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Home My WebLink About062180-A1 - General - Contract - Safe City CommissionCSC No. 62180-A1 FIRST AMENDMENT TO FORT WORTH CITY SECRETARY CONTRACT NO. 62180 This First Amendment to Fort Worth City Secretary Contract No. 62180 ("Agreement") is made between the CITY OF FORT WORTH ("City") a Texas home -rule municipal corporation acting by and through its duly authorized Assistant City Manager, and SAFE CITY COMMISSION ("Contractor") acting by and through Ken Shetter, President and General Counsel its duly authorized representative, each individually referred as a "Party" and collectively as the "Parties". WHEREAS, City and Contractor entered into an Agreement identified as Fort Worth City Secretary Contract No. 62180 beginning October 1, 2024 ("Agreement"); WHEREAS, the Parties wish to amend the Agreement to replace the Budget Narrative in Exhibit B with a new Budget Narrative that includes the Fiscal Year 2026 Budget; WHEREAS, the Parties wish to amend the Agreement to replace the Request For Reimbursement (RFR) form in Exhibit C with a new Request For Reimbursement (RFR) form that includes the Fiscal Year 2026 Budget; WHEREAS, the Parties wish to amend the Agreement to provide fbr future FY-specific budget documentation without amending the Agreement; WHEREAS, the Parties wish to amend the Agreement to provide for 4 % annual increases to the Program Funds in accordance with M&C 25-1043; and WHEREAS, the Parties wish to amend the Agreement to increase the annual amount by $16,323.70 fbr Fiscal Year 2026 with a new total program fund of $424,416.25. NOW THEREFORE the Parties do hereby agree to the following: I. AMENDMENT TO AGREEMENT The Agreement is hereby amended to be and read as follows: A. Exhibit B — Budget Narrative, which is attached hereto and incorporated herein, is made a part of this Agreement fbr all purposes, replacing the previous Exhibit B's Budget Narrative. B. Section 2.14 of the Agreement is hereby added to be and read as follows: OFFICIAL RECORD CITY SECRETARY First Amendment to Fort Worth City Secretary Contract No. 62180 FT. WORTH, TX Page 1 of 6 The Parties agree that the compensation amount ("Program Funds") payable each fiscal year is subject to appropriation by the relevant governing body(s) expending funds under the Agreement. Each fiscal year, City agrees to update the exhibits in accordance with the amount authorized under the relevant M&C. Such updates shall be provided to Contractor and incorporated by reference herein without necessitating an amendment to the Agreement. All documentation provided hereunder shall be retained for the three-year audit period pursuant to Section 7. C. Section 2.1 of the Agreement is amended as follows: 2. ProLyram Funds 2.1 In no event shall the total distribution from City made to the Contractor during the Term of this Agreement exceed the total sum of $424,416.25 FY 2026 and $441,392.90 FY 2027, as appropriated annually per fiscal year ("Program Funds"). D. Exhibit C — Request For Reimbursement (RFR), which is attached hereto and incorporated herein, is made a part of this Agreement for all purposes, replacing the previous Exhibit C's Request For Reimbursement (RFR). II. ALL OTHER TERMS SHALL REMAIN THE SAME All other provisions of Agreement which are not expressly amended herein shall remain in full force and effect. III. ELECTRONIC SIGNATURE This Amendment may be executed in multiple counterparts, each of which shall be an original and all of which shall constitute one and the same instrument. A facsimile copy or computer image, such as a PDF or tiff image, or a signature, shall be treated as and shall have the same effect as an original. [SIGNATURE PAGE FOLLOWS] First Amendment to Fort Worth City Secretary Contract No. 62180 Page 2 of 6 IN WITNESS WHEREOF, the Parties hereto have executed this amendment to be effective the day the Assistant City Manager signs it. ACCEPTED AND AGREED: CITY OF FORT WORTH � 9 By: Name: William Johnson Title: Assistant City Manager Date: 11/21/2025 APPROVAL RECOMMENDED: By: Name Title: RobAlldfov 20, 2025 18:02:40 CST) Robert A. Alldredge Jr. Executive Assistant Chief ATTEST: Name: Jamlette S. Goodall Title: City Secretary SAFE CITY COMMISSION By: Name: Ken Shetter Title: President and General Counsel Date: le) // q oQ S 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. By: D Name: Jaycee Shane Title: CCPD Partners Manager APPROVED AS TO FORM AND LEGALITY: By: 4Ma utb ly/rJosn4nl.� Name: Amarna Muhammad Title: Assistant City Attorney CONTRACT AUTHORIZATION: M&C: 25-1043 Date Approved:11/11/2025 Form 1295 Certification No.: 2024-1167218 OFFICIAL RECORD CITY SECRETARY First Amendment to Fort Worth City Secretary Contract No. 62180 FT. WORTH, TX Page 3 of 6 EXHIBIT B - BUDGET NARRATIVE Clime Control and Prevention District Mission Partutrs E_-\Mrr B - Budget Narrative AGENCY NXAIE _ II Crix StoF;.tr, Cal7akui Put-tmae na9d:li -4-* d in aneaa]h• staff The it e sroppa:s Call Cestr. takeg aaon:aoas api tv teleplrou. rev and web arc rcu=g them to thz ai:opra:a FRPD p:.�sorra! Pa)"at engtc I S +7 peLoc br d rota] patso-^,� t•spaau of 5 1 Cal ^0 : HOLMS S15.00 SS2.640.23 $82.500.00 582,300.00 t 9'.i47n:i:iag wwltd to'aday'sa;paM1'sl.5.sa@Cry Cosrau!na w::l iocaEa S.iC�7 Lois; TO the CC?D COarx: (15 [ 5.930= s_.SCOI respacubu for 07rC0nat 0bjeaae 5. Ammet 5 I. c. '_ end 5.3 owiraed n Praia Plan Preudem: F_ronr{ to the Be,-' ufD::t:ton. stt ?re>idtm sheu:d armc:part rtirealy &the carnue ar .'-It nissan of Sah _ rC oarusron m order :o Te:a a a : ebur rderstandse - of the w•:•�^.mr:s esss;nc �3 au:i Sbc aris a'ah aL prods s;a3ta a:ganizz aai mq:entmaCFrogra-rxrm:::t;a_do;n;ernes Stt air dneah' p mire protetslonal eda:arioe asv coaacr:.:!•e•atreact p:a�a:ss Edr:=roc and ot.�=_ach :,:tavias roars+of r t . S'_'^: `•).�}� 55,750.00 S11.250.00 $11,250.00 +++ pcew--mu prot-ced t. craat prestmaa proftuan.6 ILd the rear-:rzy atlrre: pcew=atiou re rpe:- 1. de-uri nolerre. d", %nets =pact and c�va ' This potannw�ucp 'ipa:e in snotlh Cr123{c_e Te s; progracrt-motrE, pa;twa.5 pnp- cotutt3g o[:esb '„arras::its.:eSriachp btlz� coleee and CMH.:e rMr apt C.�Yu:= �N'F: 1.:h-i:ec at. _l"t 'xea: t p; ei to vaolixe The Prlir!, wa ;F+1 about l) b- p+- :feel ea 7.-M Aesposale Ora.co= Ob.,tcmcs 1.:,3 and Arrwx: i Ll. 7.1 `^:. 3 ¢ Pr0)e:t 7= Eu.,,. a V. Prom- ani D: t or of rho Fat J'a::'_t Ctuer The EVP of Promara ar� FJC Dreaor os+rsrts a_ F:agramr of Saft CL7 Ca 1- au: supeatvas 2-7prop= saE S to =Ere org!.i:e .-,dry-I,...,^� a_ pa?atmtla: arnsiss a�iuuroaaes. s. ke wiC p:aliie profzssioti ceu rar1_'co�arr orareach doxas:rso:enre,-s-tprnvmion sea:agats, non•3ra1 4C.,4 ':'E S13_'.'.•: S53,00000 S33.00000 SMOCO.00 angss:aroa paaen.*tps aa3 o•.Ler prestnwnpro�sa:eas Thspeiirrotut-we,a➢ atcn ore:aa�Aopa Ttssaad ocmLa'patwarp:cgran ; aid ptvsiie>;riarca sa .m ptacr ntpled+ruar L n b par� wit .:vs arts acd anon.= Cans Pop. A=ma a>:]utiea, a!w?:=arias direct a[ erLarce at tvmh. pa:hwa rogrde.:nd track Air, :asp. { ¢Ih!irlTTll. !hu pastaet w_I rerj]a.s b- per waek at t4 proC Ras;om i Owcona ObJtarms 1. 2 an. 3 and A ,v. s I L 2. 1 atd.3 outit-3 n Pro)vt PLm 1 Drectoc. Crave Prevenwa P:aLr1Ti" This ;raffinem'rs u re;partibla i de 3--- ratncof� I aLa prne ion preaaa�a.±i,c:a:s�.:rice Supers lamp, er=e Sroppa s, Frvmb 333333 . • ar Lam. Pm scr Safe Neigtin_g ds x.h.. 4, rd TraEdncatacn. Pregrax Eeksxesatm for ` 90% _ _., 'S.000.C�p S57,150.00 S67.500A0 169,525.00 F i.3 =ludei the dete:ap-u ani igiaeca;rat of a av:e: ait•ewierant Pre Aax :ma advloc ";Top=, w..L allow for eg,=a i=hAlr 3-rera: rr rtepotst to Rni---:= of ' demestr saanre. S.he tml;pa^•abon 35 tc- ps weel oa ibu pro^ts P,espacsi tfcr ?atcome ObjMrM 1 apt Aai tK 1.1, 1 .. 14. 1.53,.n2 1 ib onhred L Pm•er: Phc DCer- cf Anvcaz• Is a:aJ-tQY (4.) hours per week! role=ear :Wrd=-.or po=AL Jet a; i:}ace direct :,.at cwe ftcugt acs,-cy' =halm, aisu ,bane; icenam0e idmu5ci W. of ' high rul rictnca. "eunton on xlalmaship d)ramics. vfeny PLar=g oat cowcad to short art anrrarm sen:x; Adsocrrw;0 be provided to docesry sielese %wt= a: Ore Safe Pace 71.1 pos¢rot urges at h=21eiate rapentsw to the Stzior.i2svoa coordmaro: aid 70!: FTE SE0.000 00 S45,920.00 556.000.00 $57.630.00 a-1 can' a -a-, etem case load :n abume of rho Stator Adivcve Coorcbrzoz tU powwn saner n the rrup mpens r is a^ wal-as arc miewi 4 hagt r.A casts auh ahvca:e stag: prior to tat turiv!a-mm; the Ce rer Ttr easares proper ai•�a'-:::at of tgL risk mmazi and coraaactnato zastdiatt ss-rues s appropm.,e for ea3:is- Wedx u:pe:ttitieas naeetiau re he1i a^t ce.-as Tkas pert== erutaa; ro:::i)•n_hidiscY'nar; h1! rrk team nxci:gs avh OSPF:C adsv:arts and co_abo:am'e panne: =giro ies Chalrms Adavcac)• Coord-avr: ptos:ies durr r=n ,tor wx%in T4 poiu=e .3l rr.txi rreaal refeaa3 and we profile vhsttacp io partnc ga_d=where their ch_drea hate Yee '_aenh•rganad T'dorxcac aioferearl=+=her npa<otmama. Thesposmanu Dan: 754 F-iE 550:0700 337.500.00 $37.305_25 $4=750.00 riled Arad w:l be rt;pou yr kr prorate oct:ratd se.-sices belcw: Lira gsuae repass :.-ash• to the Drectoc ofAds'o- Cat= Adso:ace: S he a rtrp rabl, for assurmg at n;tded Audi aIl csta u xt p:o_cax c:hsd¢g atxkes. cLa't'reds Ft mmr•i+•+. coaai=y 0=42.h pro;r=- The curve= W. FM 50.04 $9.738.7; 50.00 eepk3ve c this pvsoicn.Lren:¢Spanah and aLo ---:: in tr„lmae weh mr clu=aai 44� ibeizchL rm as reeeed. S he w'r?l;p zd 40 :+airs pir meal cn thew fop= At po a!e fir: o-ecoae ot)wn'es a: i t and dcmttir 2 1 a 1 an; e.: o.a.iraa a . m ect Plac -�- free Pms dam. Congo+., Er zecaem: S be a cesponuble k: a3 sac_I meldai oazea:h. Works w:rh Zpwgara r.a'_°toorg=e and Lndlop sacral=dn corer. The rrenics trod 5!i FM slo7'l13.00 $5.05620 S5,3711-1- 00 4-0includa rrT.agaa . ae;. conical . C`C" and 4edhack. Faspox-ble for cucamt )b)tctne '_ and Acmr,," _.' owhred n Pra)e:t Plsc,. First Amendment to Fort Worth City Secretary Contract No. 62180 Page 4 of 6 B. cRNGE Fr¢.6 kctit: W: 1_ t V>? ws,wr campmt'_ ofP]goJ rase; a: 7 ei•: tzpiloir p Le]}k dtas]L tuwca ]ii ± _•sast ca n:. � :i �;be fia:i :r zcr�r use contnhnci (cumin: i'. o: c]:ar .^is=er•cc•] xSrza arx ac:os� Po:xn_. _a .:ne to t1u crxks of sPl�:tc:s tu•Jt_ salt: Lht ca¢¢]n' sFassoaed a^:r]e:t Fps ]rl nttt� er ao[ un;;a)eeS t_i:::o tl ol: c Oke tt :t = F]a. ".3t totA of F: f becrm-r5 re"., trt M1Sev CFO: [L•TVJ tit: wtxi T' : t]34C^y.Ot•d � [klse [025 ]S3 ][f]a: Copt CALL TAE=RS 5;09.Cd fiot¢s S 55 34.748.90 16.148.61 PRESME`T 70ee FTE S 11.240 00 S576+0 SI.11S.00 51113.00• E...iCTA--- via P?FSIDeS,. 00 i.._2'0.00 O DIFFC70E C?PfE P?✓Y_.Or %Cv=4HS : _.___.___.�.____..•_ FT ? 5671 } ._S__.3.7."so ST4£59GO I S16.E750 _.,$Ta•_W_.....D Sld.S65.00 CIIE4Y - - ._._..._.._a,._..._..._._.__. ._.� V6.0 0', __— STL 00 SIi000+E0 CLLi—Aj,—, Cccclmwr. 30°° FTc S37.E05.— S:_000 OD 311.34158 $11970.00 CI'F-;T.LTiOCA' F- SO 00 536+8 .r) SO.OG fC�CO %Ila PF_ME1,T. CONM,'?,.TY EI IGAUNS17 I•' 5339.34 S80335 I IEGU."•0 C_ 17W,•EL Sc TRAL.•ING a Q ; • r r..ia E. SUPPLIES F rCONSL'LT1NG CON-MRX- C, C:ao Sax (Ctrole] Creek Cacr 7•s br }c•_t s—g is Lt'nt3 io ]¢e .?Csp Eire Tev ,xo�]c:z•�; C:mp F:gx t: ncts.Y.t ca.P n;, l�sn -5 i aiFa; aad a Fi:d a=a'4 tm-. e+ snm.�, c]a_'ts fa :'c:tra tax Sort; x:'tek Lm ]•ec 30.Gs"i C?.^.-_0: :..`g -T 3_'i000 ss.aaa a) S5!:0 _�.a) f5.O0D.OG rri rr icTa^ed 3)' datse: taut ALL: 2"yY_St rP�t2�'D UW:arY O11tTE C3.:i:>•.�" 3 � e G SUB -GRANTS r r_eOCCTJPA.\CT r 1\DMECT Fa:i=•ems oce:hta:::on: 4Lcs 'yg �,t:.sc;i]�:t;t,.i :ll:rz :u: an=:>uct :o!is _ :0°: PE CE:11 3+0.SOP 25 1+1++16; 54-.139._P tar • t 3-IT-AR TOTALS 5403,093.>5 SJ14 J161S S441 39290 . . • ... .. SJOS,O93,5; .__ SI2JyJ„16.2a _, SJd1,392-9 SO.00 SO.00 First Amendment to Fort Worth City Secretary Contract No. 62180 Page 5 of 6 EXHIBIT C - REQUEST FOR REIMBURSEMENT (RFR) FORTWORTH. 7- In %IL ('ON I ROI. A.NII PRI'%I.NI IUN PIS II?RA Submit To: By Email: PSM@fortwortlitexas.gov Mail: Bob Bolen Public Safety Complex Attn: Contract Compliance Specialist Financial Management Division 505 West Felix St. Fort Worth, TX 76115 Exhibit C Request for Reimbursement (RFR) FY 2026 Submitting Agency: Contact Nam: Phone Number: Email: Remit Address: Invoice Nwnber. Month of Request: Safe City Commission Grant Summers 817-502-7121 gsummers0onesafeolace.oro 1100 Hemphill St, Fort Worth TX 76104 DIRECT COSTS (90 % Minimum) A B C D E Budget Calcgory Budget Ansounl Total of Previous Rcimbnrsemcnls Requested This Month's Request (B+C) (A-D) Total Requested To -Date Remaining Balance Available Personnel S 313,410.90 $ - $ 313,410.90 MB Fringe Benefits $ 63,563.72 S - s 63563.72 Travel & Training $ - $ - Equipment S - s - E Supplies S - S - F Contracts/Consultants $ 5,000.00 $ - s 5,000.00 G Sub -Awards S s - H Occupancy $ - S - Tolal Direct Costs S 381,974.62 1 s s $ S 381,974.62 INDIRECT COSTS(10% Maximum) A B C D E (R+C) (A-D) Total of Previous This Month's Budget Category Budget Ammunt Reimbursements Total Requested Remaining Balance Requested Request To -Date Available Total lnDirect Costs $ 429441.63 S $ S 42A41.63 Supporting documents required with monthly requests. See Request for Reimbursement Instructions for reference Summary: Total Budget: S 424,416.25 Previous Requests: $ This Request: S Total Requested To -Date S Retraining Funds S 424,416.25 I have reviewed this request and certify that these fisted expenses and support documentation are accurate. Authorized Signatory Signatory Title Date Fiscal Agent Use Only Purchase Order N Fund Dep[ ID Account RFR Approred For Pa)vuent (ForUt 1Vonrir Police Deparraew CCPD Staff Use Only) Reviewed by: Approved by: Gant Staff Signature Date Grant StaffSignature Date Finance Received Stamp Placed Below First Amendment to Fort Worth City Secretary Contract No. 62180 Page 6 of 6 M&C Review Page 1 of 3 CITY COUNCIL AGENDA Create New From This M&C DATE: CODE 11/11/2025 REFERENCE **M&C 25- N O.: 1043 Official site of the City of Fort Worth, Texas FORTWORTH '44"� 35CCPD GRANT LOG NAME: AMENDMENTS VICTIM ASSISTANCE PRIORITY PROGRAMS C TYPE: CONSENT PUBLIC NO HEARING: SUBJECT: (ALL) Authorize Execution of Amendments to the Agreements with Alliance for Children, Inc. and Safe City Commission to Allow a 4% Annual Increase of Funding in the Combined Amount Up to $85,656.46, Consisting of Up to $41,988.46 for Fiscal Year 2026 and $43,668.00 for Fiscal Year 2027 for a New Total of $2,227,067.92 in Order to Continue Operation of Victim Assistance Initiative Programs for Fiscal Years 2026 and 2027 RECOMMENDATION: It is recommended that the City Council authorize execution of an amendment with Alliance for Children, Inc. and Safe City Commission to allow a 4\% annual increase of funding in the amount up to $85,656.46, to be the amount up to $41,988.46 for Fiscal Year 2026 and $43,668.00 for Fiscal Year 2027 for a new total of $2,227,067.92 in order to continue operation of victim assistance initiative programs for Fiscal Years 2026 and 2027. DISCUSSION: On September 17, 2024, Council approved the execution of three Mayor & Council Communications (M&C), executing contracts between two agencies to continue their respective programs related to various Victim Assistance initiatives. M&C 24-0762 executed a contract between Fort Worth Police Crime Control and Prevention District (CCPD) and Alliance for Children, Inc. in an amount up to $246,938.95 to continue operation of their Child Abuse Prevention Programs. M&C 24-0767 executed a contract between CCPD and Safe City Commission (SCC) in amount up to $408,092.55 to continue operation of the Community Advocacy Crime Prevention and the Crime Stoppers Program Call Center (ACC). M&C 24-0768 executed a contract between CCPD and SCC in amount up to $394,680.00 to continue operation of the One Safe Place Regional Family Justice Center (FJC). The approved agreements affected a 3-year contract set to begin October 1, 2024, and end on December 31, 2027. The Alliance for Children, Inc. and SCC are two of CCPD's Mission Partners, agencies which are identified by both the Fort Worth Police Department and the CCPD Board to have priorities requiring ongoing development and investment. Due to this, these contracts receive a base grant fund amount with a 4\% annual increase of funding each Fiscal Year (FY) of the contract term. When M&C's 24- 0762, 24-0767, and 24-0678 were approved, the 4\% annual increase was not included. The purpose of this Mayor and Council Communication is to authorize an amendment to these Contracts to account for the 4\% annual increase for Fiscal Years 2026 and 2027. The 4\% annual increase to be added to Alliance for Children's base grant funding amount is $9,877.56 for FY 2026 and $10,272.66 for FY 2027, in the total amount up to $20,150.22. The 4\% annual increase to be added to SCC's base grant funding for the ACC program is $16,323.70 for FY 2026 and $16,976.65 for FY 2027, in the total amount up to $33,300.35. The 4\% annual increase to be added to SCC's http://apps.cfwnet.org/council_packet/mc review.asp?ID=33906&councildate=ll/ll/2025 11/12/2025 M&C Review Page 2 of 3 base grant funding for the FJC program is $15,787.20 for FY 2026 and $16,418.69 for FY 2027, in the total amount up to $32,205.89. The table below shows the breakdown of costs between each Agency and Fiscal Year, including base amounts with their annual increases: FISCAL YEAR GRANT AMOUNT Alliance for Children, Inc. FY2026 $256,816.51 FY2027 $267,089.17 Total $523, 905.68 Safe City Commission (ACC) FY2026 $424,416.25 FY2027 $441,392.90 Total $865, 809.15 Safe City Commission (FJC) FY2026 $410,467.20 FY2027 $426,885.89 Total $837, 353.09 Fiscal Year Totals FY2026 $1,091,699.96 FY2027 $1,135,367.96 GRAND TOTAL $2,227,067.92 Funding is budgeted in the CCPD Community Based Fund for the FY26 Mission Partners Program project. Funding for Fiscal Year 2027 will be verified for availability when budgets for the Fiscal Year are determined. FISCAL INFORMATION/CERTIFICATION: The Director of Finance certifies that upon approval of the above recommendation funds are available in the current operating budget, as previously appropriated, and upon adoption of the Fiscal Year 2027 Budget by the City Council, funds will be available in the Fiscal Year 2027 Operating Budget, as appropriated, in the CCPD Community Based Fund for the FY26 Mission Partners Program. Prior to an expenditure being incurred, the Police Department has the responsibility to validate the availability of funds. TO Fund Department Account Project Program Activity Budget Reference # Amount ID ID Year (Chartfield 2) Fund Department Account Project Program Activity Budget I Reference # I Amount ID I I ID I I I Year I (Chartfield 2) Submitted for City Manager's Office by: Originating Department Head: Additional Information Contact: William Johnson (5806) Eddie Garcia (4212) Keith Morris (4243) http://apps. cfwnet.org/council_packet/mc_review.asp?ID=33906&councildate= l l / l l /2025 11 /12/2025 M&C Review Page 3 of 3 ATTACHMENTS Alliance for Children - Form 1295.pdf (CFW Internal) CCPD Mission Partners - Victim Assistance Priority Programs FY26 FID Table.xlsx (CFW Internal) S00188 FY26 Mission Partners Program PBS.pnq (CFW Internal) SCC ACC Form 1295.pdf (CFW Internal) SCC FJC Form 1295.pdf (CFW Internal) http://apps.cfwnet.org/council_packet/mc_review.asp?ID=33906&councildate=l 1 / 11 /2025 11 / 12/2025 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2024-1167218 Safe City Commission, Inc. dba One Safe Place Fort Worth, TX United States Date Filed: 05/28/2024 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Fort Worth Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. FY2025 CCPD Advocacy & Call Center Program 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name is and my date of birth is My address is 1 , (street) (city) (state) (zip code) (country) declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of on the day of , 20__ (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V4.1.0.d378aba0 FORT WORTH. City Secretary's Office Contract Routing & Transmittal Slip Contractor's Name: Safe City Commission (ACC) Subject of the Agreement: Contractor agreed to operate a Crime Prevention Agency Partnership called Advocacy & Call Center, which will support the police department's crime prevention efforts throughout the commun M&C Approved by the Council? * Yes 8 No ❑ If so, the M&C must be attached to the contract. Is this an Amendment to an Existing contract? Yes 8 No ❑ 62180-A1 If so, provide the original contract number and the amendment number. Is the Contract "Permanent"? *Yes ❑ No 8 If unsure, see back page for permanent contract listing. Is this entire contract Confidential? *Yes ❑ No 8 If only specific information is Confidential, please list what information is Confidential and the page it is located. Effective Date: 10/1/2024 Expiration Date: 12/31 /2027 If different from the approval date. If applicable. Is a 1295 Form required? * Yes 8 No ❑ *If so, please ensure it is attached to the approving M&C or attached to the contract. Project Number: If applicable. *Did you include a Text field on the contract to add the City Secretary Contract (CSC) number? Yes 8 No ❑ Contracts need to be routed for CSO processing in the following _ order: rder: 1. Katherine Cenicola (Approver) 2. Jannette S. Goodall (Signer) 3. Allison Tidwell (Form Filler) *Indicates the information is required and if the information is not provided, the contract will be returned to the department.