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CM-12-04-069Cio_jZ_ocr—btRECEIVED APR 112012 City Manager Approval Form Item Caption: Consider executing CDBG Home Repair Contracts with Homeowner and Contractor Approval Date: April 6, 2012 Department Name: Finance Department Project Manager: Elizabeth Alvarado Assigned Attorney: Jason Rammel Item Summary: The Home Repair Program assists low-income homeowners with substantial repairs such as roofing, plumbing and electrical work. The program provides grants of up to $25,000 in order to improve home safety and bring substandard properties into code compliance. The program does not address cosmetic improvements. Consider the execution of a Community Development Block Grant Home Repair Program Homeowner Agreement and Contractor Agreement for 1404 Larchwood Cove in the amount of $15,550. The contractor will be paid directly from CDBG funds. Work to be done at this property includes replacement of roof, windows, water heater, HVAC system and plumbing and electrical upgrades. No. of Originals Submitted: 4 Project Name: Single Family Rehab -Home RepairProgram Cost: $15,550 Source of Funds: CDBG HUD Entitlement Grants Source of Funds (if applicable): Select Source Fund Account Number: Finance Director Approval: S. Carter for Cheryl Delaney Date: 04/11/2012 Department Director Approval: S. Carter for Cheryl Delaney Date: 04/11/2012 **Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. ** CIP ❑ Budget N/A OK ❑� ❑ N/A OK Purchasing ri Accounting ❑ 111 N/A OK N/A OK ITEMS WILL NOT BE PLACED ON THE COUNCIL OR CM AGENDA W/OUT PRIOR FINANCE AND/OR LEGAL APPROVAL REV. 6/20/11 COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) - COMMUNITY HOUSING REPAIR AND REHABILITATION HOMEOWNER AGREEMENT This CDBG Commum Housing Repair and Rehabilitation Homeowner Agreement ("Agreement"), is made this 19'` day of P pteiI , 201'21 between the CITY OF ROUND ROCK, Texas, 221 East Main Street, Round Rock, Texas ("CITY"), and Eva Hernandez and Rosalio Rodriguez whose address is 1404 Larchwood Cove, Round Rock, Texas 78664 ("HOMEOWNER," whether one or more). RECITALS WHEREAS, the CITY has been awarded grant funds to be spent by the CITY for the provision of certain services authorized under the U.S. Department of Housing and Urban Development (HUD) Community Development Block Grant (CDBG) Program; and WHEREAS, CITY wishes to assist qualified homeowners in the minor rehabilitation of their residences by providing funds to pay a contractor for labor, materials and equipment to be utilized in the rehabilitation; and WHEREAS, HOMEOWNER has qualified for the rehabilitation of that property located at 1404 Larchwood, Round Rock, Texas 78664 (the "Property"), as specified in the Work Write -Up Bid Document, attached hereto and incorporated herein as Exhibit "A". Now therefore, for and in consideration of the mutual promises and covenants set forth herein, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the CITY and HOMEOWNER agree as follows: 1.1 ARTICLE 1 GENERAL OBLIGATIONS CITY will pay a contractor ("Contractor"), by separate agreement attached hereto and incorporated herein as Exhibit "B" ("Contractor's Agreement"), $15,550.00, ("Contract Price") for labor, materials and equipment utilized in the rehabilitation of the Property, as specified in the Work Write -Up Bid Document. Funds will not be used to pay HOMEOWNER or members of his/her family. 1.2 HOMEOWNER understands and agrees that the funds provided will be paid directly to the Contractor upon completion of the rehabilitation of the Property, as provided in the Contractor's Agreement. 246765.doc/jmr 1 1.3 HOMEOWNER expressly agrees that no material changes or alterations in the Work Write -Up Bid Document or Contract Price provided above will be made pursuant to a HOMEOWNER request unless requested in writing by HOMEOWNER and approved pursuant to a written change order submitted to and authorized by the CITY in conformance with the Contractor's Agreement. 1.4 HOMEOWNER shall grant Contractor reasonable access to the Property during rehabilitation activities. HOMEOWNER shall not interfere with, or attempt to direct, the activities of the Contractor in the performance of Contractor's obligations under the Contractor's Agreement, provided however, HOMEOWNER may respond to questions from the Contractor, including but not limited to questions regarding HOMEOWNER preferences. HOMEOWNER agrees and acknowledges that Contractor has no obligation to respond to any direction or complaints from HOMEOWNER regarding performance of Contractor's obligations under the Contractor's Agreement. If HOMEOWNER discovers or believes that Contractor is not properly performing Contractor's obligations under the Contractor's Agreement, HOMEOWNER shall immediately notify CITY of such improper performance. 1.5 HOMEOWNER understands and agrees that CITY and Contractor may alter or amend the Contractor's Agreement by a change order or otherwise, including altering the scope of the work to be performed under the Contractor's Agreement without the consent of the HOMEOWNER if such alteration or amendment is necessary to accomplish the purposes of this Agreement or the Contractor's Agreement, or to comply with applicable laws, ordinances, rules or regulations. ARTICLE 2 HOMEOWNER'S REPRESENTATIONS 2.1 HOMEOWNER has qualified for a grant under the Low to Moderate Income guidelines as set forth in Section 8, Income Limits established and amended annually by HUD, attached hereto and incorporated herein as Exhibit "C". 2.2 HOMEOWNER has resided in and been the owner(s) of the residence to be rehabilitated for at least one (1) year prior to the submission of his/her application. 2.3 All property taxes on the Property, including City, County and School District taxes, and all mortgage payments for the Property are current. 2.4 HOMEOWNER has fee simple title to the Property. The Property is not under a Contract for Deed, or any similar purchase agreement, in which HOMEOWNER does not obtain legal title until final payment is made. 2.5 HOMEOWNER has not received HUD Program assistance for the preceding three (3) years. 2 2.6 HOMEOWNER understands and agrees that the work performed by Contractor will be inspected by the CITY or its designee before any funds are paid out and the rehabilitation is completed. 2.7 HOMEOWNER has read the Work Write Up Bid Document and understands the scope of the work to be performed under such Work Write Up Bid Document and agrees that such work may be performed on the Property, as indicated by the HOMEOWNER'S initialing of each page of the Work Write Up Bid Document. ARTICLE 3 OTHER PROGRAM REQUIREMENTS 3.1 DISCRIMINATION. HOMEOWNER will not exclude any person from participation in, deny the benefits of, or subject the person to discrimination under any of the Contractor's activities while receiving federal financial assistance on the grounds of race, color, religion, sex, national origin, age or disability. 3.2 INTEREST OF MEMBERS, OFFICERS, EMPLOYEES OF PUBLIC BODY, MEMBERS OF LOCAL GOVERNING BODY, OR OTHER PUBLIC OFFICIALS. No member, officer, or employee of CITY, or its designees or agents, no member of the City Council, and no other public official of CITY during his/her tenure or for one (1) year thereafter, will have any interest, direct or indirect, in any contract or subcontract, or the proceeds thereof, for work to be performed in connection with the program assisted under this Agreement. 3.3 PROHIBITION OF BONUS OR COMMISSION. The assistance provided under this Agreement will not be used in payment of any bonus or commission for the purpose of obtaining CITY approval of the application for such assistance. 3.4 STATUTE OF LIMITATIONS. As between the parties to this Agreement, as to all acts or failures to act by either party to this Agreement, any applicable statute of limitations will commence to run and any alleged cause of action will be deemed to have accrued in any and all events when the party commencing said cause of action knew or should have known of the existence of the subject act(s) or failure(s) to act. 3.5 INDEMNIFICATION. HOMEOWNER will defend, indemnify, and hold CITY, its successors, assigns, officers, employees and elected officials harmless from and against all suits, actions, legal proceedings, claims, demands, damages, costs, expenses, attorney's fees, and any and all other costs or fees arising out of, or incident to, concerning or resulting from this Agreement, no matter how, or to whom, such loss may occur. Nothing herein will be deemed to limit the rights of CITY or HOMEOWNER (including, but not limited to the right to seek contribution) against any third party who may be liable for an indemnified claim. 3 3.6 RELATIONSHIP OF PARTIES. Nothing contained herein, either explicitly or implicitly, shall be deemed or construed to make the CITY the agent, servant, or employee of the HOMEOWNER, or to create any partnership, joint venture, or other association between the CITY and the HOMEOWNER. Alternatively, nothing contained herein, either explicitly or implicitly, shall be deemed or construed to make the HOMEOWNER the agent, servant, or employee of the CITY, or to create any partnership, joint venture, or other association between the HOMEOWNER and the CITY. 3.7 TERMS. All references in this Agreement to any particular gender are for convenience only and will be construed and interpreted to be of the appropriate gender. For the purposes of this Agreement the term "will" is mandatory. 3.8 SEVERABILITY. Should any provision in this Agreement be found or deemed to be invalid, this Agreement will be construed as not containing such provision, and all other provisions which are otherwise lawful will remain in full force and effect, and to this end the provisions of this Agreement are declared to be severable. 3.9 PUBLIC INFORMATION ACT. The City of Round Rock is governed by the Texas Public Information Act, Chapter 552 of the Texas Government Code. This Agreement and all written information generated under this Agreement may be subject to release under this Act. 3.10 ENTIRE AGREEMENT. This Agreement constitutes the entire agreement between the CITY and the HOMEOWNER. No oral agreements are in effect pertaining to this Agreement. Any changes or modifications to this Agreement must be made in writing with the consent of both parties. ARTICLE 4 SUSPENSION AND TERMINATION 4.1 If HOMEOWNER fails to fulfill in a timely and proper manner its obligations under this Agreement, or violates any of the terms or conditions of this Agreement, then HOMEOWNER will have ten (10) days from the date it receives written notice from CITY directing it to cure or correct the defects or failures to comply. If HOMEOWNER fails to make corrections as directed by CITY, then CITY may terminate this Agreement immediately. If a breach of this contract by HOMEOWNER results in a violation of federal law or regulation for which CITY receives a demand of reimbursement of grant funds from HUD or its successor, CITY may recover from HOMEOWNER the amount sought by HUD for reimbursement, up to the full amount of the award. 4.2 HOMEOWNER will not be relieved of the liability to the CITY for damages sustained by CITY by virtue of any breach of this Agreement by HOMEOWNER. 4 4.3 If CITY becomes aware of any HOMEOWNER activity which could jeopardize CITY's position with HUD and cause CITY to return CDBG funds or other federal funds received by CITY, CITY may take appropriate action, including injunctive relief against HOMEOWNER, to terminate or prevent the activity. Failure of CITY to exercise this right will not constitute a waiver by CITY of its right to demand payment or to seek any other relief in law or in equity to which it may be entitled. ARTICLE 5 ATTORNEY'S FEES 5.1 Any party to this Agreement who prevails in any legal proceedings between the parties regarding this Agreement will be entitled to recover court costs and reasonable attorney's fees from the non -prevailing party. ARTICLE 6 VENUE AND REMEDIES 6.1 This Agreement is governed by the laws of the State of Texas. Exclusive venue for any dispute arising under this Agreement is in Williamson County, Texas. ARTICLE 7 SUCCESSORS AND ASSIGNS 7.1 CITY and HOMEOWNER, respectively, bind themselves, their successors, assigns and legal representatives to the other party to this Agreement and to the successors, assigns and legal representatives of the other party with respect to all covenants of this Agreement. Neither CITY nor HOMEOWNER will assign, sublet, or transfer any interest in this Agreement without the written consent of the other; provided however, that CITY may assign the Contractor's Agreement without the consent of HOMEOWNER. This Agreement is effective as of the date first written above. (Signatures on the following page.) 5 HOMEOWNER: Rp 9 //r , fr ()e Printed Name EviA EAKI AN c�f� £JA IA Eli N A N h 62— Printed Name 6 CITY: S-fP�V2 W vw o Printed Name (vu„' l 1' v Exterior 4 W . O Nc O -+a O Remove and replace exterior window trim. Seal and paint, two coats to match. Remove all existing windows and replace with new, energy efficent, double pane windows. Caulk and seal. PATIO ROOF DECK REPLACEMENT Remove roof on back patio, redeck and roll roofing. 4x4 support posts to be brought back 18" to support ceiling beams correctly, Install base hangers at concrete. ENTIRE ROOF REPLACEMENT Remove roof shingles. Remove existing tar paper or roofing felt. Replace with 15 pound tar paper and roof shingles with like shingle and color providing 20 year warranty. Remove and replace drip molding around roof. DESCRIPTION COMMENTS id make comments, if needed, in the s s ace • rovidec Co'` c i CJ' co t,- Tl UNIT PRICE w %- `14 a 1 ...., Oe _ \ C ` tC. 1. EXTENSION N CD ID O CD N O Q. CD 0 5. a rz C. C CD 3 ac X.L 1)100N punoN eanpu6ig Jo}oeawo3 moo poomtioJei i piI. eweN Joioe.4uo0 EXHIBIT k 0 ✓ • 0 O 4 rn-n S -uo m c3CO 7J 71 • 0 N 0 m NI Abl3A1-130 TOTAL Interior 6 > 01 S. 0 -, Interior 4 > w k g 5 t,) 0' = o Exterior 6 W cn m ° b E' - Replace entry hallway GFCI. Plugs not sticking. Remove existing garbage disposal and replace with standard disposal. Install GFCI receptacles in hall bathroom, kitchen and garage per code. Remove master tub, repair drain, install new fiberglass surround unit. Repair and replace drywall and tile if needed. Remove and replace HVAC system to code with minimum rating 14 SEER. 3/4" line required through ceiling insulated and boxed. Remove and replace water heater with pan and pan drain. Replace garage door trim at wood rot. Paint to match, two coats. Remove and replace front door with like type. Reuse existing hardware. Home owner to approve door. Installation to include weather stripping. Paint, two coats to match. DESCRIPTION i COMMENTS 1{f{! c D_.i 2 1 LI O c Z n m m a ru. A v 1 ,w ti d, a 1 a 1 z z 0 0 a O 0 O �mOn 5m0 cn. c D 3p W 7J p O N O 2 m COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) - COMMUNITY HOUSING REPAIR AND REHABILITATION PROGRAM CONTRACTOR AGREEMENT This CDBG Community Housing Re air and Rehabilitation Program Contractor Agreement ("Agreement"), is made this ) 40' day of P1 1 , 20 t2, between the CITY OF ROUND ROCK, Texas, 221 East Main Street, Round Roc , Texas 78664 ("CITY"), and Mario L. Carlin Management, LLC, P.O. Box 6087, Round Rock, Texas 78683.("CONTRACTOR"). RECITALS WHEREAS, CITY has been awarded grant funds which may be spent by CITY for the provision of certain services authorized under the U.S. Department of Housing and Urban Development ("HUD") Community Development Block Grant ("CDBG") Program; and WHEREAS, CITY wishes to assist qualified homeowners in the minor rehabilitation of their residence by providing a non-interest bearing loan to pay CONTRACTOR for labor, materials and equipment to be utilized in the rehabilitation; and WHEREAS, CITY will pay CONTRACTOR for labor, materials and equipment to be utilized in the rehabilitation of the property located at 1404 Larchwood Cove, Round Rock, Texas 78664 (the "Property"), as specified in the Work -Write Up Bid Document, attached hereto and incorporated herein as Exhibit "A". Now therefore, for and in consideration of the mutual promises and covenants set forth herein, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, CITY and CONTRACTOR agree as follows: ARTICLE 1 GENERAL REQUIREMENTS 1.1 CITY will pay CONTRACTOR $15,550.00 ("Contract Amount"). Funds will not be used to pay the homeowner or members of its family. 1.2 CITY will pay CONTRACTOR for work in accordance with CITY'S Prompt Payment Policy for all work described in the Work -Write Up Bid Document only after all of such work is found to be satisfactorily completed and inspected by the CITY or its designee. 1.3 CONTRACTOR will not deviate from the work described in the Work -Write Up Bid Document without a change order from CITY. Any such change order shall be an amendment to this Agreement. The total amount of any and all change orders shall not exceed twenty-five (25) percent of the original Contract Amount. 246657.doc/jr rim- 1, -h(4-() 91 EXHIBIT 1.4 All work specified in the Work -Write Up Bid Document will be satisfactorily completed within ninety (90) days from the date of the Notice to Proceed. 1.5 CONTRACTOR will assign to the CITY all mechanic's lien notes and mechanic's lien contracts on the Property held by CONTRACTOR. 1.6 Work -Write Up Bid Document line item deletions: None ARTICLE 2 CONTRACTOR'S RESPONSIBILITIES 2.1 CONTRACTOR will ensure that all work performed under this Agreement is permitted and inspected by CITY's Building Inspection Division. CONTRACTOR agrees to be duly licensed under CITY ordinances and State laws and be responsible for obtaining the building permit. 2.2 CONTRACTOR understands and agrees that it is solely responsible for meeting the terms and conditions of this Agreement. If CONTRACTOR fails to properly perform or complete any of the work specified in the Work -Write Up Bid Document, CONTRACTOR will not receive funding for any work that is found to be improperly performed or incomplete. 2.3 CONTRACTOR understands and agrees that all work described in the Work -Write Up Bid Document with the exception of line items deleted under Section 1.6 must be completed before any funds will be paid out. 2.4 CONTRACTOR understands and agrees that the job will be inspected by the CITY or its designee before any funds will be paid out. 2.5 CITY will provide a Notice to Proceed to CONTRACTOR to commence work. CONTRACTOR agrees to start work within thirty (30) calendar days after receipt of the Notice to Proceed. If CONTRACTOR fails to commence work within thirty (30) days from the date on the Notice to Proceed, CITY will have the right to terminate this Agreement, by providing a written notice of termination to CONTRACTOR. 2.6 CONTRACTOR agrees to complete the work within ninety (90) days from the date of the Notice to Proceed. If completion is delayed for reasons beyond the CONTRACTOR's control, CONTRACTOR will provide timely notice to CITY of the reasons for such delay. If such good cause is claimed by CONTRACTOR, it will be CONTRACTOR'S obligation to substantiate its claim by adequate documentation. 2.7 CONTRACTOR affirms that it has not been debarred from performing federal contract work. 2 2.8 During the term of this Agreement, CONTRACTOR shall not enter into a contract with the owner of the Property or act upon the request of the owner of the Property to perform any work other than that work described in the Work Write -Up Bid Document or in a change order from the CITY. ARTICLE 3 OTHER PROGRAM REQUIREMENTS 3.1 PERMITS AND CODES. CONTRACTOR agrees to secure and pay for all necessary permits and licenses required for CONTRACTOR'S performance and to adhere to applicable local codes and requirements whether or not covered by the Work -Write Up Bid Document, including any CONTRACTOR registration requirements. 3.2 DISCRIMINATION. CONTRACTOR will not exclude any person from participation in, deny the benefits of or subject the person to discrimination under any of the CONTRACTOR's activities while receiving federal financial assistance on the grounds of race, color, religion, sex, national origin, age or disability. 3.3 WARRANTY. CONTRACTOR agrees to provide a full one-year warranty to the homeowner, said warranty will extend to subsequent owners of the property to be improved. The warranty will provide that improvements, hardware, and fixtures of whatever kind or nature installed or constructed on said property by the CONTRACTOR are of good quality and free from defects in workmanship or materials or deficiencies subject to the warranty provided in this paragraph. CONTRACTOR and CITY agree, however, that the warranty set forth in this paragraph will apply only to such deficiencies and defects as to which homeowner or subsequent owners will have given written notice by certified mail to the CONTRACTOR, at its principal place of business, within one (1) year from the date of the final inspection and acceptance by the City Inspector that all work under the Agreement has been completed. 3.4 BID. CONTRACTOR acknowledges that it has prepared the CONTRACTOR'S Work - Write Up Bid Document, attached hereto and incorporated herein as Exhibit "A" and that such Bid is accurate and consistent as to the name of CONTRACTOR, scope of work that the CONTRACTOR will under -take, and price. CONTRACTOR acknowledges the performance requirement established in the write up and warrants that all work undertaken will conform to said specifications. 3.5 REMOVAL OF DEBRIS. Upon completion of work CONTRACTOR agrees to remove all construction debris and surplus material from the Property and leave the Property in a neat and clean condition. 3.6 SUBCONTRACTORS. CONTRACTOR agrees that all the warranties contained herein will apply to all work performed under this Agreement, including that performed by any Subcontractors. 3.7 FRAUDULENT ACTS. CONTRACTOR nor any of its officers, partners, owners, agents, representatives, employees, subcontractors or parties in interest has in any way colluded, conspired, connived or agreed, directly or indirectly with any other bidder, 3 firm, or person to submit a collusive or sham bid in connection with CONTRACTOR for which the bid has been submitted or to refrain from bidding in connection with this Agreement, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other bidder, firm, or person to fix any overhead, profit, or cost element of the bid price or the bid price of any other bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement, any advantage against CITY or any person interested in this Agreement; and the price or prices quoted are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of CONTRACTOR or any of its agents, representatives, owners, employees, or parties in interest. 3.8 INTEREST OF MEMBERS, OFFICERS, EMPLOYEES OF PUBLIC BODY, MEMBERS OF LOCAL GOVERNING BODY, OR OTHER PUBLIC OFFICIALS. No member, officer, or employee of CITY, or its designees or agents, no member of the City Council, and no other public official of CITY during his/her tenure or for one (1) year thereafter, will have any interest, direct or indirect, in any contract or subcontract, or the proceeds thereof, for work to be performed in connection with the program assisted under this Agreement. 3.9 PROHIBITION OF BONUS OR COMMISSION. The assistance provided under this Agreement will not be used in payment of any bonus or commission for the purpose of obtaining CITY approval of the application for such assistance. 3.10 STATUTE OF LIMITATIONS. As between the parties to this Agreement, as to all acts or failures to act by either party to this Agreement, any applicable statute of limitations will commence to run and any alleged cause of action will be deemed to have accrued in any and all events when the party commencing said cause of action knew or should have known of the existence of the subject act(s) or failure(s) to act. 3.11 INDEMNIFICATION. CONTRACTOR will defend, indemnify, and hold CITY, its successors, assigns, officers, employees and elected officials harmless from and against all suits, actions, legal 'proceedings, claims, demands, damages, costs, expenses, attorney's fees, and any and all other costs or fees arising out of, or incident to, concerning or resulting from the fault of CONTRACTOR, or CONTRACTOR's agents, employees or subcontractors, in the performance of CONTRACTOR's obligations under this Agreement, no matter how, or to whom, such loss may occur. Nothing herein will be deemed to limit the rights of CITY or CONTRACTOR (including, but not limited to the right to seek contribution) against any third party who may be liable for an indemnified claim. 3.12 CHANGE ORDERS. CONTRACTOR expressly agrees that no material changes or alterations in the Work -Write Up Bid Document or price provided above will be made unless in writing, mutually agreed by the homeowner, CONTRACTOR and authorized by CITY. 4 3.13 TERMS. All references in this Agreement to any particular gender are for convenience only and will be construed and interpreted to be of the appropriate gender. For the purposes of this Agreement the term "will" is mandatory. 3.14 SEVERABILITY. Should any provision in this Agreement be found or deemed to be invalid, this Agreement will be construed as not containing such provision, and all other provisions which are otherwise lawful will remain in full force and effect, and to this end the provisions of this Agreement are declared to be severable. 3.15 PUBLIC INFORMATION ACT. The CITY is governed by the Texas Public Information Act, Chapter 552 of the Texas Government Code. This Agreement and all written information generated under this Agreement may be subject to release under this Act. 3.16 PERFORMANCE. In performing this Agreement, CONTRACTOR will comply with all local, state and federal laws. 3.17 LIEN WAIVERS. CONTRACTOR agrees to protect, defend, and indemnify homeowner and CITY from any claims for unpaid work, labor, or materials with respect to CONTRACTOR'S performance. Final payment will not be paid until the CONTRACTOR has delivered to CITY complete release of all liens for work completed arising out of CONTRACTOR'S performance or a receipt in full, covering all labor and materials for which a lien could be filed or a bond satisfactory to the homeowner and CITY indemnifying him against any lien. 3.18 REPORTING REQUIREMENTS. CONTRACTOR agrees to submit a W9 Form, attached hereto and incorporated herein as Exhibit "B" to fulfill reporting requirements with the Internal Revenue Service. ARTICLE 4 SUSPENSION AND TERMINATION 4.1 If CONTRACTOR fails to fulfill in a timely and proper manner its obligations under this Agreement, or violates any of the terms or conditions of this Agreement, then the CONTRACTOR will have ten (10) days from the date it receives written notice from CITY directing it to cure or correct the defects. If CONTRACTOR fails to cure or correct the defects, CITY will have the right to terminate this Agreement and to select a substitute CONTRACTOR. If the expense of fmishing the work exceeds the amount of this Agreement, CONTRACTOR will pay the difference to CITY. Should CONTRACTOR fail to make corrections as directed by CITY, and such breach of contract results in a violation of federal law or regulation for which CITY receives a demand of reimbursement of grant funds from HUD or its successor, CITY may terminate this Agreement immediately, and may recover from CONTRACTOR the amount sought by HUD for reimbursement, up to the full amount of funds CONTRACTOR received from CITY. 5 4.2 CONTRACTOR will not be relieved of the liability to CITY for damages sustained by the CITY by virtue of any breach of this Agreement by CONTRACTOR. CITY may withhold payment to CONTRACTOR until the amount of monetary damages due CITY from CONTRACTOR is determined. 4.3 If CITY becomes aware of any CONTRACTOR activity which could jeopardize CITY's position with HUD and cause CITY to return CDBG funds or other federal funds received by CITY, CITY may take appropriate action, including injunctive relief against CONTRACTOR, to terminate or prevent the activity. Failure of CITY to exercise this right will not constitute a waiver by CITY of its right to demand payment or to seek any other relief in law or in equity to which it may be entitled. ARTICLE 5 PAYMENTS 5.1 For work completed by CONTRACTOR, as described in the Work -Write Up Bid Document, CITY agrees to pay CONTRACTOR the Contract Amount after all of such work is found to be satisfactorily completed and is inspected by the Construction Advisor and CITY Inspector, in accordance with the CITY'S Prompt Payment Policy. ARTICLE 6 ATTORNEY'S FEES 6.1 Any party to this Agreement who prevails in any legal proceedings between the parties regarding this Agreement will be entitled to recover court costs and reasonable attorney's fees from the non -prevailing party. ARTICLE 7 VENUE AND REMEDIES 7.1 This Agreement is governed by the laws of the State of Texas. Exclusive venue for any dispute arising under this Agreement is in Williamson County, Texas. ARTICLE 8 SUCCESSORS AND ASSIGNS 8.1 CITY and CONTRACTOR, respectively, bind themselves, their successors, assigns and legal representatives to the other party to this Agreement and to the successors, assigns and legal representatives of the other party with respect to all covenants of this Agreement. Except for CONTRACTOR'S assignment of mechanic's lien contracts and mechanic's lien notes to the CITY pursuant to Paragraph 1.7, neither CITY nor CONTRACTOR will assign, sublet, or transfer any interest in this Agreement without the written consent of the other. 6 ARTICLE 9 ENUMERATION OF CONTRACT DOCUMENTS 9.1 This Agreement represents the entire and integrated agreement between CITY and CONTRACTOR for the work specified in Exhibit "A" and supersedes all prior negotiations, representations or arguments either written or oral. This Agreement may be amended only by written instrument signed by CITY and CONTRACTOR. The Agreement contains the following exhibits attached to and incorporated in this Agreement for all purposes: (1) Work -Write Up Bid Document (Exhibit "A"); (2) W9 Form (Exhibit "B"). This Agreement is effective as of the date first written above. CITY: By: Printed Name: Title: Date: CONTRACTOR: MARIO L. CARLIN MANAGEMENT LLC By: Printed Name: Title: Date: 7 A R s W W o N' o -� R s D 1 Remove and replace exterior window trim. Seal and paint, two coats to match. Remove all existing windows and replace with new, energy efficent, double pane windows. Caulk and seal. PATIO ROOF DECK REPLACEMENT Remove roof on back patio, redeck and roll roofing. 4x4 support posts to be brought back 18" to support ceiling= beams correctly. Install base hangers at concrete. ENTIRE ROOF REPLACEMENT Remove roof shingles. Remove existing tar paper or roofing felt. Replace with 15 pound tar paper and roof, shingles with like shingle and color providing 20 year warranty. Remove and replace drip molding around roof. DESCRIPTION 3 co N C -s tD 3 co m co COMMENTS m to O 2 3 so a m a m 0 9 i. c til a C -< G c o z 1 a c c z -1 UNIT PRICE I w ai \ 10 .:0 o 1 %�, o •N ,mac t EXTENSION I Xl r* N CD C N ' i7 N iT co 3 rs tr a a C▪ D 3 0 FA 1)I00 punoN an00 POOMIIOJE1 t'OIII• 0 0 0 Z m 3 0 v 03 0 �m-n NCO m n z 00 XI 0 0 m N 0 va_W C 0 mZm o011 -4 ' 0 N"4°) NI AbI3A1130 TOTAL rn9, 0 Interior I 5 Interior 4 Interior 3 No 1 �o Exterior 6 • rn '• Replace entry hallway GFCI. Plugs not sticking. Remove existing garbage disposal and replace with standard disposal. Install GFCI receptacles in hall bathroom, kitchen and garage per code. Remove and replace HVAC system to code with minimum rating 14 SEER. 3/4" line required through ceiling insulated and boxed. Remove master tub, repair drain, install new fiberglass surround unit. Repair and replace drywall and tile if needed. Removeand replace water heater with pan and pan drain. Replace garage door trim at wood rot. Paint to match, two coats. Remove and replace front door with like type. Reuse existing hardware. Home owner to approve door. Installation to • include weather stripping. Paint, two coats to match. DESCRIPTION COMMENTS QUANTITY a 1 O Z i m a o . `h' J 0 y 0 0 a 0-< �m'i Smo 0 Wxs 00 v0 m 0 0 m>� -I= 0 m Z m •• z 0m N D N-4 no Cft SUBSTITUTE W-9 FORM CITY OF ROUND ROCK, TEXAS 221 EAST MAIN STREET, ROUND ROCK, TEXAS 78664 Pursuant to Internal Revenue Service Regulations, we ask that you furnish the City of Round Rock with your Taxpayer Number (TIN). If this number is not provided, IRS regulations require us to subject you to a 20% withholding on each payment. To avoid this withholding and to ensure that accurate tax information is reported to the Internal Revenue Service, we would appreciate your cooperation in providing us with the information requested below. Please contact the City of Round Rock Purchasing Division at (512) 218-7069 if you have any questions or problems with this request. Thank you for your assistance in this matter. BUSINESS ENTITY: (please check only one): Individual Partnership Sole Proprietorship Estate/Trust Corporation Public Service Corporation Other Governmental /Non-profit Individual: List name as shown on your social security card and your social security number. (Also Partnerships) Sole Proprietorship: List owner's legal name, followed by the legal business name and list the owner's social security number. All Others: List the legal name of your corporation, partnership, organization, or other legal entity and list your Employer Identification Number. LEGAL BUSINESS NAME: Remit To Address: Email address: ENTER YOUR NINE (9) DIGIT TAXPAYER IDENTIFICATION (TIN) BELOW: Social Security Number: Federal Employer Identification Number: UNDER PENALTIES OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, I DECLARE THAT THIS FORM HAS BEEN COMPLETED FULLY AND ACCURATELY. NAME (PRINT OR TYPE) SIGNATURE: PHONE #: TITLE (PRINT OR TYPE) DATE: FAX #: THIS AREA TO BE FILLED IN BY CITY OF ROUND ROCK FINANCE DEPARTMENT ASSIGNED VENDOR #: ASSIGNED BY: Revised 09/12/06 * ub. W9 FORM EXHIBIT EXHIBIT "C" INCOME LIMITS MAXIMUM INCOME CHART Household Size Maximum Income (80% of the Area Median) 1 person $42,500 2 persons $48,600 3 persons $54,650 4 persons $60,700 5 persons $65,600 6 persons $70,450 7 persons $75,300 8 persons $80,150 Source: U.S. Department of Housing & Urban Development. These income figures are subject to change annually. Effective December 8, 2011 9 COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) - COMMUNITY HOUSING REPAIR AND REHABILITATION PROGRAM CONTRACTOR AGREEMENT This CDBG Community Housing Repair and Rehabilitation Program Contractor Agreement ("Agreement"), is made this R t day of lip Yl , 20 (2, between the CITY OF ROUND ROCK, Texas, 221 East Main Street, Round Rock, Texas 78664 ("CITY"), and Mario L. Carlin Management, LLC, P.O. Box 6087, Round Rock, Texas 78683.("CONTRACTOR"). RECITALS WHEREAS, CITY has been awarded grant funds which may be spent by CITY for the provision of certain services authorized under the U.S. Department of Housing and Urban Development ("HUD") Community Development Block Grant ("CDBG") Program; and WHEREAS, CITY wishes to assist qualified homeowners in the minor rehabilitation of their residence by providing a non-interest bearing loan to pay CONTRACTOR for labor, materials and equipment to be utilized in the rehabilitation; and WHEREAS, CITY will pay CONTRACTOR for labor, materials and equipment to be utilized in the rehabilitation of the property located at 1404 Larchwood Cove, Round Rock, Texas 78664 (the "Property"), as specified in the Work -Write Up Bid Document, attached hereto and incorporated herein as Exhibit "A". Now therefore, for and in consideration of the mutual promises and covenants set forth herein, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, CITY and CONTRACTOR agree as follows: ARTICLE 1 GENERAL REQUIREMENTS 1.1 CITY will pay CONTRACTOR $15,550.00 ("Contract Amount"). Funds will not be used to pay the homeowner or members of its family. 1.2 CITY will pay CONTRACTOR for work in accordance with CITY'S Prompt Payment Policy for all work described in the Work -Write Up Bid Document only after all of such work is found to be satisfactorily completed and inspected by the CITY or its designee. 1.3 CONTRACTOR will not deviate from the work described in the Work -Write Up Bid Document without a change order from CITY. Any such change order shall be an amendment to this Agreement. The total amount of any and all change orders shall not exceed twenty-five (25) percent of the original Contract Amount. 246657.doc/jr 1 1.4 All work specified in the Work -Write Up Bid Document will be satisfactorily completed within ninety (90) days from the date of the Notice to Proceed. 1.5 CONTRACTOR will assign to the CITY all mechanic's lien notes and mechanic's lien contracts on the Property held by CONTRACTOR. 1.6 Work -Write Up Bid Document line item deletions: None ARTICLE 2 CONTRACTOR'S RESPONSIBILITIES 2.1 CONTRACTOR will ensure that all work performed under this Agreement is permitted and inspected by CITY's Building Inspection Division. CONTRACTOR agrees to be duly licensed under CITY ordinances and State laws and be responsible for obtaining the building permit. 2.2 CONTRACTOR understands and agrees that it is solely responsible for meeting the terms and conditions of this Agreement. If CONTRACTOR fails to properly perform or complete any of the work specified in the Work -Write Up Bid Document, CONTRACTOR will not receive funding for any work that is found to be improperly performed or incomplete. 2.3 CONTRACTOR understands and agrees that all work described in the Work -Write Up Bid Document with the exception of line items deleted under Section 1.6 must be completed before any funds will be paid out. 2.4 CONTRACTOR understands and agrees that the job will be inspected by the CITY or its designee before any funds will be paid out. 2.5 CITY will provide a Notice to Proceed to CONTRACTOR to commence work. CONTRACTOR agrees to start work within thirty (30) calendar days after receipt of the Notice to Proceed. If CONTRACTOR fails to commence work within thirty (30) days from the date on the Notice to Proceed, CITY will have the right to terminate this Agreement, by providing a written notice of termination to CONTRACTOR. 2.6 CONTRACTOR agrees to complete the work within ninety (90) days from the date of the Notice to Proceed. If completion is delayed for reasons beyond the CONTRACTOR's control, CONTRACTOR will provide timely notice to CITY of the reasons for such delay. If such good cause is claimed by CONTRACTOR, it will be CONTRACTOR'S obligation to substantiate its claim by adequate documentation. 2.7 CONTRACTOR affirms that it has not been debarred from performing federal contract work. 2 2.8 During the term of this Agreement, CONTRACTOR shall not enter into a contract with the owner of the Property or act upon the request of the owner of the Property to perform any work other than that work described in the Work Write -Up Bid Document or in a change order from the CITY. ARTICLE 3 OTHER PROGRAM REQUIREMENTS 3.1 PERMITS AND CODES. CONTRACTOR agrees to secure and pay for all necessary permits and licenses required for CONTRACTOR'S performance and to adhere to applicable local codes and requirements whether or not covered by the Work -Write Up Bid Document, including any CONTRACTOR registration requirements. 3.2 DISCRIMINATION. CONTRACTOR will not exclude any person from participation in, deny the benefits of or subject the person to discrimination under any of the CONTRACTOR's activities while receiving federal financial assistance on the grounds of race, color, religion, sex, national origin, age or disability. 3.3 WARRANTY. CONTRACTOR agrees to provide a full one-year warranty to the homeowner, said warranty will extend to subsequent owners of the property to be improved. The warranty will provide that improvements, hardware, and fixtures of whatever kind or nature installed or constructed on said property by the CONTRACTOR are of good quality and free from defects in workmanship or materials or deficiencies subject to the warranty provided in this paragraph. CONTRACTOR and CITY agree, however, that the warranty set forth in this paragraph will apply only to such deficiencies and defects as to which homeowner or subsequent owners will have given written notice by certified mail to the CONTRACTOR, at its principal place of business, within one (1) year from the date of the final inspection and acceptance by the City Inspector that all work under the Agreement has been completed. 3.4 BID. CONTRACTOR acknowledges that it has prepared the CONTRACTOR'S Work - Write Up Bid Document, attached hereto and incorporated herein as Exhibit "A" and that such Bid is accurate and consistent as to the name of CONTRACTOR, scope of work that the CONTRACTOR will under -take, and price. CONTRACTOR acknowledges the performance requirement established in the write up and warrants that all work undertaken will conform to said specifications. 3.5 REMOVAL OF DEBRIS. Upon completion of work CONTRACTOR agrees to remove all construction debris and surplus material from the Property and leave the Property in a neat and clean condition. 3.6 SUBCONTRACTORS. CONTRACTOR agrees that all the warranties contained herein will apply to all work performed under this Agreement, including that performed by any Subcontractors. 3.7 FRAUDULENT ACTS. CONTRACTOR nor any of its officers, partners, owners, agents, representatives, employees, subcontractors or parties in interest has in any way colluded, conspired, connived or agreed, directly or indirectly with any other bidder, 3 firm, or person to submit a collusive or sham bid in connection with CONTRACTOR for which the bid has been submitted or to refrain from bidding in connection with this Agreement, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other bidder, firm, or person to fix any overhead, profit, or cost element of the bid price or the bid price of any other bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement, any advantage against CITY or any person interested in this Agreement; and the price or prices quoted are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of CONTRACTOR or any of its agents, representatives, owners, employees, or parties in interest. 3.8 INTEREST OF MEMBERS, OFFICERS, EMPLOYEES OF PUBLIC BODY, MEMBERS OF LOCAL GOVERNING BODY, OR OTHER PUBLIC OFFICIALS. No member, officer, or employee of CITY, or its designees or agents, no member of the City Council, and no other public official of CITY during his/her tenure or for one (1) year thereafter, will have any interest, direct or indirect, in any contract or subcontract, or the proceeds thereof, for work to be performed in connection with the program assisted under this Agreement. 3.9 PROHIBITION OF BONUS OR COMMISSION. The assistance provided under this Agreement will not be used in payment of any bonus or commission for the purpose of obtaining CITY approval of the application for such assistance. 3.10 STATUTE OF LIMITATIONS. As between the parties to this Agreement, as to all acts or failures to act by either party to this Agreement, any applicable statute of limitations will commence to run and any alleged cause of action will be deemed to have accrued in any and all events when the party commencing said cause of action knew or should have known of the existence of the subject act(s) or failure(s) to act. 3.11 INDEMNIFICATION. CONTRACTOR will defend, indemnify, and hold CITY, its successors, assigns, officers, employees and elected officials harmless from and against all suits, actions, legal proceedings, claims, demands, damages, costs, expenses, attorney's fees, and any and all other costs or fees arising out of, or incident to, concerning or resulting from the fault of CONTRACTOR, or CONTRACTOR's agents, employees or subcontractors, in the performance of CONTRACTOR's obligations under this Agreement, no matter how, or to whom, such loss may occur. Nothing herein will be deemed to limit the rights of CITY or CONTRACTOR (including, but not limited to the right to seek contribution) against any third party who may be liable for an indemnified claim. 3.12 CHANGE ORDERS. CONTRACTOR expressly agrees that no material changes or alterations in the Work -Write Up Bid Document or price provided above will be made unless in writing, mutually agreed by the homeowner, CONTRACTOR and authorized by CITY. 4 3.13 TERMS. All references in this Agreement to any particular gender are for convenience only and will be construed and interpreted to be of the appropriate gender. For the purposes of this Agreement the term "will" is mandatory. 3.14 SEVERABILITY. Should any provision in this Agreement be found or deemed to be invalid, this Agreement will be construed as not containing such provision, and all other provisions which are otherwise lawful will remain in full force and effect, and to this end the provisions of this Agreement are declared to be severable. 3.15 PUBLIC INFORMATION ACT. The CITY is governed by the Texas Public Information Act, Chapter 552 of the Texas Government Code. This Agreement and all written information generated under this Agreement may be subject to release under this Act. 3.16 PERFORMANCE. In performing this Agreement, CONTRACTOR will comply with all local, state and federal laws. 3.17 LIEN WAIVERS. CONTRACTOR agrees to protect, defend, and indemnify homeowner and CITY from any claims for unpaid work, labor, or materials with respect to CONTRACTOR'S performance. Final payment will not be paid until the CONTRACTOR has delivered to CITY complete release of all liens for work completed arising out of CONTRACTOR'S performance or a receipt in full, covering all labor and materials for which a lien could be filed or a bond satisfactory to the homeowner and CITY indemnifying him against any lien. 3.18 REPORTING REQUIREMENTS. CONTRACTOR agrees to submit a W9 Form, attached hereto and incorporated herein as Exhibit "B" to fulfill reporting requirements with the Internal Revenue Service. ARTICLE 4 SUSPENSION AND TERMINATION 4.1 If CONTRACTOR fails to fulfill in a timely and proper manner its obligations under this Agreement, or violates any of the terms or conditions of this Agreement, then the CONTRACTOR will have ten (10) days from the date it receives written notice from CITY directing it to cure or correct the defects. If CONTRACTOR fails to cure or correct the defects, CITY will have the right to terminate this Agreement and to select a substitute CONTRACTOR. If the expense of finishing the work exceeds the amount of this Agreement, CONTRACTOR will pay the difference to CITY. Should CONTRACTOR fail to make corrections as directed by CITY, and such breach of contract results in a violation of federal law or regulation for which CITY receives a demand of reimbursement of grant funds from HUD or its successor, CITY may terminate this Agreement immediately, and may recover from CONTRACTOR the amount sought by HUD for reimbursement, up to the full amount of funds CONTRACTOR received from CITY. 5 4.2 CONTRACTOR will not be relieved of the liability to CITY for damages sustained by the CITY by virtue of any breach of this Agreement by CONTRACTOR. CITY may withhold payment to CONTRACTOR until the amount of monetary damages due CITY from CONTRACTOR is determined. 4.3 If CITY becomes aware of any CONTRACTOR activity which could jeopardize CITY'S position with HUD and cause CITY to return CDBG funds or other federal funds received by CITY, CITY may take appropriate action, including injunctive relief against CONTRACTOR, to terminate or prevent the activity. Failure of CITY to exercise this right will not constitute a waiver by CITY of its right to demand payment or to seek any other relief in law or in equity to which it may be entitled. ARTICLE 5 PAYMENTS 5.1 For work completed by CONTRACTOR, as described in the Work -Write Up Bid Document, CITY agrees to pay CONTRACTOR the Contract Amount after all of such work is found to be satisfactorily completed and is inspected by the Construction Advisor and CITY Inspector, in accordance with the CITY'S Prompt Payment Policy. ARTICLE 6 ATTORNEY'S FEES 6.1 Any party to this Agreement who prevails in any legal proceedings between the parties regarding this Agreement will be entitled to recover court costs and reasonable attorney's fees from the non -prevailing party. ARTICLE 7 VENUE AND REMEDIES 7.1 This Agreement is governed by the laws of the State of Texas. Exclusive venue for any dispute arising under this Agreement is in Williamson County, Texas. ARTICLE 8 SUCCESSORS AND ASSIGNS 8.1 CITY and CONTRACTOR, respectively, bind themselves, their successors, assigns and legal representatives to the other party to this Agreement and to the successors, assigns and legal representatives of the other party with respect to all covenants of this Agreement. Except for CONTRACTOR'S assignment of mechanic's lien contracts and mechanic's lien notes to the CITY pursuant to Paragraph 1.7, neither CITY nor CONTRACTOR will assign, sublet, or transfer any interest in this Agreement without the written consent of the other. 6 ARTICLE 9 ENUMERATION OF CONTRACT DOCUMENTS 9.1 This Agreement represents the entire and integrated agreement between CITY and CONTRACTOR for the work specified in Exhibit "A" and supersedes all prior negotiations, representations or arguments either written or oral. This Agreement may be amended only by written instrument signed by CITY and CONTRACTOR. The Agreement contains the following exhibits attached to and incorporated in this Agreement for all purposes: (1) Work -Write Up Bid Document (Exhibit "A"); (2) W9 Form (Exhibit "B"). This Agreement is effective as of the date first written above. CITY: By: Printed Name• ;;: itl1' t.y, r t.q, 6r/ 7/L irJ .e. Ntrwoo d CONTRACTOR: MARIO L. CARLIN MANAGEMENT LLC By: Printed Name: Title: Date: 7 Exterior Remove and replace exterior window trim. 4 Seal and paint, two coats to match. W NW .a IAREA Remove all existing windows and replace with new, energy efficent, double pane windows. Caulk and seal. PATIO ROOF DECK REPLACEMENT Remove roof on back patio, redeck and roll roofing. 4x4 support posts to be brought back 18" to support ceiling beams correctly, Install base hangers at concrete. ENTIRE ROOF REPLACEMENT Remove roof shingles. Remove existing tar paper or roofing felt. Replace with 15 pound tar paper and roof shingles with like shingle and color providing 20 year warranty. Remove and replace drip molding around roof. DESCRIPTION ri a) 3 oVI COMMENTS la make comments, It needed, in the s ace ' rovide( � ;. z� — o UNIT z riXi �=-1 .fir s i o 1 1 m z y 0 • 5 ry O re 0 0 cr 0 a� 0 em;euBig Jo;oe,juo0 euieN . oieuuo0 0 v • 0 0 mo m D z O D 0°0 ✓ 0 m N O 0 o`—W m> v - O m z m 00 • -17 " Pt • ba 13 -4 0) NI AIIBAI130 Eg=i D N Q Interior 8 CT '' O m p. ErN m.0 g Interior 3 S I. g -. G � o O C1i p IAREA Replace entry hallway GFCI.Plugs not I sticking. Remove existing garbage disposal and replace with standard disposal. Install GFCI receptacles in hall bathroom, kitchen and garage per code. Remove master tub, repair drain, install new fiberglass surround unit. Repair and replace drywall and tile if needed. Remove and replace HVAC system to code with minimum rating 14 SEER. 3/4" line required through ceiling insulated and boxed. Remove and replace water heater with pan and pan drain. Replace garage door trim at wood rot. Paint to match, two coats. Remove and replace front door with like type. Reuse existing hardware. Home owner to approve door. Installation to include weather stripping. Paint, two coats to match. 1` DESCRIPTION ii ti t.t COMMENTS 0 c z 1 :- c UNIT PRICE A 1. co it, 1 < 1 EXTENSION 0 0 a O n o4 mon 5mo mcz 0 U0 m� ✓ o wn m SUBSTITUTE W-9 FORM CITY OF ROUND ROCK, TEXAS 221 EAST MAIN STREET, ROUND ROCK, TEXAS 78664 Pursuant to Internal Revenue Service Regulations, we ask that you furnish the City of Round Rock with your Taxpayer Number (TIN). If this number is not provided, IRS regulations require us to subject you to a 20% withholding on each payment. To avoid this withholding and to ensure that accurate tax information is reported to the Internal Revenue Service, we would appreciate your cooperation in providing us with the information requested below. Please contact the City of Round Rock Purchasing Division at (512) 218-7069 if you have any questions or problems with this request. Thank you for your assistance in this matter. BUSINESS ENTITY: (please check only one): Individual Partnership Sole Proprietorship Estate/Trust Corporation Public Service Corporation Other Governmental /Non-profit Individual: List name as shown on your social security card and your social security number. (Also Partnerships) Sole Proprietorship: List owner's legal name, followed by the legal business name and list the owner's social security number. All Others: List the legal name of your corporation, partnership, organization, or other legal entity and list your Employer Identification Number. LEGAL BUSINESS NAME: Remit To Address: Email address: ENTER YOUR NINE (9) DIGIT TAXPAYER IDENTIFICATION (TIN) BELOW: Social Security Number: Federal Employer Identification Number: UNDER PENALTIES OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, I DECLARE THAT THIS FORM HAS BEEN COMPLETED FULLY AND ACCURATELY. NAME (PRINT OR TYPE) SIGNATURE: PHONE #: TITLE (PRINT OR TYPE) DATE: FAX #: THIS AREA TO BE FILLED IN BY CITY OF ROUND ROCK FINANCE DEPARTMENT ASSIGNED VENDOR #: ASSIGNED BY: Revised 09/12/06 * ub. W9 FORM EXHIBIT i _la_