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Home My WebLink AboutContract 51326 CITY SECRETARY - �G� CONTRACT N0. y MUNICIPAL SERVICES AGREEMENT °�t5� BETWEEN THE CITY OF FORT WORTH, TEXAS AND CROWLEV 272 JOINT VENTURE, ROCKY MOUNTAIN PROPERTIES,LLC AND TASTY PIES PROPERTIES,LLC This M1:1:icipal Services Agreement ("Agreement") is entered into on day of bW 2018 by and between the City of Fort Worth, Texas, a home-rule municipality of the State of Texas, ("City") and Crowley 272 Joint Venture, Rocky Mountain Properties,LLC and Tasty Pies Properties,LLC (collectively, "Owner"). RECITALS The parties agree that the following recitals are true and correct and form the basis upon which the parties have entered into this Agreement. WHEREAS, the City is currently classified as a Tier 2 municipality for purposes of annexation under the Texas Local Government Code ("LGC"); WHEREAS, Section 43.0671 of the LGC permits the City to annex an area if each owner of land in an area requests the annexation; WHEREAS, where the City elects to annex such an area, the City is required to enter into a written agreement with the property owner(s) that sets forth the City services to be provided for the Property on or after the effective date of annexation (the "Effective Date"); WHEREAS, Owner owns certain parcels of land situated in Tarrant County, Texas, which consists of approximately 280.60 acres of land in the City's extraterritorial jurisdiction, such property being more particularly described and set forth in Exhibit "A" attached and incorporated herein by reference ("Property"); WHEREAS, Owner has filed a written request with the City for full-purpose annexation of the Property, identified as Annexation Case No. AX-18-003 ("Annexation Case"); WHEREAS, City and Owner desire to set out the City services to be provided for the Property on or after the effective date of annexation; WHEREAS, the Annexation Case and execution of this Agreement are subject to approval by the Fort Worth City Council; and NOW THEREFORE, in exchange for the mutual covenants, conditions and promises contained herein,City and Owner agree as follows: 1. PROPERTY. This Agreement is only applicable to the Property, which is the subject of the Annexation Case. 2. INTENT. It is the intent of the City that this Agreement provide for the delivery of full, available municipal services to the Property in accord ce with state Iaw,!which may be OFFI , CITY kSEPQtT MTARY Owner-Initiated Annexation Service Agreement FT WoR` HW TX 1 of 11 accomplished through any means permitted by law. For purposes of this Agreement, "full municipal services" means all services provided by the City within its full-purpose boundaries, including water and wastewater services and excluding gas or electrical service. 3. MUNICIPAL SERVICES. a. Commencing on the Effective Date, the City will provide the municipal services set forth below. As used in this Agreement, "providing services" includes having services provided by any method or means by which the City may extend municipal services to any other area of the City, including the City's infrastructure extension policies and developer or property owner participation in accordance with applicable city ordinances, rules, regulations, and policies. i. Fire — The City's Fire Department will provide emergency and fire protection services. ii. Police — The City's Police Department will provide protection and law enforcement services. iii. Emergency Medical Services — The City's Fire Department and MedStar (or other entity engaged by the City after the Effective Date) will provide emergency medical services. iv. Planning and Zoning—The City's Planning and Development Department will provide comprehensive planning, land development, land use, and building review and inspection services in accordance with all applicable laws, rules, and regulations. v. Parks and Recreational Facilities. Residents of the Property will be permitted to utilize all existing publicly-owned parks and recreational facilities and all such facilities acquired or constructed after the Effective Date (including community service facilities, libraries, swimming pools, etc.), throughout the City. Any private parks, facilities, and buildings will be unaffected by the annexation; provided, however, that the City will provide for maintenance and operation of the same upon acceptance of legal title thereto by the City and appropriations therefor. In the event the City acquires any other parks, facilities, or buildings necessary for City services within the Property, the appropriate City department will provide maintenance and operations of the same. vi. Other Publicly Owned Buildings. Residents of the Property will be permitted to use all other publicly owned buildings and facilities where the public is granted access. vii. Stormwater Utility Services — The Property will be included in the City's Stormwater Utility service area and will be assessed a monthly fee based on the amount of impervious surface. The fees will cover the direct and indirect costs of stormwater management services. viii. Roads and Streets (including Street li htg iniz) — The City's Transportation and Public Works Department will maintain the public streets and streetlights over which the City has jurisdiction. The City will provide regulatory signage services in accordance with the City policies and procedures and applicable laws. ix. Water and Wastewater to Existing Structures. Occupied structures that are Owner-Initiated Annexation Service Agreement 2 of 1 I using water-well and on-site sewer facilities on the Effective Date may continue to use the same. If a property owner desires to connect an existing structure to the City water and sewer system, then the owner may request a connection and receive up to 200 linear feet of water and sewer extension at the City's cost for each occupied lot or tract in accordance with the City's "Policy for the Installation of Community Facilities" and applicable law. Once connected to the City's water and sanitary sewer mains, the water and sanitary sewage service will be provided by the City at rates established by City ordinances for such service. x. Solid Waste Services — The City will provide solid waste collection services in accordance with existing City ordinances and policies, except where prohibited by law. xi. Code Compliance — The City's Code Department will provide education, enforcement, and abatement relating to code violations within the Property. xii. Full Municipal Services — Commencing on the Effective Date, the City will provide to the Property all services provided by the City within its full- purpose boundaries and not otherwise listed above, except as provided in Section 3(b). b. The City will provide water service and wastewater treatment service to developments established after the Effective Date in accordance with, and on the schedule determined by, the City's extension policies and applicable law and at rates established by City ordinances for such services. c. It is understood and agreed that the City is not required to provide a service that is not included in this Agreement. d. Owner understands and acknowledges that the City departments listed above may change names or be re-organized by the City Manager. Any reference to a specific department also includes any subsequent City department that will provide the same or similar services. 4. SERVICE LEVEL. The City will provide the Property with a level of services, infrastructure, and infrastructure maintenance that is comparable to the level of services, infrastructure, and infrastructure maintenance available in other parts of the City with topography, land use, and population density similar to those reasonably contemplated or projected for the Property. 5. AUTHORITY. City and Owner represent that they have full power, authority and legal right to execute, deliver and perform their obligations pursuant to this Agreement. Owner acknowledges that approval of the Annexation Case is within the sole jurisdiction of the City Council.Nothing in this Agreement guarantees favorable decisions by the City Council. 6. SEVERABILITY. If any part, term, or provision of this Agreement is held by the courts to be illegal, invalid, or otherwise unenforceable, such illegality, invalidity, or unenforceability will not affect the validity of any other part, term or provision, and the rights of the parties will be construed as if the part, term, or provision was never part of the Agreement. Owner-Initiated Annexation Service Agreement 3 of I I 7. INTERPRETATION. The parties to this Agreement covenant and agree that in any litigation relating to this Agreement, the terms and conditions of the Agreement will be interpreted according to the laws of the State of Texas. The parties acknowledge that they are of equal bargaining power and that each of them was represented by legal counsel in the negotiation and drafting of this Agreement. 8. GOVERNING LAW AND VENUE. Venue shall be in the state courts located in Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort Worth Division and construed in conformity with the provisions of Texas Local Government Code Chapter 43. 9. NO WAIVER. The failure of either party to insist upon the performance of any term or provision of this Agreement or to exercise any right granted hereunder shall not constitute a waiver of that party's right to insist upon appropriate performance or to assert any such right on any future occasion. 10. GOVERNMENTAL POWERS. It is understood that by execution of this Agreement, the City does not waive or surrender any of its governmental powers or immunities. 11. COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original and constitute one and the same instrument. 12. CAPTIONS. The captions to the various clauses of this Agreement are for informational purposes only and shall not alter the substance of the terms and conditions of this Agreement. 13. AGREEMENT BINDS AND BENEFITS SUCCESSORS AND RUNS WITH THE LAND. This Agreement is binding on and inures to the benefit of the parties, their successors, and assigns. The term of this Agreement constitutes covenants running with the land comprising the Property, is binding on the Owner and the City, and is enforceable by any current or future owner of any portion of the Property. 14. ENTIRE AGREEMENT. This Agreement constitutes the entire agreement between the parties and supersedes all prior oral and written agreements between said parties. This Agreement shall not be amended unless executed in writing by both parties. Executed as of the day and year first above written to be effective on the effective date of annexation of the Property. Owner-Initiated Annexation Service Agreement 4 of I 1 CITY OF FORT WORTH By: Jesus"Jay" Chapa Assistant City Manager Approved as to Form and Legality: Senior Assistant City Attorney Attest: •o� Mary Kayser * `_ City Secretary Approvals: '�XAS M&C L-V641 •.• Ordinance No. J33h3Vi•2U18(L-1042) State of Texas § County of Tarrant § This instrument was acknowledged before me on the j day of 1 018, by Jesus "Jay" Chapa, Assistant City Manager of the City of Fort Worth, a Te municipal corporation, on behalf of said corporation. 0-1 By: ` ��j`�p�p� _ . g` MARIA S•SA CHEZ. ` My Nota ID •, ` Notary #2256490 Notary4blic, State of Texas `'r9';P��+" Expires December 19,2021 FOFFICIALRE-CORD s7'ARY lig'C Owner-Initiated Annexation Service Agreement 5 of 11 OWNER CROWLEY 272 JOINT VENTURE By:_ 9� / Raymond B. Kelly Managing Venturer State of Texas § County of Tarrant § This instrument was acknowledged before me on the 1 st day of August, 2018, by Raymond B. Kelly III, Managing Venturer of Crowley 272 Joint Venture, on behalf of said joint venture. CAROLYN A.PHILLIPS Notary Pub66, State of Texas Notary Pub.Sate of Texas •,'�i a''• CMM.Expires 11-09-2018 Notary ID 63SS78-2 OFFICIAL RECORD CITY SECRETARY '.VVQRTH,TX Owner-Initiated Annexation Service Agreement 6 of I I ROCKY MOUNTAIN PROPERTIES, LLC By: Raymond B. Kelly ill President State of Texas § County of Tarrant § This instrument was acknowledged before me on the 1 st day of August, 2018, by Raymond B. Kelly III, President of Rocky Mountain Properties, LLC, on behalf of said limited liability company. CA OLYN A.PHILLIPS Notary Pubik,State of Texas �� Comm.Expkes 11-09-2018 Notary Publ' , State of Texas a+' Notary ID 63Sg78„2 [OFF:ICIAL-' ] Owner-Initiated Annexation Service Agreement 7 of 11 TAS T V�IF S rK""v icTIE LLC By: MO.% Name: Title: ,�- State of Texas r ' § County of § This instrument was acknowledged befor me on the2Q day of , 2018, by f Tasty Pies Properties, LLC on behalf of said limited liability 96mpany. By: '� No r --Public-S t nf_Ta ��►� MILDRED DOUGLAS Notary Public,State of Texas �( Notary ID 12987454-5 or My Commission Exp.07-03 2022 Aft ec r mg Return to: City Secretary City of Fort Worth 200 Texas Street Fort Worth, Texas 76102 FOFFICIAL RECORD EC ETARYIVGWT ,TX Owner-Initiated Annexation Service Agreement 8 of 11 EXHIBIT A GRAPHIC SCALE 1"=700' 0 700 1400 I N 00'46'54" S 00'46'54" E c 753.71' CALLED 75 1/3)109S� TRACT 1 n CSXIWLEY 272 XINT VENTLRE o VOL. 12E21, PG. 1595 00 21" W D.P.T.C.T. z 4 i' WEST CLFBURNE ROAD(CR 103 CALLED 2a ALTS`$ TRACT 2 ' f_dN� O.S. G'"CEY 272 uVINT VENTLFF V9_. 12521. PG. 1595 $ 89'10'04' E R= •�' DR.T.C.T.350.63' L=18821' I z A= 89'51'57' — — — — — — — *i o CALLED 100 AL3Z TRACT 4 — — — — — — — — LU CRDl2EY 272 LVINT VENTLRE Lu VCL. 12521, PG. 1595N N s �yT2. D.R.T.C.T. w o & CALLED 74 1/2 AOW� TRACT 3 g CRDWLEY 272 VINT VENTLAE S" g V VOL. 12621. PG. 1596 o z. 333 I DR.T.C.T. Cp �:zs8 acmes , `� N 39'30" E 487821' wESf CLEBURNE CROWL.EY ROAD(CR 101 S 89'39 30 W 4928.96' NOTE: THIS EXHIBIT REPRESENTS AN BEARINGS ARE REFERENCED ACTUAL ON THE GROUND SURVEY TO TEXAS STATE PLANE COORDINATE SYSTEM, CURRENT INCORPORATED AREA NORTH CENTRAL ZONE ` (4202 1, NORTH AMERICAN DATUM OF 1983 AS DERIVED FROM GPS OBSERVATION. Pam' � 7.263 ACRES TO BE ANNEXED EXHIBIT"A'SHOWING PROPOSED ANNEXATION O F GOGDVIWI Job No.i 10793 Scale, 1" = 700' h4[tRSHALL Drafted B.A.J. Checked J.NA. JOHN N. ROC AS CIVIL ENGINEERS—PLANNERS—SURVEYORS 6372 Qy.' Surveyed on the Ground, 04/11/2018 05 ssid? 24Mustang Drive, (_,Gr 32.9-4373 Texas 76051 Date Prepared, 06/11/2018 TBPE REGISTRATION#F-2944 TBPLS#10021700 Revised= Revised Date Slgned1 6/11./2018 Owner-Initiated Annexation Service Agreement 9 of 11 EXHIBIT A LEGAL DESCRIPTION PROPOSED ANNEXATION All that certain lot, tract, or parcel of land, situated in a portion of the Antonio Castello Survey, Abstract No. 271, the W. H. Colthorp Survey, Abstract No. 286, Antonio Fernandes Survey, Abstract No. 506, John Korticky Survey, Abstract No. 914, and the International and Great Northern Railroad Company Survey, Abstract No. 826, Tarrant County, Texas, being all of those certain called 78 1/3 acre, 20 acre, 74 1/2 acre, and 100 acre tracts described in a deed to Crowley 272 Joint Venture recorded in Volume 12621, Page 1596 of the Deed Records of Tarrant County, Texas (DRTCT), and being more completely described as follows, to-wit: BEGINNING at a 1" iron pipe found for the Northeast corner of said 100 acre tract, the Southeast corner of a called 40.004 acre tract described in a deed to Sharon Lynn Sankary recorded in Instrument No. D204323827 (DRTCT), and being in the West line of said 78 1/3 acre tract; THENCE North 00 deg. 46 min. 54 sec. West along the West line of said 78 1/3 acre tract, the East line of said 40.004 acre tract, the East line of a called 1.000 acre tract described in a deed to DTH REO Inc. recorded in Instrument No. D215152949 (DRTCT), the East line of a called 2.000 acre tract described in a deed to O. F. Bush, Sr., et al recorded in Volume 4777, Page 308 (DRTCT), and the approximate centerline of West Cleburne Road (County Road No. 1035), a distance of 753.71 feet to a P.K. nail set with washer stamped "GOODWIN & MARSHALL", hereinafter referred to as P.K. nail set with washer, for the Northwest corner of said 78 1/3 acre tract; THENCE North 89 deg. 37 min. 03 sec. East departing said centerline and continue along the North line of said 78 1/3 acre tract, the South line of a called 40.006 acre tract described in a deed to Jerry Savelle Ministries, Inc. recorded in Volume 13436, Page 290 (DRTCT), and the South line of Lot 1, Block 1 of Heritage of Faith Christian Center recorded in Cabinet A, Slide 11818 of the Plat Records of Tarrant County, Texas (PRTCT), at 24.44 feet pass a 1/2" iron rod found for the Southwest corner of a said 40.006 acre tract, continue a total distance of 2776.07 feet to a P.K. nail set with washer for the Northeast corner of said 78 1/3 acre tract and being in the approximate centerline of West Old Cleburne Crowley Junction (County Road No. 1079); THENCE South 00 deg. 34 min. 39 sec. East along the East line of said 78 1/3 acre tract, the East line of said 20 acre tract, the East line of said 74 1/2 acre tract, and said approximate centerline, a distance of 2837.06 feet to a 1/2" capped iron rod set stamped "GOODWIN & MARSHALL", hereinafter referred to as 1/2" capped iron rod set, for the Southeast corner of said 74 1/2 acre tract and being the projected centerline of said West Old Cleburne Crowley Junction and West Cleburne Crowley Road (County Road No. 1018); THENCE South 89 deg. 39 min. 30 sec. West along the South line of said 74 1/2 acre tract, the South line of said 100 acre tract, and along the approximate centerline of said West Cleburne Crowley Road, a distance of 4878.91 feet to a 1/2" capped iron rod set for the Southwest corner of said 100 acre tract; THENCE North 00 deg. 28 min. 21 sec. West along the West line of said 100 acre tract and along said centerline, a distance of 2060.33 feet to a P.K. nail set with washer for the Northwest corner of said 100 acre tract, from which a 1/2" capped iron rod found stamped "4277" for the Northeast Owner-Initiated Annexation Service Agreement 10 of 11 corner of Lot 21 of Garden Arbors Estates recorded in Cabinet A, Slide 6031 (PRTCT) bears South 30 deg. 28 min. 19 sec. West—58.34 feet; THENCE North 89 deg. 05 min. 03 sec. East along the North line of said 100 acre tract and along said centerline, a distance of 2101.76 feet to the POINT OF BEGINNING, containing 12,222,802 square feet or 280.597 acres of land, more or less. Bearings are referenced to Texas State Plane Coordinate System, North Central Zone (4202), North American Datum of 1983 as derived from GPS observation. Exhibit map attached and made a part hereof. Owner-Initiated Annexation Service Agreement 11 of 11 City of Fort Worth, Texas Mayor and Council Communication COUNCIL ACTION: Approved on 9/11/2018 DATE: Tuesday, September 11, 2018 REFERENCE NO.: L-16141 LOG NAME: 06MUNICIPAL SERVICES AGREEMENT, AX-18-003, OWNER-INITIATED SUBJECT: Authorize Execution of Municipal Services Agreement for the Proposed Owner-Initiated Annexation of Approximately 280.6 Acres of Land in Tarrant County, Located North of Cleburne Crowley Road and West of Old Cleburne Crowley Junction Road, in the Far Southwest Planning Sector, AX-18-003 (FUTURE COUNCIL DISTRICT 6) RECOMMENDATION: It is recommended that the City Council execute the attached Municipal Services Agreement between the City and property owners, Crowley 272 Joint Venture, Rocky Mountain Properties, LLC and Tasty Pies Properties, LLC for the proposed owner-initiated annexation of approximately 280.6 acres of land located north of Cleburne Crowley Road and west of Old Cleburne Crowley Junction Road. DISCUSSION: On May 15, 2018, representatives of the property owners Bloomfield Homes, L.P. submitted an application for full-purpose annexation. The proposed annexation of approximately 280.6 acres is situated in Tarrant County within the City of Fort Worth extraterritorial jurisdiction, north of Cleburne Crowley Road and west of Old Cleburne Crowley Junction Road, see map exhibit A. The proposed annexation area is currently vacant land. The property is proposed for the development 1,061 Single-Family detached lots with two Neighborhood Commercial tracts. The ordinance for AX-18-003, owner-initiated annexation, is also being considered on this docket. Subchapter C-3 of Chapter 43 of the Texas Local Government Code (LGC) provides for the process of annexation of an area upon a request of an owner of land. Section 43.0672 of the LGC requires a municipality that elects to annex an area upon the request of an owner first negotiate and enter into a written agreement with the owners of land in the area for the provision of municipal services. The agreement must include: (1) a list of each service the municipality will provide on the effective date of the annexation, and (2) a schedule that includes the period within which the municipality will provide each service that is not provided on the effective date of the annexation. The attached municipal services agreement includes these provisions as required by state law. The property affected by this Municipal Services Agreement is adjacent to COUNCIL DISTRICT 6. FISCAL INFORMATION /CERTIFICATION: The Director of Finance certifies that the Planning and Development Department has reported that revenues associated with this action will be sufficient to cover the expenditures associated with delivering Logname: 06MUNICIPAL SERVICES AGREEMENT,AX-18-003, OWNER-INITIATED Page I of 2 required services. FUND IDENTIFIERS (FIDs): TO Fund Department ccoun Project Program ctivity Budget Reference # moun ID ID Year Chartfield 2 FROM Fund Department ccoun Project Program ctivityl Budget Reference # moun ID ID Year Chartfield 2 CERTIFICATIONS: Submitted for City Manager's Office by: Jay Chapa (5804) Originating Department Head: Randle Harwood (6101) Additional Information Contact: Leo Valencia (2497) ATTACHMENTS 1. FORM 1295.pdf (Public) 2. M-C Exhibit A - Map AX-18-003.pdf (Public) 3. Municipal Services Agreement AX-18-003m.pdf (Public) Logname: 06MUNICIPAL SERVICES AGREEMENT, AX-18-003, OWNER-INITIATED Page 2 of 2 GRAPHIC SCALE 1"=700' 0 700 1400 i � I � WM ?P f AM rA1CT' MEEI' 272 JOPff N W POW OF va- 12521, PG. m BSO 9-.rr.n n 139 IBM' E 8101,76' W�TC+L +� 1 GaLLr� 217 AG51� 7Rdti'T ; 090811-f'Y 2 DINT bx. 1262-E PG- 1556 I 45 l r+ DUO 100 A7M MC7 4 �y. I �rojwr i ,280. s r` I a-p- - w a 011LO TA > A0 Taw T Gg WLEY 272 �C Nr P23 7 9E s} 8 MDL. 12152$ PIG. 1556 1 Z WEST C LEBURNE CROWLEY ROAD(CR 101 — I o I n I Z O NOTE: THIS EXHIBIT REPRESENTS AN ACTUAL ON THE GROUND SURVEY BEARINGS ARE REFERENCED x TO TEXAS STATE PLANE x ® COORDINATE SYSTEM, z CURRENT INCORPORATED AREA NORTH CENTRAL ZONE a (4202 ). NORTH AMERICAN DATUM OF 1993 AS DERIVED z FROM GPS OBSERVATION. o 280.597 ACRES TO BE ANNEXED 0 O EXHIBIT W SHOWING PROPOSED ANNEXATION E T Job No.l 10793 Scale) 1" 700' Sheet ~ JOHN N. ROGERS � SHALT. 9 Drafted) B.A.J. Checked) JNA. z • 6372 v: CML ENGINEERS-PLANNERS-SURVEYORS ... M 2405 Mustang Drhm,Grapevine,Texas 76051 Surveyed on the Ground I 04/11/2018 C,� ,�� o Metro(817)329-4373 Date Prepared I 06/01/2018 i TBPE REGISTRATION#F-2944 TBPLS#10021700 Revised I Revised) Date Signed i w CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft Complete Nos.i-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 tiling form,and the city,state and country of the business entity's place Certificate Number: of business. 2018-386033 Rocky Mountain Properties,LLC 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 0713012018 being filed. City of Fort Worth Date Ackno a ged: �Llz 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. AX-18-003 Municipal Services Agreement for Annexation AX-18-003 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling I Intermediary Kelly,W.Whitney Fort Worth,TX United States X Kelly III,Raymond B. Fort Worth,TX United States X 5 Check only if there Is NO Interested Parry. ❑ 6 UNSWORN DECLARATION My name is Raymond B. Kelly III and my date of birth is October 12, 1947 My address is 801 Cherry Street, Unit 46 Fort Worth TX 76102 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed In Fort Worth, Tarrant County, State of Texas on the 30th day July X18 J (month) (year) Signature of authorized nt of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711 (4141 CERTIFICATE OF INTERESTED PARTIES FORM 1295 loft 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. 2018-386225 Tasty Pies Properties,LLC 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 07/30/2018 being filed. City of Fort Worth Date Acknowled 3 Provide the identification number used by the governmental entity or state agency to track or identity the contract,and provide a description of the services,goods,or other property to be provided under the contract. AX-18-003 Municipal Services Agreement,AX-18-003 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Jon.Kelly Fort Worth,TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is JOn KONY and my date of birth is 7110/51 My address is 1617 Western Ave. Fort Worth TX 76107 USA (street) (CRY) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct Executed In Torrent _County, Stat f Texas on the 30th day of July Y018 (year) Sign ure of authorized agent of contr Ing business enti (Declarant) Forms provided by Texas Ethics Commission Www.ethics.s te.tx.us Version V1.0.6711 IL- 161q ) CERTIFICATE OF INTERESTED PARTIES FORM 1295 l of l 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. 2018-386044 Crowley 272 Joint Venture 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 07/30/2018 being filed. City of Fort Worth Date Acknowledged: 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. AX-18-003 Municipal Services Agreement for Annexation AX-18-003 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Lively,Brooke K. Fort Worth,TX United States X Kelly III,Raymond B. Fort Worth,TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name Is Raymond B. Kelly III and my date of birth is October 12, 1947 My address is 801 Cherry Street, Unit 46 Fort Worth , TX 76102 USA (Street) (city) (state) (zip Dodo) (--try) I declare under penalty of perjury that the foregoing is true and correct. Executed in Fort Worth, Tarrant County, State of Texas ,on the 30th day of July ,20_1&_. (month) (yeer) Signature of authorizednt of contracting business entity (D 1 rant) Forms provided by Texas Ethics Commission wwuu.ethics.state.tx.us Version V1.0.6711