property damage liability.
[XI Automobile Liability Insurance:
Contractor shall provide Commercial Automobile Liability insurance with Combined
Single Limits (CSL) of not less than $250,000:00 either in a single policy or in a
combination of basic and umbrella or excess policies. The policy will include bodily
injury and property damage liability arising out of the operation, maintenance and, use of
all automobiles and mobile equipment used in conjunction with this contract.
Satisfaction of the above requirement shall be in the form of a policy endorsement for:
• any auto, or
• all owned, hired and non-owned autos.
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[X] Workers' Compensation Insurance
Contractor shall purchase and maintain Worker's Compensation insurance which, in
addition to meeting the minimum statutory requirements for issuance of such insurance,
has Employer's Liability limits of at least $100,000 for each accident, $100,000 per each
employee, and a $500,000 policy limit for occupational disease. The City need not be
named as an "Additional Insured" but the insurer shall agree to waive all rights of
subrogation against the City, its officials, agents, employees and volunteers for any work
performed for the City by the Named Insured. For building or construction projects, the
Contractor shall comply with the provisions of Attachment 1 in accordance with
§406.096 of the Texas Labor Code and rule 28TAC 110.110 of the Texas Worker's
Compensation Commission (TWCC).
[ ] Owner's and Contractor's Protective Liability Insurance
The Contractor shall obtain, pay for and maintain at all times during the prosecution of
the work under this contract, an Owner's and Contractor's Protective Liability insurance
policy naming the City as insured for property damage and bodily injury which may arise
in the prosecution of the work or Contractor's operations under this contract. Coverage
shall be on an "occurrence" basis, and the policy shall be issued by the same insurance
company that carries the Contractor's liability insurance. Policy limits will be at least
combined bodily injury and property damage per occurrence with a aggregate.
[ ] Professional Liability Insurance
Professional liability insurance with limits not less than per claim with
respect to negligent acts, errors or omissions in connection with professional services is
required under this Agreement.
[ ] Builders' Risk Insurance
Builders' Risk Insurance, on an All -Risk form for 100% of the completed value shall be
provided. Such policy shall include as "Named Insured" the City of Denton and all
subcontractors as their interests may appear.
{ ] Commercial Crime
Provides coverage for the theft or disappearance of cash or checks, robbery inside/outside
the premises, burglary of the premises, and employee fidelity. The employee fidelity
portion of this coverage should be written on a "blanket" basis to cover all employees,
including new hires. This type insurance should be required if the contractor has access
to City funds. Limits of not less than each occurrence are required.
[ ] Additional Insurance
Other insurance may be required on an individual basis for extra hazardous contracts and
specific service agreements. If such additional insurance is required for a specific
contract, that requirement will be described in the "Specific Conditions" of the contract
specifications.
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EXHIBIT B
ATTACHMENT 1
[X] Workers' Compensation Coverage for Building or Construction Projects for
Governmental Entities
A. Definitions:
Certificate of coverage ("certificate ")-A copy of a certificate of insurance, a
certificate of authority to self -insure issued by the commission, or a coverage
agreement (TWCC-81, TWCC-82, TWCC-83, or TWCC-84), showing statutory
workers' compensation insurance coverage for the person's or entity's employees
providing services on a project, for the duration of the project.
Duration of the project - includes the time from the beginning of the work on the
project until the contractor's/person's work on the project has been completed and
accepted by the governmental entity.
Persons providing services on the project ("subcontractor" in §406.096) includes all
persons or entities performing all or part of the services the contractor has undertaken
to perform on the project, regardless of whether that person contracted -directly with
the contractor and regardless of whether that person has employees. This includes,
without limitation, independent contractors, subcontractors, leasing companies,
motor carriers, owner -operators, employees of any such entity, or employees of any
entity which furnishes persons to provide services on the project. "Services" include,
without limitation, providing, hauling, or delivering equipment or materials, or
providing labor, transportation, or other service related to a project. "Services" does
not include activities unrelated to the project, such as food/beverage vendors, office
supply deliveries, and delivery of portable toilets.
B. The contractor shall provide coverage, based on proper reporting of classification
codes and payroll amounts and filing of any overage agreements, which meets the
statutory requirements of Texas Labor Code, Section 401:011(44) for all employees
of the Contractor providing services on the project, for the duration of the project.
C. The Contractor must provide a certificate of coverage to the governmental entity prior to
being awarded the contract.
D. If the coverage period shown on the contractor's current certificate of coverage ends
during the duration of the project, the contractor must, prior to the end of the coverage
period, file a new certificate of coverage with the governmental entity showing that
coverage has been extended.
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E. The contractor shall obtain from each person providing services on a project, and
provide to the governmental entity:
1) a certificate of coverage, prior to that person beginning work on the project, so the
governmental entity will have on file certificates of coverage showing coverage
for all persons providing services on the project; and
2) no later than seven days after receipt by the contractor, a new certificate of
coverage showing extension of coverage, if the coverage period shown on the
current certificate of coverage ends during the duration of the project.
F. The contractor shall retain all required certificates of coverage for the duration of the
project and for one year thereafter.
G. The contractor shall notify the governmental entity in writing, by certified mail or
personal delivery, within 10 days after the contractor knew or should have known, of
any change that materially affects the provision of coverage of any person providing
services on the project.
H. The contractor shall post on each project site a notice, in the text, form and manner
prescribed by the Texas Workers' Compensation Commission, informing all persons
providing services on the project that they are required to be covered, and stating how
a person may verify coverage and report lack of coverage.
I. The contractor shall contractually require each person with whom it contracts to provide
services on a project, to:
1) provide coverage, based on proper reporting of classification codes and payroll
amounts and filing of any coverage agreements, which meets the statutory
requirements of Texas Labor Code, Section 401.011(44) for all of its employees
providing services on the project, for the duration of the project;
2) provide to the contractor, prior to that person beginning work on the project, a
certificate of coverage showing that coverage is being provided for all employees
of the person providing services on the project, for the duration of the project;
3) provide the contractor, prior to the end of the coverage period, a new certificate of
coverage showing extension of coverage, if the coverage period shown on the
current certificate of coverage ends during the duration of the project;
4) obtain from each other person with whom it contracts, and provide to the
contractor:
a) certificate of coverage, prior to the other person beginning work on the
project; and
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EXHIBIT B
b) a new certificate of coverage showing extension of coverage, prior to the end
of the coverage period, if the coverage period shown on the current
certificate of coverage ends during the duration of the project;
5) retain all required certificates of coverage on file for the duration of the project
and for one year thereafter;
6) notify the governmental entity in writing by certified mail or personal delivery,
within 10 days after the person knew or .should have known, of any change that
materially affects the provision of coverage of any person providing services on
the project; and
7) contractually require each person with whom it contracts, to perform as required
by paragraphs (1) (7), with the certificates of coverage to be provided to the
person for whom they are providing services.
J. By signing this contract or providing or causing to be provided a certificate of
coverage, the contractor is representing to the governmental entity that all employees
of the contractor who will provide services on the project will be covered by workers'
compensation coverage for the duration of the project, that the coverage will be based
on proper reporting of classification codes and payroll amounts, and that all coverage
agreements will be filed with the appropriate insurance carrier or, in the case of a self-
insured, with the commission's Division of Self-Insurance Regulation. Providing
false or misleading information may subject the contractor to administrative penalties,
criminal penalties, civil penalties, or other civil actions.
K. The contractor's failure to comply with any of these provisions is a breach of contract
by the contractor which entitles the governmental entity to declare the contract void if
the contractor does not remedy the breach within ten days after receipt of notice of
breach from the governmental entity.
S:\Materials Management\PRCH\BIDs, RFPs & Contracts\4000-4999\4959 SNOW CONE VENDOR\4959 CONTRACT Agreement
Services- Tropical Sno 2016.doc - 2013
DocuSign Envelope ID: 5DE3EF40-873E-4BAE-9B85-7196C534BF77
C
Exhibit
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. Q ' s tropical sno
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 1 Name of local government officer about whom the information in this section is being disclosed.
Denton waterworks
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?
F-1 0
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 0 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?
F—x]
Yes No
D. Describe each employment or business and family relationship with the local government officer named in this section.
N/A
4
X I have no Conflict of Interest to disclose.
5 Docusigned by:
5/5/2016
M55ld& doing business with the governmental entity Date
P I
A t"
Envelope Id: 5DE3EF40873E4BAE9B857196C534BF77 Status: Completed
Subject: File 4959 -Contract Agree with Tropical Snow
Source Envelope:
Document Pages: 16 Signatures: 3 Envelope Originator:
Certificate Pages: 5 Initials: 0 Jody Word
AutoNav: Enabled jody.word@cityofdenton.com
Envelopeld Stamping: Enabled IP Address: 129.120.6.150
Time Zone: (UTC -08:00) Pacific Time (US & Canada)
Status: Original Holder: Jody Word Location: DocuSign
4/29/2016 3:26:27 PM jody.word@cityofdenton.com
LaQuita R. Harmon DocuStigned by: Sent: 4/29/2016 3:38:51 PM
qs_tropicaisno@hotmaii.com r, 00*6v" Resent: 5/4/2016 6:02:29 AM
I OB480
Owner Resent: 5/5/2016 10:58:36 AM
Q's tropical sno Using IP Address: 97.94.193.79 Viewed: 5/3/2016 5:28:00 PM
Security Level: Email, Account Authentication Signed: 5/5/2016 2:15:33 PM
(Optional)
Electronic Record and Signature Disclosure:
Accepted: 5/3/2016 5:28:00 PM
ID: 8358030a-36al-4cfc-8a82-05659blblb49
Jody Word DocuSigned by: Sent: 4/29/2016 3:38:03 PM
jody.word@cityofdenton.com 0" Viewed: 5/4/2016 6:00:30 AM
Buyer 1� A17BB493 Signed: 5/6/2016 12:04:16 PM
City of Denton Using IP Address: 129.120.6.150
Security Level: Email, Account Authentication
(Optional)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
SERUM
g
'a
Cathy Avery Sent: 5/6/2016 12:04:19 PM
c6thy.avery@cityofdenton.com IAC V` EPIEU
Security Level: Email, Account Authentication
(Optional)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
Julia Wnkley
julia.winkley@cityofdenton.com
Contracts Administration Supervisor
City of Denton
Security Level: Email, Account Authentication
(Optional)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
COPIED I Sent: 5/6/2016 12:04:20 PM
Envelope Sent Hashed/Encrypted 5/6/2016 12:04:20 PM
Certified Delivered Security Checked 5/6/2016 12:04:20 PM
Signing Complete Security Checked 5/6/2016 12:04:20 PM
Completed Security Checked 5/6/2016 12:04:20 PM
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Electronic Record and Signature Disclosure created on: 4/20/2015 2:25:38 PM
Parties agreed to: LaQuita R. Harmon
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