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Home My WebLink About059969-A2 - Construction-Related - Contract - Kimley-Horn and Associates, Inc.City of Fort Worth, Texas NASJRB W&SS Main Repl. Prof Services Agreement Amendment Template 104344 Revision Date: June 13, 2025 Page 1 of 2 AMENDMENT No.2 TO CITY SECRETARY CONTRACT No. 59969 WHEREAS, the City of Fort Worth (CITY) and Kimley-Horn and Associates, Inc., (ENGINEER) made and entered into City Secretary Contract No. 59969, (the CONTRACT) which was authorized by M&C 23-0656 on the 8th day of August, 2023 in the amount of $ 1,9 2,700.00; and WHEREAS, the CONTRACT was subsequently revised by: Amendment No. 1 in the amount of $ 88,400.00 which was administratively authorized on September 30, 2024; and WHEREAS, the CONTRACT involves engineering services for the following project: NASJRB Water and Sanitary Sewer Main Replacement, CPN 104344; and WHEREAS, it has become necessary to execute Amendment No. 2 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 proposal attached hereto and incorporated herein. The cost to City for the additional design services to be performed by Engineer totals $474,800.00. 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 $2,5,900.00. 3. All other provisions of the Contract, which are not expressly amended herein, shall remain in full force and effect. City of Fort Worth, Texas NASJRB W&SS Main Repl. Prof Services Agreement Amendment Template 104344 Revision Date: June 13, 2025 Page 2 of 2 EXECUTED and EFFECTIVE as of the date subscribed by the City’s designated Assistant City Manager. APPROVED: City of Fort Worth ENGINEER Kimley-Horn and Associates, Inc. Chris Igo, P.E. Associate DATE: _________________ Jesica McEachern Assistant City Manager DATE: _______________ ATTEST: Jannette Goodall City Secretary APPROVAL RECOMMENDED: Chris Harder, P.E. Director,Water 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. _______________________________ Preeti KC, P.E. Project Manager APPROVED AS TO FORM AND LEGALITY:M&C No.#: _25-1160 _________ M&C Date: _December 9th, 2025 Douglas W. Black Sr. Assistant City Attorney kimley-horn.com 801 Cherry Street, Unit 11, Suite 1300, Ft. Worth, TX 76102 817 335 6511 August 7, 2025 Ms. Preeti KC, P.E. Project Manager City of Fort Worth Water Department 200 Texas Street Fort Worth, TX 76102 RE: NASJRB Water and Sewer Main Replacement Amendment No. 2 KHA No. 061018454 City Secretary No. 59969 City Project No. 104344 Dear Preeti: This letter is in reference to a contract between Kimley-Horn and Associates, Inc. (Kimley-Horn) and the City of Fort Worth (the City) dated 8-08-2023 Kimley-Horn is pleased to submit Amendment No. 2 for the NASJRB Water and Sewer Main Replacement. The fees for this Amendment are not to exceed $474,800, increasing the total not to exceed fee to $2,555,900. The City has requested that Kimley-Horn perform additional services under Amendment Number 2 for the NASJRB Water and Sewer Main Replacement which are out of the scope of services as defined in the Contract. These services include two additional bid packages for the water main improvements Part 1 and 2. The additional bid packages require additional Design Management, Preliminary and Final Design, Bid Phase Services, Survey and Permitting. Service details are further described as follows: Kimley-Horn will continue the services outlined as follows and as directed by the City: TASK 1. DESIGN MANAGEMENT $44,040 ENGINEER will complete Design Management in accordance with the Original Contract for the following: Twenty-four (24) monthly project meetings were included in the original contract. An additional twenty-four (24) project coordination meetings are anticipated. Prepare invoices and submit monthly in the format requested by the CITY. Prepare and submit monthly progress reports in the format provided by the Water Department. TASK 3. PRELIMINARY DESIGN $95,560 ENGINEER will complete Preliminary Design in accordance with the Original Contract for the following: Development of Preliminary Design Drawings and Specifications for two (2) additional bid packages shall include the following: Page 2 kimley-horn.com 801 Cherry Street, Unit 11, Suite 1300, Ft. Worth, TX 76102 817 335 6511 The total contract included design for 26,600 linear feet of 24-inch, 16-inch and 12-inch water line and 22,000 linear feet of 36-inch, 30-inch and 24-inch sanitary sewer rehabilitation and replacement. After meetings with the TxDOT SH-183 team, TxDOT decided to break out the SH-183 project into phases with the initial phase being the intersection of Roaring Springs/Pumphrey Dr and SH-183. The City requested Kimley- Horn to include the relocation of an additional 1,800 linear feet of 12-inch transmission main along SH-183 to the east. After the City approval of the Water Main Improvements Alignment Study the City requested to break the NASJRB Water Main Improvements project into three separate parts which resulted in an additional two (2) design/bid packages. Additional geotechnical bores are required due to the initial findings near the Trinity River and the design considerations for a Horizontal Directional Drill (HDD) installation. Additional analytical soil testing was also added to complete the cathodic protection design. Furthermore, after meetings with Tarrant Regional Water District (TRWD) and the United States Army Corps of Engineers (USACE) it was determined a Drilling and Invasive Program Plan (DIPP) will be required for the HDD segment of Part 2. The City elected to include meter vault replacements for all large meters that were identified by the City. This includes six (6) large meter vault replacements, assuming the City standard details will be utilized and updates will be required. Additional structural design was also added to complete the meter vault design. TASK 4. FINAL DESIGN (90 PERCENT) AND FINAL CONSTRUCTION DOCUMENTS (100 PERCENT) $228,220 ENGINEER will complete Final Design in accordance with the Original Contract for the following Design. Development of Final Design Drawings and Specifications for two (2) additional bid packages shall include the following: The CITY requested the ENGINEER to add two (2) additional design packages. Part 1 16-inch Water Main on NASJRB Part 2 24-inch Water Main: Carswell to River Oaks With the addition of two (2) bid packages, additional subconsultant work was required to provide cathodic protection recommendations, tunneling recommendations, structural recommendation for meter vaults, and constructability and estimating recommendations coinciding with each Part. TASK 5. BID PHASE SERVICES $41,250 ENGINEER will complete Bid Phase services in accordance with the Original Contract for the following: Page 3 kimley-horn.com 801 Cherry Street, Unit 11, Suite 1300, Ft. Worth, TX 76102 817 335 6511 The original contract included bid phase services for one (1) bid package. The City requested that the project be divided into two (2) additional phases with two (2) separate bids. TASK 8. SURVEY AND SUE SERVICES $55,300 ENGINEER will complete Survey and SUE services in accordance with the Original Contract for the following: The original contract included topographic survey along the project alignments. Additional survey was required for the revised 24-inch water main alignment crossing the Trinity River, the revised 16-inch water main crossing SH-183 and the additional parallel 12-inch water main along SH-183 for the relocations. The linear footages are below: Revised 24-inch water main crossing the Trinity River: 1,700 linear feet Revised 16-inch water main crossing SH-183: 1,150 linear feet Additional 12-inch water main along SH-183: 1,800 linear feet TASK 9. PERMITTING $10,370 ENGINEER will complete Permitting services in accordance with the Original Contract for the following: The original contract included coordination with stakeholders along the alignment. Additional coordination was required for the alignment discussion with Westworth Village for the crossing of SH-183. We recommend that the City increase the budget by $474,800 for these additional services. The following tables summarize our recommended budget revisions, water design fees, and revised contract amount: Description Water Sewer Total Task 1 Design Management $44,040 $0 $44,040 Task 2 Conceptual Design (30%) $0 $0 $0 Task 3 Preliminary Design (60%) $95,560 $0 $95,560 Task 4 Final Design (90% and 100%) $228,220 $0 $228,220 Task 5 Bid Phase Services $41,250 $0 $41,250 Task 6 Construction Phase Services $0 $0 $0 Task 7 ROW/Easement Services $0 $0 $0 Task 8 Survey and SUE Services $55,300 $0 $55,300 Task 9 Permitting $10,370 $0 $10,370 Task 10 Additional Services $0 $0 $0 Total $474,800 $0 $474,800 Page 4 kimley-horn.com 801 Cherry Street, Unit 11, Suite 1300, Ft. Worth, TX 76102 817 335 6511 The following table summarizes the Fee per Work Phase breakdown: Work Phase Water Sewer Total 30 $474,800 $0 $474,800 The following table summarizes our recommended budget revisions and shows the revised contract amount: Original Contract Amendment No. 1 Amendment No. 2 Revised Contract Task 1 $58,900 $0 $44,040 $102,940 Task 2 $180,700 $0 $0 $180,700 Task 3 $597,050 $0 $95,560 $692,610 Task 4 $468,000 $0 $228,220 $696,220 Task 5 $42,450 $0 $41,250 $83,700 Task 6 $0 $0 $0 $0 Task 7 $127,400 $0 $0 $127,400 Task 8 $338,150 $88,400 $55,300 $481,850 Task 9 $150,050 $0 $10,370 $160,420 Task 10 $30,000 $0 $0 $30,000 Total Project $1,992,700 $88,400 $474,800 $2,555,900 The following table summarizes the fee for this amendment by project phase: Water Sewer Total Original Contract $1,095,985 $896,715 $1,992,700 Amendment No. 1 $48,620 $39,780 $88,400 Amendment No. 2 $474,800 $0 $474,800 Total $1,619,405 $936,495 $2,555,900 The original contract had $444,350 (22.3%) SBE participation. The total contract SBE participation is now $562,750 (22.0%) for this amendment. Page 5 kimley-horn.com 801 Cherry Street, Unit 11, Suite 1300, Ft. Worth, TX 76102 817 335 6511 The following tables summarize our revisions to the SBE percentages: Total Contract Description Original Amend. No. 1 Amend. No. 2 Contract Amount $1,992,700 $88,400 $474,800 Total Contract SBE $444,350 $70,700 $47,700 Total Contract SBE Percentage 22.3% 80.0% 10.1% 13% 13% 13% We appreciate the opportunity to be of continued service to the City. Please contact us if we need to provide any further information. Very truly yours, KIMLEY-HORN AND ASSOCIATES, INC. Chris Igo, P.E. Associate CPI/das Copy to: Tony Sholola, P.E., City of Fort Worth Attachments: Level of Effort Spreadsheet Amend No.2 K:\FTW_Utilities\061018454-NASJRB-W-and-SS\PPP\POST_NTP\Amendment 2\NASJRB_CPN 104344_Amendment 2 Summary Ltr.docx SeniorProfessional IISeniorProfessional IProfessional AnalystRate $350 $330 $275 $230 $135 MWBE Non-MWBE Markup1.0 Design Management (24 Months Design) 24 48 72 0 $ 44,040$0 $0 $9400 $0 $0 $ 44,040 $ - $ - 0% $ 44,0401.1 Managing the Team $ -1.1.2. QA/QC 24 $ 8,4001.2 Communications and Reporting $ -1.2.1 Pre-Design Coordination Meeting $ -1.2.2 Monthly Design Coordination Meetings 24 24 $ 14,5201.2.3 Prepare Baseline Schedule 12 24 $ 10,5601.2.4 Prepare Monthly Progress Reports with Schedule 12 24 $ 10,5601.2.5 Invoicing $ - $ -2.0 Conceptual Design (30%) 0 0 0 0 $ -$0 $0 $0 $0 $0 $ - $ - $ - 0% $ - $ -3.0 Preliminary Design (60%) 0 58 124 184 $ 95,560$0 $0 $0 $0 $0 $ 95,560 $ - $ - 0% $ 95,5603.1 Preliminary Design Drawings (2 add. Bid Packages) $ -3.1.1 Cover (2) 2 8 $ 2,3903.1.2 Sheet Index and General Notes (2) 1 2 4 $ 1,8003.1.3 Shutdown & Phasing Notes (2) 8 4 2 $ 4,2003.1.4 Control and Benchmarks (2) 1 2 6 $ 2,2603.1.5 Overall Location & Prop. Sheet Ref. (4) 1 4 8 $ 3,2703.1.6 Overall Existing Map (W&SS) (4) 4 8 $ 2,9403.1.7 Abandonment (W&S) (4) 2 4 8 $ 3,6003.1.8 Prop Easement Layout (4) 2 4 8 $ 3,6003.1.9 Easement Vacations (4) 2 4 8 $ 3,6003.1.10 Prop Plan & Prof (8) 12 40 64 $ 29,6803.1.11 Meter Vaults Part 3 (4) 4 8 12 $ 6,2803.1.12 Meter Vaults Part 1 (2) 2 4 6 $ 3,1403.1.13 Meter Vaults Structural (6) 3 6 12 $ 5,4003.2 OPCC 4 8 16 $ 7,2003.3 Coordination with NASJRB/Lockheed 8 12 6 $ 7,3203.4 Coordination with Westworth Village 4 8 4 $ 4,4403.5Coordination with TRWD484 $ 4,4404.0 Final Design (90% and 100%) 0 88 188 256 $ 161,120$0 $61000 $6100 $0 $67100 $ 228,220 $ - $ - 0% $ 228,2204.2 90% Design Drawings (2 add. Bid Packages) $ -4.2.1 Cover (2) 2 $ 4604.2.2 Sheet Index and General Notes (2) 2 4 $ 1,4704.2.3 Shutdown & Phasing Notes (2) 2 4 4 $ 2,6804.2.4 Control and Benchmarks (2) 4 $ 9204.2.5 Overall Location & Prop. Sheet Ref. (4) 2 2 4 $ 2,1304.2.6 Overall Existing Map (W&SS) (4) 2 8 $ 2,3904.2.7 Abandonment (W&S) (4) 2 2 8 $ 3,0504.2.8 Prop Easement Layout (4) 4 8 $ 2,9404.2.9 Easement Vacations (4) 2 4 $ 1,4704.2.10 Prop Plan & Prof (8) 16 32 56 $ 26,9604.1.11 Meter Vaults Part 3 (4) 2 4 10 $ 4,0604.1.12 Meter Vaults Part 1 (2) 2 2 6 $ 2,5904.1.13 Meter Vaults Structural (6) 3 6 12 $ 5,4004.3 Project Spec. Details 4 8 12 $ 6,2804.3.1 Geotechnical 2 6 8 $ 4,150$46000 $4600 $50600 $ 54,7504.3.2 Tunneling 8 20 12 $ 10,900$15000 $1500 $16500 $ 27,4004.3.3 Traffic Control Plans (12) 6 12 24 $ 10,8004.3.4 Erosion Control Plans (9) 5 18 30 $ 13,5004.4 OPCC 2 4 8 $ 3,6004.5 90% Project Manual $ -4.5.1 Division 00 4 6 2 $ 3,4304.5.2 Division 01 4 6 2 $ 3,4304.5.3 Divisions 20-49 8 12 4 $ 6,8604.5.4 Non-Std. Specs 8 12 4 $ 6,8604.5.5 Appendix 2 4 8 $ 3,6004.6 Coordination with NASJRB/Lockheed 2 6 4 $ 3,2304.7 Coordination with Westworth Village 2 6 4 $ 3,2304.8Coordination with TRWD264 $ 3,2304.9 100% Design Drawings 6 12 24 $ 10,8004.10 100% OPCC 2 4 2 $ 2,2204.11100% Project Manual41612 $ 8,4805.0 Bid Phase Services (2 add. Bid Packages) 0 32 72 32 $ 41,250$0 $0 $0 $0 $0 $ 41,250 $ - $ - 0% $ 41,2505.1 Bid Support $ -5.1.1 Upload Plans to E-Builder 2 $ 5505.1.2 Print Hardcopies (8) 2 12 $ 2,1705.1.3 Maintain Plan holders List 4 6 $ 1,9105.1.4 Answer/Respond to Bidding Questions 12 20 $ 9,4605.1.5 Issue Addenda 8 8 $ 4,8405.1.6 Prepare for and Attend Pre-Bid Meeting 8 16 $ 7,0405.1.6.1 Tabulate bids and review 4 8 $ 2,1805.2 Final Design Drawings 4 16 32 $ 13,1006.0 Construciton Phase Services 0 0 0 0 $ -$0 $0 $0 $0 $0 $ - $ - $ - 0% $ -8.0 Survey and SUE Services 0 2 4 8 $ 3,600$47000 $0 $4700 $0 $51700 $ 55,300 $ - $ - 0% $ 55,3008.1 Design Survey02 4 8 $ 3,600$47000 $4700 $51700 $ 55,3008.2 Temporary Right of Entry $ - $ -8.3 Subsurface Utility Excavation00 0 0 $ - $ -Task Sub TotalAdministrativeTravel/Reproduction Fees/Permitting005202600SubconsultantTask DescriptionLabor (hours) Total Labor Cost Expense Total ExpenseCostEXHIBIT B-2Level of Effort Spreadsheet TASK/HOUR BREAKDOWNDesign Services forNASJRB Water and Sewer Main Replacement City Project No. 104344Amendment #2% CompleteTask No. Budget RemainingAmount Completed ThisinvoicePreviously Invoiced 9.0 Permitting 0 10 14 14 $ 10,370$0 $0 $0 $0 $0 $ 10,370 $ - $ - 0% $ 10,3709.1 WestWorth Village Development Coordination $ -9.1.1 Exhibit Prep 2 6 6 $ 3,690 $ -9.1.2 Meetings (up to 2) and Coordination 6 6 6 $ 5,0109.1.3 Site Visit02 2 2 $ 1,670 $ -24 238 474 494 $355,940 $47,000 $61,000 $4,700 $0 $118,800 $474,740 $0 $0 $0 $474,740Total Water Line Footage (Total of3 Bid Packages)28,400 4,700 100% Description WP Water0 0% 1,284 Conceptual Design (30%) 31 $128,340.004,700 100% $355,940 Preliminary Design (60%) 32 $256,680.00$118,800 Final Design (10%) 33 $42,780.00 $ 474,800.00 $47,000 Survey 51 $47,000.00 $ 47,000.00 $61,000 $ 427,800.00 $10,800 Subtotal $474,800.0022.0%Total$474,800Total LaborTotal ExpenseTotals 78Amendment Water Line FootageSewer Line Footage(A) Total Fee0Total Project CostProject SummaryTotal Hours$474,800.00MBE/SBE Participation (TotalContract)Non-MBE/SBE Subconsultant10% Sub MarkupMBE/SBE Subconsultant$427,800.00(C) Total Fee (-) Survey FeeWater Fee (100% of Amendment) Sewer Fee (0% of Amendment)(B) Survey Fee$0.00 N GRANTS LN B O RIVER TRAIL CT PUMPHREY DR TA Y P K PRIMARY R UNAWAY 130RD TAXIWAY F197 RD NANNETSAM CALLOWAY RDPERIME T E TAXIWAY F197RD PERIME TERRD TA N NY ST RUN STATIO NDR BOYINGTONDRS SPUR 341 BURTO N HILLRD LYNDADR DESERT STORMRDLO CKHE ED B LVD R IV ER R D BONDS T TRACYNEDR SKYLINE PARKDR PERIMETERRD City of Fort Worth, Texas Mayor and Council Communication DATE: Tuesday, December 9, 2025 LOG NAME: 60NASJRBWSSIMPROVA2-KHA REFERENCE NO.: **M&C 25-1160 SUBJECT: (CD 7 and Westworth Village) Authorize Execution of Amendment No.2 in the Amount of $474,800.00 to an Engineering Agreement with Kimley-Horn and Associates, Inc. for the Naval Air Station Joint Reserve Base Water and Sewer Main Replacement and Adopt Appropriation Ordinance to Effect a Portion of Water's Contribution to the Fiscal Years 2026-2030 Capital Improvement Program RECOMMENDATION: It is recommended that the City Council: 1. Authorize execution of Amendment No. 2 in the amount of $474,800.00, to City Secretary Contract No. 59969, an engineering agreement with Kimley-Horn and Associates, Inc. for the Naval Air Station Joint Reserve Base Water and Sewer Main Replacement for a revised contract amount of $2,555,900.00; and 2. Adopt the attached appropriation ordinance increasing estimated receipts and appropriations in the Water and Sewer Capital Projects Fund in the amount of $474,800.00, transferred from available PayGo funds within the Water & Sewer Fund, for the purpose of funding the Water & Sanitary Sewer Replacement Contract Naval Base project (City Project No. 104344) to effect a portion of Water's Contribution to the Fiscal Years 2026-2030 Capital Improvement Program. DISCUSSION: On August 08, 2023, Mayor and Council Communication (M&C) 23-0656, City Council authorized an engineering agreement in the amount of $1,992,700.00 with Kimley-Horn and Associates, Inc. (City Secretary Contract No. 59969) for the Naval Air Station Joint Reserve Base (NASJRB) Water and Sewer Main Replacement. The agreement was subsequently revised by Amendment No. 1 in the amount of $88,400.00 administratively authorized on September 30, 2024, that provided additional Subsurface Utility Engineering (SUE) services. Amendment No. 2 will include two additional bid packages for the Water Main Improvements — Part 1 and Part 2. These additional packages will require increased scopes for preliminary and final design, bid phase services, survey, and permitting. It is the practice of the Water Department to appropriate its CIP plan throughout the Fiscal Year (FY), instead of within the annual budget ordinance, as projects commence, additional funding needs are identified, and to comply with bond covenants. Funding is currently available in the Transfer to Water/Sewer account of the Water & Sewer Fund for the purpose of funding the W/SS Repl Contract Naval Base project. FY2026 — Water PAYGO Appropriations per City Ordinance 27979-09-2025 FY2026 Original �pted PayGo FY2026 Amended PayGo (includes any council actions subsequent to YTD PayGo Approved for / Moved to Capital Projects This M&C FY2026 Remaining PayGo Balance budget adoation $101,090,082.00��$101,090,082.00��($21,174,158.00)��($474,800.00)��$79,441,124.00 Note: there may be other pending actions or recently approved actions that are not reflected in the table due to timing. Appropriations for Main Replacement W/SS Repl Contract Naval Base project are as depicted below: Fund , Existing Additional project Total* Appropriations Appropriations W&S Capital Projects - $2,651,368.00 $474,800.00 $3,126,168.00 Fund 56002 Project Total � $2,651,368.00 $474,800.00 $3,126,168.00 *Numbers rounded for presentation purposes. This project is located in COUNCIL DISTRICTS 7 and WESTWORTH VILLAGE. FISCAL INFORMATION / CERTIFICATION: The Director of Finance certifies that funds are currently available in the Water & Sewer Fund and upon the approval of the above recommendations and adoption of the attached appropriation ordinance, funds will be available in the W&S Capital Projects Fund for the W/SS Repl. Contract Naval Base project to support the execution of the amendment. Prior to any expenditure being incurred, the Water Department has the responsibility of verifying the availability of funds. FUND IDENTIFIERS (FIDs).: TO Fund Department ccoun Project Program ctivity Budget Reference # moun ID ID Year (Chartfield 2) FROM Fund� Department ccoun Project Program ctivity Budget Reference # Amoun ID � � ID � Year (Chartfield 2) CERTIFICATIONS: Submitted for City Manager's Office by_ Originating Department Head: Additional Information Contact: Jesica McEachern (5804) Chris Harder (5020) Preeti KC (5467) ATTACHMENTS 1. 60NASJRBWSSIMPROVA2-KHA Map.pdf (Public) 2. 60NASJRBWSSIMPROVA2-KHA FID Table (WCF 10.16.25).xlsx (CFW Internal) 3. 60NASJRBWSSIMPROVA2-KHAfunds avail.docx (CFW Internal) 4. Form 1295 Certificate 101447892.pdf (CFW Internal) 5. ORD.APP 60NASJRBWSSIMPROVA2-KHA 56002 A026(R2).docx (Public) 6. PBS CPN 104344.pdf (CFW Internal) 60NASJRBWSSIMPROVA2-KHARec #FundDept #AccountProject IDActivityBudget YearCF 2Program Amount PurposeXfer256002060043049560011043442026$474,800.0025600206004301043442026$474,800.00Rec #FundDept #AccountProject IDActivityBudget YearCF 2Program Amount PurposeXfer25600106090205956001$474,800.00256002060043049560011043440017309999($474,800.00)Rec #FundDept #AccountProject IDActivityBudget YearCF 2Program Amount PurposeXfer156002060043053305001043440017309999$474,800.00ContractFIDs (Budget)FIDs (Actual)FIDs (REVENUE or EXPENSE - No KK or GL Entries Needed) (check applicable) and my date of birth is _______________________. (state) (zip code) (country) (year)(month) _______, ______________, _________. State of ________________, on the _____day of ___________, 20_____. (city) (Declarant) City Secretary’s Office Contract Routing & Transmittal Slip *Indicates the information is required and if the information is not provided, the contract will be returned to the department. Contractor’s Name: Subject of the Agreement: M&C Approved by the Council? *Yes No If so, the M&C must be attached to the contract. Is this an Amendment to an Existing contract? Yes No If so, provide the original contract number and the amendment number. Is the Contract “Permanent”? *Yes No If unsure, see back page for permanent contract listing. Is this entire contract Confidential?*Yes No If only specific information is Confidential, please list what information is Confidential and the page it is located. Effective Date: Expiration Date: If different from the approval date. If applicable. Is a 1295 Form required?* Yes No *If so, please ensure it is attached to the approving M&C or attached to the contract. Project Number:If applicable. *Did you include a Text field on the contract to add the City Secretary Contract (CSC) number? Yes No Contracts need to be routed for CSO processing in the following order: (Approver) Jannette S. Goodall (Signer) Allison Tidwell (Form Filler)