DocuSign Envelope ID: 5CCFFDF0-FFDB-44A2-AFFF-7A9ABE6D54A2
DocuSign Envelope ID: 5CCFFDF0-FFDB-44A2-AFFF-7A9ABE6D54A2
Esta página é integrante do 1º Termo Aditivo ao Contrato de Prestação de Serviços Especializados em Realização de Exames de Ultrassonografia nº 92-02/2020 - GCONT 13538, firmado entre INSTITUTO SOCIAL MAIS SAÚDE e XXXXXXX XXXXXXXX XXXXX, não possuindo
isoladamente qualquer valor ou força contratual.
1º TERMO ADITIVO AO CONTRATO DE PRESTAÇÃO DE SERVIÇOS ESPECIALIZADOS EM REALIZAÇÃO DE EXAMES DE ULTRASSONOGRAFIA N° 92- 02/2020 - GCONT 13538 QUE ENTRE SI CELEBRAM O INSTITUTO SOCIAL MAIS SAÚDE E XXXXXXX XXXXXXXX XXXXX.
Pelo presente Instrumento Particular e na melhor forma de direito, de um lado como CONTRATANTE, assim designado INSTITUTO SOCIAL MAIS SAÚDE, pessoa jurídica de direito privado, com sede na Rua Coronel Ponciano de Xxxxxx Xxxxxxx, n°3.323, Vila Alba, CEP: 79.830-220, Dourados – MS, devidamente inscrita no CNPJ/MF sob o nº. 18.963.002/0007-37, neste ato representado por sua Diretora Presidente, Sra. XXXXX XXXXXX XXXXX, brasileira, solteira, gestora em segurança, portadora da cédula de identidade RG nº 30.171.370-4 - SSP/SP e inscrita no CPF/MF sob nº 000.000.000-00, com endereço supracitado, onde recebe correspondência;
e, de outro lado como CONTRATADO, assim designado XXXXXXX XXXXXXXX XXXXX, pessoa jurídica de direito privado, com sede na Rua Aquidauana, nº 1.691, Vila Rosa, CEP: 79.831-040, Dourados - MS, devidamente inscrito no CNPJ/MF sob o nº. 26.925.247/0001-02, neste ato representado por XXXXXXX XXXXXXXX XXXXX, brasileiro, casado, médico, portador da cédula de identidade RG nº 000000000 - SSP/MS e inscrito no CPF/MF sob o nº 000.000.000-00, com endereço supracitado, onde recebe correspondência, e em conjunto com INSTITUTO SOCIAL MAIS SAÚDE, doravante denominadas “Partes”.
Têm entre si justo e avençado o presente Termo Aditivo, mediante as seguintes cláusulas e condições que mutuamente aceitam e outorgam, a saber:
CLÁUSULA PRIMEIRA – DO OBJETO
1.1. O presente termo aditivo tem por objeto prorrogar a vigência e alterar o foro de eleição do Contrato de PRESTAÇÃO DE SERVIÇOS ESPECIALIZADOS EM EXAMES DE ULRASSONOGRAFIA nº 92-02/2020 – GCONT 13538, pactuado em 01 de março de 2022, sem caráter de exclusividade, para atendimento ao projeto alocado no Hospital Regional de Cirurgias da Grande Dourados, conforme Contrato de Gestão nº 002/2020 – GCONT 13538 e aditivos, firmado entre o CONTRATANTE e o Estado do Mato Grosso do Sul, por intermédio da Secretaria Estadual de Saúde.
CLÁUSULA SEGUNDA – DA VIGÊNCIA CONTRATUAL
2.1. Considerando ter havido interesse mútuo entre as partes, fica prorrogado a vigência do instrumento supramencionado, a partir de 22 de agosto de 2022, pelo tempo que durar o Contrato de Gestão nº 02/2020 – GCONT 13538,
1 de 2
DocuSign Envelope ID: 5CCFFDF0-FFDB-44A2-AFFF-7A9ABE6D54A2
Esta página é integrante do 1º Termo Aditivo ao Contrato de Prestação de Serviços Especializados em Realização de Exames de Ultrassonografia nº 92-02/2020 - GCONT 13538, firmado entre INSTITUTO SOCIAL MAIS SAÚDE e XXXXXXX XXXXXXXX XXXXX, não possuindo
isoladamente qualquer valor ou força contratual.
firmados entre o CONTRATANTE e o Estado do Mato Grosso do Sul, podendo ser rescindido a qualquer momento, desde que denunciado à outra Parte por escrito com antecedência mínima de 30 (trinta) dias corridos.
CLÁUSULA TERCEIRA – DO FORO DE ELEIÇÃO
3.1. Fica eleito o foro desta cidade de Dourados - MS com exclusão de qualquer outro, por mais privilegiado que seja, para dirimir quaisquer questões oriundas do presente instrumento contratual.
CLÁUSULA QUARTA – DA CONFIDENCIALIDADE
4.1. O CONTRATADO não poderá dar publicidade ou entregar dados ou informações sigilosas apenas relativas a questões que dizem respeito a Lei Geral de Proteção de Dados n. 13.709/2018, bem como a ofícios dos quais tenham por finalidade o sigilo determinado por autoridade competente.
CLÁUSULA QUINTA – DAS CONDIÇÕES GERAIS
5.1. Ficam inalteradas e ratificadas as demais cláusulas e condições pactuadas no contrato de locação primitivo, que não conflitem com o presente termo.
E por estarem justos e acordados assinam o presente aditivo de contrato em 03 (três) vias de igual teor e forma e para o mesmo fim, para que surta seus regulares efeitos de direitos.
Dourados/MS, 30 de agosto de 2022.
INSTITUTO SOCIAL MAIS
SAÚDE
Xxxxx Xxxxxx Xxxxx Diretora Presidente
XXXXXXX XXXXXXXX XXXXX
Xxxxxxx Xxxxxxxx Dutra Titular
TESTEMUNHAS:
Nome:Xxxxxxx Xxxxxx Xxxx
Nome:
Xxxxxxxx Xxxxx Xxxxxxx
RG: CPF:
47.205.880-0
000.000.000-00
RG: CPF:
38.300.993-5
000.000.000-00
2 de 2
Certificate Of Completion
Envelope Id: 5CCFFDF0FFDB44A2AFFF7A9ABE6D54A2 Status: Completed Subject: 1° Termo aditivo ao contrato n° 92 - Xxxxxxx Xxxxxxxx.pdf
Source Envelope:
Document Pages: 2 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 3 Xxxxxxxx Xxxxx Xxxxxxx
AutoNav: Enabled
EnvelopeId Stamping: Enabled Time Zone: (UTC-03:00) Brasilia
Xxx Xxxx xx Xxxx, x. 0000, Xxxxxxxx 000 - Xxxx Xxxxxxx
Xxx Xxxxx, XX 00.000-000
xxxxxxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx IP Address: 177.103.85.239
Record Tracking
Status: Original
9/21/2022 10:31:47 AM
Holder: Xxxxxxxx Xxxxx Xxxxxxx xxxxxxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx
Location: DocuSign
Signer Events Signature Timestamp
Xxxxxxx Xxxxxxxx Xxxxx xxxxxxxxxxxxx@xxxxxxx.xxx
Security Level: Email, Account Authentication (None)
Electronic Record and Signature Disclosure:
Accepted: 9/21/2022 12:13:23 PM
ID: ee6089df-7561-4c1e-bc84-73b2fdb8fe0a
Xxxxx Xxxxxx Xxxxx xxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx
Security Level: Email, Account Authentication (None)
Signature Adoption: Drawn on Device Using IP Address: 179.252.4.210 Signed using mobile
Signature Adoption: Pre-selected Style Using IP Address: 177.103.85.239
Sent: 9/21/2022 10:35:36 AM Viewed: 9/21/2022 12:13:23 PM Signed: 9/21/2022 12:13:54 PM
Sent: 9/21/2022 12:13:56 PM Viewed: 9/21/2022 12:24:19 PM Signed: 9/21/2022 12:24:29 PM
Electronic Record and Signature Disclosure:
Accepted: 9/21/2022 12:24:19 PM
ID: b09adb3a-115e-41a1-907c-961e1259d0c4
Xxxxxxxx Xxxxx Xxxxxxx xxxxxxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx Assistente Jurídico
Instituto Social Mais Saúde
Security Level: Email, Account Authentication (None)
Signature Adoption: Pre-selected Style Using IP Address: 177.103.85.239
Sent: 9/21/2022 12:24:31 PM Viewed: 9/21/2022 12:24:55 PM Signed: 9/21/2022 12:25:15 PM
Electronic Record and Signature Disclosure:
Accepted: 6/22/2022 5:06:04 PM
ID: c5c15b33-20f8-41b2-b560-ce250d8ea80a
Xxxxxxx Xxxxxx Xxxx xxxxxxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx Supervisora Jurídica
Instituto Social Mais Saúde
Security Level: Email, Account Authentication (None)
Signature Adoption: Pre-selected Style Using IP Address: 177.103.85.239
Sent: 9/21/2022 12:25:16 PM Viewed: 9/21/2022 12:39:16 PM Signed: 9/21/2022 12:39:44 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
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 |
Witness Events | Signature | Timestamp |
Notary Events | Signature | Timestamp |
Envelope Summary Events | Status | Timestamps |
Envelope Sent | Hashed/Encrypted | 9/21/2022 10:35:36 AM |
Certified Delivered | Security Checked | 9/21/2022 12:39:16 PM |
Signing Complete | Security Checked | 9/21/2022 12:39:44 PM |
Completed | Security Checked | 9/21/2022 12:39:44 PM |
Payment Events | Status | Timestamps |
Electronic Record and Signature Disclosure | ||
Electronic Record and Signature Disclosure created on: 6/22/2022 4:21:32 PM
Parties agreed to: Xxxxxxx Xxxxxxxx Xxxxx, Xxxxx Xxxxxx Xxxxx, Xxxxxxxx Xxxxx Xxxxxxx
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, INSTITUTO SOCIAL MAIS SAUDE (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 INSTITUTO SOCIAL MAIS SAUDE:
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: xxxxxxxx0@xxxxxxxxxxxxxxxxxx.xxx.xx
To advise INSTITUTO SOCIAL MAIS SAUDE 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 xxxxxxxx0@xxxxxxxxxxxxxxxxxx.xxx.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 INSTITUTO SOCIAL MAIS SAUDE
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 xxxxxxxx0@xxxxxxxxxxxxxxxxxx.xxx.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 INSTITUTO SOCIAL MAIS SAUDE
To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:
i. decline to sign a document from within your signing session, and on the subsequent page, select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an email to xxxxxxxx0@xxxxxxxxxxxxxxxxxx.xxx.xx and in the body of such request you must state your email, full name, mailing address, and telephone 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
The minimum system requirements for using the DocuSign system may change over time. The current system requirements are found here: xxxxx://xxxxxxx.xxxxxxxx.xxx/xxxxxx/xxxxxx-xxxxx- signing-system-requirements.
Acknowledging your access and consent to receive and sign documents 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 confirm that you have read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for your future reference and access; or (ii) that you are able to email this ERSD to an email 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 as described herein, then select the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system.
By selecting the check-box next to ‘I agree to use electronic records and signatures’, you confirm that:
• You can access and read this Electronic Record and Signature Disclosure; and
• You can print on paper this Electronic Record and Signature Disclosure, or save or send this Electronic Record and Disclosure to a location where you can print it, for future reference and access; and
• Until or unless you notify INSTITUTO SOCIAL MAIS SAUDE as described above, you consent to receive exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you by INSTITUTO SOCIAL MAIS SAUDE during the course of your relationship with INSTITUTO SOCIAL MAIS SAUDE.
DocuSign Envelope ID: E3834A12-CFD7-4AEE-A389-08EB9F5EC758
Esta página é integrante do 2º Termo Aditivo ao Contrato de Prestação de Serviços Especializados em Realização de Exames de Ultrassonografia nº 92-02/2020 - GCONT 13538, firmado entre INSTITUTO SOCIAL MAIS SAÚDE e XXXXXXX XXXXXXXX XXXXX, não possuindo
isoladamente qualquer valor ou força contratual.
2º TERMO ADITIVO AO CONTRATO DE PRESTAÇÃO DE SERVIÇOS ESPECIALIZADOS EM REALIZAÇÃO DE EXAMES DE ULTRASSONOGRAFIA N° 92- 02/2020 - GCONT 13538 QUE ENTRE SI CELEBRAM O INSTITUTO SOCIAL MAIS SAÚDE E XXXXXXX XXXXXXXX XXXXX.
Pelo presente Instrumento Particular e na melhor forma de direito, de um lado como CONTRATANTE, assim designado INSTITUTO SOCIAL MAIS SAÚDE, pessoa jurídica de direito privado, com sede na Rua Coronel Ponciano de Xxxxxx Xxxxxxx, n°3.323, Vila Alba, CEP: 79.830-220, Dourados – MS, devidamente inscrita no CNPJ/MF sob o nº. 18.963.002/0007-37, neste ato representado por sua Diretora Presidente, Sra. XXXXX XXXXXX XXXXX, brasileira, solteira, gestora em segurança, portadora da cédula de identidade RG nº 30.171.370-4 - SSP/SP e inscrita no CPF/MF sob nº 000.000.000-00, com endereço supracitado, onde recebe correspondência;
e, de outro lado como CONTRATADO, assim designado XXXXXXX XXXXXXXX XXXXX, pessoa jurídica de direito privado, com sede na Rua Aquidauana, nº 1.691, Vila Rosa, CEP: 79.831-040, Dourados - MS, devidamente inscrito no CNPJ/MF sob o nº. 26.925.247/0001-02, neste ato representado por XXXXXXX XXXXXXXX XXXXX, brasileiro, casado, médico, portador da cédula de identidade RG nº 000000000 - SSP/MS e inscrito no CPF/MF sob o nº 000.000.000-00, com endereço supracitado, onde recebe correspondência, e em conjunto com INSTITUTO SOCIAL MAIS SAÚDE, doravante denominadas “Partes”.
Têm entre si justo e avençado o presente Termo Aditivo, mediante as seguintes cláusulas e condições que mutuamente aceitam e outorgam, a saber:
CLÁUSULA PRIMEIRA – DO OBJETO
1. O presente termo aditivo tem por objeto reduzir o valor unitário do Contrato de PRESTAÇÃO DE SERVIÇOS ESPECIALIZADOS EM EXAMES DE ULRASSONOGRAFIA nº 92-02/2020 – GCONT 13538, pactuado em 01 de março de 2022, sem caráter de exclusividade, para atendimento ao projeto alocado no Hospital Regional de Cirurgias da Grande Dourados, conforme Contrato de Gestão nº 002/2020 – GCONT 13538 e aditivos, firmado entre o CONTRATANTE e o Estado do Mato Grosso do Sul, por intermédio da Secretaria Estadual de Saúde.
CLÁUSULA SEGUNDA – DA ALTERAÇÃO
2. Considerando ter havido interesse mútuo entre as partes, essas pactuam a redução do valor unitário do contrato original, onde passará a viger da seguinte forma:
1 de 2
DocuSign Envelope ID: E3834A12-CFD7-4AEE-A389-08EB9F5EC758
Esta página é integrante do 2º Termo Aditivo ao Contrato de Prestação de Serviços Especializados em Realização de Exames de Ultrassonografia nº 92-02/2020 - GCONT 13538, firmado entre INSTITUTO SOCIAL MAIS SAÚDE e XXXXXXX XXXXXXXX XXXXX, não possuindo
isoladamente qualquer valor ou força contratual.
“Pela efetiva prestação de serviços e/ou fornecimento, o CONTRATANTE pagará ao CONTRATADO, o valor bruto unitário de R$ 50,00 (cinquenta reais). ”
2.1. O valor acima mencionado passará a viger a partir do dia 01 de maio de 2023.
CLÁUSULA TERCEIRA – DAS CONDIÇÕES GERAIS
3. Ficam inalteradas e ratificadas as demais cláusulas e condições pactuadas no contrato de locação primitivo, que não conflitem com o presente termo.
E por estarem justos e acordados assinam o presente aditivo de contrato em 03 (três) vias de igual teor e forma e para o mesmo fim, para que surta seus regulares efeitos de direitos.
Dourados/MS, 23 de março de 2023.
INSTITUTO SOCIAL MAIS SAÚDE
Xxxxx Xxxxxx Xxxxx Diretora Presidente
XXXXXXX XXXXXXXX XXXXX
Xxxxxxx Xxxxxxxx Dutra Titular
TESTEMUNHAS:
Nome:
Xxxxxxxx Xxxxx Xxxxxxx
Nome:
Xxxxxxx Xxxxxxxxx
RG: RG:
CPF:
38.300.993-5
000.000.000-00
CPF:
001409922
00000000000
2 de 2
Certificate Of Completion
Envelope Id: E3834A12CFD74AEEA38908EB9F5EC758 Status: Completed Subject: 2° Termo aditivo ao contrato n° 92 - Xxxxxxx Xxxxxxxx.pdf
Source Envelope:
Document Pages: 2 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 4 Xxxxxxxx Xxxxx Xxxxxxx
AutoNav: Enabled
EnvelopeId Stamping: Enabled Time Zone: (UTC-03:00) Brasilia
Xxx Xxxx xx Xxxx, x. 0000, Xxxxxxxx 000 - Xxxx Xxxxxxx
Xxx Xxxxx, XX 00.000-000
xxxxxxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx IP Address: 35.199.90.154
Record Tracking
Status: Original
3/23/2023 5:40:53 PM
Holder: Xxxxxxxx Xxxxx Xxxxxxx xxxxxxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx
Location: DocuSign
Signer Events Signature Timestamp
Xxxxxxx Xxxxxxxx Xxxxx xxxxxxxxxxxxx@xxxxxxx.xxx
Security Level: Email, Account Authentication (None)
Electronic Record and Signature Disclosure:
Accepted: 3/23/2023 7:19:12 PM
ID: 6fbd7b5d-d3e2-4ec2-bf97-02050a588adf
Xxxxx Xxxxxx Xxxxx xxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx
Security Level: Email, Account Authentication (None)
Electronic Record and Signature Disclosure:
Accepted: 3/24/2023 7:13:02 AM
ID: 7231ef7e-1801-431a-8ca7-2a3dc10daef9
Xxxxxxx Xxxxxxxxx xxxxxxxxxxxxxx@xxxxxxxx.xxxxxxxxxxxxxxxxxx.xxx.xx
Security Level: Email, Account Authentication (None)
Signature Adoption: Drawn on Device Using IP Address: 177.79.21.166 Signed using mobile
Signature Adoption: Pre-selected Style Using IP Address: 177.26.246.226 Signed using mobile
Signature Adoption: Pre-selected Style Using IP Address: 45.6.78.36
Sent: 3/23/2023 5:43:35 PM Viewed: 3/23/2023 7:19:12 PM Signed: 3/23/2023 7:20:28 PM
Sent: 3/23/2023 7:20:30 PM Viewed: 3/24/2023 7:13:02 AM Signed: 3/24/2023 7:13:30 AM
Sent: 3/24/2023 7:13:33 AM Resent: 3/30/2023 9:31:18 AM Resent: 3/30/2023 9:38:54 AM Viewed: 3/30/2023 9:48:56 AM Signed: 3/30/2023 9:49:38 AM
Electronic Record and Signature Disclosure:
Accepted: 3/30/2023 9:48:56 AM
ID: 98263598-a065-4ff9-8444-61055f8e46d6
Xxxxxxxx Xxxxx Xxxxxxx xxxxxxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx.xx Assistente Jurídico
Instituto Social Mais Saúde
Security Level: Email, Account Authentication (None)
Signature Adoption: Pre-selected Style Using IP Address: 179.191.110.78
Sent: 3/30/2023 9:49:42 AM Viewed: 3/30/2023 2:28:39 PM Signed: 3/30/2023 2:28:57 PM
Electronic Record and Signature Disclosure:
Accepted: 6/22/2022 5:06:04 PM
ID: c5c15b33-20f8-41b2-b560-ce250d8ea80a
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 |
Witness Events | Signature | Timestamp |
Notary Events | Signature | Timestamp |
Envelope Summary Events | Status | Timestamps |
Envelope Sent | Hashed/Encrypted | 3/23/2023 5:43:35 PM |
Envelope Updated | Security Checked | 3/23/2023 5:45:10 PM |
Envelope Updated | Security Checked | 3/23/2023 5:45:10 PM |
Certified Delivered | Security Checked | 3/30/2023 2:28:39 PM |
Signing Complete | Security Checked | 3/30/2023 2:28:57 PM |
Completed | Security Checked | 3/30/2023 2:28:57 PM |
Payment Events | Status | Timestamps |
Electronic Record and Signature Disclosure | ||
Electronic Record and Signature Disclosure created on: 6/22/2022 4:21:32 PM
Parties agreed to: Xxxxxxx Xxxxxxxx Xxxxx, Xxxxx Xxxxxx Xxxxx, Xxxxxxx Xxxxxxxxx, Xxxxxxxx Xxxxx Xxxxxxx
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, INSTITUTO SOCIAL MAIS SAUDE (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 INSTITUTO SOCIAL MAIS SAUDE:
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: xxxxxxxx0@xxxxxxxxxxxxxxxxxx.xxx.xx
To advise INSTITUTO SOCIAL MAIS SAUDE 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 xxxxxxxx0@xxxxxxxxxxxxxxxxxx.xxx.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 INSTITUTO SOCIAL MAIS SAUDE
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 xxxxxxxx0@xxxxxxxxxxxxxxxxxx.xxx.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 INSTITUTO SOCIAL MAIS SAUDE
To inform us that you no longer wish to receive future notices and disclosures in electronic format you may:
i. decline to sign a document from within your signing session, and on the subsequent page, select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an email to xxxxxxxx0@xxxxxxxxxxxxxxxxxx.xxx.xx and in the body of such request you must state your email, full name, mailing address, and telephone 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
The minimum system requirements for using the DocuSign system may change over time. The current system requirements are found here: xxxxx://xxxxxxx.xxxxxxxx.xxx/xxxxxx/xxxxxx-xxxxx- signing-system-requirements.
Acknowledging your access and consent to receive and sign documents 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 confirm that you have read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for your future reference and access; or (ii) that you are able to email this ERSD to an email 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 as described herein, then select the check-box next to ‘I agree to use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign system.
By selecting the check-box next to ‘I agree to use electronic records and signatures’, you confirm that:
• You can access and read this Electronic Record and Signature Disclosure; and
• You can print on paper this Electronic Record and Signature Disclosure, or save or send this Electronic Record and Disclosure to a location where you can print it, for future reference and access; and
• Until or unless you notify INSTITUTO SOCIAL MAIS SAUDE as described above, you consent to receive exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you by INSTITUTO SOCIAL MAIS SAUDE during the course of your relationship with INSTITUTO SOCIAL MAIS SAUDE.