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<br /> 6.1G <br /> Page 4 <br />THIS CONTRACT IS NOT VALID UNTIL SIGNED BY ALL PARTIES <br />Contractor's Signature Date Contractor's Name (Please Print) <br />r hereby certify that the services requested are necessary, that the selection process documentation is accurate, that all insurance certificates <br />including Worker's Compensation are on file in this office, that Risk Management has approved any reductions in Contractor's insurance <br />limits below SI,ooo,ooO. and that no work: will commence until this document is signed by the County Purchasing Agent <br />Purchasing Agent, County of San Mateo Date <br />Department or Division Head Approval Date <br />Department or Division Head Name (Please Print) Budget Unit <br />Distribution - I COPl' to each: Purchasing Agent, County Manager's OffICe, Conlroller, Contractor and Department v 6/24/04 <br />Short Form Agreement!Non Business Associate <br /> 3 <br /> - <br />