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HomeMy WebLinkAboutDocuSign - Electronic Record & Signature 2022-06-13Certificate Of Completion Envelope Id: 181A63E0A977482BBD6F176AD8A543BB Status: Completed Subject: Please DocuSign: 0540UR04080_A2.pdf FormID: Source Envelope: Document Pages: 1 Signatures: 3 Envelope Originator: Certificate Pages: 6 Initials: 2 Nathan Little AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-08:00) Pacific Time (US & Canada) 1416 9th Street Sacramento, CA 95814 Nathan.Little@resources.ca.gov IP Address: 136.200.53.19 Record Tracking Status: Original 6/3/2022 4:32:22 PM Holder: Nathan Little Nathan.Little@resources.ca.gov Location: DocuSign Security Appliance Status: Connected Pool: StateLocal Storage Appliance Status: Connected Pool: Department of Water Resources Location: DocuSign Signer Events Signature Timestamp Stacey Bell stacey.bell@resources.ca.gov Deputy Chief, Bonds Fiscal Resources California Natural Resources Agency Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Signed by link sent to stacey.bell@resources.ca.gov Using IP Address: 136.200.53.17 Sent: 6/6/2022 3:59:41 PM Viewed: 6/9/2022 11:46:44 AM Signed: 6/9/2022 11:47:34 AM Electronic Record and Signature Disclosure: Accepted: 5/15/2020 8:27:06 AM ID: 53bf5e17-b1a5-4c99-b974-95d86f740b46 Diane Sousa diane.sousa@resources.ca.gov Program Manager California Natural Resources Agency Security Level: Email, Account Authentication (None) Signature Adoption: Uploaded Signature Image Signed by link sent to diane.sousa@resources.ca.gov Using IP Address: 136.200.53.19 Sent: 6/9/2022 11:47:35 AM Viewed: 6/9/2022 12:56:29 PM Signed: 6/9/2022 1:13:36 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Sage Sangiacomo ssangiacomo@cityofukiah.com Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Signed by link sent to ssangiacomo@cityofukiah.com Using IP Address: 12.12.163.2 Sent: 6/9/2022 1:13:38 PM Viewed: 6/9/2022 1:20:39 PM Signed: 6/9/2022 2:39:08 PM Electronic Record and Signature Disclosure: Accepted: 6/9/2022 1:20:39 PM ID: 8c888b43-c535-4170-a35d-29f3f05c3a7a Signer Events Signature Timestamp Andrea Scharffer andrea.scharffer@resources.ca.gov Assistant Deputy of Bonds and Grants is Department of Water Resources Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Signed by link sent to andrea.scharffer@resources.ca.gov Using IP Address: 67.181.235.150 Sent: 6/9/2022 2:39:09 PM Viewed: 6/9/2022 10:22:06 PM Signed: 6/9/2022 10:22:12 PM Electronic Record and Signature Disclosure: Not Offered via DocuSign Ronald Vikash ronald.vikash@fire.ca.gov AAII CALFire Security Level: Email, Account Authentication (None) Signature Adoption: Drawn on Device Signed by link sent to ronald.vikash@fire.ca.gov Using IP Address: 76.248.20.166 Sent: 6/9/2022 10:22:15 PM Viewed: 6/13/2022 11:03:07 AM Signed: 6/13/2022 11:03:15 AM Electronic Record and Signature Disclosure: Accepted: 4/14/2020 8:24:18 AM ID: 57f78961-56a8-47fa-971a-8b1c7ab5cc8b 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 Sophie Xu jun.xu@fire.ca.gov CAL FIRE Security Level: Email, Account Authentication (None) Sent: 6/9/2022 10:22:14 PM Electronic Record and Signature Disclosure: Accepted: 3/30/2022 1:48:03 PM ID: f0cab955-520b-4167-991d-92fa9e30896a Deanna Ou deanna.ou@resources.ca.gov Bonds & Grants California Natural Resources Agency Security Level: Email, Account Authentication (None) Sent: 6/13/2022 11:03:16 AM Electronic Record and Signature Disclosure: Accepted: 5/8/2020 2:36:05 PM ID: fbe67b65-74f4-461c-b04d-b117ad7ee0a4 Stacey Bell stacey.bell@resources.ca.gov Deputy Chief, Bonds Fiscal Resources California Natural Resources Agency Security Level: Email, Account Authentication (None) Sent: 6/13/2022 11:03:17 AM Carbon Copy Events Status Timestamp Electronic Record and Signature Disclosure: Accepted: 5/15/2020 8:27:06 AM ID: 53bf5e17-b1a5-4c99-b974-95d86f740b46 Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 6/6/2022 3:59:41 PM Certified Delivered Security Checked 6/13/2022 11:03:07 AM Signing Complete Security Checked 6/13/2022 11:03:15 AM Completed Security Checked 6/13/2022 11:03:17 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, Department of Water Resources (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 your DocuSign, Inc. (DocuSign) Express user account. 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. For such copies, as long as you are an authorized user of the DocuSign system you will have the ability to download and print any documents we send to you through your DocuSign user account 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 your DocuSign account. 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 your DocuSign Express user account 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 your DocuSign user account 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 Department of Water Resources: Electronic Record and Signature Disclosure created on: 10/17/2018 11:08:40 AM Parties agreed to: Stacey Bell, Sage Sangiacomo, Ronald Vikash, Sophie Xu, Deanna Ou, Stacey Bell 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 phone call: (916) 653-5791 To contact us by paper mail, please send correspondence to: Department of Water Resources P.O. Box 942836 Sacramento, CA 95236-0001 To advise Department of Water Resources 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 don.davis@water.ca.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 DocuSign. To request paper copies from Department of Water Resources 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 don.davisi@water.ca.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 Department of Water Resources 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 account, 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 and in the body of such request you must state your e-mail, full name, IS Postal Address, telephone number, and account 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.. Required hardware and software Operating Systems: Windows2000? or WindowsXP? Browsers (for SENDERS): Internet Explorer 6.0? or above Browsers (for SIGNERS): Internet Explorer 6.0?, Mozilla FireFox 1.0, NetScape 7.2 (or above) Email: Access to a valid email account Screen Resolution: 800 x 600 minimum Enabled Security Settings:  Allow per session cookies  Users accessing the internet behind a Proxy Server must enable HTTP 1.1 settings via proxy connection ** These minimum requirements are subject to change. If these requirements change, we will provide you with an email message at the email address we have on file for you at that time providing you with the revised hardware and software requirements, at which time you will have the right to withdraw your consent. Acknowledging your access and consent to receive materials electronically To confirm to us that you can access this information electronicall y, 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 Department of Water Resources 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 Department of Water Resources during the course of my relationship with you.