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Contract - Smith Contracting - 2/25/2016oil City of Round Rock, Texas Contract Forms Standard Form of Agreement: Section 00500 City of Round Rock, Texas Standard Form of Agreement between Owner and Contractor AGREEMENT made as of th 4M Oday of in the year 2df.. BETWEEN the Owner: City of Round Rock, Texas (hereafter "Owner" or "City") 221 East Main Street Round Rock, Texas 78664 and the Contractor 5 &,A C4rq,t ;,, ► a Cb Lr►c ("Contractor") h . r <C yS.p �IL -TX -7Qs 72--a The Project is described as: South Mays at Mays Crossing Dr Intersection Improvements The Engineer is: Kimley-Horn and Associates, Inc. Vivek Deshpande, P.E. 10814 Jollyville Road, Avallon IV Suite 300 Austin, TX 78759 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 Ily indicated in the Contract Documents to be the responsibility of others. 00500 8-2012 Page 1 of 5 00196575 g Standard Form of Agreement 11L9iU-e1k0 ARTICLE 3 DATE OF COMMENCEMENT; DATE OF SUBSTANTIAL COMPLETION; DATE OF FINAL COMPLETION 3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated below or provision is made for the date to be fixed in a Notice to Proceed issued by Owner. 3.2 The Contract Time shall be measured from the date delineated in the Notice to Proceed. 3.3 Contractor shall commence Work within seven from the date delineated in the Notice to Proceed. (7 ) calendar days 3.4 Contractor shall achieve Substantial Completion of the items of Work listed on Attachment A to this Agreement no later, than N/A (N/A ) calendar days from issuance by Owner of Notice to Procee, and Contractor shall achieve Substantial Completion of the entire Work no later than ninety 90 ) calendar days from issuance by Owner of Notice to Proceed, subject to adjustments of this Contract Time as provided in the Contract Documents. 3.5 If Contractor fails to achieve Substantial Completion of the Work (or any portion thereof) on or before the date(s) specified for Substantial Completion in the Agreement, Contractor shall pay to Owner, as liquidated damages, the sum of one hundred and No/100 Dollars ($ 100.00 ) 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 twenty 12( 0 ) calendar days from issuance by Owner of Notice to Proceed. I 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 three hundred eighty one thousand nine hundred and eighty four dollars and Seventy cents ($-3-8—L984-70 ), subject to additions and deductions as provided in the Contract Documents. 4.2 The Contract Sum is based upon the following alternates which are described in the Contract Documents - and are hereby accepted by Owner: C] Page 2 of 5 N/A 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. 1.5 Applications for Payment shall warrant the percentage of completion of each portion of the Work as of the d of the period covered by the Application for Payment. 1.6 Subject to other provisions of the Contract Documents, the amount of each progress payment shall be mputed as provided in Article 14 of the City of Round Rock General Conditions. 1.7 Except with Owner's prior written approval, Contractor shall not make advance payments to suppliers for iterials or equipment which have not been delivered and stored at the site. FINAL PAYMENT !.l Final payment, constituting the entire unpaid balance of the Contract Sum, shall be made by Owner to intractor when: .1 Contractor has fully performed the Contract except for Contractor's responsibility to correct Work, and to satisfy other requirements, if any, which extend beyond final payment; and .2 a final Certificate for Payment has been issued by Engineer. ,.2 Owner's final payment to Contractor shall be made no later than thirty (30) days after the issuance of gineer's final Certificate for Payment. In no event shall final payment be required to be made prior to thirty (30) ✓s after all Work on the Contract has been fully performed. Defects in the Work discovered prior to final payment III be treated as non -conforming Work and shall be corrected by Contractor prior to final payment, and shall not treated as warranty items. tTICLE 6 TERMINATION OR SUSPENSION The Contract may be terminated by Owner or Contractor as provided in Article 15 of the City of Round ck General Conditions. Page 3 of 5 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. 7.1.2 The General Conditions are the "City of Round Rock Contract Forms 00700," General Conditions, as modified. 7.1.3 The Supplementary, Special, and other Conditions of the Contract are those contained in the Project Manual dated October 2015 7.1.4 The Specifications are those contained in the Project Manual dated October 2015 7.1.5 The Drawings, if any, are those contained in the Project Manual dated October 2015 7.1.6 The Insurance & Construction Bond Forms of the Contract are those contained in the Project Manual dated October 2015 7.1.7 The Notice to Bidders, Instructions to Bidders, Bid Form, and Addenda, if any, are those contained in the Project Manual dated October 2015 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: N/A 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: BILL STABLEIN City of Round Rock 2008 Enterprise Drive Round Rock, TX 78664 8.3 Contractor's representative is: Hardin Camp _Smith Contracting Co., Inc. 15308 Ginger Street Austin, Texas 78728 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. Page 4 of 5 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. 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. OWNER CONTRACTOR CITY OF ROUND ROCK, TEXAS f 5h` "A,& 4Icy 6 �- V / Printed Name: Printed Name:QST« —r� �--- Title V I Title: Date Signed: �- ' `N- I ( Date Signed: ATTEST: Y City Clerk FOR ITYI APPROVED AS FORM: City Atto y Page 5 of 5 PERFORMANCE BOND BOND NO.:58S209111 THE STATE OF TEXAS KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON That Smith Contracting Co., Inc. of the City of Austin , County of Travis , and State of Texas , as Principal, and Liberty Mutual 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 Three Hundred Eighty One Thousand Nine Hundred Eighty Four Dollars and Seventy Cents Dollars ($ 381 984.70 ) for the payment whereof, well and truly to be made the said Principal and Surety bind themselves, and their heirs, administrators, executors, successors and assigns, jointly and severally, by these presents: WHEREAS, the Principal has entered into a certain written Agreement with the Owner dated the 'Aa 4� day of P� , 2046 to which the Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied at length herein consisting of: South Mays at Mays Crossing Dr Intersection Improvements (Name of the Project)'. NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION IS SUCH, that if the said Principal shall faithfully perform said Agreement and shall, in all respects, duly and faithfully observe and perform all and singular the covenants, conditions and agreements in and by said Agreement, agreed and covenanted by the Principal to be observed and performed, including but not limited to, the repair of any and all defects in said work occasioned by and resulting from defects in materials furnished by or workmanship of, the Principal in performing the Work covered by said Agreement and occurring within a period of twelve (12) months from the date of Final Completion and all other covenants and conditions, according to the true intent and meaning of said Agreement and the Plans and Specifications hereto annexed, then this obligation shall be void; otherwise to remain in full force and effect; PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253, Texas Government code, as amended, and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at length herein. 00610 7.2009 00090656 Page 1 Performance Bond 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 31st day of March 52016 . Smith Contracting Co., Inc. Principal , 15308 Cringer St_ Austin. TX 78728 Resident Agent of Surety: 143 E. Austin Street Address Giddings, TX 78942 City, State & Zip Code Page 2 Liberty Mutual Insurance Company Surety Kenneth Nitsche Printed Name By: Titles ; 'Attorney -In -Fact ,Address; Interchange Corporate Center 450 Plymouth Road, Suite 400 Plymouth Meeting, PA 19462-8284 Performance Bond PAYMENT BOND BOND NO.: 585209111 THE STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Smith Contracting Co., Inc. , of the City of Austin , County of Travis , and State of Texas as Principal, and Liberty Mutual Insurance Company authorized under the laws of the State of Texas to act as Surety on Bonds for Principals, are held and firmly bound unto THE CITY OF ROUND ROCK, (OWNER), and all subcontractors, workers, laborers, mechanics and suppliers as their interest may appear, all of whom shall have the right to sue upon this bond, in the penal sum of Three Hundred Eighty One Thousand Nine Hundred Eighty Four Dollars and Seventy Cents Dollars ($ 381,984.70 ) for the payment whereof, well and truly be made the said Principal and Surety bind themselves and their heirs, administrators, executors, successors, and assigns, jointly and severally, by these presents: WHEREAS, the Principal has entered into a certain written Agreement with the Owner, dated the day of .Arpyyu , 2011V , to which Agreement is hereby referred to and made a part hereof a's fully and to the same extent as if copied at length herein consisting of., South Mays at Mays Crossing Dr Intersection Improvements (Name of the Project) NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the said Principal shall well and truly pay all subcontractors, workers, laborers, mechanics, and suppliers, all monies to them owing by said Principals for subcontracts, work, labor, equipment, supplies and materials done and furnished for the construction of the improvements of said Agreement, then this obligation shall be and become null and void; otherwise to remain in full force and effect. PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253, Texas Government code, as amended, and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at length herein. Page 1 00620 7-2009 Payment Bond 00090656 PAYMENT BOND (continued) Surety, for value received, stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Agreement, or to the Work performed thereunder, or the plans, specifications or drawings accompanying the same shall in anywise affect it's obligation on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract, or to the work to be performed thereunder. IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this Instrument this 31st day of March , 2016 . Smith Contracting Co., Inc. Principal Pri e ame i BY; cs IZaa l ati Title: {�e,�lder}} Address; 15308 Ginger St Austin, TX 78728 Resident Agent -of Surety: Signature Kenneth Nitsche Printed Name 143 E. Austin Street Address Giddings, TX 78942 00620 7-2009 00090656 Page 2 Liberty Mutual Insurance Company Surety Kenneth Nitsche Printed Name By' Title: 'Attorney -In -Fact Address; Interchange Corporate Center 450 Plymouth Road, Suite 400 Plymouth Meeting, PA 19462-8284 Payment Bond rlionftl- 91n2s SMITHCON '.'f'ORDTM CERTIFICATE OF LIABILITY INSURANCEF [MM/DD D3/30/201 0116 YY) 3/30/6 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the ificate holder in lieu of such endorsement(s). CER litsche Group East Austin Ings, TX 78942-3299 02-3666 CONTACT Carla West PHONE 979 542-3666 FAx A/C No Ext): A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: BITCO National Insurance Compan 20109 M.A. Smith Contracting Company, Inc. dba Smith Contracting Co., Inc. 15308 Ginger Street Austin, TX 78728 INSURER B: BITCO General Insurance Corpora 20095 INSURER C: Texas Mutual Insurance Company 22945 INSURER D: BITCO General Insurance Corpora 20095 INSURER E INSURER F GES CERTIFICATE NUMBER: REVISION NUMBER: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD GATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, gUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS &NERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ex OCCUR X PD Ded:1,000 CLP3634298 3/07/2016 03/07/2017 EACH OCCURRENCE $110001000 PREMISES (Ea occcurrrence $100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 LILAGGREGATE LIMIT APPLIES PER: POLICY X jE O LOC PRODUCTS - COMP/OP AGG $2,000,000 $ WOMOBILE LIABILITY X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED XHIRED AUTOS X AUTOS CAP3634297 3/07/2016 03/07/201 ED (CEO,aCclden SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CiUP2808680 3/07/2016 03/07/2017 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X RETENTION $10000 $ RS COMPENSATION RCOMP' LIABILITY OPRIETOR/PARTNER/EXECUTIVE Y / N ERIMEMBER EXCLUDED? %nd#Dry in NH) M, desc"be under ASCRIPTION OF OPERATIONS below N / A TSF0001160807 3/07/2016 03/07/201 WC U- STATOTH- X E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 'ON OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) I: South Mays at Mays Crossing Dr. Intersection Improvements policy provision, Certificate Holder is listed as additional insured in regard to the auto and 11 liability policies as provided by additional insured endorsement. A waiver of subrogation gement is provided to the Certificate Holder in regard to the auto, general liability and workers ensation policies as per policy provision. I`ftached Descriptions) FICATE 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 St. Round Rock, TX 78664 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. `5 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD �3g954/M635643 066 PROJECT: SOUTH MAYS ST AT MAYS CROSSING CRY: ROUND ROCK COUNTY: WILLIAMSON BID TABS COMPARISON Kimley)))Horn Kimley»>Horn November 20, 2015 Mr. Bill Stablein City of Round Rock 2008 Enterprise Dr. Round Rock, TX 78664 RE: South Mays at Mays Crossing Drive Intersection Improvements Bid Award Recommendation Dear Mr. Stablein: Kimley-Horn has reviewed the bid documents submitted by Smith Contracting CO.,Inc. (Smith) on November 20, 2015. The bid submitted by Smith was the only bid received for this project. The bid received from Smith appears to be complete and satisfactory. While reviewing the bid form, a math error was found in the subtotal for Items 0684 6030 as highlighted in 'red' in the attached bid tabulation comparison. However, the overall bid total was correct and was not affected by the errors on the above item. Kimley-Horn recommends that the City of Round Rock accept the bid and award Smith the contract for $381,984.70 for the South Mays at Mays Crossing Drive Intersection Improvements project. Please contact me at (512) 418-4507 or trey. neal(a)kimley-horn.com should you have any questions. Sincerely, Trey Neal, P.E. Attachment., Bid Tabulation Comparison 10814 Jollyville Road, Avallon IVSuite 300, Austin, TX 78759 CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2016-14659 SMITH CONTRACTING CO INC AUSTIN, TX United States Date Filed: 02/17/2016 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Round Rack Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify description of the goods or services to be provided underthe contract. the contract, and provide a South Mays St, at Mays Crossin Intersection 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. X 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. AMANDA NULL Sr �� Notofy Public, State of Texas [ My Commission Expires March 09, 2019 j Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said E~� 4`t this the h day of P�b 20__LU_, to certify which, witness my hand and seal of office. `-Y) l,C..,0— �3 u t l CU) Lk rr{ S PQtt G-% i(' Signature of officer administering oath Printed name of officer administering oath Title of officer adminlsteri oath „i,1-1 by T.— Gthirc !'nmmiccinn %AAAAAr athirc ctntoa 1y im Version V1.0.34944 r. .1...... _J .-- —... r_.,,— Y,..,,,irJorl by Tovnc Fthirc r'nmmwcinn WWW.BLn!CS.sL&LC. LX. US vc, o,v„ —....,�.,�� CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. 12016-14659 OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: Date Filed: 02/17/2016 Date Acknowledged: 02/23/2016 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. SMITH CONTRACTING CO INC AUSTIN, TX United States 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Round Rock 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 goods or services to be provided under the contract. South Mays St. at Mays Crossin Intersection 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. X 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said this the day of 20 to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath r_.,,— Y,..,,,irJorl by Tovnc Fthirc r'nmmwcinn WWW.BLn!CS.sL&LC. LX. US vc, o,v„ —....,�.,��