Contract - Halff Associates - 9/10/2020STATE OF TEXAS §
COUNTY OF WILLIAMSON §
SUPPLEMENTAL CONTRACT NO.3
TO CONTRACT FOR ENGINEERING SERVICES
FIRM: HALFF ASSOCIATES, INC. ("Engineer")
ADDRESS: 9500 Amberglen Boulevard, Building F, Suite 125, Austin, TX 78729
PROJECT: Chisholm Valley Storm Drain Improvements — Area 3
This Supplemental Contract No. 3 to Contract for Engineering Services is made by and between
the City of Round Rock, Texas, hereinafter called the "City" and Halff Associates, Inc.,
hereinafter called the "Engineer".
WHEREAS, the City and Engineer executed a Contract for Engineering Services, hereinafter
called the "Contract", on the 11 th day of July, 2019 for the Chisholm Valley Storm Drain
Improvements — Area 3 Project in the amount of $131, 5 3 5.00; and
WHEREAS, the City and Engineer executed Supplemental Contract No. 1 on the 7th day of
February, 2020 to modify the provisions for the scope of services and to increase the
compensation by $17,005.00 to a total of $148,540.00; and
WHEREAS, the City and Engineer executed Supplemental Contract No. 2 on the 20th day of
March, 2020 to modify the provisions for the scope of services and to increase the compensation
by $41,360.00 to a total of $189,900.00; and
WHEREAS, it has become necessary to amend the Contract to modify the provisions for the
scope of services and to increase the compensation by $74,630.00 to a total of $264,530.00;
NOW THEREFORE, premises considered, the City and the Engineer agree that said Contract
is amended as follows:
I.
Article 2, Engineering Services and Exhibit B, Engineering Services shall be amended as set
forth in the attached Addendum to Exhibit B. Exhibit C, Work Schedule shall be amended as set
forth in the attached Addendum to Exhibit C .
II.
Article 41, Compensation and Exhibit D, Fee Schedule shall be amended by increasing by
$74,630.00 the maximum amount payable under the Contract for a total of $264,530.00, as
shown by the attached Addendum to Exhibit D.
Supplemental Contract
0199.1928; 00452435
Rev.06/16
84275
R- Z92010-07052-
IN WITNESS WHEREOF, the City and the Engineer have executed this Supplemental
Contract in duplicate,,
Supplemental Contract
0199.1928; 00452435
[signature pages follow]
Rev.06/16
84275
2
HALFF ASSOCIATES, INC.
By: r
C.in�1 � tDirect�roF WuleQ(2eKSources
Date
Supplemental Contract Rev.06/ 1
0199.1928; 00452435 84275
CITY OF RO ND ROCK
By: A IM I
Craig Mo g n, Ma I
r
Date
Supplemental Contract
0199.1928; 00452435
APP OVED AST FORM:
Stepha L. Sheets, City Attorney
Rev.06/16
84275
ADDENDUM TO EXHIBIT B
Engineering Services
1. PROJECT PURPOSE
The purpose of this supplemental to the Chisholm Valley Subdivision — Study Area 3
Improvements is for additional services to provide utility improvements, environmental
permitting, bid phase services, construction phase services within Study Area 3. The utility
improvements will consist of water and sewer improvements on Chisholm Valley Drive, Round
Up Trail and Sagebrush Drive. Additionally, these utility improvements will include new service
connections to replace service connections within in the limits of storm drain improvements. The
storm drain and utility improvements require environmental permitting, which includes an
estimate of Waters of the US near the outfall and TCEQ coordination for WPAP and SCS approval.
In addition, the City has request bid phase and construction support services and is included in this
supplemental.
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Figure 1. Study Area 3 Project Limits
2. SCOPE OF WORK
The scope of work for the services to be provided under this additional work effort request
includes the following tasks based on the task numbering in the original scope:
Chasholm Palley — Stucv Area 3 Flood Mitigation Design
Task 5: 100% Design Phase Submittal
Task 8: Environmental Permitting
Task 9 : Bid Phase Services
Task 10: Construction Administration Services
Task 51: 1QQ% Design Phase Submittal
Upon the Ci*ty"s formal approval of the 60% Preli inary Engineering Design, Halff will proceed with
100% design efforts. The work product will require the improving the wastewater lines on Sagebrush
Drive and the refinement of the utility and storm drain design on Sagebrush Drive including design
plans and opinions of probable cost associated with the proposed improvements.
• Submit conlillent responses and redll*ned plan sheets to CORK for concurrence to
ensure that the 100% plan set fully addresses the city's comments.
• Prepare I I "x 17" 100% design plans for the proposed wasterwater main on Sagebrush
Drive to the intersection with Chisholm Valley Drive.
• 10
Revise storm drain design on Sagebrush Drive to accommodate new wastewater design
and to avoid disturbing the existing curb line.
o Add new plan and profile sheets for Sagebrush Drive based on additional
wastewater limits.
10 0
o Revise plan and profile sheets for Sagebrush Drive based on new utility and
storm drain locations as directed by CORK
o Revise storm drain lateral profile sheets for Sage Brush Drive
• Update engineer's opinion of pro bable cost utilizing the revised design
Task be, Environmental Permitting
801 Wetland Delineation and Jurisdictional Determination of Waters of the United -States and
Permit Avoidance Documentation
Consultant shall perform on -the -ground delineation within the pro40
ject area to identify the limits of
Waters of the United States (WOTUS), including wetlands, as defined in the United States Army
Corps of Engineers (USAGE) "Wetland Delineation Manual, Technical report Y-87-1" and the
"Regional Supplement to the Corps of Engineers Wetland Delineation Manual: Atlantic and Gulf
Coastal Plain Region (Version 2.0) and the 2020 Navigable Waters Protection Rule. A brief
technical memorandum will be prepared documenting the results of the field investigation, and that
the proposed project will be designed to avoid impacts to aquatic resources with the potential to be
regulated as WOTUS by the USAGE. This documentation will be based on the preliminary
jurisdictional opinion of Halff Associates, Inc. and a USAGE Approved Jurisdictional Determination
(AJD) and/or Section 404 permit application is not included in i's scope.
2
802 Cultural Resources Desktop Review and THC Consultation Letter
Halff shall perform a cultural resources literature review/archival research of the proposed project
area including perflo ing preliminary research into historic and recent aerial photography, previously
recorded archaeological or historical sites, and previous cultural resources surveys in or adjacent to
the area to determine the potential for encountering significant cultural resources within thei
project
area. Findings of this nvestigation shall be documented along with letter for submission for
review/concurrence by the Texas Historical Commission (THC).
8e3 TCEO Water Pollution Abatement Plan Permitting
The Engineer shall prepare a Water Pollution Abatement Plan (WPAP) in compliance with the
requirements of Title 30, Texas Administrative Code Chapter 213 related to the Edwards Aquifer.
No new impervious cover is anticipated to be part of the Chisholm Valley Storm Drain Improvements
Project, so no permanent Best Management Practices (BMPs) will be designed or installed. The tasks
that are anticipated include:
• Prepare a Geologic Assessment Request fori*nclusion with the WPAP
• Prepare and finalize a drainage report for inclusion in the WPAP.
• Prepare calculations, plan sheets, and details for temporary BMPs. Provide summary
of all water quality measures for inclusion in the WPAP submission.
• Finalize PS&E plans for inclusion in the WPAP submission.
804 TCEO Organized Sewage Collection System Plan Permitting
The Engineer shall prepare an Organized Sewage Collection System Plan (SCS) in compliance with
the requirements of Title 30, Texas Administrative Code Chapter 213 related to the Edwards Aquifer.
No new impervious cover is anticipated to be part of the Chisholm Valley Storm Drain Improvements
Project, so no permanent Best Management Practices (BMPs) will be designed or installed. The tasks
that are anticipated are:
• Prepare a Geologic Assessment Request for inclusion with the SCS
• Prepare and finalize the SCS Engineering Design Report.
• Prepare calculations, plan sheets, and details for temporary BMPs. Provide summary
of all water quality measures for inclusion in the SCS submission.
• Finalize PS&E plans for inclusion in both the SCS submission.
Deliver-ables0.,
The Engineer shall submit to TCEQ a complete version of both the Wj,''P and SCS consisting
of the following items:
• General Information FoC -0587 including location maps and project
description
10 Is
• The Geologic Assessment Form (TCEQ-0585), including the GA performed by rd
party consultant
• Water Pollution Abatement Plan Application Form (TCEQ-0584), including
information derived from final drainage report
• Organized Sewage Collection System Plan
(TCEQ-0582)
3
• Temporary Sto water Section (TCEQ-0602) including the temporary BMP plan
• Core Data Form (TCEQIIIIIIIIIIIIIIIIII, 10400)
� Geological Exception Request
Exclusions/ASSUMDtions.i
• USACE 404 Nationwide Permit (NW) will not require a Pre-Constructi*on
Notification (PCN)
• Based on conversations with the TCEQ it is assumed that a Geological Assessment
will not be required considering this project does not include any new impervious
cover.
• Halff will not prepare the geologic assessment (GA) required as part of the WPAP
and SCS submission
• Permanent BMP design
• Fees required for WPAP and SCS submission
The SCS and WPAP will be submitted to TCEQ concurrently with the 100% plans and a 60-day
review period is anticipated. Construction i*s prohibited until final approval is received.
Task 9: Bid Phase Services
This phase of the preproposal includes a scope of work to provide bid phase services for an
anticipated 2 months for City procurement.
OR
• Halff will attend a pre -bid meeting to discuss the project with potential bidding
contractors.
• Halff will be available to assist City in responding to questions from contractors. The
City will take the lead in responding to all questions with the Contractor. The basis of
estimate for the associated fee assumes approximately (five) 5 questions.
• Halff will assist City with addenda prenaration. The City willtake the lead on issuing
the agenda. Halff will prepare written description, drawing revision, and design
modification for agenda. The basis of estimate for the associated fee assumes two (2)
addenda.
Task 1Qe:Consl uction Phase Serv40
ices
This proposal includes a scope of work to provide construction phase support services for the
anticipated 10 months for the storm drain repairs.
• Construction Observation - Halff will attend biIIIIIIIIIIIIIIIIII,weekly visits and monthly construction
progress meetings at the site with City and Contractor. The City will lead the meetings and
Halff will respond to questions. The bl*IIIIIIIIIIIIIIIIIIIWeekly visits will be observing the progress and
the quality of work and attempt to determine in general if the work i*s proceeding in
accordance with the Construction Contract Documents. Halff assumes that daily
inspection will be conducted by the assigned City Inspector. This scope assumes 20 site
visits by one person where a maximum often (10) of the site visits will be attended by an
engineer and the remaining by an engineer in training.
• Submittal Reviews — Halff will provide a list of shopd rawings/submittals (Submittals Log)
required to be turned in by the contractor based on the 100% plans and standards. Halff
4
will be responsible for review and approval of all shop drawings or submittals of the project
and will be distributed to Halff by the City. Shop drawings or submittals will be reviewed
for general conformance with the plans and specifications. The City will be the primary
point of contact and will monitor the progress of the contractor in sending and processing
submittals to see that documentation is being processed in accordance with Contractor's
10
schedule. The basis of estimate for the associated fee assumes approximately 15
submittals.
• Response to RFIs — Halff will respond to Contractor Request for Information (RFI),
Engineer will review and respond and design drawings may be modified to address the
issue and new design details will be prepared. This scope assumes 5 RFIs from the
Contractor. The basis of estimate for the associated fee assumes approximately ten (10)
RIFI"s from the contractor with approximately two (2) requiring revisions to the plans.
• Substantial/Final Walkthrough — Halff will conduct, in company with the City and
Contractor, a final review of the Project for conformance with the design concept of the
Project and general compliance with the Construction Contract Documents. Prepare a list
of deficiencies to be corrected by the Contractor before recommendation of final payment.
• Record Drawings —Revise the construction drawings in accordance with the red lines
40
furnished by the City reflecting changes in the Project made during construction. Halff will
provide one (1) pdf set of the "Record Drawings" to the City.
• Engineer's Concurrence Letter - Prepare a letter of concurrence that the construction is
acceptable and has been completed i*n general conformance with the contract documents.
5
ADDENDUM TO EXHIBIT C
Work Schedule
Halff Associated, Inc. (Halff) can collunence work on this project immediately after notice -to -
proceed (NTP) is received from the City of Round Rock.
Halff anticipates completing Work Authorization No. 3 following the most recent project schedule.,
• Task 5: 100% Design Phase Submittal — Aug. 31, 2020 to Oct. 30,2020
• Task 6: QA/QC — Aug. 31, 2020 to Oct. 30, 2020
• Task8'.*Environ ental — Nov. 2, 2020 to Feb. 26, 2021
• Task 94.0 Bid Phase Services — Feb. 1, 2021 to May 3, 2021
• Task 10.,* Construction Phase Services — May 17, 2021 to Mar. 18, 2022
ADDENDUM TO EXHIBIT D
Fee Schedule
Attached Behind This Page
Hourly rates to be billed on a time and materials basis per the following Rate Schedule attached
(behind this page):
*Rates may be amended once between Nov. 1, 2018 and Nov. 1, 2019, not to exceed a 3%increase.
Halff Associates, Inc. Printed 8/11/2020
Chisholm Valley Storm Drain 11-1-vrovements -Area 3
Supplemental Work Authorization #3
Exhibit D
Fee Schedule
Total
Total
Other
TOTALS
Task
LaborHours
LoadedLaborCost
DirectCosts
Subconsultants
Task 1: Project Management
0
$0000
$0000
$0000
$0000
Task 2: Site Data Acquisition
0
$0,000
$0,900
$0000
$0,500
Task 3: Preliminary Engineering Design (30%)
0
$0000
$0000
$0000
$0,00
Task 4: 60% Design Phase Submittal
0
$0,00
$0000
$0000
$0000
Task 5: 100% Design Phase Submittal
186
$27,5154,00
$0000
$0,00
$27951100
Task 6: QA/QC
0
$0,600
$0000
$0000
$0,00
Task 7: Bluebonnet School
0
$0000
$0,800
$0000
$0000
Task 8: Environmental Permitting
153
$22,440e00
$0.800
$0,000
$22944OeOO
Task 9: Bid Phase Services
26
$4929OeOO
$0000
$0000
$49290.00
Task 10: Construction Phase Services
125
$20r385e00
$0000
$0,800
$20,385.00
SUPPLEMENTAL NO.3 TOTAL:
490
$ 741630e00
0
0
$ 74,630.00
SUPPLEMENTAL NO-.2 TOTAL:
269
$ 41,360.00
0
0
$ 41,360e00
SUPPLEMENTAL NO.1 TOTAL:
117
$ 179005e00
0
0
$ 179005e00
ORIGINAL CONTRACT TOTAL:
850
$ 1299360.00
29175
0
$ 131,535.00
REVISED CONTRACT TOTAL:
19726 :1$
2629355.00
- - - ME
29175
0
$ 2649530000
Chisholm Valley Drainage Assessment - Exhibit D Page D1 of 1
Chisholm Valley Storm Drain improvements - Area 3
SUPPLEMENTAL
WORK AUTHORIZATION #3
Fee Summary Details
I. Halff Associates' Direct Labor:
Project Manager
14.0
Hrs. @
$230,00
/Hr.=
$
31220
Senior Engineer (Eng. V)
86.0
Hrs. @
$200400
/Hr.=
$
17200
Mid Engineerg(En. IV)
84.0
Hrs. @
$160,00
/Hr.=
$
13440I
Jr Engineer (Eng. III)
270.0
Hrs. @
$135-00
/Hr.=
$
361450
Jr Environmental Scientist
36.0
Hrs. @
$120.00
/Hr.=
$
4320
Survey/SUE Crew
0.0
Hrs. @
$155,00
/Hr.=
$
-
Survev/SUE Technician
0.0
Hrs. @
$95-00
/Hr.=
$
RPLS
0.0
Hrs. rd)
$175,00
/Hr.=
$
-
Clerical
0.0
Hrs. @
$80,00
/Hr.=
$
-
Total
490,0
Total
=
$
741630
II. Expenses (ODC)
Total
=
$O, 00
III. Assignment Amount
=
$
741630
N
Halff Associates, Inc. Printed 8/11/2020
Direct Labor
Supplemental Work Authorization #3
rhichnlm Vallnv -qtnrm rlrain lmnrnvpmcantc _ Arna
SURVEY/
SURVEY/
PROJECT TASK
SR PE
MID PE
JR PE
MID
SUE
SUE
PM
ENG. V
ENG. IV
ENG. III
ENV
CREW
TECH
RPLS
CLERICAL
TOTAL
Labor Rate
$230,00
$200.00
$160.00
$135.00
$120.00
$155.00
$95 C0
$175 00
$80 00
HOURS BUDGET
Task 1: Project Management
Subtotal Task 1
Task 2: Site Data Acquisition
Subtotal Task 2
Task 3: Preliminary Engineering Design (30%)
Subtotal Task 3
Task 4: 60% Design Phase Submittal
Subtotal Task 4
Task 5: 100% Design Phase Submittal
5.2 Revise drainage design sheets
4
5
10
60
79
$11,620.00
52.1 Revise/Prepare utility design sheets
2
2
4
20
28
$4,200 00
5.2.3 Design new wasterwater line on Sagebrush
2
3
8
50
63
$9,090 00
5 3.1 Develop utility specifications and cost estimate
2
2
$270 00
5 5 Interdisciplinary Coordination/Review
2
2
5
5
14
$2,335.00
Subtotal Task 5
186
$27,515.00
Task 6: QA/QC
Subtotal Task 6
Task 7: Bluebonnet School
Subtotal Task 7
Task 8: Environmental Permitting;
8 1a WOTUS Field Delineation
1
8
9
$1,120 00
8 1b WOTUS Memorandum of findings
2
4
12
18
$2,540,00
8 2a THC Literature Review
1
12
13
$1,670.00
8.2b THC Consultation Letter
1
1
4
6
$870.00
8.3 TCEQ WPAP
4
29
24
57
$8,680 00
84 TCEQ SCS
4
22
24
1 50
$7,560.00
Subtotal Task 8
153
$22,440.00
Task 9: Bid Phase Services
91 Pre -bid meeting
4
4
8
$1,340 00
92 Respond to technical questions (assume 5)
4
4
8
$1,340 00
9 3 Assist with addenda preparation (assume 2)
4
6
10
$1,610.00
Subtotal Task 9
26
$4,290.00
Task 10: Construction Phase Services
10.1 Construction Observation (assume 20)
20
20
40
$6,700.00
10.2 Submittal Reviews (assume 15)
10
15
25
$4,025 00
103 Responses to RFI (assume 10)
10
10
20
$3,350.00
10.4 Substainal/Final Walkthrough
8
8
16
$2,680.00
10 5 Record Drawings
4
16
20
$2,960.00
106 Concurrence Letter
2
2
4
$670 00
Subtotal Task 10
125
$20,385.00
14
86
84
270
36
490
$74,630.00
Halff Associates, Inc Printed 8/11/2020
Other Direct Costs Summary
Reproductions
Price per copy Number of copies Cost
Standard Copies (letter, legal) $0.10 0 11x17 $0.20 0 -
22 "x34"-- Mylar $2.00-- 0 -
Delivery / Courier
Price per trip Number of trip
Courier $15 0 -
1
Traffic Control
Days
Certified Traffic Control $11000 0---
Materials and Supplies
Document preparation: binding, materials, etc. 0.00
Travel outside Round Rock, Austin
Price per mile Miles Cost
Travel @ $0.58 per mile $0.580 0 $0,00
1
Total ODC Cost0
:
$OMOO
Halff Associates, Inc.
Printed 8/11/2020
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
OR
— ---------- --------------------- ------------------- --- NMI ------- - ---------------- . ..... ......
1 of 2
Complete Nos. 1 - 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos, 1, 21 3, 5, and s 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.
2020-661034
Halff Associates, Inc.
Austin, TX. United States
Date Filed:
-- -------------------me governments enft''or state agency that is a party to t e contract for which the orm is ------------ -- ---- -------- --------------------- - - ---------------
---- --------------------- it - -- -----
�8/25/2020
being filed.
City.of Round Rock
Date Acknowledged..
----------- 11.a. wo -- ---------*
-- -------- -------- ----- --
3 Provide the identification number used by the governmental entity or state agency to track or identity the contract, and provide a
description' of the services, goods, -or other property to be provided under the contract.
R.,2019-0289
Imp rovem..............
Engineering Services, Chi---
sholm Valley Storm Drain &U-------
- --tility
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4
--- -----ents ... . .... ------------
- ---------- N0.0
Nloomature of interest
Name of Interested Party
City, State, Country (place of business)
111111111 applicable)
. . .. ............... .
-- ---------- - -- ...... .... ----- -----
........ ..........
.
------------------
. ....(check
Conttollin
Intermedia
.......... ------
Adams , Bobby
Houston, TX United States
X
............. . ------------- ..... . . . wm --------
--------- - - - --------------
Bargainer, Tim
----------------
Austin, TX United States
X -
--------------
. .......... .............
-- --------
---- -- ------------ -------------------
Baker ,Jessica
Richardson, TX United States
......... . ... ..... ..
X
NOWN.
. ............. ............
i 0 -------- ------------------ --- --- - ----
Edwards , Mark
- ---------------
Richardson, TX United States
---------- --- - ------------- --
X
--- ----- ------------- ---- ---
------- .. ............ --------------
Ickert, Andrew
NO
Fort Worth, TX United States
X
Jackson, Todd
Austin, TX United States
X
--------------- ----------------
-- --------- -
Kunz, Pat
---------- ----------
------- -
Richardson, TX United States
--------
_01*0 11111 Mo
----------- - - ---------- W,
X
11 ---------------
. . . .......... ----------- ---- --- ------
Miller, Steven
Austin, TX United States
X
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Moya, Mike
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Austin, TX United States
X
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Murray, Menton
ROM . ......
------------ ------- ---------
McAllen, TX United States
N011M
- -
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- --------------- - - . - -
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---- — - --------------- ---------------
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Sagel, Joseph
..... ------- ------ ------- ---------------
Richardson, TX United States
----- -
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X
------ .
Tanksley, Dan
-------------------------------- ------------------
Richardson, TX United States
X
- -------
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Zapalac, Russell:
- ---- ------------------ .. ... . ... --------------------------------- ......
- ----------
--------------- --------------- - -
- ---------------
Austin, TX United States
X
---- ----- --- --- ------
------ -----
Fo'''rmt provided by Texas Ethics Commission www,,ethics.state.bc.us
Version V 11*.' 3a,6aaf7*d
This Page is too large to OCR
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1 of 2
I- N
Complete Nos,, i - 4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos, 1, 21 31 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. 2020-661034
Halff Associates, 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 08/25/2020
being filed.
City of Round Rock Date Acknowledged:
08/26/2020
g 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.
R-2019-0289
Engineering Services, Chisholm Valley Storm Drain & Utility Improvements
4 Name of Interested PartyCity,State,
Country of business)
Nature of interest
a licable PP
Controlling
Intermediary
Adams ,Bobby
Houston, TX United States
X
Bargainer, Tim
Austin, TX United States
X
Baker ,Jessica
Richardson, TX United States
X
Edwards , Mark
Richardson, TX United States
X
Ickert, Andrew
Fort Worth, TX United States
X
Jackson, Todd
Austin, TX United States
X
Kunz, Pat
Richardson, TX United States
X
Miller, Steven
Austin, TX United States
X
Moya, Mike
Austin, TX United States
X
Murray, Menton
McAllen, TX United States
X
Sagel, Joseph
Richardson, TX United States
X
Tanksley Dan
Richardson, TX United States
X
Zapalac, Russell
Austin, TX United States
X
Forms provided by Texas Ethics Commission www.ethics.state.txus Version Vl,1,3a6aaf7d
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
2of2
Complete Nos, 1 4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos,, i, 21 31 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. 2020-661034
Halff Associates, 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 08/25/2020
being filed.
City of Round Rock Date Acknowledged:
08/26/2020
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.
R-2019-0289
Engineering Services, Chisholm Valley Storm Drain & Utility Improvements
4 Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is ,and my date of birth is
My address is - - I
(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)
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