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HomeMy WebLinkAboutRes 2023-05-1441 Agreement with Birkhoff, Hendrick, & Carter, LLC for Engineering Design-Twin CreekCITY OF ANNA, TEXAS RESOLUTION NO. 2.0 2 3 - 0 5 - 114141 A RESOLUTION OF THE CITY OF ANNA, TEXAS APPROVING AND AUTHORIZING THE CITY MANAGER TO EXECUTE A PROJECT SPECIFIC PURCHASE ORDER FOR PROFESSIONAL SERVICES BY AND BETWEEN THE CITY OF ANNA, TEXAS AND BIRKHOFF, HENDRICKS, & CARTER, L.L.C.,FOR ENGINEERING DESIGN SERVICES RELATED TO THE TWIN CREEK CIRCLE WATER IMPROVEMENT PROJECT, IN A FORM APPROVED BY THE CITY ATTORNEY, PER THE PROPOSAL SHOWN IN EXHIBIT "A" ATTACHED HERETO, AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, the City of Anna is the owner and operator of an undersized water main located in a utility easement along Twin Creek Circle; and, WHEREAS, the undersized water main is in poor condition and must be replaced; and, WHEREAS, the services provided by Birkhoff, Hendricks, & Carter, LLC, will be funded through the Utility Department Funds in the Fiscal Year 2022-2023 Budget; and, NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ANNA, TEXAS, THAT: Section 1. Recitals Incorporated. The recitals above are incorporated herein as if set forth in full for all purposes. Section 2. Authorization. A. That the funding shall be $118,606 in Utility Department Funds. B. That the City Council hereby approves entering into and authorizes the City Manager to execute a professional services agreement with Birkhoff, Hendricks, & Carter, LLC for the scope of services identified in Exhibit "A" attached hereto. PASSED AND APPROVED by the City Council of the City of Anna, �, 2023. ATTEST: City Secretary, Carrie L. Land 1913 APPROVED: G Texas, on this q day of Nate Pike 6,900 LF 6-inch PVC Water Main , 14, A A _7 t 500 LF 6-inch PVC Water Main - In OEM!! iop Iry - Auto -Flush Valve PROFESSIONAL ENGINEERING SERVICES AGREEMENT THIS AGREEMENT is made and entered into by and between the City of Anna, Texas, hereinafter referred to as "City", and Birkhoff, Hendricks & Carter, L.L.P., hereinafter referred to as "Engineer", to be effective from and after the date as provided herein. The City desires to engage the services of the Engineer to complete engineering design provide bidding and construction administration services and provide surveying services for the Twin Creeks Water Line hereinafter referred to as the "Project"; and the Engineer desires to render such engineering design services for the City under the terms and conditions provided herein. That for and in consideration of the covenants contained herein, and for the mutual benefits to be obtained hereby, the parties hereto agree as follows: I. Employment of the Engineer The City hereby agrees to retain the Engineer to perform professional engineering services in connection with the Project; Engineer agrees to perform such services in accordance with the terms and condition of this Agreement. II. Scope of Services The parties agree that Engineer shall perform such services as expressly set forth and described in Exhibit "A', which is attached hereto and thereby made a part of this Agreement. The parties understand and agree that deviations or modifications, in the form of written changes may be authorized from time to time by the City. Engineer shall have no further obligations or responsibilities for the project except as agreed to in writing. Engineer's services and work product are intended for the sole use and benefit of Client and are not intended to create any third party rights or benefits, or for any use by any other entity or person for any other purpose. Engineer shall perform the professional engineering services with the professional skill and care ordinarily provided by competent engineers practicing in North Central Texas and under the same or similar circumstances and professional license. Professional services shall be performed as expeditiously as is prudent, considering the ordinary professional skill and care of a competent engineer. Professional Services Agreement 2023 Page 1 of 12 1A7015 contdevlanaa12023 - twin corks wnmgiaoering saviccs agcccmcnt 2022.docx III. Schedule of Work The Engineer agrees to commence services immediately upon execution of this Agreement, and to proceed diligently with said service, except for delays beyond the reasonable control of Engineer. IV. Compensation and Method of Payment The parties agree that Engineer shall be compensated for all services provided pursuant to this Agreement in the amount and manner described and set forth in the Payment Schedule attached hereto as Exhibit "B" and thereby made a part of this Agreement. City agrees to pay invoices upon receipt. Statement for services shall include a line for previous payments, contract amount, and amount due current invoice. V. Information To Be Provided By The City The City agrees to furnish, prior to commencement of work, all information requested by Engineer that is available to the City. VI. Insurance Engineer agrees to procure and maintain for the duration of the contract Professional Liability Insurance ($3,000,000), Worker's Compensation, General Liability and Automobile Insurance. VII.Assignment and Subletting The Engineer agrees that neither this Agreement nor the services to be performed hereunder will be assigned or sublet without the prior written consent of the City. The Engineer further agrees that the assignment or subletting of any portion or feature of the work or materials required in the performance of this Agreement shall not relieve the Engineer from its full obligations to the City as provided by this Agreement. VIII. Contract Termination The parties agree that City or the Engineer shall have the right to terminate this Agreement without cause upon thirty (30) days written notice to the other. In the event of such termination without cause, Engineer shall deliver to City all finished or unfinished documents, data, studies, surveys, drawings, maps, models, reports, photographs or other items prepared by Engineer in connection with this Agreement. Engineer Professional Services Agreement 2023 Page 2 of 12 1A7015 c=ukv\u=Vozs - twin cmdm wD=&eering services agecmcnt 2022.docx shall be entitled to compensation for any and all services completed in accordance with the provisions of this Agreement prior to termination. IX. Engineer's Opinion of Cost The parties recognize and agree that any and all opinions of cost prepared by Engineer in connection with the Project represent the best judgment of Engineer as a design professional familiar with the construction industry, but that the Engineer does not guarantee that bids solicited or received in connection with the Project will not vary from the opinion by the Engineer. X. Construction On projects that include construction, the Owner recognizes that the Contractor and Subcontractors will be solely in control of the Project site and exclusively responsible for construction means, methods, scheduling, sequencing, j obsite safety, safety programs, and compliance with all construction documents and directions from Owner or Building Officials. Construction contracts are between the Client and the Construction Contractor. Consultant shall not be responsible for construction related damages, losses, costs, or claims; except only to the extent caused by Consultant's sole negligence. XI. Ownership of Documents Original drawings, specifications and reports are the property of the Engineer; however, the Project is the property of the City. City shall be furnished with such reproductions of drawings, specifications and reports. Upon completion of the services or any earlier termination of this Agreement under Article VIR, Engineer will revise drawings to reflect changes made during construction as reported by the City and contractor, and will furnish the City with one set of construction record drawings in accordance with terms provided in Exhibit "A" — Engineering Services. All deliverables shall be furnished, as an additional service, at any other time requested by the City when such deliverables are available in the Engineer's record keeping system. XII.Complete Contract This Agreement, including the exhibits hereto numbered "A" through "E" constitutes the entire agreement by and between the parties regarding the subject matter hereof, and supersedes all prior or contemporaneous written or oral understanding. This agreement may only be amended, supplemented, modified or canceled by a duly executed written agreement. Professional Services Agreement 2023 Page 3 of 12 I.X7015 coatdevlsnna12023 - twin creeks wllc Owc ing services agreement 2022.dom XIII. Mailing of Notices Unless instructed otherwise in writing, Engineer agrees that all notices or communications to City permitted or required under this Agreement shall be addressed to City at the following address: Mr. Ryan Henderson Interim City Manager City of Anna 120 W. 7`s Street Anna, Texas 75409 City agrees that all notices or communications to Engineer permitted or required under this Agreement shall be addressed to Engineer at the following address: Mr. Craig M. Kerkhoff, P.E., C.F.M. Birkhoff, Hendricks & Carter, L.L.P. 11910 Greenville Ave., #600 Dallas, Texas 75243 Phone: (214) 361-7900 ckerkhoff(@bhcllp.com All notices or communications required to be given in writing by one party or the other shall be considered as having been given to the addressee on the date such notice or communication is posted by the sending party. XIV. Texas Board of Professional Engineers & Land Surveying Contact Information Recipients of professional land surveying services under this agreement may direct complaints regarding such services to the Texas Board of Professional Engineers & Land Surveyors, 1917 South Interstate 35, Austin, Texas 78741, Phone (512) 440-7723. XV. Contract Amendments This Agreement may be amended only by the mutual agreement of the parties expressed in writing. XVI. Effective Date This Agreement shall be effective from and after execution by both parties hereto, with originals in the hand of both parties. Professional Services Agreement 2023 Page 4 of 12 en015 ooa�VOD- mm afcow wlbaginv acids a� t2o22.a WITNESS OUR HANDS AND SEALS on the date indicated below. CITY OF ANNA, TEXAS BIRKHOFF, HENDRICKS & CARTER, L.L.P. A Texas Home -Rule Municipal Corporation A Texas Limited Liability Partnership Texas Board of Professional Engineers & Land Surveyors Engineering Firm No. 526 Land Surveying Firm No. 100318-06 By: yN By: Craig M. Kerkhoff, P.E., C.F.M. Date: � Ap 3 Date: '�/ 14-1 Z 3 ATTEST n By: Ellsl ccl�iv Professional Services Agreement 2013 Page S of 12 1 W015 �tdaV m52021-win Crt sAk4ae ne snrvi<a Wy ml 20n d« EXHIBIT "A" ENGINEERING SERVICES Twin Creeks Circle Water Line The project generally consists of the design, bidding and construction administration of a 6-inch water line, replacing an existing 2-inch water line, along Twin Creeks Circle. A stub -out will be designed to connect the proposed 6-inch water line line with an existing 8-inch water line within the Park Place subdivision to the east. The proposed 6-inch water line will connect to an existing 8-inch water line at each intersection with Taylor Blvd on the south side Taylor Blvd. Land Rights for the water line along Taylor Blvd are assumed to be in place and are not included in this scope. The proposed water line is intended to be placed on the inside portion of the roadway of the Twin Creek Circles loop. The proposed water line size being designed and constructed was provided by the City. Existing land rights along Twin Creeks Circle will be evaluated with this project to determine if right-of- way (ROW) for Twin Creeks Circle or an existing easement can be utilitzed for the proposed water line. Property deeds, title and other publicly available documents will be researched with the results being presented to the City. Direction from the City will be required in order to utilize any existing Land Rights or to proceed with obtaining a water line easement and/or temporary access easements. Roadway crossings for the water line will be by open cut. The proposed water line will be designed to be buried at a depth of 5-ft of cover. For budgeting purposes, we assume the existing Twin Creeks Circle roadway will have to be repaired after the construction of the water line due to the existing condition of the roadway and the construction equipment that will be required for this project. For budgetary purposes, we have included in the Opinion of Probable Project Cost (OPC) to scarify and compact the existing roadway material and overlay with a 2-inch asphalt surface within the current limits of the existing roadway. Water services will be transferred to the proposed water line by open cut across the existing roadway. Due to the varying land rights acquisition possibilities with this project, the fees associated with deed research, plat and field notes, permission to survey requests, title research and easement acquisition have been separated. In the occurrence of the full land rights for the project not being required, the associated tasks for those efforts will not be utilized or billed to the City. If land rights direction from the City and access allow, DAS Geospatial may be used to supplement the field survey task. Professional Services Agreement 2023 Page 6 of 12 1:170I S contdevlanaa12023 - twin creeks wneagb=ring services agreement 2022.docx Part I: Design 1. Prepare Plan Sheets at a scale of not less than 1 "=20' for the approximate 8,114 linera foot 6-inch water line from the existing 8-inch water line connection points along Taylor Blvd, as well as the stub -out connection to the Park Place subdivision. 2. Prepare standard construction details. 3. Prepare Coordinate Control Plans with benchmarks 4. Prepare Cover Sheet, Location Map and Sheet Index. 5. Attend two design review meeting with City Staff. 6. Submit sets of 30%, 60% and 90% review plans for City review. All submittals shall be via electronic file format (Adobe Acrobat file format or equal) 7. Prepare Opinion of Probable Construction Estimate at 60% and 90% plan submittals 8. Prepare Bid schedule, specifications and contract documents using NCTCOG Standard Specifications as the base. 9. Submittals to State Regulatory Agencies, as required 10. Prepare Signed and Sealed Construction Plans. 11. Prepare final bid documents including bid proposal forms, construction contract documents, construction plans and technical specifications. Part H: Biddine Phase: 1. The City will publish notices in the newspaper recognized by the City Council as the official newspaper for the City of Anna. BHC will post the plans for bid adverstisement on Civcast. 2. The Engineer will answer online questions in order submitted, in addition the Engineer will prepare addenda to modify the plans and specifications. Questions must be submitted by potential bidders a minimum of 72-hours before the bid opening. All addenda shall be posted a minimum of 24-hours before the bid opening. 3. Assist during opening of bids and provide bid tabulation sheets. 4. Complete cursory review of bid documents to determine that the bid includes all sheets of the Engineer's office original file set. 5. Obtain experience record and references from the apparent low bidder. Check references of apparent low bidder. Professional Services Agreement 2023 Page 7 of 12 IA7015 contdevlenas12023 - twin creeks wlkngineering services eg=ment 2022.docx 6. Formulate opinion from information received and provide a letter of recommendation for award of a construction contract. Bid tabulation summary sheets will also be sent to the City. Part III: Construction Phase 1. After award of contract, furnish six (6) sets of 11" x 17" final plans, specifications and contract documents to the City for construction use by the City and Contractor. 2. Attend the Pre -Construction Conference, including preparing an agenda. 3. Attend coordination meetings with contractor, quality control personnel, and City representatives as required to discuss strategy, problem areas, progress, and other coordination matters (3 meetings are included). 4. Review shop drawings and other submittal information which the Contractor submits. This review is for the benefit of the Owner and covers only general conformance with information stated by the Contract Documents. The contractor is to review and stamp their approval on submittals prior to submitting to the Engineer. Review by the Engineer does not relieve the Contractor of any responsibilities, safety measures or the necessity to construct a complete and workable facility in accordance with the Contract Documents. Review of shop drawings will be completed by review of electronic PDF files provided by the Contractor. 5. Provide written responses to requests for information or clarification to City or Contractor. Responses will be in electronic format. 6. Prepare and process routine change orders for this project as they pertain to the original scope of work. Transmittal will be electronically and will include construction plan sheet changes. 7. Make periodic site visits during construction as the project requirements dictate. Minimum of one project site visit per month. 8. Prepare monthly pay request from information obtained from Contractor and/or City Inspector, and prepare pay request along with letter of recommendation for payment. Pay requests will be transmitted electronically. 9. Accompany the City during their final inspection of the project. Prepare City's punch list and transmit it electronically. 10. Prepare Record drawing utilizing information from the contractor and on -site representative. Record drawings will be transmitted electronically in PDF format. Professional Services Agreement 2023 Page 8 of 12 1A7015 contdev\m=\2023 - twin creeks wllcnginecft services agreement 2022.docx Part IV: Additional Services 1. Field survey to locate existing facilities and topographic information for proposed facilities. Boundary survey for any proposed easement acquisition. 2. Preparation of Plat and Field Note Descriptions for easements required. Thirty-six (36) easement descriptions are included for the purpose of establishing a budget for this work 3. Coordination meetings with parties other than the City of Anna 4. Deed research 5. Permission to Survey utilizing the Land Rights agent to make contact with each property owner 6. Title Research by Land Rights agent 7. Easement acquisition by Land Rights agent (does not include cost for easement paid to property owner or appraisal costs) 8. Printing of three (3) sets of final plans and specifications for distribution to the successful contractor. Part V: Terms and Conditions For Electronic File Transfers Electronic files are transmitted on the terms and conditions below: By opening, accessing, copying or otherwise using the transmitted electronic files, these terms and conditions are accepted by the user. A. The electronic files are compatible with the following software packages operating on a PC using Windows operating systems: • Autocad Civil 3D 2022, Civil 3D 2017 • Innovyse InfoWater Pro 3.0 with ESRI Arc Pro 2.7 • Innovyze InfoSewer Pro 7.6 with ESRI Arc Map 10.4 • ESRI 10.4 • MS Office 365 • Bluebeam Revu (PDF) Ver 10 - Ver 2020 B. Birkhoff, Hendricks & Carter, L.L.P. makes no warranty as to the compatibility of these files beyond the specified release of the above stated software. Professional Services Agreement 2023 Page 9 of 12 IA701 S c=tdcv\u=\2023 - twin crocks wllengk=ing services agreement 2022.docx C. Because data stored on electronic media can deteriorate undetected or be modified, Birkhoff, Hendricks & Carter, L.L.P. will not be held liable for completeness or correctness of electronic media. D. The electronic files are instruments of our service. Where there is a conflict between the hard copy drawings and the electronic files, Birkhoff, Hendricks & Carter, L.L.P.'s hard copy file will govern in all cases. E. Electronic files may only be modified in accordance with the Texas Engineering Practice Act for modifying another Engineer's design. Part VI: Exclusions The intent of this scope of services is to include only the services specifically listed herein and none others. Services specifically excluded from this scope of services include, but are not necessarily limited to the following: A. Certification that work is in accordance with plans and specifications. B. Consulting services by others not included in Scope of Services. C. Contractor's means and methods. D. Environmental cleanup. E. Environmental impact statements and assessments. F. Fees for permits. G. Fees for publicly advertising the construction project. H. Fiduciary responsibility to the Client. I. On -site construction safety precautions, programs and responsibility (Contractor's responsibility). I Phasing of Contractor's work. K. Quality control and testing services during construction. L. Revisions and/or change orders as a result of revisions after completion of original design (unless to correct error on plans). M. Services in connection with condemnation hearings. N. Traffic engineering study or reports. O. Trench safety designs. P. Utility relocations or extensions Q. Wetlands determination Professional Services Agreement 2023 Page 10 of 12 M701 S cantdev\anno12023 - twin corks wilengiaeering services agcumeat 2022.docx EXHIBIT "B" COMPLETION SCHEDULE Notice to Proceed......................................................................... May 1, 2023 Permission to Survey Requests (PTS).......................................... May 15, 2023* Begin Field Surveys..................................................................... June 15, 2023 Complete Field Surveys............................................................... August 9, 2023 Submit Preliminary Plans to City for Review .............................. September 29, 2023 Receive Review Comments from City ......................................... October 13, 2023 Plat and Field Notes completed (if required) ............................... November 10, 2023 Complete Final Plans................................................................... November 17, 2023 Advertise Project.......................................................................... pending easement acquisition Construction................................................................................. 3 Months *All dates following Permission to Survey date listed are based on the assumption that all permission to surveys can be obtained in 30 days. Professional Services Agreement 2023 Page 11 of 12 R7015 contdcv\a=\2023 - twin crech wllcn&=ing saviccs sgic==t 2022.docx EXHIBIT "C" PAYMENT SCHEDULE Payment for engineering services described under Parts I, II, and III shall be based on a lump sum amount of $118,606. The following is a summary of the estimated charges for the lump sum elements of the proposed services: Engineering Design............................................................... $889955 Bidding Services..................................................................... $69523 Construction Administration................................................. $23,128 Payment for Additional Services described under Part IV shall be on the basis of salary cost times a multiplier of 2.45 for time expended on the task. Field survey crew shall be based on $185.00 per hour, inclusive of all equipment rentals and software licensing; plus mileage charge at the IRS established rate. Expenses shall be at invoice cost times a multiplier of 1.15. We recommend a budget of $330,946 be established for the hourly or as needed services. The following is a summary of the estimated charges for the as -incurred elements of the proposed services: Field and Boundary Survey ................................................... $32,180 Plats and Field Notes (36)...................................................... $90,000 Coordination.............................................................................. $11,500 Deed Research......................................................................... $36,000 Permission to Survey.............................................................. $162920 TitleResearch.......................................................................... $202853 Land Rights Agent for Easement Acquisition ...................... $132,993 Printing of plans and specs......................................................... $500 The maximum overall fee of $449,552 established herein shall not be exceeded without written authorization from the City, based on increased scope of services. Itemized invoices for services shall be submitted not more than once per month and will (include) be accompanied by a monthly progress report. Payment shall be due upon receipt of the invoice. Professional Services Agreement 2023 Page 12 of 12 IA7015 wntdevlanaa12023 - twin creeks wRengineering scrviccs agreement 2022.dacx Water System Rehabilitation Project 2023-004 R, BLVDr,. �; TAYLOR 6LVD - iAYLOR BLVO TAYLOR BLVD .r TAYLOR.B 0 N all ..- r. Auto -Flush Valve Ikw 17 F ja F q Exhibit E BIRIMOFF, H PROFESSIONAL Texas Firm F526 Client: City of Anna Project: Twin Creeks Circle Water Line & CARTER, L.L.P. Project No. Busdev-Anna Date: 14-Apr-23 By: CMK ENGINEER'S OPINION OF CONSTRUCTION COST Item No. Description Quantity Unit Price Amount 1 Clearing and Grubbing 81 Sta $ 300.00 $ 24,432.00 2 Furnish & Install 6-Inch DR-18 Water Line 8,144 L.F. $ 75.00 $ 610,800.00 3 Furnish & Install 6-Inch R. S. Gate Valve 37 Ea $ 4,500.00 $ 164,592.00 4 Furnish & Install Fire Hydrant 17 Be $ 5,000.00 $ 86,440.00 5 Connect to 8-Inch Water Line, including Dewatering 3 Ea $ 4,000.00 $ 12,000.00 6 Transfer Water Service 67 Ea $ 1,500.00 $ 100,500.00 7 Automatic Flush Valve 1 Ea $ 8,500.00 $ 8,500.00 8 Remove & Replace Asphalt Driveway 50 S.Y. $ 100.00 $ 5,000.00 9 Remove & Replace Fence 360 L.F. $ 40.00 $ 14,400.00 10 Remove & Replace Concrete Pavement Including Full Depth Sawcut 44.44 S.Y. $ 125.00 $ 5,555.56 11 Remove & Replace Gravel Driveway 575 S.Y. $ 25.00 $ 14,375.00 12 Scarify, Remix, Reshape and Compact Existing Pavement and Base Material 6-inch thick 14,800 S.Y. $ 5.00 $ 74,000.00 13 Furnish and Install 2-inch HMAC Type "D" Surface 1,628 Tons $ 125.00 $ 203,500.00 14 Storm Water Pollution Prevention Plan 1 Ea $ 2,500.00 $ 2,500.00 15 1hriplementation of Storm Water Pollution Prevention Plan 1 Ea $ 5,000.00 $ 5,000.00 16 Preparation and Submitting to the City a Trench Safety Plan that is in accordance with latest OSHA Standards 1 Ea $ 2,500.00 $ 2,500.00 17 Furnish & Install a Complete Excavation Safety & Support System in Full Accordance with latest OSHA Standards 1 Ea $ 10,000.00 $ 10,000.00 18 Furnish Traffic Control Plan 1 Ea $ 2,000.00 $ 2,000.00 LA7015 �memn, =23-TM. aae wrwrc.w Pagel oft BIRKHOFF, HENDRICKS & CARTER, L.L.P. PROFESSIONAL ENGINEERS Texas Firm F526 Client: City of Anna Project: Twin Creeks Circle Water Line Project No. Busdev-Anna Date: 14-Apr-23 By: ENGINEER'S OPINION OF CONSTRUCTION COST CMK Item No. Description Famish, Install, Maintain & Remove Traffic Control Devices in accordance with MUTCD Quantity unit Price Amount 19 1 Ea $ 2,500.00 $ 2,500.00 20 Project Sign 1 Ea $ 1,000.00 $ 1,000.00 21 lFurnish, Install and Maintain H dromulch Seeding 122,160 S.F. $ 0.50 $ 61,080.00 Construction Subtotal: $ 1,309,662.56 Contin encies and Miscellaneous Items 15% $ 196,450.00 Total: $ 1,506,112.56 Easement Acquisition 122,160 S.F. $ 0.75 $ 91,620.00 Engineering, Surveying, Construction Admin.*** $449,552 Quality Control & Material Testing*** 2.5% $ 37,652.81 Project Total: $ 2,084,937.37 *** Budgeted amounts, this contract isjustfor design USE: $ 2,085,000.00 L7015 CavlOcdvl®Um5-T Gave W OPC.x6 Page 2 of 2 CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, S. 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. 2023-1007314 Birkhoff, Hendricks & Carter Dallas, TX United States Date Filed: 04/14/2023 2 Name of governmental entity or state agency that Is a party to the contract for which the form is being filed. City of Anna 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. Twin Creeks Water Line Professional Engineering Services 4 Nature of interest Name of Interested Party City, State, Country (place of business) (check applicable) Controlling I Intermediary Kerkhoff, Craig Dallas, TX United States X Mata, Andrew Dallas, TX United States X Chaney, Derek Dallas, TX United States X Birkhoff, John Dallas, TX United States X Hendricks, Gary Dallas, TX United States X 5 Check only if there Is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is Craig M. Kerkhoff October 10, 1982 and my dale of birth is My address is 11910 Greenville Ave, Suite 60D Dallas Texas 75243 USA (street) icily) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Dallas Texas 14th Aril Executed in County, State of , on the _day of p , 20_ 23 (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided Dy I eXas Ethics Commission www.ethics.state.tx.us Version V3.5.1.3acBBbc0