ROAD MATERIALS BID PACKET 2027.pdf

COUNTY OF REFUGIO

INVITATION TO BID, BID SPECIFICATIONS AND BID FORM

FOR

ANNUAL SUPPLY CONTRACT FOR

ROAD MATERIALS, ASPHALTS & FUEL

BIDS WILL BE RECEIVED UNTIL

11:00 A.M. NOVEMBER 6, 2026

AT THE OFFICE OF

PRISCILLA ZUNIGA, FIRST ASSIST ANT AUDITOR

ROOM 107, 808 COMMERCE, REFUGIO COUNTY, TEXAS

PUBLIC BID OPENING WILL BE

AUDITOR'S OFFICE

808 COMMERCE, ROOM 107

COURTHOUSE

REFUGIO, TEXAS

Refugio County

Complete all forms and return SEALED bid via online or by mail:

Priscilla Zuniga-First Assistant Auditor 808 Commerce, Room 107 Refugio, Texas 78377 (361)526-4434 https://www.beaconbid.com/solicitations/refugio-county

*Name of company must be listed on outside of bid envelope.

Sealed bids will be accepted until 11:00 A.M., Friday, November 6, 2026 at which time they will be publicly opened and read. Bids are expected to be awarded on Tuesday, November 10, 2026 at 9:00 AM during Commissioners Court regular meeting.

*** Refugio County reserves the right to accept or reject any and all bids. ***

By submitting this bid I agree that, if awarded, this material bid form will serve as a true and binding contract with a duration of 1 year beginning on January 1, 2027 and ending on December 31, 2027

Either party may terminate this agreement upon thirty (30) days written notice to the other party.

Attested by: _____________ _ Company Representative

Company Name

Address

E-mail

Phone#

Company Signature

Attested by:

(After bid award) Refugio County Commissioner

Refugio County Commissioner

Refugio County Commissioner

Refugio County Commissioner

Address

Phone#

Fax#

County Judge Signature

INVITATION TO BID

Notice is hereby given that the Commissioner's Court of Refugio County, Texas, will receive sealed bids for the following:

ANNUAL SUPPLY CONTRACT FOR ASPHALTS, ROAD MATERIALS, FUEL & OIL

Bid specifications may be obtained on at The County Auditor's office located at 808 Commerce Room 1 07, Refugio, Texas 78377.

Bidders should use lump sum pricing or unit pricing, if appropriate. A bidder's bond is not required.

Payments will be made by the County Auditor from currently budgeted funds in accordance with the State of Texas Prompt Payment Act, Chapter 2251, Government Code VTCA.

Bids should be submitted via online through the Refugio County website e-bid or in a sealed envelope to Priscilla Zuniga, Refugio County First Assistant Auditor at 808 Commerce, Room 107, Refugio, Texas until 11:00 A.M. FRIDAY, NOVEMBER 6, 20 26 at which time the bids will be opened in the Auditor's office. Award wi II be made during Commissioners' Court on Wednesday December 17, 2 0 25 at 9 a. m.

The outside of the envelope shall be plainly marked:

BID - ANNUAL SUPPLY CONTRACT FOR ASPHALTS,

ROAD MATERIALS, FUEL & OIL

Refugio County reserves the right to accept or reject any and/or all bids or any portion of a bid and to waive informalities or defects in bids or to accept such bids as it shall deem to be in the best interest of Refugio County. Refugio County also hereby expressly reserves the right to take up to forty-five (4 5) days after formal bid opening to render a decision. Small and minority businesses, women's business enterprises, and labor surplus area firms are encouraged to submit

;��;d �ids and vendors using subcontracto such fir s in accordance with 2 CFR

Priscilla Zuniga�nt Auditor Refugio County, Texas

COUNTY OF REFUGIO, TEXAS

PURCHASE SPECIFICATIONS

1.0 GENERAL TERMS AND CONDITIONS

1,01 Purchase Contract

The successful bidder may be asked to enter into a contract with the County of Refugio. The contract will include the specifications herein listed and any other pertinent information. The contract period will begin January I, 2025 and terminate December 31, 2025.

1.02 Description of Supplies

Any catalog or manufacturer'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. A conversion factor for pounds per cubic yard for each Item shall also be furnished.

1.03 Discounts

Bids submitted will be considered as competitive and should reflect any and all discounts offered to the County of Refugio.

1.04 Withdrawal of Bids

Bids may not be withdrawn after the time set for the bid opening. A bid that has been opened is not subject to amendment, alteration, or change for the purpose of correcting an error in the bid price. Bids containing an error may be offered "as is" or withdrawn by the bidder in accordance with applicable State Laws.

1.05 Firm Time of Bids

The bid prices shall remain firm for the term of the contract.

1.06 Pricing

Bidder shall use unit pricing. Include all pricing in the bid and ensure lowest and final offer.

Price will remain firm for the term of the contract, upon award the County will provide a fuel adjustment sheet for delivered road materials.

Purchase Specifications, Page 2

1.01 Payment

The method of payment shall be from Current Operating funds within thirty (30) days of receipt of correct invoice. Certified weight tickets signed by the Commissioner or his designated representative must accompany each invoice.

1.08 Sales Tax

These items will be exempt from payment of State and Local Sales Tax. The County of Refugio will furnish an Exemption Certificate to the successful bidder ifrequired.

1.09 Late Bids·

Bids received after the specified opening time and date will remained sealed.

1.10 Fundln,: Source

These purchases will be funded by the County of Refugio and/or grant.

1.11 Bid Document

One complete Bid Document which contains the Invitation to Bid, Bid Specifications and Bid Forms must be returm;d in its entirety.

1,12 Delivel'.Y Time

All materials ordered will be delivered to.the delivery site designatid and within twenty four (24) hours from the time of order. In the event a contracted vendor is unable to deliver the materials ordered within twenty four (24) hours from the time of order the County reserves the right to re-order the said material from any other vendor.

1.13 Cancellation of Contract

Failure to comply with any an/or all provisions of this contract and any other pertinent requirements of the County of Refugio will constitute grounds for cancellation.

Purchase Specifications, Page 3

1.14 Tran11portation

All bids must include the cost of transportation FOB• delivery sites as stated herein, unless materials are to be picked up by the County of Refugio at vendor's plant. Refugio County reserves the right to specify the type of delivery vehicle used by the vendor, i.e. belly dump truck, regular dump truck, etc.

1.15 Delivery Sites

(1) Precinct No. 1 Yard, Refugio, Texas

(2) Precinct No. 2 Yard, Bonnieview, Texas

(3) Precinct No. 3 Yard, Refugio, Texas

(4) Precinct No. 4 Yard, Tivoli, Texas

(5) Picked up at Vendor's Plant by the County of Refugio.

1.16 Bid Evaluation Factor11

A. Most Advantageous Bid. If awarded, the County of Refugio will award contracts to the lowest and/or best responsible bidder which represent the most advantageous bid to the County. In determining the most advantageous bid or proposals, price, quantifiable factors, and other factors are considered. This would include specifications, delivery requirements, the initial purchase price, life expectancy, cost of maintenance and operation, operating efficiency, training requirements, disposal value, and other factors contributing to the overall cost of an item. Consideration may be given, but not necessarily limited to conformity to the specifications, product warranty, a bidder's proposed service, ability to supply and provide service, delivery to required schedules, and past performance in other contracts with the County including timely delivery.

B. Partial Awards. Where an invitation to bid includes groups of items bidders may furnish pricing for all or any portion of the bid invitation. Unless the bidder specifies otherwise in his bid, the County may award the contract for any item or group of items, including transportation as stated on the bid invitation.

Purchase Specifications, Page 4

C. Reservations. The County expressly reserves the right to:

1. Waive as an infonn.ality, minor deviations from specifications that do not impair overall function;

2. Waive any defect, in'egularity or infonnality in any bid or bidding procedure;

3. Reject or cancel any or all bids;

4, Reissue a bid invitation;

5. Extend the bid opening time and date;

6, Procure any item by other means;

7. Increase or decrease the quantity specified in the bid invitation;

8. Consider and accept an alternate bid as provided herein when most ' advantageous to the County;

9. The County of Refugio wj)l not consider alternate bids unless provided for herein. J

1.17 Indemnification

The Contramr and its' sureties shall defend, indemnify and hold harmless the County of Refugio and all its oficers, agents, and employees from all suits, actions or claims of any character, name and description including attorney's fees/expenses brought for any injuries to persons or damages to property in connection with this contract and so much of the money due the Contractor under this Coniract as shall be considered money is due, the sureties shall be held, until all suits, aotions, and claims shall have been settled and satisfactozy evidence to that effect furnished the County.

The Contractor and its sureties expressly agree to defend, indemnify and hold harmless the County, its officers, agents, and employees in accordance with this clause regardless of whether the injury or damage is caused in whole or in part by the county, its officers, agents or employees.

1.18 HB 1Z95

Vendor must complete Form 1295 online with the Texas Ethics Commission ("TEC"), The TEC website can be accessed at http://www.ethics.state.tx.us/file/.

Business entities MUST complete Form on line prior to contracting with Refugio County. Upon completing the form, the TEC website will generate a PDF .version of the business entity,'s Form 1295, including creating a unique "Certificate Number" that is stamped in the upper right hand corner of the form. The business entity, must then execute a hard copy, of the form and submit it to Refugio County, with the submitted bid documents. Failure to submit Form 1295 with the bid documents will result in disqualification.

Submission Forms Requirements

• • Form CIQ, enclosed. 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 of interest with a local government entity. Questionnaire form CIQ is included in the RFP and must be submitted with the response.

• Noncollusion affidavit of prime bidder

• Child Support statement certification

• • System for Award Management. Consultant/Firm is not debarred or suspended from the

Excluded Parties List System (EPLS) in the System for Award Management (SAM). Include verification that your company as well as the company's principal is not listed (is not debarred) through the System for Award Management (www.SAM.gov). Enclose a print out of the search results that includes the record date.

• • Certification Regarding Lobbying, enclosed. Certification for Contracts, Grants, Loans, and Cooperative Agreements is included in the RFP and must be submitted with the response.

• • Form 1295, enclosed. Effective January 1, 2016, all contracts and contract amendments, extensions, or renewals executed by the Commissioners Court will require the completion of Form 1295 "Certificate of Interested Parties" pursuant to Government Code§ 2252.908. Form 1295 must be completed by awarded vendor at time of signed contract submission. Form 1295 is included in this RFP for your information. (R&B 22 ROAD)

• • Certification of No Boycott ofisrael Form enclosed. Certification required by Texas Government code 2270.002

COUNTY OF REFUGIO, TEXAS

2,0 INSURANCE RJCQUIREMENTS

2,0 lnsll11Ulce Requiremenl5

The vendor shall provide the County with delivery of any materials Certificate of Insurance covering the below listed insurance coverages:

A. Workers' Compensation Insurance

Contractors Insurance -The Contractor, before startirig work on the Project. must furnish to the Owner, Certificates of Insurance or other evidence from a reputable insurance company or companies (such companies to be acceptable to the Owner) licensed to write insurance in the State of Texas, showing that the Contractor is covered by the insurance as follows:

I, WORKERS' COMPENSATION INSURANCE: The Contrs()tor shall maintain, during the life ofthls contract, Workers' Compensation Insurance on employees to be engaged in work on the project under this contract, and for all subcontractors. In case any class of employees engaged in hazardous work on the project under this contract is not protected under the Workers' Compensation Statute, the Contractor shall provide adequate employer's general liability insurance for the protection of such of his employees not so protected.

a, Definitions:

Certificate of coverage ("certificate"} • A copy of a certificate of insurance, a certificate of authority to self-insure issued by the commlssion, or a coverage agreement(TWCC-81, TWCC-82, TWCC-83 orTWCC-84), showing statutory workers' compensation insurance coverage for the person's or entity's employees providing services on a project, for the duration of the project.

Duration of the project• includes the time from the beginning of the work on the project UDtil the contractor's/ person's work on the project has been completed and accepted by Refugio County.

Persons providing services on the project<"subcontractor" In/Article 406.096)

• includes all persons or entities performing all or part of the services the contractor has UDdertaken to perform on the project, regardless of whether that pmon contracted directly with the contractor and regardless of whether that person has employees. Thill includes, without limitation, independent contractors, subcot1tractors, leasing companies, motor carriers, owner-operators, employees of any such entity, or employees of any entity which furnishes persons to provide services on the project. "Services" include, without limitation, providing, hauling, or delivering equipment or materials, or providing labor, transportation or other service related to a projec� "Services" does not include activities UDre!ated to the project, such a food/ beverage vendors, office supply deliveries, and delivery of portable toilets.

b. The Contractor shall provide coverage, based on proper reporting of classification codes and payroll amounts and filing any coverage agreements, which meets the statutory requirements of Texas Labor Code, Section 401.011(44) for all employees of the Contractor providing services on the project, for the duration of the project.

o, The Contractor must provide a certificate of coverage to Refugio County prior to being awarded the contract.

d. Jfthe coverage period shown on the Contractor's current certificate of coverage ends during the duration of the project, the Contractor must, prior to the end of the coverage period, file a new certificate of coverage with Refugio County showing that coverage has been extended, e, The Contractor shall obtain from each person providing services on a project, and provide to Refugio County:

(1) a certificate of coverage, prior to that person beginning work on the project, so Refugio County will have on file certificates of coverage showing coverage for all pmons providing services on the project;

and

(2) no later than seven (7) days after receipt by the Contractor, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project.

f. The Contractor shall retain all required certificates of coverage for the duration of the project and for one (1) year thereafter.

g. The Contractor shall notify Refugio Cotwty in writing by certified mail or personal delivery, within ten (10) days after the Contractor knew or should have known, of any change that materlally affects the provision of coverage of any person providing services on the project.

h, The Contractor shall post on·eachproject site a notice, ill the text, form and manner prescribed by the Texas Workers' Compensation Commission, informing all persons providing services on the project that they are required to be covered, and stating how a person may verify coverage and report lack of coverage.

i, The Contractor shall contractually requixe each person with whom it contracts to provide services on a project to:

(1) provide coverage, based on teporting of classification codes and payroll amounts and filing of any coverage agreements, which meets the statutory requirenients of Texas Labor Code, Section 401.011( 44) for all of its employees providing services on the project, for the duration of the project;

(2) provide to the Contractor, prior to that person beginning work on the project, a certificate of coverage showing that coverage is being provided fur all employees of the person providing services on the project, for the duration of the project;

(3) provide the Contractor, prior to the end of the coverage period, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project;

( 4) obtain from each other person with whom it contracts, and provide to that Contractor:

(a) a certificate of coverage, prior to the other person beginning work on the project; and

(b) a new certificate of coverage showing extension of coverage prior to the end of the coverage period, if the coverage period shown on the current certificate of coverage ends during the duration of the project;

(5) retain 1111 required certificates of coverage on file fur the duration of the project and for one (1) year thereafter;

(6) notify Refugio County in writing by certified mail or personal deliveiy within ten (10) days after the person knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the project; and

(7) contractually require each person with whom it contracts, to perform as required by paragraphs i. (I) • i. (6), with the certificates of coverage to be provided lo the person for whom they are providing services, j By signing this contract or providing or causing to be provided a certificate of coverage, the Contractor ls representing to Refugio County that all employees of the Contractor who will provide_ services on the project will be covered by Workets' Compensation coverage for the duration of the project, that the coverage will be based on proper reporting of classification codes and payroll amounts, and that all coverage agreements will be filed with the appropriate insurance carrier or, In the case of a self-insured, with the commiss!<Jn's Division of Self-Insurance Regulation. Providing false or misleading Information may subject-the Contractor to administrative penalties, crlminal penalties, civil penalties or other civil actions.

B.

k. The Contractor's failure to comply with any of these provisions is a breach of contract by the Contractor which entitles Refugio County to declare the contract void if the Contractor does not remedy the breach within ten (10) days after receipt of notice of breach from Refugio County.

Comprehensive General Liability Insurance Amounts - Bodily Injury

Property Damage

• or

Commercial General Liability Insurance Amount - $600,000 Combined Single Limit

$500,000 each occurrence $100,000 each occurrence $100,000 for aggregate

C. Comprehensive Autompbile Liability Insurance or Texas Business Auto Polioy Amounts - Bodily Injury $250,000 each person

$500,000 each occurrence Property Damage $100,000 each occurrence

Thill insurance shall be kept in force until the temiination of contract If for any reason insurance coverage is not kept in force, all deliveries will be stopped until an acceptable Certificate of Insurance is provided to the County.

The vendor shall be responsible for any deductions stated in the policy.

3.0 ASPHALTS, ITEM 300

3.01 General Provisions

COUNTY OF REFUGIO, TEXAS

PURCHASE SPECIFICATIONS

The County of Refugio will accept sealed bids for an Annual contract to supply Asphalt, Item 300.

During the period of the purchase contract, the County will buy only the actual quantity required. These supplies will be awarded on the date as approved by Refugio County Commissioners' Court. The County reserves the right to reject any or all bids, and to accept the one deemed most advantageous to the County.

3.02 Materials • HFRS-2 Asphalt Emulsion

All material and supplies, before being accepted, may, at the County's option, be inspected and tested by the County and shall conform to "Texas Department of Transportation 2004 Standard Specifications for Construction and Maintenance of Highways, Streets and Bridges" Item 300. Sampling and testing of all materials or supplies may be required by the county. The materials tests shall be as specified under Item 300 as stated above. Any and all expenses incurred as a result of said test shall be borne by the successful bidder.

Subject to conditions established by the County, pretested and approved materials or supplies may be accepted by the County.

All materials or supplies not conforming to the requirements of these specifications will be rejected and shall be removed immediately from the delivery site by the successful bidder.

All bidders shall submit with their bid a certified test report in accordance with the requirements as stated in Item 300 and dated within the preceding (30) thirty da)'l! from an independent testing laboratory for said materials.

3.03 Bidder Information

Firm Name:

Address:

Phone Number:

Signature of Authorized Representative:

BID QUOTATION FORI\'I

Type HFRS-2 Emulsion Asphalt

Gal· □ellvered

Pot 1-Refuglo

Gal· □ellvered

Pot 1-Refuglo

Gal· Del\vered

Pot 1-Refuglo

Gaf Del\vered

Pot 1-Refugto

NOTE: Transportation and all costs to delivery sites as stated herein MUST be included in unit price per gallon.

Please refer t<> paragraph 1.12 Delivery Time concerning 4eliVllry time requirements.

:ALL TAXES ARE TO BE EXCLUDED FROM BID

lo submitting the above, the vendor agrees that acceptance of any or all quotations by the County of Refugio within a reasonable period constitutes a contract.

Per:. _________________ _

Title: ________________ _

Date: ________________ _

4.0 CRUSHED LIMESTONE BASE and AGGREGATE FOR SURFACE

TREATMENT

4.01 General Provisions

The County of Refugio will accept sealed bids for an Annual Contract to supply Crushed Limestone Base and Aggregate for Surface Treatment. During the period of the purchase contract, the County will buy only the actual quantity required.

These supplies will only be ordered as needed. The Purchase Contract will be awarded on the date as approved by the Refugio County Commissioners' Court.

The County reserves the right to reject any or all bids and to accept the one deemed most advantageous to the County.

4,02 Materials

A. Crushed Limestone Base

The material shall conform to the requirements of''TexasD!ll)artment of Transportation Standard Specifications" as stated above, Item 247, Type A, Grade I (Crushed Limestone).

B. Aggregate for Surface Treatment

This item shall govern for precoated aggregates used in the construction of surface treatments and conform to the requirements of "Texas D!ll)artment of Transportation Standard Specifications" as stated in Item 302, Type PB, Grades 3 and 4.

4.03 Bidder Information

Firm Name ___________________ _

Address ____________________ _

Telephone No.(.._ __ ) _______________ _

Signature of Authorized Representative, __________________ _

BID QUOTATION

Crushed Limestone Base, Type A, Grade 1

Per ton Per ton Per Ion Delivered Pel 1•Refuglo

Delivered Delivered Pct 2-Bonnlevlew Pct 3-Refuglo

Per ton Delivered Pct 4-Tlvoll

Surface Treatment Aggregate, Type PB, Grade 3

Per ton Delivered Pct 1-Refuglo

Per ton Per ton Delivered Delivered Pct 2-Bonnlevlew Pct 3-Refuglo

Per ton Delivered Pel 4-Tlvoli

Surface Treatment Aggregate, Type PB, Grade 4

Per ton Per ton Per ton Delivered Delivered Delivered Pct 1-Refuglo Pct 2-Bonnleview Pct 3-Refuglo

LRA PREMIX TY D

Per ton Delivered Pct 1-Refuglo

Per ton Per ton Delivered Delivered Pct 2-Bonnlevlew Pel 3-Refuglo

Per Ion Delivered Pel 4-Tivoli

. Per ton

Delivered Pct 4-Tlvoli

Per ton Picked Up

Perton Picked Up

Per ton Picked Up

Per ton Picked Up

NOTE: TRANSPORTATION/ FUEL SURCHARGE COST TO DELIVERY'SITES AS

STATED HEREIN MUST BE INCLUDED IN PRICE. ALL TAXES ARE TO BE

EXCLUDED FROM BID, LOCATIONS ARE NCLUDED IN THE BID PACKET.

In submitting the above, the vendor agrees that acceptance of any or all quotations by the County of Refugio within a reasonable period constitutes a contract.

PER:

TITLE: _______________ _

DATE:. _______________ _

Per ton Delivered Pct 1-Refuglo

Per ton Delivered Pct 2- Bonnieview

Per ton Delivered Pct 3-Refuglo

Per ton Delivered Pct 1-Refuglo

Per ton Picked Up

HOT MIX COLD LAlD (HMCL) ACP TYPE D-

PLEASE SEE ADD. TXDOT SPECIFICATIONS

Fuel Purchase Specifications

1. 1 Refugio County is now accepting formal bids for a one- year contract for the purchase of gasoline and diesel fuel. The contract period will begin January 1, 2026 and terminate December 31, 2026.

1.2 This contract may be cancelled with thirty (30) days written notification of either party.

1.3 Purchase contracts may be awarded individually by respective Refugio County Commissioner Precincts or Sheriff's Department and any given precinct or Sheriff's Department location may elect to award a contract to more than one company, depending mt that company's prices and its plant's proximity to the specified delivery location.

1.4 Prices on gasoline and diesel fuel are to be on a refinery cost per gallon plus markup basis, to include transportation cost and be delivered to

1. Precinct #1, Refugio, Texas

2. Precinct# 2, Bonnieview, Texas

3. Precinct #3, Refugio, Texas

4. Precinct #4, Tivoli, Texas

5. Sheriff's Department, Refugio, Texas

Refugio County will use the markup prices as the criteria to determine the successful bidder for gasoline and diesel fuel. Verification of refinery costs or refiner's other documentation for delivery dates may be requested periodically. Fuel storage tanks must be provided as needed.

Hazardous warning placards must also be provided.

1.5 This invitation and accompanying bid sheet, when completed by bidder, constitutes a legally binding offer and becomes the governing contract document between Refugio County and the successful bidder upon formal award of the bid. Refugio County herby expressly reserves the right to reject any incomplete bid.

1.6 Successful bidder shall invoice Refugio County for each purchase with the invoice designation the precinct or department location which purchased said product.

Signed delivery tickets must accompany each invoice.

BID SHEET, PAGE 2

Additional infonnation may be obtained with the Q&A due December 11, 2025 at 2:00 p.m. Please see address and contact info:

Precinct #1 Roy Payne 132 Padilla Road, Refugio, TX 78377

(361) 526-2897

Precinct #2 Stanley Tuttle 355 FM 629 (Bonnieview)Woodsboro, TX 78393

(361) 543-4378

Precinct #3 Gary Wright 111 Padilla Road, Refugio, TX 78377

(361) 526-2017

Precinct #4 Blaine Wolfshol 403 Gin Street, Tivoli, TX 77990

(361) 349-9241

Sheriffs Annex Matthew Tuttle 1017 Houston St, Refugio, TX 78377

(361) 526-2351

The undersigned affirms that they are duly authorized to execute this contract, that this bid has not been prepared in collusion with any other bidder, and that the

· contents of this bid have not been communicated to any other bidder prior to the official opening of this bid.

VENDOR

PHONE#

FAX#

SiGNATURE

TITLE

DATE

Product Precinct #1

Regular Unleaded Gasoline (Markup per gallon)

Highway Diesel (Markup per gallon)

Off Highway Diesel (Markup per gallon)

BID SHEET

REFUGIO COUNTY

Precinct#2 Preclnct#3 Precinct #4 Sheriffs Dept Refuolo

CONFLICT OF INTeREST QUESllONNAIRE FORMCIQ For vendor or other person doing business with local governmental entity

Tola quellllonna!nt renects c"8ng89 made to Iha law by H.B. 1491, 80th Lag., Regular Sesalan, OFFICE USE ONLY This quesUonnalre la being flied In accordance with Chapter 176, Local Government Code by a person who has a business relallonshlp as defined by Seotton 178.001{1-a) with a Data Received local governmental enUty and the person meets requirements under Section 178.006(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 faols that require the statement to be flied, See SecUon 178,006, Local Government Code. '

A person commllll an offense If the person knowingly violates Section 178,008, Local Government Code. An offense under this section Is a Class C misdemeanor.

1, Name of person doing buslnesa wlth local governmental entity. RFB I RFP / Contract #

2,0 Check this box If you are flllng an update to a prcivlously flied queatlonnalro, (The law requires that you file an updated completed quesUonnatre with the appropriate nnng aulhortty not laler lhan the 7111 business day after Iha dale the ortglnally filed quasUonnalre becomes Incomplete or lnaccurals.)

3. Name of local go':'emment officer with wham flier has employment or buslnesa relationship, Name of Officer

This secUon (Item 3 lncludlng subparts A, B, C a. 0) must be completed for each officer with whom Iha mer has an emplaymanl or other business relallonshlp as defined by Section 176.001(1-a), Local Govemment Code, Attach add(Uonal pages to this Form CIQ aa necessary.

A. Is Iha local govemment officer named In this sacUon receiving or llkely to tecalve taxable Income, olhar than Investment Income, from Iha filer of Iha questionnaire?

Yes □ No

B, Is the mer of the quesUonnalre receiving or likely lo receive taxable Income, other than Investment Income, rrcm or at the dlrecUon or Iha local government officer named In lhls secUon AND the taJ<abte Income Is not received from Iha local governmental enUly?

Yes □ No

C. Is Iha flier of this quesUonnalre employed by a corporation or other buslnessenllty w!lh respect to which the local government officer serves as an officer ardlfllClor, or holdsen ownership al 10 pen:ent or more?

Yes □ No

D, Describe each employment or business relaUonshfp wllh Iha local government ofllcer named In Ihle section.

4.

Signature of person doing business with governmental enllly Dale Signed

NONCOLLUSION'AFFIDAVIT OF PRIME BIDDER

State of ______ _, County of _____ _, ________ _, being first duly sworn, deposes and says that:

(1) He Is ...--------- of _________ ,, the Bidder that has submitted the attached Bid;

(2) He Is fully informed respecUng the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid;

(3) Such Bid Is genuine and ls not a collusive or sham Bid;

(4) Neither the said Bidder nor any of Its officers, partners, owners, agents, representatives, employees or parties In Interest, Including this afflant, has In any way colluded, conspired, connived or agreed, directly or Indirectly with another Bidder, firm or person to submit a colluslve or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding In connection with such Contract, or has In any manner, directly or Indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices In the attached Bid or of any other Bidder, orto fix an overhead, profit or cost element of the Bid price or the Bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the .......,.-,------ (Local Public Agency) or any person Interested In the proposed Contract; and

(5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, consplraoy, connivance or unlawful agreement on the part of the Bidder or any of Its agents, representatives, owners, employees, or parties In Interest, Including this afflant.

(Stgned)

TlUe

Subscrl�ed and sworn to me this ____ day of ______ _

By: ---,.,...,.---,=--:-,,..----

Notary Public

My commission expires

CHILD SUPPORT STATEMENT CERTIFICATION

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 not ineligible 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.

According to state law, a child support obliger who is more than 30 days delinquent in paying child support and a business entity in which the obliger is a sole proprietor, partner, shareholder, or owner with an ownership interest of at least 25 percent is not eligible to:

1. receive payments from state funds under a contract to provide property, materials, or services;

or

2. receive a state-funded grant or loan.

Each participant hereby certifies that the business e,:itity and its principals, partners, shareholders, or co-owners are not more than 30 days delinquent in paying child support.

Name of Contractor:. ____________ SSN: __________ _

Signature:. ___________________________ _

Title: _____________________________ _

Name of Contractor:. ____________ S.SN: __________ _

Signature:. ___________________________ _

Title: _____________________________ _

Add names, signatures, and titles of additional partners if applicable.

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 (Ml).

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 0MB control Number. The valid 0MB control number for this information collection is 0MB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 1 O 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 0MB 0348-0046

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

/See reverse for oublic burden disclosure\

Type of Federal Action: Status of Federal Action: Report Type:

a. contract a. bid/offer/application a. initial filing

b. grant

b. initial award

b. material change

c. cooperative agreement c. post-award

d. loan

e. loan guarantee

f. loan insurance

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

Tier if Known:

Congressional District, if known: 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 b. Individuals Performing Services (including

(if individual, last name, first name, Ml): address if different from No. 1 Oa) (last name, first name, Ml):

11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature:

disclosure of lobbying activities Is a material representation of fact upon which reliance was placed Print Name:

by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title:

U.S.C. 1352. This information will be reported to the --

Congress semi-annually and will be available for public Telephone No.: Date: inspection. Any person who falls 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.

Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

CERTIFICATE OF INTERESTED PARTIES FORM 1295

OFFICE USE ONLY

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.

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

Name of governmental entity or state agency that Is a party to the contract for �

_t � which the form is being filed.

Provide the identification number used by the governmental entity or state agency fTidentify the contract, and provide a description of the services, goods, or other property to be provided t e contract.

xfl>

City, State, Country

Name of Interested Party (place of business)

�(l, ·c.r

'J

Check only if there�terested Party. □

:)Nature of Interest (check applicable)

Controlling Intermediary

6 UNSWORN DEi��N

My name is � , and my date of birth is

Myaddre'o/

(street) (city)

� under penalty of perjury that the foregoing is true and correct.

Executed in County, State of , on the ___ day of

(state) (zip code) (country)

20 __

(month) (year)

Signature of authorized agent of contracting business entity (Declarant)

ADD ADDITIONAL PAGES AS NECESSARY

I

Form provided by Texas Ethics Comm1ss1on www.ethlcs.state.tx.us Revised 12/22/2017

Certification of No Boycott of Israel Form

ContractorNendor is a "company", as that term is defined in Section 808.001 of the Texas Government Code, ContractorNendor certifies and verifies that it: (i) does not boycott Israel and (ii) will not boycott Israel during the Term of this Agreement.

Form requirements:

• This certification is required by Texas Government Code§ 2270.002.

• This form is required to be attached to all Purchase Orders (goods) and Contracts (services), regardless ofwhether Contract requires the creation of a Purchase Order.

• The 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".

Vendor/Contractor Name or Company NameStreet Address

Citv/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 LISTED ABOVE FOR THE REASONS CITED BELOW

I am not required to provide the certification listed above because (select one):

Name

D am not a "company" as defined above, pursuant to Texas Government Code §808.00

□ This is not an agreement for goods or services to be provided to the County.

Signature Date