Proposed Contracts Agreement/Variation Approval Form Attached is the standard agreement / variation form for: Provider Name:__7= so fh me Trusr Provider No: Agreement No,_4°/ (O79 Contract Value: 2//0/0% Contract Length: (2 nvds This is a: NEW CONTRACT/ CONTRACT ROLL OVER If the form is not completed correctly it will be returned for completion and will not be progressed until it is complete. ¥ and initial Funding Management Group has approved the contract including: Cc 1 . Term _ Cy . © Value Or = + Specitic Conditions? 2. | Administrator has reviewed changes to the agreement and the special Cy conditions have been checked by the Administrator gq 3. | Budget for this project is available 4 | Portfolio Manager supports the attached agreement variation and confirms that it can now be signed 5 | Legal advise has been sought (with GM approval) if required Contract Approval Administrator has reviewed changes: Ae Ta (LoIOX_ ‘amiistaior Name (please print) Date LAC Chen thatthe budget for this contract is available/ tulfr6 kudise slblet Performance Moniioring Analyst ‘Name (please print) Date | support the attached agreement variation and confirm that it has been approved by the Funding Management Group Gore LOO Slo/om ger Name (please print) te ‘eroeont eee Fm do! Dagon in st WH have reviewed this Contract and authorise it under the delegation delegated to me by the General Manager Planning Funding and Performance, OR C1 Ihave reviewed this contract and do not have the delegation to authorise this contract. My review has not indicated any reason why the General Manager should not sign this contract. 14 Cislelice Kel Ig iP [or ° up Manager SC Date Name (pieaco printy © Ihave reviewed this contract and authorise it under the delegation delegated to. me by the Chief Executive Officer. OR | have reviewed this contract and do not have the delegation to authorise this contract. My review has not indicated any reason why the Chief Executive Officer should not sign this contract. General anager Name (please prin) Date Ihave reviewed this contract and authorise it under the delegation delegated to me by the Board. OR C_Thave reviewed this contract and do not have the delegation to authorise this contract. My review has not indicated any reason why the Board should not sign this contract. Chief Ereculive Officer Name (please print) Date Under instruction from the Board (attached) | authorise this contract. BoardiChief Executive Officer Name (please print) Date eset ieee pemeeneraeTinee meemedierts in