DocuSign Inc - FY2023-069 DocuSign, Inc.
221 Main Street, Suite 1000
San Francisco, CA 94105
Offer Valid Through: Jun 25,
2023
Prepared By: Jordyn Bjerke
Quote Number: Q-01177707
ORDER FORM
Address Information
Bill To: Ship To:
City of Rancho Palos Verdes City of Rancho Palos Verdes
30940 Hawthorne Blvd,
Rancho Palos Verdes, CA, 90275-5351
United States
30940 Hawthorne Blvd,
Rancho Palos Verdes, CA, 90275-5351
United States
Billing Contact Name: Shipping Contact Name:
Teri Takaoka Teri Takaoka
Billing Email Address:
terit@rpvca.gov
Shipping Email Address:
terit@rpvca.gov
Billing Phone:
(310) 544-5290
Shipping Phone:
(310) 544-5290
Order Details
Order Start Date: Jun 25, 2023 Payment Method: Check
Order End Date: Jun 24, 2024 Payment Terms: Net 30
Billing Frequency: Annual Currency: USD
Products
Product Name Subscription No. Start Date End Date Quantity Net Price
eSignature Business Pro Edition - Envelope
Subs.
SUB-1656226-1 Jun 25, 2023 Jun 24, 2024 500 $2,400.00
Premier Support - eSign SUB-1656226-1 Jun 25, 2023 Jun 24, 2024 1 $360.00
Grand Total: $2,760.00
Product Details
eSignature Envelope Allowance: 500
Overage/Usage Fees
eSignature Business Pro Edition - Envelope Subs. (Per Transaction): $5.80
DocuSign Envelope ID: 862B0C32-7F46-4FD2-A37D-276C3B209017
Page 2 of 3
Order Special Terms
Terms & Conditions
This Order Form is governed by the terms Master Services Agreement available online at:
https://www.docusign.com/company/terms-and-conditions/msa and the applicable Service
Schedule(s) and Attachments for the DocuSign Services described herein available online at
https://www.docusign.com/legal/terms-and-conditions/msa-service-schedules.
Billing Information
Prices shown above do not include any state and local taxes that may apply. Any such taxes
are the responsibility of the Customer and will appear on the final Invoice.
Is the contracting entity exempt from sales tax?
Please select Yes or No: \tax1\
If yes, please send the required tax exemption documents immediately to
taxexempt@docusign.com.
Invoices for this order will be emailed automatically from invoicing@erp.docusign.com. Please
make sure this email is on an approved setting or safe senders list so notifications do not go to
a junk folder or caught in a spam filter.
Purchase Order Information
Is a Purchase Order (PO) required for the purchase or payment of the products on this Order
Form?
Please select Yes or No: \por1\
If yes, please complete the following:
PO Number: \po1\
PO Amount: $\pa1\
DocuSign Envelope ID: 862B0C32-7F46-4FD2-A37D-276C3B209017
Yes
2760
Yes
Page 3 of 3
By signing this Agreement, I certify that I am authorized to sign on behalf of the
Customer and agree to the Terms and Conditions of this Order Form and any
documents incorporated herein.
Customer
DocuSign,
Inc.
Signature: \si1\
Signature: \si3\
Name: \na1\ Name: \na3\
Job Title: \ti1\ Job Title: \ti3\
Date: \ds1\ Date: \ds3\
\
\in2\
DocuSign Envelope ID: 862B0C32-7F46-4FD2-A37D-276C3B209017
May 23, 2023
Teri Takaoka
City Clerk Manager, Revenue Operations
May 23, 2023
Frank Parish
Certificate Of Completion
Envelope Id: 862B0C327F464FD2A37D276C3B209017 Status: Completed
Subject: [DocuSign] Request for eSignatures: City of Rancho Palos Verdes - Renewal
fcorgid: 00D300000000bS4EAI
Source Envelope:
Document Pages: 3 Signatures: 2 Envelope Originator:
Certificate Pages: 5 Initials: 1 Jordyn Bjerke
AutoNav: Disabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
221 Main Street
Suite 1000
San Francisco, 94105
Jordyn.Bjerke@docusign.com
IP Address: 13.110.78.8
Record Tracking
Status: Original
5/23/2023 8:02:57 AM
Holder: Jordyn Bjerke
Jordyn.Bjerke@docusign.com
Location: DocuSign
Signer Events Signature Timestamp
Teri Takaoka
terit@rpvca.gov
City Clerk
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 72.34.97.146
Sent: 5/23/2023 8:03:18 AM
Viewed: 5/23/2023 11:21:21 AM
Signed: 5/23/2023 11:48:19 AM
Electronic Record and Signature Disclosure:
Accepted: 6/15/2021 1:40:49 PM
ID: d84cb6de-1bc0-4a84-a8b0-522b3e540b23
Matt Felch
Matt.Felch@docusign.com
Contract Specialist
Signing Group: AOR
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 98.193.15.52
Sent: 5/23/2023 11:48:21 AM
Viewed: 5/23/2023 12:29:36 PM
Signed: 5/23/2023 12:31:21 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Frank Parish
Frank.Parish@docusign.com
Manager, Revenue Operations
DocuSign, Inc.
Signing Group: AOA
Security Level: Email, Account Authentication
(None)
Signature Adoption: Uploaded Signature Image
Using IP Address: 174.160.237.139
Sent: 5/23/2023 12:31:23 PM
Viewed: 5/23/2023 12:39:50 PM
Signed: 5/23/2023 12:39:59 PM
Electronic Record and Signature Disclosure:
Accepted: 5/1/2020 11:34:29 AM
ID: dd966330-cdca-4d4f-81a5-d1d9d7b8375c
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 5/23/2023 8:03:18 AM
Certified Delivered Security Checked 5/23/2023 12:39:50 PM
Signing Complete Security Checked 5/23/2023 12:39:59 PM
Completed Security Checked 5/23/2023 12:39:59 PM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, DocuSign, Inc. (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, Inc.
(DocuSign) electronic signing system. Please read the information below carefully and
thoroughly, and if you can access this information electronically to your satisfaction and agree to
these terms and conditions, please confirm your agreement by clicking the ‘I agree’ button at the
bottom of this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after signing session and, if you
elect to create a DocuSign signer account, you may access them for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per-page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign ‘Withdraw Consent’ form on the signing page of a
DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn your
consent to receive required notices and disclosures electronically from us and you will no longer
be able to use 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.
Electronic Record and Signature Disclosure created on: 10/17/2018 1:49:32 PM
Parties agreed to: Teri Takaoka, Frank Parish
How to contact DocuSign, Inc.:
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 paper mail, please send correspondence to:
DocuSign, Inc.
221 Main St.,
Suite 1000
San Francisco, CA 94105
To advise DocuSign, Inc. of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at and in the body of such request
you must state: your previous e-mail address, your new e-mail address. Please reach out to the
sender of the envelope if you want to change your email address..
In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in the DocuSign system.
To request paper copies from DocuSign, Inc.
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to and in the body of such request you
must state your e-mail address, full name, US Postal address, and telephone number. We will bill
you for any fees at that time, if any. Please reach out to the sender of the envelope if you want to
request paper copies.
To withdraw your consent with DocuSign, Inc.
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign session, and on the subsequent
page, select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to and in the body of such request you must state your e-mail, full
name, US Postal Address, and telephone number. Please reach out to the sender of the
envelope if you want to withdraw your consent.. The consequences of your withdrawing
consent for online documents will be that transactions may take a longer time to process..
Required hardware and software
Operating
Systems: Windows® 2000, Windows® XP, Windows Vista®; Mac OS® X
Browsers:
Final release versions of Internet Explorer® 6.0 or above (Windows only);
Mozilla Firefox 2.0 or above (Windows and Mac); Safari™ 3.0 or above
(Mac only)
PDF Reader: Acrobat® or similar software may be required to view and print PDF files
Screen
Resolution: 800 x 600 minimum
Enabled Security
Settings: Allow per session cookies
** These minimum requirements are subject to change. If these requirements change, you will be
asked to re-accept the disclosure. Pre-release (e.g. beta) versions of operating systems and
browsers are not supported.
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you were
able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to e-mail
this disclosure and consent to an address where you will be able to print on paper or save it for
your future reference and access. Further, if you consent to receiving notices and disclosures
exclusively in electronic format on the terms and conditions described above, please let us know
by clicking the ‘I agree’ button below.
By checking the ‘I agree’ box, I confirm that:
I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and
I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
Until or unless I notify DocuSign, Inc. as described above, I consent to receive from
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to me by DocuSign, Inc. during the course of my relationship with you.