Common use of PAYEE DATA RECORD FORM STD Clause in Contracts

PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity. CERTIFICATION I, the official named below, certify under penalty of perjury that I am duly authorized to legally bind the prospective Contractor to the clause(s) listed above as Exhibit D1. This certification is made under the laws of the State of California. Contractor/Bidder Firm Name (Printed) Federal ID Number By (Authorized Signature) Printed Name and Title of Person Signing Date Executed Executed in the County of EXHIBIT D2: CERTIFICATIONS State, as a matter of practice, has incorporated contracting requirements set by the federal government for grant applications. To the extent applicable, PARTNER further certifies below. Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature on this form provides for compliance with certification requirements under 34 CFR Part 82, new restrictions on Lobbying, and 34 CFR Part 85, Government-wide Debarment and Suspension (Non procurement) and Government-wide requirements for Drug-Free Workplace (Grants). The certifications shall be treated as a material representation of fact upon which reliance will be placed when the U.S. Department of Education determines to award the covered transaction, grant, or cooperative agreement.