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2015-270ORDINANCE NO. 2O 1 S-2%O AN ORDINANCE APPROVING THE EXPENDITURE OF FUNDS FOR THE PURCHASE OF A VERDERFLEX PERISTALTIC HOSE PUMP SYSTEM TO BE USED FOR THE APPLICATION OF FERRIC CHLORIDE FOR THE PECAN CREEK WATER RECLAMATION PLANT PHOSPHOROUS REMOVAL PROJECT WHICH IS AVAILABLE FROM ONLY ONE SOURCE AND IN ACCORDANCE WITH TEXAS LOCAL GOVERNMENT CODE 252.022, SUCH PURCHASES ARE EXEMPT FROM REQUIREMENTS OF COMPETITIVE BIDS; PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (FILE 5908-AWARDED TO VERDER, INC. IN THE NOT-TO-EXCEED AMOLJNT OF $196,207). WHEREAS, Section 252.022 of the Local Government Code provides that procurement of items that are only available from one source, including; items that are only available from one source because of patents, copyrights, secret processes or natural monopolies; films, manuscripts or books; electricity, gas, water and other utility purchases; captive replacement parts or components for equipment; and library materials for a public library that are available only from the persons holding exclusive distribution rights to the materials; and need not be submitted to competitive bids; and WHEREAS, the City Council wishes to procure one or more of the items mentioned in the above paragraph; NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS: SECTION 1. The following purchase of materials, equipment or supplies, as described in the "File" listed hereon, and on file in the office of the Purchasing Agent, and the license terms attached are hereby approved: FILE NUMBER VENDOR AMOUNT 5908 Verder, Inc. $196,207 SECTION 2. The City Council hereby finds that this bid, and the award thereof, constitutes a procurement of items that are available from only one source, including, items that are only available from one source because of patents, copyrights, secret processes or natural monopolies; films, manuscripts or books; electricity, gas, water and other utility purchases; captive replacement parts or components for equipment; and library materials for a public library that are available only from the persons holding exclusive distribution rights to the materials; and need not be submitted to competitive bids. SECTION 3. The acceptance and approval of the above items shall not constitute a contract between the City and the person submitting the quotation for such items until such person shall comply with all requirements specified by the Purchasing Department. SECTION 4. The City Manager is hereby authorized to execute any contracts relating to the items specified in Section 1 and the expenditure of funds pursuant to said contracts is hereby authorized. SECTION 5, The City Council of the City of Denton, Texas hereby expressly delegates the authority to take any actions that may be required or permitted to be performed by the City of Denton under File 5908 to the City Manager of the City of Denton, Texas, or his designee. SECTION 6. This ordinance shall become effective immediately upon its passage and approval. PASSED AND APPROVED this the �.� �„m day of �,�� ,, � 2015 �� E �, � � __ �. .. . �...._ ° �-- .....� ..- ... �.'T-9I�[�'f�'� I ��"�a, MA "�:�R ATTEST: JENNIFER WALTERS, CITY SECRETARY � � . BY: � � APPROVED AS TO LEGAL FORM: ANITA BURGESS, CITY ATTORNEY � � BY: �^,,,��' �°',��w"� �� ,e.��,�r � , �w. .....m. .rnd"'"� '�, .' DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E , ,, "" �� iiiiiv � //// r iiiii i iii;�i // iiiiiii ' ` � c �ii/% //ii/ , , ��//� //// r iiir , ; "; i i� .,,,,,,,,. ' ,,,,,,,%/,,,,..,// „ ,,,,. ,,,,,i,,,,e�.,.. ,,,.,�%�� .�,.. Cit of Denton y C ontract # 5908 City of Denton Verderflex Peristaltic Hose Pump System DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E � . . � � * , � � �; R I � • ,; ' � �;. � :;: ' �: � ' 1 � � � R � �1'' . 1 ` 'f 1 1. 1 -� • �. �. � !' 1' r� •��I� i � :11 � r'�� i� 1�� '11 � � .. � ` k .�, � . � . ` �� I �'. � � � ! ` � � � , � � � � I ��.. � � �' . � .I � � �, . fl ` � � /' �I 1'' / . � 1 ',. . I � � /: I � ., .. � � '.� � / ',, / ` �. � . � �.� � �:. 1 .,,,. 1 � �:. / � �.,., � •�. , � ,,.. � I �: I � � �� `., .. � '.,. � . � � � M 1 .,., I � � ,,.'� � I � � ,� _ � :a I ..... I � I !i a a a., ' � I ., . . , I ��,'. � �,� . I � 1 � ^ / � I • ��,,. � �' � I I « I � �.. � � ',: , / . ' .: � � I � I. 1 � ~ � A � Ii � � ( � 1 ' '' � �' �. � 1.1 I � � ��. � ..., , a I .� , .� , � , � ,,. � � � �! / � 1 ' , ,/' I � � � � ' •'�. 1 « � � .. ." i � I� 1 I. +;� • ,, * � a � . � ! I � � 1 ' � �' 11 �i� ! � � ' �I ,,,. � � �� I � � ` 1 ,,,,. I � 1 � ! ��, �. , � �� ' / �' I � , R ,., � � � � � � , , � � � r '" � � � � � .' ;: N 1 I ' � 1 � �' � f � � I� � � � " 1 � 1 i r '�� 1 I 1'! � ! � 1 � �; � r :1 " ' i� ' . , . +^ ! ` � i 1� .. , �I .�" � �°1 1, 4 • ` . i 1'� . ! 1 + � � '! 1 ! ., � r f � � . 1 i � � i .. 1 � 1!; . . � . � � ; r �" - � .� � � � �� . .�. ., i� . . �� ..., . ��- � ' �i� . 1� ` . �,'�. _,� � . .1 �1�� . . . 11� ` � 1' „ ' '� i 1, ' �' � 1 ' � �! DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E �` � � . � f . 1 � � �4 1 . � . � 1 VERDER, Inc. Docu5igned by: : .__ ---- ...... � ��o�� m..��...r..m.��nm.�.� ........................�.. AUTHORIZED SIGNATURE 9/3/2015 . �t�'; Kerry Ayres a 0: Reigonal Sales Manager Title: 877 476 3569 PHONE...NUMBER�--...----. __-----_ ......................�.0 877 471 3569 ' DocuSigned by: CC�e.OVC'��e. CKLh,�9ei� "' _�889E.fl2SE(lE['i..4.8Q ................................w��.....ea.�...,..,..,.,..,.,....,.......... GEORGE C. CAMPBELL CI � � ate: 4, f; � ,,, � � � f ... DocuSigned by: ��,�.;.�. w� : -_..__.._ ��.�� -------------------- -- --. � f M i � � � .. _ � �:: � ',, � ■ ,i � ` f r , � � Docu5igned by: John Knight ° .____ .�&2�1.96f��2�F�B4��„�� ........................................................-------.... DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E � � � L 1 � ' �i� � 1; � 1 � � 1 1 � � 1, � � �� .#_ DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E 8/28/15 City of Denton, TX Reference: Verderflex RFQ— Pecan Creek WWTP ��%�r�ra� iiil iiiio �� Quotation # SQ00509.4 Verder, Inc. Kerry Ayres Expiration Date: 11/14/2015 Terms: TBD Application — Ferric Chloride, 30 psi discharge pressure with flooded suction and ambient pumping temperature. QTY. (7) - Pump Units — to deliver 3.5-100 gph @ 3-88 rpm Verderflex Peristaltic Hose Pump Unit equipped as follows: • Verderflex Model Dura 15 • Cast iron pump housing • Cast iron rotor (standard pressure up to 90 psi) • ANSI 150# 304SS flanges with %" ports • Polypropylene hose inserts • Pump to be mounted on powder coated carbon steel frame • Natural Rubber Hose • VFOCS Leak Detection • Gear reducer, sized for 88 rpm output, NEMA input • 1 hp Washdown-Inverter duty Motor TENV, 1750 rpm, 3/60/230-460VAC, • Includes two spare hoses per pump and one 55-gallon drum of hose lube QTY. (1) — Quadraplex Pumping Skid equipped as follows: QTY. (1) — Triplex Pumping Skid equipped as follows: • HDPE frame with spill containment, %" SCH 80 PVC piping, dedicated pressure relief, pressure gauge w/isolation diaphragm, pulsation dampener, and isolation valves. Common calibration column. EPDM/Hypalon seals and o-rings. Assembled and tested. Skids to be set up for six dedicated feed points, with pump 7 a swing pump that can feed any of the six feed points. Skids are set up to be placed side-by-side and piped together to create a 7-pump system. �J��e, ��. � 1 Q� C:��y I�UU�� G��oe ��a��u� � 1 � � �1 ��ro��n� ��77} �'�If:Rl��6� �8�3...�.�.37� 6�� 7� �7�-I�IL�� -::��9� VW WhJ'4� ��J� V"¢� � V"V� �� ,�Q� V�1 �'��i��!'wI�R«;��„�il�':��.�'�'�';��8^. ��.,��"�.��ql",�,;i��'� DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E QTY. (7) — VFDs, mounted on skid back panel • NEMA 4X enclosure, display for status and flow rate, 200-230VAC input - VACON Model # 4XC20030C, 2 hp heavy-duty, de-rated to 1 hp for 114°F temp rating - Local and remote control - Speed input and feedback, remote start/stop, run and fail status QTY. (1) — Control panel, based on specification section 11240 - NEMA 4X 31655 wall mount Enclosure approximately 36"x 36"x 12" - Gasketed door with 3-point latch system - One UPS battery back up - One Modicon M340 processor with the required I/O cards - One Panelview 15" HMI touchscreen - Additional Panelview 15" HMI touchscreen w/program (supplied as spare) - One surge arrestor for incoming feed - One Phase Monitor - One 120VAC surge protection with line filtering - One 24VDC power supply - One alarm horn and beacon . - Two Level display meters for tank levels - One pilot light and 2 position selector switch - Interposing Relays for all Field Outputs - One Illuminated E-Stop button mounted on door. Devices to be Heavy Duty 30mm. - Required internal terminal blocks, branch circuit protection, tags, mounting hardware, wireway, etc. - One copy of Unity Pro XL software - Up to 20 line surge protectors for outgoing discrete signals - Up to 20 surge protectors for analog incoming and outgoing signals - Up to 10 Ethernet surge suppressors for incoming and outgoing Ethernet lines - One 30A 230VAC main circuit breaker with through door discount handle Inland marine insurance policy to cover equipment package in transit to jobsite. Startup services: 3 days Verder personnel onsite for installation/startup supervision and/or operator training. Total Price, fixed: $196,207.00 DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E Estimated delivery is 12-14 weeks with order, notice to proceed, and upon approved credit. ��._._�� _ .� ...............��....................��... ��_..�� Notes/Exceptions: 1. Verder Terms and Conditions apply, (under review as of proposal ddte.J 2. Anchor bolts and any item not specifically mentioned on this quotation will be supplied by others. 3. Freight charges are induded. F.0.8. Desrination. 4. No top end programming of owners SCADA system is provided in this proposal. S. Expected 30A 230V 3PH with neutral and ground service to panel. 6. Any other major equipment, panels, instruments, or services unless specifically called-out above. 7. Installation of all equipment, instrumentation, and panels shall be by others. 8. All conduit and wire shall be provided and installed by others. 9. All field wiring shall be provided and terminated by others. 10. Not included: any fiber optic cable, patch panels, termination of fiber, or testing of fiber. DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E ♦ � � � � � - '�► . , �, � � � DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E CONTRACT #5909 REVISED TERMS AND CONDITIONS FOR PUMP SKID AND CONTROL PANEL OFFER TO CITY OF DENTON, TEXAS 1. Payment Terms — Unless expressly accepted in writing by an ofiicer or manager of Verder, Inc. (hereinafter referred to as the "Seller"), all payment terms are due Net 30 days and balances not paid within terms are subject to a monthly late chaxge of the lesser of 1.5% of the outstanding balance, or the maximum amount allowed under Texas Government Code 2251 (Prompt Payment Act). In addition, if so ordered by a Court of Competent Jurisdiction, the City of Denton (hereinafter referred to as the "Buyer") shall be liable for all costs of collecting past due balances, including any legal fees and court costs. All orders accepted are subject to credit investigation and approval by the Seller. If at any time Seller, in its sole judgment, shall feel insecure as to the Buyer's willingness or ability to make payment, Seller may require full or partial payment in advance of shipping goods or performing services. In such cases, Seller also reserves the right to decline to make deliveries or to stop goods in transit should they have already shipped. 2. Retention - Should retention be required as a part of the order, it must be approved by Seller in advance, which approval will not be unreasonably withheld, in writing, it shall not exceed 10% of the total order amount (excluding freight and taxes), and must be paid upon completion of Seller's duties under this contract or within 120 days of invoicing, whichever comes first. Any exceptions must be approved by Seller in writing. 3. Price and Shipping Terms - All prices are being quoted are F.O.B. Destination and are valid for a period not to exceed thirty days. Buyer shall be responsible for, and Seller shall collect, any applicable sales tax unless a valid sales tax exemption form is provided. Freight on this order shall be prepaid and allowed. Seller agrees to obtain insurance to protect the equipment in transit and Buyer agrees to reimburse Seller for such expense. Buyer agrees prices are also exclusive of expenses related to special packaging, storage or unique shipping circumstances, unless specifically noted. 4. Title and Risk of Loss — Title to products shall pass upon delivery and acceptance of such goods to the destination specified to Seller by the Buyer, assuming the goods conform to those ordered, and has not been damaged. Buyer agrees to inspect the goods upon delivery and promptly notify Seller of any problems discovered. If items have been damaged in shipment, Buyer agrees to note such damage on the freight carrier's bill of lading. Seller agrees to promptly replace any damaged or non-conforming goods. 5. Acceptance — All orders are subject to Seller's review with Buyer to be notified in writing of non- acceptance. Our sale to the Buyer is expressly conditioned upon the Buyer's acceptance of these terms and conditions, which together with our written Contract shall apply to govern the Buyer's order. No representation of any kind has been made by the Seller except as set forth herein. This agreement shall be binding on the successors and assigns of each of the parties and shall be governed by and construed in accordance with the laws of Texas, U.S.A. The parties agree to be bound by and subject to the jurisdiction of Texas Federal and State Courts which shall have exclusive jurisdiction over all matters relating to this Agreement. If any term or condition is found to be illegal or unenforc�able, the balance liereof shall remain in full force and effect. 6. Delivery — Deliverables shall be shipped F.O.B. Destination (Point of Delivery). The place of delivery shall be that set forth in the Purchase Order. Delivery dates are estimates only and cannot be guaranteed. Seller shall not be liable for any total or partial failure to deliver, or for any delay in delivery due to causes beyond its control, including but not limited to acts of God, acts of Buyer, war or terrorism or civil unrest, priorities, fires, strikes, natural disasters, delays in transportation, or inability to obtain necessary labor or materials. Seller shall not be liable in any event for any special, indirect or consequential damages on account of failure or delay in performance caused by actions of the Buyer. DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E 7. Termination of Contract - Should Buyer become aware of a material breach in the agreement by the Seller, Buyer shall provide written notice to the Seller with a thirty day period to cure. Should the breach not be cured within thirty days, or should Seller become insolvent or seek relief under the bankruptcy laws of the United States or make any material misrepresentation in Seller's Offer, or in any report or deliverable required to be submitted by the Seller to the Buyer, Buyer can terminate the agreement immediately with written notice to the Seller. Should the Buyer wish to terminate the agreement for convenience, written notice must be given to the Seller, and the Buyer will be responsible for all costs incurred to the date of termination, any restocking fees charged by the Seller's suppliers and a reasonable profit on the work completed. 8. Change Requests - All changes or additions to the original scope of work, including any resulting changes to pricing, shall be agreed to in writing by both parties prior to work being performed. Any changes requested by the Buyer which affect the products being provided or otherwise affect the scope of work to be performed, when accepted by the buyer, may result in changes in delivery schedules, pricing or other terms which might be affected by such a change. Any delay in receipt of necessary information (specifications, drawings, purchase orders, etc.) from the Buyer, may, at Seller's option, be treated as a change. 9. Delays and Storage — As Seller intends on shipping skids and control panels directly from manufacturers or fabricators, requests from Buyer to defer delivery could require additional freight costs to ship the equipment to Seller in order to store. As such, should Buyer desire such a deferral, Seller agrees to store such equipment for up to 180 days provided that: • Buyer shall notify Seller of request for deferral at least two weeks prior to equipment's scheduled delivery date. • Buyer shall pay for the equipment upon receipt of invoice from Seller. • Buyer shall pay for cost to ship equipment back to Seller for storage. • Buyer shall pay Seller a storage fee of $25/day for storage (to be invoiced once a month). 10. Limited Product Warranty — The equipment being provided by the Seller under this contract is warranted by our manufacturers to be made of iirst-class materials, and in a skillful and workmanlike manner. They are also warranted against defective materials or workmanship, and they will perform in accordance with the agreed specifications, assuming proper installation, utilization and care. The length of the warranty term shall be 18-months from date of shipment or 12-months from date of startup, whichever occurs first. In all cases, the rules and requirements of different manufacturers regarding their equipment shall apply. The Seller will repair or replace, at its expense, any products failing to conform to the above warranties. The Seller shall not, however, be responsible for removal and reinstallation costs. In addition, the Seller shall not be responsible for the actions of, or costs incurred by, any third parties, owners, or the Buyers in connection with any repairs or replacements of the equipment being provided unless authorized by the Seller in writing in advance. No returns will be accepted without prior written authorization from the Seller. NO OTHER WARRANTIES EXCEPT AS STATED HEREIN, THERE ARE NO OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. 11. Indemnification — At the option of the Buyer, Seller will indemnify, defend and hold the Buyer, owners, engineers, and their agents and employees, harmless from and against all loss, cost, damage or expense to the extent arising out of, caused by or resulting from the Seller or its agents' negligence or DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E fault. Conversely, the Seller will not be liable for damages to the extent they are caused by the Buyer, owners, engineers, or their agents or employees. Seller will also indemnify Buyers against any infringement or violation of any patent or patent right, or any intellectual property right claims, arising in connection with this agreement or from the use by the Buyers of any of the materials furnished to it by the Seller, provided such use is in accordance with Engineer's drawings and specification. The Seller shall indemnify and hold the Buyer harmless from and against all adverse title claims to the deliverables. The Seller warrants that it has good and indefeasible title to all deliverables furnished under the Contract, and that the deliverables are free and clear of all liens, claims, security interests and encumbrances. WAIVER OF CONSEOUENTIAL DAMAGES NEITHER PARTY HERETO, NOR ANY OF THEIR RESPECTIVE AFFILIATES, SHALL BE LIABLE FOR ANY INDIRECT, INCIDE NTAL, SPECIAL, CONSEQUENTIAL OR EX EMPLARY DAMAGES OR PENALTIES, INCLUDING, BUT NOT LIMITED TO, LOSS OF REVENUES AND PROFITS OR BENEFITS. The foregoing statements of indemnification comprise the Seller's complete agreement concerning indemnification and in no way expand upon the Seller's warranty obligations as outlined previously. 12. Reporting Material Claims Against Seller - If any claim, demand, suit, or other action is asserted against the Seller which arises under or concerns the Contract, or which could have a material adverse effect on the Seller's ability to perform thereunder, the Seller shall give written notice thereof to the Buyer within ten (10) calendar days after receipt of notice by the Seller. Such notice to the Buyer shall state the date of notification of any such claim, demand, suit, or other action; the names and addresses of the claimant(s); the basis thereof; and the name of each person against whom such claim is being asserted. Such notice shall be delivered personally or by mail and shall be sent to the Buyer and to the Denton City Manager. Personal delivery to the City Attorney shall be to City Hall, 215 East McKinney Street, Denton, Texas 76205. 13. Prohibition Against Personal Interest In Contracts - No officer, employee, independent consultant, or elected official of the Buyer who is involved in the development, evaluation, or decision-making process of the performance of any solicitation shall have a financial interest, direct or indirect, in the Contract resulting from that solicitation. Any willful violation of this section shall constitute impropriety in office, and any officer or employee guilty thereof shall be subject to disciplinary action up to and including dismissal. Any violation of this provision, with the knowledge, expressed or implied, of the Seller shall render the Contract voidable by the Buyer. The Seller shall complete and submit the City's Conflict of Interest Questionnaire. 14. Compliance With All State, Federal and Local Laws - Seller shall comply with all State, Federal, and Local laws and requirements. The Respondent must comply with all applicable laws at all times, including, without limitation, the following: (i) §36.02 of the Texas Penal Code, which prohibits bribery; (ii) §36.09 of the Texas Penal Code, which prohibits the offering or conferring of benefits to public servants. The Respondent shall give all notices and comply with all laws and regulations applicable to furnishing and performance of the Contract. 15. Recordkeeping — As this contract is to be a fixed price contract, the Seller agrees to maintain copies of invoicing, payment and technical records pertaining to the Contract for a period of five years. A copy of these records will be provided to Buyer within ten (10) business days of a written request. 16. Right to Audit — A. The City shall have the right to audit and make copies of the books, records and computations pertaining to the Contract. The Seller shall retain such books, records, documents and other evidence pertaining to 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 DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E completed and resolved. These books, records, documents and other evidence shall be available, within ten (10) business days of written request. Further, the Seller shall also require all Subcontractors, material suppliers, and other payees to retain all books, records, documents and other evidence pertaining to the Contract, 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 (5) business days of receipt of an invoice. B. Failure to comply with the provisions of this section shall be a material breach of the 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. 17. Insurance — During the performance of the Services under the Agreement, Seller shall maintain the following insurance with an insurance company licensed or authorized to do business in the State of Texas by the State Insurance Commission or any successor agency that has a rating with Best Rate Carriers of at least an A or above: 17.1 Comprehensive General Liability Insurance with bodily injury limits of not less than $1,000,000 for each occurrence and not less than $2,000,000 in the aggregate, and with property damage limits of not less than $100,000 for each occurrence and not less than $250,000 in the aggregate. 17.2 Automobile Liability Insurance with bodily injury limits of not less than $500,000 for each person and not less than $500,000 for each accident, and with property damage limits of not less than $100,000 for each accident. 17.3 Worker's Compensation Insurance in accordance with statutory requirements, and Employers' Liability Insurance with limits of not less than $100,000 for each accident including occupational disease. 17.4 The Seller shall furnish insurance certificates or insurance policies to the Buyer evidencing insurance in compliance with this Article 10 at the time of the execution of the Agreement. The General Liability and Automobile Liability insurance policies shall name the Buyer as an additional insured, the Workers' Compensation policy shall contain a waiver of subrogation in favor of the Buyer, and each policy shall contain a provision that such insurance shall not be canceled or modified without thirty (30) days' prior written notice to Buyer and Seller. In such event, the Seller shall, prior to the effective date of the change or cancellation, furnish Buyer with substitute certificates of insurance meeting the requirements of this Article 10. DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E �, � I 1 � ' ��i � � , � • � � , � �� 1 ' � 1 DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E � ._,.. �.. �..r � �"1"�"� � ti� i �:�� . . �.��' 4 � . . City of Denton Purchasing 901-B Texas SY. Denton, TX 76209 Phone: (940) 349-7100 Fax: (940) 349-7302 wvuw. dentonourchasin4. com Substitute W-9 Form The IRS requires all vendors to complete a W-9 Form. The information on this form must be fifled out, signed and submitted by a vendor representafive, All information must be completed before a purchase order or payment will be issued. Name as shown on your income tax return: V�� 7ax IDlSocial Security #: a� —!�-} � 3�� (p Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxfaxpayer identification number (or I am waifing for a number to be issued to me), and Z. I am not subject to backup withholding because (a) I am exempt from backup witholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a US citizen or other U.S. person-for fededral tax purposes as defined at the bottom of this page", � ,� Authorized Signature:_ �� Printed Name: �SS�,�� _.._._. __.�.._� Mailina Address: Company Name: ,'i��"�;91" ,,„� � �� Contact Name: Address; � I � ��.� .��w_!��,�,,�� _ r�!.��. ��. u e� �6��ck ��p'�aroaic b,��c E�rr f�dt�r�N t�aa rNa��uf'rcatic�r�w rrar��uir��8�.= Individual/ .................. � Sole � Corporation � Partnership Proprietor Must designate C or S � C Exempt � ��w�� s Business Type : Type of Organization: Real Estate � RentsllLease(A1) Services Only (A- ❑ �) ConsultantlProf Fees (A-7) �� Minority Owned Equipment ❑ RentallLease (A-9) Merchandise- ❑ Goods Only (A-7) Proceeds from Real Es�te [""m� Purchases �"S;j ❑ Femafe Owned Email: Website: Phone Number: —1 ��i `�-t ��- � 3 a7 Fax Number. ..... T��i � 2,�."`� � �.��:�.� Limited Other � Liability �-j' p�ease specify: Corporation � Royalties (A-2) �Merchandise 8 Services (A-7) ❑ Non Profit � MedicallHealth Care (A�} � Legal F1rmfAttomey (A-C) ❑ Historically tJnderutilized Business �Definition of a U.S. Person-For Federal Tax purposes, you are considered a U.S. person if you are: (a) an individual who is a U.S. citizen or U.S. resident (b) a partnership, corporation, company, or association created or organized in the United States or under the laws of the United States (c) an estate {other than a foreign estate), or (d) a domestic trust (as defined in Regulations Section 301.7701-7). COD Page 1 9/23/2011 DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E Venclor Information Not Reaaired for W-9 Form Remit Address (if differentfrom above) Company Name: Contact Name: Address: Email: I'hone Number: Fax Number: List Products andlor Services Interested in Biddin : For Internal Use Only ❑ New Vendor ❑ VendorChange ❑ Refund Requesting Department: Department Representative (Printed Name) Purchasing Signature: ACH Information-Voluntarv ABA Routing#: �w � � � � U 75 Contact Name : „_��_,��1� _. BankAccount# (�1 �D� Bank Name : '��° � . ��,.Nl � ACH Email : ACH Email : Phone Number: �� 6 � ' �"I �� '�J� � Fax Number: "{�� f�f�}� � i�i'� 3 I(we) authorfze the Clty of Denton to deposit payments into the checking account listed. 7he authority remalns fn effect until the Clty of Denton has recelved written notlffcation from me of termination in time to allow reasonable opportuniEy to act on it, or until the City of Denton has sent me written not(ce of terminatlon of the agreement. Vendor Signature �'�_�� '�' Prfnt NamelTitle ��J�Sr�� ✓ F' i�.�� uJ� � - � -� �� Date , � � __w � Vendor Number �� f�i�fi�l Date COD Page 2 9l23/2011 DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E � � �+ / 1 � ' ��i � ' � 1 ` � 1 DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E .,..,.... ��, VERDE-2 OP ID: JD _ ACOROp � DATE (MMIDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 08127/15 __-__�.www�.�. .�� ...�. _ �... THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s). � �a ncT PROOUCeR � Phone:781-749-4310 ��q�, „ _ 4+��lt�r° «1� �N� ib�r�. ,�g��p.,fr�r�. a�o�ara�� ______- . �qtt . .. 1�Y� "IJUhI�I��I�� k��t Fax: ��n ��, eM�l:. __ lac, No� ��I�� I" �� G�2�!��'��d�Y ��mrar�. � w�aat�n4�a� e_ e,. �lir� h'arn �C�r�i� �i�¢ar��.� �: ir�sa�r��r�s�s�. __ � _..e...... � �"{71fEF�2A.4wF ...... I NAIC # INSURED 'V�`1"CI�'V" II1C 110 Gateway Drive Macon, GA 31210 . ..�„ �, , ,,, . iNSUReRa:Hanover Insurance ...,,,,,, iNSUReRe:Zurich Group INSURER C : INSURER D : INSURER E : 22292 COVERAGES CERTIFICATE NUMBERt: 1��"V'f�I�PN PdUiN1R'BER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEQ BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _�. .�. . _.... .� IN ... � � _ Sk �iSiL 'U��t� pt7Ll �F� �i�R,�(.N ��(P� LIMITS �„Tq TYPE OF INSURANCE I PpLICY NUMBER MIDDIYYW,,,�, '�hNhN��.7C]PNNY'Y GENERAL LIABILITY �� EACH OCCURRENCE $ i�OOO�OO . C79�i�d�45f "�� hl'fiCCb ..... _, I B X��„r��r�rr��1. �E�veRa� us,�I��TY IGL01009222 10/01114 01/01116 �r�t=�rr,�r c; fE.�..n+c�tir��rbc�� 100,00 � �._�r,� $ 5�� .. CLAIMS-MADE X OCGUFi MED EXP (Any,one persan) m _, � . PERSONAL&ADVINJURY $ 'I,OOO,OOO '�GENERALAGGREGATE $ 2,000,000 ,,,,,,,,.. >,. ,.,......,.... _. _______— .................. ......... ........ ,,, ......... ........ .................. GENi'LAGGREGATELIMITAPF'LIESF'ER: PRODUCTS-COMP/OPAGG s inclwded „X II POLICY 1 J�Ld. �.......I LOC $ auTOnnosi�e uneiurr ��.��r`�rad-�• �.�� 1 000 00 ...... (E��... keu,orit�.iv'��,,,.e.,,_, ,,,,�„� � _„ , , ,.., , ,...,,,,,,,,, A ANYAUTO '�ABNA51776600 01/01115 07101/16 BODILYINJURY(Perperson) $ ALLOWNED SCHEDULED ��..,,,,,,,,,, � �, AUTOS AUTOS DILY INJURY (Peraccident) $ I X HIRED AUTOS X NON-OWNED PY��i1gd..A�r" [3�A�P�� AUTOS �P�, -i��idarrttP $ $ � UMBRELLA LIAB C OCCUR j � EACH OCCURRENCE $ _ EXCESS LIAB � CLAIMS-MADE AGGREGATE $ DED � R�JFf�T�(�IAIR S WORKERS COMPENSATION I X WC STATU- � ��1 H- � .. ........... T4)RY !.lNIlTS E6i ..... ......... AND EMPLOYERS LIABILITY � A ANYPROPRIETOR/PARTNERIEXECUTIVEY� N�A II HNA52167400 01/07/15 �� 01/01116 ELEACHACCIDENT $ 'I,OOOOO OFFICER/MEMBER EXCLUDED9 ��— �� (Mandatory In NH) E.L DISEASE - EA EMPLOYEE' $ �,�00,�� ' If yes, describe under i pESGRIPTION QF f�PERA7I.QNS kaelaw I E L.. DISEASE �- POLICY LIMIT $ �,OOO,OO ''�� . _____ i q Property Section TO BE ASSIGNED 08/27/75 08/27/16 Inland Ma 200,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is requlred) Additional insured, all coverages except Workers Compesation, City of Denton Texas and waiver of subrogation included on Workers Compensation as required by written contract with named insured. 30 day notice of cancellation, except 10 days for non-payment of premium, included in favor of additional insured subject to individual state requirements. CERTIFICATE HOLDER City of Denton Texas 901 B Texas Street Denton, TX 76209 ACORD 25 (2010/05) DENTON1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �tl ��`�.��d.R..�C... ut.LCy'�--'� O 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E �:► � � � � ` � � � � ' � � i, 1 1 ` ` DocuSign Envelope ID: 7F447DEB-3C38-4972-8B54-4000DFC1250E CONFLICT OF� INT ...REST Q.�� W. ��. W��" ......-__._ �.��.��.m.. E UESTIONNAII2E - FORM CIQ For vendor or other person doin� business with local overnmentalment� � a_....�. �� . . This questionnaire reflects changes made to the law by H.B.1491, 80th Leg., Regular Session. This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a person who has a business relationship as deiu�ed by Section 176.001(1-a) with a local governmental entity and the person meets requirements under Section 176.006(a). By law this questionnaire must be fled with the records administrator of the loca] government entity not later than the 7th business day after the date the person becomes aware of facts that require the statement to be fled. See Section 176.006, Local Government Code. A person commits an oi�'ense if the person knowingly violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. p .,._.�s relationshi with local �� - � f erson who has a busin�� 1 I P �;'+�v��aws��r�zu�entityw � Name o �,,,,.. ;. !". �.�, .�... .. �......... _I �., � - �.._,_.� � __..... .... �.........._ .. �.., a .. 2� � Check this box if you are tling an update to a previously filed questionnaire. (The law requires that you file an updated compleled questionnaire with the appropriate feling authoriry not later than the 7'" business day after the 3 Namc of local go ern�ment ofiicer wifh whom filer ha�s an��em��lo ment`or bus � � ' �" � .. ....__.�. p y iness relationship. Name of Officer This section, (item 3 including subparts A, B, C& D), must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), i.ocal Government Code. Atlach additional pages to this Form CIQ as necessary. A. Is the local govemment officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire? �� Yes � No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at lhe direction of the local government officer named in this section AND Ehe taxable income is nol received from the ]ocal governmental entity? �_......� Yes �� No C. Is the filer ofthis questionnaire employed by a corporaEion or otlier business enEity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? �".._._.� I 1 Yes � No D. Describe each affiliation or business relationship. 4� . ---_ .., �....... �. . .,.. ,.._.._..�...._...._..��..w,....�.._ ___. ._� ��.. ,...... .,._._ ' I have no Conflict of lnterest to disclose. � . � �._.��. _..— ,.. .. . � -. I �� __.. � , _..�. _ _ �_,,_. ,,,, .,,,. , _ �: .� .. , �..� �� - � m.,,,..__�_ . -_-�_ �'� ._.�..°� I � I 5��oa�ta:arr �i �,r;t�� doing �' :� �w�a17 the govenimental entiry Date -- _ ... .� .. _. ...._.., . • �.r. � .� .. .......�..A� .... ......... ........... �.�...� ... ..��.m��..�..._ � �__ .m„�. Certificate Of Completion Envelope Number:7F447DEB3C3849728B544000DFC1250E Subject: Please DocuSign: Contract Documents #5908 Source Envelope: Document Pages: 21 Signatures: 5 Certificate Pages: 6 Initials: 0 AutoNav: Enabled Envelopeld Stamping: Enabled Record Tracking Status: Original 9/3/2015 9:56:17 AM PT Signer Events Elton D. Brock elton. brock@cityofdenton.com Purchasing Manager City of Denton Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: Kerry Ayres Kerry.Ayres@verder-us.com Reigonal Sales Manager Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Accepted: 9/3/2015 10:25:04 AM PT ID:60d3957a-97d8-4bc0-a707-e525f15ab4c0 John Knight john.knight@cityofdenton.com Deputy City Attorney City of Denton Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: Julia Klinck julia. klinck@cityofdenton.com Contracts Administration Supervisor City of Denton Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: Holder: Elton Brock elton. brock@cityofdenton.com Signature Completed Using IP Address: 129.120.6.150 DocuSigned by: C�,86Ayo�,4. Using IP Address: 68.109.58.135 �DocuSigned by: Il John Knight `�—C821996C2A2B439... Using IP Address: 129.120.6.150 DocuSigned by: �w�.ia 1�etiwc% 528950829383478... Using IP Address: 129.120.6.150 �� s�c�a��a� Status: Completed Envelope Originator: Elton Brock elton.brock@cityofdenton.com IP Address: 129.120.6.150 Location: DocuSign Timestamp Sent: 9/3/2015 10:02:12 AM PT Viewed: 9/3/2015 10:02:22 AM PT Signed: 9/3/2015 10:03:25 AM PT Sent: 9/3/2015 10:03:26 AM PT Viewed: 9/3/2015 10:25:04 AM PT Signed: 9/3/2015 10:32:03 AM PT Sent: 9/3/2015 10:32:07 AM PT Viewed: 9/8/2015 10:23:45 AM PT Signed: 9/8/2015 10:24:06 AM PT Sent: 9/8/2015 10:24:09 AM PT Viewed: 9/8/2015 11:46:05 AM PT Signed: 9/16/2015 10:07:32 AM PT Signer Events George Campbell george.campbell@cityofdenton.com City Manager City of Denton Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: Jennifer Walters jennifer.walters@cityofdenton.com City Secretary City of Denton Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: In Person Signer Events Editor Delivery Events Agent Delivery Events Intermediary Delivery Events Certified Delivery Events Carbon Copy Events Signature �DocuSigned by: C�zovea,e CrLr..�.�Aa.11 4884E925FOE6480... Using IP Address: 129.120.6.150 �DocuSigned by: I Jcrrl�ca �Uk[;etii `--CSBFAFC1821946D... Using IP Address: 129.120.6.150 Signature Status Status Status Status Status Charleta Gilbreath �� I E [� charleta.gilbreath@cityofdenton.com Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: Julia Klinck julia. klinck@cityofdenton.com Contracts Administration Supervisor City of Denton Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: � � �. Robin Fox �� p�I E L� Robin.fox@cityofdenton.com Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: Timestamp Sent: 9/16/2015 10:07:37 AM PT Viewed: 9/16/2015 10:38:00 AM PT Signed: 9/16/2015 10:38:21 AM PT Sent: 9/16/2015 10:38:23 AM PT Viewed: 9/17/2015 7:16:17 AM PT Signed: 9/17/2015 7:16:30 AM PT Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp Sent: 9/3/2015 10:32:05 AM PT Viewed: 9/3/2015 11:10:26 AM PT Sent: 9/3/2015 10:32:05 AM PT Sent: 9/16/2015 10:07:35 AM PT Viewed: 9/16/2015 11:05:51 AM PT Jennifer Bridges �� I E� Sent: 9/17/2015 7:16:33 AM PT jen nifer. bridges@cityofdenton.com Security Level: Email, Account Authentication (Optional) Carbon Copy Events Status Timestamp Electronic Record and Signature Disclosure: Not Offered ID: PS Arora �� P. S.Arora@cityofdenton.com Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: Jane Richardson �� jane.richardson@cityofdenton.com Security Level: Email, Account Authentication (Optional) Electronic Record and Signature Disclosure: Not Offered ID: Notary Events Envelope Summary Events Envelope Sent Certified Delivered Signing Complete Completed Status Hashed/Encrypted Security Checked Security Checked Security Checked Electronic Record and Signature Disclosure Sent: 9/17/2015 7:16:35 AM PT Viewed: 9/17/2015 10:25:58 AM PT Sent: 9/17/2015 7:16:36 AM PT Viewed: 9/24/2015 9:03:43 AM PT Timestamp Timestamps 9/17/2015 7:16:36 AM PT 9/17/2015 7:16:36 AM PT 9/17/2015 7:16:36 AM PT 9/17/2015 7:16:36 AM PT Electronic Record and Signature Disclosure created on: 4/20/2015 2:25:38 PM Parties agreed to: Kerry Ayres 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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