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Contract - Progressive Commercial Aquatics - 10/8/2020CITY OF ROUND ROCK AGREEMENT FOR PURCHASE OF SWIMMING POOL CHEMICALS, SUPPLIES AND EQUIPMENT WITH PROGRESSIVE COMMERCIAL AQUATICS, INC. THE STATE OF TEXAS § CITY OF ROUND ROCK § COUNTY OF WILLIAMSON § COUNTY OF TRAVIS § KNOW ALL BY THESE PRESENTS: THAT THIS AGREEMENT for the purchase of swimming pool chemicals, supplies and equipment, and for related goods (referred to herein as the "Agreement"), is made and entered into on this the 'qt day of the month of , 2020 by and between the CITY OF ROUND ROCK, a Texas home -rule municipality, whose offices are located at 221 East Main Street, Round Rock, Texas 78664-5299 (referred to herein as the "City"), and PROGRESSIVE COMMERCIAL AQUATICS, INC., whose offices are located at 2510 Farrell Road, Houston, Texas 77073 (referred to herein as "Vendor"). RECITALS: WHEREAS, City desires to purchase certain goods, specifically swimming pool chemicals, supplies and equipment; and WHEREAS, City is a member of the Buy Board Cooperative Purchasing Program ("Buy Board") and Vendor is an approved Buy Board vendor through Buy Board Contract #613-20; and WHEREAS, City desires to purchase said goods from Vendor through Buy Board as set forth herein; and WHEREAS, the parties desire to enter into this Agreement to set forth in writing their respective rights, duties, and obligations; NOW, THEREFORE, WITNESSETH: That for and in consideration of the mutual promises contained herein and other good and valuable consideration, the sufficiency and receipt of which are hereby acknowledged, it is mutually agreed between the parties as follow: 00454701 /ss2 R-Zo2a - 02�6 This Page is too large to OCR 1.01 DEFINITIONS A. Agreement means the binding legal contract between City and Vendor whereby City agrees to buy specified goods and Vendor is obligated to provide said goods. B. City means the City of Round Rock, Will10 41 iamson and Travis Counties, Texas. C. Effective Date means the date upon which the binding signatures of both parties to this Agreement are affixed. D. Force Maj*eure means acts of God, strikes, lockouts, or other industrial disturbances, acts of the public enemy, orders of any kind from the government of the United 0 * States or the State of Texas or any civil or military authority,insu ecti'lons, riots, epidemics, landslides, lightning, earthquakes, fires, hurricanes, storms, floods, restraint of the government 10 10 and the people,, civil disturbances, explosions, or other causes not reasonably within the control of the party claiming such inability. E. Goods mean the specified supplies, materials, commodities, or equipment. F. Vendor means Progressive Commercial Aquatics, Inc., its successors or assigns. 2.01 EFFECTIVE DATE, TERM A. This Agreement shall be effective on the date this Agreement has been signed by each party hereto, and shall remain iinfull force and effect unless and untl it expires by operation of the term indicated herein, or is terminated or extended as provided herein. B. This Agreement shall terminate May 31, 2023. C. City reserves the right to review the relationship with Vendor at any time, and may elect to terminate this Agreement with or without cause or may elect to continue. 3.01 CONTRACT DOCUMENTS AND EXHIBITS The goods which are the subject matter of this Agreement are described i*n Exhibit "A" and, together with this Agreement, comprise the Contract Documents. Any inconsistencies or conflicts i*n the contract documents shall be resolved by giving preference to the terms and conditions set forth i*n pages one (1) through nine (9) of this Agreement 0 4.01 ITEMS A. The goods which are the subject matter of this Agreement are described generally in the attached Exhibit "A." B. This Agreement shall evidence the entire understanding and agreement between the parties and shall supersede any prior proposals, correspondence or discussions. 2 C. Vendor shall satisfactorily provide all deliverables described in Exhibit "A" within the contract term specified. A change in the Scope of Services or any term of this Agreement, must be negotiated and agreed to i*n all relevant details, and must be embodied in a valid Supplements-] Agreement as described herein. 5.01 COSTS A. City agrees to pay for supplies during the term of this Agreement at the pricing set forth at 1"n Exhibit "A." Vendor specifically acknowledged and agrees that City i*s not obligated to use or purchase any estimated annual quantity of goods. Only if, and when needed by City, the costs listed on Exhibit "A" shall be the basis of any charges collected by Vendor. B. The City shall be authorized to pay the Vendor an amount not -to -exceed Four Hundred Twenty Thousand and No/100 Dollars ($420,000.00) for the term of this Agreement. 6.01 INVOICES All invoices shall include, at a minimum, the following information: A. Name and address of Vendor; B. Purchase Order Number's C. Description and quantity of items received; and D. Delivery or performance dates. 7.01 NON -APPROPRIATION AND FISCAL FUNDING This Agreement is a commitment of Clety's current revenues only. It is understood and agreed that City shall have the right to terminate this Agreement at the end of any City fiscal year if the governing body of City does not appropriate funds sufficient to purchase the goods as determined by City's budget for the fiscal year in question,, City may effect such termination by giving Vendor a written notice of termination at the end of its then current fiscal year. 8.01 PROMPT PAYMENT POLICY In accordance with Chapter 2251, V.T.C.A., Texas Government Code, payment to Vendor will be made within thirty (30) days of the day on which City receives the performance, 10 supplies, materials, equipment, and/or deliverables, or within thirty (30) days of the day on which the performance of services was complete, or within thirty (30) daIIIs of the day on which City receives a correct invoice for the performance and/or deliverables or services, whichever is later. Vendor may charge interest on an overdue payment aet th"rate i*n effect" on September 1 of the fiscal year in which the payment becomes overdue, i*n accordance with V.T.C.A., Texas Government Code, Section 2251.025(b)lo5 however, this Policy does not apply to payments made 3 by City in the event: A. There is a bona fide dispute between City and Vendor, a contractor, subcontractor or supplier about the goods delivered or the service performed that cause the payment to be late; or B. The terms of a federal contract, grant, regulation, or statute prevent City from making a timely payment with federal funds; or C. There is a bona fide dispute between Vendor and a subcontractor or between a subcontractor and its supplier about the goods delivered or the service performed that causes the payment to be late; or D. Invoices are not mailed to City in strict accordance with instructions, if any, on the purchase order or the Agreement or other such contractual agreement. 9.01 GRATUITIES AND BRIBES City may, by written notice to Vendor, cancel this Agreement without liability to Vendor if it is determined by City that gratuities or bribes in the form of entertainment, gifts, or otherwise were offered or given by Vendor or its agents or representatives to any City officer, employee or elected representative with respect to the performance of this Agreement. In addition, Vendor may be subject to penalties stated in Title 8 of the Texas Penal Code. 10.01 TAXES City is exempt from Federal Excise and State Sales Tax; therefore, tax shall not be included in Vendor's charges. 11.01 ORDERS PLACED WITH ALTERNATE VENDORS If Vendor cannot provide the goods as specified, City reserves the right and option to obtain the products from another supplier or suppliers. 12.01 CITY'S REPRESENTATIVE City hereby designates the following representative authorized to act in its behalf with regard to this Agreement: Rick Atkins Parks and Recreation Director 301 West Bagdad Avenue, Suite 250 Round Rock, Texas 78664 (512) 341-3344 ratkinskroundrocktexas. gov 4 13.01 INSURANCE Vendor shall meet all City of Round Rock Insurance Requirements as set forth at: http://www.roundrocktexas. og v/wp-content/uploads/2014/ 12/corr insurance 07.20112.pdf. 14.01 RIGHT TO ASSURANCE Whenever either party to this Agreement, in good faith, has reason to question the other party's intent to perform hereunder, then demand may be made to the other party for written assurance of the intent to perform. In the event that no written assurance is given within the reasonable time specified when demand is made, then and in that event the demanding party may treat such failure as an anticipatory repudiation of this Agreement. 15.01 DEFAULT If Vendor abandons or defaults under this Agreement and is a cause of City purchasing the specified goods elsewhere, Vendor agrees that it may be charged the difference in cost, if any, and that it will not be considered in the re -advertisement of the service and that it may not be considered in future bids for the same type of work unless the scope of work is significantly changed. Vendor shall be declared in default of this Agreement if it does any of the following: A. Fails to fully, timely and faithfully perform any of its material obligations under this Agreement; B. Fails to provide adequate assurance of performance under the "Right to Assurance" section herein; or C. Becomes insolvent or seeks relief under the bankruptcy laws of the United States. 16.01 TERMINATION AND SUSPENSION A. City has the right to terminate this Agreement, in whole or in part, for convenience and without cause, at any time upon thirty (30) days' written notice to Vendor. B. In the event of any default by Vendor, City has the right to terminate this Agreement for cause, upon ten (10) days' written notice to Vendor. C. Vendor has the right to terminate this Agreement only for cause, that being in the event of a material and substantial breach by City, or by mutual agreement to terminate evidenced in writing by and between the parties. D. In the event City terminates under subsections (A) or (B) of this section, the following shall apply: Upon City's delivery of the referenced notice to Vendor, Vendor shall discontinue all services in connection with the performance of this Agreement and shall proceed to cancel promptly all existing orders and contracts insofar as such orders and contracts are chargeable to this Agreement. Within thirty (30) days after such notice of termination, Vendor shall submit a statement showing in detail the goods and/or services satisfactorily performed under this Agreement to the date of termination. City shall then pay Vendor that portion of the charges, I*f undisputed. The parties agree that Vendor i*s not entitled to compensation for services it would have performed under the remaining term of the Agreement except as provided herein. 17.01 INDEMNIFICATION Vendor shall defend (at the option of City), indemnify, and hold City, its successors, assigns, officers, employees and elected officialshannIess from and against all suits, actions, legal proceedings, claims, demands, damages, costs, expenses, attorneys fees, and any and all other costs or fees arising out of, or incident to, concerning or resulting from the fault of Vendor, or Vendor's agents, employees or subcontractors, i*n the performance of Vendor's obligations under this Agreement, no matter how, or to who such loss may occur. Nothing herein shall be deemed to limit the rights of City or Vendor (including, but not limited to the right to seek contribution) against any third party who may be liable for an indemnified claim. 18.01 COMPLIANCE WITH LAWS, CHARTER AND ORDINANCES A. Vendor, its agents,, employees and subcontractors shall use best efforts to comply with all applicable federal and state laws, the Charter and Ordinances of the City of Round Rock, as amended, and with all applicable rules and regulations promulgated by local, state and national boards, bureaus and agencies. B. In accordance with Chapter 2270, Texas Government Code, a governmental entity may not enter into a contract with a company for goods or services unless the contract contains written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel and will not boycott Israel during the term of this contract. The signatory executing this Agreement on behalf of Vendor verifies Vendor does not boycott Israel and will not boycott Israel during the term of this Agreement. 19.01 ASSIGNMENT AND DELEGATION The parties each hereby bind themselves, their successors, assigns and legal representatives to each other with respect to the terms of this Agreement. Neither party shall assign, sublet or transfer any interest i*n this Agreement without prior written authorization of the other party. 20.01 NOTICES All notices and other communications in connection with this Agreement shall be i*n writing and shall be considered given as follows: 6 I's When delivered personally to the recipient's address as stated i*n this Agreement; or 2. Three (3) days after being deposited in the United States mail, with postage prepaid to the recipient's address as stated in this Agreement. Notice to Vendor: Progressive Commercial Aquatics, Inc. 2510 Farrell Road Houston, TX 77073 Notice to City0 : City Manager 221 East Main Street Round Rock, TX 78664 Stephan L. Sheets, City Attorney AND TO: 309 East Main Street Round Rock, TX 78664 Nothing contained herein shall be construed to restrict the transmission of routine communications between representatives of City and Vendor. 21.01 APPLICABLE LAW; ENFORCEMENT AND VENUE This Agreement shall be enforceable in Round Rock, Texas, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for same shall lie in Williamson County, Texas. This Agreement shall be governed by and construed in accordance with the laws and court decisions of the State of Texas. 22.01 EXCLUSIVE AGREEMENT Theis document, and all appended documents, constitutes the entire Agreement between Vendor and City. This Agreement may only be amended or supple mented by mutual agreement of the parties hereto iinwriting, duly authorzed by action of the City Manager or City Council. 23.01 DISPUTE RESOLUTION City and Vendor hereby expressly agree that no claims or disputes between the parties arising out of or relating to this Agreement or a breach thereof shall be decided by any arbitration proceeding, including without limitation, any proceeding under the Federal Arbitration Act (9 USC Section I m14) or any applicable state arbitration statute. 24.01 SEVERABILITY The invalidity, illegality, or unenforceab1*11'*ty of any provision of this Agreement or the occurrence of any event rendering any portion or provision of this Agreement void shall i*n no way affect the validity or enforceabl*lity of any other portion or provision of this Agreement. Any void provision shall be deemed severed from this Agreement, and the balance of this Agreement shall be construed and enforced as if this Agreement did not contain the particular portion or provision held to be void. The parties further agree to amend this Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. The provisions of this section shall not prevent this entire Agreement from being void should a provision which i*s of the essence of this Agreement be determined void. 25.01 MISCELLANEOUS PROVISIONS Standard of Care. Vendor represents that it employs trained, experienced and competent persons to perform all of the services, responsibilities and duties specified herein and that such services, responsibilities and duties shall be performed in a manner according to generally accepted industry practices. Time is of the Essence. Vendor understands and agrees that time is of the essence and that any failure of Vendor to fulfill obligations for each portion of this Agreement within the agreed ti* efra es will constitute a material breach of this Agreement. Vendor shall be fully responsible for its delays or for failures to use best efforts in accordance with the terms of this Agreement. Where damage i*s caused to City due to Vendor's failure to perform i*n these circumstances, City may pursue any remedy available without waiver of any of Ci*ty's additional legal rights or remedies. Force Majeure. Neither City nor Vendor shall be deemed in violation of this Agreement if it is prevented from performing any of its obligations hereunder by reasons for which it is not responsible as defined herein. However, notice of such impediment or delay in performance must be timely given and all reasonable efforts undertaken to mitigate its effects. Multiple Counterparts. This Agreement may be executed i*n multiple counterparts, any one of which shall be considered an original of this document; and all of which, when taken together, shall constitute one and the same instrument. [Signatures on the following page.] IN WITNESS WHEREOF, City and Vendor have executed this Agreement on the dates indicated. City of Round Rock, X s By: _ Printed Name: 0PAA/M ((AA NJ Title: JVWLAIA2--- - '*j Date Signed: Attest: By: _aw Sara L. White, City Clerk For City, oved as to orm: By: St Step n L. Sheets, City Attorney Progressive Commercia matics, Inc. By: P r i le4da e:clssEf.G Title: of Date Signed: t t - I =_I is - ,1_.•'1. .. J7 .• -, - �{ �; Otis," fir rrfl!'. t - - r- -11•. ir - f ,•' .�� I - - 4 '- , r .4' y� .1. J•. I�'J. !11,` .r fit i>= or a• f; pot a" • ` � ) , ' �',f���;.�` •may{-'�7f •.� inw � � r I I Exhibit "A" City of Round Rock Texas Price Sheet Progressive CommevxW Aquatics, Inc OvyBoard Conuacl 613 20 The City of Round Rock would like to enter into a conlrad with Progressive Corrvnemal Aquatics, Inc per the temps of Buy Board Contrail 613.20, The City intends to ptarchase from clots conlract .Swimming Pool Chemicaits. Supplies and Equipeteni in an estimated anrrual not -to -exceed amount of $140,000. Contract Terns: fRecty from dale of execution and will expire on 5/3112023, per the terms of Ruy8wrd Contract No 613-20 Special Irxtrudionx Complete pricing below and submit copy of price M or catalog. Section 1: Eyaipnwat, Products aad Supprires hero 9 !Short rk-wripbon Ran oftav Sob State Percatt (!•) of INScount rd('arrk>gJPric:ILct State Nam* of ('alaklZiPrieerbet viceptioru to flksemunt Please state the discount (%) off Discount 1%) CM catakrg/pricttllst for Swimming Pool 10%tiff PCA AccvTab Blue PCA Add Rate Price I cmalog/Prketist ed for Chemicals. CatakoWPr*viht MUST be includ1Ct% off List PCA Chemical Price List Swimming Pool of proposal will not be 10%off I I Chemicals considered. _ Please state the disaount (%) off 10% on PCA Accu-Tab Feeder discount (%) OK catak>g/priceliss Swimming Pool 107C off PCA Acid Rite Ftede{ Parts 10% Catalog/Pricetist for Che"kal feed Systems- Catalog/fIncefist MUST 25% efl PCA Chemical Feed Pumps ►arts 15% 2 Swimming Pool Chemical Feed Systems be included or proposal will not be considered. '-M off SOBS, CTerntrol Price list Please state the discount 1%) off S% off ECo•Fkw•Z P►ku+g Sdrrdule car{og/price(Ist Swimming Pool 5% on Aquionics UV Spare List Prking "count (%) ON Mechanical Equipment (Pumps, Motors, Filters, 20% Off Lochinvar Pool t3 Spa Heaters Catafog/Pikefnt far and related items), S%off Aqulonlac UV System Price List SWIMMiAa Pool Catalr7fMkdta MOST be tnduded or 1"tep" 15% off watemo RcYteneratwe Media Filter 3 Meclnankal Equipment vnil not be eon51dared.__-- Please state tine discount 1%) off Discount t%) Off catalwfirice*1 for Swimming Pool Catalog/Pricelist for Water Testing Pr oducm Caadog/Pricelist MUST 20% off Parts SCBS, Cheirttrol Price Ust LS% on Swimming Pvol water be induded a 4 1est ria Products Proposal will not be conslydefed, Please state the discount 1%) off Discount N Off cxtahrg/p(fcteilst for SwimmMg Pool CatalogMricelist for Automatic Ck-anlnR Equipment (Vamu ms, and 20%off PCA Automatic Vacuurn Pike tls,% Swimming Pool related items), 70%off PCA Manual Vacuum Price Ilse Automatic Cteaning catalog/Prlcelki MUST be awAs©ed W plotsosal S Equili►tent will not 11e cortsidetaecl. Please state the discount (%) off D scaunt (%) Off catafag/pricellst for 5wlmming Pool Catabg/Pricelist for Swimming Pool Underwater Lights and ElectriCal A:oe!ssortes. Caralo8/P1`M+st 207E on PCA Lighting Price LM 6 Underwater L16hisand l lectrkal Accessories MUST be Mopped or rwaposal will not be wrssidered Dis4ouni (%) Off Please state the discount (%) off Catntog/Prkelis2for car-4e /priceiistforSwimmitgPool 4%off Neptune fifAsonGrantingRetail Swimming P041 Male Main Drains. Fta(ngi, and Skimmers. 7% off Paddy It Padd"% Price List Drains, Fittings, and Catakig/Pricefist MU57 be 7 Skimmers btclu_d_ed or proposal will not be considered. Please state the at count (%) off PCA Prater Pricing Discount (%) Off c.xalog/prkelist for Swimming Pool 5%off PCs spray Catalop/Prlcetistfor Coalctgsand Compoun(,. CatalOg/f ri b%off Gtindfng Pricing Prici g 8 Swimming Pool Coatings and Compuunds MUST be included % proposal will not be considered. 6% off PCA Slide Rent;Sllii6ede Care Please state the discount (X) Ott Discount (X) Off catalog/pricetist for Swimming Pool Aqu Spectrum .ttscs CatAOg/Prkr4K1 for Comers and Storage Reels CatelogjPrkt4jA W% tttd Covversers A, Pasts Swimmin¢ Pool Covets MUST be Included or 9 and Storage Reels proposal will not be considered. Discount 1%1 Off Pk-Ase state Me discount I%) Orr catAkq/pf k*4ist for Swimming Pool Catalog/Priceiiu for Furniture and Supplies. Cata)og/Pricelist MUST 12%oft specoum Produces 2020 Swimming Poo; Furrniture be i►idudedof OfSOOS41 10 and S ^; wfU not toe wnsidesed f3lsc0tint (%) Off Please state the discount (%) oft Produce 202U Catalog/Pric0ist for catabg/prirrl;dt for SwlmmMg Pool 12%Ofl 2020►tat tes 2020 Swimming Pool Ladders, Rails, Slicim, and Div" tadders, Rails, Slides, and Diviesg Boards. Catalog/Pricelist MUST S%oft (dineTI Pricing Schedule icing Schedule 11 Boards be mcluded or proPos-10 wilt not be considered. Please stafethe discount IX) aff catadog/priwlikA for Starimmirtg We Discount (X) Off lackM. Cataba/DfkeWr MUST be inducted or C oakig/PriceWt for proposal will not be 12 Swimming Life Jackets constdiired. Miscount (%) Off Pkvse State cite discount (%) off catalog/P1kv t for Swimming Pool a% off ET`a - parts P►lcirrg Catafog/PrkMkt for Repair Potts. CaialoK/Pricertst MUST be inchrded 5%otf E7S - SP Parts Pricing 13 Swimming Pool Repair Parts of propm4t will not be considered. 5X Please state the discount (%) off NlnjaCross Systems D6COunt (%) Off CatabalPricelist for All cXa)og/prKefist for All Other Related Swimming Pool ProdtiM. ot1 opt S% A Nome Pro Nori KNA Au►actJons other Related Swimming Catalog/Prkelist MUST be 14 Poor Products Indudad or grn..nrar will not be considered. Hourly Labor Rate for Instauation/R"t of Not to Exceed Hourly Swimming Pool Labor Rate for Water Treatment Chemicals, Supplies, and Iftubatioa/Repair at Equipment - State 5110_/ How 5vrimMing Poot Water the Not to Exceed hourly labor rate for Treatment Chemicals, Instillation/Repair Service of 1S Suppll", and iCuiprnent EOulprocwt and Products. Hourly Labof Rate for instaYationJR,Vaa of Not to Earned Ilourov Swimming Pool Labor hate for trxtaltaiion/Rer►air of Co rungs and Compounds State the Nat to Exceed hourly labor I JGJ WOU7 161 Swimming Pool Coatings and Compounds fate for Installation/Repair Service of I [quis ment and Products. taformabott Cain: The City of Round Rock tc-.cr ees the right to order other produeft from the mach" lYlSitJ• Sheet per city drteatals 4to "VeGard Contract 19613.20 ii '0 � r eol � c e CL)WANY NAAT- r ,r " 've- --�—•�1 S)GNATUftE OF AUTrigitlZtN REPRESENTATIVE PRINTEDNAME: _ PHONE NLMABER ...� ..:.. .::. _„- EMNL ADDRESS: g1`712� el- y9 5�8` I� 5 Myle--5fr����<.�� �v� ,�,�. CERTIFICATE OF INTERESTED PARTIES FORM 295 10fi Complete Nos. l - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos, 1, 21 3, 5, and 6 if there are no interested parties,, CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place Certificate Number: of business. 202Om669260 Progressive Commercial Aquatics HOUSTON, TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 09/18/2020 being filed. City of Round Rock Date Acknowledged: g Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 000000 the purchase of swimming pool chemicals, supplies and equipment. Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary 5 Check only if there is NO- Interested Party. X 6 UNSWORN DECLARATION My name is Russell Leto ,and my date of birth is My address is 2510 Farrell Rd Houston TX 77073 USA (street) (city) (state) (zip code) (country) declare under penalty of perjury that the foregoing is true and correct. Executed in Harris County, State of TX , on the 18dayof Sep , 20.m�. (month) (year) Sign tu**re of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.Uc.us version V1,1,;sabaaTta CERTIFICATE OF INTERESTED PARTIES FORM 1295 10fl Complete Nos. i - 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos, 1, 21 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2020-669260 Progressive Commercial Aquatics HOUSTON, TX United States Date Filed: 09/18/2020 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Round Rock Date Acknowledged: 09/21/2020 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 000000 the purchase of swimming pool chemicals, supplies and equipment. Nature of interest 4 Name of Interested PartyCity,State, Country of business) a licable applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. FX1 6 UNSWORN DECLARATION My name is , and my date of birth is My address is - is �--- (street) (city) (state) (zip code) (country) declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of , on the day of , 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) ft In a 1W..M I&M, law& Forms provided by Texas Ethics Commission www, eth i-cs state tx. us version vl.l.saoaarra