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7216 - Contract Executed Docusign City Council Transmittal Coversheet File Name Purchasing Contact City Council Target Date Piggy Back Option Contract Expiration Ordinance DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 " $! #&&" " # % # % DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 IN WITNESS WHEREOF, the parties of these presents have executed this agreement in the year and day first above written. THIS AGREEMENT HAS BEEN BOTH REVIEWED AND APPROVED as to financial and operational obligations and business terms. _______________ ________________ SIGNATURE PRINTED NAME __________________________________ TITLE __________________________________ DEPARTMENT CITY OF DENTON, TEXAS BY: _____________________________ TODD HILEMAN CITY MANAGER ATTEST: ROSA RIOS, CITY SECRETARY BY: _______________________________ APPROVED AS TO LEGAL FORM: AARON LEAL, CITY ATTORNEY BY: _______________________________ DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 Exhibit 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: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 Exhibit B Certificate of Interested Parties Electronic Filing In 2015, the Texas Legislature adopted House Bill 1295, which added section 2252.908 of the Government Code. The law states that the City may not enter into this contract unless the Contractor submits a disclosure of interested parties (Form 1295) to the City at the time the Contractor submits the signed contract. The Texas Ethics Commission has adopted rules requiring the business entity to file Form 1295 electronically with the Commission. Contractor will be required to furnish a Certificate of Interest Parties before the contract is awarded, in accordance with Government Code 2252.908. The contractor shall: 1. Log onto the State Ethics Commission Website at : https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm 2. Register utilizing the tutorial provided by the State 3. Print a copy of the completed Form 1295 4. Enter the Certificate Number on page 2 of this contract. 5. Complete and sign the Form 1295 6. Email the form to purchasing@cityofdenton.com with the contract number in the subject line. (EX: Contract 1234 – Form 1295) The City must acknowledge the receipt of the filed Form 1295 not later than the 30th day after Council award. Once a Form 1295 is acknowledged, it will be posted to the Texas Ethics Commission’s website within seven business days. DocuSign Envelope ID: 8B3C96F3-99BA-4BFC-A621-C6E2F0213A54 Certificate Of Completion Envelope Id: 8B3C96F399BA4BFCA621C6E2F0213A54 Status: Completed Subject: Please DocuSign: City Council Contract 7216 - Hoopla Digital Services Source Envelope: Document Pages: 12 Signatures: 6 Envelope Originator: Certificate Pages: 6 Initials: 1 Suzzen Stroman AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 901B Texas Street Denton, TX 76209 suzzen.stroman@cityofdenton.com IP Address: 129.120.6.150 Record Tracking Status: Original 12/17/2019 1:42:31 PM Holder: Suzzen Stroman suzzen.stroman@cityofdenton.com Location: DocuSign Signer Events Signature Timestamp Suzzen Stroman suzzen.stroman@cityofdenton.com Buyer City of Denton Security Level: Email, Account Authentication (None) Completed Using IP Address: 129.120.6.150 Sent: 12/17/2019 2:05:17 PM Viewed: 12/17/2019 2:11:29 PM Signed: 12/17/2019 2:11:40 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: 47.184.81.15 Sent: 12/17/2019 2:11:43 PM Resent: 12/18/2019 7:57:11 PM Viewed: 12/18/2019 8:02:16 PM Signed: 12/18/2019 8:05:33 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Mack Reinwand mack.reinwand@cityofdenton.com City of Denton Security Level: Email, Account Authentication (None)Signature Adoption: Pre-selected Style Using IP Address: 129.120.6.150 Sent: 12/18/2019 8:05:35 PM Viewed: 12/19/2019 3:05:09 PM Signed: 12/19/2019 3:09:12 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Jennifer Bekker Jennifer.Bekker@cityofdenton.com Director of Libraries City of Denton Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 129.120.6.150 Sent: 1/6/2020 8:54:47 AM Viewed: 1/6/2020 8:58:53 AM Signed: 1/6/2020 9:01:52 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Signer Events Signature Timestamp Cheyenne Defee cheyenne.defee@cityofdenton.com Contract Administrator City of Denton Security Level: Email, Account Authentication (None) Completed Using IP Address: 129.120.6.150 Sent: 1/6/2020 9:01:56 AM Viewed: 1/28/2020 4:02:21 PM Signed: 1/28/2020 4:03:03 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Todd Hileman Todd.Hileman@cityofdenton.com City Manager City of Denton Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 107.77.197.132 Signed using mobile Sent: 1/28/2020 4:03:05 PM Viewed: 1/28/2020 4:18:38 PM Signed: 1/28/2020 4:18:46 PM Electronic Record and Signature Disclosure: Accepted: 7/25/2017 11:02:14 AM ID: 57619fbf-2aec-4b1f-805d-6bd7d9966f21 Rosa Rios rosa.rios@cityofdenton.com City Secretary Security Level: Email, Account Authentication (None)Signature Adoption: Pre-selected Style Using IP Address: 129.120.6.150 Sent: 1/28/2020 4:18:48 PM Viewed: 1/28/2020 4:32:52 PM Signed: 1/28/2020 4:33:36 PM Electronic Record and Signature Disclosure: Accepted: 1/28/2020 4:32:52 PM ID: a2b2b9c7-c57e-4956-b5c9-7ff79a23989a Sue Bascuk JTimm@midwesttapes.com Bid Specialist Janet Timm Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 24.52.124.254 Sent: 12/19/2019 3:09:15 PM Resent: 12/20/2019 3:58:34 PM Resent: 1/28/2020 4:33:39 PM Viewed: 1/3/2020 7:53:31 AM Signed: 1/29/2020 7:11:02 AM Electronic Record and Signature Disclosure: Accepted: 1/3/2020 7:53:31 AM ID: 0051ede6-69ca-4f41-8b24-f01c269ab299 In Ierson Signer Events Signature Timestamp Editor DeliverI Events Status Timestamp Igent DeliverI Events Status Timestamp IntermediarI DeliverI Events Status Timestamp Certified DeliverI Events Status Timestamp CarIon CopI Events Status Timestamp Cheyenne Defee cheyenne.defee@cityofdenton.com Contract Administrator City of Denton Security Level: Email, Account Authentication (None) Sent: 12/17/2019 2:11:43 PM Electronic Record and Signature Disclosure: CarIon CopI Events Status Timestamp Not Offered via DocuSign Sherri Thurman sherri.thurman@cityofdenton.com City of Denton Security Level: Email, Account Authentication (None) Sent: 1/6/2020 9:01:56 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Jane Richardson jane.richardson@cityofdenton.com Assistant City Secretary City of Denton Security Level: Email, Account Authentication (None) Sent: 1/28/2020 4:03:05 PM Viewed: 1/28/2020 4:08:27 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Zolaina Parker Zolaina.Parker@cityofdenton.com City of Denton Security Level: Email, Account Authentication (None) Sent: 1/28/2020 4:03:05 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Cynthia Carter cynthia.carter@cityofdenton.com Security Level: Email, Account Authentication (None) Sent: 1/29/2020 7:11:04 AM Viewed: 1/29/2020 8:33:46 AM Electronic Record and Signature Disclosure: Not Offered via DocuSign Iitness Events Signature Timestamp IotarI Events Signature Timestamp Envelope SummarI Events Status Timestamps Envelope Sent Hashed/Encrypted 1/29/2020 7:11:04 AM Certified Delivered Security Checked 1/29/2020 7:11:04 AM Signing Complete Security Checked 1/29/2020 7:11:04 AM Completed Security Checked 1/29/2020 7:11:04 AM IaIment 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. 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