Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.
Filing of Agreement Upon execution of this Agreement, it shall be filed with the appropriate state regulatory agency pursuant to the requirements of Section 252 of the Act. If the regulatory agency imposes any filing or public notice fees regarding the filing or approval of the Agreement, Carrier shall be responsible for publishing the required notice and the publication and/or notice costs shall be borne by Carrier.
Filing Designation The City Department Director will designate each individual who will be providing services to the City pursuant to the Agreement as full disclosure, limited disclosure, or excluded from disclosure, based on an analysis of the services the Consultant will provide. Notwithstanding this designation or anything in the Agreement, the Consultant is ultimately responsible for complying with FPPC regulations and filing requirements. If you have any questions regarding filing requirements, please do not hesitate to contact the City Clerk at (000)000-0000, or the FPPC at 0-000-XXX-XXXX, or (000) 000-0000 *2. Pursuant to the duly adopted City of Chula Vista Conflict of Interest Code, this document shall serve as the written determination of the consultant’s requirement to comply with the disclosure requirements set forth in the Code.
Application for Vacancies All employees under this Agreement, including those on layoff status, may submit application in writing for any vacancy which is posted pursuant to this Article.
Use of Force CONTRACTOR shall develop and implement use of force policies and procedures in compliance with Florida Statutes, Florida Administrative Code, FDC policies and procedures, and accepted industry practice.
Voter Registration: When designated by the Secretary of State Party agrees to become a voter registration agency as defined by 17 V.S.A. §2103 (41), and to comply with the requirements of state and federal law pertaining to such agencies.
TIME OFF FOR VOTING (a) If an employee does not have sufficient time outside of working hours to vote at a statewide election, the employee may, without loss of pay, take off enough working time that, when added to the voting time available outside of working hours, will enable the employee to vote.
Filing of Claims You must file all Claims within ninety (90) days from the date services were rendered, unless it is not reasonably possible to do so. In no event may any Claim be filed later than fifteen (15) months from the date services were rendered. Claims Administrator and Participating Providers have entered into agreements that eliminate the need for a Member to personally file a Claim for Benefits. Participating Providers will file Claims for Members either by mail or electronically. In certain situations, the Provider may request the Member to file the Claim. If Your Provider does request You to file directly with the Company, the following information will help You in correctly completing the Claim form. We will, upon receipt of a notice of claim, furnish to You such forms as are usually furnished by Us for filing proofs of loss. If such forms are not furnished within fifteen (15) days after the giving of such notice, You will be deemed to have complied with the requirements of this Contract as to proof of loss upon submitting, within the time fixed in this Contract for filing proofs of loss, any affirmative written proof covering the occurrence, the character and the extent of the loss for which the claim is made. If You have any questions about any of the information in this section, You may call Your insurance agent or Our Customer Service Department at the number shown in Your ID Card. Your Blue Cross and Blue Shield of Louisiana ID Card shows the way Your name appears on the Company records. (If You have Dependent coverage, the name(s) are recorded as You wrote them on Your application card.) The ID Card also lists Your Contract number (ID #). This number is the identification to Your Membership records and should be provided to Us each time a Claim is filed. To assist in promptly handling Your Claims, please be sure that: an appropriate Claim form is used the Contract number (ID #) shown on the form is identical to the number on the ID Card the patient's date of birth is listed the patient's relationship to the Subscriber is correctly stated all charges are itemized in a statement from the Provider the itemized statement from the Provider contains the Provider’s name, address and tax ID number and is attached to the Claim form the date of service (Admission to a Hospital or other Provider) or date of treatment is correct the Provider includes a diagnosis code and a procedure code for each service/treatment rendered the claim is completed and signed by the Member. If You need to submit documentation to Us, please sent it to: United Concordia Dental ATTN: Claims Department P.O. Box 69441 Harrisburg, PA 17106-9441
Certificate of Interested Parties Form – Form 1295 As required by Section 2252.908 of the Texas Government Code. H-GAC will not enter a Contract with Contractor unless (i) the Contractor submits a disclosure of interested parties form to H-GAC at the time the Contractor submits the contract H-GAC, or
TYPE OF FILING NOTE Parties making multiple requests (such as seeking to adopt a previously approved Agreement and Commission approval of new negotiated amendments to that agreement) should submit a separate checklist for each requested action. ☐ Adoption: Adopts existing carrier-to-carrier agreement approved by the Commission. • Docket ARB ☐■ • Parties to prior agreement: & New Agreement: Seeks approval of a new negotiated agreement. Does adoption or agreement replace an existing agreement between the parties? ☐■ NO ☐ YES, Docket ARB ☐ Amendment: Amends an existing carrier to carrier agreement. Docket ARB Does this filing replace an agreement or amendment currently pending Commission approval? ☐■ NO ☐ YES, Docket ARB , Filed on Attachment(s) provided on CD, DVD or flash drive. FM906 2/2015 Print Commercial Mobile Radio Services (CMRS) By and Between United Telephone Company of the Northwest d/b/a CenturyLink and Charge Communication Inc. For the State of Oregon TABLE OF CONTENTS ARTICLE I. DEFINITIONS 5 1. GENERAL RULES 5 2. DEFINITIONS 5 ARTICLE II. GENERAL TERMS AND CONDITIONS 17 3. APPLICATION OF THESE GENERAL TERMS AND CONDITIONS 17 4. POSITION OF THE PARTIES 17 5. REGULATORY APPROVALS 17 6. EFFECTIVE DATE, TERM AND TERMINATION 17 7. CARRIER CERTIFICATION 20 8. APPLICABLE LAW 20 9. CHANGES IN LAW 21 10. AMENDMENTS 22 11. ASSIGNMENT 23 12. CONFIDENTIAL INFORMATION 23 13. CONSENT 24 14. CONTACTS BETWEEN THE PARTIES 24 15. GENERAL DISPUTE RESOLUTION 25 16. ENTIRE AGREEMENT 26 17. FORCE MAJEURE 27 18. FRAUD 27 19. HEADINGS 28 20. INTELLECTUAL PROPERTY 28 21. LAW ENFORCEMENT 29 22. LIABILITY AND INDEMNIFICATION 30 23. SUBCONTRACTORS 33 24. INSURANCE 33 25. NON-EXCLUSIVE REMEDIES 34 26. RESERVATION OF RIGHTS 34 27. NOTICES 35 28. REFERENCES 36 29. RELATIONSHIP OF THE PARTIES 36 30. SUCCESSORS AND ASSIGNS – BINDING EFFECT 37 31. SURVIVAL 37 32. TAXES/FEES 37 33. TERRITORY 38 34. THIRD-PARTY BENEFICIARIES 38 35. USE OF SERVICE 38 36. WAIVER 39 37. WITHDRAWAL OF SERVICES 39 38. TECHNOLOGY UPGRADES 39 ARTICLE III. IMPLEMENTATION 40 39. IMPLEMENTATION PLAN 40 40. SECURITY DEPOSIT 40 41. START-UP DOCUMENTATION 41 42. LETTER OF AUTHORIZATION (LOA) 41 ARTICLE IV. OPERATIONAL TERMS 44 43. STANDARD PRACTICES 44 44. ESCALATION PROCEDURES 44 45. CONTACT WITH END USERS 44 46. CAPACITY PLANNING AND FORECASTS 44 47. BONA FIDE REQUEST (BFR) 46 48. ORDERING AND PROVISIONING 48 49. BILLING AND PAYMENTS/DISPUTED AMOUNTS 49 50. AUDITS 53 51. CENTURYLINK OSS INFORMATION 54 52. NETWORK MANAGEMENT 57 53. MAINTENANCE AND REPAIR 58 ARTICLE V. INTERCONNECTION, TRANSPORT AND TERMINATION OF TRAFFIC 59 54. SERVICES COVERED 59 55. NETWORK INTERCONNECTION METHODS 59 56. SIGNALING AND INTERCONNECTION TRUNKING REQUIREMENTS 64 57. INTERCARRIER COMPENSATION 70 58. TRANSIT TRAFFIC 73 ARTICLE VI. ADDITIONAL SERVICES 76 59. NUMBER PORTABILITY 76 60. 70. ACCESS TO POLES, DUCTS, CONDUITS AND RIGHTS-OF-WAY 79 61. BASIC 911 AND E911 SERVICE 79 62. DIRECTORY ASSISTANCE 85 ARTICLE VII. PRICING 86 63. GENERAL PRICING TERMS 86 64. APPLICABILITY OF OTHER RATES, TERMS AND CONDITIONS 86 65. APPLICATION OF NON-RECURRING CHARGES 86 66. INDIVIDUAL CASE BASIS PRICING (ICB) 86 ARTICLE VIII. MISCELLANEOUS 88 67. AUTHORIZATION AND AUTHORITY 88 68. COUNTERPARTS 88 SIGNATURE PAGE 89 TABLE 1 RATES This CMRS Interconnection Agreement (“Agreement”) is entered into by and between United Telephone Company of the Northwest d/b/a CenturyLink (“CenturyLink”), and Charge Communication Inc. (“Carrier”), in its capacity as a licensed provider of Commercial Mobile Radio Service (“CMRS”). CenturyLink and Carrier are herein referred to collectively as the “Parties” and each individually as a “Party.” This Agreement covers services in the State of Oregon.
