Legal Signature This Agreement may be executed and delivered by any party herein by sending a facsimile of the signature or by a legally recognized digital or electronic signature. Such legal signature shall be binding on the party so executing it upon receipt of signature by the other party.
AGREEMENT SIGNATURES By signing below, both parties agree to the terms and conditions of this Agreement. Please acknowledge acceptance of this document and terms by returning a signed copy within seven (7) days of issuing. If a signed copy is not returned within seven (7) days and you are attending service, Fighting Chance will deem this to be acceptance of the document. If signed by Xxx XxxXxxxxxxX: Signature of Participant: Date: If signed by Person Responsible: I confirm that this Agreement has been explained to the individual receiving the services and that they agree to the terms. I further confirm that I have authority to sign on their behalf. Signature of Person Responsible: Date: SignaĒure on behalf of FighĒing Chance: Signature of Person(s) responsible: Date: Name: Appendix 1 Key Contact Details Participant’s Name Participant’s Email Participant’s Phone Participant’s Address Person(s) responsible’s Name Person(s) responsible Relationship to Participant Person(s) responsible’s Email Person(s) responsible’s Phone Support Coordinator (where applicable) Support Coordinator’s Name Support Coordinator’s Email Support Coordinator’s Phone Shared Living/Supported Accommodation/Group Home (if applicable) House Manager’s Name House Manager’s Email House Manager’s Phone Additional Contacts (if applicable) Role Contact’s Name Contact’s Email Contact’s Phone Appendix 2 NDIS Claiming Preferences Fighting Chance supports NDIS participants who are NDIA-Managed, Self-Managed or Plan Managed. To invoice and bill you correctly, it is important you keep us updated with your plan management preferences, and let us know ongoing if your status changes. For the purposes of services delivered by Fighting Chance, your NDIS plan is: (please tick) ☐ NDIA-MANAGED You understand that Fighting Chance will claim directly through the NDIA portal if your funding for Fighting Chance is NDIA-managed, so you will not receive any direct request for payment from us. To ensure that you do not get a text from the NDIA to approve each claim weekly, endorse Fighting Chance as a ‘My Provider’ for automatic payment processing. Instructions can be found at xxxxxxxxxxxxx.xxx.xx/xxxx/ or you can contact the Fighting Chance My Provider Endorsement Helpdesk on (00) 0000 0000 or xxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx.xx ☐ (Optional) Please supply me, by email, with monthly Statements of Account to: ☐ SELF-MANAGED ☐ I am self-managed and would like to be invoiced for services once a week. Please email invoices to: Please see Appendix 3 for Self-Management Payment Options. ☐ PLAN-MANAGED Please send invoices to my plan manager: Plan management organisatio Contact Name Email Address Phone number ☐ OTHER FUNDING (eg. self-funded, iCare or other insurance funding) Please email invoices to: Appendix 3 Self-Managed Payment Options Participants who are self-managed have a number of payment options with Fighting Chance: ☐ DIRECT DEPOSIT (preferred option) Payment of Fighting Chance invoices can be made by Electronic Funds Transfer (EFT) through your bank. Fighting Chance’s bank account details are as follows: Bank: Commonwealth Bank of Australia Account Name: Fighting Chance Australia Ltd BSB: 062-438 Account Number: 00000000 To ensure all payments are correctly allocated to your account, please include the full invoice number in the reference field. ☐ CREDIT CARD Payments can be made by credit card by clicking the ‘pay by credit card’ link included on the invoice. Please note that a service fee for this option will be imposed. ☐ PAYPAL Payment of your invoices can also be made via our PayPal account. To make payment via PayPal, please access the following link: xxxxx://xxxxxx.xx/FightingChanceAus?locale.x=en_AU To ensure your payment is correctly allocated, please enter the full invoice number in the reference field. Appendix 4 Non Face to Face Time Breakdown - Jigsaw Standard Non Face-to-Face Supports Delivered to every Jigsaw Participant daily, weekly, annually Writing the Board (i.e. preparing and writing up each person’s individualised program for the following day). Reviewing Trainee records/journal notes/medical or other key information to be able to best support the person during their day. Parent/Guardian/Carer Updates, i.e. emails, phone calls. Pre- and post-shift sta briefings. Zone setup (setting up workstations, boxes, visuals and group training areas) Resource development to support each Trainee to progress towards their employment goals (adapting training resources, creating visual aids and cheat sheets, etc). Research/Coordination to implement support strategies (disability, behavioural and learning strategies). Family reviews and the development of training plans (planning, delivery and follow up). Planning social events and extra curricular training (e.g. TAFE). Standard NDIS Annual Support Review Letter. Standard Ǫuarterly Reports - Upon Request. Complex Non Face-to-Face Supports - Delivered to Jigsaw Participants with High Intensity Support Needs (in addition to supports outlined in Standard) Allied health meetings, phone calls, correspondence. Specialist/additional sta training (internal or external), i.e. BSP implementation training. Creation of additional/detailed social stories/visuals. Data collection requested by behaviour therapists. Incident follow up or crisis meetings (seperate to regular family updates or regular allied health meetings). Development/review/discussion of medication forms/transfer plans/mealtime assistance plans etc. Detailed and regular sta training on individual complex behaviour/medical/transfer/mealtime support plans. Extended daily pre-brief and debrief. Additional Non Face-to-Face Supports - billed separately upon request Detailed NDIS Review Letters One-o engagement or training with Allied Health. Detailed Ǫuarterly Reports.
Certification instructions You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (XXX), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. person ▶ Date ▶ General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an XXX. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:
Certification Regarding Entire TIPS Agreement for Part 1 and Part 2 Contracts 5 This is a two part solicitation. Part 1 is solicited for TIPS sales that are not considered a "public work" construction project. Part 1 permits the sale of goods and non-construction/non-"public work" services such as maintenance and minor repairs. Part 2 Job Order Contract (JOC) is solicited for projects considered by your TIPS Member Customers to be a "public work" construction project. The determination of whether or not a TIPS sale amounts to a "public work" construction project requiring a Part 2 JOC contract is made by the TIPS Member Customer at the time of each TIPS sale. Thus, Vendors are encouraged to respond to both Parts 1 and 2 in case your TIPS Member Customers require that a sale be made under one Part or the other. However, responding to both Parts is not required. If Vendor responds and is awarded to both Parts, Vendor will have one contract for Part 1 and a separate contract for Part 2.
Counterparts and Signatures The Agreement may be executed in multiple counterparts, each of which shall be deemed an original, but all of which taken together shall constitute one and the same instrument. A Party may evidence its execution and delivery of the Agreement by transmission of a signed copy of the Agreement via facsimile or email. In such event, the Party shall promptly provide the original signature page(s) to the other Party.
CERTIFICATION OF AGREEMENT In accordance with section 170LT of the Workplace Relations Act 1996, the Commission hereby certifies the attached written agreement. This agreement shall come into force from 7 July 2003 and shall remain in force until 31 October 2005. Printed by authority of the Commonwealth Government Printer <Price code 71> WORKPLACE RELATIONS ACT 1996 PART VIB, DIVISION 2 CERTIFIED AGREEMENT 2002-2005 BETWEEN Dembry Pty Ltd and the CONSTRUCTION, FORESTRY, MINING AND ENERGY UNION (Victorian Construction & General Division, and the Victorian FEDFA Division) TABLE OF CONTENTS Subject Matter Clause No. Page No. Accident Pay 29 32 All-In Payments 34 34 Alpine Areas 14.1.(b) 15 Altona Area Allowance 14.2.(a) 16 Amenities 37 35 Apprentices 22.(a) 23 Australian Materials 41 37 Casual Labour 12.2 13 Classification Structure & Rates of Pay, Allowances 13 14 Clothing Issue & Safety Footwear 40 36 Co-Invest (Long Service Leave) 27 31 Commitments 3 5 Consultation 8 7 Demolition Work 14.1.(d) 16 Dispute Settlement Procedure 9 8 Drugs & Alcohol 38 35 Employment & Termination 12 12 Fares & Travel Allowance 15 17 Fast Food Allowance 14.1.(a) 15 Further Flexibilities 23 24 Geelong, Altona, Portland, etc Metals Agreements 14.3 16 Geographic Area, and Sector Specific Allowances, Conditions and Exceptions 14 15 Hearing Tests 11.(2) 10 Heavy Blocks 11.(9) 12 Hours Of work, Rostered Days Off, and Protection of Leisure Time 17 17 Inclement Weather 24 24 Income Protection 28.1 31 Income Protection & Trauma Insurance 28 31 Induction Procedures 11.(4) 11 Job Stewards/Delegates 36 34 Job Xxxxxxx/Delegate Facilities 36.2 35 Journey Accidents 30 32 Latrobe Valley Allowance 14.2.(b) 16 Leisure Time Protected 17.3 18 Living Away from Home Allowance 16 17 Major Events 14.1.(c) 15 Metal Trades Labour Hire Agreement 14.4 16 Negotiation of a Subsequent Agreement 43 37 No Extra Claims 44 38 Objectives of the Agreement 2 5 Overtime 17.2 18 Parties and Persons Bound 4 6 Payment of Wages 19 21 Period of Operation 6 6 Picnic Day 31 33 Project Agreements 5.2 6 Project Pre-Commencement Conference 18 21 Protective Clothing & Equipment 11.(3) 10 Pyramid Subcontracting 35 34 Redundancy 25 30 Rehabilitation Program 39 35 Relationship to Parent Award and Victorian Building Industry Agreement 7 6 Right of Entry & Representation 33 33 Rostered Days Off 17.4 19 Safety Dispute Resolution 10 8 Scope & Application 5 6 Security & Continuity of Employment 32 33 Service Core Allowance 14.2.(c) 16 Signatories 45 39 Superannuation 26 30 Termination of Employment 12.3 13 Time & Wages Records 19.1 21 Title 1 5 Tool Storage 20 22 Toxic Substances 11(8) 11 Training & Related Matters 22 23 Trauma Insurance 28.2 32 Waste Minimisation, Recycling and Environmental Issues 42 37 Workplace Safety 11 10 APPENDICES Appendix A – Classification Structure 40 Appendix B – Rates of Pay 1. From 1 December 2002 2. From 1 March 2003 3. From 1 March 2004 4. From 1 March 2005 41 Appendix C – Site Allowances 51 Appendix D – Drugs & Alcohol Policy 54 Appendix E – Passenger and Material Lifts 61 Appendix F – Amenities 63 Appendix G – Shopping Centres 66 Appendix H – Trade Union Training Leave 67 Appendix I – Sector Appendix 70
Notification of Acceptance of General Offer of Privacy Terms Upon execution of Exhibit “E”, General Offer of Privacy Terms, Subscribing LEA shall provide notice of such acceptance in writing and given by personal delivery, or e-mail transmission (if contact information is provided for the specific mode of delivery), or first-class mail, postage prepaid, to the designated representative below. The designated representative for notice of acceptance of the General Offer of Privacy Terms is: Name: Xxxxx Xxxxxxxx Title: Technology Director Contact Information: xxxxx.xxxxxxxx@xxxxxxxxx.x00.xx.xx (000)000-0000 xxx 000
Vendor Agreement Signature Form (Part 1)
