7261 - Amendment 3 Executed
Docusign Transmittal Coversheet
File Name
Purchasing Contact
Contract Expiration
DocuSign Envelope ID: 074A71E3-CE39-4860-9DD2-CDAB1765805F
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P. O. Box 21097, St. John's, NL, A1A 5B2 phone: 709.727.6424 email: mbowman@clearrisk.com
ClearRisk/City of Denton, TX
Renewal Agreement
THIS ADDENDUM made at the City of St. John’s, Province of Newfoundland and Labrador
this __________ day of __________ 2019.
BETWEEN:
CLEAR RISK INC., a body corporate, organized and existing under the laws of the Province of
Newfoundland and Labrador (“ClearRisk”)
AND: City of Denton, TX
WHEREAS ClearRisk and Client entered into the ClearRisk Claims Services Agreement dated
the 9th day of January 2014 and the Addendum to the ClearRisk Claims Services Agreement
dated the 13th of December 2016 (the “Services Agreement”);
AND WHEREAS the parties wish to amend the Services Agreement as more particularly set out
herein;
NOW THIS ADDENDUM AGREEMENT WITNESSES that, for and in consideration of the
mutual covenants and agreements contained herein, and for other good and valuable
consideration (the receipt and sufficiency of which is hereby acknowledged), the parties hereto,
being all of the parties to the Services Agreement, agree that the Services Agreement shall be
amended as follows:
Article 2.1 to be updated from its original form in the original ClearRisk Claims Services
Agreement dated the 9th day of January 2014 to the following:
This agreement comes into force as of the date hereof and has a term of two years from
the date on which this agreement comes into force unless it is renewed in accordance
with the provisions of Section 2.2 hereto.
DocuSign Envelope ID: 074A71E3-CE39-4860-9DD2-CDAB1765805F
P. O. Box 21097, St. John's, NL, A1A 5B2 phone: 709.727.6424 email: mbowman@clearrisk.com
Pricing Breakdown (Schedule “B” update)
Pricing of ClearRisk Claims to be increased to the following for 2020 and 2021:
2-year term:
2020: $24,500
2021: $24,500
*All pricing in USD
Additional account work updates to be completed prior to renewal (8 hours included at no
cost). All work will add value to Denton and make ClearRisk much more streamlined within
the city.
1. Financial record uploads each month (rectified, but with manual work needed from
ClearRisk and your TPA)
2. Department listings being incorrect causing issues with employee and vehicle
uploads (rectified on a monthly basis but with manual work needed upfront from
ClearRisk and Denton)
3. Denton report generation (How can ClearRisk and Denton make this much easier to
access data. We have a number of ideas such as training and CR building standard
reports for Denton)
4. Streamlining HBU numbers (ClearRisk has ideas on how to streamline for Denton)
ClearRisk will be dedicating 8 hours (at no cost) to rectifying these issues between now and your
renewal once we have the go ahead from Denton. Our typical hourly rate for these services is
$150/hour. ClearRisk has improved processes and workflow and there are an abundance of
opportunity to make ClearRisk better for Denton.
Support and Maintenance
ClearRisk will be adding 20 hours of dedicated support and maintenance to your account on an
annual basis. Time will be tracked by ClearRisk’s support team and updates will be provided to
Denton upon request. Support hours can be used for items such as field customization, additional
user training and report generation requests.
Additional support hours can be purchased in blocks of 5 hours for $750/block.
Regular troubleshooting such as login issues and password reset inquiries does not count against
these hours.
DocuSign Envelope ID: 074A71E3-CE39-4860-9DD2-CDAB1765805F
P. O. Box 21097, St. John's, NL, A1A 5B2 phone: 709.727.6424 email: mbowman@clearrisk.com
This Addendum is supplementary to the Services Agreement and all other provisions of the
Services Agreement shall remain in force, unless inconsistent with this present Addendum.
Defined terms in this Services Amendment have the same meaning as the meaning given to them
in the Services Agreement, unless otherwise expressly set forth in this Addendum.
IN WITNESS WHEREOF the parties have caused to be hereto affixed their respective
corporate seals attested by the signatures of their duly authorized signing officers as of the
date indicated first herein:
City of Denton, TX
Per: _____________________________________________
Name: ___________________________________________
Title: ____________________________________________
Date: ____________________________________________
ClearRisk Inc.
Per: _____________________________________________
Name: Mike Bowman
Title: VP, Sales & Customer Success
Date: ____________________________________________
DocuSign Envelope ID: 074A71E3-CE39-4860-9DD2-CDAB1765805F
CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as
defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after the
date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a
misdemeanor.
1 Name of vendor who has a business relationship with local governmental entity.
2
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day
after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information in this section is being disclosed.
Name of Officer
This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the vendor has an employment or other business relationship
as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer
named in this section AND the taxable income is not received from the local governmental entity?
Yes No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an
officer or director, or holds an ownership of one percent or more?
Yes No
D. Describe each employment or business and family relationship with the local government officer named in this section.
4
I have no Conflict of Interest to disclose.
5
Signature of vendor doing business with the governmental entity Date
DocuSign Envelope ID: 074A71E3-CE39-4860-9DD2-CDAB1765805F
Certificate Of Completion
Envelope Id: 074A71E3CE3948609DD2CDAB1765805F Status: Completed
Subject: ***Purchasing Approval*** 7261- ClearRisk for Risk Management
Source Envelope:
Document Pages: 5 Signatures: 3 Envelope Originator:
Certificate Pages: 5 Initials: 0 Tabitha Millsop
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
901B Texas Street
Denton, TX 76209
tabitha.millsop@cityofdenton.com
IP Address: 129.120.6.150
Record Tracking
Status: Original
12/13/2019 10:20:10 AM
Holder: Tabitha Millsop
tabitha.millsop@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
Tabitha Millsop
tabitha.millsop@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 129.120.6.150
Sent: 12/13/2019 10:22:09 AM
Viewed: 12/13/2019 10:22:20 AM
Signed: 12/13/2019 10:28:20 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Mike Bowman
mbowman@clearrisk.com
VP, Sales & Customer Success
Clear Risk Inc.
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 174.117.162.111
Sent: 12/13/2019 10:28:22 AM
Viewed: 12/13/2019 10:31:53 AM
Signed: 12/13/2019 10:34:05 AM
Electronic Record and Signature Disclosure:
Accepted: 12/13/2019 7:53:08 AM
ID: d17ed7c6-fd4c-4358-8d7e-f35d80cdc8aa
Tabitha Millsop
tabitha.millsop@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 12/13/2019 10:34:07 AM
Viewed: 12/20/2019 4:09:30 PM
Signed: 12/20/2019 4:09:47 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Carbon Copy Events Status Timestamp
Cassey Ogden
Cassandra.Ogden@cityofdenton.com
Director of Procurement and Compliance
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 12/20/2019 4:09:49 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Contract Administrator
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 12/20/2019 4:09:50 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Witness Events Signature Timestamp
Wotary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 12/20/2019 4:09:50 PM
Certified Delivered Security Checked 12/20/2019 4:09:50 PM
Signing Complete Security Checked 12/20/2019 4:09:50 PM
Completed Security Checked 12/20/2019 4:09:50 PM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
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