ESBD_File_343916_24-09 Dawson Lake Dam Rehabilitation.pdf

Page 1 of 5 Signature___________________________________________________________________________ December 2023 RFQ ‐ Dawson Lake Dam Rehabilitation, ID#24‐10‐04

REQUEST FOR QUALIFICATIONS (RFQ)

For

Professional Engineering Services

Dawson Lake Dam Rehabilitation– City of Huntsville, Project ID #: 24‐10‐04

BID #24‐09

Funding Provided Under the:

City Funding and TBD Grant Funding

INTRODUCTION

The City of Huntsville, TX (hereinafter referred to as the “City”) invites Civil Engineers, Multi‐Disciplinary Firms, and any other qualified professionals, registered with the Texas Board of Professional Engineers, to submit qualifications to provide professional design engineering and construction support services for the Dawson Dam Rehabilitation improvement project as listed below:

Project : Dawson Lake Dam Rehabilitation Project, COH ID#: 24‐10‐04

a) Description of Dam Dam is located in Huntsville, TX, downstream of Veteran’s Memorial Parkway between

Montgomery Road and Daisy Lane

The dam is in the TCEQ inventory as Number TX07086

This dam is an earthen dam and classified as a small significant hazard dam

Dam height is 21 feet

Maximum capacity is 102 acre‐feet

Dam was built sometime in the 1970’s

b) Scope of Services Inspect dam to confirm TCEQ findings and note any differences from TCEQ inspection report

Perform a simplified breach analysis with develop breach inundation map (a detailed breach analysis may be required in a later phase)

Coordinate with City of Huntsville engineering staff to provide a plan to rehabilitation/restoration of the dam to its original purpose of flood risk reduction (actual design of rehabilitation will be a later phase)

Coordinate with City to address TCEQ inspection concerns

City of Huntsville 1220 11th Street

Huntsville, TX 77340

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Coordination, response, and follow‐up to TCEQ concerns

c) Firm Qualifications Experience with civil and hydrologic design of small dams

Surveying, including bathymetric survey of the lake

Experience with small dams (less than 40 feet and less than 1000 acre‐feet)

Experience with dam inspection (formal and informal)

Knowledge of TCEQ dam safety regulations and guidance

Experience with performing breach analyses (both simplified and detailed)

Experience with performing design storm analysis

Experience with design, and retrofit/repair/rehabilitation of dams (3 example projects)

A Map showing the location of the proposed improvements is attached to this RFQ. The City of Huntsville’s GIS web site www.huntsvillegis.com provides mapping of the City’s various existing infrastructure features, including water and wastewater.

The design and construction cost of the above improvements will be achieved with City Funds and if available, to be determined, Grant Funding.

CONTRACTUAL SCOPE OF WORK EXPECTATIONS

The selected firm should anticipate the negotiated scope of work for professional engineering services will include standard engineering Phases I, II, and III services consideration of the following:

1) Field Surveying and Data Collection

2) Preliminary Engineering Report

3) Final Design – Drawings, Details and Bid and Construction Documents

4) Bid Phase Services

5) Construction Phase Services

6) Specialized Services

The City reserves the right to authorize services in Phases or combinations thereof.

SUBMITTAL REQUIREMENTS FOR THIS RFQ

Proposal should be limited to no more than twenty (20) single sided pages, (not including signed RFQ packet) containing design approach, task breakdowns, schedule for the task breakdowns, qualifications, and similar work experience. This RFQ, Cover Letter, and included attachments are not counted towards the page limit.

The proposal should be accompanied by a brief introductory letter stating your firm’s interest in design of the project. The introductory letter should be limited to no more than two single‐sided pages and include all contact information.

SOQ must discuss the following elements:

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1) About the Firm: All information that the firm believes would help the City of Huntsville in getting to know about the firm (e.g., firm’s history, office locations, brief overview of the services offered, etc.) may be included in this section. Provide firm’s experience on similar / related projects during the last five (5) years.

2) Similar Projects: List a minimum of five (5) projects of a similar nature with brief narratives for the City to consider for evaluation. Specify key project personnel who represented the firm for these projects.

3) Resumes: Provide resumes of key members that the firm proposes to utilize for the City of Huntsville projects.

4) Sub‐consultants: List sub‐consultants that the firm may plan to use services of in certain areas of specialization, and provide sub‐consultants’ experience, key personnel and any other additional relevant information.

5) References: Provide a minimum of five (5) references with necessary contact information and the nature of firm’s involvement with each of the reference.

SUMMARY REQUIRED SUBMITTAL & FORMS

The submittal shall include the following:

1. Introductory Letter – The introductory letter shall be limited to no more than two single sided pages and include all contact information.

2. Proposal – Include no more than twenty (20) single sided pages, (not including signed RFQ packet) containing design approach, task breakdowns, schedule for the task breakdowns, qualifications and similar work experience.

3. System for Award Management – Service provider and its Principals, may not be debarred or suspended nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM). Include verification that the service provider as well as the principals are not listed (are not debarred) through the SAM (www.SAM.gov). Enclose a printout of the search results that includes the record date.

4. Legal Firm Name Disclosure – The form is attached and must be submitted with the response.

5. Debarment Certification – Debarment Certification is required on all negotiated contracts and the form is attached and must be submitted with the response.

6. Child Support Statement for Negotiated Contracts and Grants – The applicant must certify that the individual or business entity named in this contract, bid, or applicant is eligible to receive the specified grant, loan, or payment and acknowledges that this contract may be terminated and payment may be withheld if this certification is inaccurate. The form is attached and must be submitted with the response.

7. Form 1295 – Government Code 2252.908 states that a governmental entity or state agency may not enter into a contract with a business entity unless the business entity submits a disclosure of interested parties to the governmental entity at the time the business entity submits the signed contract. A copy of a Certificate of Interested Parties, Form 1295 is attached for reference and must be submitted at the time of signed contract submission.

8. Certification Regarding Lobbying for Grants, Contracts, Loans, and Cooperative Agreements – Certification for Contracts, Grants, Loans, and Cooperative Agreements is included in the RFQ and must be submitted with the response.

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9. Conflict of Interest Questionnaire Form CIQ – Texas Local Government Code Chapter 176 requires that any vendor or person who enters or seeks to enter into a contract with a local government entity, disclose in the Questionnaire Form CIQ the vendor or person’s employment, affiliation, business relationship, family relationship, or provision of gifts that might cause a conflict or interest with a local government entity. Questionnaire form CIQ is included in the RFP and must be submitted with the response.

10. Insurance – As per City of Huntsville minimum insurance requirements, provide a copy of your current certificate of insurance to include professional liability. Prior to the Notice to Proceed is issued/Contact signed the awarded firm must provide a certificate of insurance listing the City of Huntsville as an additional insured. Certificate of Liability Insurance to be presented to the City of Huntsville. In Description of Operations will need wording similar to: Blanket additional insured is added in favor of the certificate holder with respects to the general liability coverage, as required by a written contract. Blanket Waiver of Subrogation is added in favor of the certificate holder with respects to workers compensation coverage, as required by a written contract. Certificate Holder to be: City of Huntsville, 1220 11th Street, Huntsville, TX 77340. A sample of the form and the information required is attached.

11. Non‐Collusion Affidavit – A Non‐Collusion Affidavit is required on all bids or proposals and the form is attached and must be submitted with the response.

12. Critical Infrastructure Verification Form – Critical Infrastructure reference requirements and verification form is attached and must be submitted with the response.

13. Firearm Verification Form – Firearm referenced requirements and verification form is attached and must be submitted with the response.

14. Prohibition on Boycotting Israel Verification and Doing Business With Certain Companies – In accordance to Chapter 2271 of the Govern Code presents that contracts that are between a government entity and a company with 10 or more full‐time employees and has a value of $100,000 or more, a governmental entity may not enter into a contract with a company for goods or services unless the contract contains a written verification form the company that it does not boycott Israel and will not boycott Israel during the term of the contract. The form to be executed is attached and must be submitted with the response.

15. Iran, Sudan and Foreign Terrorist Organizations Verification Form – Iran, Sudan and Foreign Terrorist Organizations reference requirements and verification form is attached and must be submitted with the response.

16. Prohibition of Contracts Discriminating Against Energy Company Boycott Verification Form – Prohibition of Contracts Discriminating Against Energy Company Boycott reference requirements and verification form is attached and must be submitted with the response.

17. Texas Public Information Act Verification Form – Texas Public Information Act Verification Form reference requirements and verification form is attached and must be submitted with the response.

SELECTION PROCEDURE

Subsequent to the deadline for acceptance of submittals for this RFQ, the City will evaluate the submittals and will determine rankings based upon materials submitted and oral interviews (if deemed necessary by the City) using the selection criteria and weights indicated below. There may be additional forms and agreements which will require signature. Omitted forms or lack of signatures may be reason to reject and proceed to next ranking firm. The City will contact the firm with the highest ranked submittal to negotiate a contract fee.

If an agreement cannot be reached with the top ranked firm, the City will contact the firm with the next ranked submittal and attempt to negotiate with that firm. The process will be repeated until an agreement is reached. Aside from eventually announcing the successful consultant, the rankings will be kept confidential to the fullest extent of the law.

SELECTION CRITERIA

The Consultant selected for this project should have demonstrated experience in civil engineering design specific to drainage and street improvement projects. Selection shall be based on including but not limited to the following:

Experience Maximum 60 Points

1. Consultant’s experience with projects of similar complexity.

2. Experience with Federal and Grant Programs

3. Qualifications of the Consultant’s staff being assigned to this project.

Work Performance Maximum 25 Points

1. Demonstrated ability of the Consultant to perform high quality work, to control costs and to meet schedules.

2. Consultant’s understanding of the City’s desires and general approach to the projects.

Capacity to Perform Maximum 15 Points

1. Completeness of the work elements included in the RFQ.

2. Feedback from references.

Should the City determine that interviews are desirable, up to 25 additional points may be granted based on those interviews. Ranking will be on a total point basis.

SUBMITTAL DEADLINE

Five (5) bound copies and one flash drive digital pdf copy of the proposal should be forwarded to the attention of City Secretary’s Office, City of Huntsville, 1220 11th Street, Huntsville, TX 77340 by 2:30 p.m., Thursday, December 21, 2023.

The City reserves the right to waive any irregularities or reject any and all proposals .Any submittal received after the specified date and time will automatically be rejected and will not receive any further consideration by the City. Postmarks will not be accepted.

QUESTIONS ON RFQ

All questions regarding this solicitation should be directed by email to Lucy Gonzalez, Purchasing Manager, at lgonzalez@huntsvilletx.gov. Questions may be submitted through 4:00 p.m., Wednesday, December 13, 2023.

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CITY SERVICE CENTER

448 STATE HIGHWAY 75

HUNTSVILLE, TX, 77320

Map Created At:

www.huntsvilletx.gov/gis

CITY OF HUNTSVILLE, TX

ENGINEERING DEPARTMENT / GIS DIVISION

8 0 310 620155

FEET

CREATED DATE: 3/7/2023

Coordinate System: NAD 1983 StatePlane Texas Central FIPS 4203 Feet On Any Print Size

1 in = 600 ft On 8.5 x 11 inch Print

Service Layer Credits:

Dawson Lake and Autumn Rd Drainage

The City of Huntsville, Texas or its employees gives NO warranty, expressed or implied, as to the accuracy, reliability, or completeness of these data. See the full GIS Data Disclaimer at: www.huntsvilletx.gov/438/City-Maps

30.684 Latitude

-95.557 Longitude

30.678 Latitude

-95.550 Longitude

30.676Latitude -95.554 Longitude

30.683 Latitude

-95.557 Longitude

Dawson Lake Dam Repairs

Autumn Road Culvert Replacement

Autumn Road to Winter Way Desilting of McDonald Creek

LEGAL FIRM NAME DISCLOSURE

Prime providers and sub-providers proposing on this contract are required to disclose all legal firm name changes under which they have performed work within the last five years.

Still in Business Under Prior Present Name Prior Name(s) Name YES/NO Dates Effective

Signature – Company Official Printed/Typed Firm Name

Printed/Typed Name and Title Date

DEBARMENT CERTIFICATION

(Negotiated Contracts)

1. The CONSULTANT certifies to the best of its knowledge and belief that it and its 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 proposal 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 statement, or receiving stolen property;

c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission or any of the offenses enumerated in Paragraph 1.b. or this certification;

d. Have not within a three-year period preceding this application/proposal had one or more public transactions (federal, state, or local) terminated for cause or default; and

2. Where the CONSULTANT is unable to certify to any of the statements in this certification, such CONSULTANT shall attach an explanation to this certification.

CHILD SUPPORT STATEMENT FOR

NEGOTIATED CONTRACTS AND GRANTS

Under Section 231.006, Family Code, the vendor or applicant certifies that the individual or business entity named in this contract, bid, or application is eligible to receive the specified grant, loan, or payment and acknowledges that this contract may be terminated and payment may be withheld if this certification is inaccurate.

List below the name and social security number of the individual or sole proprietor and each partner, shareholder, or owner with an ownership interest of at least 25% of the business entity submitting the bid or application.

NAME SOCIAL SECURITY NUMBER

Section 231.006, Family Code, specifies that a child support obligor who is more than 30 days delinquent in paying child support and a business entity in which the obligor is a sole proprietor, partner, shareholder, or owner with an ownership interest of at least 25% is not eligible to receive payments from state funds under a contract to provide property, materials, or services; or receive a state-funded grant or loan.

A child support obligor or business entity ineligible to receive payments described above remains ineligible until all arrearage have been paid or the obligor is in compliance with a written repayment agreement or court order as to any existing delinquency.

Except as provided by Section 231.302(d), Family Code, a social security number is confidential and may be disclosed only for the purposes of responding to a request for information from an agency operating under the provision of Parts A and D of Title IV of the federal Social Security Act (42 USC Section 601417 and 651-669).

FORM 1295 NOTIFICATION

Pursuant to newly enacted Section 2252 of the Texas Government Code as of January 1, 2016, any business entity entering into a contract with a local government that requires approval of the governing body must submit a Disclosure of Interested Parties to the local government prior to the execution of the contract. The Texas Ethics Commission (TEC) has adopted a form for the Disclosure of Interested Parties (Form 1295) and has created a website application for business entities to submit the required information.

The City of Huntsville may not enter into a contract that requires the approval of the City Council until the business entity that is a party to the contract files a Form 1295 with the Texas Ethics Commission and the City of Huntsville Purchasing Department.

1. Upon being notified of a bid/recommended award, the award recipient, the business entity, must go the following website: https:///www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm and follow the login directions on the website application to complete a Form 1295. It this is a business entity’s first time login on to the website application, the business entity must create a login Username and Password then follow the application’s instructions to complete a Form 1295.

2. The City does not have a Contract ID Number System. Please insert the City of Huntsville’s bid or project number in this box.

3. Once confirmation is received, that the information has been submitted with the Texas Ethics Commission, the business entity MUST print, sign and date Form 1295.

4. Form 1295 must be filed with the Texas Ethics Commission within seven (7) business days of the date of notification of recommended award. The contract will not be presented to City Council until the form has been filed with the Texas Ethics Commission and the City of Huntsville has received Form 1295.

5. In no way does a request for filing of Form 1295 with the Texas Ethics Commission commit the City to any type of award whatsoever.

6. Once the City of Huntsville Purchasing Department receives Form 1295, the Purchasing Department will submit confirmation of receipt through the Texas Ethics Commission website within thirty (30) days.

7. This process must be followed for each contract requiring City of Huntsville Council approval.

8. A Form 1295 cannot be hand written. It must be completed electronically through the Texas Ethics Commission website application.

9. If you have any questions contact the City of Huntsville Purchasing Department, 936.291.5495 Mail signed Form 1295 to Attention Purchasing Department, City Service Center, 448 SH 75 N, Huntsville, TX 77320.

Certification Regarding Lobbying

(To be submitted with each bid or offer exceeding $100,000)

The undersigned certifies, to the best of his or her knowledge and belief, that:

(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

(c) The undersigned shall require that the language paragraph 1 and 2 of this anti-lobbying certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995).

The Contractor, ___________________, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any.

Signature of Contractor’s Authorized Official

Printed Name and Title of Contractor’s Authorized Official

Date

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks “Subawardee,” then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., “RFP-DE-90-001.”

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI).

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503

Approved by OMB

0348-0046

Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden disclosure)

Type of Federal Action:

a. contract

____ b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

Status of Federal Action:

a. bid/offer/application

_____ b. initial award

c. post-award

Report Type:

a. initial filing _____ b. material change

Name and Address of Reporting Entity:

____ Prime _____ Subawardee

Tier______, if Known:

Congressional District, if known:

If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Congressional District, if known:

Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable: __________________

Federal Action Number, if known: 9. Award Amount, if known:

10. a. Name and Address of Lobbying Registrant (if individual, last name, first name, MI):

b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI):

11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Signature: __________________________________

Print Name: _____

Title: _____

Telephone No.: ____________ Date: _______

Federal Use Only Authorized for Local Reproduction

Standard Form - LLL (Rev. 7-97)

ATTACHMENT A

MEMORDANDUM

Certificate of Insurance Explanations and Summary Requirements

To: Consultants / Contractors Prepared by: Engineering Department, City of Huntsville, Texas Date: Revised May 18, 2022

This memorandum addresses standardizing the City of Huntsville’s requirements for Certificates of Insurance, to facilitate the processing of Professional Services and Construction Contracts. It is recommended that the following information be reviewed by Consultants / Contractors to insure complete Certificates of Insurance are provided as part of the contracting process. A sample insurance form is attached, matching the numbered listings provided below:

1. Certificate must not be more than 12 months old.

2. Name and address of producer writing coverage.

3. Name of insurance company providing coverage as listed in Best's Key Rating Guide or on Company’s

Certificate of Authority on file with Texas Department of Insurance. Company must have rating of B+ or better; provided, however, that this requirement will be waived for workers compensation coverage if the coverage is placed with a company that participates in the State of Texas Workers' Compensation Assigned Risk Pool.

4. Name and address of insured, as shown on policy.

5. Must reference the insurer of the policy being described.

6. Must be a policy number, no binders.

7. Date policy became effective.

8. Must maintain and provide a current certificate.

9. Check limits of liability against contract.

10. Must check either; 1) Any Auto, or 2) All Owned, Hired, and Non-Owned Autos.

11. Statutory limits must be checked per our ordinance.

12. Must name the City as Additional Insured on Commercial General Liability and Automobile Liability.

Must have a Waiver of Subrogation in favor of the City on Commercial General Liability, Automobile Liability, and Workers' Compensation/Employers' Liability.

13. Name and file number of project.

14. Address of the City of Huntsville and the name of the project manager or City Engineer.

15. Cancellation clause of the underlying policy must be endorsed to provide that, "should any of the above described policies be canceled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder named."

16. Signature or facsimile signature of authorized representative of producer.

UNLESS OTHERWISE SPECIFIED:

Minimum Insurance Requirements: Small contracts (less than $50,000.00)-Workers compensation insurance and Automobile Liability Insurance required by law.

The awarded responder shall furnish and keep in full force (at its own cost and expense) the following insurance for the duration of the project and for one year after that:

Certificate of Insurance Explanations and Summary Requirements Revised May 18, 2022

a. Workers Compensation/Employers Liability Insurance: The Contractor shall take out and maintain during the life of this contract, Employers’ Liability and Worker's Compensation Insurance for all of their employees employed at the site of the work, and in case any work is sublet, the Contractor shall require the subcontractor similarly to provide Worker's Compensation Insurance for all of the latter's employees unless such employees are covered by the protection afforded by the Contractor. The City of Huntsville requires a waiver of subrogation against the City. Workers' Compensation limits as required by the Labor Code of the State of Texas and Statutory Employer's Liability Limits.

b. Commercial General Liability at minimum combined single limits of ($1,000,000 per occurrence and $2,000,000 general aggregate) for bodily injury, personal injury and for property damages. Policy will include coverage for a) Premises Operations; b) Contractual Liability; c) Products and Completed Operations at $1,000,000 per occurrence; d) Personal Injury; e) Property Damage; f) Explosion Collapse and Underground (XCU) Coverage (when applicable), Fire Damage, Medical Expense. NOTE: The aggregate loss limit applies to each project. The Contractor shall cause all Subcontractors to maintain the same insurance.

c. Commercial Automobile Liability at minimum combined single limits of $300,000 per occurrence for Bodily Injury and Property Damage, including owned, non-owned, and hired vehicle coverage.

d. Professional Liability Insurance shall be $1,000,000 per occurrence.

e. Builders Risk Insurance for “each” housing unit/structure in the amount of $100,000 if applicable.

f. Product Liability Insurance will be required when applicable.

All insurance must be written on forms filed with and approved by the Texas Board of Insurance. Certificates of Insurance shall be prepared and executed by the insurance company or its authorized agent.

All insurance must be written on forms filed with and approved by the Texas Board of Insurance. Certificates of Insurance shall be prepared and executed by the insurance company or its authorized agent.

The awarded responder shall furnish at their own expense to the City of Huntsville, a Certificate of Liability Insurance listing the City as an “Additional Insured” via endorsement. In Description of Operations will need wording similar to: Blanket additional insured is added in favor of the certificate holder with respects to the general liability coverage as required by written contract. Blanket Waiver of Subrogation is added in favor of the certificate holder with respects to workers compensations coverage as required by written contract.

Certificate Holder to be: City of Huntsville, Attn: Engineering Department, 1212 Ave M, Huntsville, TX 77340.

The required insurance must contain a provision that at least thirty (30) days prior notice of cancellation, non-renewal, or material change of said insurance shall be submitted to the city, by the insurance company. The City reserves the right to full, certified copies of all required insurance policies when requested in writing.

Insurance will be required prior to purchase order being issued.

Attachments:

Sample Only Certificate of Liability Insurance

Non-Collusion Affidavit

1. He/she is ____________________________________of___________________________, the responder that has submitted the attached bid or proposal.

2. He/she is fully informed respecting the preparation of contents of the attached bid or proposal and of all pertinent circumstances respecting such bid or proposal.

3. Such bid or proposal is genuine and is not collusive or a sham bid or proposal.

4. Neither the said responder not any of its officer, partners, owners, agents, representative, employees or parties in interest, including this affidavit, has in any way colluded, conspired, connived or agreed, directly or indirectly with another responder, firm or person to submit a collusive or sham bid or proposal in connection with the contract for which the attached bid has been submitted or to refrain from responding in connection with such contract, or has in any manner, directly or indirectly, sought by agreement of collusion or communication or conference with any other responder, firm or person to fix the price or prices in the attached bid or proposal or of any other responder, of to fix an overhead, profit or cost element of the bid price of the bid price of any other responder, or to secure through any collusion, conspiracy, connivance of unlawful agreement any advantage again the City of Huntsville or any per interest in the proposed contact.

5. In compliance with the specifications in the bid or proposal and quote conditions, I, the undersigned agree to furnish the services upon which prices are offered at the price opposite to each line description to the City of Huntsville within the time specified. By submitting this bid/proposal and attached signature I hereby attest that I have not received nor offered anything of value to any City employee, official, and/or board member in connection with this submitted bid or proposal.

6. Advanced disclosures of any information to any particular/potential responder which gives that particular/potential responder any advantage over any other interested responder in advance of the award whether in response to advertising or an informal request for bids or proposals, made or permitted by a member of the governing body or an employee or representative thereof, will cause to void that particular responders bid or proposal. Prior to an award any communication with a member of the selection committee or governing board will cause to void those particular responders bid or proposal and the committee member or the governing board member will be rejected from the voting process for that bid or proposal. By submission of this bid or proposal responder attests that no improper communication has occurred resulting in an advantage over any other responder, potential responder, or advance discloser.

7. The price or prices quoted in the attached bid or proposal are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the responder or any of its agents, representative, owners, employees, or parties in interest, including this affidavit.

Signature

Printed Name

Firm Name

Critical Infrastructure Verification Form

To the extent this proposal relates to critical infrastructure in the State of Texas, I, , the undersigned representative of (the “Company”) do hereby declare, represent, and verify that the Company is not owned by or has the majority of stock or other ownership interest held by or controlled by: individuals who are citizens of China, Iran, North Korea, Russia, or a country designed by the Governor of Texas as a threat to critical infrastructure under Section 2274.0103 of the Texas Government Code as amended (“designated country”); or

1. a company or other entity, including a governmental entity, that is owned or controlled by citizens of or is directly controlled by the government of China, Iran, North Korea, Russia, or a designated country; or

2. it is not headquartered in China, Iran, North Korea, Russia, or a designated country.

The foregoing representation is made solely to comply with Chapter 2274 of the Texas Government Code, as amended, and to the extent such Section does not contravene applicable federal or State law. As used in the foregoing verification, “critical infrastructure” means a communication infrastructure system, cybersecurity system, electric grid, hazardous waste treatment system, or water treatment facility.

Date Signature

Firearm Verification Form

I, , the undersigned representative of (the “Company”) do hereby declare, represent, and verify that the Company, under the provisions of Chapter 2274 of the Texas Government Code, as amended:

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 the contract against a firearm entity or firearm trade association.

Pursuant to Chapter 2274 and Section 809.001 of the Texas Government Code:

1. “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.

2. “Company” means 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 business associations that exist to make a profit.

EXCLUSION FROM CHAPTER 2274 OF THE TEXAS GOVERNMENT CODE

I, ________________________, the undersigned representative of _____________________ (the

“Company”) do hereby declare, represent, and verify that the Company is excluded from Chapter 2274 because the contract in question:

☐ will be between a governmental entity and a company with fewer than 10 full-time employees, ☐ will have a value of less than $100,000 that is to be paid wholly or partly from public funds of the governmental entity;

☐ will be between a governmental entity and a sole proprietor; or ☐ is an exempt contract under Section 2274.003 of the Texas Government Code.

Please check exceptions, if any, that apply to the potential contract between New Braunfels Utilities and the Company.

Israel Verification Form

“Company”) do hereby declare, represent, and verify that the Company, under the provisions of Chapter 2271 of the Texas Government Code, as amended:

1. does not boycott Israel currently; and

2. will not boycott Israel during the term of the contract.

Pursuant to Section 2271.001 of the 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 organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly

EXCLUSION FROM CHAPTER 2271 OF THE TEXAS GOVERNMENT CODE

“Company”) do hereby declare, represent, and verify that the Company is excluded from Chapter 2271

☐will be between a governmental entity and a company with fewer than 10 full-time employees;

☐ will have a value of less than $100,000 that is to be paid wholly or partly from public funds of the governmental entity; or ☐ will be between a governmental entity and a sole proprietor.

Please check exceptions, if any, that apply to the potential contract between The City of Huntsville, Texas and the Company.

Iran, Sudan and Foreign Terrorist Organizations Verification Form

“Company”) do hereby declare, represent, and verify that the Company, under the provisions of Chapter 2252 of the Texas Government Code, as amended:

1. will not do business with Iran, Sudan, or any foreign terrorist organization; and

2. will not do business with Iron, Sudan, or any foreign terrorist organization during the term of the contract.

Prohibition of Contracts Discriminating Against Energy Company Boycott Verification Form

I, , the undersigned representative of (the “Company”) do hereby declare, represent, and verify that the Company, under the provisions of Chapter 2274 of the Texas Government Code, as amended:

1. does not boycott energy companies currently; and

2. will not boycott energy companies during the term of the contract.

Pursuant to Chapter 2274 and Section 809.001 of the Texas Government Code:

1. "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).

2. “Company” means a for-profit organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly

EXCLUSION FROM CHAPTER 2274 OF THE TEXAS GOVERNMENT CODE

“Company”) do hereby declare, represent, and verify that the Company is excluded from Chapter 2274

☐will be between a governmental entity and a company with fewer than 10 full-time employees;

☐ will have a value of less than $100,000 that is to be paid wholly or partly from public funds of the governmental entity; or ☐ will be between a governmental entity and a sole proprietor.

Please check exceptions, if any, that apply to the potential contract between The City of Huntsville, Texas and the Company.

Texas Public Information Act Verification Form

“Company”) do hereby acknowledge that the requirements of Subchapter J, Chapter 552, Government Code, may apply to this solicitation, proposal and any resultant contract, and agree that the contract can be terminated if the contractor or vendor knowingly or intentionally fails to comply with a requirement of that subchapter.