Emergency Contact Information Form Sample Clauses

Emergency Contact Information Form is the form to be submitted to the Regional Lead Coordinating Agency and Designated Representative by each Member listing names, addresses, and 24-hour phone numbers of the Contact Person(s) of each Member. Alternatively, the phone number of a dispatch office staffed 24 hours a day that can reach the Contact Person(s) is acceptable.
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Emergency Contact Information Form. This information will be extremely important in the event of an accident or medical emergency. Please be sure to sign and date this form. Home: Cell: Home: Cell: Work: Home: Cell: Work: Company: Policy #: Signature: Date: ❏Auto Pay Credit Card Program is for customers who want to have their credit card automatically charged each month on the date your rent is due.
Sample 1
Emergency Contact Information Form. Please complete this information request sheet and return to our office. It is imperative that we are able to contact you in case of any emergency such as a flood, fire, etc.
Sample 1

Related to Emergency Contact Information Form

  • Emergency Contact Information Resident must complete and provide to University an emergency contact information form provided by University Housing before Resident will be allowed to move into the Residence Facility.

  • Emergency Contact CONTRACTOR shall have a responsible person available at, or reasonably near, the Project/Service on a twenty-four (24) hour basis, seven (7) days a week, who may be contacted in emergencies and in cases where immediate action must be taken to handle any problem that might arise. CONTRACTOR shall submit to the COUNTY’s Project Manager, the phone numbers and names of personnel designated to be contacted in cases of emergencies. This list shall contain the name of their supervisors responsible for work pertaining to this Agreement.

  • Emergency Contacts Contractor shall provide County with a list of names and telephone numbers at which Contractor’s representative, alternate, superintendent, and other key personnel can be reached during non-working hours in the case of an emergency.

  • Contact Information In the event of an emergency involving your electric service (e.g. an outage or downed power lines) you should call the emergency line for your DSP. The Ameren Illinois emergency phone number is: (000) 000-0000. In all other situations, you may contact Homefield Energy toll free at (000) 000-0000 or by e-mail at XxxxxxxxxXxxxXxxx@XxxxxxXxxx.xxx; or via mail at Homefield Energy, Attn: Customer Service, P.O. Xxx 000000, Xxxxxx, Xxxxx 00000.

  • LICENSE HOLDER CONTACT INFORMATION This notice is being provided for information purposes. It does not create an obligation for you to use the broker’s services. Please acknowledge receipt of this notice below and retain a copy for your records.

  • CHANGES IN EMERGENCY AND SERVICE CONTACT PERSONS In the event that the name or telephone number of any emergency or service contact for the Competitive Supplier changes, Competitive Supplier shall give prompt notice to the Town in the manner set forth in Article 18.3. In the event that the name or telephone number of any such contact person for the Town changes, prompt notice shall be given to the Competitive Supplier in the manner set forth in Article 18.3.

  • Operator’s Security Contact Information Xxxxxxx X. Xxxxxxx Named Security Contact xxxxxxxx@xxxxxxxxx.xxx Email of Security Contact (000) 000-0000 Phone Number of Security Contact

  • DEFECTIVE MANAGEMENT INFORMATION 5.1 The Supplier acknowledges that it is essential that the Authority receives timely and accurate Management Information pursuant to this Framework Agreement because Management Information is used by the Authority to inform strategic decision making and allows it to calculate the Management Charge.

  • Vendor Identity and Contact Information It is Vendor’s sole responsibility to ensure that all identifying vendor information (name, EIN, d/b/a’s, etc.) and contact information is updated and current at all times within the TIPS eBid System and the TIPS Vendor Portal. It is Vendor’s sole responsibility to confirm that all e-correspondence issued from xxxx-xxx.xxx, xxxxxxx.xxx, and xxxxxxxxxxxxxxxx.xxx to Vendor’s contacts are received and are not blocked by firewall or other technology security. Failure to permit receipt of correspondence from these domains and failure to keep vendor identity and contact information current at all times during the life of the contract may cause loss of TIPS Sales, accumulating TIPS fees, missed rebid opportunities, lapse of TIPS Contract(s), and unnecessary collection or legal actions against Vendor. It is no defense to any of the foregoing or any breach of this Agreement that Vendor was not receiving TIPS’ electronic communications issued by TIPS to Vendor’s listed contacts.

  • FOR FURTHER INFORMATION CONTACT Xxxxx Xxxxxx, Air and Radiation Law Office (2344A), Office of General Counsel, U.S. Environmental Protection Agency, 0000 Xxxxxxxxxxxx Xxx., XX., Xxxxxxxxxx, XX 00000; telephone: (202) 564–1272; fax number (202) 564–5603; e-mail address: xxxxxx.xxxxx@xxx.xxx.

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