Item 4E - MemoItem 4E-1
CITY OF
SOUTHLAKE
MEMORANDUM
November 7, 2022
TO: Shana K. Yelverton, City Manager
FROM: Chris Tribble, Director of Community Services
SUBJECT: Approve contract with Crowley Sports Officials for sports
officiating and scorekeeping services in the amount not to
exceed $190,000
Action Requested: City Council approval of a contract with Crowley Sports
Officials for sports officiating and scorekeeping services in the
amount not to exceed $190,000.
Background
Information: The City's current contract with Crowley Sports Officials to
provide sports officiating and scorekeeping services for
basketball, volleyball, flag football and softball expires
November 7, 2022.
Request for Proposals (RFP) were released September 23,
2022, for sports officiating and scorekeeping services. Two
proposals were received, staff completed the bid evaluation
process and Crowley Sports Officials has been selected
based on best value.
The City has worked with Crowley Sports for the past twenty
(20) years and is comfortable with their ability to provide
sports officiating services for City programs that meet the City
of Southlake standards.
The proposal from Crowley Sports includes two officials per
game for 8 & under and older basketball, volleyball, flag
football and adult softball; one official for 6 & under and 3-on-
3 basketball; two scorekeepers per game for basketball and
volleyball and an assigner's fee per game for all sports.
If approved, the proposed contract will be effective for twelve
months and eligible for up to four (4) one-year annual
renewals with a 4% increase each renewal. Additionally, the
contract requires Crowley Sports Officials to provide proof to
the City that all officials and scorekeepers assigned to City of
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
Item 4E-2
Shana Yelverton, City Manager
City Council Meeting Date — November 15, 2022
Page 2 of 3
Southlake programs have successfully passed a background
check prior to being scheduled to Southlake games.
Financial
Considerations: The FY 2023 budget contains funding for contract services for
athletics and recreation programs based on anticipated FY
2023 participation. The City's cost for these programs is offset
by the revenues received from program participant fees.
Strategic Link: This item is linked to the City's Strategy Map related to the
focus area of Performance Management and Service Delivery
and meets the core service area to Collaborate with select
partners to implement service solutions.
Citizen Input/
Board Review: City Council consideration November 15, 2022
Legal Review: The contract is a standard form of agreement previously
reviewed by the City Attorney.
Alternatives: Alternatives may include the following:
• City Council approval as presented
• City Council approval with input as desired
• City Council decision not to approve the contract
Supporting
Documents: Supporting documents include the following:
• Copy of Contract Award Letter
• Crowley Sports Officials Proposal
Staff
Recommendation: City Council approval of contract for sports officiating and
scorekeeping services with Crowley Sports Officials, in the
amount not to exceed $190,000 for a twelve-month period
ending November 15, 2023.
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
Item 4E-4
October 27, 2022
Crowley Sports
2505 Sagehill Dr.
Fort Worth, Texas 76123
Attn: Mr. Lloyd Moore
60,_J,
ini
Subject: Award Notification for Sports Officiating for City of Southlake RFP2209B540JW220010
Dear Mr. Moore:
The City of Southlake is pleased to inform you that Crowley Sports of Fort Worth, Texas is the awarded vendor for "Sports
Officiating for City of Southlake RFP2209B540JW220010" The award and this agreement are based on your proposal to the
City copy enclosed. This is a single vendor award contract. Your company's award is attached. This award was approved by
the City of Southlake City Council on
The terms and conditions proposed and accepted in this agreement are as follows:
Payment Terms: Net 30 days (Unless otherwise noted — such as pre- and/or partial payment)
Estimated Quantities: The City does not guarantee to purchase any minimum or maximum quantity but does contemplate
purchasing the awarded items exclusively during the term of the contract from the successful
vendors.
Method of Payment: Shall be made by City procurement card or purchase order
Delivery Terms: FOB Destination
Delivery Locations: Vendor Delivery or City employee pick-up.
Term of Contract: The term of awarded contract shall remain in effect for twelve months from date of award and is
eligible for up to four (4) one (1) year annual renewals
City Contact: Jonathan Weeks 817-748-8036
Send all billing to: City of Southlake
accountspayable@ci.southlake.tx.us (preferred) or
1400 Main Street, Suite 420, Accounts Payable, Southlake, TX 76092
Other Charges: The City of Southlake is a tax-exempt municipal corporation and is exempt from all federal, state,
and local sales taxes.
All other specifications, terms and conditions shall be as provided in the original procurement documents. No other
attachments to or in response to this agreement will be accepted unless approved in writing by the Purchasing Manager or an
authorized representative of the City of Southlake.
Thank you for participating in our procurement process. Please call 817-748-8312 with any questions.
Sincerely,
Tim Slifka, CPPO, CPPB
Purchasing Manager
City of Southlake
1400 Main Street, Suite 420
Southlake, Texas 76092
tslifka@ci.southlake.tx.us
Contract and Award Accepted:
Signed:
Mayor John Huffman
City of Southlake
Attest:
Amy Shelley, TRMC
City Secretary
Date: Approved as to Form and Legality:
City Attorney
Item 4E-5
Appendix B — Proposal
Submittal Checklist: (To determine validity of proposal)
Appendix B (pages _14_ through _23J must be included in the proposal submittal
,appendix C Conflict of Interest Form (page _23J must be included in the proposal submittal.
Form 1295 Certificate of Interested Party must be included in the proposal submittal. See Page _2_.
I1B 89, SB 252, SB 13, and SB 19 Acknowledgement. See Page _20 .
All proposals submitted
to the City of Southlake shall include this page with the submitted Proposal.
RFP Number:
RFP2209B540JW220010
Project Title:
Sorts Officiating for City of Southlake
Submittal
3:00 P.M. (CST), Friday October 14, 2022
Deadline:
Submit Electronically* to: https://southlake.bonfirehub.com/login
* Requires email account login and password.
ProjRoser Information:
Proposer's Legal Name:
L 6 q 1116
Address:
�fk55 j6 <3P, 41 f`
Ci , State & Zi
Federal Employers
Identification Number #
C)`f ` � 3 c,
Phone Number:
�LS " Lj
Fax Number:
E-Mail Address:
C � S , 6d' -►a-s- -� , �� �° t
roposer Authorization
1, the undersigned, have the authority to execute this Proposal in its entirety as submitted and enter into a contract
on behalf of the Proposer.
�!f y /�� �' e
Printed Name and Position of Authorized Represe tative:
Signature of Authorized Representative:
Signed this (day) of 6C (month),�1{year)
City of Southlake - RFP2209B540JV1'220010 - Page 14 of 24
Item 4E-6
Primary Responses
Success: All data is validl
Officials and Scorekeepers
Success: All values provided Bid #1-1 6U Basketball (1 Official)
Success: All values provided Bid #1-2 8U Basketball (2 Officials)
Success: All values provided Bid #1-3 10U Basketball (2 Officials)
Success: All values provided Bid #1-4 12U Basketball (2 Officials)
Success: All values provided Bid #1-5 14U Basketball (2 Officials)
Success: All values provided Bid #1-6 16U Basketball (2 Officials)
Success: All values provided Bid #1-7 18U Basketball (2 Officials)
Success: All values provided Bid #1-8 30 Basketball All Age Groups (1 Officials)
Success: All values provided Bid #1-9 Adult Basketball 3v3 (2 Officials)
Success: All values provided Bid #1-10 Adult Basketball M (2 Officials)
Success: All values provided Bid #1-11 Youth Volleyball (2 Officials)
Success: All values provided Bid #1-12 Youth Flag Football (2 Officials)
Success: All values provided Bid #1-13 Adult Flag Football (2 Officials) (Possible Future
Sport Offered)
Success: All values provided Bid #1-14 Adult Softball (2 Officials)
Success: All values provided Bid #1-15 Scorekeepers (Basketball and Volleyball)
Success: All values provided Bid #1-16 Scheduling Fee
1
2
2
2
2
2
2
1
2
2
2
2
2
2
2
1
$ 30.00
$ 27.00
$ 30.00
$ 30.00
$ 30.00
$ 31.00
$ 31.00
$18.00
$ 20.00
$ 32.00
$ 30.00
$ 30.00
$ 32.00
$ 32.00
$ 16.00
$ 2.50
n/a
n/a
$ 30.00
$ 54.00
n/a
$ 60.00
n/a
$ 60.00
n/a
$ 60.00
n/a
$ 62.00
n/a
$ 62.00
n/a
$18.00
n/a
$ 40.00
n/a
$ 64.00
n/a
$ 60.00
n/a
$ 60.00
n/a
$ 64.00
n/a
$ 64.00
n/a
$ 32.00
n/a
$ 2.50
Additional Vendor Fees Not Listed
Not Bidding
No Bid
#2-1
Additional Vendor Fee Not Specifically Requested
Not Bidding
No Bid
#2-2
Additional Vendor Fee Not Specifically Requested
Item 4E-7
Appendix B — Proposal (continued)
I.
►A
3.
REQUIRED PROPOSAL INFORMATION. IN ORDER FOR A PROPOSAL TO BE
CONSIDERED COMPLETE, AND TO BE EVALUATED FOR A CONTRACT AWARD BY THE
CITY, PROPOSER MUST SUBMIT ALL OF THE FOLLOWING INFORMATION:
Proposed Products and/or Services
A. Product or Service Description: Proposers should utilize this section to describe the technical
aspects, capabilities, features and options of the product and/or service proposed in accordance with
the required Scope of Services as identified in Appendix A. Promotional literature, brochures, or
other technical information may be used.
B. Additional Hardware Descriptions: Proposers should also include in this section a detailed
description of what additional hardware and/or software, if any, would be required by the City in
order to fully utilize the goods and/or services proposed.
C. Guarantees and Warranties: Each Proposer shall submit a complete copy of any warranties or
guarantees provided by the manufacturer or Proposer with the Proposal submitted.
D. Project Schedule/Delivery Date: Proposer must provide a project schedule noting all projected
completion dates for segments of the Project, from start-up to completion, and all delivery dates for
goods covered by the RFP. The Proposal must show the number of days required to deliver and
install the product or equipment after the receipt of the City's Purchase Order.
Cost of Proposed Products and/or Services
A. Pricing: Pricing shall reflect the full Scope of Services defined herein, inclusive of all associated
cost for delivery, labor, insurance, taxes, overhead, and profit.
B. Schedule of Pricing: Proposer shall quote unit pricing in accordance with the itemized listing of
products or contract segments stated in the Scope of Services and using the following format:
For this procurement the schedule of pricing is not available in hardeopy. You may access it via the
online portal (https://soLtthlake.bonfirchub.com/logi ). To submit your schedule of pricing, please
download the Bid Table and fill it in accordingly per the sample below.
For instructions on how to complete Bid Tables, please refer to this article on Bonfire's Support
Website, Please note: even if you do not have additional responses, you must download and re -
upload the blank document. This is to confirm that you do not require any additional costs. If you
have any additional items, please fill out the Additional Responses template accordingly.
Term of Contract and Option to Extend
Any contract resulting from this RFP shall be effective for twelve months from date of award. The
City anticipates that contract shall be renewed pursuant to the availability of funds and at the discretion
of the City. The following clauses shall be included in the contract:
City of Southlake - RFP2209B540JW220010 - Page 15 of 24
Item 4E-8
A. Option Clause: It is agreed that City will have the option to extend the contract for up to four (4)
additional years, in one-year intervals. To exercise this option, the City shall serve notice 30 days
prior to contract termination or to the end of any one-year extension. The Option to Extend will not
be considered if funding is unavailable or if the contractor's past performance is not within the
industry standard.
B. Escalation Clause: Should market conditions prevail which dictate an increase, the successful
contractor may submit documentation requesting permission to increase pricing no later than 30 days
after receiving notice from the City of its intent to extend the agreement. Escalation may only occur
at the time of renewal and only upon securing the approval of the City in writing. Requests for price
adjustments must be solely for the purpose of accommodating an increase in the contractor's cost,
not profits.
Vendors shall show in this quote their anticipated percent of escalation if/when the option to extend
is exercised. The percent quoted will be a maximum. In addition, the percentage proposed will be
a factor in determining the best value to the City. It is the average price over the period of the
contract that will be the price factor considered in the evaluation of this quote. Quotes in which
negative or no escalation is shown will be considered as 0% escalation.
C. Price Increases Upon Extension: If approved by the City, the Contractor shall modify the rates
charged by the Contractor to reflect any changes shown in the comparative statement delivered to
the City. The maximum increase allowed under this provision shall be four percent (4%) per year.
The City shall have authority, in its reasonable discretion, to determine the validity of any change in
Contractor's rates. City cannot exercise the Option to Extend with any price increases unless the
Vendor completes the section of the Quote requesting anticipated percentage of annual escalation.
First Additional Year Escalation Percentage ............................................. 4
Second Additional Year Escalation Percentage .............................................%
Third Additional Year Escalation Percentage .................................................%
Fourth Additional Year Escalation Percentage ......................................... A-%
4. Proposer's Experience / Staff
A. Project Team: Identify all members of the Proposer's team (including both team members and
management) who will be providing any services proposed and include information which details
their experience.
B. Removal or Replacement of Staff: If an assigned staff person must be removed or replaced for any
reason, the replacement person must be approved by City prior to joining the project.
C. Business Establishment: State the number of years the Proposer's business has been established and
operating. If Proposer's business has changed names or if the principals operating the business
operate any similar businesses under different names, or have operated any other businesses or
changed the legal status or form of the business within the last five (5) years, all names, of
predecessor business names, affiliated entities, and previous business entities operated by the
principals, if different than present, must be provided;
State he number of years' experience the business has:; and the number of employees:
D. Project Related Experience: All Proposals must include detailed information that details the
Proposer's experience and expertise in providing the requested services that demonstrates the
Proposer's ability to logically plan and complete the requested project.
City of Southlake - RFP2204B540JN'220010 - Page 16 of 24
Item 4E-9
5. References
Proposer shall provide four (4) references where Proposer has performed similar to or the same types of
services as described herein.
Reference #1 :
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City of Southlake - RFP2209B54OY" 220010 - Page 17 of 24
Item 4E-10
6.
7.
S.
Trade Secrets and/or Confidential Information
Trade Secrets and/or Confidential Information: This proposal _ (does) X (does not) contain trade
secrets and/or confidential information. If applicable, describe such trade secrets and confidential
information, and the basis for your assertion that such material qualifies for legal protection from
disclosure.
Federal, State and/or Local Identification Information
A. Centralized Master Bidders List registration number:
B. Prime contractor HUB / NIWBE registration number:
C. An individual Proposer acting as a sole proprietor must also enter the Proposer's Social Security
Number: # y�- 6 � -
Emergency Business Services Contact Notice
During a natural disaster, or homeland security event, there may be a need for the City of Southlake to
access your business for products or services after normal business hours and/or holidays. The City may
request City employee pick up or vendor delivery of product or services.
For this purpose, a primary and secondary emergency contact name and phone number are required. It
is critical the vendor's emergency contact information remains current. City shall be contacted by E-
mail with any change to a contact name or phone number of these emergency contacts. Updates may be
emailed to vendors(a,ci.southlake.tx.us.
All products or services requested during an emergency event are to be supplied as per the established
contract prices, terms and conditions. The vendor shall provide the fee (pricing) for an after-hours
emergency opening of the business, if any. In general, orders will be placed using a City of Southlake
procurement card (Master Card) or City issued Purchase Order. The billing is to include the emergency
opening fee, if applicable.
The contractor shall provide the names, phone numbers and fee (pricing), if any, for an after-hours
emergency opening of the business listed below.
I J �
Business Name: 6 J L� .r .6 Y` f' } () P 1 t' tn
Contract #:
Description: Oi'c'S �"` t`. .�r�,1• * l Y I
Primary Contact (Name): ! t5 1�! / ` d
Primary Contact Phone Numbers: Home: W 7', N - I Cell: �7- jd 1,6 ` J- 63
Secondary Contact (Name): 7,d 6�o
Secondary Contact Phone Numbers: Home: ��T �%�f-yB�-IZ Cell: OYU
After Hours emergency opening fee, if applicable:
City of Southlake - ItM2098540,1W220010 - Page 18 of 24
Item 4E-11
9. Cooperative Governmental Purchasing Notice
Other governmental entities maintaining interlocal agreements with the City, may desire, but are not
obligated, to purchase goods and services defined in this RFP from the successful Proposer. All
purchases by governmental entities, other than the City, will be billed directly to and paid by that
governmental entity. The City will not be responsible for another governmental entity's debts. Each
governmental entity will place their own orders with the successful Proposer and be responsible for
ensuring full compliance with the RFP specifications. Prior to other governmental entities placing orders,
the City will notify the successful Proposer of their intent.
Please indicate below if you will permit other governmental entities to purchase from your agreement
with the City.
[ I Yes, Others can purchase " No, Only the City can purchase
II. CONTRACT TERMS AND CONDITIONS. EXCEPT WHERE PROPOSER MAKES SPECIFIC
EXCEPTION IN THE SUBMITTED PROPOSAL, ANY CONTRACT RESULTING FROM THIS
RFP WILL CONTAIN THE FOLLOWING TERMS AND CONDITIONS, WHICH PROPOSER
HEREBY ACKNOWLEDGES, AND TO WHICH PROPOSER AGREES BY SUBMITTING A
PROPOSAL:
Delivery of Products and/or Services
A. Payment Terms: Unless otherwise specified in the Scope of Services or otherwise agreed to in
writing by the City, payment terms for the City are Net 30 days upon receipt of invoice.
B. Warranty of Products and Services: All products furnished under this contract shall be warranted to
be merchantable and good quality and fit for the purposes intended as described in this Proposal, to
the satisfaction of City and in accordance with the specifications, terms, and conditions of the Scope
of Services, and all services performed shall be warranted to be of a good and workmanlike duality,
in addition to, and not in lieu of, any other express written warranties provided.
C. Late Delivery or Performance: If Proposer fails to deliver acceptable goods or services within the
timeframes established in the Project Schedule, the City shall be authorized to purchase the goods
or services from another source and assess any increase in costs to the defaulting Proposer, who
agrees to pay such costs within ten days of invoice.
D. Title to Goods and Risk of Loss: For goods to be provided by Proposers hereunder, if any, the title
and risk of loss of the goods shall not pass to City until City actually receives, takes possession, and
accepts the goods and the installation of such goods, has tested the system, and determined that it is
in good and acceptable working order.
2. Miscellaneous
A. Independent Contractor: Proposer agrees that Proposer and Proposer's employees and agents have
no employer -employee relationship with City. Proposer agrees that if Proposer is selected and
awarded a contract, City shall not be responsible for the Federal Insurance Contribution Act (FICA)
payments, Federal or State unemployment taxes, income tax withholding, Workers Compensation
Insurance payments, or any other insurance payments, nor will City furnish any medical or
retirement benefits or any paid vacation or sick leave.
B. Assignments: The rights and duties awarded the successful Proposer shall not be assigned to another
without the written consent of the Purchasing Manager. Such consent shall not relieve the assigner
of liability in the event of default by the assignee.
City of Southlake - RFP2209B540JW220010 - Pane 19 of 24
Item 4E-12
C. Liens: Proposer shall indemnify and save harmless the City against any and all liens and
encumbrances for all labor, goods, and services which may be provided to the City by Proposer or
Proposer's vendor(s), and if the City requests, a proper release of all liens or satisfactory evidence
of freedom from liens shall be delivered to the City.
D. Gratuities 1 Bribes: Proposer certifies that no bribes in the form of entertainment, gifts, or otherwise,
were offered or given by the successful Proposer, or its agent or representative, to any City officer,
employee or elected representative, with respect to this UP or any contract with the City, and that
if any such bribe is found to have been made this shall be grounds for voiding of the contract
E. Financial Participation: Proposer certifies that it has not received compensation from the City to
participate in preparing the specifications or RFP on which the Proposal is based and acknowledges
that this contract may be terminated and/or payment withheld if this certification is inaccurate.
F. Required Licenses: Proposer certifies that he holds all licenses required by the State of Texas for a
provider of the goods and/or services described by the Scope of Services herein.
G. Authority to Submit Proposal and Enter Contract: The person signing on behalf of Proposer certifies
that the signer has authority to submit the Proposal on behalf of the Proposer and to bind the Proposer
to any resulting contract.
H. Compliance with Applicable Law: Proposer agrees that the contract will be subject to, and Proposer
will strictly comply with, all applicable federal, state, and local laws, ordinances, rules, and
regulations.
1. Compliance with HB 89: Proposer agrees per HB 89 vendor shall not boycott Israel at any time while
providing products or services to the City of Southlake.
0 Yes, we agree [ ] No, we do not agree [ ] NIA
J. Compliance with SB 252: Proposer agrees per SB 252 vendor shall not do business with Iran,
Sudan or a foreign terrorist organization while providing products or services to the City of
Southlake.
[A Yes, we agree [ ] No, we do not agree
K. Compliance with SB 13: Proposer agrees per SB 13 vendor does not boycott energy companies as
those terms are defined in the Texas Government Code § 809.001, and will not boycott energy
companies during the term of any contract with the City of Southlake.
[)q Yes, we agree [ ] No, we do not agree
L. Compliance with SB 19: Proposer agrees per SB 19 vendor does not have a practice, policy,
guidance, or directive that discriminates against a firearm entity or firearm trade Association as those
terms are defined in the Texas Government Code § 2274.001, and that vendor will not so
discriminate during the term of any contract with the City of Southlake.
[x] Yes, we agree [ ] No, we do not agree
Financial Responsibility Provisions
A. Insurance: The Proposer, consistent with its status as an independent contractor, shall carry, and shall
require any of its subcontractors to carry, and list the City of Southlake, its officers, and employees
as an additional insured, at least the following insurance in such form, with such companies, and in
such amounts (unless otherwise specified) as City may require:
Worker's Compensation and Employer's Liability insurance, including All States
Endorsement, to the extent required by federal law and complying with the laws of the State
of Texas;
City of Southlake - RFP220911540 "'220010 - Page 20 of 24
Item 4E-13
ii. Commercial General Liability insurance, including Blanket Contractual Liability, Broad
Form Property Damage, Personal Injury, Completed Operations/Products Liability,
Premises Liability, Medical Payments, Interest of Employees as additional insureds, and
Broad Form General Liability Endorsements, for at least One Million Dollars ($1,000,000)
Combined Single Limit Bodily Injury and Property Damage on an occurrence basis:
iii. Comprehensive Automobile Liability insurance covering all owned, non -owned or hired
automobiles to be used by the Contractor, with coverage for at least One Million Dollars
($1,000,000) Combined Single Limit Bodily Injury and Property Damage.
B. Indemnification: Proposer agrees to defend, indemnify and hold harmless the City, all of its
officers, Council members, agents and employees from and against all claims, actions, suits,
demands, proceedings, costs, damages and liabilities, including reasonable attorneys' fees,
court costs and related expenses, arising out of, connected with, or resulting from any acts or
omissions of Proposer or any agent, employee, subcontractor, or supplier of Proposer in the
execution or performance of this contract without regard to whether such persons are under
the direction of City agents or employees.
City of Southlake - RFP2209B540JW220010 - Page 21 of 24
Item 4E-14
Appendix C — Form CIQ
WHO: The following persons must file a Conflict of Interest Questionnaire with the City if the person has an
employment or business relationship with an officer of the City that results in taxable income exceeding $2,500
during the preceding twelve — month period, or an officer or a member of the officer's family has accepted gifts with
an aggregate value of more than $250 during the previous twelve — month period and the person engages
in any of the following actions:
contracts or seeks to contract for the sale or purchase of property, goods or services with the City,
including any of the following:
a, written and implied contracts, utility purchases, purchase orders, credit card purchases and any
purchase of goods and services by the City;
b, contracts for the purchase or sale of real property, personal property including an auction of
property;
e. tax abatement and economic development agreements;
submits a bid to sell goods or services, or responds to a request for proposal for services;
enters into negotiations with the City for a contract; or
applies for a tax abatement and/or economic development incentive that will result in a contract with the
City
THE FOLLOWING ARE CONSIDERED OFFICERS OF THE CITY:
l . Mayor and City Council Members;
2. City Manager;
3. Board and Commission members and appointed members by the Mayor and City Council;
4. Directors of 4A and 413 development corporations;
5. The executive directors or managers of 4A and 4B development corporations; and
6. Directors of the City of Southlake who have authority to sign contracts on behalf of the City.
EXCLUSIONS: A questionnaire statement need not be filed if the money paid to a local government official was a
political contribution, a gi ft to a member of the officer's family from a family member; a contract or purchase of less
than $2,500 or a transaction at a price and subject to terms available to the public; a payment for food, lodging,
transportation or entertainment; or a transaction subject to rate or fee regulation by a governmental entity or agency.
WHAT: A person or business that contracts with the City or who seeks to contract with the City must file a "Conflict
of Interest Questionnaire" (FORM CIQ) which is available online at www.ethics.state.tx.us and a copy of which is
attached to this guideline. The form contains mandatory disclosures regarding "employment or business
relationships" with a municipal officer. Officials may be asked to clarify or interpret various portions of the
questionnaire.
WHEN: The person or business must file:
1. the questionnaire —no later than seven days after the date the person or business begins contract discussions
or negotiations with the municipality, or submits an application, responds to a request for proposals or bids,
correspondence, or other writing related to a potential contract or agreement with the City; and
2. an updated questionnaire — within seven days after the date of an event that would make a filed
questionnaire incomplete or inaccurate.
It does not matter if the submittal of a bid or proposal results in a contract. The statute requires a vendor to file
a FORM CIQ at the time a proposal is submitted or negotiations commence.
WHERE: The vendor or potential vendor must mail or deliver a completed questionnaire to the Finance
Department. The finance Department is required by lase to post the statements on the City's
webs ite.
ENFORCEMENT: Failure to file a questionnaire is a Class C misdemeanor punishable by a fine not to exceed
$500. It is an exception to prosecution that the person files a FORM CIQ not later than seven business days
after the person received notice of a violation.
NOTE: The City does not have a duty to ensure that a person files a Conflict of Interest Questionnaire.
City of Southlake - RFP2209B540JW220010 - Page 22 of 24
Item 4E-15
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO
For vendor doing business wfth local governmental entity
This questionnaire reflects changes made to the law by N.B. 23. 84th Leg., Regular Session.
OFFICEUSEONLY
This questionnaire Is being filed in accordance, with Chapter 176, Local Government Code, by a vendor who
Dale Received
has a business relationship as defined by Section 176.001(1-a) wkh a local governmental entity and the
vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local governmental entlry not later
than the 71h business day after the date the vendor becomes aware of facts that require the statement to be
filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense A the vendor knowingly violates Section 176.006, Local Government Code. An
offense under this section Is a misdemeanor.
1 N m/e of vendor who has a business relationship with local govemmental entity-
f C CIN r
2
Check this box If you are filing an update to a previously flied questlonnalre. (The law requires that you fife an updated
completed questlonnalre with the appropriate filing authority not later than the 7th business day after the date on which
you became aware that the originally filed questionnaire was Incomplete or Inaccurate.)
3 Name of local government officer about wlit�o�� the information [s being disclosed.
rv��
Name of Officer
4 describe each employment OF other business relationship with the local government officer, or a family member of the
officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government offkar.
Complete subparts A and B foreach employment or business relationshipdasaibed. Attach additional pages to this Form
CIO as necossary.
A. Is the local government officer or a family member of the officer receiving or likely to receive taxable Income,
other than Investment Income, from the vendor?
Yes � No
B. Is the vendor receiving or likely to receive taxable income, other than Investment income, from or at the dlrection
of the local govemment officer or a family member of the officer AND the taxable Income Is not received from the
local govemmental entity?
�
a1 Yes X �t I No
8 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or
other business entity with respect to which the focal government officer serves as an officer or director, or holds an
ownership interest of one percent or more.
//"
fi
❑Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts
as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).
and..ve
doing business with the governmental entity pate
Form provided by Texas Ethics Commission www.elhlcs.stale.tx.us Revised 111l2021
City of Southiake - RFP2209B5 40JW220010 - Page 23 of 24