Laserfiche WebLink
Lu <br />LU <br />- <br />L <br />z r4 <br />o� <br />s <br />0 <br />cc <br />z <br />0 <br />U. <br />10 M r t: t-O SCE i"t <br />Program Signature Form <br />r,tBP IALISAn;imhar <br />Aryrrameitl nirmher FOY441 S <br />VnIun-tcc l__icc-,nsing <br />004-kayleed-5-04 <br />Note; Enter the applicable active nuinbe.rs nssociated with the documents below, Microsofl regijiies <br />the associated active number be indicated here, or iisled below as new. <br />For the purposes of this form, 'Customer" can mean the signing entity, Enrolled Affiliate, <br />Government Partner, Insliti0ion, or other party entming into a volumr, Itconsing program agreement. <br />This signalure form and all contract documents identified in the table below are entered into between <br />the Customer and the Micro -,oil Affiliate signing, as of the effective date identified below, <br />4 <br />Entepise Agreement rr <br />X20-10209 <br /><Chonse Agreement, <br />Dacumenl Number or rode <br /><Chooso A rcemenl- <br />Document Number or Code <br /><Choose Nreenlenl? _ <br />Choose Agreemem>r_ <br /><Choose Enrollri ent/fie istialiun> <br />Document Number or Code <br />Document Number or Code <br />Docurnent Nwrluer or`Code' <br /><Choose FnrnllrnenllRe islralion> <br />I Document Number or Code <br /><Choose EnrollmentlRe istration> <br />I Document Number or Code <br /><Choose EnrollmenURe istrationl <br />Document Number or Code <br />Choose EnrollmenURenistration> <br />Amendment to Cotra nct Docuroe—AS <br />Document Number or Code <br />CTI4t-CPT-OPT-FilVK (ne.v} _ <br />t3y signing below, Customer and the I-Acrosoft Affiliate agree that both parties (t) have received, read <br />and understand the above contract documents, including any websites or documents, incorporated by <br />reference and any amendnnents and (2) agree to be bounct by the terms of all such documonts. <br />�.• �. „ :, Mom:'. . rt-.i�.{i,4 ,..�� •. ...i ;�` :rw .;;3 <br />3: ,.►,y'cCFi:. �' f•? i','1p, _-7'i1�1��i1Ip x .i ]'t :. . <br />Name of Entity jrn t h =[I ily n. me)' Coumy or Riverside <br />Sic�naturo° ,, <br />Printed First and Last Name" <br />Printed Title J� r �/aC(�!"•21Vt t� tt� C�f1il"1�C,7 �? �r c� r <br />Signature Date' <br />Tax ID <br />h4icates required field <br />I <br />PluyramS�ynF'GIin;IvlS:iitji;}fpIA,LEI/;rr:lExdliA,MLltkrlC3�ifttlg271•Ij !'a�;C� I tli'� <br />I <br />i <br />i u":.f-nK'3- �'"�s'7..�.r�-+;':••�•.,••'��::,;••.►^7rsC7xu7:�S..ifiliZ::.�: --- ,slrlC�-�.� I .t�3Jrt�,TAG'A. � - ' ,Jr7 Tt�'y^o:.:►i�BsrTsi?rz�J�i.°ta <br />