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Grantee <br />BSCC xxx-26 <br />Page x of x <br />APPENDIX B: Criteria and Assurance for Non-Governmental Organizations that Receive BSCC <br />Grant Funds as a Subcontractor <br /> <br />Grantees are required to update this list and submit it to BSCC any time a new third -party <br />subcontract with an NGO is executed after the initial assurance date. Grantees shall retain <br />(on-site) applicable source documentation for each subcontracted party that verifies compliance <br />with the requirements listed in the Prop 64 RFP. These records will be subject to the records <br />and retention language found in the Standard Agreement. <br />Unless prior approval is obtained, the BSCC prohibits disbursement or reimbursement to any <br />NGO that does not meet the requirements listed above and for which the BSCC does not have <br />a signed Criteria and Assurance form on file. <br /> <br />A signature below is an assurance that all requirements listed above have been met. <br /> <br /> <br /> <br />AUTHORIZED SIGNATURE <br />(This document must be signed by the person who is authorized to sign the Grant Agreement.) <br />NAME OF AUTHORIZED OFFICER TITLE TELEPHONE NUMBER EMAIL ADDRESS <br /> <br />STREET ADDRESS CITY STATE ZIP CODE <br /> <br />APPLICANT’S SIGNATURE (verified e-signature is acceptable) DATE <br />x SAMPLE7.C. - Page 101 of 101 <br />160