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Certificate Of Completion <br />Envelope Id: 262ABA1853544F4195089B13C8ACBA6D <br />Subject: Please DocuSign: LHJ MAC Restatements K4649 <br />Source Envelope: <br />Document Pages: 60 Signatures: 1 <br />Certificate Pages: 2 Initials: 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 />11/3/2020 2:51:26 PM <br />Signer Events <br />Rachelle Amedne <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 Authentication <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via DocuSign <br />Tristen Lamb <br />tristen _lam b@co. kittitas.wa. us <br />Security Level: Email, Account Authentication <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via DocuSign <br />In Person Signer Events <br />Editor Delivery Events <br />Agent Delivery Events <br />Intermediary Delivery Events <br />Certified Delivery Events <br />Carbon Copy Events <br />Jon Brogger <br />jon,brogger@hca.wa.gov <br />Security Level: Email, Account Authentication <br />(None) <br />Electronic Record and Signature Disclosure <br />Not Offered via DocuSign <br />Holder: Julia Bang <br />julia.bang@hca.wa.gov <br />Signature <br />Oe[rSL n d F� <br />Signature Adoption: Pre -selected Style <br />Using IP Address: 147.55.199.233 <br />Signature <br />Status <br />Status <br />Status <br />Status <br />Status <br />COPIED <br />Jon Brogger COPIED <br />jon.brogger@hca.wa.gov <br />Security Level: Email, Account Authentication <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via DocuSign <br />Docu <br />a socuern <br />Status: Sent <br />Envelope Originator: <br />Julia Bang <br />626 8th Ave SE <br />Olympia, WA 98501 <br />julia.bang@hca.wa.gov <br />IP Address: 147.55.199.234 <br />Location: DocuSign <br />Timestamp <br />Sent: 11/3/2020 2:55:59 PM <br />Viewed: 11/3/2020 3:08:59 PM <br />Signed: 11/3/2020 3:10:29 PM <br />Sent: 11/3/2020 3:10:34 PM <br />Resent: 11/9/2020 10:51:59 AM <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Sent: 11/3/2020 2:55:59 PM <br />Viewed: 11/3/2020 2:58:35 PM <br />Sent: 11/3/2020 3:10:34 PM <br />Viewed: 11/3/2020 3:12:29 PM <br />