CERTIFICATION BY BROKER. The undersigned insurance broker represents to the New York City Health and Hospitals Corporation that the attached Certificate of Insurance is accurate in all material respects, and that the described insurance is effective as of the date of this Certification. [Name of broker (typewritten)] [Address of broker (typewritten)]
CERTIFICATION BY BROKER. 6. Consultant Agreement
CERTIFICATION BY BROKER. The undersigned insurance broker represents to the City of New York that the attached Certificate of Insurance is accurate in all material respects, and that the described insurance is effective as of the date of this Certification. [Name of broker (typewritten)] [Address of broker (typewritten)] [Signature of authorized officer of broker] [Name of authorized officer (typewritten)] [Title of authorized officer (typewritten)] [Contact Phone Number for Broker (typewritten)] [Email Address of Broker (typewritten)] Sworn to before me this day of , 201_
CERTIFICATION BY BROKER. The undersigned insurance broker represents to the City of New York that the attached Certificate of Insurance is accurate in all material respects, and that the described insurance is effective as of the date of this Certification. [Name of broker (typewritten)] [Address of broker (typewritten)] [Email address of broker (typewritten)] [Phone number/Fax number of broker (typewritten)] [Signature of authorized official or broker] [Name and title of authorized official (typewritten)] State of ) ) ss.: County of ) Sworn to before me this day of 20 NOTARY PUBLIC FOR THE STATE OF APPRENTICESHIP PROGRAM REQUIREMENTS
CERTIFICATION BY BROKER. The undersigned insurance broker represents to the City of New York that the attached Certificate of Insurance is accurate in all material respects, and that the described insurance is effective as of the date of this Certification. [Name of broker (typewritten)] [Address of broker (typewritten)] [Signature of authorized officer of broker] [Name of authorized officer (typewritten)] [Title of authorized officer (typewritten)] [Contact Phone Number for Broker (typewritten)] [Email Address of Broker (typewritten)] Sworn to before me this day of , 201_ NOTARY PUBLIC APPENDIX B Tax Affirmation The undersigned proposer or bidder Affirms and declares that said proposer or bidder is not in arrears to the City of New York upon debt, contract or taxes and is not a defaulter, as surety or otherwise, upon obligation to the City of New York, and has not been declared not responsible, or disqualified, by any agency of the City of New York, nor is there any proceeding pending relating to the responsibility or qualification of the proposer or bidder to receive public contracts except: Full name of proposer or bidder: Address: City State Zip CHECK ONE AND INCLUDE APPROPRIATE NUMBER:
CERTIFICATION BY BROKER. The undersigned insurance broker represents to the City of New York that the attached Certificate of Insurance is accurate in all material respects, and that the described insurance is effective as of the date of this Certification. [Name of broker (typewritten)] [Address of broker (typewritten)] [Signature of authorized officer of broker] [Name of authorized officer (typewritten)] [Title of authorized officer (typewritten)] [Contact Phone Number for Broker (typewritten)] [Email Address of Broker (typewritten)] Sworn to before me this day of , 201_ NOTARY PUBLIC EXHIBIT B STAFFING REQUIREMENTS A . FMS ID: TBD PROJECT: Construction Management/Design/Build for the rehabilitation, elevation and/or rebuilding of substantially damaged and non-substantially damaged residential Homes Overall staffing requirements for design and construction management personnel for the Project have been establish by the Commissioner and are set forth below. Such staffing requirements specify the titles of design and construction management personnel that may be required for the Project. A staffing plan for the project shall be established in accordance with the procedure set forth in Article 11 of the contract. List of Key Personnel: Program Executive Project Executive Project Manager Lead Design Manager Design Project Manager Project Controls Manager Xxxxx Xxxxxx Implementation Manager MWBE Compliance Officer Minimum Qualification Requirements Per Title Any personnel provided by the CM and/or its Design Consultants must satisfy the Minimum Requirements Per Title set forth below. ARCHITECTURAL PERSONNEL Title Number of Years of Experience Professional License or Certification Principal 10 Professional License Project Architect 7 Professional License Project Manager (Architecture) 7 Senior Architectural Designer 5 Junior Architectural Designer 3 Architectural Technician 1 Senior Interior Designer 5 Junior Interior Designer 3 Interiors Technician 1 Programming Specialist 3 Senior Landscape Architect 5 Professional License Junior Landscape Architect 3 Senior Landscape Architectural Designer 5 Junior Landscape Architectural Designer 3 Landscape Technician 1 Senior Draftsperson/CAD 5 Junior Draftsperson/CAD 1 ENGINEERING PERSONNEL Title Number of Years of Experience Professional License or Certification Principal 10 Professional License Project Engineer 7 Professional License Project Manager (Engineer) 7 Senior Structural Engineering Designer 5 Senior Electrical Designer...
CERTIFICATION BY BROKER. The undersigned insurance broker represents to the City of New York that the attached Certificate of Insurance is accurate in all material respects, and that the described insurance is effective as of the date of this Certification. [Name of broker (typewritten)] [Address of broker (typewritten)] [Signature of authorized officer of broker] [Name of authorized officer (typewritten)] [Title of authorized officer (typewritten)] [Contact Phone Number for Broker (typewritten)] [Email Address of Broker (typewritten)] Sworn to before me this day of , 201_ NOTARY PUBLIC APPENDIX B PROVISIONS FOR HEALTH AND SAFETY PLAN
CERTIFICATION BY BROKER. By executing this Agreement, Broker certifies that this Agreement complies with Section 73.3555 of the FCC's rules.
CERTIFICATION BY BROKER. The undersigned insurance broker represents to the City of New York that the attached Certificate of Insurance is accurate in all material respects, and that the described insurance is effective as of the date of this Certification. Xxxxxxxxx Xxxxxx, Director Healthcare Practice [Name of broker (typewritten)] 0000 Xxxx Xxxxxxx, Xxxxx 000 Xxxxxxx, XX 00000 [Address of broker (typewritten)] /s/ Xxxxxxxxx Xxxxxx [Signature of authorized officer of broker] Xxxxxxxxx Healthcare Xxxxxx X. Xxxxxxxxx Risk [Name of authorized officer (typewritten)] Xxxxxx Xxxxxxxx Xx., Division President [Title of authorized officer (typewritten)] (800) - 733 - 4474 [Contact Phone Number for Broker (typewritten)] Xxxx_Xxxxxx@xxx.xxx [Email Address of Broker (typewritten)] Sworn to before me this 3rd day of December, 2010 /s/ Xxxxx Xxxxxxxxx NOTARY PUBLIC
CERTIFICATION BY BROKER. The undersigned insurance broker represents to the New York City Health and Hospitals Corporation that the attached Certificate of Insurance is accurate in all material respects, and that the described insurance is effective as of the date of this Certification. [Name of broker (typewritten)] [Address of broker (typewritten)] [Signature of authorized officer of broker] BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement (“Agreement”), effective (“Effective Date”), is entered into by and between , with principal place of business at (“Business Associate”) and the New York City Health and Hospitals Corporation, with principal place of business at 000 Xxxxx Xxxxxx, Xxx Xxxx, Xxx Xxxx 00000 (“Covered Entity”) (each a “Party” and collectively the “Parties”). Business Associate (which, for the purposes of this Business Associate agreement, includes its directors, officers, employees, and third party workforce) is a , and Covered Entity is a public be- nefit corporation providing health care. The Parties have agreement, effective , (the “ Agreement”) under which Business Associate may use, have access to, or disclose Protected Health In- formation (“PHI”) or electronic protected health information (“ePHI”) in its performance of the Services described below. Both Parties are committed to complying with the Standards for Privacy of Individually Identifiable Health Information under the Health Insurance Portability and Accountability Act of 1996 (hereinafter, the “HIPAA Regulations”) and acknowledge the respective duties and obligations imposed on them by the privacy and security provisions of the Health Information Technology for Economic and Clinical Health Act (“HITECH Act”), Title XIII, subtitle D, of the American Recovery and Reinvestment Act of 2009 (“ARRA”), codified at 42 U.S.C. § 17921 et seq. Citations herein to the Code of Federal Regulations refer to the HIPAA Privacy Regulations published on December 28, 2000 and amended on August 14, 2002 and the HIPAA Security Regulations published on February 20, 2003, and shall include all subsequent, updated, amended or revised provisions relating thereto. Terms not otherwise defined herein shall have the meanings ascribed to them in the HIPAA Regulations, including but not limited to 45 C.F.R. §§ 160.103, 164.103, 164.304, 164.402, & 164.501 and as provided in the XXXXXX Xxx, 00 X.X.X. § 00000. References throughout this Agreement to PHI shall be deemed to include ePHI, where applicable. Unless otherwis...
