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18-856ORDINANCE NO. 18-856 AN ORDINANCE OF THE CITY OF DENTON, TEXAS, A TEXAS HOME-RULE MUNICIPAL CORPOR.ATION, AUTHORIZING THE APPROVAL OF A SECOND AMENDMENT TO A PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF DENTON AND D&S ENGINEERING LABS, LLC, FOR THE CONSTRUCTION OF CELL 3B, C, D AND ASSOCIATED SITE IMPROVEMENTS FOR THE CITY OF DENTON LANDFILL; PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (FILE 6508- SECOND AMENDMENT EXPENDITURE AMOUNT NOT-TO-EXCEED $29,648.95 FOR A TOTAL CONTRACT AMOUNT NOT-TO-EXCEED $129,548.95). WHEREAS, on August 28, 2017, the City Manager approved a contract to D&S Engineering Labs, LLC, in the amount of $78,310 for Cell 3 Liner Construction and Improvements of the Landfill; and WHEREAS, on May 1, 2018, the Purchasing Manager approved amendment one to contract to D&S Engineering Labs, LLC, increasing the contract total to $99,900 for additional services; and WHEREAS, the Staff having recommended, and the City Manager having recommended to the Council that an amendment be authorized to amend such contract agreement to provide additional professional services in the construction of Cell 3B, C, D and Associated Site Improvements, and an increase in the payment amount, and said fees under the proposed contract are fair and reasonable and are consistent with and not higher than the recommended practices and fees applicable to the Provider's profession and such fees do not exceed the maximum provided by law; NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS: SECTION 1. The Second Amendment, increasing the amount of the contract between the City and D �� &S Engineering Labs, LLC, which is on file in the office of the Purchasing Agent, in the amount of Twenty Nine Thousand Six Hundred Forty Eight and 95/100 ($29,648.95) Dollars, is hereby approved and the expenditure of funds therefor is hereby authorized in accordance with said amendment, The total contract amount increases to $129,548.95. SECTION 2. This ordinance shall become effective immediately upon its passage and approval. ..m � his ordmance was made by �,�� ,�� y�� _ m....._ �d seconded by The motion to approve t " the ordinance was �a��1 and approved by the following ��a��_��:a��.W..��.�� __......— � �f91�C�' l_..�'� � .�:. Aye Nay Abstain Absent Mayor Chris Watts: __ ` Gerard Hudspeth, District 1: Keely G. Briggs, District 2: Don Duff, District 3: John Ryan, District 4: Dalton Gregory, At Large Place 5: Paul Meltzer, At Large Place 6: PASSED AND APPROVED this the ATTEST: JENNIFER WALTERS, CITY SECRETARY ��„�•� ��day of �� .......,, 2018, � � ._.,�� ,�. �. ��n. �� ° CHRIS '�w'ATTS, MAYOR .... ��m.m.________.�._.__._..m�m �..� �,.�. � � �, `�d �� yP � ��{ � �� y��ri � �" qd�� p.�... B I .'�, �`��' yTM°.`� . �..��.�' „� N��a,��---- � �' �� APPROVED AS TO LEGAL FORM: AARON LEAL, CITY ATTORNEY BY: � � . _ ..�.. � .....................— �� .... ............. � DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 5ƚĭǒƭźŭƓ /źƷǤ /ƚǒƓĭźƌ ƩğƓƭƒźƷƷğƌ /ƚǝĻƩƭŷĻĻƷ CźƌĻ bğƒĻ tǒƩĭŷğƭźƓŭ /ƚƓƷğĭƷ t . ğƩŭĻƷ 5ğƷĻ /źƷǤ /ƚǒƓĭźƌ ğƩŭĻƷ 5ğƷĻ /ƚƓƷƩğĭƷ ğƌǒĻ tźŭŭǤ .ğĭƉ hƦƷźƚƓ /ƚƓƷƩğĭƷ 9ǣƦźƩğƷźƚƓ hƩķźƓğƓĭĻ DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 THE STATE OF TEXAS § § COUNTY OF DENTON § SECOND AMENDMENT TO CONTRACT BY AND BETWEEN THE CITY OF DENTON, TEXAS AND D&S ENGINEERING LABS. LLC \[FILE NO. 6508\] THIS SECOND Second to that certain Contract by and between the City of Denton, Texas and D&S Engineering Labs, LLC -to-exceed amount of $78,310.00, which was heretofore executed on August 28, 2017, and was approved within the delegated authority of the City of Denton Purchasing Agent; and said Agreement was heretofore entered into by and between the City of Denton, Texas, a Texas Municipal Corporation with its offices at 215 East McKinney Street, Denton, Texas 76201 (hereafter the he firm of D&S Engineering Labs, LLC D&S with its offices at 1101 Shady Oaks Dr., Denton, TX 76205. D&S has substantially completed the initial work called for in the original Agreement; and the City deems it necessary to further expand the services as referenced in Exhibit B of original contract provided by D&S to the CITY for engineer testing that is needed above the original scope of services, and provide an additional services in the amount $29,648.95, for an aggregate of $129,548.95. NOW THEREFORE, the CITY and D&S (hereafter collectively referred to as the good and valuable considerations, do hereby AGREE to the following Second Amendment, which amends the following terms and conditions of the said Agreement, to wit: 1. The provisions of Article original contract are hereby amended to add the additional language as follows, to wit: Additional services are needed for final completion of construction materials testing for Cell 3 Liner Construction and Improvements for City of Denton Landfill per (Exhibit B) of original contract. 2. The provisions of Article V in the original agreement shall instead read, - Billing and Payment: For and in consideration of the professional services to be performed by the CONSULTANT herein, the OWNER agrees to pay, based on the cost estimate detail at an hourly rate shown in Exhibit B, a total fee, including reimbursement for direct non-labor expenses not to exceed $129,548.95 1 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 3. The Parties hereto agree, that except as specifically provided for by this Second Amendment, that all of the terms, covenants, conditions, agreements, rights, responsibilities, and obligations of the Parties, set forth in both the Agreement and now the First Amendment shall be, and will remain in full force and effect. IN WITNESS WHEREOF, the City of Denton, Texas and the D&S Engineering Labs, have each executed this Second Amendment by and through their respective duly authorized representatives and officers on this day _____________________________. CITY OF DENTON, TEXAS A Texas Municipal Corporation By: __________________________________ Todd Hileman, City Manager ATTEST: JENNIFER WALTERS, CITY SECRETARY By: __________________________________ APPROVED AS TO LEGAL FORM: AARON LEAL, INTERIM CITY ATTORNEY By: ___________________________________ D&S D&S ENGINEERING LABS A Texas Limited Liability Corporation By: _________________________________ AUTHORIZED SIGNATURE, TITLE 2 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 Exhibit House Bill 89 - Government Code 2270 VERIFICATION I, _______________________________________________, the undersigned representative of ______________________________Company or Business name (hereafter referred to as company), being an adult over the age of eighteen (18) years of age, verify that the company named-above, under the provisions of Subtitle F, Title 10, Government Code Chapter 2270: 1. Does not boycott Israel currently; and 2. Will not boycott Israel during the term of the contract the above-named Company, business or individual with City of Denton. Pursuant to Section 2270.001, Texas Government Code: 1. with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes; and 2. -profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. ___________________________________ Name of Company Representative (Print) ________________________________ Signature of Company Representative _________________________________ Date DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 Exhibit Senate Bill 252 -Government Code 2252 CERTIFICATION I, ______________________________________________, the undersigned representative of ________________________________________________ (Company or business name) being an adult over the age of eighteen (18) years of age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152 and Section 2252.153, certify that the company named above is not listed on the website of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806.051, Section 807.051 or Section 2253.153. I further certify that should the above-named company enter into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas which do business with Iran, Sudan or any Foreign Terrorist Management Department. ___________________________________ Name of Company Representative (Print) ________________________________ Signature of Company Representative _________________________________ Date DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 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. Name of vendor who has a business relationship with local governmental entity. 1 2 Check this box if you are filing an update to a previously filed questionnaire. th (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7 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 Certificate Of Completion Envelope Id: E5556FC1E20F45B4A54EB60AAA6C1157Status: Completed Subject: Please DocuSign: City Council Contract 2nd REVISION 6508 Amendment 2 Source Envelope: Document Pages: 10Signatures: 7Envelope Originator: Certificate Pages: 6Initials: 1Jamie Cogdell AutoNav: Enabled901B Texas Street EnvelopeId Stamping: EnabledDenton, TX 76209 Time Zone: (UTC-06:00) Central Time (US & Canada)Jamie.Cogdell@cityofdenton.com IP Address: 129.120.6.150 Record Tracking Status: OriginalHolder: Jamie CogdellLocation: DocuSign 5/30/2018 4:43:38 PM Jamie.Cogdell@cityofdenton.com Signer EventsSignatureTimestamp Jamie CogdellSent: 5/30/2018 4:48:18 PM Completed jamie.cogdell@cityofdenton.comViewed: 5/30/2018 4:49:07 PM Senior BuyerSigned: 5/30/2018 4:51:38 PM Using IP Address: 129.120.6.150 City Of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Jason BrothersSent: 5/30/2018 4:51:40 PM jbrothers@dsenglabs.comViewed: 5/30/2018 8:46:01 PM Vice PresidentSigned: 5/30/2018 8:46:39 PM D&S Engineering Labs Using IP Address: 71.129.229.96 Security Level: Email, Account Authentication Signed using mobile (None) Electronic Record and Signature Disclosure: Accepted: 5/30/2018 8:46:01 PM ID: 3c6ebffb-83db-4147-a68d-f3ac9c2b6a38 Larry CollisterSent: 5/30/2018 8:46:43 PM larry.collister@cityofdenton.comViewed: 6/7/2018 11:28:50 AM First Assistant City AttorneySigned: 6/7/2018 11:28:59 AM City of Denton Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 9/26/2017 2:27:28 PM ID: 01f5f868-f109-4e29-ad49-21db9046c882 Jamie CogdellSent: 6/7/2018 11:29:02 AM jamie.cogdell@cityofdenton.comViewed: 6/7/2018 3:25:16 PM Senior BuyerSigned: 6/7/2018 3:27:30 PM City Of DentonFreeform Signing Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Signer EventsSignatureTimestamp Tabitha MillsopSent: 6/7/2018 11:29:02 AM Completed tabitha.millsop@cityofdenton.comViewed: 6/20/2018 8:28:43 AM City of DentonSigned: 6/20/2018 8:46:43 AM Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Todd HilemanSent: 6/20/2018 8:46:46 AM Todd.Hileman@cityofdenton.comViewed: 6/20/2018 11:04:28 AM City ManagerSigned: 6/20/2018 11:04:35 AM City of Denton Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 7/25/2017 11:02:14 AM ID: 57619fbf-2aec-4b1f-805d-6bd7d9966f21 Jennifer WaltersSent: 6/20/2018 11:04:38 AM jennifer.walters@cityofdenton.comViewed: 6/21/2018 11:51:11 AM City SecretarySigned: 6/21/2018 11:52:10 AM City of Denton Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer EventsSignatureTimestamp Editor Delivery EventsStatusTimestamp Agent Delivery EventsStatusTimestamp Intermediary Delivery EventsStatusTimestamp Certified Delivery EventsStatusTimestamp Carbon Copy EventsStatusTimestamp Sherri ThurmanSent: 5/30/2018 8:46:42 PM sherri.thurman@cityofdenton.com City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Jane RichardsonSent: 6/20/2018 8:46:45 AM jane.richardson@cityofdenton.comViewed: 6/20/2018 9:51:44 AM Assistant City Secretary City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Carbon Copy EventsStatusTimestamp Jennifer BridgesSent: 6/21/2018 11:52:13 AM jennifer.bridges@cityofdenton.comViewed: 6/25/2018 8:38:31 AM Procurement Assistant City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Jane RichardsonSent: 6/21/2018 11:52:15 AM jane.richardson@cityofdenton.comViewed: 6/26/2018 6:53:56 PM Assistant City Secretary City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Erin ClarkSent: 6/21/2018 11:52:16 AM erin.clark@cityofdenton.comViewed: 6/21/2018 12:02:23 PM Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Notary EventsSignatureTimestamp Envelope Summary EventsStatusTimestamps Envelope SentHashed/Encrypted6/21/2018 11:52:16 AM Certified DeliveredSecurity Checked6/21/2018 11:52:16 AM Signing CompleteSecurity Checked6/21/2018 11:52:16 AM CompletedSecurity Checked6/21/2018 11:52:16 AM Payment EventsStatusTimestamps 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. 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DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 5ƚĭǒƭźŭƓ /źƷǤ /ƚǒƓĭźƌ ƩğƓƭƒźƷƷğƌ /ƚǝĻƩƭŷĻĻƷ CźƌĻ bğƒĻ tǒƩĭŷğƭźƓŭ /ƚƓƷğĭƷ t . ğƩŭĻƷ 5ğƷĻ /źƷǤ /ƚǒƓĭźƌ ğƩŭĻƷ 5ğƷĻ /ƚƓƷƩğĭƷ ğƌǒĻ tźŭŭǤ .ğĭƉ hƦƷźƚƓ /ƚƓƷƩğĭƷ 9ǣƦźƩğƷźƚƓ hƩķźƓğƓĭĻ DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 THE STATE OF TEXAS § § COUNTY OF DENTON § SECOND AMENDMENT TO CONTRACT BY AND BETWEEN THE CITY OF DENTON, TEXAS AND D&S ENGINEERING LABS. LLC \[FILE NO. 6508\] THIS SECOND Second to that certain Contract by and between the City of Denton, Texas and D&S Engineering Labs, LLC -to-exceed amount of $78,310.00, which was heretofore executed on August 28, 2017, and was approved within the delegated authority of the City of Denton Purchasing Agent; and said Agreement was heretofore entered into by and between the City of Denton, Texas, a Texas Municipal Corporation with its offices at 215 East McKinney Street, Denton, Texas 76201 (hereafter the he firm of D&S Engineering Labs, LLC D&S with its offices at 1101 Shady Oaks Dr., Denton, TX 76205. D&S has substantially completed the initial work called for in the original Agreement; and the City deems it necessary to further expand the services as referenced in Exhibit B of original contract provided by D&S to the CITY for engineer testing that is needed above the original scope of services, and provide an additional services in the amount $29,648.95, for an aggregate of $129,548.95. NOW THEREFORE, the CITY and D&S (hereafter collectively referred to as the good and valuable considerations, do hereby AGREE to the following Second Amendment, which amends the following terms and conditions of the said Agreement, to wit: 1. The provisions of Article original contract are hereby amended to add the additional language as follows, to wit: Additional services are needed for final completion of construction materials testing for Cell 3 Liner Construction and Improvements for City of Denton Landfill per (Exhibit B) of original contract. 2. The provisions of Article V in the original agreement shall instead read, - Billing and Payment: For and in consideration of the professional services to be performed by the CONSULTANT herein, the OWNER agrees to pay, based on the cost estimate detail at an hourly rate shown in Exhibit B, a total fee, including reimbursement for direct non-labor expenses not to exceed $129,548.95 1 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 3. The Parties hereto agree, that except as specifically provided for by this Second Amendment, that all of the terms, covenants, conditions, agreements, rights, responsibilities, and obligations of the Parties, set forth in both the Agreement and now the First Amendment shall be, and will remain in full force and effect. IN WITNESS WHEREOF, the City of Denton, Texas and the D&S Engineering Labs, have each executed this Second Amendment by and through their respective duly authorized representatives and officers on this day _____________________________. CITY OF DENTON, TEXAS A Texas Municipal Corporation By: __________________________________ Todd Hileman, City Manager ATTEST: JENNIFER WALTERS, CITY SECRETARY By: __________________________________ APPROVED AS TO LEGAL FORM: AARON LEAL, INTERIM CITY ATTORNEY By: ___________________________________ D&S D&S ENGINEERING LABS A Texas Limited Liability Corporation By: _________________________________ AUTHORIZED SIGNATURE, TITLE 2 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 Exhibit House Bill 89 - Government Code 2270 VERIFICATION I, _______________________________________________, the undersigned representative of ______________________________Company or Business name (hereafter referred to as company), being an adult over the age of eighteen (18) years of age, verify that the company named-above, under the provisions of Subtitle F, Title 10, Government Code Chapter 2270: 1. Does not boycott Israel currently; and 2. Will not boycott Israel during the term of the contract the above-named Company, business or individual with City of Denton. Pursuant to Section 2270.001, Texas Government Code: 1. with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes; and 2. -profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. ___________________________________ Name of Company Representative (Print) ________________________________ Signature of Company Representative _________________________________ Date DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 Exhibit Senate Bill 252 -Government Code 2252 CERTIFICATION I, ______________________________________________, the undersigned representative of ________________________________________________ (Company or business name) being an adult over the age of eighteen (18) years of age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152 and Section 2252.153, certify that the company named above is not listed on the website of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806.051, Section 807.051 or Section 2253.153. I further certify that should the above-named company enter into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas which do business with Iran, Sudan or any Foreign Terrorist Management Department. ___________________________________ Name of Company Representative (Print) ________________________________ Signature of Company Representative _________________________________ Date DocuSign Envelope ID: E5556FC1-E20F-45B4-A54E-B60AAA6C1157 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. Name of vendor who has a business relationship with local governmental entity. 1 2 Check this box if you are filing an update to a previously filed questionnaire. th (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7 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 Certificate Of Completion Envelope Id: E5556FC1E20F45B4A54EB60AAA6C1157Status: Completed Subject: Please DocuSign: City Council Contract 2nd REVISION 6508 Amendment 2 Source Envelope: Document Pages: 10Signatures: 7Envelope Originator: Certificate Pages: 6Initials: 1Jamie Cogdell AutoNav: Enabled901B Texas Street EnvelopeId Stamping: EnabledDenton, TX 76209 Time Zone: (UTC-06:00) Central Time (US & Canada)Jamie.Cogdell@cityofdenton.com IP Address: 129.120.6.150 Record Tracking Status: OriginalHolder: Jamie CogdellLocation: DocuSign 5/30/2018 4:43:38 PM Jamie.Cogdell@cityofdenton.com Signer EventsSignatureTimestamp Jamie CogdellSent: 5/30/2018 4:48:18 PM Completed jamie.cogdell@cityofdenton.comViewed: 5/30/2018 4:49:07 PM Senior BuyerSigned: 5/30/2018 4:51:38 PM Using IP Address: 129.120.6.150 City Of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Jason BrothersSent: 5/30/2018 4:51:40 PM jbrothers@dsenglabs.comViewed: 5/30/2018 8:46:01 PM Vice PresidentSigned: 5/30/2018 8:46:39 PM D&S Engineering Labs Using IP Address: 71.129.229.96 Security Level: Email, Account Authentication Signed using mobile (None) Electronic Record and Signature Disclosure: Accepted: 5/30/2018 8:46:01 PM ID: 3c6ebffb-83db-4147-a68d-f3ac9c2b6a38 Larry CollisterSent: 5/30/2018 8:46:43 PM larry.collister@cityofdenton.comViewed: 6/7/2018 11:28:50 AM First Assistant City AttorneySigned: 6/7/2018 11:28:59 AM City of Denton Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 9/26/2017 2:27:28 PM ID: 01f5f868-f109-4e29-ad49-21db9046c882 Jamie CogdellSent: 6/7/2018 11:29:02 AM jamie.cogdell@cityofdenton.comViewed: 6/7/2018 3:25:16 PM Senior BuyerSigned: 6/7/2018 3:27:30 PM City Of DentonFreeform Signing Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Signer EventsSignatureTimestamp Tabitha MillsopSent: 6/7/2018 11:29:02 AM Completed tabitha.millsop@cityofdenton.comViewed: 6/20/2018 8:28:43 AM City of DentonSigned: 6/20/2018 8:46:43 AM Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Todd HilemanSent: 6/20/2018 8:46:46 AM Todd.Hileman@cityofdenton.comViewed: 6/20/2018 11:04:28 AM City ManagerSigned: 6/20/2018 11:04:35 AM City of Denton Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 7/25/2017 11:02:14 AM ID: 57619fbf-2aec-4b1f-805d-6bd7d9966f21 Jennifer WaltersSent: 6/20/2018 11:04:38 AM jennifer.walters@cityofdenton.comViewed: 6/21/2018 11:51:11 AM City SecretarySigned: 6/21/2018 11:52:10 AM City of Denton Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer EventsSignatureTimestamp Editor Delivery EventsStatusTimestamp Agent Delivery EventsStatusTimestamp Intermediary Delivery EventsStatusTimestamp Certified Delivery EventsStatusTimestamp Carbon Copy EventsStatusTimestamp Sherri ThurmanSent: 5/30/2018 8:46:42 PM sherri.thurman@cityofdenton.com City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Jane RichardsonSent: 6/20/2018 8:46:45 AM jane.richardson@cityofdenton.comViewed: 6/20/2018 9:51:44 AM Assistant City Secretary City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Carbon Copy EventsStatusTimestamp Jennifer BridgesSent: 6/21/2018 11:52:13 AM jennifer.bridges@cityofdenton.comViewed: 6/25/2018 8:38:31 AM Procurement Assistant City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Jane RichardsonSent: 6/21/2018 11:52:15 AM jane.richardson@cityofdenton.comViewed: 6/26/2018 6:53:56 PM Assistant City Secretary City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Erin ClarkSent: 6/21/2018 11:52:16 AM erin.clark@cityofdenton.comViewed: 6/21/2018 12:02:23 PM Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Notary EventsSignatureTimestamp Envelope Summary EventsStatusTimestamps Envelope SentHashed/Encrypted6/21/2018 11:52:16 AM Certified DeliveredSecurity Checked6/21/2018 11:52:16 AM Signing CompleteSecurity Checked6/21/2018 11:52:16 AM CompletedSecurity Checked6/21/2018 11:52:16 AM Payment EventsStatusTimestamps 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.