HomeMy WebLinkAboutContract 52883-R3 CSC No.52883-R3
CM'OF FORT WORTH
REQUEST TO EXERCISE RENEWAL OPTION
February 14, 2022
One Call Concepts
7233 Parkway Drive
Handover, MD 21076-1391
Attention: Adam Franco
Re: Contract Renewal Notice
Contract No. CSC No. 52883
Renewal Term No, R-3- June 30,2022 to July 1,2023
The above referenced Contract with the City of Fort Worth expires on June 30, 2021.
Pursuant to the Contract, contract renewals are at the mutual agreement of the parties_ This letter
is to inform you that the City is requesting to renew the Contract for an additional one ("1) year
period, which %vill begin immediately after the Expiration Date. All other terms and conditions of
the Contract remain unchanged.
To agree to renew the Contract for an additional one(1) year period, please si(n and
return this request to exercise renewal option, along with a copy of your current insurance
certificate, to the address set forth below.
Please log onto PeopleSoft Purchasing at httn ffi 'orthtexas ern.purchast to insure
that your company information is correct and up-to-date.
If you have any questions concerning this Contract Renewal Notice. please contact me at
the telephone number listed below_
Sincerely.
�vvew
Regina Jones
Contract Compliance Specialist
(817] 392-2698
OFFICIAL RECORD
CITY SECRETARY
Contract Renewal FT.WORTH, TX
ACCEPTED AND AGREED:
CITY OF FORT '*VORT11 CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the
person responsible for the monitoring and
Dam 397 y hdo administration of this contract including
BY: Dana Burghdoff(May9,2022 :48 CDT) ensuring all performance and reporting
Name: Dana Burghdoff requirements.
Title: Assistant City Manager
APPROVAL RECOMMENDFT)- By: /
Name: Regina Jones
Title: Contract Compliance Specialist
By: CL datgQjLer Hard �,.76202215:56CDT) APPROVED AS TO FORM AND
Name: Chris Harder. i1E LEGALITY:
Title: Water Director
ATTEST: �i (f411�
By Mack(May 9,2022 15:19 CDT)
Name: Doug Black
Tannoll l S. Good 111 Title: Senior Assistant CityAttomev
By Jannette S.Goodall(May 10,2022 09:32 CDT)
Name: Jannette Goodall �44���n� CONTRACT AUTHORIZATION:
Title: City Secretan �po�°FUR? �� v1&C:
a�►o° %io. o 0 Date Approved:
P=o 0.10
°=A
�0�. *o o* Form 1295 Certification No.: 2020-623439
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One Call Concepts, Inc.
By: f
Name: m F4Znco
Title: Director of Operations
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH, TX
Contract Renewal
CERTIFICATE OF INTERESTED PARTIES FORM 1295
ofz
OFFICE USE ONLY
complete Nos.i•4 and a if there are Interested parties. CERTIFICATION OF FILING
Compete Na5-1,2,3,s,and o if were ar@ no interested parties,
t. Name of buslnesa entity filing form,and the city,state And country of the business entity s piece 2020-2343.9 fir.
of business.
Qne Call Concepts,Inc. pate Flied-,
Hanover,,M0 Untied States 05/2612020
z Rill of governmental entty or.atate Agency that a x partyt.to a tontraat for w h t e orm 19
being filed, pate Acknowledged:
City of Fort Worth
g provide the identl IcAtl0 nuMber used
by the
property t°be lrentity U d or e.die contracto t Mck or Identify the contract,and provide e
description of the e
LTM FTW
Cloud based TIeltet ManAgemenrsemms,
Nature oflnteroat .
4 Name of Interested party City,Sutter Country(piatce ai boainass) (check tpPlkeiblef
-Controlling intomtdlary
Hanover lns..btaents<Inc., Hanover,MD United Stales
Hanover,mu United states x
Florenzo,Dan
fyiscataway,W United States x
Holzer,James
porftand,013 United Stoles
pWI011,Frank
Hanover,Mb United States
Parks,t3Ura X
Baton.Rouge;l.:A United States X.
Latham.Thelma
.waw tnsa,VA United Staten X
Schn?fdt,Connie
i-lanover,MD United State$ X
Ruddo,Kelly
Hanover,MD United States
Hoff,Tom
Wchita.KS United States
Jester,Dawn
Wauwatosa,WI United States x
Peterson.Randy
Burnsville,MN United Slates x
Franco,Adam -
• Versioia YI..1.3a6uaf7d
Forms provided by Texas Ethics Com nission vWrr:ethicS,state.tx.us
CERTIFICATE 4F INTERESTED PARTIES Fowvl 1295
2of2
Complete Nos.t-4 and 6 if there.are interested parties OFFICE USE ONLY .
Complete Nos.1,2,3,5,and s if mare are no interested parries. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country iof the business enttty`s place Ceillf1c4to Number:
of business. 2020-623439
One Call Concepts,Inc.
Hanover,MD United States Wte 120Flled2
0512 0
t3[202
2 Name of gov:mmenul en ty of sate agency t at s arry pa to too contract forty is rhe.form s
being pled.
City of Fort Worth Date Acknowledged:
3 Provide the Identification number used by.the governmental entity 9t stud agdncyi 1n track or Identify the contractr and provid+r a
description al lot service's,goods,or other propatty to be provided under the contract,.
LTM FTW
Cloud bfised 7icketManagentenl services.
. Nstun of interest
4 Name of Interested Party Ply,State,Country(pinch of business)., (check applkabte)
Controlling Interrhadlary
5 Check only If there is NO Interested Party. r
A UNSWORN Ot:CLARATION
r4�„ r�. , an my i rth is �
MY name]s��C,r. f d date of b
My address is {:
ro4e) (0ur)ary)
I declare under penalty of perjury that the foregoing lg Ing and correct
Ed to i c Couniy,State ol,. �
xecute _ �,on the_j' -day of �'. (year)
. 2Q. .
( . rm}.—
Signature of au _orized aCent of contracting business entity
- (cedararN;
Form provided by Texas Ethics Commission wWw,ethics:state,tx.Us Version V1A.3a8aar7d