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    Electronic Record and Signature Disclosure

    Uploaded by

    Anuradha Amjuri
    This document is a certificate of completion for a DocuSign envelope containing paperwork related to a GEICO Florida total loss claim. It was completed by three signers - a GEICO adjuster, the vehicle owner, and a Copart representative. The adjuster and vehicle owner electronically signed the documents, while the Copart representative signed using a mobile device. The documents were sent, viewed, signed and the envelope was completed on the listed dates in December 2020.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Electronic Record and Signature Disclosure

    Uploaded by

    Anuradha Amjuri
    45 views4 pages
    This document is a certificate of completion for a DocuSign envelope containing paperwork related to a GEICO Florida total loss claim. It was completed by three signers - a GEICO adjuster, the vehicle owner, and a Copart representative. The adjuster and vehicle owner electronically signed the documents, while the Copart representative signed using a mobile device. The documents were sent, viewed, signed and the envelope was completed on the listed dates in December 2020.

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    This document is a certificate of completion for a DocuSign envelope containing paperwork related to a GEICO Florida total loss claim. It was completed by three signers - a GEICO adjuster, the vehicle owner, and a Copart representative. The adjuster and vehicle owner electronically signed the documents, while the Copart representative signed using a mobile device. The documents were sent, viewed, signed and the envelope was completed on the listed dates in December 2020.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    45 views4 pages

    Electronic Record and Signature Disclosure

    Uploaded by

    Anuradha Amjuri
    This document is a certificate of completion for a DocuSign envelope containing paperwork related to a GEICO Florida total loss claim. It was completed by three signers - a GEICO adjuster, the vehicle owner, and a Copart representative. The adjuster and vehicle owner electronically signed the documents, while the Copart representative signed using a mobile device. The documents were sent, viewed, signed and the envelope was completed on the listed dates in December 2020.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    Certificate Of Completion

    Envelope Id: 4DD1C35E1F5E4D24A277145F70A64F13 Status: Completed


    Subject: Please DocuSign Your GEICO Florida Total Loss Paperwork
    ClaimNumber: 0644218350101011
    Stock Number: 68198301
    Ip: 01
    Source Envelope:
    Document Pages: 2 Signatures: 3 Envelope Originator:
    Certificate Pages: 4 Initials: 0 Tanetra Hill
    AutoNav: Enabled 4608 Willard Avenue
    EnvelopeId Stamping: Enabled Chevy Chase, MD 20815
    Time Zone: (UTC-08:00) Pacific Time (US & Canada) TANEHILL@geico.com
    IP Address: 205.143.205.170

    Record Tracking
    Status: Original Holder: Tanetra Hill Location: DocuSign
    12/15/2020 9:00:40 AM TANEHILL@geico.com

    Signer Events Signature Timestamp


    Tanetra Hill Sent: 12/15/2020 9:03:11 AM
    TANEHILL@geico.com Viewed: 12/15/2020 9:03:28 AM
    Adjuster Signed: 12/15/2020 9:05:47 AM
    Region 6 Claims
    Signature Adoption: Pre-selected Style
    Security Level: Email, Account Authentication
    (None) Using IP Address: 205.143.205.166

    Electronic Record and Signature Disclosure:


    Not Offered via DocuSign

    Edsel Calso Carrasco Sent: 12/15/2020 9:05:48 AM


    toolanger@yahoo.com Viewed: 12/15/2020 9:10:20 AM
    Security Level: Email, Account Authentication Signed: 12/16/2020 8:25:26 AM
    (None), Access Code
    Signature Adoption: Pre-selected Style
    Using IP Address: 174.228.14.203
    Signed using mobile
    Electronic Record and Signature Disclosure:
    Accepted: 12/15/2020 9:10:20 AM
    ID: 417e6138-b750-492a-9afd-6c70329f31b0

    In Person Signer Events Signature Timestamp

    Editor Delivery Events Status Timestamp

    Agent Delivery Events Status Timestamp

    Intermediary Delivery Events Status Timestamp

    Certified Delivery Events Status Timestamp

    Carbon Copy Events Status Timestamp


    Copart Sent: 12/16/2020 8:25:27 AM
    geicofloridaCTU@copart.com
    Security Level: Email, Account Authentication
    (None)
    Electronic Record and Signature Disclosure:
    Not Offered via DocuSign
    Witness Events Signature Timestamp

    Notary Events Signature Timestamp

    Envelope Summary Events Status Timestamps


    Envelope Sent Hashed/Encrypted 12/15/2020 9:03:11 AM
    Certified Delivered Security Checked 12/15/2020 9:10:20 AM
    Signing Complete Security Checked 12/16/2020 8:25:26 AM
    Completed Security Checked 12/16/2020 8:25:27 AM

    Payment Events Status Timestamps


    Electronic Record and Signature Disclosure
    Electronic Record and Signature Disclosure created on: 10/20/2020 5:15:16 PM
    Parties agreed to: Edsel Calso Carrasco

    The parties to this Agreement (the "Parties") are the vehicle and/or property owner, whose name
    appears below ("Vehicle and/or property owner" or "you") and Government Employees
    Insurance Company, GEICO General Insurance Company, GEICO Advantage Insurance
    Company, GEICO Choice Insurance Company, GEICO Indemnity Company, GEICO Secure
    Insurance Company, GEICO Casualty Company and GEICO County Mutual Insurance
    Company (collectively "GEICO" or "we").
    GEICO is required by law to provide you with certain disclosures and information for you to
    select or provide other requested data. With your consent, GEICO can deliver forms to you by:
    1.) displaying or delivering the forms electronically, and 2.) requesting that you print or
    download the forms and retain the forms for your records.
    This notice contains important information that you are entitled to receive before you
    consent to electronic delivery of forms. Please read this notice carefully.
    After you have read this information, if you agree to receive the forms from GEICO
    electronically, please click on the "I AGREE" check box where indicated.
    The Parties agree as follows:

    1. You agree to have GEICO electronically deliver to you the forms applicable to the
    handling of your physical damage claim.
    2. You agree to read the electronic forms to ensure that it reflects your information and your
    vehicle and/or property information correctly.
    3. You agree to read the electronic forms to ensure that you understand the content of the
    forms and the transaction that will take place upon completion of this form.
    4. If you are satisfied with the content and information shown on the electronic forms,
    completing the following actions will be evidence that you accept the transaction:
    a. Clicking the "I agree to use Electronic Records and Signatures: check box
    b. Clicking the "Continue" button at the top of the page
    c. Electronically signing the forms
    5. If you do not consent to the electronic signature of your forms, GEICO cannot
    process your transaction electronically and you must contact GEICO and process
    your transaction on paper forms, which may cause a delay.
    6. Required hardware and software:

    a. The minimum system requirements for using the DocuSign system may change
    over time. The current system requirements are found here:
    https://support.docusign.com/guides/signer-guide-signing-system-requirements

    If you do not have the required software and/or hardware, or if you do not wish to
    use electronic signatures for any other reason, please call GEICO at 1-800-207-
    7847 so that we may provide you with paper forms that you can complete and
    sign.

    7. You are responsible for accessing and reading the forms. An electronic form has the same
    legal effect as a printed form. If you cannot access or read any form, you must contact
    GEICO at 1-800-207-7847.
    8. We recommend that you print out or download any electronically signed forms and keep
    the forms for your records. If you have any trouble printing out or downloading any form,
    you may receive a paper copy of your signed form by contacting GEICO at 1-800-207-
    7847.
    9. GEICO does not warrant that the delivery of an electronic form will be uninterrupted or
    error free. We are not liable for: any loss or damage arising from problems with your
    equipment or your telecommunications provider, your failure to meet your
    responsibilities as outlined herein, or any equipment problems or other occurrences
    beyond our reasonable control.
    10. Your consent does not mean that GEICO must provide the forms electronically. GEICO
    may, at its option, deliver forms on paper if it chooses to do so. GEICO may also require
    that certain circumstances from you be delivered to GEICO on paper at a specified
    address.

    Vehicle and/or Property Owner Acknowledgement


    I have read the information about the use of my electronic signature and I consent to the
    use of my electronic signature on the forms in connection with the handling of my physical
    damage claim with GEICO. I agree that I am able to view the forms using my computer
    and/or mobile device and software in accordance with the technical requirements linked in
    this document. I consent to the use of electronic and handwritten signatures. I also
    understand that my electronic signature represents my informed consent to complete the
    forms necessary for the handling of my physical damage claim with GEICO.

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