CONTRACTOR California Department of General Services Use Only Exempt per. SCM Vol. 1 4.04(A)(2) CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) County of Sierra BY (Authorized Signature) ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON XXXXXXXXxxxx X. Huebner, Chairman ADDRESS P.O. Box 1019, Loyalton, California 96118 STATE OF CALIFORNIA AGENCY NAME California Department of Social Services BY (Authorized Signature) ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxxx Xxxxxx, Chief, Contracts and Purchasing Bureau ADDRESS 000 X Xxxxxx, XX 0-00-000, Xxxxxxxxxx, Xxxxxxxxxx 00000
CONTRACTOR California Department of General Services Use Only Exempt per. CONTRACTOR NAME (if other than an individual, state whether a corporation, partnership, etc.) City Of Costa Mesa CONTRACTOR AUTHORIZED SIGNATURE DATE SIGNED PRINTED NAME AND TITLE OF PERSON SIGNING Xxxx Xxx Xxxxxxx Xxxxxxxx, City Manager CONTRACTOR BUSINESS XXXXXXX X.X Xxx 0000, Xxxxx Xxxx, XX 00000 XXXXX XX XXXXXXXXXX CONTRACTING AGENCY NAME 00XX Xxxxxxxx Xxxxxxxxxxxx Association/OC Fair & Event Center AUTHORIZED SIGNATURE DATE SIGNED PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxxx Xxxxxxxx, Chief Executive Officer CONTRACTING AGENCY ADDRESS 00 Xxxx Xxxxx, Xxxxx Xxxx, XX 00000 EXHIBIT A – SCOPE OF WORK CONTRACT REPRESENTATIVES 32ND DISTRICT AGRICULTURAL ASSOCIATION/OC FAIR & EVENT CENTER Xxxx Xxxxx, Director Safety & Security/Parking Phone Number (000) 000-0000 Costa Mesa Police Department Xxxxx Xxxxx, Chief of Police Phone Number (000) 000-0000 CONTRACTOR AGREES:
CONTRACTOR California Department of General Services Use Only Exempt per. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) , a nonprofit charitable corporation BY (Authorized Signature) " DATE SIGNED(Do not type) RINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME Department of Parks and Recreation BY (Authorized Signature) " DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxxx X. Xxxxx, Deputy Director, Park Operations, Dept. of Parks and Recreation ADDRESS 0000 0xx Xxxxxx, Xxxx 0000, Xxxxxxxxxx, XX 00000 Contractor State Agency – Dept. of Parks and Rec. Dept. of General Services rev: 06/10 EXHIBIT A Contractor's Name: Agreement Number: SCOPE OF WORK
CONTRACTOR California Department of General Services Use Only Exempt per. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) BY (Authorized Signature) DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME Department of Health Care Services BY (Authorized Signature) DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxx Xxxxxxxx, Chief Deputy Director, Policy and Program Support
CONTRACTOR California Department of General Services Use Only Exempt per. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) BY (Authorized Signature) ✍ DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME BY (Authorized Signature) ✍ DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS Project Summary & Scope of Work Contract Grant Does this project include Research (as defined in the UTC)? Yes No PI Name: .
CONTRACTOR California Department of General Services Use Only Exempt per. Government Code Section100505 CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) BY (Authorized Signature) DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME California Health Benefit Exchange BY (Authorized Signature) DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS 0000 Xxxxxxxxxx Xxxx Xxxxxxxxxx, XX 00000
CONTRACTOR California Department of General Services Use Only Exempt per. W & I 5897(f) CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) YOLO COUNTY HEALTH AND HUMAN SERVICES BY (Authorized Signature) DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxx Xxxxxxxx, Chair, Yolo County Board of Supervisors ADDRESS 000 Xxxxx Xxxxxx, Xxxx 000, Xxxxxxxx, XX 00000 STATE OF CALIFORNIA AGENCY NAME Mental Health Services Oversight and Accountability Commission BY (Authorized Signature) DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxx Xxxxx, Executive Director ADDRESS 0000 X Xxxxxx, Xxxxx 0000, Xxxxxxxxxx, XX 00000 MHSOAC USE ONLY State Master Contractor Contract Manager Accounting State Controller Exhibit A Scope of Work
CONTRACTOR California Department of General Services Use Only Exempt per. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) BY (Authorized Signature) DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME State Energy Resources Conservation and Development Commission BY (Authorized Signature) DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxxx Xxx, Contracts, Grants, and Loans Office Acting Manager ADDRESS 0000 Xxxxx Xxxxxx, XX-00, Xxxxxxxxxx, XX 00000 Exhibit A1 SCHEDULE OF DELIVERABLES1 List all items that will be delivered to the State under the proposed Scope of Work. Include all reports, including draft reports for State review, and any other deliverables, if requested by the State and agreed to by the Parties. All Deliverables shall be delivered to the State’s Contract Project Manager identified in Exhibit A3, unless otherwise stated in this Agreement. Unless otherwise directed by the Energy Commission all Deliverables, including drafts, shall be submitted to the State Agency Accounting Contact identified in Exhibit A3 (which will then forward them to the State Agency Contract Project Manager for review and comment). The University will submit an original and two copies of the final version of all Deliverables to the State Agency Accounting Contact identified in Exhibit A3. Deliverable2 Description Due Date The following Deliverables3, to the extent not restricted by Exhibit A4, are subject to Exhibit C, Paragraph 18. Copyrights, subparagraph B Progress Report #1 Progress Report #2 Final Report Outline (draft and final) Final Report (draft and final) In-state and California Based Entity Expenditures A report documenting the Total Energy Commission Reimbursable Funds Spent in California and Total Energy Commission Reimbursable Funds to California Based Entities (CBE*) associated with the current request for payment and the cumulative-to-date must be provided with the University’s request for payment. This report can be listed on the request for payment, appended to it as an attachment, or documented using the Total Energy Commission Reimbursable Funds Spent in California* and Total Energy Commission Reimbursable Funds to CBEs form at xxxx://xxx.xxxxxx.xx.xxx/research/contractors.html. Match Funds Report Provide a report on Match Funds expenditures with the University’s request for payment. * See Definitions in Exhibit G.
CONTRACTOR California Department of General Services Use Only Exempt per. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) X.X. XXXXXXX CONSULTING, Inc. BY (Authorized Signature) " DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxxx Xxxxxxx, President ADDRESS 0 Xxxx Xxxxxx Xx. 0xx Xxxxx, Xxxxxxx, XX 00000 (312) 447-2001, email xxxxxxxx@xxxx.xxx STATE OF CALIFORNIA AGENCY NAME 32ND DISTRICT AGRICULTURAL ASSOCIATION BY (Authorized Signature) " DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxx Xxxxxx, CFE, CMP, Chief Executive Officer or Xxx Xxxxx, CFE, VP, Operations ADDRESS 00 Xxxx Xxxxx, Xxxxx Xxxx, XX 00000 EXHIBIT A – SCOPE OF WORK CONTRACT REPRESENTATIVES 32ND DISTRICT AGRICULTURAL ASSOCIATION/OC FAIR & EVENT CENTER Xxx Xxxxx, Vice President, Operations (000) 000-0000 X.X. XXXXXXX CONSULTING, INC. Xxxxxxx Xxxxxxx, President (000) 000-0000
CONTRACTOR California Department of General Services Use Only Exempt per. Exemption 46.1A1 CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) BY (Authorized Signature) " DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME Department of Parks and Recreation BY (Authorized Signature) " DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxx Xxxxxx, Chief Deputy Director, Department of Parks and Recreation ADDRESS 0000 0xx Xxxxxx, Xxxx 0000, Xxxxxxxxxx, XX 00000 EXHIBIT A Contractor's Name: Agreement Number: SCOPE OF WORK
