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Home My WebLink AboutContract 51892-CA1 CSC No.51892-CAl CITY OF FORT WORTH ASSIGNMENT For value, received 'Tailored Adjustment Services, Inc. ("Assignor"), hereby assigns to 1! Global Risk Solutions, 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 Font Worth to Assignor under PSK 13248/CSCO 51892(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, i 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 2_day of 1,6ryfac64 8- 2021, Tailored Adjustment Services,Inc. (Assignor) By: f Print: J mes M. Buchanan Title: PresidentlCEO Global Risk Solutions,Inc. (Assignee) f By: Yam . Print: Vincent Levito Title: Chief Financial Officer OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Assignment Pop 1 of Q NOTARY ACKNOWLEDGEMENT N On :11i��o day of _ 2021, personally appeared y acknowledged to me that (s)he is the Chief Operating Officer of Tailored Adjustment Services, Inc. ("Assignor"), and that (s)he executed this document for the purposes and consideration contained herein. TailoredAdju,tment Services,hic. By: Print: James M.Buchanan Title: President\CEO SUBSCRIBED TO before me on this day of '2021._ � 7 SHERYL SARTA Notary Public.State of Taxes Notary Public and for the State of t. . �y ,• `r COMM,Expl�®s 1 z 27-2023 My commission Expires: t i y+++P�►►`�� Notary 10 717921.5 NOTARY ACKNOWLEDGEMENT On. the _22 day of December 2021, personally appeared who acknowledged to me that (s)he is the Chief Financial Officer of Global Risk Solutions, Inc. ("Assignee"), and that(s)he executed this document for the purposes and consideration contained herein. Global Risk Solutions, Inc, By: --vim Print: Vincent Levito Title: Chief Financial Officer SUBSCRIBED TO before me on this day of_`�'C'.C.'�� ._� . ,2021. r r _ ��•`�`�'nrp�s,,� SHERYL SARTA Notary Pub1i in and for the State of Notary Public,State of Texas '?S�V.f"► My con Comm.Ex Jres i2 27-2023 >�Ssign Expires: ar , RIM Notary ID 717921-5 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Assignment Page 2 of3 CONSENT TO ASSIGNMENT The City of Fort Worth consents to the assignment of Total Adjustment SeMces, Enc_ "Assignor'} to Global Risk Solutions, Inc_ ("Assignee'), of all its rights, title, and obligation owing and all funds due or to became due to Assignor under PSK 13248:`CSCO 51892 as long as all terms required of Assignor in said contracts are met by Assignee_ CITY OF FORT WORTH ,Dgeq LGU�G��z Jan 13 2022 Dana Burghdoff(Jan 13,2022 2 01 CST) Dana RuWhqff,Assistant City Manager Date Jan 12, 2022 C�,ntlua Garcia,Assistant DU- -ector—FMS. Date ggovapp�4� pO�FO oo o°o oDap G—oo o d ATTESTED BY: ��o o =d o 00000000000*�d Ta nno-f'fo S. Goodall aQa p Jan 14 2022 Jannette S.Goodall(Jan 14,2022 13:55 CST) )lnXpsgbp jj;j� GoadalL Acting City Secretary Date APPROVED AS TO FORM AND LEGALITY- ?5!6"-'r John B_ Strong,Assistant City Attorney Contract Compliance Manager: By signing I acknowledge that I am the person responsible .the monitoring and administration ofthis contract, including ensuring all performance and reepLTortingg jr�equ�Qirenie�ts_ J1pryJI' Sophia ;wgd(Jan 11,2022 16:11 CST) Jan 11, 2022 Gate Employee Signature.Date Property & Casualty Manager Titre OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX Assignment Page 3 of 3 G%11i'lolutions (;Inlril Dear Valued Customer, As you know Tailored Adjustment Services, Inc was acquired by Global Risk Solutions, Inc. on 12/31/2020.We are now fully integrated and starting 1/1/2022 all payments should go to Global Risk Solutions, Inc. Attached is our W-9. At this time there is no change in how you are sending the payments for services rendered. We appreciate your patronage and support. Respectfully, James M. Buchanan Chief Operating Officer Global Risk Solutions, Inc. RECEIVED DEC 21 2021 CITY OF FT. WORTH SAFETV DIVISION Form ® 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. Global Risk Solutions, Inc. 2 Business name/disregarded entity name,if different from above m 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 rofollowing seven boxes. certain entities,not individuals;see c- instructions on page 3): c ❑ Individual/sole proprietor or ❑ C Corporation M S Corporation ❑ Partnership ❑Trust/estate c single-member LLC Exempt payee code(if any) 0. 2 Z ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership) p ._`, 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 +� a LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is d code( y)another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that if an w is disregarded from the owner should check the appropriate box for the tax classification of its owner. U El Other(see instructions)► (Applies to accounts maintained outside the U.S.) 4) fn 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional) 0) 1000 Brickell Avenue, Su_ite6_10 6 City,state,and ZIP code Miami Florida 33131 7 List account number(s)here(optional) EM 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 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 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 I Employer identification number Number To Give the Requester for guidelines on whose number to enter. 16T41 -�315 19 � 7�7 31 7 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,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 11,later. Sign Signature of I- 'Here U.S.person► I- �- Date► 01/01/2021 General Instructions r• •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.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.10231X Form W-9(Rev.10-2018) State of Florida Department of State I certify from the records of this office that GLOBAL RISK SOLUTIONS, INC. is a corporation organized under the laws of the State of Florida, filed on February 4, 2002. The document number of this corporation is P02000012582. I further certify that said corporation has paid all fees due this office through December 31, 2021, that its most recent annual report/uniform business report was filed on February 3, 2021, and that its status is active. I further certify that said corporation has not filed Articles of Dissolution. Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Third day of February, 2021 Sentryof-State Tracking Number: 3264786696CC To authenticate this certificate,visit the following site,enter this number,and then follow the instructions displayed. https://services.sunbiz.org/Filings/CertificateOfStatus/CertificateAuthentication