HomeMy WebLinkAbout065815 - General - Contract - Fort Worth ISDDocusign Envelope ID: BC5F1546-Al1A-88BD-8201-B191B93DC7AB
CSC No. 65815
RESTATED CITY OF FORT WORTH
RESTATED CLINICAL AFFILIATION AGREEMENT
This Restated Clinical Affiliation Agreement ("Agreement") is made between the City of
Fort Worth ("Fort Worth"), a home -rule municipal corporation organized under the laws of the state
of Texas, and the Fort Worth Independent School District, a political subdivision of the state of
Texas and a legally constituted independent school district located in Tarrant County, Texas
("School"). Fort Worth and School are each a "Party" and collectively the "Parties" to this
Agreement.
WHEREAS, Fort Worth, by and through the Fort Worth Fire Department, provides
regulated prehospital emergency medical services ("EMS") and emergency ambulance
transportation ("EMS System") to the public within its jurisdiction and those jurisdictions that
have executed an EMS Interlocal Agreement with Fort Worth;
WHEREAS, School has an EMS Program ("Program") that provides its students
("Students" or "Student") with academic and clinical experiences;
WHEREAS, School desires for Fort Worth, as a licensed EMS Provider, to provide the
Students with suitable clinical experience consistent with School's curriculum and assist with
clinical teaching and supervision of Students in the Program;
WHEREAS, the purpose of this Agreement is to state the terms and conditions under
which Fort Worth will cooperate with School to promote the success of the Program and provide
clinical experiences for the Students;
WHEREAS, on November 12, 2025, the Parties entered into an affiliation agreement
that inadvertently listed the Fort Worth Fire Department as the responsible legal party for the City
(the "Original Agreement").
NOW THEREFORE, known by all these present, Fort Worth and School, acting herein
by, and through, their duly authorized representatives, agree to the following terms. The Original
Agreement is hereby amended and restated in its entirety to read as set forth herein. This
Agreement supersedes the Original Agreement in all respects, and the Original Agreement shall
be of no further force or effect from and after the date hereof. [
ated Terms. The terms of the Agreement between the Parties shall henceforth be as follows:
I. RESPONSIBILITIES OF SCHOOL
School shall:
1.1 Plan the educational activities for the Student's clinical experience at Fort Worth after
consultation with and approval by Fort Worth's Medical Director, or their designee (the "Medical
Director").
1.2 Provide qualified teachers from School to teach the pre -requisite core curriculum and
support courses in the Program;
OFFICIAL RECORD
Clinical Affiliation Agreement CITY SECRETARY Page 1 of 8
FT. WORTH, TX
Docusign Envelope ID: BC5F1546-Al1A-88BD-8201-B191B93DC7AB
1.3 Provide administrative functions for each Student in the Program.
1.4 Provide a faculty member to be available for consultation at all times Students are at Fort
Worth, and to supervise Students participating in the Program.
1.5 Instruct Students to abide by Fort Worth's patient care policies and guidelines. Information
regarding Fort Worth's applicable policies and guidelines will be available at the time of student
orientation at Fort Worth.
1.6 If applicable, provide Fort Worth with the appropriate forms to be used in evaluating the
performance of Students in the Program.
1.7 Require Students to comply with the regulatory and accreditation standards provided by
Fort Worth at the time of student orientation at Fort Worth.
1.8 Ensure each student has current immunizations, including: Influenza, Hepatitis B, MMR,
TDAP, Varicella (or titer), and provide Fort Worth proof if requested.
1.9 Confirm that Students have been tested for tuberculosis within one (1) year of
commencement of the Program and are tested at least annually while participating in the Program,
and provide evidence of such testing and the results to Fort Worth prior to commencement of the
Program or upon request of Fort Worth thereafter.
1.10 Confirm Students have been instructed in Standard Precautions, as recommended and
defined by the Centers for Disease Control and Prevention (CDC), and completed a Basic Life
Support cardiopulmonary resuscitation course prior to the beginning of the Program and provide
evidence of such confirmation to Fort Worth prior to commencement of the Program or upon
request of Fort Worth thereafter.
1.11 Confirm that Students have been instructed in HIPAA privacy law standards and have
successfully completed any training required by Fort Worth prior to participating in clinical
experiences at Fort Worth.
1.12 Provide to Fort Worth, at least two (2) weeks prior to commencement of the Program, a
letter outlining the needs of Students, days and hours Students will be on patient units or service
areas, names of Students and supervising faculty members, length, and dates of clinical experience.
1.13 Consider promptly any complaints made by Fort Worth against a Student and participate
in joint problem solving. Patient safety and welfare shall be the primary concern. Student issues
will be documented by Fort Worth and provided to the designated Faculty member and/or other
representative of School. The Medical Director, in their sole discretion, may require permanent
withdrawal of any Student from Fort Worth at any time for cause.
1.14 Comply with Fort Worth's substance abuse policies, and, at Fort Worth's request, remove
any Student or faculty member from the Program if there is reasonable suspicion that the Student
or faculty member has violated Fort Worth's substance abuse policies.
1.15 Verify that a background evaluation, including a criminal background history in all fifes
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(50) states, has been performed on each Student, and verify that there are no negative findings for
each Student prior to commencing any assignment at Fort Worth. For purposes of this Agreement,
a criminal background history shall include any felony conviction within the last ten (10) years.
For purposes of this Agreement, a background evaluation shall include the last ten (10) years and
all counties (in Texas and outside of Texas) in which the Student has been a resident of or
employed in.
1.16 Ensure that each Student and faculty member at all times while at Fort Worth wears a name
tag, badge, or other identifying label that clearly states the Student or faculty member's identity
and the name of the School.
II. RESPONSIBILITIES OF FORT WORTH
Fort Worth shall:
2.1 Provide reasonable cooperation to promote the success of the Program.
2.2 Provide equipment and supplies that are necessary for clinical care by Fort Worth, unless
otherwise specified in writing for a special requirement such as personal protective equipment.
2.3 Provide suitable clinical experience situations as prescribed by the curriculum provided by
School.
2.4 Assist with clinical teaching and supervision of an agreed -upon number of Students in the
Program.
2.5 Upon request by School, formally evaluate the performance of Students in the Program
using the form provided by School;
2.6 Retain responsibility for patient care;
2.7 Reserve the right to determine the manner in which its equipment shall be operated;
2.8 To the extent allowed by law, assume no professional or financial liability for injury to
Students or faculty except that which might occur as a member of the public, unless due to Fort
Worth's sole negligence or gross misconduct; and
2.9 Provide access to acute emergency care at Student's expense in the event of an accident or
injury to a student on Fort Worth's property.
III. RESPONSIBILITIES OF FORT WORTH AND SCHOOL
Fort Worth and School shall:
3.1 Agree upon the number of Students to be placed with Fort Worth for clinical rotations prior
to the beginning of each School semester in which Students are assigned to and accepted by Fort
Worth;
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3.2 Agree on a schedule and provide an orientation of faculty and Students to Fort Worth and
assigned units.
3.3 Comply with all applicable federal, state, and local laws, rules, regulations, and ordinances.
IV. TERM
4.1 This Agreement will be effective upon execution by Fort Worth's Assistant City Manager
and will expire on September 30 of the next fiscal year of Fort Worth, unless terminated earlier in
accordance with the terms and conditions of this Agreement. This Agreement may be renewed by
the written, mutual agreement of the Parties for an unlimited number of one-year renewals, each a
"Renewal Term."
V. TERMINATION
5.1 Convenience. Either Fort Worth or School may terminate this Agreement at any time and
for any reason by providing the other party with 30 days written notice of termination.
5.2 Breach. If either party commits a material breach of this Agreement, the non -breaching
Party must give written notice to the breaching party that describes the breach in reasonable detail.
The breaching party must cure the breach ten (10) calendar days after receipt of notice from the
non -breaching party, or other time frame as agreed by the parties. If the breaching party fails to
cure the breach within the stated period, the non -breaching party may, in its sole discretion, and
without prejudice to any other right under this Agreement, law, or equity, immediately terminate
this Agreement by giving written notice to the breaching party.
5.3 Duties and Obligations of the Parties. Upon termination of this Agreement for any reason,
School shall provide Fort Worth with copies of all completed or partially completed documents
prepared under this Agreement. In the event that School has received access to Fort Worth
information or data as a requirement to perform services hereunder, School shall return all Fort
Worth provided data to Fort Worth in a machine-readable format or other format deemed
acceptable to Fort Worth.
VI. HIPAA
6.1 It is the intent of the parties to comply fully with the Health Insurance Portability and
Accountability Act, Texas Health and Safety Code Chapter 181, and implementing regulations
issued pursuant thereto (collectively "HIPAA" herein). The parties agree that protected health
information (hereinafter referred to as "Protected Health Information" or "PHI") is subject to
protection under HIPAA, and it is the intent of the parties to be in full compliance with, state and
federal law, including applicable provisions of HIPAA, the Health Information Technology for
Economic and Clinical Health Act ("HITECH") its related regulations, and all applicable state
privacy and security laws related to access of PHI by the Parties. To the extent that the services
performed under this Agreement are determined to be performing a transaction subject to HIPAA
or the HITECH Act, the Business Associate Agreement shall control.
6.2 To the extent applicable, each party shall implement and maintain such safeguards as are
necessary to ensure that the PHI is not used or disclosed except as is provided in this Agreement
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and any referenced documents, including the Business Associate Agreement.
VII. STATUS OF STUDENTS
7.1 School and Fort Worth understand and agree that while faculty and Students are participating
in the Program, faculty and students are not employees of Fort Worth. Accordingly, faculty and
Students are not entitled to any of the rights or benefits established for Fort Worth's employees,
such as salary, vacation, sick leave with pay, paid holidays, insurance, and/or workers'
compensation coverage. Further, nothing herein shall be construed as creating a partnership or
joint venture between School and Fort Worth, its officers, agents, employees, and subcontractors,
and doctrine of respondeat superior has no application as between the School and Fort Worth.
VIII. INDEMNIFICATION
8.1 [Reserved]
8.2 [Reserved]
IX. NOTICE
9.1 Notices. Notices required pursuant to the provisions of this Agreement shall be conclusively
determined to have been delivered when (1) hand -delivered to the other party, its agents,
employees, servants or representatives; or (2) received by the other party by United States Mail,
registered, return receipt requested, addressed as follows:
FORT WORTH:
City of Fort Worth
Attn: Medical Director
100 Fort Worth Trail
Fort Worth TX 76102
ith Copy to the City Attorney
same address
[Reserved]
SCHOOL:
ort Worth Independent School District
,ttn: Robert Wright
060 Camp Bowie Blvd.
ort Worth, TX 76116
ith Copy to the Office of Legal Services at
same address
X. INSURANCE
XI. GENERAL PROVISIONS
11.1 Governmental Powers. It is understood and agreed that by execution of this Agreement,
Fort Worth and School do not waive or surrender any of their governmental powers or immunities.
11.2 No Waiver. The failure of Fort Worth or School to insist upon the performance of any term
or provision of this Agreement or to exercise any right granted herein shall not constitute a waiver
of Fort Worth's or School's respective right to insist upon appropriate performance or to assert any
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such right on any future occasion.
11.3 Governing Law and Venue. This Agreement shall be construed in accordance with the
laws of the State of Texas. If any action, whether real or asserted, at law or in equity, is brought
on the basis of this Agreement, venue for such action shall lie in state courts located in Tarrant
County, Texas, or the United States District Court for the Northern District of Texas, Fort Worth
Division.
11.4 Severability. If any provision of this Agreement is held to be invalid, illegal or
unenforceable, the validity, legality, and enforceability of the remaining provisions shall not in any
way be affected or impaired.
11.5 Force Majeure. Fort Worth and School shall exercise their best efforts to meet their
respective duties and obligations as set forth in this Agreement, but shall not be held liable for any
delay or omission in performance due to force majeure or other causes beyond their reasonable
control, including, but not limited to, compliance with any government law, ordinance or
regulation, acts of God, acts of the public enemy, fires, strikes, lockouts, natural disasters, wars,
riots, epidemics or pandemics, material or labor restrictions by any governmental authority,
transportation problems, restraints or prohibitions by any court, board, department, commission,
or agency of the United States or of any States, civil disturbances, other national or regional
emergencies, and/or any other similar cause not enumerated herein but which is beyond the
reasonable control of the Party whose performance is affected (collectively "Force Majeure
Event"). The performance of any such obligation is suspended during the period of, and only to
the extent of, such prevention or hindrance, provided the affected Party provides notice of the
Force Majeure Event, and an explanation as to how it hinders the party's performance, as soon as
reasonably possible, as determined in the Fort Worth's discretion, after the occurrence of the Force
Majeure Event. The form of notice required by this section shall be the same as section 13 above.
11.6 Headings Not Controlling. Headings and titles used in this Agreement are for reference
purposes only and shall not be deemed a part of this Agreement.
11.7 Review of Counsel. The parties acknowledge that each party and its counsel have reviewed
this Agreement and that the normal rules of construction to the effect that any ambiguities are to
be resolved against the drafting party shall not be employed in the interpretation of this Agreement
or exhibits hereto.
11.8 Amendments. No amendment of this Agreement shall be binding upon a party hereto
unless such amendment is set forth in a written instrument and duly executed by an authorized
representative of each party.
11.9 Entirety of Agreement. This Agreement, including any exhibits attached hereto and any
documents incorporated herein by reference, contains the entire understanding and agreement
between Fort Worth and School, their assigns and successors in interest, as to the matters contained
herein. Any prior or contemporaneous oral or written agreement is hereby declared null and void
to the extent in conflict with any provision of this Agreement.
11.10 Counterparts. This Agreement may be executed in one or more counterparts, and each
counterpart shall, for all purposes, be deemed an original, but all such counterparts shall together
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constitute one and the same instrument. An executed Agreement, modification, amendment, or
separate signature page shall constitute a duplicate if it is transmitted through electronic means,
such as fax or e-mail, and reflects the signing of the document by any party. Duplicates are valid
and binding even if an original paper document bearing each party's original signature is not
delivered.
11.11 Signature Authority. The person signing this agreement hereby warrants that he/she has
the legal authority to execute this agreement on behalf of the respective party, and that such binding
authority has been granted by proper order, resolution, ordinance or other authorization of the
entity. Each party is fully entitled to rely on these warranties and representations in entering into
this Agreement or any amendment hereto.
11.12 Electronic Signatures. This Agreement maybe executed by electronic signature, which will
be considered as an original signature for all purposes and have the same force and effect as an
original signature. For these purposes, "electronic signature" means electronically scanned and
transmitted versions (e.g., via pdf file or facsimile transmission) of an original signature, or
signatures electronically inserted via software such as Adobe Sign.
[Signature Page Follows]
Clinical Affiliation Agreement Page 7 of 8
Docusign Envelope ID: BC5F1546-Al1A-88BD-8201-B191B93DC7AB
ACCEPTED AND AGREED:
FORT WORTH:
By: 9
Name:
Title: Assistant City Manager
Date: 09/14/2026
APPROVAL RECOMMENDED:
'1.
Jam s Horton (Sep 14, 2026 14:21:35 CDT)
By:
Name: James Horton
Title: Fire Chief
Date: 09/14/2026
ATTEST:
By:
Name: Jannette Goodall
Title: City Secretary
Date: 09/15/2026
r Ul L VV UL LLL 1iuCu iiu rlli JCLLUUl I/1111CL
D�3
By:
Name Dr. Peter B. Licata
Title: Fort Worth ISD Superintendent
Date: Jun 29, 2026
By NID�a
Name: Mo ammec noudhury
Title: Deputy Superintendent
Date: 6/14/2026
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: Gina Nix (Sep 14, 2026 13:39:47 CDT)
Name:
Title:
Date: 09/14/2026
APPROVED AS TO FORM AND
LEGALITY:
By:
Name: Taylor Paris
Title: Assistant City Attorney
Date: 09/14/2026
CONTRACT AUTHORIZATION:
M&C:
Approved as to Form and Legality
Si ned by:
By:
D935C5CC96604AD...
Date: 6/15/2026
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Clinical Affiliation Agreement Page 8 of 8
Docusign Envelope ID: BC5F1546-Al1A-88BD-8201-B191B93DC7AB
CONSENT AGENDA ITEM
BOARD MEETING
June 23, 2026
TOPIC: APPROVE AN INTERLOCAL AGREEMENT WITH THE CITY OF FORT
WORTH FIRE DEPARTMENT FOR PARTICIPATION IN THE CAREER AND
TECHNICAL EDUCATION HEALTH SCIENCE TECHNOLOGY PROGRAM
EXECUTIVE SUMMARY:
The Career and Technical Education Department provides Health Science Technology
students the opportunity for work -based learning providing essential clinical experience
required for industry -based certification and career readiness. The need for such
experiential learning was identified through program planning to align with CTE goals and
expand hands-on training opportunities. This follows the interlocal agreement approved
in August 2025, with the 2026-2027 renewal pending. This is a renewal agreement and
is valid through September 30, 2027.
RECOMMENDATION:
Approve an Interlocal Agreement with the City of Fort Worth Fire Department for
Participation in the Career and Technical Education Health Science Technology program.
THEORY OF ACTION PILLAR:
4 - Excellent CCMR Pathways for Graduates
FINANCIAL IMPACT:
No Cost
PROVIDER(S)NEN DOR(S):
City of Fort Worth Fire Department
PARTICIPATING SCHOOL(S)/DEPARTMENT(S)/EDUCATIONAL ENTITY:
North Side High School
O.D. Wyatt High School
Texas Academy of Biomedical Sciences
Trimble Tech High School
Docusign Envelope ID: BC5F1546-A11A-88BD-8201-8191 B93DC7AB
INFORMATION SOURCE:
Mohammed Choudhury, Deputy Superintendent of Curriculum and Instruction
FUNDING SOURCE:
No Cost
PURCHASING MECHANISM:
Interlocal Agreement with the City of Fort Worth Fire Department
Docusign Envelope ID: BC5F1546-A11A-88BD-8201-8191 B93DC7AB
Contract #
PO#
FortWorth I BUSINESS
INDEPENDENT SCHOOL DISTRICT AND FINANCE
Date: 05/06/2026 Cart Name:
FOR INTERNAL USE ONLY- DO NOT SEND TO VENDOR / PROVIDER
Complete the Contract Routing Form in its entirety. Incomplete forms will not be processed. Allow up to 15 business days
for review and approval. Goods/Services are not authorized without the purchase order generated from this contract.
A. Contact Information:
Originating Department / Campus: Career and Technical Education
*Contract Administrator: Rob Wright
Email: robert.wright@fwisd.org
*This person is responsible for oversight of the contract performance, including agreed District responsibilities.
Provider/Vendor: City of Fort Worth
Vendor #: 18915
Contact Name: Gina Nix
Email: gina.nix@fortworthtexas.gov
Phone: (817) 392-6874
Contract Purpose: Interlocal instructional support agreement for CTE students in the Health Science Technology
program of study
Will any Personal Identification Information (Student / Staff) or other Confidential District Information be released or
ared as,. result of this contract?
es !4kJo If Yes, a Data Sharing Agreement is required to accompany this contract. (Link to DSA)
Will the vendor/provider have regular interaction in any of the following areas during the term(s) of this contract?
®'es ®No (Students, Employe... .. Monies, Facilities) Link to Criminal History/Background - Form D
Contract Administrator Signature:
_
Date: 05/06/2026
As the point of contact responsible for the contr c ed goo services, I confirm that I have read the attached contract and agree to
abide by the terms and conditions of the contract and agree to perform my duties as the Contract Administrator.
B. Contract Details
Status:
Q Original
O Amendment (attach original)
® Renewal (attach original)
Start Date:
07/01/2026
End Date:
09/30/2027
Renewal Options:
® Yes
No
Final End Date:
Total Contract Amount (Fixed + Reimbursable) NOT TO EXCEED:
$ 0.00
Board Meeting Date (if applicable):
06/23/2026
Type:
No Cost (MOU)
Funding Source:
n/a (fund, function, object, owner)
Purchasing Mechanism:
No Cost / Not a Purchase
PM Reference #:
interlocal
C. Routing / Administrative Review and Approval
Printed Name Signature
Date
Executive Director:
Signed by:
Chief / Area Supt / Deputy:
Mohammed Choudhury, Deput
wU
6/14/2026
Technology if applicable):
8129C81585 455.._
Procurement Services:
Tina Harris
iln- kvns
6/15/2026
Legal Services:
alexander Athanason B9F431
6/15/2026
*Legal review is required for all contracts valued above $2 C tt86i2S?all Non-FWISD form contracts
regardless of value.
❑ Approved as to legal form and sufficiency
❑ Subject to the following changes/comments:
Docusign Envelope ID: BC5F1546-A11A-88BD-8201-8191 B93DC7AB
CONTRACT ROUTING FORM Fort Worth I BUSINESS
Contract # PO# INDEPENDENT SCHOOL DISTRICT AND FINANCE
Guidelines:
A Contract Routing Form is an internal document required for all applicable contracts, contract renewals, and
contract amendments. It is used to facilitate a standard contract review and approval process. Plan for at least
10-15 business days for processing. The time for complex contracts and/or legal process may take longer.
Contracts or other legal documents that create obligations or liability on the part of the District, must be
reviewed before they are signed by the appropriate signatory and an authorized purchase order is issued.
Use District approved contract templates (not vendor forms) whenever possible. Vendor forms and vendor
quotes with terms and conditions must be reviewed and approved. Do not sign any vendor -issued documents.
The contract administrator is the District representative responsible for the contract administration from an
operation perspective, reading the contract before submitting it for review as to legal form, and ensuring that all
terms are clear, accurate, and meet the needs of the user department/campus needs. Basic business terms of
a contract include the: start date, end date, contract duration (optional renewals), responsibilities and
obligations of each party, costs, and payment terms. Review and approval as to legal form ensures that District
contracts comply with applicable contracting laws but does not serve as review or approval of the underlying
transaction. The Contract Administrator should retain an executed copy of the contract for reference.
Any contracts for software or hardware are required to be reviewed and approved by the Technology
Department to ensure compliance, compatibility, and security protections are in place.
Contracts valued at more than $50,000, require the signature of the Superintendent.
Contracts valued at $250,000 or more and all Interlocal Agreements require the approval of the Board of
Education prior to the Superintendent's signature.
Vendors/Providers of contracted consulting work must be determined as Independent Contractors. The
Contract Administrator is responsible for completing the form. (Link to ICDF)
Upon review, it may be determined that additional forms and/or documents need to be included with the
contract prior to execution.
Contracts can be delayed due to:
• Not submitting accurate or complete information
• Using expired quotes or solicitations
• Failure to consolidate multiple contracts for one project/program
• Not involving reviewers in the early stages of complex contracts
• Not securing appropriate funding
• Not attaching all required forms
List of forms, as applicable:
✓ Contract Routing Form
✓ 690 Contract Form - completed
✓ Vendor Contract - only if 690 form is not used
✓ DSA
✓ SB9 / Criminal History
✓ Independent Contractor Determination Form
Please refer to the complete Contract Administrator's Guide
Docusign Envelope ID: BC5F1546-A11A-88BD-8201-8191 B93DC7AB
CEI \�III"Ma, I 101 ML'1tI1 ) 1L' I
Contract # PO#
Contract Checklist:
Fort Worth I BUSINESS
INDEPENDENT SCHOOL DISTRICT AND FINANCE
1.
I have read the contract, including any attachments, and understand all provisions.
�✓
2.
All documents incorporated by reference in the contract (e.g. exhibits, appendices, or web link
information) are attached to the contract.
3.
The written contract matches any verbal understanding of the parties and accurately reflects the
transaction between the vendor/provider and the District.
❑
4.
The contract adequately describes all services/work the vendor/provider will perform, including
required outcomes.
5.
In accordance with the District's Conflict of Interest Policy, a conflict of interest, if any, has been
disclosed.
6.
To the best of your knowledge, the contract does not conflict with any other contracts, promises,
or obligations of the District.
7.
The contract specifies the total not -to -exceed contract cost.
�✓
8.
The funds for the contract are budgeted and available.
RI
9.
The contract does not automatically renew.
�✓
10.
The vendor/provider's legal name and address on the contract are the same as in the financial
system.
❑�
City of Fort Worth Fire Department
Final Audit Report 2026-06-29
Created: 2026-06-29
By: Patti Ramon (patti.ramon@fwisd.org)
Status: Signed
Transaction ID: CBJCHBCAABAAV4PeIE9g6LtP2tfvx11_Sxyy4kW1 LNNO
"City of Fort Worth Fire Department" History
Document digitally presigned by DocuSign\, Inc. (enterprisesupport@docusign.com)
2026-06-15 - 4:44:54 PM GMT- IP address: 216.200.134.62
Document created by Patti Ramon (patti.ramon@fwisd.org)
2026-06-29 - 9:48:31 PM GMT- IP address: 216.200.134.62
Document emailed to superintendent@fwisd.org for signature
2026-06-29 - 9:51:51 PM GMT
Email viewed by superintendent@fwisd.org
2026-06-29 - 9:52:03 PM GMT- IP address: 72.152.84.142
Signer superintendent@fwisd.org entered name at signing as Peter B. Licata
2026-06-29 - 9:53:22 PM GMT- IP address: 216.200.134.62
Document e -signed by Peter B. Licata (superintendent@fwisd.org)
Signature Date: 2026-06-29 - 9:53:24 PM GMT - Time Source: server- IP address: 216.200.134.62 - Signature Appearance Selected:
IMAGE
® Agreement completed.
2026-06-29 - 9:53:24 PM GMT
O Adobe Acrobat Sign
FORT WORTH®
City Secretary's Office
Contract Routing & Transmittal Slip
Contractor's Name: Fort Worth Independent School District
Subject of the Agreement: Emergency Ambulance Transportation
M&C Approved by the Council? * Yes ❑ No II
If so, the M&C must be attached to the contract.
Is this an Amendment to an Existing contract? Yes ❑ No 0
If so, provide the original contract number and the amendment number.
Is the Contract "Permanent"? *Yes 0 No ❑
If unsure, see back page for permanent contract listing.
Is this entire contract Confidential? *Yes ❑ No ❑ If only specific information is
Confidential, please list what information is Confidential and the page it is located.
Effective Date:
If different from the approval date.
Expiration Date:
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.
*Did you include a Text field on the contract to add the City Secretary Contract (CSC)
number? Yes 0 No 0
Contracts need to be routed for CSO processing in the following order:
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.