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RFP
NUMBER CONT CTOR AMOUNT
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SECTION 3. That should the City and person submitting approved and accepted items and
of the submitted proposals wish to enter into a formal written agreement as a result of the acceptance,
approval, and awarding of the proposals, the City Manager or his designated representative is hereby
authorized to execute the written contract; provided that the written contract is in accordance with
the terms, conditions, specifications, standards, quantities and specified sums contained in the
Proposal and related documents herein approved and accepted. This will be an initial three (3) year
contract with options to extend the contract for two (2) additional one (1) year periods.
SECTION 4. 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 the RFP 6091 to the City Manager of the City of Denton, Texas, or his designee.
TION 5. By the acceptance and approval of the above enumerated bids, the City Council
.S.E.C.....
hereby authorizes the expenditure of funds therefor in the amount and in accordance with the
approved bids.
SECTION 6, That this ordinance shall become effective immediately upon its passage and
a roval.
The motion to c������� �����, this ordinance was ��.����1+�, ���� .... ..�����.��` ,,�� ����� .... ..����..........� ��r��� ��s��ca������� la�
� ��,�' �� �°�����" ---- ........ . ...... t:l�� t��-ci����������� °�vx�� ������ ��.� ���ae:� ���������������� l��' [���� ����I�r�r�i:���
� � �"� �
vote �—� �� u �� � w � �
Mayor Chris Watts:
Gerard Hudspeth, District 1:
Keely G. Briggs, District 2:
Don Duff, District 3:
John Ryan, District 4:
Deb Armintor, At Large Place 5:
Paul Meltzer, At Large Place 6:
Aye Nay
✓
✓
�
�
✓
� �
Abstain Absent
PASSED AND APPROVED on this the / 7��"! day of `�6��t,J , 2018.
T
�
d�
� ���.m.� � j � ��,f
i � �
� i i��1�a ,�.�► l�� � MA ...._�.�..._._.�Aa
' YOR
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
�
� ��
BY: .. .� ..����°" �.. ���� ���"����'�� ������� � ';��° ,
�, .�___�.
APPROVED AS TO LEGAL FORM:
AARON LEAL, CITY ATTORNEY
w.
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B . - �� ���� ��,�
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
5ƚĭǒƭźŭƓ /źƷǤ /ƚǒƓĭźƌ ƩğƓƭƒźƷƷğƌ /ƚǝĻƩƭŷĻĻƷ
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
MASTERSERVICESAGREEMENT
ThisMASTERSERVICESAGREEMENT(thisMA)iseffectivethelatestdateinthesignatureblockbelow
(theEffectiveDate)betweenChangeHealthcareTechnologyEnabledServices,LLC,formerlyknownas
PSTServicesLLC(ServiceProvider)andCityofDenton,Texas(Client),consistingoftheMATermsand
ConditionsandallExhibits,Schedules,andAmendments.ThisMAgovernsalltheServicesdescribedona
ServiceSchedulethatisincludedinthisMAduringtheterm.ServiceProviderisasuccessorininterestto
PSTServices,LLC,whosubmittedtheproposaltoClientsRequestforProposal6091.
SubjecttothetermsandconditionsofthisMA,ClientagreestopurchasefromServiceProvider,andService
ProvideragreestoprovideClientwith,theservice(s)listedinthetablebelow(individually,aServiceand
collectively,theServices).ThedescriptionofeachServiceprovidedunderthisMAandanyadditionalterms
andconditionsrelatingtosuchServicearesetforthintheServiceSchedulereferencedinthetablebelow
andattachedhereto.
SERVICESSERVICESCHEDULE
ScopeofServicesEmergencyMedicalServicesServiceSchedule1
BusinessPerformanceInsightServicesServiceSchedule2
ThisMAisexecutedbyanauthorizedrepresentativeofeachparty.
CITYOFDENTON,TEXAS
CHANGEHEALTHCARE
TECHNOLOGYENABLED
SERVICES,LLCFORMERLY
KNOWNASPSTSERVICESLLC
By:By:
PrintedName:PrintedName:
Title:Title:
Date:Date:
TaxID:
Client:ServiceProvider:
332E.HickoryStreet5995WindwardParkway
Denton,Texas76201Alpharetta,Georgia30005
Attention:PurchasingManagerAttention:President
WithacopytotheCityAttorneysOfficeat215E.
WithacopytotheGeneralCounselatthesame
McKinneySt.,Denton,Texas76201
address
yes
invoicessenttoaboveaddress
no
Ifno,listinvoiceaddressbelow:ATTEST:
JENNIFERWALTERS,CITYSECRETARY
215E.McKinneyStreet
Denton,TX76201
Attention:ArisSaucedoAPPROVEDASTOLEGALFORM:
aris.saucedo@cityofdenton.comAARONLEAL,CITYATTORNEY
Page1of27
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
MATERMSANDCONDITIONS
1.TERM
1.1.ThisMAwillbeginontheEffectiveDateandcontinuesuntilterminationorexpirationofeach
Scheduleoramendmentattachedhereunder,unlessearlierterminatedassetforthherein.
1.2.Further,thisMAwillremaininforcesolongasthereisanactiveServiceSchedule(s).
2.SERVICES
2.1.Responsibilities.
2.1.1.ServiceProviderwillperformtheServicessetforthontheapplicableService
Schedule(s)onbehalfofClient.
2.1.2.ServiceProvideragreestoperformtheServicesinaccordancewithallmaterial
applicablelaws,rulesandregulations,includingapplicablethird-partypayerpolicies
andprocedures.
2.1.3.ClientwillprovideServiceProviderwiththenecessarydataintheproperformatto
enableServiceProvidertoproperlyfurnishtheServicesandanyinformationset
forthintheServiceSchedule(s)onatimelybasisandinaformatreasonably
acceptabletoServiceProvider(theClientResponsibilities).Clientauthorizes,to
theextentnecessary,anddirectsServiceProvidertoreleaseanyorallnecessary
dataandinformation(including,withoutlimitation,IndividuallyIdentifiableHealth
Informationassuchtermisdefinedin45C.F.R.§160.103)receivedbyService
Provider.Further,Clientshallobtainallnecessaryconsentsandagreementfrom
patientstoensurethatServiceProvidercancomplywithallapplicablefederaland
statelawsandregulationsinprovidingtheServicesincluding,butnotlimitedto,
HIPAA(asdefinedherein),andtheTelephoneConsumerProtectionAct(47U.S.C.
Section227)andrelatedregulations,aswellassimilarstatelawsandregulations
governingtelephonecommunicationswithconsumers.Clientshallensurethatall
informationitprovidestoServiceProvidermaybeusedbyServiceProviderfor
telephonecontacts,includingobtainingandmaintainingarecordoftheconsent
Clienthasobtainedfrompatientstoreceivetelephonecontactsfromoronbehalfof
Client.
2.2.OperatingProcedures.
2.2.1.Clientacknowledges(i)thattheServicesorobligationsofServiceProvider
hereundermaybedependentonClientprovidingaccesstodata,information,or
assistancetoServiceProviderfromtime-to-time(collectively,"Cooperation");and
(ii)thatsuchCooperationmaybeessentialtotheperformanceoftheServicesby
ServiceProvider.ThepartiesagreethatanydelayorfailurebyServiceProviderto
providetheServiceshereunderwhichiscausedbyClient'sfailuretoprovidetimely
Cooperation,asreasonablyrequestedbyServiceProvider,shallnotbedeemeda
breachofServiceProvidersperformanceobligationsunderthisMA.Therefore,
Clientherebyacknowledgesthatsuchvariablesarespecificallyexcludedfrom
ServiceProvidersliabilityunderthisMA.
2.2.2.ClientacknowledgesthatServiceProviderhaseveryincentivetoperformthe
Servicesinatimelyandproficientmanner,butthetimingandamountofcollections
generatedbytheServicesaresubjecttonumerousvariablesbeyondService
Providerscontrolincluding,withoutlimitation,(i)theinabilityofthirdpartiesor
systemstoaccuratelyprocessdata,(ii)thetransmissionofinaccurate,incomplete
orduplicatedatatoServiceProvider,(iii)untimelyreimbursementsorpayer
bankruptcies,(iv)latechargedocumentationsubmissionsbyClient,or(v)managed
carecontractdisputesbetweenpayersandClient.Therefore,Clienthereby
Page2of27
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
acknowledgesthatsuchvariablesarespecificallyexcludedfromServiceProviders
liabilityunderthisMA.
2.2.3.ServiceProviderwillbethesoleprovideroftheServicestoClient.
3.PAYMENT
3.1.Lockbox.AnelectroniclockboxwillbemaintainedinClientsnameatabankdesignatedby
Client.Allcashreceiptswillbedepositedintothelockbox.ServiceProviderwillhaveno
ownershiprightsinthelockboxandwillhavenorighttonegotiateorassertownershipof
checksmadepayabletoClient.Clientwillberesponsibleforallfeesassociatedwithsuch
lockbox.
3.2.InvoicingTerms.BeginningontheCommencementDate(asdefinedineachService
Schedule),ClientwillpayallfeesandotherchargesinU.S.dollarswithin30daysafterthe
invoicedate.PriortotheCommencementDate,Clientfurtheragreestoestablishan
automaticelectronicfundsdebitarrangementforpayingServiceProvidersinvoices.
3.3.LatePayments.ServiceProvidermaychargeClientinterestonanyoverduefees,charges,
orexpensesatarateequaltothelesserof1.5%permonthorthehighestratepermittedby
law.ClientwillreimburseServiceProviderforallreasonablecostsandexpensesincurred
(includingreasonableattorneysfees)incollectinganyoverdueamounts.
3.4.SuspensionoftheServices.ServiceProviderreservestherighttosuspendperformanceof
theServices(i)fornonpaymentofsumsowedtoServiceProviderthatare31daysormore
pastdue,wheresuchbreachisnotcuredwithintendaysafternoticetoClient,or(ii)ifsuch
suspensionisnecessarytocomplywithapplicablelawororderofanygovernmental
authority.
3.5.FeeChange.Eitherpartymayrequestafeechangeintheeventofamaterialchangein
legislation,Clientsbusinessorothermarketconditionswhichresultinamaterialchangein
eitherthecostassociatedwithServiceProvidersprovisionoftheServicesorService
ProvidersanticipatedrevenuesunderthisMA.Inaddition,ServiceProvidermayrequesta
feechangeintheevent(i)ClientfailstodisclosetoServiceProviderinformationrelatingto
Client'spractice,whichinformation,ifdisclosedpriortotheEffectiveDate,wouldhaveled
ServiceProvidertoproposeahigherfeeor(ii)anyoftheinformationprovidedbyClientto
ServiceProvideruponwhichthepracticeassumptionssetforthinanyapplicableService
Schedulearebased,isorbecomesinaccurate.Intheeventeitherpartyrequestsachange
intheFee,therequestingpartywillprovidethenon-requestingpartywithninety(90)days
priorwrittennotice(theNoticePeriod)oftherequestedchange(theNotice)andsuchfee
changewillbeeffectiveattheendoftheNoticePeriod.Ifthenon-requestingpartyprovides
therequestingpartywrittennoticeduringanysuchNoticePeriodthatanysuchfeechange
requestisunacceptabletothenon-requestingparty,theMAwillterminateattheendofthe
NoticePeriodandtheFeeinplaceatthattimewillremainineffectuntiltheendofthe
WorkoutPeriod,ifany.
4.GENERALTERMS
4.1.ConfidentialityandProprietaryRights.
4.1.1.UseandDisclosureofConfidentialInformation.Eachpartymaydisclosetotheother
partyconfidentialinformation.ExceptasexpresslypermittedbythisMA,neither
partywill:(i)disclosetheotherpartysconfidentialinformationexcept(a)toits
employeesorcontractorswhohaveaneedtoknowandareboundbyconfidentiality
termsnolessrestrictivethanthosecontainedinthisMA,or(b)totheextentrequired
bylawfollowingpromptnoticeofsuchobligationtotheotherparty,or(ii)usethe
otherpartysconfidentialinformationforanypurposeotherthanperformingits
obligationsunderthisMA.ServiceProviderunderstandsthatthisAgreementis
subjecttotheTexasOpenRecordsActandthatcertaininformationmaybesubject
toreleaseinaccordancewiththeprovisionsoftheAct.Clientwillnotdisclosenor
causeitsemployees,agentsandrepresentativestodisclosetoanyoneService
Providersbusinesspractices,tradesecretsorConfidentialInformation,exceptas
legallyrequired.Eachpartywilluseallreasonablecareinhandlingandsecuring
Page3of27
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
theotherpartysconfidentialinformationandwillemployallsecuritymeasuresused
foritsownproprietaryinformationofsimilarnature.Notwithstandingtheforegoing,
ClientagreesthatServiceProvidermayde-identifyClientinformationconsistentwith
theHIPAAPrivacyRuleanduseClientinformationanddatafromtransactions
receivedorcreatedbyServiceProviderforstatisticalcompilationsorreports,
researchandforotherpurposes(theUses).SuchUsesshallbethesoleand
exclusivepropertyofServiceProvider.
4.1.2.UseandDisclosureofBillingSoftware.
(a)ClientagreesthatthesoftwareServiceProviderusestoperformthe
Services(theBillingSystem)isproprietaryandconfidentialandthat
ServiceProvideristhesoleownerorlicenseeoftheBillingSystem.All
reportformatsandreportsgeneratedbytheBillingSystemareproduced
andwillbemadeavailabletoClientforinternaloperationalpurposesonly.
(b)Clientwillnotdiscloseorcauseitsemployees,agentsandrepresentatives
todisclosetoanyonetheBillingSystemoranyinformationitreceivesabout
theBillingSystem,exceptaslegallyrequired.
(c)AccesstoSoftware.IfServiceProvidergrantsClientoritsemployeesor
agentsread-onlyordirectaccesstotheBillingSystemorothersoftware
providedbyServiceProviderbyanymeans,ClientagreestotheEndUser
TermsandConditionssetforthinExhibitDtothisMA.
4.1.3.PeriodofConfidentiality.Therestrictionsonuse,disclosureandreproductionof
confidentialinformationsetforthinSection4.1,whichareatradesecret(asthat
termisdefinedunderapplicablelaw)willbeperpetual,andwithrespecttoother
confidentialinformationsuchrestrictionswillremaininfullforceandeffectduringthe
termofthisMAandforthreeyearsfollowingtheterminationofthisMA.Following
theterminationofthisMA,eachpartywill,uponwrittenrequest,returnordestroyall
oftheotherpartystangibleconfidentialinformationinitspossessionandwill
promptlycertifyinwritingtotheotherpartythatithasdoneso.
4.1.4.InjunctiveRelief.Thepartiesagreethatthebreach,orthreatenedbreach,ofany
provisionofthisSection4.1maycauseirreparableharmwithoutadequateremedy
atlaw.Uponanysuchbreachorthreatenedbreach,thebreachedpartywillbe
entitledtoseekinjunctiverelieftopreventtheotherpartyfromcommencingor
continuinganyactionconstitutingsuchbreach,withouthavingtopostabondor
othersecurityandwithouthavingtoprovetheinadequacyofotheravailable
remedies.NothinginthisSection4.1.4willlimitanyotherremedyavailabletoeither
party.
4.1.5.RetainedRights.ClientsrightsintheServiceswillbelimitedtothoseexpressly
grantedinthisMA.ServiceProvideranditssuppliersreserveallintellectualproperty
rightsnotexpresslygrantedtoClient.Allchanges,modifications,improvementsor
newmodulesmadeordevelopedwithregardtotheServices,whetherornot
(i)madeordevelopedatClientsrequest,(ii)madeordevelopedincooperationwith
Client,or(iii)madeordevelopedbyClient,willbesolelyownedbyServiceProvider
oritssuppliers.ServiceProviderretainstitletoallmaterial,originatedorprepared
forClientunderthisMA.Clientisgrantedalicensetousesuchmaterialsin
accordancewiththisMA.Forpurposesofclarification,alldatausedinthereports
preparedbyServiceProviderintheperformanceofServicesorClient,andallrights
andintereststherein,shallbethesolepropertyofClient.Theformofthereports,
workproduct,includingprocessesandtemplatesusedtopreparesuchreportsshall
bethesolepropertyofServiceProvider.
4.2.Termination.
4.2.1.TerminationforDefault.EitherpartymayterminatethisMAbyproviding30days
priorwrittennoticeofterminationtotheotherparty,iftheotherparty(i)materially
breachesthisMAandfailstoremedyorcommencereasonableeffortstoremedy
Page4of27
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
suchbreachwithin15days,andmateriallycurewithin45days,afterreceivingnotice
ofthebreachfromtheterminatingparty,(ii)materiallybreachesthisMAinsucha
waythatcannotberemedied,(iii)commencesdissolutionproceedingsor(iv)ceases
tooperateintheordinarycourseofbusiness.
4.2.2.IntentionallyOmitted.
4.2.3.TerminationbyServiceProvider.
(a)ServiceProvidermayimmediatelyterminatethisMAwithoutincurringany
liabilitytoClientifServiceProviderdoesnotreceivethecleantestfileor
completedimplementationdiscoverypacketwithinthreemonthsofthe
CommencementDateofaServiceScheduleandClientwillpayService
Providerforallexpensesincurredpriortotheterminationdate;or
(b)IfServiceProviderusesthird-partysoftwaretoprovidetheServices,Client
agreestoexecuteadditionaldocumentsotherthantheMA,includingbut
notlimitedtonondisclosureorproprietarymaterialdocumentationthatis
reasonablyrequiredbyServiceProvideroranyotherthird-partysoftware
licensor.IfClientisunwillingtosignsuchadditionaldocumentation,Service
ProvidermayterminatethisMA90daysafterServiceProviderpresented
thedocumentationtoClient.
4.2.4.TerminationbyClient.ClientmayterminatethisMAimmediatelyifServiceProvider
failstocureanymaterialbreachoftheBusinessAssociateAgreement(setforth
onExhibitAtothisMA)within30daysofServiceProvidersreceiptofwrittennotice
fromClientspecifyingthebreach.
4.2.5.TerminationProceduresServiceProviderBillingSystem.IntheeventthisMAor
anyServiceScheduleisterminatedorexpires,ClientwillnotifyServiceProviderin
writingnolaterthantenbusinessdayspriortotheexpirationorterminationofthe
ServiceScheduleofitschoiceofeithertheoptionsetforthinsub-Section(a)below
ortheoptionsetforthinsub-Section(b)belowasameansoftransferringits
accountsreceivablefromServiceProvidertoanotherproviderofbillingservices
(exceptasotherwisesetforthinsub-Section(c)below,inwhichcaseonlythe
proceduressetforthinsub-Section(b)willapply).
(a)WorkoutPeriod.Upontheeffectivedateoftermination/expiration,Service
ProvidershallceasetoenternewpatientandchargedataintotheBilling
SystemonbehalfofClient,butwillcontinuetoperformtheServices
identifiedintheapplicableServiceScheduleatthethen-currentrates
hereunder,foraperiodof90dayswithrespecttoallofClientsaccounts
receivablearisingfromchargesrenderedpriortotheterminationdate(such
periodhereinafterreferredtoastheWorkoutPeriod).AftertheWorkout
Period,ServiceProviderwilldiscontinueprocessingsuchaccounts
receivable,andafterfullpaymentofallfeesowed(1)delivertoClientafinal
listofaccountsreceivableand(2)providereasonabletransitionalservices,
assetforthonExhibitCtothisMA.Aftercompletionoftheabove,Service
ProviderwillhavenofurtherobligationstoClient,exceptasexpresslyset
forthinthisMA.Thepartiesagreethatallapplicabletermsandconditions
ofthisMAwillbeinfullforceandeffectuntiltheendoftheWorkoutPeriod.
(b)Fees.ForClientsaccountsreceivableforwhichServiceProviderreceives
aFeebasedonapercentageoftheNetCollections(asdefinedinthe
ServiceSchedule\[s\]),ClientshallpayServiceProvider,onorbeforethe
effectivedateoftermination/expiration,aone-timefeeequaltotheaverage
monthlyinvoiceforthesix(6)monthsimmediatelyprecedingtheeffective
dateofsuchterminationmultipliedbyoneandone-half(1.5)(theServices
RenderedFee).WithrespecttoClientsaccountsreceivableforwhich
ServiceProviderreceivesaFeebasedonasetdollaramount,noadditional
Page5of27
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
feesshallbeowedtoServiceProviderasoftheeffectivedateof
termination/expiration.Upontheeffectivedateoftermination/expirationof
thisMAorServiceSchedule,ServiceProvidershallbeimmediatelyrelieved
ofitsobligationtoprovideanyfurtherServicesonbehalfofClient.Afterfull
paymentofallfeesowed,includingbutnotlimitedtotheServicesRendered
Fee,ServiceProviderwilldelivertoClientafinallistofaccountsreceivable
andprovidereasonableTransitionalServices,assetforthonExhibitCto
thisMA.Aftercompletionoftheabove,ServiceProviderwillhavenofurther
obligationstoClient,exceptasexpresslysetforthinthisMA.TheServices
RenderedFeedoesnotlimittherightsandremediesServiceProvidermay
haveagainstClientarisingoutofanybreachofthisMA.
(c)DefaultSelection.If(i)thisMAisterminatedbyServiceProviderpursuant
tothetermssetforthinSection4.2.2,or(ii)Clientfailstomaketheabove-
requiredselectionintheallottedtime,onlytheproceduressetforthin
Section4.2.5(b)willapplywithregardstoanytermination/expiration
transition.
4.2.6.SurvivalofProvisions.ThoseprovisionsofthisMAthat,bytheirnature,areintended
tosurviveterminationorexpirationofthisMAwillremaininfullforceandeffect,
including,withoutlimitation,thefollowingSectionsofthisMA:3(Payment),4.1
(Confidentiality),4.3(LimitationofLiability),4.5(CivilMonetaryFineorPenalty),4.6
(Audits),4.7(Warranties),and4.104.26(GoverningLawEntireAgreement).
4.3.LimitationofLiability.
4.3.1.TotalDamages.ServiceProviderstotalcumulativeliabilityinconnectionwith,or
relatedtothisMAwillbelimitedtothesumoffeespaidbyClienttoServiceProvider
duringthe12-monthperiodprecedingthedateoftheclaim,asapplicable,whether
basedonbreachofcontract,warranty,tort,productliability,orotherwise.Service
ProviderwillhavenoliabilityforsystemsbeyondthecontrolofServiceProvider.
4.3.2.ExclusionofDamages.INNOEVENTWILLSERVICEPROVIDERBELIABLETO
CLIENTUNDER,INCONNECTIONWITH,ORRELATEDTOTHISMAFORANY
SPECIAL,INCIDENTAL,INDIRECT,ORCONSEQUENTIALDAMAGES,
INCLUDING,BUTNOTLIMITEDTO,LOSTPROFITSORLOSSOFGOODWILL,
WHETHERBASEDONBREACHOFCONTRACT,WARRANTY,TORT,
PRODUCTLIABILITY,OROTHERWISE,ANDWHETHERORNOTSERVICE
PROVIDERHASBEENADVISEDOFTHEPOSSIBILITYOFSUCHDAMAGE.
SERVICEPROVIDERUNDERSTANDSANDACKNOWLEDGESTHATTHE
CLIENTSHALLHAVENOLIABILITYTOSERVICEPROVIDERBEYONDTHE
TYPEORAMOUNTOFDAMAGESTHATISPROVIDEDBYANDCONSISTENT
WITHTHEPROVISIONSOF§271.153OFTHETEXASLOCALGOVERNMENT
CODE.
4.3.3.MaterialConsideration.THEPARTIESACKNOWLEDGETHATTHEFOREGOING
LIMITATIONSAREAMATERIALCONDITIONFORTHEIRENTRYINTOTHISMA.
4.4.InternetDisclaimer.CERTAINPRODUCTSANDSERVICESPROVIDEDBYSERVICE
PROVIDERUTILIZETHEINTERNET.SERVICEPROVIDERDOESNOTWARRANT
THATSUCHSERVICESWILLBEUNINTERRUPTED,ERROR-FREE,ORCOMPLETELY
SECURE.SERVICEPROVIDERDOESNOTANDCANNOTCONTROLTHEFLOWOF
DATATOORFROMSERVICEPROVIDERSORCLIENTSNETWORKANDOTHER
PORTIONSOFTHEINTERNET.SUCHFLOWDEPENDSINLARGEPARTONTHE
INTERNETSERVICESPROVIDEDORCONTROLLEDBYTHIRDPARTIES.ACTIONS
ORINACTIONSOFSUCHTHIRDPARTIESCANIMPAIRORDISRUPTCLIENTS
CONNECTIONSTOTHEINTERNET(ORPORTIONSTHEREOF).ACCORDINGLY,
SERVICEPROVIDERDISCLAIMSANYANDALLLIABILITYRESULTINGFROMOR
RELATEDTOTHEABOVEEVENTS.
4.5.CivilMonetaryFineorPenalty.ServiceProviderwillpayanycivilormonetaryfineorpenalty
andinterest(butnotoverpayments)assessedagainstClientbyMedicare,Medicaidorother
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
third-partyhealthinsuranceproviderarisingoutofServiceProviderssolenegligenceor
willfulmisconductintheperformanceofitsobligationsunderthisMA.Overpayments
receivedbyClientarethesoleresponsibilityofClient.
4.6.Audits.
4.6.1.InternalAuditbyClient.Clientmayuseitsowninternalresources(Internal
Auditors)toperformauditsofServiceProvidersaccuracyandcorrectnessofthe
accountingandinternalcontrolsperformedandmaintainedbyServiceProvider.
ServiceProviderwillprovidetheInternalAuditorswithinformationthattheInternal
Auditordeterminestobereasonablynecessarytoperformandcompletetheaudit
procedures.Clientagreesthatanauditconductedunderthissectionwillbe
conductedatsuchtimesandinamannerthatavoidsunduedisruptionofService
Providersoperations.
4.6.2.Third-PartyAuditbyClient.Clientmayengage,atitsownexpense,independent,
external,third-partyauditors(Third-PartyAuditors)toperformauditsofService
Providersaccuracyandcorrectnessoftheaccountingandinternalcontrol
performedandmaintainedbyServiceProvider.IfClientengagesThird-Party
Auditors,whoperform,orareassociatedwithagroupwhoperforms,billingand
accountsreceivablemanagementservicessubstantiallysimilartoanyofthe
ServicesidentifiedonanyServiceScheduletothisMA,suchThird-PartyAuditors
maynotvisitServiceProvidersprocessingfacilityoraudittheactualbillingand
collectionprocess.ServiceProviderwillprovidetheinformationthattheThird-Party
Auditorsdeterminetobereasonablynecessarytoperformandcompleteallaudit
procedures.TheThird-PartyAuditorsshallexecuteServiceProviders
ConfidentialityAgreement,substantiallyintheformattachedheretoasExhibitB,
priortothestartoftheaudit.Clientagreesthatanauditconductedunderthissection
willbeconductedatsuchtimesandinamannerthatavoidsunduedisruptionof
ServiceProvidersoperations.
4.6.3.BooksandRecords.IfrequiredbySection952oftheOmnibusReconciliationActof
1980,42U.S.C.Section1395x(v)(I)(i)and(ii),foraperiodoffouryearsafterthe
Servicesarefurnished,thepartiesagreetomakeavailable,uponthewrittenrequest
oftheSecretaryofHealthandHumanServices,theComptrollerGeneral,ortheir
representatives,thisMAandsuchbooks,documents,andrecordsasmaybe
necessarytoverifythenatureandextentoftheServiceswithavalueorcostof
$10,000ormoreoveratwelvemonthperiod.
4.7.Warranties
4.7.1.ServiceProvider.
(a)PriortotheCommencementDate.UnlessServiceProviderprovided
ServicespriortotheCommencementDateofanyServiceSchedule,Client
willberesponsibleforallmattersrelatedtoClient'spracticepriortothe
CommencementDate,including,butnotlimitedto,Client'sbillings,
collections,thirdpartyreimbursements,accountsreceivableandcredit
balances.
(b)DisclaimerofWarranties.ServiceProviderdisclaimsanywarrantiesor
representationspertainingtothetimingandamountofcollectionsgenerated
bytheServices.ClientacknowledgesandagreesthatClientissolely
responsibleforrefundinganyoverpaymentsandprocessinganyunclaimed
propertypayments.ServiceProviderwillprovideClientwithwrittennotice
ofunresolvedcreditbalancesofwhichServiceProviderbecomesaware
(suchasoverpaymentsorunclaimedproperty).
4.7.2.Client.
(a)ChargesandInformation.
(i)ClientrepresentsandwarrantsthatitwillforwardtoService
Provider(pursuanttotheapplicableServiceSchedule\[s\])only
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Client:DentonFireDepartment
ContractNumber:RMS155330
chargesforwhichClientisentitledtobill.Clientagreestomonitor
andtorefrainfromknowinglysubmittingfalseorinaccurate
information,charges,documentationorrecordstoService
ProviderandtoensurethatthedocumentationprovidedbyClient
oranagentofClienttoServiceProvidersupportsthemedical
servicesprovidedbyClient.Clientacknowledgesandagreesit
hasanobligationtoreportandcorrectanycredibleevidenceof
deficienciesonthepartofClient.Clientalsoacknowledgesthat
ServiceProviderdoesnotmakeadeterminationofmedical
necessityforanyclaims.
(ii)ClientacknowledgesandagreesthatServiceProviderisnota
collectionagency.Clientrepresentsandwarrantsthatanydebtor
accountreferredtoServiceProviderpursuanttothisMAisnotin
defaultordelinquentorhasnotbeenwrittenoffasbaddebt.If
anyaccountsarefoundtobewrittenoff,indefaultorotherwise
delinquent,Clientagreestoimmediatelyrecallthoseaccounts
fromServiceProvidersresponsibilityunderthisMA.
(b)ReleaseofInformation.ClientrepresentsandwarrantsthatClienthas
obtainedareleaseofinformationandinsuranceassignmentofbenefitsfrom
allindividualsforwhomClientissubmittingchargestoServiceProviderfor
theprovisionoftheServicesandwillimmediatelynotifyServiceProviderif
suchreleaseofinformationandinsuranceassignmentofbenefitsis
changedorrevokedorifsuchindividualrefused/failedtoexecutesuch
documents.Clientfurtheragreestoprovideacopyofsuchsigned
documentsuponServiceProvider'srequest.Thetermindividualsinthis
Sectionreferstotheindividualphysicians/practitioners,orgroupmembers,
onwhosebehalftheClientisdirectingServiceProvidertosubmitclaims.
4.8.BusinessAssociate.ThepartiesagreetotheobligationssetforthinExhibitA.
4.9.ExclusionFromFederalHealthcarePrograms.Eachpartywarrantsthatitisnotcurrently
listedbyaFederalagencyasexcluded,debarred,orotherwiseineligibleforparticipationin
anyFederalhealthcareprogram.Eachpartyagreesthatitwillnotemploy,contractwith,or
otherwiseusetheservicesofanyindividualwhomitknowsorshouldhaveknown,after
reasonableinquiry,(i)hasbeenconvictedofacriminaloffenserelatedtohealthcare(unless
theindividualhasbeenreinstatedtoparticipationinMedicareandallotherFederalhealth
careprogramsafterbeingexcludedbecauseoftheconviction),or(ii)iscurrentlylistedbya
Federalagencyasexcluded,debarred,orotherwiseineligibleforparticipationinanyFederal
healthcareprogram.Eachpartyagreesthatitwillimmediatelynotifytheotherintheevent
thatit,oranypersoninitsemploy,hasbeenexcluded,debarred,orhasotherwisebecome
ineligibleforparticipationinanyFederalhealthcareprogram.Eachpartyagreestocontinue
tomakereasonableinquiryregardingthestatusofitsemployeesandindependent
contractorsonaregularbasisbyreviewingtheGeneralServicesAdministrationsListof
PartiesExcludedfromFederalProgramsandtheHHS/OIGListofExcluded
Individuals/Entities.
4.10.GoverningLaw.ThisMAisgovernedbyandwillbeconstruedinaccordancewiththelaws
oftheStateofTexas,exclusiveofitsrulesgoverningchoiceoflawandconflictoflawsand
anyversionoftheUniformCommercialCode.
4.11.ClaimsPeriod.AnyactionrelatingtothisMAandanyclaimfordamages,including,butnot
limitedto,aclaimforrecurringdamagesarisingoutofthesamecauseorevent,otherthan
collectionofoutstandingpayments,mustbecommencedwithinoneyearafterthedateupon
whichthecauseofactionoccurred.
4.12.AssignmentandSubcontracts.NeitherpartywillassignthisMAwithoutthepriorwritten
consentoftheotherparty,whichwillnotbeunreasonablywithheld,delayedorconditioned.
ServiceProvidermay,uponnoticetoClient,assignthisMAtoanyaffiliateortoanyentity
resultingfromthetransferofallorsubstantiallyallofServiceProvidersassetsorcapital
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Client:DentonFireDepartment
ContractNumber:RMS155330
stockorfromanyothercorporatereorganization.ServiceProvidermaysubcontractits
obligationsunderthisMAwithnoticetoandtheconsentoftheClient.
4.13.Severability.IfanypartofaprovisionofthisMAisfoundillegalorunenforceable,itwillbe
enforcedtothemaximumextentpermissible,andthelegalityandenforceabilityofthe
remainderofthatprovisionandallotherprovisionsofthisMAwillnotbeaffected.
4.14.Notices.AllnoticesrelatingtothepartieslegalrightsandremediesunderthisMAwillbe
providedinwritingandwillreferencethisMA.Suchnoticeswillbedeemedgivenifsentby:
(i)postageprepaidregisteredorcertifiedU.S.Postmail,thenfiveworkingdaysafter
sending;or(ii)commercialcourier,thenatthetimeofreceiptconfirmedbytherecipientto
thecourierondelivery.Allnoticestoapartywillbesenttoitsaddresssetforthonthecover
pagehereto,ortosuchotheraddressasmaybedesignatedbythatpartybynoticetothe
sendingparty.
4.15.Waiver.FailuretoexerciseorenforceanyrightunderthisMAwillnotactasawaiverofsuch
right.
4.16.ForceMajeure.Exceptfortheobligationtopaymoney,apartywillnotbeliabletotheother
partyforanyfailureordelaycausedinwholeorinmaterialparttoanycausebeyonditssole
control,includingbutnotlimitedtofire,accident,labor,disputeorunrest,flood,riot,war,
rebellion,insurrection,sabotage,terrorism,transportationdelays,shortageofrawmaterials,
energy,ormachinery,actsofGodorofthecivilormilitaryauthoritiesofastateornation,or
theinability,duetotheaforementionedcauses,toobtainnecessarylabororfacilities.
4.17.Amendment.ThisMAmaybemodified,oranyrightsunderitwaived,onlybyawritten
documentexecutedbytheauthorizedrepresentativesofbothparties.Toavoiddoubt,this
MAmaynotbeamendedviaelectronicmailorotherelectronicmessagingservice.
4.18.NoThird-PartyBeneficiaries.ExceptasspecificallysetforthinaServiceSchedule,nothing
inthisMAwillconferanyright,remedy,orobligationuponanyoneotherthanClientand
ServiceProvider.
4.19.RelationshipofParties.Eachpartyisanindependentcontractoroftheotherparty.ThisMA
willnotbeconstruedasconstitutingarelationshipofemployment,agency,partnership,joint
ventureoranyotherformoflegalassociation.Neitherpartyhasanypowertobindtheother
partyortoassumeortocreateanyobligationorresponsibilityonbehalfoftheotherpartyor
intheotherpartysname.
4.20.Non-solicitationofEmployees.DuringthetermofthisMAandforaperiodof12months
followingtheterminationofthisMA,eachpartyagreesnottoemploy,contractwithfor
services,solicitforemploymentonitsownbehalforonbehalfofanythirdparty,orhave
ownershipinanyentitywhichemploysorsolicitsforemployment,anyindividualwho(i)was
anemployeeoftheotheroritsparent,affiliatesorsubsidiariesatanytimeduringthe
preceding12monthsand(ii)wasmateriallyinvolvedintheprovisionorreceiptofthe
Serviceshereunderwithoutthepriorwrittenconsentoftheotherparty.Notwithstandingthe
foregoing,uponanyterminationofthisMA,Clientmayrehireanyindividualwhowas
employedbyClientontheEffectiveDate,andwhowashiredbyServiceProvideronorafter
suchdate.Eachpartyagreesthattheotherpartydoesnothaveanadequateremedyatlaw
toprotectitsrightsunderthisSectionandagreesthatthenon-defaultingpartywillhavethe
righttoinjunctiverelieffromanyviolationorthreatenedviolationofthisSection.
4.21.Publicity.ThepartiesmaypubliclyannouncethattheyhaveenteredintothisMAand
describetheirrelationshipingeneralterms,excludingfinancialterms.Thepartieswillnot
makeanyotherpublicannouncementorpressreleaseregardingthisMAoranyactivities
performedhereunderwithoutthepriorwrittenconsentoftheotherparty.
4.22.ConstructionofthisMA.ThisMAwillnotbepresumptivelyconstruedfororagainsteither
party.Sectiontitlesareforconvenienceonly.AsusedinthisMA,willmeansshall,and
includemeansincludeswithoutlimitation.ThepartiesmayexecutethisMAinoneor
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Client:DentonFireDepartment
ContractNumber:RMS155330
morecounterparts,eachofwhichwillbedeemedanoriginalandoneandthesame
instrument.
4.23.ConflictBetweenMAandSchedules.Intheeventofanyconflictorinconsistencyinthe
interpretationofthisMA(includingitsServiceSchedulesandallAmendmentsexecuted
hereunder),suchconflictorinconsistencywillberesolvedbygivingprecedenceaccording
tothefollowingorder:(a)theAmendment,(b)theServiceSchedule,(c)theMATermsand
ConditionsandExhibits,(d)DocumentsIncorporatedbyReference.
4.24.SectionHeadings.TheSectionheadingsusedhereinareforconvenienceonlyandshallnot
beusedintheinterpretationofthisMA.
4.25.Authority.ServiceProviderandClientrepresentandwarrantthattheyhavethefullpower
andauthoritytoenterintothisMA,thattherearenorestrictionsorlimitationsontheirability
toperformthisMA,andthatthepersonexecutingthisMAhasthefullpowerandauthority
todoso.
4.26.EntireAgreement.ThisMA,includingServiceSchedules,Exhibits,Amendments,and
DocumentsIncorporatedbyReference,isthecompleteandexclusiveagreementbetween
thepartieswithrespecttothesubjectmatterhereof,supersedingandreplacingallprior
agreements,communications,andunderstandings(writtenandoral)regardingitssubject
matter.DocumentsIncorporatedbyReferenceincludetheServiceProvidersProposaland
BestandFinalOffertoClientsRequestforProposal6091,ClientsRequestforProposal
6091.
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
EXHIBITA
BUSINESSASSOCIATEAGREEMENT
ThisBusinessAssociateAgreement(Agreement)isenteredintobyandbetweenServiceProvider
(BusinessAssociate)andClient(CoveredEntity).BusinessAssociateandCoveredEntitymaybe
individuallyreferredtoasaPartyand,collectively,thePartiesinthisAgreement.ThisAgreementshall
beincorporatedintoandmadepartoftheUnderlyingAgreement(asdefinedbelow).
STATEMENTOFPURPOSE
PursuanttotheUnderlyingAgreement,BusinessAssociateprovidesservicestoCoveredEntityand
CoveredEntitydisclosescertaininformation,includingPHI(asdefinedbelow),toBusinessAssociate.The
purposeofthisAgreementistoprotecttheprivacyandprovideforthesecurityofsuchPHIincompliance
withthePrivacyRuleandSecurityRule.
SECTION1:DEFINITIONS
“ElectronicProtectedHealthInformation”or“ElectronicPHI”willhavethemeaninggivento
suchtermunderthePrivacyRuleandtheSecurityRule,including,butnotlimitedto,45C.F.R.§160.103,
asappliedtotheinformationthatBusinessAssociatecreates,receives,maintainsortransmitsfromoron
behalfofCoveredEntity.
“PrivacyRule”willmeantheStandardsforPrivacyofIndividuallyIdentifiableHealthInformationat
45C.F.R.Part160andPart164,SubpartsAandE.
“ProtectedHealthInformation”or“PHI”willhavethesamemeaningasthetermprotectedhealth
informationin45C.F.R.§160.103,asappliedtotheinformationcreated,received,maintainedortransmitted
byBusinessAssociatefromoronbehalfofCoveredEntity.
“SecurityRule”willmeantheSecurityStandardsat45C.F.R.Part160andPart164,SubpartsA
andC
“UnderlyingAgreement”willmeantheapplicablewrittenservicesagreement(s)betweenCovered
EntityandBusinessAssociateunderwhichCoveredEntitymaydisclosePHItoBusinessAssociate.
CapitalizedTerms.CapitalizedtermsusedinthisAgreementandnototherwisedefinedhereinwill
havethemeaningssetforthinthePrivacyRuleandtheSecurityRulewhichdefinitionsareincorporatedin
thisAgreementbyreference.
SECTION2:PERMITTEDUSESANDDISCLOSURESOFPHI
2.1UsesandDisclosuresofPHIPursuanttotheUnderlyingAgreement.Exceptasotherwiselimitedin
thisAgreement,BusinessAssociatemayuseordisclosePHItoperformfunctions,activitiesorservicesfor,
oronbehalfof,CoveredEntityasspecifiedintheUnderlyingAgreement,providedthatsuchuseordisclosure
wouldnotviolatethePrivacyRuleifdonebyCoveredEntity.
2.2PermittedUsesofPHIbyBusinessAssociate.ExceptasotherwiselimitedinthisAgreement,
BusinessAssociatemayusePHIforthepropermanagementandadministrationofBusinessAssociateorto
carryoutthelegalresponsibilitiesofBusinessAssociate.
2.3PermittedDisclosuresofPHIbyBusinessAssociate.ExceptasotherwiselimitedinthisAgreement,
BusinessAssociatemaydisclosePHIforthepropermanagementandadministrationofBusinessAssociate,
providedthatthedisclosuresareRequiredbyLaw,orBusinessAssociateobtainsreasonableassurances
fromthepersontowhomtheinformationisdisclosedthatitwillremainconfidentialandwillbeusedorfurther
disclosedonlyasRequiredbyLaworforthepurposeforwhichitwasdisclosedtotheperson(whichpurpose
mustbeconsistentwiththelimitationsimposeduponBusinessAssociatepursuanttothisAgreement),and
thatthepersonagreestonotifyBusinessAssociateofanyinstancesinwhichitisawarethatthe
confidentialityoftheinformationhasbeenbreached.
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2.4DataAggregation.ExceptasotherwiselimitedinthisAgreement,BusinessAssociatemayusePHI
toprovideDataAggregationservicesfortheHealthCareOperationsoftheCoveredEntityaspermittedby
45C.F.R.§164.504(e)(2)(i)(B).
2.5De-identifiedData.BusinessAssociatemayde-identifyPHIinaccordancewiththestandardsset
forthin45C.F.R.§164.514(b)andmayuseordisclosesuchde-identifieddataunlessprohibitedby
applicablelaw.
SECTION3:OBLIGATIONSOFBUSINESSASSOCIATE
3.1AppropriateSafeguards.BusinessAssociatewilluseappropriateadministrative,physical,and
technicalsafeguardstocomplywiththeSecurityRulewithrespecttoElectronicPHI,topreventuseor
disclosureofsuchinformationotherthanasprovidedforbytheUnderlyingAgreementandthisAgreement.
ExceptasexpresslyprovidedintheUnderlyingAgreementorthisAgreement,BusinessAssociatewillnot
assumeanyobligationsofCoveredEntityunderthePrivacyRule.TotheextentthatBusinessAssociateis
tocarryoutanyofCoveredEntitysobligationsunderthePrivacyRule,BusinessAssociatewillcomplywith
therequirementsofthePrivacyRulethatapplytoCoveredEntityintheperformanceofsuchobligations.
3.2ReportingofImproperUseorDisclosure,SecurityIncidentorBreach.BusinessAssociatewillreport
toCoveredEntityanyuseordisclosureofPHInotpermittedunderthisAgreement,BreachofUnsecured
PHIoranySecurityIncident,withoutunreasonabledelay,andinanyeventnomorethanfourteen(14)days
followingdiscovery;provided,however,thatthePartiesacknowledgeandagreethatthisSectionconstitutes
noticebyBusinessAssociatetoCoveredEntityoftheongoingexistenceandoccurrenceofattemptedbut
UnsuccessfulSecurityIncidents(asdefinedbelow).UnsuccessfulSecurityIncidentswillinclude,butnot
belimitedto,pingsandotherbroadcastattacksonBusinessAssociatesfirewall,portscans,unsuccessful
log-onattempts,denialsofserviceandanycombinationoftheabove,solongasnosuchincidentresultsin
unauthorizedaccess,useordisclosureofPHI.BusinessAssociatesnotificationtoCoveredEntityofa
Breachwillcomplywiththerequirementssetforthin45C.F.R.§164.404.
3.3BusinessAssociatesAgents.BusinessAssociatewillenterintoawrittenagreementwithanyagent
orsubcontractorthatcreates,receives,maintainsortransmitsPHIonbehalfofBusinessAssociatefor
servicesprovidedtoCoveredEntity,providingthattheagentagreestorestrictionsandconditionsthatare
nolessrestrictivethanthosethatapplythroughthisAgreementtoBusinessAssociatewithrespecttosuch
PHI.
3.4AccesstoPHI.TotheextentBusinessAssociateagreesintheUnderlyingAgreementtomaintain
anyPHIinaDesignatedRecordSet,BusinessAssociateagreestomakesuchinformationavailableto
CoveredEntitypursuantto45C.F.R.§164.524,withinten(10)businessdaysofBusinessAssociates
receiptofawrittenrequestfromCoveredEntity;provided,however,thatBusinessAssociateisnotrequired
toprovidesuchaccesswherethePHIcontainedinaDesignatedRecordSetisduplicativeofthePHI
containedinaDesignatedRecordSetpossessedbyCoveredEntity.
3.5AmendmentofPHI.TotheextentBusinessAssociateagreesintheUnderlyingAgreementto
maintainanyPHIinaDesignatedRecordSet,BusinessAssociateagreestomakesuchinformationavailable
toCoveredEntityforamendmentpursuantto45C.F.R.§164.526withinten(10)businessdaysofBusiness
AssociatesreceiptofawrittenrequestfromCoveredEntity.
3.6DocumentationofDisclosures.BusinessAssociatewilldocumentdisclosuresofPHIandinformation
relatedtosuchdisclosuresaswouldberequiredforCoveredEntitytorespondtoarequestbyanIndividual
foranaccountingofdisclosuresofPHIinaccordancewith45C.F.R.§164.528.
3.7AccountingofDisclosures.BusinessAssociatewillprovidetoCoveredEntity,withintwenty(20)
businessdaysofBusinessAssociatesreceiptofawrittenrequestfromCoveredEntity,informationcollected
inaccordancewithSection3.6ofthisAgreement,topermitCoveredEntitytorespondtoarequestbyan
IndividualforanaccountingofdisclosuresofPHIinaccordancewith45C.F.R.§164.528.
3.8GovernmentalAccesstoRecords.BusinessAssociatewillmakeitsinternalpractices,booksand
recordsrelatingtotheuseanddisclosureofPHIreceivedfrom,orcreatedorreceivedbyBusinessAssociate
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onbehalfof,CoveredEntityavailabletotheSecretaryforpurposesoftheSecretarydeterminingcompliance
withthePrivacyRuleandtheSecurityRule.
3.9Mitigation.Totheextentpracticable,BusinessAssociatewillcooperatewithCoveredEntitysefforts
tomitigateaharmfuleffectthatisknowntoBusinessAssociateofauseordisclosureofPHIbyBusiness
AssociatethatisnotpermittedbythisAgreement.
3.10MinimumNecessary.BusinessAssociatewillrequest,useanddisclosetheminimumamountofPHI
necessarytoaccomplishthepurposeoftherequest,useordisclosure,inaccordancewith45C.F.R.§
164.514(d),andanyamendmentsthereto.
SECTION4:CHANGESTOPHIAUTHORIZATIONS
CoveredEntitywillnotifyBusinessAssociatefifteen(15)days,ifpracticable,priortotheeffective
dateof(1)anylimitation(s)initsnoticeofprivacypracticesinaccordancewith45C.F.R.§164.520,(2)any
changesin,orrevocationof,permissionbyanIndividualtouseordisclosePHI,or(3)anyrestrictiontothe
useordisclosureofPHIthatCoveredEntityhasagreedtoinaccordancewith45C.F.R.§164.522.Covered
Entitywillmakesuchnotificationtotheextentthatsuchlimitation,restriction,orchangemayaffectBusiness
AssociatesuseordisclosureofPHI.
SECTION5:TERMANDTERMINATION
5.1Term.ThetermofthisAgreementwillcommenceasoftheEffectiveDate,andwillterminatewhen
allofthePHIprovidedbyCoveredEntitytoBusinessAssociate,orcreatedorreceivedbyBusinessAssociate
onbehalfofCoveredEntity,isdestroyedorreturnedtoCoveredEntity.
5.2TerminationforCause.UponeitherPartysknowledgeofamaterialbreachbytheotherPartyofthis
Agreement,suchPartymayterminatethisAgreementimmediatelyifcureisnotpossible.Otherwise,the
non-breachingpartywillprovidewrittennoticetothebreachingPartydetailingthenatureofthebreachand
providinganopportunitytocurethebreachwithinthirty(30)businessdays.Upontheexpirationofsuch
thirty(30)daycureperiod,thenon-breachingPartymayterminatethisAgreementandtheaffected
underlyingproductorserviceifthebreachingpartydoesnotcurethebreachorifcureisnotpossible.
5.3EffectofTermination.
5.3.1ExceptasprovidedinSection5.3.2,uponterminationoftheUnderlyingAgreementorthis
Agreementforanyreason,BusinessAssociatewillreturnordestroyallPHIreceivedfromCoveredEntity,or
createdorreceivedbyBusinessAssociateonbehalfofCoveredEntity,atCoveredEntitysexpense,andwill
retainnocopiesofthePHI.ThisprovisionwillapplytoPHIthatisinthepossessionofsubcontractorsor
agentsofBusinessAssociate.
5.3.2IfitisinfeasibleforBusinessAssociatetoreturnordestroythePHIuponterminationofthe
UnderlyingAgreementorthisAgreement,BusinessAssociatewill:(a)extendtheprotectionsofthis
AgreementtosuchPHIand(b)limitfurtherusesanddisclosuresofsuchPHItothosepurposesthatmake
thereturnordestructioninfeasible,forsolongasBusinessAssociatemaintainssuchPHI.
5.3.3TherespectiverightsandobligationsofBusinessAssociateunderSection5.3ofthis
AgreementwillsurvivetheterminationofthisAgreementandtheUnderlyingAgreement.
SECTION6:COOPERATIONININVESTIGATIONS
ThePartiesacknowledgethatcertainbreachesorviolationsofthisAgreementmayresultinlitigationor
investigationspursuedbyfederalorstategovernmentalauthoritiesoftheUnitedStatesresultingincivil
liabilityorcriminalpenalties.EachPartywillcooperateingoodfaithinallrespectswiththeotherPartyin
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connectionwithanyrequestbyafederalorstategovernmentalauthorityforadditionalinformationand
documentsoranygovernmentalinvestigation,complaint,actionorotherinquiry.
SECTION7:COMPLIANCEWITHLAW
BusinessAssociatewillcomplywithallapplicablefederalprivacyandsecuritylawsgoverningPHI,asthey
maybeamendedfromtimetotime.
SECTION8:AMENDMENT
ThisAgreementmaybemodified,oranyrightsunderitwaived,onlybyawrittendocumentexecutedbythe
authorizedrepresentativesofbothParties.Inaddition,ifanyrelevantprovisionofthePrivacyRuleorthe
SecurityRuleisamendedinamannerthatchangestheobligationsofBusinessAssociateorCoveredEntity
thatareembodiedintermsofthisAgreement,thenthePartiesagreetonegotiateingoodfaithappropriate
non-financialtermsoramendmentstothisAgreementtogiveeffecttosuchrevisedobligations.
SECTION9:GENERAL
ThisAgreementisgovernedby,andwillbeconstruedinaccordancewith,thelawsoftheStatethatgovern
theUnderlyingAgreement.CoveredEntitywillnotassignthisAgreementwithoutthepriorwrittenconsent
ofBusinessAssociate,whichwillnotbeunreasonablywithheld.AllnoticesrelatingtothePartieslegalrights
andremediesunderthisAgreementwillbeprovidedinwritingtoaParty,willbesenttoitsaddresssetforth
intheUnderlyingAgreement,ortosuchotheraddressasmaybedesignatedbythatPartybynoticetothe
sendingParty,andwillreferencethisAgreement.NothinginthisAgreementwillconferanyright,remedy,
orobligationuponanyoneotherthanCoveredEntityandBusinessAssociate.
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EXHIBITB
CONFIDENTIALITYAGREEMENT
ServiceProviderandCityofDenton,Texas(theClient)haveenteredintoanagreementwherebyService
Providerprovidescertainservices(theServices)toClient(theMasterServicesAgreement).Clienthasentered
intoacontractualrelationshipwith_____\[insertnameofperson/entityperformingtheaudit\]____(Recipient)
andinstructsServiceProvidertoallowRecipienttoreviewcertaininformationinServiceProviderspossession
regardingClientsbusinessandaccountsreceivablebillingandcollectionsperformedbyServiceProvider(the
ClientProprietaryInformation).Therefore,inconsiderationofthemutualcovenantsandconditionscontainedin
thisConfidentialityAgreement(theConfidentialityAgreement),RecipientandClientagreeasfollows:
A.DuringthecourseofRecipientsexaminationandreviewofClientProprietaryInformation,Recipientmay
beexposedtoorreviewcertainproprietaryinformationregardingServiceProvider(ServiceProviderProprietary
Information).ServiceProviderProprietaryInformationreferstoanyandalldataandinformationrelatingtothe
businessofServiceProviderwhichhasvaluetoServiceProviderandisnotgenerallyknownbyitscompetitorsor
thepublic,including,withoutlimitation,financialinformation,inventions,methods,techniques,actualorpotential
customersandsuppliers,theMasterServicesAgreement,ServiceProvidersbusinesspracticesorothertrade
secretsorconfidentialinformationofServiceProvider,allreportformats,andexistingandfutureproductsand
computersystemsandsoftware.RecipientacknowledgesandagreesthatallServiceProviderProprietary
InformationandallphysicalembodimentsthereofareconfidentialtoServiceProviderandareandwillremainthe
soleandexclusivepropertyofServiceProvider.AllServiceProviderProprietaryInformationacquiredbyRecipient
willbekeptstrictlyconfidentialandwillnotbedisclosedtoanyotherpersonorentity(includinganyentityaffiliated
withoranydivisionofRecipient).
B.ServiceProviderProprietaryInformationdoesnotincludeinformationwhich(i)ispubliclyknownorwhich
becomespubliclyknownthroughnoactorfailuretoactonthepartofRecipient;(ii)islawfullyobtainedbyRecipient
fromanythirdpartyentitledtodisclosesuchinformation;(iii)isinthelawfulpossessionofRecipientpriortosuch
informationhavingbeendisclosedtoRecipientbyServiceProvider;or(iv)isindependentlydevelopedbyRecipient.
C.RecipientfurtheragreesthatduringRecipientsengagementbyClientandforaperiodofone(1)year
followinganyterminationofRecipientsengagementforwhateverreason,Recipientwillnot,directlyorindirectly,
onRecipientsownbehalforintheserviceof,oronbehalfofanyotherindividualorentity,divert,solicitorhire
away,orattempttodivert,solicitorhireaway,toorforanyindividualorentity,anypersonemployedbyService
Provider,whetherornotsuchemployeeisafull-timeemployee,temporaryemployee,leasedemployeeor
independentcontractorofServiceProvider,whetherornotsuchemployeeisemployedpursuanttowritten
agreementandwhetherornotsuchemployeeisemployedforadeterminedperiodorat-will.
D.RecipientacknowledgesthatgreatlossandirreparabledamagewouldbesufferedbyServiceProviderif
RecipientshouldbreachorviolatethetermsofthisConfidentialityAgreement.IntheeventRecipientbreachesor
violatesthisConfidentialityAgreement,RecipientagreesthatServiceProviderwouldnothaveanadequate
remedyatlawand,therefore,thatServiceProviderwouldbeentitledtoatemporaryrestrainingorderand
permanentinjunctiontopreventabreachofanyofthetermsorprovisionscontainedinthisConfidentiality
Agreement,inadditiontoanymonetarydamagesthatmaybeavailableatlaworequity.Recipientsobligations
underthisConfidentialityAgreementwillsurviveindefinitely.
E.Recipientrepresentsandwarrantsthat(i)ithasthefullpowerandauthoritytoenterintothisConfidentiality
Agreement,and(ii)thepersonexecutingthisConfidentialityAgreementhasthefullpowerandauthoritytodoso.
INWITNESSWHEREOF,RecipienthassignedthisConfidentialityAgreementasofthedatebelowwritten.
RECIPIENT:__________________________CLIENT:CITYOFDENTON,TEXAS
By:___________________________________By:_________________________________
SAMPLE
SAMPLE
PrintName:____________________________PrintName:__________________________
(NoSignatureRequired)
(NoSignatureRequired)
Title:_________________________________Title:________________________________
Date:_________________________________Date:_______________________________
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
EXHIBITC
TRANSITIONSPECIFICS
UponterminationorexpirationofthisMA,foranyreason,ServiceProvideragreestoprovidethefollowing
assistancetoClientorClientsdesignatedagenttotransferServiceProvidersresponsibilitiesunderthisMA
andServiceScheduletoClientorClientsdesignatedagent(TransitionalServices):
Patientinformationwillbeprovidedviaawrite-protectedCD.
DetailedspecificationswillbeprovidedtoClientorClient's
Dataspecificationsdesignatedagent.
ServiceProviderSupportcontactswillbeprovidedtoanswer
questionsregardingthespecificationsdocumentand
Technicalandoperationalrequirements.Questionsmaybepresentedby
OperationalcontactsClientoritsdesignee.
AtestCDwillbeprovidedcontaining100patientaccountsand
TestCDtheirassociatedtransactionactivity.
AfinalCDwillincludealldebitandcreditbalanceaccounts
FinalCDresidingintheactiveAR.Zerobalanceaccountswillbe
provideduptotheageoftwoyears(basedonthedatethe
accountwasplacedonthesystem).Patientdemographicand
transactioninformationisincluded.
ListingswillbeprovidedtoClientoritsdesigneeforthe
followingfiles:
Utilityfilecodes
Chargecodes,descriptionandCPT
Referringphysiciancode,nameandNPI(ifavailable)
Performingphysician,codeandname
Locationofservice,codeanddescription
Transactioncodesanddescription
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
EXHIBITD
ENDUSERTERMSANDCONDITIONS
I.ClientacknowledgesandagreesthatallServices,computersoftware,programs,specificationsand
designs,documentation,manuals,methodologies,processes,andothermaterials,information,and
thecontentoftheforegoingaccessedbyClientthatisprovidedbyoronbehalfofServiceProvider
oritslicensors,andanycopiesthereof,(theServiceProviderProprietaryandConfidential
Information)aretheproprietary,confidentialandtradesecretinformationofServiceProvider,orits
licensors,andshallremainso;andthatsuchServiceProviderProprietaryandConfidential
InformationmaybeutilizedbyClientonlytofacilitateitsuseoftheServicesinaccordancewiththe
termsofthisExhibitandtheMA.Clientagrees,andwillcauseitsemployees,agentsand
representativestoagree,thatit/they(i)shallnotcopy,modify,change,disassemble,orreverse
engineeranyServiceProviderProprietaryandConfidentialInformation,and(ii)shallnotdisclose
ServiceProviderProprietaryandConfidentialInformation,exceptaslegallyrequired.Datafrom
transactionsreceivedorcreatedbyServiceProvidermaybeutilizedbyServiceProviderfordata
aggregationand/orstatisticalcompilationsorreports,research,andforotherpurposes(theUses)
solongassuchUsesareincompliancewithallapplicablelawsandpatientidentifyinginformationis
de-identifiedconsistentwiththeHIPAAPrivacyRule,andsuchUsesshallbethesoleandexclusive
propertyofServiceProvider.ThepartiesagreenottodisclosethetermsofthisExhibit,eitherpartys
businesspracticesorothertradesecretsorconfidentialandtradesecretinformationoftheother
partyoritslicensors,exceptaslegallyrequired.
II.Clientagrees,andshallcauseitsemployees,agentsandrepresentativestoagree,thatit/theyshall
not:(a)transmitorshareidentificationand/orpasswordcodestopersonsotherthantheAuthorized
Usersforwhomsuchcodesweregenerated;(b)permitAuthorizedUserstoshareidentification
and/orpasswordcodeswithothers;(c)permittheidentificationand/orpasswordcodesfrombeing
cachedinproxyserversandaccessedbyindividualswhoarenotAuthorizedUsers;(d)permit
accesstotheSoftwarethroughasingleidentificationand/orpasswordcodebeingmadeavailableto
multipleusersonanetwork;or(e)attemptorpermitanypersonwithoutvalididentificationand/or
passwordcodestoattempttoaccesstheSoftware.Clientagreesthat(w)theSoftwareembodies
valuableandproprietarytradesecretsofServiceProviderandoritslicensors,(x)theidentification
andpasswordcodesissuedbyServiceProviderhereunderconstitutevaluableconfidential
information,whichisproprietarytoServiceProvider,(y)anyreports,reportformats,documents,
ideasorotherdiscoveriesmadeordevelopedbyClientduringitsuseoftheSoftwaremaybeutilized
byClientonlyatClientfacilitywhereitisinstalled,onlytofacilitateitsuseoftheServiceshereunder
inaccordancewiththetermsofthisExhibitandtheMA,onlyinaccordancewithuserinstructions
andspecificationsprovidedbyServiceProviderandshallnotbegivenorsoldtoorusedonbehalf
ofanythird-party,andanyreports,reportformats,documents,ideasorotherdiscoveriesshallremain
thesoleandexclusivepropertyofServiceProvider,and(z)Clientagrees,andwillcauseits
employees,agents,subcontractorsandrepresentativestoagree,thatit/theyshallnotcopy,modify,
change,disassemble,orreverseengineeranypartoraspectoftheSoftware.
III.TheSoftwareshallbeinmachine-readableobjectcodeandmayonlybeutilizedatClientfacility
whereitisinstalled,solelyforClienttransactionsforwhichServiceProvideristoperformthe
Services,andonlyinaccordancewithuserinstructionsandspecificationsprovidedbyService
Provider.Clientshallobtainandmaintain,atnocostorexpensetoServiceProvider,the
software/hardwarerequiredbyClienttoaccesstheSoftwareandacknowledgesthatService
Providerrecommendsnospecificmanufacturerand/orsoftwarethatcomplieswithitsspecifications.
AsbetweenServiceProviderandClient,allsuchSoftwareisacknowledgedtobesubjecttoSection
VofthisExhibitandtheMA.SERVICEPROVIDERMAKESNOREPRESENTATIONSOR
WARRANTIES,EXPRESSEDORIMPLIED,WITHRESPECTTOTHESOFTWAREAND
DISCLAIMSALLOTHERWARRANTIES,INCLUDINGBUTNOTLIMITEDTOTHEIMPLIED
WARRANTIESOFMERCHANTABILITYAND/ORFITNESSFORAPARTICULARPURPOSE.
IV.ClientusersshallaccesstheSoftwarethroughacombinationofusernamesandpasswordsas
necessarytoprovideappropriatesecurity.Clientshallbesolelyresponsibleforassigninguser
namesandpasswordstoitsusersandforstrictlymaintainingtheconfidentialityofsuchusernames
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
andpasswords.Clientshallensurethatallofitsuserscomplywithallofthetermsandconditionsof
thisExhibitandtheMA.Clientshallnotpermitanypersonorentity,otherthanitsdesignatedusers,
touseorgainaccesstotheServicesandshallprovidereasonablesafeguardstoprotectagainst
unauthorizedusageoforaccesstotheServices.
V.ClientshallnotusetheSoftwareinanymanner,orinconnectionwithanyClientspecificmaterials
that(i)infringesuponorviolatesanyintellectualpropertyrightofanythird-party,(ii)constitutesa
defamation,libel,invasionofprivacy,orviolationofanyrightofpublicityorotherthird-partyrightor
isthreatening,harassingormalicious,or(iii)violatesanyapplicableinternational,federal,stateor
locallaw,rule,legislation,regulationorordinance,includingwithoutlimitation,theCommunications
DecencyActof1996,asamended,andwillnotinitiateorotherwisepursuedevelopmenteffortsthat
attempttoduplicateorre-createanyfunctionality,processesorbusinessmodelconceptsincluded
intheSoftware.
VI.ServiceProviderreservestherighttosubstitutealternativeproductsprovidingequivalentcore
functionalitytotheSoftware.
VII.UponClientsceasinguseoftheSoftware,theterminationofthisExhibitandtheMA,orService
Providerswrittenrequest,ClientshallceaseusingallServiceProviderprovidedSoftwareandrelated
materialsandpromptlyreturnsametoServiceProvideratClient'sexpense.Clientshallcertifyto
ServiceProviderinwritingthatallcopies(inanyformormedia)ofthematerialsreceived,whetheror
notmodifiedorincorporatedintoothermaterials,havebeendestroyedorreturnedtoServiceProvider.
TerminationofthisExhibitandtheMAoranylicenseshallnotrelieveClient'sobligationtopayallfees
incurredpriortosuchterminationandshallnotlimiteitherpartyfrompursuinganyotherremedies
availabletoit.
VIII.Eachpartyagreesthattheotherpartyand/oritslicensorsdonothaveanadequateremedyatlaw
toprotecttheirrespectiverightsunderthisExhibitandwillhavetherighttoseekinjunctiverelieffrom
anyviolationorthreatenedviolationofthisExhibitwithrespecttotheirrespectiverights.
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
SERVICESCHEDULE1
REIMBURSEMENTMANAGEMENTSERVICES
FOREMERGENCYMEDICALSERVICES
TheMATermsandConditionsandthisServiceScheduleapplytoallservicesrenderedbyServiceProvider
underthisServiceSchedule.
1.TERM
1.2 InitialTermofSchedule.TheinitialtermofthisServiceScheduleisthreeyears(the
ScheduleTerm)beginningSeptember1,2018(theCommencementDate).
1.3 AutomaticRenewal.ThisServiceSchedulewillautomaticallyrenewfortwoone-yearterms
unless(i)eitherpartydeliverstotheotherwrittennoticeofterminationatleast90daysprior
totheexpirationofthethen-currentterm,or(ii)asotherwisesetforthintheMA.
2ScopeofServices
2.1 Scope.ServiceProviderwillprovidetheservicesrelatedtothebillingofEmergencyMedical
Services(EMS)asspecifiedbelowbasedoninformationprovidedbyClientforprofessional
ambulanceservicesrenderedbyClientinaccordancewiththetermsoftheMAandthis
ServiceSchedule.
2.2 Responsibilities.Eachpartyagreestoperformitsrespectiveresponsibilitiesidentifiedbelow
inatimelyanddiligentmanner.ClientacknowledgesandagreesthatServiceProviders
performanceoftheServicesdescribedhereinisdependentuponClientsperformanceofits
responsibilitiesassetforthinthisServiceSchedule.
2.2.1 ServiceProviderResponsibilities.ServiceProviderwillhavemanagerial
responsibilitiesoverallbusinesssupportservicesastheyrelatetothebillingofEMS
providedbyClient,subjecttoClient'sultimatecontrol.InorderforServiceProvider
toprovidethenecessarybusinesssupportservicesonbehalfofClient,thefollowing
operatingpolicieswillbeusedwithrespecttoClientsEMS:
(a)BillingResponsibilities.ServiceProviderwillberesponsibleforbillingforall
EMSprovidedbyClient.ServiceProviderwill:
(i)Processalldemographicandchargeinformationenteredintothe
billingsystembasedontheinformationprovidedbyClient,including
thescheduleofEMSfees;
(ii)Processallrequiredinsuranceformswhethersubmitted
electronicallyoronhardcopy.Insuranceclaimswillbesubmitted
atleastweeklybasedontheavailabilityofinformationreceivedfrom
Client;
(iii)ProvideallHCFA-1500universalclaimformsneededtosubmit
claimsforEMSprovidedbyClient;
(iv)Printandmailpatientstatementsforaccountswithpatientbalances
greaterthan$0.01.Mailuptothreestatementsandprovide
telecollectcallaccordingtotheschedulesetforthbyClient,to
patientsforfeesnotreimbursedbythird-partypaymentsincluding
deductibles,co-paymentsandnon-coveredservicesforwhich
Clientmaintainsappropriatewaiverdocumentation.Clientwill
specifyifresidentsreceiveabalanceduestatementandifunpaid
patientbalancedueamountsarewritten-offorforwardedtoa
collectionagencyforfurtheractivity;
(v)ReceivefromClient'slockbox,notificationofpaymentandoriginal
remittanceadvices,andallotherbillingcorrespondence,as
appropriate;
(vi)Enterallremittanceinformation,including,contractualadjustments
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Client:DentonFireDepartment
ContractNumber:RMS155330
forthird-partypayerswithwhichClientparticipates(baseduponan
approvedlistprovidedbyClient),andsubmitsecondaryinsurance
claimsasnecessary;
(vii)Foraperiodofoneyear,maintainapaperorelectroniccopyof
explanationofbenefitstatements(EOBs)receivedfromthird-
partypayers.Attheendofoneyear,allEOBswillbereturnedto
ClientwhenrequestedormaybedestroyedbyServiceProvider;
(viii)Evaluateappropriatedocumentationofanyrequestbyapatient,
third-partyforanadjustmenttoapatient'sbill,andcoordinate
findingswithClient;
(ix)Codeeachpatientchart,onthebasisoftheinformationprovided
byClient,includingICDandHCPCScodes,proceduralmodifiers
andHCPCSLevelIIregulatorymodifiers;and
(x)AssistwithdesigningforClientallnecessaryforms,feeslips,
insuranceauthorizations,etc.,forprocessing.Costsofactualforms,
etc.willbetheresponsibilityofClient.
(b)CollectionResponsibilities.Inundertakingtheseresponsibilities,Service
Providerwill:
(i)Answerallpatientandthird-partypayerinquiries.Insomecases,
additionaldatawillberequestedfromClient.Responsestoall
patientinquirieswillbemadewithinonebusinessdaywhenever
possible;
(ii)Payforalltelephonecostsforpatientandthird-partypayerinquiries
andfollow-up;
(iii)Pursuebalanceswithanythird-partypayerasfollows:
1.Monitorthebalancesandfollow-upeitherinwritingorby
telephone,asappropriate,whenpaymentsareoverdue.
2.Monitorallpaymentsreceivedagainstanticipatedpayments.
Discrepanciesnotedwillbereviewedand,whenappropriate,
contactwillbemadebytelephone,inwriting,orinpersonwith
thethird-partypayertorequestclaimreview.
3.Monitorpaymentpatternsforeachthird-partypayeratleast
monthlytoidentifyanythird-partypayerwithlargeamountsof
pendingopenclaims.Appropriateactionwillbetakenwiththe
third-partypayertoexpeditepromptpayment.
4.Intheeventanyclaimisdeniedbyanythird-partypayerfor
reasonsotherthanapatient'sinsuredstatus,ServiceProvider
willuseitscommerciallyreasonableeffortstore-submitaclean
claiminatimelymanner.Intheeventaclaimisdeniedasa
resultofimpropercodingorotheractattributabletoService
Provider,ServiceProviderwillpursueatimelyappealofthe
deniedclaim.
5.Followupwiththethird-partypayeronassignedclaimsbased
upontheappropriatestrategyforworkingwithsuchthird-party
payer.
(iv)Pursuebalanceswithpatientsbyattachingnotesonstatementsat
pre-determinedintervalsusinglanguageapprovedbyClient;and
(v)Amountsduefromathird-partyorpatient,thathavenotbeen
collectedaftertheactivitiesdescribedaboveandthathaveaged
greaterthan180days,willbeconsidereduncollectable.Service
Providerwillprovidepertinentdemographicandtransactionaldetail
toClientidentifyinguncollectableaccountsmonthly.Unless
otherwiseinstructedbyClient,ServiceProviderwillwrite-offthe
identifiedaccountsasbaddebtsandwillceasecollectionefforts
associatedwiththoseaccounts.
(vi)NotifyClientinwritingoftheMonthlyRefundAmountowedbyClient
forthepreviousmonth.UponClientsdepositoftheMonthlyRefund
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
AmountintheRefundAccount,prepare,signandreleasethe
applicableindividualpatientandcarrierrefundchecks.
(vii)Research,identify,andnotifyClientofoverpaymentsthroughthe
refundregister/refundcheckspreparedforClientorthrougha
monthlymanagementreport.Overpaymentsthatremain
unresolvedsixty(60)daysafterClientsreceiptofnoticewillbe
removedfromServiceProvidersbillingsystem.
(viii)Makereasonableeffortstoidentifytheownersofunclaimed
property.NotifyClientofanyunresolvedrefundsthatService
Providerwroteoffafterninety(90)days.
(c)ReportingResponsibilities.ServiceProviderwillberesponsibleformaking
periodicreportstoClientonthecurrentstatusofallactivepatientaccounts.
Inundertakingtheseresponsibilities,ServiceProviderwill:
(i)Producemonthlyactivityandsummaryreportsasfollows:
1.Fire/EMSExecutiveSummary-oftheEMSforcurrentmonth
andyeartodateproducedby:
a.Numberoftransportsandgrosscharges/receiptsby
levelofservicedelivered;
b.Dropofflocation;and
c.PayerCategoryAnalysis.
2.FinancialSummary-ofcharges,write-offsandpaymentsofthe
EMSforcurrentmonthandyeartodateanalyzedby:
a.Currentchargesandpaymentsreceived;
b.PayerCategoryAnalysis;and
c.Summaryagingofaccountsreceivableand
adjustmentsandwrite-offs.
(ii)Provideoff-sitebackupofallactivedatafiles;and
(iii)ProvideadditionalreportsreasonablyrequestedbyClient.
(d)Implementation.ServiceProviderwillberesponsibleforimplementingthe
billingandcollectionservicesonbehalfofClient.Inundertakingsuch
implementation,ServiceProviderwill:
(i)AssignanaccountmanagertoClientwhowillberesponsibleforthe
following:
1.ActasprimarycontactwiththepersonnelofClient;
2.ServeastheliaisonwiththeServiceProvideremployees
assignedtoperformservicesforClient;
3.CommunicateregularlywiththekeymanagementofClientto
reviewallactivitieswithrespecttothebillingandcollection
services;
4.WorkcloselywithClienttoensureasmoothtransitionand
implementation;and
(ii)ReviewbothitsproceduresandtheproceduresofClientand
recommendandimplementapprovedchangesforimprovementsof
collections.
2.2.2 ClientsResponsibilities.InorderforServiceProvidertoundertakethebillingand
collectionservices,Clientwill:
(a)CausethepersonnelofClienttotimelysubmittoServiceProviderthename
ofthepatientwhenavailable,apapercopyofthePatientCareReportoran
electronicextractwhenavailable,thedateofservice,adescriptionofthe
nature,andtheextentofservicesprovidedandanysupportingmedical
informationnecessarytoobtainpaymentorreimbursement,includingthe
levelofserviceprovided,anaddressandzipcodeofwherethepatientwas
pickedupfromandapatientsignatureorotherappropriatesignaturewhen
apatientsignatureisnotpossible.Whereadispatchsystemisused,the
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ContractNumber:RMS155330
dispatchcodeordescriptionmustbeprovided.ServiceProviderwillrelyon
thetruthandaccuracyofsuchinformationandwillnotinanyeventbe
requiredtoverifymedicaltreatmentinformationsubmittedtoService
ProviderbyClient.Furthermore,Clientwilluseitsbesteffortstoprocureall
necessaryconsentstoallassignmentsandobtainallotherapprovals,
consents,andsignaturesnecessaryforServiceProvidertocollectpayment
forreimbursementonbehalfofClient;
(b)AssistServiceProviderwithestablishingdialogandadatainterfacewith
transporthospitalsmeanstogatherpatientdemographicandinsurance
datafromtransporthospitalswhenrequested,orprovidecopiesofthe
hospitalfacesheetifothermeansofcapturingthisdataarenotavailable.
(c)Besolelyresponsibleforsecuringorcausingtobesecuredfromoronbehalf
ofpatientswhoseaccountsarecoveredunderthisServiceSchedule,any
andallnecessaryconsentsforthereleaseofinformationtothirdpartiesas
contemplatedbythisServiceSchedule,andanyandallnecessary
assignmentsofinsurancebenefitsandbenefitsduefromandrightsto
paymentorreimbursementbyanyotherthirdparty.ClientwillnotifyService
Providerintheeventthatassignmentwasnotobtained;
(d)Supplycompleteandaccuratepatientchargeinformation;
(e)ProvidetoServiceProviderascheduleofprofessionalfeeschargedfor
servicesrenderedbyClientsEMS.ServiceProviderwillmakerevisionsto
thefeeschedulefromtimetotimeuponatleast10dayspriorwrittennotice
fromClienttotheeffectivedateofanysuchrevision.ServiceProviderwill
continuetobillattheratesthenineffectuntilreceiptofsuchnotice.Fee
schedulerevisionsmustincludeaneffectivedateforthenewcharges;
(f)Establishadequatecontrolstoassurethatallchargesarecaptured,batched
andreconciledwithbatchtotals;
(g)Provideallinputforms;
(h)Providemedicalexpertiseregardingreimbursementofmedicallynecessary
servicesofClientarisingfromthird-partypayerdisputesorpatientinquiries;
(i)Beresponsibleforallmedicaldecisionsconcerningpatientcare.
(j)Clientwillpromptlyreviewtherefundregister/refundcheckspreparedfor
Clientorthroughamonthlymanagementreportthatidentifiescurrent
refundsthataredueandwill,withinthirty(30)daysofreceiptoftherefund
register,refundcheckspreparedforClientormonthlymanagementreport
willwriteachecktoServiceProvider'srefundaccountforrefundstobesent
tothepatientorthird-partypayerbaseduponinformationprovidedby
ServiceProvider;and
(k)PrepareandreleaseClientsannualunclaimedpropertyreturn.
3SERVICEFEES
3.1 ClientagreestopayServiceProvideranamountequalto3.75%ofitsNetCollections(as
definedbelow)madeonClientsaccountsreceivableduringthepreviousmonth.Intheevent
thatthetotalrevenueforServiceProviderinamonthdoesnotexceed$500.00,Service
Providershallbepaidaminimumservicefeeof$500.00forthatmonth.
3.2 NetCollectionsmeansthetotalsumofallmoniescollectedforservicesrenderedbyClient,
lessamountsrefundedorcreditedtoapatientorthird-partypayerasaresultof
overpayments,erroneouspaymentsorbadchecks.
3.3 FeeforPostage.ClientagreestopayServiceProvideranamountequaltothepostage
chargesrelatedtotheServicesprovidedduringthepreviousmonth,includinganyincrease
inthecostofpostagepaidbyServiceProviderarisingoutofanyincreaseintheU.S.Postal
ServiceratesaftertheCommencementDate.
3.4 Equipment.ClientwillpayServiceProviderassetforthinSection3.7upondeliveryofthe
softwaredescribedinSections3.7and3.8ofthisServiceSchedule(collectively,
Equipment).WithrespecttotheEquipment,ServiceProvideragreesitwillberesponsible
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Client:DentonFireDepartment
ContractNumber:RMS155330
forannualfeesforthesoftwareincludingthebillinginterface.ServiceProviderwillalsobe
responsiblefortheinitialandmonthlyfeesrelatedtotheair-cardsoninternetservicefees
forthedurationoftheMA.
3.5 TherewillbeanadditionchargetoClientforrequests,includingbutnotlimitedto,forspecial
programmingandnon-standardreports.Thecostforsuchrequestswillbedeterminedon
anindividualbasisandsetforthinanamendmenttotheMA.
3.6 ClientacknowledgesthattheEquipmentandanyservicesrelatedtheretoareprovided
strictlyasis,andServiceProvidermakesnoadditionalwarranties,express,implied,arising
fromcourseofdealingorusageoftrade,orstatutory,astotheEquipment,anyassociated
servicesoranymatterwhatsoever.Inparticular,anyandallwarrantiesofmerchantability,
fitnessforaparticularpurpose,titleandnon-infringementareexpresslyexcluded.
3.7ePCRSolution.PatientCareReportingsoftware.ServiceProvideragreestoprovidethe
followinglistedsoftwareandhardwareforpatientcarereportingbasedontheconditions
listedbelow.
Software:
ePCRSolution
Conditions:
1.Termsofagreementforthesoftwarewillbeforaoneyearperiodwithtwoadditional
oneyearperiodsifagreementisautomaticallyrenewed.
2.Fees.$84,049breakdownasfollows:
$50,834for13CF20s(hardware)forEPCR
$28,730EPCRAnnualSoftwaresubscriptionforyear1.Thisincludesimplementation
fee.Itgoesdownto$24,245eachyeargoingforward.
$4,485implementationforbillinginterface.
3.SupportservicesforePCRSolutionareprovidedbyESOthroughon-lineandphone
support.
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DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
SERVICESCHEDULE2
BUSINESSPERFORMANCEINSIGHTSERVICES
TheTermsandConditionsoftheMAandthisServiceScheduleapplytotheBusinessPerformanceInsight
ServicesrenderedbyServiceProviderunderthisServiceSchedule.
1.TERM
1.1 InitialTermofSchedule.TheinitialtermofthisServiceScheduleisthreeyears(the
ScheduleTerm)beginningSeptember1,2018(theCommencementDate).
1.2 AutomaticRenewal.ThisServiceSchedulewillautomaticallyrenewfortwoone-yearterms
unless(i)eitherpartydeliverstotheotherwrittennoticeofterminationatleast90daysprior
totheexpirationofthethen-currentterm,or(ii)asotherwisesetforthintheMA.
2ScopeofServices
2.1 Responsibilities.Eachpartyagreestoperformitsrespectiveresponsibilitiesidentifiedbelow
inatimelyanddiligentmanner.ClientacknowledgesandagreesthatServiceProviders
performanceoftheBusinessPerformanceInsightServicesisdependentuponClients
performanceofitsresponsibilitiesassetforthinthisExhibit.
2.1.1 ServiceProviderResponsibilities.
(a)BasicUserAccess.
(i)Provide24-houraccess,lessscheduledorunscheduleddowntime
formaintenanceorrepair,fromanyInternetaccesspointtoClient
reportingportal.
(ii)Provideaccesstoallcurrentandfuturestandardlevelreports
generatedbyServiceProvider.
(iii)ProvideabilitytoreviewreportsasHTMLandPDFdocuments.
(iv)ProvidetheabilitytosavereportdocumentsasPDF,ExcelorCSV
fileformatteddocuments.
(v)ProvideaccesstotheDashboardfolderandassociatedcurrentand
futureDashboardbaseddeliverables.
(b)IntermediateUserAccess.
(i)IncludesallactivitiesdefinedintheBasicUserAccess.
(ii)Provideaccesstoallcurrentandfuturepublicreportsgeneratedby
ServiceProvider.
(iii)ProvideonlineanalysisfunctionalitywhichallowsClienttheability
todrilldown,filterandgroupdataaswellasapplysimpleupdates
suchasadding/removingfields,re-sorting,calculations,etc.
(iv)ProvideapersonalreportingmailboxwhichenablesClientto
send/receivereportsto/fromotheruserswithinClientsgroup.
(v)Provideabilitytosaveinapersonalfolderacopyofanaltered
reportforfuturedatarefreshorediting.
(vi)Providetheabilitytoschedulesavedreportsasneeded.
(c)AdvancedUserAccess.
(i)IncludesallactivitiesasdefinedintheBasicandIntermediateUser
Access.
(ii)Provideabilitytocreate,editandsavedocumentstructuresand
formats.
(iii)Provideabilitytomanipulatereportquery,prompts,filtersand
scopeofanalysis.
(iv)Provideabilitytomodify/createformulasandreportvariables.
page24of27
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
(v)ProvideaccesstoServiceProviderscompletead-hocreporting
developmentframework.
(vi)Providetheabilitytocustomizereportingqueries.
(vii)Providetheabilitytosetpersonaluserreportingpreferences.
(viii)UponClientsrequest,provideClientnamedfoldertobeutilizedby
ClientappointedAdvancedUser(s)tostorereportsforClientsuse.
(d)SupportServices.ServiceProviderwillprovidetelephoneande-mail
supporttoanswerquestionsandaddressissuesrelatedtothePractice
FocusWebBasedReportingproductatnocosttoClient.Normalsupport
hoursandresponsetimeareasfollow:
MondaythroughFriday:8:00a.m.until8:00p.m.easterntime
(e)TrainingServices.ServiceProviderwillprovideClientwithone1-hour
webinarforBasicUsersonthePracticeFocusWebBasedReporting
ProductatnocosttoClient.RecommendedtrainingforIntermediateUsers
iseithera2-dayon-siteIntermediatetrainingsessionorattendanceata
publicIntermediatetrainingsession.RecommendedtrainingforAdvanced
UsersisattendanceatanIntermediatetrainingsessionandadditional
attendanceateithera2-dayon-siteAdvancedtrainingsessionor
attendanceofapublicAdvancedtrainingsession.ServiceProvidercan
provideClienttrainingclassesforaspecificClientenvironmentoras
specificallyrequestedbyClient.
(f)eLearningTrainingForIntermediateUserAccess.IfrequestedbyClients
Manager,ServiceProviderwillprovideaoneyearsubscriptionfor
IntermediateUser(s).
(g)MobileElectronicAuthorizedUserAccess.IfrequestedbyClients
Manager,ServiceProviderwillprovideClientanAuthorizedUserand
allowsuchAuthorizedUsertoaccessBusinessPerformanceInsight
ServicesbymeansofanI-Padorothermobileelectronicdeviceauthorized
byServiceProvider.
(h)ConsultingServices.IfrequestedbyClientsManager,ServiceProviders
staffofresourcescandesign,buildandgeneratecustomizedClientspecific
PracticeFocusdeliverables,includingbutnotlimitedtocustomizedreports,
graphsanddashboards.
2.1.2 ClientsResponsibilities.Clientwill:
(a)EstablishClientsbroadbandaccesstotheInternetforuseofthePractice
FocusWebBasedReportingproduct.
(b)AllowaccesstosuchPracticeFocusWebBasedReportingProductonlyto
user(s)authorizedbyServiceProvidertoaccessandusesuchPractice
FocusWebBasedReportingProduct(AuthorizedUser).
(c)ProvideacompetentmemberofClientsstaff(Manager)tobetrainedby
ServiceProvideronuseofthePracticeFocusWebBasedReporting
producttoserveasaliaisontoServiceProvideronPracticeFocusWeb
BasedReportingmatters.
(d)AfterServiceProviderhasprovidedtrainingtoClientsManager,Client
agreestotrainonlyotherAuthorizedUsersonuseofthePracticeFocus
WebBasedReportingproduct.
(e)ClientsManagermaychangeAuthorizedUserslevelofuseoraddor
subtractAuthorizedUsersonnolessthan5dayspriorwrittennoticeto
ServiceProvider(e-mailrequestsareacceptable).
(f)Clientacknowledgesandagreesthatitshallnot:(i)transmitorshare
identificationand/orpasswordcodestopersonsotherthantheAuthorized
page25of27
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
Usersforwhomsuchcodesweregenerated;(ii)permitAuthorizedUsersto
shareidentificationand/orpasswordcodeswithothers;(iii)permitthe
identificationand/orpasswordcodesfrombeingcachedinproxyservers
andaccessedbyindividualswhoarenotAuthorizedUsers;(iv)permit
accesstotheBusinessPerformanceInsightServicesproductthrougha
singleidentificationand/orpasswordcodebeingmadeavailabletomultiple
usersonanetwork;or(v)attemptorpermitanypersonwithoutvalid
identificationand/orpasswordcodestoattempttoaccesstheBusiness
PerformanceInsightServicesproduct.
(g)Clientacknowledges(i)thatcertainservicesorobligationsofService
ProviderhereundermaybedependentonClientprovidingaccesstocertain
data,information,orassistancetoServiceProviderfromtimetotime
(collectively,"Cooperation");and(ii)thatsuchCooperationmaybeessential
totheperformanceofservicesbyServiceProvider.Thepartiesagreethat
anydelayorfailurebyServiceProvidertoprovideServiceshereunderwhich
iscausedbyClient'sfailuretoprovidetimelyCooperationreasonably
requestedbyServiceProvidershallnotbedeemedtobeabreachof
ServiceProvidersperformanceobligationsunderthisMA.
(h)Clientacknowledgesthat(i)theBusinessPerformanceInsightServices
productembodiesvaluableandproprietarytradesecretsofService
Provider,(ii)theidentificationandpasswordcodesissuedbyService
Providerhereunderconstitutevaluableconfidentialinformation,whichis
proprietarytoServiceProvider,(iii)theBusinessPerformanceInsight
ServicesproductmaybeutilizedbyClientonlytofacilitateitsuseofthe
ServiceshereunderinaccordancewiththetermsofthisMA,(iv)anyreports,
reportformats,documents,ideasorotherdiscoveriesmadeordeveloped
byClientduringitsuseoftheBusinessPerformanceInsightServices
productmaybeutilizedbyClientonlytofacilitateitsuseoftheServices
hereunderinaccordancewiththetermsofthisMAandshallnotbegivenor
soldtoorusedonbehalfofanythird-partyandshallremainthesoleand
exclusivepropertyofServiceProvider,and(v)Clientagrees,andwillcause
itsemployees,agents,subcontractorsandrepresentativestoagree,that
it/theyshallnotcopy,modify,change,disassemble,orreverseengineerany
partoraspectoftheBusinessPerformanceInsightServicesproduct.Client
shallsafeguardtherighttoaccesstheBusinessPerformanceInsight
Servicesproductandconfidentialityofsuchidentificationandpassword
codes,usingthesamestandardofcarewhichClientusesforitssimilar
confidentialmaterials,butinnoeventlessthanreasonablecare.
(i)Clientacknowledgesandagreesthatitissolelyresponsibleforthesecurity
ofanyinformationreceivedthroughBusinessPerformanceInsightServices
onanydeviceorinanyprintedformat.
(j)Clientacknowledgesandagreesthatitshall(1)immediatelynotifyService
ProviderofanyAuthorizedUserClientnolongerwishestohaveaccessto
theSoftware,and(2)indemnifyandholdServiceProviderharmlessfrom
andagainstanylosses(includingfinesorpenaltiesandinterest)incurred
byServiceProviderasaresultofClientsfailuretosonotifyService
Provider.
3ADDITIONALSERVICES
3.1.1 UserAccess.ServiceProviderwillprovide2AuthorizedUsersatnocosttoClient
forBasicUserAccess.ServiceProviderwillprovide1AuthorizedUseratnocostto
ClientforAdvancedUserAccess.ServiceProviderwillprovide3AuthorizedUsers
atnocosttoClientforIntermediateUserAccess.
3.1.2 TrainingServices.IfClientsManagerrequestprivateclassesataServiceProvider
facilityoratClientssite,ServiceProviderwillprovidesuchTrainingServicesatno
costtoClient.
page26of27
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Client:DentonFireDepartment
ContractNumber:RMS155330
3.1.3 ConsultingServices.IfClientsManagerrequestConsultingServices,Service
ProviderwillprovidesuchConsultingServicesatnocosttoClientandwillbeset
forthinaseparate PracticeFocusWebBasedReportingProductServiceForm;and
3.1.4 eLearningTrainingforIntermediateUserAccess.IfClientsManagerrequest
eLearningTrainingforIntermediateUserAccess,thenServiceProviderwillprovide
a1yearsubscriptionatnocosttoClient.
3.1.5 Implementation.ServiceProviderandClientsManagerwillmutuallyagree-uponthe
numberofAuthorizedUsers,andTrainingifapplicable,andClientsManagerwill
completethe PracticeFocusWebBasedReportingProductServiceForm.Clients
ManagerandServiceProviderwillmutuallyagreeuponarevised PracticeFocus
WebBasedReportingProductServiceForm anytimeClientsManagerrequestsa
changeinClientsuseofthePracticeFocusWebBasedReportingProduct;and
3.1.6 MobileElectronicAuthorizedUserAccess.AtClientsManagerrequest,Service
ProviderwillprovideClientanAuthorizedUsertoaccessBusinessPerformance
InsightServicesbymeansofanI-Padorothermobileelectronicdeviceatnocost
toClient.
page27of27
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Exhibit
House Bill 89 - Government Code 2270
VERIFICATION
I, _______________________________________________, the undersigned
representative of ______________________________Company or Business name
(hereafter referred to as company), being an adult over the age of eighteen (18)
years of age, verify that the company named-above, under the provisions of
Subtitle F, Title 10, Government Code Chapter 2270:
1. Does not boycott Israel currently; and
2. Will not boycott Israel during the term of the contract the above-named
Company, business or individual with City of Denton.
Pursuant to Section 2270.001, Texas Government Code:
1.
with, or otherwise taking any action that is intended to penalize, inflict
economic harm on, or limit commercial relations specifically with Israel, or
with a person or entity doing business in Israel or in an Israeli-controlled
territory, but does not include an action made for ordinary business
purposes; and
2. -profit sole proprietorship, organization,
association, corporation, partnership, joint venture, limited partnership,
limited liability partnership, or any limited liability company, including a
wholly owned subsidiary, majority-owned subsidiary, parent company or
affiliate of those entities or business associations that exist to make a profit.
___________________________________
Name of Company Representative (Print)
________________________________
Signature of Company Representative
_________________________________
Date
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
Exhibit
Senate Bill 252 -Government Code 2252
CERTIFICATION
I, ______________________________________________, the undersigned
representative of ________________________________________________
(Company or business name) being an adult over the age of eighteen (18) years of
age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152 and
Section 2252.153, certify that the company named above is not listed on the
website of the Comptroller of the State of Texas concerning the listing of
companies that are identified under Section 806.051, Section 807.051 or Section
2253.153. I further certify that should the above-named company enter into a
contract that is on said listing of companies on the website of the Comptroller of
the State of Texas which do business with Iran, Sudan or any Foreign Terrorist
Management Department.
___________________________________
Name of Company Representative (Print)
________________________________
Signature of Company Representative
_________________________________
Date
DocuSign Envelope ID: 4B0F1D1E-E25B-4D21-B031-1D7310C11DF3
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: 4B0F1D1EE25B4D21B0311D7310C11DF3Status: Completed
Subject: Please DocuSign: City Council Contract 6091
Source Envelope:
Document Pages: 33Signatures: 7Envelope Originator:
Certificate Pages: 6Initials: 0Jody Word
AutoNav: Enabled901B Texas Street
EnvelopeId Stamping: EnabledDenton, TX 76209
Time Zone: (UTC-08:00) Pacific Time (US & Canada)jody.word@cityofdenton.com
IP Address: 129.120.6.150
Record Tracking
Status: OriginalHolder: Jody WordLocation: DocuSign
7/13/2018 12:13:12 PM jody.word@cityofdenton.com
Signer EventsSignatureTimestamp
Jody WordSent: 7/13/2018 12:51:58 PM
Completed
jody.word@cityofdenton.comViewed: 7/13/2018 12:52:08 PM
BuyerSigned: 7/13/2018 12:54:09 PM
Using IP Address: 129.120.6.150
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Christopher W. RobertsonSent: 7/13/2018 12:54:11 PM
BPS_ServicesContracts@mckesson.comResent: 7/13/2018 1:08:06 PM
Senior Vice PresidentResent: 7/13/2018 1:11:02 PM
Change Healthcare Technology Enabled Services, Resent: 7/13/2018 1:20:22 PM
Using IP Address: 143.112.32.4
LLCResent: 7/13/2018 1:28:41 PM
Security Level: Email, Account Authentication Resent: 7/13/2018 1:43:59 PM
(None)
Resent: 7/13/2018 1:54:41 PM
Viewed: 7/13/2018 2:04:20 PM
Signed: 7/13/2018 2:07:17 PM
Electronic Record and Signature Disclosure:
Accepted: 7/13/2018 2:04:20 PM
ID: 2e0c3526-9c58-45ea-a25d-295867fd01b7
Larry CollisterSent: 7/13/2018 2:07:22 PM
larry.collister@cityofdenton.comViewed: 7/13/2018 2:08:41 PM
First Assistant City AttorneySigned: 7/13/2018 2:09:02 PM
City of Denton
Using IP Address: 129.120.6.150
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 9/26/2017 12:27:28 PM
ID: 01f5f868-f109-4e29-ad49-21db9046c882
Tabitha MillsopSent: 7/13/2018 2:09:05 PM
Completed
tabitha.millsop@cityofdenton.comViewed: 7/18/2018 2:23:24 PM
City of DentonSigned: 7/18/2018 2:31:22 PM
Using IP Address: 129.120.6.150
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Signer EventsSignatureTimestamp
Todd HilemanSent: 7/18/2018 2:31:28 PM
Todd.Hileman@cityofdenton.comViewed: 7/18/2018 3:19:08 PM
City ManagerSigned: 7/18/2018 3:19:17 PM
City of Denton
Using IP Address: 129.120.6.150
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 7/25/2017 9:02:14 AM
ID: 57619fbf-2aec-4b1f-805d-6bd7d9966f21
Jane RichardsonSent: 7/18/2018 3:19:20 PM
jane.richardson@cityofdenton.comViewed: 7/19/2018 7:52:20 AM
Assistant City SecretarySigned: 7/19/2018 7:52:42 AM
City of Denton
Using IP Address: 129.120.6.150
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer EventsSignatureTimestamp
Editor Delivery EventsStatusTimestamp
Agent Delivery EventsStatusTimestamp
Intermediary Delivery EventsStatusTimestamp
Certified Delivery EventsStatusTimestamp
Carbon Copy EventsStatusTimestamp
Sherri ThurmanSent: 7/13/2018 2:07:21 PM
sherri.thurman@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jennifer WaltersSent: 7/18/2018 2:31:26 PM
jennifer.walters@cityofdenton.com
City Secretary
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jennifer BridgesSent: 7/19/2018 7:52:45 AM
jennifer.bridges@cityofdenton.com
Procurement Assistant
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Carbon Copy EventsStatusTimestamp
Jane RichardsonSent: 7/19/2018 7:52:46 AM
jane.richardson@cityofdenton.comViewed: 10/29/2018 8:37:43 AM
Assistant City Secretary
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Christine TaylorSent: 7/19/2018 7:52:47 AM
christine.taylor@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Mauricio ChavezSent: 7/19/2018 7:52:48 AM
mauricio.chavez@changehealthcare.comViewed: 7/19/2018 8:02:14 AM
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Cynthia AlonzoSent: 7/19/2018 7:52:49 AM
cindy.alonzo@cityofdenton.comViewed: 7/19/2018 8:13:50 AM
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Notary EventsSignatureTimestamp
Envelope Summary EventsStatusTimestamps
Envelope SentHashed/Encrypted7/19/2018 7:52:49 AM
Certified DeliveredSecurity Checked7/19/2018 7:52:49 AM
Signing CompleteSecurity Checked7/19/2018 7:52:49 AM
CompletedSecurity Checked7/19/2018 7:52:49 AM
Payment EventsStatusTimestamps
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.
DocuSign Envelope ID: FCE30DAA-4A69-4F0B-9476-F77DD37B9FEA
5ƚĭǒƭźŭƓ /źƷǤ /ƚǒƓĭźƌ ƩğƓƭƒźƷƷğƌ /ƚǝĻƩƭŷĻĻƷ
CźƌĻ bğƒĻ
tǒƩĭŷğƭźƓŭ /ƚƓƷğĭƷ
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tźŭŭǤ .ğĭƉ hƦƷźƚƓ
/ƚƓƷƩğĭƷ 9ǣƦźƩğƷźƚƓ
hƩķźƓğƓĭĻ
DocuSign Envelope ID: FCE30DAA-4A69-4F0B-9476-F77DD37B9FEA
ORDER INSTRUCTIONS
1. Fill in Contact Info Below
Contact Name Email Phone
Battalion Chief David
Primary Business Contact David.Becker@cityofdenton.com (940) 349-8834
Becker
N/A (To be billed by Change
Invoicing Contact N/A N/A
Healthcare Technology
Enabled Services, LLC)
Legal Contact N/A (940) 349-8333
Software Administrator
Cherie Reed cherie.reed@cityofdenton.com (940) 349-7533
Contact
Battalion Chief David
Privacy/HIPAA Contact David.Becker@cityofdenton.com (940) 349-8834
Becker
Tax Exempt? N/A If YES, return Exempt Certificate with Agreement
Purchase Order
N/A If YES, return PO with Agreement
Required?
2. Sign page 8 & the last page.
3. Email entire contract to legal@esosolutions.com and your sales representative.
4. Enjoy your ESO Software
DocuSign Envelope ID: FCE30DAA-4A69-4F0B-9476-F77DD37B9FEA
MASTER SUBSCRIPTION AND LICENSE AGREEMENT
This Master Subscription and License ___________________ (
by and between ESO Solutions, Inc., a Texas corporation having its principal place of business at 11500 Alterra Parkway, Ste 100, Austin, Texas
78758 City of Denton having its principal place of business at 215 East McKinney Street., Denton, Texas 76201. This
Agreement consists of the General Terms & Conditions below and any Addenda (as defined below) executed by the parties, including any
attachments to such Addenda.
The parties have agreed that ESO will provide Customer with certain technology products and/or services and that Customer will pay
to ESO certain fees. Therefore, in consideration of the covenants, agreements and promises set forth below, and for other good and valuable
consideration, the receipt and sufficiency of which is hereby acknowledged, the parties, intending to be legally bound, hereby agree as set forth in
the pages that follow.
GENERAL TERMS AND CONDITIONS
1. DEFINITIONS. Capitalized terms not otherwise defined in this 1.11.
Agreement shall have the meanings below: meaning set forth in HIPAA. All references herein to PHI
shall be construed to include electronic PHI, or ePHI, as
that term is defined by HIPAA.
1.1. -
components or reporting service(s) that ESO makes
available to customer through its Licensed Software, 1.12. Reporting Services
Interoperability Software or SaaS. programs or tools ESO provides for Customer to generate
compilations of data, including but not limited to ad-hoc
reports, analytics, benchmarking or any other reporting tool
1.2. means a writing addressing an
provided through the Software.
order of a specific set of products or services executed by
authorized representatives of each party. An Addendum
may be (a) a Software Schedule (see Exhibit A1 A4), (b) a 1.13. s software-as-a-service that ESO hosts
Statement of Work, or (c) another writing the parties intend
to be incorporated by reference into this Agreement. avoidance of doubt, SaaS does not include Licensed
Software, but does include Add-on Software and
Interoperability Software.
1.3. ectronic form managed or
stored by ESO, which is entered into or transmitted through
the Software. 1.14. Software means any computer program, programming or
modules specified in each Software Schedule or SOW. For
the avoidance of doubt, Add-on Software, SaaS;
1.4. work product
Interoperability Software; and Licensed Software shall
created pursuant to a Statement of Work.
collectively be referred to as Software.
1.5. s user guides, operating manuals,
1.15. refers to an Addendum in which
and specifications regarding the Software covered by this
Customer has ordered either Add-on Software, Licensed
Agreement.
Software, Interoperability Software or SaaS, collectively
Software. See Exhibits A1 A4.
1.6. Feedback refers to any suggestion or idea for improving
or otherwise
1.16. refers to an Addendum in
which Customer has ordered Professional Services or a
1.7.
Deliverable from ESO.
subject matter, patents, and patent applications and other
proprietary information, activities, and any ideas, concepts,
1.17.
innovations, inventions and designs.
Exhibit B.
1.8. -as-a-service
1.18. the Software on
that ESO hosts (directly or indirectly) for Customer to
exchange healthcare data with others. Some of
passwords, whether authorized or not.
Reporting Services may be made available to Customer via
the Interoperability Software. For the avoidance of doubt,
Interoperability Software does not include Add-on 2. SOFTWARE SCHEDULES. During the Term of this
Software, Licensed Software or SaaS. Agreement, Customer may order Software from ESO by signing
a Software Schedule.
and its subscription to SaaS are set forth below. Each such
1.9. means on premise software that ESO
Software Schedule, Exhibits A-1, A-2, A-3, and A-4, are
provides to Customer for its reproduction and use. For the
incorporated herein by reference.
avoidance of doubt, Licensed Software does not include
Add-on Software, Interoperability Software or SaaS.
3. LICENSE/SUBSCRIPTION TO SOFTWARE
1.10. s professional services that a
Statement of Work calls on ESO to provide. 3.1. Grant of License. In the case of Licensed Software, during
the Term of this Agreement ESO hereby grants Customer a
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limited, non-exclusive, non-transferable, non-assignable, 4.2. Service Level Agreement. No credits shall be given in the
revocable license to copy and use the Licensed Software, in SaaS is delayed, impaired or
such quantities as are set forth on the applicable Software otherwise . If such
Schedule and Outage, excluding Scheduled Downtime (as defined below),
purposes; provided that, Customer complies with the results in the service level uptime falling below 99% for
Restrictions on Use (Section 3.3) and other limitations and three consecutive months or three months in any rolling
obligations contained in this Agreement. Such internal twelve-,
business purposes do not include reproduction or use by any then Customer shall have the option to immediately
parent, subsidiary, or affiliate of Customer, or any other terminate this Agreement; and ESO will refund any prepaid,
third party, and Customer shall not permit any such use. unearned Fees to Customer. This is
for Uptime Commitment.
3.2. Grant of Subscription. In the case of SaaS, during the term
of this Agreement Customer may access and use the SaaS, 4.3. Scheduled Downtime. In the event ESO determines that it
in such quantities as are set forth on the applicable Software is necessary to intentionally interrupt the SaaS or that there
Schedule; provided that, Customer complies with the is a potential for the SaaS to be interrupted for the
Restrictions on Use (Section 3.3) and other limitations performance of system maintenance (collectively,
contained in this Agreement. , ESO will use good-faith efforts to
notify Customer of such Scheduled Downtime at least 72
hours in advance and will ensure Scheduled Downtime
3.3. Restrictions on Use. Except as provided in this Agreement
occurs during non-peak hours (midnight to 6 a.m. Central
or as otherwise authorized by ESO, Customer has no right
Time). In no event shall Scheduled Downtime constitute a
to: (a) decompile, reverse engineer, disassemble, print, copy
failure of performance by ESO.
or display the Software or otherwise reduce the Software to
a human perceivable form in whole or in part; (b) publish,
release, rent, lease, loan, sell, distribute or transfer the 4.4. Support and Updates. During the Term of this Agreement,
Software to another person or entity; (c) reproduce the ESO shall provide to Customer the Support Services, in
Software for the use or benefit of anyone other than accordance with Exhibit B. Exhibit B is incorporated herein
Customer; (d) alter, modify or create derivative works based by reference.
upon the Software either in whole or in part; or (e) use or
permit the use of the Software for commercial time-sharing
5. FEES
arrangements or providing service bureau, data processing,
rental, or other services to any third party. The rights
5.1. Fees. In consideration of the rights granted and except in the
granted under the provisions of this Agreement do not
event there is a Third-Party Payer (as defined below),
constitute a sale of the Software. ESO retains all right, title,
Customer agrees to pay ESO the fees for the Software
and interest in and to the Software, including without
and/or Professional Services as set forth in the Software
limitation all software used to provide the Software and all
Except as
graphics, user interfaces, logos and trademarks reproduced
otherwise provided herein, the Fees are non-cancelable and
through the Software, except to the limited extent set forth
non-refundable. Either Customer or Third-Party Payer, as
in this Agreement. This Agreement does not grant
applicable, shall pay all invoices within thirty (30) days of
Customer any intellectual property rights in the Software or
receipt. In the event a third-party is paying some or all of
any of its components, except to the limited extent that this
the Fees on behal-Party Paye
Software Schedule will state that payment obligation if so,
access, use, or copy the Software during the Term of this
Third-Party Payer shall be responsible for paying the Fees.
Agreement. Customer recognizes that the Software and its
The parties agree that Customer may replace the Third-
components are protected by copyright and other laws.
Party Payer by submitting to ESO written notice
memorializing the change. In the event the Third-Party
3.4. Delivery. In the case of Licensed Software, ESO shall
Payer does not pay the Fees, ESO shall notify Customer in
provide the Licensed Software to Customer through a
writing. Upon delivery of said notice, Customer shall be
reasonable system of electronic download. In the case of
granted a thirty (30) day period during which it may, at its
SaaS, ESO shall grant Customer access to SaaS promptly
sole discretion, either i) immediately terminate this
after the Effective Date.
Agreement by sending written notice to ESO, in which case
Customer shall not be responsible for any unpaid Fees, or
3.5. Third-Party Software. Software may incorporate software ii) pay the unpaid Fees and continue to pay future Fees as
and other technology owned and controlled by third parties though Customer were the Third-Party Payer, in which case
("Third-Party Software"). ESO is licensed to sublicense this Agreement shall not terminate,
and distribute Third-Party Software. All Third-Party to the Software shall not be interrupted. In the event
Software falls under the scope of this Agreement. Customer is incapable of paying the Fees due to budgetary
Moreover, ESO neither accepts liability, nor warrants the restrictions but wishes to continue using the Software, ESO
functionality, reliability or accuracy of Third-Party may, at its sole discretion, develop a payment plan with
Software, including but not limited to third-party mapping Customer which shall be formalized in writing and signed
applications. by both parties. Unless Customer sends notice of
termination to ESO during the aforementioned thirty (30)
day period, Customer is responsible for payment in the
4. HOSTING, SLA & SUPPORT SERVICES
event the Third-Party Payer does not pay the Fees and
Customer continues using the Software.
4.1. Hosting & Management. Customer shall be solely
responsible for hosting and managing the Licensed
5.2. Uplift on Renewal. Except in the instance of Overages (as
Software. ESO shall be responsible for hosting and
defined below), Fees for Software, which recur annually,
managing the SaaS.
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shall increase by three percent (3%) each year this breach, Customer agrees to immediately remit all
Agreement is in effect. unpaid Fees as set forth on the applicable Software
Schedule equal to the Fees that will become due
during the remaining Term.
5.3. Taxes and Fees. This Agreement is exclusive of all taxes
and credit card processing fees, if applicable. Customer is
responsible for and will remit (or will reimburse ESO upon 6.4.2. If Customer terminates this Agreement or any
) all taxes of any kind, including sales, use,
duty, customs, withholding, property, value-added, and to the extent that Customer has prepaid any Fees,
other similar federal, state or local taxes (other than taxes ESO shall refund to Customer any prepaid Fees on a
related to this Agreement. pro-rata basis to the extent such Fees are
attributable to the period after the termination date.
5.4. Appropriation of Funds. If Customer is a city, county or
other government entity, the parties accept and agree that 6.4.3. Upon termination of this Agreement or any
Customer has the right to terminate the Agreement at the Software Schedule, Customer shall cease all use of
end of the Cthe Software and delete, destroy or return all copies
of the Documentation and Licensed Software in its
for the next fiscal year. Notwithstanding the foregoing, this possession or control, except as required by law.
provision shall not excuse Customer from past payment
obligations or other Fees earned and unpaid. Moreover,
6.4.4. Termination of this Agreement is without prejudice
Customer agrees to provide ESO reasonable documentation
to any other right or remedy of the parties and shall
evidencing such non-appropriation of funds.
not release either party from any liability (a) which
at the time of termination, has already accrued to
5.5. Audit Rights. ESO may regularly audit of the other party, (b) which may accrue in respect of
the Software and charge Customer a higher annual Fee if any act or omission prior to termination, or (c) from
has increased beyond the tier contracted any obligation which is intended to survive
for in the current Software Schedule or otherwise assess termination.
additional fees (for example, Customer is uploading more
records into the Software than it has previously contracted
6.5. Delivery of Data. If Customer requests its data within sixty
for) (collectively, . ESO may invoice for
(60) days of expiration or termination of this Agreement,
Overages immediately. Notwithstanding the foregoing, it is
ESO will provide Customer access to Customer Data in a
solely Custoverages to ESO
searchable .pdf format within a reasonable time frame
in a timely manner.
thereafter. ESO is under no obligation to retain Customer
Data more than sixty (60) days after expiration or
6. TERM AND TERMINATION termination of this Agreement.
6.1. Term
7. REPRESENTATIONS AND WARRANTIES
commence on the Effective Date and continue for a period
of three years. Thereafter, the Term will renew for a
7.1. Material Performance of Software. ESO warrants and
maximum of two successive one-year periods, unless either
represents that the Software will materially perform in
party opts out of such renewal by providing at least sixty
accordance with the Documentation provided by ESO, if
written notice before the scheduled renewal date. The
any.
license period or subscription period shall begin on the date
specified in the applicable Software Schedule, and this
7.2. Warranty of Services. ESO warrants that its personnel are
Agreement shall automatically be extended to ensure that
adequately trained and competent to perform Professional
the contract Term is coterminous with the subscription
Services and/or Support Services and that each will be
period or license period, as applicable.
performed in a professional and workmanlike manner.
6.2. Termination for Cause. Either party may terminate this
7.3. Due Authority
Agreement or any individual Software Schedule for the
performance of this Agreement and each agreement or
s material breach by providing written notice.
instrument contemplated by this Agreement has been duly
The breaching party shall have thirty days from receipt to
authorized by all necessary corporate or government action.
cure such breach to the reasonable satisfaction of the non-
breaching party.
7.4. Customer Cooperation. Customer agrees to reasonably and
timely cooperate with ESO, including but not limited to
6.3. Bankruptcy/Insolvency. This Agreement and any applicable
providing ESO with reasonable access to its equipment,
Software Schedule may be terminated immediately upon the
software, data and using current operating system(s).
following: (a) the institution of insolvency, receivership or
bankruptcy proceedings or any other proceedings for the
8. DISCLAIMER OF WARRANTIES. EXCEPT AS
settlement of debts of the other party; (b) the making of an
OTHERWISE PROVIDED IN SECTION 7, ESO HEREBY
assignment for the benefit of creditors by the other party; or
DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED,
(c) the dissolution of the other party.
INCLUDING, WITHOUT LIMITATION, ALL IMPLIED
WARRANTIES OF MERCHANTABILITY, FITNESS FOR A
6.4. Effect of Termination.
PARTICULAR PURPOSE, PERFORMANCE, SUITABILITY,
TITLE, NON-INFRINGEMENT, OR ANY IMPLIED
6.4.1. If this Agreement or any Software Schedule is
WARRANTY ARISING FROM STATUTE, COURSE OF
terminated by Customer prior to the expiration of its
DEALING, COURSE OF PERFORMANCE, OR USAGE OF
then-
TRADE. WITHOUT LIMITING THE GENERALITY OF THE
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FOREGOING: (a) ESO DOES NOT REPRESENT OR so long as such information remains subject to trade secret
WARRANT THAT THE SOFTWARE WILL PERFORM protection pursuant to applicable law. Upon termination of
WITHOUT INTERRUPTION OR ERROR; AND (b) ESO this Agreement, a party shall return all copies of
DOES NOT REPRESENT OR WARRANT THAT THE Confidential Information to the other or certify, in writing,
SOFTWARE IS SECURE FROM HACKING OR OTHER the destruction thereof.
UNAUTHORIZED INTRUSION OR THAT CUSTOMER
DATA WILL REMAIN PRIVATE OR SECURE. CUSTOMER
9.6. Retention of Rights. This Agreement does not transfer
-
ownership of Confidential Information or grant a license
thereto.
9. CONFIDENTIALITY
9.7. Open Records and Other Laws. Notwithstanding anything
in this Section to the contrary, the parties expressly
9.1. acknowledge that Confidential Information may be
any document marked disclosed if such Confidential Information is required to be
orally designated disclosed by law, a lawful public records request, or judicial
provided the disclosing party confirms such designation in order, provided that prior to such disclosure, written notice
writing within five (5) business days; (c) the Software and of such required disclosure shall be given promptly and
Documentation, whether or not designated confidential; and without unreasonable delay by the receiving party in order
(d) any other nonpublic, sensitive information reasonably to give the disclosing party the opportunity to object to the
considered a trade secret or otherwise confidential. disclosure and/or to seek a protective order. The receiving
Notwithstanding the foregoing, Confidential Information party shall reasonably cooperate in this effort. In addition,
does not include information that: (i) is in Customer may disclose the contents of this Agreement
possession at the time of disclosure; (ii) is independently solely for the purpose of completing its review and approval
developed without use of or reference to Confidential processes under its local rules, if applicable.
Information; (iii) becomes known publicly, before or after
disclosure, other than as a result of improper
10. INSURANCE. Throughout the term of this Agreement, and for a
action or inaction; (iv) is approved for release in writing by
period of at least three (3) years thereafter for any insurance
the disclosing party; (v) is required to be disclosed by law;
written on a claims-made form, ESO shall maintain in effect the
or (vi) PHI, which shall be governed by the Business
insurance coverage described below:
Associate Agreement rather than this Section.
10.1. Commercial general liability insurance with a minimum of
9.2. Nondisclosure. The parties shall not use Confidential
$1 million per occurrence and $1 million aggregate;
Information for any purpose other than to fulfill the terms of
this Agreement Each party: (a) shall ensure
10.2. Commercial automobile liability insurance covering use of
that its employees or contractors are bound by
all non-owned and hired automobiles with a minimum limit
confidentiality obligations no less restrictive than those
of $1 million for bodily injury and property damage
contained herein and (b) shall not disclose Confidential
liability;
Information to any other third party without prior written
consent from the disclosing party. Without limiting the
10.3. W
generality of the foregoing, the receiving party shall protect
insurance or any alternative plan or coverage as permitted
Confidential Information with the same degree of care it
uses to protect its own confidential information of similar
liability limit of $1 million each accident or disease; and
nature and importance, but with no less than reasonable
care. A receiving party shall promptly notify the disclosing
party of any misuse or misappropriation of Confidential
10.4. Computer processor/computer professional liability
Information of which it is aware.
insurance (Technology Errors and Omissions) covering
the liability for financial loss due to error, omission or
negligence of ESO, and Privacy and Network Security
9.3. Policies. Customer
insurance (Cyber) covering losses arising from a
acknowledges that any information provided by ESO
disclosure of confidential information, with a combined
pertaining
aggregate amount of $3 million.
audits,
security posture are considered Confidential Information
and shall be treated by Customer in accordance with the
10.5. The insurance provided in 10.1 and 10.2 shall be endorsed
terms and conditions of this Agreement.
to name the Customer as an Additional Insured.
9.4. Injunction. Customer agrees that breach of this Section
10.6. The insurance provided in 10.1, 10.2, and 10.3 shall provide
would cause ESO irreparable injury, for which monetary
a Waiver of Subrogation in favor of the Customer.
damages would not provide adequate compensation, and
that in addition to any other remedy, ESO will be entitled to
11. INDEMNIFICATION
injunctive relief against such breach or threatened breach,
without ESO proving actual damage or posting a bond or
A. Definitions:
other security.
i. "Indemnified Claims" shall exclude claims, demands,
9.5. Termination & Return. With respect to each item of
suits, causes of action, judgments and liability between
Confidential Information, the obligations of nondisclosure
ESO and Customer, but shall include any and all third-
will terminate three (3) years after the date of disclosure;
party claims, demands, suits, causes of action,
provided that, such obligations related to Confidential
judgments and liability of every character, type or
Information constituting ESO
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description, including all reasonable costs and expenses CONNECTION WITH THIS AGREEMENT, SHALL
of litigation, mediation or other alternate dispute NOT EXCEED THE GREATER OF SIXTY-THOUSAND
resolution mechanism, including attorney and other DOLLARS OR THE FEES PAID BY CUSTOMER (OR
professional fees for (a) damage to or loss of the ON BEHALF OF CUSTOMER IN THE CASE OF A
property of any person (including, but not limited to, THIRD-PARTY PAYER) UNDER THE APPLICABLE
the Customer, ESO, their respective agents, officers, SOFTWARE SCHEDULE OR SOW GIVING RISE TO
employees and subcontractors; the officers, agents, and THE CLAIM WITHIN THE PRECEDING 24-MONTH
employees of such subcontractors; and third parties), PERIOD.
and/or (b) death, bodily injury, illness, disease,
,
12.3.
but not limited to, the agents, officers and employees of
LIABILITY AS TO CUSTOMER. TO THE EXTENT
the Customer
PERMITTED BY LAW,
parties).
LAIMS FOR WHICH INSURANCE
COVERAGE IS PROVIDED BY SECTION 10 SHALL
B. SUBJECT TO THE LIMITATIONS OF LIABILITY NOT EXCEED THE INSURANCE LIMITS IN SECTION
SET OUT IN SECTION 12 OF THE AGREEMENT, 10 OF THE AGREEMENT. FOR CLAIMS FOR WHICH
ESO SHALL DEFEND (AT THE OPTION OF THE
CUSTOMER), INDEMNIFY, AND HOLD MAXIMUM AGGREGATE LIABILITY SHALL BE
CUSTOMER, ITS SUCCESSORS, ASSIGNS, $3,000,000.00.
OFFICERS, EMPLOYEES AND ELECTED
OFFICIALS HARMLESS FROM AND AGAINST
12.4. EXCEPTIONS TO LIMITATION OF
ALL INDEMNIFIED CLAIMS DIRECTLY
LIABILITY TO THIRD PARTIES.
LIABILITY FOR THIRD PARTY CLAIMS
AGENTS, EMPLOYEES OR SUBCONTRACTORS,
INVOLVING INDEMNIFICATION
IN THE PERFORMANCE OF E
OBLIGATIONS ARISING OUT OF SECTION 11 OF
UNDER THE AGREEMENT, EXCEPT THAT ESO
THE AGREEMENT SHALL BE LIMITED TO THE
WILL HAVE NO LIABILITY TO THE CUSTOMER
LESSER OF THE INSURANCE LIMITS IN SECTION 10
TO THE EXTENT OF ANY COMPARATIVE
OF THE AGREEMENT, IF APPLICABLE, OR THE
NEGLIGENCE OF ANY INDEMNIFIED PARTY.
APPLICABLE TORT LIABILITY SET
THIS OBLIGATION TO DEFEND, INDEMNIFY,
OUT IN TEXAS CIVIL PRACTICE AND REMEDIES
AND HOLD HARMLESS DOES NOT EXTEND TO
CODE CHAPTER 101, IF APPLICABLE. FOR CLAIMS
PROFESSIONAL LIABILITY CLAIMS ARISING
FROM PROFESSIONAL ERRORS AND
AGGREGATE LIABILITY SHALL BE $3,000,000.00
OMISSIONS. ESO ALSO AGREES TO REIMBURSE
THE INDEMNIFIED PARTIES FOR ALL COSTS,
12.5. THIS SECTION 12 SHALL SURVIVE EXPIRATION OR
TERMINATION OF THE AGREEMENT.
IF THE INDEMNIFIED PARTIES PREVAIL ON ANY
CLAIM AGAINST ESO FOR ESTABLISHMENT OF
13. CUSTOMER DATA & PRIVACY
EMNITY OBLIGATIONS. NOTHING
HEREIN SHALL BE DEEMED TO LIMIT THE
RIGHTS OF THE CUSTOMER OR ESO
13.1. Ownership of Data & Reports. As between ESO and
(INCLUDING, BUT NOT LIMITED TO, THE RIGHT
Customer, all Customer Data shall be owned by Customer.
TO SEEK CONTRIBUTION) AGAINST ANY THIRD
Without limiting the foregoing, ESO will own all right, title
PARTY WHO MAY BE LIABLE FOR AN
and interest in all Intellectual Property in any aggregated
INDEMNIFIED CLAIM.
and de-identified reports, summaries, compilations, analysis
or other information made available through
Reporting Services. If subscribed to by Customer, ESO
C. THIS SECTION 11 SHALL SURVIVE
grants to Customer a limited, non-exclusive license to use
EXPIRATION OR TERMINATION OF THE
ernal purposes
AGREEMENT.
only during the Term of this Agreement. No other third
party shall
12. LIMITATION OF LIABILITY
thereof. ESO disclaims all liability for any damages related
thereto. Customer acknowledges and agrees that any such
12.1. LIMITATION OF DAMAGES. UNDER NO
license expires upon the expiration or termination of the
CIRCUMSTANCES SHALL ESO OR CUSTOMER BE
LIABLE TO EACH OTHER FOR ANY
Reporting Services.
CONSEQUENTIAL, INDIRECT, SPECIAL, PUNITIVE
OR INCIDENTAL DAMAGES, INCLUDING CLAIMS
13.2. Use of Customer Data.
FOR DAMAGES FOR LOST PROFITS, GOODWILL,
written consent, ESO: (a) shall not access, process, or
USE OF MONEY, INTERRUPTED OR IMPAIRED USE
otherwise use Customer Data; and (b) shall not intentionally
OF THE SOFTWARE, AVAILABILITY OF DATA,
grant any third-party access to Customer Data, including
STOPPAGE OF WORK OR IMPAIRMENT OF OTHER
without limitation ESOept
ASSETS.
subcontractors that are subject to a reasonable nondisclosure
agreement or authorized participants in the case of
12.2. LIMITATION OF LIABILITY AS TO CUSTOMER.
Interoperability Software. Notwithstanding the foregoing,
TO THE EXTENT PERMITTED BY LAW, WITH THE
ESO may use and disclose Customer Data to fulfill its
EXCEPTION OF SECTION 12
obligations under this Agreement or as required by
AGGREGATE LIABILITY FOR ALL CLAIMS OF
applicable law or by proper legal or governmental authority.
LIABILITY TO CUSTOMER ARISING OUT OF OR IN
ESO shall give Customer prompt notice of any such legal or
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governmental demand and reasonably cooperate with 15.4. Excluded Parties List. ESO agrees to immediately report to
Customer in any effort to seek a protective order or Customer if an employee or contractor is listed by a federal
otherwise to contest such required diagency as debarred, excluded or otherwise ineligible for
expense. participation in federally funded health care programs.
13.3. Anonymized Data. Notwithstanding any provision herein, 16. PHI ACCURACY & COMPLETENESS
ESO may use, reproduce, license, or otherwise exploit
Anonymized Data; provided that Anonymized Data does
16.1. ESO provides the Software to allow Customer (and its
Anonymized
respective Users) to enter, document, and disclose Customer
Customer Data with the following removed: personally
Data, and as such, ESO gives no representations or
identifiable information and the names and addresses of
guarantees about the accuracy or completeness of Customer
Data (including PHI) entered, uploaded or disclosed
through the Software.
13.4. Risk of Exposure. Customer recognizes and agrees that
hosting data online involves risks of unauthorized
16.2. Customer is solely responsible for any decisions or actions
disclosure.. Customer has sole responsibility for obtaining,
taken involving patient care or patient care management,
maintaining, and securing its connections to the Internet.
whether those decisions or actions were made or taken
ESO makes no representations to Customer regarding the
using information received through the Software.
reliability, performance or security of any network or
provider.
17. MISCELLANEOUS
14. FEEDBACK RIGHTS & WORK PRODUCT
17.1. Independent Contractors. The parties are independent
contractors. Neither party is the agent of the other, and
14.1. Feedback Rights. ESO does not agree to treat as
confidential any Feedback that Customer provides to ESO.
parties agree that no ESO employee or contractor is or will
Nothing in this Agreement will restrict ESO
be considered an employee of Customer.
profit from, disclose, publish, keep secret, or otherwise
exploit Feedback, without compensation or crediting
17.2. Notices. Notices provided under this Agreement must be in
Customer. Feedback will not constitute Confidential
writing and delivered by (a) certified mail, return receipt
Information, even if it would otherwise qualify as such
requested as forth in
pursuant to Section 9 (Confidential Information).
the recitals on page 1 of this Agreement, (b) hand delivered,
(c) facsimile with receipt of a "Transmission Confirmed"
14.2. Work Product Ownership. In the event Customer hires ESO
acknowledgment, (d) e-mail, or (e) delivery by a reputable
to perform Professional Services, ESO alone shall hold all
overnight carrier service. In the case of delivery by
right, title, and interest to all proprietary and intellectual
facsimile or e-mail, the notice must be followed by a copy
property rights of the Deliverables (including, without
of the notice being delivered by a means provided in (a), (b)
limitation, patents, trade secrets, copyrights, and
or (e). The notice will be deemed given on the day the
trademarks), as well as title to any copy of software made
notice is received.
by or for Customer (if applicable). Customer hereby
explicitly acknowledges and agrees that nothing in this
17.3. Merger Clause. In entering into this Agreement, neither
Agreement or a separate SOW gives the Customer any
party is relying upon any representations or statements of
right, title, or interest to the intellectual property or
the other that are not fully expressed in this Agreement;
proprietary know-how of the Deliverables.
rather each party is relying on its own judgment and due
diligence and expressly disclaims reliance upon any
15. GOVERNMENT PROVISIONS
representations or statement not expressly set forth in this
Agreement. In the event the Customer issues a purchase
15.1. Compliance with Laws. Both parties shall comply with and order, letter or any other document addressing the Software
give all notices required by all applicable federal, state and or Services to be provided and performed pursuant to this
local laws, ordinances, rules, regulations and lawful orders Agreement, it is hereby specifically agreed and understood
of any public authority bearing on the performance of this that any such writing is for the internal
Agreement. purposes only, and that any terms, provisions, and
conditions contained therein shall in no way modify this
Agreement.
15.2. Business Associate Addendum. The parties agree to the
terms of the Business Associate Addendum attached hereto
as Exhibit C and incorporated herein by reference. 17.4. Severability. To the extent permitted by applicable law, the
parties hereby waive any provision of law that would render
any clause of this Agreement invalid or otherwise
15.3. Equal Opportunity. The parties shall abide by the
unenforceable in any respect. If a provision of this
requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-
Agreement is held to be invalid or otherwise unenforceable,
741.5(a), and the posting requirements of 29 CFR Part 471,
such provision will be interpreted to fulfill its intended
appendix A to subpart A, if applicable. These regulations
purpose to the maximum extent permitted by applicable
prohibit discrimination against qualified individuals based
law, and the remaining provisions of this Agreement will
on their status as protected veterans or individuals with
continue in full force and effect.
disabilities, and prohibit discrimination against all
individuals based on their race, color, religion, sex, sexual
orientation, gender identity or national origin. 17.5. Assignment & Successors. Neither party may assign,
subcontract, delegate or otherwise transfer this Agreement
or any of its rights or obligations hereunder, nor may it
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contract with third parties to perform any of its obligations U.S. city, county, municipality or other U.S. governmental
hereunder except as contemplated in this Agreement, entity, then any Dispute will be governed by the law of state
where Customer is located, without regard to its conflicts of
either party may, without the prior consent of the other, law. The UN Convention for the International Sale of
assign all its rights under this Agreement to (i) a purchaser Goods and the Uniform Computer Information Transactions
of all or substantially all assets related to this Agreement, or Act will not apply. In any Dispute, each party will bear its
(ii) a third party participating in a merger, acquisition, sale
of assets or other corporate reorganization in which either
party is participating (cTexas Civil Practices and Remedies Code.
provided however, that the non-assigning party is given
notice of the Change in Control.
17.13. Venue. The parties agree that any Dispute shall be brought
exclusively in the state or federal courts located in Denton
17.6. Modifications and Amendments. This Agreement may not County, Texas. The parties agree to submit to the personal
be amended except through a written agreement signed by jurisdiction of such courts. Notwithstanding the foregoing,
authorized representatives of each party. in the event Customer is a U.S. city, county, municipality or
other U.S. governmental entity, then any Dispute shall be
brought exclusively in the state or federal courts located in
17.7. Force Majeure. No delay, failure, or default, other than a
the county where Customer is located.
failure to pay Fees when due, will constitute a breach of this
Agreement to the extent caused by acts of war, terrorism,
hurricanes, earthquakes, other acts of God or of nature, 17.14. Intentionally deleted.
strikes or other labor disputes, riots or other acts of civil
disorder, embargoes, or other causes beyond the performing
17.15. No Class Actions. NEITHER PARTY SHALL BE
.
ENTITLED TO JOIN OR CONSOLIDATE CLAIMS BY
In such event, however, the delayed party must promptly
OR AGAINST THE OTHER CUSTOMERS, OR PURSUE
provide the other party notice of the Force Majeure. The
ANY CLAIM AS A REPRESENTATIVE OR CLASS
excused for
ACTION OR IN A PRIVATE ATTORNEY GENERAL
the duration of the Force Majeure, but if the event last
CAPACITY.
longer than thirty (30) days, the other party may
immediately terminate the applicable Software Schedule.
17.16. Limitation Period. NEITHER PARTY, shall be liable for
any claim brought more than 2 years after the cause of
17.8. Marketing. Customer hereby grants ESO a license to
action for such claim first arose.
press release announcing this Agreement; provided ESO
17.17. Dispute Resolution. Customer and ESO will attempt to
first submits each such press release or customer list to
resolve any Dispute through negotiation or by utilizing a
Customer and receives written approval, which approval
mediator agreed to by the parties, rather than through
shall not be unreasonably withheld. Goodwill associated
litigation. Negotiations and mediations will be treated as
with the logo inures solely to Customer, and ESO shall take
confidential. If the parties are unable to reach a resolution
no action to damage the goodwill associated with the logo
within thirty (30) days of notice of the Dispute to the other
or with Customer.
party, the parties may pursue all other courses of action
available at law or in equity.
17.9. Waiver & Breach. Neither party will be deemed to have
waived any of its rights under this Agreement unless it is an
17.18. Technology Export. Customer shall not: (a) permit any third
explicit written waiver made by an authorized
party to access or use the Software in violation of any U.S.
representative. No waiver of a breach of this Agreement
law or regulation; or (b) export any software provided by
will constitute a waiver of any other breach of this
ESO or otherwise remove it from the United States except
Agreement.
in compliance with all applicable U.S. laws and regulations.
Without limiting the generality of the foregoing, Customer
17.10. Survival of Terms. Unless otherwise stated
shall not permit any third party to access or use the
and respective obligations, representations and
Software in, or export such software to, a country subject to
warranties under this Agreement which are not, by the
a United States embargo (as of the Effective Date - Cuba,
expressed terms of this Agreement, fully to be performed
Iran, North Korea, Sudan, and Syria).
while this Agreement is in effect shall survive the
termination of this Agreement.
17.19. Order of Precedence. In the event of any conflict between
this Agreement, Addenda or other attachments incorporated
17.11. Ambiguous Terms. This Agreement will not be construed
herein, the following order of precedence will govern: (1)
against any party by reason of its preparation.
the General Terms and Conditions; (2) any Business
Associate Agreement; (3) the applicable Software Schedule
17.12. Governing Law. This Agreement, any related Addenda, and or SOW, with most recent Software Schedule or SOW
any CLAIM, DISPUTE, OR CONTROVERSY taking precedence over earlier ones; and (4) any ESO policy
(WHETHER IN CONTRACT, TORT, OR OTHERWISE, posted online, including without limitation its privacy
INCLUDING STATUTORY, CONSUMER policy. No amendments incorporated into this Agreement
PROTECTION, COMMON LAW, INTENTIONAL TORT after execution of the General Terms and Conditions will
AND EQUITABLE CLAIMS) BETWEEN CUSTOMER amend such General Terms and Conditions unless it
AND ESO, including their affiliates, contractors, and specifically states its intent to do so and cites the section or
agents, and each of their respective employees, directors, sections amended.
the State of Texas, without regard to conflicts of law.
Notwithstanding the foregoing, in the event Customer is a
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17.20. Counterparts. This Agreement may be executed in one or 17.21. Signatures. Electronic signatures on this Agreement or on
more counterparts. Each counterpart will be an original, and any Addendum (or copies of signatures sent via electronic
all such counterparts will constitute a single instrument. means) are the equivalent of handwritten signatures.
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IN WITNESS WHEREOF, the parties have executed this Agreement as of the Effective Date.
ESO Solutions, Inc. Customer: City of Denton, Texas
\[Signature\] \[Signature\]
TODD HILEMAN
\[Printed Name\] \[Printed Name\]
CITY MANAGER
\[Title\] \[Title\]
THIS AGREEMENT HAS BEEN BOTH
REVIEWED AND APPROVED
as to financial and operational obligations
and business terms.
________________ ________________
Signature Printed Name
_________________________________
Title
_________________________________
Department
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
BY:___________________________________
APPROVED AS TO LEGAL FORM:
AARON LEAL, CITY ATTORNEY
BY:___________________________________
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EXHIBIT A-1
SAAS SOFTWARE SCHEDULE
(Applications - ESO EHR, ESO Fire, ESO PM)
1. The General Terms & Conditions are incorporated herein by reference. The SaaS subscription term shall begin fifteen (15) calendar days
SaaS Customer shall be deemed to have accepted the SaaS on the SaaS Subscription
Start Date. The parties will make reasonable efforts to ensure that Customer is live on the SaaS as quickly as possible, and in no event will
the SaaS Subscription Start Date be modified for implementation delays.
2. The following SaaS may be ordered under this Exhibit:
2.1. ESO SaaS software application for prehospital patient documentation
(http://www.esosolutions.com/software/ehr).
2.2. ESO SaaS software application for tracking personnel records, training courses and education
history (http://www.esosolutions.com/software/personnel-management).
2.3. ESO Fire is a SaaS software application for NFIRS reporting (http://www.esosolutions.com/software/fire).
3. Third-Party Payer is responsible for the following products and Fees:
4. Customer hereby agrees to timely pay for the following products according to the schedule below:
NA
5. the Fees above will be invoiced by ESO to Third Party Payer as follows:
5.1. Training and Training Travel Fees shall be invoiced on the Effective Date.
5.2. During the first year, 100% of the recurring Fees shall be invoiced on the Subscription Start Date.
5.3. During the second year and any renewal years thereafter, 100% of the Fees shall due on the anniversary of the SaaS Subscription
Start Date.
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EXHIBIT A-3
INTEROPERABILITY SOFTWARE SCHEDULE
(ESO Health Data Exchange )
1. The General Terms & Conditions are incorporated herein by reference. The Interoperability Software subscription term shall begin the
earlier of one hundred eighty (180) calendar day after the Effective Date or the first day the Interoperability Software is used in production
Interoperability Customer shall be deemed to have accepted the Interoperability Software on the
Interoperability Subscription Start Date. The parties will make reasonable efforts to ensure that Customer is live on the Interoperability
Software as quickly as possible, and in no event will the Interoperability Subscription Start Date be modified for implementation delays.
2. The following Interoperability Software may be ordered under this Exhibit:
2.1. HDE is a data interoperability platform for connecting EMS with other healthcare providers
http://www.esosolutions.com/software/hde).
3. Third-Party Payer is solely responsible for the following products and Fees:
4. Customer hereby agrees to timely pay for the following products according to the schedule below:
NA
5. ll Fees above will be invoiced by ESO to Third Party Payer as follows:
5.1. During the first year, the Implementation Fee shall be invoiced on the Effective Date and the recurring Fees (e.g. Connection Fees
and Volume Fees) shall be due on the Interoperability Subscription Start Date. In addition, an additional Implementation Fee shall be
due if Customer migrates to a new hospital EHR vendor that requires ESO to update the Interoperability Software.
5.2. During the second year and any renewal years thereafter, 100% of the Fees shall be due on the anniversary of the Interoperability
Subscription Start Date.
EXHIBIT B
SUPPORT SERVICES ADDENDUM
1. DEFINITIONS. Capitalized terms not defined below shall have the same meaning as in the General Terms & Conditions.
1.1. that when added to the Software, materially changes
its utility, efficiency, functional capability or application.
1.2. E-mail S-mail at any time concerning the use of the
then-current release of Software.
1.3. Software, which significantly degrades performance of such Software then-
published Documentation.
1.4. .
1.5. means the repair or replacement of object code for the Software or Documentation to remedy an Error.
1.6. upport Representative after the incident has been logged and a ticket generated. This
may include an automated email response depending on when the incident is first communicated.
1.7. uch
Error(s) have been reported and of steps being taken to correct such Error(s).
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1.8. Severity Software completely inoperative (e.g. a User cannot access the Software due to
unscheduled downtime or an Outage).
1.9. Severity an Error in which Software is still operable; however, one or more significant features or functionality are
unavailable (e.g. a User cannot access a core component of the Software).
1.1. Severity rror that does not prevent a User from accessing a significant feature of the Software (e.g. User
is experiencing latency in reports).
1.2. Severity Documentation or a Customer Enhancement request.
1.3. tion of the Customer regarding the progress
of the Workaround or Fix.
1.4. website (www.esosolutions.com), including frequently asked
questions and bug reporting via Live Chat.
1.5. shall be ESO employee(s) or agent(s) designated to receive Error notifications from Customer, which
1.6. typically for Error Correction.
1.7. or
which adds functional capabilities to the Software and is not included in an Update. Upgrades may include Enhancements.
1.8.
Software.
2. SUPPORT SERVICES.
2.1. Customer will provide at least one who will handle all requests
for first- with respect to the Software.
support and information about Users. ESO will provide training, documentation, and materials to the
Administrator to enable the Administrator Users. The Administrator will notify a
Support Representative of any Errors that the Administrator cannot resolve and assist ESO in information gathering.
2.2. ESO will provide Support Services consisting of (a) Error Correction(s); Enhancements, Updates and Upgrades that ESO, in its
discretion, makes generally available to its customers without additional charge; and (c) E-mail Support, telephone support, and
Online Support. ESO may use multiple forms of communication for purposes of submitting periodic status reports to Customer,
including but not limited to, messages in the Software, messages appearing upon login to the Software or other means of
broadcasting Status Update(s) to multiple customers affected by the same Error, such as a customer portal.
2.3. support desk will be staffed with competent technical consultants who are trained in and thoroughly familiar with the
intelligible
English.
2.4. Customer will receive a call back
from a Support Representative after-hours for a Severity 1 Error.
3. ERROR PRIORITY LEVELS. Customer will report all Errors to ESO via e-mail (support@esosolutions.com) or by telephone (866-766-
9471, option #3). ESO shall exercise commercially reasonable efforts to correct any Error reported by Customer in accordance with the
priority level reasonably assigned to such Error by ESO.
3.1. Severity 1 Error. ESO shall (i) commence Error Correction promptly; (ii) provide an Initial Response within four hours; (iii) initiate
Management Escalation promptly; and (iv) provide Customer with a Status Update within four hours if ESO cannot resolve the Error
within four hours.
3.2. Severity 2 Error. ESO shall (i) commence Error Correction promptly; (ii) provide an Initial Response within eight hours; (iii) initiate
Management Escalation within forty-eight hours if unresolved; and (iv) provide Customer with a Status Update within forty-eight
hours if ESO cannot resolve the Error within forty-eight hours.
3.3. Severity 3 Error. ESO shall (i) commence Error Correction promptly; (ii) provide an Initial Response within three business days; and
(iii) provide Customer with a Status Update within seven calendar days if ESO cannot resolve the Error within seven calendar days.
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3.4. Severity 4 Error. ESO shall (i) provide an Initial Response within seven calendar days.
4. CONSULTING SERVICES. If ESO reasonably believes that a problem reported by Customer is not due to an Error in the Software, ESO
will so notify Customer. At that time, Customer may request ESO to proceed with a root cause analysis at expense as set forth
herein or in a separate SOW. If ESO agrees to perform the investigation on behalf of Customer, then ESO-current and standard
consulting rates will apply for all work performed in connection with such analysis, plus reasonable related expenses incurred. For the
avoidance of doubt, Consulting Services will include customized report writing by ESO on behalf of Customer.
5. EXCLUSIONS.
5.1. ESO shall have no obligation to perform Error Corrections or otherwise provide support for: (i) Customer repairs, maintenance or
modifications to the Software (if permitted); (ii) altered or
damaged Software not caused by ESO; (iv) any third-
and (vii) any other causes beyond the ESO.
5.2. ESO shall that may be necessary to use the Software
due to a Workaround or Fix.
5.3. ESO is not responsible for any Error Correction unless ESO can replicate such Error on its own software and hardware or through
hardware.
5.4. Customer is solely responsible for its selection of hardware, and ESO shall not be responsible the performance of such hardware even
if ESO makes recommendations regarding the same.
6. MISCELLANEOUS. The parties acknowledge that from time-to-time ESO may update its support processes specifically addressed in this
Exhibit and may do so by
provided however, that they do not materially decrease the level of
Support Services that Customer will receive from ESO. THESE TERMS AND CONDITIONS DO NOT CONSTITUTE A PRODUCT
WARRANTY. THIS EXHIBIT IS AN ADDITIONAL PART OF THE AGREEMENT AND DOES NOT CHANGE OR SUPERSEDE
ANY TERM OF THE AGREEMENT EXCEPT TO THE EXTENT UNAMBIGUOUSLY CONTRARY THERETO.
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EXHIBIT C
HIPAA BUSINESS ASSOCIATE ADDENDUM
Customer and ESO Solutions, Inc. ("Business Associate") agree that (1) this HIPAA Business Associate Addendum is entered into for
the benefit of Customer, which is a covered entity under the Privacy Standards ("Covered Entity").
Pursuant to the Agreement, Business Associate may perform functions or activities involving the use and/or disclosure of PHI on
behalf of the Covered Entity, and therefore, Business Associate may function as a business associate. Business Associate, therefore, agrees to the
following terms and conditions set forth in this HIPAA Business Associate Addendum .
1. Scope. This Addendum applies to and is hereby automatically incorporated into all present and future agreements and relationships,
whether written, oral or implied, between Covered Entity and Business Associate, pursuant to which PHI is created, maintained, received or
transmitted by Business Associate from or on behalf of Covered Entity in any form or medium whatsoever.
2. Definitions. For purposes of this Addendum, the terms used herein, unless otherwise defined, shall have the same meanings as used in the
Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), or the Health Information Technology for Economic and Clinical
Health Act ("HITECH"), and any amendments or implementing regulations, (collectively "HIPAA Rules").
3. Compliance with Applicable Law. The parties acknowledge and agree that, beginning with the relevant effective date, Business Associate
shall comply with its obligations under this Addendum and with all obligations of a business associate under HIPAA, HITECH, the HIPAA
Rules, and other applicable laws and regulations, as they exist at the time this Addendum is executed and as they are amended, for so long
as this Addendum is in place.
4. Permissible Use and Disclosure of PHI. Business Associate may use and disclose PHI as necessary to carry out its duties to a Covered
Entity pursuant to the terms of the Agreement and as required by law. Business Associate may also use and disclose PHI (i) for its own
proper management and administration, and (ii) to carry out its legal responsibilities. If Business Associate discloses Protected Health
Information to a third party for either above reason, prior to making any such disclosure, Business Associate must obtain: (i) reasonable
assurances from the receiving party that such PHI will be held confidential and be disclosed only as required by law or for the purposes for
which it was disclosed to such receiving party; and (ii) an agreement from such receiving party to immediately notify Business Associate of
any known breaches of the confidentiality of the PHI.
5. Limitations on Use and Disclosure of PHI. Business Associate shall not, and shall ensure that its directors, officers, employees,
subcontractors, and agents do not, use or disclose PHI in any manner that is not permitted by the Agreement or that would violate Subpart E
of 45 C.F.R. 164 ("Privacy Rule") if done by a Covered Entity. All uses and disclosures of, and requests by, Business Associate for PHI are
subject to the minimum necessary rule of the Privacy Rule.
6. Required Safeguards to Protect PHI. Business Associate shall use appropriate safeguards, and comply with Subpart C of 45 C.F.R. Part 164
("Security Rule") with respect to electronic PHI, to prevent the use or disclosure of PHI other than pursuant to the terms and conditions of
this Addendum.
7. Reporting to Covered Entity. Business Associate shall report to the affected Covered Entity without unreasonable delay: (a) any use or
disclosure of PHI not provided for by the Agreement of which it becomes aware; (b) any breach of unsecured PHI in accordance with 45
C.F.R. Subpart D of 45 C.F.R. 164 ("Breach Notification Rule"); and (c) any security incident of which it becomes aware. With regard to
Security Incidents caused by or occurring to Business Associate, Business Associate shall cooperate with the Covered Entity's investigation,
analysis, notification and mitigation activities, and except for Security Incidents caused by Covered Entity, shall be responsible for
reasonable costs incurred by the Covered Entity for those activities. Notwithstanding the foregoing, Covered Entity acknowledges and shall
be deemed to have received advanced notice from Business Associate that there are routine occurrences of: (i) unsuccessful attempts to
penetrate computer networks or services maintained by Business Associate; and (
8. Mitigation of Harmful Effects. Business Associate agrees to mitigate, to the extent practicable, any harmful effect of a use or disclosure of
PHI by Business Associate in violation of the requirements of the Agreement, including, but not limited to, compliance with any state law
or contractual data breach requirements.
9. Agreements by Third Parties. Business Associate shall enter into an agreement with any subcontractor of Business Associate that creates,
receives, maintains or transmits PHI on behalf of Business Associate. Pursuant to such agreement, the subcontractor shall agree to be bound
by the same or greater restrictions, conditions, and requirements that apply to Business Associate under this Addendum with respect to such
PHI.
10. Access to PHI. Within five (5) business days of a request by a Covered Entity for access to PHI about an individual contained in a
Designated Record Set, Business Associate shall make available to the Covered Entity such PHI for so long as such information is
maintained by Business Associate in the Designated Record Set, as required by 45 C.F.R. 164.524. In the event any individual delivers
directly to Business Associate a request for access to PHI, Business Associate shall within five (5) business days forward such request to the
Covered Entity.
11. Amendment of PHI. Within five (5) business days of receipt of a request from a Covered Entity for the amendment of an individual's PHI or
a record regarding an individual contained in a Designated Record Set (for so long as the PHI is maintained in the Designated Record Set),
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Business Associate shall provide such information to the Covered Entity for amendment and incorporate any such amendments in the PHI
as required by 45 C.F.R. 164.526. In the event any individual delivers directly to Business Associate a request for amendment to PHI,
Business Associate shall within five (5) business days forward such request to the Covered Entity.
12. Documentation of Disclosures. Business Associate agrees to document disclosures of PHI and information related to such disclosures as
would be required for a Covered Entity to respond to a request by an individual for an accounting of disclosures of PHI in accordance with
45 C.F.R. 164.528 and HITECH.
13. Accounting of Disclosures. Within five (5) business days of notice by a Covered Entity to Business Associate that it has received a request
for an accounting of disclosures of PHI, Business Associate shall make available to a Covered Entity information to permit the Covered
Entity to respond to the request for an accounting of disclosures of PHI, as required by 45 C.F.R. 164.528 and HITECH.
14. Other Obligations. To the extent that Business Associate is to carry out one or more of a Covered Entity's obligations under the Privacy
Rule, Business Associate shall comply with such requirements that apply to the Covered Entity in the performance of such obligations.
15. Judicial and Administrative Proceedings. In the event Business Associate receives a subpoena, court or administrative order or other
discovery request or mandate for release of PHI, the affected Covered Entity shall have the right to control Business Associate's response to
ws. Business
Associate shall notify the Covered Entity of the request as soon as reasonably practicable, but in any event within seven (7) business days of
receipt of such request.
16. Availability of Books and Records. Business Associate hereby agrees to make its internal practices, books, and records available to the
Secretary of the Department of Health and Human Services for purposes of determining compliance with the HIPAA Rules.
17. Breach of Contract by Business Associate. In addition to any other rights a party may have in the Agreement, this Addendum or by
operation of law or in equity, either party may: i) immediately terminate the Agreement if the other party has violated a material term of this
Addendum; or ii) at the non- option, permit the breaching party to cure or end any such violation within the time specified
by the non-breaching party. The non- option to have cured a breach of this Addendum shall not be construed as a waiver
of any other rights the non-breaching party has in the Agreement, this Addendum or by operation of law or in equity.
18. Effect of Termination of Agreement. Upon the termination of the Agreement or this Addendum for any reason, Business Associate shall
return to a Covered Entity or, at the Covered Entity's direction, destroy all PHI received from the Covered Entity that Business Associate
maintains in any form, recorded on any medium, or stored in any storage system. This provision shall apply to PHI that is in the possession
of Business Associate, subcontractors, and agents of Business Associate. Business Associate shall retain no copies of the PHI. Business
Associate shall remain bound by the provisions of this Addendum, even after termination of the Agreement or Addendum, until such time
as all PHI has been returned or otherwise destroyed as provided in this Section. For the avoidance of doubt, de-identified Customer Data
shall not be subject to this provision.
19. Injunctive Relief. Business Associate stipulates that its unauthorized use or disclosure of PHI while performing services pursuant to this
Addendum would cause irreparable harm to a Covered Entity, and in such event, the Covered Entity shall be entitled to institute
proceedings in any court of competent jurisdiction to obtain damages and injunctive relief.
20. Owner of PHI. Under no circumstances shall Business Associate be deemed in any respect to be the owner of any PHI created or received
by Business Associate on behalf of a Covered Entity.
21. Data Usage Provision. Business Associate may aggregate and de-identify PHI and/or create limited data sets for use in research, evaluation
and for publication or presentation of patient care quality improvement practices and outcomes. The Parties understand and agree that such
aggregated and de-identified data is no longer PHI subject to the provisions of HIPAA and agree that Business Associate may retain such
limited data sets indefinitely thereafter. Business Associate agrees that it will comply with all terms of this Agreement with respect to the
limited data sets and that it shall not re-identify or attempt to re-identify the information contained in the limited data set, nor contact any of
the individuals whose information is contained in the limited data set.
22. Safeguards and Appropriate Use of Protected Health Information. Covered Entity is responsible for implementing appropriate privacy and
security safeguards to protect its PHI in compliance with HIPA obligation to:
22.1. Not include PHI in information Covered Entity submits to technical support personnel through a technical support request or to
community support forums. In addition, Business Associate does not act as, or have the obligations of a Business Associate under the
HIPAA Rules with respect to Customer Data once it is sent to or from Covered Entity Software over the public
Internet; and
22.2. Implement privacy and security safeguards in the systems, applications, and software Covered Entity controls, configures and
connects to ESO Software.
23. Third Party Rights. The terms of this Addendum do not grant any rights to any parties other than Business Associate and the Covered
Entity.
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IN WITNESS WHEREOF, the parties have executed this Agreement as of the Effective Date.
ESO Solutions, Inc. Customer
\[Signature\] \[Signature\]
TODD HILEMAN
\[Printed Name\] \[Printed Name\]
CITY MANAGER
\[Title\] \[Title\]
THIS AGREEMENT HAS BEEN BOTH
REVIEWED AND APPROVED
as to financial and operational obligations
and business terms.
________________ ________________
Signature Printed Name
_________________________________
Title
_________________________________
Department
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
BY:___________________________________
APPROVED AS TO LEGAL FORM:
AARON LEAL, CITY ATTORNEY
BY:___________________________________
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Exhibit
House Bill 89 - Government Code 2270
VERIFICATION
I, _______________________________________________, the undersigned
representative of ______________________________Company or Business name
(hereafter referred to as company), being an adult over the age of eighteen (18)
years of age, verify that the company named-above, under the provisions of
Subtitle F, Title 10, Government Code Chapter 2270:
1. Does not boycott Israel currently; and
2. Will not boycott Israel during the term of the contract the above-named
Company, business or individual with City of Denton.
Pursuant to Section 2270.001, Texas Government Code:
1.
with, or otherwise taking any action that is intended to penalize, inflict
economic harm on, or limit commercial relations specifically with Israel, or
with a person or entity doing business in Israel or in an Israeli-controlled
territory, but does not include an action made for ordinary business
purposes; and
2. -profit sole proprietorship, organization,
association, corporation, partnership, joint venture, limited partnership,
limited liability partnership, or any limited liability company, including a
wholly owned subsidiary, majority-owned subsidiary, parent company or
affiliate of those entities or business associations that exist to make a profit.
___________________________________
Name of Company Representative (Print)
________________________________
Signature of Company Representative
_________________________________
Date
DocuSign Envelope ID: FCE30DAA-4A69-4F0B-9476-F77DD37B9FEA
Exhibit
Senate Bill 252 -Government Code 2252
CERTIFICATION
I, ______________________________________________, the undersigned
representative of ________________________________________________
(Company or business name) being an adult over the age of eighteen (18) years of
age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152 and
Section 2252.153, certify that the company named above is not listed on the
website of the Comptroller of the State of Texas concerning the listing of
companies that are identified under Section 806.051, Section 807.051 or Section
2253.153. I further certify that should the above-named company enter into a
contract that is on said listing of companies on the website of the Comptroller of
the State of Texas which do business with Iran, Sudan or any Foreign Terrorist
Management Department.
___________________________________
Name of Company Representative (Print)
________________________________
Signature of Company Representative
_________________________________
Date
Certificate Of Completion
Envelope Id: FCE30DAA4A694F0B9476F77DD37B9FEAStatus: Completed
Subject: City Council Docusign Item-6091-Software Contracts-ePCR System for EMS Billing Svcs.
Source Envelope:
Document Pages: 20Signatures: 12Envelope Originator:
Certificate Pages: 6Initials: 0Cindy Alonzo
AutoNav: Enabled901B Texas Street
EnvelopeId Stamping: EnabledDenton, TX 76209
Time Zone: (UTC-08:00) Pacific Time (US & Canada)Cynthia.Alonzo@cityofdenton.com
IP Address: 129.120.6.150
Record Tracking
Status: OriginalHolder: Cindy AlonzoLocation: DocuSign
10/18/2018 9:32:19 AM Cynthia.Alonzo@cityofdenton.com
Signer EventsSignatureTimestamp
Cindy AlonzoSent: 10/18/2018 9:50:56 AM
Completed
cynthia.alonzo@cityofdenton.comViewed: 10/18/2018 9:51:11 AM
Senior BuyerSigned: 10/18/2018 9:52:46 AM
Using IP Address: 129.120.6.150
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Chris DillieSent: 10/18/2018 9:52:49 AM
chris.dillie@esosolutions.comViewed: 10/18/2018 12:29:27 PM
CEOSigned: 10/18/2018 12:30:02 PM
ESO
Signature Adoption: Pre-selected Style
Security Level: Email, Account Authentication
Using IP Address: 67.79.254.156
(None)
Electronic Record and Signature Disclosure:
Accepted: 10/18/2018 12:29:27 PM
ID: 04f202fc-59e1-48b2-aa7e-7a1d83f8d705
Kenneth HedgesSent: 10/18/2018 12:30:04 PM
Kenneth.Hedges@cityofdenton.comViewed: 10/18/2018 1:37:53 PM
Fire ChiefSigned: 10/18/2018 1:38:38 PM
Security Level: Email, Account Authentication
Signature Adoption: Pre-selected Style
(None)
Using IP Address: 129.120.6.150
Electronic Record and Signature Disclosure:
Accepted: 10/18/2018 1:37:53 PM
ID: 99088fe4-1238-4c27-8048-f8316337c775
Larry CollisterSent: 10/18/2018 1:38:42 PM
larry.collister@cityofdenton.comViewed: 10/18/2018 3:58:12 PM
First Assistant City AttorneySigned: 10/18/2018 3:58:24 PM
City of Denton
Signature Adoption: Pre-selected Style
Security Level: Email, Account Authentication
Using IP Address: 129.120.6.150
(None)
Electronic Record and Signature Disclosure:
Accepted: 9/26/2017 12:27:28 PM
ID: 01f5f868-f109-4e29-ad49-21db9046c882
Signer EventsSignatureTimestamp
Todd HilemanSent: 10/18/2018 3:58:27 PM
todd.hileman@cityofdenton.comViewed: 10/19/2018 2:56:46 AM
City ManagerSigned: 10/19/2018 2:56:53 AM
City of Denton
Signature Adoption: Pre-selected Style
Security Level: Email, Account Authentication
Using IP Address: 47.184.66.109
(None)
Electronic Record and Signature Disclosure:
Accepted: 7/25/2017 9:02:14 AM
ID: 57619fbf-2aec-4b1f-805d-6bd7d9966f21
Jennifer WaltersSent: 10/19/2018 2:56:56 AM
jennifer.walters@cityofdenton.comViewed: 10/19/2018 6:58:27 AM
City SecretarySigned: 10/19/2018 7:00:20 AM
City of Denton
Signature Adoption: Pre-selected Style
Security Level: Email, Account Authentication
Using IP Address: 129.120.6.150
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer EventsSignatureTimestamp
Editor Delivery EventsStatusTimestamp
Agent Delivery EventsStatusTimestamp
Intermediary Delivery EventsStatusTimestamp
Certified Delivery EventsStatusTimestamp
Carbon Copy EventsStatusTimestamp
Chris DillieSent: 10/18/2018 9:52:49 AM
scott.kelly@esosolutions.comViewed: 10/18/2018 12:23:06 PM
Scott Kelly
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 8/23/2018 8:25:46 AM
ID: 055f039c-2c32-4e2e-98f8-2ffadb3a4e9f
Sherri ThurmanSent: 10/18/2018 1:38:42 PM
sherri.thurman@cityofdenton.com
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jane RichardsonSent: 10/18/2018 3:58:26 PM
jane.richardson@cityofdenton.comViewed: 10/19/2018 7:10:10 AM
Assistant City Secretary
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Carbon Copy EventsStatusTimestamp
Jennifer BridgesSent: 10/19/2018 7:00:23 AM
jennifer.bridges@cityofdenton.com
Procurement Assistant
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jane RichardsonSent: 10/19/2018 7:00:24 AM
jane.richardson@cityofdenton.com
Assistant City Secretary
City of Denton
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Christine TaylorSent: 10/19/2018 7:00:25 AM
Christine.Taylor@cityofdenton.com
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Notary EventsSignatureTimestamp
Envelope Summary EventsStatusTimestamps
Envelope SentHashed/Encrypted10/19/2018 7:00:25 AM
Certified DeliveredSecurity Checked10/19/2018 7:00:25 AM
Signing CompleteSecurity Checked10/19/2018 7:00:25 AM
CompletedSecurity Checked10/19/2018 7:00:25 AM
Payment EventsStatusTimestamps
Electronic Record and Signature Disclosure
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To let us know of a change in your e-mail address where we should send notices and disclosures
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