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o ' mir-'IT)SOfr volt.lrmr I_ir.t_nsing <br />Supplemental Contact Information Form <br />This form can be used in combination with MBGA, Agreement, and EnrollmentlRegistration <br />However, a separate form must be submitted for each enrollment/registration, when more than one is <br />submitled on a signature form. For the lurposes of this form, 'entity" can mean the signing entity, <br />Cuslorner, Enrolled Affiliate, Government Partner, Insti(ution, or otfler party entering into a voluine <br />licensing program agreement. Primary and Notices contacts in this foam will not apply to enrollments <br />or registrations. <br />This forrti applies to: ❑ I` IBSA I <br />jk] Agreement <br />r <br />❑ EnrollmentlAffiliate Registration Form <br />Insert primary entity name if more than one Enroilrnenl/RPgistration <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 completed far each section. By providing contact <br />information, entity consents to its use for purposes of administering the Enrollment by Microsoft and other <br />parties that help Microsoft administer this Enrollment. The personal intonnation provided in connection <br />with this agreement avil! be used arid prolecled according to the privacy statement available at <br />lit tos'lllicensi micrasoft.com. <br />I. 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 <br />Contact name': First Regina Last Funderl}urk <br />Contact entail address' RFunderburk@rivco.org <br />Street address' 3450 14th Street, 41h Floor' <br />City' Riverside State/Province" California 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 contact will receive online permissions to manage the Software Assurance benefits ulider the <br />Enrollment or Registration. <br />Name of entity' County of Riverside <br />Contact name': First Regina Last Funderburk <br />Contact email address` RFunderburk@rivco.org <br />Street address' 3450 14th Street, 4th Floor, <br />City' Riverside StatelProvince' California (Postal code' 92501-3881 <br />r <br />I <br />:xrCCDitrn(;Il,rlgFOrrR{PJ11,I7JCI)(�hIC}((�rl7Ul3} i-'6qi: '4 ci(;i <br />