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HomeMy WebLinkAboutC2015-013 - 1/13/2015 - Approved AGREEMENT for Construction Materials Testing and Engineering Services This AGREEMENT is between the City of Corpus Christi, Texas, a Texas home-rule municipal corporation ("CITY"), acting through its duly authorized City Manager or designee ("City Engineer"), and TOLUNAY-WONG ENGINEERS, INC., a Texas corporation or partnership ("LAB"), acting through its duly authorized representative who is Don R. Rokohl, Branch Manager, which agree as follows: 1. DECLARATIONS: "CITY" desires to engage "LAB" to provide services in connection with City's project, described as follows: Cefe Valenzuela Landfill Pavement Life Cycle Replacement(Project No. 5232) ("PROJECT"). 2. SCOPE OF WORK: "LAB" shall provide services to the PROJECT in accordance with the accompanying Scope of Services and Fee Schedule attached as "Exhibit A" and the Terms and Conditions to AGREEMENT attached as "Exhibit C". 3. FEE: The "CITY" agrees to pay the "LAB" for services provided in accordance with Exhibit "A", Scope of Services and Fee Schedule under this AGREEMENT, a total fee not to exceed $147,075.00 (One Hundred Forty Seven Thousand Seventy Five Dollars and Zero Cents). Monthly invoices will be submitted in accordance with Exhibit "D". 4. INDEMNIFICATION AND HOLD HARMLESS: The Consultant agrees to indemnify, save harmless and defend the City of Corpus Christi, and its agents, servants, and employees as more fully set forth in Exhibit "B". 5. CITY'S DISCLOSURE OF HAZARDOUS & TOXIC MATERIALS AND CONDITIONS AT THE PROJECT SITE. To the best of the City's knowledge, based upon currently available information, the only hazardous or toxic materials, as defined by the laws and regulations of the Federal government, the state, and city which exist at the PROJECT SITE are as follows: None. CI '� OF C•RPS' �•f RISTI TOLUNAYY-WONGENGINEERS, INC. ,� :._4✓ z1.14-11%.— 1-.), (2- 1214 PV"ail rpa�-, (Date) Don R. Rokohl, P.E. (Date) Ac F' g ail Branch Manager of Capital Programs 5233 IH-37, Suite B-7 .1 ./WI J . Sg0e-✓lA-C - 4'..F Corpus Christi, TX 78408 (361) 884-5050 Office RE MMENDED Mot4 ilt:4211Pdriti, 12.01.261y O erating Department (Date) 0, I . 'I0 1U li4 IT COUNCIL-...._.J 3 1 2015-013 ----..4.—Ock, SFC RTARY 1/13/15 Ord. 030392 INDEXED Tolunay-Wong Engineers Inc. I\SOLID WASTE\5232 JC ELLIOTTAND CEFE VALENZUELA LANDFILL PAVEMENTAND ROADWAY LIFE CYCLE ENT.DOC APPROVED Project No. 5232 4 64141.44._ `.�/1/ Accounting Unit: 3365-033 'l / Account: 550920 Office of Management ( Activity: 140329013365EXP and Budget Account Category: 50920 Fund Name: Sanitary/Land CIP 2008 Encumbrance No. dir OVED AS TO LEGAL FORM '. 5/ 124-8 regal Department (Date) LeC,e.ATTEST TTC.1Z City Secretary K\ENGINEERING DATAEXCHANGE\ANGIEM\SOLID WASTE\5232 JC ELLIOTTAND CEFE VALENZUELA LANDFILL PAVEMENTAND ROADWAY LIFE CYCLE REPLACEMENT\TOLUNAY WONGWGREEMENT.DOC Tolunay-Wong 5233 IH-37,Suite B-7 Engineers, Inc Corpus Christi,Texas 78408 g Phone:(361)884-5050 November 6,2014 City of Corpus Christi 1201 Leopard Street Corpus Christi,Texas 78401 (Via e-Mail:GraceG@cctexas.com) Phone: (361)826-3527 Attn: Ms.Grace M.Gonzalez, P.E. Re: Construction Materials Testing Services For: Cefe F.Valenzuela Landfill Pavement Life Cycle Replacement Nueces County,Texas City of Corpus Christi Project No.5232 TWEI Proposal No.P14-0098 Ms.Gonzalez: Tolunay-Wong Engineers (TWE) appreciates the opportunity to submit our detailed proposal to provide construction materials testing and inspection services for the above referenced project. The proposed scope of services was based on the anticipated constriction schedule of 300 calendar days and the testing schedule provided in the Addendum No. 1 to the project plans and specifications. We understand that upon acceptance of the proposal, the City of Corpus Christi will issue an Agreement for Construction Materials Engineering Laboratory's Inspection and Materials Testing Services as our authorization for the work. Tolunay-Wong Engineers has established a reputation for excellence in the materials engineering field through a business philosophy based on quality professional services responsive to the needs of our clients. We thank you for the opportunity to serve you with this philosophy and your consideration for this project. Please do not hesitate to contact us,if you have any questions regarding the proposal or if additional information is needed. Respectfully submitted, Tolunay-Wong Engineers,Inc. IZ Pt.-led-4k Don R.Rokohl,P.E. Branch Manager drokohl@tweinc.com DRR/drr EXHIBIT"A" Page 1 of 3 Geotechnical Engineering*Environmental Field and Consulting Services*Construction Materials Testing*Deep Foundations Testing /10 Tolunay-Wong November 6,2014 Engineers,Inc. Proposal No.P14-0098 INTRODUCTION TWE understands the importance of this project to the City of Corpus Christi and the special needs associated with construction of a project of this type. Of particular importance is for the overall project team to be comprised of experienced professionals working together toward a common objective. This objective is to obtain a quality project, meeting the intent of the project specifications, as well as completion on schedule and within budget. From our Corpus Christi facility located at 826 South Padre Island Drive, we will provide experienced engineering technicians to perform the on-site testing and inspection services. Additionally, we meet the requirements of ASTM E-329 "Standard Practice for Inspection and Testing Agencies for Concrete, Steel and Bituminous Materials Used in Construction" regarding qualifications of the testing laboratory and our Corpus Christi laboratory is accredited by the American Association for Laboratory Accreditation(A2LA). WORK PLAN TWE's approach to providing materials testing services is to assign qualified engineering technicians, directed by Senior Professional Engineers, experienced in their respective disciplines. Our assigned Project Manager will provide communication, service direction, and overall project coordination. It is presumed that the contractor will be encouraged to provide their own formalized quality control program separate and apart from our acceptance inspection/testing program stated herein. We anticipate providing the majority of the required testing services for this particular project on a "part- time"basis.The anticipated services required on this project are as follows: A. In-Place Soil Compaction(nuclear method) B. Hot Mix Asphalt Concrete Inspection/Testing All reports of materials tests and inspection services provided will be issued to appropriate members of the project team. In the event individual reports indicate potential problems or items of non-conformance to the project specifications,you will be contacted as soon as possible. SCOPE OF SERVICES The specific materials monitoring services and laboratory tests anticipated for this project are as follows: A. In-Place Soil Compaction(Nuclear Method) • The technician will obtain samples of soil, borrow material, base materials, and/or cement treated recycled asphalt pavement and deliver them to our laboratory facility for testing. Laboratory testing will include Moisture/Density Relationships,Atterberg Limit determinations, sieve analysis,and wet ball mill evaluation. • The technician will perform in-place compaction testing (nuclear method) at the frequency required by the project specifications to determine the moisture content and degree of compaction. EXHIBIT"A" Page 2 of 3 Geotechnical Engineering*Environmental Field and Consulting Services*Construction Materials Testing*Deep Foundations Testing (110 Tolunay-Wong November 6,2014 Engineers,Inc. Proposal No.P14-0098 B. Hot Mix Asphalt Concrete • During lay down of hot mix asphalt concrete, the technician will obtain and record temperature of the mixture and obtain samples for laboratory testing. • After lay down and compaction, the asphalt will be cored to determine and record in-place thickness,%air voids,and laboratory density. The in-place%air voids and in-place theoretical density will be determined from the asphalt cores in the laboratory. • The asphalt samples obtained during lay down will tested in the laboratory for extraction and gradation, laboratory density and stability,and maximum theoretical density(rice method). COST ESTIMATE&GENERAL NOTES In this section of the proposal you will find our cost estimate. Additional services or tests requested and not specifically addressed in this proposal will be invoiced per the standard fees set forth in our 2014 Fee Schedule. Based on the testing schedule provided in the project construction documents (plans) provided to us at this time and the anticipated construction schedule, we have established what we believe is the most realistic cost estimate for this project. Please remember that the units stated are only an estimate. Due to factors beyond our control such as weather, unforeseen conditions, contractor expertise, contractor scheduling,etc.,the cost of our services may vary from the estimated amount. We estimate the cost of the construction materials testing for our proposed Scope of Services will be $147,075.00 as detailed in the following section, although all services will be invoiced on a time and materials basis. A minimum 4-hour labor equivalent charge is applicable for all field testing and inspection services. Overtime rates for field personnel are applicable for all hours worked in excess of 8 hours per day, weekends, and holidays and are assessed at 1.5 times the standard rates. All field hours will be charged portal to portal from our Corpus Christi laboratory. All sample pick-ups will be charged travel time from portal to portal and will include associated vehicle charges.Administrative costs, Engineering consultation and evaluation in connection with field and laboratory testing services will be charged at a rate of approximately one hour for each 20 hours of field work performed. Our prices include copies of our reports distributed through e-mail in accordance with your instructions. Additional copies mailed at$0.50 per page. Direct expenses incurred in connection with the project will be invoiced at cost plus 15%for handling. Travel and lodging expenses for out of town assignments will be invoiced at cost plus 15% or$125.00 per day, whichever is greater. Our terms are net 30 days upon receipt of invoice. Invoices will be submitted on a monthly basis. EXHIBIT"A" Page 3 of 3 Geotechnical Engineering*Environmental Field and Consulting Services•Construction Materials Testing•Deep Foundations Testing EXHIBIT "B" MANDATORY INSURANCE REQUIREMENTS & INDEMNIFICATION FOR NE PROFESSIONAL SERVICES/CONSULTANT SERVICES (Revised October 2010) A. Consultant must not commence work under this agreement until all insurance required herein has been obtained and such insurance has been approved by the City. The Consultant must not allow any subcontractor to commence work until all similar insurance required of the subcontractor has been obtained. B. Consultant must furnish to the City's Risk Manager, two (2) copies of Certificates of Insurance, showing the following minimum coverages by insurance company(s) acceptable to the City's Risk Manager. The City must be named as an additional insured for all liability policies, and a blanket waiver of subrogation is required on all applicable policies. TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE 30-Day Written Notice of Cancellation, Bodily Injury & Property Damage non-renewal or material change required Per occurrence - aggregate on all certificates COMMERCIAL GENERAL LIABILITY $1,000,000 COMBINED SINGLE LIMIT including: 1. Broad Form 2. Premises - Operations 3. Products/ Completed Operations 4. Contractual Liability 5. Independent Contractors AUTOMOBILE LIABILITY to included $1,000,000 COMBINED SINGLE LIMIT 1. Owned vehicles 2.. Hired— Non-owned vehicles PROFESSIONAL LIABILITY including: $1,000,000 per claim / $2,000,000 Coverage provided shall cover all aggregate employees, officers, directors and agents (Defense costs not included in face value 1. Errors and Omissions of the policy) If claims made policy, retro date must be prior to inception of agreement; have extended reporting period provisions and identify any limitations regarding who is an Insured WORKERS' COMPENSATION Which Complies with the Texas Workers Compensation Act EMPLOYERS' LIABILITY 500,000/500,000/500,000 EXHIBIT"B" Page 1 of 3 C. In the event of accidents of any kind, Consultant must furnish the Risk Manager with copies of all reports within (10) ten days of accident. D. Consultant must obtain workers' compensation coverage through a licensed insurance company in accordance with Texas law. The contract for coverage must be written on a policy and endorsements approved by the Texas Department of Insurance. The coverage provided must be in amounts sufficient to assure that all workers' compensation obligations incurred will be promptly met. E. Consultant's financial integrity is of interest to the City; therefore, subject to Successful Consultant's right to maintain reasonable deductibles in such amounts as are approved by the City, Consultant shall obtain and maintain in full force and effect for the duration of this Contract, and any extension hereof, at Consultant's sole expense, insurance coverage written on an occurrence basis, by companies authorized and admitted to do business in the State of Texas and with an A.M. Best's rating of no less than A-VII. F. The City shall be entitled, upon request and without expense, to receive copies of the policies, declarations page and all endorsements thereto as they apply to the limits required by the City, and may require the deletion, revision, or modification of particular policy terms, conditions, limitations or exclusions (except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwriter of any such policies). Consultant shall be required to comply with any such requests and shall submit a copy of the replacement certificate of insurance to City at the address provided below within 10 days of the requested change. Consultant shall pay any costs incurred resulting from said changes. All notices under this Article shall be given to City at the following address: City of Corpus Christi Attn: Risk Management P.O. Box 9277 Corpus Christi, TX 78469-9277 Fax: (361) 826-4555 G. Consultant agrees that with respect to the above required insurance, all insurance policies are to contain or be endorsed to contain the following required provisions: i. Name the City and its officers, officials, employees, volunteers, and elected representatives as additional insured by endorsement, as respects operations and activities of, or on behalf of, the named insured performed under contract with the City, with the exception of the workers' compensation and professional liability polices; ii. Provide for an endorsement that the "other insurance" clause shall not apply to the City of Corpus Christi where the City is an additional insured shown on the policy; iii. Workers' compensation and employers' liability policies will provide a waiver of subrogation in favor of the City; and iv. Provide thirty (30) calendar days advance written notice directly to City of any suspension, cancellation, non-renewal or material change in coverage, and not less than ten (10) calendar days advance written notice for nonpayment of premium. EXHIBIT"B" Page 2 of 3 • H. Within five (5) calendar days of a suspension, cancellation, or non-renewal of coverage, Successful Consultant shall provide a replacement Certificate of Insurance and applicable endorsements to City. City shall have the option to suspend Consultant's performance should there be a lapse in coverage at any time during this contract. Failure to provide and to maintain the required insurance shall constitute a material breach of this contract. I. In addition to any other remedies the City may have upon Consultant's failure to provide and maintain any insurance or policy endorsements to the extent and within the time herein required, the City shall have the right to order Consultant to stop work hereunder, and/or withhold any payment(s) which become due to Consultant hereunder until Consultant demonstrates compliance with the requirements hereof. J. Nothing herein contained shall be construed as limiting in any way the extent to which Successful Consultant may be held responsible for payments of damages to persons or property resulting from Consultant's or its subcontractors' performance of the work covered under this agreement. K. It is agreed that Consultant's insurance shall be deemed primary and non-contributory with respect to any insurance or self insurance carried by the City of Corpus Christi for liability arising out of operations under this contract. L. It is understood and agreed that the insurance required is in addition to and separate from any other obligation contained in this contract. INDEMNIFICATION AND HOLD HARMLESS Consultant shall indemnify, save harmless and defend the City of Corpus Christi, and its agents, servants, and employees, and each of them against and hold it and them harmless from any and all lawsuits, claims, demands, liabilities, losses and expenses, including court costs and attorneys' fees, for or on account of any injury to any person, or any death at any time resulting from such injury, or any damage to any property, which may arise or which may be alleged to have arisen out of or in connection with the negligent performance of Consultant's services covered by this contract. The foregoing indemnity shall apply except if such injury, death or damage is caused by the sole or concurrent negligence of the City of Corpus Christi, its agents, servants, or employees or any other person indemnified hereunder. EXHIBIT"B" Page 3 of 3 TERMS AND CONDITIONS TO AGREEMENT ARTICLE 1. SERVICES: "LAB"will: 1.1 Provide only those services requested by "CITY ENGINEER" that, in the opinion of "LAB", lie within the technical or professional areas of expertise of "LAB" and which "LAB" is adequately staffed and equipped to perform. 1.2 Perform technical services under the supervision of a licensed professional engineer and in compliance with the basic requirements of the appropriate standards of the American Society for Testing and Materials, where applicable, and other standards designated in writing by the "CITY ENGINEER." 1.3 Promptly submit formal reports (printed and electronic copies) of tests, inspections and services performed indicating, where applicable, compliance with the PROJECT specifications or other contract documents. Such reports must be complete and factual, citing the tests performed, methods employed, values obtained, and parts of the structure of THE PROJECT area subjected to any testing. 1.4 Utilize testing equipment which has been calibrated according to applicable standards and, upon request, submit to the "CITY ENGINEER", or his authorized representative, documentation of such calibration. Secure representative samples of those materials that the City's Contractor proposes to use which require testing, together with relevant data concerning such materials including the point of origin and supplier. 1.5 Consider reports to be confidential, and distribute reports only to those persons, organizations or agencies specifically designated in writing by the"CITY ENGINEER". 1.6 Retain records relating to services performed for "CITY" for a period of two years following submission of any reports, during which period the records will be made available to the"CITY" at all reasonable times. 1.7 Pay salaries, wages, expenses, social security taxes, federal and state unemployment taxes, and any other similar payroll taxes relating to the services. ARTICLE 2. CITY RESPONSIBILITIES: City Engineer or authorized representative will: 2.1 Provide "LAB" with all plans, specifications, addenda, change orders, approved shop drawings and other information for the proper performance of services by"LAB". 2.2 Issue authorization in writing giving "LAB" free access to THE PROJECT site, and to all shops or yards where materials are prepared or stored. 2.3 Designate in writing those persons or firms which will act as the "CITY's" representative with respect to "LAB'S" services to be performed under this AGREEMENT and which must be promptly notified by "LAB" when it appears that materials tested or inspected are in non- compliance. Only the "CITY ENGINEER" or his designated representative have authority to transmit instructions, receive information and data, interpret and define the CITY's policies and decisions with respect to THE PROJECT. "LAB" acknowledges that certain "CITY" representatives may have different types of authority concerning THE PROJECT. 2.4 Advise "LAB" sufficiently in advance of any operations so as to allow for assignment of personnel by "LAB" for completion of the required services. Such advance notice will be in accordance with that established by mutual agreement of the parties. 2.5 Direct THE PROJECT contractor, either by the Construction Contract or direct written order to: EXHIBIT"C" Page 1 of 3 • (a) Stop work at the appropriate times for"LAB"to perform contracted services; (b) Furnish such labor and all facilities needed by "LAB" to obtain and handle samples at THE PROJECT and to facilitate the specified inspection and tests; (c) Provide and maintain for use of "LAB" adequate space at THE PROJECT for safe storage and proper curing of test specimens which must remain on THE PROJECT site prior to, during, and up to 60 days after testing. ARTICLE 3. GENERAL CONDITIONS 3.1 "LAB", by the performance of services covered hereunder, does not in any way assume, abridge or abrogate any of those duties, responsibilities or authorities with regard to THE PROJECT which, by custom or contract, are vested in THE PROJECT architects, design engineers, or any other design agencies or authorities. 3.2 "LAB" is not authorized to supervise, alter, relax, enlarge or release any requirement of THE PROJECT specifications or other contract documents nor to approve or accept any portion of the work. "LAB" does not have the right of rejection or the right to stop the work. "CITY ENGINEER" will direct THE PROJECT contractor to stop work at appropriate times for "LAB" to conduct the sampling, testing, or inspection of operations covered by the AGREEMENT. ARTICLE 4. FIELD MONITORING AND TESTING 4.1 "CITY" and "LAB" agree that "LAB" will be on-site to perform inspections for contracted services. The "CITY" and "LAB" also agree that "LAB" will not assume responsibility for PROJECT Contractor's means, methods, techniques, sequences or procedures of construction, and it is understood that the final services provided by "LAB" will not relieve the PROJECT Contractor of his responsibilities for performing the work in accordance with THE PROJECT plans and specifications. For the purposes of this AGREEMENT, the word "inspection" is used to mean periodic observation of the work and the conducting of tests by "LAB" as specified in the AGREEMENT. Continuous monitoring by"LAB" or its subcontractors does not mean that"LAB" is approving placement of materials. Inspection is not and should not be construed to be a warranty by"LAB"to the"CITY"or any other party. 4.2 Samples collected or tested by "LAB" remain the property of the "CITY" while in the custody of the "LAB". "LAB" will retain the samples for a period of 60 days following the date of submission of any report related to the sample. Following the retention period, "LAB" will dispose of non- hazardous samples, and return hazardous, acutely toxic, or radioactive samples and samples containers and residues to "CITY". "CITY" agrees to accept such samples and samples containers. ARTICLE 5. STANDARD OF CARE AND WARRANTY Services performed by "LAB" will be conducted in a manner consistent with that level of care and skill ordinarily exercised by reputable members of the profession currently practicing under similar conditions in the same locality. No other warranty either expressed or implied is made or intended by the AGREEMENT or any reports. "LAB" will not be responsible for the interpretation or use by others of data developed by"LAB". ARTICLE 6. SAFETY "CITY" and "LAB" agree that, in accordance with the generally accepted construction practice, the PROJECT'S general contractor will be solely and completely responsible for working conditions on THE PROJECT, including safety of all persons and property during the performance of the work, and for compliance with all municipal, state, and federal laws, rules and regulations, including OSHA. The duty of "LAB" in providing services is not, therefore, to include any review of, or responsibility for, the adequacy of the PROJECT'S general contractor's safety measures in, on, or near THE PROJECT site. EXHIBIT"C" Page 2 of 3 ARTICLE 7. INVOICES AND PAYMENT "LAB" will submit progress invoices to "CITY ENGINEER" monthly and final invoice upon completion of services. Each invoice is due and payable by "CITY"within 30 days of receipt and approval to pay by the City Engineer. ARTICLE 8. EXTENT OF AGREEMENT 8.1 This AGREEMENT, including Exhibit "A" and these terms and conditions, represents the entire AGREEMENT between "CITY" and "LAB" and supersedes all prior negotiation, representations or agreements, written or oral. This AGREEMENT may be amended only by a written instrument signed by duly authorized representative of "CITY" and "LAB". If any conflict occurs between these terms and conditions and this AGREEMENT, these terms and conditions are controlling. 8.2 In the event that any one or more of the provisions contained in this AGREEMENT are for any reason held invalid, illegal or unenforceable in any respect, the remaining terms will be in full effect and this AGREEMENT will be construed as if the invalid or unenforceable matters were never included in this AGREEMENT. No waiver of any default will be a waiver of any future default. 8.3 Neither party will assign this AGREEMENT without the express written approval of the other, but "LAB" may subcontract laboratory procedures as "LAB" deems necessary to meet the obligations of this AGREEMENT. EXHIBIT"C" Page 3 of 3 COMPLETE PROJECT NAME Project No. xxxxxx Invoice No. 12345 Invoice Date: Total Amount Previous Total Percent Basic Services: Contract Amd No. 1 Amd No. 2 Contract Invoiced Invoice Invoice Complete Preliminary Phase $15,117 $0 $0 $15,117 $0 $1,000 $1,000 7% • Design Phase 20,818 0 0 20,818 1,000 500 1,500 7% Bid Phase 0 0 0 0 0 0 0 n/a Report Phase 14,166 0 0 14,166 0 0 0 0% Construction Phase 0 0 0 0 0 0 0 n/a Subtotal Basic Services $50,101 $0 $0 $50,101 $750 $1,500 $2,500 5% Additional Services: Permitting $0 $0 $0 $0 $0 $0 $0 n/a Warranty Phase 0 0 0 0 0 0 0 n/a Inspection 9,011 0 0 9,011 0 0 0 0% Platting Survey 29,090 0 0 29,090 0 0 0 0% Reporting 1,294 0 0 1,294 0 0 0 0% Co & M Manuals TBD TBD TBD TBD TBD TBD 0 0% SCADA TBD TBD TBD TBD TBD TBD TBD 0% Subtotal Additional Services $39,395 $0 $0 $39,395 $0 $0 $0 0% Summary of Fees Basic Services Fees $50,101 $0 $0 $50,101 $750 $1,500 $2,500 5% Additional Services Fees 39,395 0 0 39,395 0 0 0 0% - x Total of Fees $89,496 $0 $0 $89,496 $750 $1,500 $2,500 3% go i -a = °, v • SUPPLIER NUMBER TO BE ASSIGNED BY CITY PURCHASING DIVISION �..� City of CITY OF CORPUS CHRISTI Carpus DISCLOSURE OF INTEREST Chnsti 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: Tolunay-Wong Engineers, Inc. P.O.BOX: STREET ADDRESS: 5233 IH-37,Suite B-7 CITY: Corpus Christi ZIP: 78408 FIRM IS: 1. Corporation 2. Partnership [ 3. Sole Owner 0 4. Association LJ 5. Other L 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 havins an "ownership interest"constituting 3%or more of the ownership in the above named`"firm.' / me 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." /4 Title 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 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 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: Don R.Rokohl,P. E. Title: Branch Manager (Type or Print) Signature of Certifying Dv Date: 4 , 3 / . Person: _\ 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.