Tax 2009-CL110415 STATE OF TEXAS
11111111 11111111111 NOTICE TO PRIME CONTRACTOR AND
BONDING COMPANY
GOVERNMENT PROJECT
7196 9002 4000 1385 4946
Bildrs No: 3280231
CITY OF COPPELL RETURN RECEIPT
ENGINEERING DEPT 04/15/2011
255 PKWY BLVD Bildrs No.3280231
COPPELL TX 76019-9478 7196 9002 4000 1385 4946
RE: 92014034-GENERAL BUILDING MATERIALS
2009 STREET REPLACEMENT, SANDY LAKE & HEARTZ, COPPELL, TX 75019
Notice is hereby given pursuant to Tex. Govt. Code§2253.041 that HD SUPPLY/WHITE CAP CONSTRUCTION SUPPLY
has furnished materials or labor consisting of GENERAL BUILDING MATERIALS and related materials or labor pursuant to an
agreement with RKM UTILITY SERVICES INC, 92014000, 1171, 1544 VALWOOD PKWY STE#100, CARROLLTON TX
75006 for the above-referenced job for CITY OF COPPELL, 255 PKWY BLVD, COPPELL TX 76019-9478, ENGINEERING
DEPT. The materials were delivered and installed during the month(s)of Jan 11. To date, the amount due and unpaid for such
labor and/or materials is$5,833.54, which amount is now claimed by this notice.
Attached hereto is a sworn statement of account, which is made a part of this claim for all purposes. A copy of the invoices
that represent the materials delivered to the project that have not been paid for, may also be attached.
HD SUPPLY/WHITE CAP CONSTRUCTION SUPPLY
9950 S 134TH ST
OMAHA, NE 68138
800-209-3526
(1--Z6F2rZ
Title: BICA Representative
04/15/2011
BICA 1-800 722-2422
Owner: CITY OF COPPELL,255 PKWY BLVD,COPPELL TX 76019-9478,ENGINEERING DEPT
Orig Contr: RKM UTILITY SERVICES INC, 1544 VALWOOD PKWY#100,CARROLLTON TX 75006
Surety: ULLICO CASUALTY COMPANY, 1625 EYE STREET NW, WASHINGTON DC 20006,Bond#SB001000670,BOND DEPT
Customer:RKM UTILITY SERVICES INC, 92014000, 1171, 1544 VALWOOD PKWY STE#100,CARROLLTON TX 75006
Job No: 92014034
Form Rev: 12/06 VR
04/15/2011
STATE OF TEXAS
STATE GOVERNMENT FORM
Sworn Statement of Account
THE STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
BEFORE ME THE UNDERSIGNED AUTHORITY on this day personally appeared VICTOR
RODARTE who upon his/her oath,deposed and stated the following:
1) My name is VICTOR RODARTE. I am the Agent of the claimant named in the foregoing Notice,and
that I am informed and believe the facts herein to be true,and,on that ground,allege that the facts stated in
the foregoing Notice are true.
2) In accordance with a contract with RKM UTILITY SERVICES INC,92014000,1171,1544
VALWOOD PKWY STE#100,CARROLLTON TX 75006,HD SUPPLY/WHITE CAP
CONSTRUCTION SUPPLY has furnished GENERAL BUILDING MATERIALS in connection with
the building of the 2009 STREET REPLACEMENT,SANDY LAKE&HEARTZ,COPPELL,TX
75019.
3) The amount due and unpaid by RKM . t TY SERVICES INC,92014000, 1171 for such materials,
after allowing for all just and la offse ,payments,and credits known to me is$5,833.54,for which a
claim is hereby made. This .• ount is ' .:t and correct.
HD SU' 'LY/WH C C I TION SUPPLY
By:
Agent
9950 S 134TH ST
OMAHA,NE 68138
800-209-3526
SUBSCRIBED AND SWORN TO BEFORE me on this the 15 day of April,2011.
JENNY STELES
Commission # 1777347
/A' TY PUBLIC
W! a" Notary Public -California
'!�' Los Angeles County
Comm.Noires Nov28,2011
Bildrs No:3280231