Form STD.13A "Intergovernmental Service Agreement and Invoice" - California

What Is Form STD.13A?

This is a legal form that was released by the California Department of General Services - 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 October 1, 2019;
  • The latest edition provided by the California Department of General Services;
  • 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 STD.13A by clicking the link below or browse more documents and templates provided by the California Department of General Services.

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Download Form STD.13A "Intergovernmental Service Agreement and Invoice" - California

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STATE OF CALIFORNIA
INTERGOVERNMENTAL SERVICE AGREEMENT AND INVOICE
STD. 13A (Rev. 10/2019)
IDENTIFICATION NUMBER
SEE REVERSE FOR TERMS AND CONDITIONS AND INSTRUCTIONS
DATE
THIS IS A SELF-INVOICING FORM - NO SEPARATE INVOICE NEEDED
CHARGE TO
ORDERING UNIT
ORDERING UNIT WILL
FOR OWNING
EQUIPMENT WILL BE
PICK-UP
REQUEST DELIVERY
AGENCY USE ONLY
RETURNED ON OR BEFORE
AT
RENTAL RATE
TYPE OF EQUIPMENT
EQUIPMENT
DATE
DATE
QTY.
AMOUNT
AND SECTION CODE
NUMBER
RECEIVED
RETURNED
Daily
Monthly
SERVICES
UNIT (Gal,
UNIT
DESCRIPTION (Lube, Fuel, Cleaning, Repair, Labor, Etc.)
QTY.
Hrs., Ea., Etc.)
COST
ADDITIONAL INFORMATION
TOTAL CHARGES
0.00
FISCAL YEAR
FUNCTION, FUND OR W.O. NUMBER
I hereby certify that the above equipment and/or
LINE ITEM ALLOTMENT
services were received by me and are necessary for an
official job.
FUND NUMBER/TITLE
EXPENDITURE CODING
SIGNATURE
SIGNATURE OF ACCOUNTING OFFICER
DATE RECEIVED
DATE EQUIPMENT RETURNED
OWNING AGENCY APPROVAL
OWNING AGENCY
BY
FUND NUMBER AND TITLE
TITLE
DATE
DISTRIBUTION: White, Green—Ordering Unit Fiscal Officer; Goldenrod—State Equipment Council, 1416 9th Street, Room 151, Sacramento 95814; Pink—Owning Agency, Headquarters Equipment
Coordinator; Blue—Owning Agency, Area Equipment coordinator; Canary—Ordering Unit, Area Equipment Coordinator.
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STATE OF CALIFORNIA
INTERGOVERNMENTAL SERVICE AGREEMENT AND INVOICE
STD. 13A (Rev. 10/2019)
IDENTIFICATION NUMBER
SEE REVERSE FOR TERMS AND CONDITIONS AND INSTRUCTIONS
DATE
THIS IS A SELF-INVOICING FORM - NO SEPARATE INVOICE NEEDED
CHARGE TO
ORDERING UNIT
ORDERING UNIT WILL
FOR OWNING
EQUIPMENT WILL BE
PICK-UP
REQUEST DELIVERY
AGENCY USE ONLY
RETURNED ON OR BEFORE
AT
RENTAL RATE
TYPE OF EQUIPMENT
EQUIPMENT
DATE
DATE
QTY.
AMOUNT
AND SECTION CODE
NUMBER
RECEIVED
RETURNED
Daily
Monthly
SERVICES
UNIT (Gal,
UNIT
DESCRIPTION (Lube, Fuel, Cleaning, Repair, Labor, Etc.)
QTY.
Hrs., Ea., Etc.)
COST
ADDITIONAL INFORMATION
TOTAL CHARGES
0.00
FISCAL YEAR
FUNCTION, FUND OR W.O. NUMBER
I hereby certify that the above equipment and/or
LINE ITEM ALLOTMENT
services were received by me and are necessary for an
official job.
FUND NUMBER/TITLE
EXPENDITURE CODING
SIGNATURE
SIGNATURE OF ACCOUNTING OFFICER
DATE RECEIVED
DATE EQUIPMENT RETURNED
OWNING AGENCY APPROVAL
OWNING AGENCY
BY
FUND NUMBER AND TITLE
TITLE
DATE
DISTRIBUTION: White, Green—Ordering Unit Fiscal Officer; Goldenrod—State Equipment Council, 1416 9th Street, Room 151, Sacramento 95814; Pink—Owning Agency, Headquarters Equipment
Coordinator; Blue—Owning Agency, Area Equipment coordinator; Canary—Ordering Unit, Area Equipment Coordinator.
STATE OF CALIFORNIA
INTERGOVERNMENTAL SERVICE AGREEMENT AND INVOICE
STD. 13A (Rev. 10/2019) (REVERSE)
TERMS AND CONDITIONS
INSTRUCTIONS
1. Lessor agency (hereinafter referred to as “owning agency”)
(Ordering unit will initiate form; owning agency will complete.)
agrees that the equipment leased to the acquiring agency
1. Complete original and five copies.
(hereafter referred to as “ordering unit”) under this agreement is
undamaged and in good mechanical condition, and ordering unit
2. Obtain authorization number from headquarters equipment
agrees to return said equipment to the owning agency in same
coordinator or fiscal control officer.
condition in which it was received, loss or damage resulting from
ordinary wear and tear or causes over which the ordering unit
3. Indicate whether ordering unit will pick up, or owning agency will
has no control excepted, on the due date stated on the reverse
deliver. Specific delivery information should be given under
side, provided, however, that the owning agency shall have the
“Additional
Information.”
Also
indicate
when
and
where
right to demand the return of the equipment at any time,
equipment will be returned.
notwithstanding any other terms or conditions herein contained.
4. Fill in type of equipment and section code (when applicable) per
2. The terms of this agreement shall commence when possession
designation in the State Equipment Council Equipment Coding
of the equipment is delivered to ordering unit, and shall end when
Classifications.
the equipment is returned to owning agency provided that if
ordering unit involuntarily loses the use of said equipment before
5. Specify quantity.
it is returned to owning agency, the term shall not extend beyond
the time such loss occurs.
6. Enter owning agency’s equipment identification number.
3. Ordering unit agrees to pay owning agency a charge computed at
7. Indicate whether owning agency will furnish operator. (Enter
the rates specified in the current rate schedules for interagency
operator cost under description of “Services” if owning agency
rental of the equipment and necessary supportive services.
furnishes operator.)
4. Services rendered by owning agency, such as repairs,
8. Indicate condition of equipment at time of pick-up or delivery.
lubrication, fuels, cleaning, etc., will be provided at actual cost
(When equipment is returned, indicate condition at that time.)
plus administrative assessment which shall include actual salary
plus overhead whenever labor is provided.
9. Show appropriate rental rate from the State Rental Schedule for
Mobile Equipment.
5. The ordering unit shall indemnify the owning agency against all
loss and damage to the owning agency’s property or equipment
10. Enter any services, p urchases of bulk fuel, labor, cost of
during its use under this agreement and it shall at its own
equipment operators, etc., by unit and unit cost.
expense maintain such fire, theft, liability or other insurance as it
deems necessary for its protection. The ordering unit assumes all
11. Obtain signature of agent of ordering unit.
responsibility which may be imposed by law for property damage
or personal injuries caused by defective equipment furnished
12. Show actual period of rental.
under this agreement or by operations of the ordering unit or its
employees under this agreement.
13. Enter charge rate times period—after equipment returned and/or
services performed.
14. Fiscal information to be entered by ordering unit’s fiscal officer.
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