Monitor Name
Monitor Name Sample Clauses
Related to Monitor Name
Contractor Name Business License #: Address: City, State, Zip Code: Telephone: Facsimile: Email: * If you are an independent contractor you are required to obtain a business license with the City of Thousand Oaks. Contractor certifies under penalty of perjury that Contractor is a Sole Proprietor Corporation Limited Liability Company Partnership Nonprofit Corporation Other [describe: ]
Project Name Register ASIC
Xxxxxxxx’s Physical Address In addition to the designated Notice Address, Borrower will provide Lender with the address where Xxxxxxxx physically resides, if different from the Property Address, and notify Lender whenever this address changes.
Print Name Designation ...................................
Secondary Contact Name Please identify the individual who will be secondarily responsible for all TIPS matters and inquiries for the duration of the contract. Xxxxx Xxxxx Secondary Contact Title Secondary Contact Title VP Service Secondary Contact Email Please enter a valid email address that will definitely reach the Secondary Contact. xxxxxx@xxxxxxxxxxxxxxxxxxxx.xxx Secondary Contact Phone Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). Please provide the accurate and current phone number where the individual who will be secondarily responsible for all TIPS matters and inquiries for the duration of the contract can be reached directly. 0000000000 Secondary Contact Fax Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 1 0000000000 Secondary Contact Mobile Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 1 7 2812172425 Administration Fee Contact Name Please identify the individual who will be responsible for all payment, accounting, and other matters related to Vendor's TIPS Administration Fee due to TIPS for the duration of the contract. Xxxxx Xxxx Administration Fee Contact Email Please enter a valid email address that will definitely reach the Administration Fee Contact. 9 xxxxx@xxxxxxxxxxxxxxxxxxxx.xxx Administration Fee Contact Phone Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 2 0 7139802880
CONTRACT NAME The name of this contract is Prepaid Mental Health Plan - Four Corners Community Behavioral Health Inc.
COMPANY NAME The Members may change the name of the Company or operate under different names, provided a majority of the Members agree and the name complies with Section 00-00-000 of the Act.
Customer Service A. PRIMARY ACCOUNT REPRESENTATIVE. Supplier will assign an Account Representative to Sourcewell for this Contract and must provide prompt notice to Sourcewell if that person is changed. The Account Representative will be responsible for: • Maintenance and management of this Contract; • Timely response to all Sourcewell and Participating Entity inquiries; and • Business reviews to Sourcewell and Participating Entities, if applicable.
CONTRACTOR NAME CHANGE An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment.
Account Manager A designated Account Manager for the Centralized Contract shall be provided. The Account Manager is responsible for the overall relationship with the State during the course of the Contract and shall act as the central point of contact. Billing Contact A designated Billing Contact for the Centralized Contract shall be provided. The Billing Contact will become the single point of contact between the Contractor and the Authorized User for matters related to invoicing, billing and payment. Emergency Contact Not a complete sentence. A designated Emergency Contact for the Centralized Contract shall be provided. The Emergency Contact will be available 24 hours a day, 365 days per year for emergency procurements.
