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Item 4F - Contract DocumentSOUTHLAI<E August 18, 2023 Lipsey Trucking LLC 5600 Brainerd Rd. Suite E-2B Chattanooga, Tennessee 37411 Attn: Mr. Richard Elam Subject: Contract Award Notification for Emergency Bulk Drinking Water Services RFP2302B320AM230006 Dear Mr. Elam: The City of Southlake is pleased to inform you that Lipsey Trucking LLC of Chattanooga, Tennessee is the awarded vendor for Emergency Bulk Drinking Water Services RFP2302B320AM230006. 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 vendor. 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 ten (10) one (1) year annual renewals City Contact: Amanda Meneses 817-748-8903 Send all billing to: City of Southlake accountspayablena,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.southiake.tx.us Attest: Contract and Award Accepted: Signed: Mayor John Huffman City of Southlake Amy Shelley, TRMC City Secretary Date: Approved as to Form and Legality: City Attorney "i m N O tm E m > o E o c .E N N N C 7 yp C ►- m m U u C > p a O N O T f0 a 0 !p E 1O U' m °D cm 7 Z E C A 0 (n O O 3 LL. ECD .!L u) 00 U O C m o a m C jy O r- c c U o f Q r m U «� p p � •- p '- p Y cn V) 0 O O N a C a 0 m O m m � io LL O 3 3 Y r '> d ` > C > > T3 m d .Q N N N N M N N L V m 0 0 0 m 0 af6i z z z z a h v v � o a rn U m it Z O Z z o Z G) w co m L Y > >L d m m w a om m z Timothy Slifka From: Richard Elam <RElam@lipseylogistics.com> Sent: Thursday, August 17, 2023 2:07 PM To: Timothy Slifka Cc: Michael Knaby; Amanda Meneses; Mike Canzoneri; Connie Nunn Subject: RE: Proposal Submission Good afternoon Tim, Thank you for the time on the phone today and thank you for the opportunity to provide this valuable service to your community. As discussed, Lipsey Trucking will honor the pricing submitted for RFP230006 Emergency Bulk Drinking Water Services. I have cc'd the rest of our Division Management Team so they have clarity on the issue. Please send Michael and I any contractual paperwork which may be required for the contract. Thank you again for the opportunity to serve in this capacity and we look forward to working with you. Thank you, Rich COL(R) Richard (Rich) Elam, Director, Business Development Lipsey Response and Recovery Services 1 5600 Brainerd, Rd I Chatanooga, TN 37411 1 Mobile: 904-814-1330 1 e-mail: rel am@lipsevlogis itcs.com OMEN STI r 5 r�anspoRat+an S S TEAInrermediarieb Stewart a e S Mces Inc. Association LIPSEY TRUCKING Disclaimer This e-mail and its attachments may contain privileged or confidential information. Please consult Lipsey Logistics before sharing this e-mail with anyone else. If you are not the intended recipient of this e-mail, you may not use, copy, distribute, or forward this e- mail. If you received this e-mail by mistake, please notify Lipsey and immediately delete this message. Although Lipsey does not know of any viruses present in this e-mail, you are encouraged to scan it using antivirus software, and Lipsey will not accept responsibility for any loss or damage arising from this e-mail. This e-mail neither constitutes an agreement to conduct transactions by electronic means nor creates any legally binding contract or enforceable obligation in the absence of a fully signed written contract. Lipsey takes no responsibility for any unauthorized reliance on the contents of this e-mail. From: Timothy Slifka <tslifka@ci.southlake.tx.us> Sent: Thursday, August 17, 2023 11:46 AM To: Richard Elam <RElam@lipseylogistics.com> Cc: Michael Knaby <mknaby@lipseytrucking.com>; Amanda Meneses <ameneses@ci.southlake.tx.us> Subject: Proposal Submission CAUTION: This email originated from outside our organization. Do not click links or open attachments unless you recognize the sender and know the content is safe. Mr. Elam, Thank you for your time on the phone this morning. Per our conversation, Lipsey Trucking will honor submitted proposal pricing for RFP230006 Emergency Bulk Drinking Water Services per your submission dated March 23, 2023. Please confirm at your convenience so we may move forward with the award of this contract. Regards, Tim Timothy Slifka, CPPO, CPPB Purchasing Manager 1400 Main Street Suite 420 Southlake, Texas 76092 Phone: 817-748-8312 Fax: 817-748-8010 tslifka(cc,D-ci.south lake. tx.us CityofSouthlake. com * Current Biddina Opportunities * Please take a moment and click on the appropriate link below to complete our Purchasing Department Survey. Your answers will help us to continually improve our services. * City Staff Survey * * Internal Staff Bid Survev * Vendor Survev - How are we Doina? i5 ` hocoreseaN 2021 Award Wimier fp,_ Appendix B — Proposal Submittal Checklist: (To determine validity of proposal) Appendix B (pages _8_ through _17_) must be included in the proposal submittal Appendix C Conflict of Interest Form (page _17j must be included in the proposal submittal. Form 1295 Certificate of Interested Party must be included in the proposal submittal. See Page 2. HB 89, SB 252, SB 13, and SB 19. See Page —14_. All proposals submitted to the City of Southlake shall include this page with the submitted Proposal. RFP Number: RFP2302B320AM230006 Project Title: Emergency Bulk Drinking Water Services Submittal 3:00 P.M. (CST), Friday March 24, 2023 Deadline: Submit Electronically* to: https://southlake.bonfirehub.com/login * Requires email account login and password. Proposer Information: Proposer's Legal Name: Lipsey Trucking LLC Address: 5600 Brainerd Rd,Suite E-2B Chattanooga, TN 37411 City, State & Zip Federal Employers 47-1695671 Identification Number # Phone Number: 770-870-7920 Fax Number: E-Mail Address: mknaby@lipseytrucking.com Proposer Authorization I, the undersigned, have the authority to execute this Proposal in its entirety as submitted and enter into a contract on behalf of the Proposer. Printed Name and Position of Authorized Represent : e; Richard E. Elam Signature of Authorized Representative: Signed this 23 (day) of March (month), 2023 (year) City of Southlake - RFP2302B320A1)4230006 Page 8 of 18 Appendix B — Proposal (continued) I. 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: 1. 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. 2. 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 hardcopy. You may access it via the online portal (bgps://southlake.bonfirehub.com/login). 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. 3. Term of Contract and Option to Extend Any contract resulting from this RFP shall be effective for thirty-six 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: A. Option Clause: It is agreed that City will have the option to extend the contract for up to ten (10) 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 City of Southlake - RFP2302B320A,yi230006 - Page 9 of 18 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 ten percent (10%) 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 ............................................. % Second Additional Year Escalation Percentage ............................................. % Third Additional Year Escalation Percentage ................................................. % Fourth Additional Year Escalation Percentage ......................................... % Fifth Additional Year Escalation Percentage ............................................. % Sixth Additional Year Escalation Percentage ............................................. % Seventh Additional Year Escalation Percentage ................................................ % Eighth Additional Year Escalation Percentage ......................................... % Ninth Additional Year Escalation Percentage ............................................. % Tenth Additional Year Escalation Percentage ............................................. % 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 the number of years' experience the business has: 9 ; and the number of employees: < 100 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 - RFP2302B320AM230006 - Page 10 of 18 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: Client / Company Name: Mississippi Emergency Management Agency Contact Name: Don Wilson Contact Title: Logistics Chief Phone: (601) 933-6705 Email: dwilson@mema.ms.gov Date and Scope of Work Provided: Provided over 500 truckloads of emergency relief water to the State of Mississippi during the 2022 Jackson, MS water crisis Reference #2: Client / Company Name: Kentucky Emergency Management Agency Contact Name: Jordan Howard Contact Title: Emergency Management Phone: 615.289.0141 Email: jordan.howard@tn.gov Date and Scope of Work Provided: Provided over 200 truckloads of emergency relief water support to the State of Kentucky during the historic flooding of 2022. Reference #3: Client / Company Name: Department of Veterans Affairs Contact Name: Contact Title: Derrell Poole Contracting Officer Representative Phone: 318-466-2830 Email: jerrell.poole@va.gov Date and Scope of Work Provided: Providing emergency generators for the VA hospital facility in Pineville, LA (ongoing contract) Reference #4: Client / Company Name: Mississippi Emergency Management Agency Contact Name: Contact Title: Sallie Sones Purchasing Agent Phone: 601-933-6381 Email: ssones@mema.ms.gov Date and Scope of Work Provided: Provided over 600 transportation shuttles providing emergency relief water to numerous location in and around Jackson, MS during the 2022 water crisis City of Southlake - RFP2302B320AM230006 - Page 1 l of 18 6. 7 8. 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 / MWBE registration number: N/A N/A C. An individual Proposer acting as a sole proprietor must also enter the Proposer's Social Security Number: # - - 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 vendorsgci.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. Business Name: Lipsey Trucking, LLC Contract #: Description: Transportation Brokerage and Trucking entity Primary Contact (Name): Michael Knaby Primary Contact Phone Numbers: Home: Secondary Contact (Name): Connie Nunn Secondary Contact Phone Numbers: Home: After Hours emergency opening fee, if applicable: $ Cell: 770-870-7920 Cell: 850-445-3515 City of Southlake - RFP2302B320AM230006 - Page 12 of 18 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. [XI 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: 1. 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 quality, 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 - RFP2302B320AM230006 - Page 13 of 18 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 / 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 RFP 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. I. 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. [X] Yes, we agree [ ] No, we do not agree [ ] N/A 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. [X] 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. [X] 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 3. 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 - RFP2302B320AM230006 - Page 14 of 18 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 - RFP2302B320AM230006 - Page 15 of 18 Appendix C — Form CIQ INFORMATION REGARDING VENDOR CONFLICT OF INTEREST QUESTIONNAIRE V HO: 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 S2,500 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 S250 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; c. 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: 1. 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 4B development corporations; 5. The executive directors or managers of 4A and 413 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 gift to a member of the officer's family from a family member; a contract or purchase of less than S2,500 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 wwtiv.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 law to post the statements on the City's website. ENFORCEMENT: Failure to file a questionnaire is a Class C misdemeanor punishable by a Fine not to exceed S500. It is an exception to prosecution that the person files a FOR_M 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 - RFP2302B320AM230006 - Page 16 of 18 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session. OFFICEUSEONLY This questionnaire is being filed in accordance with Chapter 176. Local Government Code Date Received by a person who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the person meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code. A person commits an offense if the person knowingly violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. 11 Name of person who has a business relationship with local governmental entity. N/A 2 ❑Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3 Name of local government officer with whom filer has employment or business relationship. N/A Name of Officer This section (item 3 including subparts A. B. C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.00 1i.l-a), Local Government Code. Attach additional pages to this Form (--to as necessary A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire? Yes F-1 No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? Yes E-1 No C. Is the filer of this questionnaire employed by a corporation or other business entity ;with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more'? F1 Yes E7No D. Describe each employment or business relationship with the local government officer named In this section. 4 Richard E. Elam 23MAR23 Signature of person doing business with the govemmental entity Date Adopted 08129?2007 City of Southlake - RFP2302B320ANI230006 - Page 17 of 18 BYRD ANTI -LOBBYING AMENDMENT Contractors who apply or bid for an award of $100,000 or more shall file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, officer or employee of Congress, or an employee of a Member of Congress in connection with obtaining any Federal contract, grant, or any other award covered by 31 U.S.C. § 1352. Each tier shall also disclose any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the recipient who in turn will forward the certification(s) to the awarding agency. APPENDIX A, 44 C.F.R. PART 18 — CERTIFICATION REGARDING LOBBYING — REQUIRED FOR CONTRACTS OVER $100,000 Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: r 1. 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. 2. 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. 3. The undersigned shall require that the language of this 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 section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The Contractor, Lipsey Trucking, LLC 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. Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any. Signature of Contractor's Authorized Official Richard E. Elam Director, Business Development Name and Title of Contractor's Authorized Official 23MAR23 Date DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT RECIPIENT) As required by Executive Order 12549, Debarment and Suspension, and implemented at 44 CFR Part 67, for prospective participants in primary covered transactions, as defined at 44 CFR Part 17, Section 17.510- A. The applicant certifies that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this application been convicted of a or had a civilian judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or perform a public 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 statements, or receiving stolen property; (c) Are not presently indicted for otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and (d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause of default; and Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application. Signature of Contractor's Authorized Official Richard E. Elam Director, Business Development Name and Title of Contractor's Authorized Official 23MAR23 Date ip_sey Truc LIPSEY TRUCKING EXECUTIVE SUMMARY, RELEVANT EXPERIENCE AND TECHNICAL APPROACH Emergency Bulk Drinking Water Services RFP2302B320AM230006 Lipsey Trucking Mission The Lipsey Trucking mission is to be recognized as a premier employer, transportation provider, and business partner by building long-term partnerships and fostering a culture of trust, safety, and service to both the customer and the community in which we live. We strive to be a valued partner for logistics and transportation services by honoring our commitments and providing consistently superior service and innovative solutions tailored to each customer's unique business model. 5600 Brainerd Road, Ste E-213 Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 Bid Response Content: Section L. Tab A — Executive Summary Tab B — Relevant Experience Tab C — Past Experience Tab D — Brief Introduction to Lipsey Trucking Tab E — Transportation Operations Tab F — Transportation Management Team Tab G — Tracking and Reporting Management Information System Tab H — Invoicing Tab I — Licensing, Insurance, Certifications and Representations Sustainability Plan Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Section I Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseviogistics.com (423) 475-6468 Tab A — Executive Summary Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab A Executive Summary: Lipsey Trucking is pleased to present this response to the Emergency Bulk Drinking Water Services RFP2302B320AM230006. For 8 years Lipsey Trucking has built an industry leading model for meeting or exceeding its customers' requirements by building long-term partnerships and fostering a culture of trust, safety, and service with our customers and team members. This model enables Lipsey Trucking to retain a highly talented team with extensive experience in providing efficient, reliable, and highly flexible transportation and logistics services to Federal, State and Local agencies and municipalities. Trucking has a demonstrated track record in successfully fulfilling numerous State and Federal emergency contracts providing Disaster Relief Services to affected communities during times of natural and man-made crisis. At the state level, Lipsey Trucking has partnered with Alabama, Florida, Louisiana, Texas, Mississippi, Georgia, Tennessee, South Carolina, North Carolina, Virginia, New York, and California. At the national level, Lipsey Trucking has supported Lipsey Logistic contracts supporting emergency management and relief efforts with the US Army Corps of Engineers, the Department of Defense, Department of the Navy, Department of the Army, the US Coast Guard, the CDC, and FEMA. The submission of this RFQ response certifies that Lipsey Trucking acknowledges all requirements contained in RFP2302B320AM230006 including any published addenda. Lipsey Trucking looks forward to the opportunity to work closely with the City of Southlake, TX in providing a wide range of critical transportation and logistical services supporting operational missions. Sincerely, COL(R) Richard (Rich) Elam Director, Business Development Lipsey Logistics Response and Recovery Services Office: (423) 702-4979 Email: relam(cDlipseylogistics.com Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseviogistics.com (423) 475-6468 Tab B — Relevant Experience Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-213 Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab B Relevant Experience: Since its inception, Lipsey trucking has been one of the fastest growing and highly recognized freight companies in the United States. This is attributable to Lipsey Trucking's high retention rates of highly trained and skilled personnel who are directly responsible for the ongoing successes of Lipsey Trucking Lipsey Trucking professionals constantly seek out opportunities to improve systems and processes and they are never satisfied until every customer receives personable attention and the mission is complete. In partnership with Lipsey Logistics Worldwide, Lipsey Trucking has supported a significant number of routine and emergency management critical transportation missions. In demonstrating relevant experience shown below is a partial listing of some of Lipsey Trucking's recent accomplishments and ongoing missions. 2020 — provided the following capabilities during the response to Hurricane Laura: - 335 Trailers of Water to FEMA to support impacted States - Water tankers to LA - Fuel tankers to LA - Provided logistical manning at LSA Roseland, LSA Beauregard, LSA Selma, and LSA Texarkana 2020 — provided the following capabilities during the response to Hurricane Zeta: - Provided water trucks to support the AL DEM 2020 — Pandemic response support —ongoing: - Box Trucks to GA DEM for Pandemic response -ongoing - Reefer trucks to LA DEM for Pandemic response -ongoing 2021 — provided the following capabilities during the response to Hurricane Ida: - 50 Trucks for Shuttle Fleet to LA with LSA Staff - Water tankers to LA - Box truck support for LA non-profit organizations 2021 — provided the following capabilities during the Texas winter storm response: - 225 Trailers of water to support TX DEM - Provided logistical manning at LSA Sequin, and LSA Houston - Water tankers to LA 2021 — Lipsey Logistics restocked critical commodities in FEMA's warehouses located in: Atlanta GA, Dallas TX, Tracey CA, Cumberland and Frederick, MD and _ a,nar Puerto Rico. 2022 — Lipsey Logistics supported the following state Covid response missions: Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 -Supplied (8) Sprinter Vans and (10) Box trucks for the Georgia Department of Health (GDH) supporting PPE deliveries throughout the State of GA - Supplied (13) Box trucks for the Louisiana Department of Health (LDH) supporting PPE deliveries throughout the State of LA - Supplied (2) 53' Reefer drop Trailers plus re -fueling of the reefers supporting LDH Covid testing missions - Supplied (3) 53' Dry vans to LDH supporting various other Covid response missions throughout the State AUG 2022 — provided 49 truckloads of water to the State of Kentucky in response to the historic flooding in 11 eastern counties SEP 2022 - provided over 500 truckloads of emergency relief water to Jackson, MS during their water crisis Other relief efforts: Supported Humanitarian relief efforts in Puerto Rico - Over a three-week period, Lipsey Trucking in coordination with Lipsey Logistics moved: - 4,100 shipments of water - 3,000 containers - 1,100 53' dry vans Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylo.gistics.com (423) 475-6468 Tab C — Past Performance Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-213 Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab C Past Performance: Lipsey Trucking has extensive experience in supporting a multitude of state and federal contracts during normal and emergency situations. As reflected in our mission statement, Lipsey Trucking strives to be a valued partner for logistics and transportation services by honoring our commitments and providing consistently superior service and innovative solutions tailored to each customer's unique business model. With the depth of our fleet offerings and the breadth of experience of our professional team, Lipsey Trucking is well suited in meeting the requirements of this solicitation. Reference 1: Contract/Project Title: Hurricane Laura Scope of Work: Provided 335 trailers of water to FEMA to support the impacted state. Provided water and fuel tankers to the state of LA. Provided logistical manning to support operations at LSA Roseland, LSA Beauregard, LSA Selma, and LSA Texarkana (LSA-Logistical Staging Area). Agency: FEMA Contact Name/Title: Julie Nato Contact Telephone: 202-704-8061 Email: julie.nato@fema.dhs.gov Contract/Project Dates (Month and Year): Aug -Oct 2020 Contract Amount: $3.5M Reference 2: Contract/Project Title: Hurricane Ida Scope of Work: Provided the state of LA with 50 trucks and trailers along with water tankers and staff to support various Logistical Staging Areas (LSAs). Agency: LA Governor's Office of Homeland Security and Emergency Preparedness Contact Name/Title: Steven Buchholz Contact Telephone: 225-925-7556 Email: steven.buchholz@la.gov Contract/Project Dates (Month and Year): Aug -Oct 2021 Contract Amount: $2.1 M Reference 3: Contract/Project Title: 2021 Texas Winter Storm Response Scope of Work: Provided 225 trailers of water to the TX DEM and provided logistical manning at LSA Sequin, and LSA Houston. Agency: FEMA Contact Name/Title: Carolyn Ward Contact Telephone: 202-646-4654 Email: carolyn.ward@fema.dhs.gov Contract/Project Dates (Month and Year): Various times during the winter of 2021 Contract Amount: $2.6M Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-26 Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab D — Brief Introduction to Lipsey Trucking Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-213 Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab D Brief Introduction to Lipsey Trucking: For 9 years Lipsey Trucking has built an industry leading model for meeting or exceeding its customers' requirements by building long-term partnerships and fostering a culture of trust, safety, and service with our customers and team members. This model enables Lipsey Trucking to retain a highly talented team with extensive experience in providing efficient, reliable, and highly flexible transportation and logistics services to Federal, State and Local agencies and municipalities. Lipsey Trucking was founded in 2014 and since that time, (singularly or in partnership with Lipsey Logistics) has successfully fulfilled numerous State and Federal contracts moving a wide variety of goods during normal operations as well as during times of natural and man-made crisis. At the state level, Lipsey Logistics has partnered with Alabama, Florida, Louisiana, Texas, Mississippi, Georgia, Tennessee, South Carolina, North Carolina, Virginia, New York, and California. At the national level, Lipsey Logistics has supported emergency management and relief efforts with the US Army Corps of Engineers, the Department of Defense, Department of the Navy, Department of the Army, the US Coast Guard, the CDC, and FEMA. The Lipsey Logistics leadership team understands the need in delivering a reliable and scalable logistics organization capable of managing complex logistical and transportation requirements over a wide spectrum of operational environments. These logistical operations could encompass managing and, in some cases, manning fixed, temporary, and mobile warehousing locations but would have to be robust enough in pushing commodities and services through austere environmental conditions down to the user level. Through its extensive previous experience in supporting Lipsey Trucking also understands the demanding transportation requirements contained in this solicitation as it relates to potential 24/7 operations. As evidenced by our relevant experience track record, Lipsey trucking is well postured in supporting a variety of mission sets requiring extended operational hours as well as the capacity to surge vehicles, equipment and manpower as needed. When coupled with the Lipsey Logistics brokerage team, Lipsey Trucking's operational reach expands significantly. To meet the requirements of this solicitation the Lipsey Trucking team will dedicate a team of highly trained and experienced personnel who are well versed in managing geographically dispersed operations. The Lipsey Trucking team prides themselves on providing first-rate, anticipative and responsive service in supporting customer requirements. Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www, lipseylogistics.com (423) 475-6468 Tab E — Transportation Operations Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-213 Chattanooga, TN 37411 www.lipseviogistics.com (423) 475-6468 Tab E Transportation Operations: As stated previously, Lipsey Trucking is a preeminent transportation brokerage with a multitude of years of national and international transportation experience which includes significant experience in supporting a myriad of routine and complex mission sets. Lipsey Trucking retains extensive experience in providing efficient, reliable, and highly flexible transportation solutions and services during normal operations as well as emergency management situations. In addition, Lipsey Trucking has a demonstrated track record of success in providing exceptional transportation and logistics services to the Federal Emergency Management Agency (FEMA) Lipsey Trucking maintains a significant transportation fleet capability which has an extensive knowledge of the Central and Southwestern United States primary and secondary road transportation network. These resources coupled with the extensive experience of the Lipsey Trucking Team means Lipsey Trucking can rapidly expand its logistical and operations reach making it uniquely postured in meeting the requirements as detailed in this solicitation. In addition, Lipsey Trucking employs the latest in information technology in efficiently managing, tracking, communicating, and processing information and supplies at all levels throughout the transportation support process. Lipsey Logistics in concert with Lipsey Trucking maintains positive control of the following assets which can be employed on short notice to support known and emergent transportation management requirements: a. over 800 company owned or leased trucks and trailers b. 3000 portable satellite tracking devices c. employees ready to deploy within hours in response to an emergent requirement Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab F — Transportation Management Team Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab F Transportation Management Team: To meet the requirements of this solicitation and upon contract award, Lipsey Trucking will immediately assign a dedicated account manager to oversee the execution of the contract. Likewise, the account manager will establish communications with appropriate client staff to review the contract and solidify operational expectations. Concurrently, the designated Lipsey Trucking account manager will confirm internal and management controls are in place to ensure continuity of transportation services are sustained and that all provisions of the contract are being satisfied. The management and internal controls will at a minimum address arrival and delivery performance, driver performance and reporting actions for lost, damaged, misplaced or destroyed commodities to include documentation management of any mishap occurrences. Upon alert from appropriate client staff, select power units and trailers would be put on standby status to deploy on short notice as directed. To facilitate this effort, the Lipsey Trucking account manager will pre -coordinate with client staff on what type of assets to have ready on short notice deployment status. Lipsey Trucking will then select the pre -designated power units and trailers whose operational range is within or in close proximity to the operational zones. The Lipsey Trucking account manager will ensure all assigned drivers understand contractual requirements. The Lipsey Trucking account manager with utilize the `PACE system methodology in designating the trucks and trailers to ensure maximum operational response to high operational tempo demand signals. (* PACE — Primary, Alternate, Contingency, Emergency). As a matter of normal business practices all power units and trailers utilized by Lipsey Trucking are equipped with state-of-the-art GPS tracking capability to ensure up -to -the minute in -transit visibility of shipments. During periods of high -volume transportation operations, the Lipsey Trucking account manager will remain in close contact with designated client staff or other authorized representatives to ensure continuity of shipment operations. Lipsey Trucking operates 24/7 so it can quickly respond to client staff inquiries, questions or concerns. Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-213 Chattanooga, TN 37411 www,lipse\/Ioqistics.com (423) 475-6468 Tab G — Tracking and Reporting Management Information System Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.Iiipseylo.gistics.com (423) 475-6468 Tab G Tracking and Reporting Movement/Management Information System Technology: 1. Transportation Movement Management System (TMMS) — Tracking: Lipsey Trucking currently uses a state-of-the-art cloud -based Transportation Movement Management System (TMMS) in providing customizable status reports which are tailorable to meet various operational needs. As reflected in the below graphic, this system provides Lipsey Trucking with the capability of providing detailed reporting on in -transit visibility tracking and related tracing information of goods and supplies. S3rch =. _ Add update Lst Uovemema DehyW Receipt. DuDkate=. Crate OSSD Refs- Stop Searph, Orf&Order Gamer Orrxr Subtact ON r,, . nrst5 i=:! cam Q � Sort Touts Order number,0557979 Revenue code TH ,P Tennessee C. Loadboard Loadboard Ho Mode'TruckJoad ! Status lDelivered Recurring order! -� Ordertype 'htl P; DRYVAN ❑ Hold Reason._ M FollowUp Reason) Master order ID r? 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Macropoint GPS update from Carriers Driver 11/01/2021 0656 TRACY CA macropoint 0557979;1GTRMI.. macropoint GPS update from Carriers Driver 11/01/2021 0645 TRACY CA macropoint 05579791GTRML. Macropoint GPS update from Carriers Driver 11/01/2021 0635 TRACY CA macropoint 1b557979�GTRML. acropoint GPS update from Carriers Driver 11/01/2021 0625 RACY CA macropoint 0557979;IGTRMI.. M aaopaint GPS update from Carriers Driver 10/31/2021 2259 TRACY CA jbfandont 11110512021 1845 , 5579791GTRML. Delivery order 0557979 move 565937 The Lipsey Trucking TMMS is cloud based, therefore any requested tracking and tracing information required by client staff is readily available 24 hours a day, 7 days a week (24/7). The Lipsey Trucking TMMS is an enhanced permissions -based security protected website providing customers with a reliable and secure website which supports making more informed conditions -based decisions. Since the Lipsey Trucking TMMS is a permission -based platform, it is accessible via the worldwide web from government and personal computer systems and web accessible handheld electronic devices on a 24/7 basis. The Lipsey Trucking TMMS provides the following capabilities: a. Provides customizable status reports of all equipment and supplies during all operational stages b. Provides no cost, highly efficient electronic reporting and near -real time dashboard reporting which is compatible with all Microsoft system platforms c. Provides a secure cloud -based system residing on the worldwide web which can be viewed on government and personal computers and web accessible handheld electronic devices Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-21B Chattanooga, TN 37411 www.Iipseylogistics.com (423) 475-6468 d. Provides an enhanced Transportation Movement Management System which, at a minimum has the capacity of delivering high fidelity reports containing the below listed information points: 1. Shipment order information 2. Prices applied to each shipment 3. Movement data 4. BOL information as required 5. Other movement information as deemed necessary by USDA authority or other approved government agencies In addition, the Lipsey Trucking TMMS is capable of interfacing with other electronic systems using SMTP, FTP, EDI, and VAN electronic file formats as well as being exportable as ASCII files or other database files such as Microsoft Access and Excel. The Lipsey Trucking TMMS is a live operational information management system meaning the data contained therein is updated on a near -real time basis. Therefore, the Lipsey Trucking TMMS can provide the authorized USDA personnel with high -quality reporting information. The Lipsey Trucking TMMS is an operational archive of all Lipsey Trucking transactions and movements. Therefore, if required, on-line access to shipping records as noted are readily accessible for as long a deemed necessary by competent government authority. Upon request by approved government contracting personnel, the requested information will be provided within ten calendar days of the date of the request for the files or as agreed upon with the government contracting official. Those transactions which have claims, billing disputes or similar unresolved areas will remain separate from the other provided archived files until they are settled, and full payment is received. 2. Transportation Movement Management System (TMMS) — Reporting: As discussed previously, the Lipsey Trucking TMMS can provide a wide selection of tailorable near -real time status reports upon demand. Examples of reports are as follows: 1. In -transit asset visibility (tracking) of routed shipments 2. Completed shipments from designated pickup locations to designated delivery sites 3. If required, cross -docking reports detailing movement of commodities between trailers As discussed, the Lipsey Trucking cloud based TMMS can deliver quality in-depth and tailorable reports based on known and emergent data requirements as demonstrated below. As displayed, a user can click on a specific entry and drill down into a significant number of quantity data points including those referenced in items 1-3 above. Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 , :-. c- Llpie•. Le]!: �p ... ^;I:..-.e _ fr J Seach Previo t4 �t Add Update List Mote to 1i Delivery Receipt Duprwta= create OS3D Ref—ce Stop Search Off. 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Ivlacropoint GPS update from Carriers Driver 10/31/20212259 Y CA brandont 11/0512021 1845 Delivery order 0557979 move 565937 As demonstrated, in providing preeminent services to supported customers, Lipsey Trucking uses cutting -edge GPS, RFID, QR Code, OMS, and scanner technology in supplying a high-fidelity level of detail on all operational aspects and reporting relating to receipt, movement and delivery of good and supplies. Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP23028320AM230006 5600 Brainerd Road, Ste E-26 Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab H — Invoicing Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-26 Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab H Bill of lading / Invoicing: Lipsey Trucking uses industry standard electronic and manual Bills of Lading (BOL). Using the previously referenced cloud -based TMMS, most of the specific shipment information items requested are contained in BOLs as evidenced by the actual delivery BOL example shown below. Example BOL information items: a. Vendor name b. Purchase order number c. Shipment reference number d. Date and time of delivery e. Printed name and signature of individual receiving the order f. GPS location of delivery to include decimal level location g. Shipment and tracking information I:11';4h;1 BILL OF LADING _... _._ ._. . Additionally, the cloud based TMMS used by Lipsey Trucking is capable of being able to tailor BOLs to meet any additional information requirements as deemed necessary by authorized client staff. Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Tab I — Licensing, Insurance, Certifications and Representations Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylo,gistics.com (423) 475-6468 Tab I Licensing and Insurance: Lipsey Trucking owned and leased drivers are commercially licensed and fully insured and they operate in all 48 contiguous US States as well as Canada. Lipsey Trucking Motor Carrier Number is 884030 Lipsey Trucking SCAC is LPYK The assignment of this motor carrier number validates Lipsey Trucking's compliance with all licensing and certification requirements. Upon notification of being awarded this contract and as required by the client, Lipsey Trucking will provide the required insurance certificates as directed. Additionally, Lipsey Trucking acknowledges and will comply with the below listed requirements should it be awarded the contract: 1. As appropriate, all Lipsey Trucking HAZMAT carriers maintain valid Hazmat Certificates issued by competent US DOT authority. A copy of the required certification will be submitted upon award of contract or inquiry. 2. In accordance with FY2019 National Defense Authorization Act (NDAA) Section 889(a)(1)(B). Additionally, Lipsey Trucking certifies their compliance with all provisions of Sections A and B of the FY2019 National Defense Authorization Act Section 889(a)(1)(B). 3. Lipsey Trucking acknowledges and accepts and will conform to all safety and security requirements and regulations while operating on state and federal highways, secondary roads and property. 4. Upon contract award and if required by the client staff, Lipsey Trucking can provide the client with all assigned drivers information in advance prior to any pickup in accordance with specisal instructions by the client staff. 5. Upon contract award, Lipsey Trucking will assign a dedicated account manager and alternate account manager responsible for coordinating with Oregon Department of Administrative Services staff or other approved staff. The Lipsey Trucking account manager will provide the client staff with a listing containing the primary and alternate POCs, email addresses, and normal and emergency telephone numbers. 6. If required and upon request, Lipsey Trucking will provide client staff with maps, plans, or equivalent documents describing the location of all Lipsey Trucking equipment and materials as necessary. Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylo.gistics.com (423) 475-6468 8. The Lipsey Trucking account manager or designated Lipsey Trucking dispatch operation will: a. coordinate with the client staff in developing load plans and support operations. b. As mentioned earlier, Lipsey Trucking uses cutting -edge GPS, RFID, QR Code, OMS, and scanner technology in supplying a high-fidelity level of detail on all operational aspects and reporting relating to receipt, movement and delivery of good and supplies. c. During coordination meetings between the client staff and Lipsey account manager, specialized equipment requirements will be resolved and programmed. d. Lipsey Trucking will provide assistance as required in obtaining required transportation permits for assets that are oversized, overweight capacity, escorts and exceed height restrictions. e. Lipsey Trucking will provide dispatching services for replacement vehicles if an asset becomes inoperable by the next duty day. f. As referenced earlier, Lipsey Trucking will assign a dedicated contract manager and alternate as well as a dedicated dispatch POC who collectively will coordinate with the designated Project Officer for daily sequence of events in forecasting daily commercial truck requirements. This Lipsey Trucking Team will notify the client staff if any vehicle becomes inoperable, source a replacement equipment mover and advise the client staff of any commercial transportation delays. g. The Lipsey Trucking team will ensure any and all drivers communicate through the dispatch office for pickup and delivery information. Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 5600 Brainerd Road, Ste E-2B Chattanooga, TN 37411 www.lipseylogistics.com (423) 475-6468 Sustainability Plan: Lipsey Trucking strives to be an active agent in environmental conservation when and where practical. For the purposes of this bid response and as referenced in the technical approach section, Lipsey Trucking will utilize prime movers which operate within close proximity to the service areas. This process serves to limit the need to pull a prime mover from distant locations, thereby reducing Lipsey Trucking's overall carbon footprint. Lipsey Trucking will ensure the right vehicle platform is used in accomplishing the required task which will alleviate `overkill' on using oversized vehicles for small movements. All Lipsey Trucking owned and leased vehicles use low emission diesel fuels and they comply with federal and state emission standards. Additionally, Lipsey Trucking strongly encourages with all of company and contracted drivers the need to shut down power units during long periods of inactivity. As a matter of normal business practices, Lipsey Trucking utilizes a three -tiered framework which guides transportation operations planning, policy decisions, and implementation. The framework consists of: • Economy — Support economic vitality while developing transportation movement and operations in the most cost-efficient and effective manner. • Social — Provide transportation, which is accessible, safe, and secure for all social cross sections including socially and economically challenged echelons and develop transportation movement and operations which are an asset to the environment and supported communities. • Environment — Develop solutions that are compatible with - and when and where practical an enhancement to the environment, reduce emissions and pollution from the transportation system, and reduce the material resources required to support transportation. As stated, Lipsey Trucking seeks to be a valued business partner in providing first-rate services to its customers while simultaneously being good environmentally conscious stewards. Lipsey Trucking response to Emergency Bulk Drinking Water Services RFP2302B320AM230006 CITY OF SOUTHLAKE 0 City of Southlake REQUEST FOR PROPOSALS Proposal Reference Number: RFP2302B320AM230006 Project Title: Emergency Bulk Drinking Water Services Proposal Closing Date: 3:00 P.M.(CST), Friday March 24, 2023 TABLE OF CONTENTS Tableof Contents................................................................................................................................ Page l Request for Proposals (1) Introduction.............................................................................................................................. Page 2 (2) Definitions................................................................................................................................ Page 3 (3) General Information................................................................................................................. Page 3 (4) UP Withdrawals and/or Amendments.................................................................................... Page 3 (5) Estimated Quantities................................................................................................................ Page 3 (6) Proposal Submittal Requirements............................................................................................ Page 3 (7) Proposal Evaluation and Contract Award................................................................................ Page 4 Appendix A — Scope of Services (1) Project Title.............................................................................................................................. Page 6 (2) Scope of Services Contact........................................................................................................ Page 6 (3) Special Conditions.................................................................................................................... Page 6 (4) Proposal Evaluation Factors..................................................................................................... Page 6 (5) Brand Manufacture Reference.................................................................................................. Page 6 (6) Key Events Schedule................................................................................................................ Page 6 (7) Scope of Services..................................................................................................................... Page 6 Appendix B — Proposal (-) Label Format for Submittal Packet's Sealed Envelope............................................................. Page 8 I Required Proposal Information (1) Proposed Product..................................................................................................................... Page 9 (2) Cost of Proposed Product......................................................................................................... Page 9 (3) Term of Contract and Option to Extend................................................................................... Page 9 (4) Proposer's Experience / Staff................................................................................................. Page 10 (5) References.............................................................................................................................. Page 11 (6) Trade Secrets and/or Confidential Information...................................................................... Page 12 (7) Federal, State and/or Local Identification Information......................................................... Page 12 (8) Emergency Business Services Contact Notice....................................................................... Page 12 (9) Cooperative Governmental Purchasing Notice...................................................................... Page 13 I1 Contract Terms and Conditions (1) Delivery of Products and/or Services.................................................................................... Page 13 (2) Miscellaneous........................................................................................................................ Page 13 (3) Financial Responsibility Provisions...................................................................................... Page 14 AppendixC — Form CIQ................................................................................................................ Page 16 Appendix D — No Intent to Submit Form...................................................................................... Page 18 Appendix F — TCEQ Guidance for Public Water System Water Haulers ............................................... City of Southlake - RFP2302B320AM230006 - Page 1 of 18 Southlake, Texas Request for Proposals Introduction A. Project Overview: The City of Southlake is requesting Proposals with the intent of awarding a contract for the purchase of goods and services contained in Appendix A — Scope of Services. B.Questions: Following are contacts for questions as identified. i. RFP Clarifications: All questions related to requirements or processes of this RFP should be submitted in writing to the Purchasing Manager identified in section 2 below. ii. Scope of Service Questions: All questions related to the scope of services should be submitted in writing to the contact person(s) noted in Appendix A — Scope of Services. iii. Replies: Responses to inquiries which directly affect an interpretation or effect a change to this RFP will be issued in writing by addendum posted to City website. All such addenda issued by City prior to the submittal deadline shall be considered part of the RFP. The City shall not be bound by any reply to an inquiry unless such reply is made by such formal written addendum. iv. Acknowledgement of Addenda: The Proposer must acknowledge all addenda by signing and returning such document(s) or by initialing appropriate area of the Proposal. C. Notification of Errors or Omissions: Proposers shall promptly notify the City of any omissions, ambiguity, inconsistency or error that they may discover upon examination of this RFP. The City shall not be responsible or liable for any errors and/or misrepresentation that result from the solicitations which are inadvertently incomplete, ambiguous, inconsistent or obviously erroneous. D. Conflict of Interest Questionnaire (Form C1Q): A person or business, and their agents, who seek to contract or enter into an agreement with the City, are required by Texas Local Government Code, Chapter 176, to file a conflict of interest questionnaire (FORM CIQ) which is found in Appendix C. The form must be filed with the City Secretary no later than seven (7) days after the date the person or business begins contract discussions or negotiations with the City, or submits an application, response to a request for proposals or bids, correspondence, or other writing related to any potential agreement with the City. E. Form 1295 Certificate of Interested Parties: In 2015, the Texas Legislature adopted House Bill 1295, which added section 2252.908 of the Government Code. The law states that a governmental entity or state agency may not enter into certain contracts with a business entity unless the business entity submits a disclosure of interested parties to the governmental entity or state agency at the time the business entity submits the signed contract to the governmental entity or state agency. The law applies only to a contract of a governmental entity or state agency that either (1) requires an action or vote by the governing body of the entity or agency before the contract may be signed or (2) has a value of at least $1 million. The disclosure requirement applies to a contract entered into on or after January 1, 2016. Please go to the Texas Ethics Commission webpage (www.ethics. state.tx.us) for full instructions and to complete the required steps for creation of Form 1295. Once the form is completed online, printed and signed please return the form with your proposal submission. City of Southlake - RFP2302B320AM230006 - Page 2 of 18 2. Definitions Proposal: The signed and executed submittal of the entirety of Appendix B — Proposal. Proposer: The Proposer and the Proposer's designated contact signing the first page of the Proposal. City of Southlake ("Cites: The City of Southlake, Texas. City Secretary's Office: The office of the City Secretary of the City, located at 1400 Main Street, Suite #270, Southlake, Texas 76092. PH: (817) 748-8016; Fax: (817) 748-8270. Project: The name of this Request for Proposals as identified on the cover sheet and first page of Appendix A — Scope of Services. Purchasing Manager: The City of Southlake Purchasing Manager is Timothy Slifka CPPO, CPPB, Phone: (817) 748-8312, E-Mail: tslifka&ci.southlake.tx.us; Fax (817) 748-8010. Request for Proposals (RFP): The entirety of this document, including all Appendices and Addenda. Scope of Services: The entirety of Appendix A — Scope of Services. 3. General Information A. Tax Exempt Status: City purchases are exempt from State Sales Tax and Federal Excise Tax. Do not include tax in the Proposal. City will furnish Excise Tax Exemption Certificate upon request. B. Public Inspection of Proposals: The City strictly adheres to the Texas Public Information Act (Texas Government Code Chapter 552.001, et seq.) and all other governing statutes, regulations, and laws regarding the disclosure of RFP information. Proposals are not available for public inspection until after the contract award. If the Proposer has notified the City, in writing, that the Proposal contains trade secrets or confidential information, the City will generally take reasonable steps to prevent disclosure of such information, in accordance with the Public Information Act. This is a statement of general policy only, and in no event shall the City be liable for disclosure of such information by the City in response to a request, regardless of the City's failure to take any such reasonable steps, even if the City is negligent in failing to do so. 4. RFP Withdrawals and/or Amendments A. RFP Withdrawal: The City reserves the right to withdraw this RFP for any reason. B. RFP Amendments: The City reserves the right to amend any aspect of this UP by formal written Addendum prior to the Proposal submittal deadline and will endeavor to notify all potential Proposers that have registered with the City, but failure to notify shall impose no obligation or liability on the City. 5. Estimated Quantities The City does not guarantee to purchase any minimum or maximum quantity but does contemplate purchasing exclusively during the term of the contract from the successful vendor. 6. Proposal Submittal Requirements A. Submittal Packet — Required Content: All proposals must be submitted electronically. The Proposer must visit https:Hsouthlake.bonfirehub.com/login and register. Once registered for this City of Southlake - RFP2302B320AM230006 - Page 3 of 18 complimentary service, the Proposer may submit Proposal Documents electronically by selecting the appropriate Proposal Identification. B. Submittal Deadline: The deadline for submittal of Proposals shall be as identified on page 8 (eight) of Appendix B-Proposal. It is the Proposer's responsibility to have the Proposal Documents correctly electronically submitted by the submittal deadline. No extensions will be granted and no late submissions will be accepted. C. Proposals Received Late: Proposers are encouraged to submit their proposals as soon as possible. The time and date of receipt as recorded within the Bonfire electronic system shall be the official time of receipt. The City is not responsible for late submission regardless of the reason. Late Proposals will not be considered under any circumstances. D. Alterations or Withdrawals of Proposal Document: Any submitted Proposal may be withdrawn or a revised proposal substituted prior to the submittal deadline. Proposal Documents cannot be altered, amended or withdrawn by the Proposer after the submittal deadline, unless such alteration, amendment or withdrawal notice is approved in writing by the Purchasing Manager. E. Proposal Document Format: All Proposal Documents must be prepared in single-space type, on standard 8-1/2" x I I" vertically oriented pages, numbered at the bottom. The City only accepts electronic submissions via https://southlake.bonftrehub.com/login. Any other format (via telephone, fax, email, etc.) may be rejected by the City at its discretion. F. Validity Period: Once the submittal deadline has passed, any Proposal Document shall constitute an irrevocable bid to provide the commodities and/or services set forth in the Scope of Services at the price(s) shown in the Proposal Document. Such proposal shall be irrevocable until the earlier of the expiration of ninety (90) days from the submittal deadline, or until a contract has been awarded by the City. 7. Proposal Evaluation and Contract Award A. Proposal Evaluation and Contract Award Process: An award of a contract to provide the goods or services specified herein will be made using competitive sealed proposals, in accordance with Chapter 252 of the Texas Local Government Code and with the City's purchasing policy. The City will evaluate all proposals to determine which proposers are reasonably qualified for the award of the contract, applying the anticipated evaluation factors and emphasis to be placed on each factor as identified in the Scope of Services. The City may, at its option, conduct discussions with or accept proposal revisions from any reasonably qualified proposer. The City reserves the right to determine which proposal will be most advantageous to the City. B. Completeness: If the Proposal is incomplete or otherwise fails to conform to the requirements of the RFP, City alone will determine whether the variance is so significant as to render the Proposal non- responsive, or whether the variance may be cured by the Proposer or waived by the City, such that the Proposal may be considered for award. C. Ambiguity: Any ambiguity in the Proposal as a result of omission, error, lack of clarity or non- compliance by the Proposer with specifications, instructions and all conditions shall be construed in the favor of the City. In the event of a conflict between these standard RFP requirements and details provided in Appendix A — Scope of Services or Appendix B — Proposal, the Appendices shall prevail. D. Unit Prices and Extensions: If unit prices and their extensions do not coincide, the City may accept the price most beneficial to the City, and the Proposer will be bound thereby. City of Southlake - RFP2302B320AM230006 Page 4 of 18 E. Additional Information: City may request any other information necessary to determine Proposer's ability to meet the minimum standards required by this RFP. F. Partial Contract Award: City reserves the right to award one contract for some or all the requirements proposed or award multiple contracts for various portions of the requirements to different Proposers based on the unit prices proposed in response to this request, or to reject any and all Proposals and re -solicit for Proposals, as deemed to be in the best interest of City. G. Terminate for Cause: The occurrence of any one or more of the following events will justify termination of the contract by the City of Southlake for cause: i) The successful proposer fails to perform in accordance with the provisions of these specifications; or ii) The successful proposer violates any of the provisions of these specifications; or iii) The successful proposer disregards laws or regulations of any public body having jurisdiction; or iv) The successful proposer transfers, assigns, or conveys any or all of its obligations or duties under the contract to another without written consent of the City. v) If one or more of the events identified in Subparagraphs G i) through iv) occurs, the City of Southlake may, terminate the contract by giving the successful proposer seven (7) days written notice. In such case, the successful proposer shall only be entitled to receive payment for goods and services provided before the effective date of termination. The successful proposer shall not receive any payment on account of loss of anticipated profits or revenue or other economic loss resulting from such termination. vi) When the contract has been so terminated by the City of Southlake, such termination shall not affect any rights or remedies of the City then existing or which may thereafter accrue. H. Terminate for Convenience: This contract may be cancelled or terminated at any time by giving vendor thirty (30) days written notice. Vendor may be entitled to payment for services actually performed; to the extent said services are satisfactory. City of Southlake - RFP2302B320AM230006 - Page 5 of 18 Appendix A — Scope of Services 1. Project Title: Emergency Bulk Drinking Water Services 2. Scope of Services Contact Questions about the technical nature of the Scope of Services, etc. may be directed to TIM SLIFKA, Phone. 817.748.8312, e-mail: tslifka@ci.south]ake.tx.us. 3. Special Conditions The following special conditions shall prevail over areas of conflict in previous pages: NONE 4. Proposal Evaluation Factors Emphasis Factor 30% Vendor Overall Price for Services 35% Vendor Experience and Qualifications Providing Required Services 35% Vendor Ability to Provide Required Services 5. Brand Manufacture Reference The City has determined that any manufacturer's brand defined in the Scope of Services meets the City's product and support need. The manufacturer's reference is not intended to be restrictive and is only descriptive of the type and quality the City desires to purchase. Quotes for similar manufactured products of like quality will be considered if the Proposal is fully noted with the manufacturer's brand name and model. The City reserves the right to determine products and support of equal value, and whether other brands or models meet the City's product and support needs. 6. Key Events Schedule Proposal Release Date Deadline for Submittal of Written Questions Sealed Proposals Due to and Opened by City Anticipated Committee Evaluation Review Date Anticipated Contract Approval Scope of Services February 24, 2023 March 10, 2023 Shown on First Page of this RFP March 2023 April 2023 The City of Southlake is soliciting proposals for bulk clean, potable, and chemical free water during a local water emergency. These services shall include, but not be limited to, bulk drinking water supplied via appropriate tank truck(s) to various City locations, gravity fed stand-alone water dispensers, and bulk bottled water as requested by the City. These services and products are anticipated to be requested during emergency events, whether a natural disaster or localized incident, but may be requested by the City at any time. Resulting contract will be utilized on an "as needed" basis. The City does not guarantee to purchase any specific amount of product or services under a contract resulting from this request for proposal. In the event of a catastrophe, be it a natural disaster or localized incident, ensuring safety and beginning the process of recovery can be exceptionally challenging. Even seemingly simple tasks, such as procuring safe potable water, can prove to be quite complex. City of Southlake - RFP2302B320AM230006 - Page 6 of 18 The City of Southlake would like a vendor capable of providing bulk clean, potable, and chemical -free water for residents experiencing a local water emergency. • The vendor must provide services in accordance with TCEQ 30 TAC 290.44(i). A water provider that distributes drinking water for human consumption by tank truck or trailer who meets the definition of a public water system under 30 TAC 290.38(71) will be regulated as a water hauler under 30 TAC 290.44(i). Water haulers shall obtain approval from TCEQ prior to providing drinking water to the public. • When requested the vendor shall ensure delivery within 24 hours of order placement. • The City/Residents shall provide containers for water provided by the vendor. Equipment Proposers shall supply a list of equipment owned by the company or provide proof of the ability to obtain the necessary product and type of equipment needed to successfully perform the job duties under this contract. Mobilization: Within 24 hours of notice to proceed from the City, the proposer shall provide requested product and services. The City may award a contract for these services and products to multiple proposers to ensure availability as required. City of Southlake - RFP2302B320AM230006 Page 7 of 18 Appendix D — No Intent to Submit Form If your firm has chosen not to submit a proposal for this procurement, please complete this form and submit to: City of Southlake Purchasing Division, Department of Finance 1400 Main Street, Suite 420 Southlake, Texas 76092 Please check all items that apply: ❑ Do not sell the item(s) required ❑ Cannot be competitive ❑ Cannot provide Insurance required ❑ Cannot provide Bonding required ❑ Cannot meet specifications highlighted in the attached ❑ Cannot comply with Indemnification request requirement ❑ Job too large ❑ Job too small ❑ Do not wish to do business with the City of Southlake ❑ Other: ❑ Cannot submit electronically Company Name (Please print): Authorized Officer Name (Please print): Telephone: (� Fax: () City of Southlake - RFP2302B320AM230006 - Page 18 of 18