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Docusign City Council Transmittal Coversheet DocuSign Envelope ID: 77E59CA4-8312-4131-A8AC-30D35C765194 Docusign City Council Transmittal Coversheet 6470C FILE File Name PCWRP Raw Sewage Pump Station 2 - Change Order #2 Purchasing Contact Cindy Alonzo PUB Target Date July 9, 2018 City Council Target Date July 17, 2018 Contract Value Change Order #2: $137,016.17; Contract: $622,780.17 Piggy Back Option Not Applicable Contract Expiration N/A Ordinance DocuSign Envelope ID: 77E59CA4-8312-4131-A8AC-30D35C765194 EXHIBIT 2 FILE #6470 CHANGE ORDER NO. 2 XXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Approved as to Legal Form: 7/3/2018 By:_________________________ Aaron Leal, City Attorney City of Denton City of Denton Attest: Reviewed by: Approved by: 7/17/2018 PS Arora, P.E. Todd Hileman By:_________________________ Director of Wastewater City Manager Jennifer Walters, City Secretary DocuSign Envelope ID: 77E59CA4-8312-4131-A8AC-30D35C765194 DocuSign Envelope ID: 77E59CA4-8312-4131-A8AC-30D35C765194 DocuSign Envelope ID: 77E59CA4-8312-4131-A8AC-30D35C765194 Exhibit A House Bill 89 - Government Code 2270 VERIFICATION George Brown I, _______________________________________________, the undersigned representative of ______________________________CompanyControl Specialist Services, LP or Business name (hereafter referred to as company), being an adult over the age of eighteen (18) years of age, verify that the company named-above, under the provisions of Subtitle F, Title 10, Government Code Chapter 2270: 1. Does not boycott Israel currently; and 2. Will not boycott Israel during the term of the contract the above-named Company, business or individual with City of Denton. Pursuant to Section 2270.001, Texas Government Code: 1. “Boycott Israel” means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes; and 2. “Company” means a for-profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit. George Brown ___________________________________ Name of Company Representative (Print) ________________________________ Signature of Company Representative 7/2/2018 _________________________________ Date DocuSign Envelope ID: 77E59CA4-8312-4131-A8AC-30D35C765194 Exhibit B Senate Bill 252 -Government Code 2252 CERTIFICATION George Brown I, ______________________________________________, the undersigned representative of ________________________________________________Control Specialist Services, LP (Company or business name) being an adult over the age of eighteen (18) years of age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152 and Section 2252.153, certify that the company named above is not listed on the website of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806.051, Section 807.051 or Section 2253.153. I further certify that should the above-named company enter into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas which do business with Iran, Sudan or any Foreign Terrorist Organization, I will immediately notify the City of Denton’s Materials Management Department. ___________________________________George Brown Name of Company Representative (Print) ________________________________ Signature of Company Representative 7/2/2018 _________________________________ Date Certificate Of Completion Envelope Id: 77E59CA483124131A8AC30D35C765194 Status: Completed Subject: Please DocuSign: City Council Contract 6470 CO #2 Source Envelope: Document Pages: 6 Signatures: 7 Envelope Originator: Certificate Pages: 6 Initials: 0 Cindy Alonzo AutoNav: Enabled 901B Texas Street EnvelopeId Stamping: Enabled Denton, TX 76209 Time Zone: (UTC-08:00) Pacific Time (US & Canada) [email protected] IP Address: 129.120.6.150 Record Tracking Status: Original Holder: Cindy Alonzo Location: DocuSign 6/29/2018 10:16:03 AM [email protected] Signer Events Signature Timestamp Cindy Alonzo Completed Sent: 6/29/2018 10:25:00 AM [email protected] Viewed: 6/29/2018 10:25:13 AM Senior Buyer Signed: 6/29/2018 10:28:46 AM Using IP Address: 129.120.6.150 City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign George Brown Sent: 6/29/2018 10:28:48 AM [email protected] Viewed: 7/2/2018 6:10:34 AM President Signed: 7/2/2018 6:12:41 AM Control Specialist Services, LP Using IP Address: 4.31.130.210 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 7/2/2018 6:10:34 AM ID: e776bc12-70ba-4876-a7fd-cd2af7adf9a0 PS Arora Sent: 6/29/2018 10:28:48 AM [email protected] Viewed: 6/29/2018 12:20:22 PM Director Wastewater Utility Signed: 6/29/2018 12:21:30 PM Security Level: Email, Account Authentication (None) Using IP Address: 129.120.6.150 Electronic Record and Signature Disclosure: Accepted: 6/29/2018 12:20:22 PM ID: 1fec56fb-1d0b-40a6-ba31-bc9747c9838b Larry Collister Sent: 7/2/2018 6:12:44 AM [email protected] Viewed: 7/3/2018 11:48:39 AM First Assistant City Attorney Signed: 7/3/2018 11:48:46 AM City of Denton Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 9/26/2017 12:27:28 PM ID: 01f5f868-f109-4e29-ad49-21db9046c882 Signer Events Signature Timestamp Tabitha Millsop Completed Sent: 7/3/2018 11:48:49 AM [email protected] Viewed: 7/18/2018 2:39:54 PM City of Denton Signed: 7/18/2018 2:40:04 PM Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Todd Hileman Sent: 7/18/2018 2:40:09 PM [email protected] Viewed: 7/18/2018 3:08:10 PM City Manager Signed: 7/18/2018 3:08:19 PM City of Denton Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 7/25/2017 9:02:14 AM ID: 57619fbf-2aec-4b1f-805d-6bd7d9966f21 Jane Richardson Sent: 7/18/2018 3:08:21 PM [email protected] Viewed: 7/19/2018 7:49:01 AM Assistant City Secretary Signed: 7/19/2018 7:49:28 AM City of Denton Using IP Address: 129.120.6.150 Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Sherri Thurman Sent: 7/2/2018 6:12:43 AM [email protected] City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Jennifer Walters Sent: 7/18/2018 2:40:07 PM [email protected] City Secretary City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Carbon Copy Events Status Timestamp Jennifer Bridges Sent: 7/19/2018 7:49:30 AM [email protected] Procurement Assistant City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Jane Richardson Sent: 7/19/2018 7:49:31 AM [email protected] Assistant City Secretary City of Denton Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 7/19/2018 7:49:31 AM Certified Delivered Security Checked 7/19/2018 7:49:31 AM Signing Complete Security Checked 7/19/2018 7:49:31 AM Completed Security Checked 7/19/2018 7:49:31 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 7/21/2017 1:59:03 PM Parties agreed to: George Brown, PS Arora, Larry Collister, Todd Hileman ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, City of Denton (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through your DocuSign, Inc. (DocuSign) Express user account. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the 'I agree' button at the bottom of this document. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. For such copies, as long as you are an authorized user of the DocuSign system you will have the ability to download and print any documents we send to you through your DocuSign
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