7183 - Contract Executed
Docusign City Council Transmittal Coversheet
File Name
Purchasing Contact
City Council Target Date
Piggy Back Option
Contract Expiration
Ordinance
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payments under this agreement by doing business with Iran, Sudan, or a foreign terrorist organization
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the successful contractor shall have a duty to maintain throughout the course of this contract.
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Without limiting any of the other obligations or liabilities of the Contractor, the Contractor
shall provide and maintain until the contracted work has been completed and accepted by
the City of Denton, Owner, the minimum insurance coverage as indicated hereinafter.
Contractor shall file with the Purchasing Department satisfactory certificates of insurance
including any applicable addendum or endorsements, containing the contract number and
title of the project. Contractor may, upon written request to the Purchasing Department,
ask for clarification of any insurance requirements at any time; however, Contractor shall
not commence any work or deliver any material until he or she receives notification that
the contract has been accepted, approved, and signed by the City of Denton.
All insurance policies proposed or obtained in satisfaction of these requirements shall
comply with the following general specifications, and shall be maintained in compliance
with these general specifications throughout the duration of the Contract, or longer, if so
noted:
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described on the certificate be cancelled or materially changed before the
expiration date.
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additionally comply with the following marked specifications, and shall be maintained in
compliance with these additional specifications throughout the duration of the Contract,
or longer, if so noted:
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EXHIBIT F
2
Table of Contents
Executive Overview ........................................................................................................................................ 3
Qualifications and Experience ......................................................................................................................... 5
Company Overview .......................................................................................................................... 5
Regional Market Presence—Dallas Fort Worth ............................................................................. 5
Regional Experience – City of Denton ........................................................................................... 5
Company Experience – EMS Medical Direction Texas .................................................................... 6
Ability to Meet Scope of Work Requirements ................................................................................................. 7
On-Line Medical Direction ............................................................................................................... 7
Adherence to Texas State Board EMS Requirements .................................................................... 7
On-Line Medical Control Capabilities ............................................................................................ 7
On-Line Medical Control Location ................................................................................................. 7
On-Line Medical Control for Disasters and MCIs ........................................................................... 8
Audio Recordings ......................................................................................................................... 8
24/7/365 Coverage ....................................................................................................................... 8
Off-Line Medical Direction ............................................................................................................... 8
Adherence to Texas State Board EMS Requirements .................................................................... 8
Board Certification ....................................................................................................................... 9
Protocol Implementation ............................................................................................................. 9
Continuous Protocol Development and Review ............................................................................ 9
Quality Assurance/Quality Improvement ................................................................................... 10
Skills Review and Protocol Test .................................................................................................. 10
Written Remediation Plan .......................................................................................................... 11
EMS Continuing Education .......................................................................................................... 11
Specialty Courses........................................................................................................................ 12
Collaboration with Local Medical Community ............................................................................. 12
Procurement of Equipment, Medications, Etc. ............................................................................ 12
Attachment 1: Conflict of Interest Questionnaire .......................................................................................... 13
Attachment 2: Pricing Sheet .......................................................................................................................... 14
Attachment 2: Curriculum Vitae .................................................................................................................... 15
Attachment 3: Letter of Recommendation .................................................................................................... 17
Attachment 4: Bidder Invitation .................................................................................................................... 18
3
Executive Overview
January 30, 2020
Crystal Westbrook
Buyer
City of Denton
901-B Texas Street
Denton, TX 76209
Ms. Westbrook,
Questcare, a Dallas-based operating unit of Envision Physician Services, is pleased to have this opportunity to
present our response to the City of Denton’s Request for Proposal for Medical Control Services (RFP 7183). Our
company acknowledges and confirms our ability to provide all services requested. The Questcare group is
uniquely qualified to provide the services required by the City of Denton. We are excited about the opportunity
to partner with the City to build a joint premier health team to deliver the best healthcare services possible to
the citizens of our community.
Questcare, with a 19-year history of EMS medical direction services, provides those services for 32
governmental and ambulance agencies throughout Texas, including the cities of Denton, Arlington, Plano,
Frisco, Lewisville, Grand Prairie, McKinney, Coppell, Lake Cities, Highland Village, Murphy, Rowlett, Sanger,
Krum, Justin, Ponder, and the Town of Fairview. Questcare coordinates an EMS Council that includes the
medical directors of these departments and representatives of these departments’ EMS leadership. Maintaining
the contract with Questcare will allow the city of Denton to benefit from expansive EMS resources and
experience, including qualified medical director back-up, cost efficiencies, insurance coverage, and a proven
track record of success within EMS.
Dr. Thomas Olmsted has been providing the services of Medical Director for the City of Denton Fire
Department since February 2016, as well as to the Lake Cities Fire Department, the City of Ponder Fire
Department, the City of Justin Fire Department, the City of Sanger Fire Department, and the City of Krum Fire
Department. He is a Board-Certified emergency physician working at Medical City Denton since November
2013. He holds certifications in ACLS, ATLS, and BLS.
Our experienced leadership team is committed to helping the City of Denton raise the bar in EMS services. We
are driven by a culture of clinical excellence, accountability, and collaboration. We know that prehospital
emergency care is a vital part of a fully integrated healthcare system.
4
Questcare is committed to assist the Denton Fire Department in the following areas to ensure measurable and
sustained performance excellence:
Implementation and maintenance of quality databases
Data-informed process improvement initiatives
Routine collaborative performance review with EMS and group leadership
Implementation and maintenance of ECMT credentialing process
Evidence-based lectures and skill labs
Unique educational opportunities
We look forward to the opportunity to discuss our partnership in greater detail with you.
Sincerely,
Matthew D. Bush, MD, FACEP
President Questcare
President Integrated Markets Envision
Matthew.Bush@envisionhealth.com
214.217.1913
5
Qualifications and Experience
Company Overview
Envision Healthcare is the nation’s largest provider of healthcare management services, and employs over
63,400 persons. The company’s combined service divisions have provided hospital-based practice management
services since 1953.
Envision Physician Services branch is the only provider that
offers multiple hospital-based services with one point of contact
for emergency medicine, hospital medicine, women’s and
children’s services, acute care surgery, anesthesiology, and
radiology services. Envision Physician Services serves 2,236
practices across 48 states and D.C., and employs over 30,000
physicians.
Regional Market Presence—Dallas Fort Worth
The breadth and scope of our national resource network is backed
by a regionally-dedicated support structure. Envision’s physician-
led Questcare operating unit is headquartered in Dallas. Our
regionally-based, physician-led operations teams work diligently
to align our goals with those of our client programs to obtain
desirable and sustainable organizational quality and growth.
Envision Physician Services supports:
342 hospital-based practices across the state of Texas
177 hospital-based practices in the Dallas Fort Worth metro
EMS medical director services to 34 cities in Texas and for several cities in the DFW Metroplex:
Arlington, Plano, Frisco, Lewisville, Grand Prairie, McKinney, Coppell, Lake Cities, Highland
Village, Murphy, Rowlett, Sanger, Krum, Justin, Ponder, and the Town of Fairview.
Regional Experience – City of Denton
Questcare has been the exclusive provider of emergency physician
services for Medical City Denton for 19 years, and additionally provides
Medical City Denton with hospitalist physician services. The hospital in
turn has a long history with Denton Fire Department in providing support
for emergency medical services. Administration at Medical City Denton
has expressed strong support for Questcare’s continued medical control
responsibility for the City of Denton. Please see attached letter of
recommendation from Steven Edgar, CEO Medical City Denton
(Attachment 3).
6
Company Experience – EMS Medical Direction Texas
Questcare has a 19-year history of performing EMS medical direction services in the region. Questcare
provides or previously provided EMS medical director services for the following municipalities across the
state of Texas:
Arlington EMS – Arlington, TX
Corinth EMS – Corinth, TX
Denton EMS – Denton, TX
City of Justin – Justin, TX
Krum EMS – Krum, TX
Sanger EMS – Sanger, TX
Ponder FD – Ponder, TX
Oak Point FD – Oak Point, TX
City of Highland Village – Highland Village, TX
Preston FD – Preston, TX
Locust FD – Locust, TX
Van Alstyne EMS – Van Alstyne, TX
Princeton FD – Princeton, TX
City of Frisco EMS – Frisco, TX
Medical City Plano EMS – Plano, TX
Murphy EMS – Murphy, TX
City of Plano EMS – Plano, TX
Lucas EMS – Lucas, TX
City of Melissa – Melissa EMS
PHI Air Medical – Texas
Texas EMS – Granbury, TX
Coppell EMS – Coppell, TX
Airbus – American Eurocopter – Texas
Grand Prairie EMS – Gran Prairie, TX
Fairview FD – Fairview, TX
Bedford EMS – Bedford, TX
Sherman EMS – Sherman, TX
Denison EMS – Denison, TX
Paris EMS – Paris, TX
Lewisville EMS – Lewisville EMS
Rhome Fire Rescue – Rhome, TX
Rowlett EMS – Rowlett, TX
City of Celina – Celina, TX
The Colony FD – Colony, TX
7
Ability to Meet Scope of Work Requirements
The Questcare leadership group has carefully reviewed the required scope of work and is prepared to comply
with all requirements as listed below.
On-Line Medical Direction
a) On-line services shall be provided as required by the Texas State Board of Medical Examiners’
Emergency Medical Services (EMS) regulations for Medical Directors.
Adherence to Texas State Board EMS Requirements
The on-line direction will continue to meet all the criteria outlined in Texas State Medical Board’s
regulations for EMS Medical Directors, Title 22, Texas Administrative Code §197. The EMS medical
director shall assign the prehospital provider under his or her direction to a specific on-line
communication resource by a predetermined policy. Specific local protocols shall define the
circumstances under which on-line direction is required. The on-line physician shall be appropriately
trained in the use of prehospital protocols. The physician providing on-line direction shall have personal
expertise in the emergency care of ill and injured patients. The physician providing on-line medical
direction for a particular patient assumes the responsibility for the appropriateness of prehospital care
provided under his or her direction by EMS personnel.
b) On-line service capable of receiving 12-lead electrocardiogram (EKGs) data from the City of
Denton Fire Department (DFD) shall be provided 24 hours a day, 7 days per week (currently
DFD transmits data via Physio Control from Lifefpak 15s).
On-Line Medical Control Capabilities
The Medical City Denton (the base station) has the capability to receive 12 lead EKG’s and the on-line
physician shall be available to interpret the 12 lead EKG 24 hours a day, 7 days a week.
c) On-line medical control shall be demonstrated with a hospital located within the city limits of
Denton.
On-Line Medical Control Location
Questcare will continue to provide on-line Medical Direction through a base station located at Medical
City Denton Emergency Department.
8
d) Additional on-line services shall be provided during disasters and Mass Casualty Incidents
(MCIs).
On-Line Medical Control for Disasters and MCIs
In the event of a disaster or mass casualty incident, Questcare will provide assistance with destination
control and bed availability in conjunction with the Incident Commander, hospital administration, and
ED personnel. Dr. Olmsted will review the hospital and Fire Departments disaster plans on a routine
basis and provide suggestions to integrate the two seamlessly. Additionally, Dr. Olmsted will participate
in the execution of disaster drills as performed by the Fire Department and the hospital.
e) Audio recordings shall be maintained of all on-line medical direction and copies will be
provided to the designated DFD personnel upon request.
Audio Recordings
Audio recordings of on-line medical direction are recorded at Medical City Denton and are
available to all DFD personnel upon request.
f) The Medical Director or a similarly-qualified designee shall be available 24 hours per day, 7
days per week, and 365 days per year.
24/7/365 Coverage
Denton Regional Emergency Department is staffed 24 hours a day, 7 days a week, 365 days a year, and
will continue to provide on-line medical direction. Every physician on duty at Denton Regional is board
certified in Emergency Medicine.
Off-Line Medical Direction
a) Off-line services shall be provided as required by the Texas State Board of Medical Examiners’
EMS regulations for Medical Directors.
Adherence to Texas State Board EMS Requirements
Dr. Olmsted will provide off-line medical direction that will meet all the criteria outlined in the Texas
State Medical Board’s regulations for EMS medical Directors, Title 22, Texas Administrative Code 197.
9
b) The Medical Director shall be a board certified Emergency Medicine Physician.
Board Certification
Dr. Olmsted is board certified by the American Osteopathic Board of Emergency Medicine effective
November 17, 2010.
c) The Medical Director shall provide protocols that will address basic and advanced life support
procedures. Two (2) copies, one (1) written and one (1) electronic, of the protocols shall be
provided to the DFD EMS Program Manager no later than 30 days from the start of the
contract.
Protocol Implementation
Dr. Olmsted will provide a comprehensive set of pre-hospital protocols that will address both basic and
advanced life support procedures. Dr. Olmsted will include both written and electronic copies of the
protocols to the DFD EMS Program Manager with in 30 days of the start of the contract. These protocols
have been utilized by DFD EMS for the last eight years and have been continuously reviewed and
updated with input from the Fire Department’s EMS Program Manager, Field Training Officers, and
Front-Line Medics. The skills and procedures detailed in these protocols have successfully withstood the
rigors of EMS fieldwork in both urban and rural settings.
d) Continuous protocol development and review will be provided with input from the DFD EMS
Program Manager and DFD Field Training Officers (FTO). At a minimum, all protocols will be
reviewed and/or updated annually.
Continuous Protocol Development and Review
Dr. Olmsted will provide a continuous protocol development and review process consisting of quarterly
meetings with the EMS Program Manager and Field Training Officers as well as a comprehensive annual
protocol review with all appropriate updates. We will update the protocols regularly to reflect the latest
in pre-hospital medical care standards, changes in ACLS, PALS, and ATLS recommendations, and the
specific needs of the Fire Department’s pre-hospital personnel.
10
e) A Quality Assurance/Quality Improvement Program shall provide a systematic plan and shall
include a system that uses audits to drive training needs, protocol development, quality
assurance, and quality improvement.
Quality Assurance/Quality Improvement
Questcare will provide to the Denton Fire Department the same successful quality assurance program
that is already in place within Denton Fire Department, as well as, other local EMS programs under the
Questcare protocols. This program has been proven to be invaluable in the developing the skills and
competence of the pre-hospital personnel and identifying the necessary protocol changes. Ideally, the
Denton Fire Department will be involved in community wide QA program.
The Denton Fire Department EMS Program Manager and Dr. Olmsted will perform audits on a quarterly
basis on topic determined on the basis of the EMS system’s current needs. Initial audits will reflect
common and high-risk categories such as cardiac, respiratory, pediatrics, and trauma. We will collect
data over a three-month period, subject it to a systematic review, and then present our finding to the
Medics on each shift in a grand rounds forum following the review. During this presentation, Dr.
Olmsted will provide the statics gathered, review the documentation, and present specific cases to
illustrate valuable teaching points. These sessions will be recorded for subsequent review and teaching
which will complement the Denton Fire Department’s plan to teleconference to the substations.
Dr. Olmsted will conduct on-scene Quality Assurance activities, monitor EMS traffic closely, respond to
calls on an intermittent basis, and conduct occasional ride-outs with pre-hospital personnel.
Dr. Olmsted, Medical City Denton, the Denton Fire Department EMS Program Manager, and Field
Training Officers will collaborate on a thorough and comprehensive QI process for Denton Fire
Department. We will provide priority run reviews by EMS personnel, advanced airway cases,
cardiopulmonary arrests, dead on scene, STEMI cases, stroke cases, and sepsis cases. We will focus on
reducing medical errors and needless morbidity and mortality.
f) A skills review and protocol test shall be formulated by the Medical Director.
Skills Review and Protocol Test
Dr. Olmsted will work with the Denton Fire Department EMS Program Manager, Field Training Officers
to develop a comprehensive skills review and protocol test. He will help supplement the successful
process already in place to ensure that paramedic personnel are meeting the minimum skill sets in order
to promote skill proficiency while striving for mastery of those skills. We will also continue to challenge
EMS personnel utilizing scenario based CE and testing methodologies. We will incorporate protocol test
questions into each CE offering to allow us to transition to a more challenging quiz during CE and yearly
protocol testing.
11
g) A written remediation plan shall define procedures for DFD employees who fail to meet
minimum requirements of the evaluation tools used by the Provider and Texas Department of
State Health Services (DSHS).
Written Remediation Plan
Periodically, a paramedic’s clinical competency may come into question. This issue may arise from run
reviews performed by the EMS program manager, or by the Medical Director, or by the Field Training
Officer. Together with the DFD EMS Program director, Field Training Officers, and Medical Director will
place the paramedic under a review process. This process may require the paramedic to obtain
additional continuing education and/or perform monitored ride-outs with Field Training Officers or
other appropriate personnel. This process will take place for a specified period of time lasting at least
two weeks. While the paramedic is under review, the EMS Program Manager and Medical Director will
review all of his/her run documents carefully for accuracy and appropriateness. We will use additional
input from the Field Training Officers and direct interactions between the EMS Program Manager and
the Medical Director to determine the paramedic’s qualification to return to independent duty.
h) The Medical Director shall provide EMS Continuing Education (CE) once a quarter (4 times a
year). Each CE shall be offered twice to each of the three (3) shifts for a total of six (6) classes
per quarter. The current format is EMS CE being offered for three (3) consecutive days with
one (1) morning and one (1) afternoon session each day. Each class session shall be
approximately three (3) hours in length.
EMS Continuing Education
Questcare and Dr. Olmsted plan to continue to use the program of providing continuing education to
the Denton Fire Department’s EMS personnel. Dr. Olmsted plans to continue to give CME lectures which
will reference current protocols and possible updates to protocols within his lecture. We will also use
the continuing educational services of Mr. Paul Newby and his company, Lead II Excellence, to
supplement Questcare’s program. We will be providing four in-person CE sessions each year.
12
i) Medical Director shall support DFD efforts to develop specialty courses such as ACLS, BTLS,
ITLS, PEPP/PALS and others.
Specialty Courses
The Medical Director will support the Denton Fire Department’s efforts to develop specialty courses
such as ACLS, BTLS, PEPP, PALS and others. Medical City Denton has a well-established education
department and has committed to assist the Fire Department in establishing an ACLS program and in
training ACLS instructors from within the Department. Dr. Olmsted will act as a liaison between the Fire
Department and the hospital in designing and implementing these programs. Additionally, Dr. Olmsted
will assist the Fire Department in investigating opportunities for further training for its pre-hospital
personnel through UT Southwestern Medical Center.
j) Medical Director shall provide a mechanism that encourages the local medical community to
collaborate on issues of concern on a continuous basis.
Collaboration with Local Medical Community
Dr. Olmsted will help maintain an open dialogue with the local medical community through participation
in meeting of the Denton County Medical Society and Medical City Denton medical staff and through
other hospital and emergency medicine community relationships. He will participate in discussions
related to EMS and will be a staunch advocate of the Denton Fire Department EMS program. He will
take direct responsibility, in conjunction with the Denton Fire Department EMS Program Manager, for
addressing any conflicts or disagreements between the Denton Fire Department personnel and
members of the medical community.
k) Medical Director shall enable DFD to use the Medical Director certification(s), DEA #, etc. that
is necessary to procure equipment, medications, controlled substances, etc. deemed
necessary as outlined in the EMS Protocols.
Procurement of Equipment, Medications, Etc.
Dr. Olmsted will continue to enable Denton Fire Department to use his State of Texas Medical License
number, DEA number, and any other numbers/certifications which are necessary to procure equipment,
medications, controlled substances, or other items deemed necessary as outlined in the EMS Protocols.
13
Attachment 1: 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
Envision Physician Services/ Questcare
x
January 30, 2020
14 Attachment 2: Pricing Sheet ITEM UOM Type of Service Cost of Service FY 2016-17 Cost of Service FY 2017-18 Cost of Service FY 2018-19 Current Proposed Cost of Service 1 Biannual Online medical direction $60,000.00 $70,000.00 $70,000.00 $72,100.00 2 Annual Medical malpractice insurance $500.00 $500.00 $500.00 n/a 3 EA EMS protocols, updated annually, one hard copy and one digital copy supplied prior to invoicing $1,000.00 $1,000.00 $1,000.00 $1,030.00 4 EAQA/QI program, t be completed mid-year annually prior to invoicing. Medical Director and EMS Program Manager shall jointly determine annual goals $2,000.00 $2,000.00 $2,000.00$2,060.00Total Annual Cost $63,500.00 $73,500.00 $73,500.00 $75,190.00
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
Certificate Of Completion
Envelope Id: 4B7769AF57214CE99FD30075FEB26FEC Status: Completed
Subject: Please DocuSign: City Council Contract 7183-Medical Control Services
Source Envelope:
Document Pages: 47 Signatures: 6 Envelope Originator:
Certificate Pages: 6 Initials: 1 Crystal Westbrook
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
901B Texas Street
Denton, TX 76209
crystal.westbrook@cityofdenton.com
IP Address: 198.49.140.104
Record Tracking
Status: Original
5/12/2020 3:16:08 PM
Holder: Crystal Westbrook
crystal.westbrook@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
Crystal Westbrook
crystal.westbrook@cityofdenton.com
Buyer
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 198.49.140.104
Sent: 5/12/2020 3:20:07 PM
Viewed: 5/12/2020 3:20:16 PM
Signed: 5/12/2020 3:21:44 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: 129.120.6.150
Sent: 5/12/2020 3:21:46 PM
Viewed: 5/12/2020 5:25:06 PM
Signed: 5/12/2020 5:26:04 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: 5/12/2020 5:26:06 PM
Viewed: 5/13/2020 4:26:14 PM
Signed: 5/13/2020 4:37:20 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Matthew Bush
Matthew.Bush@EnvisionHealth.com
EVP
Security Level: Email, Account Authentication
(None)Signature Adoption: Drawn on Device
Using IP Address: 107.77.199.43
Signed using mobile
Sent: 5/13/2020 4:37:23 PM
Resent: 5/18/2020 5:13:16 PM
Viewed: 5/18/2020 5:13:56 PM
Signed: 5/18/2020 5:17:19 PM
Electronic Record and Signature Disclosure:
Accepted: 5/18/2020 5:13:56 PM
ID: 7bbe20d5-93ac-4f78-833a-520f175b4898
Signer Events Signature Timestamp
Kenneth Hedges
kenneth.hedges@cityofdenton.com
Fire Chief
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 129.120.6.150
Sent: 5/18/2020 5:17:22 PM
Viewed: 5/19/2020 8:55:13 AM
Signed: 5/19/2020 8:55:34 AM
Electronic Record and Signature Disclosure:
Accepted: 5/19/2020 8:55:13 AM
ID: 0922b07a-a3cf-4629-a97d-553f97693899
Cheyenne Defee
cheyenne.defee@cityofdenton.com
Contract Administrator
City of Denton
Security Level: Email, Account Authentication
(None)
Completed
Using IP Address: 198.49.140.104
Sent: 5/19/2020 8:55:37 AM
Viewed: 6/3/2020 1:19:48 PM
Signed: 6/3/2020 1:20:45 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: 129.120.6.150
Sent: 6/3/2020 1:20:48 PM
Viewed: 6/3/2020 1:53:36 PM
Signed: 6/3/2020 1:53:42 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: 198.49.140.104
Sent: 6/3/2020 1:53:45 PM
Viewed: 6/3/2020 11:40:05 PM
Signed: 6/3/2020 11:40:53 PM
Electronic Record and Signature Disclosure:
Accepted: 6/3/2020 11:40:05 PM
ID: d992c30e-a5d2-4f1a-979c-1c68add3a000
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: 5/12/2020 3:21:46 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: 5/19/2020 8:55:37 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Kane Richardson
jane.richardson@cityofdenton.com
Assistant City Secretary
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 6/3/2020 1:20:48 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: 6/3/2020 1:20:48 PM
Viewed: 6/3/2020 2:04:39 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Dinora VelasKueK
dinora.velasKueK@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Sent: 6/3/2020 11:40:55 PM
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 6/3/2020 11:40:55 PM
Certified Delivered Security Checked 6/3/2020 11:40:55 PM
Signing Complete Security Checked 6/3/2020 11:40:55 PM
Completed Security Checked 6/3/2020 11:40:55 PM
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. 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.
#! ! #$!
" "$!!#
!# "!# ##% $" #" " "
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.