HomeMy WebLinkAboutContract 46322-A1 =�gi0 �1 y2
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CITY SECRETAW,
�1 • F �� CONTRACT NO.
3 2W16 AMENDMENT No.1
TO CITY SECRETARY CONTRACT No. 46322
d z� l l 61- 4'
WHEREAS, the City of Fort Worth (CITY) and Pacheco Koch Consulting
Engineers, Inc. , (ENGINEER) made and entered into City Secretary Contract
No. 46322, (the CONTRACT) which was authorized by M&C C-27094 on the 2nd
day of December, 2014 in the amount of $414, 500.00; and
WHEREAS, the CONTRACT involves engineering services for the
following project:
Blue Mound Road from Willow Springs Road to US Highway 81/287;
and
WHEREAS, it has become necessary to execute Amendment No. 1 to the
CONTRACT to include an increased scope of work and revised fee.
NOW THEREFORE, CITY and ENGINEER, acting herein by and through their
duly authorized representatives, enter into the following agreement,
which amends the CONTRACT:
1.
Article I of the CONTRACT is amended to include the additional
engineering services specified in a proposal dated November 6, 2015, a
copy of which is attached hereto and incorporated herein. The cost to
City for the additional design services to be performed by Engineer
totals $277, 000 . 00 . (See Attached Funding Breakdown Sheet, Page -3-) .
2.
Article II of the CONTRACT is amended to provide for an increase in
the fee to be paid to Engineer for all work and services performed under
the Contract, as amended, so that the total fee paid by the City for all
work and services shall be an amount of $691, 500. 00.
3.
City of Fort Worth
Professional Services Agreement Amendment Template OFFICIAL RECORD
PMO Official Release 8/1/2012
Page 1 of 3 CITY SECRETARY
IT• WORTH$ TX
All other provisions of the Contract, which are not expressly
amended herein, shall remain in full force and effect.
EXECUTED and EFFECTIVE as of the date last written by a signatory,
below.
APPROVED:
City of Fort Worth ENGINEER
Pacheco Koch
Cons i.ng Engineers Inc.
Jay Chapa Mark A. Pacheco, P. E. , RPLS
Assistant City Manager President
DATE: —6//1 < ( DATE: 04 1-04.z2ole-
APP]aR,ECOMMENDED:1j
(�. W
Douglas Wiersig, P.E.
Director, Transportation and Public Works Department
APPROVED AS TO FORM AND LEGALITY: M&C: C-27651
W)4& Date: 3-29-16
Doug as W. Black
Assistant City Attorney
ATTEST:
F0
.3
a
Mary J. KaVs rO �
City Secretary N. 00000
�� �
City of Fort Worth ' {
Professional Services Agreement Amendment Template EOFFICIALEC®RDPMO Official Release 8/1/2012 s 1/�AR�Page 2 of 3 'H, TX
FUNDING BREAKDOWN SHEET
City Secretary No. 46322-A1
Amendment No. 1
Department Fund - Dept. - Account - Project - Activity - Year -
Amount
Reference
TPW 39008 - 0200431 - 5740010 - CO2161 - UN2330 - 2016 - $277, 000 .00
14010199
Total: $277,000.00
City of Fort Worth
Professional Services Agreement Amendment Template
PMO Official Release 8/1/2012
Page 3 of 3
1&2Lhheco Koch
6100WESTERN FLACE,SUITE 1001
FORT NORTH, TX 76107
PHONE(817)412.7155 November 6 2015
ATTACHMENT "A" '
DESIGN SERVICES
Scope for Engineering Design and Construction Phase Services
WILLOW SPRINGS ROAD
from Blue Mound Road to Eagle Parkway
City Project No. 02161
The scope set forth herein defines the contemplated work to be performed by the ENGINEER in
completing the project. Both the CITY and ENGINEER have attempted to clearly define the
work to be performed and address the needs of the Project.
OBJECTIVE
The objective of this Task Order Agreement is to complete the construction plans for Willow
Springs Road from Blue Mound Road to Eagle Parkway as a four-lane divided arterial street.
Additionally, the intersection of Blue Mound Road and Eagle Parkway will be designed as a
roundabout. Work under this Task Order Agreement includes, but is not limited to,project
management,verification of topographic survey,preliminary, and final design plans,
specifications, and estimates, and additional task orders as necessary to accomplish this
objective.
WORK TO BE PERFORMED
ENGINEER hereby agrees to provide services on a Task Order basis as may be directed by the
CITY. All work under this agreement will be performed on a Task Order basis. The CITY will
request services for each Task Order individually and independently. The ENGINEER shall
prepare scope, fee and schedule to perform the services requested by each Task Order within 10
working days of the CITY'S request.
Each Task Order shall include a detailed scope of services as Attachment"A". This scope of
services will outline tasks required to complete the Task Order. The scope shall include a
detailed description of each task, outline any assumptions and list the required deliverables.
Each Task Order shall include Attachment`B", detailing the compensation for the Task Order.
Compensation will be based upon hours and labor costs agreed upon by the CITY and the
ENGINEER for each Task Order. Compensation will be based on the Schedule of Rates in
Attachment"B" of this agreement. The fee will include an estimate of reimbursable and sub-
consultant cost for each Task Order. Compensation for each Task Order shall be based upon the
agreed upon not-to-exceed fee and paid via invoiced amount.
If the Task Order requires a schedule it shall be attached as Attachment"D".
City of Fort Worth,Texas
Attachment A
PMO Release Date:07.23.2012
Page 1 of 1
ATTACHMENT B
COMPENSATION
Design Services for
WILLOW SPRINGS ROAD
from Blue Mound Road to Eagle Parkway
City Project No. 02161
I. Compensation
a. The ENGINEER shall be compensated for personnel time, non-labor expenses,
and subcontract expenses in performing services for Task Orders up to
$276,402.00 unless amended. CITY and ENGINEER will agree upon
compensation for each Task Order prior to starting work. Each Task Order shall
be Lump Sum.
i. Personnel Time. Personnel time shall be compensated based upon
hours worked directly in performing the PROJECT multiplied by the
appropriate Labor Category Rate for the ENGINEER's team member
performing the work and includes all direct salaries, overhead, and profit.
Labor Category Rate as presented in the rate schedule table below is
the rate for each labor category performing the work and includes all
direct salaries, overhead, and profit.
LABOR CATEGORY RATE ($/HOUR)
Project Manager/Principal $215
Senior Engineer $180
Project Engineer $140
RLA $140
EIT $95
GIS/CADD $80
Survey PM $190
Field Crew—Two Person $135
Survey Technician $75
Survey Manager/Coordinator $120
Administrative $70
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 ENGINEER plus a markup of ten percent (10%).
City of Fort Worth,Texas
Attachment B
PMO Official Release Date:8.09.2012
Page 1 of 4
B-1
ATTACHMENT B
COMPENSATION
IV. Budgets. ENGINEER 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.
ENGINEER is not obligated to incur costs beyond the indicated budgets, as may be
adjusted, nor is the City obligated to pay ENGINEER beyond these limits.
If ENGINEER 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
ENGINEER 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, ENGINEER'S excess costs expended prior to
such increase will be allowable to the same extent as is such costs had been
incurred after the approved increase.
The Engineer shall be paid monthly payments as described in Section II — Method of
Payment.
II. Method of Payment
a. The ENGINEER 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
ENGINEER, based on the actual hours and costs expended by the ENGINEER 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 ENGINEER.
C. ENGINEER 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 ENGINEER 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. A Summary of Task Order Fees shall accompany each Task Order.
Summary of Total Pro'ect Fees
Firm Primary Responsibility Fee Amount %
Prime Consultant
Pacheco Koch Project Management, $206,162 74.6%
Consulting Engineers, Survey/Easements, &
Inc. Engineering
Proposed MBE/SBE Sub-Consultants
Civil Associates, Inc. Traffic Analysis and $58,265 21.1%
Roundabout Geometric Design
j Rios Group SUE Utility Study $11,975 4.3%
i
Non-MBE/SBE Consultants
TOTAL $276,402 100%
Additional Task Orders
Project Number & Name Total Fee MBE/SBE Fee MBE/SBE
02161 — Blue Mound Road —Task No. 1 $25,327 $0 0%
— Management & Review
02161 — Blue Mound Road —Task No. 3 $157,270 $70,240 42%
— Preliminary Design 60%
02161 — Blue Mound Road —Task No. 4 $61,735 $0 0%
— Final Design (90%)
02161 — Blue Mound Road —Task No. 5 $4,380 $0 0%
— Bid Phase Services
02161 — Blue Mound Road —Task No. 6 $8,190 $0 0%
—Construction Phase Services
02161 — Blue Mound Road —Task No. 7 $5,000 (2 @ 2,500 if $0 0%
— ROW/Easement Services req'd
02161 — Blue Mound Road —Task No. 8 $14,500 $0 0%
—Survey
City MBE/SBE Goal = 20% Consultant Committed Goal = 25%
City of Fort Worth,Texas
Attachment 8
PMO Official Release Date:8.09.2012
Page 3 of 4
B-3
EXHIBIT "B-1"
ENGINEER 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
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ATTACHMENT "C"
CHANGES AND AMENDMENTS TO STANDARD AGREEMENT
Design Services for
Blue Mound Road (Amendment for Willow Springs Design)
City Project No. 02161
None.
City of Fort Worth,Texas
Attachment C
PMO Release Date:05.19.2010
Page I of I
Consulting Contract Schedule Specifications FO RT WO RT H
City of Fort Worth Capital Improvement Program
Attachment D-Project Schedule
This PROTECT requires a Tier 3 schedule as defined herein and in the Citi/'s Schedule Guidance
Document.
D1. CONSULTING SERVICES SCHEDULE DEVELOPMENT: The CONSULTANT shall
prepare schedules for consulting services that meet the requirements described in this
specification, showing by Critical Path Method (CPM) the planned sequence and timing of
the Work associated with the Agreement. All submittals shall be submitted in PDF format,
and schedule files shall also be submitted in native file format (i.e. file formats associated
with the scheduling software). The approved scheduling software systems for creating the
schedule files are:
- Primavera (Version 6.1 or later or approved by CITY)
- Primavera Contractor(Version 6.1 or later or approved by CITY)
- Microsoft Project(Version 2003/2007 or later or approved by CITY)(PHASING OUT)
D2. BASELINE CONSULTING SERVICES SCHEDULE: Following notice-to-proceed, the
CONSULTANT shall develop, submit and review the draft detailed baseline consulting
services schedule with the CITY to demonstrate the CONSULTANT's understanding of the
Agreement requirements and approach for performing the work. The CONSULTANT will
prepare the final detailed baseline consulting services schedule based on CITY comments, if
any, and submit to the CITY no later than the submittal of the first project invoice.
The following guidelines shall be adhered to in preparing the baseline schedule, and as
described in further detail in the CITY's Schedule Guidance Document.
a. The scope shall be subdivided by work breakdown structure (WBS) representing the
tasks, subtasks,and activities associated with delivering the work.
b. The schedule shall accurately describe the major work activities, key milestones, and
dependencies/relationships as appropriate to the work.
c. The schedule should include appropriate meetings, review periods, critical decision
points,including third party utility dependencies and reviewing agencies.
D3. PROGRESS CONSULTING SERVICES SCHEDULE: The CONSULTANT shall prepare
and submit monthly to the CITY for approval the updated schedule in accordance with D1
and D2 and the CITY's Schedule Guidance Document inclusive. As the Work progresses,
the CONSULTANT shall enter into the schedule and record actual progress as described in
the CITY's Schedule Guidance Document.
The updated schedule submittal shall also include a concise schedule narrative that
highlights the following,if appropriate and applicable:
• Changes in the critical path,
• Expected schedule changes,
• Potential delays,
• Opportunities to expedite the schedule,
• Coordination issues the CITY should be aware of or can assist with,
City of Fort Worth,Texas
Attachment D
PMO Release Date:02.15.2011
Page 1 of 2
• Other schedule-related issues that the CONSULTANT wishes to communicate to the
CITY.
D4. PERFORMANCE AND CONSULTING SERVICES SCHEDULE: If the work
accomplished falls behind that scheduled due to factors within the CONSULTANT's
control, the CONSULTANT shall take such action as necessary to improve the progress of
the Work. In addition, the CITY may require the CONSULTANT to submit a revised
schedule demonstrating the proposed plan to make up the delay in schedule progress and
to ensure completion of the Work within the allotted Agreement time.
D5. SCHEDULE TIERS SPECIAL INSTRUCTIONS:
The requirements for the schedule are determined based on the nature and needs of the
project. The schedule tier for this project is stated at the top of this document.
CONSULTANT shall submit each schedule relying on the CITY's current Schedule
Guidance Document.
D6. SCHEDULE SUBMITTAL AND PAYMENT:
As stated in III.A.(1). of the Agreement, CONSULTANT shall provide the information
required by Attachment D. CONSULTANT's monthly invoices will not be accepted and
processed for payment without monthly schedule updates that are submitted in the time
and manner required by Attachment D and the CITY's current Schedule Guidance
Document.
City of Fort Worth,Texas
Attachment D
PMO Release Date:02.15.2011
Page 2 of 2
Attachment E: Project Location Mai d4ftcheco Koch
City of Fort Worth -Willow Springs Road 6100VWESTERN PLACE, SUITE 1001 �
From Blue Mound Road to Eagle Boulevard FPHCINE.ORT (817 7X -7107
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NOTES DATUM
BACKGROUND IMAGE FROM NAD 1983 TEXAS STATE PLANE
BINE AERIALS NORTH CENTRAL ZONE FIDS 4202
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.M&C Review Pagel of 3
Official site of the City of Fort Worth, Texas
LITY COUNCIL AFORTWORTIll
COUNCIL ACTION: Approved on 3/29/2016 -Ordinance No. 22138-03-2016
REFERENCE ** 20WILLOWSPRINGSDESIGN - i
DATE: 3/29/2016 NO ; C-27651 LOG NAME: 02161 E
CODE: C TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT: Authorize Execution of Amendment No. 1 to the Engineering Services Agr ith
Pacheco Koch Consulting Engineers, Inc., in the Amount Not to Exceed 277,000.0 or
the Design of Blue Mound Road from Willow Springs Road to US Highway 81/287, a
2014 Bond Program Project, for a Revised Engineering Services Contract Amount of
$691,500.00, Provide for Additional Project Management and Contingencies in the I
Amount of$55,000.00 and Adopt Appropriation Ordinance (COUNCIL DISTRICT 7) I
RECOMMENDATION:
It is recommended that the City Council:
1. Adopt an appropriation ordinance increasing estimated receipts and appropriations in the Blue
Mound Road, Project- US Highway 81/287 to Willow Springs Road, of the Transportation Impact
Fund in the amount of$1,944,000.00 and reduce the fund balance in the Unspecified Center of
Service Area B Fund by the same amount; and
2. Authorize the execution of Amendment No. 1 to the Engineering Serv' ent with
Pacheco Koch Consulting Engineers, Inc., in the amount not to excee 277 x.00 r the design of
Blu oad from Willow Springs Road to US Highway 81/287 for a revised contract amount of
691,500.00.
DISCUSSION:
The 2014 Bond Program includes funding for roadway capacity improvements along Blue Mound
Road between Willow Springs Road and US 287. The main purpose of this project is to provide for
the increasing traffic volume associated with the new V.R. Eaton High School campus and extensive
land development activity to the north and west of the school. Staff is recommending additional
funding be added to the project based on the revised project cost estimate and the need to
coordinate the improvements along Blue Mound Road with future expansion of Willow Springs Road.
During the preliminary project design, Staff determined that intersection modifications are needed in
the form of a roundabout at the intersection of Blue Mound Road and Willow Springs Road to provide
safety and capacity improvements based on the forecasted increase in traffic volume. The total cost
estimate for the project now exceeds the planning budget established in 2013 by $1,462,000.00 with
the addition of the roundabout and the higher project costs associated with land acquisition and
accelerated construction inflation. ;
The original Engineering Services Agreement provided task-ordered engineering services (Contract
No. 46322) for the design of Blue Mound Road from Willow Springs Road to US Highway 81/287 and
pursuant to an Interlocal Agreement with the Northwest Independent School District (M&C C-27011). '
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The Appropriation Ordinance will provide a total of$1,944,000.00 of impact fees associated with this
project, which consists of$1,462,000.00 for Blue Mound Road, $277,000.00 for design of Willow
Springs Road and $205,000.00 for land acquisition along Willow Springs Road. The total project
budget and funding sources for Blue Mound Road and Willow Springs Road are outlined below. Staff
is currently negotiating with Northwest Independent School District and adjacent land developers to
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partner in the funding of the construction phase of Willow Springs Road.
The construction phase of this project is anticipated to begin in Fall 2016 with an anticipated
completion date of Fall 2017.
Blue Mound Road Willow Springs Road
PROJECT Transportation Transportation To Be
FUNDING SOURCE Impact Fees 2014 CIP Impact Fees Determined Total
Design Contract
Budget - $ 414 500.00 $277,000.00 - $ 691 500.00
City Project
Management,
Design Coordination - $ 137 500.00 - $ 55 000.00 192 500.00
Total Design - $ 552,000.00 $277,000.00 $ 55,000.00 $ 884,000.00
Right-of-Way and
Easement
Acquisition
Coordination - 795 000.00 - $ 330 000.00 1,125,000.00
ROW Parcel on
Willow Springs Road - $ 205 000.00 - $ 205 000.00
Utility Relocations - $ 100,000.00 - $ 50,000.00 $ 150,000.00
Total ROW, Utilities - $ 895 000.00 $205,000.00 $ 380 000.00 $1 ,480,000.00
Construction Costs $1,462,000.00 $2,430,000.00 - $4,865 000.00 $ 8,757,000.00
City Project F
Management,
Inspections, QA/QC
and Coordination - $ 316,000.00 - $ 315,000.00 $ 631,000.00
Construction Project
Contingencies - $ 857,000.00 - $ 967,000.00 $ 1,824,000.00
Total Construction $1,462,000.00 $3,603,000.00 $ 0.00 $6,147,000.00 $11 212 000.00
TOTAL PROJECT
BUDGET $1,462 000.00 $5,050,000.00 $482,000.00 $6,582,000.00 $13,576,000.00
Authorizations provided with this Mayor and Council Communication will result in no additional annual
operating impacts to the Transportation and Public Works Department's Operating Budget.
M/WBE OFFICE - Pacheco Koch Consulting Engineers, Inc., agrees to maintain its initial SBE
commitment of 20 percent that it made on the original Agreement and extend and maintain that same
SBE commitment of 20 percent to this first amendment. Therefore Pacheco Koch Consulting
Engineers, Inc., remains in compliance with the City's BDE Ordinance and attests to its commitment by
its signature on the Acceptance of Previous SBE Commitment form executed by an authorized
representative of its company.
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This project is located in COUNCIL DISTRICT 7, Mapsco 19F, 19G and 19K.
FISCAL INFORMATION/CERTIFICATION:
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The Director of Finance certifies that upon approval of the above recommendations and adoption of
the appropriation ordinance, funds will be available in the current capital budget, as appropriated of
the Transportation Impact Fund.
FUND TOTAL PENDING REMAINING
APPROPRIATIONS ENCUMBRANCES/EXPENDITURES BALANCE
BLUE MOUND RD/ $1,944,000.00 $277,000.00 $1,667,000.00
TRANSPORATION
IMPACT FEES
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M&C Review Page 3 of 3
TO
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year Chartfield 2
1 39008 0200431 4413001 CO2161 CO2383 $1,944,000.0
1 39008 0200431 5740010 CO2161 CO2383 $1,944,000.00
f
FROM
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID YearChartfield 2
11139008 0060419 4413001 UN9912 UN2300 $1944,000.00
2 39008 0200431 5740010 CO2161 UN2330 $277,000.00
Submitted for City Manager's Office by: Jay Chapa (5804)
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Originating Department Head: Douglas INersig (7801)
Additional Information Contact: Martin Phillips (8447)
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ATTACHMENTS F
20WILLOWSPRINGSDESIGN - 02161 A016 39003 .docx
Pacheco Koch Consulting Engineers Form 1295 for Fort Worth Blue
Mound Road signed.pdf
lA
WILLIOW SPRINGS DESIGN MAP.pdf
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http://apps.cfwnet.org/council_packet/mc review.asp?ID=21991&councilda... 3/31/2016
Ordinance No.
AN ORDINANCE INCREASING THE ESTIMATED RECEIPTS AND APPROPRIATIONS
IN THE BLUE MOUND ROAD, US 287 TO WILLOW SPRINGS ROAD PROJECT OF THE
TRANSPORTATION IMPACT FUND IN THE AMOUNT OF $1,944,000.00, FROM
AVAILABLE FUNDS AND REDUCE FUND BALANCE IN THE UNSPECIFIED CENTER
OF SERVICE AREA B FUND BY THE SAME AMOUNT, FOR THE PURPOSE OF
CONSTRUCTION OF BLUE MOUND ROAD PROJECT AND DESIGN OF WILLOW
SPRINGS ROAD; PROVIDING FOR A SEVERABILITY CLAUSE; MAKING THIS i
ORDINANCE CUMULATIVE OF PRIOR ORDINANCES; REPEALING ALL ORDINANCES
IN CONFLICT HEREWITH;AND PROVIDING AN EFFECTIVE DATE.
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF FORT WORTH,TEXAS:
SECTION 1.
That in addition to those amounts allocated to the various City departments for Fiscal Year 2015-2016 in the
Budget of the City Manager, there shall also be increased estimated receipts and appropriations in the Blue
Mound Road, US 287 to Willow Springs Road of the Transportation Impact Fund in the amount of
$1,944,000.00, from available funds and reduce fund balance in the unspecified center of Service Area B by
the same amount,for the purpose of construction of Blue Mound Road and design of Willow Springs Road.
SECTION 2.
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That should any portion, section or part of a section of this ordinance be declared invalid, inoperative or void E
for any reason by a court of competent jurisdiction, such decision, opinion or judgment shall in no way
impair the remaining portions, sections, or parts of sections of this ordinance, which said remaining
provisions shall be and remain in full force and effect.
SECTION 3. I
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That this ordinance shall be cumulative of Ordinance No. 21873-09-2015 and all other ordinances and t`
appropriations amending the same except in those instances where the provisions of this ordinance are in
direct conflict with such other ordinances and appropriations, in which instance said conflicting provisions of
said prior ordinances and appropriations are hereby expressly repealed.
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SECTION 4.
This ordinance shall take effect upon adoption.
APPROVED AS TO FORM AND LEGALITY: CITY SECRETARY
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Assistant City Attorney Mary J. Kayser
ADOPTED AND EFFECTIVE:
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CERTIFICATE OF INTERESTED PARTIES
FORM 1.295
10f1
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, 2016-5591
Pacheco Koch Consulting Engineers,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 01/25/2016
being filed.
City of Fort Worth,TX Date Acknowledged:
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 goods or services to be provided under the contract.
Contract No,46322
Civil engineering,land surveying and landscape architecture services for Blue Mound Road from Willow Springs Road to US
Highway 81/287.
4 Nature of interest(check applicable)
Name of Interested Party City,State,Country(place of business)
Controlling Intermediary
Koch,James Dallas,TX United States X
Pacheco,Mark Dallas,TX United States X
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5 Check only if there is NO Interested Party.
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6 AFFIDAVIT
I swear,or affirm,under penally of perjury,that the above disclosure is true and correct.
uu,Y
n�a. KRYSTA-MARIE RODRIGUEZ -
`f- Notory PUbII0,State of Texas
N �€ My Commission Expires
October 19, 2019 Signature o authorized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
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Sworn to and subscribed before me,by the said Mark A. Pacheco this the 26th day of .lanuary
20 16 to certify which,witness my hand and seal of office.
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MAYOR AND COUNCIL COMMUNICATION MAP
20 WILLOW SPRINGS DESIGN
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CERTIFICATE OF INTERESTED PARTIES C-a7&51
FORM 3.295
101`1
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. 2016-5591
Pacheco Koch Consulting Engineers, 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 01/25/2016
being filed.
City of Fort Worth,TX Date Acknowledged:
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 goods or services to be provided under the contract.
Contract No. 46322
Civil engineering,land surveying and landscape architecture services for Blue Mound Road from Willow Springs Road to US
Highway 81/287.
4 Nature of interest(check applicable)
Name of Interested Party City,State,Country(place of business)
Controlling Intermediary
Koch,James Dallas,TX United States X
Pacheco, Mark Dallas,TX United States X
5 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
KRYSTA•MARIE RODRIGUEZ
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�S Notary Public,state of texas
My Commission Expires
October 19, 2019 Signature o authorized agent of contracting business entity
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AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said Mark A. Pacheco ,this the 26th day of Januar\/
20 16 to certify which,witness my hand and seal of office.
K sta-Marie Rodriquez Notary Public,State of Texas
i nature of officer administering Uth Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.34416