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HomeMy WebLinkAboutRes 22-10 Approving an agreement with Logical Solutions, Inc. to update the WA building automation systemTOWN OF WESTLAKE RESOLUTION NO.22-10 A RESOLUTION OF THE TOWN COUNCIL OF THE TOWN OF WESTLAKE, TEXAS, APPROVING AGREEMENT WITH LOGICAL SOLUTIONS, INC. TO UPDATE THE WESTLAKE ACADEMY BUILDING AUTOMATION SYSTEM AND AUTHORIZE THE TOWN MANAGER TO MAKE FUNDING CHANGES NOT TO EXCEED $25,000 ON THIS PROJECT. WHEREAS, the Town of Westlake owns and operates the Westlake Academy and provides facilities for Town and Academy use; and, WHEREAS, the building automation system was installed in 2003 in the PYP and Gym buildings; and, WHEREAS; the system will run the HVAC systems for the Westlake Academy campus; and, WHEREAS, the PYP I and II and gym building will receive an stat controls and module upgrade the HVAC roof top units; and, WHEREAS, Automated Logic products and services for Tarrant County, Texas and the surrounding counties, are solely represented by Logical Solutions, Inc. of Richardson, Texas. They have the exclusive right to sell our products within their assigned territory, and they are the sole source for all ALC products, after sales service and warranty on ALC products installed in their territory.; and, WHEREAS, the service meet the bid requirement for the state of Texas; and, WHEREAS, the Town Council finds that the passage of this resolution is in the best interest of the citizens of Westlake. NOW, THEREFORE, BE IT RESOLVED BY THE TOWN COUNCIL OF THE TOWN OF WESTLAKE, TEXAS: SECTION 1: That, all matters stated in the Recitals hereinabove are found to be true and correct and are incorporated herein by reference as if copied in their entirety. SECTION 2: That the Town of Westlake Town Council hereby approves the agreement with Logical Solutions, Inc. as attached as Exhibit "A" and authorize Town Manager to make funding changes not to exceed $25,000 on this project., attached as Exhibit 'A". SECTION 3: If any portion of this Resolution shall, for any reason, be declared invalid by any court of competent jurisdiction, such invalidity shall not affect the remaining provisions hereof and the Council hereby determines that it would have adopted Resolution 22-10 Page 1 of 2 this Resolution without the invalid provision. SECTION 4. That this resolution shall become effective from and after its date of passage. PASSED AND APPROVED ON THIS DAY 28T1l OF FEBURARY 2022. ATTEST: Tod6 Wood, Town Secretary APPROVED AS TO FORM: z�� 6, L. Stanton Lowry, Town Attorney ! 'Z 1�4ezt_ Laura L. Wheat, Mayor _ a ?&tj- Amanda DeGan, Town Manager Resolution 22-10 Page 2of2 10 Resolution 22-jA' Exhibit "A" ULOGICAL I SOLUTIONS,INC LSI HVAC CONTROLS PROPOSAL PREPARED FOR: Troy Meyer — The Town of Westlake PROJECT NAME: Westlake Academy - Energy Management System Upgrade DDC PROPOSAL PROPOSAL DATE: LIMITING DATE: 4/19/2021 6/19/2021 PREPARED BY: Dane Martin Logical Solutions, Inc. — (469) 265-1608 dmartin@lsicontrols.com Logical Solutions, Inc. proposes to furnish labor, equipment, and materials to upgrade the existing Web Based Building Automation System for the above referenced project. The proposal is based on the attached scope of work. All DDC equipment will be Automated Logic's Native BACnet Control System. Free training and on-line technical support for the life of the DDC system included. Monthly training classes held at our facility in Richardson, TX. Remote connection access required for on-line support. PRICING The below pricing excludes all tax. Payment terms: Net 30 days; Progress payments Pods A-D: $ 55,175.00 Pods E,F & H: $ 41,405.00 Pod G: $ 30,340.00 Scope of Work Total: $126,920.00 Thank you for your consideration of Logical Solutions, Inc. (Automated Logic) for this project. We look forward to working with you and your team. Please feel free to contact me anytime with questions. APPROVAL AND AUTHORITY TO PROCEED We approve the project as described above and authorize the team to proceed. NAME SIGNATURE TITLE -- -1 T094 Confidential c 407 Iniemcari(�;nul Suile 4C,1_�� Phone 972.4375.50(_` Pchafdson TX 7_5081 DATE 3 -IO-Z2-1 Page 1 of 4 ,v1,vw.lsiconh0Is corn I TX D 15530 u; LOGICAL SOLUTIONS, INC. SCOPE OF WORK: LSi to provide and install all new current generation hardware to replace the existing obsolete hardware from 2003 on the following equipment: Pods A-1 o (3) Roof Top Units (Controller: S6104 --> SE6104SP & Stat: RS Sensor 4 ZS2 Sensor w/slide, no display) o (24) Fan Powered Terminal Units (Controller: U341 4ZN341AStat: RS Sensor 4ZS2 Sensor w/slide, no display) o (1) Exiting M16160 with MX440 Expander Module with the following equipment will be replaced with a new OF1628: ■ (2) Exhaust Fans ■ (3) Unit Heaters ■ (12 Lighting Zones Pods E,F & H- o (2) Roof Top Units (Controller: S6104 4 SE6104SP & Stat: RS Sensor 4 ZS2 Sensor w/slide. no disola O (14) Fan Powered Terminal Units (Controller: U341 4ZN341A Stat: RS Sensor 4ZS2 Sensor w/slide, no display) o (1) Fire Panel (Simplex BACpack 4 New BACnet card or pick up dry contacts) o (1) Exiting M16160 Module with the following equipment will be replaced with a new OF1628: ■ (4) Exhaust Fans ■ (2) Unit Heaters • (3) Lighting Zones Pod G: o (3) CV DX Solit Svstems Gvm Units (Controller: U551 4 ZN551 & Stat: RS Sensor 4 ZS21P-temp/humidity sensor w/slide, no display) o (2) Humidifiers (U220 4 ZN220) o (1) Exiting M8102 with MX800 Expander Module with the following equipment will be replaced with a new OF1628: • (1) Boiler Control Panel ■ (2) HW Boilers ■ (2) HW Pumps ■ (3) Exhaust Fans ■ (9) Lighting Zones ■ (1) Outside Air Temp/Humidity Sensor — LSI to replace the existing sensor with a new sensor. *Includes all new programs and graphics where applicable. **All equipment and associated end devices will be inspected during installation. LSi will generate a defienciey list if any existing, reused end devices or instrumentation is found to be faulty. Repair/replacement of items on this list will be done with prior approval from The Town of Westlake.** Confidential Page 2 of 4 407 International Parkway, Suite 406 1 Richardson, TX 75081 Phone 972.4375500 1 FAX 972.4373318 I www.lsicontiols.corn I TX D15530 LOGICAL SOLUTIONS, INC. PROVISIONS & INCLUSIONS • All items provided and installed by LSi will have a 1-year parts and labor warranty. • Includes free online and phone support during the (1) year warranty period. • Any and all EMS points shall be capable of Alarming Actions. Owner/owner representative shall provide direction for alarming actions/routing. • 120V power to LSi enclosures to be provided by others. • Includes fire rated plenum wire where required. • Customer to provide required Static IP Addresses and network drops COORDINATION ITEMS & EXCLUSIONS _ • Excludes any and all work at any campus other than Westlake Academy. • Additional equipment or control not listed above will be added under a change order contract. • Pricing is based on all work being performed during normal hours. • All existing Terminal Units are assumed to have exposed damper shafts for external mounting of our new actuator control modules. Any additional required modifications to the terminal units (duct modifications, shaft extensions, etc.) will be added as a change order to this proposal. • Thermostat Conduit Stub -ups in vertical walls are excluded in this proposal. • Pricing assumes all existing mechanical equipment is in proper working order • Excludes provision and installation of louvers, dampers, and valves. • Excludes any work associated with Fire/Life Safety system • Excludes any liquidated or consequential damages. • Excludes any permits of fee associated with this contract. • Excludes any water or air balancing. TERMS AND CONDITIONS OF SALE Confidential Page 3 of 4 Phony; q _ I TX D 15530 ULOGICAL I SOLUTIONS, INC. I. Parties. Logical Solutions, Inc., is referred to herein as "Seller" and the person, firm or other entity purchasing as indicated on the front hereof is referred to herein as "Buyer." All materials, goods, services, or merchandise described on the front hereof, regardless of type, including materials delivered to the job site or to an off -site facility and for all work performed onsite and off -site are referred to herein as *Products." 2. Aueotance of Purchase Orders. Quotations furnished by Seller do not constitute an offer to sell. Quotations are based upon straight -time labor. Any requests by the Buyer for overtime work shal beconsklered an extra.Ths proposal expires 60 clays aherits date, unless otherwise provide by Seller. No written or oral order of Buyer shall become a binding obligation of Seller unless and until Seller has issued its order confirmation as provided herein. Seller reserves the right to reject any order based on Buyers creditworthiness. Sales of Products hereunder are subject to and include the Terms and Conditions of Sale set forth herein and are expressly conditioned upon Buyers assent to any Terms and Conditions of Sale herein which are additional to or different from any terms or conditions of sale contained in any order submitted by Buyer. Without limiting the generality of the foregoing, no acknowledgment by Seller of or reference by Seller to or performance by Seller under any order submitted by Buyer shall be deemed to be an acceptance by Seller of any terms or conditions contained in such order which are additional to or contrary to the Terms and Conditions of Sale contained herein. 3. Order Cancellations. Seller reserves to its sole judgment and discretion when and under what circumstances it will approve any order changes and/or cancellations. If cancellations are accepted, a cancellation charge may be charged to Buyer in accordance with Sellers then current cancellation policy. 4. Prices and Payment. (a) Unless otherwise stated, all prices are F.O.B. Seller's facility specified on the front hereof, and include standard packaging. Prices do not include applicable sales, use, excise, ad valorem and similar taxes. All such taxes will be added to Seller's invoice as a separate charge and will be paid by Buyer. (b) Seller reserves the right to invoice Buyer monthly for the Products. Engineering, drafting and other mobilization costs incurred prior to installation shall be included in Sellers initial invoice and be equal to 25%of the contract price. Unless otherwise provided on the front hereof, the purchase price for Products sold hereunder shall be due and payable in the full invoice amount in U.S. dollars within 30 days from the date of invoice; providedhowever. that Seller reserves the right in its sole discretion to cancel or change credit terms and to request advance payment at any time. Any check or remittance received from or for the account of Buyer may be accepted and applied by Seller against any indebtedness or obligation owing by Buyer to Seller, without prejudice to and without discharging the remainder of any such indebtedness or obligation, regardless of any condition, provision, statement, legend or notation appearing on, referring to, or accompanying such check or remittance. (c) Any amounts payable to Seller hereunder which are not paid when due shall thereafter bear interest at the rate of eighteen percent (18%) per month or the maximum amount permitted by applicable law, whichever is less. Time is of the essence of all payments due hereunder, and if any payment due Seller is collected at law, or through an attorney -at -law or under advice therefrom, or through a collection agency, Buyer agrees to pay all costs of collection, including, without limitation, all court costs and reasonable attorneys fees. (d) Upon the failure of Buyer to make any payment when due hereunder, or in the event of default, breach or repudiation by Buyer of any obligation to Seller, whether contained herein or otherwise, or if Buyer becomes insolvent, calls a meeting of its creditors, or if any bankruptcy, insolvency, reorganization or arrangement proceeding is commenced by or against Buyer, Seller shall have (in addition to all rights and remedies Seller may have at law or in equity) the option to: (i) cancel this and any other transaction with Buyer; (ii) defer any deliveries to Buyer; or (III) declare the full purchase price of all Products sold hereunder immediately due and payable. (e) If Seller agrees to vary or relax the method or terms of payment with respect to any order placed by Buyer, such variance or relaxation shall not affect in any manner whatsoever Sellers right thereafter as to that or any other order to require payment in accordance with the terms specified herein. 1. Security Interest. To secure Buyers obligations hereunder, Seller reserves a security interest in all Products sold hereunder together with all proceeds thereof, until all payments with respect to the Products have been received by Seller. Buyer agrees upon request by Seller to perfect and maintain the security interest reserved herein. Buyer hereby constitutes and irrevocably appoints Seller as its agent and attorney -in -fact for the purpose of executing any and all financing statements, notice and other documents that may be necessary from time to time for Seller to perfect and maintain the security interest reserved herein. 2. Delivervand Risk. Unless otherwise provided on the front hereof, delivery of Products hereunder shall be F.O. B. Seller's facilities. Seller agrees to make arrangements, for and on behalf of Buyer, for the carriage and insurance of the Products to the address shown on the front side hereof, by such means and carrier as determined by Seller unless otherwise designated by Buyer in writing. In all cases Buyer shall reimburse Seller for any additional costs or charges for express delivery or similar shipment. Unless otherwise provided on the front hereof, any arrangements and expenses incurred by Seller for carriage and insurance of Products shall be for the account of Buyer, shall be billed to Buyer and shall be due and payable together with the purchase price for the Products. Seller may ship Products in partial shipments and Seller reserves the right to invoice for partial shipments. Buyer acknowledges that the and date shown on the front hereof is its requested delivery date. Seller shall use reasonable efforts to arrange shipment of Products in accordance with any delivery dates set forth on the front side hereof, but such delivery dates are not guaranteed. 3. Deferred Deliveries, If Seller defers deliveries at Buyers request, Buyer shall indemnify Seller against all loss and additional expense incurred by Seller in connection with such deferred deliveries including, without limitation, demurrage, handling, storage, insurance and similar charges. Transfer to storage shall be considered delivery for all purposes hereunder, including invoicing and payment, and during such storage Buyer shall bear all risks of loss or damage to Products in accordance with the terms of paragraph 6. 4. Limited Warranty. Seller warrants that the Products sold hereunder shall be free from defects in workmanship and material for a period of one year from the date of delivery. In the event that any Product (or component thereof) sold hereunder proves to be defective during the warranty period, Seller's sole obligation, and Buyers sole remedy, shall be the repair or replacement of the defective Product (or component), at Sellers option. Seller shall bear costs of transporting the replacement Product (or component). Under no circumstances may Buyer return any Product or component to Seller without prior written permission from Seller. EXCEPT AS EXPRESSLY PROVIDED IN THIS PARAGRAPH, SELLER MAKES NO REPRESENTATIONS OR WARRANTIES REGARDING THE PRODUCTS OF ANY KIND, NATURE OR DESCRIPTION, EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY WARRANTY OF MERCHANTABILITY OR FITNESS OF ANY OF THE PRODUCTS FOR ANY PARTICULAR PURPOSE, AND SELLER HEREBY DISCLAIMS THE SAME. 5. Exclusions. The warranty provided by Seller shall not apply to any damage or failure of any Products resulting from accident, fire, misuse (including, without limitation, any use not in accordance with Sellers published specifications for the Products), improper installation, improper storage, modifications, alterations, tampering or failure to properly maintain the Products. Buyer shall be responsible for ensuring that the Products meet its specific requirements, and Seller shall have no responsibility in connection therewith. 6. Limitation of Liability. In no event shall Seller be liable to Buyer or any other person, firm or entity ("Person"), whether in contract or in tort, or under any other legal theory, (including, without limitation, negligence or strict liability) for lost profits or revenues, loss of use or similar economic loss, or for any indirect, special, incidental, consequential or similar damages arising out of or in connection with the sale, delivery, non -delivery, servicing, use, maintenance, loading, unloading, installation, condition, ownership, possession, operation, selection, transportation, maintenance or return of any of the Products, or for any claim made against Buyer by any other Person, even if Seller has been advised of the possibility of such claim. In no event shall Seller's liability under any claim made by Buyer exceed the purchase price of the Products in respect of which such claim Is made. 7. Buyers Remedles. The Buyer's remedies with respect to Products found to be defective in material or workmanship shall be limited exclusively to the right of repair or replacement of such defective equipment. IN NO EVENT SHALL SELLER BE LIABLE FOR CLAIMS (BASED UPON BREACH OF IMPLIED WARRANTY) FOR ANY OTHER DAMAGES, WHETHER DIRECT, IMMEDIATE, FORESEEABLE, CONSEQUENTIAL, OR SPECIAL OR FOR ANY EXPENSES INCURRED BY REASON OF THE USE OR MISUSE OF EQUIPMENT WHICH DOES OR DOES NOT CONFORM TO THE TERMS AND CONDITIONS OF ANY CONTRACT RESULTING FROM THIS PROPOSAL 12. Force Maieure. Seller shall not be liable for any default or delay in the Performance of any of its obligations hereunder if such default or delay is caused, directly or indirectly, by fire, flood, earthquake, the elements, or other such occurrences; labor disputes, strikes or lockouts; wars (declared or undeclared), rebellions or revolutions in any country; riots or civil disorder; terrorist attacks; accidents or unavoidable casualties; interruptions of transportation or communications facilities or delays in transit or communication; supply shortages or the failure of any party to perform any commitment to Seller relative to the production or delivery of any equipment or material required by Seller to perform its obligations hereunder; laws, rulings, regulations, decisions or requirements, whether valid, invalid, formal or informal, of any government, tribunal or governmental agency, board or official; or any other cause, whether similar or dissimilar to those enumerated herein, beyond Seller's reasonable control. Seller shall notify Buyer of the happening of any such contingency within a reasonable period of time. If due to an excusable delay, performance cannot be completed within the original period for performance, the period for performance shall be extended for a reasonable period of time to allow for completion of performance. 13. Miscellaneous. (f) Limitations on Assignment. Buyer shall not assign all or any portion of its rights hereunder, or delegate or subcontract all or any portion of its obligations hereunder, without the prior written consent of Seller. (g) Waiver. No failure on the part of Seller to exercise, and no delay by Seller in exercising any right, power or remedy hereunder shall operate as a waiver thereof, nor shall any single or partial exercise of any right, power or remedy by Seller preclude any other or further exercise thereof or the exercise of any other right, power or remedy. No express waiver or assent by Seller to any breach of or default in any term or condition of this Agreement shall constitute a waiver of or an assent to any succeeding breach of or default in the same or any other term or condition hereof. (h) Govemine Law. This document and all amendments, modifications, alterations or supplements hereto, and all rights of the parties hereunder shall be governed by and construed and enforced in accordance with the laws of the State of Texas, This regard to its principles of conflicts of law. (1) Headings. The headings describing the contents of particular paragraphs are inserted only for convenience and shall not be construed as a part hereof or as a limitation on or enlargement of the scope of any of the terms or provisions contained herein. 0) Entire Agreement. These Terms and Conditions supersede all prior discussions and agreements between the parties with respect to the subject matter hereof, and contains the sole and entire agreement between the parties with respect to the matters covered hereby. By way of illustration and not by way of limitation, all orders submitted by Buyer shall be deemed to incorporate without exception all of the Terms and Conditions of Sale contained herein notwithstanding any additional or contrary terms and conditions contained therein. Unless Seller shall expressly advise Buyer to the contrary in writing apart from the provisions of such order, no acknowledgment by Seller of or reference by Seller to or performance by Seller under any such order form shall be deemed to be an acceptance by Seller of any terms or conditions contained therein which are additional to or contrary to the Terms and Conditions of Sale contained herein. The Terms and Condition of Sale contained herein may not be modified or amended except by an instrument in writing signed by one of Sellers duly authorized officers. Confidential Page 4 of 4 407 International Parkway, Suite 406 1 Richardson, TX 75081 Phone 972.4375500 1 FAX 972.4373318 I www.Isicoiitiols.corn I TX D15530 VERIFICATION REQUIRED BY TEXAS GOVERNMENT CODE SECTION 2274.002 By signing below, the signatory hereby verifies that the firm it represents: Does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and, 2. Will not discriminate during the term of the contract against a firearm entity or firearm trade association. SIGNED BY: PRINT NAME & TITLE: FIRM NAME: l� a��' ��� �a/d �Hf Z e . DATE SIGNED: / 49_Z - e The following definitions apply to this state statute: (1) "Ammunition" means a loaded cartridge case, primer, bullet, or propellant powder with or without a projectile; (2) "Company" means a for -profit organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit; (3) "Discriminate against a firearm entity or firearm trade association": (A) means, with respect to the entity or association, to: (i) refuse to engage in the trade of any goods or services with the entity or association based solely on its status as a firearm entity or firearm trade association; (ii) refrain from continuing an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; or (iii) terminate an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; and (B) does not include: (i) the established policies of a merchant, retail seller, or platform that restrict or prohibit the listing or selling of ammunition, firearms, or firearm accessories; and (ii) a company's refusal to engage in the trade of any goods or services, decision to refrain from continuing an existing business relationship, or decision to terminate an existing business relationship: (aa) to comply with federal, state, or local law, policy, or regulations or a directive by a regulatory agency; or (bb) for any traditional business reason that is specific to the customer or potential customer and not based solely on an entity's or association's status as a firearm entity or firearm trade association; (4) "Firearm" means a weapon that expels a projectile by the action of explosive or expanding gases; (5) "Firearm accessory" means a device specifically designed or adapted to enable an individual to wear, carry, store, or mount a firearm on the individual or on a conveyance and an item used in conjunction with or mounted on a firearm that is not essential to the basic function of the firearm. The term includes a detachable firearm magazine; (6) "Firearm entity" means: (A) a firearm, firearm accessory, or ammunition manufacturer, distributor, wholesaler, supplier, or retailer; and (B) a sport shooting range as defined by Section 250.001, Local Government Code; (7) "Firearm trade association" means any person, corporation, unincorporated association, federation, business league, or business organization that: (A) is not organized or operated for profit and for which none of its net earnings inures to the benefit of any private shareholder or individual; (B) has two or more firearm entities as members; and (C) is exempt from federal income taxation under Section 501(a), Internal Revenue Code of 1986, as an organization described by Section 501(c) of that code. Form TGC 2270 VERIFICATION REQUIRED BY TEXAS GOVERNMENT CODE CHAPTER 2270 Contract identifier: Department: By signing below, Company herby verifies the following: 1. Company does not boycott Israel; and 2. Company will not boycott Israel during the term of the contract. SIGNED BY: � Print Name of Person: �'jfcr.3 1-�L.e,��tzQ�l �1t l'ets�►,�T Signing, Title, and Company-ota�L�q► Sow�TLowS, ��L . Date signed: l C;� / Z,4 / -t-d STATE OF TEXAS COUNTY OFw6 BEFORE ME, the undersigned Notary Public on this day personally appeared,-&ABk}s-�(Name), on behalf of -: J�_;J�'►�l�htrnS= l( ompany) who being duly sworn, stated under oath that he/she has read the foregoing verification required by Texas Government Code Section 2270.002 and said statements contained therein are true and correct.. i fore me, this l da of d r 20 a n� BRUCE HOLMAN y [.�5� Notary ID #128505312. : My Commission Expires January 27, 2023 RY OF PUBLIC, FOR THE STATE OF TEXAS My C mmissiy�n Expires: Government Code § 2270.002. Provision Required in Contract Effective: September 1, 2017 A governmental entity may not enter into a contract with a company for goods or services unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. The following definitions apply: (1) "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes. (2) "Company" means a for -profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit. (3) "Governmental entity" means a state agency or political subdivision of this state. State law requires verification from a Company for contracts involving goods or services (regardless of the amount) before the City can enter into the contract. CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- n and 6 if there are interested parties. OFFICE USE ONLY Complete Nos, 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 2021-818061 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Logical Solutions, Inc. Richardson, TX United States Date Filed: 10/28/2021 2 Name of governmental entity or state agency that is a party tot the contract for which the form is being filed. Town of Westlake Date Acknowledged: 11/01/2021 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2021-06 BAS Upgrade 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. x 6 UNSWORN DECLARATION My name is %i Y) ,/ , f ( /'�— and my date of birth is My address is (V � � i1 � �C`�iJ�� ( eit(cn� C�z'� �{ -o 1 4, 5 1 (street) (city) (state) (zip code (country) I declare under pe Ity of perjury that the foregoing is true and correct. Executed in _� GC, County, State of e k� �, on the day of ice, 20.�. (month) (year) Signature f authorized agent of contracting business entity (Declarant) -- . -- . — �z , — —1— —!!IIna�iui i www.euucs.state.rx.us Version V1.1.191b5cdc