HomeMy WebLinkAboutContract 53799-NC1CSC No. 53799-NC1
Memorandum
Date: 4/9/2025
To: Hye Kim, Assistant City Attorney
To: Rhonda Hinz — Sr. Administrator Services Manager
Kacey Bess — Director, Neighborhood Services
From: Tracy Walter — Management Analyst II/FMS- Vendor Management
Re: Entity Classification Change Only- Benevate Inc to Benevate LLC
Prior Name: Benevate Inc
New Name: Benevate LLC
Supplier id: 7000000840
Effective Date:
CSCO:
09/24/2024
53499
APPROVED BY:
Assistant City Attorney
APPROVAL DATE: Apr 14, 2025
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Delaware
Page 1
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY THAT THE ATTACHED IS A TRUE AND
CORRECT COPY OF THE CERTIFICATE OF CONVERSION OF A DELAWARE
CORPORATION UNDER THE NAME OF "BENEVATE INC." TO A DELAWARE
LIMITED LIABILITY COMPANY, CHANGING ITS NAME FROM "BENEVATE INC."
TO "BENEVATE, LLC", FILED IN THIS OFFICE ON THE TWENTY—FOURTH DAY
OF SEPTEMBER, A.D. 2024, AT 12:26 O'CLOCK P.M.
5898722 8100V
SR420243768038
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Authentication: 204475516
Date:09-24-24
You may verify this certificate online at corp.delaware.gov/authver.shtml
STATE OF DELAWARE
CERTIFICATE OF CONVERSION
FROM A DELAWARE CORPORATION
TO
A DELAWARE LIMITED LIABILITY COMPANY
Pursuant to Section 18-214 of the Limited Liability Company Act of the State of Delaware
1. The jurisdiction where the Corporation was first formed and remains immediately prior to
the filing of this Certificate is the State of Delaware.
2. The date the Corporation was first formed is December 4, 2015,
3. The name of the Corporation immediately prior to ding this Certificate is Benevate Inc.
4. The name of the Limited Liability Company as set forth in the Certificate of Formation is
Benevate, LLC.
(Remainder ofpage intentionally left blank)
State of Delaware
Secretary of State
Division of Corporations
Delivered 12:26 P34 09/24/2024
FILED 12:26 PM 09/24/2024
SR 20243768038 - File Number 5898722
IN WITNESS WHEREOF, the undersigned has executed this Certificate on September 24, 2024.
BENEVATE INC.
By; J. Jason Rusnak
J. Jason Rusnak
President
[Signature Page to Certificate of Conversion]
Delaware ,.g„
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE DO HEREBY CERTIFY THAT THE ATTACHED IS A TRUE AND
CORRECT COPY OF THE CERTIFICATE OF FORMATION OF "BENEVATE,
LLC" FILED IN THIS OFFICE ON THE TWENTY—FOURTH DAY OF
SEPTEMBER, A.D. 2024, AT 12:26 O'CLOCK P.M.
5898722 8100V
SR# 20243768038
J9i1AX IOS�,$M1�la fy 41 S[#7■
Authentication: 204475516
Date: 09-24-24
You may verify this certificate online at corp.delaware.gov/authver.shtml
STATE OF DELAWARE
LIMITED LIABILITY COMPANY
CERTIFICATE OF FORMATION
Pursuant to Section 15-214 of the Limited Liability Company Act of the State of Delaware
1. The name of the limited liability company is Benevate, LLC.
2. The address of its registered office in the State of Delaware is 1209 Orange Street, City of
Wilmington, County of New Castle, Delaware 19801. The name of its registered agent at
such address is The Corporation Trust Company.
[Remainder ofpage intentionally left blank]
State of Delaware
Secretary of State
Division of Corporations
Delivered 12:26 P34 09/24/2024
FILED 12:26 PM 09/24/2024
SR 20243768038 - File Number 5898722
IN WITNESS WHEREOF, the undersigned has executed this Certificate on September 24, 2024.
By. John Jason Rusnak
_John Jason Rusnak
Authorized Person
[Signature Page to Certificate of Formation]
Form W111109 Request for Taxpayer Give fort to the
(R8V. March2a24) Identification Number and Certification requester. Do not
Department R per of the Treasury Go to www.fra,gov1FormlV9 for Instructions end the latest Information. send to the IRS.
Internal Revrrnue Service _
gef0re You bagin. For guidance related to the purpose of Form W-9„ see Purpose of Form, below.
1 Naas of entity/Individual. An entry Is required. (For a We proprietor or disregarded entity, enter the owners name on line 1, and enter the business/disregarded
entity's name on line 2.)
Benevate. I I C,
2 Busies name/disregarded entity name, if different from above.
Neighborly Software
m 30 Check the appropriate box for federal tax classification of the entity/Individual whose name Is entered on line 1. Check 4 Exemptions (codes apply only to
only one of the following seven boxes. carton entities, not individuals;
c ❑ Individual(sob proprietor El C corporation ❑ S corporation ❑ Partnership❑ Trus1/satate
see instructions on page 3):
a ❑ LLC. Enter the tax classification (C - C corporation, S - S corporation, P - Partnership) . . . . C Exempt payee code (rf arry)
Not« Check the "LLC" box above and, In the entry space, enter the appropriate code (C, S, or P) for the tax
classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate Exemption from Foreign Accou rd Tax
box for the tax classification of its owner. Compliance Act (FATCA) reporting
❑ Other (see Instructions.) code (of any)
3b If on line 3a you checked "Partnership' or "Trustlestate," or checked "LLC' and entered "P' as its tax classification, {Applies to accounts rnontained
and you are providing this form to a partnership, trust, or estate In which you have an ownership interest, check ❑ outside the Unified States]
this box it you have any foreign partners. owners, or beneficiaries. See instructions ,
5 Address (number, street, and apt. or suite no.). See instructions. Requester's name and address (optional)
3423 Piedmont Road NE Suite 420
6 City, state, and ZIP code
Adanta. GA 30305
7 List account number(s) here (optionaf)
1131M Taxpayer Identification Number
Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a I I _ M
I I
resident alien, ads 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 or
TIN, later.
R Employer identification nurr►ber
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter, M81 - I 0 18 18 I 0 ] 3 16 18
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
2.1 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 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; 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.
Certfficatim Iraltructions. You must cross out item 2 above lt you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all Intgrest and dividends on your tax return, For real estate transactions, Item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of , cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
other than Interest and d a t rlquired to sign the cer ificatkm, but you must provide your correct TIN. See the instructions for Part II, later.
sign I signat. of `_— � 1-7
2
Here U.S. person Date /
General Instructions New line 3b has been added to this form. A flow -through entity is
ulred t 1 t th1' t 1 di t th
Section references are to the Internal Revenue Code unless otherwise
noted.
Fulws developments. For the latest Information about developments
related to Form W-9 and its Instructions, such as legislation enacted
the
y ey were published, go to wwwJrs.gov1FormW9.
What's New
Une 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that Is a disregarded entity should check the
appropriate box for the tax classification of its owner, Otherwise, it
should check the "LLC" box and enter its appropriate tax daseiflcation.
req o comp e e is Ina o n ca a at d has direct or indirect
foreign partners, owners, or beneficiaries when it provides the Form W-9
to another flow -through entity In which it has an ownership interest. This
change Is Intended to provide a flow -through entity with infomhation
regarding the status of its Indirect foreign partners, owners, or
beneficiaries, so that it can satisfy any applicable reporting
requirements. For example, a partnership that has any Indirect foreign
partners may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Purpose of Form
An Individual or entity (Fort W-g requester) who is required to file an
Information return with the IRS Is giving you this form because they
Cat. No. 10231 X Form W-g (Ftw, 3-2024)
Delaware Page
The First State
1, JEFFREY W . BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY "BENEVATE, LLC" IS DULY FORMED UNDER
THE LAWS OF THE STATE OF DELAWARE AND IS IN GOOD STANDING AND HAS A
LEGAL EXISTENCE SO FAR AS THE RECORDS OF THIS OFFICE SHOW, AS OF
THE TWENTY—SIXTH DAY OF SEPTEMBER, A.D. 2024.
AND I DO HEREBY FURTHER CERTIFY THAT THE ANNUAL TAXES HAVE BEEN
PAID TO DATE.
5898722 8300
xw �
SR# 20243795570
You may verify this certificate online at corp.delaware.gov/authver.shtml
J9i1Ay ix■ Sxfc7�rydSC�1• )
Authentication: 204492094
Date: 09-26-24