HomeMy WebLinkAboutContract 53677-R1 CSC No. 53677-R1
CITY OF FORT WORTH
CONTRACT RENEWAL NOTICE
September 9, 2020
Public Sector Personnel Consultants, Inc.
2824 N. Power Rd#113-486
Mesa, AZ 85215
Re: NOTICE OF CONTRACT RENEWAL
Process and Procedures Management Consultant
Contract No. CSC No. 53677 (the "Contract")
Renewal Term No. 1: January 6, 2020 to September 30, 2020
The above referenced Contract will expire on September 30, 2020. 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.
53677 for an additional one year period,which will be effective as of October 1, 2020 and will end on September
30, 2021. All other terms and conditions of CSC No. 53677 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 PeopleSoft Purchasing 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,
Cristina Macias
Administrative Assistant
Human Resources Department
817-392-7511
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
CSC No.
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
la 7 Chwa this contract, including ensuring all performance and
By: Jesus J.Chapa(Sep 22,2 2016:29 CDT) reporting requirements.
Name:Jesus J.Chapa
Title: Deputy City Manager
f'arw-e)
By: Harold Cates(Sep 22,2020 09:35 CDT)
Name: Harold Cates
APPROVAL RECOMMENDED: Title: Manager of Human Resources
APPROVED AS TO FORM AND LEGALITY:
Nafhan ,+r86fai'Y
By: Nathan Gregory(Sep 2,2020 09:43 CDT)
Name:Nathan Gregory
Title: Interim Director of Human Resources By: trong(Sep 22,202016: DT)
44nan
Name:11B Strong
ATTEST: � oo
� FORrooa�d Title: Assistant City Attorney
pro �id CONTRACT AUTHORIZATION:
°d*a P°* M&C: C-53677
By: aaaa�nez A50pp� Date Approved: January 6,2020
Name: Mary Kayser
Title: City Secretary
Public Sector Personnel Consultants, Inc.
By:
Name: 2 �,.V�12�fi�t�r�y
Title:
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY NUMBER: 601977762 17239
1st Edition
FARMERS
INSURANCE
ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS-
SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the fol lowing:
BUSINESSOWNERS LIABILITY COVERAGE FORM
BUSINESSOWNERS COVERAGE FORM
APARTMENTOWNERS LIABILITY COVERAGE FORM
CONDOMINIUM LIABILITY COVERAGE FORM
SCHEDULE
Name Of Additional Insured Location(s)Of Covered Operations
Person(s)Or Organization(s)
ITY OF FT WORTH
Information required to complete this Schedu le,if not shown above,will be shown in the Declarations.
A. The following is added to Paragraph C.Who Is An Insured of the applicable Coverage Form:
Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to
liabilityfor"bodily injury","property damage"or"personal and advertising injury"caused,in whole or in part, by
your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing
operations forthe additional insured(s)atthe location(s)designated above.
However:
a. The insurance afforded to such additional insured only applies to the extent permitted bylaw;and
b. If coverage provided to the additional insured is required by a contractor agreement,the insurance afforded
to such additional insured will not be broader than that which you are required by the contractor agreement
to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply:
This insurance does not apply to"bodily injury"or"property damage"occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work,on the project(other
than service,maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of
the covered operations has been completed;or
2. That portion of"yourwork"out of which the injury or damage arises has been put to its intended use by any person
or organization other than another contractor or subcontractor engaged in performing operations for a principal
as a part of the same project.
C. With respect to the insurance afforded to these additional insureds,the following is added to Paragraph D. Liability
And Medical Expenses Limits Of Insurance of the applicable Coverage Form:
If coverage provided to the additional insured is required by a contract or agreement,the most we will pay on behalf of
the additional insured is the amount of insurance:
1. Required by the contractor agreement;or
2. Available underthe applicable Limits Of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits Of I nsurance shown in the Declarations.
This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the
terms of the policy.
J7239-ED 1 02-19 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1
937239 J7239101
Farm 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 ►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.
Public Sector Personnel Consultants, Inc.
2 Business name/disregarded entity name,if different from above
c�5 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
gfollowing seven boxes. certain entities,not individuals;see
o. instructions on page 3):
p ❑ Individual/sole proprietor or ❑ C Corporation Z S Corporation ❑ Partnership ❑ Trust/estate
0 single-member LLC Exempt payee code(if any)
6 c
CL v ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)►
p 2 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
a v is disregarded from the owner should check the appropriate box for the tax classification of its owner.
y ❑ Other(see instructions)► (Applies to accounts maintained outside the U S.)
W 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional)
a 2824 N. Power Road#113-486
U)
6 City,state,and ZIP code
Mesa,AZ 85215
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(S However,fora m -
resident alien,sale 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 Now 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 Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
270 - 4 3 7 1 8 M96
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.I 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 dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part ll,later.
Sign Signature of �y _
Here U.S.person 0- 45Af Date► [4�
•Form 1099-DIV(dividends,includin11 g those from stocks or mutual
General Instructions
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.irs.gov/FormW9.
+ 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.10231 X Farm W-9(Rev.10-201 B)