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.) County of San Bernardino BY (Authorized Signature) ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxx Xxxxxxxxxx, Chair, Board of Supervisors ADDRESS 000 Xxxx Xxxxx Xxxxxx Xxx Xxxxxxxxxx, XX 00000 AGENCY NAME Department of Consumer Affairs, Dental Board of California BY (Authorized Signature) ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxx Xxxxxx, Contract Operations Manager ADDRESS 0000 X. Xxxxxx Xxxx., Xxxxx X-000 Xxxxxxxxxx, XX 00000

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) County of San Bernardino Mendocino - Health and Human Services Agency BY (Authorized Signature) ✍  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxx Xxxxxxxxxx, Chair, Board of Supervisors Xxxxx ADDRESS 000 X. Xxxx Xxxxx Xxxxxx Xxx XxxxxxxxxxUkiah, XX 00000 CA 95482 AGENCY NAME Department of Consumer Affairs, Dental Board of California Health Benefit Exchange BY (Authorized Signature) ✍  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx XxxxxxXxxxxxx-Xxxxx. Chief Deputy Executive Director, Contract Operations Manager Strategy Government Code Section100505 ADDRESS 0000 X. Xxxxxx Xxxx.Covered CA, Xxxxx X-000 XxxxxxxxxxX.X. Xxx 0000, XX Xxxxxxxxxx Xxxxxxxxxx 00000-0000

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) County of San Bernardino Seaside Fire Department BY (Authorized Signature) ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxx Xxxxxxxxxx, Chair, Board of Supervisors ADDRESS 000 Xxxx Xxxxx Xxxxxx Xxx Xxxxxxxxxx, XX 00000 AGENCY NAME Department of Consumer Affairs, Dental Board of California BY (Authorized Signature) ✍  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxx Xxxxxxx, Chief ADDRESS 0000 Xxxxxxxx Xxxxxx Xxxxxxx, XX 00000 AGENCY NAME California Governor’s Office of Emergency Services (Cal OES) BY (Authorized Signature)  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxx Xxxxxxxxx, Assistant Director, Administrative Services ADDRESS 0000 Xxxxxxxxx Xxxxxx Xxxxxx, Contract Operations Manager ADDRESS 0000 X. Xxxxxx Xxxx., Xxxxx X-000 Xxxxxxxxxx, XX 00000CA 95655

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) Contra Costa County of San Bernardino Fire Protection District BY (Authorized Signature) ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxx XxxxxxxxxxXxxx Xxxxxx, ChairFire Chief ADDRESS 0000 Xxxxx Xxxx Pleasant Hill, Board of Supervisors ADDRESS 000 Xxxx Xxxxx Xxxxxx Xxx Xxxxxxxxxx, XX 00000 CA 94523 AGENCY NAME Department California Governor’s Office of Consumer Affairs, Dental Board of California Emergency Services BY (Authorized Signature) ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxx Exempt per: Xxxx Xxxxxxxxx, Assistant Director, Administrative Services Section ADDRESS 0000 Xxxxxxxxx Xxxxxx Xxxxxx, Contract Operations Manager ADDRESS 0000 X. Xxxxxx Xxxx., Xxxxx X-000 Xxxxxxxxxx, XX 00000CA 95655

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) County of San Bernardino Orange BY (Authorized Signature) ✍ DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxx XxxxxxxxxxX. Xxxxxxx, ChairChief Probation Officer ADDRESS 0000 X. Xxxxx Xxx., Board of Supervisors ADDRESS 000 Xxxx XX Xxx 00000 Xxxxx Xxxxxx Xxx XxxxxxxxxxXxx, XX 00000 AGENCY NAME California Department of Consumer Affairs, Dental Board of California Corrections and Rehabilitation (CDCR) BY (Authorized Signature) ✍  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx Xxxxxx, SSMI, Headquarters Contract Operations Manager Unit #3 ADDRESS 0000 X. Xxxxxx Xxxx.Xxx Xxxxxxxxxxx Xx Xxx X-0, Xxxxx X-000 Xxxxxxxxxx, XX 00000

CONTRACTOR California Department of General Services Use Only. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) Mendocino County Sheriff’s Office of San Bernardino Emergency Services BY (Authorized Signature) ✍  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Xxxxxx XxxxxxxxxxXxxxxx, Chair, Board of Supervisors Sheriff-Coroner ADDRESS 000 Xxxx Xxxxx Xxxxxx Xxx XxxxxxxxxxXxx Xxxx, Xxxxx, XX 00000 AGENCY NAME Department of Consumer Affairs, Dental Board of California CaliforniaVolunteers BY (Authorized Signature) ✍  DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: Xxxxx Xxxxx, Secretary of Service and Volunteering ADDRESS 000 X Xxxxxx, Contract Operations Manager ADDRESS 0000 X. Xxxxxx Xxxx.Xxxxx 0000, Xxxxx X-000 Xxxxxxxxxx, XX 00000