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HomeMy WebLinkAboutC2016-012 - 1/19/2016 - Approved CITY OF CORPUS CHRISTI CONTRACT FOR PROFESSIONAL SERVICES The City of Corpus Christi, a Texas home rule municipal corporation, P.O. Box 9277, Corpus Christi, Nueces County, Texas 78469-9277 (City) acting through its duly authorized City Manager or Designee (Director of Engineering Services) and HDR Engineering, Inc., a Texas corporation, 555 N. Carancahua, Suite 1600, Corpus Christi, Nueces County, Texas 78401, (Architect/Engineer—A/E), hereby agree as follows: 1. SCOPE OF PROJECT McGee Beach Breakwater Improvements (Project No. E15219)—The project includes: • Demolition of the concrete pile-supported (elevated) access walkway and replacement with an extension of the rock breakwater. • Replacement of the concrete cap/walkway along the rock breakwater • Replacement of electrical line/lights • Replacement of trash receptacles and signage • Replacement of steps between beach and breakwater • Replacement of the fish-cleaning station 2. SCOPE OF SERVICES The NE hereby agrees to perform design services necessary to review and prepare plans, specifications, and bid and contract documents. In addition, NE will provide monthly status updates (project progress or delays, gantt charts presented with monthly invoices) and provide contract administration services, as described in Exhibit "A", to complete the Project. Work will not begin on Additional Services until requested by the NE (provide breakdown of costs, schedules), and written authorization is provided by the Director of Engineering Services. NE services will be "Services for Construction Projects"- (Basic Services for Construction Projects") which are shown and are in accordance with "Professional Engineering Services- A Guide to the Selection and Negotiation Process, 1993" a joint publication of the Consulting Engineer's Council of Texas and Texas Society of Professional Engineers. For purposes of this contract, certain services listed in this publication as Additional Services will be considered as Basic Services. 3. ORDER OF SERVICES The NE agrees to begin work on those authorized Basic Services for this contract upon receipt of the Notice to Proceed from the Director of Engineering Services. Work will not begin on any phase or any Additional Services until requested in writing by the NE and written authorization is provided by the Director of Engineering Services. The anticipated schedule of the preliminary phase, design phase, bid phase, and construction phase is 2016-012 This schedule is not to be inclusive of all additional time that may 1/19/16 Ord. 030745 Contract for Professional Services HDR Engineering Inc. Page 1 of INDEXEC SAJ\PARKS\E15219-BREAKWATER AT MCGEE BEACH\1 CONTRACT FOR PROFESSIONAL SERVICES DOCX The Director of Engineering Services may direct the NE to undertake additional services or tasks provided that no increase in fee is required. Services or tasks requiring an increase of fee will be mutually agreed and evidenced in writing as an amendment to this contract. NE shall notify the City of Corpus Christi within three (3) days of notice if tasks requested requires an additional fee. 4. FEE The City will pay the NE a fee as described in Exhibit "A" for providing services authorized, a total fee not to exceed $19,900.00 Monthly invoices will be submitted in accordance with Exhibit "B". 5. INDEMNITY NE shall fully indemnify and hold harmless the City of Corpus Christi and its officials, officers, agents, employees, lunteers, directors and representatives ("Indemnitee") from and against any and all claims, damages, liabilities or costs, including reasonable attorney fees and defense costs, to the extent that the damage is caused by and/or results from an act of negligence, intentional tort, intellectual property infringement or failure to pay a subcontractor or supplier committed by NE or its agent, NE under contract or another entity over which A/E exercises control while in the exercise of rights or performance of the duties under this agreement. This indemnification does not apply to any liability resulting from the negligent acts or omissions of the City or its employees, to the extent of such negligence. If the liability results solely from the negligent acts or omissions of the NE, the A/E shall also defend the Indemnitee with counsel satisfactory to the City Attorney. If a claim is based wholly or partly on the negligence of, fault of or breach of contract by the City, the A/E shall reimburse the City's reasonable attorney's fees in proportion to the NE's liability. A/E must advise City in writing within 24 hours of any claim or demand against City or NE known to NE related to or arising out of NE's activities under this Agreement. 6. INSURANCE 6.1 NE must not commence work under this agreement until all required insurance has been obtained and such insurance has been approved by the City. NE must not allow any subcontractor to commence work until all similar insurance required of any subcontractor has been obtained. 6.2 NE must furnish to the Director of Engineering Services with the signed agreement 2 copies of Certificates of Insurance (COI) with applicable policy endorsements showing the following minimum coverage by an insurance company(s) acceptable to the City's Risk Manager. The City must be listed as an additional insured on the General Contract for Professional Services Page 2 of 7 K:\ENGINEERING DATAEXCHANGE\CLARISSAJ\PARKS\E15129-BREAKWATER AT MCGEE BEACH\1 CONTRACT FOR PROFESSIONAL SERVICES.DOCX liability and Auto Liability policies, and a waiver of subrogation is required on all applicable policies. Endorsements must be provided with COI. Project name and or number must be listed in Description Box of COI. TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE 30-written day notice of cancellation, Bodily Injury and Property Damage required on all certificates or by Per occurrence - aggregate applicable policy endorsements Commercial General Liability including: $1,000,000 Per Occurrence 1. Commercial Broad Form $2,000,000 Aggregate 2. Premises — Operations 3. Products/ Completed Operations 4. Contractual Liability 5. Independent Contractors 6. Personal Injury- Advertising Injury AUTO LIABILITY (including) $1,000,000 Combined Single Limit 1. Owned 2. Hired and Non-Owned 3. Rented/Leased PROFESSIONAL LIABILITY $1,000,000 Per Claim (Errors and Omissions) $2,000,000 Aggregate (Defense costs not included in face value 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 insured. WORKERS' COMPENSATION Statutory (All States Endorsement if Company is not domiciled in Texas) Employer's Liability $500,000 /$500,000 /$500,000 6.3 In the event of accidents of any kind related to this agreement, NE must furnish the City with copies of all reports of any accidents within 10 days of the accident. 6.4 Applicable for paid employees, NE must obtain workers' compensation coverage through a licensed insurance company. The coverage must be written on a policy and Contract for Professional Services Page 3 of 7 K:\ENGINEERING DATAEXCHANGE\CLARISSAJ\PARKS\E15129-BREAKWATER AT MCGEE BEACH\1 CONTRACT FOR PROFESSIONAL SERVICES.DOCX • endorsements approved by the Texas Department of Insurance. The workers' compensation coverage provided must be in an amount sufficient to assure that all workers' compensation obligations incurred by the NE will be promptly met. An All States Endorsement shall be required if NE is not domiciled in the State of Texas. 6.5 NE shall obtain and maintain in full force and effect for the duration of this Contract, and any extension hereof, at NE'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. A/E is required to provide City with renewal Certificates. 6.6 NE shall be required to submit a copy of the replacement certificate of insurance to City at the address provided below within 10 days of the requested change. NE 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: Engineering Services P.O. Box 9277 Corpus Christi, TX 78469-9277 6.7 A/E agrees that with respect to the above required insurance, all insurance policies are to contain or be endorsed to contain the following required provisions: 6.7.1 List the City and its officers, officials, employees, vel-u-nteeFs, and elected representatives as additional insured by endorsement, as respects operations, completed operation and activities of, or on behalf of, the named insured performed under contract with the City, with the exception of the workers' compensation policy; 6.7.2 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; 6.7.3 Workers'compensation and employers' liability policies will provide a waiver of subrogation in favor of the City; and 6.7.4 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. 6.8 Within five (5) calendar days of a suspension, cancellation or non-renewal of coverage, NE shall provide a replacement Certificate of Insurance and applicable endorsements to City. City shall have the option to suspend NE'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. 6.9 In addition to any other remedies the City may have upon NE's failure to provide and maintain any insurance or policy endorsements to the extent and within the time Contract for Professional Services Page 4 of 7 K:\ENGINEERING DATAEXCHANGE\CLARISSAJ\PARKS\E15129-BREAKWATER AT MCGEE BEACH\1 CONTRACT FOR PROFESSIONAL SERVICES.DOCX herein required, the City shall have the right to order NE to remove the exhibit hereunder, and/or withhold any payment(s) if any, which become due to NE hereunder until NE demonstrates compliance with the requirements hereof. 6.10 Nothing herein contained shall be construed as limiting in any way the extent to which NE may be held responsible for payments of damages to persons or property resulting from NE's or its subcontractor's performance of the work covered under this agreement. 6.11 It is agreed that NE'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 agreement. 6.12 It is understood and agreed that the insurance required is in addition to and separate from any other obligation contained in this agreement. 6.13 Contracts Less than $50,000 - Insurance not required; however, if contract is amended to exceed $50,000, the above insurance requirements must be met. 7. TERMINATION OF CONTRACT The City may, at any time, with or without cause, terminate this contract upon seven days written notice to the NE at the address of record. In this event, the NE will be compensated for its services on all stages authorized based upon NE and City's estimate of the proportion of the total services actually completed at the time of termination. 8. LOCAL PARTICIPATION The City Council's stated policy is that City expenditures on contracts for professional services be of maximum benefit to the local economy. 9. ASSIGNABILITY The NE will not assign, transfer or delegate any of its obligations or duties in this contract to any other person without the prior written consent of the City, except for routine duties delegated to personnel of the NE staff. If the NE is a partnership, then in the event of the termination of the partnership, this contract will inure to the individual benefit of such partner or partners as the City may designate. No part of the NE fee may be assigned in advance of receipt by the NE without written consent of the City. The City will not pay the fees of expert or technical assistance and consultants unless such employment, including the rate of compensation, has been approved in writing by the City. 10.OWNERSHIP OF DOCUMENTS All documents including contract documents (plans and specifications), record drawings, contractor's field data, and submittal data will be the sole property of the City, may not be Contract for Professional Services Page 5 of 7 K:\ENGINEERING DATAEXCHANGE\CLARISSAJ\PARKS\E15129-BREAKWATER AT MCGEE BEACH\1 CONTRACT FOR PROFESSIONAL SERVICES DOCX used again by the NE without the express written consent of the Director of Engineering Services. However, the NE may use standard details that are not specific to this project. The City agrees that any modification of the plans will be evidenced on the plans, and be signed and sealed by a professional engineer prior to re-use of modified plans. 11. DISCLOSURE OF INTEREST NE further agrees, in compliance with City of Corpus Christi Ordinance No. 17112, to complete, as part of this contract, the Disclosure of Interests form. 12.STANDARD OF CARE Services provided by NE under this Agreement shall be performed with the professional skill and care ordinarily provided by competent engineers or architects practicing in the same or similar locality and under the same or similar circumstances and professional license; and performed as expeditiously as is prudent considering the ordinary professional skill and care of a competent engineer or architect. 13.CONFLICT OF INTEREST NE agrees, in compliance with Chapter 176 of the Texas Local Government Code, to complete and file Form CIQ with the City Secretary's Office. For more information and to determine if you need to file a Form CIQ, please review the information on the City Secretary's website at http://www.cctexas.com/government/city-secretary/conflict- disclosure/index. 14. ENTIRE AGREEMENT AND CONTROLLING LAW This Agreement represents the entire and integrated Agreement between City and NE and supersedes all prior negotiations, representations or agreements, either oral or written. This Agreement may be amended only by written instrument signed by both the City and NE. This Agreement is governed by the laws of the State of Texas without regard to its conflicts of laws. Venue for legal proceedings lies exclusively in Nueces County, Texas. 15. CONFLICT RESOLUTION BETWEEN DOCUMENTS NE hereby agrees and acknowledges if anything contained in the NE-prepared Exhibit A, NE's Scope of Services, or contained in any other document prepared by NE and included herein, is in conflict with this Agreement, this Agreement shall take precedence and control to resolve said conflict. Contract for Professional Services Page 6 of 7 K:\ENGINEERING DATAEXCHANGE\CLARISSAJ\PARKS\E15129-BREAKWATER AT MCGEE BEACH\1 CONTRACT FOR PROFESSIONAL SERVICES DOCX • CITY OF CORPUS HRISTI HDR ENGINEERING, INC. Aeiy// # moi. :� = i 2 s /(o /i4 ' Z,�� 1>'24-l . H. Edmonds, P.E. Dat: Arthur B. Colwell, P.E. Date Director of Engineering Services Vice President 555 N. Carancahua, Suite 1600 Corpus Christi, Texas 78401-0850 (361) 696-3300 Office RECOMMENDED /L7 97'y r / of i Operating Depart nt Date APPROVED AS TO LEGAL FORM r /6 4?-1-411 Date 0t47 ceur cli....._lorci . o 3Di 14-s . Ai U.. 1t� L al Dep rtment ,. APPROV D .,.�u_..•_............. . SFc -raPv 11 :4a . A ., liiy/L. % Office of Management D.J - and Budget ATTEST RVa_40/1 6 Rebecca Huerta Date City Secretary Fund Name Accounting Unit Account No. Activity No. Account Category Amount C.%5-119 Seawall Maint 3272-707 550950 l9013272EXP 50950 $19,900.00 Total $19,900.00 Contract for Professional Services Page 7 of 7 K:\ENGINEERING DATAEXCHANGE\CLARISSAJ\PARKS\E15129-BREAKWATER AT MCGEE BEACH\1 CONTRACT FOR PROFESSIONAL SERVICES DOCX , • October 5, 2015 P111827 Mr. Jeff Edmonds, P.E., Director, Capital Programs City of Corpus Christi P.O. Box 9277 Corpus Christi, TX 78469-9277 RE: PROPOSAL FOR DEVELOPMENT OF CURSORY-LEVEL BREAKWATER IMPROVEMENT CONCEPT AT MCGEE BEACH Dear Mr. Edmonds: Thank you for inviting HDR to submit this proposal for professional engineering services. Based on our recent correspondence, the City desires an updated concept assessment and opinion of probable construction cost (OPCC) for breakwater improvements at McGee Beach. An improvement concept and associated cost was previously developed by HDR in 2009; this concept was developed for funding consideration through the City's Seawall 4A Board. Having a local staff of experienced coastal and marine structural engineers, as well as familiarity with the project site, we feel well qualified to help. SCOPE OF SERVICES HDR proposes to provide the following services: • Participate in a kickoff meeting and project site visit with City staff. The purpose of the meeting and site visit will be to review project goals and observe the general condition of the existing breakwater and supporting amenities. • Review the previous project concept and OPCC developed by HDR in 2009. • Update the improvement concept for the breakwater, adjoining structures, and selected amenities.Anticipated improvements are as follows: - Demolition of the concrete pile-supported (elevated) access walkway and replacement with an extension of the rock breakwater. - Replacement of the concrete cap/walkway along the rock breakwater. - Replacement of electrical line/lighting. - Replacement of trash receptacles and signage. - Replacement of steps between beach and breakwater. - Replacement of the fish-cleaning station. • Note that repairs and/or replacement of the concrete structure that supports the existing concession area and restrooms was not included in the previous (2009) improvement i,drinc,c©fii EXHIBIT"A" Page 1 of 3 Mr.Jeff Edmonds October 5,2015 Page 2 concept. HDR will provide an assessment of the structure and, if replacement or repairs are recommended, develop a cursory-level improvement concept. • Develop an updated OPCC for the breakwater improvement concept and selected amenities. In addition, if replacement of the concrete structure that supports the existing concession area is determined to be necessary, develop OPCC for replacement structure(including concession structure and restrooms). • Provide a brief technical memorandum summarizing the results. ASSUMPTIONS AND LIMITATIONS HDR's proposal for the services and fee described herein is based on the following assumptions and limitations: 1. This effort will be limited to a desktop-level review and does not include detailed analysis, data collection, calculations, modeling, environmental and regulatory review, or other items that might typically be associated with detailed engineering or design. 2. OPCC will be conceptual-level. 3. Except for adding the concrete structure that supports the existing concession area, the project location and limits will be similar to those considered during the previous assessment completed by HDR in 2009. Improvements to the seawall, McGee Beach, and/or marina will not be included. FEE, DELIVERABLES,AND SCHEDULE HDR proposes to provide these services for a lump-sum fee of$19,900 as shown in the table below. We propose to provide these services in accordance with HDR's standard Terms and Conditions (attached to this letter). Any work outside the proposed Scope will be added, with authorization from the City, through a formal Scope Change Document and associated fee agreement. This proposal is valid for 45 days from the date of this letter. Approximate Approximate Task Deliverables Schedule of Amount per jCompletion Task Technical Breakwater Improvements Assessment Memorandum and 60 Days $19,900 OPCC Total Proposed Lump Sum Fee: $19,900 EXHIBIT"A" Page 2 of 3 Mr.Jeff Edmonds October 5,2015 Page 3 Thank you again for considering us for this project. Please do not hesitate to contact Dan Heilman at 361-696-3344 if you have questions or require any additional information. Sincerely, HDR ENGINEERING, INC. Daniel J. Heilman, P.E. Arthur B. Colwell, P.E. Project Manager Vice President/Managing Principal DJH/jcm Cc: Jerry Shoemaker, P.E., City of Corpus Christi Shane Torno, P.E., City of Corpus Christi Carl Crull, P.E., HDR Attachments: HDR Engineering, Inc. Terms and Conditions for Professional Services EXHIBIT"A" Page 3 of 3 PROJECT NAME Project No. EXXXXX . 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 $0 $0 $0 $0 $0 $0 $0 0% Design Phase 0 0 0 0 $0 0 0 0% Bid Phase 0 0 0 0 0 0 0 0% Report Phase 0 0 0 0 0 0 0 0% Construction Phase 0 0 0 0 0 0 0 0% Subtotal Basic Services $0 $0 $0 $0 $0 $0 $0 0% Additional Services: Permitting $0 $0 $0 $0 $0 $0 $0 0% Warranty Phase 0 0 0 0 0 0 0 0% Inspection 0 0 0 0 0 0 0 0% Platting Survey 0 0 0 0 0 0 0 0% Reporting 0 0 0 0 0 0 0 0% O & M Manuals TBD TBD TBD TBD TBD TBD 0 0% SCADA TBD TBD TBD TBD TBD TBD TBD 0% Subtotal Additional Services $0 $0 $0 $0 $0 $0 $0 0% Summary of Fees Basic Services Fees $0 $0 $0 $0 $0 $0 $0 0% Additional Services Fees 0 0 0 0 0 0 0 0% - Total of Fees $0 $0 $0 $0 $0 $0 $0 0% . -E, m CM s moo: o (-eaSUPPLIER NUMBER TO BE ASSIGNED BY CII Y = PURCHASING DIVISION City of CITY OF CORPUS CHRISTI Corpus DISCLOSURE OF INTEREST Chnsti City of Corpus Christi Ordinance 17112, as amended, requires all persons or firms seeking to do business with the ifto provlde the following information. tEvery3questlontmust , nswered trithe. u ofy pelt latiswe eith N'A See reverse side fo'r Filing�RequIremen s, Certifications and definitions. COMPANY NAME: HDR Engineering,Inc. P.O.BOX: STREET ADDRESS: 555 N.Carancahua,Suite 1600 CITY: Corpus Christi ZIP: 78401 FIRM IS: I. Corporation X 2. Partnership _ 3. Sole Owner ❑ 4. Association ❑ 5. Other DISCLOSURE QUESTIONS additional space is necessary, please use the reverse side of this page or attach separate sheet. State the names of each employee' of the Cityof Corpus Christi having an "ownership interest"constituting 3%or more of the ownership in the above named "firm.' Name N/A Job Title and City Department(if known) i,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." Nam Title Title 411 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." NameA/AA Board,Commission or Committee *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 A/A 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: Arthur B.Colwell,P. E. Title: Vice President (T)pe or Print) v`;, Y 4;.,of„Certifjtingili f 5 #4gtvzifelid_ 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. • CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 OFFICE USE ONLY 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. CERTIFICATION OF FILING 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2016-1627 HDR Engineering, Inc. Corpus Christi,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 01/07/2016 being filed. City of Corpus Christi,TX Dat q�Ackno ledged:(.0 TO I' 3 Provide the identification number used by the governmental entity or state agency to track or identify,,,the contras,and provide a description of the goods or services to be provided under the contract. E15219 McGee Beach Breakwater Study 4 Nature of interest(check applicable) Name of Interested Party City,State,Country(place of business) Controlling Intermediary Little,George Omaha, NE United States X Keen, Eric Omaha, NE United States X Felker, Brett Davis,CA United States X O'Reilly,Charles Boston, MA United States X HDR, Inc. Omaha, NE United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct. ------------------ oR rr PMMISSI N ITH EX //�`` /f '*6 *' MY COMMISSION EXPIRES -� �i11jfif I August 2,2018 Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP/SEAL ABOVE �� '7 Sworn to and subscribed before me,by the said , 1[�r Htu( Co/with ,this the ( day of Ja et r to f 20 I.(O ,to certify which,witness my hand and seal of office. J /� 10 Cat- AVIA,t6 Prt5t( //a S m( Acco u ndrhLew,sit Signature of officer administering oath Printed name of officer administering oath Title of officer ainistering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.33598