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Home My WebLink AboutC2012-050 - 2/9/2012 - NAAMENDMENT NO. 5 TO CONTRACT FOR PROFESSIONAL SERVICES The City of Corpus Christi, Texas hereinafter called "CITY', and CH2M HILL hereinafter called "CONSULTANT," agree to the following amendment to the Contract for Professional Services for Kostoryz Road, Phase 1 from Horne to Sunnybrook (BOND 2008) (Project No. 6489), as authorized and amended by: Original Contract Aril 21, 2009 . Motion No. 2009 -095 $1,414,850.00 Amendment No. 1 November 17, 2009 Motion No. 2009 -328 $92,900.00 Amendment No. 2 March 22, 2010 Administrative Approval $6,720.00 Amendment No. 3 June 03, 2010 Administrative Approval $44,055.00 Amendment No. 4 January 09, 2012 Administrative Ap roval $49,955.00 EXHIBIT "A ", PART 1. SCOPE OF SERVICES, SECTION A. BASIC SERVICES ITEM NO. 1 PRELIMINARY DESIGN PHASE shall be amended to include additional Preliminary Design Phase Services as set forth in the attached Amendment No. 5 Exhibit "A ". EXHIBIT "A ", PART 1. SCOPE OF SERVICES, SECTION A. BASIC SERVICES ITEM NO. 2 DESIGN PHASE shall be amended to include additional Design Phase Services as set forth in the attached Amendment No. 5 Exhibit "A EXHIBIT "A ", PART 1. SCOPE OF SERVICES, SECTION A. BASIC SERVICES ITEM NO.3 BID DESIGN PHASE shall be amended to include additional Bid Phase Services as set forth in the attached Amendment No. 5 Exhibit "A EXHIBIT "A ", PART 1. SCOPE OF SERVICES, SECTION A. BASIC SERVICES ITEM NO. 4 CONSTRUCTION DESIGN PHASE shall be amended to include additional Construction Phase Services as set forth in the attached Amendment No. 5 Exhibit "A ". EXHIBIT "A" PART 3. FEES SECTION B. SUMMARY OF FEES shall be modified and is attached as Amendment No. 5 Exhibit "B" for a revised fee not to exceed 7,790.00 Seven Thousand Seven Hundred Ninety Dollars and Zero Cents) for a total restated fee not to exceed 616 270.00 One Million Six Hundred Sixteen Thousand Two Hundred Seventy Dollars and Zero Cents) All other terms and conditions of the April 21, 2009 contract between the City and Consultant will remain in full force and effect. CITY OF CORPUS CHRISTI Oscar R. Martinez (Date) Assistant City Manager RECOMMENDED 1 /ZC� 1 L Dan Biles, P.E. (Date) Interim Director of Engineering Services CH ILL Sidney A. Faas; P. E. (Date) Vice President 555 N. Carancahua Tower II Suite 310 Corpus Christi, TX 78401 (361) 888 -8100 Office; (361) 888 -8600 Fax TBPE FIRM #2297 2012 -050 02/09/12 CH2M Hill AMD. No. 5 Pa e 1 of 2 MUM FM 1, INDEXED y — per ing Depaitmen a I &j It,- g rz of Ma nagement and Budget (Date ATTEST Armando Cfiapa, City Sec tary (Date} APPROVED AS TO FORM C{tY ttorneY (Date) Fund Source: Phase 1 550950 -3546- 00000 - 170126 $7,790.00 Phase 2 550950- 3546 - 00000 - 170121 $0.00 Total E6964WH $7,790.00 K, Engineering D atai sxchangeTohertQ%TREETkProject AMENDMENT NO. 51Amendment No 5.doc ENTERED JAN 2 tF 2012 Pq CONTRACT MANAGERS AMD. No. 5 Page 2 of 2 CHM HILL 214 S. Carancahua. Suite 200 July 20, 2011 Corpus Chrtst1, TX 76401 Tel 161.888.8100 Fax 361.88 &8600 1 PN: 390888 Mr. Pete Anaya, P.E. c/o Armando Gutierrez, P.E. Director of Engineering Services City of Corpus Christi P.O. Box 9277 Corpus Christi, TX 78469 -9277 RE: Kostoryz Road, Phase 1. from Horne to Sunnybrook (Project No. 6489) Kostoryz Road, Phase 2 from Sunnybrook to S.P.I.D. (Project No. 6490) AMENDMENT NO.5 Dear Mr. Anaya: Please accept this letter as our proposal to amend our original and amended contract to obtain additional funding for the following items related to Kostoryz Road — Phases 1 and 2: m Landscape services to place trees, shrubs and possibly irrigation on both sides of the Brawner Detention Area to include preliminary, design, bid and construction services. This Contract Amendment No. 5 includes fees incurred for landscape architect services not authorized in the original contract. The addition of these landscape services was not a part of the original Contract Scope of Services and is to be performed as Addendum No. 5, A total additional enginecring fee of $7,790.00 will be needed for the landscaping services, The folio-Mrig are the proposed changes to the original amended, executed contract. 1. Scope of Services: Added section A. Lk_ for Landscape Architect Services Preliminary Phase. Added section A.2.n. for Landscape Architect Services — Design Phase. Added section A.3.e. for Landscape Architect Services — Bid Phase. Added section A.4 j. for Landscape Architect Services — Construction Phase. (see Exhibit A -1). 2. Schedule: No Changes 3. Fees: A. Fee for Basic Services: Added to Part 1, 2, 3 and 4 (changes are shown in bold). B. Fee for Additional Services: No Changes. C. Summary of Fees: See the following tables for an explanation of the additional fees (changes are shown in bold). AMD. NO.6 EXHIBIT " A ll Page 7 of 3 P:4Gtp5f ,WsChdst%390M Kos;oryzRdiCCNTRAG — TS- CHANGE ORDERS ClionfAmssidmonlsVvnandment No. 5420110721 Cannel Amendment No 5 Exhibit A, I= Mr. Pete Anaya, P.E. July 7, 2011 AMD. NO. 5 EXHIBIT "A" Pa e2of3 P:'.CityotUorpusC1v isti %390668 KostoryzRd,COKTRACTS- CHANGE ORD F.R51CliertAmendmerts.Amendment No. 522611 07 21 Contract Amendment -No 5 Exhibit A.do" ORIGINAL CONTRACT TR AMD. N0.1 AMD" No.2 AMD. 40.3 AMD. No.4 AMD, No. b TOTAL C0NTRAC7 Phase 1: Kost z Road from Horne to Basic Services Basic Services 7 2 3 PrOrrina Phase Desion Phase Bid Phase 8! $ 550 000.00 S 6 OODAD $ S S S S $ 20,340. DD S S 44 980.00 1 470 $ "OD.00 500.00 $1470.00 620 oD 6 S40.OD 4 Con ftmion Phase $ 18 000.00 S S S - S 40 OOO.pQ S 740.00 16 744.00 subtotal Bask Services 654 000.00 $ - $ $ 20,340.06 $ 44 980.00 7 790.00 727 114.00 B-4 Phase 1,500.00 3 S 1 5DO.OD Additional services $ 14 500.00 S 3 S 14 SQ0.00 Subtotal Basic Services Pamit Pre ce S S $ .23,716. S 1,125"00 S 270 840.OD TiCOT 5 $ S Additional S TCEQ allouienca S 1 $ $ $ 1 S 1 400.OD K T OLR allowance $ 6,200.00 $ S S 6 S 4 0DOAD Subtotal PermitPre ation 7,600.00 $ S $ TWO allowance 7,600,00 2 RTA Bus authorized S S $ 3,840.00 S MLR allowance 1 2 S 3,840.00 3 1 ROW AWisition S S - S $ 1,600.00 $ 11W0.00 4 Topogr Su aulhorizod $ 120,000-00 S 5,000,00 S S S 2.880.00 S 125 OpD.DO 6 Utility LocaAons and Wastewater Line S 5D DDROD $49 090 "00 $ $ 5 2,260.00 $ 99 090, DO 6 Construction Observation Services ( allowance) 5 153000"on $ S $ $ 62,500. 0 $ 1S OQQ.00 7 Pubic Meeting authorized $ 5,350.00 5 $ $ 61 O.OD 6 $ 350.00 8 Warran Phase authorized 5 700.OD 5 - S $ 7 Public Meet authorized 5 700.00 Sr YOW Additional Services S 341,650-00 $54,090-00 S 3,840.00 S 2800.00 1,W0.00 Warranty Phase authori 401 , 100.00 100.00 $ $ S 5800.00 SubtAW Additional Services $ 173 200.00 $38,810.00 Phase 1: TetWAuthorized Fee 1 $ 095 650.DO S54,090.00 S 3.840.00 - S20.340,00 $ 46 580.00 j 7,790.00 1,1.28,29a0l) AMD. NO. 5 EXHIBIT "A" Pa e2of3 P:'.CityotUorpusC1v isti %390668 KostoryzRd,COKTRACTS- CHANGE ORD F.R51CliertAmendmerts.Amendment No. 522611 07 21 Contract Amendment -No 5 Exhibit A.do" ORIGINAL CONTRACT A1110. N0.1 AMD, AMD- No.2 N0.3 AMD. No.4 AMD, No.5 TOTAL CONTRACT Phase 2: Kostoryx Road from Sue brook to Basic Services 1 [Prakninmy Phase S 40.000.00 $ - S 40 OOO.pQ 2 Phase $ 190 000.00 $ 23.7`15.00 $ 1,125.00 214 64Q.OD 3 B-4 Phase 1,500.00 3 S 1 5DO.OD 4 Construction Phase $ 14 500.00 S 3 S 14 SQ0.00 Subtotal Basic Services 246 000.00 S S $ .23,716. S 1,125"00 S 270 840.OD Additional Services 1 PemdtP ration TiOOT S 4 0DOAD $ - S 4.000.00 TWO allowance S 1400.00 S Is S 1 MLR allowance 6,200,00 S I $ S 6,200.00 5ublolel Pamit Eteoration $ 11 500,0D S $ S 11 600.00 2 RTA Bus StDps fautwized) S $ S 2.880.00 $ 2.M.00 3 PZVV AcgLimition Sur $ $ $ - 5 2,260.00 S 2,250.00 4hopparenhic Sur authorized 110 MO.00 S 2,500.00 $ $ 62,500. 0 5 Uti ty Locations and Wasbwater fine $ 25.00D.00 $36,310,00 5 $ 61 O.OD 6 nstructon on SeNces a50vrance 5 68 000.00 $ 5 48 000.00 7 Public Meet authorized . S 2800.00 $ $ S 2800.00 8 Warranty Phase authori S 5,800-00 $ $ S 5800.00 SubtAW Additional Services $ 173 200.00 $38,810.00 $ 2,880.00 S Z250.00 S 217 140.40 Phase 2: Total Authorized Fee $ 419,200.00 $38,810.00 S 2,880.00 1 S 23,715.00 1 5 3.375.00 $ S 487,980.00 AMD. NO. 5 EXHIBIT "A" Pa e2of3 P:'.CityotUorpusC1v isti %390668 KostoryzRd,COKTRACTS- CHANGE ORD F.R51CliertAmendmerts.Amendment No. 522611 07 21 Contract Amendment -No 5 Exhibit A.do" Mr. Pete Anaya, P.E. July 7, 20111 ' ORIGINAL CONTRACT AND. Na.1 Alum. No.2 AMD. No.3 AMD. Na.4 AMD. No. B TOTAL CONTRACT Total Phase S and Phase 2 Basic Services S Prearrid Phase s 120.0w,00 6 7 _00 121 70 -DD 2 e i phase 740 OD0.D0 $ 255 44 .00 46J05.00 6,080.00 836,240- 3 Bid Phase $ 7 SD0.00 $ S $ - S 2 600.00 8 000 -00 4 Cansb'uct or% Phase S 32,500.00 S S $ S 740.00 11240 -OD Subtatat B"C S 90D,000.00 S 44.055M 46 105.00 7 790.00 887 960 -00 Additional Services t Perrt Pre re on T )D4T 4,000.00 S 4.000.00 TCE eltowance 28D0 .DO S 2800.00 l'011t Almwce 12400.00 12400.00 Subb Met Permit Prepar S 19.200.00 $ $ S 19, 200.00 2 RTA Bus Sftlm t4unhwized) 6,720-00 $ 6 3 ROW Acguisition Su $ 3850.00 S 3 850.170 4 Toppgra iC Survoy lauthorinwdj S 180,00D,00 7,500.00 $ 787 500 -00 5 U81ity Locadonsantl Wasterrator Line $ 75 000.00 S85,400.00 160 400.00 6 Construdon ObservMon Services alm ame 227 0D0.00 221 D00.00 7 Public Meeting Buthorized 8 150.DD g 150,00 8 warren Phase authorized 11 500.00 $ S 11 500.00 Su ry blotal Additional Seices S 514 850,04 rswqoo.00 $ 6.720.00 3 85D.00 61B 320 - 00 Total Phase 7 end Phase 2 1 41485000 .D0 S 6 720.00 44 055.00 S 49,955. 1,79000 3 � Very truly yours, CH2M HILL TBPE Firm No.: 2297 Sidney A. Faas, P.E. Vice President SAF /1p AMD. NO, 5 EXHIBIT "A" Page 3 of 3 P:?Cityof orpWChristi. ?40868 KostoryzRd'+CONTRACl'S- CHANGE 0 RDERS 1.Client:Amendmcmw..Arnendinent No. 5 +20110 7 21 Contract Amendment No 5 Exhibit A.docx EXHIBIT A -1 CITY OF CORPUS CHRISTI KOSTORYZ ROAD, PHASE 1 (Project No. 6489) KOSTORYZ ROAD, PHASE 2 (Project No. 6490) 1. SCOPE OF SERVICES Remaining work on the project is reported and amended as follows: A. Basic Services 1. Preliminary Phase a. No change. b. No change. c. No change. d. No change. e. No change. f. No change. g. No change. h. No change. i. No change. j. No change. k. Landscape Architect Services - Preliminary Phase • Confirm and evaluate all site conditions. Field verify the accuracy of drawings supplied by CH2M HILL. • Develop a schematic design for approval which will identify all proposed planting. 0 Preliminary review of the project budget related to alternate schematic designs and construction. 6 Attend a citizen public meeting with exhibits of the new landscape improvements. .2. Design Phase a. No change. b. No change. c_ No change. d. No change. e. No change. f. No change. g. No change. AMD. NO.5 EXHIBIT "A -1" Page 1 of 3 h. No change. i. No change. j. No change. k. No change. I. No change. m. No change. n. Landscape Architect Services - Design Phase • Provide landscape and irrigation construction documents. • Address options for plant material establishment with an irrigation system. The system will be designed to water the plaint material only with a drip or bubbler method. • Prepare construction drawings, plans, and specifications in requested format. • Coordinate improvements with CH2M HILL. • Submit construction cost estimate for landscape and the irrigation. • Provide summary sheets with total quantities and pertinent notes for the referenced project. The City staff will: a. No change. b. No change. c. No change. d. The City of Corpus Christi shall supply or reimburse the following: • All base and site reaps. Auto 2007 • Approval of preliminary conceptual design and/or sketches. • All printing and reproduction fees. 3. Bid Phase a. No change. b. No change. c. No change. d. No change. e. Landscape Architect Services: • Attend pre -bid conference. (if required) • Assist City in securing bids. AMD. NO. 5 EXHIBIT "A -9" Page 2 of 3 + Attend and assist the City with the facilitation of a preconstruction meeting with the contractor, City representatives and other third parties. 4. Construction Phase a. No change. b. No change. c. No change. d. No change. e. No change. f. No change. g. No change. h. No change. i. No change. j. Landscape Architect Services: • Review and check for approved materials and other submittals provided by the contractor. • Inspect and approve all plant and all landscape and irrigation improvements. • Provide interpretations and clarifications of plans and specifications for the contractor. Authorize minor changes, which do not affect the contractor's price and are not contrary to the interest of the City. • Confer with representative of the City and governmental authorities as needed. • Visit the site to confer with City project inspector and contractor to observe general progress and quality of work, and to determine, in general, if the work is being done in accordance with the contractor documents. • Conduct a preliminary inspection and prepare documentation or a "punch list" for items needing correction. • Conduct a final inspection with City personnel and Contractor for complete and proper installation. B. Additional Services -- No change. AMD. NO. 5 EXHIBIT "A4" Page 3of3 KOSTORYZ ROAD, PHASE I FROM HORNE TO SUNNYBROOK WITH BRAWNER DITCH OFF SITE DRAINAGE (Project No. 6489) KOSTORYZ ROAD, PHASE 2 FROM SUNNYBROOK TO S.P.I.D. (project No. 6490) SUMMARY OF FEES rn � 2 � CD W_ v o c wC7?w ORIGINAL CONTRACT AMD. NO. i AMD. NO. 2 AMD. NO. 3 AMD. NO. 4 AMD. NO. 5 TOTAL Phase 1: Kostoryz Road from Borne to Sunnybrook (including Off-Site Drainage) Basic services 1 Preliminary Phase $80,000.00 0.00 0.00 0.00 0.00 $1,470.00 $81,470.00 2 Design Phase 550,000.00 0.00 0.00 20,340.00 44,980.00 5,080.00 620,400.00 3 Bid Phase 6,000.00 0.00 0.00 0,00 P.m 500.00 6,500.00 4 Construction Phase 18,000.00 0.00 0.00 0.00 0.00 740.00 18,740.00 Subtotal Basic Services 654,000.00 0.00 0.00 20,340.00 44,980.00 7,790.00 727,110.00 ADDITIONAL SERVICES 1 Permit Preparation TxDOT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TCEQ (allowance) 1,400.00 0,00 0.00 0.00 0.00 0.00 1,400.00 TDLR (allowance) 6,200.00 0:00 0.00 0.00 0.00 0.00 6,200.00 Subtotal Permit Preparation 7,600.00 0.00 0.00 0.00 0.00 0.00 7,600.00 2 ROW Acquisition Survey 0.00 0.00 0.00 0.00 1,600.00 0.00 1,600.00 3 Topographic Survey (authorized) 120,000.00 5,000.00 0.00 0.00 0.00 0.00 125,000.00 4 Utility Locations and Wastewater Line Inspection (allowance) 50,000.00 49,090.00 0.00 0.00 0.00 0.00 99,090.00 5 Construction Observation Services (allowance) 153,000.00 0.00 0.00 0.00 0.00 0.00 153,000.00 6 Public Meeting (authorized) 5,350.00 0,00 0.00 0.00 0.00 0.00 5,350.00 7 Warranty Phase (authorized) 5,700.00 0.00 0.00 0.00 0.00 0.00 5,700.00 8 RTA Bus Stops (authorized) 0.00 0.00 3,840.00 0.00 0.00 0.00 3,840.00 Subtotal Additional Services 341,650.00 54,090,00 3,840.00 0,00 1,600.00 0.00 401,180.00 Phase 1: Total Authorized Fee $995,650.001 $54,090.00 $3,840.00 $20,340.001 $46,580.00 $7,790.001 $1,128 ,290.00 rn � 2 � CD W_ v o c wC7?w m CD 00 D o =i z 0 wW� ORIGINAL_ CONTRACT AMD. NO. 7 AMD. NO. 2 AMD. NO. 3 AMD. NO.4 AMD. NO. 5 TOTAL Phase 2: Kostoryz Road from Sunnybrook to SPID Basic Services 1 Preliminary Phase $40,000.00 0.00 0.00 0.00 0.00 0.00 $40,000.00 2 Design Phase 190,000.00 0.00 0.00 23,715.00 1,125.00 0.00 214,840.00 3 Bid Phase 1,500.00 0.00 0.00 0.00 0.00 0.00 1,500.00 4 Construction Phase 14,500.00 0.00 0.00 0.00 0.00 0.00 14,500.00 Subtotal Basic Services 246,000.00 0.00 0.00 23,715.00 1,125.00 0.00 270,840.00 ADDITIONAL SERVICES i 1 Permit Preparation TxDOT 4,000.00 0.00 0.00 0.00 0.00 0.00 4,000.00 TCEQ (allowance) 1,400.00 OM 0.00 0.00 0.00 0.00 1,400.00 TDLR (allowance) 6,200.00 0.00 0.00 0.00 0.00 0.00 6,200.00 Subtotal Permit Preparation 11,600.00 0.00 0.00 0.00 0.00 0.00 11,600.00 2 ROW Acquisition Survey 0.00 0.00 0.001 0.00 2,250.00 0.00 2,250.00 3 Topographic Survey (authorized) 60,000.00 2,500.00 0.00 0.00 0.00 0.00 62,500.00 4 Utility Locations and Wastewater Line Inspection (allowance) 25,000.00 36,310.00 0.00 0.00 0.00 0.00 61,310.00 5. Construction Observation Services (allowance) 68,000.00 0.00 0.00 0.00 0.00 0.40 66,000.00 6 Public Meeting (authorized) 2,800.00 0.00 0.00 0.00 0.00 0.00 2,800.00 7 Warranty Phase (authorized) 5,800.00 0.00 0.00 0.00 0.00 0.00 5,800.00 8 1 RTA Bus Stops (authorized) 0.00 0 .00 2,880.00 0.00 0.00 0.00 2,880.00 Subtotal Additional Services 173,200.00 38,810.00 2,880.00 0.00 2,250.00 0.00 217,140.00 Phase 2: Total Authorized Fee $419 $38,810.00 $2,880.00 $23,715.00 $3,375.00 $0.001 $487,980.00 m CD 00 D o =i z 0 wW� �Xn � =n cp W . O O C.0 !A U, ORIGINAL CONTRACT AMD. NO. 1 AMID. NO. 2 AMD. NO, 3 AMD. NO. 4 AMD. NO. 5 TOTAL Total Phase 1 and Phase 2 Basic Services 1 Preliminary Phase $120,000.00 0.00 0.00 0.00 0.00 $1,470.00 $121,470.00 2 Design Phase 740,000.001 0.00 0.00 44,055.00 46,105.00 5,080.00 835,240.00 3 Bid Phase 7,500.00. 0.00 0.00 0,001 0.00 500.00 8,000.00 4 Construction Phase 32,500.00 0.00 0.00 0.00 0.00 740.00 33,240.00 Subtotal Basic Services 900,000.00 0.00 0.00 44,055.00 $46,105.00 $7,790.00 997,950.00 ADDITIONAL SERVICES 1 Permit Preparation TxDOT 4,000.00 0.00 0.00 0.00 0.00 0.00 4,000.00 TCEQ (allowance) 2,800.00 0.00 0.00 0.00 0.00 0.00 2,800.00 TDLR (allowance) 12,400.00 0.00 0.00 0.00 0.00 0.00 12,400.00 Subtotal Permit Preparation 19,200.00 1 0,001 0.00 0.00 0.00 0.00 19,200.00 2 ROW Acquisition Survey 0.00 0.00 0.00 0.00 3,850.00 0.00 3,850.00 3 Topographic Surve {authorized 180,000.00 7,500.00 0.00 0.00 0.00 0.00 187,500.00 4 Utility Locations and Wastewater Line Inspection (allowance) 75,000.00 85,400.00 0.00 0.00 0.00 0.00 160,400.00 5 Construction Observation Services (allowance) 221,000.00 0.00 0.00 0.00 0.00 0.00 221,000.00 6 Public Meeting (authorized) 8,150.00 0.00 0.00 0.00 0.00 0.00 8,150.00 7 Warranty Phase (authorized) 11,500.00 0.00 0.00 0.00 0.00 0.00 11,500.00 8 RTA Bus Stops (authorized) 0,00 0.00 6,720.00 0.00 0.00 0.00 6,720.00 Subtotal Additional Services 514,850.00 92,900.001 6,720.00 0.00 3,850.00 0.00 618,320.00 Total Phase 1 and Phase 2 1 $1,414,850.00 $92,900.001 $6,720.001 $44,055.001 $49,955.001 $7,790.001 1,616,270.00 �Xn � =n cp W . O O C.0 !A U, bAd SUPPLIER NUMBER TO BE ASSIGNED BY CITY - . = PURCHASING DIVISION City of CITY OF CORPUS CHRISTI Corpus Christi DISCLOSURE OF INTEREST City of Corpus Christi Ordinance 17112, as amended, requires all persons or firms seeking to do business with the City to provide the following information. Every question must be answered. If the question is not applicable, answer with `NA ". See reverse side for Filing Requirements, Certifications and definitions. COMPANY NAME: CH2M Hill, Inc. P. O. BOX: STREET ADDRESS: 555 N Carancahua, Towner 11 CITY: Corpus Christi ZIP: 78401 FIRM IS: 1. Corporation X 2. Partnership ❑ 3. Sole Owner ❑ 4. Association ❑ . 5. Other 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) NIA 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 Title NIA 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 "firm." Name Board, Commission or Committee NIA 4. State the names of each employee 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 NIA AMD. No. 5 EXHIBIT "C" Page 1 of 2 FILING REQUIREMENTS If a person who requests official action on a matter knows that the requested action will confer an economic benefit on any City official or employee that is distinguishable from the effect that the action will have on members of the public in general or a substantial segment thereof, you shall disclose that fact in a signed writing to the City official, employee or body that has been requested to act in the matter, unless the interest of the City official or employee in the matter is apparent. The disclosure shall also be made in a signed writing filed with the City Secretary. [Ethics Ordinance Section 2 -349 (d)] CERTIFICATION I certify that all information provided is true and correct as of the date of this statement, that I have not knowingly withheld disclosure of any information requested; and that supplemental statements will be promptly submitted to the City of Corpus Christi, Texas as changes occur. Certifying Person: Sidney A. Faas Title: Vice President (Type or Print) Signature of Certifying Date: Person: l(z31f DEFINITIONS a. `Board member." A member of any board, commission, or committee appointed by the City Council of the City of Corpus Christi, Texas. b. "'Economic benefit ". An action that is likely to affect an economic interest if it is likely to have an effect on that interest that is distinguishable from its effect on members of the public in general or a substantial segment thereof c. "Employee." Any person employed by the City of Corpus Christi, Texas either on a full or part-time basis, but not as an independent contractor. d. "Firm." Any entity operated for economic gain, whether professional, industrial or commercial, and whether established to produce or deal with a product or service, including but not limited to, entities operated in the form of sole proprietorship, as self- employed person, partnership, corporation, joint stock company, joint venture, receivership or trust, and entities which, for purposes of taxation are treated as non -profit organizations. e. "Official." The Mayor, members of the City Council, City Manager, Deputy City Manager, Assistant City Managers, Department and Division Heads, and Municipal Court Judges of the City of Corpus Christi, Texas. f "Ownership Interest." Legal or equitable interest, whether actually or constructively held, in a firm, including when such interest is held through an agent, trust, estate, or holding entity. "Constructively held" refers to holdings or control established through voting trusts, proxies, or special terms of venture or partnership agreements." g. "Consultant." Any person or firm, such as engineers and architects, hired by the City of Corpus Christi for the purpose of professional consultation and recommendation. AMD. No. 5 EXHIBIT "C" Pa e2of2