HomeMy WebLinkAboutContract 44649-A4 CITY SECRETARY,
CONTRACT NO..
RECEIVED AMENDMENT No.No. 4
DEC 2 7 2019
CITY OF FORT WORT[, TO CITY SECRETARY CONTRACT No. 44649
CITY SECRETARY
WHEREAS, the City of Fort Worth (CITY) and Wade Trim, Inc. ,
(ENGINEER) made and entered into City Secretary Contract No. 44649, (the
CONTRACT) which was authorized by M&C C-26320 on the 9th day of July, 2013
in the amount of $ 524 , 244 . 00; and
WHEREAS, the CONTRACT was subsequently revised by Amendment Number 1
in the amount of $47, 710 . 00 which was administratively authorized on May
12, 2016, Amendment Number 2 in the amount of $574 , 992 . 00 which was
authorized by M&C C-28254 on June 6th, 2017; Amendment Number 3 in the
amount of $836, 860 . 00 which was authorized by M&C C-29087; and
WHEREAS, the CONTRACT involves engineering services for the
following project:
Westcliff Drainage Improvements Project; 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 November 21st, 2019, 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 $77, 415. 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 $2, 061, 221 . 00.
3 .
All other provisions of the Contract, which are not expressly
City of Fort Worth Westcliff Ph
Professional Services Agreement Amendment Template 0FF110 Via, 4$MnfW. R
CFW Official Release 9/19/2017
Page 1 of 4
@. �aBitl+Pa d lf'ug 'u 6i1
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
Wade Trim, Inc.
Dana Burgh#f Shawn Keough
Interim Assistant City Manager Vice President
DATE: Z l Z 7 1 DATE: 1� Z6 G o
APPROVAL RECOMMENDED:
L�7L
VJ�
William Johnso
Director, Tran portation and Public Works Department
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 requirements .
i nnett
Pr je t Manager
OFFICIAL RECORD
CITY SECRETARY
City of Fort Worth FT. WORT cff h
Professional Services Agreement Amendment Template C N' 9
CFW Official Release 9/19/2017
Page 2 of 4
APPROVED AS TO FORM AND LEGALITY: M&C: N lA-
Date :
Douglas W. Black
Assistant City Attorney
ATTE � i� �
m o
ar J. Kayser
City Secretary
City Fort Worth ®FFICIA(
Professional Services Agreement Amendment Template
CFW Official Release 9/19/2017 & ;'^� *• dd
Page 3 of 4
FUNDING BREAKDOWN SHEET
City Secretary No. 44649
Amendment No. 4
Department Fund-Account-Center Amount
TPW 52002-0200431-5330500-001669-0O2830 77, 415 . 00
Total : 77, 415 . 00
City of Fort Worth Westcliff Ph1
Professional Services Agreement Amendment Template CPN 01669
CFW Official Release 9/19/2017
Page 4 of 4
WADE TBPE Firm No. 4
TBPLS Firm No.10194374374
TRIM Wade Trim,Inc.
IN3575 Lone Star Circle,Suite 410• Fort Worth,TX 76177
682.237.7718•www.wadetrim.com
November 21, 2019
City of Fort Worth
Capital Delivery Division/TPW
200 Texas St.
Fort Worth, TX 76102
Attention: Mike Bennett, PE, Project Manager
Re: Westcliff Drainage Improvements, Phase 1 - Revised Proposal for Additional Services (0)
Dear Mike,
As we discussed during our conference call on October 21, 2019 regarding the urgent need for
selection of a final alignment to meet the City's target bid advertisement date for the Westcliff
Phase 1 project, and proposed completion of the design for the City's preferred alignment,
Wade Trim is providing this revised Proposal to define the additional engineering and other
services needed to complete the project. This proposal incorporates the further comments the
City provided on the revised proposal previously submitted.
Exclusions: as previously verified by our President & CEO Andy McCune, this proposal
excludes Wade Trim's effort related to development of the additional alignment options study,
and design of additional alignment options following the study's review meeting. It also
excludes Wade Trim's effort to design the new preferred alignment up to October 21, 2019,
when the City explained that additional services already performed without the City's prior
approval were not being considered eligible for compensation, and affirmed the City's intention
to put the project on hold until the City could evaluate alignment options alongside future
additional services. The message Wade Trim received from the City on the morning of
November 20, 2019 excluded future additional work for two out of the three new junction
structures; in the spirit of moving the project forward, we have revised this proposal to exclude
two of the new junction structures.
Regarding this revised proposal, remember that some of the proposed future effort is directly
related to continued design of the new preferred storm drain alignment, while other additional
effort is independent of either the original alignment or the new alignment.
In the revised table that follows, are the explanations of tasks and their proposed budgets. A
revised detailed level-of-effort is attached for reference.
Per the City's questions on Wade Trim's proposal dated November 15, 2019, discussed by
phone on November 19, 2019, along with the City's follow-up comments received by Wade Trim
on November 20, 2019, this revised proposal changed and considered:
• Reduced junction structure design to one new structure;
• The scope and effort of roadway design has not changed;
• The scope and effort of our subconsultant's participation in the Phase 2B tunnel review and
observation has not changed.
City of Fort Worth,Capital Delivery Division/TPW
November 21,2019
Page 2
Per the City's comments on Wade Trim's proposal dated October 31, 2019, the following
adjustments were incorporated previously:
• Provided more information and explanations to clarify effort and answer questions;
• Verified level of effort for inlet lateral design, roadway engineering and design to be
performed by Wade Trim engineers, and subconsultant's additional Time & Materials effort
for the Phase 2B tunnel;
• Reduced proposed contacts with the City to every other week;
• Reduced CADD technician effort for roadway design;
• Reduced Project Manager coordination with the water& sanitary sewer design firm, and
reduced Senior Engineer coordination with the Wade Trim team to incorporate the water&
sanitary sewer improvements to resolve utility conflicts;
• Deleted Utility Conflict Matrix effort; and
• The proposed levels of effort have been vetted by other Wade Trim managers and
engineering staff regarding their respective areas of expertise.
IAI
estcliff Phase 1, Additional Services Proposed
Budget
Additional services related to the preferred storm drain alignment
Design of additional junction boxes, including structural engineering $ 6,965
(1 additional new junction structure)
Revise inlet lateral designs (11 of 13 inlet laterals affected by revised $ 6,590
storm drain location —verified)
Additional roadway and pavement engineering, assisted by CADD $ 22,870
technician (affected curbs and 2,000 LF road reconstruction on Trail
Lake, Manderly, and a portion of Suffolk)
Additional water and sanitary sewer conflicts (Additional conflict $ 18,000
analysis, additional Project Manager coordination with the
engineering firm performing water& sanitary sewer utility design,
and incorporation of additional conflict resolution designs into storm
drain sheets—coordination estimates are based on Wade Trim
staff's previous experience with similar coordination between
engineering firms for various other City of Fort Worth projects)
Total additional services related to preferred storm drain alignment $ 54,425
Additional services unrelated to storm drain alignment
Bi-Weekly conference calls with the City's PM to mitigate project $ 1,800
delays (4 months remaining)
Floodplain easement acquisition documents (qty 5, including survey $ 15,540
and exhibits by subconsultant PK)
City of Fort Worth,Capital Delivery Division/TPW
November 21,2019
Page 3
Extra subconsultant effort for Phase 2B tunnel change order $ 4,000
(Schnabel; upcoming submittal reviews and construction site visits— (T&M)
Amendment 3, Task 6 Construction Phase Services is a Time &
Materials contract item, where the existing budget has been utilized
for Schnabel to attend multiple extra meetings precipitated by the
Phase 2B tunnel change order, as well as working with the
Contractor to correct many submittal deficiencies and omissions)
Subconsultant mark-up (Schnabel and PK) $ 1,650
Total additional services unrelated to storm drain alignment $ 22,990
Total proposed Additional Services budget (v2) $ 77,415
We look forward to your selection, and to moving forward with the Westcliff project.
Respectfully,
%A/Aa. e Trim, inc.
Karen Stafford-Brown, PE, Senior Project Manager
682-237-7713 office
817-507-7685 cell
kstaffordbrown@wadetrim.com
Ftw2004.04X
cc: Linda Young, PE, Engineering Manager and Dillon Johns, Deputy Project Manager(TPW)
Shawn Keough, PEmI, Steve Kalinowski, PE, and Andy McCune, PE (Wade Trim)
Westcliff Amendments No. 3 and No. 4 Page 1 of
Amendment No. 4 Additional Services Proposal - Manhour Breakdown
11/21/19
WESTCLIFF AMENDMENT No.4(highlighted Items) Struct Hyd Civil Tech Tech Sr Tech Proj Sr WT WT
Phase 1 Imprpvrmpnfy Gtllgn t10g9F)
PE PE PE EIT CADD-GIS Admin Specs Mgr Eng Labor Labor
Activity Name 21 00 1 0 1U44` $1QQ � 2 0 200 $3Q Hours C t
1.1 Managing the Team
Internal Project Mana ement 0 0 96 0 0 0 0 160 80 336 $69,280
Pre-Submittal OA/OC of Plans(60/90/100Bid) 0 0 24 0 0 0 0 12 12 48 $9,720
Pre Submittal CNOC of Specs(60/90/100Bid) 0 0 24 0 0 0 0 12 12 48 $9,720
1.2 Communications and Reporting
Project Kick-Off Meeting0 0 4 0 0 0 0 4 0 8 $1,520
Month) Project U date Meetin s/Calls(Deli n-9) 0 0 18 0 0 0 0 14 14 45 $9,315
WMWFMN0 4 0 Ei 0 @ 4
Monthly Project Update Meetings/Calls(Construction-27 0 0 54 0 0 0 0 41 41 135 $27,945
Monthly Invoices(Design-9) 0 0 45 0 0 0 0 0 0 45 $8,100
Monthly Invoices(Construction-27) 0 1 0 135 0 1 0 0 0 0 0 135 $24,300
Monthly MWBE Reports(Design-9) 0 1 0 0 0 0 9 0 5 0 14 $1,675
Month) MWBE Reports(Construction-27) 0 1 0 0 0 0 27 0 13 0 40 $4,625
Monthly P6 Schedule Updates(9) 0 0 9 0 0 0 0 6 0 15 $2,820
Conduct Plan Review Meetings(60/90/100) 0 0 12 0 0 0 0 12 0 24 $4,560
Coordination Meetings/Calls w/Water Department 0 0 8 0 0 0 0 8 0 16 $3,040
Coordination Meetings/Calls w/Streets Division 0 0 8 0 0 0 0 8 0 16 $3,040
Coordination Meetings/Calls w/Parks Department 0 0 8 0 0 0 0 8 0 16 $3,040
0 0 lip 40 0 0 35 0 306 M 949 $48400
2.2-Drainage Computations(If Authorized
Step Pool Channel Improvements Layout 0 2 8 0 16 0 0 0 6 32 $4,940
Step Pool Hydraulics 0 1 8 16 6 0 0 0 2 0 32 $5,750
2.3-Subsurface Utility Engineering
Coordination 0 0 12 0 0 0 0 4 0 16 $2,960
(Subconsultant Budget at Bottom)
Task 2-ConceliA,00811P 6 is 36r12
is 0 a 6 60
3.1-Development of Preliminary Design Drawings
Include Plat/Easement Information in Plans 0 0 6 0 0 0 0 0 18 $2,820
Include Environmental Assessment Information in Plans 0 0 18 0 0 0 0 0 32 $5,200
60%CivilDesign-Ad dress City Comments 0 8 60 0 0 0 1 8 16 172 1 $29,600
60%Civil Design-Add Dimensions from ROW,etc. 0 0 [ff1224
0 0 0 0 0 16 $2,460
60%Civil Design-Finalize Inlet Calculations 0 24 0 0 0 2 4 70 $12,560
i of iS 4 0 2 4
60%Civil Design-Finalize Calculations Plans Presentation 0 24 0 0 0 0 4 48 $9,120
60%Civil Des! n-Add HGL's to Profiles 0 4 0 0 0 0 2 22 $4,040
60%Civil Design-Outfall Improvements 0 8 0 0 0 8 8 60 $10,840
60%Civil Design-Update Downstream Assessment 0 30 0 0 0 6 4 64 $12,240
60%Civil Design-Construct on Details 0 0 0 0 0 0 4 24 $4,040
60%Civil Design-Traffic Control Plan 0 0 0WOO
8 0 18 $3,120
60%Civil Design-Detour Plan 0 0 2 8 to
8 0 18 $3,120
60%Civil Design-Traffic Control Details 0 0 2 8 4 0 14 $2,320
60%Structural Desi n 30 0 2 20 2 2 76 $12,460
AttditbnOwilli Structural i adddonsi ou t res 4c 0 1 7 7 1 1 27 1 $04
60%Specs/Project Manual 16 1 0 18 22 0 0 5 13 4 78 $14,390
Update OPCC 3 1 0 6 0 0 0 0 1 1 11 $2,160
Update Project Decision Log 0 1 0 2 0 0 0 0 0 0 2 $360
3.2-Geotechnical Investigation/Pavement Desi n
Coordinate Pavement Cores Needed 0 0 2 2 0 0 0 2 1 7 $1,300
Incorporate Data from Cores into Pavement Repair Design 0 0 4 6 0 0 0 2 0 12 $1,990
1 00 0 q 0 0 2 2 I
Coordinate w/Streets Division for POL/MOL Recommendations 0 0 4 0 0 0 0 4 0 8 $1,520
0 0 2 Q 0 2 0 #
3.3-Constructability Review
Schedule&Attend Constructabili Review Meetin 0 0 4 0 0 0 0 4 0 8 $1,520
Prepare&Submit Meeting Notes/Minutes/Comments 0 0 4 0 0 0 0 1 1 6 $1,170
3.4-Public Meeting
Prepare Exhibits 0 2 2 6 0 0 0 0 1 11 $1.880
Attend Public Meetin 0 0 5 0 1 0 0 0 5 0 10 $1,900
3.5-UtilityClearance
Communicate w/Ci Staff Regarding Potent al Issues 0 0 4 2 0 0 0 2 1 9 $1,660
0 0 6 a 0 0 a a 4 4rF
Create&Upload DWF Files to Buzzsaw 0 0 2 6 0 0 0 0 0 8 $1,230
Task 3-Pirellimitmy Des SWR 50 104 325 329 79 0 5 96 61 Idm Si7$XM
4.1-Pre-Final Design Drawings(90%)
90%Civil Design-Address City Comments 0 0 60 80 0 0 0 6 8 154 $25,600
90%Structural Desi n 18 0 0 0 0 0 0 0 0 1 18 $3,780
AIRS 90% 6 0 0 0 0 6 0 e 0 a _
90%Soecs/ProiectManual 6 0 46 6 1 0 10 31 31 4 124 1 $23,810
Westcliff Amendments No. 3 and No. 4 Page 2at3
Amendment No. 4 Additional Services Proposal - Manhour Breakdown
11/21/19
Check Water Department Plans for Coordination 0 r 0 16 6 0 0 0 4 4 30 $5,550
Coordinate w/Streets Division for Final Limits 0 0 2 2 0 0 0 2 0 6 $1,050
4 # E $ A 4
Update OPCC 0 0 4 0 0 0 0 1 1 6 $1,170
Update Project Decision L 0 0 2 0 0 0 0 0 1 3 $610
4.2-Final Design Drawin s(100%)
100%Civil Design-Address City Comments 0 0 30 40 0 0 0 4 8 82 $14,000
100%Structural Design 18 0 0 0 0 0 0 0 0 18 $3,780
10094 4 0 0 0 4 C
Check Water Department Plans 0 0 16 6 0 0 0 4 4 30 $5,550
Incorporate Water Department Plans 0 0 24 36 0 0 0 16 16 92 $16,740
WMer
Coordinate w/Streets Division for Final Limits 0 0 2 2 0 0 0 2 0 6 $1,050
# @
Incur orate Streets Division Specs 0 0 8 16 0 0 0 4 2 30 $5,060
Inco orate Water Department Specs 0 0 24 24 0 0 0 16 4 1 68 $12,000
100%Specs/Project Manual 6 0 24 24 0 0 16 16 4 90 $16,460
Update OPCC 0 0 8 4 0 0 0 2 2 16 $2,920
Update Project Decision Log 0 0 4 0 0 0 0 0 2 6 $1,220
Create&Upload DWF's of All Plans 0 0 2 8 0 0 0 0 0 10 $1,520
Task 4-Fktat Des rk 813-100% as 0 307 302 0 0 1 47 124 79 90 "1112-3ee
5.1-Bid Support
Sell Contract Documents and Maintain Plan Hollers List 0 0 4 0 0 16 0 8 0 28 $3,520
Log 8 Answer Bidder's Questions(Issue Addenda) 4 0 40 0 0 0 0 12 8 64 $12,440
Attend Pre-bid Conference 0 0 4 0 0 0 0 4 0 8 $1,520
Attend Bid Opening 0 0 4 0 0 0 0 4 0 8 $1,520
Tabulate Bids and Recommend Award 0 0 8 4 0 0 0 4 0 16 $2,826
Issue Conformed Contract Documents 0 0 4 4 0 0 0 4 4 16 $3,100
5.2-Final Design Drawings
PDF Drawings 0 0 12 0 0 0 0 8 0 20 $3,760
DWFDrawings 0 0 8 0 0 0 0 2 0 10 $1,840
DWG Sheet File Drawings(Bound) 0 0 8 0 0 0 0 2 0 10 $1,840
Task 5-Sid Phase Services 4 s a2 a s 1s 6 48 12 in $3""
6.1-Construction Support
V�
Attend Preconstruction Conference 0 0 4 F
0 0 0 0 4 6 $1,720
Attend Public Meetin 0 0 4 0 0 0 0 4 8 $1,720
Project Site Visits 0 0 42 0 0 0 48 0 90 $17,160
Submittal Review16 16 28 0 0 0 40 8 108 $21,600
Request for Information/Change Order Review0 0 40 0 0 0 40 24 104 $21,200
Final Walk Through and Punch List 0 0 16 0 0 0 0 16 8 40 $8,080
rPh.2B CPh.2B C onst.Supp.Used for Cox McLain+Management 0 0 20 20 0 20 20 18 16 114 $19,600
6.2-Record Drawings
Create Record Drawings from Construction Information 0 0 12 24 0 0 0 0 2 38 $6,140
Create&Upload New PDF&DWFs 0 0 4 8 0 0 0 0 1 13 $2,130
Task 8-C.W WftttkM Phase SVVICM &M t6 1a 17a 52 0 20 20 1 162 67 =3
7.2-ROW/Easement Preparation&Submittal
Finalize Easement Documents 0 0 2 0 0 0 0 2 2 6 $1,260
ModOOTANn" 0 i 5 0 0 0 0 a 0
Coordination w/Survey Subconsultant 0 0 2 0 0 0 0 2 0 4 $760
coordination w/Survey Subconsultant for floodplaim_ _ 0 0 3 0 0 0 0 3 0 6 $1,140
7.3-Temporary Right of Entry
Prepare,Mail,&Obtain Temporary ROE from Landowners 0 0 2 0 0 0 0 2 0 4 $760
7.4-Parks Conversion
Finalize Limits of Conversion Area,Access,etc. 0 0 4 2 0 0 1 0 2 2 10 $1,910
Coordination w/Survey Subconsultant 0 1 0 2 0 0 0 0 2 0 4 $760
Prepare Exhibits 0 0 4 8 0 0 0 2 0 14 $2,280
Attend Meetings 0 0 10 0 0 0 0 0 0 10 $1,800
Task 7-ROW Eettement 0 a 34 10 0 0 rO
20 4 68 €12,ST0
8.1-Design Survey
Coordination w/Survey Subconsultant 0 0 16 0 0 0 12 4 32 $6,280
Task 8- a 0 15 0 0 0 12 4 32 $6,280
9.1-SWPPP
iSWM Construction Plan 0 0 8 12 0 0 0 2 2 24 $4,080
Prefiminary iSWM Checklist 0 0 2 0 0 0 0 0 1 3 $610
Final iSWM Checklist 0 0 2 0 0 0 0 0 1 3 $610
9.2-Environmental Services
Coordinate w/Environmental Subconsultant 0 0 24 0 0 0 0 12 4 40 $7,720
Examine Altematives 0 8 10 10 0 0 1 0 2 2 32 $5,750
Prepare Exhibits,Calculations 0 1 12 20 20 0 0 0 2 2 56 $9,800
Westcliff Amendments No. 3 and No. 4 Page 3of3
Amendment No. 4 Additional Services Proposal - Manhour Breakdown
11/21/19
Attend Meetings 0 0 8 0 0 0 t 0 8 0 16 $3,040
Task 9-PermitUng 0 20 74 42 0 0 0 26 12 174 $31,610
TOTAL W r Labor Budget 139 150 1499 749 95 72 72 794 406 3976 $121,635
Subconaultant Bud is
_ RIOS-SUE Survey(2.2.1) _ _ $3,700
_ RIOS-SUE B,C,D 2.2.1 $12,500
RI nt-SUE A 2.2.1 _ _ 2
SUE Sub-Consulta Total(R I OS) $18,700
PK-Topo Survey(8.1) _ $10,500
PK-Property Survey(7.2) $14,400
PK-Meets&Bounds for Parks Conversion(7.4) $4,000
PK-Tree Survey(7.4) $2,500
PK-Floodplain easement acquisition exhibits(q 5) $12,500
PK-Bidding Assistance(5.1.5 and 5.1.6) $10,000
PK-Construction Assistance(6.1.3 and 6.1.4) $10,000
Surve Sub-Consultant Total(Pacheco Koch) $63,900
Westra-Hydraulic Computations 3.1 j $11,500
Westra-OA/OC&Calculations(3.1&4.1) S39,700
Hydrology Sub-Consultant Total(Westra) $51,200
Phase 2B Tunnel Inspection&Construction Phase Services _ _ $14,000
..Additional Phase 2B Tunnel inspection&Construction Phase Services 00
Tunnel Inspection&Construction Phase Services Sub-Consultant $18,000
Total Schnabell
AGG-Pavement Cores $3,850
AGG-Soil Type Samples $1295
Geotsch Sub-Consultant Total AGG $5,145
Total Sub-Consultant Budget- $156 945
10%Sub Markup-original $14,045
10%Markup on Additional subconsultant services _ $1,650
10%Sub Marku _ _ $15,695
WT Exvense Bud t 1 $20 000
Total $914,275
Amendment 3 $836.860
Amendment 4 $77,415
Westcliff Amendment No. 4
Prime and Subconsultants Breakdown
11/21/19
Fee %of Total SBE
Amendment 4 Total $ 77,415 100%
Prime Consultant Wade Trim $ 60,915 79%
Subconsultants Pacheco Koch $ 12,500 16% X*
Schnabel $ 4,000 5%
*Participation exceeds 6% SBE goal for project
DOE PROJECT-(_BID NUMBER
FORT WORTH 01669(Please check one)
Minority/Women Business Enterprise Office
LETTER OF INTENT TO PERFORM AS A SBE SUBCONTRACTOR/SUBCONSULTANT
[NOTE: Pursuant to the City of Fort Worth Business Diversity Enterprise Ordinance, SBE firms participating under the Ordinance must be certified
prior to recommendation of award in order to be counted towards subcontracting participation. A Small Business Enterprise(SBE)is defined as a
business concern located in the marketplace that meets the Unites States Small Business Administration definition of a small business as
outlined in the code of Federal Regulation 13 CFR 121. Firms certified as a Disadvantaged Business Enterprise (DBE) also meet small
business enterprise requirements.]
1. Name of Project Westcliff Drainage Improvements,Amendment No.4
2. Name of Offeror/Prime contractor Wade Trim, Inc.
3. The undersigned is prepared to perform the following described work and/or supply the material listed in connection with the
above project(where applicable specify"supply"or"install"or both):
Surveying & Floodplain Easement Acquisition Document Preparation (special services)
at the price of$12,500
Pacheco Koch Consulting Engineers, Inc. 12/10/2019
(Name of SBE Firm) (Date)
Mark A. Pacheco P.E. R.P.L.S. ....
Circle one iOjR 7/Authorized Agent of SBE firm)Type or Print Name (Signature of 0 ner or Authorized Agent of SBE firm)
mpacheco -Pkce.com (972)235-3031 /(972)235-9544
(Email Address to appear on Listings provided by the MWBE Office) (Office and Fax Numbers)
AFFIDAVIT OF Offeror/Prime CONTRACTOR
I HEREBY DECLARE AND AFFIRM that I,Shawn Keough am the duly authorized representative of
Circle one(Owne thorized A e
Wade Trim, Inc. and that I have personally reviewed the material and
Name of Prime Contractor
facts set forth in this Letter of Intent to Perform. To the best of my knowledge, information and belief, the facts in this form are true, and no
material facts have been omitted.
Pursuant to the City of Fort Worth Business Diversity Enterprise Ordinance, any person [entity]who makes a false or fraudulent
statement in connection with participation of a SBE in any City of Fort Worth contract may be referred for debarment procedures
under the City of Fort Worth Business Diversity Enterprise Ordinance.
I do solemnly swear or affirm that the signatures contained herein and the information provided by the Prime Contractor are true
and correct,and that I am authorized on behalf of the Prime Contractor to make the affidavit.
Shawn Keough Wade Trim, Inc.
Circle One(Owner/Authorized Agent)Type or Print Name (Name of Prime Contractor-Print or Type)
-� ��_�' 12/10/2019
(Signature of Owner or Authorized Agent) (Date)
(734)947-2622 n/a
(Office Number) (Fax Number)
6/1/2012