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HomeMy WebLinkAboutContract 48833� � � C��Q C�i $�C�� X �( �j � �E .\ u�Z`1\� CITY OF FORT WORTH, TEXAS CONTRACT N0. `� U�� ; N,P� ,�Wp'�'CN ��o�,-=G�`� STANDARD AGREEMENT FOR PROFESSIONAL SERVICES G� �" �'. This AGREEMENT is between the City of Fort Worth, a Texas home-rule municipality (the "CITY"), and Teague Nall and Perkins, Inc., authorized to do business in Texas, for a PROJECT generally described as: Construction Inspection Services for Infrastructure Projects. Article I Scope of Services (1) Consultant hereby agrees to perForm the professional services set forth in the Scope of Services attached hereto as Attachment -"A". These services shall be performed in connection with Construction Inspection Services for Infrastructure Projects. (2) Additional services, if any, will be requested in writing by the City. City shall not pay for any work performed by Consultant or its subconsultants, subcontractors and/or suppliers that has not been ordered in writing. It is specificatly agreed that Consultant shall not be compensated for any alleged additional work resulting from oral orders of any person. Article II Compensation Consultant shall be compensated in accordance with the Fee Schedule shown in Attachment "B". Payment shall be considered full compensation for all labor, materials, supplies, and equipment necessary to complete the services described in Attachment "A". However the total fee paid by the City shall not exceed a total of $900,000.00 unless the City and the Consultant mutually agree upon a fee amount for additional services and amend this Agreement accordingly. The Consultant shall provide monthly invoices to the City. Payment for services rendered shall be due within thirty (30) days of the uncontested performance of the particular services so ordered and receipt by City of Consultant's invoice for payment of same. Acceptance by Consultant of said payment shall operate as and shall release the City from all claims or liabilities under this Agreement for anything related to, done, or furnished in connection with the services for which payment is made, including any act or omission of the City in connection with such services. City of Fort Worth, Texas Standard Agreement for Professional Services Revision Date: 12.22.2016 Page 1 of 9 -- -- - . - -� �,._- - � —_- � "�FFICIAL RECORD � ��TY SECRETARY ^ �r. woarH, rx i ?�-.,.- -- -�— Article 111 Term Section 1. The term of this Agreement shall commence on the Effective Date and shall be for a term of one (1) year, unless terminated in accordance with the terms of this Agreement. Section 2. City, in its sole discretion, shall have the right, but not the obligation, to renew this Agreement two (2) times, each for a period of one (1) year from the termination date provided that Consultant shall agree in writing to continue such agreement pursuant to the same conditions as contained herein. Section 3. The City has the option to extend the term of this Agreement, or any renewal period, as necessary for Consultant to complete work on any project entered into prior to the expiration of the Agreement. Article IV Independent Contractor Consultant shall operate hereunder as an independent contractor, and not as an officer, agent, servant, or employee of the City. Consultant shall have exclusive control of and the exclusive right to control the details of the work to be perFormed hereunder and of all persons performing same, and shall be solely responsible for the acts and omissions of its officers, agents, employees, contractors and subcontractors. The doctrine of respondeat superior shall not apply as between City and Consultant, its officers, agents, employees, contractors, and subcontractors, and nothing herein shall be construed as creating a partnership or joint venture between City and Consultant. Article V Professional Competence and Indemnification (1) Work performed by Consultant shall comply in all aspects with all applicable local, state and federal laws and with all applicable rules and regulations promulgated by the local, state and national boards, bureaus and agencies. Approval by the City shall not constitute or be deemed to be a release of the responsibility and liability of Consultant or its officers, agents, employees, contractors and subcontractors for the accuracy and competency of its services performed hereunder. (2) The CONSULTANT, AT NO COST TO THE CITY, AGREES TO DEFEND, INDEMNIFY AND HOLD THE CITY, ITS OFFICERS, AGENTS SERVANTS AND EMPLOYEES, HARMLESS AGAINST ANY AND ALL CLAIMS, LAWSUITS, ACTIONS, COSTS AND EXPENSES OF ANY KIND, INCLUDING, BUT NOT LIMITED TO, THOSE FOR PROPERTY DAMAGE OR LOSS (INCLUD/NG ALLEGED DAMAGE OR LOSS TO CONSULTANT'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL INJURY, INCLU�/NG City of Fort Worth, Texas Standard Agreement for Professional Services Revision Date: 12.22.2016 Page 2 of 9 DEATH, THAT MAY RELATE TO, ARISE OUT OF OR BE OCCASIONED BY CONSULTANT'S BREACH OF (i) ANY OF THE TERMS OR PROVISIONS OF THIS AGREEMENT OR (ii) ANY NEGLIGENT ACT OR OMISSION OR INTENTIONAL MISCONDUCT OF CONSULTANT, ITS OFFICERS, AGENTS, ASSOCIATES, EMPLOYEES, CONTRACTORS (OTHER THAN THE CITI� OR SUBCONTRACTORS, RELATED TO THE PERFORMANCE OR NON- PERFORMANCE OF THIS AGREEMENT. THIS SECTION SHALL SURVIVE ANY TERM/NATION OR EXP/RATION OF THIS AGREEMENT. Article VI Insurance (1) Consultant shall not commence work under this Agreement until it has obtained all insurance required under this Article and the City has approved such insurance, nor shall Consultant allow any subcontractor to commence work on its subcontract until all similar insurance of the subcontractor has been so obtained and approval given by the City; provided, however, Consultant may elect to add any subconsultant as an additional insured under its liability policies. Commercial General Liability $1,000,000 each occurrence $2,000,000 aggregate Automobile �iability $1,000,000 each accident (or reasonably equivalent limits of coverage if written on a split limits basis). Coverage shall be on any vehicle used in the course of the Project. Worker's Compensation Coverage A: statutory limits Coverage B: $100,000 each accident $500,000 disease - policy limit $100,000 disease - each employee (2) Additional Insurance Requirements a. Except for employer's liability insurance coverage under Consultant's worker's compensation insurance policy, the City, its officers, employees and servants shall be endorsed as an additional insured on Consultant's insurance policies. b. Certificates of insurance shall be delivered to the Transportation & Public Works, Attention: Roy Teal, 8851 Camp Bowie West Blvd., Fort Worth, TX 76116, and attached to this Agreement prior to its execution. City of Fort Worth, Texas Standard Agreement for Professional Services Revision Date: 12.22.2016 Page 3 of 9 c. Any failure on part of the City to attach the required insurance documentation hereto shall not constitute a waiver of the insurance requirements specified herein. d. Each insurance policy shall be endorsed to provide the City a minimum thirty days notice of cancellation, non-renewal, and/or material change in policy terms or coverage. A ten days notice shall be acceptable in the event of non-payment of premium. e. Insurers must be authorized to do business in the State of Texas and have a current A.M. Best rating of A: VII or equivalent measure of financial strength and solvency. f. Other than worker's compensation insurance, in lieu of traditional insurance, City may consider alternative coverage or risk treatment measures through insurance pools or risk retention groups. The City must approve in writing any alternative coverage. g. Workers' compensation insurance policy(s) covering employees employed on the Project shall be endorsed with a waiver of subrogation providing rights of recovery in favor of the City. h. City shall not be responsible for the direct payment of insurance premium costs for Consultant's insurance. i. Consultant's insurance policies shall each be endorsed to provide that such insurance is primary protection and any self-funded or commercial coverage maintained by City shall not be called upon to contribute to loss recovery. j. In the course of the Agreement, Consultant shall report, in a timely manner, to City's officially designated contract administrator any known loss occurrence which could give rise to a liability claim or lawsuit or which could result in a property loss. k. Consultant's liability shall not be limited to the specified amounts of insurance required herein. I. Upon the request of City, Consultant shall provide complete copies of all insurance policies required by these Agreement documents. Article VII Transfer or Assignment City and Consultant each bind themselves, and their lawful successors and assigns, to this Agreement. Consultant, its lawful successors and assigns, shall not assign, sublet or transfer any interest in this Agreement without prior written consent of the City. City of Fort Worth, Texas Standard Agreement for Professional Services Revision Date: 12.22.2016 Page 4 of 9 Article VIII Termination of Contract (1) (a) City may terminate this Agreement for its convenience on 30 days' written notice. (b) Either the City or the Consultant for cause may terminate this Agreement if either Party fails substantially to perForm through no fault of the other and the nonperforming party does not commence correction of such nonperformance within 5 days of written notice or thereafter fails to diligently complete the correction. (2) If City chooses to terminate this Agreement, upon receipt of notice of termination, Consultant shall discontinue services rendered up to the date of such termination and City shall compensate Consultant based upon calculations in Article II of this Agreement and Exhibit "B" attached hereto and incorporated herein. (3) All reports, whether partial or complete, prepared under this Agreement, including any original drawings or documents, whether furnished by the City, its officers, agents, employees, consultants, or contractors, or prepared by Consultant, shall be or become the property of the City, and shall be furnished to the City prior to or at the time such services are completed, or upon termination or expiration of this Agreement. Article IX Right to Audit (1) Consultant agrees that the City shall, until the expiration of three (3) years after final payment under this Agreement, have access to and the right to examine any directly pertinent books, documents, papers and records of Consultant involving transactions relating to this Agreement. Consultant agrees that the City shall have access during normal working hours to all necessary facilities and shall be provided adequate and appropriate workspace in order to conduct audits in compliance with the provisions of this section. City shall give Consultant reasonable advance notice of intended audits. (2) Consultant further agrees to include in all its subcontracts hereunder, a provision to the effect that the subcontracting consultant agrees that the City shall, until the expiration of three (3) years after final payment under the subcontract, have access to and the right to examine any directly pertinent books, documents, papers and records of such sub-consultant, involving transactions to the subcontract, and further, that City shall have access during normal working hours to all sub- consultant facilities, and shall be provided adequate and appropriate work space in order to conduct audits in compliance with the provisions of this article. City shall give Consultant and any sub-consultant reasonable advance notice of intended audit. City of Fort Worth, Texas Standard Agreement for Professional Services Revision Date: 12.22.2016 Page 5 of 9 (3) Consultant and sub-consultants agree to photocopy such documents as may be requested by the City. The City agrees to reimburse Consultant for the cost of copies at the rate published in the Texas Administrative Code in effect as of the time copying is performed. Article X Minority Business and Small Business Enterprise (MBE)(SBE) Participation In accordance with the City's Business Diversity Enterprise Ordinance No. 20020-12-2011, as amended, the City has goals for the participation of minority business enterprises and/or small business enterprises in City contracts. Consultant acknowledges the MBE and SBE goals established for this Agreement and its accepted written commitment to MBE and SBE participation. Any misrepresentation of facts (other than a negligent misrepresentation) and/or the commission of fraud by the Consultant may result in the termination of this Agreement and debarment from participating in City contracts for a period of time of not less than three (3) years. Article XI Observe and Comply Consultant shall at all times observe and comply with all federal, state, and local laws and regulations and with all City ordinances and regulations which in any way affect this Agreement and the work hereunder, and shall observe and comply with all orders, laws ordinances and regulations which may exist or may be enacted later by governing bodies having jurisdiction or authority for such enactment. No plea of misunderstanding or ignorance thereof shall be considered. Consultant agrees to defend, indemnify and hold harmless City and all of its officers, agents and employees from and against all claims or liability arising out of the violation of any such order, law, ordinance, or regulation, whether it be by itself or its employees. Article XII Venue and Jurisdiction If any action, whether real or asserted, at law or in equity, arises on the basis of any provision of this Agreement, venue for such action shall lie in state courts located in Tarrant County, Texas or the United States District Court for the Northern District of Texas — Fort Worth Division. This Agreement shall be construed in accordance with the laws of the State of Texas. Article XIII City of Fort Worth, Texas Standard Agreement for Professional Services Revision Date: 12.22.2016 Page 6 of 9 Contract Construction The Parties acknowledge that each party and, if it so chooses, its counsel have reviewed and revised this Agreement and that the normal rule of construction to the effect that any ambiguities are to be resolved against the drafting party must not be employed in the interpretation of this Agreement or any amendments or exhibits hereto. Article XIV Severability The provisions of this Agreement are severable, and if any word, phrase, clause, sentence, paragraph, section or other part of this Agreement or the application thereof to any person or circumstance shall ever be held by any court of competent jurisdiction to be invalid or unconstitutional for any reason, the remainder of this Agreement and the application of such word, phrase, clause, sentence, paragraph, section, or other part of this Agreement to other persons or circumstances shall not be affected thereby and this Agreement shall be construed as if such invalid or unconstitutional portion had never been contained therein. Article XV Notices Notices to be provided hereunder shall be sufficient if forwarded to the other Party by hand-delivery or via U.S. Postal Service certified mail return receipt requested, postage prepaid, to the address of the other Party shown below: City of Fort Worth Attn: Transportation and Public Works Dept. 8851 Camp Bowie West Blvd. Fort Worth, Texas 76116 Consultant: Teague Nall and Pekins, Inc. Attn: Ty Hilton, P.E., Principal 5237 N. Riverside Dr., Suite 100 Fort Worth, Texas 76137 Article XVI Headings The headings contained herein are for the convenience in reference and are not intended to define or limit the scope of any provision of this Agreement City of Fort Worth, Texas Standard Agreement for Professional Services Revision Date: 12.22.2016 Page 7 of 9 Article XVII Attachments, Schedules and Counterparts This Agreement may be executed in one or more counterparts and each counterpart shall, for all purposes, be deemed an original, but all such counterparts shall together constitute but one and the same instrument. The following attachments and schedules are hereby made a part of this AGREEMENT: Attachment A- Scope of Services Attachment B — Compensation Attachment C- Amendments to Standard Agreement for Engineering Services Attachment D - Project Schedule Attachment E - Location Map Duly executed by each party's designated representative to be effective on the date subscribed by the City's designated Assistant City Manager. BY: CITY OF FORT WORTH ��' ; � Jay Chapa Assistant City Manager Date: �> �'�`1% APPROVAL RECOMMENDED: By, 1,,,� � � Doug rsig, P.E. Director, Transportation & ublic Works City of Fort Worth, Texas Standard Agreement for Professional Services Revision Date: 12.22.2016 Page 8 of 9 BY: ENGINEER Teague Nall and Perkins, Inc. y il on, P.E. Principal Date: 2 �4' � 7 ��. i � ' � � •r: i� �> .a�, . By �ignit�g, 1�cknowiedge that 9�m the persan res�on�ib(e fc�r the monitaring and administration of thi� contract, including ensuring all performance �nd reporting requirernent . Roy al Co truction Manager APPROVED AS TO FORM AND LEGALITY By:�da—, Doug Black Assistant City Attorney City Secretary City of Fort Worth, Texas Standard Agreement for Professional Services Revision Date: 12.22.2016 Page 9 of 9 Form 1295 No. ZD/i, l�6 ���- M&C No.: G' � O l� � M&C Date: 2 � � � � �' OP�ICU#1. R�CORD CIT'!r ��CRETA�Y Fi`� !�l'a�'H, TX ATTACHMENT "A" Scope for Construction Inspection Services for Citv Infrastructure Proiects The scope set forth herein defines the work to be perFormed by the Inspector praject. Both the CITY and CONSU�TANT have attempted to clearly define the work to be performed and address the needs of the Project. TASKS TO BE PERFORMED All of the work mentioned below shall be performed by CONSULTANT for the following task: Task 1 Construction Inspection TASK 1. CONSTRUCTION INSPECTION Work assigned under this task may include, but not limited to: Pre-Construction Phase • Visit the project site to verify the accuracy of the construction plans with respect to the field conditions. • Video the project site to document the pre-construction conditions. • Review the project plans and contract documents. Notify the City of any omissions, overages or under runs of the bid items. • Prepare project folders and daily log books for each client department. • Attend both the pre-construction meeting with the contractor and the pre- construction neighborhood meeting with the public, if required. Construction Phase • Inspect contractor's work for adherence to the project's construction plans and specifications. • Collect water samples for bacteriological testing. • Provide daily inspections of the project to insure that the contractor's activities adhere to the construction plans and specifications. • Report any issues with the contractor or citizens to City staff. • Maintain red-line drawings of project to document field changes during construction. City of Fort Worth Attachment A Page 1 of 2 • Maintain daily log record of project. Should include but not limited to contractor comments, instructions given, construction conflicts, disputes, construction activity. • Prepare pay estimates. The quantities shall be field verified with the contractor. Post-Construction Phase • Perform preliminary walk through with contractor to create punch-list of corrections. • Insure that all work required of the contractor has been completed. • Schedule, attend and participate in the final inspection with City staff and the contractor. Inspect any punch-list items after the contractor has completed them. • Collect close-out documentation from the contractor. (i.e. consent of surety, affidavit of bills paid) • Prepare close-out documents required by the City. City of Fort Worth Attachment A Page 2 of 2 ATTACHMENT B COMPENSATION Construction Inspection Services for Infrastructure Projects Time with Rate Schedule I. Compensation A. The CONSULTANT shall be compensated up to $900,000.00 for personnel time, non-labor expenses, and subcontract expenses in performing services enumerated in Attachment A as follows: i. Personnel Time. Personnel time shall be compensated based upon hours worked directly in perForming the PROJECT multiplied by the appropriate Labor Category Rate for the CONSULTANT's team member performing the work. Labor Cateqory Rate as presented in the rate schedule table below is the rate for each labor category performing the work and includes all direct salaries, overhead, and profit. Labor Category Rate ($/hour)* Construction Ins ector I(<5 rs exp) $70 Construction Inspector II (5 — 10 yrs exp) $80 Construction Inspector III (> 10 rs exp) $90 * Hourly Labor Rate may be adjusted annually with each renewal in an amount not to exceed the percentage Construction Cost Index as published by Engineering News- Record. The November 2016 Construction Cost Index of 10442 shall be used as the base index when determining the annual percentage adjustment for the twelve (12) months following the Effective Date. The CONSULTANT shall notify the City of Fort Worth in writing before each renewal during the term of this Agreement the CONSULTANT's projected annual increase in the Hourly Rates. Non-Labor Expenses. Non-labor expenses shall be reimbursed as Direct Expenses at invoice or internal office cost. Direct Expenses (non-labor) include, but are not limited to, mileage, travel and lodging expenses, mail, supplies, printing and reproduction services, other direct City of Fort Worth, Texas Attachment B PMO O�cial Release Date: 8.09.2012 Page 1 of 3 � ATTACHMENT B COMPENSATION expenses associated with delivery of the work; plus applicable sales, use, value added, business transfer, gross receipts, or other similar taxes. iii. Subcontract Expenses. Subcontract expenses and outside services shall be reimbursed at cost to CONSULTANT plus a markup of ten percent (10%). iv. Budgets. CONSULTANT will make reasonable efforts to complete the work within the budget and will keep the City informed of progress toward that end so that the budget or work effort can be adjusted if found necessary. CONSULTANT is not obligated to incur costs beyond the indicated budgets, as may be adjusted, nor is the City obligated to pay CONSULTANT beyond these limits. If CONSULTANT projects, in the course of providing the necessary services that the PROJECT cost presented in Article 2 of this Agreement will be exceeded, whether by change in scope of the project, increased costs or other conditions, the CONSULTANT shail immediately report such fact to the City and, if so instructed by the City, shall suspend all work hereunder. When any budget has been increased, CONSULTANT's excess costs expended prior to such increase will be aliowable to the same extent as if such costs had been incurred after the approved increase. B. The CONSULTANT shall be paid monthly payments as described in Section 11 - Method of Payment. II. Method of Payment A. The CONSULTANT shall be paid by the City based upon an invoice created on the basis of statements prepared from the books and records of account of the CONSULTANT, based on the actual hours and costs expended by the CONSULTANT in performing the work. B. Each invoice shall be verified as to its accuracy and compliance with the terms of this Agreement by an officer of the CONSULTANT. C. CONSULTANT shall prepare and submit invoices in the format and including content as presented in Exhibit B-1. D. Payment of invoices will be subject to certification by the City that such work has been perFormed. City of Fort Worth, Texas Attachment B PMO Official Release Date: 8.09.2012 Page 2 of 3 � EXHIBIT "B-1" CONSULTANT INVOICE (Supplement to Attachment B) Insert required invoice format following this page, inciuding negotiated total budget and allocations of budgets across desired work types and work phases. City of Fort Worth, Texas Attachment B PMO Officiai Release Date: 8.09.2012 Page 3 of 3 � 2/8/2017 M&C Review • ' �i COUNCIL ACTION: Approved on 2/7/2017 DATE: 2/7/2017 REFERENCE **C_28098 LOG NO.: NAME: CODE: C TYPE: CONSENTPUBLIC HEARING: dfFicia! site of tlie Ciiy of F�rz VJo�h, T2aas FURTWORTf1 20_2016CONSTRUCTION INSPECTION SERVICES CONTRACTS 1►[�7 SUBJECT: Authorize Execution of One-Year Annual Contracts with Renewal Options for Construction inspection Services for Various City Construction Projects with Freese and Nichols, Inc., Lamb-Star Engineering, L.P., Lina T. Ramey and Associates, Inc., Multatech Engineering, Inc., Pape-Dawson Engineers, Inc., CMT Engineering, Inc. d/b/a PaveTex, TEI Program/Construction Management, Inc., Teague Nall & Perkins, Inc., and VRX, Inc., with a Fee Not to Exceed $900,000.00 Annually Per Firm (ALL COUNCIL DISTRICTS) RECOMMENDATION: It is recommended that the City Council authorize the City Manager to execute individual contracts with Freese and Nichols, Inc., Lamb-Star Engineering, L.P., Lina T. Ramey and Associates, Inc., Multatech Engineering, Inc., Pape-Dawson Engineers, Inc., CMT Engineerin , Inc. d/b/a PaveTex, TEI Program/Construction Management, inc., Teague Nall & Perkins�c., and VRX, Inc., for construction inspection services for various City construction projects. The term of each contract is one-year with two one-year renewal options. The annual amount of each contract not to exceed $900,000.00. DISCUSSION: The Transportation and Public Works Department solicited firms to provide construction inspectors to inspect various City-wide projects as a supplement to Staff in order to accommodate peak periods of construction. A Request for Qualifications (RFQ) was published for these services in the Fort Worth Star-Telegram in August 2016. The Department received Statements of Qualifications (SOQ) for professional services from 11 firms for providing construction inspection services. Each firm's SOQ was evaluated based upon pre-established selection criteria including qualification of personnel, experience and performance on previous City contracts and availability. An inter-departmental committee selected as most qualified and recommends the following firms for contract approval, Freese and Nichols, Inc., Lamb-Star Engineering, L.P., Lina T. Ramey and Associates, Inc., Multatech Engineering, Inc., Pape-Dawson Engineers, Inc., CMT Engineering, Inc. d/b/a PaveTex, TEI Program/Construction Management, Inc., Teague Nall & Perkins, Inc., and VRX, Inc. Funding for the construction inspection services for various City construction projects will be provided through various project funding sources. The Office of Business Diversity in conjunction with the Transportation and Public Works Department has determined compliance with the City's Business Diversity Enterprise Ordinance by the inclusion of SBE firms on this project. Lamb-Star Engineering, L.P., Lina T. Ramey & Associates, Inc., Multatech Engineering, Inc., CMT Engineering, Inc. d/b/a PaveTex, TEI Program Construction Management, Inc., and VRX, Inc., are certified SBE firms. Freese and Nichols, Inc., Pape-Dawson Engineers and Teague Nall & Perkins, Inc., are also being recommended for awards. http://apps.cfwnet.org/council�acketlmc_review.asp?ID=24238&councildate=2l1/2017 1/2 ?J8/2017 M&C Review FISCAL INFORMATION/CERTIFICATION: The Director of Finance certifies that upon approval of the above recommendations, funds will be available in the current capital project budgets, as appropriated in the various funds for TPW Capital Projects. The participating department has the responsibility to validate the availability of funds prior to an expenditure being made. Fund I Department I Account I Project Program ( Activity ( Budget Reference # ID ID Year (Charlfield 2 Fund I Department Account I Project Program ( Activity I Budget ( Reference # ID ID Year (Chartfield 2'. Submitted for City Manager's Office by: Originating Department Head: Additional Information Contact: Jay Chapa (5804) Douglas Wiersig (7801) Roy Teal (7958) ATTACHMENTS 2016-12-15 Lamb-Star 1295 Form.pdf Form 1295-Multatech-Cont-Insp.pdf Freese Nichols Form 1295 for Infr Const Inspec.pdf Lina Ramey Assoc 1295 FormRev.pdf Pa�e-Dawson Engineers Form 1295 Signed.pdf PaveTex SMuratec1295.pdf TEI Program Construction Manaqement 1295 Form C28016121616380.pdf TNP Form1295.pdf VRX Form 1295 Form-City of FW Inspection-121516.pdf Amount Amount http:/lapps.cfwnet.org/council�ackeUmc_review.asp?ID=24238&councildate=2/7/2017 2/2 C-28098 C CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 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 1 Name of business entity filing form, and the city, state and country of the business entity's place Certificate Number: of business. 2016-146777 Teague Nall and Perkins, Inc. Fort Worth, TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 12/15/2016 being filed. City of Fort Worth Date Ac novyledged: 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. TBD Infrastructure Engineering Construction Inspection Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary Hilton, Ty Fort Worth, TX United States X Atwood, Joe Fort Worth, TX United States X Wimberley, Bill Fort Worth, TX United States X Rutledge, Tom Fort Worth, TX United States X Berry, Mark Fort Worth, TX United States X Jones, Michael Fort Worth, TX United States X 5 Check only if there is NO Interested Party. 6 AFFIDAVIT ti►*� !4� PAULA R SULLIVAN l STATE OF TEXAS NO" 0 011911110e21 loll ill11 III I 1 II lip III Ili Roll, AFFIX NOTARY STAMP / SEAL ABOVE I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Swor and subscn d before me, by the said 21 2 , certify hich, witness my hand and seal of office. ~ Signature of authorized agent of contracting business entity fri�t4e'd,� �InI Slgnalure of offic r a inistering oath name of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us this the / 5� day o&W, b kim J n . AfsS , Title of officer administering oath Version V1.0.277