HomeMy WebLinkAboutContract 52835-R1 CSC No.52835-R1
CITY OF FORT WORTH
CONTRACT RENEWAL NOTICE
December 7, 2020
Work Loss Data Institute, LLC
PO Box 742350
Atlanta GA 30374-2350
Re:Contract Renewal Notice
Contract No, CSC No, 52835(the" Contract")
Renewal Term No.1: September 26,2020 through September 25, 2021
The above referenced Contract with the City of Fort Worth expired on September 25, 2020 the("Expiration Date").
Pursuant to the Contract,contract renewals are at the sole option of the City.This letter is to inform you that the City
requests renewal of 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. 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 Contract Renewal Notice.
To ensure that your company information is correct and up-to-date, please log onto PeopleSoft Purchasing at
httos://www,fortwodhtexas.gov/departments/finance/purchasinq
If you have any questions concerning this Contract Renewal Notice, please contact me at the telephone number
listed below.
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Sincerely,
Chris Lam
Workers'Compensation Manager
Christopher,arn0fortworthtexas.gov
(817) 392-6398
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OFFICIAL RECORD j
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CITY SECRETARY
FT.WORTH, TX
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ACCEPTED AND AGREED.
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CITY OF FORT WORTH,TEXAS CONTRACT COMLIANCE MANAGER:
By signing I acknowledge that I am the person responsible l
for the monitoring and administration of this contract,
Including ensuring all erformance and reporting i
requirements,
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By;Jesus Cliapa(Jan W—202100:52 CST) -
Jay J.Chapa ChrisTam
Assistant City Manager Workers'Compensation Manager
Jan 29 2021 11
Date: Date:-_l —(-2 -a �OZ
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APPROVAL RECOMMENDED: ATTEST. 44��nT1� I
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By:.. B � � °
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Mark J.Barta Mary J.Kayser o o o d
Assistant Director Human Resources City Secretary �0 00 *Icy
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Date: L^'z& ate: Jan 29, 2021 �a��ExASoAp
APPROVED AS TO FORM AND LEGALITY-
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John Strong
Assistant City Attorney
Date: Jan 29, 2021 E
VENDOR:
Work Loss Data Institute,LLC
Name: Phil LeFevre
Title: Managing Director
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Date: 12/28/20
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH, TX