CONTRACT/AMENDMENT EXECUTION CHECKLIST



PY2020-21 YOUTHSOURCE CENTERCHECKLIST OF REQUIRED DOCUMENTS / REQUIRED INFORMATIONAGENCY NAME: *Please attach backup documentation if there has been any change to requested information. Otherwise indicate “NO CHANGE” (right-click on checkbox and select Properties →Default Value→CheckedDOCUMENT/INFO REQUESTEDNO CHANGE/CONFIRMEDDOCATTACHED/ON FILEINFO/NOTES*State of California corporate number: () FORMCHECKBOX FORMCHECKBOX Please confirm #For out-of-state entity conducting business in CA:Copy of signed Franchise Tax Board Form 587 () FORMCHECKBOX N/AD-U-N-S? Number:() FORMCHECKBOX FORMCHECKBOX Please confirm # and provide documentationBusiness Tax Registration Cert. Number: FORMCHECKBOX Copy: City of LA “Tax Registration Certificate” (TRC) OR FORMCHECKBOX Copy: City of LA Vendor Registration Number (VRN) () OR FORMCHECKBOX Copy: Exemption FORMCHECKBOX FORMCHECKBOX IRS Number: FORMCHECKBOX For entities: IRS Number & copy of IRS letter with number OR FORMCHECKBOX For individuals: Individual’s Social Security number & proof document OR FORMCHECKBOX For individuals, instead of personal IRS number: W-9 form, “IRS EIN Certification form”() OR FORMCHECKBOX For non-profit, 501(c)(3) organization: Copy of IRS letter dated within last 5 years FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Certification of Authorities (on City form) – with signatures and email addresses - dated, signed, & with corporate seal affixed and Board/Company resolution FORMCHECKBOX NEW FORM, email addresses required FORMCHECKBOX Original: Board Resolution authorizing this contract -- dated, signed, and with corporate seal affixed (for corporations), OR. FORMCHECKBOX Original: Company Resolution authorizing this contract – dated, signed, and with corporate seal affixed (for LLC), OR FORMCHECKBOX Original: Self-Statement authorizing this contract – dated and signed (for individuals / sole proprietorships) FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Copy: Articles of Incorporation & any amendments thereto (if corporation), OR FORMCHECKBOX Copy: Articles of Organization & any amendments thereto (if LLC), OR FORMCHECKBOX Copy: Partnership Agreement & any amendments thereto (if partnership) FORMCHECKBOX FORMCHECKBOX Please provide documents only if there are changes FORMCHECKBOX Copy: By-laws & any amendments thereto (if corporation), OR FORMCHECKBOX Copy: Operating Agreement of LLC, & any amendments thereto (if LLC) FORMCHECKBOX FORMCHECKBOX Please provide documents only if there are changes FORMCHECKBOX Copy: Roster of Board Members with contact information (updated annually & for any change in membership) FORMCHECKBOX FORMCHECKBOX BAVN registration by Contractor ()(Includes the following forms to be uploaded: EBO/FSHO, DO, etc.) FORMCHECKBOX FORMCHECKBOX Please confirm ordinance docs are up-to-date on LABAVN website FORMCHECKBOX Insurance: To be posted by Contractor’s broker in City’s “KwikComply” database at FORMCHECKBOX FORMCHECKBOX Please confirm that req’d insurance is in place and is posted FORMCHECKBOX Original: Contractor Responsibility Ordinance Questionnaire – dated & signed (Required for each new City contract) FORMCHECKBOX Responsibility Questionnaire FORMCHECKBOX Original: CRO Pledge – dated & signed (Required for each new City contract) FORMCHECKBOX Pledge of ComplianceOriginal: LWO-6 (Employee Info)N/AOriginal: LWO-18 (Subcontractor Info)N/AOriginal: LWO-13 (Non-Profit Exemption Certification)N/A FORMCHECKBOX Original: Code of Conduct – dated & signed FORMCHECKBOX Organization Chart of ContractorN/AResumes of Contractor’s key personnelN/AJobs Descriptions and Salary Range SummaryN/A ................
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