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Supplier's Name <br />Funding Agreement No. 84 <br />Page 1 of 20 <br />STATE OF CALIFORNIA <br />HEALTH AND HUMAN SERVICES AGENCY <br />CALIFORNIA DEPARTMENT OF PUBLIC HEALTH <br />FUNDING AGREEMENT <br />BETWEEN <br />STATE OF CALIFORNIA <br />DEPARTMENT OF PUBLIC HEALTH <br />AND <br />(Entity name) <br />PROJECT NUMBER P84- <br />UNDER THE SAFE DRINKING WATER, WATER QUALITY AND SUPPLY, FLOOD <br />CONTROL, RIVER AND COASTAL PROTECTION BOND ACT OF 2006 <br />THIS AGREEMENT, is entered into between the State of California <br />Department of Public Health herein referred to as "State", and (Entity name), a <br />(ownership/business type from Authorization memo), in the County of . <br />State of California, duly organized, existing, and acting <br />pursuant to the laws thereof, herein referred to as "Supplier", which parties do hereby <br />agree as follows: <br />SECTION 1. PURPOSE OF FUNDING <br />This Agreement provides funding in the form of a grant made by State to the <br />Supplier under the provisions of the Safe Drinking Water, Water Quality and Supply, <br />Flood Control, River and Coastal Protection Bond Act of 2006, under Public Resources <br />Code, Section (75022/75025 select one). The purpose of the funding is to assist in <br />financing a project which will enable Supplier to <br />herein referred to as the "Project". Funds may be used only for such eligible project <br />costs as are approved by State. <br />Supplier is solely responsible for the design, construction, operation, and <br />maintenance of the Project; and for all persons or entities engaged in such work, <br />including but not limited to contractors, subcontractors, suppliers, and providers of <br />55B-19