HomeMy WebLinkAboutContract 57119 DocuSign Envelope ID:611EAC09-08FO-4E13-A25F-F31F9D7BF152 CSC No.57119
PUBLIC UTILITIES VENDOR AGREEMENT
COMPREHENSIVE ENERGY ASSISTANCE PROGRAM
The purpose of the Comprehensive Energy Assistance Program ("CEAP") funded from the Low-Income
Home Energy Assistance Program ("LIHEAP") grant is to maintain an energy supply to heat and cool the
residences of eligible low-income clients.
The Energy Services provider ("Vendor"), agrees to honor the purpose of the CEAP grant and to accept
pledges of payment from CEAP agencies only for certified customers to whom Vendor continues to
provide energy services. The Energy Assistance Provider ("Agency"), agrees to make payments only for
eligible low-income clients.
This vendor agreement is by and between:
City of Fort Worth
and
Energy Assistance Provider(Agency)
Champion Energy Services, LLC
(Vendor)
Vendor and Agency agree to assist customers in the following counties: Tarrant County
This agreement shall be effective from the 1st day of january,2022for a period not to exceed two years
from the effective date. Either party may terminate this agreement by written notice. Such written notice
of termination shall not affect any obligation by either party incurred prior to the receipt of such notice.
Notice shall be sent via certified mail with return receipt requested.
Champion Energy Services, LLC
(Vendor Name)
1500 Rankin Road,Suite 200, Houston,TX 77073
(Vendor Mailing Address)
City of Fort Worth; Neighborhood Services Department
(Agency Name)
200 Texas Street Fort Worth,TX 76102
(Agency Mailing Address)
1 OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
DocuSign Envelope ID:611EAC09-08F0-4E13-A25F-F31F9D7BF152
The Agency named above represents and warrants to Vendor that it is a subrecipient of the Texas
Department of Housing and Community Affairs ("TDHCA") and as such is authorized and has received
funding from the TDHCA to provide bill payment assistance service for eligible low-income households.
The Vendor named above represents and warrants that it will apply any payments received from Agency
to the account of the customer that the Agency has determined to be eligible under the CEAP guidelines
and such is a "Certified Customer".
Vendor will, with reference to a Certified Customer:
• Extend the CEAP applicant's energy service for up to five business days while the Agency
determines whether the CEAP applicant is eligible pursuant to the CEAPguidelines.
• Upon accepting pledge from Agency for Certified Customer, continue or restore energy service
to Certified Customer with no increases in charges,service charges or other charges affecting the
total cost of the bill, except as allowed by the stated tariff cost registered with the Public Utility
Commission "PUC" and/or Texas Railroad Commission.
• In the event the full past due balance is not paid by the Agency,the Certified Customer must pay
the remaining balance on or before the disconnect date stated in the customer's Disconnect
Notice required by PUC regulations in order to avoid disconnection or be eligible for
reconnection. Nothing in this agreement requires the Vendor to reconnect the customer upon
receipt of a pledge that does not cover the full past due balance or if the customer has already
been disconnected by the time the pledge is received by the Vendor.
• Invoice the Certified Customer in accordance with Vendor's normal billing practices.
• Upon verbal or written request from Agency, provide at no cost to the Agency the Certified
Customer's billing and usage history for previous twelve months, or available history plus
monthly estimates if less than twelve months of billing history and usage is available. Vendor will
transmit such billing history via electronic mail or facsimile as soon as possible, but no later than
forty-eight hours following the request.
• Work with Agency and Certified Customer to explore the feasibility of offering flexible payment
arrangements that may include, without limitation, waiving security deposits, reconnect fees,
application fees, and all other fees whenever possible.
• Not discriminate against Certified Customer in price or services, including the availability of
deferred payment plans, level or average payment plans, discount, budget,advance payment or
other credit plans.
• Not refuse to provide energy service or otherwise discriminate in the marketing and provision of
energy service to any Certified Customer because of race, creed, color, national origin, ancestry,
sex, marital status, lawful source of income, level of income, disability,financial status, location
2 Revised January 2021
DocuSign Envelope ID:611EAC09-08F0-4E13-A25F-F31F9D7BF152
of customer in an economically distressed geographic area, or qualification for low-income or
energy-efficiency services.
• Allow Agency forty-five days from the date of the pledge to forward payment to the Vendor.
Vendor agrees not to consider the portion of the Certified Customer's account to be paid by the
Agency delinquent if said payment is received within the above mentioned forty-five day period,
and Vendor is provided with a verbal or signed pledge from the Agency within forty-five days of
identifying a Certified Customer.
• Not interrupt service if Certified Customer is eligible under PUC regulations,or other state
agency regulations(as applicable),and enters into an agreement with the Vendor concerning
how the Certified Customer will pay the balance owed Vendor and the Certified Customer is
meeting the obligation under such agreement.
• If the Agency has paid for an initial deposit or similar refundable instrument, upon the
termination of service to the Certified Customer,the Vendor shall return funds including
interest(after any balance owed)to the Agency in accordance with PUC regulations or 10 Texas
Administrative Code§6.312(f)(as applicable).
The Agency will:
• Obtain written permission for Agency to request and have access to customer information,
including confidential or personal account information, credit and payment history, from
customers seeking Agency's assistance. Social Security numbers are not required for the CEAP
program and may not be disclosed to Agency.
• Provide to Vendor, at Vendor's request, customer's written permission for Agency's access to
customer information as stated above.
• Not provide pledges on behalf of a Certified Customer to Vendor without having adequate funds
to pay such pledge.
• Pay pledges within forty-five days of making pledge to Vendor.
• Determine if a customer is a Certified Customer within five daysof contacting Vendor.
• Provide Vendor a list of names, telephone numbers and e-mail addresses of Agency staff
designated to make pledges on behalf of the Agency and Certified Clients, if requested from
Vendor.
The terms of any confidential transaction under this agreement or any other information exchanged by
the Agency and Vendor relating to any transaction shall not be disclosed to any person not employed or
retained by the Agency or Vendor,their affiliates,or brokers,except to the extent disclosure is 1)required
by law; 2) necessary to disclose to the other party in connection with a dispute between the parties; 3)
otherwise permitted by written consent of the other party; 4) required by guarantors to be disclosed;5)
3 Revised January 2021
DocuSign Envelope ID:611EAC09-08F0-4E13-A25F-F31F9D7BF152
information which must be disclosed to a third party to transmit energy; 6) to meet reliability council,
regulatory,administrative,judicial,governmental,or regulated commodity exchange requirements where
necessary; or 7) information which was or is hereafter in the public domain (except by breach of this
Agreement).
If vendor has fewer than 10 employees or the Agreement is for less than $100,000,this section does not
apply. Vendor acknowledges that in accordance with Chapter 2270 of the Texas Government Code, City
is prohibited from entering into a contract with a company for goods and services unless the contract
contains a written verification from the company that it: (1) does not boycott Israel; and (2) will not
boycott Israel during the term of the contract. The terms "boycott Israel" and "company" shall have the
meanings ascribed to those terms in Section 808.001 of the Texas Government Code. By signing this
Vendor Agreement, Vendor Certifies that Vendor's signature provides written verification to City that
Vendor: (1) does not boycott Israel;and (2)will not boycott Israel during the term of the Agreement.
Vendor agrees that City shall, until the expiration of three (3) years after final payment under the
Agreement, have access to and the right to examine any directly pertinent books,documents, papers and
records of Vendor involving transactions relating to the Agreement. Vendor agrees that City shall have
access during normal working hours to all necessary Vendor facilities and shall be provided adequate and
appropriate workspace in order to conduct audits in compliance with the provisions of this section. City
shall give Vendor reasonable advance notice of intended audits.
[Signature page follows]
4 Revised January 2021
DocuSign Envelope ID:611EAC09-08F0-4E13-A25F-F31F9137BF152
DS
FDocuSlgned by:
11/22/2021
Authorize en or Signature Date
Michael Sullivan President and CEO
Typed Name of Authorized Signature Title
877-653-5090
Vendor(Area Code)Telephone Number
support@championenergyservices.com
//Vendor Email Address
Feb 2,2022
Authorized Agency Signature Date
Victor Tu rner Director,Neighborhood Services Dept.
Typed Name of Authorized Signature Title
817-392-7540
Agency(Area Code)Telephone Number
CITY OF FORT WORTH,TEXAS:
Feb 11, 2022
Fernando Costa Date
Assistant City Manager
RECOMMENDED:
rA- &-4
By: Soniasnglet (Feb 11,202214:50 CST)
Sonia Singleton
Assistant Neighborhood Services Director
APPROVED AS TO FORM AND LEGALITY:
By:
Taylor Paris
Assistant City Attorney I
OFFICIAL RECORD
5 CITY SECRETARY
FT. WORTH, TX
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ATTEST: a°° °
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By:Jannette S.Goodall(Feb 16,2022 07:51 CST) P�o o Z'
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Jannette Goodall o
City Secretary � °°°° °°° a,
?EXASaa
Contract Authorization:
M&C: N/A
Date Approved: N/A No M&C required. Ordinance No. 24161-04-2020
CONTRACT COMPLIANCE MANAGER:
By signing below, I acknowledge that I am the person responsible for the monitoring and administration of
this contract, including ensuring all performance and reporting requirements.
4•/
Soniglet (Feb 11,202214:50 CST)
Sonia Singleton
Assistant Neighborhood Services Director
OFFICIAL RECORD
6 CITY SECRETARY
FT. WORTH, TX
Form W-9 Request for Taxpayer Give Form to the
(Rev_October2018) Identification Number and Certification requester.Do not
❑eparfirient of the Treasury send to the IRS.
internal Revenue Service ►Go to www irs.gov1Form W9 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
Cal ine Corporation
2 Business nameldisregarded entity name,ff different from above
Charnpion_Energy Services, LLC(EIN 20-1466960
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
mfollowing seven boxes. certain entities,not individuals;see
r instructions on page 3):
❑ IndividuaVsole proprietor or 0 C Corporation ❑ 5 Corporation ❑ Partnership ❑Tmstlestate
on single-member LLC Exempt payee code(if any) 5
� c
11 0
.4+N ❑ limited liability company.Enter the tax classification(C-C corporation,S=S corporation,P=Partnership)0-
6 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
G m 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 an
t2i 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 classification of its owner,
m ructions)► (apples to manianen outmle me US.)
❑ Other(see inst
rn 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional}
rn 717 Texas Avenue,Suite 1000
6 City,state,and Z1P code
Houston,Texas 77002
7 List account number(s)here(optional)
IRM Taxpayer Identification Nurnber(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,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 gel 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.
7 7 - 0 1 2 1 1 1 z 119 1 7 1 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 it 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 o sign the ertification,but you must provide your correct TIN.See the instructions for Part 11,later.
Sign signature of /�
Here u.S person► �i Cti� Date I,-
�� /r�.
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.irs.gov1FonnW9.
•Form 1099-5(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),1 D98--E(student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(FIN)which may be your social security number •Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number([TIN),adoption .Form 1099-A(acquisition or abandonment of secured property)
taxpayer identification number(AT1N),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(ncluding 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 Form W-9(Rev.1 D-2018)