Dave Evans
CFO
Douglas Kleam
President
DocuSign Envelope ID: 7F301F8E-2667-4697-992F-F014AB7EBE19 Dec 28, 2021
Dec 27, 2021
Certificate Of Completion
Envelope Id: 7F301F8E26674697992FF014AB7EBE19
Status: Completed
Subject: Please DocuSign: SBPD MFIE Policing Agreement A1 PAS-210782-254294.pdf Source Envelope:
Document Pages: 1
Signatures: 2
Envelope Originator:
Certificate Pages: 5
Initials: 0
Corrina Sanchez
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
2101 North Waterman Ave
San Bernardino, CA 92404
[email protected]
IP Address: 162.135.0.60
Record Tracking
Status: Original
12/27/2021 3:31:34 PM
Holder: Corrina Sanchez
[email protected]
Location: DocuSign
Signer Events
Signature
Timestamp
Dave Evans
[email protected]
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 162.135.0.59
Sent: 12/27/2021 3:32:28 PM
Viewed: 12/28/2021 11:14:18 AM
Signed: 12/28/2021 11:14:20 AM
Electronic Record and Signature Disclosure:
Accepted: 9/25/2020 3:50:08 PM
ID: eb4490a9-39fe-45c5-9b9e-69ebcf93407a
Douglas Kleam
[email protected]
President
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 76.86.196.151
Signed using mobile
Sent: 12/27/2021 3:32:27 PM
Viewed: 12/27/2021 3:40:58 PM
Signed: 12/27/2021 3:41:09 PM
Electronic Record and Signature Disclosure:
Accepted: 12/27/2021 3:40:58 PM
ID: 8713d1eb-fe4b-4e23-9d17-8aad38ce8624
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Envelope Summary Events
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Envelope Sent
Hashed/Encrypted
12/27/2021 3:32:28 PM
Certified Delivered
Security Checked
12/27/2021 3:40:58 PM
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Signing Complete
Security Checked
12/27/2021 3:41:09 PM
Completed
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12/28/2021 11:14:20 AM
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Electronic Record and Signature Disclosure
Consent to Electronic Signatures and Communications
Under certain laws, Dignity Health (including its subsidiaries and affiliated entities and collectively referred to as “Dignity Health” in this Consent) is required to obtain your authorization and consent to obtain your electronic signature on documents related to your interactions with Dignity Health (the “Interactions”) and to receive electronically copies of such documents. As a result, we are providing this notice to you in order to obtain your agreement and consent to conduct our business with you electronically, including your consent to electronically sign documents arising from Interactions with Dignity Health and to confirm your consent to provide you with electronic copies of the same.
Please note that we will not provide you with a paper copy of your documents, but we will email a copy to you and you may otherwise print or save a copy of these documents for your records.
Scope of Your Consent
An "electronic signature" may be clicking a check box, orally stating "I Agree", or otherwise taking any other action that indicates your agreement to and receipt of a document. By indicating your consent below, you are agreeing that any electronic signatures that you may provide are legally binding signatures with the full legal force of a handwritten signature, which does not need to be verified, validated or certified by any third party. By indicating your consent below you are also agreeing that we can send you and you will receive electronically disclosures, communications, notices, forms, applications, policies and modifications to the same, which we choose to provide you electronically, unless and until you withdraw your consent as set forth below.
This Consent is voluntary and you may refuse to sign this Consent, but your ability to submit your request for services electronically will be restricted and potentially delayed.
If you (1) do not wish to consent to electronic signatures in connection with the Services, (2) do not consent to the electronic submission and receipt of disclosures, communications, notices, forms, applications, policies and modifications related to the Services or (3) otherwise wish not to engage in electronic transactions, you may contact us at [email protected] for alternatives to submit your paperwork.
In the event that we elect to discontinue the provision of any electronic communications or change the terms and conditions on which we provide electronic communications, we will provide you with any notice of such discontinuance or changes as required by law.
Obtaining a Paper Copy
Your copy of this Consent and all disclosures and communications related to this Consent, including documents in relation to the Service, will be sent and received electronically as set forth below. We reserve the right, but assume no obligation except as set forth in this Consent to provide a paper copy of any communication that you have authorized us to provide electronically.
Electronic Record and Signature Disclosure created on: 8/26/2020 12:14:59 PM Parties agreed to: Dave Evans, Douglas Kleam
You may save a paper copy of certain disclosures and communications by printing them. You may obtain additional paper copies by contacting us at:
[email protected]. There will be no additional charge for obtaining paper copies.
Accessing Your Electronic Records
In order to receive documents electronically, you need a valid email address, Internet access and a computer that meets the following minimum hardware and software requirements.
Required hardware and software
Operating
Systems: Windows® 2000, Windows® XP, Windows Vista®; Mac OS® X Browsers:
Final release versions of Internet Explorer® 6.0 or above (Windows only); Mozilla Firefox 2.0 or above (Windows and Mac); Safari™ 3.0 or above (Mac only)
PDF Reader: Acrobat® or similar software may be required to view and print PDF files Screen
Resolution: 800 x 600 minimum
Enabled Security
Settings: Allow per session cookies
** These minimum requirements are subject to change. If these requirements change, you will be asked to re-accept the disclosure. Pre-release (e.g. beta) versions of operating systems and browsers are not supported.
In addition, if you wish to print copies of your documents or otherwise retain your own soft copy, you will need to have a printer attached to the computer you are using or access to a hard drive or other electronic storage device, such as a hard drive or USB drive.
By signing below, you are representing that you have access to the minimum requirements above.
All communications and disclosures related to the Service provided to you electronically will be provided either via email or via download of a file that contains the electronic record Withdrawing Your Consent
You may withdraw your consent to engage in electronic communications and transactions as described in this Consent at any time by contacting Dignity Health’s Supply and Service Resource Management Department at: [email protected]. Any withdrawal of consent will be effective only after we have a reasonable period of time for us to process your withdrawal.
There is no charge for withdrawing your consent. However, in the event you withdraw your consent, you will not be able to receive electronically information and materials related to the Service. Withdrawing your consent does not invalidate any electronic signatures you have previously executed, which remain valid and enforceable as electronic signatures and you authorize us to continue to take action in reliance on such electronic signatures and the activities authorized by the same, unless and until you direct us otherwise. In addition, we have no obligation to provide you paper copies of documents that you previously consented to receive electronically, although you may request additional paper copies as set forth above.
Updating Your Records
In order to ensure that you will continue to receive electronic communications from us, you must notify us of any updates to your email address. You may update your electronic contact information that we have on file by contacting us at [email protected].
If you provide us with an invalid email address or your email address ceases to function, we may consider such occurrence as a withdrawal of your consent to receive electronic communications and transactions.
Electronic Signature
You understand that by signing this document, you are confirming your agreement to sign this Consent electronically. A copy of this consent will be made available to you via email.
You will receive only an electronic copy of your signature to this Consent. You are also confirming your agreement to use electronic signatures and receive electronic communications and records from Dignity Health and that you have access to a computer that meets the minimum requirements previously mentioned. Your act of clicking “I Agree” below is your legally binding electronic signature and agreement to the above terms, consents and disclosures. If you agree, please check “I Agree”. If you do not agree, you may not proceed with the electronic application, but may contact us to alternatively submit your paperwork.