Drug Abuse Program Management Services-6033-Award/Ordinance/PricingPage 1 of 8
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eScreen End User Agreement
(Drug and Alcohol Testing Services and Program Management)
Contract 6033
eScreen: eScreen, Inc.
Physical Address: 7500 W. 110th Suite 500
Overland Park, KS 66210-2328
Mailing Address: PO Box 25902
Overland Park, KS 66225-5902
Attn: Contract Administrator
Fax: (913) 234-4551
e-Mail: contracts@eScreen.com
Customer: City of Denton
Address: 901 B Texas Street, Denton, TX 76209
Contact: Karen E. Smith
Email: karen.smith@cityofdenton.com
Phone: (940) 349-7100
Fax:
Federal Tax ID _____________________________
Sole Proprietor
Partnership
Corporation
Other
Agreement Effective Date: _____________________________
This eScreen End User Agreement ("Agreement") is made by and between eScreen and Customer as of the date first
set forth above.
BACKGROUND
eScreen offers the drug and alcohol testing, program management services and physical examination and related
services described on Exhibit A (the "Services"). Customer and eScreen desire: (1) for eScreen to provide the Services to
Customer; (2) for Customer to have access to eScreen's network of collection sites (each, a "Clinic") known as the eScreen
Occupational Health Network (the "EOHN"); and (3) for Customer to have access to eScreen's Instant Drug Testing Systems
(each, a "Testing System") installed at certain Clinics.
AGREEMENT
eScreen and Customer therefore agree as follows:
1. Drug Abuse Program Management Services. eScreen will provide the Services, as described in this Agreement in
connection with its management of Customer's drug and alcohol testing program.
(a) Clinic Services. Where available: (i) each Customer location will use a Clinic in the EOHN for the collection of
urine drug test specimens (each, a "Specimen"); and (ii) each Customer location will use a Clinic with a Testing System for
eScreen Instant Drug Testing Services. The Clinic will exclusively utilize eScreen’s designated laboratory for services to
confirm the "non-negative" results from the Testing System. If a Clinic with a Testing System is not available, or for
Specimens subject to Department of Transportation oversight, the Clinic will forward the Specimen to a laboratory designated
by eScreen for screening and confirmation. A Clinic used for collection must be located within the City of Denton city limits.
(b) Test Results Reporting. eScreen will arrange to receive all test results from the EOHN Clinics and the
laboratories selected by eScreen. If requested by a Customer, eScreen will arrange for Medical Review of all such test results
in accordance with Section 1(e) below. eScreen will report to Customer the test results in accordance with applicable law,
nationally accepted standards of medical judgment, and the Department of Health and Human Services Guidelines for Federal
Workplace Drug Testing Programs (the “Guidelines”). eScreen will archive the test results for a minimum of 5 years on all
positive test results, or such greater period of time as required under applicable federal, state, or local laws.
(c) Other eScreen Services. eScreen will also provide Customer the other Services described on Exhibit A.
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(d) Medical Review Officer Services. If requested, eScreen, using the services of a "Medical Review Officer," as
that term is defined in the Guidelines, will review all test results received pursuant to Section 1(b). The Medical Review Officer
will have the qualifications as specified in the Guidelines and any applicable federal, state, or local law.
2. Physical Examination and Related Services. Each Customer location will use a clinic in the EOHN for its
employees’ DOT or DOT-look-alike physical examinations or other medical service components as further described on
Exhibit A. eScreen will also provide certain Evaluation and Review Services of the physical examination results as requested
by Customer and as further described on Exhibit A. For purposes of this Agreement, such services are included in the
definition of Services.
3. Price and Payment.
(a) Price. Customer agrees to pay eScreen for the Services in accordance with the pricing schedule attached as
Exhibit A. Effective at the time of any periodic renewal of this Agreement, eScreen may adjust the price for any Service by
providing written notice to Customer at least ninety days prior to the renewal date.
(b) Payment. eScreen will bill Customer monthly for Services rendered to Customer. Customer agrees to make
payments to eScreen within thirty (30) days from the date of invoice. Overdue accounts bear interest at a rate of the lesser of
1.5% per month or the highest rate allowed under applicable law.
(c) Contract Value. The total contract value shall not exceed $50,000.
4. Limited Warranties and Remedies.
(a) Warranty. eScreen warrants that the Services will be provided consistent with nationally recognized industry
standards. The warranty will not apply and eScreen will have no liability for (i) delays beyond the control of eScreen in
reporting results; (ii) delays, or errors on the part of the Clinic, laboratory, Medical Review Officer, or persons, or organizations
responsible for the transport of delivery of Specimens; or (iii) errors or omissions on the part of the Customer.
(b) Limitation of Warranties. THE FOREGOING WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES OR
OBLIGATIONS, EXPRESS OR IMPLIED. ESCREEN EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES, INCLUDING
THE IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
(c) Remedies and Limitation. eScreen shall, at eScreen's option, replace, refund the price, or credit (against the
price of future purchases of Services) the price of any Service that does not comply with the warranty set forth in Section 4(a).
(d) Limitation of Remedies and Liability. EXCEPT FOR eSCREEN'S OBLIGATIONS RESULTING FROM THIRD
PARTY CLAIMS, CUSTOMER'S SOLE AND EXCLUSIVE REMEDY FOR DEFECTIVE SERVICES SHALL BE REFUND OR
REPLACEMENT AS PROVIDED IN SECTION 4(c), AND IN NO EVENT SHALL ESCREEN BE LIABLE FOR THE COST OF
PROCUREMENT OF SUBSTITUTE SERVICES, LOSS OF PROFITS, OR FOR ANY OTHER SPECIAL, CONSEQUENTIAL,
OR INCIDENTAL DAMAGES, HOWEVER CAUSED, EVEN IF ESCREEN HAS BEEN ADVISED OF THE POSSIBILITY OF
SUCH DAMAGES. IF THE FOREGOING LIMITATION SHALL BE FOUND INAPPLICABLE FOR ANY REASON, ESCREEN'S
LIABILITY UNDER THIS AGREEMENT SHALL NOT EXCEED THE TOTAL FEES PAID UNDER THIS AGREEMENT FOR
THE IMMEDIATELY PRIOR SIX MONTHS.
5. Term and Termination.
(a) Term. The term of this Agreement is two years, beginning on the Effective Date. The contract may be extended
for an additional year, if agreed in writing by both parties.General Termination. Either party (the "Non-breaching Party") may
terminate this Agreement immediately by written notice to the other party (the "Breaching Party") following the occurrence of
any of the following events:
(i) The Breaching Party fails to make any payment required hereunder and such failure continues for a
period of five (5) days after written notice of such breach;
(ii) The Breaching Party is in material breach of this Agreement (other than for nonpayment or for a
violation of Section 6) and such breach is not cured within thirty (30) days after written notice thereof;
(iii) Either party breaches this Agreement in any respect more than two (2) times in any calendar year
even if such breach is cured;
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(iv) The Breaching Party becomes the subject of insolvency or bankruptcy proceedings, ceases doing
business, makes an assignment of assets for the benefit of creditors, dissolves, or has a trustee appointed for all or a
substantial portion of Breaching Party's assets; or
(v) The Customer breaches Section 6 (Proprietary Information).(c) Survival. Upon the termination or expiration
of the term of this Agreement, the rights and obligations of the parties under this Agreement shall end, and neither party shall
have any claim, including any claim for termination damages, against the other; provided, however, that the following
obligations shall survive termination or expiration of this Agreement: (i) Customer and eScreen's payment obligations
specified in this Agreement; (ii) eScreen's limited warranty obligations and limitations on liability; (iii) the non-disclosure and
non-use of proprietary information provisions of Section 6; (iv) the miscellaneous provisions in Section 7; and (v) any other
obligation that by its terms survives such termination or expiration.
6. Proprietary Information.
(a) Proprietary Information. Each party recognizes that it has had and will continue to have access to the other
party's confidential information, including but not limited to Personal Information (defined below), trade secrets, technical
product information, financial and marketing data, catalog information, customer lists, sales records and leads, specific
knowledge of the types and categories or items ordered by customers and particular needs and requirements related thereto,
as well as pricing, business practices and other proprietary commercial information (the "Proprietary Information") and that
Proprietary Information constitutes valuable special and unique property of such party.
(b) Non-Disclosure. Each party agrees that it will not, for any reason or purpose whatsoever, during the term of
this Agreement and thereafter, directly or indirectly, disclose to any party, or use for its own purposes, any of the Proprietary
Information without the other party's written authorization, except as is necessary in the ordinary course of performing its
duties under this Agreement. In the event of a breach or threat of breach by a party of the provisions of this section, the non-
breaching party shall be entitled to an injunction restraining such party from using or disclosing the Proprietary Information, but
the foregoing shall not be construed as prohibiting the non-breaching party from having available to it any other remedy, either
at law or in equity, for such breach or threatened breach, including but not limited to the recovery of damages from such
breaching party.
(c) Exceptions. This section does not apply to Proprietary Information that: (i) is or becomes publicly available
through no fault of the recipient; (ii) is or has been received in good faith by the recipient without restriction on use or
disclosure from a third party having no obligation of confidentiality to the disclosing party; or (iii) is or has been independently
developed by the recipient without reference to Proprietary Information received from the disclosing party, as evidenced by the
recipient's written records.
(d) Personal Information. "Personal Information" means any individual's name, address, phone number, email
address, date of birth, social security number, official state or government issued driver's license or identification number, alien
registration number, government passport number, employer or taxpayer identification number, unique biometric data (such as
fingerprint, voiceprint, retina or iris image, or other unique physical representation), consumer report, credit history or score or
other credit information, employment history or other employment information, health history, medical records, test results, or
any Protected Health Information under HIPAA, criminal or background check data, credit card, bank account or other financial
data, and any personal data required by law or regulation to be kept confidential.
(e) Customer is subject to open records statutes and must provide information as deemed appropriate by
the Customer’s legal department and the State of Texas Attorney General, in accordance with the provisions of Texas
Government Code 552 (Public Information Act).
7. Miscellaneous.
(a) Insurance. Throughout the term of this Agreement, eScreen shall provide and maintain commercial general
liability insurance for all agents and employees, with such limits as eScreen and Customer agree are reasonable; provided,
however, that such limits shall not be less than One Million Dollars ($1,000,000.00 per claim) and Two Million Dollars
($2,000,000.00) annual aggregate policy limits.
(b) Non-assignment. Customer may not assign, transfer, or sell (including by operation of law) its rights under this
Agreement, or delegate its duties hereunder to any person including any affiliate of Customer, without the prior written consent
of eScreen. A transfer of a controlling interest in Customer shall constitute an assignment. Any purported assignment without
eScreen's consent shall be void and shall constitute a breach of this Agreement. eScreen may freely delegate or subcontract
its obligations under this Agreement, eScreen may delegate or subcontract only is obligations under this Agreement related to
collection, laboratory or medical review officer obligations.
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(c) Entire Agreement; Modification; Waiver. This Agreement contains the entire agreement between the parties.
No modification of any of its provisions, or any future representation, promise, or addition, shall be binding upon the parties
unless made in writing and signed by both parties. A waiver of any obligation by either party under this Agreement shall be
effective only if in writing signed by both parties. A waiver on one occasion shall not affect either party’s right to require strict
compliance with this Agreement in the future.
(d) Notices. Any notices hereunder shall be given in writing directed to the address of each party set forth on the
cover page of this Agreement, or to such other address as either party may substitute by written notices to the other, and shall
be deemed given: (i) if sent by U.S. mail, upon receipt as evidenced by a delivery confirmation receipt; or (ii) if sent by
recognized courier service, upon receipt as evidenced by the courier’s records.
(e) Attorney Fees. In the event of a default under this Agreement, the defaulting party shall reimburse the non-
defaulting party for all costs and expenses reasonably incurred by the non-defaulting party in connection with the default,
including, without limitation, attorney fees. Additionally, in the event any suit or action is brought to enforce or interpret any of
the terms of this Agreement, the prevailing party shall be entitled to recover from the other party all reasonable attorney fees
incurred at trial, on appeal, and on any petition for review, together with such other expenses, costs, and disbursements as
may be allowed by law.
(f) Governing Law; Jurisdiction. The rights of the parties in connection with or arising under this Agreement and
the relationship of the parties whether or not arising out of this Agreement shall be governed by the laws of Texas, U.S.A.,
excluding choice of law rules. The parties each consent to the jurisdiction of the state or federal courts of Texas. Each party
agrees that service of process may be made upon it wherever it can be located or by certified mail directed to its address for
notices under this Agreement.
(g) Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original,
but both of which together shall constitute one and the same instrument.
(h) Agency. Customer is an independent business and has no power, right, or authority to bind eScreen or to
assume or to create any obligation or responsibility, express or implied, on behalf of eScreen. Customer shall not take any
action that could lead a third party to believe it has such authority. Nothing stated in this Agreement shall be construed as
creating relationships of partners, employer and employee, franchisor and franchisee, or principal and agent between the
parties.
(i) Force Majeure. Neither party shall be liable for any delay or default in performing its obligations (other than
payment obligations) if such default or delay is caused by any event beyond the reasonable control of such party, including,
but not limited to, acts of nature, war or insurrection, civil commotion, destruction of production facilities or materials by
earthquake, fire, storm or flood, epidemic, or other similar event. The party suffering such cause shall immediately notify the
other party of the cause and the expected duration of such cause. If either party's performance is delayed by more than
60 days pursuant to this Section, the other party may immediately terminate this Agreement by written notice given before the
affected party resumes performance.
The duly authorized representatives of the undersigned have executed and delivered this eScreen End User Agreement as of
the Effective Date.
eScreen, Inc. City of Denton
By:
Christopher Tarpey, Chief Executive Officer Signature
_______________________________________
Name, Title
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John Knight
Deputy City Attorney
Karen E. Smith Assistant Purchasing Manager
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Exhibit A
Schedule of Fees and Services
Self-
Collect
eScreen Network
Per Test In
network
Tier 2 Out of
Network
Instant Testing
eScreen Instant Testing-eCup. Includes
GC/MS Confirmation, Electronic Results
Reporting, Data
Management. Includes MRO Review
Services
$30.00 $33.00 $37.00
Laboratory Testing
Includes GC/MS Confirmation, Electronic
Results Reporting, Data Management.
Screening and (GC/MS) is performed at a
designated SAMHSA certified laboratory.
Includes MRO Review Services.
5 panel: Cannabinoids (THC), Cocaine,
methamphetamine, Opiates, Phencyclidine.
9 panel: Methadone, Barbiturates,
Benzodiazepines and Propoxyphene.
5-9 standard panel $34.00 $37.00 $44.00
Methaqualone test-cost addl. to any panel $1.00
Heroin (non-reflexive) -cost addl. to any panel $0.50
Ecstasy test-cost addl. to any panel $1.00
Oxycodone test-cost addl. to any panel $4.00
Urine Alcohol test-cost addl. to any panel $3.00
Cotinine test-cost addl. to any panel $8.00
urine Fentanyl test-cost addl. to any panel $7.00
Tramadol test-cost addl. to any panel $7.00
Meperidine test-cost addl. to any panel $7.00
K2 test-cost addl. to any panel $25.00
Narcotics panel (oxycodone, meperidine,
fentanyl, nalbuphine, pentazocine)
$20.00
DOT Laboratory Testing
Includes GC/MS Confirmation, Electronic
Results Reporting, Data Management.
Screening and (GC/MS) is performed at a
designated SAMHSA certified laboratory. All
systems infrastructure to include software
and hardware licenses, communication
systems and data storage. Excludes MRO
Review Services.
DOT 7 panel: Cannabinoids (THC), Cocaine,
Methamphetamine, Opiates, Phencyclidine,
MDMA, 6-AM.
$35.15 $38.15 $45.15
Medical Review Officer Services include
physician interview, document review, and
release of final report (positive and negative).
$0.35
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Hair Testing Self Collect In Network Tier 2 Out of
Network
Hair testing at eScreen-designated lab. Laboratory
screening, confirmation and electronic results feed into
client’s system for reporting.
Includes MRO review services. Excludes shipping.
Psychemedics Labs
7-panel includes expanded opiates $47.00 $65.00 $75.00
Omega Labs
5 Panel $37.00 $55.00 $65.00
7-panel includes expanded opiates $47.00 $65.00 $75.00
Breathe Alcohol Testing
In network Tier 2 Out of Network
Breath Alcohol Testing $35.00 $45.00
Emergency On-Site Breath Alcohol Testing Service (no
advance notice) cost plus $10.00
Oral Drug Testing
5 panel lab based oral testing $4.00 per device, $21.00/test
9 panel lab based oral testing $4.00 per device, $22.00/test
Collection Cost additional $20.00/test
On-Site Drug Testing Service-standard 5-9 panel
72 business hours advance notice is required. If this is not met then a $350 rush charge plus listed collection fees
below will be charged. For cancellation less than 48 business hours.
Tier 1: 1-9 tests. Minimum fee: $300.00 $38.00/test
Tier 2: 10-19 tests. Minimum fee: $350.00 $33.00/test
Tier 3: 20+ tests. Minimum fee: $600.00 $28.00/test
Random Consortiums
Random Consortium: for employers with
less than 50 covered employees
$100.00 annual membership fee per pool
Stand Alone Pool: for employers with 50 or
more covered employees
$250.00 annual membership fee per pool
Biometric Screening
In Network Out of Network
Biometric Screen: Height, weight, blood pressure, BMI, lipid plus glucose;
included online scheduling and electronic reporting to provider designee
$65.00 $85.00
Occupational Health Services
Per Test In Network Out of Network
DOT or DOT-look-alike physical (not medically reviewed),
Electronic Results Reporting through myescreen.com.
Physicals pricing predicated on use pre-notification feature
for all physicals
$65.00 Cost plus $30.00
Medical Review for adherence to federal guidelines and/or
job specific requirements
$7.00
Audiogram $36.00 Cost plus $20.00
Vision Test: Snellen $25.00 Cost plus $20.00
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Vision Test: Titmus $25.00 Cost plus $20.00
Vision Test: Ishihara $20.00 Cost plus $20.00
Vision Test: Jaeger $20.00 Cost plus $20.00
OSHA Respirator Questionnaire $29.00 Cost plus $20.00
Pulmonary Function Test/Spirometry $65.00 Cost plus $20.00
Respirator Fit Test- Qualitative $40.00 Cost plus $20.00
Respirator Fit Test- Quantitative $45.00 Cost plus $20.00
Chest Xray- 1 view $78.00 Cost plus $20.00
Chest Xray- 2 view $98.00 Cost plus $20.00
EKG $80.00 Cost plus $20.00
Height/Weight/ Blood Pressure $25.00 Cost plus $20.00
ASR $30.00 Cost plus $20.00
Kraus Weber Evaluation Cost plus $10.00 Cost plus $20.00
TB/PPD testing per 1 step $35.00 Cost plus $20.00
Vaccinations and titers Cost plus $10.00 Cost plus $20.00
Lab Panels (eg complete blood count) Cost plus $10.00 Cost plus $20.00
Additional Services
After Hours Collections Cost plus $7.00
Observed Collections Cost plus $7.00
Blood Alcohol Collection and Testing $50.00
Client-Requested Re-Analysis of a Drug Specimen $150.00
Cab Packs for DOT Testing Only $3.00
Blind Specimen Submission (DOT Only) $25.00
Expert Witness Testimony – MRO $250.00 per hour plus travel
Litigation Package $150.00
Legal Support: Any required legal support required by Client or eScreen will be billed to Client at its cost plus any
travel expenses outside of Kansas City, KS
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Evaluation and Review Services
Position Evaluation (clinical and administrative recommendation for components of physical examination and allowable range with respect to
each component based on employer-provided written job description and applicable regulations, if any).
Administrative Review (review Clinic-generated documentation for DOT or DOT-look-alike physical examination (with established agreed
upon criteria), or other medical service components, for completion of required elements; follow-up with Clinics as necessary and
appropriate).
Clinical Review (review Clinic-generated documentation for DOT or DOT-look-alike physical examination for completion of required elements;
identification of any reported value outside allowable range for individual’s position; follow-up with clinic as necessary and appropriate).
Consultative Review (clinical recommendation regarding whether injured or disabled individual is physically able to return to work in a specific
position based on employer-furnished written documentation regarding such individual’s then-current capabilities, employer-furnished written
job description for the position, and applicable regulations, if any; provided, however that eScreen shall only provide a recommendation for an
individual already cleared by his or her treating physician to return to work).
Each of the Evaluation and Review Services is offered subject to the following terms and conditions. By requesting or receiving any of
these services (regardless of whether Customer pays for the service), Customer agrees to and is bound by the following except as
otherwise prohibited by law:
(1) Customer acknowledges and agrees that eScreen relies solely on documentation and other information actually received by
eScreen from Customer. eScreen is not responsible for performing any other review, examination, interview, investigation, or compilation
of documentation or other information in providing any Evaluation and Review Services.
(2) Customer acknowledges and agrees that the provider who actually performs the specific physical examination or other
diagnostic services is not employed by nor contracted with eScreen. Customer is solely responsible for the selection of the provider who
performs those services. eScreen has no responsibility for such provider’s performance or non-performance of such medical or nursing
services. Nor is eScreen responsible for such provider’s health information privacy and security practices. While eScreen representatives
may communicate with such provider as part of its Evaluation and Review Services, eScreen has no authority to require or direct a
provider to take certain action or to refrain from engaging in certain conduct.
(3) Customer understands, acknowledges and agrees that, except as provided in the following sentence, neither eScreen nor any
of its clinicians owes a duty to warn, report, or counsel any individual regarding any health condition, status, or risk indicated by or
reflected on documentation reviewed by eScreen. Customer understands, acknowledges and agrees that eScreen’s duty warn and report
to an individual regarding any health condition, status, or risk is strictly limited to (a) in-person services provided by an eScreen clinician,
including biometric screenings, or (b) laboratory results that are provided directly to eScreen (as opposed to results provided to a third-
party clinic). Neither eScreen nor any of its clinicians enters into a treatment relationship with any individual as a result of providing
Evaluation and Review Services.
(4) Customer acknowledges and agrees that no statement made nor opinion expressed by eScreen or any of its employees or
contracted clinicians relating to any Evaluation and Review Service constitutes a medical or nursing opinion or advice.
DocuSign Envelope ID: 0EC5F80E-41E2-4C1F-A24D-090DF89A8ED8
Certificate Of Completion
Envelope Id: 0EC5F80E41E24C1FA24D090DF89A8ED8 Status: Completed
Subject: 6033 Contract with Escreen
Source Envelope:
Document Pages: 8 Signatures: 3 Envelope Originator:
Certificate Pages: 5 Initials: 0 Karen E. Smith
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
karen.smith@cityofdenton.com
IP Address: 129.120.6.150
Record Tracking
Status: Original
5/17/2016 4:13:23 PM
Holder: Karen E. Smith
karen.smith@cityofdenton.com
Location: DocuSign
Signer Events Signature Timestamp
Christopher Tarpley
Christopher.tarpey@escreen.com
Security Level: Email, Account Authentication
(Optional)
Using IP Address: 198.97.228.8
Sent: 5/17/2016 4:33:32 PM
Resent: 5/20/2016 11:30:07 AM
Viewed: 5/20/2016 2:40:05 PM
Signed: 5/20/2016 2:40:16 PM
Electronic Record and Signature Disclosure:
Accepted: 5/20/2016 2:40:05 PM
ID: 161ff257-6a84-45dd-bf5a-54bff38f7e57
John Knight
john.knight@cityofdenton.com
Deputy City Attorney
City of Denton
Security Level: Email, Account Authentication
(Optional)
Using IP Address: 129.120.6.150
Sent: 5/20/2016 2:40:17 PM
Viewed: 5/20/2016 3:04:18 PM
Signed: 5/20/2016 3:04:35 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
Karen E. Smith
karen.smith@cityofdenton.com
Assistant Purchasing Manager
City of Denton
Security Level: Email, Account Authentication
(Optional)
Using IP Address: 129.120.6.150
Sent: 5/20/2016 3:04:36 PM
Viewed: 5/20/2016 3:23:20 PM
Signed: 5/20/2016 3:23:31 PM
Electronic Record and Signature Disclosure:
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ID:
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Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
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Michael Jensen
michael.jensen@escreen.com
Security Level: Email, Account Authentication
(Optional)
Sent: 5/20/2016 3:23:33 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
Patty Keller
Patty.keller@cityofdenton.com
HR Analyst
City of Denton
Security Level: Email, Account Authentication
(Optional)
Sent: 5/20/2016 3:23:34 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
Jennifer Bridges
jennifer.bridges@cityofdenton.com
Procurement Assistant
City of Denton
Security Level: Email, Account Authentication
(Optional)
Sent: 5/20/2016 3:23:34 PM
Viewed: 5/25/2016 1:20:10 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
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Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 5/20/2016 3:23:34 PM
Certified Delivered Security Checked 5/20/2016 3:23:34 PM
Signing Complete Security Checked 5/20/2016 3:23:34 PM
Completed Security Checked 5/20/2016 3:23:34 PM
Electronic Record and Signature Disclosure
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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: 4/20/2015 2:25:38 PM
Parties agreed to: Christopher Tarpley
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: kevin.gunn@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 kevin.gunn@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 kevin.gunn@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 kevin.gunn@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.