HomeMy WebLinkAboutContract 39524-NC1 CITY SECRETARY
R�cErvE° CONTRACT NO. 3Q 5a
MAY 15vova 20
` C�C17y SECN ARY H
Memoimdm
Date: 5/15/2020
To: JB Strong,Assistant City Attorney
Return to: Tracy Walter,Vendor Management-Purchasing
Re: WebQA,Inc to GovQA,LLC—Name change only
Prior Name: WebQA,Inc—Supplier ID: 0000033676
New Name: GovQA,LLC
**** City Secretary Agreement 39524****
APPROVED BY:
JB Strong,Assistant City Attorney
May 15,2020
APPROVAL DATE:
For. W-9 Request for Taxpayer Give Form to the
(Rev.October2018) Identification Number and Certification requester.Do not
Dartmertt of Me T IIntema)Revenue Service ry ►Go to wwwJrs.gov/FormW9 for instructions and the latest information, send to the IRS.
1 Name(as shown on your income tax return).Name is regwrea on this tine:do not leave this fine blank.
GovQA,LLC
2 Business name/disregarded entity name,J different from above
m3 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
M following seven boxes, certain entities,not individuals;see
a instructions on page 3):
o ❑ Individuai/sote proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate
C single-member LLC Exempt payee code(if any)
y ✓❑ Limited liability company.Enter the tax classification(C-C corporation,S=S corporation,P=Partnership)► P
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
C LLC If the LLC is classified as a sin le-member LLC that is disregarded from the owner unless the owner of the LLC is y)
d u another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that co de¢f an
is disregarded from the owner should check the appropriate box for the tax classification of Its owner.
m ❑ Other(see instructions)► wow•.r,M.00mk. .dowown.ust
5 Address(number,street,and apt.or su::e no.)See instructions. Requester's name and address(optional)
900 South Frontage Road, Suite 110
6 City,state,and ZIP code
Woodridge,IL 60517
7 List account number(s)here(optional)
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,fora � ^ ;� —��
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
TiN,later, or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Empioyer identification number
Number To Give the Requester for guidelines on whose number to enter.
M36 — 4 3 8 9 1 5 1 5 181
OMM Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or 1 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 1 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 dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part II,later.
Sign Signature of
Here lu.s.piersonl- Date► / 7 ZC
General instructions •Form 1099-DIV(dividends,including those from stocks or mutual
funds)
Section references are to the internal Revenue Code unless otherwise .Form 1099-MISC(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.1rs.gov1FormW9. .Form 1099-S(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),1098-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(ITIN),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.
returns include,but are not limited to,the following. if you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
later.
Cat.No,10231X Form W-8(Rev.10-2016)
GovQA, LLC
900 S Frontage Rd.Suite 110
Gov - Woodridge, IL 60517
` Office (630)985-1300
August 8, 2019
Subject: Change of Company Name and Entity Type
We are pleased to inform you that instead of doing business as GovQA, WebQA Incorporated
has now formally changed our company name, effective June 27, 2019, to GovQA, LLC.
This name and entity change is administrative only and our commitment to you as a customer
has not changed. We will continue to provide the same quality of services and the same
dedicated team of consultants, project managers, and other professionals.
Please be advised that our FEIN has not changed as a result of this name and entity change.
For your records, we enclose a current Form W-9 reflecting the new entity name. All our
business correspondence will now reflect the GovQA, LLC name. If your company requires any
changes to our contract documents or has any other procedural requirements, please advise at
your earliest convenience and we will work with you to process any required documentation.
If you have any questions regarding the name change, please contact Gerard Gozum (Jerry) at
igozumagovga.com or (630) 633-7388 and Kim Sullivan at ksullivana-govga.com or (630) 633-
7334. Thank you for your continued business and we look forward to continuing to serve you.
Sincerely,
4zd-
Will Repole
COO
GovQA, LLC
GovQA is the Nation's#1 provider of public records and enterprise workflow solutions for Government.The
GovQA SAAS Exchange Platform enables the Nation's top cities, counties, and state agencies to securely
collect and control time sensitive information within, across, and outside Governments.
09/19/2019 1 : 09:27 PM WBD—US PAGE 3 OF 8
Form 422 '^ = F 1 L E
(Revised 05/11) 1n tl}a Office ►
Secretary of State+ 9
Return in duplicate to:Secretary of State SEt"p
19 201
P.O. Box 13697
Austin,TX 78711-3697 Amendment to Registration Corpordon8 Section
512 463.5555 To Disclose a Change Resulting from
FAX: 512/463-5709 A Conversion or Merger
Filing Fee: See instructions
Entity Information
1. The legal name of the convening or merging entity is:
WebQA Incorporated
State the nine of the entity as currently shorn in the records of the secreraly of state.
2, If the entity attained its registration under an assumed name, the qualifying assumed name as
shown on the records of the secretary of state is:
3. The application for registration was issued to the entity un: 4/20/2015 �
u,nJJd/y�yg•
The file number issued to the filing entity by the secretary of state is: 802198578
Reason for Transfer of Registration
4A. V1 The application for registration is amended to disclose a change resulting from a conversion
from one type of foreign entity to another type of foreign filing entity in order for the converted entity
to succeed to the registration of the converting entity, The name,jurisdiction of organization, and
entity type of the converted entity succeeding to the registration arc:
GovQA,LLC _
Name of Enttry S„oeeeding to Registration
_Delaw_ar_e_ Limited Liability Co_m_ pang
Jurisdicrian a/O,g air i_aIiun N-of ErttiA•
03. ❑The application for registration is amended to disclose a change resulting from a merger into
another foreign filing entity in order for the entity that survived or resulted from the merger to succeed
to the registration of the merging entity. The name,jurisdiction of organization,and entity type of the
entity succeeding to the registration are:
Ann,r of Emit,Sr,cceeding in Regislralion — ---•T_ —
Jariidirtion ofOrgoni_arian --- --_ Tjw of Endly
Changes to the Application for Registration
(Attach a completed application for registration.)
S. The entity succeeding to the registration hereby attaches an application for re gistration,settingforIh;
the information applicable to that entity and amends the prior registration accordingfy: ' i ' i;j11F
font 422 3
. i
09/19/2019 1 : 09:27 PM WBD—US PAGE 4 OF 8
Effectiveness of Filing(select either A,13,or Q
A. ®This document become"s effective'when the document is filed by the secretary of state.
B. ❑ This document becomes effective at a later date,which is not more than ninety(90)days from
the date of signing. The delayed effective date is:
C. ❑This document takes effect upon the occurrence of a future event or fact,other than the
passage of time. The 901"day after the date of signing is:
The following event or fact will cause the document to take effect in the manner described below:
Execution
The undersigned signs this document subject to the penalties imposed by law for the submission of a
materially false or fraudulent instrument.
Date: t -
By:
S121 ature of authorized person(see instructions)
Jon Dilenschneider
Typed or printed name of authorized person
Form 422 4
09/19/2019 1 :09: 27 PM WBD—US PAGE 6 OF 8
Form 304 This space reserved for office use.
..
(Revised 05/11)
Submit in duplicate to:.. .'. .° ," ' i
Secretary of State '
P.O.Box 13697
Austin.TX 78711-3697 Application for
512 463-5555 Registration
FAX: 512/463-5709 of a Foreign Limiled
Filing Fee: $750 Liability Company
L The entity is a foreign limited liability company. The name of the entity is:
GovQA, LL.0
Provide the frdl legal name ofthe entily as stated in the enin),'s fonnation document in its jurisdiction offornration.
2A. The name of'lhe entity in its jurisdiction of formation does not contain the word `limited liability
company'or"limited company" (or an abbreviation thereof). The name of the entity with the word or
abbreviation that it elects to add for use in"Texas is:
213. The entity name is not available in 'Texas. The assumed name under which the entity will qualify
and transact business in Texas is:
The assumed name must include on acceptable organizational identifier or an accepted abbreviation ofone ofthese terms.
3. Its federal employer identification number is: 36-4389558
❑ Federal employer identification number information is not available at this time.
4. It is organized under the laws of:(set lorth state or foreign couniry) Delaware
and the date of its formation in that jurisdiction is: 06/25/2019 T
muvdd!vvyY
5. As of the date of filing, the undersigned certifies that the foreign limited liability company
currently exists as a valid limited liability company under the laws of the jurisdiction of its formation.
6. The purpose or purposes of the limited liability company that it proposes to pursue in the
transaction of business in"Texas are set forth below.
Software development and sales
The entity also certifies that it is authorized to pursue such stated purpose or purposes in the state or
country under which it is organized.
7, The date on which the foreign entity intends to transact business in Texas,or the date on which the;
foreign entity first transacted business in Texas is: 06/27/2019
.nmidd/yyav Latt fees may apply(see instnrcliorrs).
8. The principal ofrice address of the limited liability company is:
900 South Frontage Rd.,Ste. 110 Woodridge IL USA, ,60517-_,.._...,,_ _ .. ..
Address _— —^— city — — State _Cotrnrry ' Vip{Poslali(Fode Il�4�
L ' of I.
Form 104 6
09/19/2019 1 :09:27 PM WBD—US PAGE 7 OF 8
Complete item 9A or 913,but not both.Complete item 9C.
n 9A. The registered agent is an organization(cannot he entity named above)by the name of:
„• _O'Corporation System OR
❑ 9B. The registered agent is an individual resident of the slate whose name is:
First Name hf.l. — Los(Name Suffix
9C. The business address of the registered agent and the registered office address is:
1999 Bryan Street,Suite 900w_ _� Dallasy _! TX 75201
es
Street Addrs City State Zip Code
10. The entity hereby appoints the Secretary of State of Texas as its agent for service of process under
the circumstances set forth in section 5.251 of the Texas Business Organizations Code.
11. The name and address ofeach governing person is:
NAME AND ADDRESS OF GOVERNING PERSON(Enter thr name orcither an individual or art organization,but not both.)
IF INDIVIDUAL
First Name M.L Last Name - ___.._..-•Sub/s _-——
OR
IF ORGANIZATION
GovQA I loldings, LI.0
(Jrgoniratioa Narnr. __.. -- --__—__-,_.------------_---•- _---I
900 S. Frontage Rd. Ste. 110 Woo,diid c I USA 60517 '
Street ar MailAddresr Stote Country_Zip Code
NAME AND ADDRESS OF GOVERNING PERSON('Enter the name oreither an individual or an mAwiretion.but not both.)
IF INDIVIDUAL
-First Nome — M.L. Last Name --- ___-- .-_.-
OR I
IF ORGANISATION
t
Organization Nome
i
t
i
street ar Maifir�Address City _-� State Country lip('ode_
NAME AND ADDRESS OF GOVERNING PERSON(enter the name oreither an individual or an urpnization,but not both)
IF INDIVIDUAL
First Namc M.l. - -/.a.st Namc suffix
oil
as
IF ORGANIZATION
OrRanizatiorrNamr
Sxrael ar Uadin Address Y City _stare Country Zip Code
Fonn 304 7
09/19/2019 1 :09:27 PM WBD—US PAGE 8 OF 8
Supplemental Provisions/Information
Text Area: The attached addendum,irapy,is incorporated herein by reference.]_
Effectiveness of Filing(select either A,B.or C.)
A. 0 This document becomes effective when the document is filed by the secretary of state.
B.❑This document becomes effective at a later date,which is not more than ninety(90)days from
the date of signing. The delayed effective date is:
C.❑This document takes effect upon the occurrence of a future event or fact,other than the
passage of time. The 901h day after the date of signing is:
The following event or fact will cause the document to take effect in the manner described below:
Execution
The undersigned affirms that the person designated as registered agent has consented to the
appointment. The undersigned signs this document subject to the penalties imposed by law for the
submission of a materially false or fraudulent instrument and certifies under penalty of perjury that the
undersigned is authorized under the provisions of law governing the entity to execute the filing
instrument.
Date:
r
Sigma ire of authorized person(see instructions)
John Dilenschneider
Printed or typed name of authorized person.
Form 304 g