Disabled Veteran Business Enterprise Dvbe Participation Requirement Page 6

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THE TRUSTEES OF THE CALIFORNIA STATE UNIVERSITY
Attachment 1
SUMMARY OF DISABLED VETERAN OWNED BUSINESS PARTICIPATION
CLAIMED
DVBE
PERCENTAGE OF
OSDS DVBE
COMPANY NAME
NATURE OF WORK
CONTRACTING WITH
TIER
VALUE $
CONTRACT (%)
CERTIFICATION
declare under penalty of perjury, under the laws of the State of California, that the information herein is true and correct to the best of my knowledge.
I
Executed on: ___________________________, at _____________________________ in the state of ____________________________
Date
City
Signature of Contractor or Authorized Agent
Project Name
Project Number
Printed Name
Firm Name
Telephone
CRL:016:08/26/09

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