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EXHIBIT A -4 <br /> SAMPLE NOTICE OF ACCEPTANCE <br /> [Do NOT use this form. Use the electronic version downloadable from <br /> http : / /www.bayareatrashtracker.org /content /contract -resou rces] <br /> USE ONE FORM PER VENDOR. ATTACH ADDITIONAL SHEETS, SHOWING ALL INSTALLATION <br /> LOCATIONS, AS NECESSARY. <br /> Date: <br /> This form verifies installation of trash control device(s), as required by the State Water Resources Control Board Clean <br /> Water State Revolving Fund Project Finance Agreement with ABAG for the Bay Area -Wide Trash Capture Demonstration <br /> Project, Agreement No. 09 -823 -550. <br /> To: San Francisco Estuary Partnership <br /> Attn.: Janet Cox <br /> 1515 Clay Street, Suite 1400 <br /> Oakland, CA 94612 <br /> (510) 622 -2334 <br /> Please be advised that [PARTICIPATING ENTITY NAME] has received the following goods (TCD), pursuant to <br /> Purchase Order # , dated <br /> Date Line # Project device <br /> Installed (from number Description /Model Location Price <br /> p.o.) <br /> Tax <br /> Shipping /delivery (if applicable) <br /> TOTAL <br /> Authorized representatives of [PARTICIPATING ENTITY NAME] and [VENDOR NAME] have inspected the 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 the TCD(s) noted above and authorize ABAG to pay the vendor the total amount 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) Phone <br /> Approval to pay by: Date: <br /> (Project Manager, SFEP) <br /> Comments /Instructions: <br /> • Payment will be based on this NOA. If Vendor is using its own invoicing system, the invoice must be attached to this <br /> NOA for payment. <br /> OWP # 102147 <br /> 11 <br />