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20-1163 - 7118 - Change Order 1 Ordinance ExecutedORDINANCE NO.20-1163 AN ORDINANCE OF THE CITY OF DENTON, A TEXAS HOME-RULE MUNICIPAL CORPORATION, AUTHORIZING THE APPROVAL OF CHANGE ORDER NO. 1 TO THE CONTRACT BETWEEN THE CITY OF DENTON AND PAVECON PUBLIC WORKS LP, FOR THE CONSTRUCTION OF THE SOUTH BONNIE BRAE STREET WIDENING AND IMPROVEMENTS PHASE 2rviNTAGE BLVD PROJECT FOR THE CITY OF DENTON: PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (IFB 7118– CHANGE ORDER NO. 1 1N THE NOT-TO-EXCEED AMOUNT OF 5393,93 1.40 FOR A TOTAL CONTRACT AWARD AGGREGATED TO $12,032,254.80). WHEREAS, on November 19, 2019, by Ordinance No. 19-2728, the City Council awarded a contract to Pavecon Public Works LP, in the amount of $11,638,323.40 for the construction of the South Bonnie Brae Street widening and improvements Phase 2/Vintage Blvd Project; and WHEREAS, the Staff having recommended, and the City Manager having recommended to the Council that a change order be authorized to amend such contract with respect to the scope of work and an increase in the payment amount; NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS: SECTION 1. Change Order No. 1, increasing the amount of the contract between the City and Pavecon Public Works LP, which is on file in the office of the Purchasing Agent, in the amount of Three Hundred Ninety-Three Thousand Nine Hundred Thirty-One and 40/100 Dollars ($393,931.40), is hereby approved and the expenditure of funds therefore is hereby authorized in accordance with said change order. The total purchase order amount increases to $12,032,254.80. SECTION 2. This ordinance shall become effective immediately upon its passage and approval The moti% to approve this ordinance seconded by 2 afollowing vote [E - a] : Owas made by paed andthe ordinancl and )proved by the -/ Z JZ Z Aye ./ LZ Nay Abstain Absent Mayor Chris Watts: Gerard Hudspeth, District 1 : Keely G. Briggs, District 2: Jesse Davis, District 3 : John Ryan, District 4: Deb Annintor, At Large Place 5 : Paul Meltzer, At Large Place 6: b// t day ofPASSED AND APPROVED this the 2020 ATTEST: ROSA RIOS, CITY SECRETARY _rf/z30/ APPROVED AS TO LEGAL FORM: AARON LEAL, CITY ATTORNEY d„(.„,„e DocuSign Envelope ID: 77EDD35B-FC8B-444C-B09F-34B2302AE9B3 DENTON Docusign City Council Transmittal Coversheet 7118I FB File Name I SOUTH BONNIE BRAE PH 2 (VINTAGE BOULEVARD) – co#1 PurchasingContact } Laura Hermos1110 City COuncil Target Date June 23’ 2020 Piggy Back Option Contract Expiration 20 1163Ordinance l• Vb rtF/ F/ 1 1 \= U V I \n N/A DocuSign Envelope ID: 77EDD35B-FC8B444C.B09F-34B2302AE9B3 FILE #7118 CITY OF DENTON CHANGE ORDER F 191814T 350288444 Channel Excavation NEW 3.525 $6.30 $22,094.10 $22,207.50 $7.9450 16 53859.00 54.031 $2.94 $158,345.46 $158.851.14 1. Division (Department) Engineering a a Bonnie Brae Phase 2 7. Name and Address of Contractor Pawcon Public Works LP 3022 Roy Orr BIW ,Grand Prairie, TX 75050 ml Work includes constructing a 4 lane roadway with a drainge system, lighting, and traffic signals 1 @s Changes include additional signage, and changes in paving for TxDOT permit connections. Additional Drainage and asphalt to avoid needed TCE for installation Changes in connection to Bonnie Brae Phase 1 to avoid pavement leave outs and need for temporary asphalt. Quantity IPrice IEstimate IC.O.UnitPricejCost ICost Quantity $4.25 1 26,321 $5.49 $2,37 $609.35 $0.00 $0.00 $8.82 $0.00 $6.30 $0.00 $2.94 3. Change Order No. 6 6/1 2/2020 Topsoil (4" Mixed from Landscape supply Block Sodding (Bermuda) Seeding (Hydromulch) Prep ROW Clear & Grub 50x1 5 Area 5 25,611 25,611 54.454 141.3 $4.25 1 $108,846.75 1 $111,864.25 6 27,111 $5.49 1 $14a,604.39 1 $148,839.39 $2.37 1 $129,055.98 1 $138,772.98 143 1 $609,35 1 $86,101.16 1 $87,319.86 7 58,554 9 NEW 0 1 1 $8,125.oo 1 $o.oo $8,125.00 $1,951.65 1 $o.oo I $19,516.50 $8.82 1 $192,205.44 1 $192,&49.30 $16,625.00 Trim Trees NEW 0 10 Excavation 10 21.792 0 21 ,865 350 $47.50 1 $o.oo Remove EHsting Paving (CONC) 1 11 =='.":.::'*”““”“ ~ " Embankment 3,507 0 $0.00 $397.00 Page 1 of 6 DocuSign Envelope ID: 77EDD35B-FC8B444C-B09F-34B2302AE9B3 Channel Embankment Backfill Lime Slurry 8" Lime Treated Subgrade Concrete Pavement 8" Concrete Pavement (12"CRCP) Concrete Pavement (6" DIvieway) 2" Type "C" ACP 4" Type "C" ACP 5" Type "B" ACP 8" Type "B" ACP Mona Curb TY II Curb 18" Concrete Ribbon Curb Concrete Street Header 24" Concrete Curb & Gutter 10' Shared UsePath (6") PED-18 Curb Ramp NEW 18 19 NEW 22 NEW NEW 26 NEW 28 29 30 NEW NEW NEW 31 34 NEW 0 141.3 1 ,415.1 0 560 0 0 9,525 0 332 476.0 27,917,0 0 0 0 671 10,463 0 $0'00 $566.17 $1 52.85 $0.00 $60.98 $0.00 $0.00 $13.36 $0.00 $44.15 $48.81 $3.00 $0.00 $0.00 $0.00 $38.39 $54.04 $0.00 130 143.3 1 ,435 979 997 813 48 9,768 1 ,155 521 530.0 28,171 277 40 31 554 10,505 1 $62.50 $566.17 $152.85 $11.24 $60.98 $128.38 $113.15 $13.36 $37.55 $44.15 $48.81 $3.00 $3.00 $76.67 $24.73 $38.39 $54.04 $2,056.94 $0.00 $79,999.82 $216,298.04 $0.00 $34 , 148.80 $0.00 $0.00 $127,254.00 $0.00 $14,657.80 $23,233.56 $83,751 .00 $0.00 $0.00 $o.ao $25,759.69 $565,420.52 $0.00 $8,125.00 $81 ,132.16 $219,293.90 $11 ,003.96 $60,797.06 $104,372.94 $5,431.20 $130,500.48 $43,370.25 $23,002.15 $25,869.30 $84,513.00 $831.00 $3,066.80 $766.63 $21 ,268.06 $567,690.20 $2,056.94 Page 2 of 6 DocuSign Envelope ID: 77EDD35B-FC8B444C-B09F-34B2302AE9B3 4" Stmaped & Stained Concrete 8' High Wood Fence (Metal Poles) 16' Wide X 8' High Double Wooden Gate Temporary Mailbox Remove and Replace Brick Mailbox Traffic Control - Old Bonnie Brae 18" RCP (CL III) 18" RCP (CL V) 24" RCP (CL III) 24" RCP (CL V) 36" RCP (CL III) 42" RCP (CL III) 3'x2" RCB (Less 2' Cover) 4'x2' RCB (Less 2" Cover) Type C-1 Drop Inlet Type M Manhole "CH-FW-0" Headwall 4'}a' RCB TY II SET 37 NEW NEW NEW NEW NEW 48 49 50 NEW 56 58 NEW NEW NEW 67 71 3,940 0.0 0-0 0.0 0.0 0.0 2,715.0 895.0 1,125.0 0.0 680.0 1 ,554.0 0.0 0.0 0.0 30.0 1.0 0.0 $97.97 $0.00 $0.00 $0.00 $0.00 $0.00 $68.25 $73.50 $85.05 $0.00 $134.40 $176.40 $0.00 $0.00 $0.00 $3,360.00 $3,360.00 $0.00 3,892 48.0 2 1 1 1 2,560 900 1 ,006 30 992 1 ,268 165 38 1 29 2 1 $97.97 $95.63 $3,900.00 $142,37 $4,666.41 $5,912.50 $68.25 $73.50 $85.05 $150.00 $134,40 $176,40 $256.69 $290.44 $6,062.50 $3,360.00 $3,360.00 $5,312.50 $386,001.80 $0.00 $0.00 $0.00 $0.00 $0.00 $185,298.75 $65,782.50 $95,681.25 $0.00 $91 ,392.00 $274,125.60 $0.00 $0'00 $0'00 $100,800.00 $3,360'00 $a.oo $381 ,299.24 $4,590.24 $7,800.00 $142.37 $4,666.41 $5,912.50 $174,720.00 $66,150.00 $85,560.30 $4,500.00 $133,324.80 $223,675.20 $42,353.85 $1 1 ,036.72 $6,062.50 $97,440.00 $6,720.00 $5,312.50NEW Page 3 of 6 DocuSign Envelope ID: 77EDD35B-FC8B444C-B09F-34B2302AE9B3 18" RCP TY II SET NEW NEW 75 77 86 87 91 NEW 94 97 98 99 100 101 103 NEW NEW NEW 0.0 0.0 9,826.0 312.0 22,0 1,913.0 9,055.0 0.0 11.0 304.0 428,0 626.0 309.0 84.0 3,295.0 0-0 0.0 0.0 $0.00 $0.00 $1.05 $1 10.25 $1 ,260.00 $21.00 $1 .21 $0.00 $1 ,496.25 $1 0.50 $1 1 .55 $13,65 $2.10 $1 .05 $2.10 $0.00 $0.00 $0.00 1 $1 ,843.75 $2,312.50 $1 .Q5 $110.25 $1 ,260.00 $21 .00 $1 ,21 $1 ,116.38 $1 ,496.25 $10.50 $11.55 $13.65 $2.10 $1.05 $2,10 $1.75 $2.10 $250.00 $0.00 $0.00 $10,317.30 $34,398.00 $27,720.00 $40,173.00 $10,956.55 $0.00 $16,458.75 $3,192.00 $4,943.40 $8,544.90 $648.90 $88.20 $6,919.50 $Q.QO $0.00 $0.00 $1 ,843.75 $2,312.50 $10,306.80 $44 ,210.25 $30,240.00 $41 ,328.00 $11 ,640.20 $1 ,116.38 $17,955.00 $3,654.00 $4,885.65 $8,599.50 $445.20 $136.50 $5,917.80 $350.00 $25.20 $15,250.00 24" RCP TY II SET Trench Safety 9,816 401 24 1 ,968 9,620 1 12 348 423 630 212 130 2,818 200 12 61 12" Grouted Rock Rip-Rap Remove EHsting Headwall Remove EMsting Storm Pipe Silt Fence Rock Check Dam Construction Entrance Conduit (PVC) (SCHD 40) (2") Conduit (PVC) (SCHD 40) (3") Conduit (PVC) (SCHD 40) (4") Elec Condr (NO 4) (Insulated) Elec Condr (NO 6) (Ground) Tray cable (3 CONDR) (14 AWG) - ILSN Luminaires Tray cable (3 CONDR) (16 AWG) Tray cable (3 CONDFI) (20 IAWG) - op Install 12x1 2 Plastic Ground Box (Provided by DME) Page 4 of 6 DocuSign Envelope ID: 77EDD35B-FC8B444C-B09F-34B2302AE9B3 Backplate (12 IN) (3 SEC) Backplate (12 IN) (4 SEC) VEHICLE SIGNAL SECTN. (12 IN) (LED) (RED) VEHICLE SIGNAL SECTN. (12 IN) (LED) (YEL) VEHICLE SIGNAL SECTN. (12 IN) (LED) (GRN) VEHICLE SIGNAL SECTN. (12 IN) (LED) (RED ARROW) E IN) (LED) (STEADY YEL IARROW) VEHICLE SIGNAL SECTN. (12 IN) (LED) (FLASH YEL ARROW) VEHICLE SIGNAL SECTN. (12 IN) (LED) (GRN ARROW) TRAFFIC SIGNAL CABLE (TY A) (14 AWG) (21 CONDR) TRAFFIC SIGNAL CABLE (TY A) (14 AWG) (7 CONDR) INSTALL CAT 5E CCW-RADIO RESENCE ETECTOR CABLE INSTALL RADD CABLE RADD COMMUNCATION CABLE (9 CONDUCTOR) [TYPE IB DOUBLE LINE A/A RPM TYPE IB DOTrED LINE SYMBOL SHARED PAVEMENT MARKING SMALL SIGN ASSEMBLY 109 110 112 113 114 115 116 117 118 120 121 132 13SA 136 165 166 173 174 16.0 10.0 18.0 18.0 18.0 10.0 12.0 10.0 12.0 744.0 3,802.0 1 ,092.0 1 ,726.0 3,371.0 264.0 9,216.0 40.0 121 $126'00 $147,00 $393.75 $393.75 $393,75 $393.75 $393.75 $393.75 $393.75 $7.35 $2,10 $2.10 $3.15 $3.15 $4.20 $0.63 $367.50 $488.25 17 11 21 21 21 9 11 9 13 761 3,900 657 2 ,434 3,536 290 9,736 44 124 $126.00 $147.00 $393.75 $393.75 $393'75 $393.75 $393.75 $393.75 $393.75 $7.35 $2,10 $2.10 $3.15 $3'15 $4,20 $0.63 $367.50 $488.25 $2,016.00 $1 ,470.00 $7,087.50 $7,087.50 $7,087.50 $3,937.50 $4,725.00 $3,937.50 $4,725.00 $5,468.40 $7,984.20 $2,293.20 $5,436.90 $10,618.65 $1,108.80 $5,806.08 $14,700.00 $59,078.25 $2,142.00 $1 ,617.00 $8,268.75 $8,268.75 $8.268.75 $3,543.75 $4,331 .25 $3,543.75 $5,118.75 $5,593.35 $8,190.00 $1 ,379.70 $7,667.10 $11 ,138.40 $1 ,218.00 $6,1 33.68 $16,170.00 $60,543.00 Page 5 of 6 DocuSign Envelope ID: 77EDD35B-FC8B444C-B09F-34B2302AE9B3 TOTAL $3,529,146.88 $3,923,078.28 11. Original Contract Price + Previous CO's New Contract Price 12. Contract time increased/decreased by _0_days, $11,638,323.40 1ncrease in contract price $12,032,254.80 Decrease in contract price New contract time days. $393,931.40 SUBMITTED BY ACCEPTED BY CITY ENGINEER/DIRECTOR OF CAPITAL PR ACCEPTED BY CONTRACTOR: Pres1 dent Title CITY MANAGER: Project Manager 13. 14. 15 16. DwuSlgned by:till hLLM4tl -Signature kg Signature ::1 7 5A 9 3 U U kC 14BDocuS ATTEST: CITY SECRETARY 17, PURCHASING/FINANCE: 18 APPROVED AS TO LEGAL FORM: Page 6 of 6 DocuSign Envelope ID: 77EDD35B-FC8B-444C-B09F-34B2302AE9B3 Exh1 bIt 1 PUBLIC WORKS JOB NAME: BONNIE BRAE CO#1 LOCATION: DENTON, TEXAS BID DATE: BID I IME: DESCRfPIIQN Ql Y UNIt UNI I AMC)UNI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 I C)Pbl)IL (4" MIXED StIIL FROM A LANL BLOCK SODDING (BERMUDA) SEEDING (HYDROMULCF}) PREPARING R.0.W. CLEAR & GRUB St)' X ]5' AREA TRIM TREES EXCAVATION CHANNEL EXCAVATION REMOVE EXISTING PAVING (CONC.) REMOVE & REPLACE BARBED WIRE F EMBANKMENT CHANNEL EMBANKMENT BACKF ILL nME SLURRY 8" LIME TREATED SUBGRADE CONCRETE PAVEMENT 8" CONCRETE PAVEMENT (12" CRCP) CONCRETE PAVEMENT (6" DRIVEWAY 2" TYPE "C" A,C.P. 4" TYPE "C" A.C.P. 5" TYPE "B’' A.C.P 8" WPE "B" A.C.P. MONO CURB TY II CURB 18" CONCRETE RIBBON CURB CONCRETE STREET HEADER 24" GONG. CURB & GU II ER 1 C' SHARED USE PATH (6") PED-18 CURB RAMP 4" STAMPED AND STAINED CONCRETE u HIGH WOOL) FENCE (ME I AL PQLESJ 16’ WIDE X 8' HIGH DOUBLE WOODEN TEMPORARY MAILBOX REMOVE & REPLACE BRICK MAILBOX TRAFFIC CONTROL - OLD BONNIE BR/ 1500 4100 2 1 710 SY SY SY STA. LS EA CY CY SY LF CY CY SIA. TON SY SY SY SY SY SY SY SY LF LF LF LF LF $4.25 $5.49 $2.37 $609.35 $8,125.00 $1 ,951.65 $8.82 $47.50 $6.30 $7,94 $2.94 $62.50 $566, 17 $1 52.85 $11.24 $60.98 $128.38 $113.15 $13.36 $37.55 $44.15 $48,81 $3,00 $3.00 $76.67 $24,73 ($38.39) $54.04 $2,056.94 ($97.97)$95.63 $3,900.00 $142.37 $4,666.41 $5,912.50 $3.017.SU $8.235.00 $9.717_00 $1 ,218.70 $8,125,DO $19.516.50 $643.86 §16,625.00 $1 13.40 $397.oa $505.68 $8, 125.00 $1 , 132.34 $2,995.86 $11 ,003.96 $26,648.26 $104,372.94 $5,431.20 §3,246.48 $43,370.25 $8, 344.35 $2,635.74 $762,00 $831 ,00 §3,066.80 $766.63 ($4,491 .63) $2 , 269.68 $2 ,056.94 ($4, 702.56)$4,590.24 $7,800.00 $142.37 $4.666.41 $5.912.50 10 73 350 18 50 172 130 2 19.6 979 437 813 48 243 1155 189 54 254 277 40 31 117 42 SY 1 EA 48 SY 48 LF 2 EA 1 EA I EA 1 LS JQB IUI ALS:$309,L)91 .4U DocuSign Envelope ID: 77EDD35B-FC8B-444C-B09F-34B2302AE9B3 Raw@&PLBUC WORKS JOB NAME: BONNIE BRAE CO#1 LOCATION: DENTON. TEXAS BID DATE BID I IME: NQ. DESCRIP I ION CitY UNll UNll AMQUNI 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 18" R.C.P. (CL III) 18" R.C.P. (CL V) 24" R.C.P. (CL III) 24" CL V RCP 36" R.C.P. (CL III) 42" R.C.P. (CL III) 3' X 2’ RCD (LESS 2' COVER) 4' X 2' RCB (LESS 2' COVER) TYPE C-1 DROP INLET TYPE M MANHOLE "CFI-FW-0" HEADWALL 4' X 2' RCB TY 11 S.E.T. 18" RCP TY II S.E.T. 24" RCP TY II S.E.T. TRENCH SAFETY 12" GROUTED ROCK RIP-RAP REMOVE EXISTING HEADWALL REMOVE EXISTING STORM PIPE SILT FENCE ROCK CHECK DAM CONSTRUCTION ENTRANCE CONDUIT (PVC) (SCHD 40) (2") CONDUIT (PVC) (SCHD 40) (3") CONDUIT (PVC) (SCHD 40) (4") ELEC CONDR (NO 4) (INSULATED) ELEC CONDR (NO 6) (GROUND) TRAY CABLE (3 CONDR (14 AWG) - ILS TRAY CABLE (3 CONDR (16 AWG) - TRAY CABLE (4 CONDR (20 AWG) - OP INSTALL 12’X12' PLASTIC GROUND BO BACKPLATE (12 IN) (3 SEC) BACKPLATE (12 IN) (4 SEC) VEHICLE SIGNAL bEC I N. (12 IN) (LED) VEHICLE SIGNAL SECTN. (12 IN) (LED) VEHICLE SIGNAL SECTN. (12 IN) (LED) 155 5 119 30 312 286 165 38 1 1 1 1 1 1 10 89 2 55 565 1 1 44 5 4 97 46 477 200 12 61 1 1 3 3 3 LF LF LF LF LF LF LF LF EA EA EA EA EA EA LF SY EA LF LF EA EA LF LF LF LF LF LF LF LF EA EA EA bA EA EA ($68.25) $73.50 ($85.05) $150.00 $134.40 ($176.40) $256.69 $290,44 $6,062.50 ($3,360.00) $3,360.00 $5,312.50 $4 ,843.75 $2,312.50 ($ 1 .05) $ 1 10.25 $1 ,260.00 $21.00 $1 .21 $1 ,1 16.38 $1.496,25 $10.50 (§1 1 .55) $1 3.65 ($2, 10) $1 .05 ($2. 10) $1.75 $2. 10 $250.00 $126.00 $147.00 $393.75 $393.75 $393.75 ($10.578.75) $367.50 ($10,120.95) $4,500.00 $41 ,932.80 ($50,450.40) $42,353.85 §1 1 ,036.72 $6,062.50 ($3,360.00) $3,360.00 $5,312.50 $1 ,843.75 $2.312.50 ($10.50) $9,812.25 $2,520.00 $1 ,155.00 $683.65 $1 ,116.38 $1 ,496.25 $462.00 ($57.75) $54.60 ($203.70) $48.30 ($1 ,001.70)$350.00 $25.20 §15,250.00 $126.00 $147.00 $1 ,181_25 $1,181.25 $1,181.25 JUB IUI ALS:$389.180.15 DocuSign Envelope ID: 77EDD35B-FC8B-444C-B09F-34B2302AE9B3 ahwaw PWUC WORKS JOB NAME: BONNIE BRAE CO#1 LOCATION: DENTON, TEXAS BID DATE: BID IIME: NC). DESCRIPIIC)N O IY UNI I UNI I AMC)UN I VEHICLE SIGNAL SECTN. (12 IN) (LED) VEHICLE SIGNAL SECTN. (12 IN) (LED) VEHICLE SIGNAL SEC I N. (12 IN) (LED) VEHICLE SIGNAL SECTN. (12 IN) (LED) TRAFFIC SIGNAL CABLE (TY A) (14 AW TRAFFIC SIGNAL CABLE (TY A) (14 AWINSTALL CAT 5E CCW-RADIO RESENC INSTALL RADD CABLE RADD COMMUNCATION CABLE (9 CON TYPE IB DOUBLE LINE A/A RPM TYPE IB DOTrED LINE SYMBOL SHARED PAVEMENT MARKIN SMALL SIGN ASSEMBLY 1 1 1 l 17 98 435 708 1 65 26 520 4 3 EA EA LA EA LF LF LF LF LF EA LF EA EA ($393.75) ($393.75) ($393.75) $393.75 $7.35 $2.10 ($2 , 10) $3.15 $3, 15 $4,20 $0.63 $367 , 50 $488.25 ($393.75) ($393.75) ($393.75) $393.75 $124.95 $205,80 ($913,50) $2,230,20 $519.75 $109.20 $327.60 $1 ,470.00 $1 ,464.75 TOTAL $393,931.40 JOB IUI ALS:$393.931.4C) DocuSign Envelope ID: 77EDD35B-FC8B-444C-B09F-34B2302AE9B3 Exhibit 2 ©NFLICT OF INTEREST QUESTIONNAIRE - For vendor or other person doing business with local governmental entit' L lges mac by H.B. 23, 8zgular Session. FORM CIQ 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. if My. Pavecon Pub1 jc works LP 2 LJ 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. N/A Name of Officer Tbis 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 B] 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 govemmental entity? [] Yes [a No C Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local govenrment officer serves as an officer or director, or holds an ownership of one percent or more? E *”A .„, D Describe each employment or business and family relationship with the local govemment officer named in this section N/A 4 5 B] 1 have no Conflict of Interest to disclose. 6/15/2020 IPMI#wHat-dOing business with the governmental entity Date Docu eeRE B [;"did B& q&t Certificate Of Completion Envelope Id: 77EDD35BFC8B444CB09F34B2302AE9B3 Subject: Please DocuSign: CO #1 7118 - South Bonnie Brae PH 2 (Vintage Boulevard) Source Envelope. Status: Completed Document Pages: 11 Certificate Pages: 6 AutoNav: Enabled Signatures: 8 Initials: 1 Envelope Originator: Laura Hermosillo 901 B Texas Street Denton, TX 76209 laura.hermosillo@cityofdenton. com IP Address: 198.49.140.104 Envelopeld Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) Record Tracking Status: Original 6/1 2/2020 10:05:38 AM Holder: Laura Hermosillo laura.hermosillo@cityofdenton.com Location: DocuSign Signer Events Laura Hermosillo laura.hermosillo@cityofdenton.com Senior Buyer City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Signature Timestamp Sent: 6/12/2020 10: 17:09 AM Viewed: 6/1 2/2020 10:17:18 AM Signed: 6/12/2020 10:17:20 AM Completed Using IP Address: 198.49.140.104 Lori Hewell lori .hewell@cityofdenton.com Purchasing Manager City of Denton Security Level: Email, Account Authentication (None) Sent: 6/1 2/2020 10:17:23 AM Viewed: 6/14/2020 9:39:14 PM Signed: 6/14/2020 9:39:41 PM Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.104 Electronic Record and Signature Disclosure: Not Offered via DocuSign Mack Reinwand mack.reinwand@cityofdenton.corn City of Denton Security Level: Email, Account Authentication (None) ' DocuSigned by: I M& pd,H_,r ,7F9D328BF0204E5. Sent: 6/12/2020 10:17:23 AM Viewed : 6/1 5/2020 9:52:25 AM Signed: 6/1 5/2020 9:54:32 AM Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.104 Electronic Record and Signature Disclosure: Not Offered via DocuSign Seth Garcia Seth.Garcia@cityofdenton.com Security Level: Email, Account Authentication (None) Sent: 6/1 5/2020 9:54:35 AM Viewed : 6/15/2020 9:55:15 AM Signed: 6/1 5/2020 9:55:49 AM Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.104 Electronic Record and Signature Disclosure: Accepted: 6/15/2020 9:55:15 AM ID: Oeldl05f-e253-44c5-a3bl-2ba6b8b60faf Signer Events Daniel K Danielk@pavecon.com President Pavecon Ltd Co Security Level: Email, Account Authentication (None) Signature 'DocuSigned by: I DnLitl k 'DA86F07F9C65405 Timestamp Sent: 6/15/2020 9:55:52 AM Resent: 6/15/2020 1 1 :00:06 AM Resent: 6/15/2020 1 1:18:18 AM Viewed: 6/15/2020 12:46:11 PM Signed: 6/1 5/2020 1:05:51 PMSignature Adoption: Pre-selected Style Using IP Address: 170.176.240.29 Electronic Record and Signature Disclosure: Accepted: 6/15/2020 12:46:11 PM ID: bOdb66f4-47b6-47ca-86fd-6c896656bb02 Todd Estes Todd.Estes@cityofdenton.com City Engineer Capital Projects Security Level: Email, Account Authentication (None) Sent: 6/1 5/2020 9:55:52 AM Resent: 6/15/2020 1 1 :00:07 AM Resent: 6/15/2020 1 1 :38:02 AM Viewed : 6/15/2020 1 1 :38:32 AM Signed: 6/1 5/2020 1 1 :52:04 AMSignature Adoption: Drawn on Device Using IP Address: 198.49.140.104 Electronic Record and Signature Disclosure: Not Offered via DocuSign Cheyenne Defee cheyenne.defee@cityofdenton'com Contract Administrator City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Completed Sent: 6/15/2020 1 :05:55 PM Viewed: 6/24/2020 8:45:27 AM Signed: 6/24/2020 8:45:34 AM Using IP Address: 198.49.140.104 Todd Hileman Todd,Hileman@cityofdenton.com City Manager City of Denton Security Level: Email, Account Authentication (None) Sent: 6/24/2020 8:45:37 AM Viewed: 6/24/2020 10:43:50 AM Signed: 6/24/2020 10:43:54 AM Signature Adoption: Pre-selected Style Using IP Address: 47.186.196.49 Electronic Record and Signature Disclosure: Accepted: 7/25/2017 11 :02:14 AM ID: 57619fbf-2aec-4b1 f-805d-6bd7d9966f2 1 Rosa Rios rosa.rios@cityofdenton.com City Secretary Security Level: Email, Account Authentication (None) Sent: 6/24/2020 10:43:57 AM Viewed : 6/24/2020 1 1 :22:40 AM Signed: 6/24/2020 11 :23:32 AM Signature Adoption: Pre-selected Style Using IP Address: 198.49.140.104 Electronic Record and Signature Disclosure: Accepted : 6/24/2020 11 :22:40 AM ID: 8a973a35-acdl-4b5a-8a54-08ec9245adad In Person Signer Events Signature Status Timestamp Editor Delivery Events Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Status Timestamp Certified Delivery Events Timestamp Carbon Copy Events Cheyenne Defee cheyenne.defee@cityofdenton.com Contract Administrator City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Status Timestamp Sent: 6/1 2/2020 10:17:22 AM Sherri Thurman sherri,thurman@cityofdenton.com City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 6/15/2020 1 :05:54 PM Robin Davis Robin.Davis@cityafdenton.com Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 6/24/2020 1 1 :23:34 AM Annie Bunger Annie.Bunger@cityofdenton.com Contract Control Specialist City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 6/24/2020 11 :23:36 AM Zolaina Parker Zolaina.Parker@cityofdenton.com City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 6/24/2020 1 1 :23:37 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Envelope Sent Certified Delivered SIgning Complete Completed Status Timestamps 6/24/2020 11 :23:37 AM 6/24/2020 11 :23:37 AM 6/24/2020 11 :23:37 AM 6/24/2020 11 :23:37 AM Hashed/Encrypted Security Checked Security Checked Security Checked Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 7/21/2017 3:59:03 PM Parties agreed to: Seth Garcia, Daniel K, Todd Hileman, Rosa Rios 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. 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