HomeMy WebLinkAboutContract 52835-R2 CSC No.52835-R2
CITY OF FORT WORTH
CONTRACT RENEWAL NOTICE
October 20, 2021
Work Loss Data Institute, LLC
PO Box 742350
Atlanta GA 30374-2350
Re: Contract Renewal Notice
Contract No. CSC No. 52835 (the" Contract")
Renewal Term No.2: September 26, 2021 through September 25, 2022
The above referenced Contract with the City of Fort Worth expired on September 25, 2021 the ("Expiration Date").
Pursuant to the Contract, contract renewals are at the sole option of the City. This letter is to inform you that the City
requests renewal of the Contract for an additional one (1)year period,which will begin immediately after the
Expiration Date.All other terms and conditions of the Contract remain unchanged. Please return this signed
acknowledgement letter, along with a copy of your current insurance certificate, to the address set forth below,
acknowledging receipt of the Contract Renewal Notice.
To ensure that your company information is correct and up-to-date, please log onto PeopleSoft Purchasing at
https://www.fortwoghtexas.gov/departments/finance/purchasing
If you have any questions concerning this Contract Renewal Notice, please contact me at the telephone number
listed below.
Sincerely,
z4m
Chris Lam
Workers' Compensation Manager
Christopher.lam(a)fortworthtexas.gov
(817) 392-6398
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
ACCEPTED AND AGREED:
CITY OF FORT WORTH, TEXAS CONTRACT COMLIANCE MANAGER:
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract,
including ensuring all performance and reporting
requirements.
gy;Jesus J.Chapa t29, 02109:16 CDT) By: f--I.ci
Jay J. Chapa Chris Lam
Assistant City Manager Workers' Compensation Manager
Date: Oct 29, 2021 Date: 10/26/2021
APPROVAL RECOMMENDED: ATTEST:
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By: `� Uazt� y: a o B o
Mark J. Barta Mary J. Kayser �vo 0X
Assistant Director Human Resources City Secretary �P� �0000 00*9d
10/26/2021 NOv 2, 2021 a�a 00000, ICY
Date: Date: �4nEXA ob
APPROVED AS TO FORM AND LEGALITY:
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By:J trong(Oct 29,202109:0 DT)
John Strong
Assistant City Attorney
Date: Oct 29, 2021
VENDOR:
Work Loss Data Institute, LLC
By:
Name:
Title:
Date: 10/20/21
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX