CERTIFICATION AND AUTHORIZATION. Before participating AGENCY personnel receive authorization to perform immigration officer functions granted under this MOA, they must successfully complete the IADP training, as described in the accompanying SOP. The IADP will be provided by ICE instructors who will train participating AGENCY personnel in the enforcement of Federal immigration laws and policies, the scope of the powers delegated pursuant to this MOA and civil rights and civil liberties practices. Participating AGENCY personnel must pass an ICE examination after instruction. Upon completion of training, those AGENCY personnel who pass the ICE examinations shall be deemed “certified” under this MOA. ICE will certify in writing the names of those AGENCY personnel who successfully complete training and pass all required test(s). Upon receipt of the certification, the ICE Special Agent in Charge (SAC) and/or the ICE Field Office Director (FOD) in JURISDICTION will provide the participating AGENCY personnel a signed authorization letter allowing the named AGENCY personnel to perform specified functions of an immigration officer for an initial period of one year from the date of the authorization. ICE will also provide a copy of the authorization letter to the AGENCY. Only those certified AGENCY personnel who receive authorization letters issued by ICE and whose immigration enforcement efforts are subject to a designated ICE supervisor may conduct immigration officer functions described in this MOA. Along with the authorization letter, ICE will issue the certified AGENCY personnel official Delegation of Authority credentials. Upon receipt of the Delegation of Authority credentials, AGENCY personnel will provide ICE a signed receipt of the credentials on the ICE Record of Receipt – Property Issued to Employee (Form G-570). Authorization of participating AGENCY personnel to act pursuant to this MOA may be withdrawn at any time and for any reason by ICE or the AGENCY, and must be memorialized in a written notice of withdrawal identifying an effective date of withdrawal and the personnel to which the withdrawal pertains. Such withdrawal may be effectuated immediately upon notice to the other party. The AGENCY and the ICE SAC and/or the ICE FOD in JURISDICTION will be responsible for notification of the appropriate personnel in their respective agencies. The termination of this MOA shall constitute immediate revocation of all immigration enforcement authorizations delegated hereunder. The AGENCY will...
CERTIFICATION AND AUTHORIZATION. Upon successful completion of initial training, LEA personnel shall be deemed “certified” under this MOA. ICE will certify in writing the names of those LEA personnel who successfully complete training and pass all required test(s). Upon receipt of the certification, the ICE Field Office Director (FOD) will provide the participating LEA personnel a signed authorization letter allowing the named LEA personnel to perform specified functions of an immigration officer. ICE will also provide a copy of the authorization letter to the LEA. ICE will also execute ICE Form 70-006, Designated Immigration Officer. Only those certified LEA personnel who receive authorization letters and ICE Form 70-006 issued by ICE and whose immigration enforcement efforts are overseen by ICE may conduct immigration officer functions described in this MOA. Along with the authorization letter and ICE Form 70-006, ICE will issue the certified LEA personnel official immigration officer credentials. Participating LEA personnel shall carry their ICE-issued credentials while performing immigration officer functions under this MOA. Such credentials provided by ICE shall remain the property of ICE and shall be returned to ICE upon termination of this agreement, when a participating LEA employee ceases his/her participation, or when deemed necessary by the FOD. Xxxxxxx County Sheriff's Office
CERTIFICATION AND AUTHORIZATION. I certify that the above information is correct. I authorize the release of any medical information necessary to process insurance claims. I request that payments be made directly to Xxxxxxx & Associates, P.C. on my behalf. Therefore my signature will be on file with my insurance company. SIGNATURE: DATE: HIPAA Privacy Notification I have been provided a Notice of Privacy Practices that fully explains the uses and disclosures that Xxxxxxx and Associates, P.C. will make with respect to my individually identifiable health information. I understand that I have the right to review the Notice before signing this consent. Xxxxxxx and Associates, P.C. has afforded me sufficient time to review this Notice and has answered any questions that I have to my satisfaction. I also understand that Xxxxxxx and Associates, P.C. cannot use or disclose my individually identifiable health information other than as specified on the Notice. I also understand, however, that Xxxxxxx and Associates, P.C. reserves the right to change its notice and the practices detailed therein prospectively (for uses and disclosures occurring after the revision) if it sends a copy of the revised notice to the address that I have provided. Cellular Telephone Communication Notification Xxxxxxx and Associates, P.C. utilizes cellular telephone communication. Due to the nature of cellular telephone communication, telephone calls on cellular telephones are subject to the possibility of unintended disclosure. Therefore, calls made on cellular telephones can not be considered secure. Xxxxxxx and Associates, P.C. will not disclose Protected Health Information on cellular telephones unless specifically requested to do so by patients.
CERTIFICATION AND AUTHORIZATION. Borrower(s) hereby certifies that (a) the Property is not being purchased for the purposes of subdivision or real estate development but only for the purposes of a primary residence for Borrower(s); (b) Borrower(s) acknowledges and understands that Borrower(s) is receiving funds from New Hampshire Housing and that such funds are not to be used for the purpose of land development, speculation or similar purposes; and (c) Borrower(s)(s) understands, acknowledges and agrees that no portion of the Property may subdivided, sold, or transferred without the prior written consent of New Hampshire Housing which may be granted or withheld in its sole discretion. Borrower(s) authorizes New Hampshire Housing to conduct its internal audit whereby New Hampshire Housing may obtain reverification of information from any source used in the loan application given to New Hampshire Housing and agrees to cooperate fully with New Hampshire Housing should clarification or documentation be needed to complete this reverification, including, but not limited to, obtaining tax information from the Internal Revenue Service and reappraisal of the Property. The term Borrower(s) used herein shall include any reference to Mortgagor, Grantor, Debtor, or any party so described and defined in the mortgage loan documents. The term Lender used herein shall include any reference to Mortgagee, Grantee, Creditor, or any party so described in the mortgage loan documents. By signing below, Xxxxxxxx(s) accepts and agrees to the terms and provisions stated herein. Signature Date Signature Date Name (Printed) □ Occupant □ Non-Occupant Name (Printed) □ Occupant □ Non-Occupant Signature Date Signature Date Name (Printed) □ Occupant □ Non-Occupant Name (Printed) □ Occupant □ Non-Occupant STATE OF __ COUNTY OF On this _ day of _ _, _ personally appeared the above signed, known to me or satisfactorily proven to be the person whose names are subscribed to the foregoing instrument and acknowledged that they executed the same for the purposes therein contained. Before me,
CERTIFICATION AND AUTHORIZATION. The undersigned certifies that he has fully read and understands this "Request for Proposal" and has full knowledge of the scope, quantity, and quality of the services and materials to be furnished and intends to adhere to the provisions described herein. The undersigned also affirms that they are duly authorized to submit this proposal, that this proposal has not been prepared in collusion with any other Vendor, and that the contents of this proposal have not been communicated to any other Vendor prior to the official opening of this proposal. Additionally, the undersigned affirms that the firm is willing to sign the enclosed Exhibit A, Standard Form of Contract, if awarded the bid. By submitting a bid/proposal, the vendor certifies that neither he, nor any co-owner of the organization submitting this proposal, is related to a member of the City Council of the City of Xxxxx within the first, second, or third degree of consanguinity (blood) or affinity (marriage). Signed By: Title: Typed Name: Company Name: Phone No.: Fax No.: Email: Bid Address: P.O. Box or Street City State Zip Order Address: P.O. Box or Street City State Zip Remit Address: P.O. Box or Street City State Zip Federal Tax ID No.: Date: END OF RFP #15-051 EXHIBIT A CITY OF XXXXX STANDARD FORM OF AGREEMENT CONTRACT If the Service Provider should have any changes or additions to this agreement, those changes or additions must be included with their proposal to be considered by the City of Xxxxx Legal Staff. CONTRACT FOR EMS MEDICAL DIRECTOR AND RELATED SERVICES This Contract, dated , 2015, is between the City of Xxxxx, a Texas home-rule municipal corporation, (the City) and (the Service Provider), whereby the Service Provider agrees to provide the City with certain services as described herein and the City agrees to pay the SERVICE PROVIDER for those services.
CERTIFICATION AND AUTHORIZATION. 5.1 The Board, having obtained the requisite authorization for the Dual Credit Programs from Alberta Education, shall be responsible for liaising with Alberta Education on a periodic basis to obtain course codes and meet reporting requirements.
CERTIFICATION AND AUTHORIZATION. Each of Xxxxxx and Company represent and warrant to the other that:
CERTIFICATION AND AUTHORIZATION. The undersigned certifies that he has fully read RFP #19-017 and understands this "Request for Proposal" and has full knowledge of the scope, quantity, and quality of the services to be furnished and intends to adhere to the provisions described herein. The undersigned also affirms that they are duly authorized to submit this proposal, that this proposal has not been prepared in collusion with any other Vendor, and that the contents of this proposal have not been communicated to any other Vendor prior to the official opening of this proposal. Additionally, the undersigned affirms that the firm is willing to sign the enclosed Exhibit A, Standard Form of Agreement Contract. By signing below, the FIRM certifies that neither the signatory, nor any co-owner of the FIRM, is related to a member of the City Council of the City of Xxxxx within the third degree of consanguinity (blood) or within the second degree of affinity (marriage). Signed By: Title: Typed Name: Company Name: Phone No.: Fax No.: Email: Bid Address: P.O. Box or Street City State Zip Order Address: P.O. Box or Street City State Zip Remit Address: P.O. Box or Street City State Zip Federal Tax ID No.: Date: END OF RFP #19-017 RFP #19-017 - Page 18 of 27 City of Bryan, Texas RFP #19-017 - Penetration Testing & Security Assessment Appendix A – Proposed Timeline & Milestones Use or disclosure of data is subject to the restriction on the cover page of this proposal.
CERTIFICATION AND AUTHORIZATION. Orders mean the order of the Ontario Court in the form attached as Schedule B certifying the National Proceeding and Second National Proceeding as a national class proceeding and the judgment of the Quebec Court in the form attached as Schedule B authorizing the Quebec Proceeding as a class proceeding, in each case as against Apple, for the purpose of giving effect to and implementing this Agreement, and approving a Notice of Certification, Authorization and Settlement Approval Hearing;
CERTIFICATION AND AUTHORIZATION. The Member hereby acknowledges by their signature that they have read, understand, and agree to all terms and conditions of Minnesota Alliance With Youth’s Member Service Agreement. (If the Member is under the age of 18 years old, the Member’s parent or legal guardian must also sign.) *Please note that the date the Member Agreement is signed must correspond or be PRIOR to the Member’s official start date with the Program– the first date the Member may begin accruing service hours on timesheets. AmeriCorps Promise Fellow: [insert name] Signature (checking the checkbox above is equivalent to a handwritten signature) The Host Site hereby acknowledges by their signature that they have read, understand, and agree to all terms and conditions of Minnesota Alliance With Youth’s Member Service Agreement. *Please note that the date the Member Agreement is signed must correspond or be PRIOR to the Member’s official start date with the Program– the first date the Member may begin accruing service hours on timesheets. Host Site: [fill from Host Site Name on EE tab] Authorized Host Organization Representative: Signature (checking the checkbox above is equivalent to a handwritten signature)
