Ordinance No. 12,760ORDINANCE NO. 12,760
AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF BAYTOWN, TEXAS,
AUTHORIZING THE FIRST AMENDMENT TO THE PROFESSIONAL SERVICES
AGREEMENT WITH KIMLEY HORN AND ASSOCIATES, INC., FOR RIGHT -
TURN LANE IMPROVEMENTS AT SEVERAL LOCATIONS ALONG GARTH
ROAD; AUTHORIZING PAYMENT BY THE CITY OF BAYTOWN IN AN
AMOUNT NOT TO EXCEED SIXTY -TWO THOUSAND THREE HUNDRED AND
NO/100 DOLLARS ($62,300.00); MAKING OTHER PROVISIONS RELATED
THERETO; AND PROVIDING FOR THE EFFECTIVE DATE THEREOF.
****************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF BAYTOWN, TEXAS:
Section 1: That the City Council of the City of Baytown, Texas, hereby authorizes and
directs the City Manager to execute and the City Clerk to attest to the First Amendment to the
Professional Services Agreement with Kimley Horn and Associates, Inc., for right -turn lane
improvements at several locations along Garth Road. A copy of said amendment is attached hereto as
Exhibit "A" and incorporated herein for all intents and purposes.
Section 2: That the City Council of the City of Baytown authorizes payment to Kimley
Horn and Associates, Inc., in an amount not to exceed SIXTY -TWO THOUSAND THREE HUNDRED
AND NO /100 DOLLARS ($62,300.00) for professional services in accordance with the amendment
authorized in Section 1 hereinabove.
Section 3: That the City Manager is hereby granted general authority to approve a decrease
or an increase in costs by FIFTY THOUSAND AND NO /100 DOLLARS ($50,000.00) or less, provided
that the amount authorized in Section 2 hereof may not be increased by more than twenty -five percent
(25 %).
Section 4: This ordinance shall take effect immediately
City Council of the City of Baytown.
INTRODUCED, READ and PASSED by the
Baytown this the 8h day of January, 2015.
ATT T: L
E CIA BRYSCH, City Cl.�•'
APPROVED AS TO FORM: _
ACIO RAMIREZ, SR., Cit torney
and after its passage by the
of the City Council of the City of
DONCARLOS, Mayor
!.COBFS01',Legal�..Karen.Files %City CouncWOrdinances\2015Uanuary 8 FirstAmendment2KimleyHomAgreement4RightTumLanelmprovements .doc
Exhibit "A"
FIRST AMENDMENT
TO THE
PROFESSIONAL SERVICES AGREEMENT
BY AND BETWEEN
THE CITY OF BAYTOWN
AND
KIldLEY -HORN AND ASSOCIATES, INC.
STATE OF TEXAS
COUNTY OF HARRIS
This First Amendment ( "Amendment ") to that certain "Professional Services Agreement'
between the City of Baytown and Kimley -Hom and Associates, Inc., dated the day of
2014, is made by and between the same parties on the date hereinafter last
specified.
WITNESSETH:
WHEREAS, the City of Baytown (the "City ") and Kimley -Horn and Associates, Inc.,
( "Professional ") did enter into an Agreement for Professional Services, dated the 24th day of October,
2014, ( "Agreement') to perform traffic engineering services for right -turn lane improvements together
with the preparation of associated plans, specifications, cost estimates and construction phase services for
the following intersections:
➢ Garth Road at Cedar Bayou Lynchburg Road — NB Right -Turn Lane;
➢ Garth Road at Cedar Bayou Lynchburg Road — WB Right -Turn Lane;
➢ Garth Road at Baker Road — EB Right -Turn Lane;
➢ Garth Road at Baker Road — WB Right -Turn Lane; and
WHEREAS, the City now desires Professional to perform additional services for three additional
right -turn lane improvements at the following intersections:
➢ Garth Road at IH -10 WBFR— WB Right -Turn Lane;
➢ Garth Road at IH -10 WBFR — SB Right -Turn Lane; and
➢ Garth Road at IH -10 EBFR — NB Right -Turn Lane;
NOW THEREFORE, for and in consideration of the mutual covenants and agreements herein
contained, the parties hereto do hereby mutually agree as follows:
Definitions. Unless a different meaning clearly appears from the context, words and phrases as
used in this Amendment shall have the same meanings as in the Agreement.
2. Amendments
a. Section 1 "Scope of Services/Professional Fees" of the Agreement is hereby amended to
read as follows:
1. Scope of Services/Professional Fees
This Agreement authorizes Professional to perform engineering services right -turn lane
improvements at multiple locations in Baytown, including the following intersections:
➢ Garth Road at Cedar Bayou Lynchburg Road — NB Right -Turn Lane;
First Amendment to the Agreement for Professional Services, Page 1
➢ Garth Road at Cedar Bayou Lynchburg Road — WB Right -Turn Lane;
➢ Garth Road at Baker Road — EB Right -Turn Lane;
➢ Garth Road at Baker Road — WB Right -Turn Lane;
➢ Garth Road at IH -10 WBFR— WB Right -Turn Lane;
➢ Garth Road at IH -10 WBFR— SB Right -Turn Lane; and
➢ Garth Road at IH -10 EBFR — NB Right -Turn Lane.
The Professional shall also perform engineering services associated with the preparation
of associated plans, specifications, cost estimates, and construction phase services (the
"Work ") for and on behalf of the City. The compensation for Professional shall be on the
basis described in Exhibit "A," with reimbursement of costs on the basis described in
Exhibit "B," for a total contract amount not to exceed ONE HUDRED THIRTY -THREE
THOUSAND EIGHT HUNDRED AND NO 1100 DOLLARS ($133,800.00). The time
schedules for the Work are attached as Exhibit "C." The scope of the work and
projection of costs of the construction project is as denoted in Exhibit "D." Each of these
Exhibits "A" through "D" is incorporated into this Agreement by reference for all
purposes.
b. Exhibit "A" "Compensation," as incorporated into the Agreement, is hereby amended to
read as follows:
EXHIBIT A
Compensation
Survey Services required under this Agreement shall not exceed SEVENTEEN
THOUSAND THREE HUNDRED AND N01100 DOLLARS ($17,300.00) based upon
the actual cost to the Professional times a factor of 1.10.*
Engineering Services required under this Agreement shall not exceed the following for
each task herein identified based upon the rate schedule included below:
Task
Description
Cost Not to
Cost Not To
Exceed Per
Exceed
Intersection
1
Survey
$ 17,300.00*
2
Turn Lane Design Plans
$ 111,500.00
Garth Road at Cedar Bayou Lynchburg
$13,000.00
Road — NB Right-Turn Lane
Garth Road at Cedar Bayou
$11,000.00
Lynchburg Road — WB Right -
Turn Lane
Garth Road at Baker Road — EB Right-
$17,000.00
Turn Lane
Garth Road at Baker Road — WB Right-
$21,000.00
Turn Lane
Garth Road at IH -10 — WB Right -Turn
$17,500.00
Lane
Garth Road at IH -10 — SB Right -Turn
$16,000.00
Lane
Garth Road IH -10 —NB Right -Turn
$16,000.00
Lane
3
Construction Phase Services
$ 3,000.00
First Amendment to the Agreement for Professional Services, Page 2
C.
Task
Description
Cost Not to
Cost Not To
$230
- $260
Exceed Per
Exceed
$240
Engineer/Professional
Intersection
$210
Total
$140 -
$131800.00
Rate Schedule
Senior Engineer I/Senior Professional I
$230
- $260
Senior Engineer II/Senior Professional II
$215 -
$240
Engineer/Professional
$155 -
$210
CAD Technician
$140 -
$155
Designer
$105 -
$165
Analyst
$135 -
$170
Support Staff /Technician
$60 -
$115
Additional Services
Professional will perform additional services, if any, at a price agreed upon by the parties
in writing prior to the performance of such services. The City shall not be responsible or
liable for any additional services performed by the Professional unless such additional
services have been approved in writing prior to the performance of the same.
Exhibit `B" "Reimbursable Expenses," as incorporated into the Agreement is hereby
amended to read as follows:
EXHIBIT B
Reimbursable Expenses
Reimbursable expenses shall include costs for incidental items such as parking, mileage,
deliveries, and copies. Such expenses will be invoiced to the City at the Professional's
direct cost plus 10 %, except that mileage will be invoiced at the IRS rate, which is
currently $0.485 per mile. Reimbursable expenses will not exceed TWO THOUSAND
AND NO/ 100 DOLLARS ($2,000.00).
Additionally, expenses associated with transportation, including, but not limited to,
meals, travel, and lodging, must be approved in writing by the City prior to the
Professional incurring any expense associated therewith; otherwise, the parties hereto
agree and understand that the City shall not be liable and the Professional shall not make
a claim against the City for any such expenses.
d. Exhibit "C" "Schedule of Work," as incorporated into the Agreement is hereby amended to
read as follows:
EXHIBIT C
Schedule of Work
Professional shall complete the services required herein in accordance with the following
schedule commencing from the date of the City's issuance of the notice to proceed:
First Amendment to the Agreement for Professional Services, Page 3
Survey .............................................. .............................28 Calendar Days*
Turn Lane Design Phase .................. .............................70 Calendar Days*
*From Notice to Proceed in accordance with this Amendment
and is contingent upon addressing any ROW issues with
OWNER.
Professional shall perform Construction Phase Services throughout and until completion
and acceptance by the City Council of the work associated with the Project.
Exhibit "D" "Scope of Work," Section A "Generally" as incorporated into the Agreement is
hereby amended to read as follows:
EXHIBIT D
Scope of Work
A. Generally:
The City has a need for increased capacity at the intersections of Garth Road at Cedar
Bayou Lynchburg Road, Garth Road at Baker Road, and Garth Road at IH -10. At Garth
Road and Cedar Bayou Lynchburg Road, the Professional shall design right -turn lane
improvements to provide additional vehicular capacity for both the northbound and
westbound approaches. At Garth Road and Baker Road, the Professional shall design
right -turn lane improvements to provide additional vehicular capacity for both the
eastbound and westbound approaches. At Garth Road at 111-10, the Professional shall
design right -turn lane improvements to provide additional vehicular capacity for the
westbound, southbound and northbound approaches. The Professional's services shall
include the preparation of plans and quantities for the construction of the turn lane
improvements described herein. This design will be done in accordance with City of
Baytown design standards and guidelines. No biding documents or bid phase services
shall be required pursuant to this Agreement, as the City will perform the construction of
the turn lane improvements.
f. Exhibit "D" "Scope of Work," Section B "Basic Services," is hereby amended to read as
follows:
EXHIBIT D
Scope of Work
B. Basic Services:
Professional shall provide the following scope of services:
Task 1: Survey
The Professional will engage a surveying sub - consultant to obtain a
topographic survey of the project intersections. Information gathered by
the survey will include right -of -way, edge of pavement, curb lines,
islands and medians, pavement markings, signs, sidewalks, trees, and
other above ground features within the survey area. This will also include
vertical survey at the intersection including ditch lines, if any. The
survey will provide project baselines, identify benchmarks, and identify
and show above and underground utilities that can be reasonably
determined via markings by a utility locator service. This survey will
First Amendment to the Agreement for Professional Services, Page 4
form the base sheets for the turn-lane improvement designs that will be
performed. The deliverables shall include survey CADD files.
Task 2: Turn Lane Design Plans
The Professional shall prepare the civil engineering design documents in
accordance with published City of Baytown design standards and
specifications. Plans shall consist of 11 "x17" plan sheets.
a. Data Collection: The Professional shall
(1) visit the project intersection for observation of existing
conditions;
(2) perform a field reconnaissance of the intersection and
collect the existing geometry and examine lane
configuration, utilities, and traffic /pedestrian operations
within the study area;
(3) gather existing record drawings and file information of
the project intersection from the City's files, including
the existing record or construction roadway and traffic
signalization plans, right -of -way information, and utility
maps;
(4) prepare a base map of existing geometrics, apparent or
known utilities from record drawings and the
topographic survey;
b. Preliminary Design: The Professional shall prepare preliminary
right -turn lane layout sheets showing the proposed
improvements, typical sections and submit to the City for review
and comment.
C. Final Desim: The Professional shall incorporate the City's
review comments from the preliminary layout and prepare the
final design plan set for the project intersection. The basic
design parameters will be based on discussions with the City.
The Professional anticipates this submittal will include the
following items:
(1) Typical Sections. The Professional will prepare
proposed typical sections for each of the right -turn lanes
improvements, but detailed plan and profiles will not be
included. The typical section will show the pavement
and subgrade section, existing edge of concrete,
proposed edge of concrete (or curb), existing right -of-
way, travel lanes. The pavement section will match the
existing roadway section. Pavement design is not
included in this scope of services.
(2) Paving Plans. The Professional will prepare paving
design showing plan view (no profile) of the proposed
right turn lane improvements. The plan will show the
existing and proposed horizontal roadway improvements
with tie -in elevations, existing and proposed (if needed)
right -of -way and easements, existing driveways,
proposed driveway modifications (if necessary), existing
and proposed drainage structures, horizontal and vertical
control data.
First Amendment to the Agreement for Professional Services, Page 5
(3) Pavement Markings and Si nape. The Professional will
prepare a pavement marking and signage design
showing plan view of the proposed lane dimensions and
lane designation arrows.
(4) Storm Drain. The Professional will prepare design for
storm drain adjustments due to the proposed right -turn
lane improvements, where needed. Adjustments could
include moving inlets, adding inlets, typical re- grading,
and adjusting manhole elevations. No drainage analysis,
drainage area map, or calculations will be performed.
Relocation or adjustment of other utilities such as
sanitary, water, and gas is not included in this design;
these would be considered additional services.
(5) Electric Poles. The Professional will coordinate with
CenterPoint Energy and the City to plan for new electric
pole locations where needed. No electrical line
calculations or design is included in this design, as this is
in the CenterPoint Energy service area.
(6) Traffic Signal Modifications. The Professional will
prepare traffic signal modification plans to relocate and
modify the traffic signal equipment (vehicular in-
pavement loop detection, pedestrian poles and
pushbuttons, red light- camera poles, ground boxes,
pedestrian ramps) wherever needed based on proposed
right -turn lane design. The extent to the relocation will
be determined after survey and field work is complete.
Traffic signal pole relocation is not anticipated at this
time.
d. Administration: The Professional shall perform general
administration services and coordination with the City, including
phone calls, emails and project status meetings.
e. Deliverables: The Professional shall provide quantity listings
and three (3) final sealed design 11 "x17" drawings and plan sets
for paving and grading, pavement markings, signage, traffic
signal modifications, standard sheets, quantities, and engineer's
opinion of probable construction cost for the Project, which
includes:
o Garth Road at Cedar Bayou Lynchburg Road — NB
Right -Turn Lane;
o Garth Road at Cedar Bayou Lynchburg Road — WB
Right -Turn Lane;
o Garth Road at Baker Road — EB Right -Turn Lane;
o Garth Road at Baker Road — WB Right -Turn Lane;
o Garth Road at IH -10 WBFR— WB Right -Turn Lane;
o Garth Road at IH -10 WBFR— SB Right -Turn Lane; and
o Garth Road at IH -10 EBFR — NB Right -Turn Lane.
(the "Contract Documents ").
First Amendment to the Aereement for Professional Services, Page 6
Task 3: Construction Phase Services.
a. Visits to Site and Observation of Construction. The Professional
shall provide on -site construction observation services during the
Construction Phase. Professional will make visits at intervals as
directed by City in order to observe the progress of the Work.
Such visits and observations by Professional are not intended to
be exhaustive or to extend to every aspect of the work in
progress. Observations are to be limited to spot checking,
selective measurement, and similar methods of general
observation of the Work based on Professional's exercise of
professional judgment. Based on information obtained during
such visits and such observations, Professional will evaluate
whether the work is generally proceeding in accordance with the
Contract Documents, and Professional will keep City informed
of the general progress of the Work.
The purpose of Professional's site visits will be to enable
Professional to better carry out the duties and responsibilities
specifically assigned in this Agreement to Professional, and to
provide the City a greater degree of confidence that the
completed Work will conform in general to the Contract
Documents. Professional shall not, during such visits or as a
result of such observations of the work in progress, supervise,
direct, or have control over the work, nor shall Professional have
authority over or responsibility for the means, methods,
techniques, equipment choice and usage, sequences, schedules,
or procedures of construction selected by the City, for safety
precautions and programs incident to the work, nor for any
failure of the City to comply with laws and regulations
applicable to its furnishing and performing the Work.
Accordingly, Professional neither guarantees the performance of
the City nor assumes responsibility for any the City's failure to
furnish and perform its work in accordance with the Contract
Documents.
b. Recommendations with Respect to Defective Work. The
Professional will recommend to City that the work be
disapproved and rejected while it is in progress if, on the basis of
such observations, the Professional believes that such work will
not produce a completed Project that conforms generally to
Contract Documents.
C. Clarifications and Interpretations. The Professional will respond
to reasonable and appropriate requests for information and issue
necessary clarifications and interpretations of the Contract
Documents to City as appropriate to the orderly completion of
the work. Any orders authorizing variations from the Contract
Documents will be made by City.
d. Change Orders. The Professional may recommend Change
Orders to City, and will review and make recommendations
related to change orders.
First Amendment to the Agreement for Professional Services, Page 7
e. Shop Drawings and Samples. The Professional will review and
approve or take other appropriate action in respect to Shop
Drawings and Samples and other data which the City submits,
but only for conformance with the information given in the
Contract Documents. Such review and approvals or other action
will not extend to means, methods, techniques, equipment choice
and usage, sequences, schedules, or procedures of construction
or to related safety precautions and programs.
f. Substitutes and "or- equal." The Professional shall evaluate and
determine the acceptability of substitute or "or- equal" materials
and equipment proposed by the City in accordance with the
Contract Documents, but subject to the provisions of applicable
standards of state or local government entities.
g. Final Notice of Acceptability of the Work. The Professional
shall conduct a final site visit to determine if the completed work
is generally in accordance with the Contract Documents and the
final punch list so that Professional may recommend acceptance
of the Project. The Professional shall also provide a notice that
the Work is generally in accordance with the Contract
Documents to the best of Professional's knowledge, information,
and belief based on the extent of its services and based upon
information provided to Professional upon which it is entitled to
rely.
3. Entire Agreement. The provisions of this First Amendment and the Agreement should be read
together and construed as one agreement provided that, in the event of any conflict or
inconsistency between the provisions of this First Amendment and the provisions of the
Agreement, the provisions of this First Amendment shall control.
4. Interpretation. This First Amendment has been jointly negotiated by the parties hereunder and
shall not be construed against a party hereunder because that party may have assumed primary
responsibility for the drafting of this Amendment
5. Captions. Captions contained in the Agreement and First Amendment are for reference only and,
therefore, have no effect in construing the documents. The captions are not restrictive of the
subject matter of any section.
6. No Waiver. By this First Amendment, the Owner does not consent to litigation or suit, and the
Owner hereby expressly revokes any consent to litigation that it may have granted by the terms of
this First Amendment, the Agreement or any other contract or agreement or addenda, any
charter, or applicable state law. Nothing contained in this First Amendment or in the Agreement
shall be construed in any way to limit or to waive the City's sovereign immunity.
IN WITNESS WHEREOF, the parties hereto have executed this Amendment in multiple copies,
each of which shall be deemed to be an original, but all of which shall constitute but one and the same
amendment, this day of , 2014, the date of execution by the City
Manager.
CITY OF BAYTOWN
By:
ROBERT D. LEIPER, City Manager
First Amendment to the Agreement for Professional Services, Page 8
LETICIA BRYSCH, City Clerk
APPROVED AS TO FORM:
IGNACIO RAMIREZ, SR., City Attorney
KIMLEY -Hp 4 AND ASSOCIATES, INC.
By:
(Sign re
Gl{-WS '��`{S t t�LCc FiL
(Printed Name)
svP
(Title)
STATE OF TEXAS
Before me on this day personally appeared Cbris trAsmacir ' in his capacity
as S1/P of KIMLEY -HORN AND ASS CIA S, INC., on behalf of such
corporation,
known to me;
proved to me on the oath of ; or
proved to me through his current
{description of identification card or other document issued by the federal government or
any state government that contains the photograph and signature of the acknowledging
person}
(check one)
to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he
executed the same for the purposes and consideration therein expressed.
SUBSCRIBED AND SWORN before me this day of -I CCCmber 2014.
Vie►• "T ►`;�rz DONNA W. tale STOEVER 1� J
?`. Notary Public, State of Texas
. My Commission Expires Notary Public in and for the State of Texas
July 14, 2015
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First Amendment to the Agreement for Professional Services, Page 9
Orig. Dept.:
File/I.D. No.:
INSTRUCTION: ENTITIES USING AN ASSUMED NAME SHOULD DISCLOSE SUCH FACT TO AVOID
REJECTION OF THE AFFIDAVIT. THE FOLLOWING FORMAT IS RECOMMENDED:
CORPORATE/LEGAL NAME DBA ASSUMED NAME.
STATE OF TeXa.5
§ AFFIDAVIT OF OWNERSHIP OR CONTROL
COUNTY OF liar ri S §
BEFORE ME, the undersigned authority, on this day personally appeared
C49S [FULL NAME] (hereinafter "Affiant "),
4ou �)N , T'EJCkS [STATE TITLE /CAPACITY WITH
CONTRACTING ENTITY] of - 40e g Acs D &SSDCVX165 1140 . [CONTRACTING
ENTITY'S CORPORATE/LEGAL NAME ( "Contracting Entity "), who being by me duly sworn on
oath stated as follows:
1. Affiant is authorized to give this affidavit and has personal knowledge of
the facts and matters herein stated.
2. Contracting Entity seeks to do business with the City in connection with
WFGSS lohl,At. EW,It i &,V V361 5)EQNIC'25 [DESCRIBE PROJECT
OR MATTER] which is expected to be in an amount that exceeds $50,000.
The following information is submitted in connection with the proposal,
submission or bid of Contracting Entity in connection with the above
described project or matter.
4. Contracting Entity is organized as a business entity as noted below (check
box as applicable).
FOR PROFIT ENTITY: NON - PROFIT ENTITY:
[ ] SOLE PROPRIETORSHIP [ ] NON - PROFIT CORPORATION
CORPORATION [ ] UNINCORPORATED ASSN.
[ ] PARTNERSHIP
[ J LIMITED PARTNERSHIP
[ ] JOINT VENTURE
[ ] LIMITED LIABILITY COMPANY
[ ] OTHER (Specify type in space below):
5. The information shown below is true and correct for the Contracting
Entity and all owners of 5% or more of the Contracting Entity and, where
the Contracting Entity is a non - profit entity, the required information has
been shown for each officer. [NOTE: IN ALL CASES, USE FULL NAMES,
LOCAL BUSINESS AND RESIDENCE ADDRESSES AND TELEPHONE
Affidavit of Ownership or Control, Page 1
Orig. Dept.:
File/I.D. No.:
NUMBERS. DO NOT USE POST OFFICE BOXES FOR ANY ADDRESS.
INCLUSION OF E -MAIL ADDRESSES IS OPTIONAL, BUT RECOMMENDED.
ATTACH ADDITIONAL SHEETS AS NEEDED.]
Contracting Entity
Name: 1,LIMLt -� -Ho PLA ^r4D ASSOCi ; irLC
Business Address [NO. /STREET] I W (C.KGt VE'S W5CC1
[CITY /STATE /ZIP CODE] 4Qkk!6—%Qq' TY, 770-19
Telephone Number (Zf Lu
Email Address [OPTIONAL]
Residence Address [NO. /STREET]
[CITY /STATE /ZIP CODE]
Telephone Number [OPTIONAL] (
Email Address [OPTIONAL]
5% or More Owner(s) /Officers of Non - Profit Corporation
(IF NONE, STATE "NONE. ")
Name: NON E
Business Address [NO. /STREET]
[CITY /STATE /ZIP CODE]
Telephone Number
Email Address [OPTIONAL]
Residence Address [NO. /STREET]
[CITY /STATE /ZIP CODE]
Telephone Number [OPTIONAL] (___)
Email Address [OPTIONAL]
Optional Information
Contracting
Affidavit of Ownership or Control, Page 2
Entity
and/or
[NAME OF
Orig. Dept.: File/I.D. No.:
OWNER OR NON - PROFIT OFFICER] is actively protesting, challenging or
appealing the accuracy and/or amount of taxes levied against
[CONTRACTING ENTITY,
OWNER OR NON - PROFIT OFFICER] as follows:
Name of Debtor:
Type of Debt:
Account Nos.:
Case or File Nos.:
Attorney /Agent Name:
Attorney /Agent Phone No.:_
Delinquent Years/Months:
Status of Appeal [DESCRIBE]:
Affiant certifies that he or she is duly authorized to submit the above information on
behalf of the Contracting Entity, that Affiant is associated with the Contracting Entity in the
capacity noted above and has personal knowledge of the accura4y of the information provided
herein, and that the information provided herein is true a d rrect to the best of Affiant's
knowledge and belief.
SWORN TO AND SUBSCRIBED before me thisl& day of DcCcrubrX , 2011}.
(Seal) %V. " " "" 1, DONNA W. STOEVER
=! Notary Public, State of Texas
M My Commission Expires
%�EOi:�;•i July 14, 2015
`6 MW0, OR 1'A"6UK'K)
Notary Public in and for the State of
1tcxa s
NOTE:
This affidavit constitutes a government record as defined by Section 37.01 of the Texas Penal
Code. Submission of a false government record is punishable as provided in Section 37.10 of the
Texas Penal Code.
Attach additional pages if needed to supply the required names and addresses.
R:\ Karen\Files \Contracts\Affidiavit of Ownership or Control.doc
Affidavit of Ownership or Control, Page 3