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Certificate Of Completion <br />Envelope Id: F9647D7F7B34488CAAE1832760177A38 Status: Completed <br />Subject: Complete with DocuSign: CSA Amendment Sedgwick for Claims Administration <br />Source Envelope: <br />Document Pages: 7 Signatures: 5 Envelope Originator: <br />Certificate Pages: 5 Initials: 0 Megan Stephenson <br />AutoNav: Enabled <br />EnvelopeId Stamping: Enabled <br />Time Zone: (UTC-08:00) Pacific Time (US & Canada) <br />835 E 14th St <br />San Leandro, CA 94577 <br />mstephenson@sanleandro.org <br />IP Address: 192.83.149.200 <br />Record Tracking <br />Status: Original <br /> 10/10/2023 9:25:46 AM <br />Holder: Megan Stephenson <br /> mstephenson@sanleandro.org <br />Location: DocuSign <br />Security Appliance Status: Connected Pool: StateLocal <br />Storage Appliance Status: Connected Pool: City of San Leandro Location: DocuSign <br />Signer Events Signature Timestamp <br />Michael Shook <br />amy.whitman@sedgwick.com <br />Security Level: Email, Account Authentication <br />(None) <br />Signature Adoption: Pre-selected Style <br />Using IP Address: 24.14.54.187 <br />Sent: 10/10/2023 9:28:28 AM <br />Viewed: 10/10/2023 12:13:55 PM <br />Signed: 10/10/2023 12:16:51 PM <br />Electronic Record and Signature Disclosure: <br /> Accepted: 10/10/2023 12:13:55 PM <br /> ID: 89a68bb3-7fbd-44b4-a5d5-ff82bd61fb51 <br />Richard Pio Roda <br />rpioroda@meyersnave.com <br />Principal <br />Signing Group: City Attorney <br />Security Level: Email, Account Authentication <br />(None) <br />Signature Adoption: Pre-selected Style <br />Using IP Address: 206.169.145.130 <br />Sent: 10/10/2023 12:16:53 PM <br />Resent: 10/11/2023 1:11:58 PM <br />Viewed: 10/16/2023 6:56:43 PM <br />Signed: 10/16/2023 7:03:28 PM <br />Electronic Record and Signature Disclosure: <br /> Accepted: 10/16/2023 6:56:43 PM <br /> ID: bb3d2653-02ce-4aaf-9f6b-1a628786538c <br />Michael Yuen <br />myuen@sanleandro.org <br />Finance Director <br />Signing Group: Finance Available Funds Check <br />Security Level: Email, Account Authentication <br />(None) <br />Completed <br />Using IP Address: 192.83.149.205 <br />Sent: 10/16/2023 7:03:29 PM <br />Viewed: 10/16/2023 7:04:21 PM <br />Signed: 10/16/2023 7:04:37 PM <br />Electronic Record and Signature Disclosure: <br /> Accepted: 8/31/2022 12:14:37 PM <br /> ID: f6c69ffb-fe18-4f82-a915-02cfaf87aeaf <br />T. Michael Yuen <br />MYuen@sanleandro.org <br />Finance Director <br />Signing Group: Finance Director <br />Security Level: Email, Account Authentication <br />(None) <br />Signature Adoption: Uploaded Signature Image <br />Using IP Address: 192.83.149.205 <br />Sent: 10/16/2023 7:04:39 PM <br />Viewed: 10/16/2023 7:04:57 PM <br />Signed: 10/16/2023 7:05:01 PM <br />Electronic Record and Signature Disclosure: <br /> Accepted: 8/31/2022 12:14:37 PM <br /> ID: f6c69ffb-fe18-4f82-a915-02cfaf87aeaf