Laserfiche WebLink
DocuSign <br /> Certificate Of Completion <br /> Envelope Id:52BB70E396E24B7D8028A3475A4F7A1E Status:Sent <br /> Subject:Please DocuSign this document: SHIIP Gov Exec.Contracts.pdf <br /> Source Envelope: <br /> Document Pages: 16 Signatures: 1 Envelope Originator: <br /> Certificate Pages:5 Initials: 1 Kathy Moger <br /> AutoNav:Enabled 325 N.Salisbury St. <br /> Envelopeld Stamping:Enabled Raleigh, NC 27603 <br /> Time Zone:(UTC-05:00)Eastern Time(US&Canada) kathy.moger@ncdoi.gov <br /> IP Address: 149.168.74.8 <br /> Record Tracking <br /> Status:Original Holder:Kathy Moger Location:DocuSign <br /> 9/21/2021 9:54:11 AM kathy.moger@ncdoi.gov <br /> Security Appliance Status:Connected Pool:StateLocal <br /> Storage Appliance Status:Connected Pool:Carahsoft OBO North Carolina Department of Location: DocuSign <br /> Insurance <br /> Signer Events Signature Timestamp <br /> Kathy Moger Completed Sent 9/21/2021 9:55:07 AM <br /> kathy.moger@ncdoi.gov Viewed:9/21/2021 9:55:20 AM <br /> Administrative Assistant Signed:9/21/2021 9:58:23 AM <br /> Department of Insurance Using IP Address: 149.168_74.8 <br /> Security Level: Email.Account Authentication <br /> (None) <br /> Electronic Record and Signature Disclosure: <br /> Accepted: 1/8/2021 3:39:36 PM <br /> ID: 11681731-8c6f-40be-a417-fl e0f33240c8 <br /> Kevin Robertson '-DS Sent:9/21/2021 9:58:29 AM <br /> kevin.robertson@ncdoi.gov *- Viewed:9/21/2021 11:28:41 AM <br /> NCSMP Program Director Signed:9/21/2021 11:29:01 AM <br /> Department of Insurance <br /> Signature Adoption:Pre-selected Style <br /> Security Level: Email,Account Authentication <br /> (None) Using IP Address: 149.168.74.8 <br /> Electronic Record and Signature Disclosure: <br /> Not Offered via DocuSign <br /> Melinda Munden D°`"S'gned by. Sent:9/21/2021 11:29:06 AM <br /> ' ' Viewed:9/21/2021 12:55:44 PM <br /> melinda.munden@ncdoi.gov `-0 3C6 6CC3GD/A <br /> Signed:9/21/2021 12:55:56 PM <br /> Deputy Commissioner and Director for the Seniors' <br /> Health Insurance Information Program Signature Adoption:Pre-selected Style <br /> Department of Insurance Using IP Address: 149.168.74.8 <br /> Security Level:Email,Account Authentication <br /> (None) <br /> Electronic Record and Signature Disclosure: <br /> Accepted:2/19/2021 9:07:23 AM <br /> ID:c3429ee5-9930-481b-a4a7-5f2e8245fe27 <br /> Jourdan Huskey Sent:9/21/2021 12:56:01 PM <br /> jhuskey@leecountync.gov Viewed:9/21/2021 2:20:44 PM <br /> Security Level: Email,Account Authentication <br /> (None) <br /> Electronic Record and Signature Disclosure: <br /> Accepted:9/21/2021 2:20:44 PM <br /> ID:0d454100-74a8-4aa8-b697-b206f051a3a7 <br />