HomeMy WebLinkAboutContract 28006-NC1CSC No. 28006-NC1
Memorandum
Date: 5/20/2021
To:
From
Re
JB Strong, Assistant City Attorney
Tracy Walter, Vendor Management —Purchasing
Dannenbaum Engineering Corporation to DE Corp. —
Name Change Only
**** City Secretary Agreement 28006****
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Prior Name: Dannenbaum Engineering Corporation
New Name: DE Corp.
Supplier ID: 0000003834
�� May 21, 2021
J tron^(May71.�OJ116: DT;
Approved By: JB Strong, Assistant City Attorney/ Date
������ M ay 24, 2021
Attested By: Mary Kayser, City Secretary/Date
Contract Compliance Manager:
By signing I acknowledge that I am the person responsible
for the monitaring and administration of this contract, including ensuring all
performance and reporting requirements.
L70�G/,� �G�IGIVIG�I May 21, 2021
John R. Kasavich (May 21, 202117'.19 CDTI
Employee Signature/Date
Engineering Manager
Title
OFFICIAL RECORD
CITY SECRETARY
FT. W�RTH, TX
Form ���
(Rev. Octobel' 2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
► Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name (as shown on youl' income tax return). Name is required on this line; do not leave this line blank.
DE C
2 Business name/disregarded entity name, if different from above
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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
following seven boxes. certain entities, not individuals; see
instructions on page 3):
❑ Individual/sole proprietor or ❑'' C Corporation ❑ S Corporation ❑ Partnership ❑ TrusUestate
single-member LLC Exempt payee code (if any)
❑ Limited liability company. Enter the tax classification (C=C corporation, �S corporation, P=Partnership) ►
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
is disregarded from the owner should check the appropriate box for the tax classificaiion of its owner.
U Other (see instructions)►
5 Address (number, street, and apt. or suite no.) See instructions.
3100 West Alabama Street
Give Form to the
requester. Do not
send to the IRS.
(Applies to accowts maintained outside the U.S.)
Requester's name and address (optional)
6 City, state, and ZIP code
Houston, Texas 77098
7 List account number(s) here (optional)
�r ldentification Number �
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, for a �_ m
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 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
Number To Give the Requester for guidelines on whose number to enter.
identification number
D�e�������
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. I 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 retum. 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 1 "
Here U.S. person ► ' � � 1 f�. � � ( % ` � <_ r� �ti L �
Date ► ��/� /�Q 2
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
Corporations Section
P.O.Box 13697
Austin, Texas 78711-3697
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Office of the Secretary of State
CERTIFICATE OF FILING
OF
DE Corp.
23000100
[formerly: DANNENBALJNI ENGINEERING CORPORATION]
Ruth R. Hughs
Secretary of State
The undersigned, as Secretary of State of Texas, hereby certifies that a Certificate of Amendment for the
above named entity has been received in this office and has been found to conform to the applicable
provisions of law.
ACCORDINGLY, the undersigned, as Secretary of State, and by virtue of the authority vested in the
secretary by law, hereby issues this certificate evidencing filing effective on the date shown below.
Dated: 03/19/2021
Effective: 03/19/2021
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Ruth R. Hughs
Secretary of State
Come visit us on the internet at https://www. sos. texas.gov/
Phone: (512) 463-5555 FaY: (512) 463-5709 Dial: 7-1-1 for Relay Services
Prepared by. Kika Garza TID: 10303 Document: 1036524430002
0�43-19-Z021 11:08 AM� Foley�&:Lardner LLP -�T'exas 50S
pg 3, of 5
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Submit in dupli�;:�t� to;
�BCf�� Ot .�L.7��
P.O. Bnx 13697
Anstin, 'TX 787�11 3697
S�l 2 463-5555
F�.Y: S1�Z/4G3�5709
Filing Fee:.5ee•instructinns
T1us space reserved t'ur ufticc uye.
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In F'..:.� :iie'lc:3 G`i'��IED
;. �;,;�i::�ry of Stat� of "te::as
MAR 1 � 20Z1
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Entity Information
The name•of the f�ling entii}� is:
l�annenbaurir En�i�eex�n� Curpuratiun
State thc natn� of the enEih� as ctqrenlly shown:in the�records,of the sectetary of statz. If lhe:amrndmenk char►ges the name
of thr entity, statr. the �1d�namG an1 not the new ns�me.
`Tile filing �ritity is•a: {select the ap}n�o�uiate endty type �eluw.) �
X For-protit Cotporation - ❑ Professional Corporation
❑ Nunprutit Curp�ratio�x ❑ Proi'ession:il Limited Liability Company
❑ c,oapr.rativ� �ssociutian ❑ Prafession� Asso�iation
❑ LimiEcd Liability Company ❑ Limited Partners�vp
Tl�c file nu��ibe�- issued to tlie�fil[ng entit}� by tt�e secre#ar}' of st��te is: 23�OOlOp
77�e dake:of format�on of the entit}- is: 1211119bb
Amendments
1. �tr�ended Natne
(if t��e ptugose of t}ie cettifieate of amen��ent is to ctia�ge t}ia namo of llie entity, use tl�e fdlowing afateroent)
The amendment changes the certificate of formation to change the article or pro�ision that names the
filing ei�titv. The�:u�ticle �r pro�i�iun is�am�uded to read as�follaws:
Tli� nanxe af� #1�e �iling entity�is: (state klie nev,� nariie of�t�ie er�tily below)
1lE Carp.
Tlie name af 1ku anbiy muat contain an organiza�onyl deaignatian ot aecepted abinevialion of aucl� t�.m, aa applicable:
2. Arnended Regist�r�d Agrnt/Re�ster�d �tiic�
The amendment ch�nges the ce�-tificate of' fotittation to chat�ge the a��ticle ar .provision stating the
na�n� of the regiatered agent and the� t-egis#ered o#�ice ad�ress of the fili�ag en#ity. The� article or
�
pruvision is aniende�!'t�,read.as follows:
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Certificate of Amendment
Fon�i 424
41330-5f�,95-,381 B.1
� 03-19-2021 11:08 AM Foley.& Lardner LLP a7exas 50S pg 4 oF•S
Registered Agcnt
(Complete�aitiirr A or B, but nat boF�i. A15o cumplete C.)
❑�. 'TII� 1'ea1SXe1'e� 3gett[ 1S 311 org�7111z3�1o11 fcannat 1�e cntity nan���l aUovc� by ti�e name of:
OR
❑ B. The fegistered agent 'ss an it�dividual resident of the state t�ose name is:
]olrs[.i'uute lll. I[Ai[ NtA11E Se�ir
'Il�e �'sun �xecuting this insfrurt�ent af3irms that the pers�n designated as the new c�egistereii agea�t
hasconsented ta se�ve as re�istered �genf.
L. T#�e business address of fihe registered agentand the registered office address is:
'I'�C
Sh•relAddreas,(NoP:O.Bar% Cih� Sldte ZipCode
3: Othcr added; Altered;�or lleleted Pruvisionis
Other changes or additiuns to the c�rtiiicaEe oi ioimatiun may be made in the space pro�ided�below. Tf tlse space provicled
is insuff�icicnt, inco;porafe the additianal text by providing an attachment ta fhis f'oim. Please read Ihe ins[ructions�to this
form for fiu-thcr inform ation nn form at.
Text .�,rra (Tl�e �ttaclied addendwn, if a�ty, ia inc:o�p�rated herein �y referencr.)
�Add e:�ch o#��l�e tollowing protrisions ta th� certificat� uf tcn�matioii. Th� isi�ntiticatiun or
r�tei�et�ce of the added provisit�n �d khe fiull text are as�f'ollo��+�s_
A�ter each of the follawinp pro�-isions of the:cerEificate:of formation. The�identiftcation or
retez•ence of the altered }�'o�isic�� and the full test ot'the provisiun.as aniended �u'e as foltows:
Delete•e�ch uf th� pru��isions.id�nt�feed Uelow� fi�um th� c:ettificat� of�f'cnrnation.
5takement af Approval
Tlte anyenc�nten#s t��the ce�4iticat� of�furmatic�n hat�� l�e�n appt'uved in the R�anner requirecl by the
F.�,n aza Z
48345685-381 B. 4
� 03-14-2021 11:06 AM Foley &�ardner LLP -�Texas 505 pg'5 of 5
Te�as Business Organizations'Cade and by the go��erning docume�nts ot'tha entity.
Effectiveness� uf Filin�,(Sele�t either A, B; ar C.)
A. I� This docwnent becomes effective `vhen the cEocumez�t is filed�by the secretary of state.
�B. ❑ TI11s [locLlrriellt;�ecs3itles�eftecti��e at a later d�te,. which:ia r�ot mar•e th�t nere�ty (90) dsys frvm
the date af si�ting. The delaved effectiVe�date is:
[:_ � Th�s�docwneni tatces effect upon the:accurrence af a futui•e e��enk ar fact, other than the
passage of time. Tl�a 90� day aY�er'iftie date of sigtting is:
'Phe fulle��ving �v�nt or fact v►�ill cause the document #a. take efieat�in_the manner describeei Ueluw:
Ezecutiun
Tlte undersi�ned slgns this doctuuent suUject W the penalties iniposed U}� la�v fcn• the submissiun ot� a
tnaterially false or fraudulent inshvment:atid.certifies ut�der penally of perjury that the�undersigned is
authorized urtder the pruvisiaiis uf [aiv govei-ning the entity tu eYecute tl�e filing instYvment. .
Date: 31i S12U21
$y:� Du�eenbauta En�ineerin�.Qnrpnratiun
Michel Maksoud
SiKri�hu e af �►ulhrnize�i peratm
A�iichel A4alcsoud
Prinind or typcd nazne of autl�vziud pereun (sce instructions)
F�mu 424
483a569�3818:1
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ENGI
EXCELLENCE
MEMO TO:
DE Corp.
2501 Parkview Dr., Suite 670, Fort Worth, TX 76102 (817) 763-8883
Tracy Walter
Business Process Analyst — Vendor Management
Purchasing Division
City of Fort Worth, Texas
Office Phone: 817-392-6100
Fax: 817-392-8440
Email: Trac_y.Walter(a�fortworthtexas.gov
DATE:
May 18, 2021
Dear Ms. Walter:
The company name of Dannenbaum Engineering Corporation was changed to DE Corp. effective 03/19/2021 as
certified by the Texas Secretary of State. The Tax ID Number and addresses remain the same. Only the name
was changed.
Respectfully submitted,
DE Corp.
/ �� 1 �
Michel Maksoud, Ph.D., P.E.
President/CEO
Engineering Excellence Since 1945