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HomeMy WebLinkAboutContract 48725-FP2 City Secretary 48725 -FP2 FORTWORTH, ontract No. Date Received Feb 8,2019 CITY�FOIA ApY CITY SE 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:ANDREWS DISTRIBUTING COMPANY City Project No.: 100615 Improvement Type(s): Water ® Sewer Original Contract Price: $191,747.00 Amount of Approved Change Order(s): $22,990.00 Revised Contract Amount: Total Cost of Work Complete: $214,737.00 �70hI�A,R�P.�%Gff Feb 7,2019 ee.� Contractor Date Project Manager Title Lee Lewis Construction Inc. Company Name Shawn Fano(Feb to 2019) Feb 8,2019 Project Inspector Date Fmd Chia Feb 8 2019 Fred Hhle(Feb a.2019) Pro'ect Manager Date e Scarlett Morales I Feb 1,2019) Feb 8,2019 CFA Manager Date fQ�l�Qh�f Susan A4n1e IFeb S.2M) Feb 8,2019 Asst. City Manager Date OFFICIAL RECORD Page 1 of 2 CITY SECRETARY FT.WORTH,TX Notice of Project Completion Project Name:ANDREWS DISTRIBUTING COMPANY City Project No.: 100615 City's Attachments Final Pay Estimate ❑ Change Order(s): X Yes ❑ N/A Pipe Report: © Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 365 CD Days Charged: 682 Work Start Date: 3/6/2017 Work Complete Date: 1/16/2019 Page 2of2 Sgc�o I- 1 bd(�IS City Project Numbers 100615 DOE Number 0615 Contract Name ANDREWS DISTRIBUTING COMPANY Estimate Number I Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 1/16/2019 Project Funding Project Manager NA City Secretary Contract Number Inspectors DICKINSON / FARGO Contract Date Contractor LEE LEWIS CONSTRUCTION,INC. Contract Time 365 CD 17111 PRESTON ROAD Days Charged to Date 682 CD DALLAS, TX 75379 Contract is .000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Total Cost of Work Completed $214,737.00 Less %Retained $0.00 Net Earned $214,737.00 Earned This Period $214,737.00 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 $214,737.00 Friday,January 25,2019 Page 4 of 4 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name ANDREWS DISTRIBUTING COMPANY Contract Limits i Project Type WATER&SEWER City Project Numbers 100615 p DOE Number 0615 Estimate Number 1 Payment Number 1 For Period Ending 1/16/2019 I. CD i City Secretary Contract Number Contract Time 36ED Contract Date Days Charged to Date 682 Project Manager NA Contract is 100.00 Complete I Contractor LEE LEWIS CONSTRUCTION,INC. 17111 PRESTON ROAD 1 I DALLAS, TX 75379 Inspectors DICKINSON / FARGO jI I I i I Friday,January 25,2019 Page I of 4 I 11 N City Project Numbers 100615 DOE Number 0615 Contract Name ANDREWS DISTRIBUTING COMPANY Estimate Number I Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 1/16/2019 Project Funding WATER Item Description of Items Estimated Estimated Completed Completed No. Unit Unit Cost P P Quanity Total Quanity Total --------------------------------------- I --------------------- 1 REMOVE 12"WATER LINE 904 LF $20.00 $18,080.00 904 $18,080.00 2 12"WATERLINE LOWERING 1 EA $5,000.00 $5,000.00 1 $5,000.00 3 6"WATER PIPE 93 LF $44.00 $4,092.00 93 $4,092.00 4 8"WATER PIPE 50 LF $35.00 $1,750.00 50 $1,750.00 5 FIRE HYDRANT 5 EA $4,500.00 $22,500.00 5 $22,500.00 6 CONNECTION TO EXISTING 4"-12"WATER 4 EA $4,000.00 $16,000.00 4 $16,000.00 MAIN 7 2"WATER SERVICE 3 EA $4,400.00 $13,200.00 3 $13,200.00 8 6"GATE VALVE 4 EA $900.00 $3,600.00 4 $3,600.00 9 8"GATE VALVE 3 EA $1,200.00 $3,600.00 3 $3,600.00 10 12"GATE VALVE 4 EA $2,100.00 $8,400.00 4 $8,400.00 11 12"X6"TAPPING SLEEVE&VALVE 2 EA $5,000.00 $10,000.00 2 $10,000.00 I2 12"X8"TAPPING SLEEVE&VALVE 2 EA $6,100.00 $12,200.00 2 $12,200.00 13 1"PRIVATE WATER SERVICE(CO#1) 1 EA $1,950.00 $1,950.00 1 $1,950.00 -------------------------------------- Sub-Total of Previous Unit $120,372.00 $120,372.00 SEWER Item Description of Items Estimated Estimated Completed Completed No.NP Unit Unit Cost P P —o.—— Quanity Total Quanity Total ----------------------------------- I REMOVE 10"SEWER LINE 82 LF $20.00 $1,640.00 82 $1,640.00 2 CONCRETE ENCASE SEWER PIPE(CO#1) 25.5 CY $250.00 $6,375.00 25.5 $6,375.00 3 MANHOLE VACUUM TESTING(CO#1) 5 EA $950.00 $4,750.00 5 $4,750.00 4 CONCRETE COLLAR(CO#1) 4 EA $2,750.00 $11,000.00 4 $11,000.00 5 8"SEWER SERVICE 1 EA $3,500.00 $3,500.00 1 $3,500.00 6 8"2-WAY CLEANOUT 1 EA $2,500.00 $2,500.00 1 $2,500.00 7 8"SEWER PIPE(CO#1) 592 LF $45.00 $26,640.00 592 $26,640.00 8 10"DIP SEWER 82 LF $105.00 $8,610.00 82 $8,610.00 9 4'MANHOLE(CO#1) 4 EA $4,750.00 $19,000.00 4 $19,000.00 10 4'EXTRA DEPTH MANHOLE,(CO#1) 38 VF $200.00 $7,600.00 38 $7,600.00 11 10"SEWER PIPE(CO#1) 55 LF $50.00 $2,750.00 55 $2,750.00 -------------------------------------- Sub-Total of Previous Unit $94,365.00 $94,365.00 -------------------------------------- Friday,January 25,2019 Page 2 of 4 City Project Numbers 100615 DOE Number 0615 Contract Name ANDREWS DISTRIBUTING COMPANY Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 1/16/2019 Project Funding Contract Information Summary Original Contract Amount $191,747.00 Change Orders Change Order Number 1 $22,990.00 Total Contract Price $214,737.00 Total Cost of Work Completed $214,737.00 Less %Retained $0.00 Net Earned $214,737.00 Earned This Period $214,737.00 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 $214,737.00 Friday,January 25,2019 Page 3 of 4 _+ � G G Q 2 2 3 m # 0 o_ 0 0 -v ) g @ § / / 0 % m 2 / ) > z § } ; } -on / --I \ \ §§ ^ q q ® $ © / \ M Cl) (n « ; o ; ; y ® 0 � $ / o z § ƒk [ k 7 / G § \ 2 0 § § G _/ ;2 / ? ` ° > § § / § 2 § o ! m i ) ( � \ 0 § _ 2 ° 2 m . o - eo [ / m ƒ G m / ± \ + 2 f 7 $ ao) ® & m k \ (� w CD - �� ( � C) 8 - \ i e ( . 0 2/ \ \_ w t m . 33 � C) � ( k ` _ ° ° m 2 # q e e \ § o $ . _ > ƒ2 § m \ # ° ° 7 7G /f \ 0 C- 00 m ;\ n \ \ n � , \ / > / ƒ � q /\ \ 7 { \ \ / 2 kG - > \ o ° g k y 7 k ^ � 2/ 2 ° em £ 2 �0 ( � ) { n 5 � } } § \ �\ � 0 � ( t o o � � N 'fl CI OO M ➢ 0 Z " m m G) at m m o ro o a m s il 7077 a � n v m v — — — -- Lnp to O 3n w mm ca (n o •-� mS �j 3 �,T De rt� rl mmrnmm2 rn aa0 a Z � ro m r- m zta a� n 1 Z a p , D '0 O w _q x o g ,ME a o g q C C O I o —ro � T rn, 9�Q oro Zz 03 o y 0 N D UJ n !O j •A t0�p j C O !IN�, �T1 Q O Ci O� O 000-.00 a mCD m c�o C a m " p 2 mm r a' m anecr v < O c `�. o' C3m ° to 0 I m o G'n ? aT S -00 a N o ;u N ,o 1 W w m m m n d o 1 + v o � 1 y O Z I O o �. z W T x m 3 v m m n f c O o D w N v b. 7 N' m w m 3 m a 2 ; o D N — Z � C 2 V w ti i O p O G O O C O O P O(17 a 4- N N N N In A N -4 P1 m il "' q 0 0 p9 o O m O D 0 0 0 g O g q o0 0 N 0 I FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Andrews Distributing PROJECT NUMBER: 100615 DOE NUMBER: NA WATER PIPE LAID SIZE TYPE OF PIPE LF North American 12" c-900 pvc 907' North American 8" c-900 pvc 50' North American 6" c-900 pvc 93' FIRE HYDRANTS: 5 VALVES(16"OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF n/a 12" pvc 904' DENSITIES: NEW SERVICES: 3-2" copper 82' copper 5' SEWER PIPE LAID SIZE TYPE OF PIPE LF DIAMOND 8" SDR-26 PVC 592' AMERICAN 10" D.I. 82' PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 8" PVC 20' TRANSPORTATION AND PUBLIC WORKS 7 The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 _R; ­ `)',AIADocument G706tM - 1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: Andrews Distributing ARCHITECT:❑ 500 Northeast Loop 820 CONTRACT FOR: CONTRACTOR:Q Ft. Worth,TX 76106 SURETY:❑ TO OWNER:(Name and address) CONTRACT DATED:August 31,2016 OTHER:❑ Andrews Distribution Company of North Texas,LLC 2730 Irving Blvd. Dallas,TX 75207 STATE OF: Texas COUNTY OF: Dallas The undersigned hereby certifies that,except as listed below,payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment furnished,for all work,labor,and services performed,and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Conti-act referenced above for which the Owner or Owner's property might in any way be held responsible or encumbered. EXCEPTIONS: SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1. Consent of Surety to Final Payment. Whenever Lee Lewis Construction,Inc. Surety is involved,Consent of Surety is 17177 Preston Rd.,Ste. 160 required. AIA Document G707,Consent of Surety,may be used for this purpose Indicate Attachment ❑ Yes ® No — RN. The following supporting documents should be attached rrtrrrc. of uuthrj,i_ecl representative) hereto ifrequired by the Owner: 1. Contractor's Release or Waiver of Liens, (Printed name and title) conditional upon receipt of final payment. 2. Separate Releases or Waivers of Liens from Subscribed and sworn to before me on this date: Subcontractors and material and equipment suppliers, to the extent required by the Owner, accompanied by a list thereof. .�''Rva'r SHARON STORY Notary Public. IT, rublic,State of Texas 3. Contractor's Affidavit of Release of Liens(AIA My Commission Expi �310ompf�. Exoires 08-15 2021 Document G706A). '�,IO M,r�` Mary ID 4180549 AIA Document G706T"—1994.Copyright®1970 and 1994 by The American Institute of Architects.All rights reserved.WARNING:This AIA' Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA"Document,or any portion of it, may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 14:19:20 ET on 01/30/2019 under Order No 3780910300 which expires on 04/25/2019,and is not for resale User Notes: (3B9ADA53) CITY OF FORT WORTH, TEXAS STREET AND STORM DRAIN CONTRACTORS BOND Bond No. SG 0087 THE STATE OF TEXAS ) KNOW ALL MEN BY THESE PRESENTS: COUNTY OF TARRANT ) That We Mario Sinacola & Sons Excavating, Inc. , As, principal, and Travelers Casualty & Surety Company of America , As surety, are held and firmly bound unto the City of Fort Worth, Texas, in the penal sum of twenty-five thousand Dollars ($25,000.00) good and lawful money of the United States of America, well and truly to be paid for the payment of which we, and each of us, hereby bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT WHEREAS, the above principal desires to engage in the business of laying, constructing, building, repairing, rebuilding, grading, graveling, paving, surfacing, resurfacing and doing work in and upon the public streets, alley or thoroughfares within the corporate limits of the City of Fort Worth and has complied with all the terms and conditions of ordinance No. 3449 of the City of Fort Worth, Texas, and has applied to the Director of Transportation and Public Works as provided in said ordinance NOW, THEREFORE, if said principal shall fully indemnify and save whole and harmless the said City of Fort Worth, its agents and employees, as well as indemnify and save harmless any person, firm or corporation with whom the Principal has contracted, from any and all damages of any character arising from or caused directly or indirectly by any negligence in the performance of such work as above set forth under the terms of said ordinance and said license or for any imperfect or inadequate work done by said principal under the terms of said ordinance and said license, and shall maintain said work in good and workmanlike state of repair for a period of two (2) years from and after its completion and acceptance by the City of Fort Worth, then this obligation shall be null and void, otherwise to remain in full force and effect: provided, however, this bond is executed by the surety on the condition that its liability shall be limited by and subject to the conditions and provisions hereinunder contained: Successive actions may be brought on this bond for successive breaches of its conditions or any of them; provided, however, that the total sum of all liability of the surety on any one or all of such actions shall not exceed a total sum of Twenty-five Thousand Dollars ($25,000.00). The liability of the Surety under this bond, if not canceled as hereinafter provided, shall cease and terminate of its own force and effect one year from the date hereon, saving and excepting for the maintenance of the work performed previous to the date of termination, for which work the liability of the Surety for maintenance shall continue for two years from and after the date of the completion and acceptance of said work by the City, but no longer. The Surety may terminate its liability under this bond at any time by giving the City Council of the City of Fort Worth, Texas, five (5) days notice in writing of the Surety's intention to do so, and from and after said date the Surety will no longer be liable for any subsequent act, save and except as to maintenance as herein above provided. IN WITNESS WHEREOF, the said Principal and the said Surety have set their hand and seal this the loth day of November 20 18 Mario Si o & Sons Ex avating, Inc Michae Sinacola - ViBEin$ ident Travelers Casualty ?, Surety Company of America /Surety Att rney-in-Fact Kathleen M. McCann 7 Travelers Casualty and Surety Company of America TRAI�ELERS Travelers Casualty and Surety Company St.Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St. Paul Fire and Marine Insurance Company are corporations duty organized under the laws of the State of Connecticut (herein collectively called the "Companies"),and that the Companies do hereby make,constitute and appoint Kathleen M.McCann of BINGHAM FARMS Michigan ,their true and lawful Attomey-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory In the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this Instrument to be signed,and their corporate seals to be hereto affixed,this 3rd day of February, 2017. Jqtwwpor;AX COre. i OL 1iR • T fs` State of Connecticut By: City of Hartford ss. Robert L Raney,Sehfor Voce President On this the 3rd day of February,2017,before me personally appeared Robert L Raney,who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St.Paul Fire and Marine Insurance Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official seal. T My Commission expires the 30th day of June,2021 w t�# Mane C.Telreault,Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Comparry of America,Travelers Casualty and Surety Company,and St.Paul Fire and Marine Insurance Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President.any Second Vice President,the Treasurer.any Assistant Treasurer,the Corporate Secretary or ary Assistant Secretary may appoint Attorneys-in-Fact and Agents to ad for and on(behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Comparyrs name and seal with the Companys seal bonds,recognizances,contracts of Indemnity,and other wrrti Vs obligatory In the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her,and It Is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer, arty Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,If required)by one or more Attorneys-In-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority,and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsknile to any Power of Attomey or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attomeysan-Fad for purposes only of executing and attesting bonds and undertakings and other writings obligatory In the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shag be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. 1, Kevin E. Hughes, the undersigned. Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company,and St.Paul Fire and Marine insurance Company.do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which remains in full force and effect. Dated this 20th f� day of November ,2018 ff �.1a s11�ARp 4 coal. Q •�� �� ///� V Kevin E.Hughes,Asst tant Secretary To verify the autheo6cily of tf#&PbwerofA[Gvrney,please cal/us atl-8A0425 38M Pfease refer to bre above-named AtWmey-ln-Fact and the details of the bond to which the power/s attadied. CITY OF FORT WORTH, TEXAS STREET AND STORM DRAIN CONTRACTORS BOND Bond No. SG 0087 THE STATE OF TEXAS ) KNOW ALL MEN BY THESE PRESENTS: COUNTY OF TARRANT That We Mario Sinacola & Sons Excavating, Inc. As, principal, and Travelers Casualty & Surety Company of America , As surety, are held and firmly bound unto the City of Fort Worth, Texas, in the penal sum of twenty-five thousand Dollars ($25,000.00) good and lawful money of the United States of America, well and truly to be paid for the payment of which we, and each of us, hereby bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT WHEREAS, the above principal desires to engage in the business of laying, constructing, building, repairing, rebuilding, grading, graveling, paving, surfacing, resurfacing and doing work in and upon the public streets, alley or thoroughfares within the corporate limits of the City of Fort Worth and has complied with all the terms and conditions of ordinance No. 3449 of the City of Fort Worth, Texas, and has applied to the Director of Transportation and Public Works as provided in said ordinance NOW, THEREFORE, if said principal shall fully indemnify and save whole and harmless the said City of Fort Worth, its agents and employees, as well as indemnify and save harmless any person, firm or corporation with whom the Principal has contracted, from any and all damages of any character arising from or caused directly or indirectly by any negligence in the performance of such work as above set forth under the terms of said ordinance and said license or for any imperfect or inadequate work done by said principal under the terms of said ordinance and said license, and shall maintain said work in good and workmanlike state of repair for a period of two (2) years from and after its completion and acceptance by the City of Fort Worth, then this obligation shall be null and void, otherwise to remain in full force and effect: provided, however, this bond is executed by the surety on the condition that its liability shall be limited by and subject to the conditions and provisions hereinunder contained: Successive actions may be brought on this bond for successive breaches of its conditions or any of them; provided, however, that the total sum of all liability of the surety on any one or all of such actions shall not exceed a total sum of Twenty-five Thousand Dollars ($25,000.00). The liability of the Surety under this bond, if not canceled as hereinafter provided, shall cease and terminate of its own force and effect one year from the date hereon, saving and excepting for the maintenance of the work performed previous to the date of termination, for which work the liability of the Surety for maintenance shall continue for two years from and after the date of the completion and acceptance of said work by the City, but no longer. The Surety may terminate its liability under this bond at any time by giving the City Council of the City of Fort Worth, Texas, five (5) days notice in writing of the Surety's intention to do so, and from and after said date the Surety will no longer be liable for any subsequent act, save and except as to maintenance as herein above provided. IN WITNESS WHEREOF, the said Principal and the said Surety have set their hand and seal this the ?oth day of November 20 18 Mario Si o & Sons Ex avating, Inc Michae Sinacola — vi&;inpkp@hident Travelers Casualty & Surety Carpany of America urety Attmey-in-Fact Kathleen M. McCarin r Travelers Casualty and Surety Company of America Travelers Casualty and Surety Company TRAVELERS J St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That Travelers Casually and Surety Company of America,Travelers Casualty and Surety Company,and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies'),and that the Companies do hereby make,constitute and appoint Kathleen M.McCann of BINGHAM FARMS Michigan , their true and lawful Attomey-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted In any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed,and their corporate seals to be hereto affixed,this 3rd day of February, 2017. ,A er State of Connecticut By: City of Hartford ss. Robert L.Raney,Sehl-or Vice President On this the 3rd day of February,2017,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and Sl.Paul Fire and Marine Insurance Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official seal My Commission expires the 30th day of June,2021 c Mane C.C.Tetreault,Notary Pubtic This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St.Paul Fire and Marine Insurance Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to ad for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her,and it is FURTHER RESOLVED,that the Chairman,the President,any,Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed In the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond, recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duty attested and sealed with the Company s seal by a Secretary or Assistant Secretary:or(b)duly executed(under seal,if required)by one or more Attomeys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority:and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attomeys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. 1, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America. Travelers Casualty and Surety Company.and St.Paul Fire and Marine Insurance Company.do hereby certify that the above and foregoing is a true and torted copy of the Power of Attorney executed by said Companies,which remains in full force and effect. Dated this 20th y� day of November x,/2018 1 Kevin E.Hughes,Asst Cant Secretary To verffy the authendd*of this power ofAttorney please-/l as at 1-800-421 3880. Please refer to the above-named Attorney-in-Fad and Me details of the bond to whidr the power is attached. Texas Department of Transportation Permit Completion of work I Bill Boothe, Texas Department of Transportation Permit Chief Inspector have verified the completion of work for the below mentioned permit. Permit#: 10-DCC-33-17 Location: IH 820 @ Railhead Andrews Distribution Bill Boothe Texas Department of Transportation Permit Chief Inspector North Tarrant Area Office 817-291-6413 Bill.Boothe@Txdot.gov MR-, Document G706 — 1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER: Andrews Distributing ARCHITECT:❑ 500 Northeast Loop 820 CONTRACT FOR: CONTRACTOR:E] Ft. Worth,TX 76106 SURETY:❑ TO OWNER:(Name and address) CONTRACT DATED: August 31,2016 OTHER:❑ Andrews Distribution Company of North Texas,LLC 2730 Irving Blvd. Dallas,TX 75207 STATE OF: Texas COUNTY OF: Dallas The undersigned hereby certifies that,except as listed below,payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment furnished,for all work,labor,and services performed,and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract referenced above for which the Owner or Owner's property might in any way be held responsible or encumbered. EXCEPTIONS: SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1. Consent of Surety to Final Payment. Whenever Lee Lewis Construction,Inc. Surety is involved,Consent of Surety is 17177 Preston Rd.,Ste. 160 required. AIA Document G707,Consent of Surety,may be used for this purpose Indicate Attachment ❑ Yes ® No — 131 . The following supporting documents should be attached muri- of waho,i:ed representative) hereto ifrequired by the Owner: _ /� ,,� �j CG,) 0 f"r �Ch=- !(h�eL�-I"t'�hEtPtl2 1. Conti-actor's Release or Waiver of Liens, (Printed name and title) conditional upon receipt of final payment. 2. Separate Releases or Waivers of Liens from Subscribed and sworn to before me on this date: Subcontractors and material and equipment suppliers,to the extent required by the Owner, — —— accompanied by a list thereof. A-20.- SHARON STORY Notary Public. 11- 6 t FuLlic,State of Texas 3. Conti-actor's Affidavit of Release of Liens(AIA My Commission Expi SwCom Expires 08 15-2021 Document G706A). '!�;OF tart' ID 4160549 AIA Document G706-—1994.Copyright m 1970 and 1994 by The American Institute of Architects.All rights reserved.WARNING:This AIA" Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA"Document,or any portion of it, may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 14:19:20 ET on 01/30/2019 under Order No 3790910300 which expires on 04/25/2019,and is not for resale User Notes: (3B9ADA53) CITY OF FORT WORTH, TEXAS STREET AND STORM DRAIN CONTRACTORS BOND Bond No. SG 0087 THE STATE OF TEXAS ) KNOW ALL MEN BY THESE PRESENTS: COUNTY OF TARRANT ) That We Mario Sinacola & Sons Excavating, Inc. As, principal, and Travelers Casualty & Surety Company of America As surety, are held and firmly bound unto the City of Fort Worth, Texas, in the penal sum of twenty-five thousand Dollars ($25,000.00) good and lawful money of the United States of America, well and truly to be paid for the payment of which we, and each of us, hereby bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT WHEREAS, the above principal desires to engage in the business of laying, constructing, building, repairing, rebuilding, grading, graveling, paving, surfacing, resurfacing and doing work in and upon the public streets, alley or thoroughfares within the corporate limits of the City of Fort Worth and has complied with all the terms and conditions of ordinance No. 3449 of the City j of Fort Worth, Texas, and has applied to the Director of Transportation and Public Works as provided in said ordinance NOW, THEREFORE, if said principal shall fully indemnify and save whole and harmless the said City of Fort Worth, its agents and employees, as well as indemnify and save harmless any person, firm or corporation with whom the Principal has contracted, from any and all damages of any character arising from or caused directly or indirectly by any negligence in the performance of such work as above set forth under the terms of said ordinance and said license or for any imperfect or inadequate work done by said principal under the terms of said ordinance and said license, and shall maintain said work in good and workmanlike state of repair for a period of two (2) years from and after its completion and acceptance by the City of Fort Worth, then this obligation shall be null and void, otherwise to remain in full force and effect: provided, however, this bond is executed by the surety on the condition that its liability shall be limited by and subject to the conditions and provisions hereinunder contained: Successive actions may be brought on this bond for successive breaches of its conditions or any of them; provided, however, that the total sum of all liability of the surety on any one or all of such actions shall not exceed a total sum of Twenty-five Thousand Dollars ($25,000.00). The liability of the Surety under this bond, if not canceled as hereinafter provided, shall cease and terminate of its own force and effect one year from the date hereon, saving and excepting for the maintenance of the work performed previous to the date of termination, for which work the liability of the Surety for maintenance shall continue for two years from and after the date of the completion and acceptance of said work by the City, but no longer. The Surety may terminate its liability under this bond at any time by giving the City Council of the City of Fort Worth, Texas, five (5) days notice in writing of the Surety's intention to do so, and from and after said date the Surety will no longer be liable for any subsequent act, save and except as to maintenance as herein above provided. IN WITNESS WHEREOF, the said Principal and the said Surety have set their hand and seal this the 2Qth day of November 20 18 a o & Sons Ex avating, Inc Sinacola - vj&inpipahident Travelers Casualty_& Surety Campany of America Surety L`L, Att rney-in-Fact Kathleen M. McCann R Travelers Casualty and Surety Company of(America 5. Travelers Casualty and Surety Company TRAVELERS i St.Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the Companies'),and that the Companies do hereby make,constitute and appoint Kathleen M.McCann of BINGHAM FARMS Michigan ,their true and lawful Attomey-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances. conditional undertakings and other writings obligatory In the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this Instrument to be signed,and their corporate seals to be hereto affixed,this 3rd day of February, 2017. y� a L Stale of Connecticut City of Hartford ss. Robert L Raney.Sehror Vice President On this the 3rd day of February,2017,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St.Paul Fire and Marine Insurance Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,1 hereunto set my hand and official seal. Q My Commission expires the 30th day of June,2021 0' tt t i Mane C.Tetreault,Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Comparry of America,Travelers Casualty and Surety Company,and St.Paul Fire and Marine Insurance Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of autliority may prescribe to sign with the Companys name and seal with the Company's seal bonds,reoogrdzances,contracts of Indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her,and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman, ary Executive Vice President,any Senior Vice President or any Vice President may delegate all or any pan of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation Is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Comparry when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President, any Second Vice President,the Treasurer, any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-In-Fact and Agents pursuant to the power prescribed In his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fad for purposes only of executing and attesting bonds and undertakings and other writings obligatory In the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company In the future with respect to any bond or understanding to which it is attached. 1, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Comparry of America, Travelers Casualty and Surety Company,and St.Paul Fire and Marine Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which remains in full force and effect. Dated this 20th day of November ,yy2018 4 Kevin E_Hughes,Assi Cant Secretary To verify the authenticity of tris Power of Attorney,plea w call as at 1-80421 3ma Please refer to the above-named Attorney-in-Fact and the details of the bond to which the power Is attached CITY OF FORT WORTH, TEXAS STREET AND STORM DRAIN CONTRACTORS BOND Bond No. SG 0087 THE STATE OF TEXAS ) KNOW ALL MEN BY THESE PRESENTS: COUNTY OF TARRANT ) That We Mario Sinacola & Sons Excavating Inc. , As, principal, and Travelers Casualty & Surety Company of America , As surety, are held and firmly bound unto the City of Fort Worth, Texas, in the penal sum of twenty-five thousand Dollars ($25,000.00) good and lawful money of the United States of America, well and truly to be paid for the payment of which we, and each of us, hereby bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT WHEREAS, the above principal desires to engage in the business of laying, constructing, building, repairing, rebuilding, grading, graveling, paving, surfacing, resurfacing and doing work in and upon the public streets, alley or thoroughfares within the corporate limits of the City of Fort Worth and has complied with all the terms and conditions of ordinance No. 3449 of the City of Fort Worth, Texas, and has applied to the Director of Transportation and Public Works as provided in said ordinance NOW, THEREFORE, if said principal shall fully indemnify and save whole and harmless the said City of Fort Worth, its agents and employees, as well as indemnify and save harmless any person, firm or corporation with whom the Principal has contracted, from any and all damages of any character arising from or caused directly or indirectly by any negligence in the performance of such work as above set forth under the terms of said ordinance and said license or for any imperfect or inadequate work done by said principal under the terms of said ordinance and said license, and shall maintain said work in good and workmanlike state of repair for a period of two (2) years from and after its completion and acceptance by the City of Fort Worth, then this obligation shall be null and void, otherwise to remain in full force and effect: provided, however, this bond is executed by the surety on the condition that its liability shall be limited by and subject to the conditions and provisions hereinunder contained: Successive actions may be brought on this bond for successive breaches of its conditions or any of them; provided, however, that the total sum of all liability of the surety on any one or all of such actions shall not exceed a total sum of Twenty-five Thousand Dollars ($25,000.00). The liability of the Surety under this bond, if not canceled as hereinafter provided, shall cease and terminate of its own force and effect one year from the date hereon, saving and excepting for the maintenance of the work performed previous to the date of termination, for which work the liability of the Surety for maintenance shall continue for two years from and after the date of the completion and acceptance of said work by the City, but no longer. The Surety may terminate its liability under this bond at any time by giving the City Council of the City of Fort Worth, Texas, five (5) days notice in writing of the Surety's intention to do so, and from and after said date the Surety will no longer be liable for any subsequent act, save and except as to maintenance as herein above provided. IN WITNESS WHEREOF, the said Principal and the said Surety have set their hand and seal this the ?oth day of November 20 1 g Mario Si o & Sons Ex avating, Inc Michae Sinacola — viF4ginp ident Travelers Casualty & Surety Carpany of America /Surety ri Att mey-in-Fact Kathleen M. McCann d Travelers Casualty and Surety Company of America ` ' Travelers Casualty and Surety Company TRAVELERS i St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies").and that the Companies do hereby make,constitute and appoint Kathleen M.McCann of BINGHAM FARMS Michigan , their true and lawful Attomey-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted In any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed,and their corporate seals to be hereto affixed,this 3rd day of February, 2017. J O f� pn 1, q �� � tOOGfyR �� o ilr0 State of Connecticut `f� City of Hartford ss. Robert L.Raney,Sefrror Vice President On this the 3rd day of February,2017,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St.Paul Fire and Marine Insurance Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official sealer My Commission expires the 30th day of June,2021 �'�t mOJV��� C :LM[�iLSVt" Mane C.Tetreault,Notary Pubtic This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company,and St.Paul Fire and Marine Insurance Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attomeys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Companys seal bonds,recogn"rzances,contracts of indemnity,and other writings obligatory In the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her,and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman, any Executive Vire President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed In the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond, recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attomeys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes. the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company.and St.Paul Fire and Marine Insurance Company.do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies.which remains in full force and effect. Dated this 20th day of November ,2018 Kevin E.Hughes,Asst last Secretary To verify fire authej7Vd y of this power ofAttDvrrrey,please tali us at 1-800-421 3880 please anter to the above-named Attorney-in-Fact and eye details of the bond to whidr the power is attadred. Texas Department of Transportatfon Permit Completion of work I Bill Boothe, Texas Department of Transportation Permit Chief Inspector have verified the completion of work for the below mentioned permit. Permit#: 10-DCC-33-17 Location: IH 820 @ Railhead Andrews Distribution Bill Boothe Texas Department of Transportation Permit Chief Inspector North Tarrant Area Office 817-291-6413 Bill.Boothe@Txdot.gov } = - - Green Sheet CPN 100615 Andrews Distributing Company p Y w ��v W&S w Adobe Sign Document History 02/13/2019 Created: 01/28/2019 _ By: Etta Bacy(etta.bacy@fortworthtexas.gov) Status: Signed Transaction ID: CBJCHBCAABAAPgRheT1xhGmf 1SB2fmOHdE57EImxn1s "Green Sheet CPN 100615 Andrews Distributing Company W&S " History "d Document created by Etta Bacy(etta.bacy@fortworthtexas.gov) 01/28/2019-9:46:55 AM CST-IP address:209.194.29.100 Document emailed to Jon C. Frederick(sstone@leelewis.com)for signature 01/28/2019-10:03:38 AM CST ®L Document viewed by Jon C. Frederick(sstone@leelewis.com) 01/28/2019-11:45:24 AM CST-IP address:208.87.236.201 (i Jon C. Frederick(sstone@leelewis.com) uploaded the following supporting documents: File Attachment 1 File Attachment 2 02/07/2019-8:42:26 AM CST 6a Document e-signed by Jon C. Frederick (sstone@leelewis.com) Signature Date:02/07/2019-8:42:26 AM CST-Time Source:server-IP address:208.87.239.202 Cw Document emailed to Shawn Fargo (shawn.fargo@fortworthtexas.gov)for signature 02/07/2019-8:42:27 AM CST Document viewed by Shawn Fargo(shawn.fargo@fortworthtexas.gov) 02/08/2019-10:48:13 AM CST-IP address:209.194.29.100 d Document e-signed by Shawn Fargo (shawn.fargo@fortworthtexas.gov) Signature Date:02/08/2019-10:51:09 AM CST-Time Source:server-IP address:209.194.29.100 Document emailed to Ariel Duarte (ariel.duarte@fortworthtexas.gov)for approval 0 02/08/2019-10:51:10 AM CST FOR a Adobe be SSign L Document viewed by Ariel Duarte(ariel.duarte@fortworthtexas.gov) 02/08/2019-10:57:12 AM CST-IP address:209.194.29.100 bc. 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Document receipt acknowledged by Trudy Brotherton (therese.brotherton@fortworthtexas.gov) Receipt Acknowledgement Date:02/12/2019-11:03:41 AM CST-Time Source:server-IP address:209.194.29.100 Document emailed to Julie A Geho Qulie.geho@fortworthtexas.gov)for delivery 02/12/2019-11:03:47 AM CST Document viewed by Julie A Geho Qulie.geho@fortworthtexas.gov) 02/12/2019-12:21:51 PM CST-IP address:209.194.29.100 Document receipt acknowledged by Julie A Geho oulie.geho@fortworthtexas.gov) Receipt Acknowledgement Date:02/12/2019-12:22:11 PM CST-Time Source:server-IP address:209.194.29.100 E4 Document emailed to TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov)for delivery 02/12/2019-12:22:12 PM CST Document viewed by TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov) 02/12/2019-12:43:20 PM CST-IP address:209.194.29.100 C Document receipt acknowledged by TPW Fiscal Staff(tpwcfafiscal@fortworthtexas.gov) Receipt Acknowledgement Date:02/13/2019-9:07:31 AM CST-Time Source:server-IP address:209.194.29.100 Signed document emailed to Susan Alanis (susan.alanis@fortworthtexas.gov),Ariel Duarte (ariel.duarte@fortworthtexas.gov), Etta Bacy(etta.bacy@fortworthtexas.gov), TPW Fiscal Staff (tpwcfafiscal@fortworthtexas.gov), and 7 more 02/13/2019-9:07:31 AM CST FOn u Adobe Sign