HomeMy WebLinkAboutContract 48467-CA1 EIS&L) CITY
2020 CONTRACT NO.SECRETARY 7-CA�
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ECRETARY CITY OF FORT WORTH
ASSIGNMENT
For value received, Southeastern Security Consultants, Inc. ("Assignor"), hereby assigns
to SportsEngine, Inc. ("Assignee"), all of its right, title and interest in and to any and all sums of
money now due or to become due from the City of Fort Worth to Assignor under PSK 8557/
CSCO 48467 (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 L CA fit^.6-l" 2019.
Southeastern Security Consultants, Inc.
(Assignor)
By: -
Print: �
Title: eY C perXng Officer
SportsEngine, Inc.
(Assignee)
Print: m
Title: Chief Financial Officer
UFFiUAL.RECORD
CITY SECRETARY
FT. WORTH,TX
Assignment Page 1 of
NOTARY ACKNOWLEDGEMENT
On the day of y, 2019, personally appeared
�, who acknowledged to me that (s)he is the Chief Operating Officer of
Southern Securi Consultants, Inc., and that (s)he executed this document for the purposes and
consideration contained herein.
Southeastern Security Consultants, Inc.
x
BY: ,�-
Print: .
Title: Chief Operating Officer
SUBSCRIBED TO before me on this day of 'De(.P M b -- ,2019.
„�nnnnMnnnnN++►
KRISTA NJAN N
W=W~=
to u tc n an r e State of M1140 6_1A
My commission Expires:_ �(
NOTARY ACKNOWLEDGEMENT
On the �M^ day of bf t o JA bE 2019, personally appeared
( ,(Ttk 7`x who acknowledged to me that(s)he is the Chief Financial Officer of
SportsEngine, Inc., and that (s)he executed this document for the purposes and consideration
contained herein.
SportsEngine,Inc.
By:
Print:
Title: Chief Financial Officer
SUBSCRIBED TO before me on this y o ( 12019.
KF45TAMI M
Notary Room Notary Public in and f e State of IIoA Xf�
My commission Expires: 1131) aoaS
Assignment Page 2 of
CONSENT TO ASSIGNMENT
The City of Fort Worth consents to the assignment of Southeastern Security Consultants,
Inc. ("Assignor") to SportsEngine, Inc. ("Assignee"), of all its rights, title, and obligation owing
and all funds due or to become due to Assignor under PSK 8557/ CSCO 48467, as long as all
terms required of Assignor in said contracts are met by Assignee.
CITY OF FORT WORTH
/ Z 7 Zo Zo
Kevin Gunn, I teem Assistant City Manager D E
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yn is Garcia,Assistant Director—FMS DATE
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ATTESTED BY:
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At It
Kayser, City Secretar - TE
APPROVED AS TO FORM AND LEGALITY:
Jo . Strong, Assist At City Attorney
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CIAL RECOR SEA �, A,WORTH, TX
Assignment Page 3 of 3
NCS1MOW,
BACKGROUND SCREENING SOLUTIONS
SSCI IS NOW NCSI!
New name, same commitment to service
In early 2017, SSCI and the National Center for Safety Initiatives (NCSI)were acquired by
SportsEngine, Inc., an NBC Sports Group company. As SSCI and NCSI advance together as a
national leader in background screening services for civic organizations, youth sports
associations and national governing bodies we are proud to unite under the brand name of NCSI.
Together as NCSI,we have one goal -to protect vulnerable populations.
Through in-depth courthouse research and applicant identity verification, we work tirelessly to
provide the gold standard of safety through comprehensive background checks, training,
education, and unparalleled service.
Important Notes:
• Our phone number, mailing address, and billing information have not changed.
• Our website is currently being updated and you will see the new NCSI logo added in the
coming weeks.
• Our customer service team remains ready to provide you with the highest level of support
you've come to expect.
We look forward to continuing to serve you as NCSI, the leader in providing the gold standard of
safety to organizations across the country. If you have any questions, please do not hesitate to
contact us at: support!a ncsisafe.com.
The NCSI Team
Delaware Page 1
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY THE ATTACHED IS A TRUE AND CORRECT
COPY OF THE CERTIFICATE OF AMENDMENT OF 'SE BACKGROUND
SERVICES, LLC', CHANGING ITS NAME FROM "SE BACKGROUND SERVICES,
LLC" TO "NATIONAL CENTER FOR SAFETY INITIATIVES, LLC", FILED IN
THIS OFFICE ON THE NINETEENTH DAY OF APRIL, A.D. 2017, AT 9:25
O'CLOCK P.M.
y/ 'may
��Ai��B�� .IeMsy Yt.Cw1la�R d 3ta1E -
6277996 8100 � Authentication: 202403147
SR#20172644090 `""' Date:04-19-17
You may verify this certificate online at corp.delaware.gov/authver.shtml
State of Delaware
Secretary of State
Division of Corporations
CERTIFICATE OF AMENDMENT OF Delivered 09:25PNA041191017
FILED 09:25 PX104119/2017
CERTIFICATE OF FORMATION OF SR 20172644090 - Filevumber 6277996
SE BACKGROUND SERVICES, LLC
1. The name of the limited liability company is SE Background Services,
LLC.
2. Article 1 of the Certificate of Formation of the limited liability company is
hereby amended to read as follows:
.1. The name of the limited liability company is National
Center for Safety Initiatives, LLC."
IN WITNESS WHEREOF,the undersigned member has executed this
Certificate of Amendment this 19th day of April, 2017.
/s/Gabriela Komzweici
Gabriela Kornzweig
An authorized person
Execution Version
ASSET PURCHASE AGREEMENT
dated as of
February 28, 2017
by and among
SE Background Services,LLC or its nominee,
and
Southeastern Security Consultants Inc.
and
Byron R. Palmer
and
Randy L. Rodebaugh
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be duly
executed by their respective authorized officers as of the day and year first above written.
BUYER:
SE BACKGROUND SERVICES,LLC
Name: Aim a RooMbrd
Title: 1be Pt
oddwd
[SIGNATURE PAGE TO ASSET PURCHASE AGREEMENT]
IN WITNESS WHEREOF; the parties hereto have caused this Agreement to be duly
executed by their respective authorized officers as of the day and year first above written.
SELLER:
SOUTHEASTERN SECURITY CONSULTANTS
INC.
Name-*,,' ��m�'Z
Title: ��
PRINCIPALS:
-001
Byron R. Pat L,—=
Randy L. Rodebaugh
Forn w_9 Request for Taxpayer Give Form to the
(Rev.October2018) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS,
Internal Revenue Service 1 Go to www.irs.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.
SportsEngine Inc
2 Business nameldisregarded entity name,if different from above
National Center for Safety Initiatives LLC
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(c6M apply only to
following seven boxes. certain entities,not individuals;see
Q. instructions on page 3):
a ❑ Individuallsole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Tnrsvestate
single-member LLC Exempt payee code(if any)
' ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)►
`o 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)
a 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)► (AW"ro> ft mr twed- d.A4 u s)
�j 5 Address(number,street,and apt,or suite no.)See Instructions. Requester's name and address(optional)
807 BROADWAY ST NE STE 300
8 City,state,and ZIP code
MINNEAPOUS,MN S6413
7 List account numbers)here(optional)
IMH Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on tine 1 to avoid Jf Social security number
backup withholding.For individuals,this is generally your social security number(SSN.However,fora
resident alien,sole proprietor,or disregarded entity,see the instructions for Part 1,later.For other
entities,it is your employer identification number(EIM.if you do not have a number,see How to get a
TIN,later. or
Note.ff the account is in more than one name,see the instructions for fine 1.Also see What Name and Empiayer identification=ber
Number To Give the Requester for guidelines on whose number to enter.
4 5 - 2 1 9 1 0 1 4 1 51 T53
LZM 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,Rem 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 dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part 11,later.
Sign signature of
Here U.S.person► Data s `' r
General Instructions •Fomn 1099-DIV(dividends,including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISO(various types of income,prizes,awards,or gross
noted.
proceeds)
Future developments.For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.frs.gov1FormlNS. •Form 1099-8(proceeds from real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1D98-E(student loan interest),
Information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number •Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number(iTIIN),adoption •Form 1099 A{acquisition or abandonment of secured property)
taxpayer identification number(ATIN),or employer identification number
(EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return.Examples of information alien),to provide your correct TIN.
retums include,but are not limited to,the following. If you do not retum Form W-9 to the requester with a TW,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
later.
Gat.No.10231X Form W-9(Rev.10-2018)