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O docusign <br />Gertificate Of Completion <br />Envelope ld: 3968D7F6-CFB6-4E4E-9821-636EBA7B3BF9 Status: Completed <br />Subject: Complete with Docusign: 20250725 Kititas County Public Healh District - Final.docx, Attachment... <br />Source Envelope: <br />Document Pages: 10 Signatures: 2 Envelope Originator: <br />Certificate Pages: 4 lnitials: 0 Brenda Merritt <br />AutoNav: Enabled Old Capitol Building <br />Envelopeld Stamping: Enabled 600 Washington St SE <br />Time Zone: (UTC-08:00) Pacific Time (US & Canada) Olympia, WA 98504 <br />Brenda.Menitt@k1 2.wa.us <br />lP Address: 104.225.186.61 <br />Record Tracking <br />Status: Original <br />5|152025 1:13:10 PM <br />Security Appliance Status: Connected <br />Storage Appliance Status: Connected <br />Signer Events <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: 611312025 8:12:42 AM <br />lD: d7a652f5-fdbd-431 a-a8e5-54acb2ea92d8 <br />Kyla Moore <br />kyla.moore@k12.wa.us <br />Contracts Administrator <br />Offlce of Superintendent of Public lnstruction <br />Security Level: Email, Account Authentication <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered via Docusign <br />ln Person Signer Events <br />Editor Delivery Events <br />Agent Delivery Events <br />lntermediary Delivery Events <br />Gertified Delivery Events <br />Holder: Brenda Merritt Location: DocuSign <br />Brenda. M srritt@k1 2.wa.us <br />Pool: FedRamp <br />Pool: State of Washington Office of Superintendent Location: Docusign <br />of Public lnstructicn <br />Signature <br />WA*g^ <br />Signature Adoptior: Pre-selected Style <br />Using lP Address: 66.243.254.18 <br />fi!'it'tu* <br />Signature Adoptior: Uploaded Signature lmage <br />Using lP Address: 136.228.204.209 <br />Signature <br />Status <br />Status <br />Status <br />Status <br />Status <br />Timestamp <br />Sent: 5/1 5/2025 1:17:57 PM <br />Viewed: 611312025 8:12:42 AM <br />Signed: 711512025 12:34'.44 PM <br />Senl: 7 I 1 512025 12:34:46 PM <br />Viewed: 7 12412025 6:30:57 AM <br />Signed: 712412025 6:31:27 AM <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />by: <br />Carbon Copy Events