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HomeMy WebLinkAboutRes 18-07 Authorizing the Town Manager to enter into an Agreement with Green Scaping Outdoor Learning Stations TOWN OF WESTLAKE RESOLUTION NO. 18-07 A RESOLUTION AUTHORIZING THE TOWN MANAGER TO ENTER INTO AN AGREEMENT WITH C. GREEN SCAPING LP TO COMPLETE PHASE II OF THE OUTDOOR LEARNING STATIONS WHICH INCLUDES THE MATH AND SCIENCE PLAZA AND SIDEWALKS AND AUTHORIZE THE TOWN MANAGER TO MAKE FUNDING CHANGES NOT TO EXCEED $25,000 ON THIS PROJECT. WHEREAS, the Town of Westlake owns and operates the Westlake Academy and provides facilities for Town and Academy use; and, WHEREAS, Phase II of the outdoor learning station includes the Math and Science Plaza and sidewalks which are designed for grades K-12; and, WHEREAS the Math and Science Plaza will give the Westlake Academy facility members the tools to enhance the outdoor learning experience; and, WHEREAS, having received bids and properly evaluated said bids as required by state law, the Town Council accepts the bid from C. Green Scaping, LP and reject all other bids for the Math and Science Plaza; and WHEREAS, the Town Council finds that the passage of this resolution is in the best interest of the citizens of Westlake. NOW, THEREFORE, BE IT RESOLVED BY THE TOWN COUNCIL OF THE TOWN OF WESTLAKE, TEXAS: SECTION 1: That, all matters stated in the Recitals hereinabove are found to be true and correct and are incorporated herein by reference as if copied in their entirety. SECTION 2: That the Town of Westlake Town Council hereby accepts the bid from C. Green Scaping, LP and reject all other bids to complete Phase II of the outdoor learning station which includes the Math and Science Plaza and sidewalks and authorize Town Manager to make funding changes not to exceed $25,000 on this project., attached as Exhibit "A". SECTION 3: Ifany portion of this Resolution shall, for any reason, be declared invalid by any court of competent jurisdiction, such invalidity shall not affect the remaining provisions hereof and the Council hereby determines that it would have adopted this Resolution without the invalid provision. Resolution 18-07 Page 1 of 2 SECTION 4: That this resolution shall become effective from and after its date of passage. PASSED AND APPROVED ON THIS DAY 5 t h OF FEBURARY, 2018. ATTEST: � � Laura L. Wheat, Mayor two Kell EdwaW, Town SecretaryBrymer, o� n Manager \P!ES 7-4,1 Zr APPROVED AS FORA L. Stant6o kry, tt e T E;C CO Resolution 18-07 Page 2 of 2 TOWN OF WESTLAKE/WESTLAKE ACADEMY 2600 J T OTTINGER Road Westlake, Texas 76262 :u. R 4 � 1 OUTDOOR LEARNING STATIONS FOR THE FOR TOWN OF WESTLAKE/WESTLAKE ACADEMY CAMPUS ISSUE FOR BIDDING January 9th 2018 Town of Westlake 1500 Solana Blvd., BUilding 4, Suite 7200 Westlake. Tx. 76262 Westlake, TX 76262 Fax: 817-430-1812 Contact: Troy J. Meyer— Facilities Director tmeyer@westlake-tx.org RES 18-07 WA Outdoor Space 2017 AGREEMENT BETWEEN TOWN AND CONTRACTOR THIS AGREEMENT is dated as of the 5 day of Feburary in the year 2018, by and between the Town of Westlake, Texas (hereinafter called OWNER) and C. Green Scaping (hereinafter called CONTRACTOR). OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set forth, agree as follows: Article 1. WORK. CONTRACTOR shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: The work to be done as covered by these contracts and specifications consists of the furnishing of all labor, materials, equipment, and incidentals for the Outdoor Learning Stations which includes; (1) Interactive Math and Science Plaza (approximately 1,912 sq. ft.), and (2) connecting sidewalks (approximately 325 LF) the project also oversees the installation of stone benches, storage boxes, irrigation system, erosion control, tree protection fencing and retaining walls. All final as-build drawings,manufacture and warranty information must be provided in a three ring notebook and CD/flash drive. Article 2. CONTRACT TIME. CONTRACTOR agrees to commence work within five (5) days after the date of written notice to commence work, and to complete the work on which he has bid within eighty (90) working days as provided in the General Conditions. Article 3. CONTRACT PRICE. OWNER shall pay CONTRACTOR for completion of the Work on a Unit Price Work Basis in accordance with the Contract Documents in current funds based on the measured quantities and the unit prices stated in the Proposal. Article 4. PAYMENT PROCEDURES. CONTRACTOR shall submit Applications for Payment on work completed during the previous month on the first day of the month. CONTRACTOR shall present only one Application for Payment each month. Applications for Payment will be processed by ENGINEER and OWNER shall make payment to CONTRACTOR within thirty (30) days of the date of the invoice. Article 5. INTEREST. All moneys not paid when due shall bear interest at the maximum rate allowed by law at the place of the Project. WA Outdoor Space 2018 Page 10 Article 6. CONTRACTOR'S REPRESENTATIONS. In order to induce OWNER to enter into this Agreement, CONTRACTOR makes the following representations. 6.1 CONTRACTOR has familiarized itself with the nature and extent of the Contract Documents, Work, site, locality, and all local conditions and Laws and Regulations that in any manner may affect cost, progress, performance or furnishing of the Work. 6.2. CONTRACTOR binds itself to use such materials and so construct the work that it will remain in good repair and condition for and during the period of one (1) year from the date of the repair and to maintain said work in good repair and condition for said term of one (1) year. CONTRACTOR binds itself to repair or replace the furnishing in whole or in part at any time within said period, if, in the opinion of the owner, it be deemed necessary. 6.3. To the fullest extent permitted by laws and Regulations, CONTRACTOR shall indemnify and hold harmless OWNER and ARCHITECT and their consultants, agents and employees from and against all claims, damages, losses and expenses, direct, indirect or consequential (including but not limited to fees and charges of engineers, architects, attorneys and other professionals and court and arbitration costs) arising out of or resulting from the performance of Work, provided that any such claim, damage, loss or expense (a) is attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible property (other than the Work itself) including the loss of use resulting there from and (b) is caused in whole or in part by any negligent act or omission of CONTRACTOR, and Subcontractor, any person or organization directly or indirectly employed by any of them to perform or furnish any of the Work or anyone for whose acts any of them may be liable, regardless of whether or not it is caused in part by a party indemnified hereunder or arises by or is imposed by Laws and Regulations regardless of the negligence of any such party. 6.4. In any and all claims against OWNER or ARCHITECT or any of their consultants, agents or employees by any employee of CONTRACTOR, any Subcontractor, any person or organization directly or indirectly employed by any of them to perform or furnish any of the Work or anyone for whose acts any of them may be liable, the indemnification obligation under paragraph 6.3 shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for CONTRACTOR or any such Subcontractor or other person or organization under workers' or workmen's compensation acts, disability benefit acts or other employee benefit acts. Article 7. Contract Documents The Contract Documents which comprise the entire agreement between OWNER and CONTRACTOR concerning the Work consists of the following: • Notice to Bidders consisting. • Instructions to Bidders. • Proposal. • This Agreement. • Pre-bid Bond, Performance Bond, Maintenance Bond and Payment Bond • General Conditions. • General Requirements. • Set of Plans. WA Outdoor Space 2018 Page 11 There are no Contract Documents other than those listed above in this Article 7. Article 8. TERMINATION. OWNER may terminate contract if CONTRACTOR persistently fails to perform the work in accordance with the Contract Documents including, but not limited to, failure to supply sufficient skilled workers, or suitable materials or equipment, or otherwise violates in any substantial way any provisions of the Contract Documents. OWNER may, after giving CONTRACTOR seven (7) days written notice and to the extent permitted by Laws and Regulations,terminate the services of CONTRACTOR, exclude CONTRACTOR from the site and take possession of the Work. Article 9. MISCELLANEOUS. No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound, and specifically but without limitation moneys that may become due and moneys that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. OWNER and CONTRACTOR each binds itself, its partners, successors, assignees and legal representatives to the other party hereto, its partners, successors, assignees and legal representatives in respect of all covenants, agreements and obligations contained in the Contract Documents. IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed Three (3) copies of the Agreement. Two counterparts each have been delivered to OWNER and CONTRACTOR. All portions of the Contract Documents have been signed or identified by OWNER and CONTRACTOR. This agreement will be effective on the 5 day of Feburary, 2018. OWNER: CONTRACTOR: C Gree SCeP!0 La Town of Westlake, Texas By: `�/�ti�,C Mz� 7` By: ' r Laura Wheat, Mayor CUr�iS Etreeh - V icr ��(�iG�c►'t� ATTEST: � °�. ��� ���,�%��-" (kATTEST: r Kelly Edwards, TMRC, Town rES7' �o WA Outdoor Space 2018 Page 12 TE X p,s D/M/WBE HFDB01952Y0918 and Small Business Enterprise GREEN SCAPING ine -,,,_.,,, ,,, , Grass Establishment Erosion Control Wetland Development Mitigation Biotechnical Embankment PROJECT: Westlake-Outdoor Learning Station Phase II Math &Science Plaza BID OF: C.Green Scaping, L.P. 2401 Handley Ederville Rd. Ft.Worth,TX 76118 Contract Bid Items &Total Item No Description Unit Quantity Price Total 1 Tree Protection Installation and Removal LF 161 $4.00 $644.00 2 Grading, including site preparation removal and subgrade preparation LS 1 $25,500.00 $25,500.00 3 Concrete Trail SF 305 $7.80 $2,379.00 4 Stone Retaining walls LF 56 $142.00 $7,952.00 5 Solid Sod Bermuda Grass- Not watered or guaranteed SY 755 $5.20 $3,926.00 6 Specialty Concrete Paving including stains,finishes, lettering and saw cutting SF 1509 $75.92 $114,558.00 8 Limestone seats EA 8 $960.00 $7,680.00 9 Storage Bin EA 1 $360.00 $360.00 10 Tall Simple machine rack EA 2 $3,200.00 $6,400.00 11 Short Simple machine rack EA 1 $2,400.00 $2,400.00 Total $171,799.00 2/6/2018 PERFORMANCE BOND BOND No. 022057037 STATE OF TEXAS COUNTY OF TARRANT KNOW ALL MEN BY THESE PRESENTS: That C. Green Scaping, LP(contractor's company) of the Town of Westlake County of Tarrant , and the State of Texas, as principal and Liberty Mutual Insurance Company (surety company) authorized under the laws of the State of Texas to act as surety on bonds for principals, are held and firmly bond unto Town of Westlake, One Hundred Seventy One Thousand Seven Texas (Owner), in the penal sum of kt'rdmdW4wlyNine&nni1nn Dollars ($171,799.00 ) for the payment whereof, the said Principal and Surety bind themselves, and their heirs, administrators, executors, successors, and assigns,jointly and severally, by these presents: WHEREAS, the Principal has entered into a certain written contract with the Owner, dated the 5th day of February 2018, to Town of Westlake/Westlake Academy Phase I Expansion which contract is hereby referred to and made part hereof as fully and to the same extent as if copied at length herein. NOW THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the said Principal shall faithfully perform the said Contract and shall in all respects duly and faithfully observe and perform all and singular the covenants, conditions and agreements in and by said contract agreed and covenanted by the Principal to be observed and performed, and according to the true intent and meaning of said Contract and the Plans and Specifications hereto annexed, then this obligation shall be void; otherwise to remain in full force and effect: "PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253 of the Texas Government Code for Public Works as amended and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter to the same extent as if it were copied at length herein." Surety, for value received, stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract, or to the work performed thereunder, or the plans, specifications, or drawings accompanying the same, shall in any way affect its obligation on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract, or to the work to be performed thereunder. IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this instrument this 5th day of February 2018. Principal Surety �; B � Title Attorney In Fact KyA KMsoe Address-320 Eagle Drive Ste 210Denton.TX 76201 The name and address of the Resident Agent of Surety is: Kylie Kelsoe, 320 Eagle Drive, Ste 210, Denton,TX 76201 WA Outdoor Space 2018 Page 18 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No.7952702 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Kylie Kelsoe;James E.King;Jeff P.King;Rachyl Mullins all of the city of Denton state of TX each individually if there be more than one named,its true and lawful attorney-in-tact to make,execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 30th day of November 2017 The Ohio Casualty Insurance Company N fn 1919 n > 1912 ° 1991 Liberty Mutual Insurance Company C - a b West merican Insurance Company S d By STATE OF PENNSYLVANIA ss David M.Care ;Assistant Secretary c cc += COUNTY OF MONTGOMERY c tss dOn this 30th day of November 2017 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance L)f- v O Company,The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes >,� p therein contained by signing on behalf of the corporations by himself as a duly authorized officer. LV L E C`> > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. O CL 8P PAS;. COMMONWEALTH_OF PENNSYLVANIA /�4 Q M 0Q o�ouwFq` l Notarial Sear%�� 4-4 EU'P'PC-0TMM-:1' a Pastella,Notary Public By: 1�! — d of ion Twp.,Montgomery County Teresa Pastella,Notary Public d ssion Expires March 28,2021 3 rG dO 2 wP ,u OE 61 �qRy Ply Member,Pennsylvania Association of Notaries a C rC This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 0 p y Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: rn R d ARTICLE IV—OFFICERS—Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O e CL_ to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, y O acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations setforth in their respective T3 E y powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so m p y executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under > Q Othe provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. to �� = ARTICLE XIII—Execution of Contracts—SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, E , d and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, '-M C) seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their C o0 v respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so v o executed such instruments shall be as binding as if signed by the president and attested by the secretary. O cfl Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- ~ fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company.wherever appearing upon a certified copy of any power of:attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. T' I U IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this �rn day of I f/� 20 0 1919 on Y 1912 „1991 By: Renee C.Llew ssistant Secretary 45 of 300 LMS 12873 022017 Liberty Mutual' SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener information o para someler una queja: You may call toll-free for information or to Usted puede llamar al humero de telefono gratis make a complaint at para information o para someter una queja al 1-977-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: Interchange Corporate Center Interchange Corporate Center 450 Plymouth Road, Suite 400 450 Plymouth Road, Suite 400 Plymouth Meeting, PA 19462-1644 Plymouth Meeting, PA 19462-1644 You may contact the Texas Department of Puede comunicarse con el Departamento de hisuI:ance to obtain Infunnation on I:oIIIpaIlles, Seguros de Texas pard obtener inforniacion coverages, rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection(111-IA) de Texas Consumer Protection(111-1A) P. O. Box 149091 P. O. Box 149091 Austin, TX 78714-9091, Austin, TX 78714-9091 FAX: (512)490-1007 FAX#(512) 490-1007 Web: http://www.tdi.texas.gov Web: http://wwW.tdi.texas.gov E-mail: ConsumerProtectionQ)tdi.rtexas.gov E-mail: ConsumerProtectionotdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concemiente a su prima o a premium or about a claim you should first un reclamo, debe coinunicarse con el agente o contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved,you may contact the entonces comunicarse con el departamento (TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR iDNA ESTE AVISO A STJ POLIZA: POLICY: This notice is for information only and does not Este aviso es solo para proposito de information become a part or condition of the attached y no se convierte en parte o condition del document. documento adjunto. NP 70 68 09 01 MAINTENANCE BOND THE STATE OF TEXAS COUNTY OF TARRANT KNOW ALL MEN BY THESE PRESENTS THAT: C. Green Scaping, LP (contractor's company), as principal AND Liberty Mutual Insurance Company (surety company), A corporation organized under the laws of Texas , as sureties, do hereby expressly acknowledge themselves to be held and bound to pay unto the town of Westlake, a municipal corporation, chartered by virtue of a special act of legislature of the state of Texas, at Westlake, Tarrant county, Texas, the sum of Hunedintyino 'ro � RS ($ 171,799.00ddrdNeNe „ � ), for the payment of which sum will truly be made unto said Town of Westlake, and its successors, and said principal and sureties do hereby bind themselves,their assigns and successors jointly and severally. THIS OBLIGATION IS CONDITIONED; HOWEVER, THAT WHEREAS, the said C. Green Scaping, LP (contractor's company) has this day entered into a written contract with the said Town of Westlake to build and construct Civic Campus Outdoor Learning Stations which contract and the plans and specifications therein mentioned, adopted by the Town of Westlake are hereby expressly made a part thereof as though the same were written embodied herein. WHEREAS, under the plans, specifications, and contract, it is provided that the contractor will maintain and keep in good repair, the work herein contracted to be done and performed, for a period of one (1) years from the date of the acceptance of said work, and to do all necessary repairing and/or reconstructing in whole or in part of said improvements that should be occasioned by settlement of foundation, defective workmanship or materials furnished in the construction or any part thereof or any of the accessories thereto constructed by the contractor. It being understood that the purpose of this section is to cover all defective conditions arising by reason of defective material and charge the same against the said contractor, and sureties on this obligation, and the said contractor sureties hereon shall be subject to the liquidation damages mentioned in said contract for each day's failure on its' part to comply with the terms of said provisions of said contract. NOW, THEREFORE, if the said contractor shall keep and perform its' said agreement to maintain said work and keep the same in repair for the said maintenance period of one (1) years, as provided, then these presents shall be null and void, and have not further effect, but if default shall be made by said contractor in the performance of its' contract to so maintain and repair said work, then these presents shall have full force and effect, and said Town of Westlake shall have and recover from the said contractor and its' principal and sureties damages in the premises, as provided; and it is further agreed that this obligation shall be a continuing one against the principal and sureties, hereon, and that successive recoveries may be and had hereon for successive branches until the full amount shall have been exhausted; and it is further understood that the obligation herein to maintain said work shall continue throughout said maintenance period, and the same shall not be changed, diminished or in any manner affected from any cause during said time WA Outdoor Space 2018 Page 19 IN WITNESS THEREOF, said C.Green Scaping,LP has caused these present to be executed by its President and The said Liberty Mutual Insurance Company (name of surety company) has caused these Present to be executed by its' attorney-in-fact and said Attorney-in-fact Kylie Kelsoe (name of attorney) has hereunto set this hand, this the 5th day of February 2018. PRINCIPAL: C. Green Scaping, LP SURETY: Liberty Mutual Insurance Company Name of Contractor's Company Name of Insurance Company Signatur Signature zc CA4h1te*, RLj;-Z r2sio�tY� Kylie K soe,Attorney in Fact Name of Representative-UTle(Print) Name of Representative—Title(Print) WITNESS: ATTEST: p �� Bailey Lyles, ocess Signature &AJ4 SECRETARY—Signatur Sherry Watson NOTE: DATE OF MAI NTENANA BOND MUST NOT BE PRIOR TO DATE OF CONTRACT. WA Outdoor Space 2018 Page 20 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 7952703 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Kylie Kelsoe;James E.King;Jeff P. King; Rachyl Mullins all of the city of Denton state of TX each individually if there be more than one named,its true and lawful attorney-in-fact to make,execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed;any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 30th day of November 2017 >,I CU -w INS{ vaorw:sUF� yttasu;, G �yJPoy�oitn:v'�5 c, ;�Pr�eY �� ff� The Ohio Casually Insurance Company 791 � Liberty Mutual Insurance Company a� o �il 1912 1891 West American Insurance Company N a ~ V = STATE OF PENNSYLVANIA ss David M.Care ,Assistant Secretary w COUNTY OF MONTGOMERY c c0 dOn this 30th day of November 2017 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance U f— v d Company,The Ohio Casualty Company, and West American Insurance Company, and that he,as such, being authorized so to do,execute the foregoing instrument for the purposes >,W p =itherein contained by signing on behalf of the corporations by himself as a duly authorized officer, to j_ G) > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. O CL gP PASp COMMONWEALTH Of PENNSYLVANfA �%�� Q M _O �Q Q*�orvwF�F�� Notarial Seal /G _ 4_4 C.n t— o v Teresa Pastella,Notary Public BY O GCl) OF Upper MerionTwp.,Montgomery County Teresa Pastella,Notary Public y L g My Commission Expires March 28,2021 3 rT5 0 y NSYL`1Qa L c � �"tAY P�y� Member,Pennsylvania Rssociatinn nr Notaries O G 02 I� RS C O This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual m p aj w`, Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: r to L ARTICLE IV—OFFICERS—Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O e Q; to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, y 0,S acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their respective Ey- powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so m p` executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney in fact under > a the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. .(DC �CM ra r ARTICLE XIII-Execution of Contracts-SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, E , d and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, w M O seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their =o0 Z v respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so v o executed such instruments shall be as binding as if signed by the president and attested by the secretary. O 1? Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- ~ fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of anyassistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio_Casualty Insurance Company, Liberty Mutual Insurance Company, and.West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this l/ day of 20 . INSLF� 'F T�oapn,tty�y2 .J`'.�e,^:rarF•L, �,���;a";var�'"�, 19,t941 0 1912 1991 i By. ti Renee C.Llew , mistant secretary 46 of 300 LMS 12873 022017" 0NLiberty MUtUCA, SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or makc a complaint: Para oblener informacion o para someler una queja: You may call toll-free for information or to Usted puede llamar al numero de telefono.gratis make a complaint at para informacion o para someter una queja al 1-R77-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: Interchange Corporate Center Interchange Corporate Center 450 Plymouth Road, Suite 400 450 Plymouth Road, Suite 400 Plymouth Meeting, PA 19462-1644 Plymouth Meeting, PA 19462-1644 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain infounation oI1 I:oIIlpanles, Seguros de Texas para obteI er hirbri acio l coverages,rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection (111-1A) de Texas Consumer Protection(111-1A) P. O. Box 149091 P. O. Box 149091 Austin, TY 78714-9091. Austin, TX 78714-9091 FAX: (512) 490-1007 FAX#(512) 490-1007 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection u,tdi.texas.gov E-mail: ConsumerProtectionotdi.texas.goy PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a premium or about a claim you should first un reclalno, debe comiluucarse con el agente o . contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved,you may contact the entonces comunicarse con el departamento (TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SLJ POLIZA: POLICY: This notice is for information only and does not Este aviso es solo para proposito de informacion become a part or condition of the attached y no se convierte en parte o condicion del document. documento adjunto. NP 70 68 09 01 PAYMENT BOND BOND No. STATE OF TEXAS COUNTY OF TARRANT KNOW ALL MEN BY THESE PRESENTS: That C. Green Scaping, LP (contractor's company) of the City of Westlake County of Tarrant and the State of Texas , as principal, and Liberty Mutual Insurance Company (surety company) authorized under the laws of the State of Texas to act as surety on bonds for principals, are held and firmly bond unto the Town of Westlake, Texas (Owner), in the penal sum of One Hundred Thousand Seventy One,Seven Hundred Ninety Nine and 00/100 Dollars ($ 171,799.00 ) for the payment whereof, the said Principal and Surety bind themselves, and their heirs, administrators, executors, successors, and assigns, jointly and severally, by these presents: WHEREAS, the Principal has entered into a certain written contract with the Owner, dated the 5th day of February 2018, to Town of Westlake/Westlake Academy Outdoor Learning Stations which contract is hereby referred to and made part hereof as fully and to the same extent as if copied at length herein. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the said Principal shall pay all claimants supplying labor and material to him or a subcontractor in the prosecution of the work provided for in said contract, then, this obligation shall be void; otherwise to remain in full force and effect: "PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253 of the Texas Government Code for Public Works as amended and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter to the same extent as if it were copied at length herein." Surety, for value received, stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract, or to the work performed thereunder, or the plans, specifications, or drawings accompanying the same, shall in any way affect its obligation on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract, or to the work to be performed thereunder. IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this instrument this 5th day of February 2018, C. Green Scaping, LP Liberty Mutual Insurance Company. Principa Surety By: By: Title: ; Title: Kylie Kelsoe, Attorney in Fact Address: Z4p I Nodid leg @ vill[Uddress: 320 Eagle Dr, Ste 210, Denton, TX 76201 F:4-. Wo-44n, IAT"1 u I IIA WA Outdoor Space 2018 Page 21. THIS GOWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No.7952704 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Kylie Kelsoe;James E.King;Jeff P.King;Rachyl Mullins all of the city of Denton state of TX each individually if there be more than one named,its true and lawful attorney-in-fact to make,execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds;recognizances and other surely obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 30th day of November 2017 DKV IN.S(� 1N5Uq „sraSUq � z ,� The Ohio Casualty Insurance Company Liberty Mutual Insurance Company 44) o 1919r 1912 1991 tC L �T West American Insurance Company O STATE OF PENNSYLVANIA ss David M.Carey,Assistant Secretary 4.M COUNTY OF MONTGOMERY c M T3 On this 30th day of November 2017,before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance v 1-- a) — N Company,The Ohio Casualty Company, and West American Insurance Company,and that he,as such, being authorized so to do, execute the foregoing instrument for the purposes >,W p 2 therein contained by signing on behalf of the corporations by himself as a duly authorized officer. to Oa > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. O CL 5p PASA COMMONWEALTH OF PENNSYLVANIA ��%� or�WENotarial Seal 4—q<F< Wit' G'y >• u s v Teresa Pastella,Notary Public By �.. OL OF Upper Marion Twp.,Montgomery County Teresa Pastella,Notary Public d My Commission Expires March 28,2021 fC �P 0 yOrq P���G Member,Pennsylvania Association of Notarios O Om rfir ate: C This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual V)o y Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: of inL ARTICLE IV—OFFICERS—Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject o c t0 to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, >+ O,S acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their respective41 3 E powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so as p (C executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fact under > Athe provisions of this article may be revoked at any by the Board,the Chairman,the President or by the officer or officers granting such power or authority. cu CD r = ARTICLE XIII—Execution of Contracts—SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, E , > m and subject to such limitations as the chairman or the president may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute, L rNi O seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their 00 Z v respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so O C executed such instruments shall be as binding as if signed by president and attested by the secretary. U Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- ~ fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company:in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of.which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this day of rO 20 hJP�oti~.sn2ar�9� y�JP oxF3 „1:��'i�F 0 1919 1991 ' By: Renee C.I lew ssistant Secretary J,/y''v%�;r^.��`C�D 9y 7ani.m1`>'•���� y �No1anP `2 47 of 300 LMS 12873 022017 liberty Mutua.I�, SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain inforniation or make a complaint: Para obtener informacion o para someter una queja: You may call toll-free for information or to Usted puede llamar al humero de telefono gratis make a complaint at para informacion o para someter una queja al 1-977-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: Interchange Corporate Center Interchange Corporate Center 450 Plymouth Road, Suite 400 450 Plymouth Road, Suite 400 Plymouth Meeting, PA 19462-1644 Plymouth Meeting, PA 19462-1644 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain infoIination VII I;VInpanles, Su urns de Texas para. obtener informacion coverages, rights or complaints at acerca de companies, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection(111-1A) de Texas Consumer Protection(111-1A) P. O. Box 149091 P. O. Box 149091 Austin, TX 78714-9091 Austin, TX 78714-9091 FAX: (512) 490-1007 FAX 9(512) 490-1007 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtectioncaatdi.texas.gov E-mail: ConsumerProtectiongtdi.texas.goy PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a premium or about a claim you should first un reclamo, debe comunicarse con el agente o contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved, you may contact the entonces comunicarse con el departamento (TDI) Texas Department of Insurance. ATTACH THIS NOTICE,TO YOUR iDNA ESTE, AVTSO A SU POLI7,A: POLICY: This notice is for information only and does not Este aviso es solo para proposito de informacion become a part or condition of the attached y no se convierte en parte o condicion del document. documento adjunto. NP 70 68 09 01 DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 1 2/13/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Rechy 1 Mullins Agents Alliance Services, Ltd a/CNNo Ext: (800)453-9691 FVC No: (940)243-1050 Ramey King Insurance ADDRESS:rachylmullins@rameyking.com 320 Eagle Drive, Ste 210 INSURERS AFFORDING COVERAGE NAIC# Denton TX 76201 INSURERA:West American Company 44393 INSURED INSURERB:Ohio Casualty 24074 C Green Scaping, LP INSURERC:Texas Mutual Ins. Co. 22945 2401 Handley Ederville Rd. INSURER DAmerica. First Insurance 12696 INSURER E: Fort Worth TX 76118 INSURER F: COVERAGES CERTIFICATE NUMBER:CL175431853 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE XI OCCUR PREMISES Ea occcur ante $ 100,000 BKW57098415 5/13/2017 5/13/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X OTHER: $0 Deductible Pollution Liability $ 300,000 AUTOMOBILE LIABILITY COEaMBINED accident SINGLE LIMIT $ 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS BAW57098415 5/13/2017 5/13/2018 BODILY INJURY(Per accident) $ AUTOS NON-OWNEDPROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 US057098415 5/13/2017 5/13/2018 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A C (Mandatory in NH) TSF0001252254 5/13/2017 5/13/2018 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Equipment Floater IM8854626 5/13/2017 5/13/2018 Rented/Leased Equipment $125,000 Deductible $1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: Westlake - Outdoor Learning Station Phase 2 - Math & Science Plaza .The insured's policy includes a blanket additional insured endorsement as required by written contract with regards to the General Liability policy. The general liability endorsements include coverage for ongoing (Form CG8810) and completed operations (Form CG8980) . The insured's general liability policy includes form CG8810 - Primary and Non-Contributory. The insureds workers compensation policy has a blanket waiver of subrogation as required by written contract per form WC 42 03 04 A (Ed. 1-00) . The insureds auto , liability policy has a blanket additional insured and blanket waiver of subrogation endorsement as CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Westlake THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Westlake Academy ACCORDANCE WITH THE POLICY PROVISIONS. 2600 J T Ottinger Road Westlake, TX 76262 AUTHORIZED REPRESENTATIVE ,fes Jeff King/RLM ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I NS025(201401) COMMENTS/REMARKS required by written contract per form CA8810. Blanket Waiver of Subrogation also applies to the General Liability (CG8810) as required by written contract. The Umbrella applies as per scheduled underlying insurance. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. 1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2018-310358 C. Green Scalping, LP Fort Worth,TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 02/06/2018 being filed. Town of Westlake Date Acknowledged: g 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. 2018-03 Outdoor Learning Station From Westlake Academy Campus Phase II 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling I Intermediary C&C Green Enterpises, LLC FORT WORTH,TX United States X Green,Curtis FORT WORTH,TX United States X Ruiz, Cathleen FORT WORTH,TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is Curtis J. Green and my date of birth is My address is 2401 Handley Ederville Rd. Ft. Worth TX , 76118 US (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Tarrant County, State of TPxaa on theF; Y 20_da of 18_ (month) (year) � ignature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.5523 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. 1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2018-310358 C. Green Scalping, LP Fort Worth,TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 02/06/2018 being filed. Town of Westlake Date Acknowledged: 02/19/2018 g 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. 2018-03 Outdoor Learning Station From Westlake Academy Campus Phase II Nature of interest 4 Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary C&C Green Enterpises, LLC FORT WORTH, TX United States X Green, Curtis FORT WORTH, TX United States X Ruiz, Cathleen FORT WORTH, TX United States X 5 Check only if there is NO Interested Party. ❑ 6 UNSWORN DECLARATION My name is and my date of birth is My address is (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of on the day of ,20 (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.5523 Form TGC 2270 VERIFICATION REQUIRED BY TEXAS GOVERNMENT CODE CHAPTER 2270 Contract identifier: Department: By signing below, Company herby verifies the following: 1. Company does not boycott Israel; and 2. Company will not boycott Isra- •. g the term of the contract. SIGNED BY: _ ��� Print Name of Pe A47Curtis J. Green —Vice President Signing,Title, and Company C. Green Scaping, LP Date signed: 10/22/2018 STATE OF TEXAS § COUNTY OF Tarrant § BEFORE ME, the undersigned Notary Public on this day personally appeared Curtis 3. Green (Name), on behalf of C. Green Scapino, LP (Company) who being duly sworn, stated under oath that he/she has read the foregoing verification required by Texas Government Code Section 2270.002 and said statements contained therein are true and correct. SWORN AND SUBSCRIBED TO before me, this 22 day of October , 2018 . NOTARY PUBLIC, _ FOR THE ATE OF T S ��,,,,,ii�. STACY LEE GEIGENMILLER My Commission Expires: .�PVP z; .Notary Public, State of Texas Comm. Expires 03-13-2022 Notary ID 125817920 Government Code § 2270.002. Provision Required in Contract Effective: September 1, 2017 A governmental entity may not enter 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 following definitions apply: (1)"Boycott Israel"means refusing to deal with,terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on,or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes. (2)"Company"means a for-profit sole proprietorship, organization, association, corporation, partnership,joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit. (3)"Governmental entity"means a state agency or political subdivision of this state. State law requires verification from a Company for contracts involving goods or services(regardless of the amount) before the City can enter into the contract.