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Contract - Lee Lewis Construction - 3/22/2018 rTh City of Round Rock, Texas Contract Forms Standard Form of Agreement for Competitive Sealed Proposal: Section 00500 City of Round Rock, Texas Standard Form of Agreement between Owner and Contractor A vi tql24 tr- AGREEMENT made as of therX day of the year 2018. BETWEEN the Owner: City of Round Rock,Texas(hereafter"Owner"or"City") 221 East Main Street Round Rock,Texas 78664 and the Contractor: Lee Lewis, Construction,Inc. ("Contractor) 8303 N. Mopac Expressway, Suite A215 Austin,Texas 78759 The Project is described as: Luther Peterson Service Center 3400 Sunrise Road Round Rock,Texas The Architect is: Jacob Engineering 1999 Bryan Street, Suite 1200 Dallas,Texas 75201 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 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. 00500 Page 1 of 6 Standard Form of Ab eement �.✓ 00394599/ss2 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. A Notice to Proceed will not be issued before June 1, 2018 unless requested by the City and agreed upon by the Contractor. Contractor shall commence work ten(10)calendar days from the date delineated in the Notice to Proceed. 3.4 Contractor shall achieve Substantial Completion of the entire Work no later than four hundred five (405) 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 One Thousand and No/100 Dollars ($1000.00) 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 four hundred thirty-five (435) 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 Fifteen Million Four Hundred Eighty-Three Thousand Dollars and No/100 ($15,483,000.00),subject to additions and deductions as provided in the Contract Documents. 4.2 The Contract Sum is based upon the following alternates which are described in the Contract Documents and are hereby accepted by Owner: Alternate#1 —Not Accepted Alternate#2—Not Accepted Alternate#3—Not Accepted Alternate#4—Not Accepted U Page 2 of 6 ARTICLE 5 PAYMENTS 5.1 PROGRESS PAYMENTS 5.1.1 Based upon Applications for Payment submitted to Architect and Owner by Contractor,and Certificates for Payment issued by Architect 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 Architect and Owner, and Architect 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 Architect and Owner after the application date fixed above,payment shall be made by Owner not later than one month after the Architect 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 Architect and Owner may require. This schedule, unless objected to by Architect 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 Architect. 5.2.2 Owner's final payment to Contractor shall be made no later than thirty (30) days after the issuance of Architect'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. U Page 3 of 6 6.2 The Work may be suspended by Owner as provided in Article 15 of the City of Round Rock General 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 for Competitive Sealed Proposals,as modified. 7.1.2 The General Conditions are the "City of 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 March 22,2018. 7.1.4 The Specifications are those contained in the Project Manual dated March 22,2018. 7.1.5 The Drawings,if any,are those contained in the Project Manual dated March 22,2018. 7.1.6 The Insurance&Construction Bond Forms of the Contract are those contained in the Project Manual dated March 22,2018. 7.1.7 The Notice to Bidders, Instructions to Bidders,Bid Form,and Addenda,if any,are those contained in the Project Manual dated March 22,2018. 7.1.8 If this Agreement r 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: Contractor's Proposal Dated December 14,2017; Supplement to Agreement dated February 27,2018 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: Richard Will Building Construction Manager General Services Department 212 Commerce Road Round Rock,Texas 78664 8.3 Contractor's representative is: Matt Vitek Vice President Lee Lewis Construction,Inc. 8303 N.Mopac Expressway, Suite A215 Austin,Texas 78759 4 t � `�f Page 4 of 6 (") 8.4 the other Neitparthy.er Owner's nor Contractor's representative shall be changed without ten (10) days' written notice to 8.5 Waiver of any breach of this Agreement shall not constitute waiver of any subsequent breach. 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 In accordance with Chapter 2270, Texas Government Code, a governmental entity may not enter into a contract with a company for goods or services unless the contract contains written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of this contract. The signatory executing this Agreement on behalf of Contractor verifies Contractor does not boycott Israel and will not boycott Israel during the term of this Agreement. 8.9 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. 8.10 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. 8.11 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. [Signatures on the following page.] U Page 5 of 6 �. 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 Architect for use in the administration of the Contract, and the remainder to Owner. 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 Architect for use in the administration of the Contract,and the remainder to Owner. OWNER CONTRACTOR CITY OF ROUND ROCK,TEXAS LEE LEWIS CONSTRUCTION,INC. Ada Y Printed Name: _, �! G�Lt 41A Printed Name: MffildEW ✓17 Title: 1\1911112 .' Title: %i Gf 7P4m4 r.ir Date Signed: 1"--124 Date Signed: ✓' •16. ©0 e ATTEST: City Clerk FOR CITY, •,'PROVED AS TO FORM: City Attorney �I Page 6 of 6 f City of Round Rock, Texas Contract Preparation February 27, 2018 Supplemental Information to Standard Form of Agreement between Owner and Contractor Luther Peterson Service Center Related to Article 4 Contract Sum A. TOTAL CONTRACT SUM(including Owner's Betterment): Fifteen million four hundred eighty three thousand dollars and no/100 Dollars($ 15,483,000.00) (-) B. See attached Exhibit: Scope and Price Descriptions C. All changes to the project represented by a change order or a change directive incurring cost shall be limited to fifteen (15) percent (%) of Overhead and Profit generated by Subcontractors and five (5) percent (%) Profit/Fee submitted by the General Contractor. Related to Article 8 Miscellaneous Provisions A. Contractors proposed Supervision and Superintendence for the project shall be as specified below and follow the terms and condition set forth in Article 6 of the 00700 General Conditions Senior Project Manager: Mike Morgan, Vice President name/title Assumed work capacity dedicated to project Thirty(30) percent (%) Project Manager: Drew Gregston, Project Manager name/title Assumed work capacity dedicated to project One Hundred (100) percent (%) Superintendent: Jaime Rodriguez, Superintendent name/title p � p Assumed work capacity dedicated to project One Hundred (100) percent (%) Contractor: Lee. L vi,s L-ri j I �1•� , Representative Signature: Printed Name: /1441N4a4 V Date Signed: ,F.1 4 •2 p 1 e r , BOND NO. 022058360 !: .1 PERFORMANCE BOND THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Lee Lewis Construction, Inc. of the City of AUSTIN , Count of TRAVIS , and State of TEXAS Principal, L._BERTY , as and COMPANY MUTUAL y INSURANCE authorized under the law of the State of Texas to act as surety on bonds for principals, are held vicAigyach tc F �FE �, IATIMCK, TEXAS, (Owner), in the penal sum of THOUSAND AND NO/100 Dollars ($ 15,483,000.00 ) 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,,.- 'rincip I has entered into a certain written Agreement with the Owner dated the % � day of , 20 )ato which the Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied at length herein consisting of: LUTHER PETERSON SERVICE CENTER O (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. Page 1 00610 7-2009 Performance Bond (�`"`� 00090656 (Th PERFORMANCE BOND (continued) Surety, for value received, stipulates and agrees that no change, extension of time, alteration or 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 day of NALCO , 20 J8. LEE LEWIS CONSTRUCTION, INC. LIBERTY MUTUAL INSURANCE COMPANY Principal Surety M kTtwEN 1I 17:EI4 HOWARD COWAN Printed Name Printed a e By: By: a(1/4/04k),71 Title: I�ta-slO ►?" Title: ATTORNEY-IN-FACT Address: 8303 N. MOPAC EXPRESSWAY Address: P. O. BOX 54020 SUITE A215 LUBBOCK, TEXAS 79453 AUSTIN, TEXAS 78759 0 Resid t Agent of S ty: Zi/d4 /4-041/' Signature HOWARD COWAN Printed Name 9810 INDIANA AVE., SUITE 160 Street Address LUBBOCK, TEXAS 79423 City, State & Zip Code 0 Page 2 00610 7-2009 Performance Bond 00090656 BOND NO. 022058360 PAYMENT BOND THE STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Lee Lewis Construction, Inc. , of the City of AUSTIN County of TRAVIS , and State of TEXAS as Principal, and LIBERTY M TU.AL ANY 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 Fifteen Million Four Hundred Eighty Three Thousand and NO/100 Dollars ($ 15,483,000.00 ) 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, t - Princi al has entered into a certain written Agreement with the Owner, dated the day of L , 20 1S, to which Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied at length herein consisting of: LUTHER PETERSON SERVICE CENTER (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. Page 1 00620 7-2009 Payment Bond 00090656 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 WHEREOF, the said Principal and Surety have signed and sealed this Instrument this J5 day of M147f..414 , 20 j $. LEE LEWIS CONSTRUCTION, INC. LIBERTY MUTUAL INSURANCE COMPANY Principal Surety MA II1tE4/ 07104— HOWARD COWAN Printed Name Printed N isokrjr/a} By: By: Title: 16E- Pe_ev/4 EWT Title: ATTORNEY-IN-FACT Address: 8303 N. MOPAC EXPRESSWAY Address: P. O. BOX 54020 SUITE A215 LUBBOCK, TEXAS 79453 AUSTIN, TEXAS 78759 Resit • •t Agent o . ,ety: Ai/ t ignature HOWARD COWAN Printed Name 9810 INDIANA AVE., SUITE 160 Street Address LUBBOCK, TEXAS 79423 0 Page 2 00620 7-2009 Payment Bond 00090656 t' Competitive Sealed Proposal Ranking for:Luther Peterson Service Center ROUNO ROCK T;r�5 Contractor Narne m N Base Price Alternates Totals Total Cost 1 d c c c c Total Points Alt No.1 Alt No.2 Alt No.3 to v � N Q Q 17 C % N Sf 1r 4L STR Constructors x x x 515,efi 1,011)0,0} c $ 400,000.00 $ 84,000.00 $ 88,000.00 e s1s,s6c,DGG.GG (CawsiFrcedPrice) 40,00 7,80 10.50 11.2!- 1.00 68.50 FT'Woods x x � x S16,150,0DO.a0 $15,150,000.00 $ 800,000.00 $ 325,000,00 $ 260,000,00 ('Lowest Priced P•epotcl;Propme,sPrice)X40=Price Score 38.79 12.90 1 15.00 15.70 0.00 82.39 3 Chaney Cox X x x 51fi,480,000.0a 516,480,000.00 $ 550,000.00 $ 135,000.00 $ 80,000.00 1 tLowest Priced propose.'Jp:opuser's Price)X 40=Price Score 38.:11 11.70 15.10 `:' 15.65 0.00 $0.56 IE2 Construction x x x $16,5ao,aoa.aG $16,500,000.00 $ 472,331.00 $ 115,433.00 $ 270,313.00 ;"Lowest?riudPrupcsot/Prapcser'sPrice)X40=Price Score 37,90" 12..90 12.10 15.30 0.00 79.26 Emerson Construction x X x 516,690,000.00 516,590,000,00 $ 454;oaa.00 $ 72,000.00 $ 211,000.00 (:Cwest Priced P/cynsci j"P/oFaSC!'s xi-)x4o=Price Score ! 37.53 1.1.40 17.30 16.55 0.00 8?.78 2 Prime Construction x x x $16,700,000.00 $1s,7aa,aaG,aD $ 580,000.00 $ 97,000.00 $ 70,000.00 (Lcwrsr P:icrc ProHo5a;1 P•oPXrr's P:ice)X 40=Price Score 37.51 O.GO 0.00 0.00 0.00 37.51 Joeris x x X $16,717,000.0.0, $16,717,0001.00 $ 557,000.00 S 119,x00.00 $ 84,000.00 (icwrstPricedAraPosafJP!apcsrr'sP:iujXaO=Price Score 37.47 11.40 14.65 13.3E 0,00 76.82 StrurtureTone x x x $16,$8s,coo,00 S16,888,000.00 $ 450,000.00 $ 90,000.00 $ 280,000.00 (Lcwcs,P:iccdPra,�esa1/P.np,srr'sP-r:rxao=Price Score 3?.C9 7.40 16.50 16.30 -0.40 76.89 Lee Lewis x x x $16,920,000,00 $16,920,000.00 $ 620,000.00 $ 156,000.00 $ 85,000.00 (Lowes,Pored Prapxal/?raparrr's Price)X 40 Price,Score 37.C2 11.75 17,15 17,35 0.00 33.27 3 Vaughn x x x $17,620,000.00 $w7,620,GG0.L0 $ 669,000.00 $ 222,000.00 $ 76,000.00 (Lower Pricrd PrapasaijPraprr's P!r_e)X 4=Price Score 35.55 11.40 17.10 15.20 a.CG 79.25 Chasco x x x $18,617,500.00 $18,617,$00.00 $ 689,000,00 $ 145,000.00 $ 1133,000.00 riowc:tP-icedFroposaij?ropos.r'sPrice!XMc=Price Score 33.65 0.010. O.00 OAO 0.00 33.65 Selection Committee: Date: CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f1 Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2018-325744 LEE LEWIS CONSTRUCTION, INC AUSTIN,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 03/14/2018 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. TBD CONSTRUCTION OF LUTHER PETERSON SERVICE CENTER 4 Nature of interest Narne 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 UNSWORN DECLARATION (� My name is J ~�-- t�` - and my date of birth is ` L r t,i My address is (street) (city) (state) (zip code) (country) I declare under penalty, t� � pry that the foregoing is true and correct. Executed in ` �" '. '�y County, State off mt- on the day of A64 ,20 15 . ' (month) (year) �'''' Signature of authorized age tracting business entity /moi✓�� 0 I... , ��ti`` (Declarant) Forms provided by �kas)Fnihi& ommission www.ethics.state.tx.us Version V1.0.5523 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. 2018-325744 LEE LEWIS CONSTRUCTION, INC AUSTIN,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 03/14/2018 being filed. CITY OF ROUND ROCK Date Acknowledged: 03/15/2018 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. TBD CONSTRUCTION OF LUTHER PETERSON SERVICE CENTER 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name is and my date of birth is My address is (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of on the day of 20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.5523