Form CEM-1202B "Contractor Action Request - Assignment of Contract Monies, Assignee Change of Name/Address" - California

What Is Form CEM-1202B?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2015;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-1202B by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-1202B "Contractor Action Request - Assignment of Contract Monies, Assignee Change of Name/Address" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONTRACTOR ACTION REQUEST - ASSIGNMENT OF CONTRACT MONIES,
ASSIGNEE CHANGE OF NAME/ADDRESS
CEM-1202B (REV 09/2015)
Page of
CONTRACT INFORMATION OF ASSIGNOR (As it currently appears)
Contract Number:
Contractor: (business name)
Contractor License #:
ASSIGNMENT OF MONIES
Assignee: (business name)
Assignee Representative's Name: (type or print)
Mailing Address:
Title:
City:
Phone Number:
State:
Zip Code:
Fax Number:
Phone Number:
Fax Number:
Email Address:
By checking this box, I confirm that a completed STD. 204 PAYEE DATA RECORD is attached.
I certify that the above information has been reviewed and
Notary Public's signature and stamp here, or as an attachment.
determined to be complete and accurate. Both assignor and
assignee have been verbally contacted to confirm validity of the
requested action.
Notary Public's Name: (type or print)
Contractor Representative's Name: (type or print)
Signature:
Date:
Signature:
Date:
ASSIGNEE MAILING ADDRESS CHANGE
Assignee (Payee Vendor) Name:
Mailing Address:
Email Address:
City:
Phone Number:
State:
Zip Code:
Fax Number:
ASSIGNEE BUSINESS NAME CHANGE
Assignee (Payee Vendor) Name:
New Business Name:
By checking this box, I confirm that a completed STD. 204 PAYEE DATA RECORD is attached.
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONTRACTOR ACTION REQUEST - ASSIGNMENT OF CONTRACT MONIES,
ASSIGNEE CHANGE OF NAME/ADDRESS
CEM-1202B (REV 09/2015)
Page of
CONTRACT INFORMATION OF ASSIGNOR (As it currently appears)
Contract Number:
Contractor: (business name)
Contractor License #:
ASSIGNMENT OF MONIES
Assignee: (business name)
Assignee Representative's Name: (type or print)
Mailing Address:
Title:
City:
Phone Number:
State:
Zip Code:
Fax Number:
Phone Number:
Fax Number:
Email Address:
By checking this box, I confirm that a completed STD. 204 PAYEE DATA RECORD is attached.
I certify that the above information has been reviewed and
Notary Public's signature and stamp here, or as an attachment.
determined to be complete and accurate. Both assignor and
assignee have been verbally contacted to confirm validity of the
requested action.
Notary Public's Name: (type or print)
Contractor Representative's Name: (type or print)
Signature:
Date:
Signature:
Date:
ASSIGNEE MAILING ADDRESS CHANGE
Assignee (Payee Vendor) Name:
Mailing Address:
Email Address:
City:
Phone Number:
State:
Zip Code:
Fax Number:
ASSIGNEE BUSINESS NAME CHANGE
Assignee (Payee Vendor) Name:
New Business Name:
By checking this box, I confirm that a completed STD. 204 PAYEE DATA RECORD is attached.
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONTRACTOR ACTION REQUEST - ASSIGNMENT OF CONTRACT MONIES,
ASSIGNEE CHANGE OF NAME/ADDRESS
CEM-1202B (REV 09/2015)
Page of
- For Department Use Only -
Payee Vendor Information Update
PRIOR to Payee Vendor update in CAS (data
AFTER Payee Vendor update in CAS (data
entered by District Payments Coordinator)
entered by HQ Payments Coordinator)
CT Document Identification Number
Vendor/Customer Identification Number
Vendor/Customer Address Identification Number
Resident Engineer's Verification
Division of Construction Field Coordinator's Concurrence
Resident Engineer's Name: (type or print)
Field Coordinator's Name: (type or print)
Signature:
Date:
Signature:
Date:
CAS Updated By
HQ Payments Coordinator's Name: (type or print)
Signature:
Date:
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CONTRACTOR ACTION REQUEST - ASSIGNMENT OF CONTRACT MONIES,
ASSIGNEE CHANGE OF NAME/ADDRESS
CEM-1202B (REV 09/2015)
Page of
GENERAL INSTRUCTIONS
1. This form and form STD. 204 Payee Data Record are required when requesting assignment of contract monies or change of assignee's
name/address to another entity (i.e. surety, bonding companies).
Instructions to the CONTRACTOR and ASSIGNEE
2. Make a separate request per contract.
3. For assignment of monies, complete sections 1, 2, and 3. Signatures in Section 3 must be acknowledged before a Notary Public.
4. For change only of assignee's mailing address, complete Sections 1, 4, and 6.
5. For change only of assignee's business name, complete Sections 1, 5, and 6.
6. For change of assignee's mailing address and business name, complete Sections 1, 4, 5, and 6.
7. Submit completed form CEM-1202B and form STD. 204 to the resident engineer (do not complete Section 6 of form STD. 204). Prompt and
correct requests will prevent delay in processing payments.
Instructions to the RESIDENT ENGINEER
8. VERIFY form STD. 204 is attached to submitted form CEM-1202B.
9. REVIEW submittal for completeness and accuracy.
10. VERIFY business name and mailing address in form STD. 204 matches information in form CEM-1202B or if the request is for change in
Assignee's business name or mailing address, VERIFY business name and mailing address in form STD. 204 matches address in Section 4
and business name in Section 5 of form CEM-1202B.
11. Print or type name, sign and date in appropriate section.
12. Forward reviewed submittal to the District Payments Coordinator.
Instructions to the DISTRICT PAYMENTS COORDINATOR
13. Upon receipt of submittal, enter existing Advantage CT document and vendor information.
14. Forward submittal to Division of Construction Field Coordinator for concurrence. Forward a copy of the submittal to the resident engineer.
Instructions to the DIVISION OF CONSTRUCTION FIELD COORDINATOR
15. Upon receipt of submittal, conduct a quality assurance review in coordination with the resident engineer.
16. Print or type name, sign, and date in appropriate section.
17. Forward submittal, with concurrence, to HQ Payments Coordinator.
Instructions to the HQ PAYMENTS COORDINATOR
18. Upon receipt of submittal, forward a copy of form STD. 204 to HQ Accounting (Payee.Data.Records@dot.ca.gov).
19. Update payee vendor information in Contract Administration System (CAS).
20. Enter new Advantage CT document and vendor information.
21. Print or type name, sign and date in appropriate section.
22. Send a copy of the processed submittal to the resident engineer, District Payments Coordinator and Division of Accounting, Office of
Commodity and Contract Payables (OCCP).
Instructions to the DISTRICT PAYMENTS COORDINATOR
23. Upon receipt of the processed submittal, verify requested change was made in Advantage.
Instructions to the RESIDENT ENGINEER
24. Upon receipt of the processed submittal, provide a copy of the processed submittal to the CONTRACTOR and ASSIGNEE.
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