HomeMy WebLinkAboutContract 46079-R4 CSC No.
CITY OF FORT WORTH
yvp� ` CONTRACT RENEWAL NOTICE
JU41*1018
UWS INC.
Zach Hughes
P O BOX 516
TRION,GA 30753
Email:zach.hughes@uwsinc.net
Phone:(706)734-0577
FAX: (706)734-0805
Re: REQUEST TO EXERCISE RENEWAL OPTION
Professional Services Agreement
Contract No. CSC No.46079(the"Contract")
Renewal Term No.4: August 1,2018 thru July 31,2019
The above referenced Contract will expire on July 31, 2018. Pursuant to the Contract, contract renewals are at the sole option of the
City. This letter is to inform you that the City is exercising its right to renew CSC No.46079 for an additional one year period,which
will begin immediately upon the expiration of the current term and will end on July 31, 2019. All other terms and conditions of CSC
No. 46079 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 Notice of Contract Renewal.
Please log onto BuySpeed Online at http://fortworthtexas.gov/purchasing 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 yours,
FMS,Purchasing Division
817-392-8355—Direct
817-392-8440—Fax
I hereby acknowledge receipt of the Contract Renewal Notice for CSC No.46079 for a one year period ending on July 31,2019
By: &"4 eawK, Rrts'de+'►f Date:
Printed Name and Title
Sig ure _
CITY OF FOR RTH: ATTEST:
Jesus"Jay"Chapaa�AAssssiistannt ity Manager M Ka er i ydtdry
cr
Date: / 7� M&C No. -y OF F91 �
°o
RECOMMENDED BY:
C 'st er ,H der,Irate Water Director
OFFICIAL RECORD
Date: ?13 0 l r8 CITY SECRETARY
FT.WORTH,TX
CSC No.
APPROVED AS TO FORM AND LEGALITY:
By: Lj��A �,4 - (L-,
Christa R.Lopez olds
Sr.Assistant City Attorney
Contract Compliance 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.
lf�'—
Edgar Garc' , ater Systems Superintendent
L'
Date: 7
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
l of l
Complete Nos.i-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2018-384846
UWS,INC
TRION,GA United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 07/26/2018
being filed.
City Of Fort Worth Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identity the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
46079
Water Meter Testing
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
5 Check only if there is NO Interested Party.
X
6 UNSWORN DECLARATION , t
My name is wc� and my date of birth is Coll 04 1 IcIsa
My address is-t'O 31,J=Sl U 7;-;M M C 30-15.3
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in a County, State of on the day of t�. 20_.
(month (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711