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Contract - Preferred Technologies - 12/2/2021 CITY OF ROUND ROCK AGREEMENT FOR SURVEILLANCE, SECURITY,AND MONITORING PRODUCTS WITH PREFERRED TECHNOLOGIES,LLC THE STATE OF TEXAS § CITY OF ROUND ROCK § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § COUNTY OF TRAVIS § THAT THIS AGREEMENT for purchase of surveillance, security, and monitoring products and related services (referred to herein as the "Agreement"), is made and entered into on this the � jday of the month of D6c9rvtBEp_ , 2021 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 PREFERRED TECHNOLOGIES, LLC, whose address is 1414 Wedgewood Street, Houston, Texas 77093 (referred to herein as the "Vendor"). RECITALS: WHEREAS, City desires to purchase goods and services related to surveillance, security, and monitoring products; and WHEREAS, Chapter 271, Subchapter D of the Texas Local Government Code allows for a local government to participate in a state cooperative purchasing program for the purposes of procuring goods and services; and WHEREAS, the Texas Department of Information Resources ("DIR") is a state approved cooperative purchasing program wherein the state performs purchasing services on behalf of local governments; and WHEREAS,Vendor is an approved DIR vendor; and WHEREAS, the City is permitted to purchase from a DIR Contract and desires to purchase certain goods and services from Vendor's DIR Contract No. DIR-CPO-4742; and WHEREAS, the parties desire to enter into this Agreement to set forth in writing their respective rights, duties, and obligations; 1�-201 0048377 /ss2 1 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 follows: 1.01 DEFINITIONS A. Agreement means the binding legal contract between City and Vendor whereby City agrees to buy specified goods and services and Vendor is obligated to provide same. The Agreement includes Vendor's Proposal, attached as Exhibit "A," and incorporated herein by reference for all purposes. B. City means the City of Round Rock, Williamson 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 Majeure 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 States or the State of Texas or any civil or military authority, insurrections, riots, epidemics, landslides, lightning, earthquakes, fires, hurricanes, storms, floods, restraint of the government and the people, civil disturbances, explosions, or other causes not reasonably within the control of the party claiming such inability. E. Goods and services mean the specified services, supplies, materials, commodities, or equipment. F. Vendor means Preferred Technologies, LLC, its successor or assigns. 2.01 EFFECTIVE DATE AND TERM A. This Agreement shall be effective on the date this Agreement has been signed by each party hereto, and shall remain in full force and effect unless and until it expires by operation of the term indicated herein, or is terminated or extended as provided herein. B. The term of this Agreement shall be from the effective date hereof until February 18, 2026; and C. City reserves the right to review the relationship at any time, and may elect to terminate this Agreement with or without cause or may elect to continue. 00483775/ss2 2 3.01 CONTRACT DOCUMENTS AND EXHIBITS The goods and services which are the subject matter of this Agreement are described in Exhibit "A," together with this Agreement, comprise the total Agreement and is fully a part of this Agreement as if repeated herein in full. 4.01 SCOPE OF WORK Vendor shall satisfactorily provide all goods and services described under the attached Exhibit"A." Vendor's undertakings shall be limited to providing goods and performing services for City and/or advising City concerning those matters on which Vendor has been specifically engaged. Vendor shall perform its services in accordance with this Agreement, in accordance with the appended exhibits, in accordance with due care, and in accordance with prevailing industry standards for comparable services. 5.01 CONTRACT AMOUNT In consideration for the goods and services to be performed by Vendor, City agrees to pay the Vendor an amount not-to-exceed a total of One Million Five Hundred Thousand and No/100 Dollars ($1,500,000.00). 6.01 INVOICES All invoices shall include, at a minimum, the following information: A. Name and address of Vendor; B. Purchase Order Number; C. Description and quantity of items received or services provided; and D. Delivery or performance dates. 7.01 NON-APPROPRIATION AND FISCAL FUNDING This Agreement is a commitment of City'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 and services as determined by City's budget for the fiscal year in question. City may affect 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 7251, V.T.C.A., Texas' Government Code, pent to Vendor will be(made within thirty (30)days of the day on which City receives the performance, 00483775/ss2 3 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) days 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 at the "rate in effect" on September 1 of the fiscal year in which the payment becomes overdue, in accordance with V.T.C.A., Texas Government Code, Section 2251.025(b); however, this Policy does not apply to payments made 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 INSURANCE Vendor shall meet all insurance requirements set forth on the City's website at: https://www.roundrocktexas.goy/wp-content/uploads/2014/12/corr insurance 07.20112.pdf I 00483775/ss2 4 13.01 CITY'S REPRESENTATIVES City hereby designates the following representatives authorized to act in its behalf with regard to this Agreement: Eric Dady Building Construction Superintendent 212 Commerce Cove Round Rock, Texas 78664 512-218-5472 edady_(@roundrocktexas.gov 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 parry 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 make any payment in full when due; B. Fails to fully, timely and faithfully perform any of its material obligations under this Agreement; C. Fails to provide adequate assurance of performance under the "Right to Assurance" section herein; or D. 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 witho t cause, at any time upon thirty(30) days' written notice to Vendor. 00483775/ss2 5 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, if undisputed. The parties agree that Vendor is 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 officials harmless from and against all suits, actions, legal proceedings, claims, demands, damages, costs, expenses, attorney's 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, in the performance of Vendor's obligations under this Agreement, no matter how, or to whom, 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 2271, Texas Government Code, a governmental entity may not enter into a contract with a company for goods and services unless the contact contains written verification from the company that it: (1) does not boycott Israel; and(2)will not boycott Israel during the terms 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. C. In accordance with 2274, Texas Government Code, a governmental entity may not enter into a contract with a company with at least ten (10) full-time employees for a value of at east One Hundred Thousand and No/100 Dollars ($100,000.00) unless the contract has pr vision in the contract verifying that it: (1) d es not have a practic�, policy, guidance, or I 0 83775/ss2 6 directive that discriminates against a firearm entity or firearm trade association; and (2) will not discriminate during the term of the contract against a firearm entity or firearm trade association. The signatory executing this Agreement on behalf of Consultant verifies consultant does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association, and it will not discriminate during the term of this Agreement against a firearm entity or firearm trade association. D. In accordance with 2274, Texas Government Code, a governmental entity may not enter into a contract with a company with at least ten (10) full-time employees for a value of at least One Hundred Thousand and No/100 Dollars ($100,000.00) unless the contract has provision in the contract verifying that it: (1) does not boycott energy companies; and(2)will not boycott energy companies during the term of this Agreement. The signatory executing this Agreement on behalf of Consultant verifies consultant does not boycott energy companies, and it will not boycott energy companies 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 in 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 in writing and shall be considered given as follows: 1. When delivered personally to the recipient's address as stated in 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: Preferred Technologies, LLC 1414 Wedgewood Street Houston, TX 77093 Notice to City: Laurie Hadley, City Manager Stephan L. Sheets, City Attorney 221 East Main Street AND TO: 309 East Main Street Round Rock, TX 78664 Round Rock, TX 78664 i 004837�1 5/ss2 7 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 This document, and all appended documents, constitutes the entire Agreement between Vendor and City. This Agreement may only be amended or supplemented by mutual agreement of the parties hereto in writing, duly authorized 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 1-14)or any applicable state arbitration statute. 24.01 SEVERABILITY The invalidity, illegality, or unenforceability of any provision of this Agreement or the occurrence of any event rendering any portion or provision of this Agreement void shall in no way affect the validity or enforceability 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 is 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 timeframes will constitut a material breach of this Agreement. Vendor shall be fully responsible for its delays or for f�ilures to use best efforts in accordance with the terms of this 00483775/sg2 8 Agreement. Where damage is caused to City due to Vendor's failure to perform in these circumstances, City may pursue any remedy available without waiver of any of City'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 in 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.] I00483775/ss2 9 IN WITNESS WHEREOF, City and Vendor have executed this Agreement on the dates indicated. City of Round Rock, Texas Preferred Technologies,LLC By: By' Printed Name: Prince W5 ��Jj4 S-n l,c Title: Title: l?(Z6 5 i D E N i Date Signed: jZ Eil Date Signed: L o Z 1 zo z 1 Attest: B '/' City erk-M ( 4LVLF 6 J For Ci pproved as Form: L Steph L. Sheets, City Attorney 00483775/ss2 10 Exhibit "A" DIR-CPO-4742 Appendix C- Pricing Index Preferred Technologies, LLC R00 Off MSRP Altronix 44.S0% Antaira 5.00% Assa Abloy 43.00% Axis Communications 24.50% BCD Video 22.50% BTU Research 10.00% Corbin Russwin 16.S0% Digital Monitoring Products (DMP) 44.50% Future Fibre Technologies (FFT) 15.00% General Cable 38.00% Genetec 28.50% Genetec-Professional Services 10.00% Genetec-Streamvault 30.00% Hanwha Techwin 40.00% Holliday Process Solutions 15.00% Invixium 5.00% Jemez Technology 5.00% LifeSafety Power 30.00% Matica S.00% Medeco 15.00% National Monitoring Center(Netwatch) 2.50% Norton Door Controls 1S.00% NVT Phybridge 19.00% Paige Datacom Solutions 2.50% Panduit 35.00% PedestalCEO 3.00% Pivot3 20.00% Preferred Technologies, LLC 15.00% Salient 24.00% Sargent 15.50% Security Door Controls(SDC) 40.00% Siklu 16.50% SpotterRF 10.50% Strongpoles 5.00% Sunwize 15.00% Talkaphone 37.50% Transition Networks 32.50% TSi Power 5.00% Tycon 2.50% Veracity 20.00% VideoTec 10.00% Windy City Wire 31.50% Yale 16.50% Zenitel 20.00% 1 Exhibit "A" DIR-CPO-4742 Appendix C- Pricing Index Preferred Technologies, LLC SERVICES Part Number/Description Definition of Services DIR Discount% Off MSRP INSTALL PRODUCTS AND SYSTEMS FOR INSTALL SURVEILLANCE, SECURITY,AND MONITORING. 15.00% PRICING IS PER MAN HOUR. REVIEW, INSPECT,TEST,AND DOCUMENT THE PERFORMANCE OF AN ENTIRE SURVEILLANCE, SECURITY, OR DETECTION SYSTEM TO MAKE SURE THE SYSTEM MEETS ALL COMMISSION SPECIFICATIONS, INTENT OF THE DESIGN, 15.00% OPERATION AND FUNCTIONAL REQUIREMENTS, AND THE REQUIREMENTS OF THE END USER/OWNER. PRICING IS PER MAN HOUR. CONDUCT ROUTINE TESTING OF SYSTEMS AND ALL COMPONENT PARTS TO THE LEVEL TEST AND FREQUENCY STIPULATED BY THE 15.00% CUSTOMER. PRICING IS PER MAN HOUR. PERFORM ON-SITE TRAINING OF CUSTOMER EMPLOYEES OR DESIGNATED THIRD PARTY EMPLOYEES IN THE OPERATION AND/OR MAINTENANCE OF THE PRODUCT OFFERED, TRAIN INCLUDING PROVIDING OPERATION AND 15.00% MAINTENANCE MANUALS, FORMAL TRAINING CLASSES AND DEMONSTRATION OF OPERATION OF ALL EQUIPMENT AS SPECIFIED BY THE CUSTOMER. PRICING IS PER MAN HOUR. PERFORM ROUTINE CLEANING, MAINTENANCE,AND REPAIR (INCLUDING EMERGENCY REPAIR SERVICES)OF SYSTEMS MAINTAIN AND ALL COMPONENT PARTS TO THE LEVEL 15.00% AND FREQUENCY STIPULATED BY THE CUSTOMER. PRICING IS PER MAN HOUR. BUILD SHOP DRAWINGS, SUBMITTALS,AS- BUILT DOCUMENTS,OPERATIONS AND DOCUMENTATION MAINTENANCE MANUALS,AND OTHER 15.00% DOCUMENTATION REQUIRED BY THE CUSTOMER. PRICING IS PER MAN HOUR. DEVELOP DESIGNS AND ENGINEERED SOLUTIONS FOR SURVEILLANCE,SECURITY, DESIGN AND MONITORING SYSTEMS. PRICING IS PER 15,00% MAN HOUR. 2 Exhibit "A" DIR-CPO-4742 Appendix C - Pricing Index Preferred Technologies, LLC PROGRAM AND CONFIGURE SURVEILLANCE, SECURITY,AND MONITORING SYSTEM PROGRAMMING SOFTWARE, FIRMWARE, OPERATING 15.00% SYSTEMS, DATABASES, ETC.,AS REQUIRED BY THE CUSTOMER. PRICING IS PER MAN HOUR. DEVELOP SOFTWARE AND SOFTWARE SOFTWARE DEVELOPMENT INTEGRATIONS,AS REQUIRED BY THE 15.00% CUSTOMER. PRICING IS PER MAN HOUR. PROVIDE PROJECT MANAGEMENT SERVICES, TO INCLUDE BUT NOT LIMITED TO ATTENDING MEETINGS, COORDINATING WORK, BUILDING PROJECT MANAGEMENT AND MAINTAINING PROJECT SCHEDULES, 15.00% CONDUCTING SAFETY MEETINGS, FULFILLING CONTRACT COMPLIANCE REQUIREMENTS, AND DEVELOPING APPLICATIONS FOR PAYMENT. PRICING IS PER MAN HOUR. PROVIDE PERMIT DOCUMENTS AND INSPECTIONS PER THE REQUIREMENTS OF THE PERMITTING AUTHORITY HAVING JURISDICTION. PRICING 15.00% IS PER MAN HOUR. PERFORM SURVEYS AND AUDITS OF EXISTING SYSTEMS, TO INCLUDE DEVELOPING SURVEY 15.00% ASSOCIATED REPORTS. PRICING IS PER MAN HOUR. 3 Exhibit "A" DIR-CPO-4742 Appendix C - Pricing Index Preferred Technologies, LLC Volume • • x WAN-y �AbDTlOt-Z tf r Per Customer, Per Year,Additional Discount $1,000,000-$1,499,999.99 Applies to Orders Placed After Cumulative 1.00% Threshold is Met Per Customer, Per Year, Additional Discount $1,500,000-$1,999,999.99 Applies to Orders Placed After Cumulative 2.00% Threshold is Met Per Customer, Per Year,Additional Discount $2,000,000-$4,999,999.99 Applies to Orders Placed After Cumulative 3.00% Threshold is Met Per Customer, Per Year,Additional Discount $5,000,000+ Applies to Orders Placed After Cumulative 5.00% Threshold is Met PERTRAfACTION F,.REQUENCY Aooirfowai aDISCOUNT ; $500,000-$999,999.99 Per Transaction 1.00% $1,000,000-$1,499,999.99 Per Transaction 2.00% $1,500,000-$1,999,999.99 Per Transaction 3.00% $2,000,000+ Per Transaction 5.00% END i 4 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1,2,3,5,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. 2021-815851 Preferred Technologies, LLC 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 10/22/2021 being filed. City of Round Rock Date Acknowledged: 10128/2021 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-Surveillance,Security Surveillance,Security and Monitoring Products and Related Services 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Castillo,Charlie Montgomery,TX United States X Castillo, Shaun Conroe, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is and my date of birth is My address is (street) (city) (state) ( p cone) (country) i 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) Forms provided by Texas Ethics Commission w%w.ethics.state.tx.us Version V1.1.191b5cdc CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1,2,3,5,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. 2021-815851 Preferred Technologies, LLC 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 10/22/2021 being filed. City of Round Rock Date Acknowledged: 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-Surveillance, Security Surveillance, Security and Monitoring Products and Related Services 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Castillo,Charlie Montgomery,TX United States X Castillo, Shaun Conroe,TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is� V/V C �(�LV and my date of birth is My address is ! y7^�(A'�' (street) (city) (state) (zip code) (country) i I declare under penallt/y/of perjury that the foregoing is true and correct. 1 Executed in j�✓fit S County, State of K�S ,on the 22 day of �7 20 Z (month) (year) Signature of authorize ent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc