CONSULTANT SIGNATURE Sample Clauses

CONSULTANT SIGNATURE. Consultant represents that Consultant has had the opportunity to consult with its own independently selected attorney in the review of this Contract. Neither Party has relied upon any representations or statements made by the other Party that are not specifically set forth in this Contract. This Contract constitutes the entire agreement between the City and Consultant and supersedes all prior and contemporaneous proposals and oral and written agreements, between the Parties on this subject, and any different or additional terms on a City purchase order or Consultant quotation or invoice. The Parties agree that they may execute this Contract and any Amendments to this Contract, by electronic means, including the use of electronic signatures. This Contract may be signed in two (2) or more counterparts, each of which shall be deemed an original, and which, when taken together, shall constitute one and the same agreement.
Sample 1Sample 2Sample 3See All (5)
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CONSULTANT SIGNATURE. This contract may be signed in two (2) or more counterparts, each of which shall be deemed an original, and which, when taken together, shall constitute one and the same Agreement. The parties agree the City and Consultant may conduct this transaction, including any contract amendments, by electronic means, including the use of electronic signatures. I, the undersigned, agree to perform work outlined in this contract in accordance to the STANDARD CONTRACT PROVISIONS, the terms and conditions, made part of this contract by reference, and the STATEMENT OF THE WORK made part of this contract by reference; hereby certify under penalty of perjury that I/my business am not/is not in violation of any Oregon tax laws; hereby certify that my business is certified as an Equal Employment Opportunity Affirmative Action Employer and is in compliance with the Equal Benefits Program as prescribed by Chapter 3.100 of Code of the City of Portland; and hereby certify I am an independent contractor as defined in ORS 670.600. BY: Date: Name: Title: CONTRACT NUMBER: 30004087 CONTRACT TITLE: Employee Benefits Consultant Services CITY OF PORTLAND SIGNATURES: By: Date: Bureau Director By: Date: Elected Official Approved: By: Date: Office of City Auditor Approved as to Form: By: Date: Office of City Attorney 186832 Exhibit 186832 Exhibit Proposal for Employee Benefits Consultant Services RFP Number: BHR013 Prepared for the City of Portland November 15, 2013 Contact: Xxx Xxxxxxxx Senior Vice President Aon Hewitt 0000 Xxxxx Xxxxxx, Xxxxx 0000 Seattle, Washington 98101 Cover Letter 3 Project Team 5 Proposer’s Capabilities 14 Project Approach and Understanding 37 Corporate Responsibility 56 Proposed Cost 67 Supporting Information 69 Item 1 List of Redactions 70 Item 2 Team Biographies 72 Item 3 2012-13 Experience Report Sample 79 Item 4 Decision Support Tool—Sample Screenshot 80 Item 5 IBNP Letter—June 30, 2013 81 Item 6 Five-Year Rate Projection Sample—Spring 2013 82 Item 7 Five-Year Budget Projection Sample—Fall 2013 83 Item 8 2013-14 Benefits Survey 84 Item 9 2013-14 Dental Benefits Survey 85 Item 10 Strategy Development Discussion Presentation 86 Item 11 Actuarial Valuation Report Sample—July 1, 2011 87 Completed PTE Participation Disclosure Form 1 88 Employee Benefits Consulting Services Prepared for the City of Portland | November 15, 2013 1 Cover Letter November 15, 2013 Ms. Xxxxx Xxxxx City of Portland Bureau of Human Resources Benefits and Wellness Office 0000 XX 0xx Xxxxxx, ...
Sample 1See All (4)
CONSULTANT SIGNATURE. This contract may be signed in two (2) or more counterparts, each of which shall be deemed an original, and which, when taken together, shall constitute one and the same Agreement. The parties agree the City and Consultant may conduct this transaction, including any contract amendments, by electronic means, including the use of electronic signatures. I, the undersigned, agree to perform work outlined in this Contract in accordance to the STANDARD CONTRACT PROVISIONS, the terms and conditions, made part of this Contract by reference, and the STATEMENT OF THE WORK made part of this Contract by reference; hereby certify under penalty of perjury that I/my business am not/is not in violation of any Oregon tax laws; hereby certify that my business is certified as an Equal Employment Opportunity Affirmative Action Employer and is in compliance with the Equal Benefits Program as prescribed by Chapters 5.33.076 and 5.33.077 of Code of the City of Portland; and hereby certify I am an independent consultant as defined in ORS 670.600 (Consultant’s Name) BY: Date: Name: Title: CONTRACT NUMBER: 3000XXXX CONTRACT TITLE: PROJECT TITLE CITY OF PORTLAND SIGNATURES: By: Date: Bureau Director By: Date: Chief Procurement Officer By: Date: Elected Official Approved: By: Date: Office of City Auditor Approved as to Form: By: Date: Office of City Attorney
Sample 1
CONSULTANT SIGNATURE. Consultant represents that Consultant has had the opportunity to consult with its own independently selected attorney in the review of this Price Agreement. Neither Party has relied upon any representations or statements made by the other Party that are not specifically set forth in this Price Agreement. This Price Agreement constitutes the entire agreement between the City and Consultant and supersedes all prior and contemporaneous proposals and oral and written agreements, between the Parties on this subject, and any different or additional terms on a City purchase order or Consultant quotation or invoice. The Parties agree that they may execute this Price Agreement and any Amendments to this Price Agreement, by electronic means, including the use of electronic signatures. This Price Agreement may be signed in two (2) or more counterparts, each of which shall be deemed an original, and which, when taken together, shall constitute one and the same agreement.
Sample 1
CONSULTANT SIGNATURE. ADDENDUM II NONCOLLUSIVE AFFIDAVIT State of Michigan County of ) , BEING DULY SWORN deposes and says that:
Sample 1
CONSULTANT SIGNATURE. Date *This Agreement is not an authorization to proceed. A signed copy of this agreement will accompany the Purchase Order authorizing services to begin. Fax or email signed Agreement to Site/Department requesting services: SITE/DEPARTMENT ACCEPTANCE Site/Department Requesting Service:   Site/Department Contact:   Phone:   Site/Department Email:   Fax:  
Sample 1
CONSULTANT SIGNATURE. Date   Please Print Name:   Mailing Address   Street or PO Box, City, State, Zip Social Security Number:   or Tax ID:   Phone:   Fax:   Consultant/Contractor: Please submit this certification to Site/Department with Consultant Service Agreement if required.
Sample 1
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Related to CONSULTANT SIGNATURE

  • Employee Signature Employee ID: Telephone No: Employee Address: Work Location:

  • AGREEMENT SIGNATURES By signing below, both parties agree to the terms and conditions of this Agreement. Please acknowledge acceptance of this document and terms by returning a signed copy within seven (7) days of issuing. If a signed copy is not returned within seven (7) days and you are attending service, Fighting Chance will deem this to be acceptance of the document. If signed by Xxx XxxXxxxxxxX: Signature of Participant: Date: If signed by Person Responsible: I confirm that this Agreement has been explained to the individual receiving the services and that they agree to the terms. I further confirm that I have authority to sign on their behalf. Signature of Person Responsible: Date: SignaĒure on behalf of FighĒing Chance: Signature of Representative: Date: Name: Appendix 1 Key Contact Details Participant’s Name Participant’s Email Participant’s Phone Participant’s Address Representative’s Name Representative Relationship to Participant Representative’s Email Representative’s Phone Support Coordinator (where applicable) Support Coordinator’s Name Support Coordinator’s Email Support Coordinator’s Phone Shared Living/Supported Accommodation/Group Home (if applicable) House Manager’s Name House Manager’s Email House Manager’s Phone Additional Contacts (if applicable) Role Contact’s Name Contact’s Email Contact’s Phone Appendix 2 NDIS Claiming Preferences Fighting Chance supports NDIS participants who are NDIA-Managed, Self-Managed or Plan Managed. To invoice and bill you correctly, it is important you keep us updated with your plan management preferences, and let us know ongoing if your status changes. For the purposes of services delivered by Fighting Chance, your NDIS plan is: (please tick) ☐ NDIA-MANAGED You understand that Fighting Chance will claim directly through the NDIA portal if your funding for Fighting Chance is NDIA-managed, so you will not receive any direct request for payment. ☐ (Optional) Please supply me, by email, with monthly Statements of Account to: ☐ SELF-MANAGED ☐ I am self-managed and would like to be invoiced for services every two weeks. Please email invoices to: Please see Appendix 3 for Self-Management Payment Options. ☐ PLAN-MANAGED Please send invoices to my plan manager: Plan management organisatio Contact Name Email Address Phone number ☐ OTHER FUNDING (eg. self-funded, iCare or other insurance funding) Please email invoices to: Appendix 3 Self-Managed Payment Options Participants who are self-managed have a number of payment options with Fighting Chance: ☐ DIRECT DEPOSIT (preferred option) Payment of Fighting Chance invoices can be made by Electronic Funds Transfer (EFT) through your bank. Fighting Chance’s bank account details are as follows: Bank: Commonwealth Bank of Australia Account Name: Fighting Chance Australia Ltd BSB: 062-438 Account Number: 00000000 To ensure all payments are correctly allocated to your account, please include the full invoice number in the reference field. ☐ CREDIT CARD Payments can be made by credit card by clicking the ‘pay by credit card’ link included on the invoice. Please note that a service fee for this option will be imposed. ☐ PAYPAL Payment of your invoices can also be made via our PayPal account. To make payment via PayPal, please access the following link: xxxxx://xxxxxx.xx/FightingChanceAus?locale.x=en_AU To ensure your payment is correctly allocated, please enter the full invoice number in the reference field. Appendix 4 Non Face to Face Time Breakdown - Jigsaw Standard Non Face-to-Face Supports Delivered to every Jigsaw Participant daily, weekly, annually Writing the Board (i.e. preparing and writing up each person’s individualised program for the following day). Reviewing Trainee records/journal notes/medical or other key information to be able to best support the person during their day. Parent/Guardian/Carer Updates, i.e. emails, phone calls. Pre- and post-shift sta briefings. Zone setup (setting up workstations, boxes, visuals and group training areas) Resource development to support each Trainee to progress towards their employment goals (adapting training resources, creating visual aids and cheat sheets, etc). Research/Coordination to implement support strategies (disability, behavioural and learning strategies). Family reviews and the development of training plans (planning, delivery and follow up). Planning social events and extra curricular training (e.g. TAFE). Standard NDIS Annual Support Review Letter. Standard Ǫuarterly Reports - Upon Request. Complex Non Face-to-Face Supports - Delivered to Jigsaw Participants with High Intensity Support Needs (in addition to supports outlined in Standard) Allied health meetings, phone calls, correspondence. Specialist/additional sta training (internal or external), i.e. BSP implementation training. Creation of additional/detailed social stories/visuals. Data collection requested by behaviour therapists. Incident follow up or crisis meetings (seperate to regular family updates or regular allied health meetings). Development/review/discussion of medication forms/transfer plans/mealtime assistance plans etc. Detailed and regular sta training on individual complex behaviour/medical/transfer/mealtime support plans. Extended daily pre-brief and debrief. Additional Non Face-to-Face Supports - billed separately upon request Detailed NDIS Review Letters One-o engagement or training with Allied Health. Detailed Ǫuarterly Reports.

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