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Home My WebLink AboutContract 56878-CA1 MCLUNG ROOFI CSC No.56878-CAl NG 103 E.Trammell Avenue Everman,TX 76140 Phone: 817.551.7222 Fax: 817.551.7221 Date: Feb 10t�', 2022 L�oAi{ec!��fY,e1, To: The City of Fort Worth $u� 401 w 131h Street Fort Worth, Texas 76102 Attn: Ronnie Clements Shingles RE: City of Forth Worth Assignment Tile For value received, HHA Endeavors LLC ("Assignor"), hereby assigns to "P.ODTNPUNTENANCE Adamsmark Construction LLC ("Assignee"), all of its right, title and interest in and to any LW-_E"Pft1:9 and all sums of money now due or to become due from the City of Fort Worth to Assignor '5wUhigSurve4s under CSCO 56878 (the "Contracts") and Assignee agrees to assume and perform all L eak-2epair duties and obligations required by Assignor under the terms of the Contracts. - -?cos L�laSnteiiance 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, 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 2022. HHA Endeavors LLC (Assignor,-- Print- Title- Corporate Manager Adamsmark Construction LLC (Assignee) OFFICIAL RECORD f � By: CITY SECRETARY FT.WORTH,TX Print: 'j7,• �y/ j) �f �' Title: Chief Financial Officer NOTARY ACKNOWLEDGEMENT On the Cl day of _ �� 2022, personally appeared _, who acknowledged to me that (s)he is the Chief Operating Officer of HHA Endeavors LLC, and that (s)he executed this document for the purposes and consideration contained herein. HHA EEnnde rs LL By, Print: 77/--"/' Title: Chief Operating Officer SUBSCRIBED TO before me on this Iy day of i=�6441u-./ 2022. Notary Public in and for the State of 7`eXcr �,pY PpB VICKIE G ADAMS My commission Expires: Ile,/,3a.=Y r° n Notary ID#130825179 v My Commission Expires 'TeoFs�} September 16, 2024 NOTARY ACKNOWLEDGEMENT On the day of 2022, personally appeared , who acknowledged to me that (s)he is the Chief Financial Officer of Adamsmark Construction LLC, and that (s)he executed this document for the purposes and consideration contained herein. Adamsmark Construction LLC By:l Print: iy /GlC Title: Chief Financial Officer SUBSCRIBED TO before me on this_/ day of G�`ruUGrF/ 2022. {pRV POa VICKIE G ADAMS x° Notary ID#130825179 N��}P My commission ExpiresN tary Public in and for the State of i xg�L or September 16, 2024 commission Expires: &- ,Tau--/ OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX CONSENT TO ASSIGNMENT The City of Fort Worth consents to the assignment of HHA Endeavors LLC ("Assignor") to Adamsmark Construction LLC (Assignee"), of all its rights, title, and obligation owing and all funds due or to become due to Assignor under CSCO 56878, as long as all terms required of Assignor in said contracts are met by Assignee. CITY OF FORT WORTH `?n Feb 25, 2022 R�ald Zeno(Feb 25,2022 13:57 CST) Reginald Zeno, Interim Assistant City Manager Date Feb 25, 2022 Cynthia Garcia, Assistant Director— FMS Date pap FORr�ad °000 °° off'=� ATTESTED BY: o o oO 000000 ° ,c/� J ette S.Soodall(Feb 25,202214 CST) Feb 25 2022 ��4 nEXASoA Jannette Goodall, City Secretary Date APPROVED AS TO FORM AND LEGALITY: sty , John B. Strong, Assistant City Attorney Contract Compliance Manager: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. Feb 22, 2022 Employee Signature/Date City Architect Title OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX QQ Request for Taxpayer Form ��7 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 IvwwJrs.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. Adamsmark Construction LLC 2 Business name/disregarded entity name,K different from above McClung Roofing M 3 Check appropriate box for federal tax clw4sification of the person whose name is entered on line 1.Check only one of the 4 Exemptions codes apply only to � P Y P ( PP Y Y m following seven boxes. certain entities,not individuals;see a instructions on page 3): o ❑ IndividuaVsole proprietor or ❑ C Corporation ❑ S Corporation ❑r Partnership ElTrust/estate single-member LLC Exempt payee code(if any) � ❑ Limited liability company.Enter the ta> classification(C=C corporation,S=S corporation.P=Partnership)P. `o r Note:Check the appropriate box in th;line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting .5 .5 w LLC if the LLC is classified as a single-}member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S.federal tax purposes_Otherwise,a single-member LLC that code(if any) v is disregarded from the owner should¢heck the appropriate box for the tax classification of its owner. tl ❑ Other(see instructions)► (Apphes to accounts mainfaned outside the U.S.) y' 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional) 3440 South Freeway 6 City,state,and ZIP code Fort Worth,TX 76118 7 List account number(s)here(optional) Taxpayer Identification'Number(TIN) Enter your TIN in the appropriate box.The TI provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals,this is ge erally your social security number(SSN).However,for a T resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later. For other entities,it is your employer identification numtaer(EIN). If you do not have a number,see How to get a 1 TIN, later, or Note:If the account is in more than one nam I see the instructions for line 1.Also see What Name and Employer identification number Number To Give the Requester for guidelines�n whose number to enter. M45 - 4 8 5 1 3 1 2 L JUEM 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; a?d 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 i�ny)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 propert „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 Here I U.S.person► v Date► 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.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. E�amplesof information alien),to provide yourcorrect 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) ( LU 7 � ) ) $ � § � \ ) § _ � § S f / j d # § \ ¢ 7 2 >2 ! § J» ¥ 2 . � - . ® . LU§ E < ) � � � k c / $} _ 2Cj $ § §2 § n� 2 ) \) § o [ J § _ R � E cm cu | fo ■ § =/k\/ m � | \ / LL0L ■�0 <