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HomeMy WebLinkAboutContract 49172-FP5 City Secretary 491-72 -FP5 Contract No. FORTWORTH, Date Received Oct 4,2018 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- HARRIS PARKWAY City Project No.: 100424 Improvement Type(s): Water ® Sewer Original Contract Price: $304,626,70 Amount of Approved Change Order(s): Revised Contract Amount: Total Cost of Work Complete: $304,626.70 Aug7,2018 Contractor Date Contract Manager Title Burnsco Construction,Inc. Company Name A(&qz`e4t - Se 17 2018 Neal Kime(Sep 17,2018) p f Project Inspector Date Fred Eh,.(Oct 2. Ol8i 0ct:2,2018 Projectanager Date �76?izz8 c�wQ?A / br-aCt Od 2,2018 Janie ScarleR Lloraies(Oct 2,2018) CFA Manager Date Sw'A"Ze 44ycrk Oct 4,2018 Susan Alanis(Oct 4,2018) Asst. City Manager Dale OFFICIAL RECORD Page 1 of 2 CITY SECRETARY FT.WORTH$TX i! Notice of Project Completion Project Name:TAVOLO PARK- HARRIS PARKWAY 1 City Project No.: 100424 City's Attachments Final Pay Estimate 7 Change Order(s): ❑ Yes © N/A Pipe Report: ® Yes El N/A j Contractor's Attachments it Affidavit of Bills Paid Consent of Surety i Statement of Contract Time Contract Time150 CD Days Charged: 373 Work Start Date: 7/24/2017 Work Complete Date: 7/31/2018 Page 2 of 2 a i s"glp01- City Project Numbers 100424 DOE Number 0424 Contract Name TAVOLO PARK-IIARRIS PARKWAY Estimate Number 1 Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/6/2018 Project Funding i I Project Manager NA City Secretary Contract Number Inspectors OWEN / SAMANIEGO Contract Date Contractor BURNSCO CONSTRUCTION,INC. Contract Time 150 CD 6331 SOUTHWEST BLVD Days Charged to Date 373 CD FORT WORTH, TX 76132 Contract is .000000 Complete 1 CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded ............. -- — - Total Cost of Work Completed $304,626.70 Less %Retained $0.00 Net Earned $304,626.70 Earned This Period $304,626.70 Retainage This Period $0.00 Less Liquidated Damages 0 Days @ $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 $304,626.70 Monday,August 6,2018 Page 4 of 4 FORT ORTIH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name TAVOLO PARK-HARRIS PARKWAY Contract Limits Project Type WATER&SEWER City Project Numbers 100424 DOE Number 0424 Estimate Number I Payment Number I For Period Ending 8/6/2018 CD City Secretary Contract Number Contract Time 15CD 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 Monday,August 6,2018 Page I of 4 City Project Numbers 100424 DOE Number 0424 Contract Name TAVOLO PARK-HARRIS PARKWAY Estimate Number 1 Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/6/2018 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ---------------------------------------- 1 8"WATER PIPE 25 LF $29.60 $740.00 25 $740.00 2 12"WATER PIPE 1484 LF $53.00 $78,652.00 1484 $78,652.00 3 DUCTILE IRON WATER FITTINGS 5.2 TN $3,900.00 $20,280.00 5.2 $20,280.00 W/RESTRAINT 4 CONNECTION TO EXISTING 24"WATER MAIN 1 EA $3,800.00 $3,800.00 1 $3,800.00 5 1 1/2"WATER SERVICE 3 EA $1,900.00 $5,700.00 3 $5,700.00 6 4"WATER PIPE 8 EA $24.00 $192.00 8 $192.00 7 4"GATE VALVE 1 EA $600.00 $600.00 1 $600.00 8 8"GATE VALVE 3 EA $1,400.00 $4,200.00 3 $4,200.00 9 12"GAPE VALVE 7 EA $2,400.00 $16,800.00 7 $16,800.00 10 24"XI2"TAPPING SLEEVE&VALVE 1 EA $11,300.00 $11,300.00 1 $11,300.00 11 AUTOMATIC FLUSHER 1 EA $4,350.00 $4,350.00 1 $4,350.00 12 TRENCH SAFETY 1509 LF $0.50 $754.50 1509 $754.50 Sub-Total of Previous Unit $147,368.50 $147,368.50 SEWER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ---------------------------------------- 1 24"STEEL CASING PIPE BY OTHER THAN 200 LF $675.00 $135,000.00 200 $135,000.00 OPEN CUT 2 12"SEWER PIPE 5 LF $45.00 $225.00 5 $225.00 3 12"SEWER CARRIER PIPE 248 LF $71.00 $17,608.00 248 $17,608.00 4 4'MANHOLE 1 EA $3,300.00 $3,300.00 1 $3,300.00 5 VACUUM MANHOLE TESTING 1 EA $200.00 $200.00 1 $200.00 6 POST CCTV INSPECTION 253 LF $2.40 $607.20 253 $607.20 7 TERNCH SAFETY 53 LF $6.00 $318.00 53 $318.00 Sub-Total of Previous Unit $157,258.20 $157,258.20 Monday,August 6,2018 Page 2 of 4 City Project Numbers 100424 DOE Number 0424 Contract Name TAVOLO PARK-HARRIS PARKWAY Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 8/6/2018 Project Funding Contract Information Sumxnaiy Original Contract Amount $304,626.70 Change Orders Total Contract Price $304,626.70 Total Cost of Work Completed $304,626.70 Less %Retained $0.00 Net Earned $304,626.70 Earned This Period $304,626.70 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 $304,626.70 Monday,August 6,2018 Page 3 of 4 FORTWORTH TRANSPORTATION AND PUBLIC WORDS PIPE REPORT FOR: PROJECT NAME: Tavolo Park-Harris Parkway PROJECT NUMBER: 100424 DOE NUMBER: N/A WATER PIPE LAID SIZE TYPE OF PIPE LF 8"inch PVC 25 LF 12"inch PVC 1,484 LF FIRE HYDRANTS:I VALVES(16"OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF N/A DENSITIES: All passed. NEW SERVICES: 2-2"inch copper 8 LF SEWER PIPE LAID SIZE TYPE OF PIPE LF 12"inch Sewer Pipe PVC 5 LF 12"inch Sewer Carrier Pipe PVC 248 LF 24"inch Steel Casing Pipe 240 LF PIPE ABANDONED SIZE TYPE OF PIPE LF N/A DENSITIES: NEW SERVICES: N/A TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 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 construction, Inc.,known to me to be a credible person, who being by me duly sworn, upon his oath deposed and said; That all persons, fines, associations, corporations, or other organizations fiirnishing 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 Harris Pkwy CPN 100424-Water, Sewer and Drainage BY 1 Ab Grant-es, ontract Manager Subscribed and sworn before me on this date 6th of August, 2018. Nod -y Public Tarrant County, Texas :,I! AY.......,, MARY PANNELL �i -(r_• =NCItOry Public,Stale of Texas \:Yt' L.Orrrfl. Expires 10-19.2018 C Not0ry ID 5144239 { CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ Conforms with the American Institute of OTHER Architects,AIA Document G707 Bond No 022056833 PROJECT: (name, address)Tavolo Park-Harris Parkway 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-Harris Parkway-Water,Sewer& Drainage Dallas TX 75231 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 or 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 LIBERTY MUTUAL INSURANCE COMPANY jLrh(,��, Surety Company Attest:Tina McEwan ` (Seal): Sign tune of Authorized Representative Soohinie Hunter Attorney-in-Fact 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. I 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- Certificate No.8138332 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company I 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 State or 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;Sophinie Hunter;V.DeLene Marshall;Tina McEwan•Ricardo J Revna-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 attorney-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,recognizances 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,bythe 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 dayof June 2018 The Ohio Casualty Insurance Company w tei�Y r r 3stz 1sstN Liberty Mutual Insurance Company 4) West/American Insurance Company STATE OF PENNSYLVANIA ss David M.Care sistant Secretary COUNTY OF MONTGOMERY = Q 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 v I— (o 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 0 therein contained by signing on behalf of the corporations by himself as a duly authorized officer. 0 LLI 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. 0 CL 3 cA PASS, COMMONWEALTH OF PENNSYLVANIA M ZS NW�F No'arial Seal �.Q%4� ,7.i ^ Teresa Pastella.Nntary Public By: 0,�_�-�'D� Q 0 i o OF l Upper MerionTWFt„Montgomery County Teresa Pastella,Notary Public My Commission Ex;Nres March 28.2021 •e�-+^Q 2�rvSYLV�y�G Member.Pennsylvanin Association of Notaries O N AF?'y PU 0 E CL C 2 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 ur O ,,° Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: w c U) ARTICLE IV--OFFICERS—Section 12.Power of Attomey.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O s_ 0) 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 0 acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their respective 'v 3 E °�'� 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 ii m 0 tp 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 attorney-in-fact under > 4 the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. cc C ARTICLE Xill—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, .+o? iand subject to such limitations as the chairman or the president may prescribe;shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute. M 0v seal,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 e? respective powers of attomey,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 0 0 executed such instruments shall be as binding as if signed by the president and attested by the secretary.. 00 Certificate of Designation—The President:of the Company,acting pursuanYto the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-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 attomey 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: I, 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,isinfull force and effect and has not been revoked, IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this day of -,201S 1 . aJ';yuvSr.,27:;y'!f �1a.,,rt};.�,J•2�� `C: �N'��t7:��Cn. .. � ,.iT/W�'��. n ti c� 1 Y V1R1?_ ° ` 1U91 By _ Renee C.Lle ssistant Secretary I I 43 of 300 LMS 12873 022017 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 al numero de telefono gratis make a complaint at para informacion o para someter una queja al 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 al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection (111-1A) de Texas Consumer Protection (111-1A) P. O. Box 149091 P. O. Box 149091 Austin, TX 78714-9091 Austin, TX 78714-9091 FAX: (512) 490-1007 FAX# (512) 490-1007 Web: http•//www.tdi.texas.gov Web: http•//www tdi texas.zov E-mail: ConsumerProtectionna tdi.texas.eov E-mail: ConsumerProtectionna tdi texas.eov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a should first un reclamo, debe comunicarse con el age c premium or about a claim you ede contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, p 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: I" 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 dy no ocumee onvieadjune en parte o condicion del document. M'70690901 LMS-15292 10115 w= Greensheet for Tavolo Park- Harris Parkway CPN#100424 ......... ___...... . WS _ Adobe Sign Document History 10/09/2018 - Created: 08/06/2018 By: Shameka.Kennedy@fortworthtexas.gov Status: Signed Transaction ID: CBJCHBCAABAAabEm89aDXEyDnyWJOW-00IFIP-a9U6m "Greensheet for Tavolo Park- Harris Parkway CPN#100424 WS" History i Document created by Shameka.Kennedy@fortworthtexas.gov 08/06/2018-3:41:15 PM CDT-IP address:209.194.29.100 > Document emailed to Ab Grantges (kcarwine@aol.com)for signature 08/06/2018-3:44:50 PM CDT v Document viewed by Ab Grantges (kcarwine@aol.com) 08/06/2018-7:16:14 PM CDT-IP address: 107.77.197.110 CP/ Ab Grantges (kcarwine@aol.com) uploaded the following supporting documents: &, File Attachment 1 & File Attachment 2 08/07/2018-9:04:45 AM CDT &0 Document e-signed by Ab Grantges (kcarwine@aol.com) Signature Date:08/07/2018-9:04:45 AM CDT-Time Source:server-IP address:12.246.109.114 Document emailed to Neal Kime (neal.kime@fortworthtexas.gov)for signature 08/07/2018-9:04:46 AM CDT �I Document viewed by Neal Kime (neal.kime@fortworthtexas.gov) 09/17/2018-12:48:09 PM CDT-IP address:174.206.18.68 6Q Document e-signed by Neal Kime (neal.kime@fortworthtexas.gov) Signature Date:09/17/2018-12:48:45 PM CDT-Time Source:server-IP address:174.206.18.68 C' Document emailed to Edwin R. Rodriguez, Sr. (edwin.rodriguez@fortworthtexas.gov)for approval /� 09/17/2018-12:48:47 PM CDT FORT o I Adobe:JtY e Sign `:- Document emailed to Trudy Brotherton (therese.brotherton@fortworthtexas.gov)for delivery 10/04/2018-4:26:49 PM CDT Document viewed by Trudy Brotherton (therese.brotherton@fortworthtexas.gov) 10/05/2018-6:58:36 AM CDT-IP address:209.194.29.100 Document receipt acknowledged by Trudy Brotherton (therese.brotherton@fortworthtexas.gov) i Receipt Acknowledgement Date: 10/05/2018-6:58:56 AM CDT-Time Source:server-IP address:209.194.29.100 Document emailed to Julie A Geho Oulie.geho@fortworthtexas.gov)for delivery 10/05/2018-6:58:57 AM CDT Document viewed by Julie A Geho Oulie.geho@fortworthtexas.gov) 10/05/2018-7:48:35 AM CDT-IP address:209.194.29.100 Document receipt acknowledged by Julie A Geho Oulie.geho@fortworthtexas.gov) Receipt Acknowledgement Date: 10/05/2018-7:48:56 AM CDT-Time Source:server-IP address:209.194.29.100 C� Document emailed to Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov)for delivery 10/05/2018-7:48:57 AM CDT 9 Document viewed by Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov) 10/05/2018-8:39:04 AM CDT-IP address:209.194.29.100 Document viewed by Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov) 10/09/2018-9:22:29 AM CDT-IP address:209.194.29.100 G Document receipt acknowledged by Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov) Receipt Acknowledgement Date:10/09/2018-9:22:44 AM CDT-Time Source:server-IP address:209.194.29.100 C Signed document emailed to freidoon.ehia@fortworthtexas.gov, Neal Kime (neal.kime@fortworthtexas.gov), Janie Scarlett Morales (Janie.morales@fortworthtexas.gov), Susan Alanis (susan.alanis@fortworthtexas.gov), and 8 more 10/09/2018-9:22:44 AM CDT FORT WORTH. Adobe Sign L] Document viewed by Edwin R. Rodriguez, Sr. (edwin.rodriguez@fortworthtexas.gov) 09/17/2018-1:12:09 PM CDT-IP address:209.194.29.100 Document approved by Edwin R. Rodriguez, Sr. (edwin.rodriguez@fortworthtexas.gov) Approval Date:09/17/2018-1:12:28 PM CDT-Time Source:server-IP address:209.194.29.100 Document emailed to freidoon.ehia@fortworthtexas.gov for signature 09/17/2018-1:12:30 PM CDT Shameka.Kennedy@fortworthtexas.gov replaced signer freidoon.ehia@fortworthtexas.gov with Fred Ehia (Keith.Ghanma@fortworthtexas.gov) 10/02/2018-10:46:45 AM CDT-IP address:209.194.29.100 > Document emailed to Fred Ehia (Keith.G han ma@fortworthtexas.gov)for signature 10/02/2018-10:46:46 AM CDT Document viewed by Fred Ehia (Keith.Ghanma@fortworthtexas.gov) 10/02/2018-10:47:50 AM CDT-IP address:209.194.29.100 GSp Document e-signed by Fred Ehia (Keith.Ghanma@fortworthtexas.gov) Signature Date: 10/02/2018-10:50:44 AM CDT-Time Source:server-IP address:209.194.29.100 C' Document emailed to Janie Scarlett Morales (Janie.morales@fortworthtexas.gov)for signature 10/02/2018-10:50:47 AM CDT Document viewed by Janie Scarlett Morales Qanie.morales@fortworthtexas.gov) 10/02/2018-11:27:12 AM CDT-IP address:209.194.29.100 6o Document e-signed by Janie Scarlett Morales (Janie.morales@fortworthtexas.gov) Signature Date:10/02/2018-11:35:20 AM CDT-Time Source:server-IP address:209.194.29.100 Pw Document emailed to Susan Alanis (susan.alanis@fortworthtexas.gov)for signature 10/02/2018-11:35:22 AM CDT Document viewed by Susan Alanis (susan.alanis@fortworthtexas.gov) 10/04/2018-9:48:12 AM CDT-IP address:209.194.29.100 dQ Document e-signed by Susan Alanis (susan.alanis@fortworthtexas.gov) Signature Date: 10/04/2018-9:48:26 AM CDT-Time Source:server-IP address:209.194.29.100 v Document emailed to Allison Tidwell (cso_finalpay@fortworthtexas.gov)for filling 10/04/2018-9:48:28 AM CDT 1 Document viewed by Allison Tidwell (cso_finalpay@fortworthtexas.gov) 10/04/2018-4:20:30 PM CDT-IP address:209.194.29.100 lsa Form filled by Allison Tidwell (cso_finalpay@fortworthtexas.gov) Form filling Date:10/04/2018-4:26:48 PM CDT-Time Source:server-IP address:209.194.29.100 Form eS Adobe Sign