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HomeMy WebLinkAboutShelter Program Grant Amendment ADocuSign Envelope ID: 86E0C8FB-F6EA-4B43-BC1D-5E8B876FDC60 1/3/2022 | 2:59 PM PST DocuSign Envelope ID: 86E0C8FB-F6EA-4B43-BC1D-5E8B876FDC60 Certificate Of Completion Envelope Id: 86E0C8FBF6EA4B43BC1D5E8B876FDC60 Status: Completed Subject: Please DocuSign: Kittitas Shelter Program Grant Amendment A signed.pdf Division: Community Services and Housing Program: Shelter Program ContractNumber: 21-4610C-109 DocumentType: Contract Amendment Source Envelope: Document Pages: 2 Signatures: 1 Envelope Originator: Certificate Pages: 2 Initials: 0 Megan Kendig AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-08:00) Pacific Time (US & Canada) 1011 Plum Street SE MS 42525 Olympia, WA 98504-2525 megan.kendig@commerce.wa.gov IP Address: 198.239.10.165 Record Tracking Status: Original 1/3/2022 1:03:51 PM Holder: Megan Kendig megan.kendig@commerce.wa.gov Location: DocuSign Security Appliance Status: Connected Pool: StateLocal Storage Appliance Status: Connected Pool: Washington State Department of Commerce Location: DocuSign Signer Events Signature Timestamp Diane Klontz diane.klontz@commerce.wa.gov Assistant Director Washington State Department of Commerce Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 147.55.149.242 Sent: 1/3/2022 2:12:14 PM Viewed: 1/3/2022 2:59:17 PM Signed: 1/3/2022 2:59:23 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Kathy Kinard Kathy.Kinard@commerce.wa.gov Security Level: Email, Account Authentication (None)Using IP Address: 198.239.10.147 Sent: 1/3/2022 1:06:59 PM Viewed: 1/3/2022 1:58:09 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Certified Delivery Events Status Timestamp Tedd Kelleher tedd.kelleher@commerce.wa.gov Senior Managing Director Washington State Department of Commerce Security Level: Email, Account Authentication (None) Using IP Address: 147.55.149.205 Sent: 1/3/2022 1:58:10 PM Viewed: 1/3/2022 2:12:13 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Carbon Copy Events Status Timestamp Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 1/3/2022 1:06:59 PM Certified Delivered Security Checked 1/3/2022 2:59:17 PM Signing Complete Security Checked 1/3/2022 2:59:23 PM Completed Security Checked 1/3/2022 2:59:23 PM Payment Events Status Timestamps