Name of Grievant Building Assignment Date Filed Sample Clauses

Name of Grievant Building Assignment Date Filed. The date(s) on which the alleged violation, misinterpretation or misapplication of a provision(s) of the Agreement occurred:
Sample 1Sample 2
AutoNDA by SimpleDocs
Name of Grievant Building Assignment Date Filed. The date(s) on which the alleged violation, misinterpretation or misapplication of a provision(s) of the Agreement occurred: The provision(s) of the Agreement which has been violated, misinterpreted or misapplied: The facts on which the alleged grievance is based (Attach a separate sheet to this Grievance Form if a complete statement of the facts requires more space than is provided on this form): The remedy sought: Signature of Grievant Date I hereby acknowledge that this grievance was filed with me on the date set forth below: Signature of Principal or Immediate Supervisor Date Disposition of Principal or Immediate Supervisor Signature Date Signature of Grievant Date I hereby acknowledge that this grievance was filed with me on the date set forth below: Signature of Superintendent Date Disposition of Superintendent: Signature Date Signature of Grievant Date I hereby acknowledge that this grievance was filed with me on the date set forth below: Signature of Superintendent Date Disposition of STEP 4: Signature Date Huron-Erie School Employee Insurance Association MEDICAL Wellness Plan Benefit Period January 1st through December 31st Dependent Age Limit 26 Removal upon End of Month Blood Pint Deductible 0 pints Overall Annual Benefit Period Maximum Unlimited Wellness Plan Deductible – Single/Family1 $500 / $1,000 $500 / $1,000 High Deductible Health Plan – Single/Family1 $750 / $1,500 $750 / $1,500 Requirements for Wellness Plan (Deductible change occurs on calendar years basis) Complete Screening and/or Physician form and Health Assessment – November 1st. Complete Screening and/or Physician form and Health Assessment – November 1st. Coinsurance 90% 70% Coinsurance Out-of-Pocket Maximum (Excluding Deductible) – Single/Family $1,000 / $2,000 (Wellness) $750 / $1,500 (HDHP) $2,500 / $5,000 (Wellness) $2,250 / $4,500 (HDHP) Coinsurance Out-of-Pocket Maximum (Including Deductible) – Single/Family $1,500 / $3,000 (Wellness) $1,500 / $3,000 (HDHP) $3,000 / $6,000 (Wellness) $3,000 / $6,000 (HDHP) Office Visit (Illness/Injury)2 $25 copay, then 100% $25 copay, then 70% Specialist Office Visit2 $40 copay, then 100% $40 copay, then 70% Urgent Care Office Visit2 $40 copay, then 100% $40 copay, then 70% Preventive Services, in accordance with federal law6 100% 70% after deductible Routine Physical Exams2 100% $25 copay, then 70% Well Child Care Services including exam, Routine Vision, Routine Hearing Exams, Well Child Care Immunizations and Laboratory Tests (Birth to a...
Sample 1Sample 2
Name of Grievant Building Assignment Date Filed. The date(s) on which the alleged violation, misinterpretation or misapplication of a provision(s) of the Agreement occurred: The provision(s) of the Agreement which has been violated, misinterpreted or misapplied: The facts on which the alleged grievance is based (Attach a separate sheet to this Grievance Faun if a complete statement of the facts requires more space than is provided on this form): The remedy sought: Signature of Grievant Date I hereby acknowledge that this grievance was filed with me on the date set forth below: Signature of Principal or Immediate Supervisor Date Disposition of Principal or Immediate Supervisor Signature Date I hereby notify the Superintendent that this grievance is being appealed to STEP 3. The reason for the appeal is as follows: Signature of Grievant Date I hereby acknowledge that this grievance was filed with me on the date set forth below: Signature of Superintendent Date Disposition of Superintendent: I hereby notify the Superintendent that this grievance is being appealed to STEP 4. The reason for the appeal is as follows: Signature of Grievant Date I hereby acknowledge that this grievance was filed with me on the date set forth below: Signature of Superintendent Date Disposition of STEP 4:
Sample 1Sample 2

Related to Name of Grievant Building Assignment Date Filed

  • List of Operator’s Subprocessors [Box 26] [Box 27] [Box 28] [Box 29]

  • PREVAILING WAGE RATES - PUBLIC WORKS AND BUILDING SERVICES CONTRACTS If any portion of work being Bid is subject to the prevailing wage rate provisions of the Labor Law, the following shall apply:

  • CONTRACT EXHIBIT I PREFERRED PRICING AFFIDAVIT This preferred-pricing affidavit is entered into in accordance with section 216.0113, F.S., and as required by Contract No. 80101507-21-STC-ITSA (“Contract”) between (“Contractor”) and the Department of Management Services. As the person authorized by Contractor to sign this affidavit, I attest that the Contractor is in full compliance with the preferred-pricing clause of the Contract. Contractor’s Name: By: Signature Printed Name/Title Date: STATE OF COUNTY OF Sworn to (or affirmed) and subscribed before me this day of , by Vendor Name: FEIN# Vendor’s Authorized Representative Name and Title: Address: City, State, and Zip code: Phone Number: ( ) - E-mail: CORPORATE SEAL (IF APPLICABLE) (Print, Type, or Stamp Commissioned Name of Notary Public) [Check One] Personally Known OR Produced the following I.D.

  • FORMAT AND CONTENT FOR REGISTRY OPERATOR MONTHLY REPORTING Registry Operator shall provide one set of monthly reports per gTLD, using the API described in draft-­‐xxxxxx-­‐icann-­‐registry-­‐interfaces, see Specification 2, Part A, Section 9, reference 5, with the following content. ICANN may request in the future that the reports be delivered by other means and using other formats. ICANN will use reasonable commercial efforts to preserve the confidentiality of the information reported until three (3) months after the end of the month to which the reports relate. Unless set forth in this Specification 3, any reference to a specific time refers to Coordinated Universal Time (UTC). Monthly reports shall consist of data that reflects the state of the registry at the end of the month (UTC).

  • Attachment  C_ CONTRACT AFFIRMATIONS For purposes of these Contract Affirmations, HHS includes both the Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). System Agency refers to HHSC, DSHS, or both, that will be a party to this Contract. These Contract Affirmations apply to all Contractors and Grantees (referred to as “Contractor”) regardless of their business form (e.g., individual, partnership, corporation). By entering into this Contract, Contractor affirms, without exception, understands, and agrees to comply with the following items through the life of the Contract:

  • Drug-Free Workplace Certification As required by Executive Order No. 90-5 dated April 12, 1990, issued by the Governor of Indiana, the Company hereby covenants and agrees to make a good faith effort to provide and maintain a drug-free workplace at the Project Location. The Company will give written notice to the IEDC within ten (10) days after receiving actual notice that the Company, or an employee of the Company in the State of Indiana, has been convicted of a criminal drug violation occurring in the workplace. False certification or violation of this certification may result in sanctions including, but not limited to, suspension of payments under the Agreement, termination of the Agreement and/or debarment of contracting opportunities with the State for up to three (3) years. In addition to the provisions of the above paragraph, if the total amount set forth in the Agreement is in excess of $25,000.00, the Company agrees that it will provide a drug-free workplace by: A. Publishing and providing to all of its employees a statement notifying them that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Company’s workplace, and specifying the actions that will be taken against employees for violations of such prohibition;

  • Deed; Xxxx of Sale; Assignment To the extent required and permitted by applicable law, this Agreement shall also constitute a “deed,” “xxxx of sale” or “assignment” of the assets and interests referenced herein.

  • Project or Building Name and Signage Landlord shall have the right at any time to change the name of the Project or Building and to install, affix and maintain any and all signs on the exterior and on the interior of the Project or Building as Landlord may, in Landlord’s sole discretion, desire. Tenant shall not use the name of the Project or Building or use pictures or illustrations of the Project or Building in advertising or other publicity or for any purpose other than as the address of the business to be conducted by Tenant in the Premises, without the prior written consent of Landlord.

  • ASSIGNMENT/SUB-CONTRACTING The Contractor agrees that he will not sell, assign or transfer this Agreement or any part thereof or interest therein without the prior written consent of the Owner.

  • Assignment of Space It is understood by Exhibitor that space will be assigned to Exhibitor by Show Management at Show Management’s sole discretion. Notification of space assignment shall be mailed to Exhibitor. After assignment, space location may not be changed, transferred or canceled except on written request and with the subsequent written approval of Show Management. Space assignments may be revoked or changed by Show Management if Exhibitor fails to meet payment deadlines. The size and location of Exhibitor’s space may, at Show Management’s election, differ from show to show. Notwithstanding and aforementioned, Show Management reserves the right to relocate Exhibitor. Show Management will make every effort by phone, fax and mail to notify Exhibitor of such relocation. Show Management assumes no responsibility whatsoever for exhibitor’s goods, products or fixtures before, during or after the show. In assigning exhibit space, Show Management shall carefully consider and at its sole discretion weigh collectively such factors (NOTE--factors are not presented in priority order nor to be construed to be weighed or prioritize) as: A. The size of exhibit space requested versus the overall space available for allocation to eligible exhibitors; B. The need to accommodate and encourage the introduction of new products for the buyer’s benefit; C. The quality and creativity of the product displays; D. The continuity and length of an Exhibitor’s previous exhibit activity; E. The size and shape of the space need as it relates to the effective display of an applicant’s products for the convenience and benefit of the buyers; F. The Exhibitor’s commitment to aggressively promote buyer attendance both independently and in cooperation with Show Management; and G. The need to balance traffic and promote buyer activity in all exhibit areas.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!