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<br />THIS CONTRACT IS NOT VALID UNTIL SIGNED BY ALL PARTIES <br /> <br />Contractor's Signature <br /> <br /> <br />1,1 {~/~~ <br /> <br />Date i <br /> <br />-fl3\il'- I tJt1l4r1"l <br /> <br />Contractor's Name (Please Print) <br /> <br />I hereby certify that the services requested are necessary, that the selection process documentation is accurate, that all insurance certificates <br />including Wor r s ompensation are on file in this office, that Risk Management has approved any reductions in Contractor's insurance <br />limits belo 1,000 00, and that no work will commence until this document is signed by the County Purchasing Agent. <br /> <br />)~l <br /> <br />'ed L Date <br /> <br /> <br />I <br />'1) ~ )...~ 1 DV\..... \. / <br />Department or Division Head Approval <br /> <br />3/:;J"fi' <br />Date <br /> <br />'1)ebort..11 l-u.- I b ft(L~ <br />Department or Division Head Name (Please Print) <br /> <br />71140-5856 <br />Budget Unit <br /> <br />Distribution - ] copy to each: Purchasing Agent, County Manager's Office, Controller, Contractor and Department <br />Short Form Agreement/Non Business Associate <br /> <br />v 6/24/04 <br /> <br />3 <br />