HomeMy WebLinkAboutContract 53252 CITY SECRETARY r
C) coNTRACT ho ol5 r,
SEC 3 9 CITY OF FORT WORTH, TEXAS
STANDAR®AGREEMENT FOR PROFESSIONAL SERVICES
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This AGREEMENT is between the City of Fort Worth, a Texas home-rule municipality
("City"), and Hazen and Sawyer, authorized to do business in Texas ("Consultant"), for a
PROJECT generally described as: Risk Assessment Framework Development.
Article I
Scope of Services
(1) Consultant hereby agrees to perform the professional services set forth in the
Scope of Services attached hereto as Attachment "A". These services shall be
performed in connection with Risk Assessment Framework Development.
(2) Additional services, if any, will be requested in writing by the City. City shall not pay
for any work performed by Consultant or Its subconsultants, subcontractors and/or
suppliers that has not been ordered in writing. It is specifically agreed that
Consultant shall not be compensated for any alleged additional work resulting from
oral orders of any person.
Article If
Compensation
Consultant shall be compensated an amount up to $99,820.00 (Ninety Nine Thousand Eight
Hundred and Twenty Dollars and Zero Cents) in accordance with the Fee Schedule shown
in Attachment "B". Payment shall be considered full compensation for all labor, materials,
supplies, and equipment necessary to complete the services described in Attachment "A".
The Consultant shall provide monthly invoices to the City. Payment for services rendered
shall be due within thirty (30) days of the uncontested performance of the particular
services so ordered and receipt by City of Consultant's invoice for payment of same.
Acceptance by Consultant of said payment shall operate as and shall release the City from
all claims or liabilities under this Agreement for anything related to, done, or furnished in
connection with the services for which payment is made, including any act or omission of
the City in connection with such services.
Article III
Term
Unless terminated pursuant to Article VIII herein, this Agreement shall be for a term
beginning on the effective date, as described below, and shall continue until the expiration of
the funds or completion of the subject matter contemplated herein, whichever occurs first.
City of Fart Worth,Texas yOFFICIAL RECORD
Standard Agreement for Professional ServicesAR°
Revision Date:11,07.17
Page 1 of g M WORTKU
nF _ ._
Article 1V
Independent Contractor
Consultant shall operate hereunder as an independent contractor, and not as an officer,
agent, servant, or employee of the City. Consultant shall have exclusive control of and the
exclusive right to control the details of the work to be performed hereunder and of all persons
performing same, and shall be solely responsible for the acts and omissions of its officers,
agents, employees, contractors and subcontractors. The doctrine of respondeat superior
shall not apply as between City and Consultant, its officers, agents, employees, contractors,
and subcontractors, and nothing herein shall be construed as creating a partnership or joint
venture between City and Consultant.
Article V
Professional Competence and Indemnification
(1) Work performed by Consultant shall comply in all aspects with all applicable local,
state and federal laws and with all applicable rules and regulations promulgated by
the local, state and national boards, bureaus and agencies. Approval by the City
shall not constitute or be deemed to be a release of the responsibility and liability of
Consultant or its officers, agents, employees, contractors and subcontractors for the
accuracy and competency of its services performed hereunder.
(2) THE CONSULTANT", AT NO COST TO THE CITY, 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 PROPERTY DAMAGE OR LOSS (INCLUDING
ALLEGED DAMAGE OR LOSS TO CONSULTANT'S BUSINESS AND ANY
RESULTING LOST PROFITS) AND/OR PERSONAL INJURY, INCLUDING
DEATH, THAT MAY RELATE TO, ARISE OUT OF OR BE OCCASIONED BY
CONSULTANT'S BREACH OF (1) ANY OF THE TERMS OR PROVISIONS OF
THIS AGREEMENT OR (U) ANY NEGLIGENT ACT OR OMISSION OR
INTENTIONAL MISCONDUCT OF CONSULTANT, ITS OFFICERS, AGENTS,
ASSOCIATES, EMPLOYEES, CONTRACTORS (OTHER THAN THE CITY) OR
SUBCONTRACTORS, RELATED TO THE PERFORMANCE OR NON-
PERFORMANCE OF THIS AGREEMENT. THIS SECTION SHALL. SURVIVE
ANY TERMINATION OR EXPIRATION OF THIS AGREEMENT.
Article VI
Insurance
(1) Consultant shall not commence work under this Agreement until it has obtained all
insurance required under this Article and the City has approved such insurance, nor
shall Consultant allow any subcontractor to commence work on its subcontract until
all similar insurance of the subcontractor has been so obtained and approval given
by the City; provided, however, Consultant may elect to add any subconsultant as
an additional insured under its liability policies.
City of Fort Worth,Texas
Standard Agreement for Professional Services
Revision pate:11 V 17
Page 2 of 9
Commercial General Liability
$1,000,000 each occurrence
$2,000,000 aggregate
Automobile Liability
$1,000,000 each accident (or reasonably equivalent limits of
coverage if written on a split limits basis). Coverage shall be
on any vehicle used in the course of the Project.
Worker's Compensation
Coverage A: - statutory limits
Coverage B: $100,000 each accident
$500,000 disease - policy limit
$100,000 disease - each employee
(2)Additional Insurance Requirements
a. Except for employer's liability insurance coverage under Consultant's worker's
compensation insurance policy, the City, its officers, employees and servants shall
be endorsed as an additional insured on Consultant's insurance policies.
b. Certificates of insurance shall be attached to this Agreement prior to its execution.
c. Any failure on part of the City to attach the required insurance documentation
hereto shall not constitute a waiver of the insurance requirements specified
herein.
d. Each insurance policy shall be endorsed to provide the City a minimum thirty days
notice of cancellation, non-renewal, and/or material change in policy terms or
coverage. A ten days notice shall be acceptable in the event of non-payment of
premium.
e. Insurers must be authorized to do business in the State of Texas and have a
current A.M. Best rating of A: V11 or equivalent measure of financial strength and
solvency.
f. Other than worker's compensation insurance, in lieu of traditional insurance, City
may consider alternative coverage or risk treatment measures through insurance
pools or risk retention groups. The City must approve in writing any alternative
coverage.
g. Workers' compensation insurance policy(s) covering employees employed on the
Project shall be endorsed with a waiver of subrogation providing rights of recovery
in favor of the City.
City of Fort Worth,Texas
Standard Agreement for Professional Services
Revision Date:11,07.17
Page 3 of 9
h. City shall not be responsible for the direct payment of insurance premium costs
for Consultant's insurance.
L Consultant's insurance policies shall each be endorsed to provide that such
insurance is primary protection and any self-funded or commercial coverage
maintained by City shall not be called upon to contribute to loss recovery.
J. In the course of the Agreement, Consultant shall report, in a timely manner, to
City's officially designated contract administrator any known loss occurrence which
could give rise to a liability claim or lawsuit or which could result in a property loss.
k. Consultant's liability shall not be limited to the specified amounts of insurance
required herein.
I. Upon the request of City, Consultant shall provide complete copies of all
insurance policies required by these Agreement documents.
Article VII
Transfer or Assignment
City and Consultant each bind themselves, and their lawful successors and assigns, to this
Agreement. Consultant, its lawful successors and assigns, shall not assign, sublet or transfer
any interest in this Agreement without prior written consent of the City,
Article Vill
Termination of Contract
(1) a. City may terminate this Agreement for its convenience on 30 days' written notice
to Consultant.
b. Either the City or the Consultant, for cause, may terminate this Agreement if
either party fails substantially to perform through no fault of the other and the
nonperforming party does not commence correction of such nonperformance within
5 days' written notice or thereafter fails to diligently complete the correction.
(2) If City chooses to terminate this Agreement, upon receipt of notice of termination,
Consultant shall discontinue services rendered up to the date of such termination
and City shall compensate Consultant based upon calculations in Article 11 of this
Agreement and Exhibit "B" attached hereto and incorporated herein.
(3)All reports, whether partial or complete, prepared under this Agreement, including
any original drawings or documents, whether furnished by the City, its officers,
agents, employees, consultants, or contractors, or prepared by Consultant, shall be
or become the property of the City, and shall be furnished to the City prior to or at
the time such services are completed, or upon termination or expiration of this
Agreement.
City of Fort Worth,Texas
Standard Agreement for Professional Services
Revision Date:11.07.17
Page 4 of 9
Article IX
Right to Audit
(1) Consultant agrees that the City shall, until the expiration of three (3) years after final
payment under this Agreement, have access to and the right to examine any directly
pertinent books, documents, papers and records of Consultant involving transactions
relating to this Agreement. Consultant agrees that the City shall have access during
normal working hours to all necessary facilities and shall be provided adequate and
appropriate workspace in order to conduct audits in compliance with the provisions of
this section. City shall give Consultant reasonable advance notice of intended audits.
(2) Consultant further agrees to include in all its subcontracts hereunder, a provision to
the effect that the subcontracting consultant agrees that the City shall, until the
expiration of three (3) years after final payment under the subcontract, have access
to and the right to examine any directly pertinent books, documents, papers and
records of such sub-consultant, involving transactions to the subcontract, and
further, that City shall have access during normal working hours to all sub-
consultant facilities, and shall be provided adequate and appropriate work space in
order to conduct audits in compliance with the provisions of this article. City shall
give Consultant and any sub-consultant reasonable advance notice of intended
audit.
(3) Consultant and sub-consultants agree to photocopy such documents as may be
requested by the City. The City agrees to reimburse Consultant for the cost of copies
at the rate published in the Texas Administrative Code in effect as of the time copying
is performed.
Article X
Minority Business and Small Business Enterprise (MBE)(SBE) Participation
In accordance with the City's Business Diversity goals (Chapter 20, Article X of the City's
Code of Ordinances alkla Ordinance No. 20020-12-2011, as amended), the City has goals
for the participation of minority business enterprises and/or small business enterprises in City
contracts. Consultant acknowledges the MBE and SBE goals established for this Agreement
and its accepted written commitment to MBE and SSE participation. Any misrepresentation
of facts (other than a negligent misrepresentation) and/or the commission of fraud by the
Consultant may result in the termination of this Agreement and debarment from participating
in City contracts for a period of time of not less than three (3) years.
Article XI
Observe and Comply
Consultant shall at all times observe and comply with all federal, state, and local laws and
regulations and with all City ordinances and regulations which in any way affect this
Agreement and the work hereunder, and shall observe and comply with all orders, laws
ordinances and regulations which may exist or may be enacted later by governing bodies
having jurisdiction or authority for such enactment. No plea of misunderstanding or ignorance
City of Fort Worth,Texas
Standard Agreement for Professional Services
Revision Date:11.07.17
Page 5 of 9
thereof shall be considered. Consultant agrees to defend, Indemnify and hold harmless City
and all of its officers, agents and employees from and against all claims or liability arising out
of the violation of any such order, law, ordinance, or regulation, whether it be by itself or its
employees.
Article XIl
Immigration Nationality Act
Consultant shall verify the identity and employment eligibility of its employees who perform
work under this Agreement, including completing the Employment Eligibility Verification
Form (1-9). Upon request by City, Consultant shall provide City with copies of all 1-9 forms
and supporting eligibility documentation for each employee who performs work under this
Agreement. Consultant 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
Consultant employee who is not legally eligible to perform such services. CONSULTANT
SMALL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY PENALTIES,
LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS PARAGRAPH BY
CONSULTANT, CONSULTANT'S EMPLOYEES, SUBCONTRACTORS, AGENTS, OR
LICENSEES. City, upon written notice to Consultant, shall have the right to immediately
terminate this Agreement for violations of this provision by Consultant.
Article XIII
Venue and Jurisdiction
If any action, whether real or asserted, at law or in equity, arises on the basis of any
provision of this Agreement, venue for such action shall lie in state courts located in
Tarrant County, Texas or the United States District Court for the Northern District of Texas
— Fort Worth Division. This Agreement shall be construed in accordance with the laws of
the State of Texas.
Article XIV
Contract Construction
The parties acknowledge that each party and, if it so chooses, its counsel have reviewed
and revised this Agreement and that the normal rule of construction to the effect that any
ambiguities are to be resolved against the drafting party must not be employed in the
interpretation of this Agreement or any amendments or exhibits hereto.
Article XV
Severabiiity
The provisions of this Agreement are severable, and if any word, phrase, clause,
sentence, paragraph, section or other part of this Agreement or the application thereof to
any person or circumstance shall ever be held by any court of competent jurisdiction to be
invalid or unconstitutional for any reason, the remainder of this Agreement and the
application of such word, phrase, clause, sentence, paragraph, section, or other part of this
Agreement to other persons or circumstances shall not be affected thereby and this
City of Fort Worth,Texas
Standard Agreement for Professional Services
Revision Date:11.07.17
Page 6 of 9
Agreement shall be construed as if such invalid or unconstitutional portion had never been
contained therein.
Article XVI
Notices
Notices to be provided hereunder shall be sufficient if forwarded to the other Party by
hand-delivery or via U.S. Postal Service certified mail return receipt requested, postage
prepaid, to the address of the other Party shown below:
City of Fort Worth
Attn: Ana J. Pena-Tijerina, PhD, PE, BCEE
Water Department—Strategic Operations
4500 Wilma Lane
Arlington, Texas 76012
Consultant:
Hazen and Sawyer
Attn: Scott. A. Hardy, PE, PMP
500 West 71t" Street, Suite 702
Fort Worth, TX 76102
Article X1/ll
Prohibition On Contracts With Companies Boycotting Israel
Consultant acknowledges that in accordance with Chapter 2270 of the Texas Government
Code, the City is prohibited from entering into a contract with a company for goods or
services unless the contract contains a written verification from the company that it: (1)
does not boycott Israel; and (2) will not boycott Israel during the term of the contract. The
terms "boycott Israel" and "company" shall have the meanings ascribed to those terms in
Section 808.001 of the Texas Government Code. By signing this contract, Consultant
certifies that Consultant's signature provides written verification to the City that
Consultant. (1) does not boycott Israel, and (2) will not boycott Israel during the
term of the contract.
Article XVIII
Headings
The headings contained herein are for the convenience in reference and are not intended
to define or limit the scope of any provision of this Agreement
city or Fort Worth,Texas
Standard Agreement for Professional Services
Revision Date:11.07,17
Page 7 of 9
Article XIX
Attachments, Schedules and Counterparts
This Agreement may be executed in one or more counterparts and each counterpart shall,
for all purposes, be deemed an original, but all such counterparts shall together constitute
but one and the same instrument.
The following attachments and schedules are hereby made a part of this Agreement:
Attachment A- Scope of Services
Attachment B—Compensation
Attachment C - Project Schedule
Duly executed by each party's designated representative to be effective on the date
subscribed by the City's designated Assistant City Manager.
BY: BY:
CITY OF FORT WORTH CONSULTANT
Hazen and Sawyer
�AMAWI' (JAC44--&
Dana Burgh ff Chamindra Dassanayak 'PhD, PE
Assistant C ManagVr Vice-President
Date: I L 13 [ Date: 12J�' I
APPROVAL RECOMMENDED:
B :
Y a zt —
Christopher Harder, P.E.
Director, Water Department
EOFFICPALORD
city of Fort MO.Texas
Standard Agreement for Professional Services ARYRevision bate:11.07.17
Page s of 9 TX
Contract Compliance Manager:
By signing, I acknowledge that I am the
person responsible for the monitoring and
administration of this contract, including
ensuring all performance and reporting Form 1295 No._
requirements. A
1 M&C Date:
Ana -T" hD, PE, BCEE
Engineering Ma ger ATTEST:
APPROVED AS TO FORM AND LEGALITY
f � .
B m
ouOasBc.k K4ary J. 1*s@V
Assistant CityAttorneyCity Secretary
Y ry
City of Fart Worth,Texas EOFFICIAL RECORD
Standard Agreement for ProFessional Services eRET'3Revision Date:11.07.17 4Page9of9
RTkn °r
ATTACHMENT A
SCOPE OF WORK FOR
RISK ASSESSMENT FRAMEWORK DEVELOPMENT
The scope set forth herein defines the work to be performed by the CONSULTANT in
completing the project. Both the CITY and CONSULTANT have attempted to clearly define
the work to be performed and address the needs of the Project.
The purpose of this project is to provide the City of Fort Worth Water Department (FWWD)
with a uniform risk assessment framework for vertical (facility)assets that incorporates best
practices from the water and asset management industries. The development of the risk
assessment framework will be aligned with FWWD's long-term enterprise asset
management framework, currently under development.
WORK TO BE PERFORMED
Task 1. Evaluation of Current Asset Management Practices and Inventory Data
Task 2. Develop Framework for Risk Assessment
Task 3. Risk Assessment Framework Implementation
TASK 1. EVALUATION OF CURRENT ASSET MANAGEMENT PRACTICES AND
INVENTORY DATA
This task consists of performing an evaluation of the City of Fort Worth's MAXIMO System
for all facilities assets. The CONSULTANT will perform the following:
1.1. Review existing Asset Management practices and procedures to develop a risk
assessment framework.
1.2. Review Asset Hierarchy—CONSULTANT will review the current hierarchy and make
recommendations for the hierarchy to better meet FWWD's needs and provide
alignment with the proposed risk assessment framework.
TASK 2. DEVELOP FRAMEWORK FOR RISK ASSESSMENT
CONSULTANT will work with FWWD to develop a risk assessment framework for vertical
(facility) assets. CONSULTANT will include the development of risk assessment guidelines
and training for staff on appropriate risk assessment techniques and procedures.
2.1. Condition Assessment Framework (Likelihood of Failure - LoF)—The FWWD
currently has common condition assessment scoring criteria for all vertical (facility)
assets. However, the existing condition assessment scoring criteria lack the detail
and depth necessary to obtain a true assessment of actual asset condition.
CONSULTANT will work with the FWWD to refine detailed LoF scoring criteria for the
following disciplines: mechanical, electrical, structural, and HVAC. The goal of the
framework is to refine sufficient detailed scoring criteria that will result in thorough
and consistent ratings when scored by multiple people and allow for accurate rating
of the physical condition of the vertical (facility) assets,
Clty of Fort worth,Texas
Attachment A
PMO Release Date:07.23.20V
Page 1 of 3
ATTACHMENT
2.2 Criticality Framework (Consequence of Failure—CoF)— CONSULTANT will review
the existing criticality(CoF) ratings that the FWWD has established within MAXIMO
and work with the FWWD to refine the CoF criteria to include further detail based on
the economic, social, and environmental impacts of potential asset failure.
2.3 Condition (LoF)and Criticality (CoF) Scoring Training— CONSULTANT will conduct
classroom training for FWWD personnel on the developed scoring criteria. After the
classroom training, the CONSULTANT and FWWD personnel will independently
score one process area. The scores will then be compared and discussed to
determine if any scoring deviations warrant modification of the developed risk
assessment framework. Training will occur one day at the Village Creek Water
Reclamation Facility and a second day at one of the Water Production Facilities.
The goal of the training is to achieve consistency of scoring between multiple staff
members on both water production and water reclamation facilities.
TASK 3. RISK ASSESSMENT FRAMEWORK IMPLEMENTATION.
CONSULTANT will develop a plan for implementing the risk assessment framework
including guidelines to enable FWWD to continue to maintain asset condition scoring and
enable a more efficient process for adding new assets to the FWWD's MAXIMO system
3.1 Implementation Road Map— CONSULTANT will provide recommendations of tasks,
resources, staffing and schedule to implement the risk assessment framework in
accordance with the timeframe and requirements of FWWD's enterprise asset
management framework.
3.2 Asset Onboarding — CONSULTANT will develop a guidance document with
processes for incorporating new assets into MAXIMO. This may include a new
standard specification for construction contracts that states the required asset
attributes and format to allow FWWD to efficiently add new assets to its asset
registry.
3.3 Condition Scoring Process and Frequency Refinement—CONSULTANT will work
with FWWD to refine processes for updating an asset's condition at a reasonable
(i.e., annual or semi-annual)frequency for each asset class.
3.4 Data Collection Tools—CONSULTANT will provide recommendations for mobile
application(s) to aid in condition assessment data collection and scoring that allow
for efficient data population and updates of asset attributes.
ASSUMPTIONS
The FWWD is currently performing quality control review and removing duplicate and/or
incorrect data in the existing MAXIMO system. CONSULTANT will not perform quality
control of MAXIMO data.
4 CONSULTANT will only perform condition (LoF) assessment and criticality (CoF)scoring
on the variety of facility asset classifications within the selected process area for the
training sessions. The completion of the risk assessment scoring for any remaining
facility assets will be performed by the FWWD.
CONSULTANT is not responsible for delays outside of its control, such as FWWD or
other third-party review periods.
City of Fort Worth,Texas
Attachment A
PMo Release Date:08.1.2014
Page 2 of 3
ATTACHMENTA
® The FWWD will provide advanced notice of any requested meetings to the
CONSULTANT to allow for appropriate preparation. The FWWD shall be responsible for
coordinating the schedules of FWWD personnel and determining appropriate personnel
to attend meetings, workshops, and training sessions. CONSULTANT will not be
responsible for additional meetings required due to FWWD personnel's inability to attend
scheduled meetings.
DELIVERABLES
A. Handouts of presentation material for attendees of all scheduled meetings and
workshops.
B. Laminated LoF scoring definitions and instructions for maintenance personnel.
C. Risk Assessment Framework Technical Memorandum: One digital PDF and six hard
copies.
City of Fort Worth,Texas
Attachment A
PMO Release Date:09.1.2014
Page 3 of 3
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ATTACHMENT C
PROJECT SCHEDULE
A. PROJECT SCHEDULE
The following is the proposed project schedule:
Kickoff Meeting/Practices and Inventory Data Review 45 days from NTP
(or receipt of data)
Risk Assessment Framework Development Workshops 75 days from NTP
Draft Practices/inventory Data Review and Risk Assessment 105 days from NTP
Framework TM
Onsite Condition Assessment Training 120 days from NTP
Final Deliverables 135 days from NTP
City of Fort Worth,Texas
Attachment C
Revision Date:07.20.2018
Page 1 of 1
Form 503 This space reserved for office use.
(Revised 09/13)
FILED
Return in duplicate to: Secrets a Off fiice of o the
Secretary of State' rY e
P.O. Box 13697
Assumed Name Certificate AUG 2 6 2025
Austin, TX 78711-3697 ,
512 463-5555 Section
FAX: 512 463-5709
Filing Fee: $25
Assumed Name
1. The assumed name under which the business or professional service is,or is to be,conducted or
rendered is: Hazen and Sawyer
Entity Information
2. The legal name of the entity filing the assumed name is:
Hazen and Sawyer, P.C.
State-the name of the entity as currently shown in the records of the secretary of state or on its organizational documents,
if not filed with the secretary of state.
3. The entity filing the assumed name is a: (Select the appropriate entity type below.)
❑For-profit Corporation ❑Limited Liability Company
❑Nonprofit Corporation ❑Limited Partnership
Q Professional Corporation ❑Limited Liability Partnership
❑Professional Association ❑Cooperative Association
❑Other
Speck type of entity. For example,foreign real estate investment trust,state bank, insurance company,etc.
4. The file number, if any, issued to the entity by the secretary of state is: 801448771
5. The state, country,or other jurisdiction of formation of the entity is: New York
6. The entity's principal office address is:
498 Seventh Avenue
Street or Mailing Address
New York NY us 10018
City State Country Postal or Zip Code
Period of Duration
Q 7a. The period during which the assumed name will be used is 10 years from the date of filing
with the secretary of state.
OR
❑ 7b. The period during which the assumed name will be used is years from the date of filing
with the secretary of state (not to exceed 10 years).
OR
❑ 7c. The assumed name will be used until (not to exceed 10 years).
mm/dd/Vy
Form 503 4
County or Counties in which Assumed Name Used
S. The county or counties where business or professional services are being or are to be conducted or
rendered under the assumed name are:
❑✓ All counties
❑ All counties with the exception of the following counties: _
❑ Only the following counties:
Execution
The undersigned signs this document subject to the penalties imposed by law for the submission of a
materially false or fraudulent instrument and also certifies that the person is authorized to sign on
behalf of the identified entity. If the undersigned is acting in the capacity of an attorney in fact for the
entity, the undersigned certifies that the entity has duly authorized the undersigned in writing to
execute this document.
Date:
William Crayon,Chief Financia)Officer
Signature of a person authorized by law to sign on behalf of the
identified entity(see,instructions)
Form 503 5