HomeMy WebLinkAboutContract 52883-R4CSC No. 52883-R4
CITY OF FORT WORTH
REQUEST TO EXERCISE RENEWAL OPTION
June 22, 2023
One Call Concepts, Inc.
Attn: Adam Franco
7233 Parkway Drive, Suite 210
Hanover, MD 21076-1391
Re: Contract Renewal Notice — 4th Renewal
Contract No. CSC No. 52883
Renewal Term: June 30, 2023 to July 1, 2024
Renewal Amount: $28.080.00
The above referenced Contract with the City of Fort Worth expires on June 30, 2023 (the
"Expiration Date). This letter is to inform you that the City is exercising its right to renew the
contract for its 1 st term in an amount up to $28,080.00, which will be effective immediately after
the Expiration Date. All other terms and conditions of the contract remain unchanged. Please sign
and return the second page of this letter, along with a copy of your current insurance
certificate, to the undersigned.
Please log onto PeopleSoft Purchasing at http://fortworthtexas.�ov/Durchasiniz to insure
that your company information is correct and up-to-date.
If you have any questions concerning this Contract Renewal Notice, please contact me at
the telephone number listed below.
Sincerely,
Regina Jones
Regina Jones
Contract Compliance Specialist
817-392-8277
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Contract Renewal Page 1 of 2
ACCEPTED AND AGREED:
ICTTY OF FORT WORTH
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the _
person responsible for the monitoring and
Dana BUL4�HdoAc
administration of this contract, including
By: Dana Burghdoff (JurK, 202319:28 CDT)
ensuring all performance and reporting
Name: Dana Burghdoff
requirements.
Title: Assistant City Manager
APPROVAL RECOMMENDED:
Name: Regina Jones
Title: Contract Compliance Specialist
APPROVED AS TO FORM AND
By: Christopher Ffarder fJun 23.2023 08:38 CDT)
LEGALITY:
Name: Chris Harder
Title: Water Director a� FORTa�
°�p9�dG
/.g
ATTEST:oo
p
I� .+h�smt� �E4p4o
By. RRlark! iiil F 7n731C-41 CnT)
Name: Doug Black
By.
Name: Jannette Goodall
Title: Assistant City Attorney
Title: City Spy
CONTRACT AUTHORIZATION:
M&C: N/A
Date Approved:
Dne Call Concepts, Inc.
i
By:
Name: Adam Franco
Title: Director of Operations
Form 1295 Certification No.: 2020-623439
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Contract Renewal Page 2 of 2
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
Complete Nos. 1 •4 and 8 if there are lnterested Parties.
OFFICE USE ONLY
Compieto Nai. 1, 2, 3, 5, and S If [bete are"60 Interested parties,
CERTIFICAMN OF RUNG
1. Name of business entity filing form, and the City, state And country of the business entlty's place
Certlttcate Number,
of business.
2020-623435
One Call Concepts, Inc.
Hanover, MO United States
Date Filed_
2 Name of governmental entity or.state agency that in R party to the contract for which the form is
05n6/2020
boing filed,
City of Fort Worth
Date Acknowledged:
g provide the Identification number used by the governmental entity or.ftate agency to track or identify the contract, and provide a
description of the srrvtces, goods, or other property to be provided under.the contract,
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Nature 01_Int4wost .
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Name of Interested party _
Clty, Stater Country (pi4pe of busina�s) (cheek applicable)
I .controilin g
interme8 tart
Hanover Jnvest'nents, Inc., Hanover, MD United Stales
X
Fforenza, Dan }ianover, MD United"States
I }(
Holzer, James f�Iscslaway, NJ United Stated
X
Plantoo. Frank Porflond, QR United States
! X
Parks, Data Hanover, MD United States
Latham, Thelma Baton. Rouge; LA United States
X I
Schmidt, Connie Wav"I.0sa, Wt united Staten
X . J
Rvddo, Kelly -�larlover, MD Untied States
X
Hoff, Tom Hanover, MO Uniled States
Jester, Davin Wichhai. KS United States
X
Peterson, Randy
Wauwatosa; WI United States
X II
Franco, Adam Sumsv le, MN United States
. I,
X
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Forms provided by Texas Ethics Commission YAwi.ethics,smte,ix.us
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Version VIA 3a6aaf7d
CERTIFICATE OF INTERESTED PARTIES FoRrvl 1295
2of2
Complete Nos. 1- 4 and 6 it thereare interested partlesz OFFICE USE ONLY .
Complete Nos. 1, 2, 3, 5, and 6 It there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity tiling form, and the city, state and country of the business entity's place Cettiflcate Number:
of business. 2020-62.3439
One Cal( Concepts, Inc.
Hanover, MD United States Otte Flied:
2 Name at govemmental epdty of state agency ihdt Is a parry to the contract for which the, form Is 05/2612020
being hied,
City of Fort Worth Date Acknowledged;
3 Provide the identification number used by .the governmental entity of Rite agency to track or Identify the contract, and provides
description of the s4rvlces, goods, or other, property to be provided under the contract, .
LTM FTW
Cloud based Tic*etManagameril services.
'a - I+iatun of interest
Name of Interested Fatty City, State, Country (puce of business) (ch+fck appticebte)
Controlling Intermediary
5 Check only K there Is NQ interested Party:
A UNSWORN MCL%A�RA fTION ` r
My name is E—i 1 .- i �'� • r r :+ s and my date of birth is .- Q f o e//.fq v 1
My address is % 7�11{.;{:fr i' ( U c ^a�� _� �7 3 ?
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(afreet) lSn!) MAW (IV case) _ (ox0y)
I declare under penalty of�jperjury that the foregoing is rove and correct
Execu(ptltni c 4t Cotmty, 81001,.8 pAtife.da.Vof :>r'_
/r _�____ (q Mil (year)
Signature of au`$orized aaerd of contracting business entity
Forms provided by Texas Ethics Commission www.ethics.State,fx.-Vs Version VU,Waarta