State of California DEPARTMENT OF COMMUNITY SERVICES AND DEVELOPMENT CSBG CONTRACT CLOSE‐OUT EQUIPMENT INVENTORY SCHEDULE CSD 715D (Rev. 1/17) Complete this form if equipment was purchased with current or prior CSBG funds which cost $5,000 or more per unit. If no equipment was purchased with CSBG funds, place a check mark () in the box “Not Applicable “below. Preparer must complete the Contractor Name, Contract Term, Contract Number, preparer’s Name, Title, Date, and Contact Number. Not Applicable List all Equipment Inventory items purchased with CSBG funds which cost $5,000 or more per unit. Condition *Item Name Vehicle Identification Vehicle License Plate Purchase (e.g., freezer, Purchase Serial Number Number (if Number # (if G=Good F=Fair applicable) laptop, Date (1234567) Price applicable) P=Poor I=Inoperative (ABCD2568) van, etc.) (17‐digit VIN#) (2/15/16) N=No Longer Needed ($5,528.00) *Note: Invoice and proof of payment must be submitted for all Vehicle Purchases during the contract term. Comments: Preparer’s Name & Title (Please Print): Date: Telephone number: ( )
State of California DEPARTMENT OF COMMUNITY SERVICES AND DEVELOPMENT CSBG CONTRACT CLOSE‐OUT EQUIPMENT INVENTORY SCHEDULE CSD 715D (Rev. 1/17) Complete this form if equipment was purchased with current or prior CSBG funds which cost $5,000 or more per unit. If no equipment was purchased with CSBG funds, place a check mark () in the box “Not Applicable “below. Preparer must complete the Contractor Name, Contract Term, Contract Number, preparer’s Name, Title, Date, and Contact Number. Not Applicable List all Equipment Inventory items purchased with CSBG funds which cost $5,000 or more per unit. *Item Name (e.g., freezer, laptop, van, etc.) Serial Number (1234567) Vehicle License Plate Number (if applicable) (ABCD2568) Vehicle Identification Number # (if applicable) (17‐digit VIN#) Purchase Date (2/15/16) Purchase Price ($5,528.00) Condition G=Good F=Fair P=Poor I=Inoperative N=No Longer Needed *Note: Invoice and proof of payment must be submitted for all Vehicle Purchases during the contract term. Comments: Preparer’s Name & Title (Please Print): Date: Telephone number: ( )