7700 - Informal Amendment 2 Executed
DocuSign Transmittal Coversheet
File Name
Purchasing Contact
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
7700 Risk & Safety Management Information System - Amendment 2
Christina Dormady
Procurement
901 B Texas St., Denton, TX 76209 (940) 349-7100
OUR CORE VALUES
Inclusion Collaboration Quality Service Strategic Focus Fiscal Responsibility
May 9, 2025
Origami Risk LLC
222 North LaSalle Street
Suite 2100
Chicago, IL 60601
Re: File 7700 – Risk & Safety Management Information System, Amendment 2
Dear Earnest Bentley
Thank you for being such a valued partner. By signing this Amendment below, COD and Origami
Risk, LLC agree that the Contract is hereby deemed amended to the updated Schedule of Charges, as
shown in Attachment A.
Except as amended by this Amendment, the Contract is not otherwise amended and all other terms
and conditions of the Contract remain in full force and effect, as amended hereby. This Amendment
may be executed in any number of counterparts, each of which shall be deemed an original and all of
which together shall constitute one and the same instrument. Signatures transmitted electronically
shall have the same effect as the delivery of original signatures.
We look forward to future business with your firm.
Regards,
____________________________ ___________________________
Christina Dormady, Buyer Earnest Bentley
Procurement or Authorized Representative
City of Denton Origami Risk LLC
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
ORDER FORM #20250405
CONTACT INFORMATION
Client: City of Denton, Texas Bill To Contact: Tiffany Harris
Address: 601 E. Hickory, Suite A Bill To Email: tiffany.harris@cityofdenton.com Denton, TX 76208-6301
Primary Contact: Tiffany Harris Is purchase order (PO) required?
Primary Contact Email: tiffany.harris@cityofdenton.com Upon entering into this Order Form, please send any Pos,
vendor registration links or tax exemption certificates to
finance@origamirisk.com
SUBSCRIPTION DETAILS
Subscription Term: 12 Months
Effective Date: 2025-04-05
RECURRING SUBSCRIPTIONS – LICENSES
Subscription Quantity / Functionality Purchased
RMIS Functionality Selected
Claims Admin User(s) 4 Claims Admin User(s)
Enterprise-Wide Record Entry Up to 1000 records added per year
Mobile Forms App License Selected
SDS consumption for all employees - BLOCK 1 Special License(s)*
IT System Admins 5 Special License(s)**
Light User(s) 16 User(s)
Origami API Access Up to 5,000 call(s) per day
Annual Total: $52,920.00
RECURRING SUBSCRIPTIONS – HOSTING
Subscription Quantity / Functionality Purchased
Hosting, Network & Storage Up to 5 GBs of Database Size
Free Non-Searchable File Attachment Storage Includes 100 GBs of Non-Searchable file storage
Annual Total: $15,750.00
RECURRING SUBSCRIPTIONS – DATA PROCESSING
Subscription Quantity / Functionality Purchased
Claim Only Feed Daily Feed From Gallagher Bassett (GB)
HR Employee Demographic Import Integration Selected
Fleet Schedule Feed Integration Selected
Annual Total: $21,000.00
RECURRING SUBSCRIPTIONS – Client Support
Subscription Quantity / Functionality Purchased
Client Support Tier Selected Client Support tier includes support resourcing based on
up to 2 hours of Client Support services per month beginning on
the Effective Date.
Attachment A
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
Annual Total: $7,500.00
Annual Fees (before discount): $97,170.00
Discount (applied to $97,170.00): ($18,600.00)
Total Annual Fees: $78,570.00
CONFIDENTIAL
BILLING DETAILS AND ADDITIONAL TERMS
This negotiated Order Form is effective as of the Effective Date (as identified above) for the purchase of the
subscription services listed above from Origami Risk LLC (“Origami”). This Order Form is subject to all the terms and
conditions of the underlying agreement between Client and Origami (the “Agreement”). To the extent the Agreement
does not contemplate order forms, this Order Form will be deemed a Statement of Work for purposes of the Agreement.
This Order Form will be deemed a part of the Agreement. Origami and Client agree that the term of the Agreement shall
be extended through the duration of the term of this Order Form.
Fees for the first year of recurring subscription fees and all one-time fees under this Order Form will be invoiced and
due upon execution of this Order Form. Fees for ongoing contract years are due annually upfront on each anniversary
date thereafter. To the extent that the Client maintains a valid tax-exempt certificate, Client will not be charged any
sales tax. All travel costs and expenses will be pre-approved by Client in writing and billed to Client as incurred.
Service descriptions and service-specific terms and conditions are attached as Exhibit A to this Order
Form, which are hereby incorporated as of the Effective Date. Additional professional services may be set
forth in other Statements of Work as agreed between the parties.
*SDS consumption for all employees - BLOCK: Provides for Safety Data Sheet (SDS) consumption as a view only
ability for all employees to have access to view existing SDS content only.
**IT System Admins: These licenses are for usage by IT Professionals only and have access to the System
Administration functionalities for purposes of supporting the system administration settings and configurations for the
Client, including the ability to grant permissions/modify users role.
ORDER FORM APPROVAL
The undersigned agree to this Order Form.
ORIGAMI RISK LLC
By: __________________________________
Name: Earnest Bentley
(Print Name)
Title: President, Risk Solutions
Date: March 27, 2025
CITY OF DENTON, TEXAS
By: __________________________________
Name: _______________________________
(Print Name)
Title: _________________________________
Date: ________________________________
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
Buyer
5/13/2025
Christina Dormady
Exhibit A
ORIGAMI RISK
SERVICE DESCRIPTIONS AND SERVICE-SPECIFIC TERMS AND CONDITIONS
Effective For Order Forms Executed After March 13, 2025
SUBSCRIPTION/LICENSE DESCRIPTIONS
Base Subscription Functionality
Risk Management Information
System (RMIS)
Includes risk management functionality, including incidents, claims, insurance policy management, locations,
and safety
Claims Adjudication Includes claims adjudication functionality
Policy Underwriting and Issuance Includes policy underwriting and issuance functionality
Governance, Risk and
Compliance (GRC)
Includes GRC functionality, which includes, to the extent selected: Enterprise Risk Management (ERM),
Internal Control Management (ICM), Compliance Management, Business Continuity Management (BCM),
Internal Audit, Surveys, Vendor Risk Management (VRM), and Policies & Procedures
Environment, Health, and Safety
(EHS)
Includes EHS functionality, which includes, to the extent selected: General EHS (including incident
management, root cause analysis, inspections and audits, safety meetings, location hierarchies, employee
tables, and corrective actions and tasks), Process Safety Management (PSM) (including chemicals
management, safety data sheets, JSA/JHA, lockout/tagout), Environmental (including environmental permit
compliance), and Occupational Health (including IH and Ergonomics management)
Employee Health Includes employee health functionality for tracking hearing and vision assessments, respirator fit tests, TB
testing, drug and alcohol testing, physical examinations, radiology, and Covid tests, in addition to tracking
vaccinations (e.g., Covid-19, Influenza, and Hepatitis B)
Contract Management Includes functionality for document controls related to contract management, inclusive of a contract
repository and the related workflow tools therein
* Origami may offer other base functionality that is not explicitly listed above.
User Licenses
Full User These licenses provide the right for a named individual to access all the capabilities and features of the Service, except
those features utilized for adjusting claims such as check writing, setting reserves and calculating indemnity benefits.
These licenses have access to Extended Functionality features to the extent selected.
Light User These licenses provide the right for a named individual to access the dashboard, reports pre-configured for them, and
readonly access to other areas of the Service. Light Users do not have access to Administration features or Extended
Functionality features.
Claims Adjusting
User
These licenses provide the right for a named individual to access all the features and capabilities of the Service, including
those features utilized for adjusting claims such as check writing, setting reserves and calculating indemnity benefits.
These licenses have access to Extended Functionality features to the extent selected.
External User Access Licenses
External Portal
User
These licenses are geared toward Client insured/member/client users. They will have access to pre-defined dashboards.
They will be able to view claims, transactions and notes/tasks and they will be able to run reports utilizing pre-defined
report templates. These users will not have access to Administration features or Extended Functionality features.
External Full
Access User
These licenses are geared toward Client insured/member/client users. These licenses have access to all the capabilities and
features of the Service under the base functionality selected above as outlined by Client, except those features utilized for
adjusting claims such as check writing, setting reserves and calculating indemnity benefits. These users will not have
access to Administration features or Extended Functionality features.
External Claims
Adjusting User
These licenses are geared toward Client insured/member/client users. These licenses have access to all the features and
capabilities of the Service required to adjudicate claims, including those that are not under the care of Client. These users
will not have access to Administration features or Extended Functionality features.
Broker Customer User Licenses
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
Broker Customer
User
These licenses are geared toward broker Clients’ customer users. They will have access to pre-defined dashboards. They
will be able to view claims, transactions and notes/tasks and they will be able to run reports utilizing pre-defined report
templates. These users will not have access to Administration features or Extended Functionality features.
IMPORTANT:
If any of the following statements are true, the client will require a “Direct Customer RMIS” as described above:
• Customer is self-administering claims or making payments within the RMIS.
• The customer requires direct data feed conversion from a TPA or Carrier.
• The customer requires administration access in Origami Risk.
• The customer requires its own set of currency conversion rates in Origami Risk.
• The customer requires the ability for customer users to add claims or incidents to the service above 200 per year.
For clarity, the following table sets forth the functionality available to Broker Customer Users:
Enterprise Wide
Record Entry
Enterprise Values
Collection
Broker Customer User
(Insured)
Non-named user incident reporting YES NO NO
Non-named user values reporting NO YES NO
Dashboard NO NO YES
View claims and associated transactions NO NO YES
Edit claims and associated transactions NO NO NO
View and add tasks and notes NO NO YES
Utilize template reports NO NO YES
Custom template builder NO NO NO
Administration module NO NO NO
Certificate tracking NO NO NO
View allocations & TCOR NO NO YES
Edit allocations & TCOR NO NO NO
Check writing NO NO NO
CMS 111 NO NO NO
Features that require 3rd party agreement NO NO NO
Self-administration of claims NO NO NO
EHS User Licenses
EHS User These licenses provide the right for a named individual to access all the EHS capabilities and features of the Service. These
licenses have access to Extended Functionality features to the extent selected.
EHS Portal User EHS portal allows for either anonymous or named users to input data to the EHS platform using configured portals on
tablets or other devices. Portals can also be configured to retrieve specified records from the platform including but not
limited to JSAs, LOTOs, and SDS documentation.
GRC User Licenses
Full User These user licenses provide authorization for the stated number of users to access the base functionality set forth above.
Light User These user licenses have access to the dashboard, reports pre-configured for them, and read-only access to the base
functionality set forth above. They do not have access to the Administration features.
Special User These user licenses have access to the dashboard, reports pre-configured for them, and add/edit access to the base
functionality set forth above. They do not have access to the Administration features.
Data Entry Licenses
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
Enterprise Wide
Record Entry
These licenses are not named licenses and have access only to enter records either by (1) an anonymous collection portal,
by clicking an anonymous collection link generated via the administration features in the Service (“Portal Data Entry”) or
(2) granting access to a URL sent from the Service as a Data Entry Event email notification, giving time limited access to a
single record (“Grant Access”).
Enterprise Values
Collection
These licenses allow representatives in the field to enter data through the Service’s online platform pertaining to
information necessary for renewal submissions, such as TIV, Square Footage, COPE information, or other such asset and
exposure data.
Assessments These licenses are not named licenses and have access only to enter records by clicking a link generated by the Service to
view a record or conduct an assessment.
Disease and
Vaccination Entry
Portal
These licenses are non-named licenses and have access to add records either by an anonymous collection portal, by
clicking an anonymous collection link generated via Origami’s administration features, or via Origami’s mobile forms
application to capture only disease related information such as exposure, vaccine data, and testing information. For the
avoidance of doubt, these unlimited records are limited to the Vaccination Solution and shall not apply to any other base
functionality which may be purchased under a separate Statement of Work.
Extended Functionality Licenses
API Access This license provides access to Origami’s web service REST APIs using calls. Includes access for up to 5,000 calls per
day. API calls may be made concurrently, subject to reasonable limitation when needed to preserve system performance.
Requires a minimum of five (5) Full Users and/or Claims Adjusting Users.
Secure Email This license provides secure email functionality, which provides password protected hosting for email communications
from and to the Service.
OCR Scanning This license provides optical character recognition (OCR) functionality for mapping specified data from scanned documents
to data fields within the Service.
Certificate of
Insurance Tracking
This license provides certificate of insurance tracking for third party insureds, such as tenants, vendors, contractors or
customers.
SMS Messaging This license provides the ability to send and receive SMS messages as workflow actions within the Service’s administration
features.
Client agrees to use the Twilio services in accordance with the Twilio Terms of Service set forth at
https://www.twilio.com/legal/tos. In no event shall Origami be responsible or liable for any acts or omissions of Twilio.
Client hereby consents to Origami providing Twilio with its data to the extent necessary to perform such services. If the
relationship between Origami and Twilio is terminated during the term of the Order Form, Origami shall provide prompt
written notice to Client and the Twilio services under the Order Form shall be terminated as of such date (and Origami will
provide a refund to Client of any prepaid and unused fees for the Twilio services).
Two Factor
Authentication
This license provides the ability to send SMS and/or email messages to users to validate their identity before logging in
from a new device and/or once every 30 days from the same device.
Mobile Forms App This license may be used by any named user for no additional license fee, but service hours are required for configuration.
Mobile Claimant
App
This license may be used by any named user for no additional license fee, but service hours are required for configuration.
Requires a minimum of three (3) Claims Adjusting Users.
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
Workers’
Compensation
Solutions
This license includes the following Origami Compliance solutions (this functionality is only available to Claims Adjusting
Users):
• Automated EDI FROI/SROI State Reporting via Mitchell
• Indemnity Benefits Rates
• Workers’ Compensation State Forms
This license gives access to Origami’s interface with Mitchell for the purpose of state workers’ compensation reporting.
Pursuant to this license, Origami will provide its First Reports of Injury (“FROI”)/Subsequent Reports of Injury (“SROI”)
Automation Module within the Service to facilitate tracking and reporting of FROI and SROI related data, configured on a
per-state basis; and will allow Client to maintain and process claim and transactional data for submission to states via
Electronic Data Interchange (“EDI”). Origami’s interface with Mitchell allows for the creation, validation and submission
of First Report of Injury submissions. Origami’s interface will receive a file back noting any exceptions, driving adjuster
notifications and workflow.
EDI FROI/SROI Reporting via Mitchell is a subscription service which requires a separate agreement with Mitchell. Client
understands that Origami is providing an interface with Mitchell and that Mitchell will provide its services pursuant to an
agreement between Client and Mitchell. Origami makes no representations or warranties with respect to Mitchell’s
services and in no event shall Origami be responsible or liable for any acts or omissions of Mitchell. Origami's automated
EDI FROI/SROI solution requires the Client to utilize Origami’s standard EDI FROI/SROI functionality and layouts,
including EDI related claim fields, codes, financial buckets, and financial categories. If the agreement between Origami and
Mitchell is terminated during the term of the Order Form, Origami shall provide prompt written notice to Client, and the
Mitchell services under the Order Form shall be terminated as of such date (and Origami will provide a refund to Client of
any prepaid and unused fees for the Mitchell services). Origami will only support this feature in an ongoing phase if no
modifications to these areas have been made.
ODG Integration
User
This license provides integration with ODG’s Return to Work guidelines. Only Claims Adjusting Users and Full Users may
utilize this feature. This feature queries ODG’s RTW and treatment guidelines based on WC claim diagnosis codes.
Client understands and agrees that Origami makes no representations or warranties with respect to the data provided by
ODG. In no event shall Origami be liable for any damages in connection with data provided by ODG or for any acts or
omissions of ODG. If the relationship between Origami and ODG is terminated during the term of the Order Form,
Origami shall provide prompt written notice to Client and the ODG services under the Order Form shall be terminated as of
such date (and Origami will provide a refund to Client of any prepaid and unused fees for the ODG services).
Tableau This license allows users to access Tableau within the Service, providing enhanced data visualization.
Client understands and agrees that Tableau shall have no warranty, support or other obligation or liability to Client. Client
understands and agrees that data contained in Tableau data visualizations is not restricted by Origami’s permissions and that
Client is responsible for ensuring that any such data visualizations are shared only with appropriate users. If the
relationship between Origami and Tableau is terminated during the term of the Order Form, Origami shall provide prompt
written notice to Client and the Tableau services under the Order Form shall be terminated as of such date (and Origami
will provide a refund to Client of any prepaid and unused fees for the Tableau services).
eSignature
Integration
This license provides the ability to tag mail merge documents with electronic signature fields, authenticating through a
third-party eSignature tool (currently DocuSign).
In no event shall Origami be responsible or liable for any acts or omissions of DocuSign. Client hereby consents to
Origami providing DocuSign with its data to the extent necessary to perform such services. If the relationship between
Origami and DocuSign is terminated during the term of the Order Form, Origami shall provide prompt written notice to
Client and the DocuSign services under the Order Form shall be terminated as of such date (and Origami will provide a
refund to Client of any prepaid and unused fees for the DocuSign services).
TCOR AI Analytics TCOR AI Analytics provides the ability for users to create standard and custom visualizations of their TCOR data using
natural language prompts. Use of TCOR AI Analytics is subject to the Additional Terms and Conditions for AI
Functionality set forth at www.origamirisk.com/servicedescriptions.
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
STP
ComplianceEHS
Pass-Through
Client hereby agrees to be bound by the STP ComplianceEHS End User License Agreement, available at
https://www.stpub.com/wp-content/uploads/End-User-License-Agreement-2024.pdf. In no event shall Origami be
responsible or liable for any acts or omissions of STP Publications Limited Partnership DBA STP ComplianceEHS (“STP
ComplianceEHS”). Client hereby consents to Origami providing STP ComplianceEHS with its data to the extent necessary
to perform such services. If the relationship between Origami and STP ComplianceEHS is terminated during the term of
this SOW, Origami shall provide prompt written notice to Client and the DocuSign services under this SOW shall be
terminated as of such date (and Origami will provide a refund to Client of any prepaid and unused fees for the STP
ComplianceEHS services).
Subscription Notes:
1. Origami adds generally available features from time to time that may require configuration prior to use. If Client requests
Origami’s assistance in this configuration, Origami may require support hours or professional service hours for any such
configuration.
2. In addition to the generally available features, Origami may occasionally deploy new functionality that will require a separate
license. These features may require additional fees based on record volume, number of additional users accessing the new
features, or some other incremental cost driver. Client may agree to add such a new license in an Order Form.
HOSTING AND CLOUD MANAGED SERVICES
Origami will host the application and data and will back up Client Data at periodic intervals each day as set forth in the Service Level
Agreement.
ADDITIONAL PRODUCTION TENANT
If Client has purchased an additional production tenant, the following terms and conditions apply:
• Upon Client’s request (no more often than once in any three-month period), Origami will refresh the additional tenant
with data from Client’s live tenant.
• Upon Client request, additional refreshes can be requested and will erode Client Support hours.
• Origami’s Service Level Agreement does not apply to additional production tenants.
• Any data manipulation or transition of configuration between the environments will erode Client Support hours.
PRE-PRODUCTION ENVIRONMENT
If Client has purchased a tenant in the pre-production environment (the “Pre-Prod Environment”), the following terms and conditions
apply:
• Grant of Access. Subject to the Agreement, Origami grants the Client access to the Pre-Prod Environment solely for the
purpose of evaluating upcoming updates and features in a non-production setting.
• Monthly Code Releases. The Pre-Prod Environment will receive new beta code on a monthly basis. This code release
will occur in conjunction with the monthly update release, which will include release notes detailing the changes and
improvements.
• Automatic Code Updates. Client acknowledges that all updates to the Pre-Prod Environment will be applied
automatically by Origami.
• No SLA. Any Service Level Agreement contained in the Agreement is not applicable to the Pre-Prod Environment.
Origami does not guarantee any specific level of performance, availability, or support for this environment.
• Additional Restrictions. In addition to the restrictions set forth in the Agreement, the Client is permitted to conduct
testing only within their specific environment in the Pre-Prod Environment. No testing or evaluation of the system as a
whole or other clients’ environments is allowed. Termination; Suspension
• Discontinuation. Origami reserves the right to discontinue the provision of the Pre-Prod Environment at any time and for
any reason without prior notice. If Origami discontinues the provision of the Pre-Prod Environment, it will provide a
refund of any prepaid but unearned fees paid by Client for the Pre-Prod Environment.
• Suspension or Removal of Access. Origami may suspend or remove the Client's access to the Pre-Prod Environment at
its sole discretion if the Client breaches the terms and conditions for the Pre-Prod Environment.
DISCLAIMER OF WARRANTIES. THE PRE-PROD ENVIRONMENT IS PROVIDED “AS IS” AND AS
AVAILABLE, EXCLUSIVE OF ANY WARRANTY WHATSOEVER. ORIGAMI (1) MAKES NO
REPRESENTATIONS OR WARRANTIES OF ANY KIND, WHETHER EXPRESS, IMPLIED, STATUTORY OR
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
OTHERWISE, WITH RESPECT TO ANY MATTER, INCLUDING ANY REPRESENTATION
THAT THE PREPROD ENVIRONMENT WILL BE UNINTERRUPTED OR ERROR-FREE,
AND (2) EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES OR CONDITIONS OF NON-INFRINGEMENT,
MERCHANTABILITY AND
FITNESS FOR ANY PARTICULAR PURPOSE. THE PRE-PROD ENVIRONMENT IS PRELEASE, IS EXPECTED
TO CONTAIN DEFECTS, SOME OF WHICH MAY BE MATERIAL, AND IS NOT EXPECTED TO OPERATE AT
THE LEVEL OR PERFORMANCE OR COMPATIBILITY OF A FINAL, PUBLICLY AVAILABLE PRODUCT
OFFERING. IN NO EVENT SHALL ORIGAMI BE LIABLE FOR ANY DAMAGES WHATSOEVER ARISING OUT
OF THE USE OF OR INABILITY TO USE THE PRE-PROD ENVIRONMENT.
DATA PROCESSING
Origami will process the claims data received from Client data providers and maintain import and/or export routines and schedules
with third parties as indicated in the applicable Order Form.
In connection with these data processing activities, if any, Client agrees that it will:
• Use tools in the Service to resolve exceptions, if any, such as missing locations, incomplete code maps, and other exceptions,
which may occur in the update as a result of data errors or missing data from data providers.
• Notify Carrier / TPA of data exceptions when appropriate to have data corrected at source.
• Ensure the ongoing performance of import and export responsibilities of each 3rd party system.
ADDITIONAL SERVICES
Additional subscriptions, users, hosting or other use beyond that which is listed in the Order Form shall require additional fees.
Origami shall invoice Client, and Client shall pay for any additional licenses, hosting, service hours or other usage in excess of what
is specified in the applicable Order Form. All such fees will be at Origami’s then-current rates. If needed, additional services can be
purchased through an Order Form or Statement of Work, as applicable.
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
ORIGAMI RISK
DESCRIPTION AND TERMS AND CONDITIONS FOR CLIENT SUPPORT AND
PROFESSIONAL SERVICES
Effective For Order Forms Executed After April 12, 2023
SUPPORT
CLIENT SUPPORT
Origami provides Client Support through a subscription package for the term of the contract. Client Support includes an Origami
assigned, focused coverage team that can be contacted directly by client administrators for real time, point-of-contact production
support inquiries. Client Support includes the following work performed by such coverage team on behalf of the client:
• Service Case Management, meaning the receipt and capture of all client production support inquiries as Service Cases, and
the timely acknowledgement, review and qualification of those cases. Service Cases will be evaluated and addressed
following Origami’s process based on industry standards. Service Cases will be qualified as Service Requests, Incidents or
Professional Services. Service Requests and Incidents are included in Client Support while Professional Services are not
included in Client Support and are further defined below.
• Service Requests include requests for information, guided assistance to users/administrators, coordination of activities related
to client-requested basic security changes in the Origami platform (e.g., SSO link changes and FTP site modifications),
routine modifications and maintenance of existing system configurations, data feeds, interfaces, integrations or
customizations, and triage and execution of minor enhancements and changes that do not require a Change Request (see
definition below).
• Incidents (Qualified and Unqualified) include any unplanned interruptions or degradations in the quality of the Origami
delivered software-as-a-service.
• Qualified Incidents include any interruption or degradation that occurs as a result of (1) an Origami software defect or cloud
infrastructure issue or (2) a client configuration issue caused by standard Origami updates to the Origami Risk platform, but
only to the extent such client configuration was originally designed, tested and delivered by Origami in accordance with
direction received and approved during implementation.
• Unqualified Incidents include any interruption or degradation that does not qualify as a Qualified Incident, including (1)
issues that occur as a result of configurations created by the client or a third party, (2) issues caused by the client or a third
party, or (3) issues that are known or existing at Go-Live for the applicable Service.
• High-level estimates for Professional Services, provided that time required for functional specifications, detailed design or
technical review is not included and requires Professional Services.
• Access to current and future Origami product documentation, knowledge and best practice education that Origami generally
makes available to clients.
• Efforts required by Origami to address routine client-specific regulatory and compliance changes or data security updates to
configurations.
• Routine assistance with technical audits, product reviews, quality assurance and data exceptions handling.
• Efforts as needed as an advisor, escalation point and advocate throughout the customer journey.
Any work that is not included in the definitions of Client Support (as determined in Origami’s reasonable discretion) must be
separately contracted as Professional Services.
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
Client Support Subscription
Origami offers a Client Support subscription to align Origami’s support resourcing and staffing
for the appropriate needs of the client. A Client Support subscription provides the client with resourcing and staffing based on a
specified number of hours of Client Support Version Date: April 12, 2023
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
services per calendar month, after which there may be substantial delays in response times. These hours allocations allow Origami to
staff Client Support engagements appropriately and do not cumulate or roll over. The staffing hours allocation for the client’s selected
Client Support subscription will be set forth in the contract.
Qualified Incidents (as defined above) are addressed by Origami as part of Client Support without taking into account a client’s
support subscription or any hour allocations.
Origami reserves the right to review a client’s selected Client Support subscription periodically, including when client resourcing and
staffing demands exceed the selected subscription, to ensure there is sufficient resourcing and staffing for the client’s support needs.
Origami account management will propose adjustments if a client’s support needs should increase in order to avoid delays in Client
Support case processing, availability and responsiveness.
PROFESSIONAL SERVICES
Any work performed by Origami service or support professionals that does not fall into the definition of Client Support above is
deemed to be Professional Services. Examples of work that requires Professional Services include:
• Implementations and Projects: include the creation or implementation of new product functionality and any related new
configurations, customizations, enhancements, data feeds, interfaces or integrations (i.e., multiple distinct deliverables)
requiring detailed scoping and design, project management (specified resources, documented plans and artifacts, etc.),
multifunctional resource commitments (e.g., professional services and development resources or third party service
integrators); project administration, calls and meetings related to such work; detailed Origami testing and/or client user
acceptance testing (UAT); and scheduled/planned deployments.
• Change Requests: include complex modifications or maintenance of functionality, configurations, customizations,
enhancements, data feeds, interfaces or integrations, and other changes that are not mutually agreed to be reasonably
delivered by the client’s assigned focused coverage team resources under Client Support, generally requiring some scoping,
design, change management (approval and/or authorization to deploy), testing and post-deployment validation from Origami.
• Other work or engagements that requires specialized skills or resources other than the assigned focused coverage team
resources for Client Support.
• Dedicated on-call support during special projects or specific events.
• Client-requested travel and tasks conducted during such visits.
A client may purchase Professional Services in an initial contract or at any time during the then-current contract term. Fees for
Professional Service hours will be at Origami’s prevailing hourly rates at the time of purchase.
ACCOUNT MANAGEMENT
Origami also provides account management services to clients in order to understand and support client on-going and future business
requirements, objectives and strategic development plans. Time spent by Origami account management resources is provided without
cost and is separate from Client Support or Professional Services.
CLIENT ROLES AND RESPONSIBILITIES
Each client is responsible for identifying an administrator who will be responsible for client-side system maintenance and working
with Origami to provide support to end users, as well as assigning security rights and maintaining user IDs for all users. Origami does
not provide support directly to end users of the client, and only these client administrators will have direct access to Origami’s
assigned focused coverage team. Client administrators are the first point of contact for client end users and responsible for triaging
any support needs where the Origami team needs to be engaged.
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
Client administrators and, from time to time, other client employees are responsible for providing timely direction and feedback as
needed by Origami to complete implementation and support tasks. Client administrators are also responsible for gathering appropriate
information about any issue in advance of contacting Origami.
The client will have final responsibility for decisions regarding configurations or customizations (such as forms, dashboards,
interfaces, reports, workflows and data flows) created by or for a client or its users in the Origami platform. For all such
configurations and customizations, the client shall be responsible for quality assurance to ensure that such configurations and
customizations operate as intended (including functionality, usability and data access rights), and Origami shall not be responsible for
any damages caused by any such configurations or customizations.
Docusign Envelope ID: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
CONFLICT OF INTEREST QUESTIONNAIRE
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: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D
X
X
N/A
X
X
5/12/2025
Certificate Of Completion
Envelope Id: FF8B780C-F9CD-47D1-9FB6-AEBD4235DA2D Status: Completed
Subject: ***Purchasing Approval*** 7700 Risk & Safety Management Information System - Informal Amendment 2
Source Envelope:
Document Pages: 16 Signatures: 4 Envelope Originator:
Certificate Pages: 6 Initials: 3 Christina Dormady
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
901B Texas Street
Denton, TX 76209
christina.dormady@cityofdenton.com
IP Address: 198.49.140.10
Record Tracking
Status: Original
5/9/2025 1:26:35 PM
Holder: Christina Dormady
christina.dormady@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
Christina Dormady
christina.dormady@cityofdenton.com
Buyer
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 198.49.140.10
Sent: 5/9/2025 1:31:06 PM
Viewed: 5/9/2025 1:31:13 PM
Signed: 5/9/2025 1:31:31 PM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Lori Hewell
lori.hewell@cityofdenton.com
Purchasing Manager
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.104
Sent: 5/9/2025 1:31:33 PM
Viewed: 5/9/2025 4:08:09 PM
Signed: 5/9/2025 4:11:47 PM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Marcella Lunn
marcella.lunn@cityofdenton.com
Senior Deputy City Attorney
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.10
Sent: 5/9/2025 4:11:49 PM
Viewed: 5/12/2025 2:00:18 PM
Signed: 5/12/2025 2:02:08 PM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Earnest Bentley
legal@origamirisk.com
President - Risk Solutions
Origami Risk LLC
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 67.175.120.46
Sent: 5/12/2025 2:02:11 PM
Viewed: 5/12/2025 3:44:16 PM
Signed: 5/12/2025 4:42:09 PM
Electronic Record and Signature Disclosure:
Accepted: 3/14/2022 10:28:02 AM
ID: b9a39397-3c3d-429a-a3c7-55b85ad7f349
Signer Events Signature Timestamp
Megan Gilbreath
Megan.gilbreath@cityofdenton.com
HR Director
City of Denton - Human Resources
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.10
Sent: 5/12/2025 4:42:12 PM
Resent: 5/13/2025 1:47:52 PM
Viewed: 5/13/2025 4:02:12 PM
Signed: 5/13/2025 4:12:26 PM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Christina Dormady
christina.dormady@cityofdenton.com
Buyer
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.104
Sent: 5/13/2025 4:12:28 PM
Viewed: 5/13/2025 4:13:10 PM
Signed: 5/13/2025 4:13:16 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
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Procurement Administration Supervisor
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 5/13/2025 4:13:18 PM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Tiffany Harris
tiffany.harris@cityofdenton.com
Risk Supervisor
Security Level: Email, Account Authentication
(None)
Sent: 5/13/2025 4:13:19 PM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Christopher Dickman
cdickman@origamirisk.com
Security Level: Email, Account Authentication
(None)
Sent: 5/13/2025 4:13:20 PM
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 5/9/2025 1:31:06 PM
Envelope Updated Security Checked 5/12/2025 2:27:56 PM
Certified Delivered Security Checked 5/13/2025 4:13:10 PM
Signing Complete Security Checked 5/13/2025 4:13:16 PM
Completed Security Checked 5/13/2025 4:13:20 PM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, City of Denton (we, us or Company) may be required by law to provide to
you certain written notices or disclosures. Described below are the terms and conditions for
providing to you such notices and disclosures electronically through your DocuSign, Inc.
(DocuSign) Express user account. Please read the information below carefully and thoroughly,
and if you can access this information electronically to your satisfaction and agree to these terms
and conditions, please confirm your agreement by clicking the 'I agree' button at the bottom of
this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. For such copies, as long as you are an authorized user of the
DocuSign system you will have the ability to download and print any documents we send to you
through your DocuSign user account for a limited period of time (usually 30 days) after such
documents are first sent to you. After such time, if you wish for us to send you paper copies of
any such documents from our office to you, you will be charged a $0.00 per-page fee. You may
request delivery of such paper copies from us by following the procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign 'Withdraw Consent' form on the signing page of your
DocuSign account. This will indicate to us that you have withdrawn your consent to receive
required notices and disclosures electronically from us and you will no longer be able to use your
DocuSign Express user account to receive required notices and consents electronically from us
or to sign electronically documents from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through your DocuSign user account all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
Electronic Record and Signature Disclosure created on: 7/21/2017 3:59:03 PM
Parties agreed to: Earnest Bentley
How to contact City of Denton:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: purchasing@cityofdenton.com
To advise City of Denton of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at melissa.kraft@cityofdenton.com
and in the body of such request you must state: your previous e-mail address, your new e-mail
address. We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in DocuSign.
To request paper copies from City of Denton
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to purchasing@cityofdenton.com and in
the body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with City of Denton
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign account, and on the subsequent
page, select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to purchasing@cityofdenton.com and in the body of such request you
must state your e-mail, full name, IS Postal Address, telephone number, and account
number. We do not need any other information from you to withdraw consent.. The
consequences of your withdrawing consent for online documents will be that transactions
may take a longer time to process..
Required hardware and software
Operating Systems: Windows2000? or WindowsXP?
Browsers (for SENDERS): Internet Explorer 6.0? or above
Browsers (for SIGNERS): Internet Explorer 6.0?, Mozilla FireFox 1.0,
NetScape 7.2 (or above)
Email: Access to a valid email account
Screen Resolution: 800 x 600 minimum
Enabled Security Settings:
•Allow per session cookies
•Users accessing the internet behind a Proxy
Server must enable HTTP 1.1 settings via
proxy connection
** These minimum requirements are subject to change. If these requirements change, we will
provide you with an email message at the email address we have on file for you at that time
providing you with the revised hardware and software requirements, at which time you will
have the right to withdraw your consent.
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you
were able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to
e-mail this disclosure and consent to an address where you will be able to print on paper or
save it for your future reference and access. Further, if you consent to receiving notices and
disclosures exclusively in electronic format on the terms and conditions described above,
please let us know by clicking the 'I agree' button below.
By checking the 'I Agree' box, I confirm that:
• I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and
• I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
• Until or unless I notify City of Denton as described above, I consent to receive from
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to me by City of Denton during the course of my relationship with you.