BID 26-43 ANNUAL SUPPLY OF READY-MIX CONCRETE AND FLOWABLE FILL.pdf

CITY OF WICHITA FALLS, TEXAS

NOTICE OF CALL FOR BIDS

Sealed bids will be received at the office of the City Purchasing Manager, Memorial Auditorium, 1300 7th Street, 2nd Floor, Room 2B18, Wichita Falls, Texas 76301 until 1:30 PM on the day of OCTOBER 19, 2026 for furnishing the material, supplies, equipment, services, or for supplying the materials and/or doing the work necessary for the repair, construction or improvement, as the case may be, as indicated by the items hereunder listed and in accordance with the applicable specifications.

BID START DATE: SEPTEMBER 29, 2026 BID NUMBER: 26-43

BID CLOSING DATE: OCTOBER 19, 2026

These columns to be filled in by firm quoting:

ITEM

NO.

QTY UNIT DESCRIPTION UNIT

PRICE

TOTAL

NET PRICE

NOTICE OF INTENT TO BID DUE

OCTOBER 7, 2026 - 1:30 PM

1 2500 CY CLASS S CONCRETE (6 SACK)

2 400 CY CLASS A CONCRETE (5 SACK)

3 300 CY CURB & GUTTER (3/8” PEA GRAVEL) (6 SACK)

4 400 CY CLASS C-C CONCRETE (7 SACK)

5 800 CY FLOWABLE FILL

AS PER ATTACHED CITY SPECIFICATIONS

Copies of bid forms, specifications and/or plans and instructions to bidders may be obtained from http://www.wichitafallstx.gov/bids.aspx or the office of the City Purchasing Manager, Memorial Auditorium, 1300 7th St, Room

2B18, Wichita Falls, Texas 76301. Phone # 940-761-7466. All bids received by the time set for receipts of bids, will be opened publicly and read aloud at that time, in the office of the City Purchasing Manager or other designated place, Wichita Tower, Wichita

Falls, Texas. Any bid received after the bid closing date and time will be returned to the bidder unopened and will not be considered.

Bidder shall complete Conditions of Sale section hereunder listed, including signature.

Cash Discount Terms: ______% ______Days Delivery F.O.B.

(NET-30 Days unless otherwise stated) (F.O.B. Delivered unless otherwise stated)

NOTE: CASH DISCOUNTS ARE NOT USED Shipping From:

FOR BID EVALUATION.

Quotation firm for _________________Days Company Name:

(45 Days unless otherwise stated) Contact Name:

Date: _________________________

Signature:

For Further Information

Contact: Title:

Address:

Email:

Phone #: Fax #:

CITY OF WICHITA FALLS, TEXAS P.O. Box 1431, Wichita Falls, TX 76307 940-761-7466 http://www.wichitafallstx.gov/bids.aspx

TERMS AND CONDITIONS OF CALL FOR BIDS

1. GENERAL CONDITIONS:

a) Bidders shall thoroughly examine the specifications, drawings, schedule, instructions and all other contract documents.

b) Bidders shall make all investigations necessary to thoroughly inform themselves regarding plant and facilities for delivery of material and equipment as required by the bid conditions. No plea of ignorance by the bidder of conditions that exist or that may hereafter exist as a result of failure or omission on the part of the bidder to make the necessary examinations and investigations, or failure to fulfill in every detail the requirements of the contract documents, will be accepted as a basis for varying the requirements of the City or the compensation to the vendor

c) Bidders are advised that all City contracts are subject to all legal requirements provided for in the City Charter, Code and/or applicable

City Ordinances, State of Texas and Federal statutes.

d) No officer or employee of the City shall have a financial interest, direct or indirect, in any contract with the City, or shall be financially interested, directly or indirectly, in the sale to the City of any materials, supplies or service, except on behalf of the City as an officer or employee.

2. PREPARATION OF BIDS:

a) All information required by the bid form shall be furnished. The bidder shall sign in ink the Call for Bid document and the

Specification Compliance Certification document in the places indicated, stating the firm’s name and address where required.

b) Unit prices shall be shown, and where there is an error in extension of price, the unit price shall govern.

c) Proposed delivery time shall be stated from the time the Purchase Order is received by the Vendor and shall include Sundays and

Holidays.

d) Bidders will not include neither federal taxes nor State of Texas sales, excise or use taxes in bid prices as the City of Wichita Falls is exempt from payment of such taxes. An exemption certificate will be furnished upon request.

3. DESCRIPTION OF PRODUCT/SERVICE:

Any catalogue or manufacture’s reference used in describing an item is merely descriptive, and not restrictive, unless otherwise noted, and is used only to indicate type and quality of material. Bidders are required to state exactly what they intend to furnish, otherwise they shall be required to furnish the items as specified.

4. CLARIFICATION OF OBJECTION TO BID SPECIFICATIONS:

In the absence of a scheduled Pre-Bid Conference, a bidder may, if in doubt as to the true meaning of the specifications or other bid documents or any part thereof, submit to the City Purchasing Manager on or before ten calendar days prior to scheduled bid opening, a request for clarification. All such requests for information shall be made in writing (use Intent to Bid form) and the person submitting such request shall be responsible for its prompt delivery. Any interpretation of the bid, if made, will be made only by Addendum and posted on the City’s website. All vendors are strongly urged to sign up on the City’s website: http://www.wichitafallstx.gov/list.aspx?Mode=Subscribe#bids to receive notifications of postings. The City will not be responsible for any other explanation or interpretation of the proposed bid made or given prior to the award of the contract.

5. SUBMISSION OF BIDS:

a) Bids and changes thereto shall be enclosed in sealed envelopes addressed to Purchasing Manager, City of Wichita Falls. The name and address of the bidder, the bid number, and the closing date and time shall be placed on the outside of the envelope.

b) Bids must be submitted on the forms furnished. Faxed or electronic bids will not be considered. Bids, however, may be modified by written notice, if such notice is received by the City Purchasing Manager prior to the time and date set for the bid closing.

c) Samples, when required, must be submitted within the time specified, at no expense to the City of Wichita Falls. If not destroyed or used up during testing, samples will be returned upon request, at the bidder’s expense.

6. WITHDRAWAL OF BIDS:

Bids may not be withdrawn after the time set for the bid opening, unless approved by the City Council.

7. LATE BIDS OR MODIFICATION OF BID:

Bids and modifications received after the time set for the bid opening, regardless of the mode of delivery, will be returned to the bidder unopened, as required by State law.

8. REJECTION OF BIDS:

a) The City may reject a bid if:

1. The bidder misstates or conceals any material fact in the bid, or if

2. The bidder does not strictly conform to law or the requirements of the bid, or if

3. The bid is conditional, except that the bidder may qualify his bid for acceptance by the City on an “All or None” basis or a “Low item” basis

b) The City reserves the right to accept or reject any or all bids, or any part thereof, and to accept that offer considered most advantageous to the City. The City may also waive any minor informalities or irregularities in any bid.

http://www.wichitafallstx.gov/list.aspx?Mode=Subscribe#bids

9. AWARD OF CONTRACT:

a) The contract will be awarded to the lowest responsible bidder, conforming to the Call for Bid, whose bid is most advantageous to the City, price and other factors considered.

b) The City reserves the right to accept any item or group of items, unless the bidder restricts his bid by specific reference, as in 8(a) above.

c) Written notice of award will be furnished the successful bidder.

d) A binding contract results after the issuance of an authorized Purchase Order by the City. The Purchase Order and the Call for Bid document shall constitute the contract documents.

e) The City of Wichita Falls may, in its discretion, apply any monies owed the City, which remain delinquent at the effective date of this contract.

10. ASSURANCE OF COMPLIANCE - PERFORMANCE BOND OR DEPOSIT:

a) When specified in the Call for Bid, the successful bidder shall be required to furnish, as a part of the contract acceptance, a

Performance Bond, in the amount specified. Upon receipts of the completed Performance Bond from the successful bidder, the

City Purchasing Manager will issue a Purchase Order. In lieu of said bond, a certified check drawn upon a State or National Bank or Trust Company shall be deposited with the City Clerk.

b) In the event a Performance Bond is not required, and the vendor breaches the contract, the vendor shall be liable for liquidated damages in the amount specified in the Call for Bid.

11. ASSURANCE OF COMPLIANCE - EQUAL EMPLOYMENT OPPORTUNITY AND SMALL AND/OR MINORITY BUSINESS

ENTERPRISE REQUIREMENTS;

Bidder agrees that if his bid is accepted, he/she will not engage in employment practices which have the effect of discriminating against employees or prospective employees because of race, color, national origin, sex, age, handicap or political belief or affiliation. In addition, bidder agrees that he/she will abide by all applicable terms and provision of the Nondiscrimination Clause and the Small or Minority Business

Enterprise Clause as contained in the City of Wichita Falls current Affirmation Action Plan, or applicable Federal statutes.

Notice of Intent to Bid

Please fill in the following form and mail or fax to City of Wichita Falls.

FAX or EMAIL Due: OCTOBER 7, 2026 - 1:30 PM

NOTICE OF INTENT TO BID

Date:

TO: CITY OF WICHITA FALLS

JENNIFER BABINEAUX, PURCHASING MANAGER

1300 7TH ST, ROOM 2B18

WICHITA FALLS, TEXAS 76301

PHONE: 940-761-7466

FAX: 940-761-7688

EMAIL: JENNIFER.BABINEAUX@WICHITAFALLSTX.GOV

From: ____________________________________

REFERENCE: This is our letter of intent to bid on Bid 26-43 ANNUAL SUPPLY OF

READY-MIX CONCRETE & FLOWABLE FILL.

COMMENTS:

BID 26-43 READY MIX

DATE: 9/28/26

SPEC/STREETS

READY MIX CONCRETE

FLOWABLE FILL

It is the intent of this Call for Bids to solicit quotations for the City's annual requirements of Ready- Mix Concrete, and Flowable Fill. The primary user of concrete and flowable fill is the City’s Street Maintenance Division. However, various City departments will have requirements throughout the year.

Bidder agrees to supply more or less than the quantity stated, as needed, and at the prices quoted. Bidder should bid all the prices delivered to job or plant site. It is assumed that all bidders will be capable of delivering product on the same day as ordered. Normal delivery within two (2) hours of ordering is desirable. Should the successful bidder be unable to deliver within two (2) hours, the City reserves the right to purchase from an alternative source.

Bids shall be awarded to the supplier offering the “Best Value” to the City. Evaluating factors will include price and delivery history of the supplier.

The successful bidder shall be required to show evidence of Comprehensive General Liability Insurance in the amount of $300,000 with the City of Wichita Falls, Texas, listed as additional named insured. The successful bidder shall also be required to carry Workers' Compensation Insurance in full compliance with the laws of the State of Texas.

The successful bidder shall be required to submit a batch design to the City Engineer for approval on all products bid.

Please note that bids will be awarded on a line item basis. Bidders may quote all categories or only a single item according to their capability to supply product.

Purchases on this contract are expected to begin on or about November 3, 2026 and remain in effect for a period of twelve (12) months, with a one (1) year renewal option upon like terms and conditions. Such renewal is to be exercised at the option of the City of Wichita Falls.

NOTE: A complete set of the City's February 2003, Concrete Specifications and Flowable Fill Specifications are included with this bid. Please retain these specifications for your file. The bid products (Ready Mix concrete) are identified on Table # 3, the last page of the Specification.

Please note the "Entrained Air" provision on Class S concrete, Table 3.

SPEC/STREETS

PRICE FORM

Item Concrete Class (Estimate)

Annual Quantity

Description Unit Cost

Total Cost

1.a) Class S (6 Sack)

2500 CY Ready Mix Concrete (2 CY Minimum)

CY

b) 75 *Purge or Truck Time occurrences (15 Min Increments)

EA

TOTAL

2.a) Class A

(5 Sack) 400 CY Ready Mix Concrete w/ Entrained Air b)

(2 CY Minimum) *Purge or Truck Time occurrences

3.a) Curb & Gutter 300 CY Ready Mix Concrete

(3/8 pea gravel) (6 Sack) CY

b) 20 *Purge or Truck Time occurrences

4.a) Class C-C

(7 Sack) 400 CY Ready Mix Concrete

b) 20 *Purge or Truck Time occurrences

5.a) Flowable Fill 800 CY Per Attached Specifications

b) 30 *Purge or Truck Time occurrences

*First 30 minutes of truck time to point of 1st delivery is to be included in cost of concrete; purge time to be paid on basis of 15-minute increments beyond 30 minutes.

Signed: Date:

Title: Company:

SPEC/STREETS

FLOWABLE FILL SPECIFICATIONS

American Concrete Pavement Association – "Municipal Concrete Pavement Manual - Guide Specifications and Design Standards. Flowable Low-Strength Mortar Backfill"

Quantities of Dry Materials per cubic yard

Cement (Portland Normal) - 50 lbs. Sand (SSD) - 2800 lbs

Fly Ash - 275 lbs Water (Maximum) - 500 lbs

Fine Aggregate Gradations*

Sieve Size % Passing 3/4 100 200 0-10

*Note: It is intended that the sand be a fine sand that will stay in suspension in the mixture to the extent required to obtain a flowable consistency.

Specifications should be strictly adhered to.

SPEC/STREETS

CITY OF WICHITA FALLS

STANDARD SPECIFICATION FOR PORTLAND CEMENT CONCRETE

REVISED, FEBRUARY, 2003

This item governs the materials used, the storing and handling of materials, and the proportioning and mixing of concrete for bridges, pavements, culverts, prestressed concrete, and other concrete construction for the City of Wichita Falls.

Cement concrete is composed of Portland cement, aggregates, (fine and coarse), admixtures if desired or required, and water, proportioned and mixed as hereinafter provided.

The north Texas Council of Governments, (NTCOG), Standard Specifications for Public Works shall be the governing base specification. The following supplemental conditions modify or expand the NTCOG standard specifications. If required, the City Engineer of Wichita Falls shall determine interpretation.

ITEM 7.4.4 Concrete Mix Design and Control:

Delete Section 7.4.4 and replace with the following:

Classification and Mix Design. It is the responsibility of the Contractor to furnish the mix design, using a Coarse Aggregate Factor acceptable to the City Engineer, for the class(es) of concrete specified, to conform with the requirements contained herein. The Contractor will perform, at his/her own expense, the work required to substantiate the design. Submit complete concrete design data to the City Engineer for approval. Submit one mix design before initial delivering; and at not less than 6-month intervals, unless otherwise requested by the City.

It is also the responsibility of the Contractor to determine and measure the batch quantity of each ingredient, including all water, not only for batch designs but for all concrete produced for the project, so that the mix conforms to these specifications and other requirements shown on the plans.

In lieu of the above mix design responsibility, the Contractor may accept a design furnished by the City, however, this will not relieve him of the responsibility of providing concrete meeting the requirements of these specifications.

Trial batches will be made and tested using all the proposed ingredients prior to the placing of concrete, and when the aggregate, and/or type, brand or source of cement only is changed, the City Engineer may waive trial batches only if a prior record of satisfactory performance of the cement has been established.

Make the trial batches in the mixer to be used on the job. When Transit Mix concrete is to be used, the trial designs will be made in a transit mixer representative of the mixers to be used. Batch size shall not be less than 50 percent of its rated mixing capacity.

Mix designs from previous or concurrent jobs may be used without trial batches if it is agreed and determined acceptable to the City in writing.

The coarse aggregate factor shall not be more than 0.82 except that when the voids in the coarse aggregate exceed 48 percent of the total dry loose volume, the coarse aggregate factor shall not exceed

SPEC/STREETS

0.85. The coarse aggregate factor shall not be less than 0.68 unless authorized by the City Engineer in writing. Note that beam strengths listed on Table 3 are center point loadings.

Water reducing or retarding agents may be used with all classes of concrete at the option of the Contractor, and will be required for hot weather concreting, for cased drilled shafts and for continuous slab placement, provided written permission is obtained in advance from the City Engineer. This material shall be considered subsidiary to the various pay items included in the contract.

When a retarding admixture is required for hot weather concreting, as specified in Article 420.13 of the Texas Specifications, the amount to be used will be as required in the Item, "Concrete Admixtures", subject to change by the City Engineer when required. When used in continuous slab placement, the amount to be used will be established by several trial batches with varying retarder content and simulating the placing conditions to be encountered. When water reducing or retarding agents are used at the option of the Contractor, reduced dosage of the admixture will be permitted.

In hot weather, cool the aggregates and the mixing water, as necessary, to maintain the concrete temperature within 50F to 90F, at the time of placing, except for bridge deck concrete placement, as specified.

Entrained air will be required in accordance with Table 3. Design the concrete to entrain 4 percent air in the plastic state when Grade 1 or 2 coarse aggregate is used, 5 percent when Grade 3, 4, or 9 coarse aggregate is used, and 6 percent for Grades 5, 6 or 7 unless otherwise specified by the City Engineer.

Incorporate the air-entraining admixture solution into the batch with the mixing water, using a suitable visual measuring device. When another type of admixture is used with an air-entraining admixture, add it in solution in another portion of the mix water, as directed, by an additional, suitable visual measuring device.

Equip the measuring device with interlocks to prevent discharging during the charge cycle and to prevent charging during the discharging cycle. Provide a means to calibrate the measuring device to within + or

- 1.5%. Dispense the air-entraining admixture solution to the batch from a bulk supply tank.

For paving and when directed, provide a bulk supply tank containing sufficient solution for the entire day's concreting operations. On the dispensing system, provide device(s) capable of detecting and indicating the presence or absence of admixture flow. When the quantity of entrained air is found to be more than 1.5 percentage points over those values given herein, additional test beams or cylinders may be made. Voids 1 millimeter or more/ in size will be considered entrapped air. Voids less than 1 millimeter will be considered entrained air.

Slump requirements will be as specified in Table 3.

ITEM 7.4.5 Quality of Concrete

Replace the first paragraph of 7.4.5(b) with:

The concrete shall be uniform, workable and of a consistency acceptable to the City Engineer. The cement content, maximum allowable water/cement ratio, the desired and maximum slump, the proper amount of entrained air and the strength of requirements for all classes of concrete shall conform to the

SPEC/STREETS

requirements of these specifications. It is the responsibility of the Contractor to provide concrete meeting these requirements.

During the progress of the work, the City may cast test cylinders or beams, perform slump and entrained air tests and will make temperature checks, as required, to insure compliance with the specifications.

Specimens will be tested in accordance with established testing procedures.

If the required strength or consistency of the class of concrete being produced cannot be secured with the minimum cement specified or without exceeding the maximum water/cement ratio, the Contractor will be required to furnish different aggregates, use a water reducing agent, an air entraining agent or increase the cement content in order to provide concrete meeting these specifications.

All test specimens, beams or cylinders, representing tests for removal of forms and/or falsework shall be cured using the same methods, and under the same conditions as the concrete represented.

Add the following as Section 7.4.5. (c):

"Mortar" for repair of concrete, consists of 1-part cement, 2 parts finely graded sand, and enough water to make the mixture plastic. When required to reduce color difference, white cement shall be added to the satisfaction of the City to produce the color required. When required by the City Engineer, acceptable latex adhesive shall be added to the mortar.

ITEM 7.4.6 Mixing

Replace 7.4.6(a) with:

Mix all concrete in quantities required for immediate use. Any concrete, which is not in place within the limits outlined in Texas Specifications Article 420.11, will not be used.

Maintain all equipment, tools, and machinery used for hauling materials and performing any part of the work in such condition to insure completion of the work under way without excessive delays for repairs or replacement.

Perform the mixing in a mixer of approved type and size that will produce a uniform distribution of the material throughout the mass and is capable of producing concrete meeting the requirements of these specifications.

Attach a plate to the mixer showing the manufacturer’s recommended operating data and operate it within the speed and capacity limits stated thereon unless otherwise directed by the City Engineer.

Do not exceed the absolute volume of the concrete batch the rated capacity of the mixer.

The mixing equipment shall be capable of producing sufficient concrete to provide the quantities required to comply with Article 420.11 of the Texas Specifications.

Discharge the entire contents of the drum before any materials are placed therein for the succeeding batch.

Do not place improperly mixed concrete into the structure.

SPEC/STREETS

Mixers shall be subject to daily examination for changes in condition due to accumulations of hardened concrete and/or blade wear. Remove any hardened concrete to the satisfaction of the City before using the mixer. Make available upon request of the City Engineer a copy of the Manufacturer's design, showing dimensions and arrangement of blades. Repair or replace worn blades with new ones when they have worn as much as 10% from their original dimensions except that blade wear in truck mixers and agitators shall be in accordance with the Item, "Ready-Mix Plants".

Deliver concrete to the site of the work and discharge it from the mixer, agitator, or non-agitating equipment in accordance with the requirements of Article 420.11 of the Texas Specifications.

Batch Mixers. Batch the mixer by either the volumetric method or by weighing, and equip with a suitable timing device which locks the discharging mechanism and signals when the specified time of mixing has elapsed.

Provide an adequate water supply and suitable metering devices.

Except for incidental construction, include an extra quantity of sand, cement, and water sufficient to coat the inside surface of the drum with the first batch of concrete materials placed in the mixer for each placement.

After all the required materials are in the mixer, mix the concrete not less than 50 seconds nor more than 90 seconds, measured from the time the last material enters the mixer to the time discharge of the concrete begins unless otherwise specified by the City Engineer.

Add the following to 7.4.6(b)(6):

The use of ready-mixed concrete will be permitted for all structural concrete provided that the plant, truck mixers, agitators and mixing equipment conform to the requirements of the Texas Specifications Item, "Ready-Mix Plants".

Replace second sentence in 7.4.6(c) with:

When approved by the City Engineer in writing or when specified for use, these mixers may be used for other types of concrete construction, including structural concrete, if the number of mixers furnished will supply the amount of concrete required for the particular operation in question.

Calibration of these mixers will be required.

NOTE: All material related Specifications from Item 7.4 (Concrete For Structures) including the following, shall apply to Item 5.8 (Portland Cement Concrete Pavement)

Add the following to 7.6.9(a) Substitute "any" in lieu of Class C, F, H, X and Z and delete the words "used in bridge structures" in the second sentence.

SPEC/STREETS

Class Min. Sack Min. 28-day Min. 7-day Maximum CCI Acceptable Maximum

Of Cement Compressive 3rd pt. Flex. w/c Ratio Design Coarse Aggr. Slump

Concrete Per C.Y. Strength (psi) Strength (psi) (lb / lb) Number Grades General Usage (in)

A 5.0 3000 425 or 390* 0.58 01-507 1-2-3-4 Drilled Shafts, Bridge Substructure, Non-Traffic 3

Bearing Culverts, Inlets, Manholes, Headwalls and

Pavement Slabs to be cured by Contractor

Minimum 28 days

B 4.0 2000 280 0.71 01-476 2-3-4-5-6-7 Riprap, Long Span Structure Thrust Beams 6

C 6.0 3600 510 or 470* 0.53 01-607 1-2-3-4-5-8 Drilled Shafts, Bridge Railing & Substructure, 7

Traffic Bearing Culverts, Wingwalls, Concrete

Approach Slabs, Concrete Barrier Railing and

Machine Laid Curb

S 6.5 4000 570 or 525* 0.44 01-655 2-3-4-5 Utility Cuts, Bridge Slabs, Pavement Slabs and 3.5

Culverts

D 3.0 1500 215 0.98 2-3-4-5-6-7 Riprap 6

H 6.0 - - 0.49 3-4-5-6 Pre-Stressed Concrete Beams, Boxes, Pilings and 3

Concrete Barrier Railing

C-C 7.0 - - 0.37 2-3-4-5 Bridge Slab, Special High Strength Concrete, when a 3

High-Range Water Reducer is used

F 6.0 to 8.0 - - 0.49 2-3-4-5 Railroad Structures, Occasionally for Bridge Piers, 4

Columns or Bents

SP - 3600 510 or 470* - 01-607 2-3-4-5 Utility Cuts 3.5

*Minimum flexural strength requirement when Type II or Type I/II cement is used.

• Entrained air will be required for bridge slabs, top slabs of traffic bearing culverts, piers, bents, precast piling(non-pressured), drilled shafts placed in water, bridge railing and concrete barrier railing. When Class "H" concrete is used in barrier railing, entrained air will not be required.

• Grade 1 coarse aggregate will not be permitted in cased drilled shafts.

• 5 ½" maximum slump permitted for pavement slabs.

• When Type II cement is used with Classes "C" or "S" concrete, the 7-day flexural strength required will be 550 psi minimum and with

Class "A", 460 psi minimum.

• The use of Grade 7 aggregate must have prior approval of the Engineer.

• Grade 8 aggregate for use in machine-laid curb.

• Class "C-C" concrete may be used only when included in the contract or permitted by the Engineer. A high-range water-reducing admixture will be required. Class "H-H" concrete may be used only when properly certified by the Engineer.

• When Class "H-H" concrete is used, entrained air will not be required.

• Concrete classes ending in "P" designation shall conform to ASTM C618-84.

Certification of No Boycott

Effective Date: 9/1/2021

No Boycott Israel

If Contractor/Vendor is a “Company”, as that term is defined in Section 808.001 of the Texas Government Code and is not a sole proprietorship, then Contractor/Vendor certifies and verifies that it: (i) does not boycott Israel and (ii) will not boycott Israel during the term of the Purchase Order or Contract this Certification is attached to and incorporated into; or (iii) that it meets the requirements of an exception listed below.

Form requirements:

• This certification is required by Texas Government Code § 2271.002.

• This form is required to be attached to and is incorporated into all Purchase Orders (goods) and Contracts (services) with a value of $100,000 or more that is paid in whole or in part with state funds with a company with 10 or more full time employees. The campus department making the purchase of goods or contracting for services is responsible for obtaining the form from the Vendor or Contractor.

Texas Government Code §808.001 states that "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”. Furthermore, Texas Government Code §808.001 states that the term “Company” means a “for-profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit”, provided however that Texas Government Code §2271.001(2) excludes sole proprietorships from this definition of “Company”.

Vendor/Contractor Name or Company Name

Street Address

City

State

Zip Code

Phone Number

Printed Name of Authorized Representative

Title of Authorized Representative

Signature of Authorized Representative

Date

ONLY COMPLETE THIS SECTION IF YOU BELIEVE YOU ARE NOT REQUIRED TO PROVIDE THE

CERTIFICATION - No Boycott Israel - FOR THE REASONS CITED BELOW

My business is not required to provide the certification listed above because (select one):

My business is not a for-profit “Company” as defined above, pursuant to Texas Government Code §808.001 and §2271.001.

My Company has less than 10 full-time employees This is not an agreement for goods or services to be provided to the City.

Name Signature Date

No Boycott Energy Company

If Contractor/Vendor is a “Company”, as that term is defined in Section 809.001 of the Texas Government Code and is not a sole proprietorship, then Contractor/Vendor certifies and verifies that it: (i) does not boycott energy companies and (ii) will not boycott energy companies during the term of Purchase Order or Contract this Certification is attached to and incorporated into; or (iii) that it meets the requirements of an exception listed below.

• This certification is required by Texas Government Code § 2274.002.

• This form is required to be attached to and is incorporated into all Purchase Orders (goods) and Contracts (services) with a value of $100,000 or more that is paid in whole or in part with state funds with a company with 10 or more full time employees. The campus department making the purchase of goods or contracting for services is responsible for obtaining

Texas Government Code §809.001(1) states that "Boycott energy company" means “without an ordinary business purpose, 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 with a company because the company: (A) engages in the exploration, production, utilization, transportation, sale, or manufacturing of fossil fuel-based energy and does not commit or pledge to meet environmental standards beyond applicable federal and state law; or (B) does business with a company described by Paragraph (A)”. Furthermore, Texas Government Code §809.001(2) states that the term “Company” means a “for-profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit”, provided however that Texas Government Code §2274.001(2) excludes sole proprietorships from this definition of “Company”.

CERTIFICATION – No Boycott Energy Company - FOR THE REASONS CITED BELOW

My business is not required to provide the certification listed above because (select one):

My business is not a for-profit “Company” as defined above, pursuant to Texas Government Code §809.001(2) and §2274.001(2).

No Discrimination against Firearm and Ammunition Industries

If Contractor/Vendor is a “Company”, as that term is defined in Section 2274.001 of the Texas Government Code and is not a sole proprietorship, then Contractor/Vendor certifies and verifies that it: (i) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and (ii) will not discriminate against a firearm entity or firearm trade association during the term of the Purchase Order or Contract this Certification is attached to and incorporated into; or (iii) that it meets the requirements of an exception listed below.

• This certification is required by Texas Government Code § 2274.002

• This form is required to be attached to and is incorporated into all Purchase Orders (goods) and Contracts (services) with a value of $100,000 or more that is paid in whole or in part with state funds with a company with 10 or more full time employees. The campus department making the purchase of goods or contracting for services is responsible for obtaining

Texas Government Code §2274.001(3) states that " discriminate against a firearm entity or firearm trade association " means “with respect to the entity or association, to: (i) refuse to engage in the trade of any goods or services with the entity or association based solely on its status as a firearm entity or firearm trade association; (ii) refrain from continuing an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; or (iii) terminate an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association”. Furthermore, Texas Government Code §2274.001(2) states that the term “Company” means a “a for-profit organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those entities or associations that exists to make a profit. The term does not include a sole proprietorship.”

CERTIFICATION –No Discrimination against Firearm and Ammunition Industries-

FOR THE REASONS CITED BELOW

My business is not required to provide the certification listed above because (select one):

My business is not a for-profit “Company” as defined above, pursuant to Texas Government Code §2274.001(2).

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

FORM 1295CERTIFICATE OF INTERESTED PARTIES

OFFICE USE ONLOFFICE USE ONLOFFICE USE ONLOFFICE USE ONLOFFICE USE ONLYYYYY

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

Name of Interested Party

Nature of Interest (check applicable) City, State, Country

(place of business) Controlling Intermediary

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 services, goods, or other property to be provided under the contract.

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.

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

Check only if there is NO Interested Party.

Mus t fi le on lin e a t w ww.et hic s.s tat e.t x.u s/F ile

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor or other person doing business with local governmental entity

This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session.

Yes No

Yes No

Yes No

FORM CIQ

Name of Officer

This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form

CIQ as necessary.

A person commits an offense if the person knowingly violates Section 176.006, Local Government

Code. An offense under this section is a Class C misdemeanor.

(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)

OFFICE USE ONLY

Date Received

This questionnaire is being filed in accordance with Chapter 176, Local Government Code by a person who has a business relationship as defined by Section 176.001(1-a) with a local government entity and the person meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code.

Signature of person doing business with the governmental entity Date

Updated 05/20/2014

Name of person who has a business relationship with local governmental entity.

Check this box if you are filing an update to a previously filed questionnaire.

Name of local government officer with whom filer has employment or business relationship.

A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire?

B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local government entity?

C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more?

D. Describe each employment or buisness relationship with the local government officer named in this section.

PURCHASING DEPARTMENT

CITY OF WICHITA FALLS

1300 7th St., Room 113, Wichita Falls, TX 76301 t: 940.761.7466 f: 940.761.7688

The City of Wichita Falls must have a W-9 on file in order to conduct business with any vendor.

All vendors must include the following items in their bid submission:

• W-9 Form

• EIN # or Social Security #

• Current mailing address

• Current remittance address

• Sample Invoice

All accounts are to be updated or created with the following information:

Billing Address: Electronic Invoices:

City of Wichita Falls accounts.payable@wichitafallstx.gov

PO Box 1431

Wichita Falls, TX 76301

Included is an Automated Check Handling (ACH) form which may be completed by any vendors interested in receiving electronic payments.

The City’s Vendor Verification Policy can be found on our website:

http://www.wichitafallstx.gov/243/Purchasing Please review this policy at your convenience.

Jennifer Babineaux

Purchasing Manager http://www.wichitafallstx.gov/243/Purchasing

City of Wichita Falls

Electronic Fund Transfer / Email Notification Authorization Form

Type of Action: New Change

Vendor / Payee Information

Financial Institution Information

Authorization for direct deposit setup/changes/cancellations

Authorization for e-mail payment notification

Please return your completed form and a voided check to:

City of Wichita Falls

Accounting & Finance

1300 7th Street

Room 2B18

Wichita Falls, TX 76301

Email: accounts.payable@wichitafallstx.gov

Phone Number: (940) 761-7462 □ EFT change verified with vendor

E m a il

N o ti fi c a ti o n By completing this section, I authorize the City of Wichita Falls to send payment notification to the e-mail address designated below. I understand that notifications may include payment information that is considered confidential and therefore exempt from public disclosure.

Email address

Accounts Payable Use Only

Received By/Date:

Processed By/Date:

A C

H A u th o ri z a ti o n

Authorized Signature Printed Name Date

I authorize the City of Wichita Falls to deposit my payments from City of Wichita Falls to my financial institution electronically. I further understand that the City of Wichita Falls will reverse any payments made to my account in error.

Type of account (Checking or Savings)

Financial Institution name City State

Customer account number

State ZipCity

F in a n c ia l In s ti tu ti o n

Routing transit number (9 digits)

V e n d o r

P a y e e I n fo rm a ti o n

Payment Address

Cancel

Vendor or payee name

Identification Number (SSN or TIN)

Vendor contact name Title Contact Phone