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. • � <br /> For Contractor: <br /> �� �� <br /> Contractor Signa ure � ate C atr tor ame(please print) <br /> , <br /> �. <br /> Fa�caunc�: Si�; T ?��;;� �,in en, City Clerk <br /> 1 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 /> sig by the County Purchasing Agent. <br /> C9 �,� f�� �' �.) <br /> `���""`�`� /�l� �� Ann Stillman <br /> Contract Requestor Signature Date Contract Requestor Name(please print) <br /> County of San Mateo County of San Mateo <br /> Deautv Director <br /> Contract Requestor Title(please print) <br /> 3� �� James C. Po�ter <br /> Purch n gent Signature Date Purchasing Agent Name(please print) <br /> (De men ead or Designee) (Department Head or Designee) <br /> Coun of S Mateo County of San Mateo <br /> Director of Public Works <br /> Purchasing Agent Title(please print) <br /> 4$406 <br /> Budget Unit <br /> Distribution: 1 copy to each:Purchasing Agent,Controller,and Contractor (Revised 7/11/13) <br /> � <br /> REV:09-04-14 MLG <br /> ATTY/AGR/2014.163/COUNTY OF SAN MATEO <br />