HomeMy WebLinkAboutContract 39524-CA1 CSC No.39524-CAl
CITY OF FORT WORTH
ASSIGNMENT
For value, received GovQA, LLC ("Assignor"), hereby assigns to Granicus, 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 14205/CSCO 39524 (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 (;Nay of October 2022.
GovQA,LLC
(Assignor)
By:. �,� ,
Print: Jessica Yang
Title: Director, Global Renew s
Granicus,LLC
(Assignee)
r
By:
Print: Jessica Yang �Ir
Title: Director,Global Renewals
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Assignment Page 1 of 3
NOTARY ACKNOWLEDGEMENT
On the October day of 2022, personally appeared Jessica
Yang,who acknowledged to me that she is that Director, Global Renewals, of GovQA,LLC
(Assignor")and that she executed this document for the purposes and consideration contained herein.
GovQAL•LiC
By: g. ;
Print: Jessica Yang
Title: Director, Global Rene
SUBSCRIBED TO before me on this day of October ,2022
•; Bernadette F Foley NotaryPublic in and for the State � ca
Notary Public e o + in u
Minnesota My commission Expires: I 1 2�2-7 My Cammisssiion E bra Jannary 31,2027 NOTARY ACKNOWLEDGEMENT
On the 17) day of October 2022, personally appeared
Jessica Yang,who acknowledged to me that she is the Director, Global Renewals
of Granicus, LLC ("Assignee"), and that she executed this document for the purposes
and consideration contained herein.
Granic C
By:
Print: Jessica Yang
Title: Manager,Renewals
SUBSCRIBED TO before me on this -2 o day of Octoboer 2022
—� � Notary Public in and for the State of
Bernadette F Foley My commission Expires:
} = Notary Public
Minnesota
M'C= Jar+uary 31,2027
Assignment Page 2 of 3
CONSENT TO ASSIGNMENT
The City of Fort Worth consents to the assignment of GovQA, LLC ("Assignor") to
Granicus, LLC ("Assignee"), of all its rights, title, and obligation owing and all funds due or to
become due to Assignor under PSK 14205/CSCO 39524 as long as all terms required of
Assignor in said contracts are met by Assignee.
CITY OF FORT WORTH
�/�Iv Nov 7, 2022
Reginald Zeno(Nov 7,202213:59 CST)
Reginald Zeno—Chief Financial Officer Date
4mt6710&11d� Nov 7, 2022
Anthony Rousseau, Assistant Director—FMS Date
4.d044p4q�
P o�FopT�aad
ATTESTED BY:
// PVo °=d
lgnnmE -S. C/oor7aCG �P�� oo*�a
JannetteS.Goodall(NOv8,202209:58CST)
a4�QEXagbp Nov 8, 2022
Jannette Goodall, City Secretary 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.
Nov 7, 2022
Steven Vandever(Nov 7,202211:33 CST)
Employee Signature/Date
Senior IT Solutions Manager
OFFICIAL RECORD
Title
CITY SECRETARY
FT. WORTH, T
Assibamnent Page 3 of 3
Form Request for Taxpayer 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 wwwJrs.gov1FormW9 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.
Granicus, LLC
2 Business name/disregarded entity name,if different from above
Granicus
m 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
m
following seven boxes. certain entities,not individuals;see
a instructions on page 3):
o ❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑Trust/estate
to single-member LLC Exempt payee code(if any)
,� ❑✓ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)► P
`p .�L. 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
to LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is (if any)
a uanother LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that code
r= is disregarded from the owner should check the appropriate box for the tax classification of its owner.
u ❑ Other(see instructions)► (Applies to accounts maintained outside the U.S.)
w _
fn 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional)
0 408 Saint Peter Street,Suite 600 Remit Payment to Address:
6 City,state,and ZIP code Dept CH-Box 19634
Saint Paul,MN 55102 Palatine, IL 60055-9634
7 List account numbers)here(optional)
NUTM Taxpayer Identification Number(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 How to get 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.
[T41 — 1 9 1 4 1 0 T88
Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or 1 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 1 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 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 property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments
other than interest and dividends,you are n required o sign the certification,but you must provide your correct TIN.See the instructions for Part 11,later.
Sign Signature of
Here U.S.person► Date► 7-
General Instruct)19147
•Form 1099-DIV(dividends,including those from stocks or mutual
funds)
Section references are to the Int dal Revenue Code unless otherwise e 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. e 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.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.10231X Form W-9(Rev.10-2018)
GG R A N I C U S granicus.com
December 1, 2021
To Whom It May Concern:
From: Granicus
Subject: Acquisition of GovQA
On August 24, 2021, GovQA, LLC was acquired by Granicus. Granicus, LLC will be assuming its
operations, support and client care.
Granicus, LLC's FEIN is: 41-1 941 088.
If you have any further questions regarding the acquisition, please feel free to contact us.
Regards,
M ynesJCE OO
Washington D.C. Denver Saint Paul United Kingdom
1152 15th Street NW,Suite 800 1999 Broadway,Suite 3600 408 St.Peter St,Suite 600 15 Worship Street
Washington,DC 20005 Denver,CO 80202 Saint Paul,MN 55102 EC2A 2DT,London
202.407.7500 800.314.0147 651.726.7309 +44(0) 1293 804622
J
L )
(D [6
E
0
U J
E
c
0
cm
(p Lo
Li ;t
1-2 �
z
ww LL
w73
1
� LIDJ
T
J �
r J d]
f� I— ff) c d] � < +r � ru
r6 l M 00 L) -0 -8 LV t 7
�E CD V)
CD to zc � �
.� w Q m
CLI
en 2
w 0
C: LL 0 LY 0 IZ-
4� .,n d) 6.
O
LL
00 O �
CD
xL) 0
ii0LL Z d LL LLC