Contract - Whitestone Civil Construction - 7/27/2017 I
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City of Round Rock, Texas Contract Forms
Standard Form of Agreement: Section 00500
City of Round Rock, Texas
Standard Form of Agreement between
Owner and Contractor
AGREEMENT made as of th ?al;of 4"-- in the year 20 R.
BETWEEN the Owner: City of Round Rock,Texas(hereafter"Owner"or"City")
221 East Main Street
Round Rock,Texas 78664
and the Contractor Whitestone Civil Construction,LLC ("Contractor")
P.O.Box 1537
Cedar Park,Texas 78630
The Project is described as: Settlers Crossing Lift Station Bypass
The Engineer is: Garza EMC,LLC
221 West Sixth Street
Suite 300
Austin,Texas 78701
For and in consideration of the mutual terms, conditions and covenants of this Agreement and all
accompanying documents between Owner and Contractor, the receipt and sufficiency of which are hereby
acknowledged,Owner and Contractor agree as follows:
ARTICLE I THE CONTRACT DOCUMENTS
The Contract Documents consist of this Agreement,Conditions of the Contract(General,Supplementary and
other Conditions),Drawings, Specifications,Addenda issued prior to execution of this Agreement, other documents
listed in this Agreement and Modifications issued after execution of this Agreement;these form the Contract,and are
I as fully a part of the Contract as if attached to this Agreement or repeated herein. The Contract represents the entire
and integrated agreement between the parties hereto and supersedes prior negotiations,representations or agreements,
either written or oral.An enumeration of the Contract Documents,other than Modifications,appears in Article 7.
` ARTICLE 2 THE WORK OF THIS CONTRACT
Contractor shall fully execute the Work described in the Contract Documents,except to the extent specifically
indicated in the Contract Documents to be the responsibility of others.
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ARTICLE 3 DATE OF COMMENCEMENT;DATE OF SUBSTANTIAL COMPLETION;DATE OF
FINAL COMPLETION
3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated
below or provision is made for the date to be fixed in a Notice to Proceed issued by Owner.
3.2 The Contract Time shall be measured from the date delineated in the Notice to Proceed.
3.3 Contractor shall commence Work within ten ( 10 ) calendar days
from the date delineated in the Notice to Proceed.
3.4 Contractor shall achieve Substantial Completion of the items of Work listed on Attachment A to this
Agreement no later than_ N/A ( N/A )calendar days from issuance by Owner of Notice to
Proceed, and Contractor shall achieve Substantial Completion of the entire Work no later than
One Hundred Twenty ( 120 )calendar days from issuance by Owner of Notice to Proceed, subject to
adjustments of this Contract Time as provided in the Contract Documents.
3.5 If Contractor fails to achieve Substantial Completion of the Work(or any portion thereof) on or before the
date(s)specified for Substantial Completion in the Agreement,Contractor shall pay to Owner,as liquidated damages,
the sum of Five Hundred Dollars and No/100
Dollars($500.00 ) for each calendar day that Substantial Completion is delayed after the date(s)
specified for Substantial Completion. It is hereby agreed that the liquidated damages to which Owner is entitled
hereunder are a reasonable forecast of just compensation for the harm that would be caused by Contractor's failure to
achieve Substantial Completion of the Work(or any portion thereof)on or before the date(s)specified for Substantial
Completion in the Agreement. It is agreed that the harm that would be caused by such failure,which includes loss of
expected use of the Project areas,provision of alternative storage facilities and rescheduling of moving and occupancy
dates,is one that is incapable or very difficult of accurate estimation.It is hereby agreed that if Substantial Completion
of the Work (or any portion thereof) is not achieved on or before thirty (30) days after the date(s) specified for
Substantial Completion in the Agreement,the Owner shall have the option to either collect liquidated damages as set
forth herein or to thereafter rely on its remedies under the Contract Documents and at law and in equity, including
without limitation,the recovery of actual damages.The date(s)specified for Substantial Completion of the Work(or
any portion thereof)in the Agreement shall be subject to adjustment as provided in the Contract Documents.
3.6 Contractor shall achieve Final Completion of the entire Work no later than One Hundred Fifty
( 150 )calendar days from issuance by Owner of Notice to Proceed.
ARTICLE 4 CONTRACT SUM
4.1 Owner shall pay Contractor the Contract Sum in current funds for Contractor's performance of the Contract.
The Contract Sum shall be One-Thousand-Forty-Nine,Nine-Hundred-Fifty-One Dollars
($ 149,951.00 ),subject to additions and deductions as provided in the Contract Documents.
4.2 Does the Contract Sum include alternates which are described in the Bid Form?
No X . Yes .If yes,please provide details below:
N/A N/A
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ARTICLE 5 PAYMENTS
5.1 PROGRESS PAYMENTS
5.1.1 Based upon Applications for Payment submitted to Engineer and Owner by Contractor,and Certificates for
Payment issued by Engineer and not disputed by Owner and/or Owner's lender,Owner shall make progress payments
on account of the Contract Sum to Contractor as provided below, in Article 14 of the City of Round Rock General
Conditions,and elsewhere in the Contract Documents.
5.1.2 The period covered by each Application for Payment shall be one calendar month ending on the last day of
the month.
5.1.3 Provided that an Application for Payment is received by Engineer and Owner, and Engineer issues a
Certificate of Payment not later than the tenth(10th) day of a month, Owner shall make payment to Contractor not
later than the tenth(10th)day of the next month. If an Application for Payment is received by Engineer and Owner
after the application date fixed above,payment shall be made by Owner not later than one month after the Engineer
issues a Certificate for Payment.
5.1.4 Each Application for Payment shall be based on the most recent schedule of values submitted by Contractor
in accordance with the Contract Documents.The schedule of values shall allocate the entire Contract Sum among the
various portions of the Work. The schedule of values shall be prepared in such form and supported by such data to
substantiate its accuracy as Engineer and Owner may require.This schedule,unless objected to by Engineer or Owner,
shall be used as a basis for reviewing Contractor's Applications for Payment.
5.1.5 Applications for Payment shall warrant the percentage of completion of each portion of the Work as of the
end of the period covered by the Application for Payment.
5.1.6 Subject to other provisions of the Contract Documents, the amount of each progress payment shall be
computed as provided in Article 14 of the City of Round Rock General Conditions.
5.1.7 Except with Owner's prior written approval, Contractor shall not make advance payments to suppliers for
materials or equipment which have not been delivered and stored at the site.
5.2 FINAL PAYMENT
5.2.1 Final payment, constituting the entire unpaid balance of the Contract Sum, shall be made by Owner to
Contractor when:
.1 Contractor has fully performed the Contract except for Contractor's responsibility to correct Work,
and to satisfy other requirements,if any,which extend beyond final payment;and
.2 a final Certificate for Payment has been issued by Engineer.
5.2.2 Owner's final payment to Contractor shall be made no later than thirty (30) days after the issuance of
Engineer's final Certificate for Payment. In no event shall final payment be required to be made prior to thirty(30)
days after all Work on the Contract has been fully performed.Defects in the Work discovered prior to final payment
shall be treated as non-conforming Work and shall be corrected by Contractor prior to final payment,and shall not be
treated as warranty items.
ARTICLE 6 TERMINATION OR SUSPENSION
6.1 The Contract may be terminated by Owner or Contractor as provided in Article 15 of the City of Round Rock
General Conditions.
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6.2 The Work maybe suspended byOwner asprovided in Article 15 of the Cityof Round Rock General
P
Conditions.
ARTICLE 7 ENUMERATION OF CONTRACT DOCUMENTS
7.1 The Contract Documents,except for Modifications issued after execution of this Agreement,are enumerated
as follows:
7.1.1 The Agreement is this executed version of the City of Round Rock, Texas Standard Form of Agreement
between Owner and Contractor,as modified.
7.1.2 The General Conditions are the "Cityof Round Rock Contract Forms 00700," General Conditions, as
modified.
7.1.3 The Supplementary, Special,and other Conditions of the Contract are those contained in the Project Manual
dated June 2017
7.1.4 The Specifications are those contained in the Project Manual dated June 2017
7.1.5 The Drawings,if any,are those contained in the Project Manual dated June 2017
P7.1.6 The Insurance&Construction Bond Forms of the Contract are those contained in the Project Manual dated
June 2017
7.1.7 The Notice to Bidders,Instructions to Bidders,Bid Form,and Addenda,if any,are those contained in the
Project Manual dated June 2017
7.1.8 If this Agreement covers construction involving federal funds, thereby requiring inclusion of mandated
contract clauses, such federally required clauses are those contained in the "City of Round Rock Contract Forms
03000,"Federally Required Contract Clauses,as modified.
7.1.9 Other documents,if any, forming part of the Contract Documents are as follows:
N/A
ARTICLE 8 MISCELLANEOUS PROVISIONS
8.1 Where reference is made in this Agreement to a provision of any document, the reference refers to that
provision as amended or supplemented by other provisions of the Contract Documents.
8.2 Owner's representative is: Eddie Zapata-Project Manager
City of Round Rock
221 E. Main Street
Round Rock,Texas 78746
8.3 Contractor's representative is: Carrie Lewis
Whitestone Civil Construction,LLC
P. O. Box 1537
Cedar Park,Texas 78630
8.4 Neither Owner's nor Contractor's representative shall be changed without ten(10)days'written notice to the
p g Y
other party.
111 8.5 Waiver of any breach of this Agreement shall not constitute waiver of any subsequent breach.
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8.6 Owner agrees to pay Contractor from available funds for satisfactory performance of this Agreement in
accordance with the bid or proposal submitted therefor,subject to proper additions and deductions,all as provided in
the General Conditions, Supplemental Conditions, and Special Conditions of this Agreement, and Owner agrees to
make payments on account thereof as provided therein. Lack of funds shall render this Agreement null and void to
the extent funds are not available. This Agreement is a commitment of City of Round Rock's current revenues only.
8.7 Although this Agreement is drawn by Owner,both parties hereto expressly agree and assert that,in the event
of any dispute over its meaning or application,this Agreement shall be interpreted reasonably and fairly,and neither
more strongly for nor against either party.
8.8 This Agreement shall be enforceable in Round Rock,Texas, and if legal action is necessary by either party
with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for same shall lie in
Williamson County, Texas. This Agreement shall be governed by and construed in accordance with the laws and
court decisions of the State of Texas.
8.9 Both parties hereby expressly agree that no claims or disputes between the parties arising out of or relating
to this Agreement or a breach thereof shall be decided by an arbitration proceeding,including without limitation,any
proceeding under the Federal Arbitration Act(9 USC Section 1-14)or any applicable state arbitration statute.
8.10 The parties, by execution of this Agreement, bind themselves, their heirs, successors, assigns, and legal
representatives for the full and faithful performance of the terms and provisions hereof
This Agreement is entered into as of the day and year first written above and is executed in at least three(3)
original copies, of which one is to be delivered to Contractor, one to Engineer for use in the administration of the
Contract,and the remainder to Owner.
OWNER C• TRACTOR
CITY OF "•UND ROC►,TE AS hit,stone Civil Con u on,LLC
Printed Name: Printed Name:
Carrie ewi
Title member
Title:
Date Signed: e..2A ' Date Signed: 8/9/2017
ATTEST: it
SaA4, •
City Clerk
FOR Y APPROVED A TO FORM:
I
City Attor ey
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1051990
PERFORMANCE BOND
THE STATE OF TEXAS §
§ KNOW ALL BY THESE PRESENTS:
COUNTY OF WILLIAMSON §
That Whitestone Civil Construction,LLC of the City of Cedar Park County of
Williamson , and State of Texas , as Principal, and The Hanover Insurance Company
authorized under the law of the State of Texas to act as surety on bonds for principals, are held
and firmly bound unto THE CITY OF ROUND ROCK, TEXAS, (Owner), in the penal sum of
One Hundred Forty Nine Thousand Nine Hundred Fifty One and 00/100
Dollars ($ 149,951.00 ) for the payment whereof, well and truly to be made the said
Principal and Surety bind themselves, and their heirs, administrators, executors, successors and
assigns,jointly and severally, by these presents:
WHEREAS, the Principal has entered into a certain ritten Agreement with the Owner dated the
day of , 20(1-to which the Agreement is
herebyreferred to and made apart hereof asTand to the y same extent as if copied at length
herein consisting of: Settlers Crossing Lift Station Bypass
(Name of the Project)
NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION IS SUCH, that if the said
Principal shall faithfully perform said Agreement and shall, in all respects, duly and faithfully
observe and perform all and singular the covenants, conditions and agreements in and by said
Agreement, agreed and covenanted by the Principal to be observed and performed, including but
not limited to, the repair of any and all defects in said work occasioned by and resulting from
defects in materials furnished by or workmanship of, the Principal in performing the Work
covered by said Agreement and occurring within a period of twelve (12) months from the date of
Final Completion and all other covenants and conditions, according to the true intent and
meaning of said Agreement and the Plans and Specifications hereto annexed, then this obligation
shall be void; otherwise to remain in full force and effect;
PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253,
Texas Government code, as amended, and all liabilities on this bond shall be determined in
accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at
length herein.
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PERFORMANCE BOND (continued)
Sure for value received, stipulates and agrees that no change, extension of time, alteration or
Surety, p
addition to the term of the Agreement, or to the Work performed thereunder, or the Plans,
Specifications, or drawings accompanying the same, shall in anywise affect its obligation on this
bond, and it does hereby waive notice of any such change, extension of time, alteration or
addition to the terms of the Agreement, or to the work to be performed thereunder.
IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this instrument
this 1I P1 day of 3 , 20 l
Whitestone Civil Construction, LLC The Hanover Insurance Company
Princip- Surety
' Carri Lewis Jeremy Farque
Prim-d N me Printed Name
By: ' _ ,.� By:
Title: ,fiLem ger Title: Attorney In Fact
Address: P.O. Box 1537 Address: 440 Lincoln St
Cedar Park, TX 78630 Worcester, MA 01653
Resident Agent of Surety:
Sign ure
Jeremy Farque
Printed Name
11200 Jollyville Road
Street Address
Austin, TX 78759
City, State & Zip Code
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PAYMENT BOND
THE STATE OF TEXAS §
§ KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF WILLIAMSON §
•
Whitestone Civil Construction,LLC Cityof Cedar Park Countyof
That of the
Williamson , and State of Texas as Principal, and TheHanover Insurance Conspany
authorized under the laws of the State of Texas to act as Surety on Bonds for Principals, are held
and firmly bound unto THE CITY OF ROUND ROCK, (OWNER), and all subcontractors,
workers, laborers, mechanics and suppliers as their interest may appear, all of whom shall have
the right to sue upon this bond, in the penal sum of
One Hundred Forty Nine Thousand Nine Hundred Firty One and 00/100 Dollars
($ 149,951.00 ) for the payment whereof, well and truly be made the
said Principal and Surety bind themselves and their heirs, administrators, executors, successors,
and assigns,jointly and severally, by these presents:
WHEREAS, thel�rjncipal has entered into a certain written Agreement with the Owner, dated
the `moi dayof , 20 1-, to which Agreement is
� !
hereby referredto and made a part hereof as lly and to the same extent as if copied at length
herein consisting of: Settlers Crossing Lift Station Bypass
(Name of the Project)
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the said
Principal shall well and truly pay all subcontractors, workers, laborers, mechanics, and suppliers,
all monies to them owing by said Principals for subcontracts, work, labor, equipment, supplies
and materials done and furnished for the construction of the improvements of said Agreement,
then this obligation shall be and become null and void; otherwise to remain in full force and
effect.
PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253,
Texas Government code, as amended, and all liabilities on this bond shall be determined in
accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at
length herein.
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PAYMENT BOND (continued)
Surety, for value received, stipulates and agrees that no change, extension of time, alteration or
addition to the terms of the Agreement, or to the Work performed thereunder, or the plans,
specifications or drawings accompanying the same shall in anywise affect it's obligation on this
bond, and it does hereby waive notice of any such change, extension of time, alteration or
addition to the terms of the contract, or to the work to be performed thereunder.
IN WITNESS WHERE F, the said Principal and Surety have signed and sealed this Instrument
this Q(I'\ day of , 20 O-.
Whitestone Civil Construction, LLC The Hanover Insurance Company
Princip. Suret
y
Carri +is Jeremy Farque
Print-d Na e / Printed Name
By: -A Imo. 411 By:
wr
Title: Member
Title: Attorney In Fact
Address: P.O. Box 1537 Address: 440 Lincoln St
Cedar Park, TX 78630 Worcester, MA 01653
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Resident Agent of Surety:
Signa re
Jerem Farque
Printed Name
11200 Jollyville Road
Street Address
Austin, TX 78759
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THE CITY OF ROUND ROCK BIDS EXTENDED AND CHECKED
Utilities & Environmental Services
2008 Enterprise Drive BY: AM
Round Rock, Texas 78664 DATE : 6/29/2017
BID TABULATION
SHEET: 1 of 2
CONTRACT : .Settlers Crossing Lift Station Bypass
Whitestone Civil Austin Engineering Patin Construction Gra back Utility
LOCATION: 2008 Enterprise Drive Large Conference Room Statement of Safety?Yes Statement of Safety?Yes Statement of Safety?Yes Statement of Safety?Yes
DATE: 6/29/2017 Addendum(s)? N/A Addendum(s)? N/A Addendum(s)? N/A Addendum(s)? N/A
Bid Bond? Yes Bid Bond? Yes Bid Bond? Yes Bid Bond? Yes
Z:
APPROX. UNIT UNIT UNIT UNIT
TEM A ITEM DESCRIPTION QTY. UNIT PRICE COST PRICE COST PRICE COST PRICE COST
1 Borrow(Class C Topsoil) 85 CY $20.00 $1,700.00 $46.00 $3,910.00 $20.00 $1,700.00 $90.00 $7,650.00
2 P.C. Concrete Sidewalks 80 SF $12.00 $960.00 $32.00 $2,560.00 $20.00 $1,600.00 $70.00 $5,600.00
3 Jacking and Boring Pie 80 LF $503.00 $40,240.00 $400.00 $32,000.00 $700.00 $56,000.00 $425.00 $34,000.00
4 New Manhome Construction,4-FT 1 EA $7,500.00 $7,500.00 $13,000.00 $13,000.00 $8,500.00 $8,500.00 $10,000.00 $10,000.00
5 Trench Safety System 281 LF $3.00 $843.00 $1.00 $281.00 $5.00 $1,405.00 $40.00 $11,240.00
6 PVC Pipe 8-in 361 LF $108.00 $38,988.00 $60.00 $21,660.00 $145.00 $52,345.00 $50.00 $18,050.00
7 Sodding For Re-ve etation,Bennuda 15 SY $10.00 $150.00 $14.00 $210.00 $10.00 $150.00 $200.00 $3,000.00
8 Sedding for Re-Vegetation 820 SY $1.00 $820.00 $8.00 $6,560.00 $4.50 $3,690.00 $11.50 $9,430.00
9 Preservation of Trees 1 LS $400.00 $400.00 $685.00 $685.00 $1,500.00 $1,500.00 $5,000.00 $5,000.00
10 Inlet Protection 50 LF $15.00 $750.00 $9.00 $450.00 $25.00 $1,250.00 $12.50 $625.00
11 Rock Benn 50 LF $50.00 $2,500.00 $50.00 $2,500.00 $30.00 $1,500.00 $50.00 $2,500.00
12 Stabilized Construction Entrance 50 LF $35.00 $1,750.00 $50.00 $2,500.00 $30.00 $1,500.00 $70.00 $3,500.00
13 Silt Fence 300 LF $3.00 $900.00 1 $2.50 $750.00 $3.00 $900.00 $3.50 $1,050.00
14 Ifencing, Chain Link 60 LF $55.00 $35300.00 $135.00 $8,100.00 $15.00 $900.00 1 $130.00 $7,800.00
THE CITY OF ROUND ROCK BIDS EXTENDED AND CHECKED
Utilities & Environmental Services
2008 Enterprise Drive BY: AM
Round Rock, Texas 78664 DATE : 6/29/2017
BID TABULATION
,
SHEET: 2 of 2
CONTRACT : Settlers Crossing Lift Station Bypass
Whitestone Civil Austin Engineering Patin Construction Gra back Utility
LOCATION: 2008 Enterprise Drive Large Conference Room Statement of Safety?Yes Statement of Safety?Yes Statement of Safety?Yes Statement of Safety?Yes
DATE: 6/29/2017 Addendum(s)?N/A Addendum(s)? N/A Addendum(s)? N/A Addendum(s)? N/A
Bid Bond? Yes Bid Bond? Yes Bid Bond? Yes Bid Bond? Yes
s
APPROX. UNIT UNIT UNIT UNIT
TEM A ITEM DESCRIPTION QTY. UNIT PRICE COST PRICE COST PRICE COST PRICE COST
15 Project Sip 1 LF $750.00 $750.00 $1,000.00 $1,000.00 $800.00 $800.00 $3,000.00 $3,000.00
16 Barricades, Sips and Traffic 1 LS $4,000.00 $4,000.00 $3,500.00 $3,500.00 $1,500.00 $1,500.00 $5,000.00 $5,000.00
17 Abandoranent of Sewer Mains, Bin 350 LF $6.00 $2,100.00 $10.00 $3,500.00 $20.00 $7,000.00 $16.50 $5,775.00
18 Abandonment of Sewer Mains,4in 1500 LF $2.00 $3,000.00 $5.50 $8,250.00 $10.00 $15,000.00 $7.00 $10,500.00
19 Bypass Pumping 1 LS $6,000.00 $6,000.00 $11,000.00 $11,000.00 $7,500.00 $7,500.00 $20,000.00 $20,000.00
20 Lift Station Decommissioning 1 LS $24,000.00 $24,000.00 $40,000.00 $40,000.00 $50,000.00 $50,000.00 $50,000.00 $50,000.00
21 Removable Bollards 3 EA $600.00 $1,800.00 $2,100.00 $6,300.00 $250.00 $750.00 $4,000.00 $12,000.00
22 Mobilization,Bonds and Insurance 1 LS $7,500.00 $7,500.00 $5,000.00 $5,000.00 $10,000.00 $10,000.00 $10,000.00 $10,000.00
GRAND TOTAL: $149,951.00 1 $173,716.00 $225,490.00 $235,720.00
y,o� a r z a
July 3,2017 emc
City of Round Rock
Mr. Eddie Zapata
Project Manager, Utilities& Environmental Services
2008 Enterprise Drive
Round Rock,Texas 78664
Re: Settler's Crossing LS Bypass Project
Contract Award Recommendation
Dear Mr.Zapata:
On Thursday,June 29,2017,bids were received and opened for the above-referenced project.A total of four
(4) bids were received.The following is a list of contactors that submitted a bid:
• Whitestone Civil Construction • Patin Construction, LLC.
• Austin Engineering,Co. • Greyback Utility,LLC.
Whitestone Civil Construction, from Cedar Park, Texas, submitted the low bid with a Total Bid Amount of
$149,951.00.The second lowest Total Bid Amount was for$173,716.00 from Austin Engineering.Upon review
of the Bid's and company information, we recommend this project be awarded to Whitestone Civil
Construction for the total amount of$149,951.00 as shown on the enclosed bid tabulation.
If you should have any questions or require additional information, please do not hesitate to contact our
office(210)526-0286 or email me at blarson@garzaernc.com.
Sincerely,
-----------------
Brett A. Larson, PE
Project Manager
Garza EMC—TBPE#F-14629
Cc: Kit Perkins, Senior Utility Engineer
Enclosures:
1. Tabulation of Bids
CERTIFICATE OF INTERESTED PARTIES
FORM 1.295
loft
CERTIFICATION OF FILING
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
q
place Number:
Complete Nos,1,2,3,5,and 6 if there are no interested parties. the :entit—y's pi C
I Name of business entity filing form,and the city,state and country of
of business.
Whitestone Civil Construction, LLC 2017-232944
Cedar Park,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 07/06/2017
being filed.
City of Round Rock 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.
Settlers Crossing Lift Station
wastewater bypass and decommissioning of lift station
4 Name of Interested Party Nature of interest
City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only it there is NO Interested Party. FX_]
6 AFFIDAVIT
I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
CARRIE LEWS
My Commission Expires
September 24.2017 Signature of authorized agent of contracting business entity
AP VE
Sworn to and subscribed beforq'me.by the said
,,° ,this the
J 0 to certify whichitne s my hand and seal of office. -I-day of
-A A
nature of acWim_f6�§oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission wvAv,ethics-state.ix.us Version V1,0.883
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. 2017-232944
Whitestone Civil Construction, LLC
Cedar Park,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 07/06/2017
being filed.
City of Round Rock Date Acknowledged:
07/20/2017
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.
Settlers Crossing Lift Station
wastewater bypass and decommissioning of lift station
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
5 Check only if there is NO Interested Party. ❑
X
6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said this the day of
20 ,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883