Certification of Information Sample Clauses

Certification of Information. The Plan Sponsor certifies that the information provided on the following page, and on any exhibits hereto, is true, correct, and complete.

Certification of Information. Helios represents and warrants that the information provided in this Schedule is accurate, complete, and up-to-date as of the Effective Date. ▇▇▇▇▇▇ further agrees to notify Energea of any changes to the information in this Schedule within ten (10) Business Days of such changes.

Certification of Information. □ Yes □ No The above Purchaser and Seller have agreed to these purchase terms.

Certification of Information. The annual financial and operating statements provided under this Subsection shall be certified by an independent certified public accountant as having been prepared in accordance with generally accepted accounting principles, consistently applied, or, in the case of financial statements prepared on a cash or income tax basis, or of operating statements, as not materially misleading based on an audit conducted in accordance with generally accepted auditing standards. The quarterly financial and operating statements provided under this Subsection need not be audited. The Borrower shall, however certify that such statements are true and correct.

Certification of Information. Print the Name of the Authorized Representative – print the name of the authorized representative, Authorized Representative’s Signature – the authorized representative must sign the form. Signatures must be original, preferrably in blue ink. Stamped signatures and initials are not accepted. Date of Signature – enter the date this form was signed. MANAGED CARE ORGANIZATION (MCO) Louisiana Medicaid Registration Form Revised 10/14 Louisiana Medicaid MCO Number (if known) Registering for: New Update Reactivation Other (Please specify): Change of Ownership (CHOW) A Entity/Business Information & Location “Doing Business As” Name Area Code & Telephone Number ( ) - Parish/County Parish/County Code State Status Location In-State (0) Out-of-State (1) Location Type Urban (1) Rural (2) Effective Date: MCO Type Description/Code MCO (PT-05) MCO Specialty MCO- (5Q) D Contact Information The following person may be contacted for additional information regarding this registration: Contact Name: Contact Phone Number ( ) Contact Fax Number ( ) Contact Email: Only an authorized representative may sign this form. This authorized representative must be someone designated to enter into a legal and binding contract with Louisiana Medicaid. This person must be someone currently listed on the Disclosure of Ownership as either an owner or manager. Any other signature will be grounds for rejecting this form. Original signatures only; no stamps or copied signatures will be accepted. (Blue or colored ink preferred – not black ink). The provider name on this form must match the provider name associated with the Louisiana Medicaid number, the NPI, or both. Call Gainwell Provider Enrollment at (▇▇▇) ▇▇▇-▇▇▇▇ if you have questions regarding the completion of this form or the status of your request. You may also go to ▇▇▇▇▇▇▇▇▇▇.▇▇▇ under the Provider Enrollment link for Provider Enrollment contact information. Once you are enrolled for EFT and if there is a time when the electronic payments are missing or late, first contact the Automated Clearinghouse (ACH) representative at your bank, not a bank teller. If the bank is unable to locate the deposit, check to ensure that the account has not been closed or changed. Finally, if still unable to locate a deposit, call Gainwell Provider Enrollment at (▇▇▇) ▇▇▇-▇▇▇▇ and report the late and/or missing EFT transaction. Provider Name Complete legal name of institution, corporate entity, practice or individual provider. DBA Name The name by which th...

Certification of Information. The financial and operating statements provided under this Subsection need not, as an initial matter, be certified by an independent certified public accountant as having been prepared in accordance with generally accepted accounting principles, consistently applied, or, in the case of financial statements prepared on a cash or income tax basis, or of operating statements, as not materially misleading based on an audit conducted in accordance with generally accepted auditing standards. The Borrower shall, however certify that such statements are true and correct, and the Lender expressly reserves the right to require such a certification by an independent certified public accountant if a Default exists or if the Lender in the exercise of its reasonable discretion has reason to believe that any previously provided financial or operating statement is misleading in any material respect.

Certification of Information. Helios certifies that: All bank accounts listed in this Schedule are accurate, complete, and up-to-date as of the Effective Date. Helios shall notify Energea of any changes to its banking arrangements, including the opening or closing of accounts, within ten (10) Business Days of such changes. Any new accounts, including Foreign Accounts or Trust Accounts, must be pre-approved by Energea and incorporated into this Schedule through a written amendment.

Certification of Information. The financial and operating statements provided under this Subsection need not, as an initial matter be certified by an independent certified public accountant as having been prepared in accordance with generally accepted accounting principles, consistently applied, or, in the case of financial statements prepared on a cash or income tax basis, or of operating statements, as not materially misleading based on an audit conducted in accordance with generally accepted auditing standards. The Mortgagor shall, however certify that such statements fairly present in all material respects the financial condition of the Mortgagor, and Mortgagee expressly reserves the right to require such a certification by an independent certified public accountant if a Default exists or if Mortgagee has reason to believe that any previously provided financial or operating statement is misleading in any material respect.

Certification of Information. I certify that the information provided in this Application is complete, correct and true to the best of my knowledge.