CTR063924_Contract_Amendment_Summary_One__1_.pdf

ARIZONA DEPARTMENT OF TRANSPORTATION

1655 W. Jackson Street, MD 100P

Phoenix, AZ 85007

Contract Amendment Summary CONTRACTOR: Senergy Petroleum AMENDMENT NO.: One (1) DESCRIPTION: Vehicle Lubricants

Rev. 04/2020

Procurement

Pursuant to the Uniform Terms and Conditions, Section 5, Contract Changes, the above referenced contract is amended. Summary of changes is as follows:

1. Amendment One (1) to mutually extend this contract from January 11, 2024 through January 10, 2025 unless terminated, canceled or extended as otherwise provided in the contract.

2. The executed SPO205 Forced Labor of Ethnic Uyghurs Ban form is hereby included with this amendment.

3. All other terms, conditions and provisions of this contract remain unchanged.

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Solicitation No: BPM Available online at https://app.az.gov

SPO Form 205 (rev 09-2022)

Procurement

ATTACHMENT

FORCED LABOR OF ETHNIC UYGHURS BAN

Forced Labor of Ethnic Uyghurs Ban

Please note that if any of the following apply to the Contractor, then the Offeror shall select the “Exempt Contractor” option below:

Contractor is a sole proprietorship;

Contractor has fewer than ten (10) employees; OR

Contractor is a non-profit organization.

Pursuant to A.R.S. § 35-394, the State of Arizona prohibits a public entity from entering into or renewing a contract with a company unless the contract includes written certification that the company does not use the forced labor, or any goods or services produced by the forced labor, of ethnic Uyghurs in the People's Republic of China.

Under A.R.S. §35-394:

1.

2.

"Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company or other entity or business association, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full-time employees.

"Public entity" means this State, a political subdivision of this State or an agency, board, commission or department of this State or a political subdivision of this State.

In compliance with A.R.S. §§ 35-394 et seq., all offerors must select one of the following:

The Company submitting this Offer does not use, and agrees not to use during the term of the contract, any of the following:

• Forced labor of ethnic Uyghurs in the People’s Republic of China;

• Any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China; or

• Any Contractors, Subcontractors, or suppliers that use the forced labor or any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China.

☐ The Company submitting this Offer does participate in use of Forced Uyghurs Labor as described in A.R.S. § 35-394.

Exempt Contractor.

Indicate which of the following statements applies to this Contractor (may be more than one):

☐ Contractor is a sole proprietorship;

☐ Contractor has fewer than ten (10) employees; and/or

☐ Contractor is a non-profit organization.

Signature of Person Authorized to Sign

Carlos Zubiate Printed Name

Contract Specialist

Senergy Petroleum, LLC.

Company Name

1470 N. Horne St.

Address

Gilbert, AZ 85233

City State Zip Title

July 20, 2023

Date https://app.az.gov/