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6.2A <br /> � Page 15 <br /> EXHIBIT A-4 <br /> SAMPLE NOTICE OF ACCEPTAIYCE <br /> [Do NOT use this form. Use the electronic version downloadable from <br /> http://www.bay$reatrashtracker.org/content/contract-resources] � <br /> USE ONE FORM PER VENDOR. ATTACH ADDITIONAL SHEETS, SHOWING ALL CNSTALLATION <br /> LOCATIONS, AS NECESSARY. <br /> Date: <br /> This form verifies installation oftrash contro! device(s), as required by the State Watcr Resources Control Board Clean <br /> Water State Revolving Fund I'roject Finance Agreement wiU� ABAG for the Bay Area-Wide Trash Capture Demonstration <br /> Project, Agreement No. 09-R23-.S50. <br /> To: San Prancisco Estuary Partnership <br /> Attn.: Janet Cox <br /> I515 Clay Street, Suite 1400 <br /> Oakland, CA 94612 <br /> (510)622-2334 <br /> Please be advised that [PARTICIPATING ENT'ITY NAIVI�] has received the following goods (TCD), pursuant to I <br /> Purchase Order # ^, dated � ! <br /> llntc Line Il yroject dcvicc <br /> Installed (from �umber Descri�tion / A1ode1 Location Price <br /> p.o.) <br /> Tax <br /> I <br /> Shipping/Aelivery (if appticablc) <br /> TOTAL <br /> Authorized representatives of [PARTICIPATTNG ENTiTY NAMB] and [VENDOR NAME] have inspected tho trash <br /> capture devices (TCD) which have been received and installed in good condition, with no defects and in conformity with <br /> the order. <br /> We accept lhe TCD(s) noted ebove and authorize ABAG to pay the vendor the total amoimt listed above, $XXX. <br /> Approved by Date: ', <br /> (Signature of authorized Representative, Participating Entity) ' <br /> Name (print) Phone <br /> Approved by Date: <br /> (Signature of device vendor representative) <br /> Name (print) p(�an� <br /> Approval to pay by: Date: <br /> (Pmject Manager, SPEP) <br /> Comments/Instructi ons: <br /> . Payment will be based on this NOA. If Vendor is using its own invoicing system, tlle invoice must be attached to this <br /> NOA for payment. <br /> OWP N 102147 <br /> � 11 <br />