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HomeMy WebLinkAboutContract 49172-FP2 City Secretary 49172 -FP2 Contract No. FORT WORTHO. Date Received Aug 21,2018 !� C/ (001 - j� 05< � NOTICE OF PROJECT COMPLETION (Developer Projects) The Transportation and Public Works Department upon the recommendation of the Project Manager has accepted the following project as complete: Project Name: TAVOLO PARK City Project No.: 100549 Improvement Type(s): ❑ Paving © Drainage ❑ Street Lights ❑ Traffic Signals Original Contract Price: $2,737,270.00 Amount of Approved Change Order(s): $140,690.50 Revised Contract Amount: $2,877,960.50 Total Cost of Work Complete: $2,877,960.50 Ab Cz ADGrantgn(A��.:__ Aug 7, 2018 Contractor Date Contract Manager Title Burnsco Construction, Inc. Company Name N&AZ Neal Nime(Aug21.2018) Aug 21, 2018 Pro'ect Inspector Date Fred Ehia(Aug 21,2018) Aug` 21, 2018 Project Manager Date �a�rrI S(aal-L elwvyaCPr Aug 217 2018 Janie Scarlett Morales(Au'21.2018) CFA Manager Date sw,a`L ALziui- Aug 21,2018 Susa„Alanis(Aug 21.2018) Asst. City Manager Date OFFICIAL R6C041110 N E CITY SECRETARY 1 a �pGG 2aR °A FT.Wrfftil TX Page 1 of 2 �vo,2t�t 8 L � l6 Cb Notice of Project Completion Project Name:TAVOLO PARK City Project No.: 100549 City's Attachments Final Pay Estimate 71 Change Order(s): ® Yes ❑ N/A N Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 270 CD Days Charged: 373 Work Start Date: 7/24/2017 Work Complete Date: 7/31/2018 ! I 'r i I� ! Page 2 of 2 J 1 6q 400 !i City Project Numbers 100549 DOE Number 0549 'I Contract Name TAVOLO PARK Estimate Number 1 Contract Limits Payment Number 1 Project Type STORM DRAIN For Period Ending 8/6/2018 Project Funding Project Manager NA City Secretary Contract Number Inspectors OWEN / SAMANIEGO Contract Date Contractor BURNSCO CONSTRUCTION,INC. Contract Time 270 CD 6331 SOUTHWEST BLVD Days Charged to Date 373 CD FORT WORTH, TX 76132 Contract is .000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Total Cost of Work Completed $2,877,960.50 Less %Retained $0.00 Net Earned $2,877,960.50 Earned This Period $2,877,960.50 Retainage This Period $0.00 Less Liquidated Damages 0 Days a $0.00 /Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 Less Previous Payment $0.00 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $2,877,960.50 Monday,August 6,2018 Page 5 of 5 �I Il FORT' ORTH i{ CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name TAVOLO PARK Contract Limits Project Type STORM DRAIN City Project Numbers 100549 DOE Number 0549 Estimate Number t Payment Number 1 For Period Ending 8/6/2018 CD City Secretary Contract Number Contract Time 27CD Contract Date Days Charged to Date 373 Project Manager NA Contract is 100.00 Complete Contractor BURNSCO CONSTRUCTION,INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 Inspectors OWEN / SAMANIEGO G y 6 q Monday,August 6,2018 Page I of 5 City Project Numbers 100549 DOE Number 0549 Contract Name TAVOLO PARK Estimate Number l Contract Limits Payment Number i Project Type STORM DRAIN For Period Ending 8/6/2018 Project Funding STORM DRAIN Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total -------------------------------- ------ I 10'CURB INLET 22 EA $3,900.00 $85,800.00 22 $85,800.00 2 201 CURB INLET 4 EA $8,200.00 $32,800.00 4 $32,800.00 3 21"RCP 678 LF $61.00 $41,358.00 678 $41,358.00 4 24"RCP CO#1 1401 LF $69.00 $96,669.00 1401 $96,669.00 5 30"RCP 101.6 LF $87.00 $88,392.00 1016 $88,392.00 6 36"RCP CO#1 1064 LF $117.00 $124,488.00 1064 $124,488.00 7 42"RCP 374 LF $153.00 $57,222.00 374 $57,222.00 8 48"RCP CO#1 465 LF $184.00 $85,560.00 465 $85,560.00 9 5 X 4 BOX CULVERT 395 LF $286.00 $112,970.00 395 $112,970.00 10 6 X 4 BOX CULVERT CO#1 328 LF $354.00 $116,112.00 328 $116,112.00 11 MODIFIED 7 X 6 BOX CULVERT 2 EA $9,900.00 $19,800.00 2 $19,800.00 12 7 X 6 BOX CULVERT 2578 LF $553.00 .,425,634.00 2578 ,1,425,634.00 13 8 X 4 BOX CULVERT 200 LF $470.00 $94,000.00 200 $94,000.00 14 8 X 5 BOX CULVERT 105 LF $550.00 $57,750.00 105 $57,750.00 15 4'STORM JUNCTION BOX 4 EA $4,400.00 $17,600.00 4 $17,600.00 16 6'STORM JUNCTION BOX 3 EA $5,200.00 $15,600.00 3 $15,600.00 17 4'DROP INLET COY 1 6 EA $4,800.00 $28,800.00 6 $28,800.00 18 24"STORM PLUG I EA $100.00 $100.00 1 $100.00 19 42"STORM PLUG 2 EA $300.00 $600.00 2 $600.00 20 4'MANHOLE RISER 2 EA $2,500.00 $5,000.00 2 $5,000.00 21 21"FLARED HEADWALL 1 EA $2,100.00 $2,100.00 1 $2,100.00 22 24"FLARED HEADWALL I EA $7,000.00 $7,000.00 1 $7,000.00 23 30"FLARED HEADWALL 1 EA $3,000.00 $3,000.00 1 $3,000.00 24 36"PARALLEL HEADWALL I EA $24,000.00 $24,000.00 1 $24,000.00 25 HEADWALL,BOX CULVERT CO#1 200.8 CY $800.00 $160,640.00 200.8 $160,640.00 26 MEDIUM STONE RIPRAP 1465 SY $56.00 $82,040.00 1465 $82,040.00 27 GALVANIZED HANDRAIL CO#1 258 LF $160.00 $41,280.00 258 $41,280.00 28 TRENCH SAFETY CO#1 8531 LF $0.50 $4,265.50 8531 $4,265.50 29 CONCRETE RIP-RAP 378 SY $85.00 $32,130.00 378 $32,130.00 66 6'X 4'RCB PLUG CO#1 1 EA $500.00 $500.00 1 $500.00 68 48"RCP TYPE"B"HEADWALL CO#1 1 LF $4,200.00 $4,200.00 1 $4,200.00 Monday,August 6,2018 Page 2 of 5 City Project Numbers 100549 DOE Number 0549 Contract Name TAVOLO PARK Estimate Number I Contract Limits Payment Number 1 Project Type STORM DRAIN For Period Ending 8/6/2018 Project Funding 69 5'DROP INLET CO#1 1 EA $5,000.00 $5,000.00 1 $5,000.00 70 RISER SAFETY TREATMENT FOR 6X4 DROP 2 EA $2,300.00 $4,600.00 2 $4,600.00 STRUCTURE CO#1 71 CONCRETE CAP FOR 6X4 RCB&EXIST 30"SS I EA $950.00 $950.00 1 $950.00 CO#1 Sub-Total of Previous Unit $2,877,960.50 $2,877,960.50 ---------------------------------------- Monday,August 6,2018 Page 3 of 5 City Project Numbers 100549 DOE Number 0549 Contract Name TAVOLO PARK Estimate Number 1 Contract Limits Payment Number 1 Project Type STORM DRAIN For Period Ending 8/6/2018 Project Funding Contract Information Summary Original ContractAmount $2,737,270.00 Change Orders Change Order Number 1 $140,690.50 Total Contract Price $2,877,960.50 I� Total Cost of Work Completed $2,877,960.50 Less %Retained $0.00 Net Earned $2,877,960.50 Earned This Period $2,877,960.50 Retainage This Period $0.00 Less Liquidated Damages Days @ /Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 Less Previous Payment $0.00 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $2,877,960.50 Monday,August 6,2018 Page 4 of 5 CD im9om A v z cnSXc=>1c> c� v m n � ° -�+ o 0 �T 2 -G D z o � o a m m mm -0 ;u '' o o 0 f� p Cm7 o v v 0 0 n N v o 0 1 p > > -Zi � x 0 � R7 -I Z m A �A 0 V m m D C— C— 0 O a O -r 0 m n z m m —! 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N W !✓1 V/VI V)ww sw VI CnCn Co VI V)w��Vl Z Z -� n cl COj(wOIV W OO mO m(wJl Co p N N�t>t t0�W� C7 �' � �O O O A O�O O O a�!�CIl•_0 0 0 0 0 0 IV•p z j N o 0 0 0 0 0 O 0 0 0 0 0 0 0 0 0 0 0 0 0 p O n o m a o 0 0 0 0 0 0 0 0 o m z h j C O ¢ + V1 U!(A y �(nww'1 V/j V)cn fA V)W W a pJ A C71 A (V(II N O y A O W w y W O W N C.1 0I O N m 0 W J W OI--I:b.tD V N N N O w N O O a (AI p OCOONO N OO W O W ON0000 X001 j (.J 0006 N Q 0 0 OOOOOO OOOO O O o r C o 0 0 o 0 0 0 0 0 0 0 0 0 0 0- 0 0 0 0 0 v m �n m N AFFIDAVIT STATE OF TEXAS COUNTY OF TARRANT Before me,the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Ab Grantges, Contract Mgr, Of Burnsco constriction, Inc., known to me to be a credible person, who being by me duly sworn, upon his oath deposed and said; That all persons, firms, associations, corporations, or other organizations furnishing labor and/or materials have been paid in full; That the wage scale established by the City Council in the City of Fort Worth has been paid in full; That there are no claims pending for personal injury and/or property damages; On Contract described as; Tavolo Park CPN 100549 -Water, Sanitary Sewer and Storm Drain BY x' Ab Grantges, -tract Manager Subscribed and sworn before me on this date 6th of August, 2018. Nbt-ary Public Tarrant County, Texas MARY PANNELL Nolary Public.State of TEXc L �N.'•/�.'�.°` Caf1�(11.EXplres 1u-19-2018 ' � �''•:;,,,.�,,,.�` i•Jofnry ID 5144239 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ Conforms with the American Institute of SURETY El OTHER Architects,AIA Document G707 Bond No 022056869 PROJECT: (name, address)Tavolo Park Phase 1 TO (Owner) Fort Worth TX PATE RANCH SINGLE FAMILY,LP AND CITY OF ARCHITECT'S PROJECT NO: FORT WORTH CONTRACT FOR: 10210 N Central Expwy#300 Tavolo Park Phase 1 -Water,Sewer&Drainage Improvements Dallas TX 75231 .I CONTRACT DATE: CONTRACTOR:BURNSCO CONSTRUCTION,INC. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the (here insert name and address of Surety Company) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 SURETY COMPANY on bond of (here insert name and address of Contractor) BURNSCO CONSTRUCTION, INC. 6331 Southwest Boulevard Benbrook TX 76132 CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) PATE RANCH SINGLE FAMILY, LP AND CITY OF FORT WORTH 10210 N Central Expwy#300 Dallas TX 75231 OWNER, as set forth in the said Surety Company's bond. IN WITNESS,WHEREOF, the Surety Company has hereunto set its hand this 30th day of July,2018 n LIBERTY MUTUAL INSURANCE COMPANY Surety Company I ? Attest:Tina McENfan (Seal): S1gna(ture of Authorized Representative hinie Hunter�Attorney Attorney-in- Title NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition ONE PAGE THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND, This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Mutual Insurance Company Certificate No.8138333 The Ohio Casualty Insurance Company West American Insurance Company i t POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Slate of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the'Companies-),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Robbi Morales-Don E.Cornell-Soiphinie Hunter V.DeLene Marshall-Tina McEwan-Ricardo J.Reyna;Kelly A.Westbrook i all of the city of Dallas state of TX each individually if there be more than one named;its true and lawful attomey-in-fact to make,execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act.and deed,any and all undertakings,bonds„recognizance's and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 26th day of June 2018 LSY INCL.;, itas,Jn iNstry cc J'”,aW+aar..9 Jr'.gw:ti• '�f- arc+ The Ohio Casualty Insurance Company to 1914 n o- 1912 fa W 1 o 3 1991 Liberty Mutual Insurance Company CD West merican Insurance Company = •yif�'ar.,,S^'�� % ''S,n�,,Mn < ' is•, , _ y OSTATE OF PENNSYLVANIA ss David M.Carey Assistant Secretary _ COUNTY OF MONTGOMERY m � 3 O On this 26th day of June 2018,before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance O I.- d) Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes �,Cn 0.2 therein contained by signing on behalf of the corporations by himself as a duly authorized officer, y m? IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. >r � � c4 O fl. 45PONAS?. COMMONWEALTH OF PENNSYLVANIA C'4, Notanat oto � �.�_ 4..� eat O L !' U of ° Teresa Paste!la,Notary Public By: O Upper MerionTwp.,Monloomery County Teresa 'F `* Pastella.Notary Public -0 My Commission Expires March 28,2G21 RjO � yyJ (D O O Member.Pennsylvania Association of Notaries O a M This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual N o Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: o ca L ARTICLE IV—OFFICERS—Section 12,Power of Attorney.Any officer or otherofficial of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O r— a; to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, >y 2 o S acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations.Such atlorneys4n-fact,subject to the limitations set forth in their respective :5 6 powers of attorney,shall have full power to bind.the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so a) pct; executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fact under >.Q Z the provisions of this article may be revoked at any time by the Board,the Ghairtnan,the President or by the officer or officers granting such power or authority: C> ARTICLE XIII—Execution of Contracts—SECTION 5_Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, r oho > d and subject to such limitations as the chairman or the president may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute, N o U seat,acknowledge and deliver as surety any and all undertakings,bonds;recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their =m respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so V o executed such instruments shall be as Binding as K signed by the president and attested by the secretary, o co Certificate of Designation—The President:of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey.Assistant Secretary to appoint such attomeys-in- ~ fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge:and deliver as surety.any and all undertakings,bonds,recognizances and other surety obligations. Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually.affixed. - 1, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance,Company, Liberty:Mutual Insurance Company, and West American insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in.full force and effect and has not been revoked. . i IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this Gum day of 20 _ �`•('i INSpq �.�.tNSu 'h%N>u6., o c91s o > 1972 * 1991 u `c By. Renee C.Llewe ssistant Secretary i 44 of 300 LMS12873 022o17 4 Liberty Mutual. SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call toll-free for information or to Usted puede llamar at numero de telefono gratis make a complaint at para informacion o para someter una queja at 1-877-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste. 400 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 1.9406-2755 King of Prussia,PA 19406-2755 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain information on companies, Seguros de Texas para obtener informacion coverages, rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas at 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir at Departamento de Seguros Consumer Protection (111-1A) de Texas Consumer Protection (111-1A) P. 0. Box 149091 P. 0, Box 149091 Austin, TX 78714-9091 Austin, TX 78714-9091 FAX: (512) 490-1007 FAX# (512) 490-1007 Web: http://www.tdi.texas.goy Web: http•//Nvwvw.tdi.texas.gov E-mail: Cons umerProtectionntdi.texas. ov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RE,CLAMOS: Should you have a dispute concerning your Si tiena Una disputa concerniente a su prima o a premium or about a claim you should first un reclamo, debe comunicarse con el agente o contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved, you may contact the entonces comunicarse con el departamento (TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA: POLICY: This notice is for information only and does not Este aviso es solo para proposito de informacion become a part or condition of the attached y no se convierte en parte o condicion del document. documento adjunto. NP 70 68 09 01 LMS-15292 10115 Greensheet for Tavolo Park CPN#100549 SD Adobe Sign Document History 08/22/2018 --" - Created: 08/07/2018 By: Shameka.Kennedy@fortworthtexas.gov Status: Signed µ~ Transaction ID: CBJCHBCAABAA3CBnlo-StB4WgRn3lDVIAaXcu_BZrHbt "Greensheet for Tavolo Park CPN#100549 SD" History Document created by Shameka.Kennedy@fortworthtexas.gov 08/07/2018-7:06:42 AM CDT-IP address:209.194.29.100 C°y Document emailed to Ab Grantges (kcarwine@aol.com)for signature 08/07/2018-7:10:34 AM CDT Document viewed by Ab Grantges (kcarwine@aol.com) 08/07/2018-7:15:29 AM CDT-IP address: 107.77.197.110 Cvi Ab Grantges (kcarwine@aol.com) uploaded the following supporting documents: 611 File Attachment 1 cP/ File Attachment 2 08/07/2018-9:07:06 AM CDT 6c, Document e-signed by Ab Grantges (kcarwine@aol.com) Signature Date:08/07/2018-9:07:06 AM CDT-Time Source:server-IP address:12.246.109.114 C' Document emailed to Neal Kime(neal.kime@fortworthtexas.gov)for signature 08/07/2018-9:07:07 AM CDT `Lj Document viewed by Neal Kime (neal.kime@fortworthtexas.gov) 08/21/2018-10:09:29 AM CDT-IP address:174.206.14.127 b Document e-signed by Neal Kime (neal.kime@fortworthtexas.gov) Signature Date:08/21/2018-10:09:52 AM CDT-Time Source:server-IP address:174.206.14.127 ' Document emailed to EDWIN RODRIGUEZ(edwi n.rod rig uez@fortworthtexas.gov)for approval 08/21/2018-10:09:53 AM CDT Document viewed by EDWIN RODRIGUEZ(edwin.rodriguez@fortworthtexas.gov) 08/21/2018-12:31:51 PM CDT-IP address: 107.77.198.18 FORS Adobe Sign Fppcument approved by EDWIN RODRIGUEZ(edwin.rodriguez@fortworthtexas.gov) roval Date:08/21/2018-12:32:26 PM CDT-Time Source:server-IP address: 107.77.198.18 w Document emailed to Fred Ehia (freidoon.ehia@fortworthtexas.gov)for signature 08/21/2018-12:32:28 PM CDT Document viewed by Fred Ehia (freidoon.ehia@fortworthtexas.gov) 08/21/2018-3:02:05 PM CDT-IP address:209.194.29.100 moo, Document e-signed by Fred Ehia (freidoon.ehia@fortworthtexas.gov) Signature Date:08/21/2018-3:04:49 PM CDT-Time Source:server-IP address:209.194.29.100 Cb Document emailed to Janie Scarlett Morales Qanie.morales@fortworthtexas.gov)for signature 08/21/2018-3:04:50 PM CDT Document viewed by Janie Scarlett Morales Qanie.morales@fortworthtexas.gov) 08/21/2018-3:21:29 PM CDT-IP address:209.194.29.100 bo, Document e-signed by Janie Scarlett Morales Qanie.morales@fortworthtexas.gov) Signature Date:08/21/2018-3:23:01 PM CDT-Time Source:server-IP address:209.194.29.100 Eb Document emailed to Susan Alanis (susan.alanis@fortworthtexas.gov)for signature 08/21/2018-3:23:02 PM CDT Document viewed by Susan Alanis (susan.alanis@fortworthtexas.gov) 08/21/2018-4:25:52 PM CDT-IP address:209.194.29.100 do Document e-signed by Susan Alanis (susan.alanis@fortworthtexas.gov) Signature Date:08/21/2018-4:26:13 PM CDT-Time Source:server-IP address:209.194.29.100 ► Document emailed to Allison Tidwell (cso_finalpay@fortworthtexas.gov)for filling 08/21/2018-4:26:14 PM CDT Document viewed by Allison Tidwell (cso_finalpay@fortworthtexas.gov) 08/21/2018-5:24:14 PM CDT-IP address:209.194.29.100 bG, Form filled by Allison Tidwell (cso_finalpay@fortworthtexas.gov) Form filling Date:08/21/2018-5:24:38 PM CDT-Time Source:server-IP address:209.194.29.100 D, Document emailed to Trudy Brotherton (therese.brotherton@fortworthtexas.gov)for delivery 08/21/2018-5:24:39 PM CDT 5 Document viewed by Trudy Brotherton (therese.brotherton@fortworthtexas.gov) 08/22/2018-7:08:14 AM CDT-IP address:68.116.135.3 6a, Document receipt acknowledged by Trudy Brotherton (therese.brotherton@fortworthtexas.gov) Receipt Acknowledgement Date:08/22/2018-7:08:35 AM CDT-Time Source:server-IP address:68.116.135.3 FORTWORTH. AdobeeSign E'4 Document emailed to Julie A Geho Qulie.geho@fortworthtexas.gov)for delivery 08/22/2018-7:08:36 AM CDT Document viewed by Julie A Geho oulie.geho@fortworthtexas.gov) 08/22/2018-7:43:00 AM CDT-IP address:209.194.29.100 6- Document receipt acknowledged by Julie A Geho Qulie.geho@fortworthtexas.gov) Receipt Acknowledgement Date:08/22/2018-7:43:25 AM CDT-Time Source:server-IP address:209.194.29.100 Document emailed to Sylvia Kelley (tpwcfafiscal@fortworthtexas.gov)for delivery 08/22/2018-7:43:26 AM CDT Document viewed by Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov) 08/22/2018-8:54:39 AM CDT-IP address:209.194.29.100 bG, Document receipt acknowledged by Sylvia Kelley (tpwcfafiscal@fortworthtexas.gov) Receipt Acknowledgement Date:08/22/2018-8:54:58 AM CDT-Time Source:server-IP address:209.194.29.100 Signed document emailed to Julie A Geho Qulie.geho@fortworthtexas.gov), Janie Scarlett Morales (Janie.morales@fortworthtexas.gov), Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov), Shameka.Kennedy@fortworthtexas.gov, and 7 more 08/22/2018-8:54:58 AM CDT Adobe Sign