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DocuSign Envelope ID: AEBE006C-30A5-4332-AFI E-D6ACDCECFAF7 <br />Washington State <br />16 Department of DocuSign Routing Form <br />%&V Commerce <br />SBO Unit <br />Review by (Title): <br />Name: Date: <br />Initials: <br />DS <br />SBO Infrastructure <br />Connie Rivera <br />8/5/2022 11:2[ <br />PDT <br />Programs Manager <br />LGD Deputy Assistant <br />Director <br />Tony Hanson <br />8/8/2022 8:47 <br />E4T <br />(before AD signature) <br />*** This form is completely customizable. You can edit or remove the information above. Note: this <br />is for DocuSign recipients with the Recipient action of NEEDS TO SIGN can initial that they have <br />reviewed and approved the document in DocuSign. This is the only way they will be able to void <br />(stop) the DocuSign envelope if an error is found. *** <br />** This document is set up to be merged out of CMS, if you choose to use it as is. Click here for How <br />to Mere Documents from CMS Instructions. ** <br />Updated February 2021 <br />