AGREEMENT SIGNATURES. By signing below, both parties agree to the terms and conditions of this Agreement.
AGREEMENT SIGNATURES. This Agreement, having been approved on the 23rd day of April 2002 by Anchorage Municipal Assembly Resolution No. (“AR”) 2002 - 119, the parties to this Agreement hereby enter into this Agreement effective as of the 1st day of October, 2002.
AGREEMENT SIGNATURES. The Parties, through their respective duly authorized signatories, are signing this Grant Agreement on the date set forth above.
AGREEMENT SIGNATURES. Covered Entity: Wright County, Minnesota Covered Entity Official Authorized Signature: Date: Xxx Xxxxx, Administrator Wright County Business Associate: Solid Oak Financial Services, LLC Business Associate Official Authorized Signature: Date: Xxx Xxxxxxxx Solid Oak Financial Services, LLC The Contractor will assure that services rendered hereunder are provided in compliance with all state and federal laws pertaining to the provision of guardianship and/or conservatorship services including but not limited to MN Statute 524.5-101 to 524.5-502, MN Statute 626.557, and MN Statute 245.94 Subd. 2a. Office of the Ombudsman for Mental Health, Mandatory Reporting. The Contractor will fulfill all court related guardianship and/or conservatorship responsibilities and provide all required legal notices to the court and individual for whom they are providing services, including but not limited to: the annual well-being report (guardianship) or annual account of assets (conservatorship) for each client it serves and file it with the court. The Contractor agrees to maintain, at all times during the term of this contract, a process whereby its current and prospective employees and volunteers who will have direct contact with persons served by the program or program services, will consent to a background study for evidence of maltreatment of adults or minors substantiated as required under MN Statute 524.5-118 and 245C.32. Background studies will be supplied to the County and Court upon written request. The Contractor agrees to inform the County of the following, related to it or its employees immediately: any allegation and/or investigation by government agency of fraud or criminal wrongdoing, and concerns that may impact the well-being of the individual being served. The Contractor must petition the Court and receive Court approval for any changes to services to a new provider as well as temporary delegation of guardianship power to another guardian during leaves of absence. The Contractor agrees to communicate all petitions for changes in status to the County. If the status change is approved, the Contractor must ensure new provider has access to all client information and accounts. Anyone entrusted with guardianship/conservatorship responsibilities must comply with the requirements outlined in this Appendix A. The Contractor will accurately and timely report all vulnerable adult and child protection concerns. The Contractor will report the death of an individual served...
AGREEMENT SIGNATURES. The parties agree to the terms and conditions of this Service Agreement. Signature of Participant’s representative Name of Participant’s representative Date Signature of authorised person from provider: Name of authorised person from provider: Date Appendix A - Schedule of Supports
AGREEMENT SIGNATURES. When executed by LANDLORD and TENANT(S), LANDLORD and TENANT(S) agree that this shall constitute a binding agreement for the Lease of this property. All parties to this Agreement have read and agree to abide by all rules and regulations listed herein. In consideration hereof, the undersigned hereby guarantee the faithful performance of the covenants and conditions of this Lease. By signing this lease you are securing this property for rental during the lease period.
AGREEMENT SIGNATURES. The Tenant agrees with the terms of use and house rules, and inventory control and rules in their current version and to cleaning by the tenant. Signature Tenant Signature Landlord First and Last Name Studentenwerk Tübingen – Hohenheim A.d.ö.R. p.p. ............................................................... ..................................................
AGREEMENT SIGNATURES. This agreement includes patients under the care of the practitioner(s) and extends for a period of two (2) years from this date unless rescinded earlier in writing.
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. Signature of Participant: Date: 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: Signature of Representative: Date: Name: Participant’s Email Participant’s Phone Participant’s Address Representative’s Name Representative Relationship to Participant Representative’s Email Representative’s Phone Support Coordinator (where applicable) Support Coordinator’s Email Support Coordinator’s Phone Shared Living/Supported Accommodation/Group Home (if applicable) House Manager’s Email House Manager’s Phone Additional Contacts (if applicable) Contact’s Name Contact’s Email Contact’s Phone 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. ☐ (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 every two weeks. Please email invoices to: Please see Appendix 3 for Self-Management Payment Options. ☐ PLAN-MANAGED Please send invoices to my plan manager: Contact Name Email Address Phone number ☐ OTHER FUNDING (eg. self-funded, iCare or other insurance funding) Please email invoices to: 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 Numbe...
