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Contract - Jimmy Evans Company - 3/22/2018 City of Round Rock, Texas Contract Forms Standard Form of Agreement: Section 00500 Ci• ty of Round Rock, Texas Standard Form of Agreement between Owner and Contractor AGREEMENT made as of the—Natty4 114g.4aday of •1.-- in the year 2A. BETWEEN the Owner: City of Round Rock,Texas(hereafter"Owner"or"City") 221 East Main Street Round Rock,Texas 78664 and the Contractor Jimmy Evans Company ("Contractor") P.O.Box 9749 Austin,TX 78766 The Project is described as: Texas Avenue The Engineer is: John Mutchler,P.E. Aguirre&Fields,LP 12708 Riata Vista Circle,Suite A-109 - ' Austin,Texas, 78727 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 4-2016 Page 1 of 5 Standard Form of Agreement 00307791 2'6[,(D- %111—* L i 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. r-- 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 ninety ( 90 )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 and fifty ( 150 )calendar days from issuance by Owner of Notice to Proceed, subject to 1_. 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 six hundred and ten and No/100 Dollars($610.00 ) 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 and eighty ( 180 )calendar days from issuance by Owner of Notice to Proceed. CJI 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 Five Hundred Seventy Nine Thousand Nine Dollars and Twenty Cents ($579,009.20 ),subject to additions and deductions as provided in the Contract Documents. ll 4.2 Does the Contract Sum include alternates which are described in the Bid Form? No X . Yes .If yes,please provide details below: 00500 4-2016 Page 2 of 5 Standard Form of Agreement 00307791 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, LIand 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. 00500 4-2016 Page 3 of 5 Standard Form of Agreement 00307791 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,as modified. are the "Cityof Round Rock Contract Forms 00700" General Conditions, as 7.1.2 The General Conditions , modified. 7.1.3 The Supplementary, Special,and other Conditions of the Contract are those contained in the Project Manual dated February 2018 7.1.4 The Specifications are those contained in the Project Manual dated February 2018 7.1.5 The Drawings,if any,are those contained in the Project Manual dated February 2018 . 7.1.6 The Insurance&Construction Bond Forms of the Contract are those contained in the Project Manual dated February 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 February 2018 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: Water Polution Abatement Plan 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: Randy Crum, Senior Construction Inspector City of Round Rock Transportation (512)218-6603 rcrum@roundrocktexas.gov 8.3 Contractor's representative is: P', C Z 4,4A May M7 •yaks 4 paw/ Si L- 77 3-Sig 7 d'd4&,4tz, itel/evelms,coM 8.4 Neither Owner's nor Contractor's representative shall be changed without ten(10)days'written notice to the other party. 8.5 Waiver of any breach of this Agreement shall not constitute waiver of any subsequent breach. 00500 4-2016 Page 4 of 5 Standard Form of Agreement 00307791 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. 4-1 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. (Il OWNER CONTRACTOR l«� CITY OF ROU D ROC TE ASif/ - Printed Name: \INI LL Wilta( 1 I l► Printed Name: R.-14,4-- 12(4'«e Z Title 117-6 Title: i f. MA"`^, Date Signed: 4.D0 . 16 Date Signed: 147112 I i ej ATTEST: • c?-1;)13,tuN City Clerk FOR C'I t,APPR VED TO FORM: City Attey 00500 4-2016 Page 5 of 5 Standard Form of Agreement 00307791 PERFORMANCE'1ANCE BOND Bond No.4418996 THE STATE OF TEXAS KNOW ALL BY THESE PRESENTS: CO U N TV OF WILLIAMSON That Jimmy Evans Company of the City of Austin , County of Travis , and State of Texas , as Principal, and Suretec 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 Five Hundred Seventy Nine Thousand Nine and 20/100's Dollars OR 579,009.20 ) for the payment whereof, well and truly to be made the said Principal and Surety hind themselves, and their heirs, administrators, executors, successors and assigns,jointly and severally, by these presents: WHEREAS, the Principal has entered into a certain written Agreement with the Owner dated the _ ►— day of , 2018 to which the Agreement is hereby referred to and made a part hereof s fully and to the same extent as if copied at length ' herein consisting of: Texas Avenue W _ (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 1 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 I i}0610 7-2009 Performance Bond 11009f1(1.56 J 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 12th day of April ,2018 Jimmy Evans Company Suretec Insurance Company Principal Surety Ido ti"a c, 12K David S. Ballew Printed Name Printed Name B y: G-� Title: C' Title: Attorney-In-Fact ' Address: P.O.Box 9749 Address: 1330 Post Oak Blvd., Suite 1100 Austin,Texas 78766 Houston,Texas 77056 Resident Agent of Surety: Signature David S.Ballew Ballew Surety Agency,Inc. ' Printed Name 3802 Manchaca Road Street Address Austin,Texas 78704-6734 ' City, State&Zip Code Page 2 00610 7-2009 Performance Bond 00090656 I n n PAYMENT BOND Bond No. 4418996 THE STATE OF TEXAS KNOW ALL MEN BY THESE PRESENTS: COUNTY OF WILLIAMSON That Jimmy Evans Company of the City of Austin , County of Travis , and State of Texas as Principal, and Suretec Insurance Company authorized under the laws of the State of Texas to act as Surety on Bonds for Principals, arc 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 Five Hundred Seventy Nine Thousand Nine and 20/100's Doll ars (S 579,009.20 ) for the payment whereof, well and truly be made the said Principal and Surety hind themselves and their heirs, administrators, executors, successors, and assigns,jointly and severally, by these presents: WHEREAS, the Principal has entered in o a certain written Agreement with the Owner, dated the 1.1041)k day of IZ4• , 2018 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: Texas Avenue (Name of the Prdject) 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 e tfect. 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. J - oto90656 Page 1. 00620 72009 Payment Bond 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, I— 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 12th day of April ,2018 Jimmy Evans Company Suretec Insurance Company Principal Surety 0.1'1 I. 126i 2 David S. Ballew Printed Name Printed Name By: _ Title: AAs¢- . fir-•- Title: Attorney-In-Fact Address: P.O. Box 9749 Address: 1330 Post Oak Blvd.,Suite 1100 Austin,Texas 78766 Houston,Texas 77056 Resident Agent of Surety: Signature David S.Ballew Ballew Surety Agency,Inc. Printed Name 3802 Manchaca Road Street Address Austin,Texas 78704-6734 Page 2 00620 7-2009 Payment Bond 00000656 r-. Client#: 1195394 JIMMYEVA YYYY) ACORDTM, CERTIFICATE OF LIABILITY INSURANCE 4/18/2018 DATE(MMIDD/DD/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Stefanie Wornell USI Southwest Austin PHONE FAX (A/c,No,Ext):512 451-7555 (A/C,No): 512 467-0113 7600-B N.Capital of TX Hwy#200 E-MAIL SS: stefanie.wornell@usi.com Austin,TX 78731 512 451-7555 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:United Fire&Casualty Company 13021 INSURED INSURER B: 22945 Texas Mutual Insurance Company Jimmy Evans Company, Ltd. INSURER C:Westchester Surplus Lines Insurance Co. 10172 P.O. Box 9749 Austin,TX 78766 INSURER D INSURER E: _ INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP WLIMITS LTR INSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY 85322074 03/31/2018 03/31/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE l XJ OCCUR DAMAGE O(ERENTED occu ence) $300,000 X PD Ded:5,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ COA AUTOMOBILE LIABILITY 85322074 03/31/2018 03/31/2019 (EaMBINED accident)SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NN-OWNED PROPERTY DAMAGE X AUTOS ONLY ��AUOTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR 27306121 03/31/2018 03/31/2019 EACH OCCURRENCE $6,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $6,000,000 DED X RETENTION$O $ B WORKERS COMPENSATION 0001284524 03/31/2018 03/31/2019 X. PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution G27572054004 03/31/2018 03/31/2019 $1,000,000 Ea Condition Liability $1,000,000 Aggregate $10,000 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The General Liability and Auto policies include a blanket automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder,only when there is a written contract that requires such status and only with regard to work performed on behalf of the named insured. 30 days notice of cancellation applies,when required by written contract,with the exception of 10 days notice of cancellation due to nonpayment of premium, per policy form. CERTIFICATE HOLDER CANCELLATION City of Round Rock SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Manager ACCORDANCE WITH THE POLICY PROVISIONS. 221 E.Main Street Round Rock,TX 78664 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. 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A total of 8 bids were received. The bids were opened and read aloud. From low bid to high bid the bids were as follows: 1. Jimmy Evans: $579,009.20 2. Whitestone Civil Construction: $621,420.00 3. Chasco Construction: $658,865.00 4. MA Smith Contracting: $674,495.75 S. Cox Commercial Construction: $712,351.50 6. Jordan Foster Construction: $780,327.00 7. Aaron Concrete Contractors: $906,305.70 8. Patin Construction: $944,244.40 The lowest 3 bidder's submittals were checked for inclusion of the Statement of Bidder's Safety Experience, and inclusion of a bid guarantee. All three submittals contained these items. Aguirre-Fields,LP has checked Jinuny Evans bid tabs and their bid of$579,009.20 has been confirmed. Based on our review I recommend that the City move forward with award of the project to Jimmy Evans. Sincerely, —1 � John R. Mutchler,P.E. Aguirre-Fields, LP 12708 Riata Vista Cir.Suite A-109 9 Austin,Texas 78727•Telephone:512.610.8900•Fax:512.610.8903 9 www.aguirre-fields.com CERTIFICATE OF INTERESTED PARTIES FORM 1295 101`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. 2018-321436 Jimmy Evans Company 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 03/03/2018 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. N/A Construction Services 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Evans,Jimmy Austin,TX United States X .........................._ 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is t>''%A t, C. t"�"�-"q<,^ , and my date of birth is �`Z�1 7 0 My address is b X 67f-7 4 q Ty (stye t) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in %`a V j S County, State of on the 3_day of,r IAr-t ,20t6 (month) (year) Si re of authorized agent of contracting b ess entity (Declarant) Forms provided by Texas Ethics Commission 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. 2018-321436 Jimmy Evans Company 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 03/03/2018 being filed. City of Round Rock Date Acknowledged: 03/12/2018 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. N/A Construction Services 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Evans,Jimmy Austin,TX United States X 5 Check only if there is NO Interested Party. ❑ 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