Tax 2011B-CL131119 HEADQUARTERS
ilinniuteXaMS• 11107 Morrison Lane
Dallas I TX 1 75229-5603
p: 972-484-8465
f: 972-484-8466
1-800-492-2524
TO: American Safety Casualty Ins. Co. Bond#ASB-536482
100 Galleria Parkway#700
Atlanta, GA 30339 RE: Vanbebber Drive Project
AND
City of Coppell CPS Civil, LLC
Engineering Dept. PO Box 307
265 Parkway Blvd Grapevine, TX 76099
Coppell,TX 75019 Attn: Robert Farrow
We notify each of you that North Texas Bomanite, Inc. has a claim in the sum of One
Thousand Seventy One Dollars and 80/100 ($1,071.80)for labor performed and or
materials delivered during the month of May, 2013 on the referenced project. The labor
performed and/or materials furnished by us are generally described as follows: 8"
Stamped CCT Pavement with Integral Color. Such labor and materials were furnished to
CPS Civil, LLC pursuant to the terms of a written purchase order, a copy of which is
attached hereto.
The above amount is for the contractual retainage in the amount of $1,071.80.
This notice is sent in compliance with The McGregor Act,Article 5160 of the Revised
Civil Statues of Texas.
Dated this 19th day of November, 2013.
North Texas Bomanite, Inc.
BY:
STATE OF 'TEXAS
COUNTY OF DALLAS
Before me the undersigned authority on this day personally appeared Don Bruner, who,
after being by me duly sworn did depose and say:
1. My name is Don Bruner; I am the Vice President of North Texas Bomanite, Inc.
and am authorized to make this affidavit;
2. North Texas Bomanite,Inc. has a claim in the amount of One Thousand Seventy
One Dollars and 80/100 ($1071.80) for labor performed and/or materials delivered
during the month of May, 2013 for CPS Civil,LLC.
3. The amount of this claim is just and correct, and all lawful offsets, payments, and
credits known to the undersigned claimant have been allowed.
www.texasbomanite.corn
4. The amount of any retainage applicable to the account on which the claim is made
which has not yet become due by virtue of the terms of the contract on which the
above claim is made is $0.
5. The invoices of statements attached hereto are true and correct copies of the
originals of same which were sent to Greater Austin Development.
Don Bruner
^� t
Subscribed and sworn to before me this 19th day of November, 2013.
IA/AlitiA.)
Notary Public in and for Dallas County, TX
"N. Teresa Walker
'R Notary Public.
State of Texas
_A.;t restnaw► :11.204017
North Texas Bomanite,Inc.dba Texas Bomanite
11107 Morrison Lane I Dallas,TX 75229
• 0 972-484-8465 I F 972-484-8466
www.texasbomanite.com
Invoice
May 15,2013
Job Name:Van Bebber Drive Street Improvements
Job Number: 12149
Customer P.O.#: CV1205-006
Phone: 817-251-5190 Original Contract: $21,448.50
Fax: Change Orders: $0.00
Total: $21,448.50
Percent Complete: 100%
CPS Civil, LLC
PO Box 307
Grapevine,TX 76099
Pay Request#: 3-Retainage
From May 1,2013 to May 31,2013
t i
Y ,�',, ga�£'fK,'f�i."m 1C 1 i m
f
}",,,44,:e) St� ' •Contract
110 8"Stamped CCT Pavement SY 181.00 0.00 181.00 $118.50 $0.00 $21,448.50
w/Integral Color
Extra WorWChange Orders
Total Amount of Work Performed $0.00 $21,448.50
Less Retainage 0.00% $0.00 $0.00
Net Amount Payable on Contract $0.00 $21,448.50
Less: Special Deductions
Plus: Extra Work
Net Amount Due on Project $21,448.50
Less Payments Received to Date $20,376.70
Current Amount Due on Project $1,071.80
Amounts Unpaid from Prior Invoices
Amounts Due From Current Invoice $1,071.80
Current Amount Due North Texas Bomanite $1,071.80
North Texas Bomanite,Inc.dba Texas Bomanite
1107 Morrison Lane I Dallas,TX 75229
0 972-484-8465 I F 972-484-8466
www.texasbomanite.com
Invoice
May 15,2013
Job Name:Van Bebber Drive Street Improvements
Job Number: 12149
Customer P.O.#: CV1205-006
Phone: 972-674-2950 Original Contract: $21,448.50
Fax: 372-674-2952 Change Orders: $0.00
Total: $21,448.50
Percent Complete: 100%
CPS Civil, LLC
1215 Crest Lane Drive
Duncanville,TX 75137
Pay Request#: 3-Retainage
From May 1,2013 to May 31,2013
TriTtiSlt,WISIRZ19.44
.. as vP. T i 1 F =� 1, msq 'i.$0 d t�fuotr, „4„.. La
Contract
110 8"Stamped CCT Pavement SY 181.00 0.00 181.00 $118.50 $0.00 $21,448.50
w/Integral Color
Extra WorWChange Orders
Total Amount of Work Performed $0.00 $21,448.50
Less Retainage 0.00% $0.00 $0.00
Net Amount Payable on Contract $0.00 $21,448.50
Less: Special Deductions
Plus: Extra Work
Net Amount Due on Project $21,448.50
Less Payments Received to Date $20,376.70
Current Amount Due on Project $1,071.80
Amounts Unpaid from Prior Invoices
Amounts Due From Current Invoice $1,071.80
Current Amount Due North Texas Bomanite $1,071.80
PU C SE ORDER cpscivil
12/6/2012
The following number must appear on all related correspondence, shipping papers,and invo ik
P.O.NUMBER: CV1205-006
TO: SHIP TO: DEC 17 2012 III
Texas Bomanite Vanbebber Drive
11107 Morrison Lane Coppell,TX 75019 ICI 1
Dallas,TX 75229 Attn: Chris Bailey 817-368- 4 •
972-484-8465 Pat Jojola 214-998-8782
P.O. DATE REQUISITIONER SHIPPED VIA F.O.B.POINT TERMS
December 6,2012 TBD Pay when Paid
ITEM DESCRIPTION UNIT QUANTITIY UNIT EXTENDED
PRICE PRICE
110 8"stamped cct pvmt w/integral color SY 181 $118.50 $21,448.50
jobsite mockup-if required LS 1 $550.00 $550.00
$0.00
$0.00
$0.00
$0.00
f SUBTOTAL $21,998.50
SALES TAX exempt
TOTAL AMOUNT $21,998.50
1. Provide materials and service in accordance with the
specifications,plans,general conditions, special
conditions of general contract.
2. Send all accounts payable correspondence to:
CPS Civil,LLC
Attn:Mary Dupree
mary@cpscivil.com
1215 Crest Lane Drive
Duncanville,TX 75137 _ I2 /?J�Z
p 972-674-2950 f 972-674-2952
CPS Civil, LL / Da e
3. Paid by invoice based on unit price and actual quantities
delivered and approved of by Contractor via Owner.
4. Unless otherwise specified in the general contract,all ,t��
invoices must be received by the 25th of each month to 12- it )�Z
bepaid for with the same month's payment from the Texas Bomanite Date
Oarorr_
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