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DAVEROGERS <br />Assistant Chief Executive Officer <br />Chief Information Officer <br />JIM SMITH <br />Chief Technology Officer <br />Microsoft LSP Participation Form <br />(RFQ #RTVCO-2020-RFQ-0000048 Attachment 3) <br />Complete this form and return to: <br />Attention: Rick Hai <br />E-mail: RHai(d)rivco.org <br />Company Name: <br />JENNIFER HILBER, ACIO <br />Enterprise Applications Bureau <br />GUSTAVO VAZQUEZ, ACIO <br />Converged Communications Bureau <br />Public Safety Enterprise Communications <br />GIL ME11A, ACIO <br />Technology Services Bureau <br />Payment should be made to: <br />Riverside County Information Technology <br />3450 14th Street, Fourth Floor <br />Riverside, CA 92501 <br />Comity of Riverside TIN #: 95-6000930 <br />Name: Shelly Bodine Title: SLED General Manager <br />Address: 20875 Crossroads Cir. STE 1 <br />City: Waukesha, WI Zip Code: 53188 Telephone#: 800.400-9852 <br />Fax #: Email: Shelly.BodinencQSoftwareONE.coni <br />The County of Riverside is the host of the Microsoft Master Agreement No. 8084445. All questions regarding <br />the products and licensing should be directed to Microsoft. <br />By signing below, I am agreeing to pay the participation fees for each enrollment that is established by <br />leveraging the County of Riverside Master Agreement in accordance to the schedule referenced on RFQ <br />#RIVCO-2020-RFQ-0000048 and any subsequent contracts and / or amendments. <br />By signing below, I also agree that all enrollments will be submitted to Microsoft direct, to report enrollment <br />activity and comply to the payment schedule per RFQ #RIVCO-2020-RFQ-0000048 to Riverside County <br />Information Technology. <br />Please reference the remittance information above for where to send the payment. Failure to comply may <br />result in the award being rescinded. <br />LaZz'-,Cc�Az 10/16/2019 <br />Signature Date <br />Margarita Apodaca <br />Printed Name <br />Operations Analyst <br />Title <br />25G-61 <br />