Backup Documents 03/08/2022 Item #16G 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP G
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. County Attorney Office CAO jAKI/h3 3/7722
2. Board of County Commissioners Office BOCC
WA Or AD W 3/11 z,
3. Minutes and Records Clerk of Court's Office 3/q/ ?-a 3:v7/ $(
4. Send signed copy to Heather Meyer GMD South/Airport
Heather.meyer@colliercountyfl.gov Authority
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Heather Meyer/Airport Authority 239-252-5765
Contact/ Department
Agenda Date Item was March 8,2022 Agenda Item Number 16G.2
Approved by the BCC
Type of Document FDOT Amendment #3 Additional Funding Number of Original X 2-
Attached GOZ12� Res ol,4;on Documents Attached
PO number or account N/A a0dpa,..
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A (Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK HM
2. Does the document need to be sent to another agency for additional signatures? If yes, HM
provide the Contact Information (Name; Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be HM
signed by the Chairman,with the exception of most letters,must be reviewed and signed by
the Office of the County Attorney.
FDOT requested that we do NOT date the document
4. All handwritten strike-through and revisions have been initialed by the County Attorney's HM
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the HM
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip HM
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on March 8,2022 and all changes made N/A is not
during the meeting have been incorporated in the attached document. The County .5 //1r7 an option for
Attorney's Office has reviewed the changes, if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC, all changes directed by the BCC have been made,and the document is ready for the 5Aon3 an option for
Chairman's signature. this line.
l:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
i6G 2
RESOLUTION NO.2022-42
RESOLUTION OF THE COLLIER COUNTY AIRPORT AUTHORITY
APPROVING AND AUTHORIZING THE EXECUTION OF THE ATTACHED
AMENDMENT NO.3 TO PUBLIC TRANSPORTATION GRANT AGREEMENT
GOZ12 WITH THE FLORIDA DEPARTMENT OF TRANSPORTATION.
WHEREAS,the Collier County Airport Authority has the authority to enter into the attached
agreement with the Florida Department of Transportation to undertake projects as authorized by
Chapter 332,Florida Statutes, and Section 14-60 of the Florida Administrative Code, and Ordinance
2004-03.
NOW,THEREFORE,BE IT RESOLVED BY THE Collier County Airport Authority,Collier
County, Florida,that:
1. Amendment No. 3 to Public Transportation Grant Agreement(PTGA)Number GOZ12 for
additional funding for the rehabilitation of Runway 18/36 at the Immokalee Regional
Airport, Financial Management Number 438977-1-94-01, attached hereto, is hereby
approved.
2. The Chairman of the Collier County Airport Authority, William McDaniel, is authorized
to enter into, modify or terminate Amendment No. 3 to PTGA Number GOZ12 with the
Florida Department of Transportation unless and until it may be specifically rescinded.
3. This Resolution shall take effect immediately upon adoption.
ADOPTED this 8th day of March, 2022 after motion, second and majority vote in favor of
adoption.
Y'
ATTEST: COLLIER CO T AUTHORITY
CRYSTAL K. KINZEL,CLERK
, ir t• ����. dale& r�- g By:
, ( e)**
'DEP • .�:iT�� Willi McDaniel Jr.,CHAI
Attest as to Chairman's'
signature only
ItApprove or o le_0s...
i
Jeffrey A.1latzto
,County Attorney
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1F1-DE6E1F0A58DE I 6 G 2
DocuSign Envelope ID:7802A679-F9E3.4EB5-83F0-BE33AC4FC9B6
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form 725-09043
PUBLIC TRANSPORTATION STRATEGIC
DEVELOPMENT
AMENDMENT TO THE PUBLIC TRANSPORTATION DGc 11)19
GRANT AGREEMENT
Financial Project Nurnber(s). Fund(s): DDR FLAIR Category- 088719
I dem-se9mgnl-Phase-seq Vance i
438977-1-94-01 Work Activity Code/Function: 215 Object Code: 751000
Federal Number/Federal Award Org. Code: 55012020129
Identification Number(FAIN)—Transit only: Vendor Number: VF596000558130
Contract Number GOZ12 Federal Award Dale: Amendment No.: 3
CFDA Number: N/A Agency DUNS Number. 076997790
CFDA Title: N/A
CSFA Number: 55.004
CSFA Title: Aviation Grant Program
THIS A 3ENDMEN2 TO THE PUBLICPiTRANSPORTATION GRANT AGREEMENT("Amendment")is made and entered
into on 3/1 /L , by and between the State of Florida, Department of Transportation
("Department'), and Collier County Airport Authority, ("Agency"),collectively referred to as the"Parties."
RECITALS
WHEREAS, the Department and the Agency on 1/28/2019 (date original Agreement entered) entered into a Public
Transportation Grant Agreement("Agreement').
WHEREAS, the Parties have agreed to modify the Agreement on the terms and conditions set forth herein.
NOW THEREFORE, in consideration of the mutual covenants in this Amendment, the Agreement is amended as
follows:
1. Amendment Description.The project is amended to include additional funding for the construction phase.
2. Program Area. For identification purposes only, this Agreement is implemented as part of the Department
program area selected below(select all programs that apply):
X Aviation
Seaports
Transit
_ Intermodal
Rail Crossing Closure
Match to Direct Federal Funding (Aviation or Transit)
(Note: Section 15 and Exhibit G do not apply to federally matched funding)
Other
3. Exhibits. The following Exhibits are updated,attached, and incorporated into this Agreement:
Exhibit A: Project Description and Responsibilities
X Exhibit B: Schedule of Financial Assistance
_ "Exhibit B1: Deferred Reimbursement Financial Provisions
`Exhibit B2: Advance Payment Financial Provisions
*Exhibit C: Terms and Conditions of Construction
X Exhibit D: Agency Resolution
Exhibit E: Program Specific Terms and Conditions
_ Exhibit F: Contract Payment Requirements
X 'Exhibit G: Financial Assistance (Single Audit Act)
_ 'Exhibit H: Audit Requirements for Awards of Federal Financial Assistance
*Additional Exhibit(s):
CAQ
Page 1 of 6
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1F1-DE6E1F0A58DE 1 6 2
DocuSign Envelope ID-7802A679-F9E3-4EB5-83F0-BE33AC4FC9B6 G
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form 725400.03
PUBLIC TRANSPORTATION STRATEGIC
DEVELOPMENT
AMENDMENT TO THE PUBLIC TRANSPORTATION OGC 11119
GRANT AGREEMENT
4. Project Cost.
The estimated total cost of the Project is X increased/_ decreased by $229,551 bringing the revised total
cost of the project to$6,987,445.
The Department's participation is X increased/ _ decreased by $183,641. The Department agrees to
participate in the Project cost up to the maximum amount of $5,589.956. and, additionally the Department's
participation in the Project shall not exceed 80.000/0 of the total eligible cost of the Project.
Except as modified,amended, or changed by this Amendment, all of the terms and conditions of the Agreement and any
amendments thereto shall remain in full force and effect.
IN WITNESS WHEREOF, the Parties have executed this Amendment on the day and year written above.
AGENCY Collier County Airport STATE OF FLORIDA, DEPARTMENT OF TRANSPORTATION
Authority
(i) V DocuSigned by:
C I �
By: By: urn. Wittx
Name: Na ..4%+FAAB40.atler, P.E.
Title:_ William I.. McDaniel. Jr.. Title: Director of Transportation Development
Chairman
STATE OF FLORIDA. DEPARTMENT OF TRANSPORTATION ins
496
Legal Review: Don Conway, Senior Attorney (as to legality and form)
ATTEST Docusyned by:
C YSTAL K.KINZEL,CLERK ' �" ,6a
93701135420A8409...
BY:
Atte t as • Ch rig►
C`
A we' and gality
lis01111.
Jeffrey • f.K P ow,County Attorney
CAd
`—' Page 2 of 6
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1F1-DE6E1F0A58DE 1 6 G 2
DocuSign Envelope ID:7802A679-F9E3-4EB5-B3F0-BE33AC4FC9B6
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form 725-000-02
PUBLIC TRANSPORTATION STRATEGIC
DEVELOPMENT
GRANT AGREEMENT EXHIBITS OGCOV20
EXHIBIT B
Schedule of Financial Assistance
FUNDS AWARDED TO THE AGENCY AND REQUIRED MATCHING FUNDS PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
A. Fund Type and Fiscal Year:
Financial FLAIR State Object CSFA/ CSFA/CFDA Title orF Funding
Management Tune Category Fiscal Code CFDA Funding Source Amount
Number Type Year Number Description
438977-1-94-01 DDR 088719 2019 751000 55.004 Aviation Grant Program $352,000.00
438977-1-94-01 DDR 088719 2020 751000 55.004 Aviation Grant Program $1,074,000.00
438977-1-94-01 DDR 088719 2021 751000 55.004 Aviation Grant Program $3,980,315.00
438977-1-94-01 DDR 088719 2022 751000 55.004 Aviation Grant Program $183,641.00
438977-1-94-01 LF 088719 2022 751000 55.004 Aviation Grant Program $45,910.00
438977-1-94-01 LF 088719 2019 751000 55.004 Aviation Grant Program $88,000,00
438977-1-94-01 LF 088719 2021 751000 55.004 Aviation Grant Program S995,079.00
438977-1-94-01 LF 088719 2020 751000 55.004 Aviation Grant Program $268,500.00
Total Financial Assistance $6,987,445.00
B. Estimate of Project Costs by Grant Phase:
1 1 State Local Federal
Phases' State Local 1 Federal Totals ,/o % ,to
Land Acquisition $0.00 $0.00 t $0.00 $0.00 0,00 0.00 0.00
Planning $0.00 $0,00 $0.00 $0.00 0.00 0.00 0.00
Environmental/Design/Construction $5,589,956.00 $1,397,489,00 $0.00 $6,987,445.00 80,00 20.00 0.00
Capital Equipment/Preventative $0.00 $0.00 $0.00 $0.00 0.00 ' 0.00 0.00
Maintenance
Match to Direct Federal Funding $0.00 $0.00 i $0.00 $0.00 0,00 0.00 0.00
-
Mobility Management $0.00' $0.00 $0.00 $0.00 0.00 0.00 ' 0.00
(Transit Only)
Totals $5,589,956.00 $1,397,489.00 I $0.00 $6,987,445.00
*Shifting items between these grant phases requires execution of an Amendment to the Public Transportation Grant
Agreement.
BUDGET/COST ANALYSIS CERTIFICATION AS REQUIRED BY SECTION 216.3475, FLORIDA STATUTES:
I certify that the cost for each line item budget category (grant phase)has been evaluated and determined to be
allowable, reasonable, and necessary as required by Section 216.3475. Florida Statutes. Documentation is on file
evidencing the methodology used and the conclusions reached.
Kristi A.Smith, CPM, PLS
Department Grant Manager Name
IIPID Page 3 of 6
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1 F1-DE6E1 F0A58DE i 6 (� 2
DocuSign Envelope ID 7e02A679-F9E3.4EB5.83F0-BE33AC4FC9B6 u
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form 725.000-02
PUBLIC TRANSPORTATION STRATEGIC
DEVELOPMENT
GRANT AGREEMENT EXHIBITS OGc 02120
LrgiDDacuSiynedby: 1/5/2022 I 11:29 AM EST
k,.,ac,: 4. S►...u.
aw
OEacs Date
C:10►
i
Page 4 of 6
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1F1-DE6E1F0A58DE ! 6 G 2
DocuSign Envelope ID 7802A679-F9E3-4EB5-83F0-BE33AC4FC9B6
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form 725.000.02
PUBLIC TRANSPORTATION STRATEGIC
DEVELOPMENT
GRANT AGREEMENT EXHIBITS OGC 02/20
EXHIBIT D
AGENCY RESOLUTION
PLEASE SEE ATTACHED
r 11
Page 5 of 6
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1F1-DE6E1F0A58DE
DocuSign Envelope ID 7802A679-F9E3-4EB5-83F0-BE33AC4FC9B6 L
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form/25400.02
PUBLIC TRANSPORTATION STRATEGIC
DEVELOPMENT
GRANT AGREEMENT EXHIBITS DCC 02120
EXHIBIT G
AUDIT REQUIREMENTS FOR AWARDS OF STATE FINANCIAL ASSISTANCE
THE STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING:
SUBJECT TO SECTION 215.97, FLORIDA STATUTES:-
Awarding Agency: Florida Department of Transportation
State Project Title: Aviation Grant Program
CSFA Number: 55.004
'Award Amount: S5,589,956
'The award amount may change with amendments
Specific project information for CSFA Number 55.004 is provided at: https:llapps.fldts.comlfsaa/searchCataloq.aspx
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT:
State Project Compliance Requirements for CSFA Number 55.004 are provided at:
https:f/apps.fldts.camffsaa/searchCompliance.aspx
The State Projects Compliance Supplement is provided at: htlps://apps.fldfs.cornlfsaa/compliiance.aspx
10)
Page 6of6
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1F1-DE6E1FOA58DE 1 6 G w>,
DocuSign Envelope ID:7802A679-F9E3-4EB5-83F0-BE3SAC4FC9B6
To:Krfstl.Smlth@dot.state.fl.us
FLORIDA DEPARTMENT OF TRANSPORTATION
FUNDS APPROVAL
GOZ12
1/512022
CONTRACT INFORMATION
Contract: GOZ12
Contract Type: GD-GRANT DISBURSEMENT(GRANT)
Method of Procurement: G-GOVERMENTAL AGENCY(287.057,F.S.)
Vendor Name: COLLIER COUNTY AIRPORT
Vendor ID: F596000558130
Beginning Date of This Agreement: 01/28/2019
Ending Date of Thls Agreement: C6/30/2022
Contract TotaI/Budgetary Ceiling: ct=S5,589,956.00
Description: IMMOKALEE REGIONAL ARPT REHABILITATE RUNWAY 18/36
FUNDS APPROVAL INFORMATION
FUNDS APPROVED/REVIEWED FOR ROBIN M.NAITOVE,CPA,COMPTROLLER ON 1/5/2022
'Action Supplemental
Reviewed or Approved: APPROVED
Organization Code: 55012020129
Expansion Option' A8
Object Code: 751000
Amount: S183.641.00
Financial Project: 43897719401
Work Activity(FCTi:
215
CFDA:
Fiscal Year: 2022 I
Budget Entity: 55100100
Category/Category Year: 088719/22
Amendment ID: S003
Sequence: 00
User Assigned ID: 3
Eric Line(6s)/Status: 0004/04
Total Amount: $183,641.00
Pagel of 1
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1F1-DE6E1FOA58DE 1 6 G 2
DocuSign
Certificate Of Completion
Envelope Id:7802A679F9E34EB583F08E33AC4FC9B6 Status:Completed
Subject:Please DocuSign:IMM_GOZ12_438977-1_Runway 18-36_PTGA Amendment No.3_Draft for Review.pdf,_PT...
Contract Number(ex.C9Al2,optional):GOZ12
Document Contains Confidential Information?:No
Fin Proj Num(ex.123456-1-32-01,Optional):438977-1-94-01
Office(contact Procurement if add is needed).
Aviation
Source Envelope:
Document Pages:7 Signatures: 1 Envelope Originator
Certificate Pages:2 Initials: 1 Kristi A.Smith
AutoNav:Enabled 605 Suwannee Street
Envelopeld Stamping:Enabled MS 20
Time Zone:(UTC-05:00)Eastern Time(US&Canada) Tallahassee,FL 32399-0450
krist i.s mith @dot.state.fL us
IP Address: 156.75,180.190
Record Tracking
Status:Original Holder:Kristi A.Smith Location:DocuSign
1/5/2022 11:25:53 AM kristi.smith@dot.state.fLus
Signer Events Signature Timestamp
Kristi A.Smith rk.usi"'°°r Sent:1/5/2022 11:28:40 AM
kristi.smith dot.state.fLus
@ Viewed: 1/5/2022 11:28:55 AM
Senior Aviation/Intermodal Project Manager 7°6"0S1O°`"'
1 9 Signed:1/5/2022 11:29:01 AM
Florida Department of Transportation
Security Level:Email.Account Authentication Signature Adoption:Pre-selected Style
(None) Using 13 Address: 156.75,180.190
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Don Conway °' Sent:1/5/2022 11:29:02 AM
don.conway@dot.state.fl.us Viewed: 1/5/2022 3:44:18 PM
Senior Attorney Signed: 1/5/2022 3:45:08 PM
Florida Department of Transportation
Security Level:Email,Account Authentication Signature Adoption:Pre-selected Style
(None) Using IP Address: 156.75.180.190
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
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
Witness Events Signature Timestamp
Notary Events Signature Timestamp
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1F1-DE6E1F0A58DE t 6 G 2
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 1/5/2022 11:28:41 AM
Certified Delivered Security Checked 1/5/2022 3.44:18 PM
Signing Complete Security Checked 1/5/2022 3:45:08 PM
Completed Security Checked 1/5/2022 3:45:08 PM
Payment Events Status Timestamps
alp!
DocuSign Envelope ID:7EED68D4-C2AC-468C-A1F1-DE6E1F0A58DE 1 6 G 2
RESOLUTION NO. 2022-42
RESOLUTION OF THE COLLIER COUNTY AIRPORT AUTHORITY
APPROVING AND AUTHORIZING THE EXECUTION OF THE ATTACHED
AMENDMENT NO.3 TO PUBLIC TRANSPORTATION GRANT AGREEMENT
GOZ12 WITH THE FLORIDA DEPARTMENT OF TRANSPORTATION.
WHEREAS, the Collier County Airport Authority has the authority to enter into the attached
agreement with the Florida Department of Transportation to undertake projects as authorized by
Chapter 332. Florida Statutes, and Section 14-60 of the Florida Administrative Code, and Ordinance
2004-03.
NOW, THEREFORE. BE IT RESOLVED BY THE Collier County Airport Authority,Collier
County, Florida, that:
1. Amendment No. 3 to Public Transportation Grant Agreement(PTGA)Number GOZ12 for
additional funding for the rehabilitation of Runway 18/36 at the Immokalee Regional
Airport, Financial Management Number 438977-1-94-01, attached hereto, is hereby
approved.
2. The Chairman of the Collier County Airport Authority, William McDaniel, is authorized
to enter into, modify or terminate Amendment No. 3 to PTGA Number G0212 with the
Florida Department of Transportation unless and until it may be specifically rescinded.
3. This Resolution shall take effect immediately upon adoption.
ADOPTED this 8th day of March, 2022 after motion, second and majority vote in favor of
adoption.
ATTEST: COLLIER COU - - 'I AUTHORITY
CRYSTAL K. KJNZEL,CLERK /�
e) AIP I
���l� �.a�. �. y/ By: r .�-
, DEPUTY Willi McDaniel Jr.,CHAIRM• N
Attest as to Chairman's
signature only
Approve for o legality•
1
Jeffrey A. !atilt() ,County Attorney
ibG 2
DocuSign
Certificate Of Completion
Envelope Id:7EED68D4C2AC468CA1F1DE6E1FOA58DE Status:Completed
Subject:Please DocuSign:IMM_GOZ12_438977-1_Runway 18-36_PTGA Amendment No.3_IMM Signed.pdf
Contract Number(ex.C9Al2,optional):GOZ12
Document Contains Confidential Information?:No
Fin Proj Num(ex.123456-1-32-01,Optional):438977-1-94-01
Office(contact Procurement if add is needed):
Aviation
HR Action?: No
Source Envelope:
Document Pages: 10 Signatures:2 Envelope Originator:
Certificate Pages:2 Initials:0 Dawn Gallon
AutoNav:Enabled 605 Suwannee Street
Envelopeld Stamping:Enabled MS 20
Time Zone:(UTC-05:00)Eastern Time(US&Canada) Tallahassee,FL 32399-0450
dawn.gallon@dot.state.fl.us
IP Address: 156.75.252.6
Record Tracking
Status:Original Holder:Dawn Gallon Location:DocuSign
3/15/2022 10:42:10 AM dawn.gallon@dot.state.fl.us
Signer Events Signature Timestamp
Don Conway D°°"$bnid Sent:3/15/2022 10:49:29 AM
don.conway@dot.state.fl.us C' l'" od
Viewed:3/15/2022 3:38:24 PM
Senior Attorney B37D1D5<20A51D8
Signed:3/15/2022 3:39:43 PM
Florida Department of Transportation
Security Level:Email,Account Authentication Signature Adoption:Pre-selected Style
(None) Using IP Address: 156.75.252.6
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
John Kubler ",D�' CO�e.u81pn'' l
etl�°/'�/I Sent:3/15/2022 3:39:44 PM
john.kubler@dot.state.fl.us J� t% Viewed:3/15/2022 5:26:42 PM
Director of Transportation Developm CD6BAFBD91753D,...
p p Signed:3/15/2022 5:27:14 PM
Florida Department of Transportation
Security Level:Email,Account Authentication Signature Adoption:Pre-selected Style
(None) Using IP Address: 156.75.180.190
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
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
Witness Events Signature Timestamp
16 (a 2
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 3/15/2022 10:49:29 AM
Certified Delivered Security Checked 3/15/2022 5:26:42 PM
Signing Complete Security Checked 3/15/2022 5:27:14 PM
Completed Security Checked 3/15/2022 5:27:14 PM
Payment Events Status Timestamps