SummaryDocuSign
Certificate Of Completion
Envelope Id: 3EB20FEC29644F5BA061AD99C7311CFC
Subject: Montana Department of Commerce Contract #MT-CDBG-PL-20-07A for Signature
Source Envelope:
Document Pages: 5 Signatures: 4
Certificate Pages: 5 Initials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-07:00) Mountain Time (US & Canada)
Record Tracking
Status: Original
12/7/2022 10:32:33 AM
Signer Events
Renee Lemon
Renee.lemon@mt.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 12/14/2022 10:14:11 AM
ID:626c6a3b-1c15-438b-b5bb-e049344134f6
Judy Clay
judy.clay@mt.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 12/14/2022 12:49:51 PM
ID:46af40fd-a70d-41d1-8864-12a5250add92
Ty Jones
ty.jones@mt.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 12/14/2022 12:55:41 PM
ID: a891832f-3494-4a3c-93a1-18068f896e32
Mandy Rambo
Mandy.rambo@mt.gov
Acting Deputy Director
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 12/14/2022 1:10:16 PM
ID:751319e9-edeb-4f1d-97e4-a30fabce883f
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
Holder: Contracts Admin
Location: DocuSign
doccontracts@esign.mt.gov
Signature
Timestamp
usigned by:
Sent: 12/7/2022 10:40:13 AM
[ElKA66949400
Viewed: 12/14/2022 10:14:11 AM
...
Signed: 12/14/2022 10:14:39 AM
Signature Adoption: Pre -selected Style
Using IP Address: 161.7.39.7
by:
Sent: 12/14/2022 10:14:42 AM
[Docuftned
.J, u-r
Viewed: 12/14/2022 12:49:51 PM
s38090E781c0477
Signed: 12/14/2022 12:54:39 PM
Signature Adoption: Pre -selected Style
Using IP Address: 161.7.39.7
EDocusigned by:
18 3t 9B44443 .
Signature Adoption: Pre -selected Style
Using IP Address: 161.7.118.234
ED—Signed by:
D79E9C4AOF42480
Signature Adoption: Pre -selected Style
Using IP Address: 174.202.1.130
Signed using mobile
Sent: 12/14/2022 12:54:43 PM
Viewed: 12/14/2022 12:55:41 PM
Signed: 12/14/2022 12:55:49 PM
Sent: 12/14/2022 1:02:48 PM
Viewed: 12/14/2022 1:10:16 PM
Signed: 12/14/2022 1:10:42 PM
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
Carbon Copy Events
Status
Timestamp
Cody Ferguson
Sent: 12/7/2022 10:40:12 AM
cody.ferguson@mt.gov
ED
Viewed: 12/7/2022 4:32:04 PM
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 12/7/2022 4:31:25 PM
ID:3f65d250-Odf0-4063-94fa-e0eaa3bb632a
Krista Lammers
Sent: 12/7/2022 10:40:13 AM
klammers@kalispell.com
ED
Viewed: 12/7/2022 10:49:06 AM
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Alisha Oellermann�
Sent: 12/7/2022 10:40:13 AM
Alisha.Oellermann2@mt.gov
ED
Viewed: 12/7/2022 1:49:03 PM
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 12/14/2022 11:15:08 AM
ID: d9018f5a-81 b6-4801 -aa03-1809471646f4
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
12/7/2022 10:40:13 AM
Envelope Updated
Security Checked
12/14/2022 1:02:47 PM
Envelope Updated
Security Checked
12/14/2022 1:02:47 PM
Envelope Updated
Security Checked
12/14/2022 1:02:47 PM
Envelope Updated
Security Checked
12/14/2022 1:02:47 PM
Envelope Updated
Security Checked
12/14/2022 1:02:47 PM
Certified Delivered
Security Checked
12/14/2022 1:10:16 PM
Signing Complete
Security Checked
12/14/2022 1:10:42 PM
Completed
Security Checked
12/14/2022 1:10:42 PM
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, Judy Clay, Ty Jones, Mandy Rambo, Cody Ferguson, Alisha Oellermann
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
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to you through the DocuSign system during and immediately after signing session and, if you
elect to create a DocuSign signer account, you may access them for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per -page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign `Withdraw Consent' form on the signing page of a
DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn your
consent to receive required notices and disclosures electronically from us and you will no longer
be able to use the DocuSign system to receive required notices and consents electronically from
us or to sign electronically documents from us.
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..
In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in the DocuSign system.
To request paper copies from MT Dept of Commerce
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to doccontracts@mt.gov and in the body
of such request you must state your e-mail address, full name, US Postal address, and telephone
number. We will bill you for any fees at that time, if any.
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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Operating Systems:
Windows® 2000, Windows® XP, Windows
Vista®; Mac OS® X
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or above (Windows only); Mozilla Firefox 2.0
or above (Windows and Mac); Safari' 3.0 or
above (Mac only)
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Acrobat® or similar software may be required
to view and print PDF files
Screen Resolution:
800 x 600 minimum
Enabled Security Settings:
Allow per session cookies
** These minimum requirements are subject to change. If these requirements change, you will be
asked to re -accept the disclosure. Pre-release (e.g. beta) versions of operating systems and
browsers are not supported.
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you were
able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to e-mail
this disclosure and consent to an address where you will be able to print on paper or save it for
your future reference and access. Further, if you consent to receiving notices and disclosures
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.