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a ' Microsoft Volurno Licensing <br />Supplemental Contact Information Form <br />This form can be used In combination Willi MBSA, Agreement, and Enroliment(Registralion. <br />However, a separate form must be submitted for each enrollment/registration, when more than one is <br />submitted on a signature form. For the purposes of [his form, 'entity' can mean the signing entity, <br />Cuslorner, Enrolled Affiliate, Govemment Partner, Institution, or other party entering into a volume <br />licensing program agreement. Primary arid Notices contacts in this form will not apply to enrollments <br />or regisirallons. <br />This form applies to: ❑ MBSA l <br />0 Agreement <br />❑ Enrollment/Affiliate Registration Form <br />Insert primary entity name if more than one EnrollnienllRegistration <br />Form is submitted <br />Contact information. <br />Each party will notify the other In writing If any of the information in the following contact information <br />page(s) changes. The asterisks (') indicate required fields; If the entity chooses to designate other <br />contact types, the same required fields must be mthpleted for each section. By providing contact <br />information, entity consents to Its use for purposes of administering the Enrollment by Microsoft and other <br />pasties Thal help "Microsoft administer this Enrollment. The personal Information provided In connection <br />with This agreement .vill be used and protected according to the privacy statement available at <br />tit ins ii li cen stnc6microsol I. cem. <br />Additional notices contact. <br />This contact receives all notices that are sent from Microsoft. No online access is granted to this <br />Individual. <br />Name of entity' County of Riverside i <br />Contact name'; First Regina Last Funderburh <br />Contact email address` RFutideibud(,.@rivco.org <br />Street address` 3450141h Street, 4th Floor <br />City" Riverside StatelProvineW Califarnia Postal code' 92501-3861 <br />Country` USA <br />Phone'951-955-2265 Fax <br />❑ This contact Is a third party (not the entity). Warning: This contact receives personally identifiable <br />Information of the entity. <br />2. Software Assurance manager. <br />This contacl will recelvo online permissions to manage the Software Assurance benefits under the <br />Enrollment or Registration. <br />Name of entity' County of Riverside <br />Contact name': First Regina Last Funderburk <br />Contact email address` RFuncterburk@dvco.org <br />Street address' 3450 14th Street, 4th Floor, <br />City*Riverside StatelProvince' California i Postal code' 92501.3861 <br />tiunGmrl:Kl InleForm(rJA.IVD)i EPII"d(pd2011) <br />Page 1 of 3 <br />25G-23 <br />