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Res 17-10 Authorizing the Town Manager to execute a contract with RJN, Inc Monitoring Sanitary Sewer TOWN OF WESTLAKE RESOLUTION NO. 17-10 A RESOLUTION OF THE TOWN COUNCIL OF THE TOWN OF WESTLAKE, TEXAS, ENTERING INTO AN AGREEMENT WITH RJN GROUP, INC., FOR A SANITARY SEWER EVALUATION STUDY AT A COST OF APPROXIMATELY $44,683.5; AND AUTHORIZING THE TOWN MANAGER TO EXECUTE THE AGREEMENT OF BEHALF OF THE TOWN OF WESTLAKE,TEXAS. WHEREAS,the owns 48.5 % of the flow capacity in the N-1 sewer line; and WHEREAS, the Town of Westlake and City of Southlake have been working with the trinity River Authority to assume the N-1 sewer line; and WHEREAS, Westlake desires to work with the City of Southlake to transfer ownership of the N-1 sewer line to the Trinity River Authority; and WHEREAS, the transfer to TRA is contingent upon a satisfactorily reducing Westlake's collection system contributing to increased groundwater intrusion; and WHEREAS, the Town Council finds that the proposed additional sanitary sewer evaluation study provides sound infrastructure maintenance and planning; and WHEREAS, the Town Council finds that the proposed study is necessary for the transfer; and WHEREAS, the cost for the flow analysis is included in the adopted FY 2016/2017 budget; and WHEREAS, the Town Council finds that the proposed additional study benefits the public and is in the best interest of the public. NOW, THEREFORE, BE IT RESOLVED BY THE TOWN COUNCIL OF THE TOWN OF WESTLAKE, TEXAS: SECTION 1: All matters stated in the Recitals above are found to be true and correct and are incorporated herein by reference as if copied in their entirety. SECTION 2: The Town Council of the Town of Westlake hereby approves the contract with RJN Group, Inc., for Engineering Services, attached as Exhibit "A", and further authorizes the Town Manager to execute the agreement on behalf of the Town of Westlake, Texas. SECTION 3: If any portion of this Resolution shall, for any reason, be declared invalid by any court of competent jurisdiction, such invalidity shall not affect the remaining provisions Resolution 17-10 Page 1 of 2 hereof and the Council hereby determines that it would have adopted this Resolution without the invalid provision. SECTION 4: That this resolution shall become effective from and after its date of passage. PASSED AND APPROVED ON THIS 27 I DAY OF FEBRUARY, 2017. �r1 OF M Laura"Wheat, Mayor ATTEST: ..... AS kFc-i j ca-, Kelly Edwar" , Town Secretary Thomas E. Brymer, o Manager APPROV T O M: L t on Lpwr , Tori Attorney Resolution 17-10 Page 2 of 2 TOWN OF WESTLAKE SANITARY SEWER EVALUATION STUDY (SSES) SCOPE OF SERVICES Overview This Scope of Services covers the Sanitary Sewer Evaluation Study (SSES) tasks proposed to further investigate Basin #2 as recommended in the 2016 Flow Monitoring Report SSES Field Investigation for Basin #2 SSES Field Investigation Work will consist of manhole and visual pipe inspections, smoke testing, dye water flooding, cleaning and television inspections, and data analysis. Project Administration The Engineer shall coordinate the overall work of the project to include all field inspections, engineering analysis, and oversee the work of all Subconsultants engaged in such activities. The Engineer shall provide monthly progress reports that will show the percent completion of each task. A bi-monthly (i.e. every two months) progress meeting with the Town of Westlake will be conducted. Project Management The Consultant shall utilize a comprehensive Sewer Evaluation Project Management Software Platform that offers all of the tools necessary to execute a sewer evaluation program. The comprehensive tool shall include: • Project Management Tools (for use in setting up projects, requisitioning equipment, scheduling activities, production reports and Town of Westlake deliverables such as uptime reports, site visit summaries, inspection deliverables, etc. • Data Analysis Tools for use by the engineering and data analysis staff for preparing, assimilating, correcting and delivering project data. Public Information Program The Engineer shall conduct a public notification program prior to the field inspections in order to minimize potential alarm over the presence of field personnel in backyards and over the potential for entry of test smoke into the various premises. The ENGINEER may complete press releases to submit to the Town of Westlake, hold informational meetings, and coordinate with Town of Westlake staff. Notification will be given to the TOWN OF WESTLAKE, building owners, and residents by the distribution of door hangers at least 48 hours prior to commencing Westlake SSES 1 2/16/2017 Res 17-10 smoke testing activities. The local fire department, police department, emergency vehicle services (SMSA) and the TOWN OF WESTLAKE will be notified each day prior to tests through the use of facsimile machines/E-Mail. Special coordination with property managers will be necessary for hospitals, medical offices, banks, government buildings, and other large commercial facilities. The ENGINEER will respond to all telephone calls by building owners or occupants during all active phases of the project. Manhole Inspections Utilizing industry standard safety procedures and appropriate traffic control, all subsurface manhole components will be inspected. The manhole rim to invert dimension will be recorded for all connecting lines. All subsurface manhole components including the frame seal, walls, manhole bench and trough will be inspected. Potential maintenance problems are also recorded and provisions to repair the problems are included in the Technical Memorandum recommendations. Flow rates shall be estimated for major sources of 1/1 in each of the manholes inspected. Any major 1/1 sources or defects will be immediately reported to TOWN OF WESTLAKE. The recorded data includes the following: • Location and identification number • Potential for surface water ponding on manhole cover • Cover type, fit, distance above or below grade, evidence of inflow • Frame adjustment, type and condition of seal, evidence of inflow • Corbel construction, condition, evidence of inflow • Wall construction, condition, evidence in infiltration • Bench/trough construction, condition, deposition, evidence of infiltration • Pipe seal condition, evidence of infiltration • Step and rung condition • Inside diameter • Surcharging or evidence of surcharging • Indication of groundwater level at time of inspection • Maintenance problems • Line segment diameter and direction • Line segment observations from the manhole (selected manholes) A data management/computer model will be used to process and analyze the inspection data. Westlake SSES 2 2/16/2017 Res 17-10 ENGINEER shall notify TOWN OF WESTLAKE of manholes that are inaccessible, not found, buried, or believed to be non-existent. Manholes which present inconclusive evidence of 1/1 shall be earmarked as candidates for dye water testing in order to substantiate whether or not the suspect component is an 1/1 source. A prioritized list of manholes with suspect components shall be developed and presented to the TOWN OF WESTLAKE for review. Smoke Testing Smoke testing will be conducted using dual axial blowers. Smoke testing lengths shall be limited to one line segment between the upstream and downstream blower locations. Each 12-inch diameter and smaller segment shall be isolated by sandbagging. Smoke candles shall be used to generate smoke for the smoke testing. Segments totaling less than 500 feet may include straight through manholes. Smoke testing will be performed only during dry ground periods which are anticipated to be between July and September. Flags shall be placed at observed smoke locations and digital images shall be captured. All defects identified by smoke testing shall be flagged and photographed. Smoke defect locations shall be recorded on sketches or by obtaining GPS coordinates. All private sector smoke defect images shall be entered into the field inspection database. Main line defects and service lateral defects shall be carefully scrutinized to ensure that a conservative determination of public vs. private side defects is made. If necessary the line shall be earmarked for television inspection. During the smoke testing, each building in the vicinity of the line segment will be observed for evidence of illegal or illicit connections, or other defects. All such defects shall be noted on the smoke test form. Where suspect defects are identified but are not confirmed by the smoke test, the building address, type, and suspected defect shall be noted. All such buildings will be submitted to the TOWN OF WESTLAKE as candidates for a detailed building inspection or dyed water flooding. Upon review and approval by the TOWN OF WESTLAKE these buildings will be subsequently inspected by the Engineer. Dye Water Flooding Line segments requiring dye water testing will be identified on the basis of smoke test results. Prior to initiating dye water testing, a list of line segments recommended for dye water testing will be provided to the TOWN OF WESTLAKE for review and approval. The line segments on the list will be annotated as to the priority and reason for recommendation. It is anticipated that dyed water flooding of suspected downspouts, drains, and storm sewers in the downtown area may be performed in lieu of smoke testing. Westlake SSSS 3 2/16/2017 Res 17-10 Dyed water flooding shall be conducted at selected locations prior to televised inspection to verify the existence of inflow and infiltration sources. Dye testing will also be conducted concurrently with television inspections on those line segments approved by the TOWN OF WESTLAKE for dye testing. The dye water will be induced into the line by flooding storm sewers and drainage ditches. Sufficient time will be allowed for the source to activate, at which time the television inspection equipment will be introduced into the line segment. Data Management/Quality Assurance Each field inspection form will be reviewed to ensure that the field data is complete and free from obvious errors or inaccuracies. Smoke test photos will be reviewed to ensure that background reference features appear in the photo. Manhole, visual pipe, smoke test and dyed water forms will be reviewed to ensure that they correlate with the TOWN OF WESTLAKE's atlas. Data entry will be performed concurrently with the field inspections to ensure that errors are identified, addressed, and corrected as soon after the inspection was performed as possible. All manhole, visual pipe, smoke testing, dyed water and any other observed defects shall be captured with a digital camera and loaded on to a CD or Flashdrive for delivery to the TOWN OF WESTLAKE. Discrepancies between the TOWN OF WESTLAKE's sewer atlas and actual field conditions will be recorded on standard forms and periodically delivered to the TOWN OF WESTLAKE. Basin #2 SSES Defect Analysis and Report At the conclusion of the field investigation services in Basin #2, an engineering analysis of field survey data shall be performed to develop recommendations for prioritizing 1/1 source repairs. • Develop rehabilitation and improvement costs for manhole and line repairs • Perform priority analysis for infiltration rehabilitation plan based on applicable rehabilitation method, material, and costs. • Perform priority analysis for inflow rehabilitation plan based on applicable rehabilitation method, material and costs. • Develop recommendations for rehabilitation of both public and private 1/1 sources in priority order, cost estimates by individual rehabilitation type, and estimated 1/1 reduction as a result of the recommendations. A description of field investigations, engineering analysis, and recommended action to reduce 1/1 in Basin #2 will be included in a Letter Report. Westlake SSES 4 2/16/2017 Res 17-10 COMPENSATION TABLE Basin #2 SSES Sub-Task Activity Quantity Units Rate Total Project Admin. 1 Lump Sum $4,810.00 $4,810.00 Manhole Inspections (surface) 15 Each $118.50 $1,777.50 Manhole Inspections (full descent) 30 Each $160.20 $4,806.00 Smoke Testing 12,000 Linear ft. $0.57 $6,840.00 Dyed Water Flooding 5 Each $572.00 $2,860.00 CCTV Investigation 3,000 Linear ft. $5.38 $16,140.00 TV Data Review 3,000 Linear ft. $0.22 $660.00 Engineering Analysis / Reporting 1 Lump Sum $6,790.00 $6,790.00 SSES Total = $44,683.50 --END— Westlake SSES 5 2/16/2017 Res 17-10 ATTACHMENT A AGREEMENT BETWEEN TOWN OF WESTLAKE,TEXAS AND RJN GROUP, INC THIS AGREEMENT made this4J day of _2017 by and between the TOWN of WESTLAKE,TEXAS,hereinafter called TOWN and RJN GR P, INC.,with an office in Dallas, Texas hereinafter called ENGINEER. WHEREAS,the Town of Westlake,Texas hereinafter hereby engages the ENGINEER,to perform professional services to provide Sewer Flow Monitoring service within the wastewater collection system of the Town. WHEREAS, the ENGINEER desires to perform such services to the TOWN in accordance with the terms and conditions of the AGREEMENT. NOW,THEREFORE, in consideration of the above recitals,the mutual promises and covenants hereinafter set forth,the parties hereto agree as follows: Section I-Basic Services of ENGINEER The specific services which the ENGINEER agrees to furnish are as indicated in the Attachment A "Scope of Services" which is hereby incorporated by reference and made part of this AGREEMENT. Changes in the indicated Scope of Services shall be subject to renegotiation and implemented through an Amendment of this AGREEMENT. Section II-Future Services of ENGINEER The ENGINEER is available to furnish and perform, under an Amendment or a separately negotiated agreement,future services to supplement this work. Westlake,TX SSES I of 7 2017 Res 17-10 AGREEMENT Section III- Schedule of Services A. Completion Time For those services described in Section I,the ENGINEER shall make every reasonable effort to schedule manpower and service elements in a diligent manner. It is recognized by both parties that actions of regulatory agencies and/or others may affect the final project schedule. The services described shall be performed as weather and other physical conditions permit. The ENGINEER shall not be liable to the TOWN, if delayed in, or prevented from performing the work as specified herein through any cause or causes beyond the control of the ENGINEER and not caused by his own fault or negligence. Attachment B "Schedule of Services"is hereby incorporated by reference and made part of this AGREEMENT. Section IV-Payment for Services Payment to the ENGINEER shall be made as follows: A. Payment for Services The TOWN recognizes that time is of the essence with respect to payment of the ENGINEER's invoices, and that timely payment is a material part of the consideration of this AGREEMENT. Payment for services rendered shall be made to the ENGINEER at the end of each month's billing cycle upon presentation of the ENGINEER's monthly statement. ENGINEER will provide to the TOWN a detailed statement of tasks by classification and reimbursement expenses. Total payment shall not exceed aforestated amounts without prior authorization by the TOWN. If the TOWN objects to all or any portion of an invoice,the TOWN shall so notify the ENGINEER within ten(10)calendar days of the invoice date, identify the cause of disagreement, and pay when due that portion of the invoice, if any,not in dispute. TOWN has the right to appeal or ask for clarification of any ENGINEER's billing within ten(10) days of date of billing. Until said appeal is resolved, or clarification is issued,no interest will accrue. The TOWN shall exercise reasonableness in contesting any invoice or portion thereof. Section V-Services to be Provided by the TOWN A. Authorization to Proceed The TOWN shall authorize the ENGINEER to proceed prior to the ENGINEER starting work. Westlake,TX SSES 2 of 7 2017 Res 17-10 AGREEMENT B. Access to Facilities and Property The TOWN shall make its system facilities and properties available and accessible for inspection by ENGINEER and arrange for access to make all provisions for the ENGINEER to enter upon public property as required for the ENGINEER to perform his services. C. Prompt Notice The TOWN shall give prompt written notice to ENGINEER whenever TOWN observes or otherwise becomes aware of any development that affects the scope or timing of ENGINEER's services,or any defect in the service or work of the ENGINEER or Contractors in order that the ENGINEER may take prompt,effective measures,which in the ENGINEER's opinion,will minimized the consequences of a defect. D. Compensation of a Cost Not to Exceed For basic services, as based on the estimated quantities and enumerated in Scope of Services,the TOWN shall pay the ENGINEER a maximum not to exceed cost of$44,683.50. Payments as described hereinafter shall represent full compensation to,the ENGINEER for all payroll costs, expenses,current overhead,profit,and all other costs in connection with the performance of these services. The ENGINEER, if requested, shall provide documentation to the TOWN of all costs in connection with the performance of these services,and as further described in Attachment C. E. Changes of Scope In the event additional services are required through changes in the scope of the Project,or other unusual or unforeseen circumstances are encountered,or for other consulting services,ENGINEER shall, upon written authorization by the TOWN,perform the additional services as mutually agreed by both parties by supplemental agreement. If renegotiated terms cannot be agreed to,the TOWN agrees that the ENGINEER has an absolute right to terminate the AGREEMENT. Section VI-Construction Cost and Opinions of Cost A. The ENGINEER shall submit to the TOWN an opinion of the probable cost required to construct work recommended,designed,or specified by the ENGINEER. The ENGINEER is not a construction cost estimator or construction contractor,nor should the ENGINEER's act of rendering an opinion of probable construction costs be considered equivalent to the nature and extent of service a construction cost estimator or construction contractor would provide. The ENGINEER's opinion will be based solely upon its own experience with construction. This requires the ENGINEER to make a number of assumptions as to actual conditions that will be encountered on site;the specific decisions of other design professionals engaged;the means and methods of construction the contractor will employ;the cost and extent of labor,equipment and materials the contractor will employ; contractor's techniques in determining prices and market conditions at the time,and other factors over which the ENGINEER has no control. Given the assumptions which must be made,the ENGINEER cannot guarantee the accuracy of its opinions of cost,and, in recognition of that fact,the TOWN waives any claim against the ENGINEER relative to the Westlake,TX SSES 3 of 7 2017 Res 17-10 AGREEMENT accuracy of the ENGINEER's opinion of probable construction cost. If prior to the Bidding or Negotiation Phase, TOWN wishes greater assurance as to Total Project or Construction Costs, TOWN shall employ an independent cost estimator. Section VII-General Considerations A. Standard of Practice Services performed by the ENGINEER under this AGREEMENT will be conducted in a manner consistent with that level of care and skill ordinarily exercised by members of the profession currently practicing in the same locality under similar conditions. No other representation, expressed or implied,and no warranty or guarantee is included or intended in this AGREEMENT, or in any report,opinion,document or otherwise. B. Survival All obligations arising prior to the termination of this AGREEMENT and all provisions of this AGREEMENT allocating responsibility or liability between the TOWN and the ENGINEER shall survive the completion of the services hereunder and the termination of this AGREEMENT. C. Ownership of Instruments of Service All reports, plans,specifications, field data, field notes, laboratory test data, calculations,estimates and other documents prepared by the ENGINEER as instruments of service shall remain the property of the TOWN. The ENGINEER shall retain these records for a period of five(5)years following submission of his or her report,during which period they will be made available to the TOWN at all reasonable times. If the TOWN wishes the ENGINEER to retain documents for a longer period of time,the TOWN shall so specify in advance, in writing,and shall pay in a timely manner all charges agreed to for the ENGINEER's maintenance of such documents beyond the time period otherwise prevailing. D. Reuse of Documents All documents including Drawings and Specifications prepared or furnished by the ENGINEER (and ENGINEER's independent professional associates and consultants)pursuant to this AGREEMENT are instruments of service in respect of the Project and ENGINEER shall retain an interest therein whether or not the Project is completed. TOWN may make and retain copies for information and reference in connection with the use and occupancy of the Project or on any other project. Any reuse without written verification or adaptation by ENGINEER for the specific purpose intended will be at TOWN's sole risk and without liability or legal exposure to ENGINEER's independent professional associates or consultants,and TOWN shall indemnify and hold harmless ENGINEER and ENGINEER's independent professional associates and consultants from all claims,damages, losses and expenses including attorneys'fees arising from or resulting therefrom. Any such verification or adaptation will entitle ENGINEER to further compensation at rates to be agreed upon by TOWN and ENGINEER. E. Termination of Services Westlake,TX SSES 4 of 7 2017 Res 17-10 AGREEMENT This AGREEMENT may be terminated in whole or part in writing by either party in the event of substantial failure by the other party to fulfill its obligations under this AGREEMENT through no fault of the terminating party. Such termination may not be effected unless the other party is given not less than 10 days written notice(delivered by certified mail, return receipt requested)of intent to terminate and an opportunity for consultation with the terminating party and 10 days to cure such substantial failure. Irrespective of which party shall effect termination or the cause therefore,the TOWN shall within forty-five(45)calendar days of termination remunerate the ENGINEER for services rendered and costs incurred, in accordance with the ENGINEER's prevailing fee schedule and expense reimbursement policy. Service shall include those rendered to the time of termination,as well as those associated with termination itself,such as demobilizing,modifying schedules,reassigning personnel, and so on. Costs shall include those incurred to the time of termination,as well as those associated with termination and post-termination activities. Such costs shall not include payments to third parties engaged by the ENGINEER for services not yet performed. The TOWN may terminate this AGREEMENT with or without cause or reason. Upon receipt of a notice of termination from TOWN,the ENGINEER shall promptly discontinue all services affected (unless the notice directs otherwise)and deliver or otherwise make available to the TOWN(subject to "Reuse of Documents" provisions)all data,drawings,specifications,reports, estimates, summaries,and other information and materials accumulated by the ENGINEER in performing this AGREEMENT,whether completed or in progress. F. Controlling Law and Disputes If any of the provisions of this AGREEMENT are invalid under any applicable statute or rule of law,they are,to that extent,deemed omitted. However,the TOWN and the ENGINEER will in good faith attempt to replace an invalid or unenforceable provision with one that is valid and enforceable,and which comes as close as possible to expressing or achieving the intent of the original provision.This AGREEMENT shall be governed by the laws of the State of Arkansas Pulaski County. The parties agree that they shall reasonably attempt to resolve any disputes regarding the interpretation of this AGREEMENT by informal negotiation,the final resolution of which disputes shall require the agreement of both parties. G. Successors and Assigns The TOWN and the ENGINEER each binds itself and its partners, successors,executors, administrators,assigns and legal representatives to the other party to this AGREEMENT and to the partners, successors,executors,administrators,assigns and legal representatives of such other party, in respect to all covenants,agreements,and obligations of this AGREEMENT. Neither the TOWN nor the ENGINEER shall assign, sublet or transfer any rights under or interest in(including,but without limitation,moneys that may become due or moneys that are due)this AGREEMENT without the written consent of the other. Unless specifically stated to the contrary in any written consent to an assignment,no assignment will release or discharge the assigner from any duty or responsibility under this AGREEMENT.Nothing contained in this paragraph shall prevent the ENGINEER from employing such independent consultants,associates,and subcontractors as it may deem appropriate to assist it in the performance of services hereunder. Westlake,TX SSES 5 of 7 2017 Res 17-10 AGREEMENT The ENGINEER's use of others for additional services shall not be unreasonably restricted by the TOWN provided the ENGINEER notifies the TOWN in advance. Nothing herein shall be construed to give any rights or benefits hereunder to anyone other than the TOWN and the ENGINEER,and all duties and responsibilities undertaken herein will be for the sole and exclusive benefit of the TOWN and the ENGINEER and not for the benefit of any other party. H. Dispute Resolution All claims,disputes or controversies arising from,or in relation to,the interpretation, application or enforcement of this AGREEMENT shall be decided through mediation or arbitration whichever is mutually agreed upon by TOWN and ENGINEER. L Insurance During the course of performance of these services,RJN GROUP, INC. will maintain the following minimum insurance coverages: Type of Coverage Limits of Liability Workers' Compensation Statutory Employers' Liability $500,000 Each Accident Commercial General Liability Bodily Injury and $1,000,000 Combined Single Limit Property Damage Automobile Liability: Bodily Injury and $1,000,000 Combined Single Limit Property Damage Professional Liability Insurance $1,000,000 Each Claim Westlake,TX SSES 6 of 7 2017 Res 17-10 AGREEMENT IN WITNESS THEREOF,the parties hereto have caused this AGREEMENT to be executed this day of RVYN�Ar� �L.k 12017. For the TOWN: t a At It Thomas E.Brymer,Tcv Manager ATTEST: ©FAST For the ENGINEER: RJN GROUP, INC Name: Daniel Ja kson,PE r�X AS Vice President Title ATTEST: c Attachment A—Scope of Services and Compensation Westlake,TX SSES 7 of 7 2017 Res 17-10 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 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2017-171886 RJN Group, Inc. Dallas, TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 02/27/2017 being filed. Town of Westlake Date Acknowledged: 02/27/2017 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. 2017-03 Engineering Services-Sanitary Sewer Evaluation Study Nature of interest 4 Name of Interested Party City,State,Country(place of business) (check applicable) Controlling I Intermediary Plymale, Paul Dallas,TX United States X Jackson, Daniel Dallas,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 V1.0.277 CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft Complete Nos. 1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2017-171886 RJN Group, Inc. Dallas,TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 02/27/2017 being filed. Town of Westlake Date Acknowledged: S 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. 2017-03 Engineering Services- Sanitary Sewer Evaluation Study 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Plymale, Paul Dallas, TX United States X Jackson, Daniel Dallas,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. : �Y•`� <, CHERYL D. TEAMES MY COMMISSION EXPIRES NOVEMBER 30, 2017 Signature of auth rized agent of contracting business entity AFFIX NOTARY STAMP/SEAL ABOVE \\� 1_J-1 I-Ck- IAS II Sworn to and subscribed before me, by the said /�(.'IL.LO Yl ,this the�day of .tL12 MICA r 20 ) ,to certifywhich,witness my hand and seal of office.- kri Jeu.� � �. IErAME-S 2A N6 T aturIII— e of offcer 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 V1.0.277