HomeMy WebLinkAboutContract 55299-A1 Date Received: Apr 20, 2022 City Secretary
Time Received: 1:22 pm Contract No.: 55299-A1
AMENDMENT NO. 1
TO
CITY OF FORT WORTH CONTRACT 55299
This Amendment is entered into by and between the City of Fort Worth (hereafter
"City"), a Texas home rule municipality, with its principal place of business at 200 Texas Street,
Fort Worth, Texas, and [s]Cube ("Vendor") a New York Corporation, City and Vendor may be
referred to individually as a Party and collectively as the Parties.
WHEREAS, on February 10, 2021, the Parties entered into City Secretary Contract
Number 55299 to provide system support and maintenance for issues and tasks outlined therein
("Agreement/Contract");
WHEREAS,the Parties wish to amend the Agreement to extend the term of the contract
for additional time to September 30, 2022.
NOW, THEREFORE, the Parties, acting herein by the through their duly authorized
representatives, enter into the following agreement:
1.
AMENDMENTS
1. Section 2 of the agreement with the Vendor dated February 10, 2021 is hereby amended to
extend the contract termination date from September 30, 2021 to the following:
This agreement shall commence on the date signed by the Assistant City Manager("Effective
Date") and shall terminate on September 30, 2022 ("Expiration Date"), unless terminated
earlier in accordance with this agreement.
2. Except as otherwise provided herein, all terms and conditional of the agreement shall remain
in full force and effect
3. Updated Certificate of Insurance(s) attached hereto.
2.
ALL OTHER TERMS SHALL REMAIN THE SAME
All other provisions of the Agreement which are not expressly amended herein shall
remain in full force and effect.
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
3.
ELECTRONIC SIGNATURE
This Amendment may be executed in multiple counterparts, each of which shall be
an original and all of which shall constitute one and the same instrument. A facsimile copy
or computer image, such as a PDF or tiff image, or a signature, shall be treated as and shall
have the same effect as anoriginal.
ACCEPTED AND AGREED:
CITY OF FORT WORTH:
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
b gA responsible for the monitoring and administration
By. Dana Burghdoff( r20,20 09:40CDT) of this contract,including ensuring all
./ Name: Dana Burghdoff performance and reporting requirements.
Title: Assistant City Manager
Date: Apr 20, 2022
By:
APPROVAL RECOMMENDED: NameEven Roberts
Title: Building Code Administrator
APPROVED AS TO FORM AND LEGALITY:
c�fL
BY: DJ Harrell 19,2022 09:14 CDT)
Name: D. J.Harrell
Title: Director of Development Services By:
Name: Taylor Paris
ATTEST: Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C:
By: J ette S.Goodall(Apr 20,2022 11�2 CDT) 1295:
Name: Jannette S. Goodall �44�ann��
Title: City Secretary �4Ft *oar
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By: Haileab Samuel(Apr 12,202216:25 EDT)
Name: Haileab Samuel
Title: CEO
Date: Apr 12, 2022
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
NEW Workers!
YORK CERTI FI CATE OF
STATE Compensation NYS WORKERS COM PENSATI ON I NSURANCE COVERAGE
Board
la. Legal Name& Address of Insured(use street address only) 1b. Bud ness Telephone Number of Insured
SCUBE Inc (877)437-2823
1462 Erie Blvd Suite C101
Schenectady, NY 12305 1c. NYS Unemployment Insurance Employer Registration Number of
Insured
Work Location of Insured(Onlyrequiredif coverage is Tedficallylin4ted to 1d. Federal Employer Identification Number of Insured or Social Security
certain locations in New York Gate, i.e., a WFap-Up Policy) Number
New York
47-4719457
2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier
(Entity Being Listed asthe Certificate Holder)
Twin City Fire Insurance Co
City of Fort Worth
200 Texas St. 3b. Policy Number of Entity Listed in Box"'Id'
Fort Worth, TX 76102 01 WECP10222
3c. Policy Effective Period
08/18/2021 to 08/18/2022
3d. The Proprietor, Partners or Executive Officers are
❑ Included. (Only check box if all partners/officersincluded)
❑ all excluded or certain partners/officers excluded.
This certifies that the insurance carrier indicated above i n box"3' insures the bud ness referenced above i n box"1d' for workers'
compensation under the New York State Workers' Compensation La✓v. (To usethisform, New York(NY) must be listed under Item 3A
on the I NFORMATI ON PAGE of the workers? compensation insurance policy). The Insurance Carrier or its licensed agent will send
this Certificate of I nsuranceto the entity listed above asthe certificate holder in box"2".
The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is cancded
due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancd the policy or
eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwis-, this
Certificate isvalid for one year after thisform isappraved by the insurance carrier or its licensed agent, or until the policy
expiration date listed in box"3c', whichever isearlier.
This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend,
extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsi bi I iti es beyond those contained in the
referenced policy.
This certificate may be used as evidence of a Workers' Compensation contract of insurance only whi I e the underlying policy is in effect.
Please Note: Upon cancellation of theworkers' compensation policy indicated on thisform, if the business continues to be
named on a permit, license or contract issued by a certificate holder, the business must pravide that certificate holder with a
new Certificate of Workers' Compensation Coverage or other authorized proof that the business iscomplying with the
mandatory coverage requirements of the New York State Workers Compensation Law.
Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced
above and that the named insured has the coverage as depicted on thisform.
Approved by: Camille Donato
(Print nameof authorized representativeor licensed agent of insurance carrier)
Approved by: t:Q.6yi-&- CMD 04/12/2022
(Signature) (Dale)
Title: LiscencedAgent
Telephone Number of authorized representative or licensed agent of insurance carrier: (845)297-3266
Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. I insurance brokers are NOT
authorized to issue it.
Printed by CMD on April 12,2022 at 03:55PM
C-105.2(9-17) www.wcb.ny.gov
Workers Compensation Law
Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured.
1. The head of a state or muni ci pal department, board, commission or office authorized or required by I aw to issue any
permit for or in connection with any work involving the employment of employees in a hazardous employment defined
by this chapter, and notwithstanding any general or special statute requi ri ng or authorizing the issue of such permits,
shal I not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to
the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein,
however, shall be construed as creating any liability on the part of such state or municipal department, board,
commission or office to pay any compensation to any such employee if so employed.
2. The head of a state or muni ci pal department, board, commission or office authorized or required by I aw to enter into
any contract for or in connection with any work involving the employment of empl oyees i n a hazardous employment
defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall
not enter into any such contract unless proof dul uy subscri bed by an insurance carrier is produced in a form stati stactory
to the chair, that compensation for all employees has been secured as provided by this chapter.
C-105.2(9-17) REVERSE Printed by CMD on April 12,2022 at 03:55PM