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#MT-CDBG-PL-20-07 DocuSign SummaryDocuSign Certificate Of Completion Envelope Id: 736E2FED29C94F4F8A217D6684462BA1 Subject: Montana Department of Commerce Contract #MT-CDBG-PL-20-07 for Signature Source Envelope: Document Pages: 17 Signatures: 7 Certificate Pages: 6 Initials: 0 AutoNav: Enabled Envelopeld Stamping: Enabled Time Zone: (UTC-07:00) Mountain Time (US & Canada) Record Tracking Status: Original 10/18/2021 8:42:27 AM Signer Events Renee Lemon Renee.lemon@mt.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 10/18/2021 8:58:39 AM ID:6b152687-66a7-4552-9515-5b3d18dcd7db Sarah Jordt sjordt@mt.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 10/19/2021 8:14:06 AM ID:7c185e71-ef1a-4d88-9Of6-Odef635805c4 Jessica Osterloh Jessica.osterloh@mt.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 10/19/2021 8:28:15 AM ID:aa53915f-03e5-4a62-9e44-b4f31eb62f3d Charles A. Harball charball@kalispell.com Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 10/19/2021 9:55:40 AM ID:1e515102-fa64-40ed-ad9f-99777b1c8de4 Holder: Contracts Admin doccontracts@esign.mt.gov Signature CEDocuSigned by: e�� �4 �_ E33182A66949400... Signature Adoption: Pre -selected Style Using IPAddress: 161.7.39.7 ED—Signed by: OD2308CFOA644F1... Signature Adoption: Pre -selected Style Using IPAddress: 161.7.39.7 EDOC"Slg"ed by: t,SS�c�. 4ABBF08186144AB . Signature Adoption: Pre -selected Style Using IPAddress: 161.7.39.7 ED—Signedby: ��. by, 62445209AA03416... Signature Adoption: Pre -selected Style Using IPAddress: 161.7.94.128 Status: Completed Envelope Originator: Contracts Admin PO Box 200501 301 S. Park Ave Helena, MT 596200501 doccontracts@esign.mt.gov IP Address: 161.7.39.7 Location: DocuSign Timestamp Sent: 10/18/2021 8:49:09 AM Viewed: 10/18/2021 8:58:39 AM Signed: 10/18/2021 9:00:01 AM Sent: 10/18/2021 9:00:03 AM Viewed: 10/19/2021 8:16:40 AM Signed: 10/19/2021 8:16:57 AM Sent: 10/19/2021 8:16:59 AM Viewed: 10/19/2021 8:28:15 AM Signed: 10/19/2021 8:28:22 AM Sent: 10/19/2021 8:28:25 AM Viewed: 10/19/2021 9:55:40 AM Signed: 10/19/2021 9:57:14 AM Signer Events Doug Russell drussell@kalispell.com City Manager Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 10/19/2021 10:02:14 AM ID:2e616bd1-7b23-45aa-92c7-986570154026 Aimee Brunckhorst abrunckhorst@kalispell.com Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 1/5/2021 2:08:26 PM ID:9db71286-223b-44d5-8cb4-68f7482e7910 Adam Schafer aschafer@mt.gov Deputy Director Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 10/20/2021 8:43:29 AM ID:84d8d6eb-a33a-4cc4-a514-d6ffadcabc7d In Person Signer Events Editor Delivery Events Agent Delivery Events Intermediary Delivery Events Certified Delivery Events Carbon Copy Events Becky Anseth banseth@mt.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 10/20/2021 8:43:53 AM ID:18887207-1b93-4c57-88b1-46d6e6d6101e Signature Timestamp by: Sent: 10/19/2021 9:57:17 AM C110-Sig"ed oin NSSa Viewed: 10/19/2021 10:02:14 AM 3AA4039B19624E4... Signed: 10/20/2021 8:26:28 AM Signature Adoption: Pre -selected Style Using IPAddress: 161.7.118.2 by: Sent: 10/20/2021 8:26:31 AM CA11o,"S19"ed z"'" $ "'' " Viewed: 10/20/2021 8:31:34 AM 23000A1c344F43F... Signed: 10/20/2021 8:31:58 AM Signature Adoption: Pre -selected Style Using IPAddress: 161.7.97.58 J"//Docu��Signed by: AM 34AM S 304 Signature Adoption: Pre -selected Style Using IPAddress: 161.7.39.7 Signature Status Status Status Status Status COPIED Cody Ferguson COPIED cody.ferguson@mt.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 10/18/2021 10:00:20 AM ID:18544375-9764-4a66-9313-5329f6315b18 Sent: 10/20/2021 8:32:02 AM Viewed: 10/20/2021 8:43:29 AM Signed: 10/20/2021 8:45:32 AM Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp Sent: 10/18/2021 8:49:09 AM I*=Mt elliWKiYA111CTV]NO11�i Carbon Copy Events Status Timestamp Rebecca Shaw Sent: 10/18/2021 8:49:09 AM rebecca.shaw@mt.gov ED Viewed: 10/18/2021 9:31:38 AM Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 10/15/2021 2:08:31 PM ID:b57d2416-c01d-4181-a54e-8b9c3d0e3272 Krista Lammers Sent: 10/19/2021 8:28:25 AM klammers@kalispell.com ED Viewed: 10/19/2021 8:28:55 AM Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Cyndi Davis Sent: 10/20/2021 8:45:35 AM CDavis3@mt.gov ED Payroll and Benefits Accountant Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 9/29/2021 4:28:24 PM ID:eb91b6de-dbbd-4c10-b99e-665bddc42f63 Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 10/18/2021 8:49:10 AM Certified Delivered Security Checked 10/20/2021 8:43:29 AM Signing Complete Security Checked 10/20/2021 8:45:32 AM Completed Security Checked 10/20/2021 8:45:35 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 10/7/2014 8:41:47 AM Parties agreed to: Renee Lemon, Sarah Jordt, Jessica Osterloh, Charles A. Harball, Doug Russell, Aimee Brunckhorst, Adam Schafer, Becky Anseth, Cody Ferguson, ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, MT Dept of Commerce (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign, Inc. (DocuSign) electronic signing system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the `I agree' button at the bottom of this document. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. 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All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact MT Dept of Commerce: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: doccontracts@mt.gov To advise MT Dept of Commerce of your new e-mail address To let us know of a change in your e-mail address where we should send notices and disclosures electronically to you, you must send an email message to us at doccontracts@mt.gov and in the body of such request you must state: your previous e-mail address, your new e-mail address. We do not require any other information from you to change your email address.. 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To withdraw your consent with MT Dept of Commerce To inform us that you no longer want to receive future notices and disclosures in electronic format you may: i. decline to sign a document from within your DocuSign session, and on the subsequent page, select the check -box indicating you wish to withdraw your consent, or you may; ii. send us an e-mail to doccontracts@mt.gov and in the body of such request you must state your e-mail, full name, US Postal Address, and telephone number. We do not need any other information from you to withdraw consent.. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process.. 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By checking the `I agree' box, I confirm that: • I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and • I can print on paper the disclosure or save or send the disclosure to a place where I can print it, for future reference and access; and Until or unless I notify MT Dept of Commerce as described above, I consent to receive from exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to me by MT Dept of Commerce during the course of my relationship with you.