HomeMy WebLinkAboutContract 48240 CITY sECRE° ARA Z
CONTRACT 010,
AGREEMENT FOR THE SCHOOL RESOURCE OFFICER PROGRAM
LENA POPE HOME,INC.
This agreement("Agreement") is made and entered into between the City of Fort Worth, a
home rule municipal corporation of the State of Texas ("City"), acting by and through Valerie R.
Washington, its duly authorized Assistant City Manager, and the Lena Pope Home, Inc., a non-
profit organization located in Tarrant County ("Agency"), acting by and through Todd Landry, its
duly authorized Chief Executive Officer.
RECITALS
WHEREAS, the citizens of Fort Worth and the City Council have determined that the
security of students is paramount;
WHEREAS, Agency wishes to participate in the School Resource Officer Program ("SRO
Program") through which City provides school security to participating Agencies with facilities
within the City's city limits using City's police officers; and
WHEREAS, City will receive funds through the Fort Worth Crime Control and Prevention
District("CCPD")to assist in funding City's portion of the SRO-Program costs.
NOW, THEREFORE, in consideration of the mutual covenants, promises and agreements
herein expressed,the parties agree as follows:
AGREEMENT DOCUMENTS:
The Agreement documents shall include the following:
1. This Agreement for the SRO Program
2. Exhibit A—Scope of Services
3. Exhibit B—Payment Schedule
Exhibits A and B, attached hereto are incorporated herein and made a part of this Agreement for all
purposes. In the event of any conflict between the terms and conditions of Exhibits A and B and the
terms and conditions set forth in the body of this Agreement, the terms and conditions set forth in
the body of this Agreement shall control.
The term "Agency" shall include the Agency, and its officers, agents, employees, representatives,
servants, contractors or subcontractors.
Lena Pope Home,Inc.&CFW FY 2017 SRO AgreementPage 1 of 12 OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
The term"City" shall include its officers, employees, agents, and representatives.
1. SCOPE OF SERVICES.
City hereby agrees to provide the Agency with school security services for the purpose of
creating a safe educational environment, in partnership with the Agency. The City will provide
Fort Worth Police Department ("FWPD") officers at Agency schools within the city limits of Fort
Worth. The Agency covenants and agrees to fully cooperate with the City in the implementation
of the SRO Program. Attached hereto and incorporated for all purposes incident to this
Agreement is "Exhibit A," Scope of Services, more specifically describing the services to be
provided hereunder.
2. TERM.
This Agreement shall commence on October 1, 2016 ("Effective Date") and shall continue
in full force and effect until September 30, 2017, unless terminated earlier in accordance with the
provisions of this Agreement.
3. CONSIDERATION.
The Agency shall pay City $80,961.83 in accordance with the provisions of this Agreement
and the Payment Schedule attached as "Exhibit B". Such Agreement amount is based upon fixed
expenditures for personnel and operating costs for police officers assigned to the SRO Program.
The Agreement amount represents 50% of all personnel and operating costs incurred by the City for
the one (1) police officers, which does not include the command staff, assigned to the Agency. The
Agreement amount also includes the Agency's proportional share of the personnel, training and
operating costs of the FWPD command staff that oversee the SRO Program. The command staff
costs are shared by all participating Agencies, and the participating Agencies pay a proportional
amount of the command staff costs based on the number of SRO Program officers assigned to each
participating Agency. The command staff includes one (1) detective, five (5) sergeants, two (2)
relief police officers, and one (1) lieutenant assigned to the SRO Program. In addition, the
Agreement amount includes the Agency's proportional share of the administrative operating fees of
SRO-assigned patrol vehicles.
In the event that an officer is on leave due to an occupational injury, the Agreement
Amount shall not be reduced or amended due to such absence unless agreed by both parties in
writing.
It is understood and agreed that Agency shall remit funds to the City within thirty (30)
calendar days following receipt of an official invoice. Invoices shall be provided by City to Agency
on a monthly basis.
Lena Pope Home,Inc. &CFW FY 2017 SRO AgreementPage 2 of 12
4. TERMINATION.
4.1 CCPD Funds
This Agreement is wholly conditioned upon the actual receipt by City of Program
Funds from the CCPD. In the event that funds from the CCPD are not timely received, in
whole or in part, City may, at its sole discretion, terminate this Agreement and City shall not
be liable for payment for any work or services performed by Agency under or in connection
with this Agreement.
4.2 Convenience.
The City may terminate this Agreement at any time and for any reason by providing
the other party with 30 days' written notice of termination.
4.3 Non-appropriation of Funds.
In the event no funds or insufficient funds are appropriated by the City in any fiscal
period to fund the SRO Program, City will notify Agency of such occurrence and this
Agreement shall terminate on the last day of the fiscal period for which appropriations were
received without penalty or expense to the City of any kind whatsoever.
4.5 Duties and Obligations of the Parties.
In the event that this Agreement is terminated prior to the Expiration Date, the
Agency shall pay City for services actually rendered up to the effective date of termination
and City shall continue to provide the Agency with services requested by the Agency and in
accordance with this Agreement up to the effective date of termination. Within thirty (30)
days after the effective date of such termination, City shall forward to Agency a final
invoice for the appropriately prorated unpaid balance due on the Agreement Amount for
services rendered and Agency shall remit payment in full within thirty (30) days after the
date of such invoice.
5. DISCLOSURE OF CONFLICTS AND CONFIDENTIAL INFORMATION.
5.1 Disclosure of Conflicts. Agency hereby warrants to the City that Agency has made
full disclosure in writing of any existing or potential conflicts of interest related to services under
this Agreement. In the event that any conflicts of interest arise after the Effective Date of this
Agreement,Agency hereby agrees immediately to make full disclosure to the City in writing.
Lena Pope Home,Inc.&CFW FY 2017 SRO AgreementPage 3 of 12
5.2 Confidential Information. Agency, for itself and its officers, agents and employees,
agrees that it shall treat all information provided to it by the City as confidential and shall not
disclose any such information to a third party without the prior written approval of the City.
5.3 Unauthorized Access. Agency shall store and maintain City Information in a secure
manner and shall not allow unauthorized users to access, modify, delete or otherwise corrupt City
Information in any way. Agency shall notify the City immediately if the security or integrity of
any City information has been compromised or is believed to have been compromised, in which
event, Agency shall, in good faith, use all commercially reasonable efforts to cooperate with the
City in identifying what information has been accessed by unauthorized means and shall fully
cooperate with the City to protect such information from further unauthorized disclosure.
5.4 Federal Law Enforcement Database Access. If Agency, or any Agency Personnel,
has access to any federal law enforcement database or any federal criminal history record
information system, including but not limited to Fingerprint Identification Records System
("FIRS"), Interstate Identification Index System ("III System"), National Crime Information
Center ("NCIC") or National Fingerprint File ("NFF"), that is governed by and/or defined in Title
28, Code of Federal Regulations Part 20 ("CFR Part 20"), for the purpose of providing services for
the administration of criminal justice as defined therein on behalf of the City under this
Agreement, Agency shall comply with the Criminal Justice Information Services Security Policy
and CFR Part 20, and shall separately execute the Federal Bureau of Investigation Criminal Justice
Information Services Security Addendum.
6. RIGHT TO AUDIT.
Agency agrees that the City shall, until the expiration of three years after final payment
under this Agreement, or the final conclusion of any audit commenced during the said three years,
have access to and the right to examine at reasonable times any directly pertinent books,
documents, papers and records of the Agency involving transactions relating to this Agreement at
no additional cost to the City. Agency agrees that the City shall have access during normal
working hours to all necessary Agency facilities and shall be provided adequate and appropriate
work space in order to conduct audits in compliance with the provisions of this section. The City
shall give Agency reasonable advance notice of intended audits.
7. INDEPENDENT CONTRACTOR.
Agency shall operate hereunder as an independent contractor and not as an officer, agent,
servant or employee of City. City shall operate hereunder as in independent contractor and not as an
officer, agent, servant, or employee of the Agency. City shall be solely responsible for the acts and
Lena Pope Home,Inc. &CFW FY 2017 SRO AgreementPage 4 of 12
omissions of its officers, members, agents, servants, and employees. Agency shall be solely
responsible for the acts and omissions of its officers, members, agents, servants, and employees.
Neither City nor Agency shall be responsible under the Doctrine of Respondent Superior for the
acts and omissions of the officers,members, agents, servants, or employees of the other. Nothing in
this Agreement shall waive any statutory or common-law immunity or defense of City or Agency.
8. PROPERTY LOSS.
City shall in no way nor under any circumstances be responsible for any property belonging
to Agency, its officers, members, agents, employees, subcontractors,program participants, licensees
or invitees, which may be lost, stolen, destroyed or in any way damaged.
9. PROVISIONS REGARDING AGE.
City and Agency covenant that neither it nor any of its officers, members, agents,
employees, program participants, or subcontractors, while engaged in the performance of this
Agreement shall, in connection with the employment, advancement, or discharge of employees, or
in connection with the terms, conditions or privileges of their employment, discriminate against
persons because of their age, except on the basis of a bona fide occupational qualification,
retirement plan, or statutory requirement.
10. LIABILITY/INDEMNIFICATION.
AGENCY SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY LOSS,
PROPERTY DAMAGE AND/OR PERSONAL INJURY, INCLUDING DEATH, TO ANY AND ALL
PERSONS, OF ANY KIND OR CHARACTER, WHETHER REAL OR ASSERTED, TO THE
EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR
INTENTIONAL MISCONDUCT OF AGENCY, ITS OFFICERS, AGENTS, SERVANTS OR
EMPLOYEES.
Lena Pope Home,Inc.&CFW FY 2017 SRO AgreementPage 5 of 12
AGENCY AGREES TO DEFEND, INDEMNIFY, AND HOLD THE CITY, ITS OFFICERS,
AGENTS, SERVANTS, AND EMPLOYEES HARMLESS AGAINST ANY AND ALL CLAIMS,
LAWSUITS, ACTIONS, COSTS, AND EXPENSES OF ANY KIND, INCLUDING, BUT NOT
LIMITED TO, THOSE FOR PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED
DAMAGE OR LOSS TO OWNER'S BUSINESS AND ANY RESULTING LOST PROFITS)
AND/OR PERSONAL INJURY (INCLUDING DEATH) THAT MAY RELATE TO, ARISE OUT
OF, OR BE OCCASIONED BY (I) AGENCY'S BREACH OF ANY OF THE TERMS OR
PROVISIONS OF THIS AGREEMENT OR (II) ANY NEGLIGENT ACT OR OMISSION OR
INTENTIONAL MISCONDUCT OF AGENCY, ITS OFFICERS, AGENTS, ASSOCIATES,
EMPLOYEES, CONTRACTORS (OTHER THAN THE CITY), OR SUBCONTRACTORS
RELATED TO THE PERFORMANCE OF THIS AGREEMENT; EXCEPT THAT THE
INDEMNITY PROVIDED FOR IN THIS SECTION SHALL NOT APPLY TO ANY LIABILITY
RESULTING FROM THE SOLE NEGLIGENCE OF THE CITY OR ITS OFFICERS, AGENTS,
EMPLOYEES, OR SEPARATE CONTRACTORS, AND IN THE EVENT OF JOINT AND
CONCURRENT NEGLIGENCE OF BOTH AGENCY AND CITY, RESPONSIBILITY, IF ANY,
SHALL BE APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS OF THE
STATE OF TEXAS. NOTHING HEREIN SHALL BE CONSTRUED AS A WAIVER OF THE
CITY'S GOVERNMENTAL IMMUNITY AS FURTHER PROVIDED BY THE LAWS OF TEXAS.
Section 10 shall survive the termination or expiration of this Agreement.
11. NON-DISCRIMINATION COVENANT.
Agency, for itself, its personal representatives, assigns, subcontractors and successors in
interest, as part of the consideration herein, agrees that in the performance of Agency's duties and
obligations hereunder, it shall not discriminate in the treatment or employment of any individual or
group of individuals on any basis prohibited by law. If any claim arises from an alleged violation of
this non-discrimination covenant by Agency, its personal representatives, assigns, subcontractors or
successors in interest, Agency agrees to assume such liability and to indemnify and defend the City
and hold the City harmless from such claim.
Section 11 shall survive the termination or expiration of this Agreement.
12. NOTICES.
Notices required pursuant to the provisions of this Agreement shall be conclusively
determined to have been delivered when (1) hand-delivered to the other party, c/o the designated
person listed below; or (2) received by the other party by United States Mail, registered, return
receipt requested, addressed as follows:
City of Fort Worth Lena Pone Home
Attn: Valerie R. Washington Attn: Todd Landry
Assistant City Manager Chief Executive Officer
1000 Throckmorton 3200 Sanguinet St.
Fort Worth, Texas 76102-6311 Fort Worth, TX 76107
Lena Pope Home,Inc.&CFW FY 2017 SRO AgreementPage 6 of 12
With Copy to the City Attorney
At same address
13. GOVERNMENTAL POWERS/IMMUNITIES.
It is understood and agreed that by execution of this Agreement, the City does not waive or
surrender any of its governmental powers or immunities.
14. NO WAIVER.
The failure of the City or Agency to insist upon the performance of any term or provision of
this Agreement or to exercise any right granted herein shall not constitute a waiver of the City's or
Agency's respective right to insist upon appropriate performance or to assert any such right on any
future occasion.
15. GOVERNING LAW/VENUE.
This Agreement shall be construed in accordance with the laws of the State of Texas. If any
action, whether real or asserted, at law or in equity, is brought pursuant to this Agreement, venue for
such action shall lie in state courts located in Tarrant County, Texas or the United States District
Court for the Northern District of Texas, Fort Worth Division.
16. SEVERABILITY.
If any provision of this Agreement is held to be invalid, illegal or unenforceable, the
validity, legality and enforceability of the remaining provisions shall not in any way be affected or
impaired.
17. FORCE MAJEURE.
The City and Agency shall exercise their best efforts to meet their respective duties and
obligations as set forth in this Agreement, but shall not be held liable for any delay or omission in
performance due to force majeure or other causes beyond their reasonable control, including, but
not limited to, compliance with any government law, ordinance or regulation, acts of God, acts of
the public enemy, fires, strikes, lockouts, natural disasters, wars, riots, material or labor restrictions
by any governmental authority, transportation problems and/or any other similar causes.
Lena Pope Home,Inc.&CFW FY 2017 SRO AgreementPage 7 of 12
18. HEADINGS NOT CONTROLLING.
Headings and titles used in this Agreement are for reference purposes only, shall not be
deemed a part of this Agreement, and are not intended to define or limit the scope of any provision
of this Agreement.
19. APPROVAL OF AGREEMENT.
The governing bodies of City and Agency have approved the execution of this Agreement,
and the persons signing the Agreement have been duly authorized by the governing bodies of the
City and Agency to sign this Agreement on behalf of the governing bodies.
20. REVIEW OF COUNSEL.
The parties acknowledge that each party and its counsel have reviewed and revised this
Agreement and that the normal rules of construction to the effect that any ambiguities are to be
resolved against the drafting party shall not be employed in the interpretation of this Agreement or
exhibits hereto.
21. AMENDMENTS.
No amendment of this Agreement shall be binding upon a party hereto unless such
amendment is set forth in a written instrument, which is executed by an authorized representative of
each party.
22. ENTIRETY OF AGREEMENT.
This Agreement, including Exhibits A and B, contains the entire understanding and
agreement between the City and Agency, their assigns and successors in interest, as to the matters
contained herein. Any prior or contemporaneous oral or written agreement is hereby declared null
and void to the extent it conflicts with any provision of this Agreement.
23. COUNTERPARTS.
This Agreement may be executed in one or more counterparts and each counterpart shall, for
all purposes, be deemed an original, but all such counterparts shall together constitute one and the
same instrument.
Lena Pope Home,Inc. &CFW FY 2017 SRO AgreememPage 8 of 12
APPROVED AND AGREED FOR CITY APPROVED AND AGREED FOR
OF FORT WORTH LEPE HO , C
V -�c
Valerie R. Washington Todd Landry
Assistant City Manager Chief Executive Officer
Date: Vf l Y Date: 9AZ(,,0
-
APPROVAL RECO M"7ED APPROVED AS TO FORM AND
LEGALITY FOR LENA POPE HOME
Chief Joel .Fitzgerald
Chief of Police
7 �/ Lena Pope Home Attorney
g
Date: v�
Date:
APPROVED AS TO FORM AND
LEGALITY FOR CITY OF FORT ATTE
WORTH 4
- Mary J. Ka a o �
Pte City Secretary $ o
Assistant City Attorney
,
Date: 119
Date: M&C No. �—Z7q 3-&
Form 1295 Certification No: 2016-107385
OFFICIAL RECORD
Lena Pope Home,Inc.&CFW FY 2017 SRO AgreementPage 9 of 12 CITY SECRETARY
FT.WORTHS TY,
EXHIBIT A
SCOPE OF SERVICES
1. City, through the commander of the SRO Program, shall assign FWPD officers to
specific schools within the Agency to provide school security and officers shall work
directly with the Agency's school principals.
2. There shall be one (1) City police officers assigned to the Agency for the SRO Program.
In addition, there shall be a command staff comprised of one (1) detective, five (5)
sergeants, two (2) relief police officers, and one (1) lieutenant assigned to the SRO
Program. The Lieutenant shall command the SRO Program. . Additional officers will
not be provided to Agency during the Term of the Agreement. The A14ency shall submit
a written request for additional Police Officers to City ten (10) months prior to the
start of a new Fiscal year(the end of the month of December).
3. Assigned officers shall have the SRO Program as their primary duty, and will not be
regularly assigned additional police duties. City reserves the right, however, to reassign
any or all officers temporarily in the event of an emergency or when the City, in its sole
discretion, deems necessary.
4. City shall coordinate assignment and duty hours with Agency. If necessary, to handle
unplanned absences at schools, FWPD officers from other units may be assigned
temporarily to provide coverage. City shall not provide replacements for officers who are
on leave due to an occupational injury. Replacement officers, when available, will be
assigned to Agency when the assigned police officer's absence is for an extended period
of time.
5. City shall provide to the officers assigned to the SRO Program all the law enforcement
training and certification, vehicles and police equipment, benefits, and insurance
(including liability coverage) that are provided to all City's police officers. Agency shall
provide any radio equipment necessary to allow the assigned officers to communicate
with Agency staff.
6. The City shall maintain emergency response plans for every school within their
jurisdiction. To the extent allowed under Texas law, these plans shall be kept confidential
within the Fort Worth Police Department for security purposes, but meetings shall be
held with authorized representatives of Agency to provide relevant information and
Lena Pope Home,Inc. &CFW FY 2017 SRO AgreememPage 10 of 12
excerpts from the plan necessary for implementation. City's Chief of Police shall
designate a commander to be responsible for maintenance and dissemination of these
plans.
7. All police personnel assigned to the SRO Program will remain subject to the rules and
regulations applicable to all sworn personnel, including General Orders, Special Orders,
Personnel Rules and Regulations, directives and other applicable law.
Lena Pope Home,Inc.&CFW FY 2017 SRO AgreementPage 11 of 12
EXHIBIT B
PAYMENT SCHEDULE
Agency will remit 11 payments at $6,746.81 per month within 30 days of receipt of an invoice
from the City and a final payment due in the amount of$6,746.82.
$6,746.81 x 11 =$74,215.01
Final Payment= $ 6,746.82
Total Payments $80,961.83
Lena Pope Home,Inc.&CFW FY 2017 SRO AgreementPage 12 of 12
City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 9/20/2016
DATE: Tuesday, September 20, 2016 REFERENCE NO.: **C-27932
LOG NAME: 35SCHOOL RESOURCE OFFICER PROGRAM FYI
SUBJECT:
Authorize Execution of Agreements with Fort Worth, Keller, Eagle Mountain Saginaw, Crowley, Northwest,
and Lake Worth Independent School Districts, and Lena Pope Home, Inc., to Operate the School Resource
Program (Formerly the School Security Initiative Program) for Fiscal Year 2017 in the Total Program
Amount of$5,019,633.62 (CCPD Funded) (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council authorize the execution of the School Resource Officer Program
Agreements with Fort Worth, Keller, Eagle Mountain Saginaw, Crowley, Northwest, and Lake Worth
Independent School Districts, and Lena Pope Home, Inc., to operate the school resource program for
Fiscal Year 2017 in the total program amount of$5,019,633.62.
DISCUSSION:
The Fort Worth Police Department (FWPD) and area school districts work in partnership to provide youth
a safe educational environment by providing FWPD officers at schools within the city limits of Fort Worth.
Under the School Resource Officer Program, operational costs, equipment funds and personnel costs are
provided through the Crime Control Prevention District (CCPD) budget, which is then reimbursed pursuant
to the terms of the Agreements with each school district and Lena Pope Home, Inc.
For Fiscal Year 2017, a total of 71 officers are assigned to the School Resource Officer Program with a
total budget of$8,367,062.00, of which $5,019,633.62 will be allocated for the School Resource Officer
Program Agreements with the school districts and Lena Pope Home, Inc. The participating school districts,
and Lena Pope Home, reimburse CCPD for 50 percent of operating and personnel costs for 62 of the 71
positions. The remaining nine supervisor and relief positions, consisting of two relief officers, one
detective, five sergeants and one lieutenant, are reimbursed to CCPD at 100 percent. The reimbursement
costs of the supervisor and relief positions are apportioned to each participant based on the number of
officers assigned to each school district.
During the term of these contracts, October 1, 2016 through September 30, 2017, each participant will
have a set number of officers assigned to them as follows:
- Fort Worth ISD will have 43 officers assigned to them at a cost of$3,481,358.81.
- Eagle Mountain Saginaw ISD will have five officers assigned to them at a cost of$404,809.16.
- Cowley ISD will have five officers assigned to them at a cost of$404,809.16.
- Keller ISD will have three officers assigned to them at a cost of$242,885.50.
- Lake Worth ISD will have one officer assigned to them at a cost of$80,961.83.
- Northwest ISD will have four officers assigned to them at a cost of$323,847.33.
- Lena Pope Home will have one officer assigned to them at a cost of$80,961.83.
Payments from the participating school districts and the Lena Pope Home shall be rendered to the City on
Logname: 35SCHOOL RESOURCE OFFICER PROGRAM FYI Page 1 of 2
a monthly basis and deposited into a CCPD account. The total expected reimbursement amount is
$5,019,633.62.
FISCAL INFORMATION / CERTIFICATION:
The Director of Finance certifies that, contingent upon adoption of the Fiscal Year 2017 budget by City
Council, funds will be available in the Fiscal Year 2017 budget of the Crime Control and Prevention District
Fund and the Police Department is responsible for verifying the availability of funds prior to an expenditure
being made. The Police Department is responsible for the collection and deposit of funds due to the City.
FUND IDENTIFIERS (FIDs):
TO
Fund Department ccoun Project Program ctivity Budget Reference # mount
ID ID Year (Chartfield 2)
FROM
Fund Department ccoun Project Program ctivity Budget Reference # moun
ID ID Year (Chartfield 2)
CERTIFICATIONS:
Submitted for City Manager's Office by: Valerie Washington (6199)
Originating Department Head: Joel Fitzgerald (4231)
Additional Information Contact: James Rodriguez (4286)
ATTACHMENTS
1. FID Transactions.pd (CFW Internal)
2. Form 1295 for FW Police Dept Police Officer Services for JJAEP.pdf (Public)
Logname: 35SCHOOL RESOURCE OFFICER PROGRAM FYI Page 2 of 2
C - 27932
CERTIFICATE OF INTERESTED PARTIES
FORM 3.295
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. 2016-107385
Lena Pope Home, Inc.
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 09/01/2016
being filed.
Fort Worth Police Department Date Acknowledged*
�(41�4 —
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.
Police Officer Services
Police Officer Services for Juvenile Justice Alternative Education Program
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
Lee, Erma Fort Worth,TX United States X
Estill,Jim Argyle,TX United States X
Wood, Laura FORT WORTH,TX United States X
Arnold, Kathryn Fort Worth,TX United States X
Permann, Renee Fort Worth,TX United States X
Webb, Shnease Fort Worth,TX United States X
Landry,Todd Fort Worth,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.
NANCY BURMASTER
�:°;��Ar��'•`n�=_Notary Public,State of Texas �-
3 9 +Po Comm.Expires l 1-10-2018 plbal
Notary ID 841588.7 Signature of authorized agent ontracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said o did this the 15-F day of
20 to to certify which,witness my hand and seal of office.
Signat r of officer administering oath Printed name f officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277