HomeMy WebLinkAboutContract 51688-CA1 CITY SECRUARY
COWRAca m.
CITY OF FORT WORTH
ASSIGNMENT
For value received, Life Account, LLC ("Assignor"), hereby assigns to Alight Solutions
LLC ("Assignee"), all of its right,title and interest in and to any and all sums of money now due
or to become due from the City of Fort Worth to Assignor under PSK 7013, 7014 & 7015/CSCO
51688 (the "Contracts") and Assignee agrees to assume and perform all duties and obligations
required by Assignor under the terms of the Contracts.
This Assignment constitutes the entire agreement between Assignor and Assignee with
respect to the subject matter hereof. No modification of any provision of this Assignment shall
be effective unless in writing and signed by Assignor and Assignee. This Assignment shall inure
to the benefit of and be binding upon Assignor and Assignee and their respective successors and
assigns Assignment Assignent shall be governed by the terms of the-original Contracts between
Assignor and various other entities and the City of Fort Worth and the laws of the State of Texas,
without application of principles of conflicts of law.
This Assignment may be executed in one or more counterparts each of which shall be
deemed an original but all of which together shall constitute one and the same instrument.
Signed signature pages may be transmitted by facsimile or e-mail, and any such signature shall
have the same Iegal effect as an original.
Dated the 27th day of January,2020.
Life Account, LLC
(Assignor)
By:
Prin . & .
Tit : Chief Operating Officer
Alight Solutions LLC
(Assi
By:
Print: Erin Slitt
Title: VP -Legal
RECEIVED �
1hAft ti 8 2024 DFFICIM� RECORD
ctt IV COTY SECRETARY
PT. WORTH, rx
Assignment Page 1 of 3
NOTARY ACKNOWLEDGEMENT
On the day of 2020, personally appeared
�} �ho acknowledged to me that (s)he is the Chief Operating Officer of Life
Account, LLC, and that Whe executed this document for the purposes and consideration
contained herein.
Life Account, LLC
By:
Print'
Title: Chief Operrating O icer
SUBSCRIBED TO before me on this i day of 2020.
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'' ,r h�ot�ry Puai�u,Sate of Texas '
a CdFv n Expires 04-27-2023 My commission Expires:
NolaryiD 124 0748?
NOTARY ACKNOWLEDGEMENT
On the day of ,��-'-' 2020, personally appeared
(� who acknowledged to me that he is the VP - Legal of Alight
Solutions LLC, and that he executed this document for the purposes and.consideration contained
herein.
Alight Solutions LLC
By:
Print: . z'
Title: '--
SUBSCRIBED TO before me on this day of 2020.
Notary Public in and for the St of
My commission Expires: -,5 �v
official seed
Ann l Olsxowaici OFFICIAL, RECORD
tLMNotary Public state of Illinois
MY mrrris�slo Aires�5� f128atI CITY SECRETARY
F'f. WORT 0
Assignuient
CONSENT TO ASSIGNMENT
The City of Fort Worth consents to the assignment of Life Account, LLC ("Assignor") to
Alight Solutions, LLC ("Assignee"), of all its rights, title, and obligation owing and all funds due
or to become due to Assignor under PSK 7013, 7014 & 7015/CSCO 51688, as long as all terms
required of Assignor in said contracts are met by Assignee.
CITY OF FORT WORTH
Vla Z-DZ,0
Dana Burghdoff, sista ity Manager Date
John Padinjaravila Baby, FMS Purchasing Manager Date
ATTESTED BY:
T<` -OR�:
t
Mary Ka cr, ity lecretary ` i Date
APPROVED AS TO FORM AND LEGALITY:
Joky . Strong, Assist4rt City Attorney
LECRETARY
OFFICCI ,A EC RC,.
T' - WORTH,H,
Assignment Page 3 of 3
H-111i—,-Nddmd.
December 31, 2019
Dear Valued Client:
i
In July 2018, Alight Solutions, a leader in technology-enabled health, wealth and
HR solutions,acquired Compass Professional Health Services. Bringing together
Compass' intuitive technology and healthcare experts with Alight's industry-
leading benefits administration platform allows us to help people navigate the
complex and costly healthcare environment, when they need it most. j
As a valued client of Compass, this is to inform you that we are rebranding our
invoicing as part of our Alight integration. Effective with your January 2020 E
invoice, all invoices will come from Alight Solutions.
F
Attached is a copy of our current W9 for your records. i
For any questions or concerns please reach out to invoices0alight.com
Sincerely,
ALLISON GROVES
i
FINANCE DIRECTOR
i
I
I
II
1
Form Request foy 'faxpayev Give Form to the
lJ
(Rev.October2018) Identification number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service ®Go to www.1rs.gov/FormW9 for instructions and the latest information.
1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
TEMPO HOLDING COMPANY LLC
2 Business name/disregarded entity name,if different from above
ALIGHT SOLUTIONS LLC
m 3 Check appropriate box for federal tax classification of the person whose name is entered on fine 1.Check only one of the 4 Exemptions codes apply only to
� P Y P� { PP Y Y
following seven boxes. certain entities,not individuals;see
co
a instructions on page 3):
p ElIndividuallsole proprietor or ElC Corporation ElS Corporation ElPartnership ElTrust/estate
c single-member LLC Fxempt payee code(if any)
ao
.:,:S ❑,/ Limited liability company.Enter the tax classification(C-C corporation,S=S corporation,P=Partnership)® P
`p 3 Note:Check the.appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
� LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code(if any)
d s another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that
v is disregarded from the owner should check the appropriate box for the tax classification of its owner.
d ❑ Other(see instructions)► oWfles to aocounhmatntafned aWdde Me JJ.SJ
N 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional)
ai 4 OVERLOOK POINT
v7
6 City,state,and ZIP code
LINCOLNSHIRE, IL 60069
7 List account number(s)here(optional)
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals,this is generally your social security number(S .However,for a
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other
entities,it is your employer identification number(EIN). If you do not have a number,see How to get a
TIN,later. or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
M82 - 1 1 0 1 6 1 1 1 2 3 3
Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or r(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3.1 am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA codo(s)entered on this form(if any)indicating that i am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments
other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part 11,later.
Sign Signature of
Here U.S.person® ¢ _P -A+ bate P 01/06/2020
General Instructions •Form 1099-HIV(dividends,including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise .Form 1099-MISC(various types of income,prizes,awards,or gross
noted. proceeds)
Future developments.For the latest information about developments a Form 1099-8(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to wwwJrs.gov1FormW9.
•Form 1099-5(proceeds from real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to fife an •Form 1098(home mortgage interest), 1098-E(student loan interest),
Information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number v Form 1099-0(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption .Form 1099-A(acquisition or abandonment of secured property)
taxpayer identification number(ATIN),or employer identification number
(EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return.Examples of information alien),to provide your correct TIN.
returns include,but are not limited to,the following. If you do not return Form W--9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding_See What is backup withholding,
later.
Cat.No.10231X Form W-9(Rev.10-2018)
BUSINESS ORGANIZATIONS INQUIRY- VIEW ENTITY Page I of I
TEXAS SECRETARY of STATE
RUTH R. HUGHS
BUSINESS ORGANIZATIONS INQUIRY-VIEW ENTITY
Filing Number: 700920723 Entity Type: Foreign Limited Liability Company(LLC)
Original Date of Filing: November 15, 1994 Entity Status: In existence
Formation Date: NIA
Tax ID: 13622357914 FEIN:
Name: Ahgw SaluUons, LLC
Address: 100 HALF DAY ROAD, TAX DEPARTMENT
Lincolnshire, IL 60069 USA
Fictitious Name: NIA
Jurisdiction: IL, USA
Foreign Formation NIA
Date:
ASSOCIATED
REGISTEREDAGENT FILING HISTORY NAMES MANAGEMENT ASSUMED NAMES ENTITIES
Name Address Inactive Date
Corporation Service Company dlVa CSC-Lawyers Incorporating Service Company 211 E.7th Street,Suite 620
Austin,TX 78701-3218 USA
Order Return to Search
Instructions:
To place an order for additional information about a filing press the'Order' button.
https:Hdirect.sos.state.tx.us/corp—inquiry/corp inquiry-entity.asp?spage=ra&:Spagefrom=... 2/25/2020