STATE OF CALIFORNIA Exhibit A3 State Agency Contacts University Contacts Agency Name: <Agency Name> University Name: <University Name> Contract Project Manager (Technical) Principal Investigator Name: <Name> Name: <Name> <Title> <Title> Address: <Department> Address: <Department> <Address> <Address> <City,State,Zip> <City,State,Zip> Telephone: <Telephone#> Telephone: <Telephone#> Fax: <Fax#, if available> Fax: <Fax#, if available> Email: <EmailAddress> Email: <EmailAddress> Designees to certify invoices under Section 14 of Exhibit C on behalf of PI: <Name>, <Title>, <EmailAddress> <Name>, <Title>, <EmailAddress> <Name>, <Title>, <EmailAddress> Authorized Official (contract officer) Authorized Official Name: <Name> Name: <Name> <Title> <Title> Address: <Department> Address: <Department> <Address> <Address> <City,State,Zip> <City,State,Zip> Telephone: <Telephone#> Telephone: <Telephone#> Fax: <Fax#, if available> Fax: <Fax#, if available> Email: <EmailAddress> Email: <EmailAddress> Send notices to (if different): Send notices to (if different): Name: <Name> Name: <Name> <Title> <Title> Address: <Department> Address: <Department> <Address> <Address> <City,State,Zip> <City,State,Zip> Telephone: <Telephone#> Telephone: <Telephone#> Email: <EmailAddress> Email: <EmailAddress>
STATE OF CALIFORNIA Exhibit A3 State Agency Contacts Agency Name: <Agency Name> University Contacts University Name: <University Name> Contract Project Manager (Technical) Name: <Name> <Title> Address: <Department> <Address> <City,State,Zip> Telephone: <Telephone#> Fax: <Fax#, if available> Email: <EmailAddress> Principal Investigator Name: <Name> <Title> Address: <Department> <Address> <City,State,Zip> Telephone: <Telephone#> Fax: <Fax#, if available> Email: <EmailAddress> Designees to certify invoices under Section 14 of Exhibit C on behalf of PI: <Name>, <Title>, <EmailAddress> <Name>, <Title>, <EmailAddress> <Name>, <Title>, <EmailAddress> Authorized Official (contract officer) Name: <Name> <Title> Address: <Department> <Address> <City,State,Zip> Telephone: <Telephone#> Fax: <Fax#, if available> Email: <EmailAddress> Send notices to (if different): Name: <Name> <Title> Address: <Department> <Address> <City,State,Zip> Telephone: <Telephone#> Email: <EmailAddress> Authorized Official Name: <Name> <Title> Address: <Department> <Address> <City,State,Zip> Telephone: <Telephone#> Fax: <Fax#, if available> Email: <EmailAddress> Send notices to (if different): Name: <Name> <Title> Address: <Department> <Address> <City,State,Zip> Telephone: <Telephone#> Email: <EmailAddress>