HomeMy WebLinkAboutDNR Form - Treatment Agreement - 11_15_2021_ID17d340faa36_-2408_5854decf_2x4e0s_1_audit_trail 2021-11-18 09:24:43 PM GMT Session Started lUnknown
Session Id W/1213/17D34EFFFF5/4ACFAODO
Remote IP Address 24.149.10.32
User Agent Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML,
like Gecko) Chrome/95.0.4638.69 Safari/537.36
2021-11-18 09:26:26 PM GMT Transaction Accepted by Si nix INHigby9744
Document Set Id 17d340faa36:-2408:5854decf:2x4eOs
Transaction ID M DoX........2021-11-18 16:26:26:302
Transaction Name DNR Form - Treatment Agreement - 11/15/2021
Sponsor waterloocit
Service Type SDDDC
Submitter Nancy Hi b
Submitter Email nanc .hi b waterloo-ia.or
Role waterloocit
Ref Id NHi b 9744
Parties Party Name Party Id
Quentin Hart
Documents Document Id Document Refld Document Title
PDF:17d340faa36:- UserAddedDoc- Treatment Agreement
2435:5854decf:2x4eOs Treatment Agreement
Submitting Agent
2021-11-18 09:26:27 PM GMT Email Sent INHigby9744
Session Id W/1213/17D34EFFFF5/4ACFAODO
Email Party Name Quentin Hart
Email Address To uentin.hart waterloo-ia.or
Email Address From "City of Waterloo Online Signatures"
<nore I si nixmail.com>
Body Dear Quentin Hart,
Your documents are available online
for viewing and signing.
To access your document, click here:
https://www.signix.net/enter.jsp?m=1
02&i=yFPYbiEcZVAfhcSkiPpCZI
If you have any questions, please
contact Nancy Higby at
nanc .hi b waterloo-ia.or .
Reason Picku Email
2021-11-18 09:26:50 PM GMT Session Started lUnknown
Session Id W/1215/17D34F1 EE46/AAA70BOC
Remote IP Address 209.222.82.129
User Agent Mozilla/4.0 (compatible; MSIE 8.0; Windows NT 6.1; WOW64; Trident/4.0;
SLCC2; .NET CLR 2.0.50727; .NET CLR 3.5.30729; .NET CLR 3.0.30729
2021-11-18 09:28:28 PM GMT Session Started lUnknown
Session Id W/1215/17D34F36CCA/FEEEDAFF
Remote IP Address 24.149.10.32
User Agent Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML,
like Gecko) Chrome/95.0.4638.69 Safari/537.36
2021-11-18 09:28:32 PM GMT Esi n Consent Accepted IQHart6794
Session Id W/1215/17D34F36CCA/FEEEDAFF
Service Type SelectOneClick
2021-11-18 09:28:34 PM GMT User Entered PIN IQHart6794
Session Id W/1215/17D34F36CCA/FEEEDAFF
Type Credential
Authority si nix
Party Name Quentin Hart
Method Id PIN
2021-11-18 09:28:39 PM GMT Signature Creation Authorized IQHart6794
Session Id W/1215/17D34F36CCA/FEEEDAFF
Authorization Method None
Party Name Quentin Hart
Signer Id QHart6794
Field Id Si nature 1637270729850
Documents Document Refld Document Title
UserAddedDoc-Treatment Treatment Agreement
A reement
Reason Info Reason Field Id Reason Chosen B
2021-11-18 09:28:40 PM GMT Document Signed IQHart6794
Session Id W/1215/17D34F36CCA/FEEEDAFF
Signature Type Authority Certified
Date Signed 2021-11-18 21:28:39.508 GMT
Signature Policy ID 1.3.6.1.4.1.6693.4.2.10
Field Id Signature 1637270729850
Party Name Quentin Hart
Signer Certificate Subject Distinguished Name EMAIL=support@signix.com,CN=SIG
NiX Signature Authority,O=SIGNiX,
Inc.,OU=SIGNiX Signature
Authority,L=Chattanooga,ST=Tennes
see,C=US
Issuer CN=GlobalSign GCC R6 AATL CA
2020,0=GlobalSi n nv-sa,C=BE
Serial Number 14910846612038757690046097078
Certificate MIIGNTCCBR2gAwIBAgIMMC32loS
+M1 LJUya2MAOGCSgGSlb3DQEBD
AUAM F ExCzAJ Bg N V BAYTAkJ F M Rk
wFwYDVQQKExBHbG9iYWxTaWdul
G52LXNhMScwJQYDVQQDEx5HbG
9iYWxTaWduIEdDQyBSNiBBQVRMI
ENBIDIwMjAwHhcNMjAxMjASMTUx
MTQxWhcNMjExMjEwMTUxMTQxWj
CBuzELMAkGA1 UEBhMCVVMxEjA
QBgNVBAgTCVRIbm5lc3NIZTEUMB
IGA1 UEBxMLQ2hhdHRhbm9vZ2Exl
zAhBgNVBAsTGINJR05pWCBTaWd
uYXR1 cmUgQXVOaG9yaXR5MRUw
EwYDVQQKEwxTSUdOaVgslEluYy4
xlzAhBgNVBAMTGINJR05pWCBTa
WduYXR1 cmUgQXVOaG9yaXR5MS
EwHwYJKoZlhvcNAQkBFhJzdXBwb
3JOQHNpZ25peC5jb20wggEiMAOGC
SgGSlb3DQEBAQUAA41BDwAwggE
KAoIBAQC8ctye8HBHh3FwEBzENz
aztl Fong 1/uYdaNLc6THNO7KTYJKtK
OCLtPehpYghiSuLkhaMJzO+QAolOfq
eal HTBKTyCa/I Er9kn02DHlxO3EZbD
Aex5ONB21 i+6i+gKSYEWrhVTMNO
BLP62/12BrDZ7JG9FKu3TMiwQ5fwj9
x/n9HmlDg7Q4WxfuhpuyoFugYLZSI
QwYM51E11iNp/pkj++Dj11AEa1/vSOb5
10xlh2DOUmnH 1 tKQBkpZgGnPVtgGI
RFC9/xUQT+9pCF/EDeCsO7+98+51
WRubhT05inKHDh 1 tXWcTBGmWGg
jakeBOet8JgzOfD3tftVs7QbGCpD1e5
AgMBAAGjggKgMl ICnDAOBgNVHQ
8BAf8EBAMCBsAwgZEGCCsGAQU
FBwEBBIGEMIGBMEUGCCsGAQU
FBzAChjlodHRwOi8vc2VjdXJILmdsb
2JhbHNpZ24uY29tL2NhY2VydC9nc2
djY312YWFObGNhMjAyMC5jcnQwO
AYIKwYBBQUHMAGGLGhOdHA6Ly
9vY3NwLmdsb2JhbH N pZ24uY29tL2
dzZ2NjcjZhYXRsY2EyMDIwMIHaBg
NVHSAEgd Iwgc8wgcwGCisGAQQB
oDIBKB4wgbOwgYYGCCsGAQUFB
wlCMHoMeFRoaXMgY2VydGImaWN
hdGUgaGFzIGJIZW4gaXNzdWVklGI
uIGFjY29yZGFuY2Ugd2I0aCBOaGU
gR2xvYmFsU2lnbiBDUFMgbG9jYXR
IZCBhdCBodHRwczovL3d3dy5nbG9i
YWxzaWduLmNvbS9yZXBvc2I0b3J5
LzAyBggrBgEFBQcCARYmaHROcH
M6Ly93d3cuZ2xvYmFsc2lnbi5jb20vc
mVwb3NpdG9yeS8wCQYDVROTBAI
wADBABgNVHR8EOTA3MDWgM6A
xhi9odHRwOi8vY3JsLmdsb2JhbHNp
Z24uY29tL2dzZ2NjcjZhYXRsY2EyM
DlwLmNybDAdBgNVHREEFjAUgRJz
dXBwb3JOQHNpZ25peC5jb20wVwY
KKoZ I hvcvAQ EJAQ RJ M EcCAQ G G P
2hOdHA6Ly9hYXRsLXRpbWVzdGFt
cC5nbG9iYWxzaWduLmNvbS90c2E
vdjR2NWVmZmswN3pvcjQxMHJldzl
yegEBADAUBgNVHSUEDTALBgkgh
kiG9y8BAQUwHwYDVROjBBgwFoA
UdyLZawginL/F1 uwRVjQEPK4K028
wHQYDVR0OBBYE FMabAfMZg 1 II/K
bjzfUSEIOVguljMAOGCSgGSlb3DQE
BDAUAA4IBAQAn7JDmkAL3Ss5vlc4
Io58u5xQGGDGx4dpWCx8QHQlwk+
4wU01zWpzrV5O9vH2z1jBkW/YGdW
RWI7Zztkp69LjyXxWwMOCgKhH IOri
kk8tpz8jxbKOQh27htUD14BW5gsEcv
diDCasNEwNZRazljY/w1 yngDOQgY
Qf Rg4Yu Py2 B Ntq k/ytOd htg Bq W6AS
+NvwzjwskZY7QkZ70GQDjBORge5
W1O7N6Ko0uQ/wnes5flhesOcYgSkni
TrQ272wG8sbxOsDw9hVBKgMkObT
MACT8WFgXtM93pRJPicAXipAz6sh
pAjhJUmCzz7q/uWuGsJlmrPaUYQH
dEuOPRK c6RFDW
To Be Signed Document Document Id Document Refld Document Title Digest
PDF:1 7d340faa36 UserAddedDoc- Treatment Algorith SHA-
Treatment Agreement m Id 512
2435:5854decf:2x Agreement Value ITIhTAK
4e0s
7FVA2X
7ogUr4j
6svtow1
7oPylU
gFC34g
pCYXZ
Ov53YD
p2TVX
CxfRRs
EnEijQ
Ac+t7a
BFZ5vk
czl4aJg
Signed Document Document Id Document Refld Document Title Digest
PDF:17d340faa36 UserAddedDoc- Treatment Algorith SHA-
Treatment Agreement m Id 512
2435:5854decf:2x Agreement Value 4FONH
4e0s wHf/6V
OALUk
awOH F7
iOH9Hd
9nyrSph
zw8 F Mj
ydAGh
N141-c1
U p//++P
eUn8m
nxQS7T
FLsl4D
MB89R
C7dDg=
2021-11-18 09:28:40 PM GMT Email Sent IQHart6794
Session Id W/1215/17D34F36CCA/FEEEDAFF
Email Party Name Quentin Hart
Email Address To uentin.hart waterloo-ia.or
Email Address From "City of Waterloo Online Signatures"
<nore I si nixmail.com>
Body Dear Quentin Hart,
Thank you for submitting your
electronic signature.
This confirms that you completed the
following online transaction on
Thursday, November 18, 2021 at
4:28 PM (Eastern).
For Document Set: DNR Form -
Treatment Agreement - 11/15/2021
You read and signed Treatment
Agreement.
To re-access the system and view
your document(s), visit:
https://www.signix.net/enter.jsp?m=1
02&i=yFPYbiEcZVAfhcSkiPpCZI
If you have any questions, please
contact Nancy Higby at
nancy.higby@waterloo-ia.org.
Reason Si nin Com IetedEmail
2021-11-18 09:28:40 PM GMT Email Sent JQHart6794
Session Id W/1215/17D34F36CCA/FEEEDAFF
Email Party Name
Email Address To nanc .hi b waterloo-ia.or
Email Address From "City of Waterloo Online Signatures"
<nore I si nixmail.com>
Body Dear Nancy Higby,
The transaction named below has
been completed by all parties and is
available for your processing.
Document Set Name: DNR Form -
Treatment Agreement - 11/15/2021
To access this document set, click
here:
https://www.signix.net/enter.jsp?m=1
02&i=f2wzyyZrssnGfYQNvOx95J
Reason Document Set is Complete: DNR Form - Treatment Agreement - 11/15/2021
2021-11-18 09:28:40 PM GMT Transaction Completed IQHart6794