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CMS-07-021/023 - Los Angeles County Department of Children and ...

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SAMPLE CONTRACT<br />

COUNTY OF LOS ANGELES<br />

DEPARTMENT OF CHILDREN AND FAMILY SERVICES<br />

IN WITNESS WHEREOF, the Board <strong>of</strong> Supervisors <strong>of</strong> the <strong>County</strong> <strong>of</strong> <strong>Los</strong> <strong>Angeles</strong> has<br />

caused this Contract to be subscribed on its behalf by the Director <strong>of</strong> the <strong>Department</strong> <strong>of</strong><br />

<strong>Children</strong> <strong>and</strong> Family Services, <strong>and</strong> the CONTRACTOR has subscribed the same<br />

through its authorized <strong>of</strong>ficer, as <strong>of</strong> the day, month <strong>and</strong> year first above written. The<br />

persons signing on behalf <strong>of</strong> the CONTRACTOR warrant under penalty <strong>of</strong> perjury that<br />

he or she is authorized to bind the CONTRACTOR.<br />

COUNTY OF LOS ANGELES CONTRACTOR<br />

____________________________ By<br />

Patricia S. Ploehn, LCSW, Director<br />

<strong>Department</strong> <strong>of</strong> <strong>Children</strong> <strong>and</strong> Name<br />

Family Services<br />

Title<br />

APPROVED AS TO FORM:<br />

BY THE OFFICE OF COUNTY COUNSEL<br />

RAYMOND G. FORTNER, JR., <strong>County</strong> Counsel<br />

BY<br />

Jill Meyers, Deputy <strong>County</strong> Counsel<br />

Name <strong>of</strong> Agency<br />

By<br />

Name<br />

Title<br />

Tax Identification Number

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