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ORANGE, COUNTY OF (13)
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ORANGE, COUNTY OF (13)
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Last modified
6/8/2021 9:15:41 AM
Creation date
5/18/2021 8:05:49 AM
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Contracts
Company Name
ORANGE, COUNTY OF
Contract #
N-2021-051
Agency
Community Development
Expiration Date
3/30/2022
Insurance Exp Date
1/1/1900
Destruction Year
2027
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DocuSign Envelope ID: E3EC32AC-CBE2-4379-BB09-D502E3365EE4 <br />EXHIBIT 5 <br />O R A N G F C O 11 N l Y' <br />LC community Resources <br />Our Community. Our Commitment, <br />Reimbursement Policy Status Form <br />Per OC Community Resources Contract Reimbursement Policy, in regards to the Contract # <br />listed herein, Contractor is designated with the Documentation Status of Abbreviated unless <br />Comprehensive is checked below. If the contractor's designation should change to <br />Abbreviated, a new status form shall be approved. All related documentation requirements <br />are in full force, until further notice. <br />Contractor: City of Santa Ana <br />Contract #: MA-012-20011850 <br />Effective Date: Upon Execution <br />Documentation Status: ❑ Abbreviated ® Comprehensive <br />Program Authorization by: <br />Carma Lacv <br />Print Name L6aZ <br />neaey! <br />Signed by: <br />Date: 6/4/2021 <br />Two signatures are required to implement the form. <br />Distribution: <br />Contractor <br />Auditor Controller <br />Contract File <br />Program File <br />Reimbursement Policy Status (RPS-1) <br />Auditor Controller Authorization by: <br />Eric Takanishi <br />Print Name Docusieuedby- <br />Signed by: � t'a�SL <br />Date: 6/7/2021 <br />
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