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HomeMy WebLinkAboutContract 49326 CITY OF FORT WORTH, TEXAS CITY SECRETARY/ CONTRACT N0. J. STANDARD AGREEMENT FOR PROFESSIONAL SERVICES This AGREEMENT is between the City of Fort Worth, a Texas home-rule municipality (the "CITY"), and Brown & Gay Engineers, Inc.("CONSULTANT"), authorized to do business in Texas, for a PROJECT generally described as: Full-Time Program\Project Management Staff Extension. 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 Full-Time Program\Project Management Staff Extension. (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 specifically 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 $1,500,000 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. 8 'o City of Fort Worth,Texas ` tJ Standard Agreement for Professional Services OFFICIAL.RJTX Revision Date:12.22.2016(Revised by Parties 7.14.17) D Page 1 of 9 CITY SECRc/T}• 2 j I"T.WORT of ruti 68 9 v Article Ill Term Unless terminated pursuant to the terms herein, this Agreement shall be for a term of 24 months, beginning upon the Effective Date, or until the expiration of the funds or completion of the subject matter contemplated herein, whichever occurs first. 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 INDEMNIFYAND 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 (INCLUDING ALLEGED DAMAGE OR LOSS TO CONSULTANT'S BUSINESS AND ANY RESULTING LOST PROFITS) AND/OR PERSONAL INJURY, INCLUDING 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 CITY9 OR SUBCONTRACTORS, RELATED TO THE PERFORMANCE OR NON-PERFORMANCE OF THIS AGREEMENT. THIS SECTION SHALL SURVIVE ANY TERMINATION OR City of Fort Worth,Texas Standard Agreement for Professional Services Revision Date: 12.22.2016(Revised by Parties 7.14.17) Page 2 of 9 EXPIRATION 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 Liability $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 Professional Liability Insurance The Consultant shall maintain professional liability, a claims-made policy, with a minimum of $1,000,000.00 per claim and aggregate. The policy shall contain a retroactive date prior to the date of the contract or the first date of services to be performed, whichever is earlier. Coverage shall be maintained for a period of 5 years following the completion of the contract. An annual certificate of insurance specifically referencing this project shall be submitted to the City for each year following completion of the contract. (2) Additional Insurance Requirements a. Except for employer's liability insurance coverage under Consultant's worker's compensation insurance policy and professional liability insurance, the City, its officers, employees and servants shall be endorsed as an additional insured on Consultant's insurance policies. City of Fort Worth,Texas Standard Agreement for Professional Services Revision Date:12 22.2016(Revised by Parties 7.14.17) Page 3 of 9 b. Certificates of insurance shall be delivered to the Transportation and Public Works, Attention: Kim Arnold, 200 Texas Street, Fort Worth, TX 76102, and attached to this Agreement prior to its execution. 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. City of Fort Worth,Texas Standard Agreement for Professional Services Revision Date:12.22.2016(Revised by Parties 7.14.17) Page 4 of 9 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. 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 City of Fort Worth,Texas Standard Agreement for Professional Services Revision Date:12.22.2016(Revised by Parties 7.14.17) Page 5 of 9 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. (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 City of Fort Worth,Texas Standard Agreement for Professional Services Revision Date: 12.22.2016(Revised by Parties 7.14.17) Page 6 of 9 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 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 200 Texas Street Fort Worth, Texas 76102 Consultant: Brown & Gay Engineers, Inc. Attn: Carl Krogness 500 W. 7th Street, Suite 1800 Fort Worth, Texas 76102 City of Fort Worth,Texas Standard Agreement for Professional Services Revision Date:12.22.2016(Revised by Parties 7.14.17) Page 7 of 9 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 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 Duly executed by each party's designated representative to be effective on the date subscribed by the City's designated Assistant City Manager. BY: BY: CITY OF FORT WORTH CONSULTANT Brown & Gay Engineers, Inc. — JA 12 — J Chapa Carl I<rogness Assistant City Manager Vice President Date: Date: 0 71h y 7 APPROVAL RECOMMENDED: By: D,� 0 '1 Dou las Wiersig Director, Transportation and Public Works City of Fort Worth,Texas Standard Agreement for Professional Services Revision Date:12.22.2016(Revised by Parties 7.14.17) Page 8 of 9 Contract Compliance Manager: By signing, I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting recluireme ts. Kinn C. Amolk Assistant Director T APPROVED AS TO FORM AND LEGALITY By: Douglas Back Assistant City Attorney L--W' -U� Form 1295 No._2017-220908 ATTEST: M&C No.: C-28291 ary J. Ka ser M&C Date: June 20, 2017 City Secreta OF F V O OFFICIAL RECORD City of Fort Worth.Texas SECRETARY Standard Agreement for Professional Services CITY SECC Page ioono g Date:12.22.2016(Revised by Parties 7.14.17) FT.WOR 1 119•1X ATTACHMENT A Full-Time ProgramlProject Management Staff Extension Services Scope for Program/Project Management Staff Extension Services CONSULTANT will provide providing program/project management staff extension services to advance the High Priority Projects for the Anticipated 2018 Bond Program: 1. Beach Street & Westport Parkway from northern terminus to Keller Haslet Road and then to Alta Vista Boulevard (CPN 101019) (CD 7) 2. Bailey Boswell Road from Blue Mound Road to SH287 (CPN 101018) (CD 2) 3. Park Vista Boulevard & Keller Haslet Rd. (CPN 101020) (CD 7) 4. 377 Intersections at Kroger and at Basswood (CPN 101015) (CD 4) 5. Cromwell Marine Creek Road from Boat Club Road to Marine Creek Parkway (CPN 101012) (CD 2) 6. Avondale Haslet Rd. From Willow Creek Drive to Haslet County Line Rd./FM156 (CPN 101014) (CD 7) 7. Golden Triangle Boulevard From Interstate Highway 35 West to Golden Heights Rd. (CPN101013) (CD 7) 8. Hulen Street & Granbury Rd. (CPN 101017) (CD 6) 9. Crowley Road & Sycamore School Road (CPN101016) (CD 8) City may request the CONSULTANT to work on other tasks or corridors as required. City of Fort Worth,Texas Attachment A PMO Release Date:07.23.2012 Page 1 of 1 ATTACHMENT B COMPENSATION Full-Time ProgramlProject Management Staff Extension Services Time and Materials with Rate Schedule Project I. Compensation A. The CONSULTANT shall be compensated 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 Category 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. Field Rates summarized below apply for CONSULTANT staff providing full-time staff extension services for full-time engagements with a committed duration of over 12 months. Office Rates apply for all other staff engagements. Contract Rate Contract Rate Contract Rate Labor/Staff Classification 2017 2018 2019 Field Office Field Office Field Office Program Manager $210.00 $280.00 $217.00 $289.00 $224.00 $298.00 Project Manager $165.00 $215.00 $170.00 $222.00 $176.00 $229.00 ii. 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 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. City of Fort Worth,Texas Attachment B PMO Official Release Date:8.09.2012 Page 1 of 4 B-1 ATTACHMENT B COMPENSATION 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 shall 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 allowable 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 II - 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. III. Progress Reports A. The CONSULTANT shall prepare and submit to the designated representative of the Transportation and Public Works Department monthly progress reports and schedules in the format required by the City. City of Fort Worth,Texas Attachment B PMO Official Release Date:8.09.2012 Page 2 of 4 B-2 ATTACHMENT B COMPENSATION IV. Summary of Total Project Fees Firm Primary Responsibility Fee Amount % Prime Consultant BGE, Inc. Program/Project Management $1,500,000 100 TOTAL $1,500,000 100% Project Number& Name Total Fee MBE/SBE Fee MBE/SBE Full-Time Program\Project Management $1,500,000 $0 0% Staff Extension Services City MBE/SBE Goal = 0% Consultant Committed Goal = 0% City of Fort Worth,Texas Attachment B PMO Official Release Date:8.09.2012 Page 3 of 4 B-3 EXHIBIT "B-1" CONSULTANT INVOICE (Supplement to Attachment B) Insert required invoice format following this page, including negotiated total budget and allocations of budgets across desired work types and work phases. City of Fort Worth,Texas Attachment B PMO Official Release Date:8.09.2012 Page 4 of 4 B-4 telephone fax Invoice office address remit address Consultant Project No. CFW Project Manager Proj.Invoice No. Invoice date: Consultant's Project Manager: Consultant's email: Period From Date To Date Name of Project: City Secretary Contract#: P.O.Number: Labor Cateaory Name Hours Rate($1hri Amount Project Manager(example) $0.00 Senior Engineer(example) $0.00 Engineer(example) $0.00 Junior Engineer(example) $0.00 CAD Technician(example) $0.00 Adminstrative Support(example) $0.00 etc $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Labor 0.0 $0.00 Subcontract Service Subcontract Service-<1 example> Subcontract Service-<2 example> etc Subcontractor Subtotal $0.00 10 Percent Markup on Subcontract Services $0.00 Nonlabor Expenses Nonlabor Expense Subtotal $0.00 Total Expenses(Subcontract Services+Markup+Nonlabor Expenses) $0.00 TOTAL DUE THIS INVOICE $0.00 M&C Review Official e of the City of Fort CITY COUNCIL AGENDA FORT�V+4RTVI 'COUNCIL: Ott: App av41110 V20/201 DATE: 6/20/2017 REFERENCE C-28291 LOG NAME: 20STAFF EXTENSION NO.: CONTRACT BGE INC CODE: C TYPE: NOW PUBLIC NO CONSENT HEARING: SUBJECT: Authorize Execution of a Professional Services Agreement with BGE, Inc., in an Amount Not to Exceed $1,500,000.00 to Provide Full-Time Project Management Staff Extension Services for a Performance Period Up to Twenty-Four Months for the Transportation and Public Works Department(ALL COUNCIL DISTRICTS) RECOMMENDATION: It is recommended that the City Council authorize the execution of a Professional Services Agreement with BGE, Inc., in an amount not to exceed $1,500,000.00 for project management staff extension services for a performance period up to twenty-four months for the Transportation and Public Works Department. DISCUSSION: The proposed Staff extension consulting services will be utilized to meet current and projected capacity needs and based upon projected workload. The not to exceed budget allows services for up to a twenty-four month performance period providing needed resource capacity to manage the current and growing volume of transportation capital improvement projects. The staff extension will be fully-integrated into the City's Capital Delivery Team. A critical element to meeting the expectations of cost-effective, value-driven, reliable delivery of projects is resource capacity. The Department of Transportation and Public Works (TPW) is currently managing the delivery of the 2014 Bond Program along with numerous additional projects advanced through CFAs and other funding sources. Staff extension will provide a manageable resource plan to meet current and expected demand for capital delivery services over the next 24 months. On May 1, 2017, TPW issued a Request for Qualifications (RFQ) to a list of seventy-seven pre- qualified consultants, created through a prior City solicitation for professional services in January 2017. Eleven responses were received and evaluated. BGE, Inc., was selected as the firm best qualified to provide project management staff extension services. Funding for this work effort is included in each of the projects that are assigned, no new money is being assigned/appropriated. M/WBE OFFICE: A waiver of the goal for MBE/SBE subcontracting requirements was requested by the Department and approved by the MWBE Office, in accordance with the M/WBE or BDE Ordinance, because the purchase of goods or services from source(s) where subcontracting or supplier opportunities are negligible. This contract affects ALL COUNCIL DISTRICTS. http://apps.cfwnet.org/council_packet/mc_review.asp?ID=24810&councildate=6/20/2017[7/11/2017 4:55:00 PM] M&C Review FISCAL INFORMATION/CERTIFICATION: The Director of Finance certifies that funding will be available in various capital projects utilizing the Professional Staffing Services Agreements from various capital funds on a project by project basis. It is the participating Department's responsibility to verify the availability of funds prior to the use of these services or the expenditure of funds. LQ Fund Department Account Project Program Activity Budget Reference# Amount ID ID Year (Chartfield 2) FROM Fund Department Account Project Program Activity Budget Reference# Amount ID I I I Year (ChartFeld 2) Submitted for City Manager's Office bye Jay Chapa (5804) Originating Department Head: Douglas Wiersig (7801) Additional Information Contact: Kim Arnold (2252) ATTACHMENTS 1295 bge.pdf http://apps.cfwnet.org/council_packet/mc_review.asp?ID=24810&councildate=6/20/2017[7/11/2017 4:55:00 PM] CERTIFICATE OF INTERESTED PARTIES F RM 1295 10111 Complete Nos.1.4 and 6 If there are Interested partfes. 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. 2017-220908 Brown&Gay Engineers,Inc. Fort Worth,TX United States Date Filed: 2 Name of governmental entity or state agency that Is a party tot the contract for which the form Is 06/08/2017 being filed. City of Fort Worth Date Ackno 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,a d provide a description of the services,goods,or other property to be provided under the contract. RFQ-1B2 Program&Project Management Services 4 Nature of Interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Johnston,Dave Houston,TX United States X Randermann,Randy Houston,TX United States X Dillon,William Frisco,TX United States X Lennard,Lee Houston,TX United States X 5 Check only If there Is N ter;sted PartyMeN Li 2�16 . ❑ Mi'L11 6 AFFIDAVIT& �.•...��� 11 I swear,or affirm,under penalty of perjury,that the above disclosure Is true and correct. p t• �, •S F t r L.'' OF r Signature of authorized agent of contracting business entity AFFIX NOTA4L�I E' _ farit�,*,�1► Q Sworn to and subscribed before me,by the said Willem D.Dillon this theo_`� day of --,7 LLVI& 21) 1-1 ,to certify which,witness my hand and seal of office. a-VS oherty Office Administrator Signature of fficer'alfAistering o Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commis ' www.ethics.state.tx,us Version V1,0.883