CM-07-09-204TEXAS WATER DEVELOPMENT BOARD
LOAN/GRANT PARTICIPATION SUMMARY
SRF -373
I. PROJECT INFORMATION
SRF -373
Revised 07/21/06
A. TWDB Project
Number
B. Applicant/Entity Name
C. Contract or
Loan Amount
D. Program Type (insert "X" for all that apply)
61262 City of Round Rock
$ 4,218,317.14
X
Drinking Water SRF (DWSRF)
Clean Water SRF (CWSRF)
Colonia Wastewater (CWTAP)
Project Description:
Raw Water Delivery System - Pumps
Self -Certification
Prime Contractor:
Keystone Construction, Inc.
Solicitation By: X Applicant/Entity 1 Prime Contractor
etc.)
-� Other
Column 1
Name & Address of Contracted
FirmNendor
TWDB Construction Contract
Number:
1
►
II. LIST OF ACTUAL CONTRACTS / PROCUREMENTS
I
N
S
T
U
TColumn
oColumn
N
s
Column 1 Enter the full name, street address, city/state/zip for each firm awarded a contract for the project
Column 2 Enter the procurement category: CONSTRUCTION; SUPPLIES; EQUIPMENT; SERVICES
Column 3 Enter the type of business: SBE; MBE; WBE; SRBA; or OTHER (OTHER
= Non
-SBE, MBE, WBE or SERA)
4 Enter the
5 Enter the
exact amount of the awarded contract
exact date the contract was or will be executed
Self -Certification
Column 6 Enter the certification type
(i.e. state; federal;
NCTRCA; City of Houston;
etc.)
Column 1
Name & Address of Contracted
FirmNendor
Column 2
Procurement
Category
Column 3
Type of
Business
Column 4
Actual Contract
Awarded ($)
Column 5
Contract
Execution Date
Column 6
Type of SMWBE
Certification
Keystone
PO Box
Austin
Construction, Inc.
160938
TX 78716-0938
Construction
OTHER
$4,218,317.14
01/25/07
N/A
I hereby certi5 that all of the firms luted above were contracted to work.on the specified project. I also cergb that I will immediately noti5 the Texas Water
Development Boardif any of the !utedsmall minority, women-ownedorruralfinns are terminated -from the project.
Signature - Authorized Representative
Title
Date
\Q)Nk\(--—
City Manager
9 – q .– CI
III. TWDB APPROVAL SIGNATURES
OPFCA Engineer
Approval Date
SMWBE Coordinator
Approval Date
cA\\-(ur 1- 1- .)t-: -
BLUE SHEET FORMAT
DATE: September 7, 2007
SUBJECT: City Manager Approval- September 14, 2007
ITEM: Action authorizing the City Manager to sign the TWDB Loan/Grant
Participation Summary (SRF -373).
Department: Finance
Staff Person: Cindy Demers, Finance Director
Justification:
This form must be signed and submitted to the TWDB. This form meets the
requirements of the TWDB loan and is required for notice to proceed with
construction.
Funding:
Cost: N/A
Source of funds: N/A
Outside Resources: N/A
Background Information: Council designated the City Manager as the
Authorized Representative for the TWDB
DWSRF loan application and all forms to be
submitted to TWDB.
Public Comment: N/A
Blue Sheet Format
Updated 01/20/04