AG 21-202 - STATE OF TEXAS DIRRETURN TO: Thomas Fichtner
EXT: 2547
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT./DIV: Information Technology
2. ORIGINATING STAFF PERSON: Thomas Fichtner
EXT: 2547 3. DATE REQ. BY: ASAP
4. TYPE OF DOCUMENT (CHECK ONE):
❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ)
❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT
❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT
❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG
❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS)
❑ ORDINANCE 0 RESOLUTION
❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL
❑ OTHER
5. PROJECT NAME: Texas DIR Cooperative Purchasing Agreement
6. NAME OF CONTRACTOR: State of Texas, Department of Information Resources
ADDRESS: 300 West 15th Street, suite 1300, Austin, Tx 78701 TELEPHONE
E-MAIL: interstatecontracts@dir.texas.gov FAX:
SIGNATURE NAME: Hershel Becker TITLE Chief Procurement officer
7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL
OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
8. TERM: COMMENCEMENT DATE: upon Execution
9
COMPLETION DATE: Perpetual
TOTAL COMPENSATION $ N/A (INCLUDE EXPENSES AND SALES TAX, IF ANY)
(IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED ®YES ONO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY
RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED
❑ PURCHASING: PLEASE CHARGE TO: NIA
10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED
❑ PROJECT MANAGER
0 DIRECTOR TF - 2/17/21
❑ RISK MANAGEMENT (IF APPLICABLE)
0 LAW DK 02-19-2021
11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: 2/23/21
12. CONTRACT SIGNATURE ROUTING
INITIAL / DATE APPROVED
COUNCIL APPROVAL DATE: 3/2/21
A SENT TO VENDOR/CONTRACTOR DATE SENT: 3/17/21 DATE REC'D: 3/22/21
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE
(Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.)
❑ LAW DEPARTMENT
0 SIGNATORY (MAYOR OR DIRECTOR)
❑ CITY CLERK
❑ ASSIGNED AG#
INITIAL / DATE SIGNED
3/14/21
N/A - no sig required
AG# 21-202
COMMENTS: Received by City Clerk's Office 08/04/2022
See Resolution No. 21-806
2/2017