HomeMy WebLinkAboutContract 46573-R3 DocuSign Envelope ID:C72FA3A7-0412-4372-A921-25641E069896
CSC No. 4(.5 i`%
CITY OF FORT WORTH
REQUEST TO EXERCISE RENEWAL OPTION
April 19, 2019
SIMPLYWELL, INC
Attn: Kim Stephan
75 Fountain St
Providence, RI 02902
Re: Contract Renewal Notice
Contract No. CSC No. 46573 (the"Contract")
Renewal Term No. 3: May 1, 2019 to April 30, 2020
The above referenced Contract with the City of Fort Worth(City)expires on April 30,2019
(the"Expiration Date"). Pursuant to section 2.2 of the Contract,this letter is to inform you that the
City shall renew 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.
This renewal may be executed in one or more counterparts,each of which when so executed
and delivered shall be considered an original, but such counterparts shall together constitute one
and the same instrument and agreement. Any signature delivered by a party by facsimile or other
electronic transmission (including email transmission of a portable document file(pdf) or similar
image shall be deemed to be an original signature hereto.
To agree to renew the Contract for an additional one(1)year period, please sign and
return this request to exercise renewal option, along with a copy of your current insurance
certificate, to the City.
Please log onto PeopleSoft Purchasing at: http://fortworthtexas.gov/purchasiniz to insure
that your company information is correct and up-to-date.
If you have any questions concerning this Contract Renewal Notice, please contact Vicki
Tieszen,M.A., CHPD, Wellness Manager at 817-392-8556.
Sincerely,
Susan Alanis
Assistant City Manager
OFFICIAL RECORD
CITY SECRETARY
RENEWAL No.3 OF CSC NO.46573FT ®RT H' Tag 1 172
DocuSign Envelope ID:C72FA3A7-0412-4372-A921-25641E069896
CSC No. 46573-R3
ACCEPTED AND AGREED:
CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the
person responsible for the monitoring and
administration of this contract, including
By: ensuring all performance and reporting
Name: S a Alanis requirements.
Title: Assistant City Manager
By: _
Name: Vicki Tieszen, .A., CI-AD
Title: Wellness/EAP Manager
ATTEST:
�R.
APPROVED AS TO FORM AND
EGALITY:
By:
Name: Mary Ky e
Title: City Secretary $y:
Or MA gow"
.. Name: Thomas Royce nsen
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: C-27225
Form 1295 Certification:Not Required
SIMPLYWELL, INC.
Docu84pmd by:
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Name: Kim Stephan
Title: General Counsel
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Corporate Counsel
OFFICIAL RECORD!
CITY SECRETARY
RENEWAL No.3 OF CSC NO.46573 FT. Wg4T"df2TX