NA means, did not transfer such items.” “We List from your ESIT inventory you transferred during 7/1/2018 6/30/2019. – ______________________________ ______________________________ ______________________________ If any inventoried equipment were sold or disposed of that was purchased in part or in whole with ESIT funds, prior approval was requested from DCYF. means, did not sell or dispose such items.” NA “We List items from your ESIT inventory you disposed of during 7/1/2018 6/30/2019. – ______________________________ ______________________________ ______________________________ If items were sold from ESIT inventory, the income was used for ESIT services only or the funds were returned to DCYF. NA means, did not sell such items.” “We I certify that, to the best of my knowledge, the above statements are true. Print name and title of signatory 1 Signature Date Print name and title of signatory 2 Signature Date
NA means, “We did not transfer such items.” List from your ESIT inventory you transferred during 7/1/2018 – 6/30/2019. ______________________________ ______________________________ ______________________________ If any inventoried equipment were sold or disposed of that was purchased in part or in whole with ESIT funds, prior approval was requested from DCYF. NA means, “We did not sell or dispose such items.” List items from your ESIT inventory you disposed of during 7/1/2018 – 6/30/2019. ______________________________ ______________________________ ______________________________ If items were sold from ESIT inventory, the income was used for ESIT services only or the funds were returned to DCYF. NA means, “We did not sell such items.” I certify that, to the best of my knowledge, the above statements are true. Print name and title of signatory 1 Signature Date Print name and title of signatory 2 Signature Date
Doc_15_Att_7_Contractor_Financial_Disclosure_Certification_Form.docx