Appears in 2 contracts

Samples: HHS Data Use Agreement, agendalink.co.fort-bend.tx.us:8085

Appears in 1 contract

Samples: eagenda.collincountytx.gov:8085

Appears in 1 contract

Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ AE806F7A6D9B413C82AE81671BAAC8CE Status: Sent Subject: ~~New $2,602,223.00; HHS001019500016;~~ HHS001057600019 - Fort Bend ~~County; DSHS/LIDS~~ County - ~~IMM/COVID-19~~ OHDPP COVID LHD BASE CONTRACT Source Envelope: Document Pages: 67 46 Signatures: 0 Envelope Originator: Certificate Pages: 2 5 Initials: 0 ~~Texas Health and Human Services Commission~~ CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) ~~0000 X. 00xx Xx. Austin~~00000 Xxxxxx Xxxxx Xxxx #000 Reston, ~~TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: ~~167.137.1.16~~ 160.42.85.11 Record Tracking Status: Original ~~4/16/2021 7:16:40~~ 8/13/2021 3:38:45 PM Holder: ~~Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp ~~X.X.~~ XX Xxxxxx ~~Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx County Judge Fort Bend County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx~~ Accepted: 8/2/2021 3:59:58 PM ID: 474773d2-9ba5-441a-b77e-59bd9f48590f Xxxxxx Xxxxxx xxxxxx.xxxxxx@xxxxxxxxxxxxxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Xxxxx Xxx xxxxx.xxx@xxx.xxxxx.xxx~~ Xxxxxx Xxxxxx Xxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx~~ Accepted: 8/25/2021 2:20:01 PM ID: 042050de-30da-414b-8c60-5361d55f38d2 Xxxxx ~~Xxxx.Xxxxx@xxx.xxxxx.xxx~~ Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx~~ Accepted: 8/25/2021 2:59:46 PM ID: 6b8da24b-de73-43ce-b003-c25d9155d203 Kirk Cole xxxx.xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign~~ Accepted: 8/25/2021 6:54:22 AM ID: ed32fba7-daa7-4c2d-b7c4-3f4d32e0ee94 Sent: ~~4/16/2021 7:37:09~~ 8/13/2021 3:45:50 PM Viewed: 8/13/2021 4:03:48 PM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ Xxxx Xxxxxxxx xxxx.xxxxxxxx@xxxxxxxxxxxxxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx~~ Xxxxx Xxxxx xxxxx.xxxxx@xxxx.xxxxx.xxx Contract Manager Texas Health and Human Services Commission Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Xxxxxxx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxx ~~Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ Xxxx xxxxx.xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09~~ 8/13/2021 3:45:51 PM Viewed: 8/25/2021 4:15:55 PM Sent: ~~4/16/2021 7:37:08~~ 8/13/2021 3:45:50 PM ~~Viewed: 4/16/2021 7:40:01 PM Sent: 4/16/2021 7:37:09 PM Viewed: 4/19/2021 8:40:51 AM~~ Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted ~~4/16/2021 7:37:09 PM~~8/13/2021 3:45:51 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: XX Xxxxxx, Xxxxxx Xxxxxx, Xxxxx Xxxxxxxx, Xxxx Xxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (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 the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. 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. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents 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. Further, you will no longer be able to use the DocuSign system 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 the DocuSign system 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 DSHS Contract Management Section: 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: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section 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 email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:

Appears in 1 contract

Samples: agendalink.co.fort-bend.tx.us:8085

Certification Regarding Public Access to Compensation Information. Does the public have access to information about the ~~compensation of the~~ highly compensated officers/senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code ~~of 1986~~of1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ 8C0426454A99441FA7A9AA77DB73FD9F Status: Sent Subject: ~~New~~ Amending $~~2,602,223.00~~666,667.00; ~~HHS001019500016~~HHS000563100001; ~~Fort Bend County~~WILLIAMSON COUNTY A-1; ~~DSHS/LIDS~~ HHSC MSS-IDD - ~~IMM/COVID-19~~ SUDCMU Source Envelope: Document Pages: 67 34 Signatures: 0 Envelope Originator: Certificate Pages: 2 Initials: 0 Texas Health and Human Services Commission AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 0000 X. 00xx Xx. Austin, TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx IP Address: ~~167.137.1.16~~ 168.60.148.50 Record Tracking Status: Original ~~4/16/2021 7:16:40 PM~~ 7/30/2020 9:54:47 AM Holder: Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx Location: DocuSign Signer Events Signature Timestamp ~~X.X. Xxxxxx Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx County~~ Judge ~~Fort Bend County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign~~ Xxxx ~~Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx~~ Xxxxxxx xxxxxxxx@xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxx Xxx xxxxx.xxx@xxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Xxxxx Xxxx.Xxxxx@xxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx Ita Xxxxx.Xxx00@xxxx.xxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09~~ 7/30/2020 10:01:54 AM Viewed: 7/30/2020 1:25:04 PM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ Xxxxxxx Xxxxxxxxx Xxxxxxx.Xxxxxxxxx@xxxx.xxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx Contract Manager Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxx Xxxxx Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx SA Mailbox XxxxxxxxxXxxxx.Xxxxxxxxx@xxxx.xxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09~~ 7/30/2020 10:01:53 AM Viewed: 8/3/2020 6:20:20 PM Sent: ~~4/16/2021 7:37:08 PM Viewed~~7/30/2020 10:01:53 AM Carbon Copy Events Status Timestamp Xxxxx Xxxxx Xxxxx.Xxxxx00@xxxx.xxxxx.xx.xx Security Level: ~~4/16/2021 7:40:01 PM~~ Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09 PM Viewed: 4/19/2021 8:40:51~~ 7/30/2020 10:01:53 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted ~~4/16/2021 7:37:09 PM~~7/30/2020 10:01:54 AM

Appears in 1 contract

Samples: agenda.wilcotx.gov

Appears in 1 contract

Samples: agendalink.co.fort-bend.tx.us:8085

Certification Regarding Public Access to Compensation Information. Does the public have access to information about the ~~compensation of the~~ highly compensated officers/senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code ~~of 1986~~of1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ 8C0426454A99441FA7A9AA77DB73FD9F Status: Sent Subject: ~~New~~ Amending $~~2,602,223.00~~666,667.00; ~~HHS001019500016~~HHS000563100001; ~~Fort Bend County~~XXXXXXXXXX COUNTY A-1; ~~DSHS/LIDS~~ HHSC MSS-IDD - ~~IMM/COVID-19~~ SUDCMU Source Envelope: Document Pages: 67 34 Signatures: 0 Envelope Originator: Certificate Pages: 2 Initials: 0 Texas Health and Human Services Commission AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 0000 X. 00xx Xx. Austin, TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx IP Address: ~~167.137.1.16~~ 168.60.148.50 Record Tracking Status: Original ~~4/16/2021 7:16:40 PM~~ 7/30/2020 9:54:47 AM Holder: Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx Location: DocuSign Signer Events Signature Timestamp ~~X.X. Xxxxxx Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx County~~ Judge ~~Fort Bend County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign~~ Xxxx ~~Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx~~ Xxxxxxx xxxxxxxx@xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxx Xxx xxxxx.xxx@xxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Xxxxx Xxxx.Xxxxx@xxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx Ita Xxxxx.Xxx00@xxxx.xxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09~~ 7/30/2020 10:01:54 AM Viewed: 7/30/2020 1:25:04 PM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ Xxxxxxx Xxxxxxxxx Xxxxxxx.Xxxxxxxxx@xxxx.xxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx Contract Manager Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxx Xxxxx Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx SA Mailbox XxxxxxxxxXxxxx.Xxxxxxxxx@xxxx.xxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09~~ 7/30/2020 10:01:53 AM Viewed: 8/3/2020 6:20:20 PM Sent: ~~4/16/2021 7:37:08 PM Viewed~~7/30/2020 10:01:53 AM Carbon Copy Events Status Timestamp Xxxxx Xxxxx Xxxxx.Xxxxx00@xxxx.xxxxx.xx.xx Security Level: ~~4/16/2021 7:40:01 PM~~ Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09 PM Viewed: 4/19/2021 8:40:51~~ 7/30/2020 10:01:53 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted ~~4/16/2021 7:37:09 PM~~7/30/2020 10:01:54 AM

Appears in 1 contract

Samples: Health And

Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ 86BF8B548A124A88BF203FAF73075A78 Status: Sent Subject: ~~New $2,602,223.00; HHS001019500016; Fort Bend County; DSHS/LIDS - IMM/COVID-19~~ Please DocuSign: HHS001096400010;Collin Co;Base;Signature Packet.pdf Source Envelope: Document Pages: 67 70 Signatures: 0 Envelope Originator: Certificate Pages: 2 5 Initials: 0 ~~Texas Health and Human Services Commission~~ CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) ~~0000 X. 00xx Xx. Austin~~00000 Xxxxxx Xxxxx Xxxx #000 Reston, ~~TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: ~~167.137.1.16~~ 160.42.85.11 Record Tracking Status: Original ~~4/16/2021 7:16:40 PM~~ 10/19/2021 10:13:16 AM Holder: ~~Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp ~~X.X. Xxxxxx Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ Xxxxx Xxxx XXXXX@XX.XXXXXX.XX.XX County Judge ~~Fort Bend~~ Collin County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign~~ Accepted: 9/27/2021 4:49:31 PM ID: fd2a1bec-56d0-4c00-821c-62dc88147e6b Xxxxx Xxxx ~~Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx~~ XXXXX@XX.XXXXXX.XX.XX County Judge Collin County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxxx Xxx xxxxx.xxx@xxx.xxxxx.xxx~~ Accepted: 9/27/2021 4:49:31 PM ID: fd2a1bec-56d0-4c00-821c-62dc88147e6b Xxxxxx Xxxxxx Xxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx~~ Accepted: 11/1/2021 1:25:16 PM ID: 0cfe527d-b2e9-4c81-9b12-e9e92dd50c16 Xxxxx ~~Xxxx.Xxxxx@xxx.xxxxx.xxx~~ Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx~~ Accepted: 11/1/2021 1:50:32 PM ID: f4d22398-bb8e-489b-a667-7960daac9bd7 Xxxxxx Xxxxxx XxxxxxX.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign~~ Accepted: 7/6/2021 8:08:45 AM ID: 1a6909aa-b026-45a9-be9f-4240c2e32ff9 Sent: ~~4/16/2021 7:37:09~~ 10/25/2021 4:16:54 PM Sent: 10/19/2021 10:15:10 AM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ Xxxxx Xxxxxx xxxxxxxx@xx.xxxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx Contract Manager~~ Xxxx Xxxxxx xxxxxxx@xx.xxxxxx.tx.us Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Lacy Alexander xxxx.xxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxx ~~Xxxxx Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ York xxxxxxx.xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09 PM~~ 10/19/2021 10:15:10 AM Sent: ~~4/16/2021 7:37:08~~ 10/25/2021 4:16:52 PM Viewed: ~~4/16/2021 7:40:01 PM Sent: 4/16/2021 7:37:09 PM Viewed: 4/19/2021 8:40:51~~ 11/2/2021 11:01:30 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted ~~4/16/2021 7:37:09 PM~~10/19/2021 10:15:10 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: Xxxxx Xxxx, Xxxxx Xxxx, Xxxxxx Xxxxxx, Xxxxx Xxxxxxxx, Xxxxxx Xxxxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (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 the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. 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. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents 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. Further, you will no longer be able to use the DocuSign system 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 the DocuSign system 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 DSHS Contract Management Section: 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: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section 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 email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:

Appears in 1 contract

Samples: Interlocal Cooperation Contract

Appears in 1 contract

Samples: agendalink.co.fort-bend.tx.us:8085

Appears in 1 contract

Samples: agendasuite.org

Appears in 1 contract

Samples: agendalink.co.fort-bend.tx.us:8085

Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ F9D1BE43E4064E2EB677E943913E62F5 Status: Sent Subject: ~~New $2,602,223.00; HHS001019500016; Fort~~ Please DocuSign: HHS001096400015;Fort Bend ~~County; DSHS/LIDS - IMM/COVID-19~~ Co;Base;Signature Packet.pdf Source Envelope: Document Pages: 67 70 Signatures: 0 Envelope Originator: Certificate Pages: 2 5 Initials: 0 ~~Texas Health and Human Services Commission~~ CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) ~~0000 X. 00xx Xx. Austin~~00000 Xxxxxx Xxxxx Xxxx #000 Reston, ~~TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: ~~167.137.1.16~~ 160.42.85.9 Record Tracking Status: Original ~~4/16/2021 7:16:40 PM~~ 10/19/2021 10:09:34 AM Holder: ~~Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp ~~X.X.~~ XX Xxxxxx ~~Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx County Judge Fort Bend County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx~~ Accepted: 8/2/2021 3:59:58 PM ID: 474773d2-9ba5-441a-b77e-59bd9f48590f XX Xxxxxx xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign~~ Accepted: 8/2/2021 3:59:58 PM ID: 474773d2-9ba5-441a-b77e-59bd9f48590f Xxxxx ~~Xxx xxxxx.xxx@xxx.xxxxx.xxx~~ Xxxxxxxxxxx xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx~~ Accepted: 10/19/2021 8:28:52 AM ID: f9559092-bc9c-40d9-8b2b-bb7606b5fe8c Xxxxx ~~Xxxx.Xxxxx@xxx.xxxxx.xxx~~ Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx~~ Accepted: 10/19/2021 9:39:58 AM ID: fdcbeaae-8e74-439c-ad01-cd68e879857f Xxxxxx Xxxxxx XxxxxxX.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09 PM~~ 10/19/2021 10:12:21 AM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ Xxxxxxxx Xxxxxxxx xxxxxxxx.xxxxxxxx@xxxxxxxxxxxxxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx Contract Manager~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxx ~~Xxxxx Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ York xxxxxxx.xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Lacy Alexander xxxx.xxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09 PM Sent: 4/16/2021 7:37:08 PM~~ 10/19/2021 10:12:21 AM Viewed: ~~4/16/2021 7:40:01 PM Sent: 4/16/2021 7:37:09 PM Viewed: 4/19/2021 8:40:51~~ 10/19/2021 10:13:39 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted ~~4/16/2021 7:37:09 PM~~10/19/2021 10:12:21 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: XX Xxxxxx, XX Xxxxxx, Xxxxx Xxxxxxxxxxx, Xxxxx Xxxxxxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (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 the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. 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. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents 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. Further, you will no longer be able to use the DocuSign system 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 the DocuSign system 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 DSHS Contract Management Section: 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: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section 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 email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:

Appears in 1 contract

Samples: Interlocal Cooperation Contract

Appears in 1 contract

Samples: Health And

Appears in 1 contract

Samples: Department of State Health Services

Appears in 1 contract

Samples: agenda.hidalgocounty.us

Appears in 1 contract

Samples: www.co.comal.tx.us

Appears in 1 contract

Samples: eagenda.collincountytx.gov:8085

Appears in 1 contract

Samples: agendalink.co.fort-bend.tx.us:8085

Appears in 1 contract

Samples: destinyhosted.com

Appears in 1 contract

Samples: destinyhosted.com

Certification Regarding Public Access to Compensation Information. X Does the public have access to information about the ~~compensation of the~~ highly compensated officers/senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Xxxx, J - $247,062; Xxxxxx, M - $136,813; Jordan, S - $107,849 Xxxxxxxx, X - $97,823; Ne1son, U - $86,315 DocuSign Envelope ID: 1B39118E-9560-48BE-A811-00E6998FF6E7 ATTACHMENT K INDIRECT COST RATE LETTER DocuSign Envelope ID: 1B39118E-9560-48BE-A811-00E6998FF6E7 Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ 1B39118E956048BEA81100E6998FF6E7 Status: ~~Sent~~ Completed Subject: New $~~2,602,223.00~~17,693,071; ~~HHS001019500016~~HHS000874100006; ~~Fort Bend County~~Central Texas Council of Government; ~~DSHS~~HHSC/~~LIDS - IMM~~AES/~~COVID-19~~ FCO Source Envelope: Document Pages: 67 93 Signatures: 0 6 Envelope Originator: Certificate Pages: 2 3 Initials: 0 Texas Health and Human Services Commission AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 0000 X. 00xx Xx. Austin, TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx IP Address: ~~167.137.1.16~~ 167.137.1.14 Record Tracking Status: Original ~~4/16/2021 7:16:40 PM~~ 8/27/2020 9:59:19 AM Holder: Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx Location: DocuSign Signer Events Signature Timestamp ~~X.X. Xxxxxx Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx County Judge Fort Bend County~~ Xxxx Xxxx xxxx.xxxx@xxxx.xxxxx.xx.xx Chief Financial Officer Texas Health and Human Services Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxx Xxxx xxxxx@xxxxx.xxx Executive Director Central Texas Council of Governments Security Level: Email, Account Authentication (None) Completed Using IP Address: 72.182.18.223 Signature Adoption: Pre-selected Style Using IP Address: 12.145.7.18 Sent: 8/27/2020 10:13:46 AM Viewed: 8/28/2020 9:03:04 AM Signed: 8/28/2020 9:03:08 AM Sent: 8/28/2020 9:03:12 AM Resent: 8/31/2020 2:08:57 PM Viewed: 8/28/2020 4:25:07 PM Signed: 9/9/2020 12:38:39 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx Director, System Contracting Texas Health and Human Services Commission Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxx Xxx ~~xxxxx.xxx@xxx.xxxxx.xxx~~ Xxxxx.Xxx@xxxx.xxxxx.xx.xx Chief Counsel HHSC Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Completed Using IP Address: 167.137.1.10 Completed Using IP Address: 167.137.1.9 Sent: 9/9/2020 12:38:46 PM Viewed: 9/9/2020 1:00:38 PM Signed: 9/9/2020 1:00:42 PM Sent: 9/9/2020 1:00:49 PM Viewed: 9/10/2020 8:54:28 AM Signed: 9/10/2020 8:54:35 AM Xxxx Xxxxx ~~Xxxx.Xxxxx@xxx.xxxxx.xxx~~ Xxxx.Xxxxx@xxxx.xxxxx.xx.xx Texas Health and Human Services Commission Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx~~ Xxxxx Xxxxxx Xxxxx.Xxxxxx@xxxx.xxxxx.xx.xx AES Deputy Executive Commissioner Texas Health and Human Services Commission Security Level: Email, Account Authentication (None) Completed Using IP Address: 167.137.1.16 Signature Adoption: Pre-selected Style Using IP Address: 167.137.1.7 Sent: 9/10/2020 8:54:41 AM Viewed: 9/10/2020 9:29:10 AM Signed: 9/10/2020 9:29:14 AM Sent: 9/10/2020 9:29:20 AM Viewed: 9/15/2020 6:01:43 PM Signed: 9/15/2020 6:01:49 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Sent: 4/16/2021 7:37:09 PM~~ In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ AES Contract Operations Routing AES_Contract_Operations_Routing@hhsc.state.tx.u s Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx Contract Manager~~ HHSC FS Budget Contracts XX_XxxxxxXxxxxxxxx@xxxx.xxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Xxxxxxx ~~Xxxxx Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ Xxxx.Xxxxxxx@xxxx.xxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxx Xxxxxx Xxxxxx.xxxxxx@xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09~~ 8/27/2020 10:13:46 AM Sent: 8/27/2020 10:13:46 AM Viewed: 8/27/2020 10:38:26 AM Sent: 8/27/2020 10:13:46 AM Viewed: 8/27/2020 10:44:19 PM Sent: ~~4/16/2021 7:37:08 PM~~ 8/28/2020 9:03:13 AM Viewed: ~~4/16/2021 7:40:01 PM Sent: 4/16/2021 7:37:09 PM Viewed: 4/19/2021 8:40:51~~ 8/28/2020 9:04:22 AM Witness ~~Events Signature Timestamp Notary~~ Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted ~~4/16/2021 7:37:09~~ 9/10/2020 9:29:20 AM Certified Delivered Security Checked 9/15/2020 6:01:43 PM Signing Complete Security Checked 9/15/2020 6:01:49 PM Completed Security Checked 9/15/2020 6:01:49 PM

Appears in 1 contract

Samples: Health and Human Services Commission

Appears in 1 contract

Samples: Health Services

Appears in 1 contract

Samples: agendalink.co.fort-bend.tx.us:8085

Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Department of State Health Services Contract Management Section Form 4734 – April 2022 Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ C5B33C76723F4AB9AC2D9AD7A9D6163F Status: Sent Subject: ~~New $2,602,223.00; HHS001019500016;~~ Please DocuSign: HHS001311300014, Fort Bend County~~; DSHS~~, Base Contract, CPS/~~LIDS - IMM/COVID-19~~ CRI Source Envelope: Document Pages: 67 80 Signatures: 0 Envelope Originator: Certificate Pages: 2 5 Initials: 0 ~~Texas Health and Human Services Commission~~ CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) ~~0000 X. 00xx Xx. Austin~~00000 Xxxxxx Xxxxx Xxxx #000 Reston, ~~TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: ~~167.137.1.16~~ 167.137.1.15 Record Tracking Status: Original ~~4/16/2021 7:16:40 PM~~ 3/13/2023 9:49:03 AM Holder: ~~Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp ~~X.X.~~ XX Xxxxxx ~~Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx County Judge Fort Bend County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx~~ Accepted: 8/2/2021 3:59:58 PM ID: 474773d2-9ba5-441a-b77e-59bd9f48590f Xxxxx Xxxxxxxx xxxxx.xxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign~~ Accepted: 3/10/2023 2:44:48 PM ID: 6bc7cd34-3178-45af-a343-5346b5f9b700 Xxxxx ~~Xxx xxxxx.xxx@xxx.xxxxx.xxx~~ Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign~~ Accepted: 5/5/2022 12:43:08 PM ID: f01589da-43a7-481e-996a-7c50409e5d48 Xxxx ~~Xxxxx Xxxx.Xxxxx@xxx.xxxxx.xxx~~ Xxxxxx Xxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx Security Level~~Accepted: ~~Email, Account Authentication (None) Electronic Record and Signature Disclosure~~1/3/2021 4:48:45 PM ID: ~~Not Offered via DocuSign~~ bd2f4497-b4dc-4c51-9974-71b86780cff4 Sent: ~~4/16/2021 7:37:09 PM~~ 3/13/2023 10:01:21 AM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ Xxxxxxx Xxxxxxxx Xxxxxxx.Xxxxxxxx@xxxxxxxxxxxxxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx Contract Manager~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Xxxxxxx Xxxxx Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ Xxxx X. Xxxxxxxx Xxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09 PM Sent: 4/16/2021 7:37:08 PM~~ 3/13/2023 10:01:20 AM Viewed: ~~4/16/2021 7:40:01~~ 3/13/2023 1:04:47 PM ~~Sent: 4/16/2021 7:37:09 PM Viewed: 4/19/2021 8:40:51 AM~~ Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted ~~4/16/2021 7:37:09 PM~~3/13/2023 10:01:20 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: XX Xxxxxx, Xxxxx Xxxxxxxx, Xxxxx Xxxxxxxx, Xxxx Xxxxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (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 the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. 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. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents 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. Further, you will no longer be able to use the DocuSign system 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 the DocuSign system 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 DSHS Contract Management Section: 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: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section 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 email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:

Appears in 1 contract

Samples: Grant Agreement

Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ 30C4EE5E1C4F4A0994DAFEFFFFFF0DC1 Status: Sent Subject: ~~New $2,602,223.00~~Please DocuSign: HHS001096400020; ~~HHS001019500016~~Xxxxxxx; ~~Fort Bend County~~Base; ~~DSHS/LIDS - IMM/COVID-19~~ Signature Packet Source Envelope: Document Pages: 67 71 Signatures: 0 Envelope Originator: Certificate Pages: 2 5 Initials: 0 ~~Texas Health and Human Services Commission~~ CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) ~~0000 X. 00xx Xx. Austin~~00000 Xxxxxx Xxxxx Xxxx #000 Reston, ~~TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: ~~167.137.1.16~~ 160.42.85.11 Record Tracking Status: Original ~~4/16/2021 7:16:40~~ 10/19/2021 5:04:37 PM Holder: ~~Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp ~~X.X.~~ Xxxxxxx X. Xxxxxx Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx County Judge Fort Bend County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxx Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx xxxxxx.xxxxx@xx.xxxxxxx.xx.us Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxx ~~Xxx xxxxx.xxx@xxx.xxxxx.xxx~~ Xxxxxxxxxxx xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx~~ Accepted: 10/20/2021 7:34:29 AM ID: ed84a086-b9a1-4976-8af1-f630649e7f3f Xxxxx ~~Xxxx.Xxxxx@xxx.xxxxx.xxx~~ Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx~~ Accepted: 10/19/2021 1:13:20 PM ID: c972e337-cc29-449b-8a27-a67c03d68251 Kirk Cole xxxx.xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign~~ Accepted: 10/19/2021 10:09:48 AM ID: cd150294-f3e4-4c31-8771-7f4640abb348 Sent: ~~4/16/2021 7:37:09~~ 10/19/2021 5:10:48 PM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ Xxxxxx Xxxxxxxx xxxxxx.xxxxxxxx@xxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx Contract Manager~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Xxxxxxx Xxxxx Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ Lacy Alexander xxxx.xxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09 PM Sent: 4/16/2021 7:37:08~~ 10/19/2021 5:10:47 PM Viewed: ~~4/16/2021 7:40:01 PM Sent: 4/16/2021 7:37:09 PM Viewed: 4/19/2021 8:40:51~~ 10/20/2021 7:40:00 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted ~~4/16/2021 7:37:09 PM~~10/19/2021 5:10:47 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: Xxxxx Xxxxxxxxxxx, Xxxxx Xxxxxxxx, Xxxx Xxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (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 the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. 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. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents 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. Further, you will no longer be able to use the DocuSign system 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 the DocuSign system 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 DSHS Contract Management Section: 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: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section 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 email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:

Appears in 1 contract

Samples: Grant Agreement

Appears in 1 contract

Samples: Health And

Appears in 1 contract

Samples: Grant Agreement

Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ D23FC322396A48C79435AD825B8B130D Status: Sent Subject: ~~New $2,602,223.00; HHS001019500016; Fort Bend County; DSHS/LIDS~~ HHS001057600012 - ~~IMM/COVID-19~~ Collin County Health Care Services - OHDPP COVID LHD BASE CONTRACT Source Envelope: Document Pages: 67 46 Signatures: 0 Envelope Originator: Certificate Pages: 2 5 Initials: 0 ~~Texas Health and Human Services Commission~~ CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) ~~0000 X. 00xx Xx. Austin~~00000 Xxxxxx Xxxxx Xxxx #000 Reston, ~~TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: ~~167.137.1.16~~ 160.42.85.9 Record Tracking Status: Original ~~4/16/2021 7:16:40~~ 8/13/2021 12:18:16 PM Holder: ~~Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp ~~X.X. Xxxxxx Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ Xxxxx Xxxx XXXXX@XX.XXXXXX.XX.XX County Judge ~~Fort Bend~~ Collin County Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx~~ Accepted: 8/13/2021 4:38:03 PM ID: 4b340e2e-5664-4334-ab50-7efe933bb0c9 Xxxxxx Xxxxxx Xxxxxx.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign~~ Accepted: 8/13/2021 3:30:23 PM ID: 45407799-2196-4f46-8183-c98460919d12 Xxxxx ~~Xxx xxxxx.xxx@xxx.xxxxx.xxx~~ Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx Xxxxx Xxxx.Xxxxx@xxx.xxxxx.xxx~~ Accepted: 8/13/2021 1:08:30 PM ID: 65f76030-a23c-4e46-89a5-ae26870177a0 Kirk Cole xxxx.xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx Security Level~~Accepted: ~~Email, Account Authentication (None) Electronic Record and Signature Disclosure~~8/13/2021 12:57:16 PM ID: ~~Not Offered via DocuSign~~ 4be675cb-940b-4c4e-8fa3-1c73f48d94d4 Sent: ~~4/16/2021 7:37:09~~ 8/13/2021 3:07:13 PM Viewed: 8/13/2021 4:38:03 PM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ Xxxxxxxxx Xxxxxxx xxxxxxxx@xx.xxxxxx.tx.us Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx~~ Xxxxx Xxxxx xxxxx.xxxxx@xxxx.xxxxx.xxx Contract Manager Texas Health and Human Services Commission Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Xxxxxxx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxx ~~Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ Xxxx xxxxx.xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09~~ 8/13/2021 3:07:13 PM Viewed: 8/13/2021 3:07:52 PM Sent: ~~4/16/2021 7:37:08~~ 8/13/2021 3:07:12 PM ~~Viewed: 4/16/2021 7:40:01 PM Sent: 4/16/2021 7:37:09 PM Viewed: 4/19/2021 8:40:51 AM~~ Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted ~~4/16/2021 7:37:09 PM~~8/13/2021 3:07:13 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: Xxxxx Xxxx, Xxxxxx Xxxxxx, Xxxxx Xxxxxxxx, Xxxx Xxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (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 the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. 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. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents 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. Further, you will no longer be able to use the DocuSign system 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 the DocuSign system 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 DSHS Contract Management Section: 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: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section 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 email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:

Appears in 1 contract

Samples: eagenda.collincountytx.gov

Certification Regarding Public Access to Compensation Information. Does the public have access to information about the compensation of the senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No If your answer is “Yes” to this question, where can this information be accessed? N/A If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below. Provide compensation information here: N/A Certificate Of Completion Envelope Id: ~~92441102150F468FBA21A3808FA4EECC~~ AE806F7A6D9B413C82AE81671BAAC8CE Status: ~~Sent~~ Completed Subject: ~~New $2,602,223.00; HHS001019500016;~~ HHS001057600019 - Fort Bend ~~County; DSHS/LIDS~~ County - ~~IMM/COVID-19~~ OHDPP COVID LHD BASE CONTRACT Source Envelope: Document Pages: 67 46 Signatures: 0 6 Envelope Originator: Certificate Pages: 2 6 Initials: 0 ~~Texas Health and Human Services Commission~~ CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) ~~0000 X. 00xx Xx. Austin~~00000 Xxxxxx Xxxxx Xxxx #000 Reston, ~~TX 78756 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: ~~167.137.1.16~~ 160.42.85.11 Record Tracking Status: Original ~~4/16/2021 7:16:40~~ 8/13/2021 3:38:45 PM Holder: ~~Texas Health and Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp ~~X.X.~~ XX Xxxxxx ~~Xxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx County Judge Fort Bend County Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 209.184.91.105 Sent: 8/13/2021 3:45:50 PM Resent: 9/3/2021 8:55:59 AM Viewed: 8/13/2021 4:03:48 PM Signed: 9/7/2021 4:24:37 PM Electronic Record and Signature Disclosure: Accepted: 8/2/2021 3:59:58 PM ID: 474773d2-9ba5-441a-b77e-59bd9f48590f Xxxxxx Xxxxxx xxxxxx.xxxxxx@xxxxxxxxxxxxxxxx.xxx Acountant Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 209.184.91.105 Sent: 9/7/2021 4:24:39 PM Viewed: 9/7/2021 4:57:59 PM Signed: 9/9/2021 10:46:35 AM Electronic Record and Signature Disclosure: Accepted: 9/7/2021 4:57:59 PM ID: ea7e3408-1178-4a3b-b7b9-1b7e09b86062 Xxxxxx Xxxxxx Xxxxxx.Xxxxxx@xxxx.xxxxx.xxx CTCM, Unit Director DSHS Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx Marker Xxxxxx.Xxxxxx@xxxx.xxxxx.xx.xx~~ Accepted: 9/9/2021 10:47:39 AM ID: 63a59b07-840a-4701-b130-e4007b67bc95 Xxxxx Xxxxxxxx Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Director, DSHS CMS Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxxx Xxx xxxxx.xxx@xxx.xxxxx.xxx~~ Accepted: 9/9/2021 11:32:43 AM ID: 624f97f0-c0ff-403d-b6cf-1d5bb8c31672 Completed Using IP Address: 160.42.85.12 Completed Using IP Address: 160.42.85.12 Sent: 9/9/2021 10:46:38 AM Viewed: 9/9/2021 10:47:39 AM Signed: 9/9/2021 10:49:24 AM Sent: 9/9/2021 10:49:26 AM Viewed: 9/9/2021 11:32:43 AM Signed: 9/9/2021 11:32:59 AM Kirk Cole xxxx.xxxx@xxxx.xxxxx.xxx Deputy Commissioner Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 160.42.85.12 Sent: 9/9/2021 11:33:02 AM Viewed: 9/10/2021 4:15:35 PM Signed: 9/10/2021 4:16:00 PM Electronic Record and Signature Disclosure: ~~Not Offered via DocuSign Xxxx Xxxxx Xxxx.Xxxxx@xxx.xxxxx.xxx Security Level~~Accepted: ~~Email, Account Authentication (None) Electronic Record and Signature Disclosure~~9/10/2021 4:15:35 PM ID: Not Offered via DocuSign Xxxxxxxx Xxxx Xxxxxxxx.Xxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 4/16/2021 7:37:09 PM bb657652-2501-430c-8e15-86c2d27c7652 In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp ~~CMS Inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx~~ Xxxx Xxxxxxxx xxxx.xxxxxxxx@xxxxxxxxxxxxxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Melissa D. Tafoya-Cortez xxxxxxx.xxxxxx@xxxx.xxxxx.xxx~~ Xxxxx Xxxxx xxxxx.xxxxx@xxxx.xxxxx.xxx Contract Manager Texas Health and Human Services Commission Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign ~~Xxxxxxx~~ CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx DSHS Contract Management Section Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxx ~~Xxxxxxx.Xxxxx@xxxxxxxxxxxxxxxx.xxx~~ Xxxx xxxxx.xxxx@xxxx.xxxxx.xxx Program Specialist and Contract Manager Texas Health and Human Services Commission Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: ~~4/16/2021 7:37:09~~ 8/13/2021 3:45:51 PM Viewed: 8/25/2021 4:15:55 PM Sent: ~~4/16/2021 7:37:08 PM Viewed: 4/16/2021 7:40:01~~ 8/13/2021 3:45:50 PM Sent: ~~4/16/2021 7:37:09~~ 9/10/2021 4:16:02 PM ~~Viewed~~Sent: ~~4/19/2021 8:40:51 AM~~ 9/10/2021 4:16:02 PM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope ~~Summary Events Status Timestamps Envelope~~ Sent Hashed/Encrypted ~~4/16/2021 7:37:09 PM~~8/13/2021 3:45:51 PM Certified Delivered Security Checked 9/10/2021 4:15:35 PM Signing Complete Security Checked 9/10/2021 4:16:00 PM Completed Security Checked 9/10/2021 4:16:02 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 9/14/2020 7:10:18 PM Parties agreed to: XX Xxxxxx, Xxxxxx Xxxxxx, Xxxxxx Xxxxxx, Xxxxx Xxxxxxxx, Xxxx Xxxx ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, DSHS Contract Management Section (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 the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system. 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. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents 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. Further, you will no longer be able to use the DocuSign system 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 the DocuSign system 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 DSHS Contract Management Section: 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: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section 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 email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:

Appears in 1 contract

Samples: agendalink.co.fort-bend.tx.us:8085

Appears in 1 contract

Samples: Department Of

Appears in 1 contract

Samples: agendalink.co.fort-bend.tx.us:8085

Common use of Certification Regarding Public Access to Compensation Information Clause in Contracts