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HomeMy WebLinkAboutContract 46322-A4 AMENDMENT No.4 CITY SECRETARY MN CONTRACT NO. — 0 TO CITY SECRETARY CONTRACT No. 46322 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 was subsequently revised by: Amendment Number 1 which was authorized by the City Council on the 29th day of March, 2016 (M&C C-27651) in the amount of $277, 000 . 00; WHEREAS, the CONTRACT was subsequently revised by: Amendment Number 2 which was authorized by the City Council on the 4th day of April, 2017 in the amount of $48, 590 . 00; WHEREAS, the CONTRACT was subsequently revised by: Amendment Number 3 which was authorized on the 21th day of December, 2017 in the amount of $50, 000 . 00; 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. 4 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 January'Z, 2018 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 $641, 172 . 00 . (See Attached Funding Breakdown Sheet, Page -4-) . City of Fort Worth Professional Services Agreement Amendment Template OFFICIAL RECORD PMO Official Release 6/1/2012 Page 1 of 4 CITY SECRETARY M WORTH,TX 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 $1, 431, 262 . 00 . City of Fort Worth Professional Services Agreement Amendment Template PMO Official Release 8/1/2012 Page 2 of 4 111. o7her p'_rov' s_-ons of .;hie .(-)ntract, Wh_ ch are nor expressly am. eriderj hare_' ri, shal.l rea,_a-n 'n -._ii t:,.rce and e_` ";XE---UT E= ai-d EF'FEC 1 1 `,'!,: as date -ast Safi _ten b- sI gnato-,,y, i elow . APPROVED: Cy of 'li-Iict . _,N;i',;E �R_ Pacheco Kc ,h Cor)salti!-iq E'rvjineers, :ric. l�ls /1 !–T La/1,b5 — Mark A. Pacheco, P. . . , R,%,,S Assistant r:ity Mar.aga- reside.. DA'7E: -3 �'UI�_ DAIE: 01/09/2018 APPROVAL Rte' OM IEND��`: Doagias T . Wiersig, D. Director, Trarnspertl-�iio-. and Pudic Works �epart,ter_t APPROVED AS TO FOR.IN Y&C 78 (60Z t �—� Date: � (p� 20)8 DouQ-' as d. Black 17"95741 X13 Senior Ass stmt ATT1,,S'1 : Contract Compliance Manager: By signing i :ono iey e t..-at i am and ati:�,-ninistra t: cr_ o_` -:ris c�r.t ract, rrcluding er,s nc ail ccrformance ar_a ®RT 0 repor ting rega re:ne:rts any s r V' tilitch Ri`_on, City Tt art' *' Semi ' Pr,—ssional EnrYineer �r City of Fort Worth ! C/�►`� Professional Services Agreement Amendm OFFICIAL RECORD PMO Official Release 8/1`2012 CITY SECRETARY Page 3 of a kyr y T le WORTHS TA CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 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. 2018-299837 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 01/08/2018 being filed. City of Fort Worth,Texas 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 services,goods,or other property to be provided under the contract. Contract No.46322 Amendment to contract for civil engineering, land surveying and landscape architecture services for Blue Mound Road from Willow Springs Road to US Highway 81/287. Nature of interest 4 Name of Interested Party City,State,Country(place of business) (check applicable) Controlling I Intermediary Koch,James A. Dallas,TX United States X Pacheco, Mark A. Dallas,TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is Mark A. Pacheco, P.E. R.P.L.S. and my date of birth is 10/03/1958 My address is 7557 Rambler Road, Suite 1400 Dallas . TX 75231 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Dallas County, State of Texas ,on the 11 day ofJanuary ,2Q_18 , (month) (year) KRYSTA-MARIE RODRIGUEZ Notory Public,State of Texos ,c /My Commission Expires ' Octo r IS 2012Signature of authorized Agent of contracting business entity rVIIL (Declarant) X ;�— Forms provided-Uy xas Ethics Commission www.ethics.state.tx.us Version V1.0.3337 PROHIBITION ON CONTRACTS WITH COMPANIES BOYCOTTING ISRAEL Contractor acknowledges that in accordance with Chapter 2270 of the Texas Government Code, the City is prohibited from entering 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 terms "boycott Israel" and "company" shall have the meanings ascribed to those terms in Section 808.001 of the Texas Government Code. By signing this contract, Contractor certifies that Contractor's signature provides written verification to the City that Contractor: (1) does not boycott Israel, and (2) will not boycott Israel during the term of the contract. Signature ark A.Pacheco,P.E.,R.P.L.S President Title 12/18/2017 Date FUNDING BREAKDOWN SHEET City Secretary No. 46322-A4 Amendment No. 4 Department Fund - Dept. - Account - Project - Activity - Year - Reference Amount TPW 34014 - 0200431 - 5330500 - CO2161 - UN2330 - 2017 - 14010199 $641, 172.00 Total: $641,172.0( City of Fort Worth Professional Services Agreement Amendment Template PMO Official Release 8/1/2012 Page 4 of 4 J4 Pacheco Koch January 11, 2018 Mr. Mitch Aiton,P.E. City of Fort Worth,Transportation and Public Works 200 Texas Street, 2 n Floor Fort Worth,Texas 76102 Re: Blue Mound Road; City Project#:02161 Contract Amendment 4 for Additional Services Dear Mr. Aiton: Pacheco Koch Consulting Engineers, Inc. is pleased to offer additional Professional Engineering Services for this project. These additional services are required due to needing a final design of Willow Springs Road from Blue Mound Road to Eagle Parkway for the full width of the roadway. The previous design included a design for half of the road. This amendment is for a final design of Willow Springs (taking the 75% design from Amendment 3 to 100% final design). This amendment also includes design of two roundabouts at Blue Mound Road and US 287 Frontage Roads. This includes all permits and design for frontage road improvements with the installation of the roundabouts. This Engineering Services Contract Amendment includes a detailed scope of additional services attached to this letter. Pacheco Koch Consulting Engineers, Inc. proposes to provide the attached scope of additional services for the lump sum total of $641,172.00. All the additional services proposed will be performed in accordance with the original contract dated December 2, 2014. This Amendment, consisting of one page, and the attached Additional Scope of Services represent the entire amendment to the original agreement between the City of Fort Worth and Pacheco Koch Consulting Engineers, Inc. If the terms of this Amendment are acceptable, please indicate by acknowledging acceptance of the terms of this document. Summary of Contract Fee for Blue Mound Road Original Contract Amount $414,500.00 Amendment No. 1 $277,000.00 Amendment No.2 $48,590.00 Amendment No.3 $50,000.00 Amendment No.4 $641,172.00 Revised Contract Amount $1,431,262.00 If you should have any questions, please do not hesitate to call at 817-412-7155. Sincerely, Christopher J. Cha, P.E. Pacheco Koch 6100 Western Place • Suite 1001 • Fort Worth,TX 76107-4654 • T: 817.412.7155 • F: 817.412.7156 pkce.com ATTACHMENT "A" DESIGN SERVICES Scope for Engineering Design Phase Services BLUE MOUND ROAD AND WILLOW SPRINGS ROAD 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 provide preliminary design, final design, bid and construction services for the proposed roundabouts at the intersection of Blue Mound Road and US 287 frontage roads. This includes design of two roundabouts at each frontage road intersection. Additionally, the objective is to proceed to final design of Willow Springs Road from Blue Mound Road to Eagle Parkway. Previously, only half of Willow Springs Road was designed to be constructed. This Task Order is to provide a final design for the full section of Willow Springs from Blue Mound Road to Eagle Boulevard. 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 BLUE MOUND ROAD AND WILLOW SPRINGS ROAD 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 $641,172.00 unless amended. CITY and ENGINEER will agree upon compensation for each Task Order prior to starting work. Each Task Order shall be Lump Sum. i. Personnel Time. Personnel time shall be compensated based upon hours worked directly in performing the PROJECT multiplied by the appropriate Labor Category Rate for the ENGINEER's team member performing the work and includes all direct salaries, overhead, and profit. Labor Category Rate as presented in the rate schedule table below is the rate for each labor category performing the work and includes all direct salaries, overhead, and profit. LABOR CATEGORY RATE ($/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. V. 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. VI. 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 VII. A Summary of Task Order Fees shall accompany each Task Order. Summar/of Total Project Fees_ Firm Primary Responsibility Fee Amount % Prime Consultant Pacheco Koch Engineering (Preliminary/Final $467,927 73.0% Consulting Engineers, Design) Inc. Survey Services ROW/Easement Services Bid & Construction Phase Proposed MBE/SBE Sub-Consultants Hayden Consultants, Drainage Engineering $149,245 23.3% Inc. Non-MBE/SBE Consultants Berg-Oliver Associates Environmental Assessment $24,000 3.7% Inc. TOTAL $641,172 100% Additional Task Orders Project Number& Name Total Fee MBE/SBE Fee MBE/SBE 02161 —Willow Springs Road —Task $44,965 $0 0% No. 4— Final Design 100%) 02161 — Blue Mound Road —Task No. 1 $47,382 $0 0% Management & Review 02161 — Blue Mound Road —Task No. 3 $339,035 $95,275 28.1% Preliminary Design 02161 — Blue Mound Road —Task No. 4 $112,660 $47,570 42.2% Final Design 02161 — Blue Mound Road —Task No. 5 $6,225 $0 0% Bid Phase Services 02161 — Blue Mound Road —Task No. 6 $23,865 $6,400 26.8% Construction Phase Services 02161 — Blue Mound Road —Task No. 7 $14,500 $0 0% ROW/Easement Services 02161 — Blue Mound Road —Task No. 8 $9,000 $0 0% Survey Services 02161 — Blue Mound Road —Task No. 9 $43,540 $0 0% Permitting City MBE/SBE Goal = 15% Consultant Committed Goal = 15% City of Fort Worth,Texas Attachment B 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. 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City of Fort Worth,Texas Attachment C PMO Release Date:05.19.2010 Page 1 of I Consulting Contract Schedule Specifications FORT WORTH City of Fort Worth Capital Improvement Program Attachment D- Project Schedule This PROTECT requires a Tier 3 schedule as defined herein and in the City'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 Map Pacheco Koch a City of Fort Worth - Blue Mound Road and Willow Springs Road 6100 WESTERN PLACE, SUITE 1001 a FORT WORTH, TX 76107 PHONE:(817)412-7155 Z 0 e Q ci '' Y. ... w 0 a m }~ s 10 0 s } 1 3 s - a w w jt 4 ■nrr..aa. � L r - 0 it I I i i W n 1 a 0 rn w IK NOTES DATUM BACKGROUND IMAGE FROM NAD 1983 TEXAS STATE PLANE a Mound Rd W WBING AERIALS NORTH CENTRAL ZONE FIPS 4202 ZE Ki � C7 0 1,000 2,000 w sources:Esri,HERE, gee. ? eLorme dS-69'Rermap,B 1 inch=1,667 feet w c� January 11,2018 LU M&C Review Page 1 of 2 Official site of the City of Fort Worth,Texas CITY COUNCIL AGENDA FoRT711 COUNCIL ACTION: Approved on 3/6/2018 REFERENCE *, 20BLUE MOUND ROAD & US DATE: 3/6/2018 NO.: C-28602 LOG NAME: 287 ROUNDABOUT DESIGN AMENDMENT 4 CODE: C TYPE: CONSENT PUBLIC NO HEARING: SUBJECT: Authorize Execution of Amendment No. 4 to the Engineering Services Agreement with Pacheco Koch Consulting Engineers, Inc., in the Amount of$641,172.00 for the Design of Willow Springs Road from Blue Mound Road to Eagle Boulevard and the Design of Proposed Roundabouts at US 287 and Blue Mound Road for a Revised Engineering Services Contract Amount of$1,431,262.00 (COUNCIL DISTRICT 7) RECOMMENDATION: It is recommended that the City Council authorize the execution of Amendment No. 4 to the Engineering Services Agreement with Pacheco Koch Consulting Engineers, Inc., in the amount of $641,172.00 for the design of Willow Springs Road from Blue Mound Road to Eagle Boulevard and the design of proposed roundabouts at US 287 and Blue Mound Road for a Revised Engineering Services Contract Amount of$1,431,262.00. 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. This purpose of Amendment No. 4 is to authorize Pacheco Koch to design Willow Springs Road as a four-lane concrete section and to design the future multilane roundabouts at US 287 and Blue Mound Road. Blue Mound Road from Willow Springs Road to Highway 287/81 is included in the 2014 Bond Program. No additional funds are required for this Amendment No. 4. This project is included in the 2014 Bond Program. Available resources within the General Fund will be used to provide interim financing until debt is issued. Once debt associated with this project is sold, bond proceeds will reimburse the General Fund in accordance with the statement expressing official Intent to Reimburse that was adopted as part of the ordinance canvassing the bond election (Ordinance No. 21241-05-2014) and subsequent actions taken by the Mayor and City Council. M/WBE OFFICE - Pacheco Koch Engineering, Inc., is in compliance with the City's BDE Ordinance by committing to 23 percent SBE participation on this Amendment No. 4. The City's goal on this Amendment is 15 percent. Additionally, Pacheco Koch, Inc., is a certified M/WBE. The project is located in COUNCIL DISTRICT 7. FISCAL INFORMATION/CERTIFICATION: The Director of Finance certifies that funds are available in the current capital budget, as appropriated, of the 2014 Bond Fund. http://apps.cfwnet.org/council_packet/mc review.asp?ID=25529&councildate=3/6/2018 3/8/2018 M&C Review Page 2 of 2 TO epartment Account Project Program Activity Budget Reference# Fund DAmount I I I ID Year Chartfield 2 FROM Fund Department Account Project Program Activity Budget Reference# Amount ID ID Year ChartField 2 Submitted for City Manager's Office by: Jay Chapa (5804) Originating Department Head: Douglas Wiersig (7801) Additional Information Contact: Mitch Aiton (6591) ATTACHMENTS Form 1295 Pacheco Koch.pdf Map Blue Mound.pdf http://apps.cfwnet.org/council_packet/mc review.asp?ID=25529&councildate=3/6/2018 3/8/2018 CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl 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. 2018-299837 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 01/08/2018 being filed. City of Fort Worth, Texas Date Acknowle ge ,J 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. Contract No.46322 Amendment to contract for 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 Name of Interested Party City,State,Country(place of business) (check applicable) Controlling I Intermediary Koch,James A. Dallas, TX United States X Pacheco, Mark A. Dallas,TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is! Mark A. Pacheco. P.E., R.P.L_S. and my date of birth is 10/03/1958 My address is 7557 Rambler Road Suite 1400 Dallas TX 75231 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Dallas County, State of TeXas on the 11 day ofJanuary ,20 18 , (month) (year) KRYSTA•MARIE RODRIGUEZ Nolafy Public,State of Texas �My Commission Expires Octopqr 1201 Signature of authorized ent of contracting business entity L� " �� (Declarant) Forms provided y Tbxas Ethics Commission www.ethics.state.tx.us Version V1.0.3337