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Home My WebLink AboutResolution - 2017-R0158 - Parkhill Smith & Cooper - 04/27/2017Resolution No.2017-R0158 Item No.6.22 April 27,2017 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock BE and is hereby authorized and directed to execute for and on behalf of the City of Lubbock,Amendment No. 5 to that certain Professional Services Agreement for Construction Phase Services concerning LBB Airfield-Wide Joint Seal at the Lubbock Preston Smith International Airport, between the City of Lubbock and Parkhill,Smith & Cooper, Inc., and related documents,the terms of said amendment being attached hereto and incorporated in this Resolution as if fully set forth herein and shall be included in the minutes of the Council. Passed bytheCity Council this April 27 ,2017. DANIEL M.POPE,Mayor ATTEST: "jlOjjU^ Rebecla Garza, City Secretary APPROVED AS TO CONTENT: CM^^jmjkJ^ Kelly Campbell,Executive Director of Aviation tchell Satterwhiti, First Assistant City Attorney Res.Agrmt-Amend No. 5-Prof Servs-ParkhilLSmith&Cooper,Ltd 4.3.17 Resolution No. 2017-RO158 PARKHILLSMITH&COOPER 4222 85th Street I'm Lubbock, Texas 79423 806.473.2200 March 16, 2017 Ms. Kelly Campbell, A.A.E. Director of Aviation Lubbock Preston Smith International Airport Administration Office, 2nd Floor 5401 N. Martin Luther King Jr. Blvd., Unit 389 Lubbock,Texas 79403 Re: Amendment No. 5 to Agreement for Professional Services, Design Phase Services for LBB Airfield -Wide Joint Seal Dear Ms. Campbell: As requested, we have prepared Amendment No. 5 for preliminary engineering report, preliminary design and final design phase services related to the LBB Airfield -Wide Joint Seal project. Refer to the detailed fee sheets attached for an itemization of the scope of services. The contract amendment modifies the scope of professional services included in our original agreement dated February 27, 2015. Task 1 PER Lump Sum Fee for Preliminary Engineering Report (PSC) $ 71,800.00 Task 2PDS Lump Sum Fee for Preliminary Design Services (PSC) $ 47,200.00 Task 3FDS Lump Sum Fee for Final Design Services (PSC) $ 64,000.00 TASK SRVY Lump Sum Surveying Services for Final Design (PSC) $ 14,500.00 TOTAL AMENDMENT NO.5 $ 197,500.00 We propose to modify the agreement between the City of Lubbock and Parkhill, Smith & Cooper, Inc. dated February 27, 2015 and to provide the approved Task 1, 2, 3, and SRVY services under the provisions of EXHIBIT B - PAYMENTS TO THE ENGINEER, PARAGRAPH B4.01 (Lump Sum and Hourly Rate Method) of the contract. Any necessary additional services will be provided according to EXHIBIT B - PAYMENTS TO THE ENGINEER, PARAGRAPH B4.02. Compensation for Tasks 1, 2, 3, and SRVY services shall not exceed the total above without Owner's written approval. If the terms of this amendment are agreeable to you, please sign and return one copy of this amendment to our office. We will take receipt of this signed letter as our notice to proceed with these services. We look forward to working with you in completing this project. If you have any questions, please call. Abilene Albuquerque Amarillo Austin El Paso Frisco Las Cruces Lubbock Midland team-psc.com Ms. Kelly Campbell, A.A.E. Page 2 March 16, 2017 Sincerely, PARKHIL ITH & COOPER, INC. By --J� Mark D. Haberer, PE, CM Principal/Project Manager am John T. Hamilton, PE Principal IN TRIPLICATE Accepted by: CITY OE LUBBOCK By `V" - Daniel M. Pope Mayor Attest By Re�ecca Garza Ci ecretary Approved as to Content: BO�4A& Nfr� Kelly Campbell, A.A. E. Director of Aviation App s to For By it tte i e First Assistant City Attorney MDH/amp Enclosures \\Data1\Projects\2012\0013.12\ADMIN\CONTRACTS\FEES\LBB_Airfield_JointSeaN(Campbell_Contract amendment 5.doc PARKHILL, SMITH & COOPER, INC. PROJECT BUDGET SHEET (Billing Rates) LOCATION CODE: 01 PROJECT NAME: LBB Airfield -Wide Joint Seal JOB NO.: TASK: 1PER DATE: 03/ 17/ 17 FEE TYPE: Lump Sum PREPARED BY: MDH PRINCIPAL: MDH PROJ. MANAGER: MDH MARKUP ON REIMB: 15.00% MARKUP ON DIRECTS: 15.00% $71,800 TOTAL FEE: S71,844 LABOR: $69,638 LABOR: ' $69,638 DIRECTS: $2,206 SUBTOTAL: $71,844 REIMBURSABLE. CONSULTANTS: REIMBURSABLE. EXPENSES: REIMB. DIRECT CONSULTANTS: DIRECT EXPENSES: $2,206 TOTAL FEE: $71,844 LABOR BUDGETS: DESCRIPTION LABOR CODE SS or PL Level HOURS RATE COSTS Sr Project Manager Civil/Struct X5 PL VI 58 $202.00 $11,716 Prof Eng II Civil/Struct X8 PL IV 180 $149.00 $26,820 Eng II Civil/Struct Y4 PL II 154 $107.00 $16,478 RPRIV R1 PL IV 90 $140.00 $12,600 Project Assistant (PASS) I P5 SS III 22 $92.00 $2,024 Page 1 of 3 FEE ESTIMATING SHEET PROJECT: LBB Avf cW-wide Joni seal JOB NO.: TASK: IPER SALARY Discipline, Title, Labor Code, Rates 1 2 3 4 5 6 - Staff Initials (optional) --> CADD_PASS_ Staff Discipline ---> Civil_Struct Civil_Struct Civil_Stmct RPRs Techs Clerical Sr Project Project Manager Prof Eng II Eng II Assistant Staff Tifle ---> Civil/Struct Civil/Struct Civ11/struct RPR IV (PASS) I Support Staff (SS) or Professional Level (PL) --- > PL VI PL IV PL lI PL IV SS III Labor Code ---> X5 X8 Y4 RI 1 P5 Billing Rate --- > $202.00 $149.00 5107.00 $140.00 $92.00 TASK Trips CUTAL. PRELIMINARY ENGINEERING REPORT PHASE 1 3 3 _ g Predesign Conference Coordinate geotechnical investigation and review data (not included in scope) Coordinate FWD analysis and review data (not included in the scope) Visual inspection of pavements PCN Determination and compile PCN report (o; - .0 16 90 90 90 186 included in the scope) NEPA CAT Ex (not included in scope) Preliminary Engineering Report develop design criteria compile quantifies 2 4 16 16 16 16 36 36 narrative schematic layouts opinion of costs, research unit prices 24 2 4 32 8 12 24 8 16 72 34 24 Review with LBB 1 3 3 8 BUDGET SUBTOTALS: HOURS/ Trips -1 321 581 180 154j 90j 221 504 SALARY 1 1 $11,716 1 $26,820 S16A78 1 $12,600 1 1 $2,024 1 569,638 Page 2 of 3 FEE ESTIMATING SHEET PROJECT: LBB Airfield -Wide Joint S JOB NO. TASK: 1 PER DIRECTS DIRECT CONSULTANT COSTS SUBTOTAL 611 Structural Consultant 612 Mech/Elec Consultant 613 Environ/Civil Consultant 614 Architectural Consultant 615 Testing Consultant (Geotech, CMT, TAB, etc.) 616 Surveying Consultant 618 Other Consultant - Kitchen / Food Consultant 618 Other Consultant - Acoustical Consultant 618 Other Consultant - AV/ IT Consultant 618 Other Consultant TOTAL DIRECT CONSULTANTS DIRECT EXPENSES 621 Travel Motel Days @ Men @ /Man -day = Air Travel Air Fare @ Men @ /Man = Parking Days @ /Day = Car Rental Days @ /Day = Mileage 35 Miles @ $0.535 @ 32 Trips = $599.20 SUBTOTAL S�99 622 Reproductions Blackline Prints 34" x 22" Shts @ $2.50 /Sht @ Sets = 36" x 24" Shts @ $2.75 /Sht @ Sets = 42" x 30 Shts @ $3.25 /Sht @ Sets = Other sf @ $0.55 /sf @ Sets = Mounting Foam Board Boards @ $10.00 /ea @ Printing: Set Up Fee Originals @ $0.15 /Sht @ Submittals = 8-1/2" x I I" B&W 100 Originals @ $0.09 /Sht @ 10 Sets = $90.00 8-1/2" x I V Color 100 Originals @ $0.55 /Sht @ 10 Sets = $550.00 11" x 17" B&W 50 Originals @ $0.18 /Sht @ 10 Sets = $90.00 11" x 17" Color 50 Originals @ $1.05 /Sht @ 10 Sets = $525.00 Binding Cost 10 Sets @ $2.00 /Set = $20.00 Laminating Shts @ $2.00 /Sht = Scan to file Bum to CD/DVD CD/DVD @ $13.50 /each = Scan Specs Originals @ $0.15 /Sht = Scan Drawings Originals @ $1.50 /Sht = SUBTOTAL. $1,275 623 Models/Renderings/Photos Shots @ /Shot 624 Telephone 20 Calls @ $2.00 /Call $40 625 Meals Days @ Men (c) /Man -day 626 Field Supplies 628 Postage 2 Mailings @ $2.00 /Mailing (Standard) $4 628 Postage Mailings @ /Mailing (Overnight) 630 Misc Reimbursable Exp 632 Temporary Personnel 636 Field Equip Rental 639 TDLR Review / Inspection Fees 643 NM Gross Receipt Tax TOTAL DIRECT EXPENSES 51.918 Page 3 of 3 PARKHILL, SMITH & COOPER, INC. PROJECT BUDGET SHEET (Billing Rates) LOCATION CODE: 01 PROJECT NAME: LBB Airfield -Wide Joint Seal JOB NO.: TASK: 2PDS DATE: 03/ 17/ 17 FEE TYPE: Lump Sum PREPARED BY: MDH PRINCIPAL: MDH PROJ. MANAGER: MDH MARKUP ON REIMB: 15.00% MARKUP ON DIRECTS: 15.00% —$47,200 TOTAL FEE: S47,233 LABOR: $46,593 LABOR: $46,593 DIRECTS: $640 SUBTOTAL: $47,233 REIMBURSABLE. CONSULTANTS: REIMBURSABLE. EXPENSES: REIMB. DIRECT CONSULTANTS: DIRECT EXPENSES: $640 TOTAL FEE: $47,233 LABOR BUDGETS: DESCRIPTION LABOR CODE SS or PL Level HOURS RATE COSTS Sr Project Manager Civil/Struct X5 PL VI 79 $202.00 $15,958 Prof Eng II Civil/Struct X8 PL IV 94 $149.00 $14,006 Eng 1I Civil/Struct Y4 PL 11 119 $107.00 $12,733 RPR IV RI PL IV 16 $140.00 $2,240 RPR III R2 PL III $115.00 Project Assistant (PASS) I P5 SS III 18 $92.00 $1,656 Page 1 of 3 FEE ESTIMATING SHEET PROJECT: LBB Airficld-Widc Joint Seal JOB NO. TASK: 2PO5 SALARY Discipline, Title, Labor Code, Rates 1 2 3 4 5 6 7 Staff Initials (optional) --> FP ENG ENG ENG ENG TECH CADD OPT CLERICAL CADD_PASS_ CADD_PASS_ Staff Discipline --- > Civil Struct Civil Struct Civil Struct RPRs Techs RPRs Techs Clerical Clerical Sr Project Project Manager Prol' Eng II Eng II Assistant Staff Title --> Civil/Struct CivL Struct Civil/Struct RPR IV RPR III (PASS)1 Support Staff (SS) or Professional Level (PL)--> PL VI PL IV PL II PL IV PL III SS III Labor Code --> X5 X8 Y4 RI R2 P5 Billing Rate--> $202.00 $149.00 $107.00 $140.00 5115.00 $92.00 TASK Trips TOTAL PRELIMINARY DESIGN Refine scope, coordinate with LBB 1 2 2 2 6 CSPP meeting with LBB 1 3 3 2 Complete preliminary drawings cover sheet (I sheet) I 1 summary of quantities, location map and sheet index (1 sheet) 1 I 2 4 - project airport layout plan, project general notes ( I sheet) 1 1 2 4 - stormwater pollution prevention plan (SWPPP) (1 sheet) 1 1 2 4 stormwater pollution prevention plan (site plan and 1 2 4 sheet key plan (I sheet) 1 2 4 construction phasing, safety plan and details (10 sheets) 8 16 32 56 -joint seal, spall repair and joint bevel plan sheets (20 sheets) R 16 32 56 - marking layout plan sheets (20 sheets) 4 24 24 52 - miscellaneous paving details (1 sheet) 2 4 4 10 Outline specifications - FAA Standards 2 8 4 14 Update opinion of costs 4 8 16 28 Review with LBB 1 3 3 2 8 Preliminary SQ 1 QC & Constructability Review 24 16 40 Miscellaneous meetings and conferences 2 4 4 4 12 Miscellaneous Project Management (2 months) 10 4 14 BUDGET SUBTOTALS: HOURS/ Trips - 1 51 791 941 119 161 1 181 326 SALARY 1 1$15,958 1 $14,006 1 $12,733 1 $2,240 1 1 $1,656 1 1 S46,593 Page 2 of 3 FEE ESTIMATING SHEET PROJECT: LBB Airfield -Wide Joint ;JOB NO. TASK: 2PDS DIRECTS DIRECT CONSULTANT COSTS SUBTOTAL 611 Structural Consultant 612 Mech/Elec Consultant 613 Environ/Civil Consultant 614 Architectural Consultant 615 Testing Consultant (Geotech, CMT, TAB, etc.) 616 Surveying Consultant 618 Other Consultant - Kitchen / Food Consultant 618 Other Consultant - Acoustical Consultant 618 Other Consultant - AV/ IT Consultant 618 Other Consultant TOTAL DIRECT CONSULTANTS DIRECT EXPENSES 621 Travel Motel Days @ Men @ /Man -day = Air Travel Air Fare @ Men @ /Man = Parking Days @ /Day = Car Rental Days @ /Day = Mileage 35 Miles @ $0.535 @ 5 Trips = $93.63 SUBTOTAL $94 622 Reproductions Blackline Prints 34" x 22" Slits a $2.50 /Sht @ Sets = 36" x 24" Slits a $2.75 /Sht a Sets = 42" x 30 Slits @ $3.25 /Sht @ Sets = Other sf @ $0.55 /sf @ Sets = Mounting Foam Board Boards @ $10.00 /ea @ Printing: Set Up Fee Originals @ $0.15 /Sht @ Submittals = 8-1/2" x I I" B&W 200 Originals @ $0.09 /Slit @ 1 Sets = $18.00 8-1/2" x 11" Color 200 Originals @ $0.55 /Slit @ 1 Sets = $110.00 11 x 17" B&W 30 Originals @ $0.18 /Slit @ 8 Sets = $43.20 11" x 17" Color 30 Originals @ $1.05 /Sht @ 8 Sets = $252.00 Binding Cost 8 Sets @ $2.00 /Set = $16.00 Laminating Slits @ $2.00 /Sht = Scan to file Burn to CD/DVD CD/DVD @ $13.50 /each = Scan Specs Originals @ $0.15 /Sht = Scan Drawings Originals @ $1.50 /Sht = SUBTOTAL $439 623 Models/Renderings/Photos Shots a /Shot 624 Telephone 10 Calls @ $2.00 /Call $20 625 Meals Days @ Men @ /Man -day 626 Field Supplies 628 Postage 2 Mailings @ $2.00 /Mailing (Standard) $4 628 Postage Mailings @ /Mailing (Overnight) 630 Misc Reimbursable Exp 632 Temporary Personnel 636 Field Equip Rental 639 TDLR Review / Inspection Fees 643 NM Gross Receipt Tax TOTAL DIRECT EXPENSES $557 Page 3 of 3 FEE ESTIMATING SHEET PROJECT: LBB Airfield -Wide Joint! JOB NO. TASK: 3FDS DIRECTS DIRECT CONSULTANT COSTS SUBTOTAL. 611 Structural Consultant 612 Mech/Elec Consultant 613 Environ/Civil Consultant 614 Architectural Consultant 615 Testing Consultant (Geotech, CMT, TAB, etc.) 616 Surveying Consultant 618 Other Consultant - Kitchen / Food Consultant 618 Other Consultant - Acoustical Consultant 618 Other Consultant - AV/ IT Consultant 618 Other Consultant TOTAL DIRECT CONSULTANTS DIRECT EXPENSES 621 Travel Motel Days @ Men @ /Man -day = Air Travel Air Fare @ Men @ /Man = Parking Days @ /Day = Car Rental Days @ [Day = Mileage 35 Miles @ $0.535 @ 3 Trips = $56.18 SUBTOTAL $56 622 Reproductions Blackline Prints 34" x 22" Shts @ $2.50 /Sht @ Sets = 36" x 24" Shts @ $2.75 /Sht @ Sets = 42" x 30 Shts @ $3.25 /Sht @ Sets = Other sf @ $0.55 /sf @ Sets = Mounting Foam Board Boards @ $10.00 /ea @ Printing: Set Up Fee Originals @ $0.15 /Sht @ Submittals = 8-1/2" x I V B&W 1500 Originals @ $0.09 /Sht @ 1 Sets = $135.00 8-1/2" x I V Color 500 Originals @ $0.55 /Sht @ 1 Sets = $275.00 1 V x 17" B&W 30 Originals @ $0.18 /Sht @ 10 Sets = $54.00 11" x 17" Color 30 Originals @ $1.05 /Sht @ 10 Sets = $315.00 Binding Cost 10 Sets @ $2.00 /Set = $20.00 Laminating Shts @ $2.00 /Sht = Scan to file Bum to CD/DVD CD/DVD @ $13.50 /each = Scan Specs Originals @ $0.15 /Sht = Scan Drawings Originals @ $1.50 /Sht = SUBTOTAL $799 623 Models/Renderings/Photos Shots c /Shot 624 Telephone 10 Calls @ $2.00 /Call $20 625 Meals Days @ Men @ /Man -day 626 Field Supplies 628 Postage 2 Mailings @ $2.00 /Mailing (Standard) $4 628 Postage Mailings @ [Mailing (Overnight) 630 Misc Reimbursable Exp 632 Temporary Personnel 636 Field Equip Rental 639 TDLR Review / Inspection Fees 643 NM Gross Receipt Tax TOTAL DIRECT EXPENSES $879 Page 3 of 3 PARKHILL, SMITH & COOPER, INC. PROJECT BUDGET SHEET (Billing Rates) LOCATION CODE: 01 PROJECT NAME: LBB Airfield -Wide Joint Seal JOB NO.: Pending TASK: SRVY DATE: FEE TYPE: Lump Sum PREPARED BY: SWW PRINCIPAL: MDH PROJ. MANAGER: SWW MARKUP ON REIMB: 15.00% MARKUP ON DIRECTS: 15.00% $ 1 4,500 TOTAL FEE: $14,498 LABOR: $8,896 LABOR: $8,896 DIRECTS: $5,602 SUBTOTAL: $14,498 REIMBURSABLE. CONSULTANTS: REIMBURSABLE. EXPENSES: REIMB. DIRECT CONSULTANTS: DIRECT EXPENSES: $5,602 TOTAL FEE: $14,498 LABOR BUDGETS: DESCRIPTION LABOR CODE SS or PL Level HOURS RATE COSTS' Prof Eng II Civil/Struct X8 PL IV 4 $149.00 $596 Eng Tech I U5 SS II 100 $83.00 $8,300 Eng Tech I U5 SS II $83.00 Eng Tech I U5 SS II $83.00 CADD II E6 SS II $83.00 Page 1 of 3 FEE ESTIMATING SHEET PROJECT: LBB Airfield -Wide Joint Seal JOB NO.: Pending TASK: SRVY SALARY Discipline, Title, Labor Code, Rates Staff Initials (optional) ---> Staff Discipline ---> Staff Title ---> Support Staff (SS) or Professional Level (PL)--> Labor Code --> Billing Rate--> 1 2 3 4 5 6 S W W CMW BRA NLM MTF Civil Struct RPRs Techs RPRs Techs RPRs Techs CADD_PASS— Clerical Prof Eng 11 Civil/Struct Eng Tech I Eng Tech I Eng Tech I CADD II PL IV SS 11 SS II SS II SS II X8 U5 U5 U5 E6 $149.00 $83.00 1 $83.00 SUM $83.00 TASK Trips TOTAL Field data collection to define repair locations 15 4 100 104 BUDGET SUBTOTALS: HOURS/ Trips - 15 4 100 104 11 SALARY $596 $8,300 $8,896 Page 2 of 3 FEE ESTIMATING SHEET PROJECT: LBB Airfield -Wide Joint S JOB NO. Pending TASK: SRVY DIRECTS DIRECT CONSULTANT COSTS SUBTOTAL 611 Structural Consultant 612 Mech/Elec Consultant 613 Environ/Civil Consultant 614 Architectural Consultant 615 Testing Consultant (Geotech, CMT, TAB, etc.) 616 Surveying Consultant 618 Other Consultant - Kitchen / Food Consultant 618 Other Consultant - Acoustical Consultant 618 Other Consultant - AV/ IT Consultant 618 Other Consultant TOTAL DIRECT CONSULTANTS DIRECT EXPENSES 621 Travel Motel Days @ Men @ /Man -day = Air Travel Air Fare @ Men @ /Man = Parking Days @ /Day = Car Rental Days @ /Day = Mileage 40 Miles @ $0.535 @ 15 Trips = $321.00 SUBTOTAL S321 622 Reproductions Blackline Prints 34" x 22" Shts @ $2.50 /Sht @ Sets = 36" x 24" Shts @ $2.75 /Sht @ Sets = 42" x 30 Shts @ $3.25 /Sht @ Sets = Other sf @ $0.55 /sf @ Sets = Mounting Foam Board Boards @ $10.00 /ea @ Printing: Set Up Fee Originals @ $0.15 /Sht @ Submittals = 8-1/2" x I V B&W Originals @ $0.09 /Sht @ Sets = 8-1 /2" x I V Color Originals @ $0.55 /Sht @ Sets = I V x 17" B&W Originals @ $0.18 /Sht @ Sets = I V x 17" Color Originals @ $1.05 /Sht @ Sets = Binding Cost Sets @ $2.00 /Set = Laminating Shts @ $2.00 /Sht = Scan to file Bum to CD/DVD CD/DVD @ $13.50 /each = Scan Specs Originals @ $0.15 /Sht = Scan Drawings Originals @ $1.50 /Sht = SUBTOTAL. 623 Models/Renderings/Photos Shots @ /Shot 624 Telephone Calls @ /Call 625 Meals Days @ Men (_ $15.00 /Man -day 626 Field Supplies 628 Postage Mailings @ /Mailing (Standard) 628 Postage Mailings @ /Mailing (Overnight) 630 Misc Reimbursable Ex 632 Temporary Personnel 636 Field Equip Rental $4,550 639 TDLR Review / Inspection Fees 643 NM Gross Receipt Tax TOTAL DIRECT EXPENSES $4,871 Page 3 of 3 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2017-191177 Parkhill, Smith & Cooper, Inc. Lubbock, TX United States Date Filed: 04/11/2017 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock Date Acknowledged: 04/20/2017 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2015-R0061 Amendment 5 LBB Airfield -Wide Joint Seal 4 Nature of interest Name of Interested Party City, State, Country (place of business) (check applicable) Controlling Intermediary Rangel, Rupert S. Abilene, TX United States X Hart, Daniel S. Midland, TX United States X Edwards, Jay M. Midland, TX United States X Hamilton, John T. Lubbock, TX United States X Moss, Mike W. Lubbock, TX United States X Davis, Edwin E. Lubbock, TX United States X Rapier, Joseph R. Lubbock, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said this the day of 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.n.SR3 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2017-191177 Parkhill, Smith & Cooper, Inc. Lubbock, TX United States Date Filed: 04/11/2017 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 2015-R0061 Amendment 5 LBB Airfield -Wide Joint Seal 4 Nature of interest Name of Interested Party City, State, Country (place of business) (check applicable) Controlling I Intermediary Range], Rupert S. Abilene, TX United States X Hart, Daniel S. Midland, TX United States X Edwards, Jay M. Midland, TX United States X Hamilton, John T. Lubbock, TX United States X Moss, Mike W. Lubbock, TX United States X Davis, Edwin E. Lubbock, TX United States X Rapier, Joseph R. Lubbock, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. ``""""•• APRIL M. PIER Notary Public, State of Texas 1 Comm. Expires 08-10-2019 Notary ID 13032945•5 ture of authorized agent of contracting business entity Stla AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said V(iY l� I •I I� this the JL — day of r) / 20 to certify which, witness my hand and seal of office. (",Sig,ture of o4eradmiristering oath Printed nanAe of officer administering oath Title of officer administering oath Pnrms nrnvirieri by Texas Fthirs Cnmmissinn www_ethirs_state_tx_us Version V1.0.883