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

REQUIRED FORMS – FORM 16
CONTRACTOR’S CERTIFICATION OF COMPLIANCE
WITH CHILD, SPOUSAL, AND FAMILY SUPPORT ORDERS
(Name of Prospective Contractor)
do hereby certify that our
organization complies with all orders for Child, Spousal, and Family Support and we
have complied with all lawfully served wage assignments and notices of assignment.
We understand that failure to implement lawfully served wage assignments or notices of
assignment will constitute a default under the contract, which shall subject the contract
to termination if such default is not cured within 90 days.
Failure to comply with the above requirement may be cause for debarment.
Print Name and Title of Principal Owner, an Officer, or Manager responsible for
submission of the SOQ to the County.
Signature of Principal Owner, an Officer, or Manager responsible for submission of the
SOQ to the County.
Date
Print Name and Title of Principal Owner, an Officer, or Manager responsible for
submission of the SOQ to the County.
Signature of Principal Owner, an Officer, or Manager responsible for submission of the
SOQ to the County.
Date