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ORANGE, COUNTY OF (21)
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ORANGE, COUNTY OF (21)
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Last modified
4/28/2022 9:47:33 AM
Creation date
9/14/2021 3:09:57 PM
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Contracts
Company Name
ORANGE, COUNTY OF
Contract #
N-2021-173
Agency
Community Development
Expiration Date
9/30/2022
Insurance Exp Date
1/1/1900
Destruction Year
2027
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DocuSign Envelope ID: CC1719F9-6F29-4BEA-8499-419DBFB55DCo <br />EXHIBIT 5 <br />O H A N G F C O U N T Y <br />c5cCommunity 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 Effective Date: Upon Execution <br />Contract #: MA-012-22010003 <br />Documentation Status: ❑ Abbreviated ® Comprehensive <br />Program Authorization by: Auditor Controller Authorization by: <br />Carma Lac v Eric Takanishi <br />Print Name D.usigned by: Print Name Da uSigne by: <br />Signed by: a Signed by: rAOJAASL <br />CVSiT2F1A 0_. 6334 3 9 4C .. <br />Date: 9/28/2021 Date: 9/28/2021 <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 />
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