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Contract - Raba Kistner - 2/11/2016CITY OF ROUND ROCK AGREEMENT FOR PROFESSIONAL CONSULTING SERVICES FOR CONSTRUCTION MATERIALS TESTING SERVICES WITH RABA KISTNER CONSULTANTS THE STATE OF TEXAS § THE CITY OF ROUND ROCK § KNOW ALL BY THESE PRESENTS COUNTY OF WILLIAMSON § COUNTY OF TRAVIS § THIS AGREEMENT for professional consulting services related to construction materials testing services for the Old Settlers Multipurpose Complex Improvements Project (the "Agreement") is made by and between the CITY OF ROUND ROCK, a Texas home -rule municipal corporation with offices located at 221 East Main Street, Round Rock, Texas 78664- 5299, (the "City") and RABA KISTNER CONSULTANTS, located at 8100 Cameron Road, Suite B-150, Austin, Texas 78754 (the "Consultant"). RECITALS: WHEREAS, City has determined that there is a need for a construction material testing services for the Old Settlers Multipurpose Complex Improvements Project; and WHEREAS, City desires to contract for such professional services; and WHEREAS, the parties desire to enter into this Agreement to set forth in writing their respective rights, duties and obligations hereunder; NOW, THEREFORE, WITNESSETH: That for and in consideration of the mutual promises contained herein and other good and valuable consideration, the sufficiency and receipt of which are hereby acknowledged, it is mutually agreed between the parties as follows: 1.01 EFFECTIVE DATE, DURATION, AND TERM This Agreement shall be effective on the date this Agreement has been signed by each party hereto, and shall remain in full force and effect unless and until it expires by operation of the term indicated herein, or is terminated or extended as provided herein. The term of this Agreement shall be until full and satisfactory completion of the work specified herein is achieved. 00350461/ss2 City reserves the right to review the Agreement at any time, and may elect to terminate the Agreement with or without cause or may elect to continue. 2.01 PROPOSAL FOR SERVICES City has agreed to provide the services delineated in Exhibit "A" titled "City Services," attached hereto and incorporated herein for all purposes. Consultant has issued its proposal for services for the tasks delineated therein, such proposal for services being attached hereto as Exhibit `B" titled "Scope of Work," which document is incorporated herein for all purposes. 3.01 SCOPE OF SERVICES Consultant shall satisfactorily provide all services described herein and as set forth in Exhibit "B." Such services shall be performed in the time frame set forth in the "Work Schedule," attached hereto as Exhibit "C," and incorporated herein for all purposes. Consultant's undertaking shall be limited to performing services for City and/or advising City concerning those matters on which Consultant has been specifically engaged. Consultant shall perform services in accordance with this Agreement, in accordance with the appended proposal for services, and in a professional and workmanlike manner. 4.01 LIMITATION TO SCOPE OF SERVICES Consultant and City agree that the scope of services to be performed is enumerated in Exhibit "B," and Consultant shall not undertake work that is beyond the Scope of Work set forth in Exhibit `B," however, either party may make written requests for changes to the Scope of Work." To be effective, a change to the Scope of Work must be negotiated and agreed to and must be embodied in a valid Supplemental Agreement as described in 10.01. 5.01 CONTRACT AMOUNT In consideration for the professional consulting services to be performed by Consultant, City agrees to pay Consultant in accordance with Exhibit "D" entitled "Fee Schedule," which document is attached hereto and incorporated herein for all purposes, in payment for services and the Scope of Services deliverables as delineated in Exhibit `B." Not -to -Exceed Total Payment for Services: Consultant's total compensation for consulting services hereunder shall not exceed Fifty -Six Thousand Six Hundred Twenty - Seven and No/100 Dollars ($56,627.00). This amount represents the absolute limit of City's liability to Consultant hereunder unless same shall be changed by Supplemental Agreement, and City shall pay, strictly within the not -to -exceed sum recited herein, Consultant's professional fees for work done on behalf of City. Payment for Reimbursable Expenses: There shall be no payments for reimbursable expenses included in this Agreement. 0) Deductions: No deductions shall be made for Consultant's compensation on account of penalty, liquidated damages or other sums withheld from payments to Consultant. Additions: No additions shall be made to Consultant's compensation based upon project claims, whether paid by the City or denied. 6.01 INVOICE REQUIREMENTS; TERMS OF PAYMENT Invoices: To receive payment, Consultant shall prepare and submit detailed invoices to the City, in accordance with the delineation contained herein, for services rendered. Such invoices for professional services shall track the referenced Scope of Work, and shall detail the services performed, along with documentation for each service performed. Payment to Consultant shall be made on the basis of the invoices submitted by Consultant and approved by the City. Such invoices shall conform to the schedule of services and costs in connection therewith. Should additional backup material be requested by the City relative to service deliverables, Consultant shall comply promptly. In this regard, should the City determine it necessary, Consultant shall make all records and books relating to this Agreement available to the City for inspection and auditing purposes. Payment of Invoices: The City reserves the right to correct any error that may be discovered in any invoice that may have been paid to Consultant and to adjust same to meet the requirements of this Agreement. Following approval of an invoice, the City shall endeavor to pay Consultant promptly, but no later than the time period required under the Texas Prompt Payment Act described in Section 8.01 herein. Under no circumstances shall Consultant be entitled to receive interest on payments which are late because of a good faith dispute between Consultant and the City or because of amounts which the City has a right to withhold under this Agreement or state law. The City shall be responsible for any sales, gross receipts or similar taxes applicable to the services, but not for taxes based upon Consultant's net income. 7.01 INTERLOCAL COOPERATIVE CONTRACTING/PURCHASING Authority for local governments to contract with one another to perform certain governmental functions and services, including but not limited to purchasing functions, is granter under Government Code, Title 7, Chapter 791, Interlocal Cooperation Contracts, Subchapter B and Subchapter C, and Local Government Code, Title 8, Chapter 271, Subchapter F, Section 27 1. 101 and Section 271.102. 8.01 PROMPT PAYMENT POLICY In accordance with Chapter 2251, V.T.C.A., Texas Government Code, any payment to be made by the City to Consultant will be made within thirty (30) days of the date the City receives goods under this Agreement, the date the performance of the services under this Agreement are completed, or the date the City receives a correct invoice for the goods or services, whichever is later. Consultant may charge interest on an overdue payment at the "rate in effect" on September I of the fiscal year in which the payment becomes overdue, in accordance with V.T.C.A., Texas Government Code, Section 2251.025(b). This Prompt Payment Policy does not apply to payments made by the City in the event: (a) There is a bona fide dispute between the City and Consultant, a contractor, subcontractor, or supplier about the goods delivered or the service performed that cause the payment to be late; or (b) There is a bona fide dispute between Consultant and a subcontractor or between a subcontractor and its supplier about the goods delivered or the service performed that causes the payment to be late; or (c) The terms of a federal contract, grant, regulation, or statute prevent the City from making a timely payment with federal funds; or (d) The invoice is not mailed to the City in strict accordance with any instruction on the purchase order relating to the payment. 9.01 NON -APPROPRIATION AND FISCAL FUNDING This Agreement is a commitment of the City's current revenues only. It is understood and agreed that the City shall have the right to terminate this Agreement at the end of any City fiscal year if the governing body of the City does not appropriate funds sufficient to purchase the services as determined by the City's budget for the fiscal year in question. The City may effect such termination by giving Consultant a written notice of termination at the end of its then - current fiscal year. 10.01 SUPPLEMENTAL AGREEMENT The terms of this Agreement may be modified by written Supplemental Agreement hereto, duly authorized by City Council or by the City Manager, if the City determines that there has been a significant change in (1) the scope, complexity, or character of the services to be performed; or (2) the duration of the work. Any such Supplemental Agreement must be executed by both parties within the period specified as the term of this Agreement. Consultant shall not perform any work or incur any additional costs prior to the execution, by both parties, of such Supplemental Agreement. Consultant shall make no claim for extra work done or materials furnished unless and until there is full execution of any Supplemental Agreement, and the City shall not be responsible for actions by Consultant nor for any costs incurred by Consultant relating to additional work not directly authorized by Supplemental Agreement. 11.01 TERMINATION; DEFAULT Termination: It is agreed and understood by Consultant that the City may terminate this Agreement for the convenience of the City, upon thirty (30) days' written notice to Consultant, with the understanding that immediately upon receipt of said notice all work being performed under this Agreement shall cease. Consultant shall invoice the City for work satisfactorily 11 completed and shall be compensated in accordance with the terms hereof for work accomplished prior to the receipt of said notice of termination. Consultant shall not be entitled to any lost or anticipated profits for work terminated under this Agreement. Unless otherwise specified in this Agreement, all data, information, and work product related to this project shall become the property of the City upon termination of this Agreement, and shall be promptly delivered to the City in a reasonably organized form without restriction on future use. Should the City subsequently contract with a new consultant for continuation of service on the project, Consultant shall cooperate in providing information. Termination of this Agreement shall extinguish all rights, duties, and obligations of the City and the terminated parry to fulfill contractual obligations. Termination under this section shall not relieve the terminated party of any obligations or liabilities which occurred prior to termination. Nothing contained in this section shall require the City to pay for any work which it deems unsatisfactory or which is not performed in compliance with the terms of this Agreement. Default: Either party may terminate this Agreement, in whole or in part, for default if the Party provides the other Party with written notice of such default and the other fails to satisfactorily cure such default within ten (10) business days of receipt of such notice (or a greater time if agreed upon between the Parties). If default results in termination of this Agreement, then the City shall give consideration to the actual costs incurred by Consultant in performing the work to the date of default. The cost of the work that is useable to the City, the cost to the City of employing another firm to complete the useable work, and other factors will affect the value to the City of the work performed at the time of default. Neither party shall be entitled to any lost or anticipated profits for work terminated for default hereunder. The termination of this Agreement for default shall extinguish all rights, duties, and obligations of the terminating Party and the terminated Party to fulfill contractual obligations. Termination under this section shall not relieve the terminated party of any obligations or liabilities which occurred prior to termination. Nothing contained in this section shall require the City to pay for any work which it deems unsatisfactory, or which is not performed in compliance with the terms of this Agreement. 12.01 NON -SOLICITATION All parties agree that they shall not directly or indirectly solicit for employment, employ, or otherwise retain staff of the other during the term of this Agreement. 13.01 CITY'S RESPONSIBILITIES Consultant's performance requires receipt of all requested information reasonably necessary to provision of services. Consultant agrees, in a timely manner, to provide City with a comprehensive and detailed information request list, if any. 14.01 INDEPENDENT CONTRACTOR STATUS Consultant is an independent contractor, and is not the City's employee. Consultant's employees or subcontractors are not the City's employees. This Agreement does not create a partnership, employer-employee, or joint venture relationship. No party has authority to enter into contracts as agent for the other party. Consultant and the City agree to the following rights consistent with an independent contractor relationship: (1) Consultant has the right to perform services for others during the term hereof. (2) Consultant has the sole right to control and direct the means, manner and method by which it performs its services required by this Agreement. (3) Consultant has the right to hire assistants as subcontractors, or to use employees to provide the services required by this Agreement. (4) Consultant or its employees or subcontractors shall perform services required hereunder, and the City shall not hire, supervise, or pay assistants to help Consultant. (5) Neither Consultant nor its employees or subcontractors shall receive training from the City in skills necessary to perform services required by this Agreement. (6) City shall not require Consultant or its employees or subcontractors to devote full time to performing the services required by this Agreement. (7) Neither Consultant nor its employees or subcontractors are eligible to participate in any employee pension, health, vacation pay, sick pay, or other fringe benefit plan of the City. 15.01 CONFIDENTIALITY; MATERIALS OWNERSHIP Any and all programs, data, or other materials furnished by the City for use by Consultant in connection with services to be performed under this Agreement, and any and all data and information gathered by Consultant, shall be held in confidence by Consultant as set forth hereunder. Each party agrees to take reasonable measures to preserve the confidentiality of any proprietary or confidential information relative to this Agreement, and to not make any use thereof other than for the performance of this Agreement, provided that no claim may be made for any failure to protect information that occurs more than three (3) years after the end of this Agreement. The parties recognize and understand that the City is subject to the Texas Public Information Act and its duties run in accordance therewith. Co All data relating specifically to the City's business and any other information which reasonably should be understood to be confidential to City is confidential information of City. Consultant's proprietary software, tools, methodologies, techniques, ideas, discoveries, inventions, know-how, and any other information which reasonably should be understood to be confidential to Consultant is confidential information of Consultant. The City's confidential information and Consultant's confidential information is collectively referred to as "Confidential Information." Each party shall use Confidential Information of the other party only in furtherance of the purposes of this Agreement and shall not disclose such Confidential Information to any third party without the other party's prior written consent, which consent shall not be unreasonably withheld. Each party agrees to take reasonable measures to protect the confidentiality of the other party's Confidential Information and to advise their employees of the confidential nature of the Confidential Information and of the prohibitions herein. Any and all materials created and developed by Consultant in connection with services performed under this Agreement, including all trademark and copyright rights, shall be the sole property of City at the expiration of this Agreement. 16.01 WARRANTIES Consultant represents that all services performed hereunder shall be performed consistent with generally prevailing professional or industry standards, and shall be performed in a professional and workmanlike manner. Consultant shall re -perform any work no in compliance with this representation. 17.01 LIMITATION OF LIABILITY Should any of Consultant's services not conform to the requirements of the City or of this Agreement, then and in that event the City shall give written notification to Consultant; thereafter, (a) Consultant shall either promptly re -perform such services to the City's satisfaction at no additional charge, or (b) if such deficient services cannot be cured within the cure period set forth herein, then this Agreement may be terminated for default. In no event will Consultant be liable for any loss, damage, cost or expense attributable to negligence, willful misconduct or misrepresentations by the City, its directors, employees or agents. In no event shall Consultant be liable to the City, by reason of any act or omission relating to the services provided under this Agreement (including the negligence of Consultant), whether a claim be in tort, contract or otherwise, (a) for any consequential, indirect, lost profit, punitive, special or similar damages relating to or arising from the services, or (b) in any event, in the aggregate, for any amount in excess of the total professional fees paid by the City to Consultant under this Agreement, except to the extent determined to have resulted from Consultant's gross negligence, willful misconduct or fraudulent acts relating to the service provided hereunder. 7 18.01 INDEMNIFICATION Consultant agrees to hold harmless, exempt, and indemnify City, its officers, agents, directors, servants, representatives and employees, from and against any and all suits, actions, legal proceedings, demands, costs, expenses, losses, damages, fines, penalties, liabilities and claims of any character, type, or description, including but not limited to any and all expenses of litigation, court costs, attorneys' fees and all other costs and fees incident to any work done as a result hereof. To the extent allowable by law, City agrees to hold harmless, exempt, and indemnify Consultant, its officers, agents, directors, servants, representatives and employees, from and against any and all suits, actions, legal proceedings, demands, costs, expenses, losses, damages, fines, penalties, liabilities and claims of any character, type, or description, including but not limited to any and all expenses of litigation, court costs, attorneys' fees and all other costs and fees incident to any work done as a result hereof. 19.01 ASSIGNMENT AND DELEGATION The parties each hereby bind themselves, their successors, assigns and legal representatives to each other with respect to the terms of this Agreement. Neither party may assign any rights or delegate any duties under this Agreement without the other party's prior written approval, which approval shall not be unreasonably withheld. 20.01 LOCAL, STATE AND FEDERAL TAXES Consultant shall pay all income taxes, and FICA (Social Security and Medicare taxes) incurred while performing services under this Agreement. The City will not do the following: (1) Withhold FICA from Consultant's payments or make FICA payments on its behalf, (2) Make state and/or federal unemployment compensation contributions on Consultant's behalf; or (3) Withhold state or federal income tax from any of Consultant's payments. If requested, the City shall provide Consultant with a certificate from the Texas State Comptroller indicating that the City is a non-profit corporation and not subject to State of Texas Sales and Use Tax. 21.01 COMPLIANCE WITH LAWS, CHARTER AND ORDINANCES A. Consultant, its consultants, agents, employees and subcontractors shall use best efforts to comply with all applicable federal and state laws, the Charter and Ordinances of the City of Round Rock, as amended, and with all applicable rules and regulations promulgated by local, state and national boards, bureaus and agencies. Consultant shall further obtain all permits, licenses, trademarks, or copyrights, if required in the performance of the services contracted for herein, and same shall belong solely to the City at the expiration of the term of this Agreement. B. Services Provider acknowledges and understands that City has adopted a Storm Water Management Program (SWMP) and an Illicit Discharge Ordinance, Sections 14-139 through 14-152 of the City's Code of Ordinances, to manage the quality of the discharges from its Municipal Separate Storm Sewer System (MS4) and to be in compliance with the requirements of the Texas Commission on Environmental Quality (TCEQ) and the Texas Pollutant Discharge Elimination System (TPDES). The Services Provider agrees to perform all operations on City -owned facilities in compliance with the City's Illicit Discharge Ordinance to minimize the release of pollutants into the MS4. The Services Provider agrees to comply with of the City's stormwater control measures, good housekeeping practices and any facility specific stormwater management operating procedures specific to a certain City facility. In addition, the Services Provider agrees to comply with any applicable TCEQ Total Maximum Daily Load (TMDL) Requirements and/or I -Plan requirements. 22.01 FINANCIAL INTEREST PROHIBITED Consultant covenants and represents that Consultant, its officers, employees, agents, consultants and subcontractors will have no financial interest, direct or indirect, in the purchase or sale of any product, materials or equipment that will be recommended or required hereunder. 23.01 DESIGNATION OF REPRESENTATIVES The City hereby designates the following representative authorized to act in its behalf with regard to this Agreement: Katie Baker Park Development Manger City of Round Rock 301 West Bagdad Avenue Round Rock, TX 78664 (512) 341-3355 kbaker axoundrocktexas.gov 24.01 NOTICES All notices and other communications in connection with this Agreement shall be in writing and shall be considered given as follows: (1) When delivered personally to recipient's address as stated herein; or (2) Three (3) days after being deposited in the United States mail, with postage prepaid to the recipient's address as stated in this Agreement. 0 Notice to Consultant: Raba Kistner Consultants 8100 Cameron Road, Suite B-150 Austin, Texas 78754 Notice to City: City Manager, City of Round Rock 221 East Main Street Round Rock, TX 78664 AND TO: Stephan L. Sheets, City Attorney 309 East Main Street Round Rock, TX 78664 Nothing contained in this section shall be construed to restrict the transmission of routine communications between representatives of the City and Consultant. 25.01 INSURANCE Consultant shall meet all City of Round Rock Insurance Requirements set forth at: http://www.roundrocktexas.Qov/wp-content/uploads/2014/12/corr insurance 07.20112.pdf 26.01 APPLICABLE LAW; ENFORCEMENT AND VENUE 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 Texas. 27.01 EXCLUSIVE AGREEMENT The terms and conditions of this Agreement, including exhibits, constitute the entire agreement between the parties and supersede all previous communications, representations, and agreements, either written or oral, with respect to the subject matter hereof. The parties expressly agree that, in the event of any conflict between the terms of this Agreement and any other writing, this Agreement shall prevail. No modifications of this Agreement will be binding on any of the parties unless acknowledged in writing by the duly authorized governing body or representative for each party. 28.01 DISPUTE RESOLUTION The City and Consultant 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 any arbitration proceeding, including without limitation, any proceeding under the Federal 10 Arbitration Act (9 USC Section 1-14) or any applicable state arbitration statute. 29.01 SEVERABILITY The invalidity, illegality, or unenforceability of any provision of this Agreement or the occurrence of any event rendering any portion of provision of this Agreement void shall in no way affect the validity or enforceability of any other portion or provision of this Agreement. Any void provision shall be deemed severed from this Agreement, and the balance of this Agreement shall be construed and enforced as if this Agreement did not contain the particular portion of provision held to be void. The parties further agree to amend this Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. The provisions of this Article shall not prevent this entire Agreement from being void should a provision which is of the essence of this Agreement be determined void. 30.01 STANDARD OF CARE Consultant represents that it is specially trained, experienced and competent to perform all of the services, responsibilities and duties specified herein and that such services, responsibilities and duties shall be performed, whether by Consultant or designated subconsultants, in a manner acceptable to the City and according to generally accepted business practices. 31.01 GRATUITIES AND BRIBES City, may by written notice to Consultant, cancel this Agreement without incurring any liability to Consultant if it is determined by City that gratuities or bribes in the form of entertainment, gifts, or otherwise were offered or given by Consultant or its agents or representatives to any City Officer, employee or elected representative with respect to the performance of this Agreement. In addition, Consultant may be subject to penalties stated in Title 8 of the Texas Penal Code. 32.01 RIGHT TO ASSURANCE Whenever either party to this Agreement, in good faith, has reason to question the other party's intent to perform hereunder, then demand may be made to the other party for written assurance of the intent to perform. In the event that no written assurance is given within the reasonable time specified when demand is made, then and in that event the demanding party may treat such failure an anticipatory repudiation of this Agreement. 33.01 MISCELLANEOUS PROVISIONS Time is of the Essence. Consultant agrees that time is of the essence and that any failure of Consultant to complete the services for each phase of this Agreement within the agreed project schedule may constitute a material breach of this Agreement. Consultant shall be fully responsible for its delays or for failures to use reasonable efforts in accordance with the terms of this Agreement. Where damage is caused to City due to Consultant's failure to perform in these 11 circumstances, City may withhold, to the extent of such damage, Consultant's payments hereunder without a waiver of any of City's additional legal rights or remedies. City shall render decisions pertaining to Consultant's work promptly to avoid unreasonable delays in the orderly progress of Consultant's work. Force Majeure. Notwithstanding any other provisions hereof to the contrary, no failure, delay or default in performance of any obligation hereunder shall constitute an event of default or breach of this Agreement, only to the extent that such failure to perform, delay or default arises out of causes beyond control and without the fault or negligence of the party otherwise chargeable with failure, delay or default; including but not limited to acts of God, acts of public enemy, civil war, insurrection, riots, fires, floods, explosion, theft, earthquakes, natural disasters or other casualties, strikes or other labor troubles, which in any way restrict the performance under this Agreement by the parties. Section Numbers. The section numbers and headings contained herein are provided for convenience only and shall have no substantive effect on construction of this Agreement. Waiver. No delay or omission by either party in exercising any right or power shall impair such right or power or be construed to be a waiver. A waiver by either party of any of the covenants to be performed by the other or any breach thereof shall not be construed to be a waiver of any succeeding breach or of any other covenant. No waiver of discharge shall be valid unless in writing and signed by an authorized representative of the party against whom such waiver or discharge is sought to be enforced. Multiple Counterparts. This Agreement may be executed in multiple counterparts, which taken together shall be considered one original. The City agrees to provide Consultant with one fully executed original. [Signatures on the following page.] IN WITNESS WHEREOF, the parties have executed this Agreement on the dates hereafter indicated. City of Round -\Rock, Texas By: Printed Name: Title: (� Date Signed: _ For City, Attest: By: S<m L' I A -H& Sara L. White, City Clerk For;at,.) ved as to Form: By: I � a StephanV. Sheets, City Attorney —3Y' City of Round Rock Old Settlers Park Multi -Sport Complex Raba Kistner Consultants, Inc. EXHIBIT "A" SERVICES TO BE PERFORMED BY THE CITY OF ROUND ROCK Raba Kistner will need to be furnished a set of plans and specs for above referenced project. The City of Round Rock shall provide access to project site. The City of Round Rock shall provide contact names and email addresses for the Project Design and Construction Team. Services will be provided on a call out basis as needed by the City of Round Rock R A B A K I S T N E R PAD15-136-00 December 30, 2015 EXHIBIT B—SCOPE OF WORK Raba Kistner Consultants, Inc. (RKCI) is pleased to have been selected to perform construction materials testing and observation. At your request, we are submitting our estimate to provide the construction materials observation and testing services on the above -referenced project. These fees are in accordance with City of Round Rock Contract for Engineering Services, Resolution No. R-2014- 1567, Contract No. 0127.1430; 00305376. We propose an estimated budget of $46,781.00 for Package A and $9,846.00 for Package B for construction materials testing and observation services for the referenced project. These budgets are based on our understanding of the project, an estimate of quantities, and past experience with similar projects. A cost estimate breakdown is presented in the attached spreadsheet. Construction sequencing, delays, and the number of times the client or their representative requests our services will affect the suggested budget. Services will be provided on a call out basis for the unit fees attached to this proposal. The scope of work includes the observation and testing of the following construction materials: • Laboratory testing, in-place field nuclear density testing, and proofrolling observation, • Reinforcing steel observations, • Concrete and masonry compressive strength specimen sampling, testing, and reporting, • Structural steel inspections, and • Asphalt observation and testing R A B A K I S T N E R PAD 15-036-00 December 16, 2015 EXHIBIT B GENERAL CONDITIONS Old Settlers Park Multi -Sport Complex Round Rock, Texas General: 1. We understand that The City of Round Rock will require the services of experienced engineering technicians as scheduled by you or your representatives. Client will incur a 2 hour minimum charge per each site visit. We request twenty-four (24) hour notification to properly schedule our work. 2. Service charges are based on the hourly rates stated herein and will be assessed from the time the Engineer or Technician leaves our office until he returns from the project. 3. A vehicle travel charge will be assessed for round trip travel from our office to the project site, material supplier, etc. and back to our office. 4. Our total cost of services is based upon the assumption that this project will require a technician on site during normal work hours. Services requested during days and/or hours requiring overtime rates may significantly increase the total cost of services shown herein. "Normal' work hours are defined as Monday through Friday, 7:00 am to 6:00 pm. Overtime rates at 1.4 times the normal hourly rate will be assessed after eight (8) hours of continuous work per day and/or outside normal work hours. Invoices will be submitted monthly for work in progress in our standard format. Our invoices are due and payable upon receipt at P.O. Box 971037, Dallas, Dallas County, Texas 75397-1037. All parties hereby agree that this agreement upon acceptance will be performable in Travis County, Texas. In the event that the State of Texas legislates a sales tax on professional services, the amount of tax applicable will be added to the appropriate service rate charged by Raba-Kistner Consultants, Inc. 6. Raba-Kistner will utilize the on-site initial field curing facilities provided by the contractor. The cost of providing and maintaining these initial curing facilities is not included in our proposal. R A B A K I S T N E R PAD15-036-00 December 16, 2015 REPORT DISTRIBUTION LIST Please provide RKCI with project distribution for our submittal of reports on this project. Unless otherwise indicated, testing and observation reports will be distributed via email. Client: Attention: Phone No.: Email: Architect: Attention: Phone No.: Email: Engineer: Attention: Phone No.: Email: Contractor: Other: Attention: Phone No.: Email: Attention: Phone No.: Email: Please return this Attachment via fax or mail with signed Authorization R A B A K I S T N E R EXHIBIT "C" WORK SCHEDULE Old Settlers Park Multi -Sport Complex Raba Kistner Consultants, Inc. ® Services will be performed on a call out basis with a minimum 24 hour notice. e Schedule of Work dependent upon needs of construction testing and observation. R A B A K I S T N E R EXHIBIT D - FEE SCHEDULE COST ESTIMATE BREAKDOWN Date:j December 30, 2015 Proposal Number: PAD15-136.00 Project Name: Old Settlers Park Multi -Sports Complex - Package A Project Location: Harrell Parkway, Round Rock,TX Contact Name: Katie Baker Client: City of Round Rock - Parks and Recreation Address: 301 W. Bagdad Avenue, Suite 250 City/State /Zip Round Rock, TX 78664 Phone Number:: 1512.341.3355 office Fax Number: 1512.218.5548 E -Mail: kbakerAroundrocktexas.0ov PACKAGEI Includes Alternate ,".1 TESTING/OBSERVATION ITEM UNIT COST UNIT ESTIMATED QUANTITY COST EXTENSION 50115 Laboratory Testing Moisture Density Relationship, TxDOT or ASTM $415.00 each 0 $0.00 (Includes Atterberg Limits and Sieve Analysis) Lime Series Curve $435.00 each 0 $0.00 Field Testin /Observation In -Place Nuclear Densities $25.00 each 220 $5,500.00 Field Lime Gradations (will include with Tech Time) $0.00 each 10 $0.00 Materials Technician $50.00 hour 128 $6,400.00 Vehicle Travel Charge (Based on 40 mile Round Trip) $22.40 trip 44 $985.60 Subtotal $12,885.60 REINFORCING STEEL OBSERVATIONS Field Observation/Testing Materials Technician $50.00 lhour 45 $2,250.00 Vehicle Travel Charge (Based on 40 mile Round Trip) $22.40 Itrlp 15 $336.00 Subtotal I 1 $2,586.00 CONCRETE Laboratory Testing Concrete Compressive Strength Cylinders $17.00 each 300 $5,100.00 Field Testing/Observation Materials Technician $50.00 hour 190 $9,500.00 Materials Technician (overtime) $70.00 hour 0 $0.00 Vehicle Travel Charge (Based on 40 mile Round Trip) $22.40 trip 70 $1,568.00 Subtotal $16,168.00 MASONRY Laboratory Testing Mortar Cubes $24.00 each 24 $S76.00 Compressive Strength Grout $17.00 each 16 $272.00 Field Testing/Observation Materials Technician $50.00 hour 14 $700.00 Vehicle Travel Charge (Based on 40 mile Round Trip) $22.40 trip 4 $89.60 Subtotal $1,637.60 STRUCTURAL STEEL INSPECTION Field Testing/Observation CWI Inspector $85.00 hour 40 $3,400.00 Vehicle Travel Charge (Based on 40 mile Round Trip) $22.40 trip B $179.20 Subtotal $3579.20 ASPHALT Laboratory Testing Bag Sample (Extraction, Gradation, A/C content, $459.00 each 9 $4,131.00 Molding Specimens, Laboratory Densityof Molded Specimens, StabilityTest, Hveem, Maximum Theoretical spasific Gravity) Asphalt Coring Equipment $92.00 day 27 $2,484.00 Density of Asphalt Cores $40.00 each 27 $1,080.00 Field Testing/Observation Materials Technician $50.00 hour 24 $1,200.00 Vehicle Travel Charge (Based on 40 mile Round Trip) $22.40 trip 4 $89.60 Subtotal 1$8,984.60 PROJECT ADMINISTRATION Project Engineer $165.00 hour 1 $165.00 Clerical $55.00 hour 10 $550.00 Subtotal $940.00 GRAND TOTAL $46,781.00 RABAKISTNI ER EXHIBIT D - FEE SCHEDULE COST ESTIMATE BREAKDOWN Date: December 30, 2015 Proposal Number: PADIS-136-00 Project Name: Old Settlers Park Multi -Sports Complex - Package B Project Location: Harrell Parkway, Round Rock, TX Contact Name: Katie Baker Client: City of Round Rock- Parks and Recreation Address: 301 W. Bagdad, Suite 250 City/State /Zip Round Rock, TX 78664 Phone Number:: 512.341.3355 office Fax Number: 512.218.5548 E -Mail: kbaker()roundrocktexas.00v PACKAGE TESTING/OBSERVATION ITEM UNIT COST UNIT ESTIMATED QUANTITY COST EXTENSION SOILS Laboratory Testing Moisture Density Relationship, TxDOT or ASTM $415.00 each 2 $830.00 (Includes Atterberg Limits and Sieve Analysis) Field Testing/Observation In -Place Nuclear Densities $25.00 each 36 $900.00 Materials Technician $50.00 hour 15 $750.00 Vehicle Travel Charge (Based on 40 Mile Round Trip) $22.40 trip 5 $112.00 Subtotal t $2,592.00 REINFORCING STEEL OBSERVATIONS Field Observation/Testing Materials Technician $50.00 hour 6 $300.00 Vehicle Travel Charge (Based on 40 Mile Round Trip) $22.40 trip 2 $44.80 Subtotal 1$344.80 CONCRETE Laboratory Testing Concrete Compressive Strength Cylinders $17.00 each 35 $595.00 Field Testing/Observation Materials Technician $50.00 hour 36 $1,800.00 Materials Technician (overtime) $70.00 hour $0.00 Vehicle Travel Charge (Based on 40 Mile Round Trip) $22.40 trip 12 $268.80 Subtotal $2,663.80 ASPHALT Laboratory Testing Bag Sample (Extraction, Gradation, A/C content, $459.00 each 1 $459.00 Molding Specimens, Laboratory Density of Molded Specimens, Stability Test, Hveem, Maximum Theoretical spasific Gravity) Asphalt Coring Equipment $92.00 each 27 $2,484.00 Density of Asphalt Cores $40.00 each 27 $1,080.00 Field Testing/Observation Materials Technician $50.00 hour 4 $200.00 Vehicle Travel Charge (Based on 40 Mile Round Trip) $22.40 trip 1 $22.40 Subtotal $4,245.40 PROJECT ADMINISTRATION Project Engineer $165.00 hour 2 $330.00 Clerical $55.00 hour 6 $330.00 Subtotal $720.00 GRAND TOTAL $9,846.00 RABAKISTNER AC'C>R®° CERTIFICATE OF LIABILITY INSURANCE kk_� DATE (fdMIDDIYYYY) 1/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Wortham Insurance & Risk Management Blvd. 131 InterAntonio, San Antonio, TX 78216 CONTAPRODUCER NAME: Cindy Rains PHONE(A/C, e E . 210-249-2325 Fn c No : 210-223-2806 E-MAIL ADDRESS: cind .rains worthaminsurance.com INSURERS) AFFORDING COVERAGE NAIC # www.worthaminsurance.com INSURER A: Allied World Assurance Company U$ Inc 012525 INSURED Raba Kistner Inc INSURER B: EACH OCCURRENCE S 12821 W Golden Ln INSURER C: INSURER D: San Antonio TX 78249 INSURER E: INSURER F: DAMAGE TO RENTED PREMISES Ea occurrence 5 COVERAGES CERTIFICATE NUMBER: 28079996 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDlYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS -MADE D OCCUR DAMAGE TO RENTED PREMISES Ea occurrence 5 MED EXP (Any one person) S PERSONAL 8 ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY ❑ PRO- JECT F-1 LOC PRODUCTS - COMP/OP AGG S S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) S ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) 5 NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE S Per accident S UMBRELLA LIAB Ld OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DED I I RETENTION S $ WORKERS COMPENSATION PER OTH. AND EMPLOYERS' LIABILITY Y / N STATUTE ER E.L. EACH ACCIDENT S ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUOED7 NIA E.L. DISEASE - EA EMPLOYEd S (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S A Professional Liability 03097073 7/18/2015 7/18/2016 $1,000,000 Each Claim Claims Made Policy Form $1,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) Project: PO# 20160346-00 - Old Settlers Park Multi Sport Complex k,r-M I Ir'[L,,R I C rIVLL)MM City of Round Rock Parks & Recreation 3301 W Bagdad Ave, Suite 250 Round Rock TX 78664 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE blpA&O 4,!k1d John L. Wortham & Son, L.P. 1�1.`,r[�♦/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 28079996 1 22RABAKCON 1 15-16 $/mil Professional I (SA) Cindy Rains 1 1/11/2016 9:22:18 AM (CST) I Page 1 of 2 AGENCY CUSTOMER ID: 22RABAKCON LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Wortham Insurance & Risk Management 9 Raba Kistner Inc 12821 W Golden Ln San Antonio TX 78249 POLICY NUMBER 03097073 CARRIER NAIC CODE Allied World Assurance Company US Inc 012525 EFFECTIVE DATE: 7/1812015 KtIVIAK THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) HOLDER: City of Round Rock Parks & Recreation ADDRESS: 3301 W Bagdad Ave, Suite 250 Round Rock TX 78664 Additional Named Insureds: Raba Kistner Consultants Inc Raba Kistner Infrastructure Inc Raba Kistner Environmental Inc Raba Kistner Facilities Inc Raba Ingenieros S. de R. L. de C. V. PC Sports Inc ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 28079996 1 22RABAKCON 1 15-16 $lmil Professional I (SAI Cindy Rains 1 1/11/2016 9:22:18 AFI (CST) I Page 2 of 2 ® CERTIFICATE OF LIABILITY INSURANCE DATE,h,M/DDNYYY) 1/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Catto & Catto LLP One Alamo Center 106 S. St. Mary's Street, Ste. 800 CONTACT NAME: Janet PHONE FAX arc No E:t :210-222-2161(AJC, No): E DRlessJhajek(@catto.com INSURERS AFFORDING COVERAGE NAIC k San Antonio TX 78205 INSURER Aflartford Underwriters Ins, Co. 30104 65UUNZR1762 INSURED INSURERB:Hartford Ins CO Of the Midwest 7478 INSURER C : Raba Kistner Inc. P.O. Box 690287 San Antonio TX 78269-0287 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1533618175 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR I TYPE OF INSURANCE INSR WVD POLICYNUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIODIYYYY LIMITS A GENERAL LIABILITY Y Y 65UUNZR1762 10/1/2015 10/1/2016 EACH OCCURRENCE 51,000,000 x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR DAMAGE T R N PREMISES Ea occurrence 51,000,000 MED EXP (Any one person) 510,000 PERSONAL & ADV INJURY 51,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: -]B PRODUCTS - COMP/OPAGG I S2,000,000 Deductible SO POLICY PRO LOC jECT F AUTOMOBILE LIABILITY Y Y 65UENZR2052 10/1/2015 10/1/2016 IN I Ea accident 51,000,000 BODILY INJURY (Per person) S x ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) S NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE S Peraccidenl S UMBRELLA LIAB HCLAIMS-MAGE OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAR DED I I RETENTIONS 5 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Y 6SWEAL1929 10/1/2015 10/1/2016 X ORSTATU- OTH- T RY IMIT EACH ACCIDENT 51,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICEWMEMBER EXCLUDED? a N / A E.L. DISEASE - EA EMPLOYEO $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I 57,000,000 B Auto Physical Damage 65UENZR2052 10/1/2015 10/1/2016 Comp. Deductible 1000 Coll. Deductible 1000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Named Insureds: Raba Kistner, Inc dba Raba Kistner Consultants, Inc., Raba Kistner Environmental, Inc, Raba Kistner Facilities, Inc., Raba Kistner Infrastructure and Raba Ingenieros S. de R.L. de C.V. Project: Old Settlers Park Multi -Sport Complex / PO #20160346-00 The General Liability and Auto Liability policy includes a blanket automatic additional insured endorsement provision that provides additional See Attached... t•�a.�n�L•sa>L��a�nac •s_�cL•�3.Iasivac City of Round Rock - Parks and Recreation 3301 W. Bagdad Ave., Suite 250 Round Rock TX 78664 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUT"HO/,RIZZEEEDDD REPRESENTATIVE ;;� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: _ LOC 4: A ®© ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Catto & Catto LLP Raba Kistner Inc. P.O. Box 690287 POLICY NUMBER San Antonio TX 78269-0287 CARRIER NAIC CODE EFFECTIVE DATE: 1 I IVIVHL RCIVIAMA0 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE nsured status to the parties listed in said contract when there is a written contract between the named insured and the certificate holder that equires such status. The General Liability policy contains a special endorsement with "Primary and Noncontributory" wording. The General .lability, Auto Liability and Workers Compensation policy includes a blanket waiver of subrogation endorsement that provides this feature )nly when there is a written contract between the named insured and the certificate holder that requires it. The General Liability, Auto .lability and Workers Compensation policy includes a blanket notice of cancellation to certificate holders endorsement providing for 30 days' advance notice if the policy is canceled by the company other than for nonpayment of premium. The endorsement does not provide for iotice of cancellation if the named insured requests cancellation. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl 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: 2016-8557 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Raba Kistner Consuftants, Inc. Austin, TX United States Date Filed: 02/03/2016 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 Rock Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the goods or services to be provided under the contract. 000000 Construction Materials Testing 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. EtW D Danzoy my Commission Expires.., a 03/17/2018t� Signature of authorized agent of contracting busi ess entity AFFIX NOTARY STAMP / SEAL ABOVE (}`nn Q Sworn to and subscribed before me, by the said �l t tl�l�� 0 Y tt U J Y this the r �ay of 20 �. �p to certify which, witness my hand and seal of office. IVIS Walk Signature of officer adrni ting oath Printed name o officer adrf in tering oath Title of officer administering oath Forms provided by Texas Ethics Commission wvmj. ethics. state.tx. us Version V1.0.34416 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2016-8557 Date Filed: 02/03/2016 Date Acknowledged: 02/03/2016 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Raba Kistner Consultants, 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. 000000 Construction Materials Testing 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 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Versinn V1 n 3441 R