25WS0005_-_Sample_Agreement.pdf

This is a Standard Agreement form (STD 213) between the California Department of Veterans Affairs and a to-be-determined (TBD) contractor, with Agreement Number 25WS0005. The form appears to be a sample agreement template that will be used for Non-Emergency Ambulance Transportation Services, though the specific scope details are contained in referenced exhibits rather than shown on this form. The agreement includes several exhibits: Exhibit A (Scope of Work), Exhibit B (Budget Detail and Payment Provisions), Exhibit C (General Terms and Conditions GTC 04/2017), and Exhibit D (Special Terms and Conditions).

The agreement form shows the contracting agency's address as 1227 O Street, Sacramento, CA 95814, but key information such as the contract amount, start date, and end date are not filled in on this sample template. The form includes signature blocks for both the contractor and state representatives, as well as space for Department of General Services approval and any applicable exemptions. This appears to be marked as "SAMPLE" across the document, indicating it is a template rather than an executed agreement.