HomeMy WebLinkAboutContract 61418-CC1Memorandum
Date:10/8/2025
To:Hye Won Kim, Assistant City Attorney
To: Sagar Medisetty Engineering Manager, Transportation/Public Works
Lauren Prieur Director, Transportation/Public Works
To: Jannette Goodall City Secretary
Re: Entity Classification Only- Mobotrex, Inc to Mobotrex, LLC
Prior Name:Mobotrex, Inc.
New Name:Mobotrex, Inc.
CSC: 61418
Entity classificationupdate: tax id number remains the same.
APPROVED BY:__________________________________________
Hye Won Kim, Assistant City Attorney
APPROVAL DATE:_____________________
Filing#:8018fi1fi51 Document#:139Z12999�002 Filed Qn 8�14�20Z4 recei�ed by llpload
FvCm 4ZZ
{Re�ised 45111)
Return in duplicate tv:
Secretary of State
PA. Box 136y7
.4ustin, 7'X 787i 1-3697
512 453-5555
FAX: 5121463-57D�
FiGns Fee: 5ee instructians
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Amendment to Registration
Tn Diselase a Change Resuiting from
A Cvnr+ersion or Merger
Entity Information
1. The ]egal name af the canr+erting or merging entity is:
Mobotrcx, Inc.
J7cate the name oj'the entiry as curre�rtiy shawn in the records of the secretary of staie.
2. If the entity attaincd its rcgistration under aya assumed name, the qualifying assumed name as
shawn an the records vf the secretary of state is:
3. The appliGatian for registration was issued w the entity on: 1 110 1120 1 3
The file nramber issued ta the filing entity by the secretary of s�u�e is: 48U1851651
Reason for Transfer of Reg'rstration
,��d�rrr
�A. � The application for registrativn is amended to disc�ose a change res�xlting from a canvexsion
from ane type vf Foreign en#ity ta anather type af foreign filing cntity in ordcr far tha can�erted entity
ta suoceed to the registration nf the can�erting entity. The name, jurissiictivn vf arganizativn, and
entity type af the can�erted entity succeeding ta the registration are:
Mobntrex, LLG
Nrenre qfEr�tidy Sr+cre�edir+g w ReSistrarian
Iowa Limited Liability Campany
.hrrl.rdicrian of prgasu�ztiar Type ojFxrity
4B. ❑ Thc arpplicatian far re�istxation is amended ta disclnse a change resulting from a merger inta
anothei' foreign filing entity in order fvr the entity that survi�ed or resulted from the merger to aucceed
to the regi.stratian of the merging entity. The narne, jurisdiction of organiaativn, and entity typc vf thc
entity succeading to the registratian are:
Nenar of Estity Surceeding to Regisfialivn
.lurGsdfc[1un uf 0+'�c+rxi:alfoA Type q�Entfty
Ch�nges tn the Applicatinn for Registratiun
(Attach a cornpleted applicativn for registration.]
S. The entity suc�eeding to the registratian hereby attaches an applicatian fvr registrAtion setting Fnrth
the information appiicable to that entity and amends the prior registration accordingly.
Form 422 3
Effecti�en ess of Filing cs�i�t �w�r n, s, o� c.�
A. �'This document hecomes ef�'ecti�e when the document is filed by the secreCary of sta�e.
S. ❑ This document becames effectit�e at a later date, which is not mvre than ninety [94) days from
the date af signing. The deIayed effecti�e date is:
C. ❑ This document takes effect upvn the accurren�e vf a future es+ent or fact, other fhan ihe
passage of time. Thc 90'� day after the date af signing is:
The followin� e�ent or fact will cause the document to take effect in the maruier described below:
Execution
The undersigned signs this document subje�t ta the penaltics im�oscd by law for the suhmission af a
mate�-ially false vr 6�udulent instrumcnt.
Date: ,`"r tJ l y 3 D� � a��l
�
Hy+: �
5ignaturG of authorizeci persvn [see structions)
Rnhert Ctam President
Typed or printed narne oF suthorixed perr,on
Form 4Z2 t}
Farm 304
(Rc�iscd Q5111)
Suhmit in duplicate to:
5ecretary of State
P.�. B�x 13697
AuStin, Tx �s�� 1-3s9�
512 463-5555
F�►x: 5 rar4��-s�o9
Filing Fee: $750
,`' � `�� .
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Application for
Registration
af a Foreign Limited
Liability �vmpan_y
This spacc reservad far office t�sc.
1. The entity is a fareign limited liability company. The name of the entity is:
Mvbatrex, LLC
Aruvide �h� jul! legal ►rame af the earRty Q.r stated en the entity'sjarnzu�ivrs doc+rrnen� i►r ifs jarrisdietian afformutimy.
2A. The name af the entity in its jurisc�ictioa of farmation does not �ontain the ward "lsrniteci �iability
company" or "limited campan�' {or an abbreviation thereo�. The name �f the entiiy with the ward vr
abbre►+iatioa that it elects to add for use in Texas is:
2I3. The entity name is not a�aila�le in T'exas. The assumed name under which ihe entity will qualif�y
and transaet business in Texas is:
T'he rrssumsd Mnme mnst ��rclude an accepra6Le orgu►rizarivrru! ider�rijier vr rue accepuad aLLrevtnri�n wjw7e nf rkese �ernrs.
3. Its fedcral emplayer identi�cativn number is: 3b-265fi899
❑ Fed�ral empinycr idcntificatian number infQrmation is not a�ailable at this timc.
4. It is arganized under the laws vf {�c �� sr�e or foretgn ooU�y) Iawa
RIICI iYle C�At� 8F lt5 fU�7l78tlQII lll T.�1St jllI1SC�1Ci18i1 15: 101D 111973
A.,r,��veyyr
5. As af the date of fling, the undersigned certifies that thc farcign limited liability company
currr.yntly exists as a �alid limited tiability campany under the laws of the jurisdiction af its formation.
6. The purpvse ar purposes af the limited liahility company that it pmposes ta pursue in the
trnnsaction of business in Texas are set forth beIow.
Manufachirer and distributer of traffi� contrfll praducts.
The entity also ccrtifics that it ia Authorized to pursu� suah stated purpese ar purposes in the state ar
�vuntry under which it is organized.
7. The date on which the fareign entity intends to transact business in Texas, ar the date on whi�h the:
f�rei�n enlity first transaGted business in Texas is: �G1�312d24
mmJdd/yyyy Late fees maY applY (see urstnectioxs).
$. The principal office address of the limited lia6ility company is:
109 W. 55th Street Da�en rt IA USA 52$�fi
Address City Stare Caunrry �ipl�osrat Code
F�m 3p4 6
Ca�plete item 9A ar 9Fi, lnu nrx bat6. Complet� iWn 9C.
❑,I 9A. The registered agent is an organizatian {r.aAnot bc cntity n�� ��e) by the name of:
Ca ration Service Cam an I]IBIA CSC-Law ers Inca ratin Ser�ice Com an
UR
❑ 9H. The registcred agent is an individual resident of the state whase naine is:
Firar Namr M•l. l.�rar Nane s�'+�
9C. The business addrass vf thc rcgistered agent and the registered office address is:
211 E, 7th Street Suite 52U Austin TX 787U1
Srreet �ddreaa Ciry Srale Zip Gade
10. The entity hereby appoints the Secretary Qf Sta.tc af Texas as its agent far ser�ice af pracess under
the circumstances set fart.h in sectinn 5.251 vf thc Tcxas Business Drganizations Code.
1 I. The namc and address of each go�erning persan is:
NAME AlYD ADDRESB DF GUVERNING PERSQN (Soter tLc nema oieid�cr w indiridusl ar an orgmizetian, but nol bosh_)
IF IND]VIDUAL
R�kleit C�BIiI
Firsl Name M.1. Last Name Sr�ix
OR
IF URGA1,lIZAT[aN
Q:g(lht2Ql�Ul7 NRlli�
I49 W. 55th Street
IA USA 52$06
NAME AND ADDRE55 []� GUV L�'NIYING PERSON (Ertter the peme af either �n mdi►•idunl or an organiutio� 6ut not mth.)
iF 1NIi1Vl�UAL
OlZ
F[rsr Narne
M.I. Last Name
Su,�Fx
�F UHGMIIZAT101Y
Mabotrex Ac uisitio LLC
G�gm�izutian Name
109 W. 55th Stxeet
IA USA 528(ld
NAME AND ADURESS UF GQVERNING PERSUN {Cutsr d�e �amc nf cithcr an a�diriduel or an argemezation, ba not boeh.j
I IF INDI V1�UAL
IUA
First Narne
Last Nume
5'ujfex
IF URGAN]ZATIU�i
Farm 3ua 7
Supplemental Pra�isionslInformatIvn
nerem
Effecti�enes� af FiVng (Sa�i �i�er.a, s, or C.}
A. ❑+� This document becames effecti�e when the document is filed by the secretary of stat�.
B. ❑ This document becarnes effective at a later date, which is not mare tiian ninety (9U) days frntn
the date of signing. The delayed ef%Gti�e date is:
G. ❑ This dacument taltes effect upon thc occurrcnce af a future e�ent or fact, uther than the
passage af time. The 9U`� day af}er the date af signing is:
1'he fallowinR e�ent ar fac# will cause the document to take effeci in the manner descrihed helnw:
Executian
The undersigned aff'uzns that the person dcsignatcd as rcgistered agent has consented ta thc
appointment. The undersigned signs this dc�cument subject ta the penalties impased by law for thc
submissian af a materiaily false or fraudulent instrument and certi�ies under penalty of perjury that the
undersigne�d is suthorizad under the prouisians nf law gnverning the entity to execute the filing
instrurnent.
oate: �'u�� 3�, �o �'�
Sig�amne nf authariDed pnrsan (see iashue o�]
Robert Clamp, Autharizead Persvn and CED
�� a � � oe��ti�a �.
� sna �
Form dU1-A
{Re�ised 121D9)
Acceptaace o�' Appointment
r� and
n• �� Consent to Ser�e �rs Reg�stered Agcnt
' - §5.241[h) Business Urgani�atians Code
'The fallnwing farm may he used when the person designated as registered agent in a regist�r�d agent
filing is an individual.
Acce nce of A intment and onsent to Sexve as Re 'stered A ent
I acl�nowiedge, accept and �ansent ta my designatifln ar aE}apc�intment as registered agent in Texas fqr
Name of represented entfry
I aan a resident af' the state and undcrstand tha# it will be my responsihili#y to receive any pm�ess,
notice, vr demand tha�t is ser�ed an me as the registered agent of the rcgresvnted entity; to forward
such tn the re�resented entity; and to irnmediately notify the z�epresented entity �nd submit a statement
of resignatian to the Secretary of State if I resign.
g:
aYtn1 PrinGed nonx afregulered age►r[ OaK
The following �mm� rnay be used when the persvn designated as registered agent in a registere� agent
filing is an arganiaativn.
Acce tancc of A intment end onsent tv Seive as Re istered A ent
I Rri7 &At.�lU11Z� tU aGt Qn �7C�1Sif D� Corporation Service Company a181A CSGLawyers Incorporating Sanrice Compan
Name of organizatian designa�ed as rngrstered ugent
The organization is registered or otherwise autharixed to do business in Texas. The organizatian
acknowled.ges, accepts and consents ta its appainUnent or designatian as registered agent in Texas for:
Name of reprc.sPnled entiry
The organization takes respansbility to recei�e any process, nvtice, ar demand that is ser�ed on the
organization as the registered agent af the represented entiry; ta fnrward such to the represented entity;
and to immetliately notify the represented entity and submit a statement of resignatinn to the Secretary
af State if the organization resigns.
Brendan Sheils , Asst SeCretary on
�, ��� ��� behalf of Carporation Service Campany {���� 312�24
Signchne of parson auAhorizerl to acf on behaifof arganizaHon Prrntrd amne af mrf�arised(aersn+r Date (mmlddlYSSS'1
Fam 40I-A 3
�
Form �
(Rev. March 2024)
Department of the Treasury
Intemal Revenue Service
Request for Taxpayer
Identi�ication Number and Certification
Go to www.irs.gov/FomrW9 for instructions and the latest information.
Give form to the
requester. Do not
send to the IRS.
Before you begin. For guidance related to the purpose of Farm W-9, see Purpose of Form, below.
Name of entity�ndividual. M entry is required. (For a sate proprietor or disregarded entiiy, enter the owner's name on line 1, and enter the business/disregarded
entity's name on line 2.)
MoboTrex, LLC
2 Business name/disregarded entity name, ff different from above.
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3a Check the appropriate box for federal tax class�cation of the entity�ndividuaf whose name is entered on line 1. Check
only one of the following seven boxes.
❑ IndividuaVsole proprietor ❑ C corporation ❑ S corporation ❑ Partnership ❑ TrusUestate
❑✓ LLC. Enter the tax classification (C = C corporation, S= S corporation, P= Partnership) . . . . P
Note: Check the "LLC" box above and, in tha eniry spaca, enter the appropriate code (C, S, or P) for the tax
class�cation of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate
box for the tax classification of its owner.
❑ Other (see instructions)
3b If on line 3a you checked "Partnership" or "TrusUestate," or checked "L!C" and entered "P" as Rs tax classification,
and you are providing this form to a partnership, trust, ar estate in which yau have an ownership interest, check
this box if you have any faeign partners, owners, or ben�ciaries. See instructions _ . . . . ..❑
5 Address (number, street, and apt. or suite no.). See instructians.
109 West 55th Street
City, state, and ZIP code
renaort, IA 52806
7 List account number(s) here (optional)
Identification Number
4 Exemptions (codes apply only to
certain entities, not individuals;
see instructions on page 3):
Exempt payee code (rf an�
Exemption from Foreign Account Tax
Compliance Act (FATCf� reporting
code (if an»
(Applias to accounts maintained
outside the United States.)
Requester's name and address (optiona�
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I�ial secuHty number �
backup withhalding. For individuals, this is generally your socia! security number {SSN). However, for a �_ m_�
resident alien, sole proprietor, or disregarded entity, see the instructians for Part i, later. For other
entities, it is your employer identification number (EIN). If you da not have a number, see How to get a or
TlN, later.
Note: If the account is in more than one name, see the instructions for line �. See also What Name and
Number To Give the Requester for guidelines on whose number ta enter.
Certification
Under penalties of perjury, I certify that:
000����00�
1. The number shown on this form is my correct taxpayer ident'rfication number {or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because (a) I am exempt fram backup withholding, or (b) I have not been notified by the Intemal 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 su6ject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (f any) indicating that I am exempf from FATCA reporting is correct.
Certfication 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 retum. For reai 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 (IRP�, and, generally, payments
other than interest and dividends, vou are not reauired to siQn the certiflcation, but you must provide your correct TIN. See the instructions for Part II, later.
Sign � Signature of
Here u.s. �.so�
General Instructions
Section references are to the Intemal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
What's New
Date �� / b� Jo�-O�
New line 3b has been added to this form. A flow-through entity is
required to complete this line to indicate that k 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 information
regarding the status of its indirect foreign partners, owners, or
beneficiaries, so that it can satisiy 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).
Line 3a has been modified to clarify how a disregarded entiry completes
this line. An LLC that is a disregarded entity should check the Purpose of Form
appropriate box for the tax classification of its owner. Otherwise, it
should check the "LLC" box and enter its appropriate tax classificatian. An individual or entity (Form W-9 requeste� who is required to file an
informaiion return with the IRS is giving you this fortn because they
cat. r�o. �o2six Forr„ W-9 �se�. s-2a2a�
Signature: `� �''`�`1" �'
Signature: ����u:«n.
Lauren Prieur (Oct 14, 20251620:06 CDT)
Email: sagar.medisetty@fortworthtexas.gov Email: Lauren.Prieur@fortworthtexas.gov