HomeMy WebLinkAboutP-25-157 Order form 1.pdf Docusign Envelope ID:39EB5D65-8CD9-48A2-8F87-E8B20B895E35
Service Order Form
INFORMATIONCUSTOMER
Billing Contact information Shipping Contact Information
Contact Name: Michael Miller Contact Name (Shipping):
Organization: Fresno County Department of Organization:
Behavioral Health
Email address: Email address:
mimiller@fresnocountyca.gov
Phone: Phone:
Bill-To Address: Michael Miller Ship-To Address: Same as Billing
Fresno County Department of Behavioral
Health
Tax Reg# 94-6000512
1925 E. Dakota Avenue Fresno
93726
California
CA
United States
mimiller@fresnocountyca.gov
Subscription May 13, 2025 Subscription May 13, 2028
Term Start Date: Term End Date:
Subscription 36 Months Billing Frequency: Annual
Term:
PO required on No PO Number (If
Invoice: Applicable):
Payment Method: Wire Transfer Payment Terms: Net 30
Applicable Tax FEIN Tax Registration 94-6000512
Registration: ID:
Is Tax Exempt: No
Product 1 Product Instance Domain No. of
465370 fresnodbh.freshservice.com 23
Yearly 1 (13-May-2025 - 13-May-2026)
Type Item Name List Net Duration
Price/Unit Price/Unit (months)
Product Freshservice - $ 119.00 $ 107.10 12 23 $ 29,559.60
Enterprise Annual
Plan
Total Price $ 29,559.60
Freshworks Inc.,29SO S. Delaware Street,Suite 201,San Mateo,CA 94403
Docusign Envelope ID:39EB5D65-8CD9-48A2-8F87-E8B20B895E35
$ 29,559.60
Yearly 2 (13-May-2026 - 13-May-2027)
DurationType Item Name List 'Net
Price/Unit Price/Unit (months)
Product Freshservice - $ 119.00 $ 107.10 12 23 $ 29,559.60
Enterprise Annual
Plan
Total Price $ 29,559.60
$ 29,559.60
Yearly 3 (13-May-2027 - 13-May-2028)
Type Item Name List Net Duration
Price/Unit Price/Unit (months)
Product Freshservice - $ 119.00 $ 107.10 12 23 $ 29,559.60
Enterprise Annual
Plan
Total Price $ 29,559.60
$ 29,559.60
Total Net Price for all 3 years: $ 88,678.80
COMMERCIAL TLRMS
• The Subscription Term will automatically renew for successive terms unless
terminated in accordance with the terms of the Agreement, as defined below.
• Any service performed by a third-party will be subject to the terms negotiated between
the Customer and such third-party.
• The continued activation of Customer's Account is based on the successful payment of
the Fees.
Freshworks Inc.,2950 S.Delaware Street,Suite 201,San Mateo,CA 94403
Docusign Envelope ID:39EB5D65-8CD9-48A2-8F87-E8B20B895E35
• This Service Order Form is governed by the Freshworks Terms of Service in effect as of
March 10,2025 and found at https://www.freshworks.com/tenns/, unless Customer has a
written Freshworks services agreement executed between Customer and Freshworks Inc. for
the Services purchased hereunder, in which case such written services agreement will govern
(in this case, it is the County Procurement Agreement(the "Agreement").
• The Freshworks Products listed above may have supplemental terms associated with their use
which are available at https://www.freshworks.com/tenns/supplemental-terms/.
• By signing below, Customer represents that the signor is a duly authorized agent of Customer
and hereby waives all claims to the contrary.
• Any terms in the above hyperlinks((1)Freshworks Terms of Service dated March 10,
2025 and(2)Freshworks Supplemental Terms))that conflict with the Agreement will be
resolved in favor of the Agreement.
Freshworks Inc. Customer County of Fresno
Name Justin Widlund Name Riley Blackburn
Title Authorised Signatory Title Purchasing Manager
DOCUSigned by: Riley Digitally signed by
Signature S�i� (fit Riley Blackburn
Signature glaCkbUrCl Date: 2025.10.17
D4983F413E22541B 09:44:50 -07'00'
Date October 16, 2025 1 3:18 PM Oate 10/17/25
DS
APPROVED
Freshworks Inc.,2950 S.Delaware Street,Suite 201,San Mateo,CA 94403
0 docusign.
Certificate Of Completion
Envelope Id:39EB5D65-8CD9-48A2-8F87-E8B20B895E35 Status:Completed
Subject: DD:3626404:FW-Fresno County Department of Behavioral Health-SOF
Source Envelope:
Document Pages:3 Signatures: 1 Envelope Originator:
Certificate Pages:2 Initials:0 Deal-desk-docusign
AutoNav: Enabled Stamps: 1 2950 S Delaware St Suite 201
Envelopeld Stamping: Enabled San Mateo,CA 94403
Time Zone: (UTC-08:00)Pacific Time(US& deal-desk-docusign@freshworks.com
Canada) IP Address: 13.234.188.23
Record Tracking
Status:Original Holder:Deal-desk-docusign Location: DocuSign
10/16/2025 3:09:38 PM deal-desk-docusign@freshworks.com
Signer Events Signature Timestamp
Vishal Prasad Sent: 10/16/2025 3:13:45 PM
vishal.prasad1@freshworks.com AoyEg Viewed: 10/16/2025 3:14:48 PM
Security Level: Email,Account Authentication ` Signed: 10/16/2025 3:14:52 PM
(None)
Using IP Address: 13.234.188.23
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Justin Widlund '"'l by: Sent: 10/16/2025 3:14:54 PM
justin.widlund@freshworks.com [DocuSigned 1IIbL u��� � Viewed: 10/16/2025 3:18:32 PM
Authorized Signatory 4983F413E22541B... Signed: 10/16/2025 3:18:44 PM
Freshworks
Signing Group: Modified online Terms-Group B Signature Adoption: Pre-selected Style
Security Level: Email,Account Authentication
Using IP Address:
(None) 2601:602:8b01:36c0:1d17:59e3:b139:7d9e
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
Vishal Prasad COPIED Sent: 10/16/2025 3:18:46 PM
vshal.prasad 1 @freshworks.com
Security Level: Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via Docusign
Carbon Copy Events Status Timestamp
muhil.ramakrishna@freshworks.com COPIED Sent: 10/16/2025 3:18:47 PM
muhil.ramakrishna@freshworks.com
Security Level: Email,Account Authentication
(None)
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 10/16/2025 3:13:45 PM
Certified Delivered Security Checked 10/16/2025 3:18:32 PM
Signing Complete Security Checked 10/16/2025 3:18:44 PM
Completed Security Checked 10/16/2025 3:18:47 PM
Payment Events Status Timestamps