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Envelope Number: 111C4FE8F9744Bi6BC9A67E51D5FD6C4 <br />Subject: Please DocuSign this document: ADDTL INSURED CSG ADVISORS.pdf <br />BIS: 123456 <br />Premium: 123456 <br />Source Envelope: <br />Document Pages: 7 <br />Certificate Pages: 1 <br />AutoNav: Enabled <br />Envelopeld Stamping: Enabled <br />Status: Original <br />3/17/2015 10:47:01 AM ET <br />Signatures: 1 <br />Initials: 0 <br />Holder: Jenny Ihler- O'Donnell <br />jihlerod@paychex.com <br />Status: Completed <br />Envelope Originator: <br />Jenny Ihler- O'Donnell <br />911 Panorama Trail South <br />Rochester, NY 14625 <br />jlhlerod@paychex.com <br />IP Address: 141.123.243.100 <br />Location: DocuSign <br />Do c <br />ME # #G41r4P <br />Jenny Ihler- O'Donnell D " °s'ern`d Sent: 3/17/201510:47:38 AM ET <br />jihlerod@paychex.com �.«G Oi'u'- Viewed: 3/17/201510:47:43 AM ET <br />PIA Commercial Insurance Agent — " ----- Signed: 3/17/2015 10:47:48 AM ET <br />Paychex Insurance Agency <br />Security Level: Email, Account Authentication Using IP Address: 141.123.243.100 <br />(None) <br />Electronic Record and Signature Disclosure: <br />Not Offered <br />ID: <br />fi,k m 'r" a ;1JV= <br />Notar�r EYenfs v- e r YTl ?l Tamp <br />w :s9se.,.,v <br />re �, <br />En4QjOpe .Ui�linar}I, Event, <br />...L>.„s.�a TIinStaITIpSM>.x'`..::.,.,,i <br />Envelope Sent Hashed /Encrypted 3/17/2015 10:47:38 AM ET <br />Certified Delivered Security Checked 3/17/2015 10:47:43 AM ET <br />Signing Complete Security Checked 3/17/2015 10:47:48 AM ET <br />Completed Security Checked 3/1712015 10:47:48 AM ET <br />r <br />1 <br />��9 <br />