HomeMy WebLinkAboutContract 56960-CA1CSC No. 56960-CAl
CITY OF FORT WORTH
ASSIGNMENT
For value, received Pall Corporation ("Assignor"), hereby assigns to Trojan Technologies
Corporation ("Assignee"), all of its right, title and interest in and to any and all sums of money to
become due from the City of Fort Worth to Assignor under PSK 18855/CSCO 56960 (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. This Assignment 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 legal effect as an original.
Dated the day of 2023.
Pall Corporation
(Assignor)
By:
Print: 1'=tNA �UGIt� 1.
Title: Chief Officer k
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Trojan Technologies Corporation
(Assign
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Print:
Ti Chief Financial Officer
CHRISTINE M. AMBROSINO
NOTARY PUBLIC -STATE OF NEW YORK
No. 01 AM6362052
Oualffied In Nassau County
My Commission Expires 07-24.2029
e4t:��Iq, A At449��
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Assignment Page 1 of
NOTARY ACKNOWLEDGEMENT
Oil the : IO f� day of S L t ' 2023, personally appeared
who acknowledged to me that (s)lie. is the Chief Operating Officer of pall
Corporation ("Assignor");. and that (s)lie executed this document for the purposes and
consideration contained herein.
B I Ccpor ion��_
Title: Chief Officer/) t
ff FIN" 1 �r
SUBSCRIBED TO liefore.me on this Jday of , Zt723.
CHRISTINE M. AMBROSINO1j.�
NOTARY PUBLIC -STATE OF NEW YORK ot�uy Public to and for the State of
No. Ot AMs362os2 My commission Expires:
Qualified In Nassau County
My Commission Expires 07-24-20215
NOTARY ACKNOWLEDGEMENT
On th �h day (if 2023, 2023, personally appeared
on Va who acknowledged to me that (s)he is the Chief Financial Officer of
Trojan Technologies Corporation ("Asslgnee"), and that (s)he executed this docannent for the.
purposes and consideration, contained herein:
a Trojat echnologies Co, c�Ation .
By.,
Rrint: �J _
Title Chief financial Officer
SUB3SCRMED TO before me on this day of 2023.
Notary Pub is i7i and for the °�of' C1
l M.
Mallss`a uawn 5ultt?,tland; ItiRtapkr%unc, tuwity of Middlesex, } ,My commission Expires: �/ 9
Ilinited to the att8"sta►fon o1 and the taking
-oFjlfdavits, focT(bladTecho up ULC and its
'eub91d des, aidoCiited &0IIie. and.aftiliates.
RC pirekSeptenber 10,06 , ti
Assign incnt
CHRISTtNE M. AMBROSINO
NOTARY PUBLIC -STATE OF NEW YORK
No. 01 AM6362052
Qualified In Nassau County
My Commission Expire.s07-24-2025'
Pup 2 ore'
CONSENT TO ASSIGNMENT
The City of Fort Worth consents to the assignment of Pall Corporation ("Assignor") to
Trojan Technologies Corporation ("Assignee"), of all its rights, title, and obligation owing, and
all funds due or to become due to Assignor under PSK 18855/CSC0.56960 as long as all terms
required of Assignor in said contracts are met by Assignee.
CITY OF FORT WORTH
Christopher H rder (Oct 23, 2023 10:44 CDT)
Department Director
Dom 5"1-a lk#
Dana Burghdoff (Oct �f, 2023 14�.A CDT)
Assistant City Manager
4Fman
d �ORT nod
Foaa ,e �Y dd
ATTESTED BY:
r11--
t
/, annn nExAsa4
Jannette Goodall, City Secretary
APPROVED AS TO FORM AND LEGALITY:
City of Fort Worth Assistant City Attorney
Contract Compliance Manager:
Oct 23, 2023
Date
Oct 23, 2023
Date
OU 23, 2023
Date
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.
s Oct 23, 2023
Employee Signature/Date
Contract Compliance Specialist
Title
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Assignment Plige 3 of
DocuSign Envelope ID: 8DD4A5E5-98F5-4E8B-9BAD-816CC7AFF08B
Request for Taxpayer
Form 9 (Rev. October 2018) Identification Number and Certification
Department of the Treasury
Internal Revenue Service ► Go to wwwJrs.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.
C N
C
ao
O
d
a
to
0
0
Trojan Technologies Corp
2 Business name/disregarded entity name, if different from above
Give Form to the
requester. Do not
send to the IRS.
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
following seven boxes. certain entities, not individuals; see
instructions on oaoe 3):
❑ Individual/sole proprietor or ❑✓ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate
single -member LLC
Exempt payee code (if any)
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) No -
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)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
❑ Other (see instructions) ► (Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional)
839 State Route 13
6 City, state, and ZIP code
Cortland, NY, 13045
7 List account number(s) here (optional)
JIM 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 (SSN). However, for a I _ m —
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
1 1
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.
8 5 —I 3 1 9 1 8 1 5 1 4 1 9 1 4
JIM 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 (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 code(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 dividen�s, �gu are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
� oc tgne by:
Sign Signature off fi aD�c U> August 4, 2023
Here U.S. person Do -Date Po-
ri i mi v ii uNi : i i
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
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Filing Number: 803885232
Original date of Filing: January 4. 2021
Formation date:
NIA
Tax ID:
32077231184
Name:
Trojan Technologies Corp.
Address:
29010 Avenue Paine
Valencia. CA91355 USA
Fictitious Narne:
NIA
Jurisdiction:
DE. USA
Foreign Formation
November 19. 2020
Date:
Entity Type: Foreign For -Profit Corporation
Entity Status: In existence
FEIN: 853985494
BUSINESS ORGANIZATIONS INQUIRY -VIEW ENTITY
�7
TROJAN
technologies,
DATE: September 13, 2023
TO: City of Fort Worth, TX
FROM: TROJAN TECHNOLOGIES CORPORATION
RE: NOTICE OF ASSIGNMENT
This notice ("Notice") is provided by Trojan Technologies on behalf of Pall Water also known as
Pall Advanced Separations Systems, a division of Pall Corporation, of the following:
Whereas, Pall Water also known as Pall Advanced Separations Systems, a division of
Pall Corporation, a part of Danaher Corporation's Environmental & Applied Solutions
("EAS") segment, and whereas Danaher Corp. announced its intention to separate its
EAS segment to create an independent, publicly traded company, Veralto, (the
"Transaction") (see: Danaher Announces Intention to Separate Environmental &
Applied Solutions Segment to Create an Independent, Publicly Traded Comoanv - Sep
14, 2022.1, and
2. In connection with the Transaction, the Pall Water assets, subject to consent where
required by contract, have been assigned and transferred by Pall Corporation to
Trojan Technologies Corporation (the "Assignment"), and
3. That the Assignment to Trojan Technologies Corporation occurred on August 25,
2023.
Trojan Technologies Corporation
By:
Jo Anne M. VanHooydonk
Chief Financial Officer
ttns:llinvestors.danaher.com/2022-09-14-Danaher-Announces-Intention-to-Separate
Environmental-Applied-S olutions-Se,zment-to-Create-an-Independent,-Publicly-Traded-
Companv
Trojan Technologies Group ULC
3020 Gore Road, London, Ontario, Canada, N5V 4T7
+1 (519) 457-3400 www.trojantechnologies.com
TROJAN UV ?aHaFILTPA I1Aquafine VVIQUA. scilsnes
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