Exhibit_F_Compost-Mulch-Procurement-Reporting-Form.pdf

Month: Year:

Through

Month: Year:

Contract/Agreement # or Purchase Order #:

Date:

Email:

COMPOST, MULCH, AND RENEWABLE NATURAL GAS PROCUREMENT REPORTING FORM

Contractors/Vendors that procure compost, mulch, or renewable natural gas (RNG) pursuant to their contract/agreement with the County of San Mateo, or County employees procuring products through purchase orders must complete this form and certify its accuracy, and email all corresponding invoices to SUST_SB1383Compliance@smcgov.org.

This form must be submitted to the County at the beginning of each quarter with information on the procurement that took place during the prior quarter. If no compost, mulch, or renewable natural gas was procured during the prior quarter, this form does not need to be submitted.

This form is for contains procurement information for the time period of:

I certify that the information contained in this form is correct and complete to the best of my knowledge :

Vendor/Contractor or County Employee:

Signator's Name:

Signature: X

Name of Product Procured

Quantity Procured

Date procured

Product Supplier Name Product Supplier Contact Information

(Contact Name, Phone, Email) Details of Product Use

Location of Product Application

*For Compost and Mulch Only*

Example :

Renewable Natural Gas 50 2/12/2022 Example City AD Facility

John Doe,

(123) 456-7890, rng@examplecity.gov

Transportation fuel for County Fleet

N/A

Example :

Compost 2 1/20/2022 Vision Recycling

Linzi Delconte,

(707) 751-0467, linzi.delconte@visionrecycling.com Applied in landscape installations

County Center in Redwood City

Instructions: Complete this table with information on all compost, mulch, and RNG procurement for the specified time period.

Product Supplier Location

123 Sample Rd., Example City, CA

1460 Goodyear Rd Benicia, CA, 94510

Unit or Measurement (Tons, Cubic Yards, Diesel Gallon Equivalent, kWh, etc.)

Diesel Gallon Equivalent tons