2016-412•PANWAIMI! C • • •
FOR AN ADDITIONAL THREE (3) YEAR EXPENDITURE AMOUNT OF $49,500 FOR A
TOTAL CONTRACT AWARD NOT -TO -EXCEED $99,000).
WHEREAS, Section 252.022 of the Local Goyernn7ciit Codec provides that procurement of
items that are only available from one source, including; items that are only available from one
source because of patents, copyrights, secret processes or natural monopolies; films, manuscripts or
books; electricity, gas, water and other utility purchases; captive replacement parts or components for
equipment; and library materials for a public library that are available only from the persons holding
exclusive distribution rights to the materials; and need not be submitted to competitive bids; and
WHEREAS, the City Council wishes to procure one or more of the items mentioned in the
above paragraph; NOW, THEREFORE,
SECTION 1. The following purchase of materials, equipment or supplies, as described in
the "File" listed hereon, and on file in the office of the Purchasing Agent, and the license terms
attached are hereby approved:
FILE B' VENDOR AMOUNT
5452 Clear Risk, Inc. $99,000
SECTION 2. The City Council hereby finds that this bid, and the award thereof, constitutes a
procurement of items that are available from only one source, including, items that are only available
from one source because of patents, copyrights, secret processes or natural monopolies; films,
manuscripts or books; electricity, gas, water and other utility purchases; captive replacement parts or
components for equipment; and library materials for a public library that are available only from the
persons holding exclusive distribution rights to the materials; and need not be submitted to
competitive bids.
SECTION 3. The acceptance and approval of the above items shall not constitute a contract
between the City and the person submitting the quotation for such items until such person shall
comply with all requirements specified by the Purchasing Department.
SECTION 4, The City Manager is hereby authorized to execute any contracts relating to the
items specified in Section I and the expenditure of funds pursuant to said contracts is hereby
authorized.
SECTION 5. The City Council of the City of Denton, Texas hereby expressly delegates the
authority to take any actions that may be required or permitted to be performed by the City of Denton
under File 5452 to the City Manager of the City of Denton, Texas, or his designee.
SECTION 6. This ordinance shall become effective immediately upon its passage and
approval.
r-ASSED AND APPROVED this the -..—) -� day of 2016.
.. .. . .....
vx�
C S WATTS, MAYOR
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
B Y:
BY:
DocuSign Envelope ID: 06BBB439-BF51-49EA-9D00-281AED251ACE
December 13, 2016
#¨³¸ ®¥ $¤³®Ǿ 48
601 E. Hickory, Suite A
Denton, Texas
USA, 76205
Attention: Howard Martin, Interim City Manager
RE: Amendment 2 of the ClearRisk Claims Service Agreement 5452
Dear Mr. Payne,
This is to confirm our agreement concerning the Amendment 2 of the ClearRisk Claims
th
Services Agreement effective since January 9, 2014 (Contract 5452) and entered into with
, a copy of which is attached hereto for easy reference (the
th
for the same price and term of one (1) year, from January 9, 2017
th
to January 9, 2018.
Please note: ClearRisk is initiating a 12.5% increase in 2017 on all annual user licenses and
web form fees. This
However, ClearRisk would like to take this opportunity to extend the term from the initially
agreed upon one (1) year renewal term to a three (3) year renewal term (the
). This allows the City of Denton, TX to benefit in a price freeze for the duration of the
extended term and not be affected by the 2017 price increase. Any additional user licenses
or web forms not currently under contract would also benefit from this price freeze. The
total contract shall not-to-exceed $99,000.
All the terms and conditions of the Service Agreement shall continue to govern the services
rendered by you to ClearRisk during the Extended Term.
If the above provisions are acceptable by you, please print and sign two copies of this letter
in the space provided below and return one to the undersigned.
Sincerely,
Craig Rowe
CEO & Founder, ClearRisk, Inc.
Contract 5452, Amendment 2
DocuSign Envelope ID: 06BBB439-BF51-49EA-9D00-281AED251ACE
Certificate of Interested Parties Electronic Filing
In 2015, the Texas Legislature adopted House Bill 1295, which added section 2252.908
of the Government Code. The law states that the City may not enter into this contract
unless the Contractor submits a disclosure of interested parties (Form 1295) to the City at
the time the Contractor submits the signed contract. The Texas Ethics Commission has
adopted rules requiring the business entity to file Form 1295 electronically with the
Commission.
Contractor will be required to furnish an original notarized Certificate of Interest
Parties before the contract is awarded, in accordance with Government Code
2252.908.
The contractor shall:
1. Log onto the State Ethics Commission Website at :
https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm
2. Register utilizing the tutorial provided by the State
3. Print a copy of the completed Form 1295
4. Enter the Certificate Number on page 3 of this amendment.
5. Sign and notarize the Form 1295
6. Email the notarized form to purchasing@cityofdenton.com with the contract number
in the subject line. (EX: Contract 1234 Form 1295)
The City must acknowledge the receipt of the filed Form 1295 not later than the 30th day
after Council award. Once a Form 1295 is acknowledged, it will be posted to the Texas
Contract 5452, Amendment 2
DocuSign Envelope ID: 06BBB439-BF51-49EA-9D00-281AED251ACE
Read and Accepted on ___________________________________
#«¤ ±2¨²ªǾ )¢ȁ
_______________________________________
Name: Craig Rowe
Title: CEO
_____________________________________________
TEXAS ETHICS COMMISSION
CERTIFICATE NUMBER
#¨³¸ ®¥ $¤³®Ǿ 48
_______________________________________
Howard Martin Interim City Manager
Attest: Jennifer Walters, City Secretary
_______________________________________________
Approved as to Legal Form: Anita Burgess, City Attorney
___________________________________________________________
Contract 5452, Amendment 2
DocuSign Envelope ID: 06BBB439-BF51-49EA-9D00-281AED251ACE
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.
Name of vendor who has a business relationship with local governmental entity.
1
2
Check this box if you are filing an update to a previously filed questionnaire.
th
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7 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: 06BBB439BF5149EA9D00281AED251ACEStatus: Completed
Subject: City Council Docusign Item - 5452 Amendment 2
Source Envelope:
Document Pages: 5Signatures: 5Envelope Originator:
Certificate Pages: 6Initials: 0Karen E. Smith
AutoNav: Enabledkaren.smith@cityofdenton.com
EnvelopeId Stamping: EnabledIP Address: 129.120.6.150
Time Zone: (UTC-06:00) Central Time (US & Canada)
Record Tracking
Status: OriginalHolder: Karen E. SmithLocation: DocuSign
12/2/2016 1:15:12 PM karen.smith@cityofdenton.com
Signer EventsSignatureTimestamp
Karen E. SmithSent: 12/2/2016 1:22:17 PM
Completed
karen.smith@cityofdenton.comViewed: 12/2/2016 1:22:26 PM
Assistant Purchasing ManagerSigned: 12/2/2016 1:22:58 PM
Using IP Address: 129.120.6.150
City of Denton
Security Level: Email, Account Authentication
(Optional)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ID:
Craig RoweSent: 12/2/2016 1:22:59 PM
crowe@clearrisk.comResent: 12/6/2016 7:56:00 AM
Security Level: Email, Account Authentication Viewed: 12/5/2016 7:23:48 AM
(Optional)
Signed: 12/6/2016 8:05:30 AM
Using IP Address: 99.234.101.40
Electronic Record and Signature Disclosure:
Accepted: 12/5/2016 7:23:48 AM
ID: 68bab2ae-ff45-4433-bb17-1e23d9f22a29
John KnightSent: 12/6/2016 8:05:33 AM
john.knight@cityofdenton.comViewed: 12/6/2016 11:54:38 AM
Deputy City AttorneySigned: 12/6/2016 11:55:27 AM
City of Denton
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Julia WinkleySent: 12/6/2016 11:55:29 AM
Completed
julia.winkley@cityofdenton.comViewed: 12/6/2016 1:40:33 PM
Contracts Administration SupervisorSigned: 12/14/2016 10:43:06 AM
Using IP Address: 129.120.6.150
City of Denton
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Signer EventsSignatureTimestamp
Howard MartinSent: 12/14/2016 10:43:10 AM
howard.martin@cityofdenton.comViewed: 12/20/2016 9:52:49 AM
Interim City ManagerSigned: 12/20/2016 9:53:08 AM
City of Denton
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ID:
Jennifer WaltersSent: 12/20/2016 9:53:09 AM
jennifer.walters@cityofdenton.comViewed: 12/21/2016 9:38:37 AM
City SecretarySigned: 12/21/2016 9:38:50 AM
City of Denton
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In Person Signer EventsSignatureTimestamp
Editor Delivery EventsStatusTimestamp
Agent Delivery EventsStatusTimestamp
Intermediary Delivery EventsStatusTimestamp
Certified Delivery EventsStatusTimestamp
Carbon Copy EventsStatusTimestamp
Julia WinkleySent: 12/6/2016 8:05:31 AM
julia.winkley@cityofdenton.comViewed: 12/6/2016 8:22:36 AM
Contracts Administration Supervisor
City of Denton
Security Level: Email, Account Authentication
(Optional)
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ID:
Sherri ThurmanSent: 12/6/2016 8:05:31 AM
sherri.thurman@cityofdenton.com
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Electronic Record and Signature Disclosure:
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ID:
Jane RichardsonSent: 12/14/2016 10:43:08 AM
jane.richardson@cityofdenton.comViewed: 12/14/2016 11:33:19 AM
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Robin FoxSent: 12/14/2016 10:43:08 AM
Robin.fox@cityofdenton.com
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(Optional)
Carbon Copy EventsStatusTimestamp
Electronic Record and Signature Disclosure:
Accepted: 10/9/2015 1:39:51 PM
ID: 04463961-03db-4c4d-9228-d660d6146ed6
Jennifer BridgesSent: 12/21/2016 9:38:52 AM
jennifer.bridges@cityofdenton.comViewed: 12/28/2016 3:07:05 PM
Procurement Assistant
City of Denton
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Electronic Record and Signature Disclosure:
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ID:
Jane RichardsonSent: 12/21/2016 9:38:53 AM
jane.richardson@cityofdenton.com
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Electronic Record and Signature Disclosure:
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ID:
Scott PayneSent: 12/21/2016 9:38:54 AM
scott.payne@cityofdenton.comViewed: 12/21/2016 9:40:54 AM
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ID:
Notary EventsTimestamp
Envelope Summary EventsStatusTimestamps
Envelope SentHashed/Encrypted12/21/2016 9:38:54 AM
Certified DeliveredSecurity Checked12/21/2016 9:38:54 AM
Signing CompleteSecurity Checked12/21/2016 9:38:54 AM
CompletedSecurity Checked12/21/2016 9:38:54 AM
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