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TANDARD AGREEMENT— APPROVED BY THE CONTRACT HUMBER AAA NC <br />SATTORNEY GENERAL <br />-0.2 (REV.5•91) <br />TAXPAYERS FEDERAL EMPLOYER IOENTiFICAT:ON Ku4ecR <br />THIS AGREEMENT, made and entered into this day of , 19' <br />in Lha SLate of California. by and between State of California, through its duly elected or appointed, qualified and acting <br />TL OFFICER ACTING FOR STATE j AGENCY <br />Deputy Director, Administration I Dept of Community Services and Development hereafter called the State, and <br />AM <br />hereafter called the Contractor. <br />NVITNFSSETH: That the Contractor for and in consideration of the covenants, conditions, agreements, and stipulations of the State hereinafter expressed, <br />does hereby agree to furnish to the State services and materials as follows: (Set forth service to be rendered by Contractor, amount to be paid Contractor, <br />rime for performance or completion, and attach plans and specifications, if any.) <br />This Agreement is entered into for the purpose of making direct <br />credit to the "accounts of low income energy customers of the <br />Contractor's who are identified by the Department of Community <br />Services and Development (the Department or CSD) as payment <br />recipients under the Department's Home Energy Assistance Program. <br />I. <br />The contractor is receiving no direct financial consideration <br />for participating in the direct payment system. <br />ZONTINUED ON SHEETS, EACH BEARING NAME OF CONTRACTOR AND CONTRACT NUMBER. <br />The provisions on the reverse side hereof constitute a part of this agreement <br />%VITtiESS WHEREOF, this agreement has been executed by the parties hereto. upon the date first above written. <br />STATE OF CALIFORNIA <br />CONTRACTOR <br />CONTRACTOR f i when own an UNWO A sort Wo"W a ampWal-, w+nn—,o. ow�) <br />Department of Community Services & Developwni <br />SIGNATURE} <br />8Y (AttTHORIZED SI (NATURE) <br />0= PERSON SIGNNG <br />PRINTED NAME AND TME OF PERSON SIGNING <br />Deputy Director, Administration <br />ADDRESS <br />E%C.,MpeBY THIS <br />PROGRAM/CATEGORY (CODE AND TITLE) <br />FUND TITLE <br />Dspsrttnent of GenwW Services <br />\ <br />Use only <br />(OPTK)NAL USE} <br />_. <br />' <br />AVOUNT ENCUMBERED FOR <br />;1 <br />ITEM <br />CHAPTERSTATUTE <br />FISCAL YEAR <br />Av Q:N7 ENCUMBERED TO <br />OBJECT OF EXPENDITURE (CODE AND TITLE) <br />certify upon my own personal torowledge that budgeted funds <br />T.B.A. NO. <br />d-.aoie for the period and purpose of the expenditure stated above. <br />0= ACCOUNTING OFFICER <br />DATE <br />=%-gAC70R F1 STATE AGENCY DEPT. OF GEN. SER. CONTROLLER <br />