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Contract - Raba Kistner Consultants, Inc. - 6/23/2016STATE OF TEXAS § COUNTY OF WILLIAMSON § SUPPLEMENTAL CONTRACT NO. 1 TO CONTRACT FOR ENGINEERING SERVICES FOR ON-CALL GEOTECHNICAL SERVICES WORK AUTHORIZATION FIRM: RABA KISTNER CONSULTANTS, INC. ("Engineer") ADDRESS: 8100 Cameron Road, Suite B-150, Austin, TX 78754 This Supplemental Contract No. 1 to Contract for Engineering Services is made by and between the City of Round Rock, Texas, hereinafter called the "City" and Raba Kistner Consultants, Inc., hereinafter called the "Engineer". WHEREAS, the City and Engineer executed a Contract for Engineering Services, hereinafter called the "Contract", on the 10th day of July, 2014 for the On -Call Geotechnical Services Project in the amount of $75,000.00; and WHEREAS, it has become necessary to amend the Contract to modify the fee schedule; and WHEREAS, it has become necessary to amend the Contract so that the contract term shall terminate at the close of business day on December 31, 2017; NOW THEREFORE, premises considered, the City and the Engineer agree that said Contract is amended as follows: I. Exhibit C. Fee Schedule shall be amended as set forth in the attached Addendum To Exhibit C. II. Article 3. Contract Term shall be amended so that the contract term shall terminate at the close of business day on December 31, 2017. IN WITNESS WHEREOF, the City and the Engineer have executed this Supplemental Contract in duplicate. Supplemental Contract Rev.12/01/08 0127.14330;�000358682�}�� 84275 if RABA KISTNER CONSULTANTS, INC. R., Date CITY OF OUND ROCK By: Alan McGraw, Mayor Date Supplemental Contract 0127.1430;00358682 4AP VEDA TO FORM: LI Step n L. Sheets, City Attorney Rev.12/01 /08 84275 ADDENDUM TO EXHIBIT C Work Schedule Attached Behind This Page ON-CALL GEOTECHNICAL ENGINEERING CONSULTING SERVICES City of Round Rock 2016 Fees TITLE HOURLY Rate Principal $ 208.00 Senior Engineer/Consultant $ 208.00 Project Manager $ 182.00 Project Engineer $ 172.00 Engineer $ 104.00 Engineer in Training $ 93.50 Geotechnical Technician $ 62.50 CADD Operator $ 83.00 Clerical $ 57.00 Geologist $ 135.00 Environmental Scientist $ 110.00 Lead Technician $ 62.50 CMTTechnician $ 52.00 Archaeologist $ 114.50 GIS $ 94.00 Mileage (Privately Owned Vehicle) Lodging Meals and Incidental Air Travel Copies 8 1/2 x 11, 11 x 17 Mylar 11 x 17 Schematic Plots Misc. Non -Travel Expenses Field Expenses DIRECT EXPENSES $0.56 per mile or current GSA allowable rate At cost up to GSA allowable At cost up to GSA allowable Cost + 10% $0.16/page $2.10/page $1.58/sq. ft Cost + 10% Cost + 10% 20'16 ON-CALL GEOTECHNICAL ENGINEERING CONSULTING SERVICES CITY OF ROUND ROCK RABA KISTNER CONSULTANTS, INC Field Drilling Services -1 Auger Drilling (Does not include logging) soil per ft $16.50 soft rock per ft $20.00 -2 Standard Wet Rotary (Does not include logging) per ft $22.00 -3 Nx Rock Core (Does not include logging) Soft rock (marl, shale) per ft $33.50 Hard rock (limestone, sandstone) per ft $43.50 -4 Non -conventional drilling (barge drilling or unusual time consuming drilling i.e. through bridge) per hr $290.50 -5 Field Logging Services Geotechnical Technician per hr $62.50 Geologists per hr $135.00 Engineer in Training per hr $93.50 -6 Field Coordination Field Engineer per hr $104.00 Flagman per hr $67.50 -7 Mobilization Mobilization or truck -mounted rig, rill crew and support per mile $4.00 Field logger trip charge per mile $1.00 Mobilization non-standard equipment (4x4 all terrain rig) Barge mobilization and rental -8 Sampling Standard Penetration Test (ASTM D1586) per test $23.00 Shelby Tube (ASTM D1587) per test $23.00 Texas Cone Penetrometer Test (THD, Tex -132-E) per test $27.00 -9 Other Expenses/Charges Standby Time per hr $234.00 Mileage - non -drilling equipment per mile $1.00 Grout backfill per ft $3.50 Dozer/clearing cost Logger truck charge per day $57.00 Standard pavement coring each $78.00 Concrete/AC patch each $66.50 Traffic control - signs, barricades All other outside expenses ON-CALL GEOTECHNICAL ENGINEERING CONSULTING CITY OF ROUND ROCK 2076 LABORATORY TESTING FEES ASPHALTIC CONCRE REFERENCE FIELD SERVICES ASTM D 75 Sampling Raw Materials of Composite Mix Technician Time............................................................................................. $ 52.00/hr Asphalt Institute Asphaltic Plant Observation -To Verify Aggregate Size Manual and Quality, Batch Weights and Temperature Technician Time............................................................................................. 62.50/hr Asphalt Institute Asphaltic Site Observation -To Observe Preparation, Manual Laydown Operations, Asphaltic Concrete Temperatures, Mat Thickness and Mat Density Determination Technician Time............................................................................................. 62.50/hr ASTM D 2950 Nuclear Density Test with Inspection................................................................... 16.50/ea Nuclear Density Test............................................................................................. 26.00/ea Coring (See Coring Fee Schedule) REFERENCE LABORATORY SERVICES ASTM D 2172; Extraction Test, Bitumen Content and Aggregate TxDOT, TEX-210-F Sieve Analysis of Asphaltic Concrete.................................................................... $ 197.50/ea ASTM D 2172; Extraction Test, Bitumen Content Only................................................................ 136.50/ea TxDOT, TEX-210-F Asphaltic Concrete Extraction; Bitumen Content and Aggregates; Sieve Analysis of Asphaltic Concrete; Molding Specimens (Hveem or Marshall); Laboratory Density (Molded Specimen); Stability Test (Hveem); and Maximum Theoretical Specific Gravity (Rice Gravity)............................................................................................ 477.50/set Hveem, Molding Specimens TxDOT, TEX-206-F; Hveem or Marshall........................................................................................ 62.50/set Marshall, Superpave (2 per set)........................................................................................... 124.00/set ASTM D 1559 TxDOT, TEX-207-F; Laboratory Density Test........................................................................................ 62.50/set ASTM D 2726 a) Molded Specimen.................................................................................. 62.50/set b) Asphalt Core......................................................................................... 53.00/ea c) Superpave (2 per set)............................................................................ 75.00/set Hveem, Stability Test TxDOT, TEX-208-F; Marshall......................................................................................................... 60.50/set Marshall, Hveem........................................................................................................... 60:50/set ASTM D 1559 Asphalt Institute Corp of Engineers or FAA...................................................................................... 1,990.50/ea Manual and TxDOT Quality Control/Quality Assurance............................................................ 1,990.50/ea TxDOT; TXDOTCMHB........................................................................................................ 2,828.00/ea Mix Designs TxDOT Calibration Mix and Pans.......................................................................... 333.00/ea TxDOT Black Base Design, Item 345..................................................................... 1,490.50/ea TxDOT, TEX-200-17; Sieve Analysis of Aggregate.................................................................................. 40.50/ea ASTM C 136 ASPHALTIC CONCRETE (Continued) REFERENCE LABORATORY SERVICES TxDOT, TEX-203-17; Sand Equivalent Test............................................................................................ $ 86.50/ea ASTM D 2419 AASHTO TP 33 Fine Aggregate Angularity..................................................................................... 51.00/ea ASTM D 4791-95; Flat and Elongated Particle................................................................................... 51.00/ea TOOT, TEX-201-F; Specific Gravity (Coarse or Fine Aggregate).......................................................... 40.50/ea ASTM C 127 TOOT, TEX-201-F; Absorption (Coarse or Fine Aggregate) (Includes Specific Gravity) ....................... 62.50/ea ASTM C 127 TOOT, TEX-411-A; Sulfate Soundness (Time and Test) ASTM C 88 Preparation Time............................................................................................ 52.00/hr ASTM D 4867 a) Magnesium - 5 Cycle............................................................................. 503.50/ea TOOT, Item 3157 b) Sodium - 5 Cycle................................................................................... 448.50/ea ASTM C 131; Los Angeles Abrasion Test (Time and Test) As Requested ASTM C 535 Los Angeles Abrasion Test (Small or Large Coarse Aggregate) ....................... 194.50/ea Asphalt Inst. SP -2 Superpave TM Mix Design (Includes Aggregate, Specific Gravity 785.00/set TxDOT, Item 3066 and Sieve Analysis) (Does Not Include TSR)........................................................... 6,149.50/ea AASHTO PP 28-95 TxDOT, TEX-227-F; Maximum Theoretical Specific Gravity (Rice Gravity) ........................................... 93.50/ea AASHTO T 209; ASTM D 2041 Molding and Marshall........................................................................................... 136.50/set TOOT, TEX-226-F; Moisture Sensitivity Test (Tensile Strength Ratio Test) AASHTO T 283; with Freeze/Thaw.......................................................................................... 533.50/ea ASTM D 4867 without Freeze/Thaw..................................................................................... 417.00/ea TOOT, Item 3157 Cold Processed — Recycled Paving Material (RPM) Mixture Design............................................................................................... As Requested Mixture Verification (QC) Strength, Stability (Hveem, Modified Marshall)............................................................. 785.00/set TOOT, TEX-126-E Molding and Strength........................................................................................... 381.50/set (Modified) TxDOT, TEX-208-F Molding and Hveem............................................................................................. 144.50/set (Modified) ASTM D 1559 Molding and Marshall........................................................................................... 136.50/set TxDOT, TEX-103-E Molded Moisture Content.................................................................................... 13.50/ea CEMENT TREATED BASE REFERENCE FIELD SERVICES PCA Sampling Raw Materials for Mix Verification Technician Time............................................................................................. $ 52.00/hr Sampling Contractor Processed Material TechnicianTime............................................................................................. 52.00/hr CEMENT TREATED BASE (Continued) REFERENCE LABORATORY SERVICES PCA Molding Controlled Processed Material............................................................... $ 72.00/ea PCA Unconfined Compressive Strength Testing ...................................................... I.... 32.50/ea ASTM D 559; Durability (2 Specimens per Set) (Percent Loss in 12 Cycles) ASTM D 560 Wet Dry/Freeze Thaw........................................................................................... 612.50/set Mix Design PCA; Mix Design - Cement Treated Base (Does Not Include TxDOT, TEX-120-E; Durability)...................................................................................................... $ 1,218.00/ea ASTM D 558 CONCRETE REFERENCE FIELD SERVICES ASTM C 31; Sampling Concrete to Conduct Slump Test, Measure Concrete ASTM C 172; Temperature, Cast Test Specimen and Transport ASTM C 143 Test Specimen to Laboratory Next Day Technician Time............................................................................................. $ 52.00/hr Pick -Up of Test Specimen.............................................................................. 52.00/hr StandbyTime................................................................................................. 52.00/hr ASTM C 39; Cylinder Compressive Strength Testing and Reporting ASTM C 617 (In Conjunction with Sampling) a) 6x12 or 48 - Normal Weight or Lightweight Structural (Minimum of 4)...................................................................................... 17.50/ea b) 3x6 - Lightweight Insulating Cellular (Minimum of 6 - Includes Two Dry Densities) ........................................ 26.00/ea c) "Hold" Cylinder (Additional Charge) ...................................................... 11.50/ea d) "Strip" Cylinder (Additional Charge) ...................................................... 13.50/ea e) Compressive Strength - 2x2 Cubes ........................................................ 25.00/ea f) Dry Density - Concrete Cylinder............................................................. 46.00/ea ASTM C 78 Flexural Strength Testing and Reporting (In Conjunction with Sampling Beams)................................................................. 51.00/ea Air Content (In Conjunction with Sampling) ASTMC 231 a) Pressure................................................................................................. 33.50/ea ASTMC 173 b) Volumetric............................................................................................. 39.50/ea AASHTOT 199 c) Chase..................................................................................................... 17.50/ea ASTMC 138 Unit Weight.......................................................................................................... 30.00/ea ASTM C 143 Additional Slump Test........................................................................................... 25.00/ea ACI 311; Concrete Plant Observation - To Observe and Record Aggregate ACI 304 Types, Batch Weights, Concrete Consistency and Mixing Time TechnicianTime............................................................................................. 52.00/hr ACI 311; Concrete Site Observation -To Record the Consistency of Concrete, ACI 304 Verify and Adjust Slump within Project Specifications and Sample for Test Specimens TechnicianTime............................................................................................. 52.00/hr ACI 211.1 Hardrock Concrete Mix Design Calculations and Proportioning to Include Six Confirmatory Cylinders (Physical Properties Not Included) ............................. ........................ I................. 313.00/ea CONCRETE (Continued) REFERENCE FIELD SERVICES ACI 211.1 (303.R) Architectural Mix Design...................................................................................... 343.00/ea ACI 211.2 Lightweight Structural Mix Design........................................................................ 322.50/ea ASTM C 270 Masonry Mortar Mix Design Including Six Cubes and ASTM C 566 Water Retention (Physical Properties Not Included) ............................................ $ 343.00/ea ASTM C 1202 Chloride Ion Permeability..................................................................................... 272.50/set ASTM C 39 Cylinders Compressive Strength Testing and Reporting 34.50/ea F.O.B. Cylinders to Our Laboratory....................................................................... 29.00/ea ASTM C 496 Splitting Tensile Strength of Concrete Cylinders 40.50/ea ASTM C 128; TensileTest.................................................................................................... 45.50/ea ASTM C 666 Freeze -Thaw Test................................................................................................. 378.50/set ASTM C 469 Determination of Young's Modulus of Elasticity 60.50/test (Time, Test and Set-Up)........................................................................................ 86.50/ea ASTM C 803 Windsor Probe (Includes Surface Preparation).................................................... 88.50/hr ASTM C 805 Schmidt Rebound Number................................................................................... 88.50/hr CONCRETE AGGREGATES REFERENCE FIELD SERVICES ASTM D 75; Sampling Concrete Aggregates TxDOT, TEX-400-A Technician Time............................................................................................. $ 52.00/hr REFERENCE LABORATORY SERVICES ASTM C 566 Moisture Content................................................................................................. $ 13.50/ea ASTM C 29; Unit Weight (Coarse or Fine) TxDOT, TEX-404-A a) Loose..................................................................................................... 34.50/ea b) Rodded.................................................................................................. 34.50/ea ASTM C 127; Specific Gravity (Coarse or Fine)........................................................................... 40.50/ea ASTM C 128; TxDOT, TEX-201-F ASTM C 123 Lightweight Particles (Plus Cost of Materials)...................................................... 60.50/test Absorption ASTM C 127; a) Normal Weight Aggregate (Coarse or Fine) ........................................... 26.00/ea ASTM C 128; b) Lightweight Aggregate (Coarse)............................................................. 29.00/ea TxDOT, TEX-201-F ASTM C 136; Sieve Analysis (Dry) for ASTM C 33 Specifications TxDOT, TEX-401-A a) Coarse, Per Sample................................................................................ 45.50/ea b) Fine, Per Sample.................................................................................... 54.00/ea ASTM C 117; Amount Finer than No. 200 (Decantation)........................................................... 38.50/ea TxDOT, TEX-406-A ASTM C 131; Los Angeles Abrasion (Time and Test).................................................................. 195.00/ea ASTM C 535 CONCRETE AGGREGATES (Continued) REFERENCE FIELD SERVICES ASTM C 88; Sulfate Soundness (Time and Test) TxDOT, TEX-411-A Preparation Time........................................................................................... 52.00/hr a) Magnesium - 5 Cycle.............................................................................. 503.50/ea b) Sodium - 5 Cycle.................................................................................... 448.50/ea ASTM C 117; Physical Properties of Aggregates - Includes Decantation, ASTM C 29; Rodded Unit Weight, Specific Gravity, Absorption, Sieve ASTM C 127; Analysis and Moisture Content (Per Aggregate Type and Size) ASTM C 128; Conducted in Conjunction with Concrete Mix Design ................................... 150.00/ea ASTM C 566; Conducted Separate from Concrete Mix Design ............................................ 194.50/ea TxDOT, TEX-406-A; TxDOT, TEX-404-A; TxDOT, TEX-201-F; TxDOT, TEX-401-A ASTM C40; Organic Impurities................................................................................................ 39.50/ea TxDOT, TEX-408-A ASTM C 2419; Sand Equivalent Values......................................................................................... 86,50/ea TxDOT, TEX-203-F ASTM C 142 Clay Lumps and Friable Particles.......................................................................... $ 58.50/ea ASTM C 641 Staining Materials in Lightweight Concrete Aggregate ................................................ 58.50/ea CORING REFERENCE FIELD SERVICES ASTM C 42; Technician Time and Equipment ACI318 a) One Man................................................................................................ $ 62.50/hr b) Two Men............................................................................................... 97.50/hr c) Reinforcing Steel Detector..................................................................... 30.00/day d) Coring.................................................................................................... 95.50/day e) Generator.............................................................................................. 99.00/day Bit Wear a) Limestone Aggregate. ................ I ....... " .................................................. 6.50/in.in. b) Quartz Aggregate (River Gravel)............................................................ 7.50/in.in. REFERENCE LABORATORY SERVICES ASTM C 42 Sawed Ends for Compressive Strength Test a) Limestone Aggregate............................................................................. $ 2.00/sq.1n. ASTM C 39; Compressive Strength of Concrete Core Includes ASTM C 42; Measurements, Capping and Testing................................................................... 26.00/ea ASTM C 174; ASTM C 617 Report Photographs............................................................................................. Cost +15% Laboratory Air -Dried Unit Weight......................................................................... 17.50/ea LIME REFERENCE FIELD SERVICES National Lime Continuous Observation to Monitor and Record Equipment Association Functions, Specific Gravity of the Lime Slurry and Observation Standard Method of Sampling Hydraulic Cement ................................................. of Stabilization Location and Depth ASTM C 109 Technician Time............................................................................................. $ 52.00/hr REFERENCE LABORATORY SERVICES ASTM D 422; Sieve Analysis of Pulverized Materials for Gradation Compliance ........................ $ 65.50/ea TxDOT, TEX-101-E, Air Content of Hydraulic Cement Mortar.............................................................. Pt. II ASTM C 266; ASTM D 4318; Lime Series Curve Determination Including Five Atterberg Limits ........................ 452.50/ea TxDOT, TEX-112-E PORTLAND CEMENT REFERENCE LABORATORY SERVICES ASTM C 183 Standard Method of Sampling Hydraulic Cement ................................................. $ 52.00/hr ASTM C 109 Compressive Strength of Hydraulic Cement Mortars (Using 2 -in. or 50mm Cube Specimen).................................................................. 25.00/ea ASTM C 185 Air Content of Hydraulic Cement Mortar.............................................................. 51.00/ea ASTM C 266; Time of Setting of Hydraulic Cement by Gillmore/Vicat Needles .......................... 61.50/ea ASTM C 191 ASTM C 151 Autoclave Expansion of Portland Cement............................................................. 205.00/ea ASTM C 187 Normal Consistency of Hydraulic Cement............................................................. 51.00/ea ASTM C 188 Specific Gravity of Hydraulic Cement.................................................................... 59.50/ea ASTM C 430 Fineness of Hydraulic Cement by the No. 325 Sieve ............................................. 59.50/ea ASTM C 451 Early Stiffening of Portland Cement (Paste Method) ............................................ 51.00/ea ASTM C 114 Chemical Analysis.................................................................................................. 375.50/ea ASTM C 91 Water Retention of Masonry Cement................................................................... 95.50/ea ASTM C 150 Chemical Analysis.................................................................................................. 375.50/ea PhysicalAnalysis.................................................................................................... 745.50/ea SOILS REFERENCE FIELD SERVICES ASTM D 75 Sampling Subgrade, Fill or Base Technician Time............................................................................................. $ 52.00/hr In -Place Moisture -Density Test TechnicianTime............................................................................................. 52.00/hr ASTM D 2922 Nuclear Density............................................................................................. 26.00/ea ASTM D 2167; Volumetric Density (Sand Cone)........................................................................... 75.00/ea ASTM D 1556 SOILS (Continued) REFERENCE FIELD SERVICES Fill and Embankment Observation -Testing for Compliance with the Project Specifications to Verify Proper Moisture and Compaction Conditions in Orderto Produce a Quality Fill and Uniform Workmanship (Time, Test and Mileage) Technician Time (Hourly Rate)...................................................................... Proof Rolling Observation..................................................................................... ASTM D 2922 Nuclear Density Test with Observation................................................................ ASTM D 2216; Moisture Content................................................................................................. TxDOT, TEX-103-E 52.00/hr 52.00/hr 16.50/ea 13.50/ea 86.50/ea 106.00/ea 106.00/ea 58.50/ea 86.50/ea 13.50/ea 58.50/ea 52.00/hr 259.00/ea 259.00/ea 259.00/ea 259.00/ea 194.50/ea 822.50/set 169.50/ea $ 1,366.50/set 1,254.50/set 154.00/ea 86.50/ea 284.00/ea 438.00/ea 30.00/ea 214.50/ea Atterberg Limits ASTM D 4318 a) ASTM or TxDOT (TEX-104, TEX-105-E, TEX-106-E)................................ Shrinkage Limit in Conjunction with Atterberg Limits ASTM D 427 a) Volumetric............................................................................................. b) Linear (TxDOT, TEX-107-E).................................................................... ASTM D 422; Sieve Analysis TxDOT, TEX-101-E; a) Washed through No. 40 (Up to 5 Sieves) ............................................... TxDOT, TEX-110-E; b) Washed through No. 200 (Up to 5 Sieves) ............................................. c) Additional Sieves................................................................................... ASTM D 1140 Amount Finer Than No. 200 Sieve........................................................................ Moisture -Density Relationship PreparationTime........................................................................................... ASTMD 698; ASTM............................................................................................................ ASTM D 1557 AASHTOT 99; AASHTO......................................................................................................... AASHTO T 180 TxDOT, TEX-113-E; TxDOT............................................................................................................ TxDOT, TEX-114-E MIL STD CE 55A Corp of Engineers.......................................................................................... ASTM C 131; Los Angeles Abrasion (Time and Test).................................................................. ASTM C 535 ASTM D 1883 California Bearing Ratio - Short Method; Includes Moisture -Density Relationship and One Test Specimen ....................................... Each Additional Specimen............................................................................. TxDOT, TEX-117-E TxDOTTriaxial —Short Method; Includes Moisture -Density Relationship and Up to Six Test Specimens PartI............................................................................................................. Part11............................................................................................................. Each Additional Specimen............................................................................. ASTMD 854; Specific Gravity..................................................................................................... TxDOT, TEX-108-E ASTM D 422; Hydrometer Analysis (Includes Sample Preparation, TxDOT, TEX-110-E Grain Size Curve and Specific Gravity).................................................................. ASTM D 5084 Hydraulic Conductivity.......................................................................................... ASTMD 2166 Unit Weight.......................................................................................................... TxDOT, TEX-116-E Wet Bail Mill......................................................................................................... 52.00/hr 52.00/hr 16.50/ea 13.50/ea 86.50/ea 106.00/ea 106.00/ea 58.50/ea 86.50/ea 13.50/ea 58.50/ea 52.00/hr 259.00/ea 259.00/ea 259.00/ea 259.00/ea 194.50/ea 822.50/set 169.50/ea $ 1,366.50/set 1,254.50/set 154.00/ea 86.50/ea 284.00/ea 438.00/ea 30.00/ea 214.50/ea SOILS (Continued) REFERENCE FIELD SERVICES Water Content and Visual Classification............................................................... 13.50/ea Unconfined Compression (includes unit dry weight) a) Soil Shelby Tube Specimens........................................................................... 45.00/ea b) Rock Core Specimens.................................................................................... 53.00/ea (1) Sawed Specimen Ends........................................................................... 11.50/end Triaxial Compression a) Unconsolidated -Undrained, Per Specimen .................................................... 81.00/ea b) Unconsolidated -Undrained, Multistage........................................................ 284.00/ea Direct Shear a) Unconsolidated-Undrained........................................................................... 217.00/ea b) Consolidated -Drained (Sand)......................................................................... 459.00/ea Consolidation (Not Including Specific Gravity)........................................................... 587.50/ea Swell Test a) Pressure Method........................................................................................... 308.00/ea b) Free Swell...................................................................................................... 162.50/ea r a : �.. ,► �., FORM 1295 loft 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 12016-69791 1 Name of business entity filing form, and the city, state and country of the business entity's place Certificate Number: of business. - Raba Kistner Consultants, Inc. Austin, TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 06!13!2016 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 services, goods, or other property to be provided under the contract. Professional Services Professional Services, 3rd Party Testing 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I 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. ->.`•,MARY L IS � �,..--- Nolury Putlic, $1mrla=icayFcbaw" D��VJ '`fi;/(ry?•,f ';":-. ry Dd Signature of authorized business entity nontracting AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said Wendy Dickey-Danzoy this the 13th day of JUNE 20 16 to certify which, witness my hand and seal of office. /� ix�. ��1.E3' Mary L. Davis Credit & Collections Mgr. Signature of Oicer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.1021 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: 2016-69791 Date Filed: 06/13/2016 Date Acknowledged: 06/16/2016 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 parry 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 services, goods, or other property to be provided under the contract. Professional Services Professional Services, 3rd Parry Testing 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I 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.ethlcs.state.tx.us version vl.u.lu/-.i