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HomeMy WebLinkAboutContract 48139 CITY SFCRETAIW 3p lot CONTRACT 110. 6tg 31 , F0 LEASE AGREEMENT This lease agreement ("Lease") is made and entered into with the ("Effective Date")&---day of , &J , by and between West Mount Moriah Missionary Baptist Church ("Lessor"), acting by and through W. L. D. Campbell, its duly authorized Pastor, and the City of Fort Worth, a Texas municipal corporation, acting by and through its duly authorized Assistant City Manager, Jesus J. Chapa ("Lessee"). The term "Lessor" shall include the agents, representatives, employees, and contractors of Lessor. The term "Lessee" shall include the agents, representatives, and employees of Lessee. SECTION 1. Leased Premises. For and in consideration of the rental payments to be paid under this Lease, Lessor leases to Lessee and Lessee leases from Lessor office space of approximately 556 square feet, located at 5335 Bonnell Ave, Fort Worth, Texas 76107. The office space, together with any and all structures, improvements, fixtures and appurtenances thereon, thereunder or over, shall be referred to as the "Leased Premises". The boundaries and location of the Leased Premises are described on Exhibit "A", attached hereto and made part hereof for all purposes. SECTION 2. Use of Premises. The Leased Premises shall be used as office space for City of Fort Worth Police Department. SECTION 3. Term. (a) This Lease shall be for a period of 12 months commencing on October 1, 2016 and terminating on September 30, 2017 ("Initial Term"), unless a prior termination is effected by either Lessor or Lessee under the termination provisions of this Lease. (b) This Lease shall automatically renew for up to four (4) successive terms of twelve (12) months each unless either party notifies the other party in writing of its intent to terminate the Lease on or before 30 days prior to the expiration of the Lease or any extension. The terms of this Lease shall continue to govern and control the relationship of the parties during any extensions or holdover by Lessee. SECTION 4. Rent. (a) Rent for the primary term of twelve (12)months, beginning October 1, 2016 and ending September 30, 2017, shall be $5,400.00 annually, or $450.00 per month, which represents a 0%percent increase over the month to month rental period. (b) Rent for the first renewal term, beginning October 1, 2017 and ending September 30, 2018, of twelve months shall be $5,400.00 annually, or $450.00 per month, which represents a 0% percent increase over the rental amount for the primary term. (c) Rent for the second renewal term,beginning October 1, 2018 and ending September 30, 2019, of twelve months shall be $6,000.00 annually, or $500.00 per month, which represents a 11.1111%percent increase over the rental amount for the first renewal term. City of Fort Worth Police Lease West Moriah Missionary Baptist Church OFFICIAL RECORD 5335 Bonnell Avenue Page 1 CITY -SECRETARY WORTH TX (d) Rent for the third renewal term, beginning October 1, 2019 and ending September 30, 2020, of twelve months shall be $6,000.00 annually, or $500.00 per month, which represents a 0% percent increase over the rental amount for the third renewal term. (e) Rent for the fourth renewal term, beginning October 1, 2020 and ending September 30, 2021, of twelve months shall be $6,000.00 annually, or $500.00 per month, which represents a 0% percent increase over the rental amount for the fourth renewal term and this rental rate shall remain in effect in the event of any extension or holdover of this Lease beyond the fourth renewal term, unless the parties agree otherwise in writing. SECTION 5. Taxes, Insurance, Utilities. Lessee agrees to be responsible for the payment of all electricity, natural gas, local telephone, or other utility charges that come due and payable during the term Lessee occupies the Leased Premises. Lessor agrees that Lessor will pay for water for the Premises, provided usage is within normal amounts. Additionally, Lessor agrees to pay all taxes and insurance as they come due. Leasee shall keep the Leased Premises in good, clean and habitable condition, normal wear and tear excepted. SECTION 6. maintenance. (a) Lessor shall maintain the roof, foundation, and structural soundness of exterior walls, HVAC, water and sewer lines, electrical system, and landscaping of the outside premises at its own expense in good order, condition, and repair during the Lease Term. Lessor shall also be responsible to repair any damage caused by or resulting from any failure or disrepair of the roof, foundation, exterior walls, HVAC, water and sewer lines, or the electrical system. Lessee agrees to give Lessor notice of defects or need for repairs in the roof, foundation, exterior walls, HVAC, water and sewer lines, or electrical system of the Leased Premises, damage caused thereby or resulting therefrom, and Lessor shall commence repair of such defects or disrepairs within seven (7) days of receipt of notice from Lessee. If the repair of such defects or disrepairs is not complete within ten (10) days of the notice by Lessee to Lessor, then, in Lessee's sole discretion, Lessor shall have such additional reasonable time as allowed by Lessee to complete such repairs. In the event the repairs are not performed by Lessor within such additional reasonable time, Lessee may perform the necessary repairs and shall, at Lessee's sole discretion, either (i) receive payment from Lessor in the actual amount of the repairs or (ii) receive a credit against future rent in the actual amount of the repairs. If a defect or disrepair is the result of the negligence of Lessee, Lessee shall be responsible for the actual cost of the repairs, as evidenced by invoices. (b) Lessor shall maintain, at Lessor's expense, a preventive maintenance program providing for the regular inspection and maintenance of the HVAC. Lessor shall provide all routine maintenance in and around the Leased Premises, including replacement of light bulbs, elevator maintenance, pest control, replacement of light fixture florescent lamps and incandescent bulbs and landscaping. (c) Lessee shall provide all security, if any, to the Leased Premises during the Lease Term. Lessor shall have no obligation to provide any security service or other security devised in or about the Leased Premises; and Lessor, in any event, shall have no liability hereunder for any theft, burglary, or other breach of securing during the Lease Term. Lessee shall keep the City of Fort Worth Police Lease West.lforiah Missionary Baptist Church 5335 Bonnell Avenue Page 2 Leased Premises in good, clean, attractive, sanitary, and habitable condition in compliance with all applicable health ordinances and regulatory provisions. SECTION 7. Insurance. Lessor agrees to insure the Leased Premises. Such insurance shall provide protection for liability, fire and casualty, and property damage for the property owned by the Lessor, situated at, and including, the Leased Premises. Verification of this coverage shall be provided to Lessee prior to the execution of this Lease. Lessee assumes no liability or financial obligation for the acquisition or maintenance of such insurance; all costs incurred during the course of insuring the Leased Premises shall be borne solely by the Lessor. Lessee is basically a self-funded entity and as such, generally, it does not maintain a commercial liability insurance policy to cover premises liability. Damages for which Lessee would ultimately be found liable would be paid directly and primarily by Lessee and not by a commercial insurance company. SECTION 8. Liability and Hold Harmless. LESSOR COVENANTS AND AGREES TO RELEASE, INDEMNIFY, HOLD HARMLESS AND DEFEND LESSEE, ITS OFFICERS, AGENTS, SERVANTS, AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS OR SUITS FOR PROPERTY DAMAGE, PERSONAL INJURY, OR ANY OTHER TYPE OF LOSS OR ADVERSE CONSEQUENCE RELATED IN ANY WAY TO THE EXISTENCE OF THIS LEASE OR THE USE OR OCCUPANCY OF THE LEASED PREMISES, REGARDLESS OF WHETHER THE ACT OR OMISSION COMPLAINED OF RESULTS FROM THE ALLEGED NEGLIGENCE OR ANY OTHER ACT OR OMISSION OF LESSOR, LESSEE, OR ANY THIRD PARTY LESSOR COVENANTS AND AGREEES TO RELEASE, INDEMNIFY, DEFEND, REIMBURSE, AND HOLD HARLMESS THE LESSEE, ITS OFFICEERS, AGENTS, EMPLOYEES AND VOLUNTEERS AGAINST ANY AND ALL CAUSES OF ACTION FOR ENVIRONMENTAL DAMAGES OR THE VIOLATION OF ANY AND ALL ENVIRONMENTAL REQUIREMENTS RESULTING FROM LESSEE'S USE OF THE LEASED PREMISES. SECTION 9. Fixtures and Improvements. (a) Lessee shall not make any alterations or improvements to the Leased Premises which may affect the structure of the building, or which may affect the mechanical, plumbing, or electrical systems of the building, without first securing Lessor's prior written consent thereto, which consent shall not be unreasonably withheld. (b) Lessor agrees to allow Lessee to make modification and renovation to the Leased Premises as mutually agreed by the parties to support the purposes for which the Lessee will be using the Leased Premises. All costs associated with the renovation will be at the sole expense of the Lessee. (c) Lessor herein agrees that no property or equipment, owned or installed by Lessee, or any representative of Lessee, shall, under any circumstances, become a fixture, and that Lessee shall reserve the right to remove any and all such property or equipment at any time during the City of Fort Worth Police Lease West Aforiah Missionary Baptist Church 5335 Bonnell Avenue Page 3 term of this Lease, or subsequent to its termination by either party. Lessor further agrees that Lessor will, at no time, hold or retain, any property owned or installed by Lessee, for any reason whatsoever. SEC T ION 10. Default,Termination, Funding and Non-Appropriation. (a) Lessee. A default by Lessee shall exist if Lessee fails to pay rent within thirty (30) days after written notice from Lessor that rent is due hereunder. Upon a default by Lessee, Lessor, as its sole remedy, may terminate this Lease and Lessor shall have the right to collect the past due rent from Lessee. (b) Lessor Default. If Lessor defaults in the performance or observance of any covenant or agreement of this Lease, which default is not cured within 7 days after the giving of notice thereof by Lessee, then Lessee may, at Lesse's option, either (i) terminate this Lease or (ii) cure the Lessor's default. The cost of the cure of a Lessor's default by Lessee pursuant to this Section 10(b) shall be payable by Lessor to Lessee within 7 days after written demand therefor by Lessee, or, at Lessee's option, such costs may be applied as a credit to future rent. Such costs must be actually and reasonably incurred and must not exceed the scope of the Lessor's default. Such costs must be reasonably documented and copies of such documentation shall be delivered to Lessor with the written demand for reimbursement. Nothing contained in this Section 10(b) shall create or imply the existence of any obligation by Lessee to cure any Lessor default. (c) Termination. Lessee shall have the right to terminate this Lease at any time for any reason by giving Lessor 30 days' written notice prior to the intended termination date. If this Lease is terminated under this Section, or as a result of the expiration of the Lease term or any renewal period, neither party shall have any further obligation or liability to the other under this Lease. Lessor and Lessee shall be bound by the terms, covenants and conditions expressed herein until Lessee surrenders the Leased Premises, regardless of whether the date of surrender coincides with the date of termination of the Lease. (d) Funding and Non-Appropriation. This Lease shall terminate in the event that the governing body of Lessee shall fail to appropriate sufficient funds to satisfy any obligation of Lessee hereunder. Termination shall be effective as of the last day of the fiscal period for which sufficient funds were appropriated or upon expenditure of all appropriated funds, whichever comes first. Termination pursuant to this non- appropriation clause shall be without further penalty or expense to either party. SECTION 11. Damage or Destruction. If the building or any other improvement on the Leased Premises should be damaged or destroyed by fire, tornado, or other casualty, Lessee shall promptly give written notice thereof to Lessor. If the damage is such that Lessee cannot use the Leased Premises for their intended use, Lessee shall have the right to terminate this Lease effective immediately upon written notice with no further liability. If Lessee elects not to terminate, and Lessor proceeds to rebuild or City of Fort 6Vorth Police Lease West Moriah Missionary Baptist Church 5335 Bonnell Avenue Page 4 repair such building or other improvements on the Leased Premisis to substantially the condition in which it existed prior to such damage, Rent, utility charges, and any other costs to be paid by Tenant under this Lease shall abate proportionally during such period and the abatement shall continue until the Leased Premises is fit for use by Lessee in the ordinary conduct of its business. SECTION 12. Right of Inspection. Lessor reserves the right to enter upon the Leased Premises at all reasonable times for the purpose of inspecting the Leased Premises, provided that such entry does not conflict with Lessee's rights hereunder. Notwithstanding the above, given the sensitive nature of materials handled by the Fort Worth Police Department ("FWPD"), Lessor and all others having access pursuant to this Section 12 to any portion of the Leased Premises used by the FWPD shall not enter that portion of the Leased. Premises unless accompanied by a representative of Lessee. Lessee shall make a representative available immediately, within reasonable hours, upon request of Lessor. SECTION 13. Surrender of Leased Premises. Upon the termination of this Lease for any reason whatsoever, Lessee shall surrender possession of the Leased Premises in the same condition as the Leased Premises were in upon delivery of possession under the Lease, reasonable wear and tear excepted. Lessee also shall surrender all keys for the Leased Premises to Lessor at the place then fixed for the payment for rent and shall inform Lessor of all combinations on locks, safes, and vaults, if any, on the Leased Premises. Lessee shall remove all its furniture and equipment on or before the termination of the Lease; and Lessee shall be responsible for repairing any damage to the Leased Premises caused by the removal of furniture and equipment. Additionally, if Lessee modifies the Premises with alterations, additions, or improvements made or installed by Lessee, Lessor, upon the termination of this Lease, shall have the right to demand that Lessee remove some or all of such alterations, additions, or improvements made by Lessee, provided, however, if Lessor gave prior approval of such alterations, additions, or improvements, Lessee shall not be required to perform any removal thereof. SECTION 14. Acceptance of Leased Premises. Lessee acknowledges that Lessee has fully inspected the Leased Premises, and on the basis of such inspection Lessee hereby accepts the Leased Premises as suitable for the purposes for which the same are leased. In the event any presently installed plumbing, plumbing fixtures, electrical wiring, lighting fixtures, or HVAC equipment are not in good working condition on the commencement date of this Lease, Lessor agrees to repair promptly any such defects of which Lessee delivers written notice to Lessor within thirty days after the commencement date of this Lease. SECTION 15. Assignment. Lessee shall not assign or sublet this Lease without the prior written approval of Lessor. Upon issuance of such approval, this Lease shall be binding on the successors, and lawful assignees of Lessor and the successors of Lessee, as permitted by the terms of this agreement and by the laws of the State of Texas and the United States. Any person or entity using or occupying the Leased Premises without a lawful assignment or sublease shall be subject to all the responsibilities and liabilities of Lessee and shall be subject to all provisions regarding termination and eviction. City of Fort Worth Police Lease Gest Moriah Missionan,Baptist Church 5335 Bonnell Avenue Page 5 SECTION 16. Notices. Notices required to be made under this agreement shall be sent to the following persons at the following addresses, provided, however, that each party reserves the right to change its designated person for notice, upon written notice to the other party of such change: All notices to Lessor shall be sent to: West Moriah Missionary Baptist Church 1305 Rio Grande Drive Fort Worth, TX 76126 All notices to Lessee shall be sent to: City of Fort Worth Property Management Department Real Property Division 900 Monroe Street Suite 404 Fort Worth, Texas 76102 As well as to: Fort Worth Police Department Administrator, Fiscal and Equipment Management Public Safety Complex, Administration Building 505 W. Felix Street, 76115. As well as to: City of Fort Worth City Attorney's Office Attn: Leann D. Guzman 1000 Throckmorton Fort Worth, Texas 76102 All time periods related to any notice requirements specified in the Lease shall commence upon the terms specified in the section requiring the notice. The notice shall be deemed effective when deposited in United States mail postage prepaid, certified mail, return receipt requested, addressed to the other party as set forth above. SECTION 17. Subordination to Mortgages. Lessee accepts this Lease subject and subordinate to any mortgage(s), deed(s) of trust, ground lease(s) or other lien(s) now or hereafter affecting the Leased Premises, and to renewals, modifications, refinancing's and extensions thereof and if, but only if, each holder of any mortgage, deed of trust, ground lease or other lien subsequently affecting the Leased Premises has executed and delivered to Lessee a SNDA (hereinafter defined), then to any mortgage(s), deed(s) of trust, ground lease(s) and other lien(s) subsequently affecting the Leased Premises, and to renewals, modifications, refinancing's and extension thereof (collectively, a "Mortgage"). The party having the benefit of a Mortgage shall be referred to as a "Mortgagee." This City of Fort Worth Police Lease West Moriah Missionary Baptist Church 5335 Bonnell Avenue Page 6 clause shall be self-operative, but upon request from a Mortgagee, Lessee shall execute a commercially reasonable SNDA in favor of the Mortgagee. If requested by a successor-in-interest to all or part of Lessor's interest in this Lease, Lessee shall, without charge, attorn to the successor-in- interest if, but only if, such successor-in-interest has executed a SNDA or other agreement whereby such successor in interest has agreed not to disturb or interfere with Lessee's possession of the Leased Premises (subject to the terms and conditions of this Lease) for so long as Lessee is not in default under this Lease beyond any applicable notice and cure period. Lessor represents and warrants to Lessee that as of the date of this Lease there is no Mortgage filed against the Leased Premises. Prior to permitting a Mortgagee to obtain a Mortgage on the Property, Lessor will use commercially reasonable efforts to cause such Mortgagee to execute a Subordination, Non-disturbance and Attornment Agreement ("SNDA") in form and substance reasonably satisfactory to Lessor, Lessee and the Mortgagee. The SNDA, among other things, shall provide that in the event a Mortgagee forecloses on the Leased Premises or otherwise enforces its right to divest Lessor of its fee simple interest in the Leased Premises, then such Mortgagee will not disturb Lessee's use and enjoyment of the Leased Premises for so long as Lessee is not in default under this Lease beyond any applicable notice and cure period. SECTION 18. Compliance to Laws. Lessor, at its expense, shall comply with all environmental, air quality, zoning, planning, building, health, labor, discrimination, fire, safety and other governmental or regulatory laws, ordinances, codes and other requirements applicable to the Leased Premises, including, without limitation, the Americans with Disabilities Act of 1990 (collectively, the "Building Laws"). Prior to Lessee's occupancy, Lessor shall obtain certificates as may be required or customary evidencing compliance with all building codes and permits and approval of full occupancy of the Leased Premises and of all installations therein. Lessor shall cause the Leased Premises to be continuously in compliance with all Building Laws (as they may be amended from time to time). SECTION 19. First Right of Refusal. DELETED BY AGREEMENT OF THE PARTIES. SECTION 20. Entire Agreement. This Lease shall constitute the entire agreement of the Lessor and Lessee, and shall supersede any prior agreements, either oral or written, pertaining to the Leased Premises. SECTION 21. Waivers. One or more waivers of any covenant, term, or condition of the Lease by either Lessor or Lessee shall not be construed as a waiver of a subsequent breach of the same covenant, term, or condition. The consent or approval by either Lessor or Lessee to or of any act by the other party requiring such consent or approval shall not be deemed a waiver or render unnecessary consent to or approval of any subsequent similar act. SECTION 22. Choice of Law and Venue. This Lease and the relationship created hereby shall be governed by the laws of the State of Texas. Venue for any action brought to interpret or enforce the terms of the Lease or for any breach shall be in Tarrant County, Texas. SECTION 23. Brokerage. The parties represent and warrant that neither has dealt with any broker, agent or other person in connection with this leasing transaction and that no broker, agent or other City of Fort Worth Police Lease West Woriah Missionary Baptist Church .1335 Bonnell Avenue Page 7 person brought about this leasing transaction. In no event shall Lessee be responsible for any fees charged by any broker, agent or other person. SECTION 24. Eminent Domain. If any part of the Leased Premises is taken by eminent domain, Lessee may either terminate this Lease or continue the Lease in effect. If Tenant elects to continue the Lease, rent will be reduced in proportion to the area of the Leased Premises taken by eminent domain, and Lessor shall repair any damage to the Leased Premises resulting from the taking. Sums awarded or agreed upon between Lessor and the condemning authority for the taking of the interest of Lessor or Lessee shall be the property of Lessor, except for those sums awarded with respect to claims of Lessee against the condemning authority for moving costs and unamortized cost of leasehold improvements paid for by Lessee. If this Lease is terminated under this Section 24, Lessor shall refund to Lessee any prepaid unaccrued rent less any sum then owing by Lessee to Lessor. SECTION 25. Invalidity of Particular Provisions. If any provision of this Lease is or becomes illegal or unenforceable because of present or future laws or any rule or regulation of any governmental entity, the remaining parts of this Lease will not be affected. SECTION 26. Police Protection, Lessor agrees ands understands that Lessee in no way promises to provide increased Police protection or more rapid emergency response time because of this Lease. No special relationship shall exist between Lessor and Lessee other than that of landlord and tenant. Lessee shall provide no greater police protection to Lessor than is provided to all other persons or businesses. SIGNED this day of , 2016. LESSOR: LESSEE: CITY OF FORT WORTH By: By: �— Jesus J. Chapa Name: W.L.D. Campbell Assistant City Manager Title: Pastor 7OVED AS TO FORM AND LEGALITY: ssistant City Attorn {� ATT wl(o-'1 wSo O I'- SQ City SecIt ! , 8� M & C Number: L-1594 Date: 08/23/2016 City of Fort Worth Police Lease West bloriah Missionary Baptist Church OFFICIAL RECORD 5335 Bonnell Avenue Page 8 CITY SECRETARY FT: ''IR.TH, TX EXHIBIT "A" LEGAL DESCRIPTION 5335 BONNELL AVENUE FORT WORTH, TX 76107 BLOCK: 67 LOT: 18 CHAMBERLAIN ARLINGTON HTS 2ND M&C Review Page I of 2 Official site of the City of Fort Worth,Texas CITY COUNCIL AGENDA F°�H COUNCIL ACTION: Approved on 8/23/2016 DATE: 8/23/2016 REFERENCE NO.: **L-15941 LOG NAME: 21 BONNELL5335 CODE: L TYPE: CONSENT PUBLIC NO HEARING: SUBJECT: Authorize Execution of a Lease Agreement with West Mount Moriah Missionary Baptist Church for Office Space Located at 5335 Bonnell Avenue for the Police Department at a Cost of$9,900.00 for the Continuation of the Lease and the Primary Term (COUNCIL DISTRICT 3) RECOMMENDATION: It is recommended that the City Council authorize execution of a Lease Agreement with West Mount Moriah Missionary Baptist Church for approximately 556 square feet of office space located a 5335 Bonnell Avenue for the Police Department at a cost of$9,900.00 for the month-to-month continuation of the lease and the primary lease term with four automatic successive one-year renewals for a total cost of$33,300.00. DISCUSSION: The Property Management Department, Real Properly Division, at the request of the Police Department, has negotiated the lease of office space located at 5335 Bonnell Street to be used as a Police Department storefront. The term will continue for ten months on a month-to-month basis with a new lease beginning October 1, 2016. The lease includes four one-year automatic options to renew unless terminated with written notice. The current rental charge for the month-to-month continuation of the lease from December 1, 2015, to September 30, 2016, is$450.00 per month for a total of $4,500.00 for the ten-month period. The primary term continues at a rate of$450.00 per month for a total of$5,400.00 for the annual period. Staff have continued to pay rent during the month-to-month period while negotiations for a new lease were completed with the property owner. During the second renewal term of the lease, the rent will increase by$50.00 to $500.00 per month. The City of Fort Worth is responsible for all utility and telephone payments. Each renewal shall be contingent upon approval of Crime Control and Prevention District(CCPD) funds for the next one-year renewal term. If CCPD funding is not approved and alternative funding is not identified, the City of Fort Worth will notify Mount Moriah Missionary Baptist Church that the lease will expire at the end of the then-current renewal term. The following schedule outlines the lease terms: Month to month continuation of the lease from December 1, 2015, to September 30, 2016, at $450.00 per month or $4,500.00 total; Primary term begins on October 1, 2016, at $450.00 per month or $5,400.00 annually; 1st Renewal on October 1, 2017, is $450.00 per month or $5,400.00 annually; 2nd Renewal on October 1, 2018, is $500.00 per month or $6,000.00 annually; 3rd Renewal on October 1, 2019, is $500.00 per month or $6,000.00 annually; and 4th Renewal on October 1, 2020, is $500.00 per month or $6,000.00 annually. The total cost for this lease for the duration of all terms outlined above for the approximately 556 square feet of office space will be $33,300.00. The property is located in COUNCIL DISTRICT 3, Mapsco 75N. FISCAL INFORMATION/CERTIFICATION: http://apps.cfwnet.org/council_packet/mc review.asp?ID=22598&councildate=8/23/2016 g/1110n1A M&C Review Page 2 of 2 The Director of Finance certifies that the funds are available in the current operating budget, as appropriated, of the Crime Control and Prevention District Fund. The Police Department has the responsibility to validate the availability of funds prior to an expenditure being made. TO Fund DepartmentAccount Project Program Activity Budget Reference# Amount ID ID Year Chartfield 2) FROM Fund Department Account Project Program Activity Budget Reference# Amount ID I I ID Year Chartfield 2 26001 1 0359501 1 5441101 1 $4,500.00 Submitted for City Manager's Office by: Jay Chapa (5804) Originating Department Head: Steve Cooke (5118) Additional Information Contact: Jean Petr(8367) Lester England (8053) ATTACHMENTS 5335 Bonnell Form 1295.pdf 5335 Bonnell.pdf http://apps.cfwnet.org/council_packet/mc review.asp?ID=22598&councildate=8/23/2016 9/13/2016 L-- 19' q 41 CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f1 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 partles. 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. 2016-73501 West Mount Moriah Missionary Baptist Church Fort Worth,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 06/20/2016 being filed. City of Fort Worth Date nowled d: 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 38363 Building rental for Neighborhood Police Offices. Nature of interest 4 Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 AFFIDAVIT I swear,or affirm,under penalty of perju t the above disclosure is true and correct. r C Signature of authorized age f contracting business entity AFFIX NOTARY STAMP/SEAL B �. / /, ,) �k�< Sworn to and subscribed before me,by the said r��U �.�1`hl/Q�this the !r-�✓ day of 20__/ to certify which,witness my hand and seal of office. ;&cwc-u ti iito Arr fres r Kv N o7' Signature of officer-adrIRP1st&jDb oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.1021