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.) 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 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.) TBD 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 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND 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.) TBD 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 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND 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.) 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 State Energy Resources Conservation and Development Commission BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxxx X. Xxxxx XxxxxxXxxxx, Chief, Facilities Contracts Grants and Business Services Division Loans Office Manager ADDRESS 0000 X Xxxxx Xxxxxx, Xxxxxxxxxx, XX 00000 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND SERVICESExhibit B

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) 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 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND SERVICESTOWING SERVICE (SURVEYED 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.) 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 CLINICAL PHLEBOTOMYTEMPORARY/RELIEF PHYSICAL THERAPY, LABORATORY, RADIOLOGYOCCUPATIONAL THERAPY, AND ULTRASOUND 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.) 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 General Services BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx ADDRESS 000 0xx Xxxxxx, Chief, Facilities and Business Services Division ADDRESS 0000 X Xxxxxx, Xxxx Xxxxxxxxxx, XX 00000 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND SERVICES00000-2811

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) 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 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND 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.) TBD BY (Authorized Signature)  DATE SIGNED(Do SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA XXX XXXXXXX XXX XXXXX XX XXXXXXXXXX AGENCY NAME California Department of Veterans Affairs Public Health BY (Authorized Signature)  DATE SIGNED(Do SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx XxxxxxXxxxxxx Xxxxx, Chief, Facilities and Business Manager Centralized Contract Services Division ADDRESS 0000 X Xxxxxx, Xxxxxxxxxx, XX 00000 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND SERVICESXxxx XXXXXXX

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) 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 Health Benefit Exchange BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx X. Xxx, Executive Director Government Code Section100505 ADDRESS 000 X Xxxxxx, Chief, Facilities and Business Services Division ADDRESS 0000 X XxxxxxXxxxx 000, Xxxxxxxxxx, XX 00000 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND SERVICES00000

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) 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 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND SERVICES00000

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) TBD BY (Authorized Signature)  DATE SIGNED(Do SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS AND TELEPHONE NUMBER STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs Corrections and Rehabilitation (CDCR) BY (Authorized Signature)  DATE SIGNED(Do SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx XxxxxxXxxx Xxxxxxxxx, ChiefDeputy Director, Facilities and Business Services Division ADDRESS 0000 X Xxxxxx, Xxxxxxxxxx, XX 00000 CLINICAL PHLEBOTOMY, LABORATORY, RADIOLOGY, AND ULTRASOUND SERVICESADDRESS