Common use of Claims Certification and Program Integrity Clause in Contracts

Claims Certification and Program Integrity. Anytime Contractor submits a claim to the County for reimbursement for services provided under Exhibit A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim: “Under the penalty of perjury under the laws of the State of California, I hereby certify that this claim for services complies with all terms and conditions referenced in the Agreement with San Mateo County. Executed at California, on, 20 Signed Title Agency ”

Claims Certification and Program Integrity. Anytime Contractor submits a claim to the County for reimbursement for services provided under Exhibit A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim: “Under the penalty of perjury under the laws of the State of California, I hereby certify that this claim for services complies with all terms and conditions referenced in the Agreement with San Mateo County. Executed at California, onon , 20 Signed Title Agency ”

Claims Certification and Program Integrity. Anytime Contractor submits a claim to the County for reimbursement for services provided under Exhibit A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim: “Under the penalty of perjury under the laws of the State of California, I hereby certify that this claim for services complies with all terms and conditions referenced in the Agreement with San Mateo County. Executed at California, onon , 20 Signed Title Agency ”H.

Claims Certification and Program Integrity. Anytime Contractor submits a claim to the County for reimbursement for services provided under Exhibit Schedule A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim: “Under the penalty of perjury under the laws of the State of California, I hereby certify that this the above claim for services complies with all terms and conditions referenced in the Agreement with San Mateo County. Executed at California, onon , 20 200_ Signed Title Agency ”Title

Claims Certification and Program Integrity. Anytime Contractor submits a claim to the County for reimbursement for services provided under Exhibit Schedule A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim: “Under the penalty of perjury under the laws of the State of California, I hereby certify that this the above claim for services complies with all terms and conditions referenced in the Agreement with San Mateo County. Executed at California, onon , 20 200_ Signed Title Agency ”” ATTACHMENT I

Claims Certification and Program Integrity. Anytime Contractor submits a claim to the County for reimbursement for services provided under Exhibit A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim: “Under the penalty of perjury under the laws of the State of California, I hereby certify that this claim for services complies with all terms and conditions referenced in the Agreement with San Mateo County. Executed at California, onon , 20 200 Signed Title Agency ”

Claims Certification and Program Integrity. Anytime Contractor submits a claim to the County for reimbursement for services provided under Exhibit Schedule A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim: “Under the penalty of perjury under the laws of the State of California, I hereby certify that this the above claim for services complies with all terms and conditions referenced in the Agreement with San Mateo County. Executed at , California, onon , 20 200_ Signed Title Agency ”Title

Claims Certification and Program Integrity. Anytime Contractor submits a claim to the County for reimbursement for services provided under Exhibit A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim: “Under the penalty of perjury under the laws of the State of California, I hereby certify that this claim for services complies with all terms and conditions referenced in the Agreement with San Mateo County. Executed at California, onon , 20 200_ Signed Title Agency ”

Claims Certification and Program Integrity. Anytime Contractor submits a claim to the County for reimbursement for services provided under Exhibit A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim: “Under the penalty of perjury under the laws of the State of California, I hereby certify that this claim for services complies with all terms and conditions referenced in the Agreement with San Mateo County. Executed at California, onon , 20 Signed Title Agency ”20