HomeMy WebLinkAboutContract 47855 CITY SECRETAW''//
CONTRACT W.
COMMUNITY FACILITIES AGREEMENT
WITH CITY OVERSIZING PARTICIPATION
Developer Company Name: PB Ventana 1,LLC
Address,State,Zip Code: 4145 Travis St. Suite 202,Dallas,TX 75204
Phone&Email: 214-954-7025,petergpmbinv.com
Authorized Signatory,Title: E.Peter Pincoffs III,President
Project Name and Brief Ventana Pump Station
Description:
Plat Case Number: PP-15-036 Plat Name: Ventana
Mapsco: 86N Council District: 3 City Project Number: 02749
CFA Number: 2016-25 DOE Number: None
To be completed ff
Received by: Date:
City of Fort Worth,Texas
[OFFICIAL RECORDStandard Community Facilities Agreement with City Participation TY SECRETARYCFA Official Release Date:07.30.2015Page I of 11 T.WORTH,TX
COMMUNITY FACILITIES AGREEMENT
WITH CITY OVERSIZING PARTICIPATION
THE STATE OF TEXAS § City Secretary
COUNTY OF TARRANT § Contract No.
WHEREAS, PB Ventana 1, LLC ("Developer"), desires to make certain specific
improvements as described below and on the exhibits attached hereto ("Improvements")
related to a project generally described as Ventana Pump Station("Project")within the City of
Fort Worth,Texas ("City"); and
WHEREAS, the City has reviewed the proposed Improvements and desires to have
the Developer oversize the proposed Improvements to provide capacity for future
development in the area("Oversized Improvements"); and
WHEREAS,the Developer and the City desire to enter into this Community Facilities
Agreement ("CFA" or "Agreement") in connection with the collective Improvements for the
Project; and
WHEREAS,the City has reviewed the Project and desires to participate in the Project
in accordance with this Agreement as presented by the Cost Summary Table and Exhibits
attached hereto and authorized by City Council via M&C C-27705 on - MU 10,2016;and
WHEREAS, The City's cost participation shall be in an amount not to exceed
$512,987.00("Participation"); and
WHEREAS,the City has requested the Developer to cause, and the Developer agrees
to cause,the design,permitting and construction of the Project for which the City will,subject
to City Council approval, reimburse the Developer for the City's portion of those costs after
City's final acceptance of the Project.
NOW, THEREFORE, for and in consideration of the covenants and conditions
contained herein,the City and the Developer do hereby agree as follows:
General Requirements
A. The Policy for the Installation of Community Facilities ("Policy") dated March 2001,
approved by the City Council of the City of Fort Worth, as amended, is hereby
incorporated into this Agreement as if copied herein verbatim.Developer agrees to comply
with all provisions of said Policy in the performance of its duties and obligations hereunder
and to cause all contractors hired by Developer to comply with the Policy in connection
with the work performed by said contractors.
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Official Release Date:07.30.2015
Page 2 of 11
B. Developer shall provide financial security in conformance with paragraph 6, Section II,of
the Policy and recognizes that there shall be no reduction in the collateral until the Project
has been completed and the City has officially accepted the Improvements. Developer
further acknowledges that said acceptance process requires the Developer's
contractor(s) to submit a signed affidavit of bills paid signed by its contractor and
consent of surety signed by its surety to ensure the contractor has paid any sub-
contractor(s)and suppliers in full. Additionally,the contractor will provide in writing
that the contractor has been paid in full by Developer for all the services provided
under their contract.
C. Developer agrees to cause the construction of the Improvements contemplated by this
Agreement and that said construction shall be completed in a good and workmanlike
manner and in accordance with all City standards and the City-approved construction
plans, specifications and cost estimates provided for the Project and the exhibits attached
hereto.
D. The following checked exhibits describe the Improvements and are incorporated herein:
Water (A) ®, Sewer (A-1) ❑, Paving (B) ❑, Storm Drain (B-1) ❑, Street Lights &
Signs (C) ❑.
E. The Developer shall award all contracts for the construction of community facilities in
accordance with Section 11,paragraph 7 of the Policy and the contracts for the construction
of the public infrastructure shall be administered in conformance with paragraph 8,
Section 11, of the Policy. Developer shall ensure its contractor(s) pays the then-current
City-established wage rates.
F. For all Improvements included in this Agreement for which the Developer awards
construction contract(s), Developer agrees to the following:
i. To employ a construction contractor who is approved by the director of the
department having jurisdiction over the infrastructure to be constructed, said
contractor to meet City's requirements for being prequalified, insured, licensed
and bonded to do work in public ways and/or prequalified to perform
water/wastewater construction as the case may be.
ii. To require its contractor to furnish to the City a payment and performance bond
in the names of the City and the Developer for one hundred percent(100%) of
the contract price of the infrastructure, and a maintenance bond in the name of
the City for one hundred percent (100%) of the contract price of the
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Official Release Date:07.30.2015
Page 3 of 11
infrastructure for a period of two (2) years from the date of final acceptance
insuring the maintenance and repair of the constructed infrastructure during the
term of the maintenance bond. All bonds to be furnished before work is
commenced and to meet the requirements of Chapter 2253, Texas Government
Code.
iii. To require the contractor(s) it hires to perform the construction work
contemplated herein to provide insurance equal to or in excess of the amounts
required by the City's standard specifications and contract documents for
developer-awarded infrastructure construction contracts. The City shall be
named as additional insured on all insurance required by said documents and
same will be evidenced on the Certificate of Insurance(ACORD or other state-
approved form) supplied by the contractor's insurance provider and bound in
the construction contract book.
iv. To require its contractor to give 48 hours advance notice of intent to commence
construction to the City's Construction Services Division so that City inspection
personnel will be available; to require the contractor to allow the construction
to be subject to inspection at any and all times by City inspection forces,to not
install or relocate any sanitary sewer, storm drain, or water pipe unless a
responsible City inspector is present and gives his consent to proceed, and to
make such laboratory tests of materials being used as may be required by the
City.
V. To require its contractor to have fully executed contract documents submitted
to the City to schedule a Pre-Construction Meeting. The submittal should occur
no less than 10 working days prior to the desired date of the meeting. No
construction will commence without a City-issued Notice to Proceed to the
Developer's contractor.
vi. To delay connections of buildings to service lines of sewer and water mains
constructed under this Agreement, if any, until said sewer and water mains and
service lines have been completed to the satisfaction of the Water Department.
G. Developer shall provide, at its expense,unless otherwise agreed to by City, all engineering
drawings and documents necessary to construct the Improvements under this Agreement.
H. Developer shall cause the installation or adjustment of the required utilities to serve the
development or to construct the Improvements required herein.
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Official Release Date:07.30.2015
Page 4 of 11
I. City shall not be responsible for payment of any costs that may be incurred by Developer
in the relocation of any utilities that are or may be in conflict with any of the community
facilities to be installed hereunder. City will be responsible for the costs of utility relocation
necessitated by the City's-participation in this Agreement.
J. Developer hereby releases and agrees to indemnify, defend and!told the City harmless
for any inadequacies in the preliminary plans,specifications and cost estimates supplied
by the Developer for this Agreement.
K. Developer agrees to provide, at its expense, all necessary rights of way and easements
across property owned by Developer and required for the construction of the current and
future improvements provided for by this Agreement.
L. The Developer further covenants and agrees to, and by these presents does hereby,fidly
indemnify,hold harmless and defend the City, its officers,agents and employees from all
suits, actions or claims of any character, whether real or asserted, brought for or on
account of any injuries(including death)or damages sustained by any persons or to any
property, resulting from or in connection with the construction, design,performance or
completion of any work to be performed by said Developer, his contractors,
subcontractors, officers, agents or employees, or in consequence of any failure to
properly safeguard the work, or on account of any act, intentional or otherwise, neglect
or misconduct of said Developer, its contractors, sub-contractors, officers, agents or
employees.
M. The Developer will fiirther require its contractors to indemnify, defend and hold
Harmless the City,its officers,agents and employees from and against any and all claims,
suits or causes of action of any nature whatsoever, whether real or asserted, brought for
or on account of any injuries or damages to persons or property, including death,
resulting from or in any way connected with the construction of the infrastructure
contemplated herein, whether or not such injuries, death or damages are caused, in
whole or in part, by the alleged neizligence of the City of Fort Worth, its officers,
servants, or employees. Further,Developer will require its contractors to indemnify and
Bold harmless the City for any losses, damages, costs or expenses suffered by the City or
caused as a result of said contractor's failure to complete the work and construct the
improvements in a good and workmanlike manner,free from defects, in conformance
with the Policy, and in accordance with all plans and specifications.
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Official Release Date:07.30.2015
Page 5 of 11
N. Upon completion of all work associated with the construction of the Improvements,
Developer will assign to the City a non-exclusive right to enforce the contracts entered into
by the Developer with its contractor along with an assignment of all warranties given by
the contractor, whether express or implied. Further, Developer agrees that all contracts
with any contractor shall include provisions granting to the City the right to enforce such
contracts as an express intended third party beneficiary of such contracts.
O. Inspection and material testing fees are required as follows and further apportioned in the
Cost Summary Table below
i. Developer shall pay in cash water and wastewater inspection fees and material
testing fees equal to two percent(2%)for a total of 4%of the Developer's share
of the total construction cost as stated in the construction contract.
ii. Developer shall pay in cash paving and storm drain inspection fees equal to
four percent(4%)and material testing fees equal to two percent(2%)for a total
of 6% of the Developer's share of the total construction cost as stated in the
construction contract.
iii. Developer shall pay in cash the total cost of streetlights or if the City is not
installing the streetlights, inspection fees equal to four percent (4%) of the
Developer's share of the streetlight construction cost as stated in the
construction contract.
iv. Developer shall pay in cash the total cost of street signs necessary for
Developer's portion of the Project.
P. COMPLETION WITHIN 2 YEARS
i. The City's obligation to participate (exclusive of front foot charges) in this
Agreement shall terminate if the Improvements are not completed within two
(2) years; provided, however, if construction of the Improvements has started
within the two year period,the Developer may request that the CFA be extended
for one(1) additional year. If the Improvements are not completed within such
extension period, there will be no further obligation of the City to participate.
City participation in this CFA shall be subject to the annual availability of City
funds as approved by the City Council.
ii. Subject to paragraph i, above,the City shall reimburse Developer for the City's
costs upon presentation of proper documentation of completion of installation
of the Oversized Improvements.
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Official Release Date:07.30.2015
Page 6 of 11
iii. Nothing contained herein is intended to limit the Developer's obligations
under the Policy, this Agreement, its financial guarantee, its agreement
with its contractor or other related agreements.
iv. The City may utilize the Developer's financial guarantee submitted for this
Agreement to cause the completion of the construction of the Improvements if
at the end of two (2)years from the date of this Agreement(and any extension
period)the Improvements have not been completed and accepted.
V. The City may utilize the Developer's financial guarantee to cause the payment
of costs for construction of the Improvements before the expiration of two (2)
years if the Developer breaches this Agreement, becomes insolvent or fails to
pay costs of construction and the financial guarantee is not a Completion
Agreement. If the financial guarantee is a Completion Agreement and the
Developer's contractors and/or suppliers are not paid for the costs of supplies
and/or construction, the contractors and/or suppliers may put a lien upon the
property which is the subject of the Completion Agreement.
(REMAINDER OF PAGE INTENTIONALLY LEFT BLANK)
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Oficial Release Date:07.30.2015
Page 7 of 11
COST SUMMARY TABLE
Developer's Cost City's Cost Total Cost
A.Water and Sewer Construction
1.Water $ 421,325.09 $ 422,461.89 $843,786.98
2. Sewer $ - $ - $ -
Contingency 15% $ - $ 90,525.11 $ 90,525.11
Water Construction Cost Sub-Total $ 421,325.09 $ 512,987.00 $934,312.09
B. TPW Construction
1. Paving $ - $ - $ -
2. Storm Drain $ - $ - $ -
3. Street Lights $ - $ - $ -
4.Traffic Signal $ - $ - $ -
TPW Construction Cost Sub-Total $ - $ - $ -
Total Construction Cost $ 421,325.09 $ 512,987.00 $934,312.09
Construction Fees:
C.Water/Sewer Inspection Fee (2%) $ 8,426.50 $ 10,259.74 $ 18,686.24
D.Water/Sewer Material Testing Fee(2%) $ 8,426.50 $ 10,259.74 $ 18,686.24
Water Construction Fees Sub-Total $ 16,853.00 $ 20,519.48 $ 37,372.48
E.TPW Inspection Fee $ - $ - $ -
F. TPW Material Testing Fee $ - $ - $
G. Street Light Inspection Fee $ - $ - $
H. Traffic Signal Inspection Fee $ - $ - $ -
l. Street Signs Installation Cost $ - $ - $ -
J.Civil/Geotechnical Engineering&Survey(20%) $ - $ - $ -
TPW Construction Fees Subtotal $ - $ - $ -
Total Construction Fees $ 16,853.00 $ 20,519.48 $ 37,372.48
TOTAL PROJECT COST $ 438,178.09 $ 533,506.48 $971,684.57
Financial Guarantee Options, choose one Amount Choice
Mark one
Bond = 100% $ 421,325.09 x
Completion Agreement= 100%/Holds Plat $ 421,325.09
Cash Escrow Water/Sanitary Sewer= 125% $ 526,656.36
Cash Escrow Paving/Storm Drain = 125%
The costs stated herein may be based upon construction estimates rather than actual costs. The City's
portion of inspection and material testing fees are directly allocated to the City's accounts for charges and
does not reimburse the Water Inspection and Material Testing Fees to the Developer. The City's
participation estimate shall be limited to the unit prices contained in City of Fort Worth Ordinance No.
19192-06-2010,as amended,("Unit Price Ordinance")or as determined by public competitive bid. The
City's cost participation(excluding inspection and material testing fees)is not a lump sum amount and
may be less than stated above depending upon actual quantities as shown on the Notice of Final
Completion package(`Green sheet')and based on unit prices from the construction contract documents. In
no event shall the City pay more per unit than as determined pursuant to the Unit Price Ordinance or public
competitive bid.
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Official Release Date:07.30.2015
Page 8 of 11
Check items associated with the project being undertaken; checked items must be
included as Attachments to this Agreement
Included Attachment
Attachment 1 -Changes to Standard Community Facilities Agreement
Location Map
Exhibit A: Water Improvements
Water Cost Estimate
❑ Exhibit A-1: Sewer Improvements
Sewer Cost Estimate
❑ Exhibit B: Paving Improvements
❑'' Paving Cost Estimate
❑': Exhibit B-1: Storm Drain Improvements
El Storm Drain Cost Estimate
❑ Exhibit C: Street Lights and Signs Improvements
❑ Street Lights and Signs Cost Estimate
(Remainder of Page Intentionally Left Blank)
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Official Release Date:07.30.2015
Page 9 of 11
ATTACHMENT"1"
Changes to Standard Agreement
Community Facilities Agreement
City Project No.02749
None
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Official Release Date:07.30.2015
Page 10 of 11
IN TESTIMONY WHEREOF, the City of Fort Worth has caused this instrument to be
executed in quadruplicate in its name and on its behalf by its Assistant City Manager,
attested by its City Secretary,with the corporate seal of the City affixed, and said Developer
has executed this instrument in quadruplicate, effective as of the date subscribed by the
City's designated City Manager.
CITY OF FORT WORTH DEVELOPER
PB Ventana 1,LLC
By: PB Ventana Manager, LLC,its general
partner
Jesus J. Chapa / ►-(--
Assistant City Manager Name: E. Peter Pincoffs,
f�—� -/� III
Date: �/
Title: President
Recommended by.-
Date:
1 ATTEST: (Only if required by
t a. - �hti(S
Wendy Chi- abulal,EMBA, P.E. Developer)
Development Engineering Manager
Water Department
Signature
(� Z Name:
Douglas . Wiersig, P.E.
Director
Transportation&Public Works
Department
'D I iz
Approved as to Form &Legality \ll(�( � � ,D►(L'(IV1FM'�
ATTEST: ®1W®a�16
Richard A McCraken 4 /!� 0
Assistant City Attorney 1-. 0
, � —$ a�
Date: PD
No. lG SOS `''� Mary J. Kayser V$ ooh
City Secretary A
Fc-,r-4- 111S.- 2014- 31y7g A�010 0��
City of Fort Worth,Texas
Standard Community Facilities Agreement with City Participation
CFA Official Release Date:07.30.2015 OFFICIAL RECORD
Page 11 of 11
CITY SECRETARY
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City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION , "bjr 4ed on 5/1072096 Resolution No 4627;-05,2076'
DATE: Tuesday, May 10, 2016 REFERENCE NO.: C-27705(Revised)
LOG NAME: 06VENTANA CFAS WATER FUNDING (PROJECTS CO2749 AND 100076 ) REV
SUBJECT:
Authorize Execution of Two Community Facilities Agreements with PB Ventana 1 LLC, in the Combined
Amount of$3,967,361.58 of Which City Participation is in a Combined Amount Not to Exceed $945,741.00
for Oversizing of a Water Main and a Recirculation Water Line Located in the Ventana Addition to Serve
the Development and Anticipated Future Development in the Surrounding Areas, Authorize a Waiver of the
Community Facilities Agreement Policy Regarding Competitive Bidding for Pump Stations and Adopt
Reimbursement Resolution (COUNCIL DISTRICT 3)
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize the execution of the Ventana - Pump Station Community Facilities Agreement with PB
Ventana 1, LLC, in the amount of$2,485,973.00 of which the City is participating in the amount of
$512,987.00 for the oversizing of a water main and a recirculation water line to serve the Ventana Addition
and anticipated future development in the surrounding areas;
2. Authorize the execution of the Ventana -Veale Parkway Community Facilities Agreement with PB
Ventana 1, LLC, in the amount of$1,490,389.00 of which the City is participating in the amount of
$396,378.00 for oversizing of a water main and recirculation water line to serve the Ventana Addition and
anticipated future development in the surrounding areas;
3. Adopt the attached resolution expressing official intent to reimburse expenditures with proceeds of
future debt for the oversizing of a water main and a recirculation water line located in the Ventana
Addition; and
4. Authorize a waiver of the Community Facilities Agreement Policy, Section II, Procedures for Obtaining
a Contract for the Installation of Community Facilities at subsection 7. C. 3 Construction of pump stations,
lift stations and storage tanks.
DISCUSSION:
The Ventana Addition (Ventana) is a single-family development located in southwest Fort Worth, west of
FM 2871 and south of Aledo Road. Ventana requires a 16-inch water main to serve its site. The City is
cost participating in the engineering and construction costs of oversizing the water line to a 24-inch main
to serve future development in the area. Additionally, the City is cost participating in the engineering and
construction costs of an 8-inch recirculation line to provide a looped system for the ultimate build out of the
City's Water CIP Master Plan. Staff and Developer elected to develop separate CFAs for these
improvements. Public bidding of these elements of the project is not required. The Community Facilities
Agreement (CFA) Policy requires public bidding for construction of pump stations. A pump station is
required for this project to increase water pressure to serve portions of the project. The City is not
participating in the cost of the pump station and the developer has requested relief from the public bid
Logname: 06VENTANA CFAS WATER FUNDING(PROJECTS CO2749 AND 100076)REV Page 1 of 3
requirement for this item. Staff recommends approval of this waiver request.
The City's collective cost participation of these improvements is estimated to be $945,741.00 as shown on
the table below, of that amount, $21,026.25 is for engineering services.
Item Developer CostI Ci Cost I Total Cost
Water construction Cost $671,957.00 $770,331.00$1,422,288.00
Contingency (15 percent) $100,794.00 $139,034.00$ 239,827.00
Construction Subtotal $671,957.00 $909,365.00$1,682,115.00
Inspection Fee (2 percent) F $ 15,455.00 $ 18,188.00 $ 33,643.00
Material Testing Fee (2 percent)F $ 15,455.00 $ 18,188.00-F$-33,643.00
Construction Fees Sub-Total 1 $ 30,910.00 $ 36,376.00 $ 67,286.00
Total Project Cost 1 $803,660.00 [045,741.00J$1,749,401.00
The reimbursement of the participation, excluding inspection and material testing fees, is not a lump-sum
amount and may be less than the stated amount depending upon the actual quantities and unit prices
from the Notice of Final Completion Package, commonly referred to as the Green Sheet Package.
This project is anticipated to be included in a future revenue bond issue for the Water and Sewer
Fund. Available cash within the Water and Sewer portfolio and the City's portfolio along with the
appropriation authority authorized under the Direct Purchase Note (DPN) Program will be used to provide
interim financing for this project until debt is issued. To the extent resources other than the Water and
Sewer portfolio are used to provide interim financing, the Water and Sewer Funds will be charged interest
that is equivalent to the overall rate of return being earned by the City portfolio (currently approximately
one-percent annually). Should the City's portfolio not support the liquidity needed to provide and interim
short-term financing source, another funding source will be required, which could mean issuance of
securities under the DPN Program or earlier issuance of Water and Sewer revenue bonds than is currently
planned. Once debt associated with this project is sold, bond proceeds will be used to reimburse the
Water and Sewer portfolio and the City's portfolio in accordance with the attached Reimbursement
Resolution.
The City Council adopted the Water Department's Fiscal Year 2016-2020 Five-Year Capital Improvement
Plan on February 2, 2016 (M&C G-18662). This City Council adopted plan includes this specific project,
with funding identified through the DPN Program to be reimbursed with future revenue bonds. In
accordance with the provisions of the Financial Management Policy Statements, Staff anticipates
presenting revenue-supported debt issuances to the City Council for consideration within the next three
years. This debt must be issued within approximately three years to provide reimbursement for these
expenses. If that does not occur, the costs will no longer be reimbursable by issuing tax-exempt debt and
the funding source will have to be made whole through other budgetary methods. Adoption of this
resolution does not obligate the City to sell bonds, but preserves the ability to reimburse the City from tax-
exempt bond proceeds.
This development is located COUNCIL DISTRICT 3.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that budget is available and that this project is included in the Fiscal Year
2016 Water& Wastewater Capital Improvement Plan, as appropriated. The adopted Water& Wastewater
Capital Improvement Plan includes an appropriation of$9,400,000.00 for programmable Community
Facility Agreement Projects.
Logname: 06VENTANA CFAS WATER FUNDING (PROJECTS CO2749 AND 100076)REV Page 2 of 3
FUND IDENTIFIERS (FIDs):
TO
Fund Department AccounProject ProgramActivity Budget Reference # Amount
ID I ID I Year Chartfield 2
560051 0600430 5310101 CO2749 C01483 2016 1$512,987.00
56005 0600430 5330500 CO2749 C01484 2016 $10,260.00
56005 0600430 5330500 CO2749 C01485 2016 $10,260.00
56005 0600430 5310101 100076 001480 1 2016 $396,378.00
56005 0600430 5330500 100076 001480 1 2016 $7,928.001
1560051 0600430 5330500 1 100076 001480 1 2016 $7,928.001
FROM
rtment?k��nProject Program ctivity Budget Reference # mounr7lDepaID
ID Year Chartfield 2
CERTIFICATIONS:
Submitted for City Manager's Office by: Jay Chapa (5804)
Originating Department Head: John Carman (8246)
Additional Information Contact: Julie Westerman (2677)
Logname: 06VENTANA CFAS WATER FUNDING (PROJECTS CO2749 AND 100076)REV Page 3 of 3
CERTIFICATE OF INTERESTED PARTIES �-'- 11 C11FORM y5
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 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. 2016-31479
PB Ventana 1, LLC
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 03/28/2016
being filed.
City of Fort Worth Date Ackno ed ed:
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,a p ovid a
description of the goods or services to be provided under the contract.
02749
Construction of Community Facilities
4 Nature of interest(check applicable)
Name of Interested Party City,State,Country(place of business)
Controlling Intermediary
Davis,Ken Fort Worth,TX United States X
Baird,Taylor Dallas,TX United States X
Pincoffs, Peter 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.
CASSANDRA F. FOREMAN
Notory Public,State of Texas t
i = My Commission Expires
April 26, 2017
Signature of aut prized agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE <
Swor t 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 administ ng oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.312