Certificate Of Completion
Envelope Id: C447B5CED59A435FB2895A41FC342645 Status: Completed
Subject: Please DocuSign Your GEICO Florida Total Loss Paperwork
ClaimNumber: 0171023480101060
Ip: 03
Source Envelope:
Document Pages: 3 Signatures: 6 Envelope Originator:
Certificate Pages: 4 Initials: 0 Nekira Jackson
AutoNav: Enabled 4608 Willard Avenue
EnvelopeId Stamping: Enabled Chevy Chase, MD 20815
Time Zone: (UTC-08:00) Pacific Time (US & Canada) NeJackson@geico.com
IP Address: 205.143.205.169
Record Tracking
Status: Original Holder: Nekira Jackson Location: DocuSign
7/22/2021 4:43:52 PM NeJackson@geico.com
Signer Events Signature Timestamp
Nekira Jackson Sent: 7/22/2021 4:45:40 PM
NeJackson@geico.com Viewed: 7/22/2021 4:45:58 PM
Salvage Representative Signed: 7/22/2021 4:48:05 PM
GEICO
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
Khin Sanda Sent: 7/22/2021 4:48:07 PM
chosanda10@yahoo.com Viewed: 7/22/2021 4:50:31 PM
Security Level: Email, Account Authentication Signed: 7/22/2021 4:50:57 PM
(None), Access Code
Signature Adoption: Pre-selected Style
Using IP Address: 45.50.47.221
Signed using mobile
Electronic Record and Signature Disclosure:
Accepted: 7/22/2021 4:50:31 PM
ID: ccd22c0a-f65c-421c-8eed-8309e6343e85
Cedric Maurice Coleman Sent: 7/22/2021 4:48:07 PM
ceds@aol.com Viewed: 7/22/2021 4:49:46 PM
Security Level: Email, Account Authentication Signed: 7/22/2021 4:50:24 PM
(None), Access Code
Signature Adoption: Pre-selected Style
Using IP Address: 45.50.47.221
Signed using mobile
Electronic Record and Signature Disclosure:
Accepted: 7/22/2021 4:49:46 PM
ID: e1debbd0-565e-4ae9-a0cf-c6f0565d0e99
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
IAA Sent: 7/22/2021 4:50:58 PM
FLesign@iaai.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 7/22/2021 4:45:40 PM
Certified Delivered Security Checked 7/22/2021 4:49:46 PM
Signing Complete Security Checked 7/22/2021 4:50:24 PM
Completed Security Checked 7/22/2021 4:50:58 PM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on: 10/20/2020 5:18:35 PM
Parties agreed to: Khin Sanda, Cedric Maurice Coleman
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.
