7776 - Contract Executed
Docusign City Council Transmittal Coversheet
File Name
Purchasing Contact
City Council Target Date
Piggy Back Option
Contract Expiration
Ordinance
DocuSign Envelope ID: EF3033F6-A209-49D2-B282-CEBC8F9BA41B
Not Applicable
Gabby Leeper
FILE 7776
Employee Assistance Program
DECEMBER 14, 2021
DECEMBER 14, 2026
21-2693
1
Amendment No. 1 to the Agreement Between
United Behavioral Health and City of Denton TX
This Amendment No. 1 (“Amendment”) dated January 1, 2022 (the “Amendment Effective Date”) is entered
into by and between United Behavioral Health, including its affiliates, with its principal place of business at 425
Market Street, 14th Floor, San Francisco, CA 94105-2426 (“Optum”); and City of Denton TX with its principal
place of business at 601 E Hickory St Ste F, Denton, TX 76205-4305 (“Customer”).
Whereas, Optum and Customer are parties to the Administrative Services Agreement dated February 1, 2021
(the “Agreement”) for the provision of certain services by Optum to Customer; and
Whereas, the parties desire to amend certain terms and conditions of the Agreement in accordance with this
Amendment and agree to new terms and conditions as set forth herein.
Now, therefore, the parties mutually agree as follows:
1. Capitalized terms used herein which are not otherwise defined in this Amendment or any attachments hereto
shall have the meaning assigned to them in the Agreement.
2. Section 6.1 Term of the Agreement is deleted and replaced in its entirety as shown below:
“6.1 Term. This Agreement commences on the Effective Date and therefore continues from January 1, 2022
for a period of three (3) years through December 31, 2024 (the “Initial Term”). Thereafter, Customer has the
option to continue this Agreement for two (2) additional one (1) year periods (each a “Renewal Term”) unless
this Agreement is terminated. Each Renewal Term is subject to the Customer’s issuance of a Notice of Award
and upon Optum’s receipt of a Notice of Award prior to each Renewal Term, this Agreement shall
automatically continue during that Renewal Term. At the sole option of Customer, the Agreement may further
be extended as needed, with such extension not to exceed a total of six (6) months beyond the last Renewal
Term. The Initial Term and each subsequent Renewal Term are referred to herein as the “Term”.”
3. Exhibit A – Services and Fees is deleted and replaced in its entirety with Exhibit A attached to this
Amendment.
4. This Amendment and the Agreement constitutes the entire agreement and understanding of the parties hereto
and supersede all prior agreements, consents, and understandings relating to the subject matter hereof
whether oral or in writing. The parties agree that there are no other oral or other agreements between the
parties that have not been incorporated into this Amendment and the Agreement.
5. Each of the persons signing this Amendment represents and warrants that he/she is a duly authorized officer,
director or agent of the party on whose behalf the person is signing, and further represents and warrants that
the person signing has the power and authority to bind the party, and that the party has the legal power to
enter into this Amendment.
United Behavioral Health City of Denton TX
Signature: \si2\
Signature: \si1\
Print Name:
\na2\
Print Name:
\na1\
Print Title:
\ti2\
Print Title:
\ti1\
Date:
\ds2\
Date:
\ds1\
Internal Control No.: 00814272.0
DocuSign Envelope ID: EF3033F6-A209-49D2-B282-CEBC8F9BA41B
Gabby Leeper
Buyer
Nathaniel Seltzer
11/22/2021
Director of Finance
12/14/2021
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: _____________________________
SARA HENSLEY
INTERIM CITY MANAGER
ATTEST:
ROSA RIOS, CITY SECRETARY
BY: _______________________________
APPROVED AS TO LEGAL FORM:
MACK REINWAND, CITY ATTORNEY
BY: _______________________________
DocuSign Envelope ID: EF3033F6-A209-49D2-B282-CEBC8F9BA41B
Director of Human Resources
HR
Tiffany Thomson
2
EXHIBIT A – SERVICES AND FEES
The following are the administrative services Optum has agreed to provide to Customer at the rates set forth
herein.
Product Hours Rate Type Rate Period $ Fee
Employee Assistance Program ‐ EAP – EMPLOYER –
EAP 6 Sessions
Per
Employee
Per Month $1.34
Bank of Hours for Training & Critical Incident (CIRS) 8 Per
Employee
Per Month Included in
EAP fee
Worklife Per
Employee
Per Month $0.19
Additional On‐Site Support Service hours are available on a fee‐for‐service basis. Services are billed at an hourly rate
plus travel time. Any onsite or training hours can be purchased according to the rates in the grid below.
On‐Site Support Service Fee for Service
Management Development Programs $200/on‐site hour *
Employee Development Programs $200/on‐site hour *
Wellness Seminars $200/on‐site hour *
Information Resource Events $200/on‐site hour *
Critical Incident Response Services $250/on‐site hour *
Travel Time & Trainer Downtime $100/hour
* Travel Time and Trainer Downtime charges apply when Hours are purchased on a fee for service basis
Fee Effective Period: 2/1/2021 ‐ 12/31/2024.
These rates are based on a population of 1,550. If the population changes by more than 10%, then Optum
reserves the right to revise the rates.
***End of Exhibit A***
DocuSign Envelope ID: EF3033F6-A209-49D2-B282-CEBC8F9BA41B
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
Exhibit
DocuSign Envelope ID: EF3033F6-A209-49D2-B282-CEBC8F9BA41B
United Behavioral Health dba Optum
CIQ
X
n/a
X
n/a
X
11/22/2021
X
Certificate Of Completion
Envelope Id: EF3033F6A20949D2B282CEBC8F9BA41B Status: Completed
Subject: Please DocuSign: City Council Contract 7776 Employee Assistance Program
Source Envelope:
Document Pages: 5 Signatures: 7 Envelope Originator:
Certificate Pages: 6 Initials: 1 Gabby Leeper
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
901B Texas Street
Denton, TX 76209
Gabby.Leeper@cityofdenton.com
IP Address: 198.49.140.104
Record Tracking
Status: Original
11/15/2021 9:53:10 AM
Holder: Gabby Leeper
Gabby.Leeper@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
Gabby Leeper
gabby.leeper@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: 11/15/2021 10:06:16 AM
Viewed: 11/15/2021 10:06:49 AM
Signed: 11/15/2021 10:07:28 AM
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: 11/15/2021 10:07:30 AM
Viewed: 11/15/2021 12:28:36 PM
Signed: 11/15/2021 12:29:12 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Marcella Lunn
marcella.lunn@cityofdenton.com
Catherine Clifton, Interim City Attorney
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 68.185.202.16
Signed using mobile
Sent: 11/15/2021 12:29:16 PM
Viewed: 11/15/2021 1:20:53 PM
Signed: 11/15/2021 1:22:22 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Nathaniel Seltzer
nathaniel.seltzer@optum.com
Director of Finance
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 198.203.177.177
Sent: 11/16/2021 7:24:18 AM
Resent: 11/22/2021 9:58:59 AM
Viewed: 11/16/2021 8:20:47 AM
Signed: 11/22/2021 2:41:46 PM
Electronic Record and Signature Disclosure:
Accepted: 11/16/2021 8:20:47 AM
ID: 559f8007-e003-405e-b0f4-868a00b491f0
Signer Events Signature Timestamp
Tiffany Thomson
Tiffany.Thomson@cityofdenton.com
Director of Human Resources
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 174.197.8.138
Signed using mobile
Sent: 11/22/2021 2:41:49 PM
Viewed: 11/22/2021 3:24:04 PM
Signed: 11/22/2021 3:24:28 PM
Electronic Record and Signature Disclosure:
Accepted: 11/22/2021 3:24:04 PM
ID: 0236662b-5c4b-4893-868a-93a2105f3f32
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: 11/22/2021 3:24:30 PM
Viewed: 12/15/2021 8:16:25 AM
Signed: 12/15/2021 8:16:51 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Sara Hensley
sara.hensley@cityofdenton.com
Interim City Manager
City of Denton
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.10
Sent: 12/15/2021 8:16:54 AM
Viewed: 12/15/2021 8:17:42 AM
Signed: 12/15/2021 8:17:47 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Rosa Rios
rosa.rios@cityofdenton.com
City Secretary
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 198.49.140.10
Sent: 12/15/2021 8:17:50 AM
Viewed: 12/15/2021 9:13:58 AM
Signed: 12/15/2021 9:14:22 AM
Electronic Record and Signature Disclosure:
Accepted: 12/15/2021 9:13:58 AM
ID: 784ade69-aab8-4dff-a4bc-a55ac056191e
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
Contract Administrator
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 11/15/2021 10:07:30 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Carbon Copy Events Status Timestamp
Kim Hoop
kim.hoop@optum.com
Security Level: Email, Account Authentication
(None)
Sent: 11/16/2021 7:24:21 AM
Viewed: 11/16/2021 9:58:15 AM
Electronic Record and Signature Disclosure:
Accepted: 11/15/2021 1:40:31 PM
ID: 842c5d15-95dd-4c7c-8a89-3dd430791baf
Gretna Jones
gretna.jones@cityofdenton.com
Legal Secretary
City of Denton
Security Level: Email, Account Authentication
(None)
Sent: 11/22/2021 3:24:30 PM
Viewed: 11/22/2021 3:50:14 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
City Secretary Office
citysecretary@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Sent: 12/15/2021 9:14:24 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Linda Kile
Linda.Kile@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Sent: 12/15/2021 9:14:25 AM
Electronic Record and Signature Disclosure:
Accepted: 9/27/2021 8:34:26 AM
ID: f73b5a4c-ee6d-4020-a60c-6309d82abf53
Deby Skawinski
Deby.Skawinski@cityofdenton.com
Deputy Director, Risk & Compliance
Security Level: Email, Account Authentication
(None)
Sent: 12/15/2021 9:14:26 AM
Electronic Record and Signature Disclosure:
Accepted: 12/9/2021 5:12:33 PM
ID: 29a9e0b8-bff0-48b3-ad59-821bbbc9623c
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 11/15/2021 10:06:16 AM
Certified Delivered Security Checked 12/15/2021 9:13:58 AM
Signing Complete Security Checked 12/15/2021 9:14:22 AM
Completed Security Checked 12/15/2021 9:14:26 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
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Electronic Record and Signature Disclosure created on: 7/21/2017 3:59:03 PM
Parties agreed to: Nathaniel Seltzer, Tiffany Thomson, Rosa Rios, Kim Hoop, Linda Kile, Deby Skawinski
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