HomeMy WebLinkAboutContract 51465CITY SECRETARY
CONTRACT
CONTRACT NO. —dj 4j 5
STATE OF TEXAS §
COUNTIES OF TARRANT, WISE §
AND DENTON §
AGREEMENT BETWEEN FORT WORTH POLICE ATHLETIC LEAGUE
AND CITY OF FORT WORTH
THIS Agreement is made between the City of Fort Worth ("City"), a municipal
corporation, acting herein by and through Jesus J. Chapa, its duly authorized Assistant City
Manager, and Fort Worth Police Athletic League ("FWPAL") acting by and through Allen Speed,
its duly authorized President.
RECITALS
WHEREAS, City has determined that the FWPAL provides services to engage youth in
productive activities through prevention and intervention to reduce violent and gang related crimes
in the City ("FWPAL Youth Sports Program"); and
WHEREAS, City and FWPAL desire to enter into a contract to have such services
provided which benefit the Fort Worth community by increasing the safety of neighborhood
residents while promoting mentorship that motivates, inspires, and develops confidence in youth;
and
WHEREAS, City desires to contract with FWPAL to provide such services for the public
purpose of crime prevention and youth intervention; and
WHEREAS, City, as consideration for the performance of FWPAL Youth Sports
Program, has appropriated monies in the Department's Crime Control and Prevention District
Fund Budget in the amount of $75,000.00 ("CCPD Program Funds") to provide to FWPAL on a
reimbursement basis for the operation of the FWPAL Sports Program, subject to and in accordance
with this agreement;
NOW, THEREFORE, in consideration of the mutual covenants herein expressed, the
parties agree as follows:
CONTRACT DOCUMENTS
The Contract documents shall include the following:
1. This Agreement for the FWPAL
iit 2. Exhibit A — Scope of Work
3. Exhibit B — Budget
OCA T o��N . Exhibit C — Request for Reimbursement
5. Exhibit
6. Exhibit E - Quarterly Activities
Effectiveness Measurement Report
r4FT.
ICIAL RECORD
Y SECRETARY
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 1 of OR.
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7. Exhibit F — Request for Budget Modification
8. Exhibit G — Disbursement Schedule
All Exhibits A through G, which are attached hereto and incorporated herein, and are made a
part of this Agreement for all purposes. In the event of any conflict between the terms and
conditions of Exhibits A through G, 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.
DEFINITIONS
The term "City" shall include City, and its officers, agents, employees, and representatives.
The term "FWPAL" shall include FWPAL, and its officers, agents, employees,
representatives, servants, contractors, and subcontractors.
The term "Party" shall refer to either City or FWPAL.
The term "Parties" shall refer to both City and FWPAL.
The term "CCPD Fund" shall refer to the portion of money allocated in Fiscal Year 2019 to
the Fort Worth Police Department in City's Crime Control and Prevention District Fund.
AGREEMENT
1. Responsibilities of FWPAL. FWPAL covenants and agrees to fully perform, or cause to
be performed, with good faith and due diligence, all work and services described in Exhibit
"A" — Program Scope of Work, attached, and incorporated herein for all purposes incident to
this Agreement. FWPAL shall be responsible for day-to-day administration of the FWPAL
Sports Program. FWPAL agrees to expend the Program Funds in accordance with its FWPAL
Sports Program budget, described in Exhibit "B," attached. Program activities shall be
reported in accordance with Exhibit "D," attached.
2. Program Funds.
2.1 In no event shall the total distribution of Program Funds from City made to FWPAL
during the term of this Agreement exceed the total sum of $75,000.00.
2.2 Payment of the Program Funds from City to FWPAL shall be made on a cost -
reimbursement basis following receipt by City from FWPAL of a signed Request for
Reimbursement (RFR), as described in Exhibit "C," and copies of all receipts and support
documentation. The Payment of Program Funds from City to FWPAL shall be in accordance
with the Disbursement Schedule (Exhibit "G") and this Agreement. At its sole discretion, the
City may decline to issue Program Funds to FWPAL for any month in which the FWPAL
failed to spend at least 50% of the previous month's actually disbursed Program Funds.
FWPAL shall deliver to City a written detailed Program Activities Report as described in
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 2 of 24
Section 4.2 below with each RFR to support expenditure of Program Funds. Such reports shall
be signed by FWPAL or duly authorized officer of FWPAL. The RFR and monthly Program
Activities Report shall be submitted to City no later than the 15th day following the end of the
month. Submittal of a monthly RFR and Program Activities Report is required even if services
are not provided.
Submit the monthly RFR with an original signature by an authorized representative to the
Grant Management Section of the Fort Worth Police Department, ATTENTION: Grant
Specialist, Bob Bolen Public Safety Complex, 505 W. Felix St., Fort Worth, Texas, 76115.
Reimbursements will not be made until after receipt of an acceptable and approved RFR and a
monthly Program Activities Report. Reimbursements shall be made within 30 days receipt of
said documents.
2.3 FWPAL is authorized to modify up to five (5) percent of any budgeted line -item in
the original approved budget without prior written permission from City. However, FWPAL
must submit the Budget Modification Form (Exhibit "F") to City, with the monthly RFR, in
the month when the modification took place. The new modified budget cannot exceed the total
amount of Program Funds.
2.4 Any modifications of more than five (5) percent of any budgeted line -item in the
original approved budget must have prior written permission from City before any budget
modifications are made. The Budget Modification Form (Exhibit "F") must be submitted, and
request must be approved by City, before any money is moved to the line -item. Once the
Budget Modification is approved, the modified budget will take effect on the first day of the
following month. The new modified budget cannot exceed the total amount of Program Funds.
2.5 Any modifications to zero line -items in the original approved budget must have
prior written permission from City before any budget modifications are made. The Budget
Modification Form (Exhibit "F") must be completed and approved by City before money is
transferred into the new line -item. Once the Budget Modification is approved, the modified
budget will take effect on the first day of the following month. The new modified budget
cannot exceed the total amount of Program Funds.
2.6 Budget modification can only occur within the Direct and Indirect costs. Funds
may not be moved from a Direct line -item into an Indirect line -item, or vise versus.
Modification of Direct and Indirect approved budgets must follow the guidelines outlined in
sections 2.3, 2.4. and 2.5.
Budget adjustments shall be submitted to the Grant Management Section of the Fort Worth
Police Department, ATTENTION: Grant Specialist, Bob Bolen Public Safety Complex
at 505 W. Felix St., Fort Worth, Texas, 76115.
3. Term. This Agreement shall commence upon October 1, 2018, and shall end on
September 30, 2019. All of FWPAL's expenditures under this Agreement must be completed
no later than September 30, 2019.
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 3 Of 24
4. Program Performance.
4.1 FWPAL agrees to maintain full documentation supporting the performance of the
work and fulfillment of the objectives set forth in Exhibit "A."
4.2 FWPAL agrees to provide a monthly Program Activities Report to document the
performance of the work described in Exhibit "D", respectively. The Program Activities shall
document the program activity names, numbers of participants attending, details of the
activities, and a description of the goals achieved in support of the CCPD goals. The monthly
Program Activities shall be submitted to City no later than the 15th day after the end of each
month.
4.3 FWPAL agrees that the monthly Request for Reimbursement and Program
Activities Report will be submitted to City no later than the 1511, day after the end of each
month. Should FWPAL not meet these requirements, FWPAL will be given an additional 15
days to submit the required reports to City. If, at the end of this 15 -day extension period,
FWPAL has not submitted the required reports, City will send a non-compliance letter
notifying FWPAL's duly authorized representative of a possible suspension of program
funding.
5. Default and Termination.
5.1 This Agreement is wholly conditioned upon the actual receipt by City of Program
Funds from the general fund. All monies distributed to FWPAL hereunder shall be exclusively
from monies received from the general fund appropriated for the purpose of funding this
agreement, and not from any other monies of City. In the event that funds from the general
fund are not received prior to the execution of this contract by the parties, 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 FWPAL under or in connection with this
Agreement. In the event no funds or insufficient funds are appropriated by the City in any fiscal
year for any payments due hereunder, City will notify FWPAL 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, except as to the portions
of payments herein agreed upon for which funds have been appropriated.
5.2 The City may terminate this Agreement at any time and for any reason by
providing the other party with thirty (30) days' written notice of termination.
5.3 Termination will be effected by delivering to FWPAL a notice of termination,
specifying the portion of the Agreement affected and the effective date of termination. Upon
FWPAL's receipt of notice of termination, FWPAL shall:
(a) Stop work under the Agreement on the date and to the extent specified in the notice of
termination;
(b) Place no further order or subcontracts, except as may be necessary for completion of the
work not terminated;
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 4 of 24
(c) Terminate all orders and contracts to the extent that they relate to the performance of the
work terminated by the notice of termination; and
(d) Cease expenditures of Program Funds, except as may be necessary for completion of the
work not terminated.
5.4 In the event City suspends or terminates this Agreement, FWPAL expressly waives
any and all rights to monetary damages, including but not limited to actual, consequential, and
punitive damages, court costs, and attorney's fees.
5.5 Within thirty (30) days following the date of termination of this Agreement, FWPAL
shall return to City any property provided hereunder. City will have no responsibility or
liability for FWPAL's expenditures or actions occurring after the effective date of termination
of the Agreement.
6. Equipment and Maintenance. All equipment purchased with Program Funds must meet
all eligibility requirements of City. FWPAL shall maintain all equipment used in the
administration and execution of the FWPAL Sports Program. FWPAL shall maintain, replace,
or repair any item of equipment used in support of the FWPAL Sports Program and/or for use
under the terms of this Agreement that no longer functions or is lost or stolen. The cost for
maintenance, replacement, or repair of any equipment used in support of the FWPAL Sports
Program and/or for use under the terms of this Agreement is the sole responsibility of FWPAL.
FWPAL shall not use Program Funds or City funds to repair or replace said equipment.
FWPAL shall use any and all equipment purchased with Program Funds exclusively in support
of the FWPAL Sports Program. Within 10 days following the purchase of equipment, FWPAL
shall submit to City a detailed inventory of all equipment purchased with Program Funds to
the Grant Management Section at the address set forth in paragraph 2.2 above. The equipment
inventory shall include an itemized description of each piece of equipment, the date each piece
of equipment was purchased, the cost of purchase for each piece of equipment, and the location
of each piece of equipment.
7. Administrative Requirements.
7.1 FWPAL agrees to keep sufficient records to document its adherence to applicable
local, state, and federal regulations, along with documentation and records of all receipts and
expenditures of Program Funds. All records shall be retained for three (3) years following the
termination or completion of this Agreement. City or its representatives shall have the right to
investigate, examine, and audit at any time any and all such records relating to operations of
FWPAL under this Agreement. FWPAL, its officers, members, agents, employees, and
subcontractors, upon demand by City, shall make such records readily available for
investigation, examination, and audit. In the event of such audit by City, a single audit of all
FWPAL's operations will be undertaken and may be conducted either by City or an
independent auditor of City's choice. FWPAL shall submit a copy of any audit performed by
their independent auditor within 30 days of receipt of the final audit report.
7.2 If any audit reveals a questioned practice or expenditure, such questions must be
resolved within fifteen (15) days after notice to FWPAL by City. If questions are not resolved
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 5 of 24
within this period, City reserves the right to withhold further funding under this and/or future
contract(s) with FWPAL.
7.3 If, as a result of any audit, it is determined that FWPAL misused, misapplied, or
misappropriated all or any part of the Program Funds, FWPAL agrees to reimburse City the
amount of such monies so misused, misapplied, or misappropriated, plus the amount of any
sanction, penalty, or other charge levied against City because of such misuse, misapplication,
or misappropriation.
7.4 FWPAL's obligation to City shall not end until all closeout requirements are
completed. Activities during this closeout period shall include, but are not limited to:
providing final Program Activities Report, making final payments, disposing of FWPAL
Sports Program assets as appropriate, if deemed required by City in its sole discretion.
7.5 FWPAL covenants and agrees to fully cooperate with City in monitoring the
effectiveness of the services and work to be performed by FWPAL under this Agreement, and
City shall have access at all reasonable hours to offices and records of FWPAL, its officers,
members, agents, employees, and subcontractors for the purpose of such monitoring.
Section 7 shall survive the expiration of termination of this agreement.
8. Independent Contractor.
8.1 FWPAL shall operate hereunder as an independent contractor and not as an officer,
agent, or servant or employee of City. FWPAL shall have exclusive control of, and the
exclusive right to control, the details of the work and services performed hereunder, and all
persons performing same, and shall be solely responsible for the acts and omissions of its
officers, members, agents, servants, employees, subcontractors, program participants,
licensees, or invitees. The doctrine of respondeat superior shall not apply as between City and
FWPAL, its officers, members, agents, servants, employees, subcontractors, program
participants, licensees, or invitees, and nothing herein shall be construed as creating a
partnership or joint enterprise between City and FWPAL. No federal, state, or local income
tax, nor any payroll tax of any kind, shall be withheld or paid by the City on behalf of
Contractor. Contractor shall not be treated as an employee with respect to the services
performed pursuant to this Agreement for federal or state tax purposes. It is expressly
understood and agreed that officers, members, agents, employees, subcontractors, licensees, or
invitees of the Contractor, and any program participant hereunder are not eligible for, and shall
not participate in any employer pension, health, or other fringe benefit plan provided by City.
It is expressly understood and agreed that no officer, member, agent, employee, subcontractor,
licensee, or invitee of FWPAL, nor any program participant hereunder is in the paid service of
City and that City does not have the legal right to control the details of the tasks performed
hereunder by FWPAL, its officers, members, agents, employees, subcontractors, program
participants, licensees, or invitees.
8.2 City shall in no way nor under any circumstances be responsible for any property
belonging to FWPAL, its officers, members, agents, employees, subcontractors, program
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 6 of 24
participants, licensees, or invitees, which may be lost, stolen, destroyed, or in any way
damaged.
9. Liability and Indemnification.
FWPAL SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND ALL PROPERTY
LOSS, PROPERTY DAMAGE, AND/OR PERSONAL INJURY, INCLUDING DEATH,
TOANYAND ALL PERSONS, OFANYKIND OR CHARACTER, WHETHER REAL OR
ASSERTED, TO THE EXTENT CAUSED BY THE NEGLIGENT ACT(S) OR
OMISSION(S), MALFEASANCE, OR INTENTIONAL MISCONDUCT OF FWPAL, ITS
OFFICERS, AGENTS, SERVANTS, OR EMPLOYEES.
FWPAL 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 PROPERTYDAMAGE 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)FWPAL'S
BREACH OF ANY OF THE TERMS OR PROVISIONS OF THIS AGREEMENT OR (II)
ANY NEGLIGENT ACT OR OMISSION OR INTENTIONAL MISCONDUCT OF
FWPAL, 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 CONSULTANT 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
IMMUNITYAS FURTHER PROVIDED BY THE LAWS OF TEXAS.
FWPAL shall require all of its subcontractors to include in their subcontracts a release and
indemnity in favor of City in substantially the same form as above.
This section shall survive the expiration or termination of this Agreement.
10. Non -Assignment. No assignment or delegation of duties under this Agreement by
FWPAL shall be effective without City's prior written approval.
11. Prohibition AEainst Interest.
11.1 No member, officer, or employee of City, or its designees or agents; no member
of the governing body of the locality in which the FWPAL Sports Program is situated; and no
other public official of such locality or localities who exercises any functions or
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 7 of 24
responsibilities with respect to the FWPAL Sports Program during his tenure or for one year
thereafter, shall have any interest, direct or indirect, in any contract or subcontract, or the
proceeds thereof, for work to be performed hereunder. FWPAL shall incorporate, or cause to
be incorporated, like language prohibiting such interest, in all contracts and subcontracts
hereunder.
11.2 No officer, employee, member, or program participant of FWPAL shall have a
financial interest, direct or indirect, in this Agreement or the monies transferred hereunder, or
be financially interested, directly or indirectly, in the sale to FWPAL of any land, materials,
supplies, or services purchased with any funds transferred hereunder, except on behalf of
FWPAL, as an officer, employee, member, or program participant. Any willful violation of
this paragraph with the knowledge, expressed or implied, of FWPAL or its subcontractors,
shall render this Agreement voidable by City of Fort Worth.
12. Nondiscrimination.
12.1 In accordance with the federal, state, and local laws and ordinances, FWPAL
covenants that neither it nor any of its officers, members, agents, employees, program
participants, or subcontractors, while engaged in performing this Agreement shall in
connection with the employment, advancement, or discharge of employees, 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,
statutory requirement, or statutory or ordinance exception.
12.2 FWPAL will not unlawfully discriminate against any person or persons because of
age, race, color, religion, sex, disability, national origin, or sexual orientation, nor will FWPAL
permit its officers, members, agents, employees, subcontractors, or program participants to
engage in such discrimination.
12.3 FWPAL shall verify the identity and employment eligibility of its employees who
perform work under this Agreement, including completing the Employment Eligibility
Verification Form (I-9). Upon request by City, FWPAL shall provide City with copies of all
I-9 forms and supporting eligibility documentation for each employee who performs work
under this Agreement. FWPAL shall adhere to all Federal and State laws as well as establish
appropriate procedures and controls so that no services will be performed by any FWPAL
employee who is not legally eligible to perform such services. FWPAL SHALL
INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES,
LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY
FWPAL, FWPAL'S EMPLOYEES, SUBCONTRACTORS, AGENTS, OR
LICENSEES. City, upon written notice to FWPAL, shall have the right to immediately
terminate this Agreement for violations of this provision by FWPAL.
13. Compliance.
13.1 FWPAL, its officers, members, agents, employees, program participants, and
subcontractors, shall abide by and comply with all laws, federal, state, and local, including all
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 8 of 24
ordinances, rules, and regulations of City. If City calls to the attention of FWPAL in writing
to any such violation on the part of FWPAL or any of its officers, members, agents, employees,
subcontractors, or program participants, then FWPAL shall immediately desist from and
correct such violation.
13.2 FWPAL shall utilize Program Funds strictly for those purposes and goals intended
under the terms and conditions of this Agreement. If City calls the attention of FWPAL in
writing to any such violations on the part of FWPAL or any of its officers, members, agents,
employees, program participants, or subcontractors, then FWPAL shall immediately desist
from and correct such violation.
14. Waiver of Immunity. If FWPAL is a charitable or nonprofit organization and has or
claims an immunity or exemption (statutory or otherwise) from and against liability for
damages or injury, including death, to persons or property, FWPAL hereby expressly waives
its rights to plead defensively such immunity or exemption as against City. This section shall
not be construed to affect a governmental entity's immunities under constitutional, statutory,
or common law.
15. Insurance Requirement.
15.1 FWPAL shall procure and shall maintain during the term of this Agreement the
following insurance coverage:
(a) Commercial General Liability, (CGL): $1,000,000 per occurrence, with a $2,000,000.00
annual aggregate limit, in a form that is acceptable to the City's Risk Manager.
(b) Non -Profit Organization Liability or Directors & Officers Liability: $1,000,000 per
occurrence, with a $1,000,000 annual aggregate limit, in a form that is acceptable to the
City's Risk Manager.
(c) Automobile Liability: $1,000,000 each accident on a combined single limit basis OR
split limits are acceptable if limits are at least $250,000 Bodily Injury per person,
$500,000 Bodily Injury per accident and $100,000 Property Damage.
(d) Any other insurance the City may reasonably require to protect the interests of the City.
15.2 FWPAL's insurer(s) must be authorized to do business in the State of Texas for the
lines of insurance coverage provided and be currently rated in terms of financial strength and
solvency to the satisfaction of the City's Risk Manager.
15.3 Each insurance policy required herein shall be endorsed with a waiver of
subrogation in favor of the City. Each insurance policy required by this Agreement, except for
policies of worker's compensation or accident/medical insurance shall list the City as an
additional insured. City shall have the right to revise insurance coverage requirements under
this Agreement.
15.4 FWPAL further agrees that it shall comply with the Worker's Compensation Act
of Texas and shall provide sufficient compensation insurance to protect FWPAL and City from
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 9 of 24
and against any and all Worker's Compensation claims arising from the work and services
provided under this Agreement.
16. Miscellaneous Provisions.
16.1 The provisions of this Agreement are severable, and, if for any reason a clause,
sentence, paragraph, or other part of this Agreement shall be determined to be invalid by a
court or Federal or state agency, board, or commission having jurisdiction over the subject
matter thereof, such invalidity shall not affect other provisions which can be given effect
without the invalid provision.
16.2 City's failure to insist upon the performance of any term or provision of this
Agreement or to exercise any right herein conferred shall not be construed as a waiver or
relinquishment to any extent of City's right to assert or rely upon any such term or right on any
future occasion.
16.3 Should any action, whether real or asserted, at law or in equity, arise out of the
execution, performance, attempted performance, or non-performance of this Agreement, venue
for said action shall lie in Tarrant County, Texas or the United States District Court for the
Northern District of Texas, Fort Worth Division.
16.4 FWPAL represents that it possesses the legal authority, pursuant to any proper,
appropriate, and official motion, resolution, or action passed or taken, to enter into this
Agreement and to perform the responsibilities herein required.
16.5 This written instrument and the exhibits attached hereto, which are incorporated by
reference and made a part of this Agreement for all purposes, constitute the entire agreement
between the parties concerning the work and services to be performed hereunder, and any prior
or contemporaneous, oral or written agreement which purports to vary from the terms hereof
shall be void. Any amendments to the terms of this Agreement must be in writing and must be
signed by authorized representatives of each party.
16.6 All notices required or permitted by this Agreement must be in writing and are
deemed delivered on the earlier of the date actually received or the third day following (i)
deposit in a United States Postal Service post office or receptacle; (ii) with proper postage
(certified mail, return receipt requested); and (iii) addressed to the other party at the address as
follows or at such other address as the receiving party designates by proper notice to the
sending party:
CITY: Jesus J. Chapa, Assistant City Manager
City Manager's Office
City of Fort Worth
200 Texas Street
Fort Worth, TX 76102
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 10 of 24
Copies To: Grant Management Section
Bob Bolen Public Safety Complex
505 W. Felix St.
Fort Worth, TX 76115
City Attorney's Office
ATTN: Police Contracts
200 Texas Street
Fort Worth, TX 76102
FWPAL: Allen Speed, President
Police Athletic League
505 W. Felix Street
Fort Worth, TX 76115
16.7 None of the performance rendered under this Agreement shall involve, and no
portion of the Program Funds received hereunder shall be used, directly or indirectly, for the
construction, operations, maintenance, or administration of any sectarian or religious facility
or activity, nor shall said performance rendered or funds received be utilized so as to benefit,
directly or indirectly, any such sectarian or religious facility or activity.
16.8 Captions and headings used in this Agreement are for reference purposes only and
shall not be deemed a part of this Agreement.
16.9 The provisions and conditions of this Agreement are solely for the benefit of City
and FWPAL and are not intended to create any rights, contractual or otherwise, to any other
person or entity.
16.10 The parties acknowledge that each party and its counsel have reviewed 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.
16.11 Contractors are required to conduct criminal background screenings for all
volunteers or employees who will be working with children under the proposed program. All
criminal background checks shall be in compliance with Texas Department of Family and
Protective Services standards, the Texas Administrative Code and all other applicable law.
Contractors will be responsible for conducting criminal background screening and for
maintaining appropriate records, which will be subject to review by the City. CONTRACTOR
SHALL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES,
LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY
CONTRACTOR, CONTRACTOR'S EMPLOYEES, SUBCONTRACTORS, AGENTS, OR
LICENSEES.
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 11 of 24
IN WITNESS WHEREOF, the parties hereto have executed this agree...ent in multiples in Fort
Worth, Tarrant County, Texas, to be effective this g�sr day of DbeX , 20 -t& -
APPROVED AND AGREED FOR
CITY OF FORT WORTH
Jesus J. Chapa
Assistant City Manager
Date: D —,,-> 4�—AF
APPROVAL RECOMME DED
Chief Joel F. Fitzgerald
Chief of Police
Date: j DLL r6/ / ��---
APPROVED AS TO FORM AND LEGALITY
FOR CITY OF FORT WORTH
Matthew A. Murray
Date: l3
Form 1295 Certification No.: 2018-402107
Contract Compliance Manager:
By signing I acknowledge that I am the
person responsible for the monitoring and
administration of this contract, including
ensu
rig, a11 Rerf ma e and reporting requirements.
Name w n
Title ��, <t ��, Q'gh'rt's
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 12 of 24
APPROVED D AGREED FOR FORT
WORTH PO CE ATHLETIC LEAGUE
Allen Speed
President
I%
Date:
APPROVED AS TO FORM AND LEGALITY
FOR FWPAL
FWPAL Attorney
Date:
ATTEST
Mary J. ayse
City Secretar
y Date:
M&C No.
-7
OFFICIAL RECORD
CITY SECRETARY
FT WORTH, TX
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 13 of 24
EXHIBIT A
SCOPE OF WORK
The Fort Worth Police Athletic League (FWPAL) mission is to unite the Communities of Fort Worth
with its Police Department by providing youth programs and mentorship that motivates, inspires and
develops confidence, trust and respect. FWPAL a 501(c)(3) with a board of directors that are
volunteers of both civilians through the community and sworn Peace Officers. Currently the FWPAL
has the following youth sports programs to include boxing (ages 8-17 for boys and girls), flag football
(ages 5-13 for boys and girls), Code Blue after Dark Basketball program (ages 8-17 for boys and
girls), cheerleading (ages 5-17) and outdoor excursions for ages 8-17 for boys and girls. It has been
proven the past two years the FWPAL programs develop self-discipline, self-respect, self-
confidence, self-respect, and sportsmanship. In addition our programs create L.E.A.D.E.R.S!
Leadership, Ethics, Achievement, Development, Encouragement, Respect and Safety. In addition to
our youth sports programs an emphasis on education to include literacy of all kids enrolled,
monitoring their grades to include good conduct and holding them accountable. The above listed
youth sports programs the FWPAL meets daily to include the two boxing gyms (North and East) and
a weekly mentoring program that promotes community involvement and engagement. Furthermore
the FWPAL has created an Outdoor Excursion Program that promotes youth awareness regarding
nature, camping (dormitories) that includes team building, team sports and positive interaction with
documented Mentors.
All of the above programs also have an emphasis on good conduct, law abiding and teaching the
youth of our City to be the best they can be. The Fort Worth Pal is aware that providing children
with the tools they need to develop and building their confidence and allowing them to believe in
themselves they can successfully pursue their dreams.
Currently the FWPAL list of volunteers and coaches (Mentors) for the two boxing gyms (North and
East) who have gone through extensive background checks to include NCIC and TCIC. In addition
these coaches are registered through USA and have met all requirements to include training,
reportable incidents as required by law etc. The FWPAL believe since there is youth involvement
the safety of the youth is our #1 priority. The breakdown for the Coaching Staff is as follows and
their responsibilities:
NORTH FWPAL Head Coach Joe Guzman, Assist Coaches Sgt. Joseph Maldonado (Board Member
and North Pal Facilitator), Cruz Rodriguez. All staff is responsible for overseeing the youth
development in the sport of boxing to include boxing techniques, physical conditioning to include
cardiovascular, repetitions etc. All coaches are registered with USA Boxing.
EAST FWPAL Head Coach Kendrick Releford, assistant Coach Officer Eric Canales (Fort Worth
School Resource Officer that has approximately 10 kids from North Crowley High that he transports
to the gym). Both are FWPAL Board Members and Officer Canales is the East FWPAL Gym
Coordinator.
CHEERLEADING: Under the direction of Taylor Covington this program which has 50 kids
enrolled will be active to include upgrading some required equipment to include tumbling mats, and
other apparatus that can further promote this Cheerleading program. Taylor is responsible for
informing the Board of Directors for FWPAL on progress, recruitment, equipment needs etc.
The above coaches are responsible for weekly and monthly documentation to include attendance,
schedules, events, logistics, and overall development of the programs they oversee as well as the
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 14 of 24
need documentation to the President to ensure compliance.
The above Boxing programs are responsible for development and promotion of the Boxing programs,
recruit inner city kids to prevent crime, promote education and literacy, and overall youth
development as liaisons for the FWPAL. In addition Coaches are responsible for checking report
cards, viewing youth attendance records to ensure truancy is not allowed.
For the 2018 calendar year FWPAL achieved 11 Golden Gloves which is remarkable for the amount
of time some of these boxers have been involved in the sport.
A typical list of activities include at least 5 boxing tournaments to include preparing for Golden
Gloves, Silver Gloves, Nationals, and other USA sanctioned events. The operating hours for the
North FWPAL is 18:00 hours to 20:30 hours Monday through Friday and when preparing for boxing
tournaments Saturdays and Sundays as sparring and developing the youth performance.
FLAG FOOTBALL (includes newly developed Flex Football). Commissioner Patrick Brown who
is responsible for overseeing the development and direction of the FWPAL Flag Football League.
Responsibilities are to recruit youth for the advancement of the Football League, recruit local
coaches, coordinate the referees, oversee all equipment that is ordered to include Jerseys, footballs,
flex helmets etc. with the approval of the FWPAL Board of Directors.
During the 2019 year the FWPAL will continue to promote and grow their sports programs from the
previous years. For 2018 the Flag Football League reached 325 and for 2019 goal will to be reach
500. In addition the FWPAL will create a new Flag Football League by investing in the Flex program
which includes additional safety measures of equipment (helmet and pads) even though it still will
be flag football. This League will be a first in the City of Fort Worth and further demonstrates the
FWPAL level of commitment in leading youth sports for safety.
The scope of work will continue strive to promote the Cheerleading program to include in purchasing
new equipment that will promote safety and wellness. In addition the scope of the work for 2019 for
FWPAL will be to further promote the Code Blue after dark Basketball program to include
sponsoring a tournament to promote youth sports and positive engagement between the Police
Department and the youth of our communities.
Lastly the FWPAL has created a weekly mentorship with the Flag Football Commissioner on
implementing the Cal Ripken Sr, Badges for Baseball to include weekly meetings, taking tours within
Government Facilities, promoting literacy and education. Weekly and monthly training topics will
be covered under the mentoring program to include curriculum to include Healthy Choices that
covers personal responsibility and financial literacy and ways to keep the youth engaged. This
includes having a plan, keeping activities structured, using visual tools and diagrams, providing
feedback, encouraging the youth, setting parameters and sticking to them, assigning groups and
teams, setting and achieving goals to include attendance, allowing the youth to have input, staying
consistent and creating routines. Most importantly will be rewarding all of the youth in all of our
programs through positive reinforcement and encouragement.
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 15 of 24
EXHIBIT B
BUDGET NARRATIVE
FISCAL YEAR 2019
DIRECT PROGRAM COSTS: (70k)
A. Personnel: $3,500 will be allocated to cover the cost of referees for both Flag Football, Flex Football
League and Code Blue Basketball for referees for the league and tournaments promoting the
basketball league.
3500 referees (15 per game * 2 refs)
B. Fringe Benefits: N/A
C. Travel and Training: $15,000 will be allocated to cover the costs of the North and East FWPAL
Boxing gyms for approximately 6 boxing tournaments to include both Golden and Silver Gloves,
National Pal and USA Sponsored Tournaments. In addition a fuel reimbursement for the boxing
coaches for gas reimbursement, meals and if board approved per diem to cover the cost of meals and
lodging for tournaments 2 hours or more away from Fort Worth. In addition this will cover the cost
for advance training for the board of directors for advanced training in the best interest to promote
youth sports approved by the Board of Directors.
15000 break out
-6 trips (3 destination tournaments and 3 local tournaments)
-registration $100 per kid
-3 coaches per trip/ 10 kids per trip
D. Equipment: $29,500 where the majority of the 2019 CCPD Budget is to cover the costs of fully
equipping the North FWPAL Boxing gym, $6500 for an approved boxing ring, equipping the gym
with speed bags, body bags, mats etc. Both East and North PAL Gyms will each receive 3 treadmills,
3 elliptical' s, 3 sit up benches to increase cardio and muscular development. The Flex Flag Football
League will have 4 six grade teams with 12 players and each teams will cost $1200 to equip. The total
for the Flex League will be $4800 for equipment.
7500 Ring
4800 —Helmets and shoulder pads
1200 Flag Football- flags footballs, coolers
17000- treadmills (3), elliptical (3), weights, benches (3)
E. Supplies: $9,000 will cover the costs to include certificates, plaques, banners, etc. For Code Blue
Basketball 200 youth in a league and costs for jerseys will be 15 dollar each.
3000 Jerseys
6000 —awards, plaques, certificates- "promotional"
F. Contracts/Consultants: $3,000 has been allocated for the outdoor excursion. Approximately 30 of
the FWPAL will be transported to Camp David (18 acre property with boys and girls dormitories) for
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 16 of 24
youth awareness for nature, team building, team sports etc.
$3000 outdoor excursion $100 X 30 kids
G. Other Approved: $10,000 to pay an occupancy fee for the East FWPAL gym. During the summer
months this equates to approximately $500 a month. Since the North FWPAL will be covering the
same costs, l0k would cover both gyms for the 12 month period. Any money that is not used in this
will be voted and used for equipment or the youth programs.
INDIRECT COSTS (10% maximum) (5k)
A. Personnel:
B. Fringe Benefits: N/A
C. Travel and Training: N/A
D. Equipment: N/A
E. Supplies: N/A cleaning supplies
F. Contract/Consultants: $5,000 has been allocated for the insurance to cover youth participating in
sports.
G. Other Approved: N/A
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 17 of 24
Exhibit B
Budget Summary
Fiscal Year 2019
DIRECT PROGRAM COSTS (90% Minimum) Total $70,000.00
A. PERSONNEL
Referees for multiple sports.
PERSONNEL TOTAL:
$3,500.00
B. FRINGE BENEFITS
Monthly rent for two gyms.
FRINGE BENEFITS TOTAL
$0.00—
C. TRAVEL AND TRAINING
Tournament travel.
TRAVEL AND TRAINING TOTAL
$15,000.00
D. EQUIPMENT
Several equipment items needed throughout each location.
EQUIPMENT TOTAL $29,500.00
E. SUPPLIES
Certificates, plaques, banners, cleaning supplies, etc.
SUPPLIES TOTAL
$9,000.00
F. CONTRACTS/CONSULTANTS
Expenses for outdoor excursion at Camp David.
CONTRACTS/CONSULTANTS TOTAL
$3,000.00
G. OTHER APPROVED
Occupancy rent for both East and North gyms.
OTHER APPROVED TOTAL
$101000.00
INDIRECT PROGRAM COSTS (10% Maximum) Total $5,000.00
A. PERSONNEL
PERSONNEL TOTAL:
$0.00
B. FRINGE BENEFITS
None
FRINGE BENEFITS TOTAL
$0.00-
C. TRAVELAND TRAINING
None
TRAVEL AND TRAINING TOTAL
$0.00
D. EQUIPMENT
None
EQUIPMENT TOTAL $0.00
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY19 Page 18 of 24
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 19 of 24
E. SUPPLIES
None
SUPPLIES TOTAL
$0.00
F. CONTRACTS/CONSULTANTS
None
CONTRACTS/CONSULTANTS TOTAL
$5,000.00
Contractors used for all sports throughout the year.
G. OTHER APPROVED
None
OTHER APPROVED TOTAL
GRAND TOTAL
$75,000.00
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 19 of 24
FORT WORTH,
Exhibit C
i'...,-
Request for Reimbursement (RF32)
DIRECT COSTS (90% Minimum)
B C D
Fiscal Year 2019
CRIME COMROI
Budget Category
AND PREMNTION DISTRICT
Total of Previous B
Reimbursements This Month's Total Requested
Requested Request To -Date
Submit To:
Submitting Agency: FW PAL
Bob Bolan Public Safety Complex
Contact Name: Officer Allen Speed
Attn: PD Grants Mara trent
ge
Phone Number: 817.944.2725
Financial Management Division
Einai- allenspeed fortworthtexas.ao v
505 West Felix St
$
Fort Worth, TX 76115 i
Remit Address:
Fringe Benefits
Invoice Number:
—__--------
Month of Request:
Supporting documents required with monthly requests.
Summary:
A
A
DIRECT COSTS (90% Minimum)
B C D
E
E
Budget Category
Budget Category
Total of Previous B
Reimbursements This Month's Total Requested
Requested Request To -Date
Budget Amount
Total of Previous This Month's
Reimbursements Request Total Requested
Requested To -Date
Remaining
(A -D)
Balance
Available
A
Personnel
$
3,500.00
$
$
3,500.00
B
Fringe Benefits
$
-
$ -
S
-
C
Travel & Training
$
15,000.00
$ -
$
15,000.00
D
Equipment
$
29,500.00
$ -
$
29¢00.00
E
Supplies
$
9,000:00
$
$
91000.00
F
Contracts/Consultants
$
3,000.00
$
3,000.00
G
Other
$
10,000.00
$
10,000.00
Total Direct Costs
$
70,000.00 $
$ $
S
70,000.00
Supporting documents required with monthly requests.
Summary:
A
INDIRECT COSTS (10% Maximum)
B C D
copy ofpaychecics, invoices and receipts detailing all CCPD
E
fundedespenditures.
Budget Category
Budget Amount
Total of Previous B
Reimbursements This Month's Total Requested
Requested Request To -Date
Remaining
(A -D)
Balance
Available
A
Personnel
$ _
$
_
B
Fringe Benefits
$ _
$
_
C
Travel & Training
$ -
$
_
D
Equipment
$ -
S
-
E
Supplies
S -
S
F
Contracts/Consultants
$ 5,000.00
$ -
$
5,000.00
G
Other
S
Total lnDirectCosts
Is 5,000.00 $
1 $ $
S
5,000.00
Supporting documents required with monthly requests.
Summary:
This includes, timesheets depicting CCPD funded activities,
Total Budget: S 75,000.00
copy ofpaychecics, invoices and receipts detailing all CCPD
Previous Requests: $
fundedespenditures.
This Request: S
Total Requested To -Date $
Remaining Funds' S 75,000.00
I have reviewed this request and certify that these listed expenses and support documentation are accurate
Authorized Signatory
Fiscal Agent Use Only
Purchase Order#
Fund
Dept ID
Account
RFR Approved For Payment
Gant Staff Signature Date
Finance Received Stamp Placed Below
CFW aW2bQ 't 'NF"ICE ATHLETIC LEAGUE FYI
— . Inge 20 oT24 -
FORT WORTH
CRWE CwrMM
& PREvvmm Dismcr
Exhibit D
Fiscal Year 2019
Monthly Program Activities Report
Current Reporting Month
Activity
Submitting Agency
Fort Worth Police Athletic League (FWPAL)
Contact Name
Officer Allen Speed
Phone Number and Email
817-944-2725 Allen.speed@fortworthtexas.gov
Remit Address
817-944-2725 AIIen.Speed@fortworthtexas.gov
I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the CCPD goals
set forth in the contract.
Authorized Signatory Signatory Title Date
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY 19 Page 21 of 24
Activity
Current To Date ' Year
Month Total End
Total Goal
1
Unduplicated number of students participating in the FWPAL programs.
615
2
Number of volunteer recruiting and community support contacts made
100
to new stakeholders.
307.5
3
50% of youth participating in FWPAL programs will complete the
pre/post safety surveys administered.
4
80% of youth participating in the FWPAL program will provide report
492
cards in order to prove academic and truancy compliance throughout
the school year.
5
40% of participants will attend at least one community service events
246
offered.
6
Number of participants that will have a 70% attendance record
450
throughout all FWPAL programs.
7
I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the CCPD goals
set forth in the contract.
Authorized Signatory Signatory Title Date
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY 19 Page 21 of 24
FORT WORTH
CRIME CONTROL
PREVEKnoN DIsmcr
Exhibit E
Fiscal Year 2019
Quarterly Program Effectiveness Measurement Report
Current Reporting Quarter
Effectiveness Measures and Quarterly Outcomes
Submitting Agency
Fort Worth Police Athletic League (FWPAL)
Contact Name
Allen Speed
Phone Number and Email
817-944-2725 AIIen.Speed@fortworthtexas.gov
Remit Address
505 W. Felix Street
Fort Worth Texas 76106
PIease include outcome narrative that describes how measure was accomplished for each quarter.
I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the
CCPD goals set forth in the contract.
Authorized Signatory Signatory Title Date
Report due each quarter: 1St Quarter (Oct -Dec) due January 15 2nd Quarter (Jan -Mar) due April 15
3 d Quarter (Apr -June) due July 15 41h Quarter (Jul -Sep) due October 15
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY 19 Page 22 of 24
Effectiveness Measures and Quarterly Outcomes
Measure 1
FWPAL will report 11,920 Volunteer hours for all programs.
Outcome
Measure 2
FWPAL will recruit 25 of new volunteers or community support stakeholders.
Outcome
Measure 3
70% of program participants will report an improvement in grade cards.
Outcome
Measure 4
80% of program participants will report they "feel safer" as measured by the pre/post surveys.
Outcome
I have reviewed this report and certify that the measures provided are accurate and appropriately reflect the
CCPD goals set forth in the contract.
Authorized Signatory Signatory Title Date
Report due each quarter: 1St Quarter (Oct -Dec) due January 15 2nd Quarter (Jan -Mar) due April 15
3 d Quarter (Apr -June) due July 15 41h Quarter (Jul -Sep) due October 15
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FY 19 Page 22 of 24
ORT WORT
Claw count
Pnav[mr*o Dmnu
• Up to 5% of any budgeted line -item does not need prior approval but form must be sent to City with monthly RFR
• More than 5% of any budgeted line -item must have prior City approval
• An increase in a zero line -item must have prior City approval
• Modifications cannot be made between Direct and Indirect costs
Exhibit F
Request for Budget Modification
Fiscal Year 2019
Date
DIRECT COSTS (90% minimum)
Submitting Agency
Fort Worth Police Athletic League (FWPAL)
Contact Name
Officer Allen Speed
Phone Number and Email
817.944.2725 AIIen.Speed@fortworthtexas.gov
Remit Address
$15,000.00
INDIRECT COSTS (10•A maximum)
Budget Category Approved Budget Change Requested Revised Budget
Personnel
Fringe Benefits
Travel and Training
Equipment
Supplies
Contracts/Consultants $5,000.00
Other Approved
Total Indirect Costs
Modification Narrative (describe in detail what change is for)
I have reviewed this request and certify that the listed modifications are correct.
Authorized Signatory
Modification Approved
FWPD Staff Signature
Signatory Title
FWPD STAFF USE ONLY
Date
0 Modification NOT Approved
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 23 of 24
Date
DIRECT COSTS (90% minimum)
Budget Category
Approved Budget Change Requested Revised Budget
Personnel
$3,500.00
Fringe Benefits
Travel and Training
$15,000.00
Equipment
$29,500.00
Supplies
$9,000.00
Contracts/Consultants
$3,000.00
Other Approved
$10,000.00
Total Direct Costs
$70,000.00
INDIRECT COSTS (10•A maximum)
Budget Category Approved Budget Change Requested Revised Budget
Personnel
Fringe Benefits
Travel and Training
Equipment
Supplies
Contracts/Consultants $5,000.00
Other Approved
Total Indirect Costs
Modification Narrative (describe in detail what change is for)
I have reviewed this request and certify that the listed modifications are correct.
Authorized Signatory
Modification Approved
FWPD Staff Signature
Signatory Title
FWPD STAFF USE ONLY
Date
0 Modification NOT Approved
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 23 of 24
Date
FORT ORTM
CRIMCONt>ROL _
AND PMM4TION DLSTPJCT
Exhibit G
Disbursement Schedule Form
Fiscal Year 2019
Submit To:
Bob Bolan Public Safety
Complex
Attn: Alma Ibarra
Contract Compliance Specialist
Financial Management Division
505 West Felix St.
Fort Worth, TX 76115
Monthly Spending Schedule
Fort Worth Police Athletic
Submitting Agency
League (FWPAL)
Contact Name:
Officer Allen Speed
Phone Number:
817.944.2725
Email:
alien. s peed(dfortworthtexas. gov
Remit Address:
Invoice Number:
December
Month of Request:
13,000.00
Monthly Spending Schedule
Actual Disbursed Expenses Reported
Percentage
Spent
October
$
13,000.00
November
$
13,000.00
December
$
13,000.00
January
$
3,600.00
February
$
3,600.00
March
$
3,600.00
April
$
3,600.00
May
$
3,600.00
June
$
3,600.00
July
$
3,600.00
August
$
3,600.00
September
$
3,600.00
October
$
3,600,00
Total
$
75,000.00
I have reviewed this request and certify that these listed expenses and support documentation are accurate.
Authorized Signatory Signatory Title Date
Fiscal Aggent Use Only
Purchase Order # Fund Dept ID Account
RFR Approved For Payment
Gaunt Staff Signature Date
FY 2019 CFW CCPD Program
CFW and FORT WORTH POLICE ATHLETIC LEAGUE FYI Page 24 of 24
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
loll
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
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2018-402107
Fort Worth Police Atiletic League
Fort Worth, TX United States
Date Filed:
09/10/2018
2 Name of governmental entity or state agency that Is a party to the contract for which the form is
being filed.
Fort Worth Police Department
Date AcknI I L o edg d
1
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.
FY2019 CCPD Program
Fort Worth Police Athletic League is a 501c3 Nonprofit that has a mission to unite the communities of Fort Worth with its Police
Department. Mentorship of Boxing, Flag Football, basketball etc.
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
Fort Worth Police Athletic League
Fort Worth, TX United States
X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARA'nON
j
My name is �' 4 r=h f-1 1 �J .1 S_ CID and my date of birth is �
My address is _ J J �%r }' f / i 7C ��r r 7wir •
(street) (city) (state) (Ap code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
I� e--
Executed
'Executed in r�+i�-� County, State of S on the JQ!day of 20 .
(month) (year)
Signature of authorized agent O—fcorActing business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711