Certification Statements. Do you plan on claiming meals served off-site during the field trip? Open sites are required to remain open and operational to serve the community despite a large number of children being off-site on a field trip. Do you certify that compliance with this regulation is upheld? Program Requirements including all applicable State and local health, safety and sanitation standards must be met. Do you certify that compliance with this regulation is upheld? Sponsor Representative Signature Yes No Yes No Yes No Date ADE OFFICIAL USE ONLY- DO NOT COMPLETE THIS SECTION Date Notification Received: Date Approved: ADE Specialist Signature Upon Approval:
Certification Statements. The Bidder certifies and warrants by the following assurances and covenants, that the Bidder is fully qualified to manage and operate a non-exclusive Vending Concession at the Airport.
Certification Statements. I understand payments will be issued monthly and will continue until DWS determines the COVID-19 pandemic no longer limits child care programs from operating in its regular course of business or until DWS determines that available funding is exhausted. No new applications will be accepted after that date. I will remain open and operating each month in order to receive payments. I hereby agree that funds will be utilized for the following Coronavirus Aid, Relief, and Economic Security Act or the “CARES Act” (Public Law 116-136) expenses: • To support payroll • For cleaning and janitorial services • For rent, supplies, materials • To remain open and operating • To meet health and safety requirements imposed as a result of COVID-19 I understand my program is ineligible to receive subsequent payments if I close for any other reason than a two week or less COVID-19 related closure after signing this agreement. I understand that I am required to notify the Office of Child Care if I close my child care program after receiving payment. Failure to notify the Office of Child Care will result in an overpayment that will be recouped by the Department of Workforce Services in accordance with Utah Administrative Code R986-700-731.1 (see Utah State Bulletin, April 1, 2020, Vol. 2020, No. 7, page 45). I agree to the DWS Terms and Conditions (ATTACHMENT A) attached to this agreement. I certify that all information in this application is true and accurate. If I knowingly provide false or misleading statements in this agreement, DWS will issue an overpayment in accordance with Utah Administrative Code R986-700-731.1 (see Utah State Bulletin, April 1, 2020, Vol. 2020, No. 7, page 45). Signature of Owner: /s/ Date: Submit application and required documentation to: xxx@xxxx.xxx Equal Opportunity Employer/Program Auxiliary aids and services are available upon request to individuals with disabilities by calling 000-000-0000. Individuals who are deaf, hard of hearing, or have speech impairments may call Relay Utah by dialing 711. Spanish Relay Utah: 0-000-000-0000. ATTACHMENT A Department of Workforce Services (DWS) Grant Terms and Conditions
Certification Statements. The representative of Sponsoring Organization attests that:
Certification Statements. The representative of SFA attests that:
Certification Statements. I HEREBY CERTIFY that neither this organization, nor its principal officials, have violated regulations of any other federal program; that no false statements regarding past performance in these programs have been provided; and that any violations by either the organization or any of its principal officials have been cleared to the satisfaction of all parties. I HEREBY CERTIFY that this institution and its principal officials have not been convicted in the past seven years of any activity that indicates a lack of business integrity, such as fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims, or obstruction of justice. I HEREBY CERTIFY that all of the above information is true and correct. I understand that this information is being given in connection with the receipt of federal funds; that USDA and State Officials may, for cause, verify information; and that deliberate misrepresentation will subject me to prosecution under applicable state and federal criminal statutes. SIGNATURE ON BEHALF OF INSTITUTION BY AUTHORIZED REPRESENTATIVE BY: Signature NAME: (Print or Type) TITLE: DATE: SIGNATURE ON BEHALF OF WYOMING DEPARTMENT OF EDUCATION BY: Signature NAME: Xxxxx Xxxxxxx (Print or Type) TITLE: Nutrition Programs Supervisor DATE:
Certification Statements. Teleworking/telecommuting is not a substitute for child/adult day care. If applicable, the employee agrees to make regular dependent care arrangements while teleworking/telecommuting. • The employee cannot operate a business or work for another employer during remote work hours. • Flexible work arrangements, including teleworking/telecommuting, are a privilege and are not a guarantee of employment. Management retains the right to abbreviate or terminate this agreement in totality due to changes in work demands, office staffing, or other operational needs. Management retains the right to modify or terminate this agreement if the performance of the employee’s duties decline and/or are deemed less than satisfactory. • I have read the requirements outlined in this Telework/telecommute Terms and Conditions agreement. By signing this agreement, I acknowledge that I understand, and agree to adhere to the terms and conditions set forth in this Agreement and I affirm that I will comply with the College’s Flexible Work Arrangements policy and procedures (32500CP). • I have met with my supervisor, documented a work schedule, completed the self- assessment, and reviewed the Work Site Safety Checklist. I verify that I have read the above information and affirm that my off-site workspace is a safe place to work and I am in accordance with the College’s terms and conditions. Employee Signature Date Approvals I have discussed teleworking/telecommuting with the above-named employee. Based on the employee’s assessment, job responsibilities, and performance in his or her current position, I have determined that this employee is: is approved for Regular Telework one two three day(s) per week. is approved for Situational Telework, as requested and needed. Effective Dates: from to . The Agreement will be subject to review and renewal at least annually, to correspond with the College’s fiscal year (July 1 to June 30). is not approved for telework/telecommute. If application is not approved by the immediate supervisor, please provide an explanation below. Immediate Supervisor Comments: Immediate Supervisor Signature Date I have reviewed the teleworking/telecommuting application and terms and conditions agreement for this employee, and I: support and provide my approval. do not support and do not provide my approval. If application is not approved by the next- level supervisor, please provide an explanation below. Next-Level Supervisor Comments: Next-Level Supervisor Signature Dat...
Certification Statements. I certify that the expenses were incurred by me while moving and relocating at the request of the above cited agency of the Commonwealth of Virginia. Signature of Employee: Date: I certify that the expenses were incurred in an employee relocation requested by Xxxxx Xxxxxxx University and do not exceed the requirements set forth in Moving and Relocation expense regulations. Written approval for reimbursement above normal established limits is attached. Signature of AVP for Finance: Date: Print Name: Xxxx Xxxxx Title: AVP for Finance
Certification Statements. 1. The sponsor or sub-recipient maintains a written standards of conduct governing conflict of interest and the performance of their employees engaged in the award and administration of contracts (2 CFR § 200.318(c)). To the extent permitted by state or local law or regulations, such standards of conduct provide for penalties, sanctions, or other disciplinary actions for violations of such standards by the sponsor’s and sub-recipient’s officers, employees, or agents, or by contractors or their agents. {{[]}} {{[]}} {{[]}} Yes No N/A
Certification Statements. Except for certification statements below marked not applicable (N/A), this list includes major requirements of the construction project. Selecting “
