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WATIi <br />PROPOSERS STATEMENT Atm FEE SCHEDULE <br />CERTIFICATION <br />I certify that I have read, understand and agree to the terms and conditions of this Request for <br />Proposals. I have examined the Scope of Services (Exhibit A) and I am familiar with the scope of work <br />requirements. I am familiar with all of the existing conditions and limitations that may Impact work <br />requests. I understand and agree that I am responsible for reporting any errors, omissions or <br />discrepancies to the City for clarification prior to the submission of my proposal. <br />PEE SCHEDULE <br />Please provide a description of vocational evaluation or assessment services that the company has provided <br />and can provide to the City, along with a proposed fee schedule. <br />LEGAL NAME OF <br />2Z/60 <br />BUSINESS AD <br />I ttta121 <br />U S r_ K <br />AUTHORIZED AGENT <br />3-1 7— V 67 — r 1,,,146_ <br />4r1NF Amn FAY NI IMRFk�%% <br />4/ 3 3/ Z- a 6& F rt �'t C'&- 7.2 6 <br />lrl//P;�'-l" �Iell' 'An,,- .c.�2 - zel c- S c A tv±t C"' q�ia <br />SIGNATURE OF/AUTHOiZIZED AGENT DATE E-MAILADDRESS <br />14P7— <br />FEDERAL ID NO. (IF APPLICABLE) CONTRACTOR LICENSE NO. (IF APPLICABLE) <br />City of Santa Ana WORK Center <br />Request for Qualifications for Assessment Services <br />Page 13 <br />