HomeMy WebLinkAbout063680-A1R1 - General - Contract - Form Health, Inc.Docusign Envelope ID: EB57C317-77A7-8CD1-829A-95AFD6D70EDC
CSC No. 63680-Al R1
AMENDMENT NO. 1 RENEWAL NO. 1
TO CITY OF FORT WORTH CONTRACT NO. 63680
This Amendment is entered into by and between the City of Fort Worth (hereafter
"City"), and Form Health, Inc. ("Vendor"). City and Vendor may be referred to individually
as a Party and collectively as the Parties.
WHEREAS, the Parties entered into City Secretary Contract 63680, a non-exclusive
agreement for Vendor to provide a weight management program ("Agreement");
WHEREAS, the Parties acknowledge that this is a non-exclusive agreement and there is
no guarantee of any specific amount of purchase;
WHEREAS, the Parties wish to renew the Agreement and align the renewed term
with the City's Benefits Plan Year by extending the Agreement for the period of August 1, 2026,
through December 31, 2026., as authorized by Mayor and Council Communication No.
25-0298 (04/8/2025).
NOW, THEREFORE, the Parties, acting herein by and through their duly authorized
representatives, enter into the following agreement:
1.
AMENDMENTS
Section 2, Term of the Agreement, shall be deleted in its entirety and amended to read as
follows:
The Parties hereby renew the Agreement for the period beginning August 1, 2026, and ending
December 31, 2026. This renewal aligns the Agreement with the City's Benefits Plan Year. All
subsequent renewal terms, if exercised, shall be consistent with the Agreement as amended.
2.
ALL OTHER TERMS SHALL REMAIN THE SAME
All other provisions of the Agreement which are not expressly amended herein shall
remain in full force and effect.
3.
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 anoriginal.
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Docusign Envelope ID: EB57C317-77A7-8CD1-829A-95AFD6D70EDC
ACCEPTED AND AGREED:
CITY OF FORT WORTH:
AM%_M&_
By Dianna Giordano (Aug 11, 2026 19:37:30 CDT)
Name: Dianna Giordano
Title: Assistant City Manager
Date: 08/11 /2026
APPROVAL RECOMMENDED:
to
Name: Kristen Smith
Title: Director, Human Resources
ATTEST:
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By: C
Name: Jannette Goodall
Title: City Secretary
Vendor: Form Health, Inn.
Signed by:
By' E019457150034E2...
Name: Evan Richardson
Title: CEO
8/5/2026
Date:
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.
Name: Heather Wiggins
Title: Sr. Admin Services Manager
APPROVED AS TO FORM AND LEGALITY:
By:
Name: Jordan P. Alvarez II
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: 25-0298
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
M&C Review
Page 1 of 3
Official site of the City of Fort Worth, Texas
A CITY COUNCIL AGEND FflR �'
Create New From This M&C
REFERENCE **M&C 25- 13P25-0021 WEIGHT
DATE: 4/8/2025 NO.: 0298 LOG NAME: MANAGEMENT PROGRAM
EC HR
CODE: G TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT: (ALL) Authorize Execution of Non -Exclusive Agreements with Multiple Vendors for
Weight Management Programs in a Combined Annual Amount Up to $400,000.00 for the
Initial Term and Authorize Four One -Year Renewal Options for the Same Annual Amount
for the Human Resources Department
RECOMMENDATION:
It is recommended that the City Council authorize execution of non-exclusive agreements with multiple vendors for weight
management programs in a combined annual amount up to $400,000.00 for the initial term and authorize up to four one-
year renewal options for the same annual amount for the Human Resources Department.
DISCUSSION:
The purpose of this Mayor & Council Communication (M&C) is to authorize the execution of annual agreements with
FoodRX and Al, Inc., Noom, Inc., and Form Health, Inc. for weight management programs for City employees. These
programs will support the City's health plan by providing employees with options for a program which best fits their
individual needs. The Purchasing staff issued Request for Proposals (RFP) No. 25-0021. The RFP consisted of detailed
specifications describing the responsibilities and requirements to provide these services.
The RFP was advertised in the Fort Worth Star -Telegram on November 6, 2024, November 13, 2024, November
20, 2024, November 27, 2024, and December 4, 2024. The City received fifteen (15) responses. W.W. International, dba
Weight Watchers for Business was deemed non -responsive for failing to submit RFP-08 Qualification Questionnaire and
Requirements, and their proposal was therefore not evaluated further.
An evaluation panel, consisting of members of the Human Resources Department reviewed and scored the submittals
using the Best Value criteria.
The individual scores were averaged for each of the criteria and the final scores are listed in the table below:
Proposer
Evaluation Factors
Total
Rank
a
b
c
®
0
FoodRX and Al, Inc.
30.33
17.33 =11
26.00
15.00
88.67
0
Noom Inc.
30.33
1 16.67
26.00 1
6.64
1 79.64
0
Form Health, Inc.
30.33
1 16.67
26.00 IF.81
73.81
0
Omada Health
26.83
1 16.00
25
4.01
71.84
Ilant Health 128.0011
Wellness Coaches USA,
26.83
13.33
14.67
22 IF18
25IF
63.51
66.5
6LLC
Trestle Tree
24.5
1 16
25
01
65.5 IF
7]
Welldoc 1124.5
115.33
20
F --]
59.83
MiLEO Solutions, LLC
24.5
8
17
49.5
0
DFW Endocrinology
16.33
1 13.33
19 IF
; 11
48.66
10
Well Beats, a Lifespeak Co.j
22.17
1 9.33
17
=1
48.50
11
Abacus Health Solutions, LI-C11
18.67
11 11.33
16 1=146
12
Sarah Jane Fitness, LLC
17.511
9.33
16
0
42.83
13
Coastal Medical + Wellness
14
1 11.33
13.33
**
38.66
**
* Not selected for interviews prior to pricing review, therefore no cost of services points were allocated, and only the
second round of technical scoring is shown.
** Did not achieve the minimum technical score of 42.5 points required to move forward and therefore did not
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=33161&councildate=4/8/2025 4/20/2026
M&C Review Page 2 of 3
receive cost of services points or a ranking.
Best Value Criteria:
a.) Member Experience and Enhancements
b.) Medical Research Supported Program
c.) Experience and Qualifications of the Program and Staff
d.) Cost of Services
The panel decided to interview and request Best and Final offers (BAFOs) from the proposers who achieved the top 5
technical scores. After the interviews, a third round of scoring was conducted and the panel concluded that Food RX and
Al, Inc., Noom, Inc., and Form Health, Inc. present the best value for the City. Therefore, the panel recommends that the
City Council authorize non-exclusive agreements with Food RX and Al, Inc., Noom, Inc., and Form Health, Inc. Staff
certifies that the recommended vendor's bids met specifications. No guarantee was made for a specific amount of
services or goods that would be purchased.
FUNDING: The maximum amount allowed under this agreement will be up to $400,000.00; however, the actual amount
used will be based on the need of the department and available budget. Funding is budgeted in the General Operating &
Maintenance category in the Group Health Insurance Fund for the Human Resources Department.
DVIN-BE: This solicitation was reviewed by The Business Equity Division for available business equity prospects
according to the City's Business Equity Ordinance. There were limited business equity opportunities available for the
services/goods requested, therefore, no business equity goal was established.
ADMINISTRATIVE CHANGE ORDER: An administrative change order or increase may be made by the City Manager up
to the amount allowed by relevant law and the Fort Worth City Code and does not require specific City Council approval
as long as sufficient funds have been appropriated.
AGREEMENT TERMS: Upon City Council approval this agreement shall begin upon execution and expire one year from
that date.
RENEWAL TERMS: This agreement may be renewed for up to four (4) additional, one-year terms. This action does not
require specific City Council approval provided the City Council has appropriated sufficient funds to satisfy the City's
obligations during the renewal term.
This project will serve ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that funds are available in the current operating budget, as previously appropriated, in
the Group Health Insurance Fund to support the approval of the above recommendation and award of the contracts. Prior
to any expenditure being incurred, the Human Resources Department has the responsibility to validate the availability of
funds.
BQN\\
TO
Fund Department Account Project Program Activity Budget I Reference # Amount
ID ID Year (Chartfield 2)_�
Fund Department Account Project Program Activity Budget Reference # Amount
ID ID Year (Chartfield 2)
Submitted for City Manager's Office by:
Originating Department Head:
Additional Information Contact:
ATTACHMENTS
Reginald Zeno (8517)
Jesica McEachern (5804)
Reginald Zeno (8517)
Dianna Giordano (7783)
Brandy Hazel (8087)
Eugene Chandler (2057)
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=33161&councildate=4/8/2025 4/20/2026
M&C Review
Page 3 of 3
1295 Form Noom.pdf (CFW Internal)
13P25-0021 WEIGHT MANAGEMENT PROGRAM EC HR funds avail.docx (CFW Internal)
Copy of FID table Weight Mgmt Program 2025.xlsx (CFW Internal)
Delaware EntitySearchStatusCopy February 20 2025.pdf (Public)
FOOD RX 1295.pdf (CFW Internal)
Food RX SAMs .pdf (CFW Internal)
Form 1295 Certificate 101325618 Form Health 20250221.pdf (CFW Internal)
Form Health SAM.gov Search.pdf (CFW Internal)
Form Sec of State MA Corporations Search Entity Summary.pdf (Public)
NJ Sec of State.pdf (Public)
Request for BE Waiver Final-CC.pdf (CFW Internal)
SAM.gov Noom.pdf (CFW Internal)
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=33161&councildate=4/8/2025 4/20/2026
FORT WORTH.
City Secretary's Office
Contract Routing & Transmittal Slip
Contractor's Name: Form Health
Subject of the Agreement: weight Managment
NA
NA
NA
M&C Approved by the Council? * Yes 0 No ❑
If so, the M&C must be attached to the contract.
Is this an Amendment to an Existing contract? Yes ❑ No 0 NA
If so, provide the original contract number and the amendment number.
Is the Contract "Permanent"? *Yes ❑ No 0
If unsure, see backpage for permanent contract listing.
Is this entire contract Confidential? *Yes ❑ No 0 If only specific information is
Confidential, please list what information is Confidential and the page it is located.
NA
NA
Effective Date: 08/01 /2026
If different from the approval date.
Expiration Date: 12/31 /2026
If applicable.
Is a 1295 Form required? * Yes ❑ No 21
*If so, please ensure it is attached to the approving M&C or attached to the contract.
Project Number: If applicable. NA
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes 0 No ❑
Contracts need to be routed for CSO processing in the followingorder:
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.