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D*ocuSign <br />Certificate Of Gompletion <br />Envelope ld : FF1 48287E90C42898A0FA1 4FAO0E82AF <br />Subject: Docusign NOTIFICATION: Contract K2747-04 &K4677-01 with Kittitas County Public Health <br />Source Envelope: <br />Document Pages: 37 Signatures:2 <br />Certificate Pages: 5 lnitials: 0 <br />AutoNav: Enabled <br />Envelopeld Stamping: Enabled <br />Time Zone: (UTC-08:00) Pacific Time (US & Canada) <br />Record Tracking <br />Status: Original <br />61212022 9:29:29 AM <br />Signer Events <br />Rachelle Amerine <br />rachelle.amerine@hca.wa.gov <br />Contracts Administrator <br />CloudPWR OBO Washington State Health Care <br />Authority-Sub Account <br />Security Level: Email, Account Authenticalion <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via Docusign <br />Chelsey Loeffers <br />chelsey.loeffers@co.kittitas.wa.us <br />Public Health Director <br />Security Level: Email, Account Authentication <br />(None) <br />Electronic Record and Signature Disclosure: <br />Accepted: 611312022 9:14:26 AM <br />lD: 31 1 cb8e0-b362-4bbe-894e-84cde134a27 6 <br />ln Person Signer Events <br />Editor Delivery Events <br />Agent Delivery Events <br />lntermediary Delivery Events <br />Gertified Delivery Events <br />Carbon Gopy Events <br />Lyuda Kozlova <br />lyudmila.kozlova@hac.wa.gov <br />Security Level: Email, Account Authentication <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via Docusign <br />Holder: Janet Stevens <br />janet.stevens@hca.wa. gov <br />Signature <br />ffi.,,::* <br />Status: Sent <br />Envelope Originator: <br />Janet Stevens <br />626 8th Ave SE <br />Olympia, WA 98501 <br />janet.stevens@hca.wa.gov <br />lP Address: 1 98.239.16.65 <br />Location: DocuSign <br />Timestamp <br />Sent: 61212022 9:45 :03 AM <br />Viewed: 61312022 5:09:32 AM <br />Signed: 6/3/2022 5:11:30 AM <br />Sent: 6/3/2022 5:11:33 AM <br />Viewed: 611312022 9:14:26 AM <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Senl: 6 1212022 9:45 :02 AM <br />Signature Adoption: Pre-selected Style <br />Signed by link sent to rachelle.amerine@hca.wa.gov <br />Using lP Address: 1 98.239.13.95 <br />Signature <br />Status <br />Status <br />Status <br />Status <br />Status <br />COPIED