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For Contractor: <br />Contractor Signature Date Contractor Name (please print) <br />For Countv: <br />I hereby certify that the services requested are necessary, that the selection process documentation is accurate, that all <br />insurance certificates including Workers' Compensation are on file in this office, that Risk Management has approved any <br />reductions in Contractor's insurance limits below $1,000,000, and that no work will commence until this document is <br />signed by the County Purchasing Agent. <br />Contract Requestor Signature <br />County of San Mateo <br />Ann Stillman <br />Contract Requestor Name (please print) <br />County of San Mateo <br />Deputy Director <br />James C. Porter <br />Purchasing Agent Name (please print) <br />(Department Head or Designee) <br />County of San Mateo <br />Director of Public Works <br />Purchasing Agent Title (please print) <br />48408 <br />Date <br />Purchasing Agent Signature <br />(Department Head or Designee) <br />County of San Mateo <br />Date <br />Distribution: 1 copy to each: Purchasing Agent, Controller, and Contractor <br />Budget Unit <br />(Revised 7111113) <br />REV: 09-04-14 MLG <br /> <br /> <br /> <br />ATTY/AGR/2014.163/COUNTY OF SAN MATEO <br />7.1.B. - Page 9