Common use of CONTRACTOR California Department of General Services Use Only Clause in Contracts

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) To Be Determined BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx Xxxxxx, Chief, Facilities and Business Services Division ADDRESS 0000 X Xxxxxx, Xxxxxxxxxx, XX 00000 TEMPORARY/RELIEF SKILLED NURSING FACILITY ADMINISTRATOR (LNHA) SERVICES

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) To Be Determined TBD BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx Xxxxxx, Chief, Facilities and Business Services Division ADDRESS 0000 X Xxxxxx, Xxxxxxxxxx, XX 00000 TEMPORARY/RELIEF SKILLED NURSING FACILITY ADMINISTRATOR (LNHA) COMPREHENSIVE ASSESMENT SERVICES

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) To Be Determined BY (Authorized Signature)  ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs BY (Authorized Signature)  ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx Xxxxxx, Chief, Facilities and Business Services Division ADDRESS 0000 X Xxxxxx, Xxxxxxxxxx, XX 00000 TEMPORARY/RELIEF SKILLED NURSING FACILITY ADMINISTRATOR (LNHA) SERVICES

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) To Be Determined TBD BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx Xxxxxx, Chief, Facilities and Business Services Division ADDRESS 0000 X Xxxxxx, Xxxxxxxxxx, XX 00000 TEMPORARY/RELIEF SKILLED NURSING FACILITY ADMINISTRATOR (LNHA) CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND SERVICES

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) To Be Determined TBD BY (Authorized Signature)  ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs BY (Authorized Signature)  ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx Xxxxxx, Chief, Facilities and Business Services Division ADDRESS 0000 X Xxxxxx, Xxxxxxxxxx, XX 00000 TEMPORARY/RELIEF SKILLED NURSING FACILITY ADMINISTRATOR (LNHA) PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY SERVICES

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) To Be Determined   BY (Authorized Signature)  DATE SIGNED(Do SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING   ADDRESS   STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs Education BY (Authorized Signature)  DATE SIGNED(Do SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx Xxxxxx  Xxxxxxx Xxxxx, ChiefDirector, Facilities and Business Personnel Services Division   ADDRESS 0000 X Xxxxxx, Xxxxx 0000, Xxxxxxxxxx, XX Xxxxxxxxxx 00000 TEMPORARY/RELIEF SKILLED NURSING FACILITY ADMINISTRATOR (LNHA) SERVICESExhibit A – Scope of Work Project Summary & Scope of Work Contract Grant

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) To Be Determined TBD BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: SCM I, 4.04 A.2 Xxxxx Xxxxxx, Chief, Facilities and Business Services Division ADDRESS 0000 X Xxxxxx, Xxxxxxxxxx, XX 00000 TEMPORARY/RELIEF SKILLED NURSING FACILITY ADMINISTRATOR TOWING SERVICE (LNHA) SERVICESSURVEYED VEHICLES & AS NEEDED)

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) To Be Determined TBD BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx Xxxxxx, Chief, Facilities and Business Services Division ADDRESS 0000 X Xxxxxx, Xxxxxxxxxx, XX 00000 TEMPORARY/RELIEF SKILLED NURSING FACILITY ADMINISTRATOR (LNHA) SERVICES00000