5437B_20_Crossroads_RSP_Renewal_SIGNED.pdf

DocuSign Envelope ID: C7BE7E8A-506E-4C1A-936F-2EB9A6A7A177

1/30/2020

1/31/2020 above

1/30/2020

Certificate Of Completion Envelope Id: C7BE7E8A506E4C1A936F2EB9A6A7A177 Status: Completed

Subject: 5437B Crossroads RSP Renewal Request

Source Envelope:

Document Pages: 10 Signatures: 3 Envelope Originator:

Certificate Pages: 6 Initials: 7 Charlene Orsted

AutoNav: Enabled

EnvelopeId Stamping: Enabled

Time Zone: (UTC-06:00) Central Time (US & Canada)

3099 East Washington Ave.

Madison, WI 53707 charlene.orsted@wisconsin.gov

IP Address: 165.189.255.43

Record Tracking Status: Original

1/29/2020 5:25:55 PM

Holder: Charlene Orsted charlene.orsted@wisconsin.gov

Location: DocuSign

Security Appliance Status: Connected Pool: StateLocal

Storage Appliance Status: Connected Pool: Wisconsin Department of Corrections Location: DocuSign

Signer Events Signature Timestamp Patricia M. Faulhaber patty@gbswi.com

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 75.86.48.51

Sent: 1/29/2020 5:37:40 PM

Viewed: 1/30/2020 10:27:47 AM

Signed: 1/30/2020 10:28:58 AM

Electronic Record and Signature Disclosure:

Accepted: 1/30/2020 10:27:47 AM ID: f08d2fce-b61e-4355-959a-5c2d6c62fdfc

Charlene Orsted charlene.orsted@wisconsin.gov

Procurement Specialist

Wisconsin Department of Corrections

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 165.189.255.46

Sent: 1/30/2020 10:29:03 AM

Viewed: 1/31/2020 10:27:11 AM

Signed: 1/31/2020 11:42:05 AM

Electronic Record and Signature Disclosure:

Not Offered via DocuSign

Patricia M. Faulhaber patty@gbswi.com

Security Level: Email, Account Authentication (None)

Signature Adoption: Pre-selected Style

Using IP Address: 75.86.48.51

Sent: 1/31/2020 11:42:10 AM

Viewed: 1/31/2020 11:57:54 AM

Signed: 1/31/2020 11:58:16 AM

Electronic Record and Signature Disclosure:

Accepted: 1/31/2020 11:57:54 AM ID: 0f1fa8c8-6d87-42ca-994f-149438e76399

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 Carolyn Williams

CarolynM.Williams@wisconsin.gov

Security Level: Email, Account Authentication (None)

Sent: 1/31/2020 11:58:21 AM

Electronic Record and Signature Disclosure:

Accepted: 4/9/2018 12:31:48 PM ID: 0ecb0002-841b-4922-bdc0-4516d96d1cd0

Debra J. Adamski-Pavloski debraj.adamskipavloski@wisconsin.gov

Purchasing Supervisor

Department of Corrections

Security Level: Email, Account Authentication (None)

Sent: 1/31/2020 11:58:21 AM

Electronic Record and Signature Disclosure:

Not Offered via DocuSign

DocuSign Administrator docdocusign@wi.gov

DocuSign Adminsitrator

Wisconsin Department of Corrections

Security Level: Email, Account Authentication (None)

Sent: 1/31/2020 11:58:21 AM

Electronic Record and Signature Disclosure:

Not Offered via DocuSign

Joselyn Lopez

Joselyn.Lopez@wisconsin.gov

Security Level: Email, Account Authentication (None)

Sent: 1/31/2020 11:58:21 AM

Electronic Record and Signature Disclosure:

Not Offered via DocuSign

Sandra Barg

Sandra.Barg@wisconsin.gov

Purchasing Agent

WI Department of Corrections

Security Level: Email, Account Authentication (None)

Sent: 1/31/2020 11:58:21 AM

Electronic Record and Signature Disclosure:

Not Offered via DocuSign

Shelby Slaven

Shelby.Slaven@wisconsin.gov

Security Level: Email, Account Authentication (None)

Sent: 1/31/2020 11:58:21 AM

Electronic Record and Signature Disclosure:

Not Offered via DocuSign

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 1/31/2020 11:58:21 AM

Certified Delivered Security Checked 1/31/2020 11:58:21 AM

Signing Complete Security Checked 1/31/2020 11:58:21 AM

Completed Security Checked 1/31/2020 11:58:21 AM

Payment Events Status Timestamps

Electronic Record and Signature Disclosure

CONSUMER DISCLOSURE

From time to time, Wisconsin Department of Corrections (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through your DocuSign, Inc. (DocuSign) Express user account. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the æI agreeÆ button at the bottom of this document.

Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. For such copies, as long as you are an authorized user of the DocuSign system you will have the ability to download and print any documents we send to you through your DocuSign user account for a limited period of time (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.25 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 ôWithdraw Consentö form on the signing page of your DocuSign account. This will indicate to us that you have withdrawn your consent to receive required notices and disclosures electronically from us and you will no longer be able to use your DocuSign Express user account to receive required notices and consents electronically from us or to sign electronically documents from us.

All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through your DocuSign user account all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given

us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us.

Electronic Record and Signature Disclosure created on: 4/18/2013 7:44:39 AM Parties agreed to: Patricia M. Faulhaber, Patricia M. Faulhaber, Carolyn Williams

How to contact Wisconsin Department of Corrections:

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: DOCPurchasingHelpdesk@wi.gov

To advise Wisconsin Department of Corrections 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 DOCPurchasingHelpdesk@wi.gov and in the body of such request you must state: your previous e-mail address, your new e-mail address. We do not require any other information from you to change your email address..

In addition, you must notify DocuSign, Inc to arrange for your new email address to be reflected in your DocuSign account by following the process for changing e-mail in DocuSign.

To request paper copies from Wisconsin Department of Corrections 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 DOCPurchasingHelpdesk@wi.gov and in the body of such request you must state your e-mail address, full name, US Postal address, and telephone number. We will bill you for any fees at that time, if any.

To withdraw your consent with Wisconsin Department of Corrections To inform us that you no longer want to receive future notices and disclosures in electronic format you may:

i. decline to sign a document from within your DocuSign account, and on the subsequent page, select the check-box indicating you wish to withdraw your consent, or you may;

ii. send us an e-mail to DOCPurchasingHelpdesk@wi.gov and in the body of such request you must state your e-mail, full name, IS Postal Address, telephone number, and account number. We do not need any other information from you to withdraw consent.. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process..

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** These minimum requirements are subject to change. If these requirements change, we will provide you with an email message at the email address we have on file for you at that time providing you with the revised hardware and software requirements, at which time you will have the right to withdraw your consent.

Acknowledging your access and consent to receive materials electronically

To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please verify that you were able to read this electronic disclosure and that you also were able to print on paper or electronically save this page for your future reference and access or that you were able to e-mail this disclosure and consent to an address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receiving notices and disclosures exclusively in electronic format on the terms and conditions described above, please let us know by clicking the æI agreeÆ button below.

By checking the æI AgreeÆ box, I confirm that:

• I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF ELECTRONIC CONSUMER 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 Wisconsin Department of Corrections 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 Wisconsin Department of Corrections during the course of my relationship with you.