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

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LIST OF COMMITMENTS<br />

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

Yes, there are commitments (please list below).<br />

No, there are no commitments.<br />

REQUIRED FORMS – FORM 15<br />

LIST OF COMMITMENTS/POTENTIAL COMMITMENTS<br />

NAME OF FIRM AMOUNT TIME PERIOD TYPE OF<br />

COMMITMENT<br />

I declare under penalty <strong>of</strong> perjury that the foregoing is true <strong>and</strong> correct.<br />

Print Name <strong>and</strong> Title <strong>of</strong> Principal Owner, an <strong>of</strong>ficer, or manager authorized to bind Contractor in a Contract with<br />

the <strong>County</strong>.<br />

Authorized Signature <strong>of</strong> Principal Owner, an <strong>of</strong>ficer, or manager authorized to bind Contractor in a Contract with<br />

the <strong>County</strong>.<br />

Date

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