B05526 CARBON SLURRY MIXER AND PARTS FOR WATER PLANT II FINAL.pdf

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Attached to
Carbon Slurry Mixer and Parts for Water Plant II
Solicitation number
B055-26
Issued by
Cameron County, Texas

About this file

Summary

This is an Invitation to Bid document issued by the Brownsville Public Utilities Board (BPUB) for the procurement of a Carbon Slurry Mixer and Parts for Water Plant II. The BPUB seeks a Lightnin Model 86Q40 mixer gearbox and motor assembly, or a manufacturer-approved equivalent replacement, along with associated components including a complete gearbox, mounting gear if applicable, wiring, connectors, accessories, and warranty coverage. The bid package specifies a double reduction gear drive compatible with existing mixer applications, requiring a 326T frame motor rated at 40/18 HP, operating at 1800/1200 RPM, with 460V, 60 Hz, three-phase power. Sealed or electronic bids are due by 5:00 PM CST on August 19, 2026, with public opening and reading scheduled for 10:00 AM on August 20, 2026. A non-mandatory walkthrough is scheduled for August 12, 2026 at 9:00 AM at Water Plant II located at 1495 Robinhood Drive, Brownsville, Texas. The final timeline includes bid evaluation from August 20-26, 2026, final recommendations on August 27, 2026, and presentation to the Utilities Board for approval on September 14, 2026. The deadline for asking questions is August 10, 2026.

Bidders must provide complete pricing information including unit costs for the carbon slurry mixer, gearbox, mounting gear, wiring and accessories, warranty, and freight, with all fields required for bid tabulation. Pricing shall remain firm until material delivery, and the BPUB will not accept tax in bids as it holds federal, state, and local tax exemption. The BPUB reserves the right to reject any or all bids, award to the lowest responsible bidder, increase or decrease quantities, and extend the bid period up to 90 days. Successful vendors must agree to receive payment via Automated Clearing House (ACH) direct deposit and must submit W9 or W8 tax forms with their bid response. All bidders must submit required certifications including debarment certification, ethics statement, conflict of interest questionnaire, Form 1295 (Certificate of Interested Parties), residence certification, and state law verifications regarding Iran/Sudan sanctions, Israel boycott prohibition, firearm non-discrimination, and energy company boycott compliance. The equipment will be delivered to Water Plant II at 1495 Robinhood Drive, Brownsville, Texas 78521 via purchase order issued after BPUB Board of Directors approval.

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LEGAL NOTICE

AND

INVITATION TO BID

#B055-26

The Brownsville Public Utilities Board will accept sealed or electronic bids for a Carbon Slurry Mixer and Parts for Water Plant II, until 5:00 PM, August 19, 2026, in the Brownsville PUB Purchasing Office, 1155 FM 511, Olmito, Texas. Bids received after this time will not be considered.

Bids will be publicly opened and read aloud on August 20, 2026 at 10:00 AM. Bidders can request a copy of the bid tabulation by emailing nespinoza@brownsville-pub.com.

Brownsville Public Utilities Board utilizes the Texas Purchasing Group to post Request for Proposal (RFP) and bid opportunities, https://www.bidnetdirect.com/texas/brownsville-pub.

Please mark on the outside of the envelope and on any carrier’s envelope: "B055-26

SEALED BID FOR A CARBON SLURRY MIXER AND PARTS FOR WATER PLANT II,

AUGUST 20, 2026, 5:00 PM", and send to the attention of Diane Solitaire, Purchasing Department, 1155 FM 511, Olmito, Texas 78575.

The Brownsville Public Utilities Board will not be responsible in the event that the U.S. Postal Service or any other courier system fails to deliver the sealed bids to the Brownsville Public Utilities Board, Purchasing Office by the given deadline above. Electronic bids will only be accepted via Bidnet.

The Brownsville PUB reserves the right to reject any or all bids and to waive irregularities contained therein and to accept any bid deemed most advantageous to the Brownsville PUB.

BY:

Diane Solitaire Purchasing Brownsville Public Utilities Board

(956) 983-6366 mailto:nespinoza@brownsville-pub.com https://www.bidnetdirect.com/texas/brownsville-pub

B055-26 Carbon Slurry Mixer & Parts for Water Plant II

Please submit this page upon receipt.

ACKNOWLEDGEMENT FORM

B055-26 CARBON SLURRY MIXER AND PARTS FOR WATER PLANT II

For any clarifications, please contact Nicole Espinoza at the Brownsville Public Utilities Board, Purchasing Department at (956) 983-6353 or via e-mail: nespinoza@brownsville-pub.com

Please e-mail this page upon receipt of legal notice.

Check one:

( ) Yes, I will be able to send a bid; obtained bid package from website.

( ) Yes, I will be able to send a bid; please email the bid package.

Email:

( ) No, I will not be able to send a bid for the following reason:

If you are unable to send your bid, kindly indicate your reason for “No bid” above and return this form via e-mail: nespinoza@brownsville-pub.com. This will ensure you remain active on our vendor list.

Date

Company:

Name:

Address:

City: State: Zip Code:

Phone: Fax:

IF SPECIFICATIONS ARE DOWNLOADED FROM WEBSITE, PLEASE E-MAIL THIS PAGE TO EMAIL LISTED ABOVE

Special Instructions

• Interpretation

Questions concerning terms, conditions, and technical specifications should be directed to:

Nicole Espinoza, Purchasing Department

(956) 983-6353

• Tentative Time Line

1. August 3, 2026 to August 19, 2026 - Vendors work on bid.

2. August 19, 2026 at 5:00 PM CST - Vendor must submit one (1) set of bid document sealed in an envelope to:

Diane Solitaire, Purchasing

1155 FM 511

Olmito, TX 78575

BID #B055-26 – CARBON SLURRY MIXER AND PARTS FOR WATER PLANT II

Bid Due: August 19, 2026 at 5:00 PM

The above noted information must be included on bid envelope and on any carrier’s envelope/package. The Brownsville Public Utilities Board will not be held responsible for missing, lost, late mail or late electronic submissions. Brownsville Public Utilities Board will accept electronic transmission of sealed bids via Bidnet, only.

1. August 10, 2026 - Last day for questions

2. August 12, 2026 – Non-Mandatory Walkthrough at 9:00AM

Location: Water Plant II, 1495 Robindhood Dr., Brownsville, TX Meeting Place: BPUB SCADA Gate

3. August 20, 2026 – Open bids at 10:00 AM

4. August 20-26, 2026 - Evaluate bids

5. August 27, 2026 – Provide Final Recommendations

6. September 14, 2026 - Send to Utilities Board for approval

• Or Equal

Brand name or manufacturer’s reference used in this request is descriptive – not restrictive – it is intended to indicate type and quality desired. Brands of like nature and quality will be considered. If bidding on other than referenced specifications please provide complete descriptive information of said article. BPUB also reserves the legal right to specify a “sole source” component if such component is critical for integration to a larger assembly and alternative manufactured items will not meet the design and/or performance needs of the BPUB, in BPUB’s sole discretion.

• Pricing

Bid unit price on quantity specified, extend and show total. In case of errors in extension, unit prices shall govern. Price shall remain firm until delivery of material.

All fields (UNIT PRICE, DELIVERY AND MANUFACTURER) in the Cost Sheets must be completed. The data must be complete to identify the bidding brand.

Failure to submit any of the above information with the sealed bid will disqualify bid.

• Vendor Representative

The successful vendor agrees to send a personal representative with binding authority for the company to the Brownsville Public Utilities Board upon request to make adjustments and/or assist with coordination of all transactions as needed.

• Quality of Products

All items must be new, in first class condition, including containers suitable for shipment and storage.

No substitutions in standard grades or lesser quality will be accepted.

• Determining Factors for Award

1. Bidders net price on bid items

2. Stock availability

3. Reputation of brand names offered

4. Reputation and location of the bidder

5. Time and conditions of delivery

6. BPUB financial and legal responsibility evaluations of any identified teaming arrangements involving significant joint ventures, subcontractors and suppliers

• Contract with Vendor/Entity Indebted to BPUB

It is a policy of the BPUB to refuse to enter into a contract or other transaction with an individual, sole proprietorship, joint venture, Limited Liability Company or other entity indebted to BPUB.

• Vendor ACH (Direct Deposit) Services

The BPUB has implemented a payment service for vendors by depositing the payment directly to the vendor’s bank account. Successful vendor(s) will be required to receive payments directly through Automated Clearing House (ACH) in lieu of a paper check. The awarded vendor must agree to receive payments via ACH (Direct Deposit).

• Tax Identification Number (TIN)

In accordance with IRS Publication 1220, aW9 form, or a W8 form in cases of a foreign vendor, will be required of all vendors doing business with the Brownsville PUB. If a W9 or W8 form is not made available to Brownsville PUB, the first payment will be subject to income tax withholding at a rate of 28% or 30% depending on the U.S. status and the source of income as per IRS Publication 1220. The W9 or W8 form must be included with bid response. Attached are sample forms.

• Taxes

The Brownsville Public Utilities Board is exempt from Federal Excise Tax, State Tax and local Taxes. Do not include tax in the bid. If it is determined that tax was included in the bid it will not be included in the tabulation or any awards. Tax exemption certificates will be furnished upon request.

• Signing of Bid

Failure to sign bid will disqualify it. Person signing bid should show title or authority to bind their firm to a contract.

• EEOC Guidelines

During the performance of this contract, the contractor agrees not to discriminate against any employee or applicant for employment because of race, national origin, age, religion, gender, marital or veteran status, or physically challenging condition.

• As Needed Basis (Not Applicable)

Quantities are estimated for an annual supply and are to be released on an “as needed” basis and be billed as such. However, successful vendor must have stock readily available for immediate shipment to the BPUB. Brownsville PUB will not accept the full quantity at one time as specified on Cost Sheet.

• Purchase Order

The carbon slurry mixer, gearbox, and paddles will be delivered to Brownsville Public Utilities Board, 1495 Robinhood Dr, Brownsville, Texas 78521. A contract for the carbon slurry mixer and parts will be placed into effect by means of a purchase order issued by the Brownsville Public Utilities Board after tabulation and final approval by the Brownsville PUB Board of Directors.

• Brownsville Public Utilities Board Rights

1. If only one or no bid is received by "submission date", the BPUB has the right to reject, re-bid, accept and/or extend the bid by up to an additional two (2) weeks from original submission date.

2. The right to reject any/or all bids and to make award as they may appear to be advantageous to the Brownsville Public Utilities Board.

3. The right to hold bid for 90 days from submission date without action, and to waive all formalities in bid.

4. The right to extend the total bid beyond the original 90-day period prior to an award, if agreed upon in writing by all parties (BPUB and vendor/contractor) and if bidder/vendor holds original bid prices firm.

5. The right to terminate for cause or convenience all or any part of the unfinished portion of the Project resulting from this solicitation within Thirty (30) calendar days written notice; for cause: upon default by the vendor/contractor, for delay or non-performance by the vendor/contractor; or if it is deemed in the best interest of the BPUB for BPUB’s convenience.

6. The right to increase or decrease quantities. In bid, stipulate whether an increase or decrease in quantities will affect bid price.

7. The Brownsville PUB has the right to refuse to enter into a contract or other transaction with any individual or entity indebted to the municipality as per Local Government Code 252.0436.

• Corrections

Any interpretation, correction, or change to the invitation to bid will be made by ADDENDUM.

Changes or corrections will be issued by the Brownsville PUB Purchasing Department. Addenda will be emailed to all who have returned the Bid Acknowledgment form. Addenda will be issued as expeditiously as possible. It is the responsibility of the vendors to determine whether all addenda have been received. It will be the responsibility of all respondents to contact the Brownsville PUB prior to submitting a response to the invitation to bid to ascertain if any addenda have been issued, and to obtain any all addenda, execute them, and return addenda with the response to the invitation to bid. Addenda may be posted on the Brownsville PUB’s website.

BID SCHEDULE FOR #B055-26

ITEM

QTY DESCRIPTION MFG# UNIT

COST

TOTAL

1 1 EA Carbon Slurry Mixer

2 1 EA Complete Gearbox

3 1 EA Mounting Gear (if applicable)

4 1 EA Wiring, Connectors, and Accessories

5 1 EA Warranty

6 1 EA Freight (if applicable)

7 Lead Time

GRAND TOTAL =

Please include electronic files (PDF or AutoCAD, if applicable) of any manufacturer cut-sheets, specification sheet, cell outline, rack outline, cell arrangements/connection diagrams, or data sheets with this bid as well as scanned copy of the bid submittals.

Special Instructions:

The undersigned (hereinafter called the "Bidder") hereby proposes to furnish and deliver the carbon slurry mixer, gearbox, paddles, and any accessories (hereinafter called the "Equipment") described in the Plans and Specifications attached.

The Purchase Order quantities are subject to BPUB’s right to increase or decrease as deemed necessary. Stipulate below, if an increase or decrease in quantity affects bid price:

(_____) Yes, an increase or decrease in quantity affects bid price.

(_____) No, an increase or decrease in quantity will not affect bid price.

Price shall remain firm until delivery of material

Company Name:

Authorized Company Representative:

Print Name Authorized Company Representative:

Signature *Failure to sign bid will disqualify it*

Company Address:

Telephone #:

SPECIFICATIONS FOR CARBON SLURRY MIXER AND PARTS FOR WATER PLANT II

1) MATERIAL

Quantity: 1 Description: Lightnin Model 86Q40 mixer gearbox + motor assembly, or manufacturer-approved equivalent replacement.

2) References / Matching Requirements Bidders must quote an assembly that matches the attached Lightnin double reduction gearbox drawings/assemblies for models 85Q thru 89Q, including:

• Double reduction gear drive (Lightnin drawings shown in attachment)

• Gear drive for the 80 series models (drawing number shown in attachment)

• Lower bearing assembly (noted as model 86 thru 89 only in attachment)

Bidder shall identify the exact drawings/part numbers they are matching (cross-reference list required).

3) Mechanical & Electrical Requirements (Must Match) Provide gearbox + motor with compatibility to the existing mixer application, including:

• Gearbox type: double reduction

• Motor: Provide the motor rating shown on the attached data:

• Frame: 326T

• Output: 40/18 HP (as shown)

• Speed: 1800/1200 RPM (as shown)

• Duty/connection: T-E-F-C

• Voltage/Hz: 460 V, 60 Hz

• Phase: 3-phase

• Mounting/shaft/interface: Shaft diameter, keyway/keyseat, coupling interface, and mounting pattern must match the Lightnin Model 86Q40 application (rigid/rigid mounting per attach ment notes).

Any substitution must be documented with dimensional comparison for: input/output shaft, keying, coupling type/size, bolt pattern/mounting face, and gear ratio configuration.

4) Scope of Supply Include as applicable:

• Complete gearbox + motor assembly (or equivalent)

• All required gears, bearings, seals, gaskets, covers

• Any required change gear/pinion components to achieve the correct configuration for Model

86Q40

• Necessary mounting hardware (if required for fit/function) or clearly state what is provided vs what is reused

5) Bid Submittal Requirements Please include:

1. Manufacturer + exact model/part number quoted

2. Confirmation of equivalency and which attached drawings you match (list drawing number / plates)

3. Lead time

4. Warranty (duration + start point + exclusions)

5. Price breakdown:

• Gearbox price

• Motor price

• Any included change gears/pinions

• Freight/packaging (if applicable)

6. Shipping method + estimated freight to Ship to address

7. Data sheet(s) for the motor and gearbox

8. Dimensional confirmation checklist:

• Gearbox mounting footprint/bolt pattern

• Input/output shaft diameters + keyway size

• Coupling/interface dimensions

7) Acceptance / Testing Unit must be a functional replacement for Lightnin Model 86Q40 mixer drive with correct mechanical interface and motor electrical specs. Provide inspection/acceptance documentation at shipment (packing list; serial/lot traceability where available).

REQUIRED FORMS CHECKLIST

The following forms are be submitted as a part of the Bid/RFP/RFQ document

NAME FORM DESCRIPTION SUBMITTED WITH BID

YES NO

Legal Notice

Acknowledgement Form

Debarment Certification

Ethics Statement

Conflict of Interest Questionnaire

Certification of Interested Party Form

Residence Certification

State Law Verification

House Bill 89 Verification

W9 or W8 Form

Special Instructions

Bid Schedule Rate/Cost sheet completed and signed

Cashier Check or Bid Bond of 5% of Total Amount of Bid (if applicable)

OSHA 300 Log (if applicable)

CONTRACTOR Pre-Bid Disclosure completed, signed and notarized (if applicable)

Sub-CONTRACTOR Pre-Bid Disclosure completed, signed, and notarized (if applicable)

References Complete the Previous Customer

Reference Worksheet for each reference provided

Addenda Other CONTRACTOR Job Safety Analysis

Form (Sample)

NOTE: ALL FORMS MUST BE SIGNED, NOTARIZED (IF APPLICABLE) AND

SUBMITTED WITH BID RESPONSE

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER

RESPONSIBILITY MATTERS

(THIS FORM MUST BE COMPLETED IN ITS ENTIRETY AND SUBMITTED WITH BID RESPONSE)

Name of Entity:____________________________________________________

The prospective participant certifies to the best of their knowledge and belief that they and their principals:

a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency:

b) Have not within a three year period preceding this bid been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, Local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and

d) Have not within a three-year period preceding this application/bid had one or more public transactions (Federal, State, Local) terminated for cause or default.

I understand that a false statement on this certification may be grounds for rejection of this bid or termination of the award. In addition, under 18 USC Section 1001, a false statement may result in a fine up to a $10,000.00 or imprisonment for up to five (5) years, or both.

Name and Title of Authorized Representative (Typed)

Signature of Authorized Representative Date

I am unable to certify to the above statements. My explanation is attached.

ETHICS STATEMENT

(THIS FORM MUST BE COMPLETED IN ITS ENTIRETY AND SUBMITTED WITH BID RESPONSE)

The undersigned Firm, by signing and executing this bid, certifies and represents to the Brownsville Public Utilities Board that Firm has not offered, conferred or agreed to confer any pecuniary benefit, as defined by (1.07 (a) (6) of the Texas Penal Code, or any other thing of value as consideration for the receipt of information or any special treatment of advantage relating to this bid; the Firm also certifies and represents that the Firm has not offered, conferred or agreed to confer any pecuniary benefit or other thing of value as consideration for the recipient’s decision, opinion, recommendation, vote or other exercise of discretion concerning this bid, the Firm certifies and represents that Firm has neither coerced nor attempted to influence the exercise of discretion by any officer, trustee, agent or employee of the Brownsville Public Utilities Board concerning this bid on the basis of any consideration not authorized by law; the Firm also certifies and represents that Firm has not received any information not available to other Firms so as to give the undersigned a preferential advantage with respect to this bid; the Firm further certifies and represents that Firm has not violated any state, federal, or local law, regulation or ordinance relating to bribery, improper influence, collusion or the like and that Firm will not in the future offer, confer, or agree to confer any pecuniary benefit or other thing of value of any officer, trustee, agent or employee of the Brownsville Public Utilities Board in return for the person having exercised their person’s official discretion, power or duty with respect to this bid; the Firm certifies and represents that it has not now and will not in the future offer, confer, or agree to confer a pecuniary benefit or other thing of value to any officer, trustee, agent, or employee of the Brownsville Public Utilities Board in connection with information regarding this bid, the submission of this bid, the award of this bid or the performance, delivery or sale pursuant to this bid.

THE RESPONDENT SHALL DEFEND, INDEMNIFY, AND HOLD HARMLESS THE

BROWNSVILLE PUBLIC UTILITIES BOARD, ALL OF ITS OFFICERS, AGENTS AND

EMPLOYEES FROM AND AGAINST ALL CLAIMS, ACTIONS, SUITS, DEMANDS,

PROCEEDING, COSTS, DAMAGES, AND LIABILITIES, ARISING OUT OF, CONNECTED WITH,

OR RESULTING FROM ANY NEGLIGENT ACTS OR OMISSIONS OF CONTRACTOR OR ANY

AGENT, EMPLOYEE, SUBCONTRACTOR, OR SUPPLIER OF RESPONDENT IN THE

EXECUTION OR PERFORMANCE OF THIS BID.

I have read all of the specifications and general bid requirements and do hereby certify that all items submitted meet specifications.

COMPANY: _______________________________________

AGENT NAME: ____________________________________

AGENT SIGNATURE: _______________________________

ADDRESS: ________________________________________

CITY: ____________________________________________

STATE: ____________________________ ZIP CODE: ________________

TELEPHONE: ________________________ TELEFAX: ___________________

FEDERAL ID#: ____________________ AND/OR SOCIAL SECURITY #:___________

DEVIATIONS FROM SPECIFICATIONS IF ANY:

NOTE: QUESTIONS AND CONCERNS FROM PROSPECTIVE CONTRACTORS SHOULD

BE RAISED WITH OWNER AND ITS CONSULTANT (IF APPLICABLE) AND RESOLVED,

IF POSSIBLE, PRIOR TO THE BID SUBMITTAL DATE. ANY LISTED DEVIATIONS IN A

FINALLY SUBMITTED BID MAY ALLOW THE OWNER TO REJECT A BID AS NON-

RESPONSIVE.

(THIS FORM MUST BE COMPLETED IN ITS ENTIRETY AND SUBMITTED WITH BID RESPONSE)

CERTIFICATE OF INTERESTED PARTIES-FORM 1295

Special message: Please read the Special Notification regarding HB 1295 effective January 1, 2016, implemented by the Texas Ethics Commission, which requires business entities to provide a completed Form 1295 to Brownsville PUB with signed contracts in order to execute them.

In 2015, the Texas Legislature adopted House Bill 1295. The law states that a governmental entity or state agency may not enter into certain contracts with a business entity unless the business entity submits a disclosure of interested parties to the governmental entity or state agency at the time the business entity submits the signed contract to the governmental entity or state agency. The law applies to a contract of a governmental entity or state agency that either (1) requires an action or vote by the governing body of the entity or agency before the contract may be signed or (2) has a value of at least $1 million. The disclosure requirement applies to a contract entered into on or after January 1, 2016.

To implement the law, the Texas Ethics Commission (TEC) adopted new rules necessary to prescribe the disclosure of interested parties form, and post a copy of the form on the commission’s website. The commission adopted the Certificate of Interested Parties form, Form 1295, on October 5, 2015. The commission also adopted new rules as part of Chapter 46 of the Texas Administrative Code on November 30, 2015.

On January 1, 2016, TEC made a new filing application available on their website for business entities to use to both create and file Form 1295. Business entities will enter the required information on Form 1295 within the application and print a copy of the completed form, which will include a certification of filing with a unique certification number. An authorized agent of the business entity will need to sign the printed copy of the form and have the form notarized. The completed Form 1295 with the certification of filing must be included with the signed contract to the governmental body or state agency in order for the governmental body to execute the contract.

Brownsville PUB will then notify the commission, using TEC’s filing application, of the receipt of the filed Form 1295 with the certification of filing not later than the 30th day after the date the contract binds all parties to the contract.

TEC will then post the business entity’s completed Form 1295 to its website within seven (7) business days after receiving notice from Brownsville PUB acknowledging that it was received.

To obtain additional information on HB 1295, to learn more about TEC’s process to create a new account or to complete an electronic version of Form 1295 for submission with a signed contract, please go to the following link: https://ethics.state.tx.us/whatsnew/elf_info_form1295.htm

NOTE: IF AWARDED THIS CONTRACT, FORM 1295 WILL BE SUBMITTED AT THE TIME THE SIGNED

CONTRACT IS SUBMITTED TO BPUB. ____YES ____NO

https://ethics.state.tx.us/whatsnew/elf_info_form1295.htm

CERTIFICATE OF INTERESTED PARTIES FORM 1295

Complete Nos. 1 - 4 and 6 if there are interested parties.

Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.

OFFICE USE ONLY

1 Name of business entity filing form, and the city, state and country of the business entity's place of business.

2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed.

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 goods or services to be provided under the contract.

Name of Interested Party

City, State, Country (place of business)

Nature of Interest (check applicable)

Controlling Intermediary

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) (zip code) (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)

ADD ADDITIONAL PAGES AS NECESSARY

Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 12/22/2017 http://www.ethics.state.tx.us/

BROWNSVILLE PUBLIC UTILITIES BOARD

RESIDENCE CERTIFICATION

In accordance with Art. 601g, as passed by the 1985 Texas Legislature, the following will apply.

The pertinent portion of the Act has been extracted and is as follows:

Section 1. (a)

(1) "Nonresident CONTRACTOR " means a CONTRACTOR whose principal place of business is not in this state, but excludes a CONTRACTOR whose ultimate parent company or majority owner has its principal place of business in this state.

(2) "Texas resident CONTRACTOR " means a CONTRACTOR whose principal place of business is in this state, and includes a CONTRACTOR whose ultimate parent company or majority owner has its principal place of business in this state.

Section 1. (b)

The state or governmental agency of the state may not award a contract for general construction, improvements, services, or public works projects or purchases of supplies, materials or equipment to a nonresident CONTRACTOR unless the nonresident's bid is lower than the lowest bid submitted by a responsible Texas resident CONTRACTOR by the same amount that a Texas resident CONTRACTOR would be required to underbid a nonresident CONTRACTOR to obtain a comparable contract in the state in which the nonresident's principal place of business is located.

I certify that ______________________________________________________________ (Company Name) is a resident Texas CONTRACTOR as defined in Art. 601g.

Signature: _____________________________________________________________

Print Name: _____________________________________________________________

I certify that ______________________________________________________________ (Company Name) is a nonresident CONTRACTOR as defined in Art. 601g. and our principal place of business is: ______________________________________________________________

(City and State)

Signature: _______________________________________________________________

Print Name:

State Law Verifications

I, ______________________________________ (Person’s name), the undersigned representative of (Company or Business name) ____________________________________ _________________ _____________________ ______________ (hereafter referred to as the “Company”) being an adult over the age of eighteen (18) years of age, after being duly sworn by the undersigned notary, do hereby depose and verify under oath as follows:

• IRAN, SUDAN AND FOREIGN TERRORIST ORGANIZATIONS: By submission of a response to City of Brownsville Public Utilities Board (“BPUB”) Request for Bids (B037-26) (the “BID”), the responding Company represents that, to the extent this bid submission or any contracts executed in response to this bid constitutes a governmental contract within the meaning of Section 2252.151 of the Texas Government Code, as amended, solely for purposes of compliance with Section 2252.152 of the Texas Government Code, and except to the extent otherwise required by applicable federal law, neither the responding Company, nor any wholly owned subsidiary, majority‐owned subsidiary, parent company or affiliate of the Company is a company listed by the Texas Comptroller of Public Accounts under Sections 806.051, 807.051, or 2252.153 of the Texas Government Code.

• ANTI‐BOYCOTT ISRAEL VERIFICATION: By submission of a response to the BPUB

RFQ, the responding Company represents that, to the extent this bid submission, or any contracts executed in response to this bid, constitutes a contract for goods or services within the meaning of Section 2271.002 of the Texas Government Code, as amended, solely for purposes of compliance with Chapter 2271 of the Texas Government Code, and subject to applicable federal law, including without limitation, 50 U.S.C. Section 4607, the responding Company, as well as any wholly owned subsidiary, majority‐owned subsidiary, parent company or affiliate of the Company, (1) does not boycott Israel and (2) will not boycott Israel through the term of any such contract. The term “boycott Israel” as used in this paragraph has the meaning assigned to such term in Section 808.001 of the Texas Government Code, as amended.

• VERIFICATION REGARDING NO DISCRIMINATION AGAINST FIREARMS: By submission of a response to the BPUB RFQ, the responding Company represents that, to the extent this bid submission, or any contracts executed in response to this bid, constitutes a contract for goods or services for which a written verification is required under Section 2274.002, Texas Government Code (as added by Senate Bill 19, 87th Texas Legislature, Regular Session), as amended, the responding Company hereby verifies that it, as well as any wholly owned subsidiary, majority‐owned subsidiary, parent company or affiliate of the Firm,

(1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and (2) will not discriminate during the term of any such contract against a firearm entity or firearm trade association. The foregoing verification is made solely to comply with Section 2274.002, Texas Government Code (as added by Senate Bill 19, 87th Texas Legislature, Regular Session), as amended, to the extent such section does not contravene applicable Texas or federal law. As used in the foregoing verification, “discriminate against a firearm entity or firearm trade association” shall have the meaning assigned to such term in Section 2274.001, Texas Government Code (as added by Senate Bill 19, 87th Texas Legislature, Regular Session).

• VERIFICATION REGARDING NO ENERGY COMPANY BOYCOTTS: By submission of a response to the BPUB RFQ, the responding Company represents that, to the extent this bid submission, or any contracts executed in response to this bid, constitutes a contract for goods or services for which a written verification is required under Section 2274.002, Texas Government Code (as added by Senate Bill 13, 87th Texas Legislature, Regular Session), as amended, the responding Company hereby verifies that the responding Company, as well as any wholly owned subsidiary, majority‐owned subsidiary, parent company or affiliate of the Firm, (1) does not boycott energy companies and (2) will not boycott energy companies during the term of any such contract. The foregoing verification is made solely to comply with Section 2274.002, Texas Government Code (as added by Senate Bill 13, 87th Texas Legislature, Regular Session), as amended, to the extent such section does not contravene applicable Texas or federal law. As used in the foregoing verification, “boycott energy companies” shall have the meaning assigned to such term in Section 809.001(1), Texas Government Code.

DATE SIGNATURE OF COMPANY REPRESENTATIVE

On this the _____ day of _________________________, 20____, personally appeared

________________________________________, the above-named person, who after by me being duly sworn, did swear and confirm that the above is true and correct.

NOTARY SEAL____________________________________

NOTARY SIGNATURE____________________________________

Date

Organization Name House Bill 89 Verification

I, ______________________________________(Person name), the undersigned representative of (Company or Business name)___________________________________________________ _________________ _____________________ ______________(hereafter referred to as company) being an adult over the age of eighteen (18) years of age, after being duly sworn by the undersigned notary, do hereby depose and verify under oath that the company named- above, under the provisions of Subtitle F, Title 10, Government Code Chapter 2270:

1. Does not boycott Israel currently; and

2. Will not boycott Israel during the term of the contract providing that:

(1) “company” does not include a sole proprietorship; and

(2) the law applies only to a contract that:

(a) is between a governmental entity and a company with 10 or more full-time employees; and

(b) has a value of $100,000 or more that is to be paid wholly or partly from public funds or the governmental entity

Pursuant to Section 2270.001, Texas Government Code:

1. “Boycott Israel” means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes; and

2. “Company” means a for-profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit.

DATE SIGNATURE OF COMPANY REPRESENTATIVE

On this the _____ day of _________________________, 20____, personally appeared

________________________________________, the above-named person, who after by me being duly sworn, did swear and confirm that the above is true and correct.

NOTARY SEAL____________________________________

NOTARY SIGNATURE____________________________________ Date _________________

Previous Customer Reference Worksheet

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Customer Address: Customer Phone Number:

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Name of Company Performing Referenced Work:

What was the Period of Performance? What was the Final Acceptance Date?

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Dollar Value of Contract?

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Firm Fixed Price Time and Material Not to Exceed Cost Plus Fixed Fee Other, Specify:______________________

Provide a brief description of the work performed for this customer (add additional page if required)

Please submit this page upon receipt.
ACKNOWLEDGEMENT FORM
Special Instructions:
1) MATERIAL
2) References / Matching Requirements
3) Mechanical & Electrical Requirements (Must Match)
4) Scope of Supply
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7) Acceptance / Testing
CERTIFICATE OF INTERESTED PARTIES-FORM 1295

File details come from the government source that posted it. Updated .