2015/09/02 Council Agenda Packet

7. Q 10. -14 • Completed and signed invoice Voucher, A19 -IA Form (attached). Please note that a fax or electronic copy cannot be accepted. Your agency must be identified as the "Claimant" and Federal Tax ID # and an original signature of the agency head, command officer or contracting officer must be provided on the A19 -IA form. • Payment documentation (overtime slips, payroll documents, etc.) • DRE Request Form showing all pertinent information. If for court case, evidence it came from a prior MOU overtime situation. Disputes arising under this agreement shall be resolved by a panel consisting of one representative of the WTSC, one representative from your agency and one representative from the DECP. The dispute panel shall thereafter decide the dispute with the majority prevailing. Either party may terminate this agreement upon (30 days) written notice to the other party. In the event of termination of this agreement, the terminating party shall be liable for the performance rendered prior to the effective date of termination. WTSC Termination — This project agreement may be terminated or fund payments discontinued or reduced by WTSC at any time upon written notice to the Contractor due to non-availability of funds, failure of the Contractor to accomplish any of the terms herein, or from any change in the scope or timing of the project. The Drug Evaluation Classification Program (DECP) will assist by monitoring and tracking the available funds to ensure the availability of funds and report to WTSC as funding begins to be depleted. IN WITNESS WHEREOF, PARTIES HAVE EXECUTED THIS AGREEMENT. Fiy�,��,�r P�i�cebed _� (Agency) (Date) cliftf Contracting Agent Title & NAME (print/type name) (Signature) ¢ Please return this signed form to: APPROVED/DISAPPROVED Washington Traffic Safety Commission (Date) Attention: Drug Evaluation Classification Program Washington State Patrol 811 E Roanoke ST Seattle WA 98102-3915