For US only. The customers will be instructed to ship the unit to the Philips repair depot in Dallas. If an appropriate shipping container is required, the Philips Dallas repair depot will ship the container to the customer.
For US only Sample Clauses
Related to For US only
For Office Use Only Ref No )
Office Use Only Unit Size Requested Unit Number Targeted Move-In Date Date Received Time Received _N__o__b__le__s__S__q__u_a__q__r_e__A__p__a_r_t_m___e_n__t_s____________ _2__1_7__5__N___o_b__l_e_s___S_t_r_e__e__t_______________________ _W___o__r_th__i_n_g__t_o_n__,__M__N___5__6_1__8__7__________________ _(_5__0_7__)__3_6__0__-_6_0__8__3_____________________________ APPLICANT INFORMATION Applicant Name (Head of Household): Address: Social Security Number: Date of Birth: [ ] Male [ ] Female [ ] Decline Applicant Phone #: Applicant Email: Alternate Phone #: Alternate Email: Emergency Contact: List All Other Household Members First MI Last Relationship to Head Date of Birth Male/Female/ Decline to Answer Social Security Number [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline Primary Language: Do you require an interpreter? [ ] Yes [ ] No How did you hear about this housing? [ ] Online [ ] Newspaper [ ] Local Agency [ ] Drive By [ ] Resident Referral [ ] Other What is the combined gross monthly income of all household members? $ ADDITIONAL HOUSEHOLD MEMBERS CURRENT HOUSING STATUS How long have you lived at your current address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: Do all adult household members live at this address?........................................................................................................................ [ ] Yes [ ] No If NO, include additional adult household’s current address and contact information on a separate piece of paper. PREVIOUS HOUSING STATUS Your previous address: How long did you live at your previous address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: List every state in which each household member has lived: ELIGIBILITY INFORMATION
PLEASE READ CAREFULLY THIS AGREEMENT INCLUDES A RELEASE OF ALL KNOWN AND UNKNOWN CLAIMS.
Happen After We Receive Your Letter When we receive your letter, we must do two things:
Copayments Effective January 1, 2019, the State Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist. Diagnostic/Preventive 100% 50% after deductible Fillings 80% after deductible 50% after deductible Endodontics 80% after deductible 50% after deductible Periodontics 80% after deductible 50% after deductible Oral Surgery 80% after deductible 50% after deductible Crowns 80% after deductible 50% after deductible Implants 80% after deductible 50% after deductible Prosthetics 80% after deductible 50% after deductible Prosthetic Repairs 80% after deductible 50% after deductible Orthodontics 80% after deductible 50% after deductible
REIMBURSEMENT FOR MILEAGE AND INSURANCE 1. An employee who is required by their employer to use their private vehicle for school district related purposes shall receive reimbursement of: Effective July 1, 2019 $ 0.56 c/Km Effective July 1, 2020 $ 0.57 c/Km Effective July 1, 2021 $ 0.58 c/Km 2. The mileage reimbursement rate established in Article B.10.1 shall be increased by 5 cents/kilometer for travel that is approved and required on unpaved roads. 3. The employer shall reimburse an employee who is required to use their personal vehicle for school district purposes, the difference in premium costs between ICBC rate Class 002 (Pleasure to/from Work) and ICBC rate Class 007 (Business Class) where the employee is required to purchase additional insurance in order to comply with ICBC regulations respecting the use of one’s personal vehicle for business purposes.
Minimum scope of coverage Commercial general coverage shall be at least as broad as Insurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11/88) or Insurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and Insurance Services Office form number GL 0404 covering Broad Form Comprehensive General Liability. Automobile coverage shall be at least as broad as Insurance Services Office Automobile Liability form CA 0001 (ed. 12/90) Code 1 (“any auto”). No endorsement shall be attached limiting the coverage.
Volunteer Peer Assistants 1. Up to eight (8)
What Will Happen After We Receive Your Letter When we receive your letter, we must do two things:
Education - Asthma This plan covers asthma education services when the services are prescribed by a
