#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:
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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:
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Signature Adoption: Pre -selected Style
Using IPAddress: 161.7.39.7
ED—Signedby:
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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
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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
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To request delivery from us of paper copies of the notices and disclosures previously provided
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To confirm to us that you can access this information electronically, which will be similar to
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able to read this electronic disclosure and that you also were able to print on paper or
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exclusively in electronic format on the terms and conditions described above, please let us know
by clicking the `I agree' button below.
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.