Loading...
HomeMy WebLinkAboutC2009-011 - 1/13/2009 - ApprovedSANITARY SEWER COLLECTION LINE EXTENSION CONSTRUCTION AND REIMBURSEMENT AGREEMENT THE STATE OF TEXAS COUNTY OF NUECES This Sanitary Sewer Collection Line Extension Construction and Reimbursement Agreement ("Agreement") is entered into between the City of Corpus Christi ("City"), a Texas home-rule municipality, P.O. Box 9277, Corpus Christi, Texas, 78469-9277, Corpus Christi, Texas, 78469-9277, and Marie Keast, LLC, a Texas limited liability corporation, 4916 Marador Drive, Austin, Texas 78735 ("Developer"). WHEREAS, Developer in compliance with the City Platting Ordinance, has filed a plat, approved by the Planning Commission on January 9, 2008, to develop a tract of land of approximately 68.17 acres called Bahia Vista west of Laguna Shore Road and north of Lola Johnson Road, as shown in the attached Exhibit 1; WHEREAS, under the Platting Ordinance, the Developer is responsible for construction of Sanitary Sewer Collection Line Extension (""); WHEREAS, under the Platting Ordinance, the Developer is eligible for reimbursement of the Developer's costs for the construction of Collection Line Extension; WHEREAS, it is to the best interest of the City that Collection Line Extension, be constructed to its ultimate capacity under the Master Plan; WHEREAS, Resolution No. 026869 authorized the acceptance of applications to be eligible for reimbursement in the future when funds become available and are appropriated by City Council; and WHEREAS, Developer has submitted an application for reimbursement of the costs of installing the Collection Line Extension (Exhibit 2); NOW, THEREFORE, for and in consideration of the mutual covenants in this Agreement, the parties do covenant and agree as follows: 1. REQUIRED CONSTRUCTION The Developer shall construct the Collection Line Extension, in compliance with the City's Platting Ordinance and under the plans and specifications approved by the Development Services Engineer. 2. PLANS AND SPECIFICATIONS a. The Developer shall contract with a professional engineer, acceptable to the City's Development Services Engineer, to prepare plans and specifications for the Collection 2009-011 min Exhibit 3, with the following basic design: M2009-008 01/13/09 Page 1 of 8 Marie Keast, LLC ;onstr aid ae~mb Agreement rJr i2zszoos 1. Install 786 linear feet of 10-inch PVC sanitary sewer collection line 2. Install 3 (three) 4-foot diameter fiberglass manholes. 3. Provide 786 linear feet of Trench Dewatering. 4. Install 786 linear feet of Class D Wastewater Sewer Line Embedment. 5. Provide 786 linear feet of OSHA Trench Protection. b. The Collection Line Extension must begin at the east property line of Bahia Vista Unit 1 and extend to the east approximately 600 feet to a proposed manhole located near the intersection of Jamaica Drive and Lola Johnson Road. From the proposed manhole, the Line Extension extends north along Jamaica Drive for approximately 186 linear feet and terminates at a proposed manhole located adjacent to the proposed Lola Johnson Lift Station. c. The plans and specifications must comply with City Standard Wastewater Detail Sheets and Standard Specifications. d. Before the Developer starts construction the plans and specification must be approved by the City's Development Services Engineer. 3. SITE IMPROVEMENTS. Prior to the start of construction of the Collection Line Extension, Developer shall acquire and dedicate to the City the required additional utility easements ("Easements"), if necessary for the completion of the Collection Line Extension. If any of the property needed for the Easements is owned by a third party and Developer is unable to acquire the Easements through reasonable efforts, then the City will use its powers of eminent domain to acquire the Easements. 4. PLATTING FEES. Developer shall pay to the City of Corpus Christi the required acreage fees and pro-rata fees as required by the Platting Ordinance for the area of the Collection Line Extension. 5. DEVELOPER AWARD CONTRACT FOR IMPROVEMENTS. Developer shall award a contract and complete the Collection Line Extension, under the approved plans and specifications, by October 31, 2009. 6. TIME IS OF THE ESSENCE. Time is of the essence in the performance of this contract. 7. PROMPT AND GOOD FAITH ACTIONS. The parties shall act promptly and in good faith in performing their duties or obligations under this Agreement. If this Agreement calls for review or inspections by the City, then the City's reviews or inspections must be completed thoroughly and promptly. Page 2 of 8 Bahia Vista U7 SS Collection Line Constr and Reimb Agreement rjr 12292008 8. DEFAULT. The following events shall constitute default: 1. Developer fails to engage a professional engineer for the preparation of plans and specifications by the 10th calendar day after the date of approval by City Council. 2. Developer's professional engineer fails to submit the plans and specifications to the City's Director of Engineering Services by the 60th calendar day after the date of approval by City Council. 3. Developer fails to award a contract for the construction of the project, according to the approved plans and specifications, by the 90th calendar day after the date of approval by City Council. 4. Developer's contractor does not reasonably pursue construction of the project under the approved plans and specifications. 5. Developer's contractor fails to complete construction of the project, under the approved plans and specifications, on or before [Completion Date]. 6. Either the City or Developer otherwise fails to comply with its duties and obligations under this Agreement. 9. NOTICE AND CURE. a. In the event of a default by either party under this agreement, the non-defaulting party shall deliver notice of the default, in writing, to the defaulting party stating, in detail the nature of the default and the requirements to cure such default. b. After delivery of the default notice, the defaulting party has 15 business days from the delivery of the default notice ("Cure Period") to cure the default. c. In the event the default is not cured by the defaulting party within the Cure Period, then the non-defaulting party may pursue its remedies in this section. d. Should Developer fail to perform any obligation or duty of this agreement, the City shall give notice to Developer, at the address stated above, of the need to perform the obligation or duty, and should Developer fail to perform the required obligation or duty within 15 days of receipt of the notice, the City may perform the obligation or duty, charging the cost of such performance to Developer by reducing the reimbursement amount due Developer. e. In the event of an uncured default by the Developer, after the appropriate notice and cure period, the City has all its common law remedies and the City may: 1. Terminate this Agreement after the required notice and opportunity to cure the default. Page 3 of 8 Bahia Vista U1 SS Collection Line Constr and Reimb Agreement rjr 72292008 2. Refuse to record a related plat or issue any certificate of occupancy for any structure to be served by the project. 3. Perform any obligation or duty of the Developer under this agreement and charge the cost of such performance to Developer. Developer shall pay to City the reasonable and necessary cost of the performance within 30 days from the date Developer receives notice of the cost of performance. In the event that Developer pays the City under the preceding sentence, and is not otherwise in default under this Agreement, then the Agreement shall be considered in effect and no longer in default. f. In the event of an uncured default by the City after the appropriate notice and cure period, the Developer has all its remedies at law or equity for such default. 10. FORCE MAJEURE. a. The term "force majeure" as employed in this Agreement means and refers to acts of God; strikes, lockouts, or other industrial disturbances; acts of public enemies; insurrections; riots; epidemic; landslides; lightning; earthquakes; fires; hurricanes; storms; floods; washouts; droughts; arrests; civil disturbances; explosions; or other causes not reasonably within the control of the party claiming the inability. b. If, by reason of force majeure, either party is rendered wholly or partially unable to carry out its obligations under this Agreement, then the party shall give written notice of the full particulars of the force majeure to the other party within ten (10) business days after the occurrence or waive the right to claim it as a justifiable reason for delay. The obligations of the party giving the required notice, to the extent effected by the force majeure, are suspended during the continuance of the inability claimed, but for no longer period, and the party shall endeavor to remove or overcome such inability with all reasonable dispatch. 11. NOTICES. a. Any notice or other communication required or permitted to be given under this Agreement must be given to the other Party in writing at the following address: 1. If to the Developer: Marie Keast, LLC 4916 Marador Drive Austin. Texas 78735 2. If to the City: City of Corpus Christi 1201 Leopard Street (78401) P. O. Box 9277 Corpus Christi, Texas 78469 Page 4 of 8 Bahia Vista Ut SS Collection Line Constr and Reimb Agreement rjr 12292008 ATTN: Assistant City Manager Development Services b. Notice required by the paragraph may be by United States Postal Service, First Class Mail, Certified, Return Receipt Requested, postage prepaid; by a commercial delivery service that provides proof of delivery, delivery prepaid; or by personal delivery. c. Either party may change of address for notices by giving notice of the change under the provisions of this section. 12. THIRD-PARTY BENEFICIARY. Developer's contracts with the professional engineer for the preparation of the plans and specifications for the construction of the project, contracts for testing services, and with the contractor for the construction of the project must provide that the City is a third party beneficiary of each contract. 13. PERFORMANCE AND PAYMENT BONDS. Developer shall require its contractor for the construction of the project, before beginning the work, to execute with Developer and the City a performance bond if the contract is in excess of $100,000 and a payment bond if the contract is in excess of $25,000. The performance and payment bond must comply with Texas Government Code, Chapter 2253 and must be in the form and substance as attached to this Agreement. 14. WARRANTY. Developer shall fully warranty the workmanship of and function of the Force Main and Lift Station and the construction of the Force Main and Lift Station for a period of one year from and after the date of acceptance of the facilities by the City Engineer. 15. REIMBURSEMENT. a. Subject to the appropriation of funds, the City will reimburse the Developer 100% of the reasonable cost of the Collection Line Extension, not to exceed [Reimbursement Amount]. See attached cost estimate (Exhibit 4). b. The City agrees to reimburse the Developer on a monthly basis upon invoicing for work performed. The reimbursement will be made no later than 30-days from the date of the invoice. Developer shall submit all required performance bonds and proof of required insurance under the provisions of this Agreement. c. To be eligible for reimbursement, the work completed in a good and workmanlike manner, and must have been inspected and accepted by the City. The City agrees to conduct periodic inspections and approve the progress of the work at key points during construction. d. In the event that this Agreement is terminated by the City at a time when there has been a partial completion and partial payment for the improvements, then the City shall only reimburse Developer for its costs that were legitimately incurred towards the completion of the improvements that have been inspected and accepted by the City up to the time that there is an uncured default by the Developer. Page 5 of 8 Bahia Vista U 1 SS Collection Line Constr and Reimb Agreement rjr 12292008 16. INDEMNIFICATION. Developer shall indemnify and hold harmless the City, its agents, officers, and employees ("Indemnitees") from all suits, actions, or claims and from all liability for any and all injuries or damages sustained by any person, including without limitation workers compensation, personal injury or death, arising from or incident to the construction of the Lift Station and Force Main by Developer. 17. COVENANT RUNNIG WITH THE LAND. This Agreement is a covenant running with the land, [Subdivision], a subdivision in Nueces County, Texas, and must be recorded in the Official Public Records of Nueces County, Texas. The duties, rights, and obligations of the Agreement are binding on and inure to the benefit of the Developer's successors or assigns. 18. DISCLOSURE OF OWNERSHIP INTERESTS. Developer further agrees, in compliance with the City Ordinance No. 17110, to complete, as part of this Agreement, the Disclosure of Ownership interests form attached hereto as Exhibit 5. 19. EFFECTIVE DATE. This agreement becomes effective and is binding upon and inures to the benefit of the City and Developer, and their respective heirs, successors, and assigns from and after the date of execution by all parties. 20. AUTHORITY. The person signing this Agreement on behalf of the parties represents, warrants, and guarantees that they have authority to act on behalf of the party and make this Agreement binding and enforceable by their signature. EXECUTED IN DUPLICATE originals, this ~ day of Q~,l~, 2009. ATTEST: THE CITY OF VVCORPUSCHRISTI By; /~ ~~ Armando Chapa gel R. Escobar City Secretary City Manager APPROVED AS TO FORM: /3 ~~day of . ~a•t~~"y , 2009 R. y Rei g Fi st Ass~nt City Attorney for the City Attorney Page 6 of 8 tiT Bahia Vista U1 SS Collection Line Constr and Reimb Agreement rjr 12292008 THE STATE OF TEXAS COUNTY OF NUECES This instrument was acknowledged before me on , 2009, by 'Angel R. Escobar, City Manager, City of Corpus Christi, Texas, a Texas home-rule municipal corporation, on behalf of the corporation. Notary P ic, State Texas DEVELOPER: Marie Keast, LLC HOLLY HOIKiHrON i MY COMMISSION EXPIRES Saplartar2{, 2012 By: l~ ^ . avid Keast Manager THE STATE OF TEXAS COUNTY OF TRAVIS This instrument was acknowledged before me on S , 2009, by David Keast, Manager, Marie Keast, LLC , a Texas limited liab' ty corporation, on behalf of the corporation. ~~ G. ~~ Notary Public, State of Te- xas~ .vS;,:'k ~ SNANA L JENNINS Notary Public, State of Taxas s3,,b,t~~t,~~` My Commission Expires ~„ ,,,~ June 27, 2012 Page 7 of 8 Bahia Vista U7 SS Collection Line Consir and Reimb Agreement rjr 72292008 EXHIBIT 1 [Copy of Plat] EXHIBIT 2 [Reimbursement Application] EXHIBIT 3 [Map Showing Location of Infrastructure Improvements] EXHIBIT 4 [Cost Estimate] EXHIBIT 5 [Disclosure of Interest Form] Page 8 of 8 Bahia Vista U7 SS Collection Line Constr and Reimb Agreement rjr 12292008 MATCHLINE ® - gg ; p~ o ~ 9, ` !li ~~ ~BBH ~~~~ ~ .~. E ~:.~ a a6k~~ Cox: ~ ~5= : w 5~ ~~$ Y 0 ~~: tl,~ ` .~' ~,. ,~ ~ .~~~ ..~ x a 9 il ll S li ll !9 :: !9 ii l ! l: l II I Il 9 li 99 :i l= I li i; l: :i ii i: i: :: :: :: :i ii :i ii i 6 i ii ia a i :Z : :: a : i i :9 i s '. .: .. 1. 1. .l i1 :1 ' :: :: ia : SI .o j 3 ~~~ ~aa ,P~ ~ P° elo193 ~s is ~~ ~iP~=,~ ;'q.~ a~ I f illdi!- 1 :> (s ~ a ! 1~ IF i ~'~•I[ ~ I~~~II < d E((.1 ~ e I€'(~6 ~ I~1~'~ e1i11~a °'° il. ~ I e:: 9! I!_ !j~lS !I !'!~°~ - ill, ~j~'Ei ii 'I.li 1!3 ;i III i~ al ~ 1p .6 ~o a 'ii;~~~e;i~~~¢~i~o'~~~'i6 .I ~j Ij ! ~ i€ ; ~!!I~ 9ji I~s i ; ~ ~I ~€ j. ~ E i ,~ I! ~~ i j ~~ ~ ~i~~ 91~ 141 I II ~ E I li~i 'f~ ill ~ `~ ~ ij i '„ ~ ~~ ~ ~ ~ ~ I~~ ij ~ ~ i, E i i ~f i wm ~o n / a ~ A ~ ~ N O'L 1 ~` ~ ` l .oa .ii a: ~ •i ~ ~ ~ g ~~~ ~ ~ ~~ 8 ~ ~ I ~u~p I: [ ~ ~ ~ ~a .. .~ . r ~ T ~ ay ~ Y S ~ 'f A ~ ~ ~ YSF M1 ' - 2, ' g , ,~ro R ~ ,\ ~ ' ~ H /WEl4 u!~ ae ~ ~ r • . ; ` . .~,~ ~ ~ - ~ zb9E istF ,ipnew+a ~' ~~ j ~ o o ~ i $ yc ~ 1 _-~ @ ~ ~~ ~ . a ~ ~ ' ' o, o .. .. ., - . ~ . .. ~ : ~~ _ ~; \ ' e ~ 's 9 \ ~a --~ i ~ >~ EXHIBIT 1 8 ~ i ~ h ' ,fi,. ~~~ ~. ,• x : ~~~: ,~j [, 1~'lla'R~ ~G~~r, ,owner and developer of the proposed C7~}I~IA ' IS•~ ~ Y~ ~' Subdivision, hereby request reimbursement of ~ ~ Z~t2~ ~ fo~~r~~the installation of the (lift station) (trunk main) (collection line) in conjunction with'gat~/ fa 'VI$-~ Un~t~l .Z Subdivision, as provided for by City Ordinance No. 17396. Said $ I ZU~r Z~1.O0 is the construction cost, including engineering cost, as shown by the cost supporting documents attached herewith. (Developer) (Date) THE STATE OF TEXAS )( T2r~vJ-S COUNTY OF Nfi'EC'ES )( This instntmen[ was acknowledged before me on ~ L ~ Atvt; A~'t-v( , 20Qq, By ~j7~VZD 1G~A$ ~ , (a Texas Corporation, on behalf of said corporation). 7"~i~G ~ Gv Notary Public in and for the State of Texas The information submitted with this application for reimbursement has been reviewed and determined to be correct. Reimbursement is subject to: (a) sufficiency of funds in the (Trunk Line) (Collection Line) Tnist Fund, and (b) approval and appropriation by the City Council. ~ ~ /fit ~/.~ , o~ ~~ Development ervices Engineer Date) ~.M. ' PATRICK T GRAY My Commisslon Expires June 3. 2012 'J+rta,v'' EXHIBIT 2 ' 11 ' I _. _ -- I I P~hL WAETEWATERLWE FOR EAHIA + I 9~~~ VISTA BUBDIVMNIN UNRI 12 ~ ~ )BY OTHERS) PO _ ! 1AN/A V/dTA /SIGN ~r ~r d ~ NIT f PROPQRTY L/M BEGIN WASTEWATER I COLLECTE+N LOIE I ' $CALEr h !00' I I 10' U.E. ~ ~ I ~r a~ I S' u.E. I I it I 9 I I LEGEND WASTEWATER: I I ~ II I ~ II I I m I I I -tOwW~ E%ISTIND WASTEWATER (LABELED) i I I~ I I I I oaeTmovausarole I I -IOVAV-PROPOSED fO•PVC WASTEWATER I msrwau• rose wacAT®erA® I 1 I WMBLLINE PR10R roOMAtIEC110N I I I I - 10•mV- FUTURE LO• PVC WASTEWATER ae"aE'~'iaPil"'EOm ' ~ 01 Ir O EXI8TIN0 WASTEWATER MANHOLE cOwmuctloM I m i~EN~tI~'~1111(1 t ~ NI I ~ O IOLA JOHNSON LIFT 9TATN)N rorul B I Z WASTEWATER MANHOLE ENNmlNtwaoo~nlEra< ~' iD • PROPOSED WASTEWATER MANHOLE I I ,1P saaroeERewulEO I I C -~--- E%ISTING GRADE I pwweroaxBtRUCnoN, AI 1 c~ I J wRiaun~ NI IC PROPOSED GRADE 1 J ~Ilm EN OVERYEAD I I~ .-~••- FUTURE GRADE uNE AI I ~ I ZiID I ~ ni im z ++' ~i ~~ WASTEWATER COLLECTION SYSTEM I II CONSTRUCTION NOTES: 1 t 8' I I 1 I II I 1 I 1 1 PROPOSED 5'WWMH J31 I I 4 1 1 TA2 • 9.75 I I ~ I I RN_•-8.75 I II I I I PROPOSED 4' WWMH-A2 Tht • S./B aNanaoMARaoxearoeE I I JONNBON LIFT BTATN)N I 1 INV. •-7.52 R1aocAtwewoRro I 1 ~EO~WNER~B POR~PNACffNIE MANHOLE W WNNA1 I PROPOSED 726 L.F. OF 10• AS7M D.T034 PVC wcwtroNa. pmr•Lt I I WASTEWATER UNE ~ 0.25% - ld al~-~ I I I ___I17JJJ w---- 1 PROPOBE04S0 LF.OF 10' A8TM D•3034 PVC WASTEWATER LINE@0.25x _ JAMA CA D ZO' a.L ' 20' B.L PROPOSED 6 L.F. OF B' ASTM DJ034 PVC WASTEWATER I - LB1E®0.40%,+A'PVC CAP AT THE END OF THE LINE AND I ~ ~ ~O. ~ s • a E• 1d• PVC PLUG INSIDE OF THE MANHOLE. I I 6 g I m I ~ PROP08ED 184 L.F. OF 10• ASTM 69034 PVC WASTEWATER I UNE ~ 0.28x I LO).A J H 9 GE'~ SUBD. ®pROPOBED 10•CAP I 6$ I R. C.T. 2 I SCHEMAT/C PLAN SANITARY SEWER COLLECTION LINE EXTENSION CONSTRUCTION AND REIMBURSEMENT AGREEMENT THIS DOCUMENT 5 RELEASED UNDER THE AUTHOPoTY OF: J. DON REHMET, P.E., R.P.L.S. T%. P.E. REG. N0. 36151 fOR INTERIM EXHIBIT 3 C R Co~I n.~ L REVIEW PURPOSES ONLY AND SHALL NOT BE USED FOR 1 CONSTRUCTION, BIDDING OR PERMR 583 8•utll Staplm, SuBe 230 PURPOSES. ~ G Caput Cll•atl, Tmaa 78477 F 99&7389 GATE: 08-22-2008 AUGUST 22, 2006 CRG•: 20097C &DMla a~gl~+9sle'A~ ax BAHIA VISTA SUBDIVISION OFFSITE COLLECTION LINE TO LOLA JOHNSON LIFT STATION CORPUS CHRISTI, TEXAS COST BREAKDOWN SANITARY 8EWER COLLECTION LINE EXTENSION AND CONSTRUCTION REIMBURSEMENT AGREEMENT AUGUST 22, 2008 CONSTRUCTION COSTS See Attachment "A"Detailed Bid Tabulation, Items t-16: ENGINEERING Basic Services Preliminary Phase Design Phase Construction Phase $156,455.00 10%CONTINGENCIES $15,845.50 TOTAL CONSTRUCTION COST $172,100.50 $1,020.00 $6,790.00 $3,750.00 TOTAL ENGINEERING COST $11,580.00 TOTAL PROJECT COST $183,680.80 COYM, a&HhiF:T & GU'fDiRRE2 C R E~~a~g~G•~.p. EXHIBIT 4 563645~pMe.3ve].30 „J ~ CapuFCEri1E, T%]NII !V/C n61)991-8350 FA%(361)991.]369 ~",: .~ 6/22/2006 Job No. 20097c SANITARY SEWER COLLECTION LINE EXTENSION CONSTRUCTION AND REIMBURSEMENT AGREEMENT BAHLA VISTA SUBDIVISION OFF-SITE COLLECTION LINE TO LOLA JOHNSON LIFT STATION 1 1 Clearing b Grubbing, complete and in 83,000.00 $3,000.00 L.S. place per lump sum. B^ 8DR 26, Gravity Sanitary Sewer 12'-14' 2. F Depth, complete and in place per linear 9100.00 $500.00 L foot. 10" SDR 26 Gravity Sanitary Sewer 12'-14' 3. 4 ?B Depth, complete and in place par linear $105.00 $29,820.00 F 1 foot. 13 LO" SDR 26 Gravity Sanitary Sewer 14'-16' 4. F Depth, complete and in pleas per linear $120.00 $15,600.00 L 4oot. 5 3 LO^ SDR 26 Gravity Sanitary Sewer 16'-18' 5. 8 Depth, complete and in place par linear $130.00 $46,150.00 I foot. 6 1 4' Diameter FRP Manhole 12'-14' Depth, $20,000.00 $20,000.00 EACH complete and in place per each. 7 1 5' Diameter FRP Manhole 16'-18' Depth, $30,000.00 930,000.00 EACH complete and in place per each. B 1 8^ Plug Inside of Proposed Manhole, $550.00 9550.00 EACH complete and in place per each. 9. l 8" Cap, complete and in place por each. 985.00 $85.00 E AL'fi 10. C SO" Cap, complete and in place per each. $130.00 9130.00 BP R 11. 774 Dewaterinq Por Sewer Linea fi Manholes, 81.00 $774.00 L.F. complete and in place per linear foot. 12 774 OSHA Trench Protection (All) Dapthe, $4.00 93,096.00 L.F. complete and in place par linear foot. 13. 5 Mailbox Relocation, complete and in place $50.00 9250.00 EACH per each. 14 4 Palm Trae Relocation, complete and in $500.00 $2,000.00 EACH plaoe per each. 15. 1 Wood and Metal Gate Relocation, complete ,4500.00 9500.00 EACH and in place per each. 16. 1 Bxploratory Excavations, wmplete and in $4,000.00 $4,000.00 L.3. place per 1 sum. TOTAL SASE BID BABIA VISTA UNIT 1 OFF-SITE $156,455.00 GRAVITY SE9PEEt BID ITEtd.4 (1-16) EXHIBIT 3 ATTACHMENT "A" EXHIBIT 4 Page 1 oP 1 CITY OF CORPUS CHRISTI DISCLOSURE OF INTERESTS City of Corpus Christi Ordinance 17112, as amended, requires all persons or flnns seeking to do business with fhe City to provide the following,/i_nformation. Every question must be answered. If the question is not applicable, answerwith "NA". FIRM NAME /f ~I ~'L STREET: ~/~l2AID©.e AR, CITY: ~ 21P: ~S 73 S FIRM is: 1. Corporation 2. Partnership 3. Sole Owner 4. Association 5. Other L/irrrr~/J Li~P7Pi(rr4.i ~~"0,~1~ DISCLOSURE QUESTIONS If additional space is necessary, please use the reverse side of this page or attach separate sheet. 1. State the names of each "employee" of the City of Corpus Christi having an "ownership interest" constituting 3% or more of the ownership in the above named "firm". Name Job Title and City Department (if known) -• 2. State the names of each "official" of the City of Corpus Christi having an "ownership interest" constituting 3% or more of the ownership in the above named "firm". Name Tftle ~~ ~- 3. State the names of each "board member" of the City of Corpus Christi having an "ownership Interest" constituting 3% or more of the ownership In the above named "flan". Name Soard, Commission or Committee --- ~- 4. State the names of each emptoyee or officer of a "consultant" for the City of Corpus Christi who worked on any matter related to the subject of this contract and has an "ownership Interest" constituting 3°~ or more of the ownership in the above named "firm". Name Consultant CERTIFICATE I carp. that all informagon provided is true and correct as of the date of this statement, that I have not knowingly withheld disdosure ofany infomwtion requested; and that supplemental statements will be promptty submitted to the City of Corpus Christi, Texas as changes occur. Certifying Person: ~~/ ~ ~~ Tide: /' "y ~--- (Type or Print) ~ ~ ~~~ n Signature of Certifying Person: ~ ~.U//~~~,~/ Date: _~ - ~ ~