AS TO FORM AND EXECUTION. By (authorized signature and printed name) Title
AS TO FORM AND EXECUTION. [INSERT NAME OF COLLEGE/UNIVERSITY] By (authorized signature and printed name) Title Date
AS TO FORM AND EXECUTION. By (authorized college/university/office of the chancellor initiating agreement) Title Date
AS TO FORM AND EXECUTION. By (authorized college/university/system office initiating agreement) Title Date MnSCU Joint Powers Agreement Template
AS TO FORM AND EXECUTION. By (authorized college/university/system office initiating agreement) Title
AS TO FORM AND EXECUTION. By (authorized college/university/system office initiating agreement) Xxxxxx X. Xxxxx Title Director of Purchasing Date 7/21/2021 | 12:53:11 PM CDT Certificate Of Completion Envelope Id: E0804EC660964C4B91D28A1F64CAE9B0 Status: Completed Subject: Signature request on Contract SCSU-2021-014336 City of Xxxxx Park Diversion Contract P0250754 Source Envelope: Document Pages: 6 Signatures: 4 Envelope Originator: Certificate Pages: 5 Initials: 0 Jaggaer Interface AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 00 0xx Xx X, Xxx 000 Xxxxx Xxxx, MN 55101 xxxxxxxxx@xxxxxxxxx.xxx IP Address: 199.188.157.82 Record Tracking Status: Original 6/14/2021 10:17:48 AM Holder: Jaggaer Interface xxxxxxxxx@xxxxxxxxx.xxx Location: DocuSign Signer Events Signature Timestamp Xxxxxx Xxxx xxxxxx.xxxx@xxxxxxxxxxxx.xxx Vice President of Finance and Administration Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 199.17.1.215 Sent: 6/14/2021 10:20:34 AM Viewed: 6/14/2021 1:27:06 PM Signed: 6/14/2021 1:27:12 PM Electronic Record and Signature Disclosure: Accepted: 8/19/2020 3:24:21 PM ID: fa7363ed-f433-4bab-b488-76ce8a6a45aa Xxxxxx X. Xxxxx xxxxxxx@xxxxxxxxxxxx.xxx Director of Purchasing STC Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 199.17.55.172 Sent: 6/14/2021 1:27:13 PM Viewed: 6/14/2021 2:14:30 PM Signed: 6/14/2021 2:14:44 PM Electronic Record and Signature Disclosure: Accepted: 6/14/2021 2:14:30 PM ID: fa797ee9-2c8d-4b99-8349-2dc518cf3657 Xxxx Bentrud xxxxx.xxxxxxx@xx.xxxxxxxxxxx.xx.xx Chief of Police Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 207.171.80.193 Electronic Record and Signature Disclosure: Accepted: 7/21/2021 12:42:07 PM ID: 36a3ad58-109e-452d-8f03-e323ca7a3d43 Sent: 6/14/2021 2:14:45 PM Resent: 6/16/2021 4:13:54 PM Resent: 6/18/2021 11:09:19 AM Resent: 6/24/2021 9:30:56 AM Resent: 6/25/2021 8:06:52 AM Resent: 6/28/2021 8:39:04 AM Resent: 7/1/2021 7:29:36 AM Resent: 7/7/2021 3:29:47 PM Resent: 7/11/2021 8:58:06 PM Resent: 7/15/2021 8:46:59 PM Resent: 7/19/2021 1:37:40 PM Resent: 7/19/2021 2:07:26 PM Resent: 7/21/2021 12:40:02 PM Viewed: 7/21/2021 12:42:07 PM Signed: 7/21/2021 12:42:34 PM Signer Events Signature Timestamp Xxxxxx X. Xxxxx xxxxxxx@xxxxxxxxxxxx.xxx Director of Purchasing STC Security Level: Email, Account Authenticatio...
AS TO FORM AND EXECUTION. By (authorized signature and printed name) Title Date
AS TO FORM AND EXECUTION. By (authorized signature and printed name) Title Date DocuSign Envelope ID: E0804EC6-6096-4C4B-91D2-8A1F64CAE9B0 Contract Number: SCSU-2021-014336 F.Y. Cost Center Obj. Code Amount Vendor # P.O. # 2022 339552 7010 $500.00 0000201878 P0250754 STATE OF MINNESOTA MINNESOTA STATE COLLEGES AND UNIVERSITIES ST. CLOUD STATE UNIVERSITY JOINT POWERS AGREEMENT
AS TO FORM AND EXECUTION. By (authorized signature and printed name) Title Date EXHIBIT A TO THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY AND MINNESOTA STATE COLLEGES AND UNIVERSITIES [INSERT NAME OF COLLEGE OR UNIVERSITY] STUDENT AFFILIATION AGREEMENT EDUCATIONAL INSTITUTION PROGRAMS COVERED UNDER THIS AGREEMENT [Complete this section before signing agreement. Insert names of all programs at your college/university that are covered here.] Clinical experience for students shall be in accordance with the applicable scope of practice. EXHIBIT B THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY AND MINNESOTA STATE COLLEGES AND UNIVERSITIES [INSERT NAME OF COLLEGE OR UNIVERSITY] [LIST OF The Evangelical Lutheran Good Samaritan Society facilities covered by this agreement] Minnesota State and The Evangelical Lutheran Good Samaritan Society_ Multi-Campus Nursing and Allied Health Clinical Affiliation Memorandum of Agreement
AS TO FORM AND EXECUTION. By (authorized signature and printed name) Title Date MINNESOTA STATE COLLEGES AND UNIVERSITIES AND ESSENTIA HEALTH MEMORANDUM OF AGREEMENT EXHIBIT A LIST OF COLLEGE/UNIVERSITY PROGRAMS AND ACCREDITATION STATUS
