AMD 2 - $150K ORDER FORM_SIGBLOCS.PDF

Order Form
QUALTRICS CONFIDENTIAL 
Qualtrics 
Customer 
By (signature): \s2\ 
By (signature): \s1\ 
Name: \n2\ 
Name: Bill Gates
Title: \t2\ 
Title: Chairman, Board of Supervisors
Date: \d2\ 
Date: \d1\ 
Qualtrics Primary Contact: 
Customer Primary Contact: 
Name: Sharath Bhat 
Name: Jackie Ward 
Phone: 
Phone: 6025063011 
Email: sharathb@qualtrics.com 
Email: jackie.ward@maricopa.gov 
gParties: 
Qualtrics, LLC  
333 W. River Park Dr. 
Provo, UT 84604 
United States 
(“Qualtrics”) 
County of Maricopa 
201 W Jefferson St Fl 4 
Phoenix, AZ 85003 
United States 
(“Customer”) 
Effective Date: 
The date signed by the last party to sign. 
Governing 
Document: 
This Order Form is subject to the Qualtrics Terms of Service at 
https://www.qualtrics.com/terms-of-service/ (the “Agreement”). All capitalized terms used 
but not defined herein have the meanings given to them in the Agreement. If there is a 
conflict between the terms of the Agreement and this Order Form, this Order Form will 
control. 
Attachments: 
- Service Level Exhibit
- Fees Exhibit
- Cloud Service Exhibit
Services: 
As set forth in the exhibits attached hereto 
Term: 
As set forth in the exhibits attached hereto 
Payment 
Terms: 
As set forth in the exhibits attached hereto 
Additional 
Terms: 
To be completed by Customer 
Regional Data 
Center: 
Purchase Order 
Number (if any): 
\tbx_1_text\ 
Email Address 
for Invoice 
Submission: 
Shipping 
Address: 
\addressLineA1\ 
\addressLineB1\ 
Invoicing 
Instructions (if 
applicable): 
\instructions_1_text\ 
Billing Address 
for Invoice 
Submission: 
Attn:

Order Form
QUALTRICS CONFIDENTIAL 
Service Level Exhibit 
Service Levels 
1.
Availability. Qualtrics will use commercially reasonable efforts to ensure that the Cloud Service will be
available at all times, excluding when the Cloud Service is unavailable due to (a) required system maintenance
as determined by Qualtrics (“Scheduled Maintenance”); and (b) causes outside of the reasonable control of
Qualtrics that could not have been avoided by its exercise of due care, including any outages caused by: (i) the
Internet in general; (ii) a Customer-caused event; or (iii) any Force Majeure Event (“Availability”). 
2.
Scheduled Maintenance. A minimum of five days’ advance notice will be provided by email to Customer for all
Scheduled Maintenance exceeding two hours. For Scheduled Maintenance lasting less than two hours, notice
will be displayed on the login page.
3.
Downtime. “Downtime” is defined as the Cloud Service having no Availability, expressed in minutes.
4.
Remedies for Downtime. If Downtime exceeds a certain amount per month, Customer will be entitled, upon
written request, to a credit (“Fee Credit”) based on the formula: Fee Credit = Fee Credit Percentage set forth
below * (1/12 current annual Fees paid for Software affected by Downtime). All times listed immediately
below are per calendar month.
1.
If Downtime is 30 minutes or less, no Fee Credit Percentage is awarded.
2.
If Downtime is from 31 to 120 minutes, Customer is eligible for a Fee Credit Percentage of 5%.
3.
If Downtime is from 121 to 240 minutes, Customer is eligible for a Fee Credit Percentage of 7.5%.
4.
If Downtime is 241 minutes or greater, Customer is eligible for a Fee Credit Percentage of 10.0%

Order Form
QUALTRICS CONFIDENTIAL 
Fees Exhibit 
License Details 
Start Date 
End Date 
Term in Months 
20-Jan-2022
05-Aug-2022
7 
Cloud Service Details 
Period 
Services 
Price 
Estimated 
Invoice Date 
Payment 
Terms from 
Invoice 
License 
Configuration 
20-Jan-2022 TO 05-Aug-
2022
Cloud 
Professional 
$150,000.00 
$0.00 
Effective Date
Net 30 
Q-1644813
Total 
USD 
$150,000.00 
*Term-based prorated amount of $150,000.00 annualized price.
Prices shown do not include applicable taxes. Applicable taxes will be presented on the invoice. 
Press Release 
Notwithstanding anything to the contrary in the Agreement, upon mutual execution of this Order Form Customer grants Qualtrics the right 
to issue a press release naming Customer as a customer of Qualtrics and identifying the product purchased.

Order Form 
QUALTRICS CONFIDENTIAL 
Cloud Service Exhibit 
Cloud Service Renewal (not applicable to pilots or proofs of concept). Qualtrics sends renewal notices to 
customers at least 60 days before the end of the term. Upon expiration of each term, the Cloud Service will 
automatically renew for a successive one-year term with a price increase of no more than 5% at such renewal, 
unless either party provides notice of nonrenewal at least 30 days prior to the end of the term. 
[Description of Services on following page]

Order Form
QUALTRICS CONFIDENTIAL 
YEAR 1 
Q-1644813
CLOUD SERVICE
CoreXM5 State of the Art 
SMS Text Reserve : 15000000 
FOR AND ON BEHALF OF   
MARICOPA COUNTY 
By _______________________________       
Bill Gates, 
Chairman, Board of Supervisors
Date 
_______________________________       
ATTEST:  
_______________________________       
Clerk of the Board 
_______________________________       
Date 
APPROVED AS TO FORM: 
_______________________________       
 Attorney for Maricopa County 
_______________________________       
Date