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Item 4E
CITY OF SOUTHLAKE MEMORANDUM (February 21, 2011) To: Shana Yelverton, City Manager From: Robert H. Price, P.E., Director of Public Works Subject: Approve contract for manhole rehabilitation with Lewis Concrete Restoration in the amount of $ 70,000 Action Requested: Approve contract for manhole rehabilitation with Lewis Concrete Restoration in the amount of $ 70,000 Background Information: In late 2010, RJN Group engineering completed a comprehensive assessment of the Southlake waste water collection system. Generally they found the network of pipes to be in good condition and adequately sized to serve the needs of our customers. Most of the defects found were on the concrete structures in the system such as manholes, Junction boxes and lift stations. While some of the defects were caused by post- construction activities such as earth grading, the more serious and on -going issue is the degradation of the concrete structures do to acid formation in the collection system. As waste water ages in the collection system, biological activity begins decomposing the nutrients in the sewage. The fact that so much of Southlake's waste water is collected in lift station wet wells and pumped to higher elevations adds to this detention time. Two harmful byproducts of that decomposition are the production of methane and /or hydrogen sulfide gasses. Methane presents both an explosion and respiratory hazard. The formation of Hydrogen sulfide presents a respiratory hazard and in the presence of water, it forms sulfuric acid. Constant exposure to this acid will literally dissolve concrete structures over a number of years. In July 2011 we solicited sealed bids for concrete restoration services. The project was started using Wastewater Division funding from FY 2011. Because it is clear that this project will exceed $50,000 during FY 2012, staff is requesting council approval to continue the project with up to $70,000 remaining in the 2012 CIP for sanitary sewer repairs. Financial Considerations: Funding for purchases under this contract is available in the FY 2012 CIP - Sanitary Sewer System Rehabilitation Project. Strategic Link: The maintenance of the utility system links to the city's strategy map relative to focus area of Performance Management and Service Delivery. The specific corporate objective that is met by this purchase agreement is investing to provide and maintain high quality public assets. Citizen Input/ Board Review: N/A Legal Review: N/A Alternatives: The City Council may approve or deny this agreement. Supporting Documents: Bid Specification and Addendum Staff Recommendation: Approve contract for manhole rehabilitation with Lewis Concrete Restoration in the amount of $ 70,000 Staff Contact: Robert H. Price, P.E., Public Works Director Chuck Kendrick, Deputy Director of Public Works - Operations August 5, 2011 Lewis Concrete Restoration 405 Ware Dr. Buda, Texas 78610 ATTN: Sherry Lewis Subject: RI✓B1105B420JT110016 Provide Manhole. and Wet Well Rehabilitation Services Dear Ms. Lewis: The City of Southlake is pleased to inform you that Lewis Concrete Restoration of Buda, Texas is the awarded vendor for "RFB1 105B420JT1 10016 Provide Manhole and Wet Well Rehabilitation Services." The award and this agreement are based on your bid to the City, copy enclosed: This is a single vendor award contract. Your company's award is attached. 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 purchasing 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 City Contact: JACK THOMPSON 817 - 748 -8200 Send all billing to: City of Southlake 1400 Main Street, Suite 440, 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 `f Purchasing Manager, CPPB City of Southlake 1400 Main Street, Suite 440 Southlake, Texas 76092 tslifka@ci.southlake.tx.us Phone / Fax: 817.748.8312 / 817.748.8048 Contract and Award Accepted: Signed: Pv na Yelverta Manager DATE: �O 1400 Main Street, Suite 440 Southlake, Texas 76092 Appendix B W Bid Document SUVIT l Checklist (To determine validity of bid) I learned of this Request for Bids by the following means: ❑ Newspaper Advertisement ® City E-mail Notification ❑ Southlake Website ❑ Cold Cali to City ❑ Mailed Me a Copy ❑ Other City ofSouthlake - RFB1i05B420JT110016 - Page 8 of 18 Appendix B (pages _8_ through 1$, most be included in the bid submittal, Appendix C (page_18, Conflict ofInteresi Form most be included In the bid submittal. Appendix B — Bid Document (continued) L REQUIRED BID INFORMATION IN ORDER FORA BID TO BE CONSIDERED COMPLETE, AND TO BE EVALUATED FOR A CONTRACT AWARD BY THE CITY, BIDDER MUST SUBMIT ALL OF THE FOLLOWING INFORMATION: 1. Proposed Products and/or Services A. Product or Service_ Description Bidders should utilize this section to describe the technical aspects, capabilities, features and options of the service or 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. Reference Sec A B. Additional--Hardware Desoriptionns Bidders 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. Material - SgL21y Data Sheets (LASDS): If applicable, the successful Bidder shall provide the City with applicable MSDS documentation as required by applicable laws and regulations. Reference Sec A D. Guarantees and Warranties Each Bidder shall submit a complete copy of any warranties or guarantees provided by the manufacturer or Bidder with the Bid submitted. Reference Sec D E. Project Schedule/Delivery-Date Bidder 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 RFB. The Bid Document must show the number of days required to deliver and install the product or equipment after the receipt of the City's Purchase Order. scope of approx 11 manholes to be completed 34 days from elate of PO. 2. Cost of Proposed Products andlor 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 I ej"n : Bidder 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: Reference Section B edule City ofSouthlake - RFB1105B420JT110016 - Page 9 of 18 Sewer Manhole Liner Per Vertical Foot for Four I. Per Vertical Ft. Foot Diameter Manhole 4' per Scope of Services $ n/a 2. Per Vertical Ft. Sewer Manhole Liner Per Vertical Foot for Five Foot Diameter Manhole 5' per Scope of Services $ n/a Wet Well Liner Per Square Foot per Scope of 3. Per S uare Ft. Services $ n/a Other Vendor Charges. Please Explain. 4. Per Svc. $ n/a TOTALALLLINE ITEMS see revised ice sc Reference Section B edule City ofSouthlake - RFB1105B420JT110016 - Page 9 of 18 I F Revised Schedule of Pricing: Reference Section s ckydSoMke • FhanwDwadmenl 0 1400 Main 3hW 8*440 • SPPMkb; To= 76M 817.748,831? An 1EEOIAili m be Action Inottulbn Sewer Manhole Liner Per Vertical Font for Four Foot Diameter Manhole. (4') per Scope of Services 1. Per Vertical Ft. CONDITION X 128.00 $ Sewer Manhole Liner Per Vertical Foot for Four Foot Diameter Manhole (4') per Scope of Services 2. For Vertical R. CONDMON 2 Sewer Manhole Liner Per Vertical Foot for Four Foot Diameter Manhole (4') per Scope of Services 3. Per Vertical Ft. CONDMON 3 $ 270.00 Sewer Manhole Liner Per Vertical Foot for Five Foot Diameter Manhole (5) per Scope of Services 4. Per Vertical Ft. CONDIUON 1 160.00 $ Sower Manhole Liner Per Vertical Foot for Five Foot Diameter Manhole (5') per Scope of Services 5. Per Vertical Ft. CONDITION 2 $ 237.50 Sewer Manhole Liner Fer Vertical Foot for Five Foot Diameter Manhole (5') per Scope of Services 6. Per Vertical R. CONDITION 3 3 25.00 $ Wet Well Liner Per Square Foot per Scope of 7. Per S Ft. Services 11.2 5 Additional Cementitoas Repair Material Above 8, Per W Initial 1" of material $ 4.0 0 per 3V Traffic Control as Required by Texas Manual on Uniform Traffic Control in TXDOT Right of 9. Per Hr wa y $ 200.00 TraBxc ConW as Requimd by Texas Manual on Uniform Traffic Control in High Traffle 10. Per l•Ir Non - Residential Area $ 150.00 Traffic Control as Required by Texas Manusal 75.00 11. Per Hr on Uniform Traffic Control in Residential Area $ Ven Pl ease 11 - 12 OR FFLLOOW PLUGS 12, Per Svc. WATER FTOW CONTROL UNIT COST IS PER PLUG EACH $ 400.00 flyer Vendor Charges. Please Explain. 13. Per Svc. $ T[3TAL ALL LINE ITEMS - UNIT TOTAL [ $ 2 � ckydSoMke • FhanwDwadmenl 0 1400 Main 3hW 8*440 • SPPMkb; To= 76M 817.748,831? An 1EEOIAili m be Action Inottulbn 3. Bidder's Experience / Staff A. Project Team Identify all members of the Bidder's team (including both team members and management) who will be providing any services proposed and include information which details their experience. Reference Sec C 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 Bidder's business has been established and operating. If Bidder'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; F &L Concrete Services, Inc. State the number of years experience the business has: 16 ; and the number of employees: 15 D. Project Related Experience All Bids must include detailed information that details the Bidder's experience and expertise in providing the requested services that demonstrates the Bidder's ability to logically plan and complete the requested project. 4. References Bidder shall provide three (3) references where Bidder has performed similar to or the same types of services as described herein. Reference #1 - City of Laredo Manhole Rehab Client/ Company Name: City of Laredo, TX Contact Name: Angel Leon Phone: 512- 267 -1155 ContactTitle: Super Wastewat Phone' 956- 721 -2022 x3060 Email: m. owens @robins ontexas . org Email:aleon@ci.laredo.tx.us Date and Scope of Work Provided: 2008 -2009: rehab of manholes in variou locations by application of repair mortar and epoxy lining. Reference 2: City of Lago Vista Manhole Rehab Client/ Company Name: City of Lago Vista Contact Name: Dave Stewart Contact Title: Director of Public W Phone: 512- 267 -1155 Email: dstewart@lago-vista.org Date and Scope of Work Provided: 2009-2M: manhole rehab various ocat application of repair mortar 1 - 4 " thick, epoxy coatings tank epoxy coating Reference #3: City of Robinson Manhole Rehab Client / Company Name: City of Robinson Contact Name: Mike Owens Contact Title: WW Operations Directo Phone: 254-662-1415 Email: m. owens @robins ontexas . org Date and Scope of Work Provided: locations application 2010 -2011: manhole rehab various of repair mortar and epoxy Coatings r irks ons City of South lake - RFB1105B420JT110016 Page 10 of 18 Reference Section C: Project Team Field Superintendents: Juan Moreno, Lorenzo Aguilar General Manager: Eric Lewis PresidenVCFO: Sherry Lewis Lewis Concrete Restoration Confined Space Entry Personnel Certifications. La UDERDALE ENVIRQNMENTAL ENGINEERING 3804 Cloudy Ridge Rd.., Austin, Texas 78734 Phone: 5121266 -8933; Fax: 512/266 -8933 Confined space Trained: This card certifies that the following person has completed the required permit - required confined space training. Name: Heriberto Ramirez Company: Lewis Concrete Restoration/ f /k/a F &L Concrete Sere. Date of Training: 3/01/10 Trainer: Dave Williams LAUDERDALE ENTAL EA161NEERING 3804 Cloudy Ridge Ltd -, Austin, Texas 78734 Phone: 512@66 -8933; Fax: 51212668933 Confined space Trained: This card Certifies that the following person has completed the required permit required confined apace training. Name. Jesus Joventino Ramirez Company: Lewis Concrete Restoration/ f /k /a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: Dame Williams LAUDERDALE ENVIRONMENTAL ENGINEERING 3804 Cloudy Ridge Rd... Austin, Texas 78734 Phone; 512!265-8933; Fax 512/266 -8933 Confined space Trained: This card certifies that the following person has completed the required permit- required confined space training. Name: Fransisco Ramirez Company: Lewis Concrete Restoration /f /k /a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: Dave Williams LAUDERDALE ENVIRONMENTAL ENGINEERING 3804 Cloudy Ridge Rd.., Austin, Texas 78734 Phone: 5121266 -8933; Fax: 5121266.8933 Confined space Trained: This card certifies that the following person has completed the required permit - required confined space training. Name: Jaime Ramirez Company: Lewis Concrete Restoration/ f /k/a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: Dave Williams LAUDERDAI ENVlBQWOdEWAL ENGINEERING 3804 Cloudy Ridge Rd.., Austin, Texas 78734 Phone: 5121266.8933; Fax: 5121266 -8933 Confined space Trained: This card certifies that the following person has completed the required permit - required confined space training. Name: Rodrigo Ramirez Company: Lewis Concrete Restoration/ f /k /a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: Dave Williams LAUDERDALI ENVIRONMENTAL ENGINEERING 3804 Cloudy Ridge Rd.., Austin, Texas 78734 Phone: 5121266 -8933; Fax: 512!266 -8933 Confused apace Trained; This card certifies that the following person has completed the required permit - required confined space training. Name. Eric Lewis Company: Lewis Concrete Restoration/ f /k /a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: Dave Williams LAUDERDALE ENVIRONMEEI[J'AL ENGINEERING 3904 Cloudy Ridge Rd.., Austin, Texas 78734 Phone: 5121266 -8933; Fax: 5121266 -8933 Confined space Trained: This card certifies that the following person has completed the required permit- required confined space training. Name: Dioniclo Escobar Company: Lewis Concrete Restoration/ f /k/a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: Dave Williams LAUDERDALE ENVIRONMENTAL ENGINEERING 3804 Cloudy Ridge Rd.., Austin, Taxes 78734 Phone: 5121266 -8933; Fax: S 12/266.8933 Confined space Trained: This card certifies that the following person has completed the required permit - required confined space training. Name: Jesus Ramirez Company: Lewis Concrete Restoration/ f /k/a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: Dave Williams LAUDERDALE ENVIRONMENTAL ENGINEERING, 3804 Cloudy Ridge Rd.., Austin, Texas 78734 Phone: 5121266 -8933; Fax: SIZ266 -8933 Confined space Trained: This card certifies that the following person has completed the required permit-required confined space training. Name: Raymundo Hernendez Company: Lewis Concrete Restoration/ f /k /a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: pave Williams LAUDERDALE ENVIRONMENTAL ENGINEERING 3804 Cloudy Ridge Rd_., Austin, Texas 78734 Phone: 5121266 -8933; Pax; 5121166-8933 Confined spare Trained- This card certifies that the following person has completed the required permit - required confined space training. Name: Travis Lewis Company. Lewis Concrete Restoration/ f /k /a F &L Concrete Serv. Date of Training: 3/01/10 Trainer. pave Williams LAUDERDALE ENVIRONMENTAL jNGINEERING 3804 Cloudy Ridge Rd.., Austin, Texas 78734 Phone; 5121266.8933; Fax: 5121266 -8933 Confined apace Trained; This card certifies that the following person has completed the required permit - required confined apace training. Name: LoreruoAguiiar Company, Lewis Concrete Restoration/ f /k /a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: pave Williams 38D4 Cloudy Ridge Rd.., Austin, Texas 78734 Phone: 5121166 -8933; Fax: 5121266 -8933 Confined space Trained: This card certifies that the following person has completed the required permit- required confined space training. Name: Juan Moreno Company: Lewis Concrete Restoration/ f /k/a F &L Concrete Serv. Date of Training: 3/01/10 Trainer: Dave Williams Lewis Concrete Restoration Statement of Qualifications Team Member. Juan Moreno Title. Field Supervisor Experience/Qualifications Field Supervisor- (July 2010 - current) Lewis Concrete Restoration Works with 4-6 crew members in field operations for the Coating Division. Directs and oversees labor personnel, field operations, safety guidelines, and equipment maintenance. Experience for over 13 years in the concrete rehab and coating industry. His expertise expands from concrete rehab, shotcrete, water control, surface preparation and confined space, to specializing in epoxy coatings Including those manufactured by Raven Lining Systems. Travels extensively in various central regions of the United States including Texas, Colorado, Oklahoma, Arkansas, Missouri, and California. Worked and supervised the shotcrete of a 54" tunnel for the Bama Garner Tunnel project. Oversees ail S. Texas projects and crews including Laredo, Brownsville, and Mercedes, TX. Coordinates projects and crew, equipment, and trains new personnel. Works with client's project Manager onslte. Liasion between cilentjobsite personnel and LCR personnel, Bi- lingual. Field Supervisor- (2002 -July 2010) F &L Concrete Services, Inc., Austin, TX Works with 4-6 crew members in field operations for the Austin Coating Division. Directs and oversees labor personnel, field operations, safety guidelines, and equipment maintenance. Experience for over 8 years in the concrete rehab and coating industry. My expertise expands from concrete rehab, shotcrete, water control, surface preparation and confined space, to specializing in epoxy coatings including those manufactured by Raven Lining Systems. Travels extensively in various central regions of the United States including Texas, Colorado, Oklahoma, Arkansas, Missouri, and California. Worked and supervised the shotcrete of a 54" tunnel for the Bama Garner Tunnel project. Education Confined Space Training - CSHI Jan 14, 2008 Respirator Fit Testing - CSH I Jun 16, 2008 Respirator Classroom Training- CSHI Jun 16, 2008 CPR training - CSHI May 30, 2008 Confined Space Training - Lauderdale March 3, 2010 Lewis Concrete Restoration Statement of Qualifications Team Member: Lorenzo Aguilar Project Title: Field Manager Experience /Qualifications Field Manager - (July 2010 - current) Lewis Concrete Restoration Oversees all LCR field personnel of approximately 3 crews -15 men. Assists Field Supervisor in project scheduling, equipment maintaence, supplier vendor accounts, employee relations, Liason between clientle and employees. Oversees product handling, employee travel accomodations, equipment and employee jobsite delivery, quality control, & jobsite safety. Controls costs Including gas, travel fees, equipment repairs, vendor accounts, & supplies. Responsible for employee morale and jobsite professionalism. Bilingual in Spanish. Expertise In coating application and concrete rehab with 20+ eperience. Superintendent - (1997 July 2010) F &L Concrete Services, Inc., Houston and Austin, TX Oversees all field and sales operations forthe Austin Coating Division. Manages labor personnel, field operations, safety guidelines, equipment maintenance, and client relations. Experience for over 20 years in the concrete rehab and coating industry. My expertise expands from concrete rehab, shotcrete, water control, surface preparation, confined space, to specializing in epoxy coatings including those manufactured by Raven Lining Systems. Travels extensively in various central regions of the United States including Texas, Colorado, Oklahoma, Arkansas, and California. Superintendent - (1986 -1996) Epoxy Design Systems, Inc. Houston, TX Supervised work crew of 6 -8 employees. Applied epoxys and urethane grouts, rehabilitated parking garages, water towers, piers, and wharfs. Traveled extensively throughout the US during employment. Education Confined Space Training - CSHI Jan 14, 2008 Respirator Fit Testing - CSHI Jun 16, 2008 Respirator Classroom Training - CSHI Jun 16, 2008 CPR training - CSHI May 3D, 2008 Confined Space Training - Lauderdale March 1, 2010 Lewis Concrete Restoration Statement of Qualifications Team Member: Eric Lewis Experience/Qualifications General Manager -July 2010 -current Lewis Concrete Restoration, Buda,TX Oversees Projects within Central Texas: manages field personnel, safety guidelines, equipment malntanence, and jobsite client relations. Estimates and Bids upcoming projects. Maintains product Inventory, ordering, and usage for coating and rehab market. Assists Management in submittal process for bidding/estimating. Travels extensively throughout state of Texas for sanitary sewer projects. President /Co- Founder - (1996 -July 26, 2010) F &L Concrete Services, Inc., Houston and Austin, TX Project Manager Oversees all field and sales operations for the Austin Coating Division throughout the US and Nassau, Bahamas. Manages labor personnel, field operations, safety guidelines, equipment maintenance, and client relations- Analyzes corporate financials, budgets, and profitability for both the Houston and Austin coating markets as well as Corporate overall profitabiity. Experi- ence for over 20 yrs in the construction and concrete rehab industries. My expertise expands from concrete rehab, shotcrete, water control, surface preparation, confined space, to specializing in epoxy coatings Including those manufactured by Raven Lining Systems. Experience in applying wet /dry process since 1991. Recently completed City of Austin Govalle Tunnel Shafts and Laterals Rehab (12/15/08). Project Superintendent - )1990 -1996) Epoxy Design Systems, Inc. Houston, TX Supervised work crew of 4-8 employees. Applied epoxys and urethane grouts, rehabilitated parking garages, water towers, piers, and wharfs. Traveled extensively throughout the US and abroad during employment. Supervised oversea projects such as Diego Garcia's Oil Burn Rehab ($350,000) and Cologne, Panama's Texas Oil Refinery Rehab Project ($70D,000). Education Confined Space Training - CSHI Jan 14, 2008 Respirator Fit Testing- CSHI Jun 16, 2008 Respirator Classroom Training - CSHI Jun 16, 2008 CPR training-CSHI May 30, 2008 Confined Space Training - Lauderdale Environ March 1,2010 SHERRY L. LEWIS 405 Ware Dr . Buda, TX 78610. 512983 -3283. sherrylewis@austin.rr.com Founder of Lewis Concrete Restoration Company in April 2010. I have over 20 years experience in the accounting /finance /management field and 14 years experience in the specialty coating /construction field. I hold a BA in Accounting degree from Texas A &M class of 1990. Duties include: overseeing all corporate functions including. corporate profitability, legal issues including litigation, federal and state filings, project certifications, financing of daily operations and equipment, direct Field Management Teams including Supervisors and Managers, estimating projects using Virtual Builders Exchange online software, project scheduling with clients and field personnel, coordinate client requests including submittals, jobsite duality control, oversee equipment maintenance expenses and maintenance scheduling, maintain material and field supply inventory usage and ordering, maintain vendor and client relations, handle all medical and dental and commercial insurance, maintain field safety guidelines. Travel throughout the Texas area working with client relations, jobsite safety, material usage and inventory control, and jobsite application of cement /coating procedures from North to South Texas including Lubbock, Fort Worth, Dallas to San Antonio, Laredo, Brownsville, and Valley areas. Management of field operations from management of costs to safety and application procedure of Raven Lining Systems — worked on $1.6 mill City of Austin Montopolis Shafts and Laterals Rehab project in 2008. Possess advanced computer skills in MS Office Suite, Quickbooks Pro2010, Adobe 9, and Virtual Builders Exchange and McGraw Hill online software applications as wells as maintaining desktop and server computer systems for remote users. F s, Office Management Teambuilding & Supervision Staff Development & Training Office Policies & Procedures Manuals Corporate Profit/Loss Corporate Asset Finance Field Safety Manuals Medical Benefits Administer Report & Document Preparation Spreadsheet & Database Creation Accounts Payable/Receivable Bookkeeping & Payroll Litigation Research. Corporate Tax Filings Field Safety Procedures Bidding and Estimating Corporate Insurance Administer Records Management Meeting & Event Planning Inventory Management Expense Reduction HR State Filings and Procedures Municipal Filing Requirements Project Cost Accounting Project Scheduling Direct Field Operations F &L Concrete Services, Inc. Austin, TX 1996 to 7/15/2010 Executive Assistant/Office Manager 1998 -- 711512010 Duties: Daily accounting functions including accounts receivable, payables, payroll, taxes, corporate budget reporting, project estimating, project scheduling, project cost accounting, insurance administration, corporate financing, computer system maintenance, software maintenance, corporate and field policies, human resource policies and filings, litigation support, and assist iii the on-going development of field safety procedures for Company manual and municipals. Worked extensively on City of Austin Montoplis Project in 2008 $1.6 mill project as a liason between client, vendors, and field personnel. Maintained safety materials, safety meetings, jobsite material usage, and personnel/material preparation at jobsite trailer daily. Decreased corporate expenditures 50% by implementing needed controls on: stock/supplies, vendor account controls, on -time payment procedures, re- organizing office personnel and division duties, set up division accounting by class to track expenses by Departments and standardized field procedures for estimating and field expenses. Decreased expenses resulted in reported net corporate profits within a 3 year history. Implemented and coordinated installation of corporate software and remote access to facilitate communication and information sharing for Austin and Houston offices resulting in ability for multiple users for accounting systems and real time data. Co-founder and Shareholder from 1996 - 1998. 1993 -1996 Sonat, Inc. Houston, TX Staff Accountant Accountant Recorded gas sales revenues of approx. 2 million monthly. Responsible for gross sales analysis, accounts receivable, intra office correspondence for transportation costs, and production volume variances. Developed procedures for transportation costs system tracking and reconciliation of $1 million vendor accounts resulting is decreased backlog and a $5,000 monthly savings. Corresponded interoffice booking transportation cost procedures for mainframe and desktop ledgers. Reported monthly variances for accounts receivable, gross sales, and costs to management. Promoted to Systems -gas revenue receipts in 1995. Analyzed daily cash receipt to system downloads utilizing a $100,000 software system. Conurrunicated errors and corresponded with the Systems IS department for department benefit of software use resulting in re- consideration of future software upgrades and use. Analyzed report and system errors with colleagues in the gas revenue department, communicated unresolved issues with management and Systems IS Department. Educata 1990 Bachelor of BA Texas A&M, College Station, TX 1988 -1990 School of Business Stephen F. Austin, Nacogdoches, TX 1986 -1988 1986 Graduate Lamar High School, Arlington, TX 1983 -1986 Central Texas Girl Scouts of America Member- 2006 - current. Actively involved in Girl Scouts projects such as cookie sales mentor and sponsor for 6 years. Community projects include: Santa Helpers for San Marcos, Backpack for Kids in 2008 -2009, Cookie Pac Operation for Military 2009-2010, Brownie Bronze Award 2009 - Rose Garden project for Elm Grove Elementary, Buda, TX. Managed a rose garden project for all students to use - assisted in planning, fundraising through corporate sponsors, donations, planting, and on -going maintenance. Founded "Angels in the Hill. Country" in 2009 - a non -for profit organization helping families in need. Provided a family who lost all personal items in a home fire with clothing, toys, and household items collected from members of the Buda community. With the assistance of my girl scout children, I created flyers and distributed theta to local area schools and online district schools. I corresponded with families to collect, clean, pack, and distribute donated items to the family. S. 6. VA 8. Trade Secrets and/or Confidential Information Trade Secrets and/or Confidential Information: This bid (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: #5452 B. Prime contractor HUB / MWBE registration number: 1272849234400 C. An individual Bidder acting as a sole proprietor must also enter the Bidder's Social Security Number: # ri /a - - 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 RFB from the successful Bidder. All purchases by governmental entities, other than the City, will be billed directly to and paid by that governmcntal entity. The City will not be responsible for another governmental entity's debts. Each governmental entity will place their own orders with the successful Bidder and be responsible for ensuring full compliance with the RFB specifications. Prior to other governmental entities placing orders, the City will notify the successful Bidder of their intent. Please indicate below if you will permit other governmental entities to purchase from your agreement with the City. [ x] Yes, Others can purchase; [ ] No, Only the City can purchase. Term of Contract and Option to Extend: Any contract resulting from this RFB shall be effective for th onths 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.-Clam 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 D% escalation. City of Southlake - RFBIIOSB420JT110016 - Page 11 of 18 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 (FY 11 -12) ESCALATION ........................... 5 % SECOND ADDITIONAL YEAR (FY 12 -13) ESCALATION ................. 2.5 THIRD ADDITIONAL YEAR (FY 13-14) ESCALATION ......................... 1.5 FOURTH ADDITIONAL YEAR (FY 14 -15) ESCALATION ......................... 1.5 IL CONTRACT TERMS AND CONDITIONS EXCEPT WHERE BIDDEN MAKES SPECIFIC EXCEPTION IN THE SUBMITTED BID, ANY CONTRACT RESULTING FROM THIS RFB WILL CONTAIN THE FOLLOWING TERMS AND CONDITIONS, WHICH BIDDER HEREBY ARNOWLEDGES, AND TO WHICHBIDDERAGREESBYSUBMITTINGA BID: 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 Bid, 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. see attached warranty Reference Sec D C. Late Delivery or Performance If Bidder 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 Bidder, who agrees to pay such costs within ten days of invoice. D. FOB ( ivery charges) All products offered shall be FOB final destination, with all delivery charges to be prepaid by the Bidder. The City does not accept C.O.D. or collect shipments. The contract price shall include all charges, including delivery, installation and set -up fees. All packing, crating, or other debris resulting from the delivery or set -up of the commodity purchased shall be removed and properly disposed by the successful Bidder at no additional cost to the City. E. Excess or Incorrect Commodities Products or materials delivered in error or in excess of the quantity ordered shall be returned at the successful Bidder's expense, unless otherwise agreed to in writing by the City, F. Title to Goods and Risk of Loss For goods to be provided by Bidders 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. City ofSouthlake - RFB1105B420JT110016 - Page 12 of 18 Reference Section D LIMITED WARRANTY For the Project: City of Southlake — Sewer Manhole and Wet Well Rehab Certified Applicator performing install: Lewis Concrete Restoration Manufacturer of Coating Product installed: Raven Lining Systems Raven Lining Systems, ( "RLS ") warrants its products to be free of manufacturing defects and that they will meet RLS's current published physical properties, when applied in accordance with RLS's directions and tested in accordance with ASTM and RLS standards. RLS must receive written notice of any defects within thirty (30) days of the discovery of the defect and within one (1) years of the original installation date (shown below) by the listed Raven Certified Applicator. If, within one (1) years from installation, any product does not meet the physical properties or is defective in manufacture, RLS, at its sole option, will either replace the defective product or refund the purchase price. This warranty does not include exposure to conditions other than as designed and represented as suitable within RLS written documentation, nor failure due to physical damage, improper maintenance or care by the owner. THE AFORESAID IS THE EXCLUSIVE WARRANTY AND IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESS. OR IMPLIED. THERE IS NO WARRANTY OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE. UNDER NO CIRCUMSTANCES SHALL RLS BE LIABLE FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES OR FOR LOST PROFITS. NO ACTION AGAINST RLS MAY BE COMMENCED MORE THAN ONE (1) YEAR AFTER THE CLAIM ARISES. The warranty is expressly for the subject project and material specified below and is null and void with respects to any other intended, contingent or actual application of RLS products. Dated: 7/18/2011 Installation Date: Product Used: Gallons Installed: Confirmed by: of RLS Raven Lining Systems BY: Jim Henke Signature: Lewis Concrete Restoration By: Shun Lalq Signature: Title: V. P. Sales & Marketing Title: President 13105 East 61" Street, Suite A Broken Arrow, OK 74012 800- 324.2810 918 - 615-0020 Fax 918 - 615.0190 www.rovenlining.eom 2. Miscellaneous A. Independent Contractor Bidder agrees that Bidder and Bidder's employees and agents have no employer - employee relationship with City. Bidder agrees that if Bidder 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 Bidder 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. C. Liens Bidder 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 Bidder or Bidder'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 Bidder certifies that no bribes in the form of entcrtainment, gifts, or otherwise, were offered or given by the successful Bidder, or its agent or representative, to any City officer, employee or elected representative, with respect to this RFB 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 Bidder certifies that it has not received compensation from the City to participate in preparing the specifications or RFB on which the Bid is based and acknowledges that this contract may be terminated and/or payment withheld if this certification is inaccurate. F. Required Licenses Bidder 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 Bid and Enter Contract The person signing on behalf of Bidder certifies that the signer has authority to submit the Bid on behalf of the Bidder and to bind the Bidder to any resulting contract, H. Compliance with Applicable Law Bidder agrees that the contract will be subject to, and Bidder will strictly comply with, all applicable federal, state, and local laws, ordinances, rules, and regulations. 3. Financial Responsibility Provisions — see attached certificate A. Insurance The Bidder, consistent with its status as an independent contractor, shall carry, and shall require any of its subcontractors to carry, at least the following insurance in such form, with such companies, and in such amounts (unless otherwise specified) as City may require: i. 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; 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. City of Sou Wake - RFBI IOSB420JT110016 - Page I3 of 18 B. Indemnification Bidder 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 Bidder or any agent, employee, subcontractor, or supplier of Bidder in the execution or performance of this contract without regard to whether such persons are under the direction of City agents or employees. The Bidder agrees to protect and indemnify the City, all of its officers, Council members, agents and employees, from all claims, actions, suits, demands, proceedings, costs, damages and liabilities, including reasonable attorneys' fees, court costs and related expenses, arising out of any alleged infringement of patents or copyrights arising from the Contractor's performance under the Contractor's Bid, including attorneys' fees and court costs. C. Indemnity for Intellectual Proyerty Bidder hereby warrants that the use or sale of the products, materials and services delivered hereunder will not infringe on the rights of any trade secrets, patent, copyright, registered trademark, or other intellectual property by right covering such materials and the successful Bidder agrees to indemnify and hold harmless the City for any and all costs, expenses, judgments, and damages which the City may have to pay or incur. City of Southlake - RFB1105H420dT110015 Page 14 of 18 to teams available to the public; a payment for food, lodging, transportation or entertainmmt; or A transaction subject to rate or fee regulation by a goveratmantal entity or agency. WHAT. Aperson orbasiness that cunkays with the City or who sebks to contract with the City must file a "conflict of interest questionnaire" (FORM aQ) which is available online at wamethica,state.tx.os 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 int Mp .rat various portions of the questionnaire. WHEN. The person or business must file: 1. the questionnaire no Inter than seven days after the state 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 Q4, and 2. an updated questionnaire within seven days after the date of an ovent that would snake 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 comrrenea. WHERE: The vendor or potential vendor must mail or deliver a completed questionnaire to the Finance Department The ranee Department Is requlW by late to post the statemenia on the OV's internet webske. ENJ[i'ORCEMENT: Failure to file a quesdonnare is a dame misdemeanor puaisbable by a fine not to exceed $500. It is an exception to prosecution that the person files a NORM CIQ not later than seven business days after the person received notice of a violation. MOTE: The City does not have a duty to ensure that a person files a oonfiict of interest questionnaire. W. I% Oudddcc %MisWaawuW- WpterJXAffaOwA t4C{Q,09MILdDr Page 2af3 City of Southlake - RFB1105B420JT110 ©16 - 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. 9494, 80th Leg., Regular Session. OFFICEIJSEONLY This questionnaire Is being filed In accordance with Chapter 176, Local Government Code p rtecelved 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 clay 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. 4 Name of person who has a business relationship with local governmental entity. None z ❑ 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. None 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 176.001(1 -a), Local Government Code. Attach additional pages to this Form CIQ 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 IZI 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 21 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? Yes EZ] No D. Describe each employment or business relationship with the local government officer named in this section. 41 D7gke11ydprwdby5h@ffy1 suns s °� l =sha erryL rsisau o = Sherry L Lewi Trwip email= sherrylswrfs�austlarccam, c =VS ., Date; 201 IA&202125A -osarc June 20, 2 011 Signature of person doing business with the governmental entity Date Adopted 06/2912007 f Appendix D — No Intent to Submit Form If your firm has chosen &oj to submit a bid for this procurement, please complete this form and submit to: City of Southlake Purchasing Division, Department of Finance 1400 Main Street, Suite #440 Southlake, Texas 76092 Please check all items that apply: ❑ Do not sell the item(s) required ❑ Cannot provide Insurance required ❑ Cannot be competitive p ❑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: COMPANY NAME (Please print): Authorized Officer Name (Please print): Telephone: ( 1 Fax: ( City of Southlake - RFBIIOSB420JT1100I6 - Page 18 of 1S Lewis Concrete Restoration Manhole Inspection Report MANHOLE NUMBER: DATE: DEPTH TO INVERT: TYPE CONSTRUCTION: STREET REFERENCES: INSPECTED BY: SIZE: IN. DEPTH: IN. / SIZE: ■ IN. SIZE: IN. DEPTH: — IN. SIZE: IN. SIZE: IN DEPTH: IN.0 SIZE: IN. SIZE: 1N, INSPECTION HISTORY Jan -01 Rav'ew1vod;,M'nh�ol�B: 2. THE ARE NO OTHER CHANGES. rz4u � - Sham dacksn Di=wr ofNnance City ofSouthlake IN THE SUBNIISSION OF BIND, BIDDER MUST ACKNOWLEDGE RECEIPT OF THIS ADDENDUM. BIDDER SHALL ACKNOWLEDGE THIS ADDENDUM BY SIGNING AND RETURNING ONE COPY OF THI5 NOTICE WITH THEIR BID. SIGNED: DATED: L! [0)5VIA yaz /.M.I -:� Graf Sou0rFmb * Finance D"Hint It 140#Mvh SGT Suh440 • SavlWe, Texas 78092 817.74&8312 An MrOlMrmallve Action InMMon REFERENCE SECTION A TO WHOM IT MAY CONCERN: THIS LETTER VERIFIES THAT LEWIS CONCRETE RESTORATION, IS A CERTIFIED QUADEX APPLICATOR. THEIR PERSONNEL HAVE BEEN TRAINED BY A FACTORY REPRESENTATIVE AND ARE QUALIFIED TO APPLY THE QUADEX PRODUCT. THEIR EQUIPMENT EXCEEDS THE STANDARDS REQUIRED FOR PROPER APPLICATION OF THE QUADEX PRODUCTS. IF ANY ADDITIONAL INFORMATION IS REQUIRED, OR IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT ME AT 501 -758 -8628 OR 501- 772 -5244. Sam Wisener Quadex Inc, www.quadexonline.com Southeastern U.S. Regional Manager Office 501- 758 -8628 Mobile 501 -772 -5244 swisener uadexonline.com QUADEX DESCRIPTION: Quadex Quad -Plug is a blend of special cements and admixtures which are designed to Instantly stop running water or seepage in all types of concrete and masonry structures. RECOMMENDED FOR: Sewer Pipes and Manholes Concrete Tanks Elevator Pits Cisterns Basements Concrete & Masonry Walls FEATURES AND BENEFITS: Stops running water immediately Non - Shrink, expands as it sets Contains no calcium chloride Non - Metallic Sulfate resistant Easily applied No Mixing TYPICAL PERFORMANCE DATA: Compressive Strength STRENGTH — PSI (MPa) (ASTM C109) 30 min. 1850 psi 28 -day. 5800 psi X9000 Bond Strength (ASTM C321) 30 min. 50 psi 1 day 85 psi QUAD -PLUG FAST SETTING CEMEN77TIOUS WATERSTOP PACKAGING: Quadex Quad -Plug Is supplied in a 50 lb. plastic pail. YIELD: Quadex Quad -Plug will yield approximately .45 cu. ft. (787 W. In.) per pail. APPLICATION INFORMATION: TO SEAL RUNNING WATER OR LEAKS: Prepare crack or hole by chipping out loose material to a minimum depth and width of 3 14 ". Using a rubber gloved hand, place a generous amount of dry Quadex Quad -Plug with a smooth fast motion to active leak, maintaining external pressure for 30 seconds. Repeat until leak stops. WARRANTY: Quadex warrants Its products to be free of defects in material and workmanship. Quadex will replace any product proved to be defective when applied in accordance with manufacturer's instructions. Quadex's obligation shall be limited solely to such replacement. There are no other warranties by Quadex expressed or implied. PRECAUTIONS: Avoid eye contact or prolonged contact with skin. Wash thoroughly after use. Persons using Quadex Quad -Plug should wear necessary eye protection, dusk mask and rubber gloves. Read all product labels and technical literature. 413011 Crystal HIII Road 13 North Little Rock, AR 72118 ❑ Phone: (801) 758 -8628 ❑ Toll Free: (888) $37.1650 ❑ FAX: (601) 758 -3814 QR Rar�Ag IurarD i PR r X QUADEX HYPERFORM RAPID SETTING HIGH E4RLY STRENGTH PATCHING MATERIAL QUAOEX SEWER REHABILITATION PRODUCTS DESCRIPTION: Quadex Hyperform is a one component, rapid setting, high early strength patching material designed for repairing vertical and horizontal concrete and masonry structures. PACKAGING: Quadex Hyperform Is supplied In 60 lb. (27 kg.) poly -lined bags. YIELD: RECOMMENDED FOR: Filling large voids in manhole walls Reconstructing inverts Catch basin and concrete repair Pipe repair FEATURES AND BENEFITS: Rapid - setting High early and ultimate strengths Non- Shrinking No Calcium Chloride Ready to use, just add water Excellent resistant to freeze thaw TYPICAL PERFORMANCE DATA: Compressive Strength PSI Testing Method (ASTM C109) 1 hour 4170 psi 28 day 7000 psi Flexural Strength PSI 28 day 1110 psi Freeze -Thaw Durability Testing Method (ASTM 0666) No visible damage after 300 cycles Setting Times Testing Method Gillmore ASTM 266 Initial Set 95-18 minutes Final Set 22 -25 minutes One 60 -lb. bag of Quadex Hyperform will yield approximately .50 cu. ft. (787 cu. in.) APPLICATION INFORMATION: Prepare surface to be patched by removing all loose concrete by using an air or electric hammer. Next, sandblast or water blast surface to clean away all contaminants, such as oil, chemicals, or dust Then alrblast with oil -free compressed air to remove all water or loose sand. Mix Quadex Hyperform with clean potable water at a rate of 1.0 gallon per 60 pound bag. If needed, Hyperfarm can be extended with 318 " aggregate at a rate of 25 pounds per bag. WARRANTY: Quadex warrants its products to be free of defects in material and workmanship. Quadex will replace any product proved to be defective when applied in accordance with manufacturer's instructions. Quadex's obligation shall be limited solely to such replacement. There are no other warranties by Quadex expressed or implied. PRECAUTIONS: Avoid eye contact or prolonged contact with skin. Wash thoroughly after use. Persons using Quadex Hyperform should wear necessary eye protection, dust mask and rubber gloves. Read all product labels and technical literature 4801 Crystal Hill Road ❑ North Little Rock, AR 72118 ❑ Phone: (501) 768 -8628 ❑ Toll Free: (888) 8314650 ❑ FAX: (501) 758 -3894 QUADEX DESCRIPTION: Quadex QM.13 Restore is a factory blended, one component, high strength cement based, polypropylene frber reinforced, shrinkage compensilted mortar enhanced with a monoorystallfne quartz aggregate (Granusil) It is Specifically designed for placement by IOW pressure spraying Of mortar for the repair of concrete and masonry structures. This unique formulation allows for a monolithic one -pass application up to three inches in thickness by low pressure spraying. Rr=COmMENDED FOR: Vertical and overhead repairs to concrete or masonry sewer manholes, wetwelis, pipe, water treatment faciiitles, tunnels, navigation locks, and dams. FEATURES AND BENEFITS: duality controlled one- component blend for uniform results. High early and ultimate bond strengths. Resistant to sulfate attack. Extremely low permeability. compressive, flexural and TYPICAL PERFORMANCE DATA: Compressive STRENGTH — PSI (MPa) Strength 28 Day (ASTM C109) >10,000 Flexural QM -19 Restore should wear necessary eye protection, dusk Strength 0% 2$ days mask and rubber gloves. Read all product labels and technical literature (ASTM C 293) X1400 Bond ❑ FAX: (501) 758.3814 Strength (ASTM C 321) Brick Failed Before Bond Freeze -Thaw (ASTM 0666) No visible damage after 300 cycles QM-1S RESTORE FA Cron YBL ENDED, ONE COMPONENT HIGH STRENOTH cmwramm MORTAR PACKAGING: Quadex QM -1s Restore fs suppifed in 60 lb, (27 kg_) poly -Ifned bags. YIELD: One 604b. bag of Quadex QM-1s Restore will yield 1/ 2 inch thickness. approximately .54 cu. ft. and will cover 12.5 sq, ft. at a own PROCEDURE: Prepare surface to be patched by removing unsound concrete, dirt, dust, off and other debris using high pressure (3500 PSI) water blasting. Air blast excess water with an oil free air compressor. This will provide a clean, clamp surface to allow for a good bond. Use approximately 0.9 to 1.1 gallons of potable water per 60 lb, bag of Quadex QM-18 Restore. First add water to mixer, start mixer to mixing and add Quadex QM -1s Restore until mortar is completely mixed. Apply Quadex QM -is Restore by low pressure spraying on vertical or overhead surfaces to a monolithic thickness of 1l2 to 3 Inches in one pass, trowel to smooth surface_ CURING: Cure In accordance with current ACI recommendations. Use a two coat application of a manufacturer approved water based curing compound. WARRANTY: Quadex warrants its products to be free of defects in material and workmanship, Quadex will replace any product proved to be defective when applied in accordance with manufacturer's Instructions, Quadex's obligation shag be limited solely to such replacement. There are no other warranties by Quadex expressed or Implied. Permeability (AASHTO T-277) PRECAUTIONS; 350 Coulombs Density 132 +/ 5 PCF Avoid eye contact or prolonged contact with skin. Wash thoroughly after use. persons using Quadex Shrinkage QM -19 Restore should wear necessary eye protection, dusk (ASTM C596) 0% 2$ days mask and rubber gloves. Read all product labels and technical literature 4801 Crystal Hill Road ❑ North Little Rock, AR 72118 U Phone: (501) 758 -8628 D Tall Free: (888) 831.1650 ❑ FAX: (501) 758.3814 EWER AEMABILITATION pRpplrG=rg Quad-exuln.o. :72118 P qj CM Fes. lt}xe - 8if4 MATERIAL SAFETY DATA SHEET PA0DUC7.WADEX common.:NamqR ACGIN. T. W. Soiling - t6fift: NA 13pec QFaWty POrt(And .1D mg/W VaporPressure NA.-. MelOng.Point: NA .-AdMixtuf6s. 10 Vppoe.bensft NA, Evaporation Ante: NA I a m.g1.M Solubility In Watef: 7594. polypyppylene Fllqsh.PQW NA 40 mg/W -Appeorzknee and Oddr. Grey and Odorless Stability.: Stable 1poolgll Fire -fthting"Prboeduvos: kon- Combustible'Matoft ' Conditidmia Avoid. Although.rio: I hamdous reaction will occur; -proluct-shool.d. be. keo!Ary. - lExtifigulshing- Media: NA Hazardous Deodn)g0.9itIoh-cr:Bypr6ducts; Nona IJeual Fire ansl:Eitplcsiah Hazards: None 11purd.bus-Polyrn6rizatibm. Willn6t.6dout Routes of. Entry: - Inhalation , . Yes Skin: Yes Ipgotim. Yes C"arcinogefficity.. N.TP: No 1ARC Monographs: No OSHA Regolated. No Signs and S of Exposure: May cause skin Vftfion, - eye Hfafflbrv. and. Medloal.0ondlitions Generally-Aggravated by'Exposurm May aggravate -existing e.ye' flung, and skin conditions: Emergency. and Rmt Procedurem: Rlnse•pyewWlth clean water and wash affected skin with. soap and water. Steps to Be Taken In Case,:materldll Is 1461"sed.or Spilled:. Dispose Into labeled Waste-c6ntain for.Vauseordisposal. Wear adequifte protective d1othing-and equipment. Area M�y - be washed dowhwfthmater, . .. ........ waste DIsoose Mdthod: Dlspos6 Insanite0y. landfill. in adcordinca state and local regulatIbne, until ready-to use Other Precautions: None Rfjsoir6tory P ry . jotection- Use NIOSH/MESH;k appr6ve0 VerMlatiom Local exhaust r.wQrnrnendqd if -necessary. MeetTinical If nw. 68sary. Protective Qldveim Rubber. Eye'Pratecftn. Goggles Other Protective Clothing or Equipment: -Standard We& clothN.Eind shoes Work/Hyollehic Practioew. NA QUADEX MANHOLE RESTORATION MATERIALS INSTALLATION SPECIFICATION For Restoration Usina Quadex Cernentitious Materials 1.0 GENERAL 1.1 These specifications are intended to set a standard of quality and design for the application of all cementitious materials used in the rehabilitation of manholes. 12 All materials must be approved by the engineer or owner prior to Job bid. 2.0 DEFINITIONS 2.1 The term 'approved' shall mean that the proposed material shall meet or exceed each of the performance criteria set forth in this specification. Manufacturers and vendors of various name brand materials must submit proof that any proposed material will meet the guidelines and requirements of this specification. The engineer or owner will make final approval of any proposed material. S.0 APPROVED MATERIALS 311 Infiltration Control All fast setting materials furnished shall be designed to be applied in dry powder form, with no prior mixing of water, directly to active leaks under hydrostatic pressure in manholes or related structures. Materials shall consist of rapid setting cements, sillclous aggregates, and various accelerating agents. Material shall not contain chlorides or metallic particles. Approved infiltration control material shall be Quadex Quad -Plug as manufactured by Quadex, Inc., Maumelle, Arkansas. 31.1 Specifications: Infiltration Control Materials A. Compressive Strength (ASTM C109) 30 mins: 1850 psi 3 days: 4000 psi 7 days: 5000 psi 28 days: 5890 psi B. Bond Strength (ASTM C321) 30 min: 50 psi 1 day: 85 psi C. Set Time 30 seconds 3.2 Invert Repair and Patching All material furnished shall be designed to fill large voids in manhole walls and to repair or reconstruct inverts where no hydrostatic pressure exists. Material shall consist of rapid setting cements, monocrystalline quartz aggregates, and various accelerating agents. Material shall not contain chlorides or metallic particles. Approved invert repair and patching material shall be Quadex Myperform as manufactured by Quadex, Inc., Maumelle, Arkansas. 3.2.1 Specifications: Repair and Patching Materials A. Compressive Strength (ASTM C109) 1 hour: 4170 psi 3 hours: 5040 psi 24 hours: 7660 psi B, Flexural Strength (ASTM 0348) 1 hour: 450 psi 3 hours: 625 psi 24 hours: 820 psi C. Freeze -Thaw (ASTM C666) 300 cycles with no damage D. Setting Time (Gilmore ASTM 0266) Initial 15 -18 minutes Final 22 -25 minutes 3.3 Cementitious Coating (Liner) Materials for Manhole Walls and Benches All cementitious coating (liner) materials shall be specifically designed for the rehabilitation of manholes and other related wastewater structures. Liner materials shall be cement based, poly -fiber reinforced, shrinkage compensated, and enhanced with chemical admixtures and slliceous aggregates. Liner materials shall be mixed with water per manufacturer's written specifications and applied using equipment specifically designed for either low- pressure spray or centrifugal spin casting application of cement mortars. All cement liner materials must be capable of a placement thickness of %" to 4" in a one pass monolithic application. 3.3.1 Specifications: Cementitious Coating Materials 3.3.2 Physical Properties All cementitious coating materials shall conform to the following 28-day minimum physlcal properties. A. Compressive Strength (ASTM C109) 9500 psi B. Flexural Strength (ASTM C293) 1400 psl C. Bond Strength (ASTM C882) 1500 psi D. Permeability (AASHTQ T -277) Not to exceed 400 coulombs E. Freeze -Thaw (ASTM C6015) No damage In minimum 300 cycles F. Material Wet Density Minimum 140 PCF 3.3.3 Material Design All cementitious coating materials shall be approved for use based upon the following design conditions. A. Low to mild hydrogen sulfide environments (pH > 2.0) Cementtious coating materials shall be manufactured from Type II portland cement, and enhanced with silica fume. Materials shall contain poly fiber reinforcement, chemical admixtures, and sillceous aggregates. Approved material shall be Quadex QM- 1s Restore as manufactured by Quadex, Inc., Maumelle, Arkansas. B. Extremely harsh hydrogen sulfide environments (pH c 2.0) Cementitious coating materials shall be manufactured from 100% pure calcium aluminate cement and enhanced with high - density chemically stable aggregates. Materials shall contain poly fiber reinforcement and chemical admixtures. Approved material shall be Quadex Aluminafiner as manufactured by Quadex, Inc., Maumelle, Arkansas. 4.0 Interior Manhole Rehabilitation 4.1 Manhole Cleaning and Preparation The floor and Interior walls of the manhole shall be thoroughly cleaned and made free of all foreign materials including dirt, grit, roots, grease, sludge and all debris or material that may be attached to the wall or bottom of the manhole. ,4. High pressure water blasting. with a minimum of 3500 psi shall be used to clean Free all foreign material within the manhole. B. When grease and oil are present within the manhole, an approved detergent or muriatic acid shall be used Integrally with the high pressure cleaning water. C. All materials resulting from the cleaning of the manhole shall be removed prior to application of 1h cement based coating. D. All loose or defective brick, grout, ledges, steps and protruding ledges shall be removed to provide an even surface prior to application of cement based coating. 4.2 Sealing Active Leaks The work consists of hand applying a dry quick - setting cementitious mix designed to Instantly stop running water or seepage in all types of concrete and masonry structures. The applicator shall apply material in accordance with manufacturer's recommendations and following specifications. A. The area to be repaired must be clean and free of all debris per the guidelines set forth In section 4.1 Manhole Cleaning and Preparation. B. Once cleaned, prepare crack or hole by chipping out loose material to a minimum depth and width of % inch. C. With gloved hand, place a generous amount of the dry quick - setting cemer titious material to the active leak, with a smooth fast motion, maintaining external pressure for 30 seconds, repeat until leak is stopped. D. Proper application should not require any special mixing of product or special curing requirements after application. 4.3 Invert Repair The work consists of hand mixing and applying a rapid setting, high early strength, non - shrink patching material to fill all large voids and repair inverts prior to spray lining of the manhole. For invert repairs, flow must be temporarily restricted by inflatable or mechanical plugs prior to cleaning. A. The area to be repaired must be cleaned and free of all debris per the guidelines set forth in section 4.1 Manhole Cleaning and Preparation. B. Mix water shall be clean potable water and require no additives or admixtures for use with cementitious patching materials. C. Cementitious material shall be mixed in a mortar tub or 5 gallon pail with water per manufacturer's specifications. Material should be mixed in small quantities, to avoid setting prior to placement in voids or inverts. D. Once mixed to proper consistency, the materials shall be applied to the Invert or void areas by hand or trowel. In invert applications, care should be taken to not apply excessive material in the channel, which could restrict flow. Once applied, materials should be smoothed either by hand or trowel In order to facilitate flow. E. Flows in inverts can be reestablished within 30 minutes of material placement. 4.4 Application of Cementltious Manhole Liner The work consists of spray applying and 1 or centrifugally spin casting a cementitious based liner to the inside of the existing manhole. The necessary equipment and application methods to apply the cementitious based liner materials shall be only as approved by the material manufacturer. A. Material shall be mixed with water In accordance with manufacturer's specifications. Once mixed to proper consistency, the materials shall be pumped via a rotor - stator style progressive cavity pump through a material plaster hose for delivery to the appropriate and for selected application device. B. Spray application of the cemenlitious material. a. Material hose shall be coupled to a low - velocity spray application nozzle. Pumping of the material shall commence and the mortar shall be atomized by the introduction of air at the nozzle, creating a low - velocity spray pattern for material application. b. Spraying shall be performed by starting at the manhole invert and progressing up the wall to the corbel and chimney areas. Material shall be applied to a specified uniform minimum thickness no less than % inch. Material shall be applied to the bench area in such a manner as to provide for proper drainage without ponding. C. Centrifugal spin casting application of the cemenlitious material. a. Material hose shall be coupled to a high speed rotating applicator device. The rotating casting applicator shall then be positioned within the center of the manhole at either the top of the manhole chimney or the lowest point elevation corresponding to the junction of the manhole bench and walls. b. The high speed rotating applicator shall then be initialized, and pumping of the material shall commence. As the mortar begins to be centrifugally cast evenly around the Interior of the manhole, the rotating applicator head shall be raised and 1 or lowered at a controlled retrieval speed conducive to providing a uniform material thickness on the manhole walls. c. Controlled multiple passes are then made until the specified minimum finished thickness Is attained. If the procedure is Interrupted for any reason, simply arrest the retrieval of the applicator head until flows are recommenced, d. Material thickness may be verified at any point with a depth gauge and shall be no less than a uniform '/z-inch. If additional material is required at any level, the rotating applicator head shall be placed at that level and application shall recommence until that area is thickened. D. Material shall be applied only when manhole is in a damp state, with no visible water dripping or running over the manhole walls. E. The low - velocity spray nozzle and the centrifugal spin casting head may be used in conjunction to facilitate uniform application of the mortar material to Irregularities In the contour of the manhole walls and bench areas. E Troweling of materials shall begin Immediately following the spray application. Initial troweling shall be in an upward motion, to compress the material into voids and solidify manhole wall. Precautions should be taken not to overtrowel. G. Curing will take place once the manhole cover has been replaced. It Is important that the manhole cover is replaced no more than 10 -20 minutes after troweling Is complete to avoid moisture loss in the material due to sunlight and winds. W. Material shall not be applied during freezing weather conditions. Material shall not be placed when the ambient temperature is 37 degrees Fahrenheit and falling or when the temperature is anticipated to fall below 32 degrees Fahrenheit during 24 hours. 5.0. QUALITY CONTROL The quality and performance of the material shall be maintained by one or all of the following measures to be determined and specified by the engineer or owner. 5.1 Performance Testing A. Vacuum Testing B. ExfiItration Testing C. Visual Inspection 5.2 Material Testing One 2 X 2 inch sample cube shall be taken for every 50 bags of material used. Samples shall be sprayed from nozzle, identified and sent to an independent test laboratory for compression strength testing as described in ASTM C -109. 6.0 WARRANTY Product manufacturers shall warrant all materials to be free of defects product design and workmanship for a period of one year from date of purchase. Manufacturer will provide replacement materials for any product proven to be defective when applied in accordance with manufacturer's recommendations, Manufacturer's obligation shall be limited solely to product replacement. Mareh..22, 2011 Eric Lewis Ii6wis Concrete Restoration 405 Ware Dr. Buda, Tai 78610 Dear Eric: This letter certifies that LewiKonetete Restoration is a Raven Certified Applicator in .good standing accordance with the CerCified Applicator Agreement executed between Lewis Concrete Restoration and Raven Lining- Systems for the'year of 2011. Lewis Concrete Restoration possessesthe necessary equipment and maintains trained personnel to properly apply Aggatapoxy and Raven coatings: Lewis Concrete Restoration has been a Raven Certified Applicator since 1998. if should have any further questions, please contact me accordingly. 13105 E. Ge. Street — Broken Arrow, 4K 740:12 _ 800 - 324-2810 — 918- 615 -0140 (fax) April 15, 2011 Sherry Lewis Lewis Concrete Restoration 405 Ware Dr. Buda, TX 78610 Dear Sherry. This letter certifies that Lewis Concrete Restoration is a Raven Certified Applicator in good standing in accordance with the Certified Applicator Agreement executed between Lewis Concrete Restoration and Raven Lining Systems Lewis Concrete Restoration possesses the necessary equipment and maintains the trained personnel listed herein to properly apply AquataPoxy and Raven coatings. Employee Yrs,,PE Training Aquilar, Lorenzo 14 Arthur, Lord 12 Holton, Jared 1 Escobar, Dioniclo 14 Hernandez, Raymundo 1 Eric, Lewis 14 Lewis, Travis 6 Me)ia, Oivin 1 Moreno, Juan 10 Ortlz, Crescensiano 1 month Ramirez, Fransisco 8 Ramirez,.Heriberto 8 Ramirez, Jaime 8 Ramirez, Jesus J 8 Ramirez, Jesus 0 8 Ramirez, Rodrigo 8 Reyes (EMP), Misael 8 Samuel, Andy 2 Vela, Saul Lewis Concrete has been a Raven applicator since. 1998. Should you have any other questions, please contact this office accordingly. Lining 231L15� E. 6 Street Suite A Broken Arrow, Ok 74012 918 -6154070 918.615 -Q040 (fax) Raven 155 DESCRIPTION Raven® 155 is a ,,,W.. . ie "V t 6terborne epoxy wrath ultra-low vlscoslt TYPICAL Formulated or i�SSe penetrating:pximer < for'`new and existing ccnCre`te;andsas a polymer "addit ve i`pr use with tki high - early 9 t � eci 'epaix mortars to be to pcoated with Raven COatlll�8 � . COLOR Off white, mid y or4"rateraI which dries to a transparent film.3r;; SOLIDS BY VOLUME; '.' As supplied: 71% solids lad :volurrte ,� Volatile Organic Compounds { �} TUs� gallon FILM THICKNESS Raven 155 is a waterbai'ne � epoxy.. and will exhibit shrinkage during drying. Therefore; applied- �wet film thickness (WFT) and final dry film thickness (DFT) will not be the same. Required WFT may be calculated using the following formula: WFT = desired DFT divided by % solids by volume. 3: ZZ THEORETICAL COVERAGE At 8 mils WFT coverage is 200 square feet per gallon providing 3 mils DFT at 40% solids. Actual surface coverage will depend on surface irregularities and porosity. Trials are recommended to determine the actual coverage required to yield desired surface saturation. Contact RLS for more details for use as a polymer additive with repair mortars. APPLICATION METHOD Brush, squeegee, trowel or hand application or acceptable methods of applying repair mortars utilizing WB as a polymer additive. THINNING Thin only with potable water, do not thin below 20 %p solids by volume. Contact RLS for detailed information. =3 N n^ Fi'' lbi'eF 1 RM -Up To clean tools, use sod tI 4 ' a Partxconiponent may require use of a solvers su 9. aa a for cleanup. To clean skin, immediatel'`, y with soap and water. Refer to the r ' , ilfety Data Sheet for additional information ox► itX s Sdety. POT LIFE 45 minutes for 1 gallon 30 minutes for 2 gallons at The amount of pot lifejr.. ing life will vary depending on the quanti" mixed, amount of water added, ambient Wa , axtd the container in which the mixed math" Contact RLS for additional information 4. ,;z � r . (r' CURE AND RECCtAT` ; Temperature and rela lxdity affect cure and recoat windows of Ravel}„ 1- applied as a concrete primer, at 72 deg F and, t -&Rh 4 hours recoat in 24 hours window 24 hours to 28 days When using as a polymer additive in repair mortars, cure and recoat properties reflect typical repair material guidelines. 155 typically does not require additional surface preparation treatment prior to topcoat application of Raven coatings, provided contamination of surfaces does not occur. SURFACE TEMPERATURE Minimum recommended: WE Maximum recommended: 120 °F. 155 is a waterborne epoxy. Therefore humidity levels below 90% are required to allow the coating to cure through evaporation. Environmental controls and /or sufficient ventilation may be required to attain proper cure. Raven 155 SURFACE PREPARATION All contaminants including oil, grease, u sealers, salts, or other contaminants must may be accomplished through one or following methods: detergent wat e (steam) cleaning, and /or solverft clef cleaning should be followed�o potable water. Allow surfac, ,tc c {n lint free rags l s v FmF Freshly applied troweled and al without leaving After rontamina _ been profile for adhes� e r . s can using high pressclew blasting, shotbla•$ co ml Brookfield RVF , Of hl gr dray vrith 80 °F:(15 °0'atid 27°C). eXposed to freezing t( should beli)�tly `' SAFETY may be ;tiiallc d?`nn'' Consult the Material Safet�- concerning health and safe AVAILABLE PACA1S Pints and 1- gallon pail' b eti X35 is available through Certified Applicators. COMPONENTS ANI7IVIIX',LAT XO _ Part A, Resin. Part B, Iiardeiier::;;1;1: k4y volume. Contact RLS for details when utilizing 15 ,as` . polymer additive in repair mortars. Strict y ow a notices an i and container label. If you di notices and procedures provid comply with them, do not use measures are dependent on apl environment. Contact RLS to o Safety Data Sheet at 800 - 324 -28 containers at room ,,between 60°P and ;era to freeze or be Pr this product . before using. fety Data Sheet inderstand the cannot strictly Actual safe hods and work of the Material Warranty and Disclaimer: RLS, a division of CIPAR, Inc., warrants its products to be free of manufacturing defects and that they will meet RLS current published physical properties when applied in accordance with directions and tested in accordance with ASTM and RLS standards. If, within one year from purchase, any product does not meet the physical properties or is defective in manufacture, RLS, at its sole option, will either replace the defective product or refund the purchase price. This warranty is void if the product is used contrary to RLS written directions. THE AFORESAID 15 THE EXCLUSIVE WARRANTY AND IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED. THERE IS NO WARRANTY OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE. UNDER NO CIRCUMSTANCES SHALL RLS BE LIABLE FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES OR FOR LOST PROFITS. NO ACTION AGAINST RLS MAY BE COMMENCED MORE THAN ONE YEAR AFTER THE CLAIM ARISES. wwwals- solutions.com 800 - 324.2810 + Email: contactfnJrls- solutions.com a Cn§40 many 0 2007 ELS Raven• 405 is a solvent free 100 solids, ultra high build epoxy coating formulated with exceptionally high physical strengths and broad range chemical resistance. 405 exhibits superior bond to concrete, steel, masonry, fiberglass and other surfaces, even under moist and damp condltions. Designed for operating temperatures up to 20D °F, 405'8 unique ultra high -build ability allows it to be spray applied over 200 mils in a single application on vertical and overhead surfaces, The high physical strengths of 405 allow It to be designed as a structural lining In manholes, pipelines, tanks and other vessels. w � Surfaces where rehabilitation of an existing structures requires enhancement of the structural integrity and where exposure to concentrated acids and caustios may be expected, Including: • Tunnels and pipelines • Clarifiers • Digestors • Tanks • Secondary containment • Wastewater facilities and Manhole rehabilitation ■ 6 Light blue Is standard. Limited special colors are available on request. Contact Raven Lining Systems for information. 100% solids by volume. Volatile organic Compounds: 0,0 ibslgailon Raven 405 is a 100% solkis epoxy with zero shrinkage. Therefore, actual wet film thickness and final dry film thickness are the same (Le. 10 mils WFT=10 mile DFT). Dependent upon surface profile, a maximum of 200 mlls per coat is recommended to prevent sagging on vertical or overhead surfaces. Generally, two thinner application coats are recommended for quality assurance in coverage. A wet film thickness gauge can be used to determine coaling coverage. 40 square feel per gallan at 40 mite thickness. Actual surface coverage will depend on surface irregularities and desired result. Trials are recommended to determine the actual coverage required to yield a desired film thickness for each individual type of Installation. Recommended coverages will vary from 40.250+ mils depending on the installal €on. Additional information is available in the Design Guide for the Application of AqualaPoxy and Raven Epoxy Coatings or by contacting Raven Lining Systems. For a lifetime of protection, Brush, railer, heated plural component alrless or air - assisted spray. Additional information Is available in the Design Guido for the Application of AquataPoxy and Raven Foxy Products. For specific Information on spray systems design, approved systems and Certified Applicators contact Raven Lining Systems. Do not thin with solvents; p€nholing and loss of adhesion can result. If lower viscosity Is desired, heal unmixed material by placing containers in 180 °F tap water or, If sun is available, place the containers In the hot sun until the desired flow characterisdos are present. Drum heaters and inline heaters can be used for larger quantities and on specialized spray equipment, To clean tools, use acetone, xylene or MEK. To clean skin, immed €ately wash thoroughly with soap and water - refer to the Material Safety Data Sheet for additional information on health and safety. 20 minutes for 1 gallon at 75°F, 15 minutes for 2 gallons at 75 The amount of pot life and working life will vary depending on the quantity of epoxy mixed, ambient temperature and the container in which the mixed material Is held. Costa Wra' ems for additional informati�p._ - -� After Part A and Part B are mixed, epoxy goes through a stage called gelation where the coating becomes very sticky, Thls is followed by the initial set (generally 9 hours at 7W). At this time, the coating can usually withstand light traffic or flow, but curing continues for several days even underwater. Although near maximum physical properties are achieved in 8 hours at 7VF, maximum chemical resistance may take three to seven days. This can be shortened by increasing the component andlar ambient temperature. When applying several coats to reach final dry film thickness, no more than 24 hours at 70 should be permitted to pass between coats. Before recosting clean surface thoroughly to remove all contaminants. The coated surface should be protected from contamination of any type between coats, For more information contact Raven Lining Systems, Minimum recommended: 40 °F. Maximum recommended: 12D °F. 0 2002 Raven Lining Systems, Inc. Fora lifetime of protection. Surfaces to receive coating must be cleaned of all oil, grease, rust, scale, deposits and other contaminants. Contact Raven Lining Systems for specific recommendations, STEEL surfaces may require 'Solvent Cleaning" (SSPC -SP1) to remove oil, grease and other soluble contaminants. Surfaces to be coated should then be prepared according to SSPC -SP10 or MACE No. 2: "Near White Blast Cleaning In certain situations, an alternate procedure may.be to use high ( >5,0D0psQ or ultrahigh ( >10,000psD pressure water cleaning or water with sand injection and an approved rust inhibitor. The anchor profile for surface preparation must be a minimum of 2 mlls. CONCRETE AND MASONRY surfaces can generally be prepared by law- (3,500-5,DOO psi) to high- 1x5,000 psi) pressure water cleaning, abrasive blasting, shotblasting or a combination of acid etching and water cleaning, WOOD surfaces should have all old, softened or rotten areas removed. The area to be dated should be sanded, then rinsed or cleaned to remove dust and loose particles. Allow the surface to dry thoroughly. A penetrating primer such as low viscosity AquataPoxy A -10 may be recommended as a primer. FIBERGLASS surfaces should be rinsed and neutralized, scarified and cleaned with water or an emulsion of solvent and water to remove remaining dust and loose parlclea. Allow the surface to dry thoroughly. AVAILA13LE PACKAGES 4- gallon pails (4- gallon k6), 5-gallon pails (2D- gallon kit), 30-gallon drums (120 - gallon kit), 55- gallon drums (220 -gallon kit). Raven 405 is available exclusively through Raven Certified Applicators, contact Raven Llning Systems. COMPONENTS & MIX RATIO Part A, Resin. Part B, Hardener. 3:1 by volume. VISCOSITY Part A, 180,000 cps at 23°C. Part B, 40,000 cps at 23°C. Shelf Life: 1 year in sealed, unmixed containers at room temperature. Store in a sheltered area between 6D °F and 80 (1&C and 27C). Consult the Material Safety Data Sheet for this product concerning health and safety Information before using. Strictly follow all notices on the Material Safely Data Sheet and container label. II you do not fully understand the notices and procedures provided or if you cannot strictly comply with them, do not use this product Actual safety measures are dependent on application methods and work environment. Contact Raven Lining Systems to obtain a copy of the Material Safety Data Sheet at 800-324 -2810. Warranty and Disclaimer. Raven Llning Systems, Inc. ("Raven') warrants its products to be free of manufacturing defects and that they will meet Raven's current published physical properties when applied In accordance with Raven's directions and tested In accordance with ASTM and Raven standards. If, within one (1) year from purchase, any product does not meet the physical properties or Is detective in manufacture, Raven, at its sore option, will either replace the defective product or refund the purchase price. This warranty is void If the product Is used contrary to Raven's written directions. THE AFORESAID 15 THE EXCLUSIVE WARRANTYAND IS IN L190 OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED. THERE is NO WARRANTY OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE. UNDER NO CIRCUMSTANCES SHALL RAVEN 05 LIABLE FOR INCIDENTAL OR CONSEQUENT1AL DAMAGES OR FOR LOST PROFIT$. NO ACTION AGAINST RAVEN MAY BE COMMENCIE} MORE THAN ONE (1) YEAR AFTER THE CLAW ARISES. 11102 PERFORMANCE DESCRIFnON METHOD RESULTS Flexural Strength ASTM D790 13,000 psi Campressive Strength ASTM D695 18,000 psi Tensile Strength ASTM 0638 7,600 psi Tensile Ultimate Elongation ASTM D638 1.5% Hardness, Shore D ASTM D2240 88 Water Vapor Transmission ASTM D1653, Method B 3.8 gmslsq.m. per 24 hours Taber Abrasion, CS17 Wheel ASTM D4060,1 DDO g Ioad/1000 cycles X112 mg loss Adhesion ASTM D4541, Concrete substrate failure Steel (SSPC -10) >1,400 psi Temperature Resistance Steel, unprimed and Concrete 200 deg F Warranty and Disclaimer. Raven Llning Systems, Inc. ("Raven') warrants its products to be free of manufacturing defects and that they will meet Raven's current published physical properties when applied In accordance with Raven's directions and tested In accordance with ASTM and Raven standards. If, within one (1) year from purchase, any product does not meet the physical properties or Is detective in manufacture, Raven, at its sore option, will either replace the defective product or refund the purchase price. This warranty is void If the product Is used contrary to Raven's written directions. THE AFORESAID 15 THE EXCLUSIVE WARRANTYAND IS IN L190 OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED. THERE is NO WARRANTY OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE. UNDER NO CIRCUMSTANCES SHALL RAVEN 05 LIABLE FOR INCIDENTAL OR CONSEQUENT1AL DAMAGES OR FOR LOST PROFIT$. NO ACTION AGAINST RAVEN MAY BE COMMENCIE} MORE THAN ONE (1) YEAR AFTER THE CLAW ARISES. 11102 MATERIAL SAFETY DATA SHEET Trade Name: Raven 405 - Part A SECTION I Manufacturer: Raven Lining Systems Emergency Telephone#: 800-424 -9300 1024 North Lansing Chemtrac Tulsa. OK 74106 Revision Data: 01101 Information Telephone #: 916.584 -2810 800-324 -2810 SECTION II: INGREDIENT INFORMATION INGREDIENT CAS NUMBER PLL TLV Epoxy Resin 25068 -388 NE NE SARA TiitleIII, Section 313Ingredients; None The remaining ingredient (s) is I are being +Mihheid as a trade secret. SECTION PHYSICAL DATA Boiling Point: y 200 deg F Specific Gravity: 1.23-1.28 Vapor Pressure: NIA Melting Point: NIA VaporDenaity: NIA Evaporation Rate: Not established Solubility in Water: negllglble %volatile by Volume: < 1 % Appearance and Odor. White colored liquid with a heavy paint consistency— mild epoxy odor SECTION IV: FIRE & EXPLOSION HAZARD DATA Flash Point: > 200 deg F. PMCC Method DOT Flammability Classification: non-flammable Extinguishing Media: Foam, COa, Dry Chemical Special Flre Fighting procedures: The use of self-contained breathing apparatus Is recommended for flrefighters. Water may be helpful In Keeping adjaoarrt cordainers cod. Avoid spreading buming liquid with water used for cooling purposes. Unusual Fire and Explosion Hazards: Keep work areas free of hot metal surraces and other sources of ignlNan. SECTION V: REACTIVITY RATA Stability: Stable Incompatibility: Strong adds and bases, selected amines, oxidizing agents. Hazardous Decomposition or Byproducts: Thermal decomposition in the presence of air may yield carton monoxide, carbon dioxide, aldehydes and ketones. Hazardous Polymerization: Will not occur. Raven 405 — Part A SECTION VI: HEALT}i HAZARD DATA Primary Routes of Entry: EYES: May cause moderate eye irritation. Comeal Injury Is possible. SKIN: May cause allergic skin reaction in susceptible individuals. Prolorkged exposure Ikely to cause signlftcant skin Initiation. Repealed exposure may cause skin idtation. INHALATION: Vapors are unlikely due to physical properties. INGESTION: Moderately taxi: may be harmful if swaitowed. SYSTEMIC and OTHER EFFECTS: Preexisting eye and skin disorders may be aggravated by exposure to this product. Emergency and First Aid Procedures: EYES: Flush with large quentilles of water for at least 15 minutes. Consulta physician. SKiN: Wash off In flowing water or shower. Remove contarninated clothing. INHALATION: Remove to fresh air if affects occur. Consult a phystdan. INGESTION: Cove 2 glasses of water and Induce vomiting. Consult a physlden. SECTION VII: PRECAUTIONS FOR SAFE HANDLING AND USE Steps to Be Taken In Case Material Is Released of Spilled: Keep sources of ignition and hot metal surfaces Isolated! from the spill. Material may flaw slowly. Scrapa into containers for disposal. Waste Disposal Methods: Dispose of according to all local, state and federal regulations, Precautions to Be Taken in Handling and Staring: Keep containers dosed V,fhen not In Lisa. Avoid prolonged or repeated oontact with akin. DO NOT handle or store near fame, heal or strong oxidants. Avoid prolonged storage above 38 deg C (100 deg F). SECTION VIII: CONTROL MEASURES RESPIRATORY: Respiratory proteclion should not be needed. if respiratory Irritation is experienced or during spray application, use a MSHA or NiOSH approved respirator. VENTILATION: General mechanical ventilation Is sulfident for most conditions. Local exhaust ventilation may be necessary for some operations. EYES: Use safety glasses, splash -proof eye goggles orgogglea with full faceshieid. CLOTHINGIGLOVES: Use impermeable gloves to prevent skin irritation In sensitive individuals. Wearclean, long-sleeved, body covering clothing. S ECTION IX: TRANSPORT D TA Proper Shipping Name: not regulated Hazard Class. not regulated identification Number: NIA Packing Group: NIA SECTION X— RAVEN MAKES NO REPRESENTATIONS OR WARRANTIES WITH RESPECT TO ANY INFORMATION PRESENTED HEREIN, ALL OF WHICH IS PROVIDED "AS IS ". TO THE MAXIMUM EXTENT PERMITTED BY LAW, RAVEN EXPRESSLY EXCLUDES ALL WARRANTIES, OBLIGATIONS, REPRESENTATIONS, LIABILITIES, TERMS AND CONDITIONS (WHETHER THEY ARE EXPRESS OR IMPLIED, OR ARISE IN CONTRACT, STATUTE, OR OTHERWISE, AND IRRESPECTIVE OF THE NEGLIGENCE OF RAVEN, RS EMPLOYEES OR AGENTS) IN CONNECTION WITH THE INFORMATION PRESENTED HEREIN. RAVEN MAKES NO REPRESENTATIONS OR WARRANTIES AS TO MERCHANTABILITY, FITNESS FOR PURPOSE, NONINFRINGEMENT OR CONFORMITY WITH DESCRIPTION OR SAMPLE. Raven 405 — Part A MATERIAL SAFETY DATA SHEET Trade Name: Raven 405 - Part B Manufacturer. Raven Lining Systems Emergency Telephone #: 80041249800 1024 North Lansing Chemlrec Tulsa, OK 74106 Revision Date: 8101101 Information Telephone #: 91 M842810 8003242610 SECTION II: INGREDIENT INFORMATION INGREDIENT CAS NUMBER M TLV AllphaOCamInas Mixture NE NE Cycloallphatic amines Mixture NE NE Bispherd A 60 -05-7 NE NE SARA Title III, Section 393 Ingredlents: 1319phenol A The remaining ingredients) is 1 are being withheld as a trade secret SECTION III: PHYSICAL DATA Boiling Point: a 200 deg F Spectilc Oravlty: 1.00 -1.05 Vapor Pressure: N/A Melting Point: NIA Vapor Density: NIA Evaporation Rate: Not established Solubility in Water: negligible % Volatile by Volume: e I% Appearance and Odor Blue gel with a characteristic amine odor. SECTION IV: FIRE & EXPLOSION HAZARD DATA Flash Point: a 200 deg F, Setaflash Method Fire Hazard Classification (OSHAINFPA): Class III B. Extinguishing Media: Foam, CO Dry Chemical, Water Spray Special Fire Fighting Procedures: The use of self - contained breathing apparatus Is recommended for Ilr etighters. Water may be helpful In keeping adjacent containers cool. Unusual Firs and Explosion Hazards: May generate toxic or Irritating combustion products. Sudden reaction and fire may result If product is noticed with an oxidizing agent Delayed lung damage (pulmonary edema) can be experienced after exposure to combustion products. KBD" 10)1 LIM 0 422ill L stability: Stable Incompatibility, Strong adds and bases, selected amines, oxidizing agents. Hazardous Decomposition or Byproducts: Thermal decomposition in the presence of air may yield carbon monoxide, carbon dioxide, aklehydes, ketones and nitrogen oxides. Hazardous Polymerization: Will not occur. SECTION VI: HEALTH HAZARD DATA Primary Routes of Entry: EYES: Severe eye irritant. May cause bums, Vapors may be Irritating. SKIN: Severe skin irritant May cause Injury to skin following prolonged or repealed contact. Repeated exposure may cause sensltlzatlon of the Individual. Raven 405 -- Part B INHALATION: Excess[ve inhalation is likely to cause irritation of mucous membranes. Repeated exposure can result In lung damage. INGESTION: Corrosive and may cause severe and permanent damage to mouth throat and stomach. SYSTEMIC and OTHER EFFECTS: Product can be alkaline, corrosive and Irdtaling to skin, ears, eyes and mucous membranes, Aliphatic amines can cause changes In the lungs, liver, kidneys and heart. Emergency and First Aid Procedures: EYES: Flush with large quantities of water for at least 15 minules, Get medical attention immediately, $KIN: Wash Immediately with soap and water. If irritation or sensilization occurs, remove Individual from further contact with material. Remove contaminated clothing. INHALATION: Remove to fresh air if affects occur. Get medical atlertion. INGESTION: If this product Is swallowed, administer one glass ofwater. Do not Induce vomiting. Seek medical attention immediately. SECTION VII: PRECAUTIONS FOR SAFE HANDLING AND USE Steps to Be Taken in Case Material Is Released of Spilled: Keep sources of Ignition and hot metal surfaces isolated from the spill. Material mayflow slowly. Scrape Into containers for disposal. Waste Disposal Methods: Dispose of according to all local, state and federal regulations, Precautions to Be Taken In Handling and Storing: Keep containers closed when not In use. Avoid prolonged or repeated contact with skin. 00 NOT handle or store near fame, heat or strong oxidants. Avoid prolonged storage above 38 deg C (100 deg F). SECTION VIII: CONTROL MEASURES RESPIRATORY: To avoid overexposure, wear a properly fitted NIOSHIMSHA respirator with organic vapor cartridges. VENTILATION: General mechanical ventilation Is sufticlent for most conditions. Local exhaust ventilation may be necessary for some operations. EYES, Use chemical safety glasses, splashlxoof eye goggles or goggles with full faceshield. CLOTHIN GIGLOVES: Use nitrile or other chemically resistant gloves. Wear clean, long - sleeved, body covering clothing and rubber boots. SECTION IX: TRANSPORT DATA Proper Shipping Name: Am €nes, liquid, corrosive, n.o.s. (Cydoaliphatic arnines) Hazard Class: Corosie Material - 8 Identiflcatlon Number: UN 2735 Packing Group: 11 SECTION X: DISCLAIMER RAVEN MAKES NO REPRESENTATIONS OR WARRANTIES WITK RESPECT TO ANY INFORMATION PRESENTED HEREIN, ALL OF WHICH IS PROVIDED "AS IS ". TO THE MAXIMUM EXTENT PERMITTED BY LAW, RAVEN EXPRESSLY EXCLUDES ALL WARRANTIES, OBLIGATIONS, REPRESENTATIONS, LIABILITIES, TERMS AND CONDITIONS (WHETHER THEY ARE EXPRESS OR IMPLIED, OR ARISE IN CONTRACT, STATUTE, OR OTHERWISE, AND IRRESPECTIVE OF THE NEGLIGENCE OF RAVEN, ITS EMPLOYEES OR AGENTS) IN CONNECTION WITH THE INFORMATION PRESENTED HEREIN. RAVEN MAKES NO REPRESENTATIONS OR WARRANTIES AS TO MERCHANTABILITY, FITNESS FOR PURPOSE, NONINFRINGEMENT OR CONFORMITY WITH DESCRIPTION OR SAMPLE. Raven 405 — Part B AV-333 Injec#aflex Hydrophilic Foam �erleral'Spt�ci�ca�►ns ��Techr'iicafSpe�itiaalitSn� ° . Description AV,333 Injectaflex is a single- component urethane resin that reacts rapidly with equal proportions of water to Corm a flexible, impermeable foam with excellent adhesion to concrete and some plastics. AV is a low viscosity chemical grout primarily Injected into the area of leakage, creating a mechanical and chemical bond, as well as a comprese€on seal, General Uses • Medium to large cracks or joints In concrete Stop infiltration throughout sewage systems, storm and drain culverts, manholes, utility vaults, larg"ameter pipe or similar structures. • Manhole and pipe penetrations • Excellent waterproofing for tunnels, mines, elevator pits, dams, reservoirs, eto. • Material can be used In wet or dry condltfnns. Grouting Techniques Expanded Gasket PlaoementTeohnique (EGP) Variable Pressure Application Technique (V -PAT) Viscosity 300 -600 CPS Ratio 1:1 (WatertoReeln) 5 Gallon Pail =10 Gallon batch Underwriters Laboratorles [ UL ] Rated ANSI/NSF Standard 81- Drinking Water Systems Components Additives AV -255G Grout S €deAccalerator- reduces gel time Packaging Container -1 Gallon _ 12 lb. gross weight ea. Pall - 5 Gallon --50 lb. gross weight ea., 24 pails per pallet Shipping Motor Class 55 Hazard Class: 3 Air Freight available for 0 1 Gallon Container OPOirr O 5 Gallon Pail �w� 8 Gleaming Products aR1HHIHOWNER8Y8iEAf WMPONaiIB AV-208 - Acetone, Technlcal Grade AV -284 - Pump Wash Description Excellent banding capabilities to concrete and some plastics. Properties: Uncured Appearance: Light amber liquid Solids content: 85% ASTM D -1258 Viscosity: 300.600 cps @ 70 °F ASTM D -1638 Flash Point: > WF ( -3°C) ASTM D- 93 Corrosiveness; Non - corrosive ReactionTkne: 40 seconds @ 70 Properties: Cured Foam (1:11 Tenslle Strength: 100 -120 psi ASTM D -W4 Elongatlorr:750- 850% ASTM D-3574 Shrinkage: <2% after initial cure Toxicity: Non -toxic Storage AV- 339 Injectallex is sensitive to moisture and moderately sensitive to high storage UmVeratums. Store in a dry area between 40OFand 80'E AV-333 injectallex should be properly removed from all application equipment due to the high risk of motsture contamination. Immediately after use, hoses and pumps can be cleaned WM AV-208 Acetone or AV-284 Pump Wash, This product is packaged under dry nitrogen to extend shelf life, MSDS Available by request, or download at www.avantigrout comIMSDS Safety Product contains Toluene Dlisocyanate (DI). Vapars may cause respiratory irritation and sensitization, Take precautions to avoid breathing of fumes and vapors. Operators should be equipped with protective clothing including rubber gloves and face shield. Ventilation should be used in confined spaces. First Aid Eyes: Immediately flush eyes with waterfor 15 minutes. Get medical attention. Skin: Wash affected area with soap and water. Remove contaminated clothing. Inhalation: Remove to fresh air. 9 breathing is difficult, get medical attention. Ingestion: Drink 2 glasses of water: Call a physician. Note: Nevergive anything by mouth to an unconscious orconvubing parson. Notice The data, information and statements contained herein are believed to be reliable, but are not construed as a warranty or representation for which Avanti International assumes any legal responsibility. Since field conditions vary widely, users must undertake sufficient verification and testing to determine the suitability of any product or process mentioned In this or any other written material from Avant€ for their own particular use. NO WARRANTY OF SUITABILITY OR FITNESS FOR A PARTICULAR PURPOSE 18 MADE In no case shall Avanti International be liable for consequential, special, or indirect damages resulting from the kiss or handling of this product. IC AVANTI AvaMiGrout stops leaks. Permanently. Webster, Texas 77598 / 800.877.2570 www.avantigrout.cam J sales@avant[grout.com capyr PloaX15mud Irm"r" Date: November 1, 2004 Page 1 of 3 Avanti International Chemtrec Emergency Phone: 800 - 424 -9300 822 Bay Star Blvd. Product Data Information: 281 - 4865600 Webster, TX 77598 Fax: 281 -486 -7300 n . x _ �:�r �rN��V� de! /�L��E• a r - ;.,.. Product Name: AV-333 Injectaflex ��0�1 gsitl0� II �re`dr n =Inform�iori5. " <, ,: h�, - ,- �- < °�ci:': b'r -r� r'�� "` �' v. � ��`� 5 �' €•4 3 a Ingredient Name I CAS Number Expasura Limits Concontration Urethane Prepolymer OSHA: Not established. CAS #57518 -88 -8 ACGIH: Not established. Trade Secret Acetone OSHA: 5 mg/ CAS #67 -64 -1 ACGIH: Not established. Trade Secret Toluene 2,4- Diisocyanate OSHA PEL: 0.005 ppm CAS #584 -84 -9 ACGIH TWA: 0.005 ppm Trade Secret Toluene 2,6- Diisocyanate OSHA PEL: 0.005 ppm CAS #91 -08 -7 ACGIH TWA: ams ppm Trade Secret Primary Route(s) of Entry: Skin absorption and inhalation. Health Hazards: Severe eye irritation, severe skin and upper respiratory irritation are possible, Eye Contact: Vapors are irritating to the eyes. Splashes, may cause severe irritation, with redness, tearing, blurred vision. Skin Contact: Exposure can cause defetting of the skin. Causes redness swelling, drying and cracking of the skin. Prolonged or repeated contact may cause moderate dermatitis. Ingestion: May have corrosive effects on the lining of the mouth and stomach. May produce abdominal pain, nausea, diarrhea, and vomiting. Inhalation: Exposure can cause upper respiratory tract irritation. May cause dizziness coughing, dullness, and headache. Higher concentrations can produce Central Nervous System depression, narcosis, and unconsciousness Prolonged or repeated overexposure may cause blood disorders, gastrointestinal disturbances and lung damage; kidneys, liver, and nervous system may be affected. Eyes: Flush with plenty of water for at least 15 minutes. Get immediate medical attention. Skin: Wash thoroughly with soap and water. If irritation develops, consult a physician. All contaminated clothing should be washed prior to reuse. Inhalation: Remove to fresh air. If breathing has stopped administer artificial respiration. If breathing is difficult, administer oxygen and get medical attention. Asthma like symptoms may develop, Ingestion: Vomitting may occur spontaneously. Do not induce vomiting. If vomiting occurs, keep head below hips to prevent aspiration into lungs and seek immediate medical attention. Aspiration of material into the lungs due to vomiting can cause chemical pneumonitis. (Never give anything by mouth to an unconscious or convulsing person.) n� � ez�aT'rf�: �, � 1•ha;&Si:'Y.E`,� r �� °: `.�RZ 4 � 5 1 4i:'; k Flash Point: 10.4 °F ( -12 °C) COC Flammable Limits: LEL: Not Determined Extinguishing Media: Dry chemical, alcohol foam, carbon dioxide, or water. Water may be ineffective. Special Fire Fighting Procedures: Wear self-contained breathing apparatus and full protective clothing. Unusual Fire and Explosion Hazards: This material will form vapors when above flash point. These vapors can travel along surfaces to a distant ignition source and flash back. Sealed containers may rupture when heated. AV-333 Injectaflex Page 2 of 3 Spill or leak Procedures: Eliminate all ignition sources and evacuate spill area; with adequate ventilation, cover the spill with an inert absorbent material. Pour isocyanate decontaminant solution (90% water, 8% concentrated ammonia, 2% detergent) on spill and allow to react for 10 minutes, Alternately, pour water on the spill and allow reaction to occur for more than 30 minutes. Place in a proper waste container. Do not seal the drum for 48 hours to avoid possible pressure buildup. Wear respirator and other protective equipment for protection of eyes and skin during cleanup. Storage: Protect against physical damage. Store in a cool dry area well ventilated area, away from ignition sources. Separate from incompatible, materials. Containers should be bonded and grounded for transfers, to avoid static sparks. Handling: Use only in well ventilated areas, unless used with recommended respiratory protection. Empty containers of this material may be hazardous when empty since they retain product residues; observe all warnings and precautions listed for the product. kosur ntC W%d'P Respiratory Protection: Wear NIOSH/MSHA approved supplied air respirator or self - contained breathing apparatus when airborne concentrations are unknown or exceed permissible limits. Half face organic vapor respirators may be worn for up to ten times the exposure limit, or the maximum use concentration specified by the appropriate regulatory agency or respirator supplier, whichever is lowest. A full -face organic vapor respirator maybe worn for up to 50 times the exposure limit or the maximum use concentration specified by the appropriate regulatory agency or respirator supplier, whichever is lowest. Air purifying respirators do not protect workers in oxygen deficient atmospheres. Ventilation: Mechanical general/local exhaust to control vapor or mist below maximum exposure limits. Protective Clothing: Wear impervious clothing, including boots, gloves, lab coat, apron or cover ails. Eye Protection: Use chemical safety goggles and/or a full face shield where splashing is possible. Maintain an eye wash fountain and quick drench facilities in the work area. Other Protective Equipment: Use impervious rubber gloves and boots, Work/Hygienic Practices: Wash with soap and water after handling. Remove contaminated clothing and wash before next use. �)tjr}stcaland;�her�ical I?�rc�pi+ Ens ��, 4 � � � • ,� ` Appearance and Odor. Transparent brown liquid with an acetone odor. Boiling Point: 132 °F (55 °C) Vapor Pressure (mm Hg @ 20 °C): 180 Vapor Density: 2.0 Specific Gravity (water -1): 1.023 ( +0.005) Melting Point: Not determined Evaporation Rate (butyl acetate): 1.90 Solubility in Water: Soluble in water ::gtablll ancjl;Rttia'b'tr,+}ity �'3's•� ,_ . ?`��,:?1 r�, _ � . ... ' � . ` .. � rr .,k.. � ..:k .! � i . i � .;u: Stability: Stable under normal storage and handling conditions. Incompatibility (materials to avoid): Strong bases, water, amines, alcohols, and oxidizing materials. Hazardous Decomposition Products: Carbon dioxide, carbon monoxide, toluene diisocyanate vapors, hydrogen cyanide gas, and oxides of nitrogen. Polymerization: will not occur. Tkicologrcal nformai ior>t :, . . .:, .. # t �.1 ` Carcinogenicity: NTP and IARC consider Toluene Diisocyante a potential carcinogen IARC monographs: Teratogenicity: None Determined Reproductive Toxicity: Acetone is being investigated as a reproductive effector, a tumodgen, and a mutagen. Mutagenicity: None Determined Synergistic products: None OSHA regulated: Yes AV-333 Injectaftex Page 3 of 3 k'00 Ii1fQ5matiorr v.::. x,� x $* � When released into the soil, this material is expected to readily biodegrade. If released into the soil without catalysts, this material is expected to leach into the groundwater. When released into the soil, the acetone portion will evaporate quickly. When released into water polymerization may occur. The acetone is expected to disperse and quickly evaporate. This material is not expected to be toxic to aquatic life. For acetone, the LC50/96 hour values for fish are over 100 mgll. Gisposaivis dCFatl'o�i` `E § _�: "� n t Dispose of in accordance with local, state, and federal regulations. #Oi°r�1Q 1vIV � t 'l .�: {�.•Y..i;'h it .�{ � E �-rA �.k .a. .. . -,.. � ..... :M.a :,, :isr f.t •:.:'xv �. ,. :..k: < - � � - Yr?'ry• 1f; „ Proper Shipping Name: Waste Flammable Liquid, (contains: acetone) DOT Hazard Classification: 3 UN /NA Number: UN1993 Packaging Group: PG II Freight Class: DOT Labels Required: Flammable DOT Placards Required: Flammable - x�f7tll�r�( nf�rr�l�tldn The information on this MSDS is accurate to the best of Avant] International's knowledge. Avanti International makes no expressed or implied warranty, and in no case shall be liable for consequential, special or indirect damages resulting from the use or handling of this product. TSCA SARA 302 SARA 313 CERCLA RCRA TSCA RO TPQ LIST 261.33 8fdl Urethane Prepo"r (57516 - 88-8): NO NO NO NO NO NO NO Acetone (67- 64-1): NO NO NO YES 5000 0002 NO 2,4 Toluene Dlisacyanate (584- 84.9): YES 100 YES YES LP223 YES 2,6 Toluene Dlisacyanate (91- 08-7): YES 100 YES YES U223 YES - x�f7tll�r�( nf�rr�l�tldn The information on this MSDS is accurate to the best of Avant] International's knowledge. Avanti International makes no expressed or implied warranty, and in no case shall be liable for consequential, special or indirect damages resulting from the use or handling of this product. Finance Department August 11, 2011 Ms. Sherry Lewis CIO Lewis Concrete Restoration 405 Ware Dr. Buda, Texas 78610 Re: RFB1105B420JT110016 Provide Manhole and Wet Well Rehabilitation Services Bond Requirements Dear Ms. Lewis, Please consider this letter our official written notification the required bonds per the bid addendum are each due in the amount of Fifty Thousand Dollars ($50,000.00). These bonds shall include the following: The initial bond amount for each of the required bonds shall be Fifty Thousand ($50,000). Bond Requirements Prior to the commencement of work on this Project, Bidder shall deliver to the City the following bonds issued by a good and sufficient surety licensed by the State of Texas and satisfactory to the City: i. A payment bond in the amount of 100% of the total contract amount insuring the full and prompt payment of all persons performing labor and/or furnishing materials in connection with this Project; ii. A performance bond in the amount of 100% of the total contract amount insuring full, faithful, and prompt performance of the responsibilities contained in this contract within the time parameters provided herein; and iii. A maintenance bond insuring full and prompt maintenance, repair and/or replacement of the goods to be provided by Bidder for a period of one year from date of acceptance by the City. The maintenance bond is required prior to final payment for this initial contract phase. Please call if you have any questions. Sincerely, Tim Slifka Purchasing Manager, PPB City of Southlake 1400 Main Street Suite 440 Southlake, Texas 76092 817 - 748 -8312 tslifka @ci.southlake.tx.us 1400 Main Street Suite 440, Southlake, TX 76092, (817) 748 -8345 4 INSCO INSURANCE SERVICES, INC. 'nsc Underwriting Manager for: %ICD Developers Surety and Indemnity Company CG�C]dp Indemnity Company of California 17780 Fitch, Suite 200 ■ Irvine, California 92614 - (800) 782 -1548 J www.inscoDico.com t � s�` 5, (PERFORMANCE BOND - TEXAS PUBLIC WORK) PERFORMANCE BOND Bond No .: 769404P KNOW ALL PERSONS BY THESE PRESENTS: That we, Lewis Concrete Restoration (Contractor), as Principal, and Developers Surety and Indemnity Company. 105 Decker Ct . Ste 670 Irving TX 75062 as Surety, are held and firmly bound unto City of Southlake. 1400 Main Street, Suite 440, Southlake, TX 76092 {Owner), as Obligee, in the penal sure of Fifty Thousand and not 100 ------- — ----------- ---- ------- — ----------- ---- --- — ------ — ------- — ------- — ------ — ------- — --- -- DOLLARS -- ($ 50,000.00---- ------- ---- - - -------- — _...---------- - - - - -- , lawful money of the United States of America, for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, said Contractor, Principal herein, has, by written agreement dated entered into a contract with Owner for RFB1 105B420JT1 10016 - PROVIDE SEWER MANHOLE AND WET WELL REHABILITATION SERVICES in accordance with drawings and specifications prepared by which contract is by reference made a part hereof, and is hereafter referred to as the "Contract ". NOW, THEREFORE, a condition of this obligation is such that, if the Contractor shall faithfully perform the work contracted to be performed and comply with all provisions of the Contract, with the exception of any contractual obligation requiring payment of Contractor's subcontractors and suppliers, then this obligation shall be void; otherwise to remain in full force and effect. The total amount of the surety's liability under this bond shall in no event exceed the penal sum hereof. PROVIDED, HOWEVER, This bond is executed pursuant to and in conformance with the provisions of Chapter 2253, Texas Government Code, as most recently amended, and all liabilities under this bond shall be determined in accordance with the provisions of said Chapter to the same extent as if it were copied at length herein. No right of action or recovery shall accrue hereunder to or for the use of any person or entity other than the Owner named herein, its heirs, executors, administrators or successors. 0.1541 (TX) (3104) - PAGE 1 of 2 IN WITNESS WHEREOF, the said r and ,Surety have signed and sealed this instrument the 1 5th day Of Au ! 2011 PRINCIPAL: Lewis Con " re By: T1 Title: SURETY: Developers Surety and Indemnity Compan By: Debbie Lemaster (Attorney -in -fact) Authorized Representative (Name and Title) By: Signature of Authorized Representative ID -1541 (TX) (3104) • PAGE 2 012 VDU9 INSCO INSURANCE SERVICES, INC. insc Underwriting Manager for: � .o Developers Surety and Indemnity Company C�aD�p Indemnity Company of California 17750 Fitch, Suite 206 - Irvine, California 92614 - (800) 782 -1546 www.inscoDico.com (PAYMENT BOND - TEXAS PUBLIC WORK) PAYMENT BOND STATE OF TEXAS § Bond No.: 769404P COUNTY OF § KNOW ALL PERSONS BY THESE PRESENTS: That we, Lewis Concrete Restoration of the City of Buda , County of and State of Texas as principal, and Developers Surety and Indemnity Co , a corporate surety authorized to act as surety on bonds for Principal, are held and firmly bound onto City of Southlake 1400 Main Street Suite 440, Southlake TX 76092 (Owner), in the penal sum Of Fifty Thousand and not 100--- ------- ---- --- — ------ -- --- -- ------ — ----------------------------- ------- ---------- ----------------------- DOLLARS ( 50,000.00 - - - - -- -------- - - - - -- ) , we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents: WHEREAS, the Principal did, on the day of , 2d , make and enter into a written contract with Owner for RFB1105B420JT110016 -PROVIDE MANHOLE AND WET WELL REHABILITATION SERVICE=S which contract is hereby referred to and made a part hereof as fully and to be the same extent as if copied the length herein. NOW, WHEREFORE, a condition of this obligation is such that, if said Principal shall pay all subcontractors and suppliers furnishing labor, material, equipment and/or services to Principal or its subcontractor in the prosecution of the work provided for in said contract, then this obligation shall be void; otherwise to remain in full force and effect. The total amount of the surety's liability under this bond shall in no event exceed the penal sum hereof; PROVIDED, HOWEVER, that this bond is executed pursuant to and in strict performance with the provisions of Chapter 2253, Texas Government Code, as most recently amended, and all liabilities under this bond shall be determined in accordance with the provisions of said Chapter to the same extent as if it were copied at length herein. ID -1542 (Tx) (3104) - PAGE 1 ore IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this instrument this 15th day of August 2011 PRINCIPAL: Lewis Concrete Restoration , Signature (j t Name and T #)e SURETY: Developers Surety and Indemnity Company Signature Debbie Lemaster, Attorney in Fact Name and Title Lewis Concrete Restoration 405 Ware Dr, Buda, TX 78610 NIA Authorized Representative (Name and Title) 512 -983 -3283 Phone Number By: Signature of Authorized Representative ID-1 542 (TX) (3104) • PAGE 2 of 2 CiTaI�g INSCO INSURANCE SERVICES, INC. insc%1C© Underwriting Manager for: ��° dp Developers Surety and Indemnity Company Indemnity Company of California 17780 Fitch, Suite 200 • Irvine, California 92614 • (949) 263.3300 MAINTENANCE BOND BOND NO. 769404P KNOW ALL MEN BY THESE PRESENTS: THAT we, Lewis Concrete Restoration , as Principal, and Developers Surety and Indemnity Company a corporation organized and doing business and under and by virtue of the laws of the State of Iowa and duly licensed to conduct surety business in the State of Texas as Surety, are held and firmly bound unto City of Southlake, Texas 1400 Main Street, Suite 440 Southlake, Texas 76092 as Obligee, in the Sum of Fifty Thousand and no/ 100---------------------------------------------------------------- - - - - -- --------------------------------------------------------------------------------- - - - - -- ($ 50,000.00 ---- ---------- ) Dollars, for which payment, well and truly to be made, we bind ourselves, our heirs, executors and successors, jointly and severally firmly by these presents. THE CONDITION OF THE OBLIGATION IS SUCH THAT: WHEREAS, the above named Principal entered into an agreement or agreements with said Obligee to: RFB1 105B420JT1 10016 - PROVIDE MANHOLE AND WET WELL REHABILITATION SERVICES WHEREAS, said agreement provided that Principal shall guarantee replacement and repair of improvements as described therein for a period of 1 (one) year(s) following final acceptance of said improvements. NOW, THEREFORE, if the above Principal shall indemnify the Obligee for all loss that Obligee may sustain by reason of any defective materials or workmanship which become apparent during the period of 1 (one) year(s) from and after acceptance of the said improvements by Obligee, then this obligation shall be void, otherwise to remain in full force and effect. IN WITNESS WHEREOF, the seal and signature of said Principal is hereto affixed and the corporate seal and the name of the said Surety is hereto affixed and attested by its duly authorized Attorney -in -Fact, this 15th day of August 2011 Year Lewis ConcpMV Restoration Principal BY: Developers Surety and Indemnity Company BY: D tf ie Lemaster ttorney -in -Fast ID -1005 (Variable Term) (REV. 3101} IMPORTANT NOTICE To obtain information or make a complaint: AVISO IMPORTANCE Para obtener informacion o pare someter una queja: You may call the Surety's toll free telephone number Usted puede llamar al numero de telefono gratis de for information or to mare a complaint at: para informacion o para someter una queja al: 1 -800- 782 -1546 You may also write to the Surety at: P.O. Box 19725 Irvine, CA 92623 -9725 1- 800 -782 -1546 Usted tanbien puede escribir a Surety at: You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or complaints at: 1- 800 -252 -3439 1- 800 -252 -3439 You may write the Texas Department of Insurance at: Puede escribir al Departmento de Seguros de Texas P.O. Box 149104 Austin, TX 78714 -9104 Fax# 512 -475 -1771 web: hnp://www.tdi.state.tx.us E -mail: ConsumerProtection @tdi.state.tx.us P.O. Box 149104 Austin, TX 78714 -9104 Fax# 512 -475 -1771 web: http: / /www.tdi.state.tx.us E -mail: ConsumerProtection @ tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. P.O. Box 19725 Irvine, CA 92623 -9725 Puede comunicarse con: el Departamento de Seguros de Texas para obtener information acerca de compa- nies, coberturas, derechos o quejas al: DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el Surety primero. Si no se resuelve la disputa, puede entonces comuni- carrse con el departamento (TDI). UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condition del documento adjunto. 4iA 11`151 - M IC0 L UUD Insco Insurance Services, Inc. Underwriting Manager for: Developers Surety and Indemnity Company • Indemnity Company of California 17780 Fitch, Suite 200 Irvine, CA 92614 1- 800 - 782 -1546 www.inscoDico.com ID -1404 (TX) (Rev. 7107) POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY Bond Number: 769404P PO Box 19725, IRVINE, CA 92623 (949) 263 -3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETYAND INDEMNITY COMPANY, does hereby make, constitute and appoint: ** *Kenneth Zacharek, Rosslyn Davis, Brad Johnson, Debbie Lemaster, Thomas O. West, jointly or severally * ** as its true and lawful Attorney(s) -in -Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporation, as surety, bonds, undertakings and contracts of suretyship giving and granting unto said Attorney(s) -in -Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporation could do, but reserving to each of said corporation full power of substitution and revocation, and all of the acts of said Attorney(s) -in -Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolution adopted by the Board of Directors of DEVELOPERS SURETY AND INDEM- NITY COMPANY, effective as of January 1st, 2008. RESOLVED, that a combination of any two of the Chairman of the Board, the President, any Executive Vice- President, Senior Vice - President or Vice- President of the corpo- ration be, and that each of them hereby is, authorized to execute this Power of Attorney, qualifying the attomey(s) named in the Power of Attorney to execute, on behalf of the corporation, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of the corporation be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporation when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETYAND INDEMNITY COMPANY has caused these presents to be signed by its officers and attested by its Secretary orAssistant Secre- tary this January f st, 2008. By= �Ff17 Daniel Young, Vice - President: p p D 1 By ' a" ' Stephen T Pate, Senior Vice- President a„$t� State of California County of Orange On August 13th, 2008 _ before me, Jenny TT Ng Nota Public Date Here Insert Name and Titre of the Officer personally appeared Daniel Young and Stephen T Pate Name(s) of Signer(s) Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the whose name(s) islare subscribed to the within instrument and acknowledged to me that helshelthey executed the same in hislherltheir authorized capacity(ies), and that by hislherltheir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and officials ai. Signature Je TT Ng n, Jory Public CERTIFICATE '0: . The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY COMPANY does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolution of the Board of Directors of said corporation set forth in the Power of Attorney are in force as of the date of this Certificate. This Certificate is executed in the City. of Irvine, California, this 15th day of August, 2011. By: ` r Gregg Oku Wlstant Secretary ID-1 438(Rev. 11109) CITY OF SOUTHLAKE ADDENDUM NUMBER # 1 TO: All Bidder's DATE: July 7, 2011 REQUEST FOR BIDS: RFB1105B420JT110016 PROVIDE SEWER MANHOLE AND WET WELL REHABILITATION SERVICES BID DUE DATE: 3:00 p.m., JULY 15, 2011 1. ADDENDUM _NO. 1, dated JULY 7 20.1.1, per Addendum #1, the City of Southlake is revising the Scope of Services and Schedule of Pricing, revising the Term of Contract and Option to Extend maximum percentage, answering vendor questions from the pre -bid meeting, extending the deadline for additional questions and extending the bid due date Extended Date for Submittal of Questions Deadline. Deadline for submittal of written questions has been extended to 3:00 PM CST Wednesday July 13, 2011. Extended Bid Submittal Deadline. Deadline for Bid Submittal has been extended to 3:OOPM CST FRIDAY JULY 22, 2011. Please make note of new deadline. Scope of Service Revision: The Scope of Services section is being revised as follows: The City of Southlake is seeking a vendor to perform rehabilitation services for various sewer system manhole, wet well or other sewer related structures. The concrete structure of our sanitary sewer manholes and wet wells in our wastewater system, due to high levels of hydrogen sulfide are deteriorating. This rehabilitation service shall consist of, but not be limited too, cleaning, repairing and coating with an epoxy /poly based material (Protective Coating Material -PCM) which is resistant to hydrogen sulfide. Initial Assessment. An initial assessment of the manhole, wet well or other structure shall be performed by the awarded vendor. Vendor shall submit an inspection report detailing the current condition and the recommended repair services. Vendor shall submit a sample copy of an inspection report with their bid. Cleaning and Prep Services. The awarded vendor must inspect all surfaces to be rehabilitated and notify the City of any noticeable disparities in the conditions which are different than the original assessment and City of Southlake • Finance Department • 1400 Main Street, Suite 440 ' Southlake, Texas 78092 817.748.8312 An EEO /Affirmative Action Institution designated condition once cleaning and prep services are completed. Any required additional work must be approved by City. All concrete which is not sound or has been damaged by chemical exposure shall be removed to sound concrete surface. All contaminants, including: oils, grease, incompatible and/or damaged existing coatings, waxes, form release, curing compounds, efflorescence, sealers, salts or other contaminants, must be completely removed prior to any surface applications. Contaminant removal and surface preparation methods must be based upon the designated conditions of the substrate and the requirements of the rehabilitation products. Surfaces must be cleaned and abraded to produce a sound concrete surface with adequate profile and porosity to provide a strong bond between the existing structure and the rehabilitation products. Pressure water cleaning shall be used to clean and free all foreign material within the manhole. It may be necessary to clean using a detergent or steam when grease or oils are present. All residues and materials resulting from the process of cleaning the structure must be captured and removed. All voids, joints, cracks, pipe penetrations, bug holes, honeycombs, etc shall be repaired using a non - shrink cementitous repair material (CRM). Repair and/or rebuild benches and inverts to City specifications using CRM as required. Condition Standards and Repair Methods New or Like New Condition Condition Standard: A structure which is a new pre -cast or new poured -in -place structure or still in 'a Iike new condition. All joints are sound and tight fitting with no leakage. The structure shall be capable of passing a standard vacuum test. Repair Method: Pressure wash and clean structure. Fill bug holes, joints, honeycombs and around pipe penetrations with a Cementitous Repair Material as needed. Apply a minimum of 80 mils thickness of a Protective Coating Material (PCM). Condition 1 Condition Standard: An Existing structure which is considered structurally sound with no indications of settlement, cracking or other signs of fatigue. Infiltration or exfiltration through pre- cast joints, mortar joints, or around the pipe connections may exist and structure may be experiencing mild corrosion or deterioration. Repair Method: Pressure wash and clean structure. Stop any infiltration using appropriate products and methods (injection grout/hydraulic cement). Fill bug holes, joints, honeycombs and around pipe penetrations with a Cementitous Repair Material as needed. Apply a minimum of 125 mils thickness of a Protective Coating Material (PCM). City of 5outhlake • Finance Department • 1400 Main Street, Suite 440 • Southlake, Texas 76092 817.748.8312 An EEO /Affirmative Action Institution Condition 2 Condition Standard: An existing structure which is exhibiting early signs of structural fatigue evidenced by minor cracks, loss of mortar or brick, moderate to moderately severe corrosion (less than 1 /2 inch in depth), minor cross sectional distortion (less than 10 %); however, it is currently supporting the soil and live load. Repair Method: Pressure wash and clean structure. Stop any infiltration using appropriate products and methods (injection groutthydraulic cement). Apply a Cementitous Repair Material to the structure at a minimum thickness of 1 /2 inch. Apply a minimum of 125 mils thickness of a Protective Coating Material (PCM). Condition 3 Condition Standard: An existing structure which is exhibiting severe structural fatigue and collapse is eminent. Conditions indicating this degree of deterioration may include very severe corrosion (loss of original profile of one inch or greater), cross sectional distortion beyond 10 percent, exposed reinforcing steel, loose or missing bricks, missing mortar, or large sections of the structure which are gone completely. Repair Method: Pressure wash and clean structure. Fill missing sections and voids with brick and/or a Cementitous Repair Material as necessary. Stop any infiltration using appropriate products and methods (i.e. hydraulic cement and/or injection of chemical grout). Apply a Cementitous Repair Material to the structure at a at a minimum thickness of 1 inch or in additional 1 /2 " lifts /thicknesses (i.e. additional pay item) as needed to bring structure back to original profile. Apply a minimum of 250.mils thickness of a Protective Coating Material (PCM). Cementitous Repair Material (CRM) The CRM shall be a factory blended, rapid setting, high early strength, non - shrink grout which is specifically formulated for use in the underground wastewater environment. The CRM shall be capable of being trowelled or spray applied. The CRM shall be mixed with water only and applied according to manufacturer recommendations. The water used to mix the HCM should be clean and free of contaminants. The CRM must be compatible with the Protective Coating Material which is going to be used. Hydraulic Cement Material (HCM) The HCM shall be specifically designed to stop minor water infiltration and develop high -early strengths. The HCM shall be capable of being hand mixed and applied in either a "wet" or "dry" state. The water used to mix the HCM should be clean and free of contaminants. The HCM should be formulated with calcium silicate, calcium aluminate cements, mineral fillers, and specially selected additives for set control. City of Southlake • Finance Department • 1400 Main Street Surfe 440 • Southlake, Texas 78082 817, 748.8312 An EEO /Affirmative Action Institution The HCM should be used according to the manufacturer recommendations. Chemical Grout Material The chemical grout shall be a semi ridged injection grout designed for sealing larger volume leaks in concrete cracks and fissures. The chemical grout shall be capable of filling voids, stabilize soils or gravel. The chemical grout shall be a two part system (grout and accelerator) which, when it makes contact with water, is designed to set -off and cut -off gushing water. Set times should be adjustable. Safety The vendor will be expected to comply with all City, State and federal standards. Particular attention is drawn to those safety requirements involving entry into a confined space. The vendor shall carry out its operations in strict accordance with all OSHA and manufacturer's safety requirements. All necessary traffic control measures shall be put into place according to the Texas Manual on Uniform Traffic Control. When bypass pumping or diversion plugs are used, every effort should be made to protect the public and the environment from any contamination from the sewer. Flow Control The vendor must coordinate with the City to establish flow control, where required, in advance of all rehabilitation jobs. All submitted bids should include any and all costs for flow control (inflow and outflow) for structures with 6" to 12" pipe diameters. Other flow control measures required shall be coordinated between the vendor and the City to determine additional cost prior to initiating additional flow control measures. Plugging and BIocking A sewer line plug shall be inserted into the upstream invert and downstream invert as necessary. The vendor shall be held responsible for any damage caused by flooding and will take care to avoid this occurrence. By -Pass Pumping Where flow is large enough to require by -pass pumping, the vendor will do so in accordance with current NASSCO Specifications. The vendor shall prepare and submit one (1) Bypass Flow Control Plan for the project. The bypass pumping system capacity must be sized to meet all potential flows (i.e. no sanitary sewer overflows (SSO) allowed). The vendor will be held responsible for any damage caused by flooding and will take care to avoid this occurrence. The vendor is responsible for all installation, operation, and maintenance of the system. The vendor must provide manpower, fuel, and necessary utilities required by the systems. In case of emergency, vendor shall have ready -use, stand -by pumping available to ensure 100% back -up capacity in case of equipment malfunction, or City of Southtake • Finance Department • 1400 Main Street, Suite 440 • Southlake, Texas 76092 817.748312 An EEO /Affirmative Action Institution higher than anticipated flows. The vendor must make their own determination of flow quantities and characteristics. Installation Procedures Traffic Control The vendor will coordinate with the Owner on appropriate traffic control measures and working times. Vendor shall be responsible for all traffic control measures. Confined Space Entry Prior to man entry into any structure to be rehabilitated, proper ventilation and strict confined space OSHA regulations shall be followed. Surface Preparation Proper surface preparation procedures must be followed to ensure adequate bond strength to any surface to be rehabilitated. The vendor must inspect all surfaces to be rehabilitated and notify the City of any noticeable disparities in the conditions which are different than the original assessment and designated condition. All concrete which is not sound or has been damaged by chemical exposure shall be removed to sound concrete surface. All contaminants, including: oils, grease, incompatible and/or damaged existing coatings, waxes, form release, curing compounds, efflorescence, sealers, salts or other contaminants, must be completely removed prior to any surface applications. Contaminant removal and surface preparation methods must be based upon the designated conditions of the substrate and the requirements of the rehabilitation products. Surfaces must be cleaned and abraded to produce a sound concrete surface with adequate profile and porosity to provide a strong bond between the existing structure and the rehabilitation products. Pressure water cleaning shall be used to clean and free all foreign material within the manhole. It may be necessary to clean using a detergent or steam when grease or oils are present. All residues and materials resulting from the process of cleaning the structure must be captured and removed. All voids, joints, cracks, pipe penetrations, bug holes, honeycombs, etc shall be repaired using a CRM. Repair and/or rebuild benches and inverts, as required, using a CRM. Water Infiltration Vendor shall determine the locations where infiltration is occurring and the process to use for stopping the active flow. For small leaks, a quick setting hydraulic cement product may be used. The process is as follows: City of Southtake • Finance Department • 1400 Main Street, Sufte 440 • Southlake, Texas 76092 817.748.8312 An EEO /Affirmative Action Institution The area should be free from all debris, loose brick, mortar, or concrete. Small cracks should be enlarged by chipping with a hammer and chisel to facilitate filling the crack with slurry or dry material. The product shall be placed in areas of active infiltration by hand or by trowel. Reduction of infiltration will be caused by a gradual build -up of hydrated product, which creates a barrier which is impermeable to infiltrating water. This may require multiple applications. Once infiltration is stopped, the product should be brushed and cleaned to remove any loose material. If the vendor determines the infiltration is too significant for hydraulic cement, a chemical grout shall be used. The vendor shall follow manufacture recommendations. The vendor shall determine the location(s) of the infiltration. Once the leak is stopped, excess grout shall be trimmed away and removed from the structure. Cementitous Repair Once all active infiltration, voids, and proper surface preparation have been addressed, the application of the CRM can begin. Place covers over the inverts or flow lines to prevent extraneous materials from entering the pipelines. The vendor must use manufacturer approved equipment for mixing and applying the product. The product shall be mixed as per the manufacturer recommendations. The CRM shall be applied up to one (1) inch to (1 ' /a) inch thick in one pass; however, minimum total thickness shall not be less than 1 /z inch. The surface will then be trowelled to a relatively smooth finish. Care should be taken to not "over trowel ". Once the initial cure has taken place, the exposed surface area should be given a broom finish. Prior to application of protective coating on any steel surfaces (i.e. manhole ring), all surfaces shall receive a Commercial Blast CIeaning of a minimum SSPC -SP61 NACE No. 3; which is defined as follows: This joint standard covers the requirements for commercial blast cleaning of unpainted or painted steel surfaces by the use of abrasives. These requirements include the end condition of the surface and materials and procedures necessary to achieve and verify the end condition. A commercial blast cleaned surface, when viewed without magnification, shall be free of all visible oil, grease, dust, dirt, mill scale, rust, coating, oxides, corrosion products, and other foreign matter, except for staining as noted. City of Southlake • Finance Department • 1400 Main Street Suite 440 • Southlake, Texas 76092 817.748.8312 An EEO /Affirmative Action Institution Random staining shall be limited to no more than 33 percent of each unit area of surface as defined, and may consist of light shadows, slight streaks, or minor discolorations caused by stains of rust, stains of mill scale, or stains of previously applied coating. Protective Coating Application procedures shall conform to the recommendations of the protective coating manufacturer, including material handling, mixing, environmental controls during application, and application equipment. The intended thickness of applied materials shall be determined by the designated condition and repair method of the structure. The application equipment shall be specifically designed to accurately ratio and apply the specified PCM and shall be regularly maintained and in proper working order. Appropriate personal protection equipment shall be utilized. Once the PCM is applied, any and all flow shall be reinstated to the structure per manufacturer guidelines. Testing and Inspection Visual The City shall make a final visual inspection. Any deficiencies in the finish coating shall be marked and repaired according to the manufacturer recommendations. Thickness Testing CRM-- Thickness testing of the CRM shall be done during the application by the use of a thickness gauge (example: nail or bar) and results shall be provided to City contact. Warranty The vendor must warrant all work against defects in materials and workmanship for a period of one year, unless otherwise noted, from the date of final acceptance of all work contained in the project. The vendor must repair such defects in materials or workmanship within 30 calendar days of receipt of written notice of defects. Bond Requirements Prior to the commencement of work on this Project, Bidder shall deliver to the City the following bonds issued by a good and sufficient surety licensed by the State of Texas and satisfactory to the City: i. A payment bond in the amount of 100% of the total contract amount insuring the full and prompt payment of all persons performing labor and/or furnishing materials in connection with this Project; City of Southlake • Finance Department • 1400 Main Street, Suite 440 • Southlake, Texas 78092 817.748.8312 An EEO /Affirmative Action Institution ii. A performance bond in the amount of 100% of the total contract amount insuring full, faithful, and prompt performance of the responsibilities contained in this contract within the time parameters provided herein; and iii. A maintenance bond insuring full and prompt maintenance, repair and/or replacement of the goods to be provided by Bidder for a period of one year from date of acceptance by the City. QUESTIONS and ANSWERS QUESTION: Are the manholes constructed of all concrete? ANSWER: Yes. QUESTION: Per the thickness of build -up concrete - May we exceed 2" of thickness? ANSWER: Yes, on a case by case basis. We wish to maintain no more than a 2" loss to the original interior dimensions of the structure. QUESTION: What diameter lines are running through manholes? ANSWER: 24" (twenty four) inch lines. QUESTION: Will you require surface prep of casting ring prior to application of PCM? ANSWER: Yes. Please refer to Scope of Services for exact standards. QUESTION: Are manholes in high traffic areas? ANSWER: One manhole is located in a high traffic area. QUESTION: Is access available to all manholes within 300 feet? ANSWER: Yes. QUESTION: Do you want to perform a certain number of manholes per year? ANSWER: Services will be based on available dollars. We anticipate an initial project of 11 manholes to be rehabilitated. The remainder of City manholes will be addressed on an as needed basis. QUESTION: Are many manholes located in pavement/lanes of traffic? ANSWER: Within the initial project 3 manholes are located within pavement/lanes of traffic. QUESTION: Will by -pass pumping be required? ANSWER: We do not anticipate by -pass pumping to be required during the initial project phase. QUESTION: Can flow be stopped for any length of time? ANSWER: The majority of flow can be stopped or adjusted for an estimated 24 hours. City of Southlake • Finance Department ' 1400 Main Street, Sufte 440 • Southlake, Texas 75092 817.748.8312 An EEO /Affirmative Action Institution QUESTION: How big is wet well? ANSWER: The wet well currently being considered after the initial manhole rehabilitation phase is approximately 20'L x 10'W x 32'D. QUESTION: Are bonds required? ANSWER: Yes. The initial bond amount for each of the required bonds shall be $50,000. These bond amounts may vary based on future work requested. Bond Renuirements Prior to the commencement of work on this Project, Bidder shall deliver to the City the following bonds issued by a good and sufficient surety licensed by the State of Texas and satisfactory to the City: i. A payment bond in the amount of 100% of the total contract amount insuring the full and prompt payment of all persons performing labor and/or furnishing materials in connection with this Project; ii. A performance bond in the amount of 100 % of the total contract amount insuring full, faithful, and prompt performance of the responsibilities contained in this contract within the time parameters provided herein; and iii. A maintenance bond insuring full and prompt maintenance, repair and/or replacement of the goods to be provided by Bidder for a period of one year from date of acceptance by the City. QUESTION: How many manholes does the City have? ANSWER: Approximately 3313 but only an estimated 100 are being considered at this time for rehabilitation. Original Schedule of Pricing: City of Southlake • Finance Department • 1400 Main Street, Suite 440 • Southlake, Texas 78092 817.748.8312 An EEO /Affirmative Action Institution 1. er Vertical Ft. Per Sewer Manhole Liner Per Vertical Foot for Four Foot Diameter Manhole (4') per Scope of Services $ 2. Per Vertical Ft. Sewer Manhole Liner Per Vertical Foot for Five Foot Diameter Manhole (5') per Scope of Services $ 3. Per Square Ft. Wet Well Liner Per Square Foot per Scope of Services $ 4. Per Svc. I Other Vendor Charges. Please Explain. $ TOTAL ALL LINE ITEMS $ City of Southlake • Finance Department • 1400 Main Street, Suite 440 • Southlake, Texas 78092 817.748.8312 An EEO /Affirmative Action Institution Revised Schedule of Pricing: City of Sovthlake • Finance Department ' 1400 Main Street, Suite 440 • 5outhlake, Texas 76092 617.748.8312 An EEO /Affirmative Action Institution Sewer Manhole Liner Per Vertical Foot for Four Foot Diameter Manhole (4') per Scope of Services 1. Per Vertical Ft. CONDITION 1 $ Sewer Manhole Liner Per Vertical Foot for Four Foot Diameter Manhole (4') per Scope of Services 2. Per Vertical Ft. CONDITION 2 $ Sewer Manhole Liner Per Vertical Foot for Four Foot Diameter Manhole (4') per Scope of Services 3. Per Vertical Ft. CONDITION 3 $ Sewer Manhole Liner Per Vertical Foot for Five Foot Diameter Manhole (5') per Scope of Services 4. Per Vertical Ft. CONDITION 1 $ Sewer Manhole Linter Per Vertical Foot for Five Foot Diameter Manhole (5') per Scope of Services 5. Per Vertical Ft. CONDITION 2 $ Sewer Manhole Liner Per Vertical Foot for Five Foot Diameter Manhole (5') per Scope of Services 6. Per Vertical Ft. CONDITION 3 $ Wet Well Liner Per Square Foot per Scope of 7. Per Square Ft. Services $ Additional Cementitous Repair Material Above 8. Per W Initial 1" of Material Ar V/a" Traffic Control as Required by Texas Manual on Uniform Traffic Control in TXDOT Right of 9. Per Hr Way $ Traffic Control as Required by Texas Manual on Uniform Traffic Control in High Traffic 10. Per Hr Non - Residential Area $ Traffic Control as Required by Texas Manual 11, Per Hr on Uniform Traffic Control in Residential Area $ Other Vendor Charges, Please Explain. 12. Per Svc. $ Other Vendor Charges. Please Explain. 13. Per Svc. $ TOTAL ALL LINE ITEMS $ City of Sovthlake • Finance Department ' 1400 Main Street, Suite 440 • 5outhlake, Texas 76092 617.748.8312 An EEO /Affirmative Action Institution Term of Contract and Option to Extend: The maximum increase allowable shall be eight percent (8 %). Any contract resulting from this RFB 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: 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 Iaer 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 eight percent 8% 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 (FY 11 -12) ESCALATION ........................... % SECOND ADDITIONAL YEAR (FY 12 -13) ESCALATION ........................ % THIRD ADDITIONAL YEAR (FY 13 -14) ESCALATION ........................... % FOURTH ADDITIONAL YEAR (FY 14 -15) ESCALATION ......................... % City of Southlake • Finance Department • 1400 Main Street, Sufte 440 • Southlake, Texas 76092 817.748.8312 An EEO /Affirmative Action Institution 2. THERE ARE NO OTHER CHANGES. W D 1� Sharen Jackso Director of Finance City of Southlake IN THE SUBMISSION OF BID, BIDDER MUST ACKNOWLEDGE RECEIPT OF THIS ADDENDUM. BIDDER SHALL ACKNOWLEDGE THIS ADDENDUM BY SIGNING AND RETURNING ONE COPY OF THIS NOTICE WITH THEIR BID. SIGNED: C4Li7kvA17= \►V4J► / -Ik VA1 i DATED: City of Southlake • Finance Department • 1400 Main Street, Suite 440 • Southlake, Texas 78092 817.748,8312 An Eta /Affirmative Action Institution r k City of Southlake REQUEST FOR BIDS Bid Reference Number: RFB1105B420JT110016 Project Title: PROVIDE SEWER MANHOLE AND WET WELL REHABILITATION SERVICES Bid Closing Date: 3:00 P.M.(CST), FRIDAY JULY 15, 2011 TABLE OF CONTENTS Tableof Contents ................................................................................................. ............................... Page 1 Request for Bids (1) Introduction .................................................................... ...... ......................... ...........................Page 2 (2) Definitions ................................................................................. ............... ............. . .. ................Page 2 (3) General Information .................................................................................. ............................... Page 3 (4) RFB Withdrawals and / or Amendments .................................................. ............................... Page 3 (5) Estimated Quantities ................................................................................. ............................... Page 3 (6) Bid Submittal Requirements ............. ................................................. ............................... ....... Page 3 (7) Bid 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) Bid Evaluation Factors ................................................................................... .......... ................ Page 6 (5) Brand Manufacture Reference .............................................................................. .................... Page 6 (6) Key Events Schedule ................................................................................. ............................... Page 6 (7) Scope of Services ........... ............................ . .. -- .---- .-- ............ Page 6 Appendix B — Bid ( -) Label Format for Submittal Packet's Sealed Envelope .............................. ............................... Page 8 L Required Bid Information: (1) Proposed Products and / or Services ......................................................... ............................... Page 9 (2) Cost of Proposed Products and Services ................................................... ............................... Page 9 (3) Bidder's Experience / Staff ...................................................................... ...... ....... ................. Page 10 (4) References ............................................................................................... ...... ......................... Page 11 (5) Trade Secrets and / or Confidential Information ..................................... ............................... Page 11 (6) Federal, State and / or Local Identification Information ........................ ............................... Page 11 (7) Cooperative Governmental Purchasing Notice ....................................... ............................... Page 11 (8) Term of Contract and Option to Extend .................................................. ............................... Page 11 IL Contract Terms and Conditions: (1) Delivery of Products and / of Services .................................................... ............................... Page 12 (2) Miscellaneous .......................................................................................... ............................... Page 13 (3) Financial Responsibility Provisions ........................................................ ............................... Page 13 Appendix C — Conflict of Interest Form .......................................................... ............................... Page 15 Appendix D — No Intent to Submit Form ........................................................ ............................... Page 18 City of Southlake - RFB1105B420JT110016 - Page 1 of 18 Southlake, Texas Request for Bids 1. Introduction A. Project Overview The City of Southlake is requesting Bids 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. RFB Clarifications All questions related to requirements or processes of this RFB 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 RFB will be issued in writing by addendum and mailed to all parties recorded by City as having received a copy of the RFB. All such addenda issued by City prior to the submittal deadline shall be considered part of the RFB. 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 Bidder must acknowledge all addenda by signing and returning such document(s) or by initialing appropriate area of the Bid document. C. Notification of Errors or Omissions Bidders shall promptly notify the City of any omissions, ambiguity, inconsistency or error that they may discover upon examination of this RFB. 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 CIQ) 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. 2. Definitions Bid Document The signed and executed submittal of the entirety of Appendix B — Bid Document. Bidder The Bidder and the Bidder's designated contact signing the first page of the Bid Document. City of Southlake ( "City ") : The City of Southlake, Texas. City Secretary's Office The office of the City Secretary of the City, located at 1400 Main Street, Suite 4270, Southlake, Texas 76092. PH: (817) 748 -8016; Fax: (817) 748 -8270. Project The name of this Request for Bids as identified on the cover sheet and first page of the Request for Bids herein. City of Southlake - RFB1105B420JT110016 - Page 2 of 18 Purchasing Manager The City of Southlake Purchasing Manager is Timothy Slifka, PH: (817) 748- 8312, E -Mail: tslifka e ,ci.southlake.tx.us ; Fax (817) 748 -8048. Request for Bids (RFB) 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 Bid. City will furnish Excise Tax Exemption Certificate upon request. B. Public Inspection of Bids 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 RFB information. Bid Documents are not available for public inspection until after the contract award. If the Bidder has notified the City, in writing, that the Bid Document 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. RFB Withdrawals and /or Amendments A. RFB Withdrawal The City reserves the right to withdraw this RFB for any reason. B. RFB Amendments The City reserves the right to amend any aspect of this RFB by formal written Addendum prior to the Bid submittal deadline and will endeavor to notify all potential Bidders that have registered in accordance with Section 1.0 herein, 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. Bid Submittal Requirements A. Submittal Packet — Required Content Bidder must submit one (1) signed original Bid Document and three (3) copies. This submittal packet shall be submitted in a sealed envelope with a completely signed and executed page eight (8) Appendix B affixed to the outside of the envelope. B. Submittal Deadline The deadline for submittal of Bids shall be as identified on page _8_ (eight) of Appendix B -Bid. It is the Bidder's responsibility to have the Bid correctly marked and delivered to the City Secretary's Office by the submittal deadline. No extensions will be granted and no late bids will be accepted. C. Bids Received Late Bidders are encouraged to submit their bids as soon as possible. The time and date of receipt as recorded in the City Secretary's Office shall be the official time of receipt. The City is not responsible for late delivery of mail or other carrier. Late Bids will not be considered under any circumstances. D. Alterations or Withdrawals of Bid Document Any submitted Bid may be withdrawn or a revised bid substituted if a written notice is submitted to the City Secretary prior to the submittal deadline. Any interlineations, alteration, erasure or other amendment made before the submittal deadline, must be signed or initialed by the Bidder or the Bidder's authorized agent, guaranteeing City of Southlake - RFBI105B420JT110016 - Page 3 of 18 authenticity. Bid Documents cannot be altered, amended or withdrawn by the Bidder after the submittal deadline, unless such alteration, amendment or withdrawal notice is approved in writing by the Purchasing Manager. E. Bid Document Format All Bid Documents must be prepared in single -space type, on standard 8- 1/2" x I I" vertically oriented pages, using one side of the paper only. Pages shall be numbered at the bottom. Entries shall be typed, or legibly written in ink. 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 Bid 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 Bid Document on the terms set forth in the Bid Document, such bid to 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. Bid Evaluation and Contract Award A. Bid Evaluation and Contract Award Process An award of a contract to provide the goods or services specified herein will be made using competitive sealed Bids, in accordance with Chapter 252 of the Texas Local Government Code and with the City's purchasing policy. Bid Documents will be opened publicly. The City will evaluate Bids using the best value method. A variety of factors may be used in the evaluation of the submitted Bids for this project. The anticipated evaluation factors and emphasis placed on each factor may be as identified in the Scope of Services. City reserves the right to determine which Bid provides the City with the best value and which will be in the City's best interest. B. Completeness If the Bid Document is incomplete or otherwise fails to conform to the requirements of the RFB, City alone will determine whether the variance is so significant as to render the Bid non - responsive, or whether the variance may be cured by the Bidder or waived by the City, such that the Bid may be considered for award. C. Ambiguity Any ambiguity in the Bid Document as a result of omission, error, lack of clarity or non - compliance by the Bidder with specifications, instructions and all conditions shall be construed in the favor of the City. In the event of a conflict between these standard RFB requirements and details provided in Appendix A — Scope of Services or Appendix B — Bid, 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 Bidder will be bound thereby. E. Additional Information City may request any other information necessary to determine Bidder's ability to meet the minimum standards required by this RFB. 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 Bidders based on the unit prices proposed in response to this request, or to reject any and all Bids and re- solicit for Bids, 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 bidder fails to perform in accordance with the provisions of these specifications; or City of Southlake - RFBI105B420JT110016 - Page 4 of 18 ii) The successful bidder violates any of the provisions of these specifications; or iii) The successful bidder disregards laws or regulations of any public body having jurisdiction; or iv) The successful bidder 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 bidder seven (7) days written notice. In such case, the successful bidder shall only be entitled to receive payment for goods and services provided before the effective date of termination. The successful bidder 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. City of Southlake - RFB1105B420JT110016 - Page 5 of 18 Appendix A — Scope of Services 2. 3. 4. 5. a 7. Project Title: PROVIDE SEWER MANHOLE AND WET WELL REHABILITATION SERVICES Scope of Services Contact Questions about the technical nature of the Scope of Services, etc. may be directed to JACK THOMPSON Phone. 817 - 748 -8200, e-mail: jthompson &ci.southlake.tx.us Special Conditions The following special conditions shall prevail over areas of conflict in previous pages: NONE Bid Evaluation Factors Emphasis Factor %33 Vendor Ability to Provide Required Services %33 Vendors Past Experience Providing Required Services %34 Vendor Overall Cost 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 Bid 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. Key Events Schedule Bid Release Date Pre -Bid Site Visit 10:00AM CST, 1950 East Continental Blvd Southlake. Texas 76092 Deadline for Submittal of Written Questions Sealed Bids Due to and Opened by City Anticipated Committee Evaluation Review Date Anticipated Award Date Scope of Services June 16, 2011 Tuesday June 28, 2011 July 8, 2011 Shown on First Page of this RFB Week of July 18, 2011 Week of July 18, 2011 The City of Southlake is seeking one vendor to perform sewer system manhole and wet well rehabilitation services for various City of Southlake sewer manholes and wet wells. The concrete structure of our sanitary sewer manholes and wet wells in our wastewater system, due to high levels of hydrogen sulfide have weakened and are deteriorating and are no longer structurally sound. This rehabilitation service shall consist of, but not be limited too, cleaning of all loose material, repairing with a fibrous cement and coated with an epoxy based material which is resistant to hydrogen sulfide per the following specifications: City of Southlake - RFB1105B420JT110016 - Page 6 of 18 • Services shall include interior of manhole or wet well • Finish epoxy coating shall be a minimum thickness of 125 millimeters. • Fibrous non -shrink grout /cement shall be used as a base repair or filler prior to application of epoxy coating. • Completed epoxy coated manhole interior dimensions shall be no more than two inches (2 ") less than the original design. (i.e. 4 foot manhole no less than 46" inches) • Manhole interior surfaces shall be repaired and coated from flow line up to and including one inch (1 ") overlap of manhole ring. • Wet well interior shall be repaired and coated from two (2') feet below high wet level up to and including interior roof. • All manhole pipe inlets must be plugged during rehab process. • Vendor shall remove and properly dispose of all debris generated during the manhole rehabilitation service. • Vendor shall clean up and restore job -site area to original or better than condition once completed. This shall include, but not be limited too, accidental spills, pavement/sod repair or replacement of vendor damaged landscape. • Vendor shall provide any required traffic control per TxDOT MUTC. • Vendor shall adhere to confined space procedures as approved by OSHA. • All work shall be completed Monday through Friday and between the hours of 7:00 AM and 7:00 PM. City of Southlake - RFB1105B420JT110016 - Page 7 of 18 Appendix B — Bid Document Submittal Checklist: (To determine validity of bid) Appendix B (pages _8_ through _18_) must be included in the bid submittal. Appendix C (page _18_) Conflict of Interest Form must be included in the bid submittal. All bids submitted to the this i to the i i and RFB Number: RFB1105B420JT110016 PROVIDE SEWER MANHOLE AND WET WELL Project Title: REHABILITATION SERVICES Submittal Deadline: 3:00 P.M. (CST), FRIDAY JULY 15, 2011 City Secretary's Office Submit to: 1400 Main Street, Suite 270 Southlake, TX 76092 817 748 -8016 Bidder Information: Bidder's Legal Name: Address: City, State & Zi Federal Employers Identification Number # Phone Number: Fax Number: E -Mail Address: Bidder Authorization 1, the undersigned, have the authority to execute this Bid in its entirety as submitted and enter into a contract on behalf of the Bidder. Printed Name and Position of Authorized Representative: Signature of Authorized Representative: Signed this (day) of (month), (year) I learned of this Request for Bids by the following means: ❑ Newspaper Advertisement ❑ Southlake Website ❑ Mailed Me a Copy ❑ City E -mail Notification ❑ Cold Call to City ❑ Other City of Southlake - RFB1105B420JT110016 - Page 8 of 18 Appendix B — Bid Document (continued) I. REQUIRED BID INFORMATION IN ORDER FOR A BID TO BE CONSIDERED COMPLETE, AND TO BE EVALUATED FOR A CONTRACT AWARD BY THE CITY, BIDDER MUST SUBMIT ALL OF THE FOLLOWING INFORMATION: 1. Proposed Products and /or Services A. Product or Service Description Bidders should utilize this section to describe the technical aspects, capabilities, features and options of the service or 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 Bidders 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. Material Safety Data Sheets (MSDS) If applicable, the successful Bidder shall provide the City with applicable MSDS documentation as required by applicable laws and regulations. D. Guarantees and Warranties Each Bidder shall submit a complete copy of any warranties or guarantees provided by the manufacturer or Bidder with the Bid submitted. E. Project Schedule /Delivery Date Bidder 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 RFB. The Bid Document 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 Bidder 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: Item 4 Quantity Description of Products /Services Unit Cost 1. Per Vertical Ft. Sewer Manhole Liner Per Vertical Foot for Four Foot Diameter Manhole (4') per Scope of Services $ 2. Per Vertical Ft. Sewer Manhole Liner Per Vertical Foot for Five Foot Diameter Manhole (5') per Scope of Services $ 3. Per Square Ft. Wet Well Liner Per Square Foot per Scope of Services $ 4. Per Svc. Other Vendor Charges. Please Explain. S TOTAL ALL LINE ITEMS $ City of Southlake - RFB1105B420JT110016 - Page 9 of 18 3. 4. Bidder's Experience / Staff A. Project Team Identify all members of the Bidder'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 Bidder's business has been established and operating. If Bidder'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: ; and the number of employees: D. Project Related Experience All Bids must include detailed information that details the Bidder's experience and expertise in providing the requested services that demonstrates the Bidder's ability to logically plan and complete the requested project. References Bidder shall provide three (3) references where Bidder has performed similar to or the same types of services as described herein. Client / Company Name: Contact Name: Contact Title: Phone: Email: Date and Scope of Work Provided: Reference #I: Client / Company Name: Contact Name: Contact Title: Phone: Email: Date and Scope of Work Provided: Reference 2: Client / Company Name: Contact Name: Contact Title: Phone: Email: Date and Scope of Work Provided: Reference 43: City of Southlake - RFBI105B420JT110016 - Page 10 of 18 5. 6. 7. 8. Trade Secrets and /or Confidential Information Trade Secrets and /or Confidential Information: This bid (does) (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: C. An individual Bidder acting as a sole proprietor must also enter the Bidder's Social Security Number: # - - 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 RFB from the successful Bidder. 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 Bidder and be responsible for ensuring full compliance with the RFB specifications. Prior to other governmental entities placing orders, the City will notify the successful Bidder of their intent. Please indicate below if you will permit other governmental entities to purchase from your agreement with the City. [ ] Yes, Others can purchase; [ ] No, Only the City can purchase. Term of Contract and Option to Extend: Any contract resulting from this RFB 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: 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. City of Southlake - RFBI105B420JT110016 - Page 1 I of 18 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 (FY 11 -12) ESCALATION ........................... % SECOND ADDITIONAL YEAR (FY 12 -13) ESCALATION ................. % THIRD ADDITIONAL YEAR (FY 13 -14) ESCALATION ......................... % FOURTH ADDITIONAL YEAR (FY 14 -15) ESCALATION ......................... % II. CONTRACT TERMS AND CONDITIONS EXCEPT WHERE BIDDER MAKES SPECIFIC EXCEPTION IN THE SUBMITTED BID, ANY CONTRACT RESULTING FROM THIS RFB WILL CONTAIN THE FOLLOWING TERMS AND CONDITIONS, WHICH BIDDER HEREBY AKNOWLEDGES,AND TO WHICH BIDDER AGREES BY SUBMITTING A BID: 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 Bid, 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 Bidder 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 Bidder, who agrees to pay such costs within ten days of invoice. D. FOB (delivery charges) All products offered shall be FOB final destination, with all delivery charges to be prepaid by the Bidder. The City does not accept C.O.D. or collect shipments. The contract price shall include all charges, including delivery, installation and set -up fees. All packing, crating, or other debris resulting from the delivery or set -up of the commodity purchased shall be removed and properly disposed by the successful Bidder at no additional cost to the City. E. Excess or Incorrect Commodities Products or materials delivered in error or in excess of the quantity ordered shall be returned at the successful Bidder's expense, unless otherwise agreed to in writing by the City. F. Title to Goods and Risk of Loss For goods to be provided by Bidders 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. City of Southlake - RFB1105B420JT110016 - Page 12 of 18 2. Miscellaneous A. Independent Contractor Bidder agrees that Bidder and Bidder's employees and agents have no employer - employee relationship with City. Bidder agrees that if Bidder 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 Bidder 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. C. Liens Bidder 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 Bidder or Bidder'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 Bidder certifies that no bribes in the form of entertainment, gifts, or otherwise, were offered or given by the successful Bidder, or its agent or representative, to any City officer, employee or elected representative, with respect to this RFB 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 Bidder certifies that it has not received compensation from the City to participate in preparing the specifications or RFB on which the Bid is based and acknowledges that this contract may be terminated and /or payment withheld if this certification is inaccurate. F. Required Licenses Bidder 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 Bid and Enter Contract The person signing on behalf of Bidder certifies that the signer has authority to submit the Bid on behalf of the Bidder and to bind the Bidder to any resulting contract. H. Compliance with Applicable Law Bidder agrees that the contract will be subject to, and Bidder will strictly comply with, all applicable federal, state, and local laws, ordinances, rules, and regulations. 3. Financial Responsibility Provisions A. Insurance The Bidder, consistent with its status as an independent contractor, shall carry, and shall require any of its subcontractors to carry, at least the following insurance in such form, with such companies, and in such amounts (unless otherwise specified) as City may require: i. 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; 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. City of Southlake - RFBI105B420JT110016 - Page 13 of 18 B. Indemnification Bidder 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 Bidder or any agent, employee, subcontractor, or supplier of Bidder in the execution or performance of this contract without regard to whether such persons are under the direction of City agents or employees. The Bidder agrees to protect and indemnify the City, all of its officers, Council members, agents and employees, from all claims, actions, suits, demands, proceedings, costs, damages and liabilities, including reasonable attorneys' fees, court costs and related expenses, arising out of any alleged infringement of patents or copyrights arising from the Contractor's performance under the Contractor's Bid, including attorneys' fees and court costs. C. Indemnity for Intellectual Property Bidder hereby warrants that the use or sale of the products, materials and services delivered hereunder will not infringe on the rights of any trade secrets, patent, copyright, registered trademark, or other intellectual property by right covering such materials and the successful Bidder agrees to indemnify and hold harmless the City for any and all costs, expenses, judgments, and damages which the City may have to pay or incur. City of Southlake - RFBI105B420JT110016 - Page 14 of 18 Appendix C — Form CIQ INFORMATIONREGARDING VENDOR CONFLICT OFINTEREST QUESTIONNAIRE WHO: A person must file a conflict of interest questionnaire with the City if the person has a 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: 1. 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; 2. submits a bid to sell goods or services, or responds to a request for proposal for services; 3. enters into negotiations with the City for a contract; or 4. 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 appointed by the Mayor or City Council members; 4. Directors of 4A and 4B 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 officer 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 $2,500 or a transaction at a price and subject W: 1SouthlakeWiseellaneouslChapter 176Attachment C1Q.092608.doc Page 1 of 3 City of Southlake - RFB1105B420JT110016 - Page 15 of 18 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 law to post the statements on the City's internet website. 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. W: \Southlake\Miscella"eOas \Chapter 176.Attachment C1Q.092609.doc Page 2 of 3 City of Southlake - RFB1105B420JT110016 - 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 GcvemmentCode naie aecewE� bya person who has a business relationship as defined by Section 176.001(1 - 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_{)06, Local GovemmentCode.An offense underthis section is a Class C misdemeanor. 1 j Name of person who has a business relationship with local governmental entity. 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 fling 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. Name of Officer This section (item 3 including subpars 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 176.00i(1 -a). Local 4ovemment Code, Attach additional pages to this Form CIO 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 = No B. Is the filerof 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 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 officet or director, or holds an ownership of 10 percent 6f more? Yes No I]_ Describe each employment or business relationship with the local government officer named in this section_ 4 _- Signature of person doing business Mh the governmental entity Date ,adopted 02f2812007 W : \SouthlakeNisccllaneouslChapter 176.At1:achmentC1Q.092608.doc Page 3 of 3 City of Southlake - RFB1105B420JT110016 - Page 17 of 18 Appendix D — No Intent to Submit Form If your firm has chosen not to submit a bid for this procurement, please complete this form and submit to: City of Southlake Purchasing Division, Department of Finance 1400 Main Street, Suite 9440 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: COMPANY NAME (Please print): Authorized Officer Name (Please print): Telephone: Fax: City of Southlake - RFB1105B420JT110016 - Page 18 of 18