5768 - Amendment 3 Contract Executed
Docusign City Council Transmittal Coversheet
File Name
Purchasing Contact
City Council Target Date
Piggy Back Option
Contract Expiration
Ordinance
DocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
&*''#!#
%& ()
)! %&!"&(-(")!%"#&,%*%*!&%!#!*-$%$%*
+ +)*
5768 Contract – Amendment # 3 Page 1 of 2
THIRD AMENDMENT TO CONTRACT
BY AND BETWEEN THE CITY OF DENTON, TEXAS
AND HAZEN AND SAWYER P.C.
Contract 5768
THE STATE OF TEXAS §
COUNTY OF DENTON §
THIS THIRD AMENDMENT TO CONTRACT 5768 (“Amendment”) by and
between the City of Denton, Texas (“City”) and Hazen and Sawyer P.C. (“Consultant”); to
that certain contract executed on July 21, 2015, in the original not-to-exceed amount of
$427,368 (the “Original Agreement”); amended on April 05, 2016 in the additional amount
of $112,758 aggregating a not-to-exceed amount of $540,126 (the “First Amendment”);
amended on February 07, 2017 in the additional amount of $192,239 aggregating a not-to-
exceed amount of $732,365 (the “Second Amendment”); (collectively, the Original
Agreement, the First Amendment, and the Second Amendment are the “Agreement” ) are
for services related to the Hickory Street Basin Peak Flow Detention Facility project.
WHEREAS, the City deems it necessary to further expand the services provided by
Consultant to the City pursuant to the terms of the Agreement, and to provide an addition
to the design contract in a not-to-exceed amount of $89,905 and construction
administration services in a not-to-exceed amount of $380,544 with this Amendment for
an aggregate not-to-exceed amount of $1,202,814
FURTHERMORE, the City deems it necessary to further expand the goods/services
provided by CONSULTANT to the City;
NOW THEREFORE, the City and Consultant (hereafter collectively referred to as the
“Parties”), in consideration of their mutual promises and covenants, as well as for other
good and valuable considerations, do hereby AGREE to the following Amendment, which
amends the following terms and conditions of the said Agreement, to wit:
1. The additional services described in Exhibit “A” of this Amendment, attached
hereto and incorporated herein for all purposes, for addition to the design contract
and additional construction administration services described in Exhibit “B” of this
amendment attached hereto and incorporated herein for all purposes for Hickory
Street Basin Peak Flow Detention Facility Project, are hereby authorized to be
performed by Consultant. For and in consideration of the additional services to be
performed by Consultant, the Owner agrees to pay, based on the cost estimate
details attached as Exhibit “A” and Exhibit “B” to this Amendment, a total fee,
including reimbursement for non-labor expenses an amount not to exceed
$470,449.
DocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
5768 Contract – Amendment # 3 Page 2 of 2
2. This Amendment modifies the Agreement amount to provide an additional
$470,449 for the additional services with a revised aggregate not to exceed total of
$1,202,814.
The Parties hereto agree, that except as specifically provided for by this Amendment, that
all of the terms, covenants, conditions, agreements, rights, responsibilities, and obligations
of the Parties, set forth in the Agreement remain in full force and effect.
IN WITNESS WHEREOF, the City and the Consultant, have each executed this
Amendment electronically, by and through their respective duly authorized representatives
and officers on this date _________________________.
“CITY”
CITY OF DENTON, TEXAS
A Texas Municipal Corporation
By:
_______________________________
TODD HILEMAN, CITY MANAGER
ATTEST:
ROSA RIOS, CITY SECRETARY
By:
_________________________________
“CONSULTANT”
Hazen and Sawyer P.C.
By: ___________________________
AUTHORIZED SIGNATURE, TITLE
ATTEST:
APPROVED AS TO LEGAL FORM:
AARON LEAL, CITY ATTORNEY
By:
_______________________________
THIS AGREEMENT HAS BEEN
BOTH REVIEWED AND APPROVED
as to financial and operational
obligations and business terms.
_______________ ________________
SIGNATURE PRINTED NAME
__________________________________
TITLE
__________________________________
DEPARTMENT
DocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
City of DentonContract 5768 HCDF, WPFPS and HCLS Design AmendmentEngineering Service Fee Breakdown / Details1/9/2019PD PMTASKProject DirectorProject EngineerProject Engineer Assistance Engineer CADDTechnical AdvisorSenior EngineerAssistant EngineerCADDTechnical AdvisorAssistant EngineerCADDSenior EngineerProject EngineerAssistant EngineerCD Miller/Hardy London Priest Panez Phillips Powell Johnson Grissom Nailor Hudson Bautista Ratasky Bueltel StewartAdditional geotechnical investigation0-$ 10,575$ 10,575$ 9,614.00$ Additional survey0-$ 10,025$ 10,025$ 9,114.00$ Evaluations during design 3210 28 70 10,990$ -$ 10,990$ Site configuration changes 2 32 6 16 36 4 8 24 24 2 4158 20,734$ -$ 20,734$ Surge analysis on forcemain and recommendations 1 64 62 73 9,467$ -$ 9,467$ PreCast Electrical Building and Debri Screen Changes 1 20 33 7 16 44 49 1 16 45 232 28,114$ -$ 28,114$ 0-$ -$ -$ Hours Subtotal4 90 6 49 36 0 11 24 24 14 134 73 1 18 49 5339,614$ 9,114$ Fee Subtotal 69,304$ 20,601$ 89,905$ PKCE SurveySubconsultantsFeeAlliance Geotech.203. Hickory Creek Detention Facility and West Peak Flow Pump Station 100-Percent Design207. HCLS 100-Percent DesignTotal HoursCivilStructuralProcess MechanicalElectricalExhibit 'A'DocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
-REQRKD]HQDQGVDZ\HUFRP
+D]HQDQG6DZ\HU
1&HQWUDO([SUHVVZD\6XLWH
'DOODV7;
$SULO
36$URUD3(
'LUHFWRURI:DVWHZDWHU8WLOLWLHV
&LW\RI'HQWRQ
$7H[DV6WUHHW
'HQWRQ7;
5H&RQVWUXFWLRQ0DQDJHPHQW6HUYLFHV$PHQGPHQW
+LFNRU\&UHHN/LIW6WDWLRQ
+LFNRU\&UHHN'HWHQWLRQ)DFLOLW\ 3HFDQ&UHHN:HVW3HDN)ORZ3XPS6WDWLRQ
'HDU0U$URUD
$W\RXUUHTXHVW+D]HQKDVSUHSDUHGDVFRSHDQGOHYHORIHIIRUWWRSHUIRUPFRQVWUXFWLRQDGPLQLVWUDWLRQ
VHUYLFHVIRUERWKWKH+LFNRU\&UHHN/LIW6WDWLRQDQGWKH+LFNRU\&UHHN'HWHQWLRQ)DFLOLW\ 3HFDQ&UHHN
:HVW3HDN)ORZ3XPS6WDWLRQDVDQDPHQGPHQWWR&RQWUDFW
7KH+LFNRU\&UHHN/LIW6WDWLRQLVDQHZPLOOLRQJDOORQSHUGD\PJGVXEPHUVLEOHOLIWVWDWLRQDQG
LQFOXGHVDQHZHOHFWULFDOEXLOGLQJ\DUGSLSLQJDQGVLWHZRUNZLWKLQWKHFRQILQHVRIWKHH[LVWLQJ+LFNRU\
&UHHN/LIW6WDWLRQ7KHFRQVWUXFWLRQRIWKHOLIWVWDWLRQLVVFKHGXOHGIRUGD\VPRQWKV7KLVSURMHFW
KDVELGDQGLVUHDG\IRUFRQVWUXFWLRQ
7KH+LFNRU\&UHHN'HWHQWLRQ)DFLOLW\FRQVLVWVRIDQHZPJGVXEPHUVLEOHSXPSVWDWLRQZLWKD
PLOOLRQJDOORQVWRUDJHWDQNDORQJZLWKHOHFWULFDORGRUFRQWURO\DUGSLSLQJDQGVLWHZRUN7KH3HFDQ
&UHHN:HVW3HDN)ORZ3XPS6WDWLRQFRQVLVWVRIPJGVXEPHUVLEOHSXPSVWDWLRQDORQJZLWKHOHFWULFDO
\DUGSLSLQJDQGVLWHZRUNDWDVHFRQGVLWH%RWKWKHGHWHQWLRQIDFLOLW\DQGSXPSVWDWLRQZLOOEHELGDVRQH
FRQWUDFW7KHFRQVWUXFWLRQVFKHGXOHIRUWKH+LFNRU\&UHHN'HWHQWLRQ)DFLOLW\ 3HFDQ&UHHN:HVW3HDN
)ORZ3XPS6WDWLRQSURMHFWLVHVWLPDWHGDWGD\VPRQWKV
+D]HQZLOOSHUIRUPFRQVWUXFWLRQDGPLQLVWUDWLRQVHUYLFHVIRUERWKSURMHFWV7KHFRQVWUXFWLRQ
DGPLQLVWUDWLRQLQFOXGHVUHYLHZRIVXEPLWWDOVUHTXHVWIRULQIRUPDWLRQ5),VSD\UHTXHVWVDQGRWKHU
FRQVWUXFWLRQDGPLQLVWUDWLYHDFWLYLWLHVGHVFULEHGLQWKHVFRSHEHORZ
+LFNRU\&UHHN/LIW6WDWLRQ&RQVWUXFWLRQ$GPLQLVWUDWLRQ6HUYLFHV
+D]HQZLOOSURYLGHPRQWKVRIFRQVWUXFWLRQDGPLQLVWUDWLRQVHUYLFHVLQWKHUROHRI(QJLQHHUDVGHVFULEHG
LQWKH&RQWUDFW'RFXPHQWVIRUWKH+LFNRU\&UHHN/LIW6WDWLRQ
3UHFRQVWUXFWLRQ&RQIHUHQFH±&RQGXFWSUHFRQVWUXFWLRQFRQIHUHQFHWRDGGUHVVNH\FRQWUDFW
HOHPHQWVVFKHGXOHSURJUHVVSD\PHQWVFKDQJHRUGHUVUHFRUGGUDZLQJVVKRSGUDZLQJ
VXEPLWWDOVDQGRWKHUFRRUGLQDWLRQLVVXHV+D]HQZLOOSURYLGHDJHQGDDQGPHHWLQJPLQXWHV
Exhibit 'B'
DocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
36$URUD3(
$SULO
3DJHRI
KD]HQDQGVDZ\HUFRP
&RQVWUXFWLRQ3URJUHVV0HHWLQJV±&RQGXFWXSWRQLQHFRQVWUXFWLRQSURJUHVVPHHWLQJVWR
UHYLHZFRQVWUXFWLRQSURJUHVV+D]HQZLOOSURYLGHDJHQGDDQGPHHWLQJPLQXWHV
$GGLWLRQDO6LWH9LVLWV±+D]HQZLOOSURYLGHDGGLWLRQDOVLWHYLVLWVQRWLQFOXGLQJFRQVWUXFWLRQ
SURJUHVVPHHWLQJVWRREVHUYHWKHSURJUHVVDQGWKHTXDOLW\RIZRUNDQGIRUFRRUGLQDWLRQRIWKH
ZRUN+D]HQZLOOSURYLGHXSWRDGGLWLRQDOVLWHYLVLWV
0RQWKO\3D\5HTXHVW5HYLHZ±+D]HQZLOOUHYLHZDQGFRPPHQWRQXSWRPRQWKO\DQGILQDO
3URJUHVV3D\PHQWEDVHGRQWKHREVHUYDWLRQVRIWKHSHUIRUPHGZRUN
6XEPLWWDO5HYLHZ±5HYLHZVKRSGUDZLQJVDQGPDWHULDOVXEPLWWDOVIRUFRQIRUPDQFHZLWKWKH
UHTXLUHPHQWVRIWKH&RQWUDFW'RFXPHQWV,WLVDQWLFLSDWHGWKDW+D]HQZLOOUHYLHZDQGUHVSRQG
WRDWRWDORIXSWRVKRSGUDZLQJVXEPLWWDOV
5HTXHVWIRU,QIRUPDWLRQ5),V±+D]HQZLOOUHYLHZWKH&RQWUDFWRU¶V5),VDQGSUHSDUHD
UHVSRQVHLQDFFRUGDQFHZLWKWKH&RQWUDFW'RFXPHQWV+D]HQZLOOSURYLGHLQWHUSUHWDWLRQDQG
FRPPXQLFDWHLQWHQWLILQIRUPDWLRQLVQRWDGGUHVVHGLQWKH&RQWUDFW'RFXPHQWV,WLV
DQWLFLSDWHGWKDW+D]HQZLOOUHYLHZDQGUHVSRQGXSWRDWRWDORI5),V
)LHOGDQG&KDQJH2UGHUV±+D]HQZLOOSURYLGHUHVSRQVHVWRFRQWUDFWPRGLILFDWLRQVDQGDVVLVW
LQWKHQHJRWLDWLRQVZLWKWKH&RQWUDFWRUWRGHWHUPLQHWKHFRVWDQGWLPHLPSDFWVRIFKDQJHVWRWKH
&RQWUDFW'RFXPHQWV+D]HQZLOOUHYLHZXSWRILHOGRUGHUVDQGZRUNFKDQJHGLUHFWLYHV
+D]HQZLOOSUHSDUHXSWRWKUHHFKDQJHRUGHUV
3URMHFW&ORVHRXW±+D]HQZLOOSURYLGHDVVLVWDQFHZLWKVWDUWXSDQGWHVWLQJRIWKHOLIWVWDWLRQ
VLWHYLVLWWRGHYHORSSXQFKOLVWDQGSHUIRUPRWKHUSURMHFWFORVHRXWUHTXLUHPHQWV+D]HQZLOO
DUFKLYHDOOWKHFRQVWUXFWLRQLQIRUPDWLRQDQGSURYLGHHOHFWURQLFFRS\RI'9'
5HFRUG'UDZLQJV±+D]HQZLOOUHYLVHWKHFRQVWUXFWLRQGUDZLQJVLQDFFRUGDQFHZLWKWKH
LQIRUPDWLRQIXUQLVKHGE\&RQWUDFWRUUHIOHFWLQJFKDQJHVPDGHGXULQJFRQVWUXFWLRQ+D]HQZLOO
SURYLGHRQHIXOOVL]H´[´DQGRQHKDOIVL]H´[´ERXQGVHWDQGRQHHOHFWURQLFFRS\
LQ3')IRUPDW
0HHWLQJV
•3UH&RQVWUXFWLRQ0HHWLQJ
•&RQVWUXFWLRQ3URJUHVV0HHWLQJVPHHWLQJV
'HOLYHUDEOHV
•(OHFWURQLFFRS\RIDOOFRQVWUXFWLRQDGPLQLVWUDWLYHFRUUHVSRQGHQFHDQGVXEPLWWDOV
•5HFRUGGUDZLQJV
+LFNRU\&UHHN'HWHQWLRQ)DFLOLW\ 3HFDQ&UHHN:HVW3HDN)ORZ3XPS6WDWLRQ&RQVWUXFWLRQ
$GPLQLVWUDWLRQ6HUYLFHV
+D]HQZLOOSURYLGHPRQWKVRIFRQVWUXFWLRQDGPLQLVWUDWLRQVHUYLFHVLQWKHUROHRI(QJLQHHUDVGHVFULEHG
LQWKH&RQWUDFW'RFXPHQWVIRUWKH+LFNRU\&UHHN'HWHQWLRQ)DFLOLW\ 3HFDQ&UHHN:HVW3HDN)ORZ
3XPS6WDWLRQ
DocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
36$URUD3(
$SULO
3DJHRI
KD]HQDQGVDZ\HUFRP
3UHFRQVWUXFWLRQ&RQIHUHQFH±&RQGXFWSUHFRQVWUXFWLRQFRQIHUHQFHWRDGGUHVVNH\FRQWUDFW
HOHPHQWVVFKHGXOHSURJUHVVSD\PHQWVFKDQJHRUGHUVUHFRUGGUDZLQJVVKRSGUDZLQJ
VXEPLWWDOVDQGRWKHUFRRUGLQDWLRQLVVXHV+D]HQZLOOSURYLGHDJHQGDDQGPHHWLQJPLQXWHV
&RQVWUXFWLRQ3URJUHVV0HHWLQJV±&RQGXFWXSWRHLJKWHHQFRQVWUXFWLRQSURJUHVV
PHHWLQJVWRUHYLHZFRQVWUXFWLRQSURJUHVV+D]HQZLOOSURYLGHDJHQGDDQGPHHWLQJPLQXWHV
$GGLWLRQDO6LWH9LVLWV±+D]HQZLOOSURYLGHDGGLWLRQDOVLWHYLVLWVQRWLQFOXGLQJFRQVWUXFWLRQ
SURJUHVVPHHWLQJVWRREVHUYHWKHSURJUHVVDQGWKHTXDOLW\RIZRUNDQGIRUFRRUGLQDWLRQRIWKH
ZRUN+D]HQZLOOSURYLGHXSWRDGGLWLRQDOVLWHYLVLWV
0RQWKO\3D\5HTXHVW5HYLHZ±+D]HQZLOOUHYLHZDQGFRPPHQWRQXSWRPRQWKO\DQG
ILQDO3URJUHVV3D\PHQWEDVHGRQWKHREVHUYDWLRQVRIWKHSHUIRUPHGZRUN
6XEPLWWDO5HYLHZ±5HYLHZVKRSGUDZLQJVDQGPDWHULDOVXEPLWWDOVIRUFRQIRUPDQFHZLWKWKH
UHTXLUHPHQWVRIWKH&RQWUDFW'RFXPHQWV,WLVDQWLFLSDWHGWKDW+D]HQZLOOUHYLHZDQGUHVSRQG
WRDWRWDORIXSWRVKRSGUDZLQJVXEPLWWDOV
5HTXHVWIRU,QIRUPDWLRQ5),V±+D]HQZLOOUHYLHZWKH&RQWUDFWRU¶V5),VDQGSUHSDUHD
UHVSRQVHLQDFFRUGDQFHZLWKWKH&RQWUDFW'RFXPHQWV+D]HQZLOOSURYLGHLQWHUSUHWDWLRQDQG
FRPPXQLFDWHLQWHQWLILQIRUPDWLRQLVQRWDGGUHVVHGLQWKH&RQWUDFW'RFXPHQWV,WLV
DQWLFLSDWHGWKDWWKH+D]HQZLOOUHYLHZDQGUHVSRQGXSWRDWRWDORI5),V
)LHOGDQG&KDQJH2UGHUV±+D]HQZLOOSURYLGHUHVSRQVHVWRFRQWUDFWPRGLILFDWLRQVDQGDVVLVW
LQWKHQHJRWLDWLRQVZLWKWKH&RQWUDFWRUWRGHWHUPLQHWKHFRVWDQGWLPHLPSDFWVRIFKDQJHVWRWKH
&RQWUDFW'RFXPHQWV+D]HQZLOOUHYLHZXSWRILHOGRUGHUVDQGZRUNFKDQJHGLUHFWLYHV
+D]HQZLOOSUHSDUHXSWRVL[FKDQJHRUGHUV
3URMHFW&ORVHRXW±+D]HQZLOOSURYLGHDVVLVWDQFHZLWKVWDUWXSDQGWHVWLQJRIWKHWZROLIW
VWDWLRQVRGRUFRQWURODQGVWRUDJHWDQNVLWHYLVLWWRGHYHORSSXQFKOLVWDQGSHUIRUPRWKHU
SURMHFWFORVHRXWUHTXLUHPHQWV+D]HQZLOODUFKLYHDOOWKHFRQVWUXFWLRQLQIRUPDWLRQDQGSURYLGH
HOHFWURQLFFRS\RI'9'
5HFRUG'UDZLQJV±+D]HQZLOOUHYLVHWKHFRQVWUXFWLRQGUDZLQJVLQDFFRUGDQFHZLWKWKH
LQIRUPDWLRQIXUQLVKHGE\&RQWUDFWRUUHIOHFWLQJFKDQJHVPDGHGXULQJFRQVWUXFWLRQ+D]HQZLOO
SURYLGHRQHIXOOVL]H´[´DQGRQHKDOIVL]H´[´ERXQGVHWDQGRQHHOHFWURQLFFRS\
LQ3')IRUPDW
0HHWLQJV
•3UH&RQVWUXFWLRQ0HHWLQJ
•&RQVWUXFWLRQ3URJUHVV0HHWLQJVPHHWLQJV
'HOLYHUDEOHV
•(OHFWURQLFFRS\RIDOOFRQVWUXFWLRQDGPLQLVWUDWLYHFRUUHVSRQGHQFHDQGVXEPLWWDOV
•5HFRUGGUDZLQJV
DocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
36$URUD3(
$SULO
3DJHRI
KD]HQDQGVDZ\HUFRP
([FOXVLRQV
7KHIROORZLQJLWHPVDUHH[FOXGHGIURP+D]HQ¶V6FRSHRI:RUN
([FOXGHVRQVLWHFRQVWUXFWLRQREVHUYDWLRQVXFKDVEXWQRWOLPLWHGWRVWRUDJHWDQNSLHU
IRXQGDWLRQV\VWHPVWRUDJHWDQNFRQVWUXFWLRQSXPSVWDWLRQFRQVWUXFWLRQDQGHOHFWULFDO
EXLOGLQJVDQGV\VWHPV
([FOXGHVFRRUGLQDWLRQZLWKLQGHSHQGHQWPDWHULDOVWHVWLQJODERUDWRU\
([FOXGHVUHYLHZDQGDSSURYDORI&RQWUDFWRUVXEVWLWXWLRQV
([FOXGHVSUHSDUDWLRQRIDIDFLOLW\VWDQGDUGRSHUDWLQJSURFHGXUHVRUVHSDUDWHRSHUDWLRQV
DQGPDLQWHQDQFHPDQXDOH[FHSWIRUWUDQVIHUULQJWKRVHVXSSOLHGE\WKH&RQWUDFWRU
([FOXGHVIDFWRU\ZLWQHVVWHVWLQJ
([FOXGHVGHYHORSPHQWRIIRUPDOVWDUWXSRUPDLQWHQDQFHSODQVRISXPSVWDWLRQDQGWDQN
GXULQJFRQVWUXFWLRQRXWVLGHRIWKHJXLGDQFHSURYLGHGDVSDUWRIWKHGHVLJQGRFXPHQWV
6FKHGXOH
7KHVFKHGXOHLVGHSHQGHQWRQWKHFRQVWUXFWLRQFRQWUDFWRUV6LQFHWKHQRWLFHWRSURFHHGKDVQRWEHJUDQWHG
WRWKH&RQWUDFWRUEHORZLVDQDQWLFLSDWHGSURMHFWVFKHGXOH
0LOHVWRQH 'DWH
+LFNRU\&UHHN/LIW6WDWLRQ
$QWLFLSDWHG1RWLFH7R3URFHHG 0D\
$QWLFLSDWHG)LQDO&RPSOHWLRQ )HEUXDU\
+LFNRU\&UHHN'HWHQWLRQ)DFLOLW\
3HFDQ&UHHN:HVW3HDN)ORZ3XPS6WDWLRQ
%LGGLQJ 0D\
$QWLFLSDWHG1RWLFH7R3URFHHG -XO\
$QWLFLSDWHG)LQDO&RPSOHWLRQ -DQXDU\
9HU\WUXO\\RXUV
6FRWW$+DUG\3(303
6HQLRU$VVRFLDWH
(QFORVXUH'UDIW/HYHORI(IIRUW
FF&KDPLQGUD'DVVDQD\DNH3K'3(%UDQGW0LOOHU3(
DocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
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ocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
Exhibit
CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as
defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after
the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a
misdemeanor.
1 Name of vendor who has a business relationship with local governmental entity.
2
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business
day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information in this section is being disclosed.
Name of Officer
This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the vendor has an employment or other business relationship
as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer
named in this section AND the taxable income is not received from the local governmental entity?
Yes No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an
officer or director, or holds an ownership of one percent or more?
Yes No
D. Describe each employment or business and family relationship with the local government officer named in this section.
4
I have no Conflict of Interest to disclose.
5
Signature of vendor doing business with the governmental entity Date
DocuSign Envelope ID: 03A7C792-6FC4-48D7-8DB3-B406F1BFAD6A
Certificate Of Completion
Envelope Id: 03A7C7926FC448D78DB3B406F1BFAD6A Status: Completed
Subject: Please DocuSign: City Council Contract 5768 Design of Hickory Creek Basin Peak Amendment No. 3
Source Envelope:
Document Pages: 10 Signatures: 6 Envelope Originator:
Certificate Pages: 6 Initials: 1 Monisa Rogers
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
901B Texas Street
Denton, TX 76209
Monisa.Rogers@cityofdenton.com
IP Address: 129.120.6.150
Record Tracking
Status: Original
7/16/2019 11:10:09 AM
Holder: Monisa Rogers
Monisa.Rogers@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
Monisa Rogers
monisa.rogers@cityofdenton.com
Senior Buyer
City Of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 129.120.6.150
Sent: 7/16/2019 11:27:42 AM
Viewed: 7/16/2019 11:28:00 AM
Signed: 7/16/2019 11:31:35 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Lori Hewell
lori.hewell@cityofdenton.com
Purchasing Manager
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 7/16/2019 11:31:37 AM
Viewed: 7/16/2019 2:39:26 PM
Signed: 7/16/2019 2:40:07 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Mack Reinwand
mack.reinwand@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 129.120.6.150
Sent: 7/16/2019 2:40:09 PM
Viewed: 7/25/2019 11:58:48 AM
Signed: 7/25/2019 12:01:29 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Chamindra Dassanayake
cdassanayake@hazenandsawyer.com
Vice President
Hazen and Sawyer
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 66.196.204.74
Sent: 7/25/2019 12:01:31 PM
Resent: 7/26/2019 9:26:52 AM
Viewed: 7/26/2019 9:50:19 AM
Signed: 7/26/2019 9:51:33 AM
Electronic Record and Signature Disclosure:
Accepted: 7/26/2019 9:50:19 AM
ID: 9031855f-130d-45c8-a05a-03086c8c7454
Signer Events Signature Timestamp
Frank Pugsley
frank.pugsley@cityofdenton.com
Water Utilities Director
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 7/26/2019 9:51:35 AM
Resent: 7/29/2019 2:16:11 PM
Viewed: 7/29/2019 2:19:31 PM
Signed: 7/29/2019 2:19:59 PM
Electronic Record and Signature Disclosure:
Accepted: 7/29/2019 2:19:31 PM
ID: 27d2f2dd-04ba-45a0-afdb-8ba7a96a5194
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Contract Administrator
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 129.120.6.150
Sent: 7/29/2019 2:20:02 PM
Resent: 8/2/2019 8:33:20 AM
Resent: 8/2/2019 8:36:13 AM
Viewed: 8/15/2019 9:44:43 AM
Signed: 8/15/2019 9:45:54 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Todd Hileman
Todd.Hileman@cityofdenton.com
City Manager
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 8/15/2019 9:45:57 AM
Viewed: 8/15/2019 9:56:06 AM
Signed: 8/15/2019 9:56:13 AM
Electronic Record and Signature Disclosure:
Accepted: 7/25/2017 11:02:14 AM
ID: 57619fbf-2aec-4b1f-805d-6bd7d9966f21
Rosa Rios
rosa.rios@cityofdenton.com
City Secretary
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 8/15/2019 9:56:16 AM
Viewed: 8/15/2019 11:36:23 AM
Signed: 8/15/2019 11:37:00 AM
Electronic Record and Signature Disclosure:
Accepted: 8/15/2019 11:36:23 AM
ID: 391084c5-8cee-4976-b7af-2121aed380ff
Mack Reinwand
mack.reinwand@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 8/15/2019 11:37:05 AM
Viewed: 8/15/2019 4:04:13 PM
Signed: 8/15/2019 4:04:44 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
n erson Signer Events Signature Timestamp
Editor Deliver Events Status Timestamp
gent Deliver Events Status Timestamp
ntermediar Deliver Events Status Timestamp
Certified Deliver Events Status Timestamp
Car on Cop Events Status Timestamp
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Paralegal
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 7/16/2019 11:31:37 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Sherri Thurman
sherri.thurman@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 7/16/2019 11:31:38 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jane Richardson
jane.richardson@cityofdenton.com
Assistant City Secretary
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 8/15/2019 9:56:16 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
P.S. Arora
P.S.Arora@cityofdenton.com
Director Wastewater Utility
Security Level: Email, Account Authentication
(None)
Sent: 8/15/2019 11:37:03 AM
Viewed: 8/15/2019 11:56:19 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
itness Events Signature Timestamp
otar Events Signature Timestamp
Envelope Summar Events Status Timestamps
Envelope Sent Hashed/Encrypted 8/15/2019 11:37:05 AM
Certified Delivered Security Checked 8/15/2019 4:04:13 PM
Signing Complete Security Checked 8/15/2019 4:04:44 PM
Completed Security Checked 8/15/2019 4:04:44 PM
a ment Events Status Timestamps
Electronic Record and Signature Disclosure
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, City of Denton (we, us or Company) may be required by law to provide to
you certain written notices or disclosures. Described below are the terms and conditions for
providing to you such notices and disclosures electronically through your DocuSign, Inc.
(DocuSign) Express user account. Please read the information below carefully and thoroughly,
and if you can access this information electronically to your satisfaction and agree to these terms
and conditions, please confirm your agreement by clicking the 'I agree' button at the bottom of
this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. For such copies, as long as you are an authorized user of the
DocuSign system you will have the ability to download and print any documents we send to you
through your DocuSign user account for a limited period of time (usually 30 days) after such
documents are first sent to you. After such time, if you wish for us to send you paper copies of
any such documents from our office to you, you will be charged a $0.00 per-page fee. You may
request delivery of such paper copies from us by following the procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign 'Withdraw Consent' form on the signing page of your
DocuSign account. This will indicate to us that you have withdrawn your consent to receive
required notices and disclosures electronically from us and you will no longer be able to use your
DocuSign Express user account to receive required notices and consents electronically from us
or to sign electronically documents from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through your DocuSign user account all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
$"! !" $%"
#!#%""$!
"$#"$! "
## &" %#&! !#!#
How to contact City of Denton:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: purchasing@cityofdenton.com
To advise City of Denton of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at melissa.kraft@cityofdenton.com
and in the body of such request you must state: your previous e-mail address, your new e-mail
address. We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in DocuSign.
To request paper copies from City of Denton
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to purchasing@cityofdenton.com and in
the body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with City of Denton
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign account, and on the subsequent
page, select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to purchasing@cityofdenton.com and in the body of such request you
must state your e-mail, full name, IS Postal Address, telephone number, and account
number. We do not need any other information from you to withdraw consent.. The
consequences of your withdrawing consent for online documents will be that transactions
may take a longer time to process..
Required hardware and software
Operating Systems: Windows2000? or WindowsXP?
Browsers (for SENDERS): Internet Explorer 6.0? or above
Browsers (for SIGNERS): Internet Explorer 6.0?, Mozilla FireFox 1.0,
NetScape 7.2 (or above)
Email: Access to a valid email account
Screen Resolution: 800 x 600 minimum
Enabled Security Settings:
•Allow per session cookies
•Users accessing the internet behind a Proxy
Server must enable HTTP 1.1 settings via
proxy connection
** These minimum requirements are subject to change. If these requirements change, we will
provide you with an email message at the email address we have on file for you at that time
providing you with the revised hardware and software requirements, at which time you will
have the right to withdraw your consent.
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you
were able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to
e-mail this disclosure and consent to an address where you will be able to print on paper or
save it for your future reference and access. Further, if you consent to receiving notices and
disclosures exclusively in electronic format on the terms and conditions described above,
please let us know by clicking the 'I agree' button below.
By checking the 'I Agree' box, I confirm that:
• I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and
• I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
• Until or unless I notify City of Denton as described above, I consent to receive from
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to me by City of Denton during the course of my relationship with you.