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HomeMy WebLinkAboutContract 52835-CA1 CSC No. 52835-CAl CITY OF FORT WORTH ASSIGNMENT For value, received Work Loss Data Institute, LLC ("Assignor"), hereby assigns to MCG Health, LLC ("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 Fort Worth to Assignor under PSK 145636/CSCO 52835 (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, 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 day of 2022. Work-Loss Data Institute, LLC (Assignor) By: Y Print: John Pollard Title: Chief Financial Officer MCG Health, LLC (Assignee) 1 By: Print: John Pollard Title: Chief Financial Officer OFFICIAL RECORD CITY SECRETARY Assignment FT. WORTH, TX NOTARY ACKNOWLEDGEMENT On the %'day of 'IL' 2022, personally appeared John Pollard, who acknowledged to me that he istie Chief Financial Officer of Work-Loss Data Institute, LLC ("Assignor"), and that he executed this document for the purposes and consideration contained herein. Work Lo ,Dat n nstitaW By: Print: P1in Pollard Title: /Chief Financial Officer SUBSCRIBED TO before me on this �-day of ?D , 2022. N S B A E NOTARY PUBLIC#81595 Notary Public in and for the State of �s h STATE OFVASHINGTON My commission Expires: ��{-�(� � COMMISSION EXPIRES APRIL 11, 2026 NOTARY ACKNOWLEDGEMENT On the ^ day of J12 2022, personally appeared John Pollard, who acknowledged to me that (s)he is t1fe Chief Financial Officer of MCG Health, LLC ("Assignee"), and that (s)he executed this document for the purposes and consideration contained herein. MCG�?th LC By:_ Print: ,166 Pollard Title: 'Chief Financial Officer SUBSCRIBED TO before me on this da of IIII)IIA4 52022. NSBAE S ` - NOTARY PUBLIC#81595 Notary Public in and for the State of a-<L; STATE OF WASHINGTON My commission Expires:_D /( �� COMMISSION EXPIRES APRIL 11, 2026 OFFICIAL RECORD CITY SECRETARY Assignment FT. WORTH, TX CONSENT TO ASSIGNMENT The City of Fort Worth consents to the assignment of Work Loss Data Institute, LLC ("Assignor") to MCG Health, LLC ("Assignee"), of all its rights, title, and obligation owing and all funds due or to become due to Assignor under PSK 14563/CSCO 52835 as long as all terms required of Assignor in said contracts are met by Assignee. CITY OF FORT WORTH Reginald (Aug 1,202207:55 CDT) Aug 1, 2022 Reginald Zeno—Interim Assistant City Manager Date .4mtf&17le& u Aug 1 , 2022 Anthony Rousseau, Assistant Director—FMS Date as FOR) as �� ° °�a� ATTESTED BY: �-0 g=� V0 0 dd o �� ° ° J ette S.Goodall(Aug 1,2022ette S.Goodall(Aug 1,2022 08��pT) � °0000°000°° 4- u g 1, 20 22 Jannette Goodall, City Secretary a4Z?41*x oQp Date APPROVED AS TO FORM AND LEGALITY: 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. �� Z-,,` Jul 29, 2022 Employee Signature/Date Workers' Compensation Manager Title OFFICIAL RECORD CITY SECRETARY Assignment FT. WORTH, TX 701 Fifth Avenue Suite 4900 Seattle,WA 98104 All MC USA Tel 206 389 5300 PART OF THE Fax 206 464 7813 HEARST HEALTH NETWORK mcg.com July 11, 2022 Purchasing Division City of Fort Worth 200 Texas Street Fort Worth, TX 76102 Attn: Tracy Walter Re: Acquisition of Work Loss Data Institute, LLC Dear Ms. Walter: I write in response to your request for information and documentation regarding the acquisition of Work-Loss Data Institute, LLC ("WLDI")—a registered vendor to the City of Fort Worth—by MCG Health, LLC ("MCG"). A printout of your email request is attached to this letter, on page 2 of the full email conversation. Also attached, please find the following documentation, per your request: • Memorandum of MCG's Chief Financial Officer ("CFO"), regarding MCG's acquisition of WLDI • a copy of Certificate of Existence issued to MCG by the Washington Secretary of State • a copy of the Amended Certificate of Formation filed with the Washington Secretary of State by MCG on December 6, 2012 • the original notarized Assignment form received from you, executed by MCG's CFO Any questions or requests for additional documentation or information may be addressed to Suzanne Swirsky, Senior Account Executive for MCG, by phone to (760) 753-9992 or by email to Suzanne.Swirsky@mcg.com. Respectfully, John Richard Smith Senior Contracts Manager Enclosures Master License Agreement Page 1 of 1 Helping You Drive Effective Care 701 Fifth Avenue M SuiteAll Seattlee,,W WA 98104 USA Tel 206 389 5300 PART OF THE Fax 206 464 7813 HEARST HEALTH NETWOFK9 mcg.com MEMORANDUM To: City of Fort Worth (Texas) From: MCG Health, LLC Date: July 8, 2022 Re: Acquisition of Work Loss Data Institute, LLC Please be advised that MCG Health, LLC, a Washington limited liability company, acquired all interest in and title to Work-Loss Data Institute, LLC, a Texas limited liability company, on or about July 12, 2017. Work-Loss Data Institute, LLC, has been, since that time, a wholly owned subsidiary of MCG Health, LLC. Please find additional confirming information, attached. eLfully, ohn Pollard Chief Financial Officer MCG Health, LLC 701 Fifth Avenue, Suite 4900 Seattle, WA 98104 Master License Agreement Page 1 of 1 Helping You Drive Effective Care i$ ! '- STATE S OP Aji.0- fit 117 sTar �!li O b l.,e•i.. 9 1i � e4we Of 4; Secretary of State I, STEVE R. HOBBS, Secretary of State of the State of Washington and custodian of its seal,hereby issue this CERTIFICATE OF EXISTENCE OF MCG HEALTH, LLC I CERTIFY that the records on file in this office show that the above named entity was formed under the laws of the State of Washington and that its public organic record was filed in Washington and became effective on 10/19/2004. I FURTHER CERTIFY that the entity's duration is Perpetual,and that as of the date of this certificate,the records of the Secretary of State do not reflect that this entity has been dissolved. I FURTHER CERTIFY that all fees, interest,and penalties owed and collected through the Secretary of State have been paid. I FURTHER CERTIFY that the most recent annual report has been delivered to the Secretary of State for filing and that proceedings for administrative dissolution are not pending. Issued Date: 03/17/2022 UBI Number: 602 438 679 STATE Given under my hand and the Seal of the State of Washington at Olympia, the State Capital Steve R. Hobbs, Secretary of State Date Issued: 03/17/2022 Pagel of 1 0 FILED ; Limited Liability Company DEC a 6 t0 iZ See attached detailed Instructions WA SECRETARY OF STATE ❑ Filing Fee$30.00 ❑ Filing Fee with Expedited Service$80.00 UBI Number. 602-136-679 AMENDED CERTIFICATE OF FORMATION/REGISTRATION Chapter 25.15 RCW SECTION 1 NAME OF LIMITED LIABILITY COMPANY: (as currently recorded with the Office of the Secretary of State) MILUMAN CARE GUIDELINES LLC SECTION 2 AMENDMENTS TO CERTIFICATE: (If necessary,attach additional information) Article 1.of the Certificate of Formation of the Limited Liability Company Is hereby deleted and replaced in its entirety with the following: '1.The name of the limited liability company Is MCG Health,LLC". SECTION 3 EFFECTIVE DATE OF AMENDMENTS TO CERTIFICATE: (please check one,of the following) © Upon filing by the Secretary of State ❑ Specific Date: (Specified effective date must be within 90 days AFTER the Amended Certificate has been filed by the Office of the Secretary of State) SECTION 4 MEMBER OR MANAGER SIGNATURE(see instructions page) Thls document Is hereby executed under penalties of perjury,and Is,to the best of my knowledge,true and correct. Catherine A.Bosbv%Seavaq __�X 190 ?1. Hearst Heaith=m Holdings 1,LLC,Solo Mcmbcr 12/62012 212.649-2025 Signature Printed NameMIe Date Phone LLC-Amendment Washington Secretary of State Revised 07110