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Docusign Envelope ID: FC72E12A-E2DD-42C4-BD36-C422ACOA54D2 <br />DocuSign <br />Certificate Of Completion <br />Envelope Id: 7D936459EO5A4CC7BDC9F1CD5CFE4588 <br />Subject: Complete with DocuSign: Second Amendment to MH Youth.pdf <br />Source Envelope: <br />Document Pages: 2 Signatures: 1 <br />Certificate Pages: 1 Initials: 0 <br />AutoNav: Enabled <br />Envelopeld Stamping: Enabled <br />Time Zone: (UTC-08:00) Pacific Time (US & Canada) <br />Record Tracking <br />Status: Original <br />5/4/2023 6:25:27 PM <br />Signer Events <br />Liz Perez -Howe <br />[email protected] <br />Chief Executive Officer <br />Axis Community Health <br />Security Level: Email, Account Authentication <br />(None) <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 />Witness Events <br />Notary Events <br />Envelope Summary Events <br />Envelope Sent <br />Certified Delivered <br />Signing Complete <br />Completed <br />Holder: Liz Perez -Howe <br />[email protected] <br />Signature <br />Signature Adoption: Pre -selected Style <br />Using IP Address: 76.133.87.223 <br />Signature <br />Status <br />Status <br />Status <br />Status <br />Status <br />Signature <br />Signature <br />Status <br />Hashed/Encrypted <br />Security Checked <br />Security Checked <br />Security Checked <br />Status: Completed <br />Envelope Originator: <br />Liz Perez -Howe <br />5925 W Las Positas Blvd <br />Pleasanton, CA 94588 <br />[email protected] <br />IP Address: 76.133.87.223 <br />Location: DocuSign <br />Timestamp <br />Sent: 5/4/2023 6:26:52 PM <br />Viewed: 5/4/2023 6:27:01 PM <br />Signed: 5/4/2023 6:27:16 PM <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamp <br />Timestamps <br />5/4/2023 6:26:52 PM <br />5/4/2023 6:27:01 PM <br />5/4/2023 6:27:16 PM <br />5/4/2023 6:27:16 PM <br />Payment Events Status Timestamps <br />