6518 - Assignment of Contract Executed
Procurement & Compliance
215 E. McKinney St., Denton, TX 76201 (940) 349-7100
OUR CORE VALUES
Integrity Fiscal Responsibility Transparency Outstanding Customer Service
Assignment of Contract #6518
FOR VALUE RECEIVED, FX5 Construction & Excavation, Inc. (“Assignor”) hereby assigns and
otherwise transfers to FX5 Utility Construction, LLC (“Assignee”) all rights, title and interest held by
Assignor in and to the “Contract” described as follows (this “Assignment”):
Contract approved November 7, 2017, by and between the City of Denton, FX5 Construction &
Excavation, Inc. for underground electric installation services for Denton Municipal Electric; said
Contract being in the original not to exceed amount of $6,000,000.
Assignor warrants and represents that said Contract is in full force and effect and is fully assignable.
Assignor further warrants that it has the full right and authority to transfer said Contract and that Contract
rights herein transferred are free of liens, encumbrances and adverse claims. Said Contract has not been
modified and remains on the terms and conditions originally contained therein. If said Contract has been
modified, then all modifications to said Contract are attached hereto and made a part hereof.
Assignor grants, bargains, sells, conveys, transfers, assigns and delivers all of its rights, interests,
obligations and duties under the Contract to Assignee. Assignee fully assumes and agrees to perform all
remaining covenants, duties, and obligations of Assignor under the Contract in strict accordance with the
terms and conditions of the Contract and agrees to indemnify and hold Assignor harmless from any claim
or demand resulting from non-performance by Assignee. Assignor agrees that Assignee shall be entitled
to all monies remaining to be paid under the Contract, which rights are also assigned hereunder. The City
of Denton’s obligations to make payment to Assignee shall only be effective following the date this
Assignment becomes effective. In the event that a dispute arises between Assignor and Assignee as to the
allocation or division of any payments payable or paid to Assignor of Assignee, such dispute shall be
resolved strictly between Assignor and Assignee.
This Assignment shall become effective as of the date the Consent to Assignment is executed by the City
of Denton after this Assignment is executed by the Assignor and Assignee and shall be binding upon and
inure to the benefit of the Assignor and Assignee, their heirs, administrators, successors and assigns.
IN WITNESS WHEREOF the Assignor and Assignee execute and affix their respective approval and
signature on this Assignment on the dates herein set forth.
Dated: _________________
___________________________
Assignor
Dated: _________________
___________________________
Assignee
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12/10/2020
Procurement & Compliance
215 E. McKinney St., Denton, TX 76201 (940) 349-7100
OUR CORE VALUES
Integrity Fiscal Responsibility Transparency Outstanding Customer Service
Consent to Assignment of Contract
In accordance with the provisions of the Contract, the City of Denton hereby consents to the Assignment
of Contract affirming that no modification of the Contract is made or intended, except as noted
hereinabove, and that Assignee is now and hereafter substituted for Assignor. The Assignee shall provide
to the City of Denton the following documentation before the Assignment of Contract shall become
effective: (1) a completed substitute W-9 form, and (2) a certificate of insurance which meets or exceeds
the insurance requirements of the Contract.
Attached: City of Denton Substitute W-9 form
Conflict of Interest Questionnaire
Contract #6518
Dated: _________________
Approved by:
Lori Hewell
Purchasing Manager
City of Denton
901B Texas Street
Denton, Texas
940-349-7100
lori.hewell@cityofdenton.com
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12/10/2020
Tax ID/Social Security #:
Individual/
Sole
Proprietor
Partnership
Limited
Liability
Corporation
Other
Please specify:
Exempt
Payee
Business Type :Equipment
Rental/Lease (A-9)Royalties (A-2)
Medical/Health Care (A-6)
Merchandise-
Goods Only (A-7)
Merchandise &
Services (A-7)Legal Firm/Attorney (A-C)
Proceeds from
Real Estate
Purchases (S)
Type of Organization:Female Owned Non Profit Historically Underutilized
Business
City of Denton Purchasing
901-B Texas St. Denton, TX 76209
Phone: (940) 349-7100 Fax: (940) 349-7302
www.dentonpurchasing.com
Authorized Signature:____________________________ Printed Name:_______________________________________
Mailing Address:
Consultant/Prof
Fees (A-7)
Company Name:
Real Estate
Rental/Lease (A1)
Check appropriate box for federal tax classification (required):
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxtaxpayer identification number (or I
am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because (a) I am exempt from
backup witholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding
as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup
withholding, and 3. I am a US citizen or other U.S. person-for fededral tax purposes as defined at the bottom of this page*.
*Definition of a U.S. Person-For Federal Tax purposes, you are considered a U.S. person if you are: (a) an individual who is a U.S. citizen or
U.S. resident (b) a partnership, corporation, company, or association created or organized in the United States or under the laws of the United
States (c) an estate (other than a foreign estate), or (d) a domestic trust (as defined in Regulations Section 301.7701-7).
C
Corporation
Minority
Owned
Name as shown on your income tax return:
Substitute W-9 Form
The IRS requires all vendors to complete a W-9 Form. The information on this form must be filled out, signed and submitted by a
vendor representative. All information must be completed before a purchase order or payment will be issued.
Services Only (A-
7)
Contact Name:
Address: Phone Number:
Fax Number:
S
Must designate C or S
Email:
Website:
COD Page 1 9/23/2011
4. I unsderstand that I must disclose any conflict of interest in accordance with Section 176.006 (a-1) of the Local Government Code.
DocuSign Envelope ID: 7BBA0820-D700-402A-9CC7-9E71013517C8
PO Box 1297
David Fuller
940-627-8009
FX5 Utility Construction LLC
David Fuller
85-3899697
Decatur, TX 76234
940-627-0074
X
X
FX5 Utility Construction LLC
Remit Address (if different from above)
Email:
List Products and/or Services Interested in Bidding:
For Internal Use Only
Requesting Department: Date:
Purchasing Signature: Date:
ACH Information-Voluntary
I (we) authorize the City of Denton to deposit
payments into the checking account listed. The
authority remains in effect until the City of Denton
has received written notification from me of
termination in time to allow reasonable opportunity
to act on it, or until the City of Denton has sent me
written notice of termination of the agreement.
Bank Name :
ABA Routing#:
Contact Name :
Bank Account#
Vendor Number
Company Name:
Contact Name:
Address:
ACH Email :
Phone Number: Phone Number:
Fax Number: Fax Number:
Vendor Change
Refund
New Vendor
Vendor Signature __________________________
Print Name/Title ____________________________
Date _____________________________________
Department Representative (Printed Name) ________________________________________________________
ACH Email :
Vendor Information Not Required for W-9 Form
COD Page 2 9/23/2011
DocuSign Envelope ID: 7BBA0820-D700-402A-9CC7-9E71013517C8
Exhibit
CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as
defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after
the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a
misdemeanor.
1 Name of vendor who has a business relationship with local governmental entity.
2
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business
day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information in this section is being disclosed.
Name of Officer
This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the vendor has an employment or other business relationship
as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer
named in this section AND the taxable income is not received from the local governmental entity?
Yes No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an
officer or director, or holds an ownership of one percent or more?
Yes No
D. Describe each employment or business and family relationship with the local government officer named in this section.
4
I have no Conflict of Interest to disclose.
5
Signature of vendor doing business with the governmental entity Date
DocuSign Envelope ID: 7BBA0820-D700-402A-9CC7-9E71013517C8
X
N/a
N/A
FX5 Utility Construction LLC
12/10/2020
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Certificate Of Completion
Envelope Id: 7BBA0820D700402A9CC79E71013517C8 Status: Completed
Subject: Please DocuSign: Assignment of Contract
Source Envelope:
Document Pages: 111 Signatures: 6 Envelope Originator:
Certificate Pages: 5 Initials: 0 Cheyenne Defee
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
901B Texas Street
Denton, TX 76209
cheyenne.defee@cityofdenton.com
IP Address: 198.49.140.104
Record Tracking
Status: Original
12/9/2020 1:23:43 PM
Holder: Cheyenne Defee
cheyenne.defee@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
David Fuller
dfuller@fx5construction.com
President
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 107.178.13.174
Signed using mobile
Sent: 12/9/2020 1:52:50 PM
Viewed: 12/10/2020 7:26:08 AM
Signed: 12/10/2020 7:29:03 AM
Electronic Record and Signature Disclosure:
Accepted: 10/26/2017 3:41:35 PM
ID: a5e3dcc1-cb03-4506-94d7-2a908ffd75c5
David Fuller
dfuller@fx5construction.com
President
FX5 Utility Construction LLC
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 107.178.13.174
Signed using mobile
Sent: 12/10/2020 7:29:06 AM
Viewed: 12/10/2020 7:29:42 AM
Signed: 12/10/2020 7:39:47 AM
Electronic Record and Signature Disclosure:
Accepted: 10/26/2017 3:41:35 PM
ID: a5e3dcc1-cb03-4506-94d7-2a908ffd75c5
Lori Hewell
Lori.Hewell@cityofdenton.com
Purchasing Manager
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.104
Sent: 12/10/2020 7:39:51 AM
Viewed: 12/10/2020 7:53:31 AM
Signed: 12/10/2020 7:53:41 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Contract Administrator
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 12/10/2020 7:53:44 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
David Fuller
dfuller@fx5construction.com
President
FX5 Utility Construction LLC
Security Level: Email, Account Authentication
(None)
Sent: 12/10/2020 7:53:45 AM
Electronic Record and Signature Disclosure:
Accepted: 10/26/2017 3:41:35 PM
ID: a5e3dcc1-cb03-4506-94d7-2a908ffd75c5
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 12/9/2020 1:52:50 PM
Certified Delivered Security Checked 12/10/2020 7:53:31 AM
Signing Complete Security Checked 12/10/2020 7:53:41 AM
Completed Security Checked 12/10/2020 7:53:45 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
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consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
Electronic Record and Signature Disclosure created on: 7/21/2017 3:59:03 PM
Parties agreed to: David Fuller, David Fuller, David Fuller
How to contact City of Denton:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: purchasing@cityofdenton.com
To advise City of Denton of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at melissa.kraft@cityofdenton.com
and in the body of such request you must state: your previous e-mail address, your new e-mail
address. We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in DocuSign.
To request paper copies from City of Denton
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to purchasing@cityofdenton.com and in
the body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with City of Denton
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign account, and on the subsequent
page, select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to purchasing@cityofdenton.com and in the body of such request you
must state your e-mail, full name, IS Postal Address, telephone number, and account
number. We do not need any other information from you to withdraw consent.. The
consequences of your withdrawing consent for online documents will be that transactions
may take a longer time to process..
Required hardware and software
Operating Systems: Windows2000? or WindowsXP?
Browsers (for SENDERS): Internet Explorer 6.0? or above
Browsers (for SIGNERS): Internet Explorer 6.0?, Mozilla FireFox 1.0,
NetScape 7.2 (or above)
Email: Access to a valid email account
Screen Resolution: 800 x 600 minimum
Enabled Security Settings:
•Allow per session cookies
•Users accessing the internet behind a Proxy
Server must enable HTTP 1.1 settings via
proxy connection
** These minimum requirements are subject to change. If these requirements change, we will
provide you with an email message at the email address we have on file for you at that time
providing you with the revised hardware and software requirements, at which time you will
have the right to withdraw your consent.
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you
were able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to
e-mail this disclosure and consent to an address where you will be able to print on paper or
save it for your future reference and access. Further, if you consent to receiving notices and
disclosures exclusively in electronic format on the terms and conditions described above,
please let us know by clicking the 'I agree' button below.
By checking the 'I Agree' box, I confirm that:
• I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and
• I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
• Until or unless I notify City of Denton as described above, I consent to receive from
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to me by City of Denton during the course of my relationship with you.