County Name. State: Governor, and Legislative Leadership Committees Legislative District #s: State Senator and two members of the General Assembly per district. County: Freeholders County Clerk Sheriff {County Executive} Surrogate Municipalities (Mayor and members of governing body, regardless of title): USERS SHOULD CREATE THEIR OWN FORM, OR DOWNLOAD FROM XXX.XX.XXX/XXX/XXX/X0X A COUNTY-BASED, CUSTOMIZABLE FORM.
County Name. State: Governor, and Legislative Leadership Committees Legislative District #s: State Senator and two members of the General Assembly per district. County: Freeholders County Clerk Sheriff {County Executive} Surrogate Municipalities (Mayor and members of governing body, regardless of title): USERS SHOULD CREATE THEIR OWN FORM, OR DOWNLOAD FROM XXX.XX.XXX/XXX/XXX/X0X A COUNTY-BASED, CUSTOMIZABLE FORM. PROPOSAL FORM 20: STOCKHOLDER DISCLOSURE CERTIFICATION Name of Business: ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Stockholder Name Xxxxx, Xxxx, C Name: Stockholder Name Home Address: Q"cc⭲s, Ncw Yoík, NY Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Subscribed and sworn before me this day of , 2022 . (Notary Public) My Commission expires: (Affiant) Xxxxx Xxxxxxxxxx/Vice President (Print name & title of affiant) (Corporate Seal) PROPOSAL FORM 21: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM Check one of the following responses to the General Terms and Conditions in this solicitation, including the Master Agreement: ☒ We take no exceptions/deviations to the general terms and conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ☐ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: We accept the General Terms and Conditions in this solicitation, including the Master Agreement as well as we are enclosing Herc Supplemental Terms an...
County Name. State: Governor, and Legislative Leadership Committees Legislative District #s: State Senator and two members of the General Assembly per district. County: Freeholders County Clerk Sheriff {County Executive} Surrogate Municipalities (Mayor and members of governing body, regardless of title): USERS SHOULD CREATE THEIR OWN FORM, OR DOWNLOAD FROM XXX.XX.XXX/XXX/XXX/X0X A COUNTY- BASED, CUSTOMIZABLE FORM. PROPOSAL FORM 20: GENERAL TERMS AND CONDITIONS ACCEPTANCE FORM Signature on the Vendor Contract Signature form certifies complete acceptance of the General Terms and Conditions in this solicitation, except as noted below (additional pages may be attached, if necessary). Check one of the following responses to the General Terms and Conditions: X We take no exceptions/deviations to the general terms and conditions (Note: If none are listed below, it is understood that no exceptions/deviations are taken.) ⬜ We take the following exceptions/deviations to the general terms and conditions. All exceptions/deviations must be clearly explained. Reference the corresponding general terms and conditions that you are taking exceptions/deviations to. Clearly state if you are adding additions terms and conditions to the general terms and conditions. Provide details on your exceptions/deviations below: (Note: Unacceptable exceptions shall remove your proposal from consideration for award. Region 10 ESC shall be the sole judge on the acceptance of exceptions/deviations and the decision shall be final.)
County Name. ** If: Minor Mother needs to be placed with Child - WFFH *** If: Other (Explain): SOCIAL WORK AUTHORIZATION Date: Primary SW Name: Worker#: Phone#: Secondary SW Name: Worker#: Phone#: Authorized by (if different than SW): PREVIOUS PLACEMENT INFORMATION Facility type: Previous Placement End Date: (Payment Stop Date) Name of Previous Caregiver(s): Name of Agency (If applicable): Phone Number: Address: NEW PLACEMENT INFORMATION Is this an ESH or an Emergency Placement (309D)?
County Name. Mariposa County First 5 Commission Attached SPCFA Requirement Update in progress a. Program Descriptions (2014 only) Detailed descriptions and benchmarks for programs to be funded wholly or partially by SPCFA. OR Annual Performance Report Program Descriptions (beginning July 31, 2015) Summary of achievements, lessons learned, challenges, and strategies used to overcome challenges. yes date expected 09/04/14 no Will be completed by 07/01/15 b. County Strategic Plan Current strategic plan, as described in Health and Safety Code Section 130140 (a)(1)(C)(ii), copied below. yes date expected 06/09/14 no c. Annual Evaluation Report Most recent evaluation report including description of progress towards meeting the specific outcomes of each funded program, if available. yes date expected 06/09/14 & 07/1/15 no d. Fiscal Stability Plan Long-range financial plan as described in the First 5 Financial Management Guide. yes date expected_06/09/14 no Health and Safety Code Section 130140 (a)(1)(C)(ii): The county strategic plan shall at a minimum, include a description of the goals and objectives proposed to be attained, programs, services, and projects proposed to be provided, sponsored, or facilitated, and a description of how measurable outcomes of such programs, services, and projects will be determined by the county commission using appropriate reliable indicators. In order to be deemed adequate or complete, county strategic plans will need to describe how programs, services, and projects relating to early childhood development with the county will be integrated into a consumer-oriented and easily accessible system. Mariposa County First 5 Strategic Plan covers all requirements stated in the Health and Safety Code Section 130140 (a)(1)(C)(ii). In addition, it covers detailed program descriptions, evaluation tools and all grants that have been funded since the inception of Mariposa County First 5 Commission until June 30, 2014.
County Name. Penobscot/Piscataquis Person Completing Form: Xxxxx Xxxxxxxx Completion Date: August 2007 HIGH RISK (00-00) XXXXXXXX LOGIC MODEL ALCOHOL • This group is not aware of all of the health risks. People are not educated, are misinformed. Kids don’t understand the difference between a glass of wine and binge drinking • ‘It won’t happen to me’—the risk of addiction doesn’t deter use • Most of the public doesn’t understand the risks of use. We reinforce it through our acceptance • Everything is instant gratification • Kids are going out to get drunk now—not just to have a few drinks • Mothers, young mothers, pregnant women could absorb the health message Knowledge of Health Risks • Cheap food and alcohol are targeted to college kids, but happy hour specials are expanding to include all age groups • Congregating in bars is a social event—people get together there • Specialty drinks (bright colors, fruity flavors) target young women and new drinkers • They sell small kegs in stores now • College kids buy kegs, sell beer by the cup to others, also sell tickets to pay for keg—winning ticket gets leftover money • Drink specials don’t necessarily matter. If you pregame (drink before going out) you spend less $ at the bar or party. Spending less cash is what college kids are in search of • Maine Distributors needs to support any ideas in this category • Soda not included in bar/happy hour specials Promotions & Pricing • Management of many college-area bars recognize this is an issue and are working with The River Coalition on trainings/awareness etc. Retail Sales/Over-service • There are more possibilities on campus than off campus. • If you get an OUI you are referred to DEEP classes, if you are employed you can go to EAP, the military has a place for people who need help, but if you don’t fall into any of these categories there isn’t much available beyond AA meetings. Even then the demographics of the meeting might not be yours • Most people don’t have addiction issues but they are hosting or doing something that can be harmful to the community Lack of Screening/Early Intervention
County Name. State: Governor, and Legislative Leadership Committees Legislative District #s: State Senator and two members of the General Assembly per district. County: Freeholders County Clerk Sheriff {County Executive} Surrogate Municipalities (Mayor and members of governing body, regardless of title): USERS SHOULD CREATE THEIR OWN FORM, OR DOWNLOAD FROM XXX.XX.XXX/XXX/XXX/X0X A COUNTY- BASED, CUSTOMIZABLE FORM. 2022 political contributions Uber does not have a federal PAC. Uber makes corporate contributions at the state and local levels where permissible by law. Below are the corporate contributions made in 2022. Recipient Candidate/ballot measure State Semiannual period Amount Xxxxxxx Xxxxxxxx for Assembly 2022 Xxxxxxx Xxxxxxxx CA H1 2022 $4,900 Xxxxxx Xxxxxxx for Assembly 2022 Xxxxxx Xxxxxxx CA H1 2022 $4,900 Xxxxx Xxxxxx for Assembly 2022 Xxxxx Xxxxxx CA H1 2022 $4,900 Committee for a Greater Miami n/a FL H1 2022 $10,000 Democratic Legislative Campaign Committee n/a n/a H1 2022 $35,000 Flexibility and Benefits for Massachusetts Drivers Flexibility and Benefits for Massachusetts Drivers ballot measure MA H1 2022 $5,577,5361 Xxxxx Xxxxxxxx Inaugural Committee n/a VA H1 2022 $15,0002 Xxxxx Xxxxx for Assembly 2022 Xxxxx Xxxxx CA H1 2022 $2,400 Xxxxx Xxxxxxxxx for Assembly 2022 Xxxxx Xxxxxxxxx CA H1 2022 $2,900 Xxx Xxxxxxxxx for Assembly 2022 Xxx Xxxxxxxxx CA H1 2022 $2,500 Xxxx Xxxxx for Senate 2024 Xxxx Xxxxx CA H1 2022 $2,000 Xxxxxx Xxxxxx for State Assembly 2022 Xxxxxx Xxxxxx CA H1 2022 $4,900 Xxxxxxx Xxxx for Assembly 2022 Xxxxxxx Xxxx CA H1 2022 $2,900 Republican State Leadership Committee n/a n/a H1 2022 $40,000 Xxxxx Xxxxxx for Senate 2022 Xxxxx Xxxxxx CA H1 2022 $2,000 Xxxxx Xxxxxxx for Assembly 2022 Xxxxx Xxxxxxx CA H1 2022 $4,900 Xxxxx Xxxxxxx for State Senate 2022 Xxxxx Xxxxxxx CA H1 2022 $2,500 1Total value of monetary and in-kind contributions. Recipient Candidate/ballot measure State Semiannual period Amount Xxxxxxx Xxxxxxxx Xxxxxxxxxx for Assembly 2022 Xxxxxxx Xxxxxxxx Xxxxxxxxxx CA H1 2022 $4,900 Washington Coalition for Independent Work Committee n/a WA H1 2022 $229,512 Yes on A, Committee for Safer Streets and Reliable, Accessible Transportation Proposition A (San Francisco) CA H1 2022 $50,000 1910 PAC n/a WA H2 2022 $9,000 Advancing Florida Agriculture n/a FL H2 2022 $5,000 Advocate for Florida Families, Inc. n/a FL H2 2022 $2,500 Xxxxxxxxx Xxxxx for Senate 2022 Xxxxxxxxx Xxxxx CA H2 2022 $2,500 Building On Your Dreams Political Committee n/a FL H2...
County Name. State: Governor, and Legislative Leadership Committees Legislative District #s: State Senator and two members of the General Assembly per district. County: Freeholders County Clerk Sheriff {County Executive} Surrogate Municipalities (Mayor and members of governing body, regardless of title): USERS SHOULD CREATE THEIR OWN FORM, OR DOWNLOAD FROM XXX.XX.XXX/XXX/XXX/X0X A COUNTY-BASED, CUSTOMIZABLE FORM. PROPOSAL FORM 20: STOCKHOLDER DISCLOSURE CERTIFICATION Name of Business: ☒ I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR ☐ I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. Check the box that represents the type of business organization: ☐ Partnership ☒ Corporation ☐ Sole Proprietorship ☐ Limited Partnership ☐ Limited Liability Corporation ☐ Limited Liability Partnership ☐ Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: BlackRock Fund Advisors Name: Stockholder Name Home Address: 000 Xxxxxx Xxxxxx. Home Address: San Francisco, CA 94105 Home Address: Home Address Name: Stockholder Name Name: Stockholder Name Home Address: Home Address Home Address: Home Address Name: Stockholder Name Name: Stockholder Name
