The URL can be used to link to this page

Home My WebLink AboutResolution - 2017-R0165 - Utility Contractors Of America, Inc. - 05/11/2017Resolution No. 2017-RO165 Item No. 6.7 May 11, 2017 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Change Order No. 1 to that certain Contract No. 12733 by and between the City of Lubbock and Utility Contractors of America, Inc. for the Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase 1, and related documents. Said Change Order No. 1 is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on May 11. 2017 DANIEL M. POPErMAYOR ATTEST: a Garza, City AS TO C L. WodjlFranVin, P.E., Director ohPublic Works APPROVED AS TO FORM: K lli Leisure, Assistant City Attorney RES.ChgOrd# ].Contract 12733-UtiI ityContractorsofAmerica 04.05.17 City of Lubbock Purchasing and Contract Management Change Order Contract No: 12733 Contractor: Utility Contractors of America, Inc. Change Order No. 001 Contract Title: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase 1 BID/RFP No. 16 -12733 -TF Project Number: 160-10629-101 1. "Change Order" means a written order to a Contractor executed by the Owner in accordance with the contract authorizing an addition to, deletion from, or adjustment or revision of the requirements of the contract documents, or an adjustment to the compensation payable to Contractor, or to the time for performance of the contract and completion of the Project, or a combination thereof, which does not alter the nature of the thing to be constructed and is an integral part of the project objective. Adjustments to "Estimated Quantities" to a line item in a Unit Price contract do not require a Change Order. All work that alters the nature of the thing to be constructed or that is not an integral part of the project objective must be let out for public bid. Description of change (alteration, deviation, addition, or deletion) caused by conditions encountered during construction not covered by the specifications and drawings of the project (attach additional pages if necessary): The Work of this Project involves the rehabilitation of the Canyon Lakes Sanitary Sewer. Change Order 1 include modifications to the original construction documents to add new segments and to adjust the intent of the original drawings. Refer to the attachments. 2. Where the Change Order is negotiated, the Change Order must be fully documented and itemized as to costs, including material quantities, material costs, taxes, insurance, employee benefits, other related costs, profit and overhead. Where certain unit prices are contained in the initial contract, no deviations are allowed in computing negotiated change order costs. ITEMIZED COSTS MUST BE FULLY DOCUMENTED AND ATTACHED TO THIS FORM. ITEM DESCRIPTION AMOUNT A. ORIGINAL CONTRACT VALUE: $ 5,09793600 B. AMOUNT OF THIS CHANGE ORDER: council approval required ifover 525,000 $ 350,67911 COST CENTER: 30000 ACCOUNT: 92318 C. PERCENT OF CONTRACT VALUE THIS CHANGE ORDER (B A): +6.88 0/0 D. AMOUNT OF PREVIOUS CHANGE ORDERS: $ 0.00 E. TOTAL AMOUNT OF ALL CHANGE ORDERS (B+D): $ 359,67911 F. PERCENT OF CONTRACT OF ALL CHANGE ORDERS (E A): 25"„ increase +666 010 or decrease G. NEW CONTRACT AMOUNT (A+E): $ 5,448.617.11 3. It is mutually agreed that the above dollar amount and the time extension, as applicable, as set forth in this Change Order constitutes full compensation to the Contractor for all costs, expenses and damages to the Contractor, whether direct, consequential or otherwise, in anyway incident to, or arising out of or resulting directly or indirectly; from the work performed or modified by the Contractor under this Change Order. This Change Order is not valid without the following signatures (please sire in order and return 3 originals with Contract Cover Sheet to Purchasing- and Cont% cr, ana enient D_ fEartmeng: (I) CONTRACTOR Date (2) PROJECT ARCHITECT EN` EER at e� Approved as to Content jApp ye to Fso NE ' EPRESENTATNE a (4) ITY ATTORNEY Date f' �` ✓ (5) CAPI AL PROJECTS MANAGER Date (6) PURCHASING AND CONTRACT MANAGER Date ange Orders over S25,000 require a Contract C Sat Sheet and the following signure CITY�F"2EK ATTE 5/11/17 a5/11/17 (7) MAYOR Date (8) CITY SECETARY ate Council Date: May 11, 2017 Agenda Item #: 6.7 Resolution #: 20 - 165 PUR45 (Rev 12'2012) City of Lubbock Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase 1 Change Order No. 1 DESCRIPTION OF CHANGE ORDER a. Per PCM No. 1, for relocation of the 16" water line at University Avenue to accommodate rehabilitation of interceptor crossing. b. Per PCM No. 2, for casing limit modifications per the revised TxDOT crossing permit at Clovis Road and Texas 289 Loop. c. Per PCM No. 3, for modified bore alignment accommodation at the Texas Loop 289 Crossing and rerouting of 12" force main. d. Per PCM No. 4, for the addition of new manholes at Canyon Lake Drive and Joyland. e. Per PCM No. 4A, a revision to the original PCM 4, upsizing the manhole at Canyon Lake Drive. f. Per PCM No. 5, for the removal and replacement of the existing 30" sanitary sewer aerial section at Segment 21 on the Downtown interceptor. The metal pipe had open holes and public pedestrian traffic. g. Per PCM No. 6, for the installation of 157 LF of encased pipe at Segment 6/7 by open -cut, additional utility investigation for Segment 15 and a credit for not grouting the casing installations. h. Per PCM No. 7, for the removal and replacement of the existing 24" sanitary sewer aerial section at Segment 22 on the Downtown interceptor and next to the aerial section in PCM No. 5. The metal pipe was very thin and was developing holes and had public pedestrian traffic. i. Per PCM No. 8, for completion of a sanitary sewer point repair in the middle of the MLK Blvd median to fix damage caused by a light pole installation. j. Per PCM No. 8A, a revision to the original PCM 8 to change from a point repair to a manhole installation. k. Per PCM No. 9, for additional casing at the TxDOT access road from Clovis Road to the Texas Loop Frontage Road at the request of TxDOT. EFFECT OF CHANGE Extended Additional Item Description Unit Cost Days a. PCM No. 1 Lump Sum $ 29,400.00 30 b. PCM No. 2 Lump Sum $ 0.00 0 C. PCM No. 3 Ne. Lump Sum c $ 0.00 0 El. e. ISM PCM No. 4A Lamn ,Q�^.^�^�12 Lump Sum $ 41,600.00 12 f. PCM No. 5 Lump Sum $ 180,217.67 45 9. PCM No. 6 Lump Sum $ -84,648.56 0 h. PCM No. 7 Lump Sum $ 151,685.00 0 —� j. PGM Ne 8 PCM No. 8A Lump Sum Lump Sum $ $ 35 775.0A 21,175.00 21 21 k. PCM No. 9 Lump Sum $ 11,250.00 0 Total $ 350,679.11 108 ewnkwood,Andrewsrews'■`�s�nAoNcirf- am,Inc. A DALY CUA+PA`.'+ PROPOSED CONTRACT MODIFICATION NO. 1 Date: September 20, 2016 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: 16" Water Line Repair at University Avenue Description (List attachments, if any): This PCM is for the relocation of the existing 16" water line at University Avenue in order to rehabilitate Canyon Lakes Sanitary Sewer Interceptor. See attachment 1, 16" Water Main Repair and Relocation and UCA Proposal for $29,400 and 30 calendar days. Reason for Change: Previously unidentified conflict with proposed Canyon Lakes Interceptor and existing 16" water line at University Avenue owned by the City of Lubbock. Recommended Lockwood, Andrews & Newnam Inc. By: Engineer 9/20/2016 R resents a Date Accepted By: Utility ntractors of America Contractor 9/20/2016 resentative Dale Approved By: Owner Representative (Sign, Keep Original Copy and Return All Others. See Heading for Return Address.) Date Lockwood, Andrews & am, Inc. ri LNewnEO . D kLY COMP %NN City of Lubbock 16" Water Main Repair Relocation Repair Lockwood, Andrews & Newnam, Inc. The following outlines the necessary steps to restore the existing 16" bar wrapped concrete cylinder pipe water main to active service by installing a relocation section to remove the obstruction to a 36" steel encasement pipe for a gravity sewer main. Refer to the attached drawings. The relocation shall be completed as follows: 1.0 The Contractor shall remove a section of the existing water main and continue the installation of the 36" steel encasement for the gravity, sewer main. The steel encasement pipe shall be installed to the ROW line or a minimum of 9' past the centerline of the existing water main, whichever is greater. 2.0 Once Encasement pipe is installed, the clearances for the relocated line shown in the attached drawing shall be maintained. 3.0 The Contractor shall weld a plain end (PE) adapter on each end of the remaining 16" pipe with a butt strap. The installation of the adapter and butt strap shall be according to the requirements of the manufacturer of the bar wrapped pipe, FORTERRA. PE adapters shall be epoxy coated for corrosion resistance. 4.0 The Contractor shall then install epoxy coated 16" ductile iron 900 (MJxMJ) bends as shown on the attached drawings. Bends shall be secured to the PE pipes through the use of EBAA Iron MEGA -LUG restraint glands or the approved equivalent. These pipe restraints shall be installed according to the manufacturer's recommendations. 5.0 The Contractor shall then install either 16 inch C900 PVC pipe as shown on the attached detail. All pipe shall utilize EBBA Iron MEGA -LUG PVC restraint glands or the approved equivalent installed in accordance with the manufacturer's recommendations. The Contractor shall maintain the minimum required distance of 18" of clearance on all sides of the new gravity sewer steel casing. 6.0 The Contractor shall install all 901 (MJxMJ) bends and pipe with EBAA Iron MEGA -LUG pipe restraints. 7.0 The Contractor shall install a 1" epoxy coated saddle on the highest point of the piping with a one inch corp stop for 1 inch Copper tubing. This tubing shall extend upward to an access box just off the ROW which will house an air release valve. The air release valve shall be an A.R.I. S-050 valve and shall be all plastic. Valve shall be installed such that is always maintained vertically. Contractor shall drive a steel fence post in the ground and zip tie 1" Copper tubing to post to maintain vertical installation with'/" zip ties. Air release valve shall be installed in a standard COL water meter box 6" off the ROW. 8.0 All of the installation shown in the details will have to be backed or stabilized with concrete or flowable fill as shown on the plans. 1320 South University Drive, Ste 450 • Fort Worth, Texas 76107 • 817.820.0420 • Fax: 817.820.0441 • www.lan-inc.com �n Lockwood, Andrews & Newnam, Inc. A LEO A DALY COMPANY A. Concrete Backfill. Contactor shall backfill all voids with 3000 psi concrete. Concrete shall be required between the two lower 16" 900 bends, under the 36" casing All fittings and piping shall be wrapped in plastic prior to installation of concrete. Care shall be taken to ensure that concrete does not fall into steel encasement pipe. B. Flowable Backfill. All fittings and piping shall be wrapped in plastic prior to installation of flowable fill. Once plastic wrapping are installed, Contractor shall carefully install flowable fill according to the detail to completely encapsulate the installation as shown in the detailed drawings attached. 10.0 General Backfill. Contractor shall install and compact backfill in 8" lifts to restore shoulder behind the curb to its original condition on the TxDOT ROW. 1320 South University Drive, Ste 450 • Fort Worth, Texas 76107 • 817.820.0420 • Fax: 817.820.0441 • www.lan-inc.com I ,III I II lu W IIS VLV o II I IIS III " IT, oC.O.L. METER BOX FOR AIR RELEASE VALVE x III I 329+00 16" WATERLINE \ IMPROVEMENTS AT \ , WASTEWATER CROSSING. SEE SHEETS 2 & 3. I 7III ' CANYON LAKES INTERCEPTOR � I TIT-\ Q = I I 24" WW IN 36" STEEL CASING x 0 L i I GUY IN ul � . i PP '� O TRANS]goX VLT r- -3197- I I � � 3197 _-_�_ I I � IIS III W I N II I II II 16" WATERLINE CROSSING - PLAN VIEW SCALE: 1"--20' CANYON LAKES INTERCEPTOR 16" WATERLINE CROSSING - N UNIVERSITY AVENUE �n 0 SHEET 1 OF 3 Lockwood, Andrews & Newnam, Inc. A SUBSIDIARY OF LEO A DALY I 3220 3210 3200 3190 [clEil8A 3170 3160 1 "AIR RELEASE - EXIST. GROUND 18" MIN. - Q PROP. 16" W.L. (C900) v L_ 24" WW IN 36" CASING L 18" MIN. (TYP.) 16" WATERLINE CROSSING (WATER OVER WASTEWATER) SCALE: 1"--10' 3220 3210 3200 3190 3180 3170 3160 SHEET OF CANYON LAKES INTERCEPTOR Lockwood, Andrews & Newnam, Inc. 16" WATERLINE CROSSING - N UNIVERSITY AVENUE A SUBSIDIARY OF LEO A D A L Y M N O d CC w W Q. Z E O J Oc m as �WI or-; I J< Wob x Z< O� Cc,- � Nw QN i �� I W rna ��o wh� I �1- Irm waw om m` I `�� I �Z o� �O CL CoLU Z I W3 I =W Lu a � UO Q wp ° 0 0 OxOr Ww ° Um or m W J ZW�uj co i C Ww v W J a � �W � w C/) Qm W�0? w IWjQ� � Q N W w w V- Q U ° Z O O Z CC O U w CL O Z U oo = --i Z J w W� a^ JAM 1z UQ Q ui C) LL LU I QJ I mcc m U mJZ I m� I �m aiwo ^w I m0 �vz o� I (Q I LLI CoQ Cal I �'<� I �Z Leo Z � I w3 I C U o Q O Z .= N Proposal From: Utility Contractors of America, Inc Project: 1257 5805 CR 7700 Description: 16' Water Line repair for Canyon Lubbock, TX 79424 USA Lakes (University Avenue) Phone: 806-863-2642 Fax: 806-863-4132 ITEM/ DESCRIPTION BID QTY U/M UNIT BID AMOUNT 16" C-905 20.000 LF $500.00 $10,000.00 16" C-905 Water Pipeline Restrained 1" Air Valve 1.000 EA $1,600.00 $1,600.00 1" Air valve w/box DI Fittings 1.000 LS $4,000.00 $4,000.00 Ductile Iron Fittings Flow Fill 10.000 CY $100.00 $1,000.00 Flowable Backfill 3,000 psi concrete 10.000 CY $130.00 $1,300.00 3,000 psi concrete Trench Safety 1.000 LS $1,500.00 $1,500.00 Trench Safety Tie to Existing 16" 2.000 EA $5,000.00 $10,000.00 Tie to Existing 16" SCRC Proposal TOTAL BID: $29,400.00 Signature: LanLockwood,, Andrews &_NewnanInc. A LC:, A UA V C.M ABY PROPOSED CONTRACT MODIFICATION NO.2 Date: September 26. 2016 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Clovis Road/Texas 289 Loop TxDOT Crossing Permit Description (List attachments, if any): This PCM is for the casing limit modifications per the revised TxDOT crossing permit at Clovis Road and Texas 289 Loop. See attachment 1, TxDOT Crossing Approval Form (LBB20160105155814), and attachment 2, Canyon Lakes Sanitary Sewer Interceptor Rehabilitation — Phase 1 plan sheet C-212. Reason for Change: Casing limits modified per TxDOT comments. Recommended e s & Newnan Inc. By: 9/26/2016 *Q�nkagtors Date Accepted By: of America Ctillty Con ��- / 1 09/27/2016 resenlative V Dale Approved By: Owner Representative (Sign, Keep Original Copy and Return All Others. See Heading for Return Address.) Date Approval Form Online version 11/2005 To Zoltan Fekete City of Lubbock 1625 13th Street Lubbock, TX 79407 APPROVAL Date 9/13/2016 Application No. LBB20160105155814 District App. No. Sewer Highway SL 0289 Control Section 078302 Maintenance Section LubLB) bock County Maintenance SE Office County Lubbock TxDOT offers no objection to the location on the right-of-way of your proposed utility installation, as described by Notice of Proposed Utility Installation No. LBB20160105155814 (District Application No. Sewer) dated 9/13/2016 and accompanying documentation, except as noted below. Not applicable When installing utility lines on controlled access highways, your attention is directed to governing laws, bspecially to Texas Transportation Code, Title 6, Chapter 203, pertaining to Modernization of State Highways; Controlled Access Highways. Access for serving this installation shall be limited to access via (a) frontage roads where provided, (b) nearby or adjacent public roads or streets, (c) trails along or near the highway right-of-way lines, connecting only to an intersecting roads; from any one or all of which entry may be made to the outer portion of the highway right-of-way for normal service and maintenance operations. The Installation Owner's rights of access to the through -traffic roadways and ramps shall be subject to the same rules and regulations as apply to the general public except, however, if an emergency situation occurs and usual means of access for normal service operations will not permit the immediate action required by the Utility Installation Owner in making emergency repairs as required for the safety and welfare of the public, the Utility Owners shall have a temporary right of access to and from the through -traffic roadways and ramps as necessary to accomplish the required emergency repairs, provided TxDOT is immediately notified by the Utility Installation Owner when such repairs are initiated and adequate provision is made by the Utility Installation Owner for convenience and safety of highway traffic. The installation shall not damage any part of the highway and adequate provisions must be made to cause minimum inconveniences to traffic and adjacent property owners. In the event the Installation Owner fails to comply with any or all of the requirements as set forth herein, the State may take such action as it deems appropriate to compel compliance. It is expressly understood that the TxDOT does not purport, hereby, to grant any right, claim, title, or easement in or upon this highway; and it is further understood that the TxDOT may require the Installation Owner to relocate this line, subject to provisions of governing laws, by giving thirty (30) days written notice. If construction has not started within six (6) months of the date of this approval, the approval will automatically expire and you will be required to submit a new application. You are also requested to notify this office prior to commencement of any routine or periodic maintenance which requires pruning of trees within the highway right-of- way, so that we may provide specifications for the extent and methods to govern in trimming, topping, tree balance, type of cuts, painting cuts and clean up. These specifications are intended to preserve our considerable investment in highway planting and beautification, by reducing damage due to trimming. Special Provisions: GENERAL NOTES SANITARY SEWER LINES You are required to notify TxDOT 48 hours (2 business days) before you start construction to allow for proper inspection and coordination of work days and traffic control plans. Use the UIR website for the 48-hour notification. DO NOT start construction until you have coordinated the construction start date and inspection with TxDOT. You are also required to keep a copy of this Approval, the Notice of Proposed Installation, and any approved amendments at the job site at all times. By Title District Texas Department of Transportation Ted Moore Director of Maintenance Lubbock GENERAL NOTES A copy of the approved Notice of Proposed Installation and all of its attachments must be kept on site and accessible at all times during construction. This includes the complete Notice, Approval Form, any approved Amendments, and General Notes and Special Provisions. If this information is not on the job site, construction may be halted until it can be provided. Once a permit is approved, no changes shall be made without prior authorization from TxDOT. When field changes are needed, TxDOT must review and approve these changes. If the scope of work changes significantly, the utility company may be asked to stop construction and submit a revised request that reflects these amendments for approval. All utility installations authorized by the department shall be subject to inspection and testing as may be deemed necessary by TxDOT to verify that work is being done in accordance with the Utility Accommodation Rules and TxDOT requirements. If the department determines that the facility was not installed in the location and at the depth shown on the approved notice, the department may require the utility to take appropriate corrective action as determined by TxDOT. The utility owner shall be responsible for the safety of, and shall minimize the disruption to, the traveling public with proper traffic control. Appropriate measures shall be taken in the interest of safety, traffic convenience, and access to adjacent property. Warning and protective devices including flaggers shall be used to prevent traffic hazards and to ensure the safety of the traveling public. Traffic Control Plans shall be in accordance with the Texas Manual of Uniform Traffic Control Devices. Any lane closures require TxDOT authorization and a 48 hour notice prior to set up. All personnel within the right-of-way shall wear high -visibility safety apparel that meets the Performance Class 2 or 3 requirements of the ANSI/ISEA 107-2004. Any utility pits or above ground obstructions within the horizontal clearance shall be properly protected, in compliance with National Cooperative Highway Research Project Report 350, with concrete traffic barriers, metal beam guard fencing, appropriate end treatments, or other appropriate warning devices. No construction work within the right-of-way will be allowed on Saturday, Sunday, Federal Holidays, during inclement weather or before or after sunset unless the contractor has written permission from TxDOT. Lines crossing beneath any existing highway shall be installed by boring or tunneling. Jacking or Water Jetting will not be permitted. Annular voids greater than one inch between the bore hole and the casing shall be filled with a slurry grout or other Plowable fill acceptable to the department. Excavated material shall be backfilled immediately after operations have been completed. Said material shall be compacted to a density approximating the adjacent undisturbed soil using mechanical equipment. All excess excavation, materials, supplies, etc. shall be removed from the right-of-way after installation is complete and the right-of-way reshaped to its original condition including fertilizing, seeding and/or sod as may be required when existing grass has been disturbed. The utility shall not cut into the pavement or concrete surfaces without written permission from the department. When nonmetallic pipe is installed, whether longitudinally or crossings, a durable metal wire or other district -approved means of detection shall be concurrently installed. Lubbock District Revised July 2014 Ijp SPECIAL PROVISIONS SANITARY SEWER LINES LOCATION — All parallel underground utilities shall be placed on uniform alignment within five feet of the right of way line. In no case shall the utility be placed in the bottom of the ditch or on the front slope. Any alignment change outside of five feet from the right of way MUST BE APPROVED BY TxDOT. LONGITUDINAL — The minimum depth of cover shall be 30 inches. CROSSINGS — The minimum depth of cover to the top of the casing shall be 30 inches, but not less than 18 inches below any pavement structure. Underground utilities crossing the highway shall be encased in the interest of safety, protection of the utility, protection of the highway, and for access to the utility. Pressurized line crossings under paved highways within the limits of the right of way shall be placed in steel encasement pipe. Gravity flow lines not conforming to the minimum depth of cover shall be encased in steel or concrete. Casing lengths with no longitudinal connection must be the full width of the right of way. MATERIAL TYPE - All material types used for sanitary sewer lines shall conform to 30 TAC 317.2 and applicable local requirements. INSTALLATION - Lines placed beneath any existing highway shall be installed by boring or tunneling. Jacking or Water Jetting will not be permitted. MANHOLES — Manholes serving sewer lines up to 12 inches shall have a maximum inside diameter of 48 inches. For lines larger than 12 inches, the manhole inside diameter may be increased an equal amount, up to a maximum diameter of 60 inches. Manholes for large interceptor sewers shall be designed to keep the overall dimensions to a minimum. The outside diameter of the manhole chimney at the ground level shall not exceed 36 inches. LIFT STATIONS — Lift stations and pump stations for sanitary sewer lines exceeding 48 inches inside diameter shall be located outside the limits of the right of way. Lubbock District Revised July 2014 ljp LanLAndrewsockwo, & Newnamod, Inc. A LW A DALY COM P, PROPOSED CONTRACT MODIFICATION NO. 3 Date: October 26, 2016 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Force main extension and revised manhole location at Clovis Road/Texas 289 Loop to accommodate modified bore alignment and the existing 42 -in waterline. Description (List attachments, if any): This PCM is to accommodate the modified bore alignment at the Texas Loop 289 Crossing. Reference the attached drawing for proposed revisions including the following: Re-route the 12 -in force main to the proposed manhole at Station 7+61.24 above the existing 42 -in COL waterline and abandon the existing 12" gravity sewer from Station 7+61.24 southwest and existing manholes on the southwest side of Landmark Ln. Reason for Change: Revised bore alignment across the Texas Loop 289 Crossing (contractor hit a segment of rock causing the bore alignment to shift horizontally approximately 6 -ft). Recommended Lockwood, Andrews & Newnam Inc. By: Engine r 10/26/2016 preve Date Accepted By: �WR:ontractors of America Contractor 9e94_6f t /0 10/28/2016 presentative Date Approved By: Owner Representative (Sign, Keep Original Copy and Return All Others. See Heading for Return Address.) Date LanLcokwood, Andrews&Newnam, Inc. A LCo A DALV COAlPA\Y PROPOSED CONTRACT MODIFICATION NO.4 Date: December 9, 2016 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Additional 5' Diameter Manholes on Canyon Lakes 24" Interceptor. Description (List attachments, if any): This PCM adds manholes at Canyon Lake Drive and Joyland. The two 5' diameter manholes shall be installed at the locations shown in the attached Exhibits A & B. This adds twelve (12) days to the contract. Reason for Change: This change provides access to the sewer line in order to accommodate the Phase IA cleaning & CCN contract. Recommended Lockwood, Andrews & Newnam. Inc. By: Engineer L! 12/9/2016 Representative Dale Accepted By: Utility Contractors of America Contractor [yyfyL 12/13/2016 resentative ' F Date Approved By: City of Lubbock Owner Representative (Sign, Keep Original Copy and Return All Others. See Heading for Return Address.) Date DUNBAR HISTORICAL LAKE PA. I I 1 "N'T Zfl SHEET KEY MAP CITY OF LUBBOCK 180.0'0" 45' CANYON LAKES INTERCEPTOR 30" SANITARY SEWER r L • 'CIl OF LUBB06ff PROP. 5' DIA. WWMH PROVIDE 5' STUB—OUT AT —0.08% SLOPE FOR FUTURE CONNECTION. CITY OF FL EXIST. 30"=3133.72 LUBBOCK FL PROP. 30"=3133.62 DEPTH=5.98 SEE NOTE 1. N=7268529.55 E=963042.98 RESTORE ROAD TO ORIGINAL CONDITION. REFER TO COL PAVEMENT REPAIR DETAILS. 1. FIELD VERIFY FLOWLINE OF EXISTING 30" SANITARY SEWER AT MANHOLE, AND INSTALL PROPOSED 5' STUB—OUT WITH A FLOWLINE ELEVATION 0.10' BELOW EXISTING SEWER AT —0.08% SLOPE. CANYON LAKES SANITARY SEWER INTERCEPTOR REHABILITATION PCM 4 - EXHIBIT A NEW MANHOLE AT CANYON LAKE DRIVE 0 12.6 26 60 caF� 1 INCH = 60 Ff Lockwood, Andrews & Newnam, Inc. A SUBSIDIARY OF LEO A QALY JOYLAND AMUSEMENT PARK 1� MARSHA SHARP FWY N x MARSHA SHARP FWY. E BROADWAY SHEET KEY MAP SCUP: 1.-2000' PROP. 5' DIA. WWMH FL EXIST. 24"=3146.88 (FIELD VERIFY) RIM=3166.6± DEPTH=22.00' N=7277849.16 E=953909.45 CANYON LAKES INTERCEPTOR 24" SANITARY SEWER 152'24'55" ® I JOYLAND AMUSEMENT PARK f CITY OF LUBBOCK CANYON LAKES SANITARY SEWER INTERCEPTOR REHABILITATION PCM 4 - EXHIBIT B NEW MANHOLE AT JOYLAND 0 12.8 ab 60 ( IN FEET ) 1 INCH = 50 Ft Lockwood, Andrews & Newnam, Inc. A SUBSIDIARY OF LEO A DALY p CANYON LAKES SANITARY SEWER INTERCEPTOR REHABILITATION PCM 4 - EXHIBIT B.1 I n I AS-BUILTS Lockwood, Andrews & Newnam, Inc. A SUBSIDIARY OF LEO A DALY I `7 4 p CANYON LAKES SANITARY SEWER INTERCEPTOR REHABILITATION PCM 4 - EXHIBIT B.1 I n I AS-BUILTS Lockwood, Andrews & Newnam, Inc. A SUBSIDIARY OF LEO A DALY I Lan&,o Lckwood,Andrews Newnam,Inc. tri � n,ety co,.;PA PROPOSED CONTRACT MODIFICATION NO. 4A Date: February 8, 2017 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Additional Manholes on Canyon Lakes Interceptor. Description (List attachments, if any): This PCM is a revision to the original PCM 4 and adds manholes at Canyon Lake Drive and Joyland. The 5' diameter manhole and 7' diameter manhole, shall be installed at the locations shown in the attached Exhibits A & B. This adds twelve (12) days to the contract. See itemized unit price below: • Item 17 — New 60 -inch diameter fiberglass manhole $14,000/EA. Additional cost of $14,000.00. • Item 19 — New 60 -inch diameter fiberglass beyond 6 VF $350NF (16 VF). Additional cost of $5,600.00 • Item 20 — New 84 -inch diameter fiberglass manhole $22,000/EA. Additional cost of $22,000.00. The total increase in contract price for changes in these items is $41,600.00. 12 days will be added to the contract for these changes. Reason for Change: This change provides access to the sewer line in order to accommodate the Phase IA cleaning & CCTV contract. Recommended Lockwood, An.0rews & Newnam, Inc. By: Engineer L� 02/08/2017 Representative Date Accepted By: Utility Contractors of America Contractor rult�trL Zc�, 02/09/2016 Resentalive 4t! Dale Approved By: City of Lubbock Owner Representative (Sign. Keep Original Copy and Return All Others. See Heading for Return Address.) Date 180'0'0" , —_, CANYON LAKES INTERCEPTOR 30" SANITARY SEWER CITY OF LUBBOCK' LIL - n.. DUNBAR HISTORICAL _- _LAKE 1636 SHEET KEY MAP SCAM ,•—sooty CITY OF LUBBOCK RESTORE ROAD TO ORIGINAL CONDITION. REFER TO COL PAVEMENT REPAIR DETAILS. PROP. 7' DIA. WWMH. PROVIDE 5' STUB–OUT AT –0.04% SLOPE FOR CITY OF FUTURE CONNECTION. LUBBOCK SEE ENLARGED VIEW ON EXHIBIT A.1. FL EXIST.30"=3131.91 FL PROP. 30"=3131.91 DEPTH=7.69 SEE NOTE 1. N=7268529.55 E=963042.98 1. FIELD VERIFY FLOWLINE OF EXISTING 30" SANITARY SEWER AT MANHOLE, AND INSTALL PROPOSED 5' STUB–OUT AT SAME FLOWLINE ELEVATION AT MANHOLE CONNECTION WITH A –0.04% SLOPE OUT. CANYON LAKES SANITARY SEWER INTERCEPTOR REHABILITATION PCM 4 - EXHIBIT A NEW MANHOLE AT CANYON LAKE DRIVE 0 12.5 25 50 (IN FM) 1 OUCH = 60 FT Lockwood, Andrews & Newnam, Inc. A SUBSIDIARY OF LEO A DALY EXISTING 30" SEWER V: i PROPOSED 7' DIA. WWMH ON EXISTING 30" INTERCEPTOR. FL EXIST. 30" IN (NW)=3131.91 FL EXIST. 30" OUT (SE)=3131.91 FL PROP. •30" OUT (E)=3131.91 EXISTING 30" SEWER PROPOSED 5 L.F., 30" STUB—OUT FOR FUTURE CONNECTION ® —0.04%. ENLARGED VIEW SCALE: 1" = 5' CANYON LAKES SANITARY SEWER INTERCEPTOR REHABILITATION PCM 4 - EXHIBIT A.1 Lockwood, Andrews NEW MANHOLE AT CANYON LAKE DRIVE A SUBSIDIARY OFLEInc. A DALY ENLARGED VIEW MARSHA SHARP FWY. PROP. 5' DIA. WWMH FL EXIST. 24"=3146.88 (FIELD VERIFY) RIM=3166.6± DEPTH=22.00' N=7277849.16 E=953909.45 JOYLAND AMUSEMENT PARK MARSHA SHARP N 2 CANYON LAKES INTERCEPTOR 24" SANITARY SEWER .\ 152'24'55" �\ JOYLAND AMUSEMENT PARK \ \ CITY OF LUBBOCK r R 1 ti 0 12.5 25 50 ( IN Feer ) I INCH = 50 Fr CANYON LAKES SANITARY SEWER INTERCEPTOR REHABILITATION PCM 4 - EXHIBIT B Lockwood, Andrews & Newnam, Inc. NEWMANHOLE AT JOYLAND A SUBSIDIARY OF LEO A DALY C 9 -W 2 R CANYON LAKES SANITARY SEWER INTERCEPTOR REHABILITATION PCM 4 - EXHIBIT B.1 I n I AS-BUILTS Lockwood, Andrews & Newnam, Inc. A SUBSIDIARY OF LEO A DALY LanAoNLED e+nmckwood,Andrews am,Inc. A DALY COMPANY PROPOSED CONTRACT MODIFICATION NO. 5 Date: November 15-2016 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Existing gravity sanitary sewer aerial interceptor and manhole removal and replacement at Segment 21 to accommodate failing pipe. Description (List attachments, if any): This PCM is to accommodate the removal and replacement of the existing 30" sanitary sewer aerial interceptor at Segment 21. Reference the attached drawings for proposed revisions including the following: Remove and replace existing 30" ductile iron sewer main with 227 linear feet of 30" PVC pipe and embedment from Station 0+00 to Station 2+26.94, remove and replace existing manhole DT2-005 at Station 0+00 and manhole DT2-005B at Station 2+26.94, remove existing manhole DT2-005A at Station 0+71.42, install 1/8" x 2" straps and 3/8" anchors to existing pipe supports, install approximately 16 cubic yards of flowable fill below the proposed 30" sewer line, install approximately 180 cubic yards of dirt fill, include bypass pumping and site restoration. $180,217.67 and 45 calendar days Reason for Change: Existing sanitary sewer pipe is in poor condition with corroded segments of pipe with open holes causing sanitary sewer overflows and inflow. Recommended Lockwood, Andrews & Newnam, Inc. By: Engineer 11115/2016 Representative Date Accepted By. Utility Contractors of America . Contractor. ru L� Z4¢g " P 12/01/2016 resentative 41 V Date Approved By: Owner Representadve (Sign, Keep Orlglnal Copy and Return All Others. see Heeding for Return Address.) Data Lubbock Canyon Lakes Interceptor Rehabilitation - Phase 1 PCM 5 PAY APPROXIMATE UNITS DESCRIPTION OF ITEM UNIT TOTAL UCA COST ITEM QUANTITY PRICE PROPOSAL New 2 EA Furnish and install 4 bollards around manhole $ 1,033.00 $ 2,066.00 New 16 CY Flowable Fill $ 100.00 $ 1,600.00 New 20 CY Topsoil $ 12.00 $ 240.00 New 1 1801 CY ISelect Fill Backfill $ 10.00 $ 1,800.00 New ? 1 LA lFurnish and install steel pipe straps with anchors $ 75.00 $ 525.00 TOTAL NEW ITEMS $ 6,231.00 Setup, operate, maintain, and remove bypass pumping and la I LS appurtenances as required for segment 25 improvements $ 30,000.00 $ 30,000.00 Furnish and install 30 -inch sanitary sewer (FRP or PVC) 09 22' LF by open cut (all depths), including excavation and trench $ 375.00 $ 85,125.00 safety Remove (all depths) existing manhole and replace with new 60 -inch diamtec fiberglass manhole, including 15 2 11A necessary excavation and connection(s) and $ 16,000.00 $ 32,000.00 reconnection(s) to proposed and/or existing sanitary sewer 27 227 LF Remove and dispose of existing sanitary sewer (all depths, $ 100.00 $ 22,700.00 i ie materials, and pipe diameters Perform site restoration by hydromulch seeding of all 30 757 SY areas disturbed during construction where existing $ 5.50 $ 4.161.67 irrigation systems are not in place TOTAL EXISTING BID ITEMS $ 173,986.67 TOTAL PCM 5 1 $ 180,217.67 11/29/2016 Lockwood, Andrews La &Newnam, Inc. A 1170 A 0A1Y CO%IPA%Y PROPOSED CONTRACT MODIFICATION NO. 6 Date: January 18, 2017 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Segment 6/7 Change to Open Cut, Casing grout credit and Segment 15 Utility Investigation Description (List attachments, if any): Contractor is to install 157 LF of pipe at Segment 6/7 open cut (Item 3a). The reduction in cost will be $400/1-F per email quote from UCA. This change reduces the contract amount by $62,800.00. This change also includes the removal of all instances of grouting the annular space between carrier pipe and encasement pipe from the contract. See itemized unit price reduction items below: • Item 3b — Reduction of $18.52/1-F (273 LF) for a total item reduction of $5,055.96. • Item 3c — Reduction of $18.52/1-F (138 LF) for a total item reduction of $2,555.76. • Item 3d — Reduction of $18.52/1-17 (320 LF) for a total item reduction of $5,926.40. • Item 3e — Reduction of $18.52/1-F (300 LF) for a total item reduction of $5,556.00. • Item 4 — Reduction of $22.22/LF (225 LF) for a total item reduction of $4,999.50. • Item 7 — Reduction of $18.52/LF (50 LF) for a total item reduction of $926.00. • Item 11 — Reduction of $11.11/LF (18 LF) for a total item reduction of $199.98. • Item 13 — Reduction of $14.81/1-F (716 LF) for a total item reduction of $10,603.96 The total reduction in contract price for changes in these items is $35,823.56. Also included in this PCM is the Segment 15 additional utility investigation. This investigation includes full trench excavation to new sewer flow line, with sand backfill, flowable fill cap, and all traffic control. The cost for this work is $13,975 as quoted in email from UCA. This change increases the contract amount by $13,975. When totaled, these three changes reduce the total contract amount by $84,648.56. No days will be added to the contract for these changes. Reason for Change: The first two changes are being made in order to save costs on the work performed in the contract. The additional utility excavation work is to discover all unknown utilities along the pipeline trench. Recommended Lockwood, Andrews & Newnam, JInc. By: Engineer � //il� ! f 1/27/2017 . Z �, �._., Representative It Date Accepted By: Utility Contractors of America Contractor 02/01/2017 presentative Date Approved By: Owner Representative (Sign, Keep Original Copy and Return All Others. See Heading for Return Address.) Date LanL,,&AN,, ckwood,Andrews ewnam,Inc. r a oary c0,,.PA,;,,, PROPOSED CONTRACT MODIFICATION NO. 7 Date: January 24, 2017 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Existing gravity sanitary sewer aerial interceptor and manhole removal and replacement at Segment 22 to accommodate failing pipe. Description (List attachments, if any): This PCM is to accommodate the removal and replacement of the existing 24" sanitary sewer aerial interceptor at Segment 22. Reference the attached drawings for proposed revisions including the following: Remove and replace existing 24" ductile iron sewer main with 224 linear feet of 24" PVC pipe and embedment from Station 532+08 to Station 534+32, remove and replace existing manhole DT1-006 at Station 532+08 and manhole DT1-0068 at Station 534+32, remove existing manhole DT1-006A at Station 532+76, install 1/8"'x 2" straps and 3/8" anchors to existing pipe supports, install approximately 14 cubic yards of flowable fill below the proposed 24" sewer line, install approximately 150 cubic yards of dirt fill, include bypass pumping and site restoration. This PCM will add approximately $151,685.00 to the contract. See attachment for detailed cost proposal. No additional days are given. Reason for Change: Existing sanitary sewer pipe is in poor condition with corroded segments of pipe that are seeping and weak. This Segment is being replaced with the adjoining 30" segment which will save money and eliminate future sanitary sewer overflows and inflow caused by structural failure. Recommended Lockwood, Andrews & Newnam, Inc. By: Engineer 1/25/2017 Representative Date Accepted By: Utility Contractors of America Contractor g&'�tat-� 02/01/2017 Rofesentative Date Approved By: Owner Representative (Sign, Keep Original Copy and Return All Others. See Heading for Return Address.) Date Lubbock Canyon Lakes Interceptor Rehabilitation - Phase 1 PCM 7 PAY APPROXIMATE UNITS DESCRIPTION OF ITEM UNIT TOTAL UCA COST ITEM QUANTITY PRICE PROPOSAL 36 14 CY Plowable Fill $ 100.00 $ 1,400.00 37 150 CY Select Fill Backfill $ 10.00 $ 1,500.00 38 20 CN' Topsoil $ 12.00 $ 240.00 39 5 E_1 Furnish and install steel pipe stra s with anchors $ 75.00 $ 375.00 TOTAL NEW ITEMS $ 3,515.00 Setup, operate, maintain, and remove bypass Pumping and le 1 I'S appurtenances as required for Segment 22 improvements $ 20,000.00 $ 20,000.00 Furnish and install 24 -inch sanitary sewer (FRP or PVC) 8a 211 LI' by open cut (all depths), including excavation and trench $ 320.00 $ 71,680.00 safeq, Remove (all depths) existing manhole and replace with new 60 -inch diamter fiberglass manhole, including 18 2 E -k necessary excavation and connection(s) and $ 16,000.00 $ 32,000.00 reconnection(s) to proposed and/or existing sanitary sewer 77 224 LF Remove and dispose of existing sanitary sewer (all depths, $ 100.00 $ 22,400.00 pipe materials, and pipe diameters Perform site restoration by hydromulch seeding of all 30 380 SY areas disturbed during construction where existing $ 5.50 $ 2,090.00 irrigation systems are not in place TOTAL EXISTING BID ITEMS $ 148,170.00 TOTAL PCM 7 1 $ 151,685.00 1/18/2017 Lan Lockwood, Andrews &Newnam, Inc. A I r�, A PAO' � PROPOSED CONTRACT MODIFICATION NO. 8 Date: January 25, 2017 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Point repair for Martin Luther King (MLK) Blvd Crossing of the Canyon Lakes Interceptor Description (List attachments, if any): Contractor is to complete a sanitary sewer point repair in the middle of the MLK Blvd median by open -cut construction, install a shallow bore for by-pass piping under MILK Blvd, remove and replace curb and gutter, remove and replace concrete median, and cut and grout by-pass bore upon completion. The cost for this work is $43,900 as quoted in email from UCA. See itemized unit price below: • Item 25 — Sanitary sewer point repair by open cut $20,000/EA. Additional cost of $20,000.00. • Item 41 — Shallow bore (3' deep) for by-pass piping under MILK Blvd $100/LF (80 LF). Additional cost of $8,000.00. • Item 42 — Remove and replace curb and gutter $35/LF (30 LF). Additional cost of $1,050.00. • Item 43 — Remove and replace concrete median $65/SY (25 SY). Additional cost of $1,625.00. • Item 44 — Cut and grout by-pass bore $7.50/LF (80 LF). Additional cost of $600.00. • Item 45 — MILK Blvd Traffic Control Plan and Implementation $4,500. Additional cost of $4,500.00. The total increase in contract price for changes in these items is $35,775.00. 21 days will be added to the contract for these changes. Reason for Change: This change is being made due to an apparent structural pipe failure which is creating an obstruction in the 30" Canyon Lakes Interceptor in this location. Recommended Lockwood, Andrews & Newnam, Inc. By: Engineer C' 1/27/2017 Representative Date Accepted By: Utility Contractors of America Contractor 02/01/2017 reaentative Date Approved By: Owner Representative (Sign, Keep Original Copy and Return All Others. See Heading for Return Address.) Date Lan Lockwood, Andrews tN & Newna_m, Inc. PROPOSED CONTRACT MODIFICATION NO. 8A Date: March 24. 2017 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Point repair for Martin Luther King (MLK) Blvd Crossing of the Canyon Lakes Interceptor Description (List attachments, if any): This PCM is a revision to the original PCM 8 and adds a new manhole to complete a sanitary sewer point repair in the middle of the MLK Blvd median by open -cut construction, remove and replace curb and gutter, remove and replace concrete median, and provide traffic control. See itemized unit price below: • Item 17 — Install new 60 -inch diameter fiberglass manhole $14,000/EA. Additional cost of $14,000.00. • Item 42 — Remove and replace curb and gutter $35/LF (30 LF). Additional cost of $1,050.00. • Item 43 — Remove and replace concrete median $65/SY (25 SY). Additional cost of $1,625.00. • Item 45 — MLK Blvd Traffic Control Plan and Implementation $4,500. Additional cost of $4,500.00. The total increase in contract price for changes in these items is $21,175.00. 21 days will be added to the contract for these changes. Reason for Change: This change is being made due to an apparent structural pipe failure which is creating an obstruction in the 30" Canyon Lakes Interceptor in this location. Recommended Lockwood Andrews & Newnam Inc. By: Engineer .. _. _ 3/24/2017 Representative Dale Accepted By: Utility Contractors of America Contractor Jonathan Ziemer, P.E. 03/24/2017 Representative Dale Approved By: Owner Representative (Sign, Keep Original Copy and Return All Others. See Heading for Return Address.) Dale LanLockwood, Andrews & , Inc. ,� 4Newnamer7 a r,Air cut.rnk`' PROPOSED CONTRACT MODIFICATION NO. 9 Date: March 28, 2017 Project: Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase I Project No.: RFP 16 -12733 -TF Contract For: City of Lubbock Contract Date: July 11, 2016(NTP) Subject of Proposed Contract Modification: Extension of the Bore Casing at the turn off access road from Clovis Road to the Texas 289 Loop Frontage Road of the Canyon Lakes Interceptor Description (List attachments, if any): TxDOT originally permitted a 45 -foot bore under the above access road at Segment 18. After the construction was staked, TxDOT asked for additional casing as a result of a site visit. The City negotiated down to an additional 15 -feet of casing to comply with TxDOT's request. The Contractor is hereby required to extend the casing by 15 -feet for a total of 60 -feet under the access road. See itemized unit price below: • Item 3e — Furnish and install 24 -inch sanitary sewer (FRP or PVC) and steel casing by auger bore at Segment 18 $750/1-F (15 LF). Additional cost of $11,250.00. The total increase in contract price for changes in these items is $11,250.00. 0 days will be added to the contract for these changes. Reason for Change: This change is being made at the request of TxDOT after the permit was issued for work in this location. Recommended Lockwood Andrews & Newnam Inc. By. Engineer 3/24/2017 Representative Date r Accepted By: Utility Contractors of America Contractor Jonathan Ziegner, P.E. 03/24/2017 Representative Date Approved By: Owner Representative (Sign, Keep Original Copy and Return All Others. See Heading for Return Address.) Date CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2017-202333 Date Filed: 05/04/2017 Date Acknowledged: 05/08/2017 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Utility Contractors of America, Inc. Lubbock, TX United States 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 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. 12733 Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase 1 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary Ziegner, Jonathan Lubbock, TX United States X Lane, Ty 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 orovided by Texas Ethics Commission www.ethirs_state.tx_us \/Arcinn \/1 n Raq CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. i - 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: I Name of business entity filing form, and the city, state and country of the business entity's Place of business. 2017-202333 Utility Contractors of America, Inc. Lubbock, TX United States Date Filed: 05/04/2017 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. 12733 Canyon Lakes Sanitary Sewer Interceptor Rehabilitation Phase 1 4 Nature of interest Name of Interested Party City, State, Country (glare of business) (check applicable) Controlling Intermediary Ziegner, Jonathan Lubbock, TX United States X Lane, Ty Lubbock, TX United Stales X 5 Check only if there is NO Interested Party. El 8 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct Tammy VanBuren .J = Notary Public, State of Texas I ` My Commission Expires September 27, 2020 Ignature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Swom to and subs the said Chris Bahos this the 4th day of May 20 17 t certify ch, witness my h and seal of office. Tammy VanBuren Signature of r administering o Printed name of officer administering oath Title of officer administering oath rui mb piuviucu uy i exas Ethics t-ommisslon www.etnics.state.tx.us Version V1.0.883