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Docu ftff <br />Certificate Of Completion <br />Envelope Id: 10B96BA64D414AE9906BDC337A7365AA <br />Subject: Teresa Bender - City of Centerville - Special Use Request For Anoka County Parks <br />Source Envelope: <br />Document Pages: 1 Signatures: 2 <br />Certificate Pages: 4 Initials: 0 <br />AutoNav: Enabled <br />Envelopeld Stamping: Enabled <br />Time Zone: (UTC-06:00) Central Time (US & Canada) <br />Record Tracking <br />Status: Original <br />8/16/2023 9:29:23 AM <br />Security Appliance Status: Connected <br />Storage Appliance Status: Connected <br />Signer Events <br />Teresa Bender <br />tbender@centervillemn.com <br />City Clerk <br />Security Level: Email, Account Authentication <br />(Optional) <br />Electronic Record and Signature Disclosure: <br />Accepted: 7/10/2023 2758:29 PM <br />ID: daf2b161-da99-4575-bcaf-a332e239cb3a <br />Andy Soltvedt <br />andy.soltvedt@co.anoka.mn.us <br />Assistant Director <br />Anoka County <br />Security Level: Email, Account Authentication <br />(Optional) <br />Electronic Record and Signature Disclosure: <br />Not Offered via DocuSign <br />In Person Signer Events <br />Editor Delivery Events <br />Agent Delivery Events <br />Intermediary Delivery Events <br />Certified Delivery Events <br />Carbon Copy Events <br />Debbie Schreiber <br />deborah.schreiber@co.anoka.mn.us <br />Security Level: Email, Account Authentication <br />(Optional) <br />Electronic Record and Signature Disclosure: <br />Not Offered via DocuSign <br />Holder: Andy Soltvedt <br />Andy. Soltvedt@co.anoka.mn.us <br />Pool: StateLocal <br />Pool: Anoka County <br />Signature <br />[;�ocu5i0�ed bby: � � <br />, Sa EEse47 q,& <br />Signature Adoption: Pre -selected Style <br />Using IP Address: 199.249.109.13 <br />C <br />B45C14E55F41B... <br />Signature Adoption: Uploaded Signature Image <br />Using IP Address: 156.98.106.243 <br />Signature <br />Status <br />Status <br />Status <br />Status <br />Status <br />COPIED <br />Status: Completed <br />Envelope Originator: <br />Andy Soltvedt <br />Anoka County Government Center <br />2100 3rd Avenue <br />Anoka, MN 55303 <br />Andy.Soltvedt@co.anoka.mn.us <br />IP Address: 54.209.113.95 <br />Location: DocuSign <br />Location: DocuSign <br />Timestamp <br />Sent: 8/16/2023 9:29:25 AM <br />Viewed: 8/16/2023 9:32:43 AM <br />Signed: 8/16/2023 9:33:31 AM <br />Sent: 8/16/2023 9:33:32 AM <br />Viewed: 8/16/2023 9:34:26 AM <br />Signed: 8/16/2023 9:34:46 AM <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Sent: 8/16/2023 9:34:47 AM <br />