AUTHORIZING SIGNATURES The following authorizing signatures are attached: U.S. DEPARTMENT OF THE INTERIOR A. Bureau of Land Management B. U.S. Fish and Wildlife Service C. U.S. Geological Survey
Participant Signature Ratification, Acceptance(A), Approval(AA), Accession(a)
No Signature Required When any payment or other online Service generates items to be charged to your account, you agree that we may debit your Bill Payment account without requiring your signature on the item, and without prior notice to you.
AUTHORIZING SIGNATURES (cont I. Office of the Assistant Secretary of Defense (Energy, Installations, and Environment) DALSIMER.ALLYN. Digitally signed by XXXXXXXX.XXXXX.XXX.1284843602 DN: c=US, o=U.S. Government, ou=DoD, XXX.1284843602 ou=PKI, ou=OTHER, cn=DALSIMER.XXXXX.XXX.1284843602 Date: 2016.08.11 11:15:51 -04'00' Xxxxxx X. Xxxxxxxx Date Director, DoD Natural Resources Program 8‐26‐16
Logo and Other Company Marks No response If you desire, please upload your company logo to be added to your individual profile page on the TIPS website. If any particular specifications are required for use of your company logo, please upload that information under the Supplementary section or another non-required section under the “Response Attachment” tab. Preferred Logo Format: 300 x 225 px - .png, .eps, .jpeg preferred Conflict of Interest Form CIQ- ONLY REQUIRED IF A CONFLICT EXISTS PER THE INSTRUCTIONS ONLY REQUIRED IF A CONFLICT EXISTS PER THE INSTRUCTIONS TIPCIQ.pdf Conflict of Interest Form for Vendors that are required to submit the form. The Conflict of Interest Form is included in the Base documents or can be found at xxxxx://xxx.xxxx-xxx.xxx/assets/documents/docs/CIQ.pdf. Certificate of Corporate Offerer - COMPLETE ONLY IF OFFERER IS A CORPORATION CORPORATEOFFERER.pdf COMPLETE AND UPLOAD FORM IN ATTACHMENTS SECTION ONLY IF OFFERER IS A CORPORATION Disclosure of Lobbying Activities Standard Form LLL LOBBYING.pdf ONLY IF you answered "I HAVE Lobbied per above" to attribute #66, please download and complete and upload the Standard Form-LLL, “disclosure Form to Report Lobbying,” in the Response attachments section. Confidentiality Form RCF.pdf REQUIRED CONFIDENTIALITY FORM. Complete the form according to your company requirements, make any desired attachments and upload to the appropriate section under "Response Attachments" THIS FORM DETERMINES HOW ESC8/TIPS RESPONDS TO LEGAL PUBLIC INFORMATION REQUESTS. Current W-9 Tax Form W-9 SIGNED COPY 2020 (003).pdf You are required by TIPS to upload a current W-9 Internal Revenue Service (IRS) Tax Form for your entity. This form will be utilized by TIPS to properly identify your entity. Additionally, if not designated “Confidential” in your proposal response, this W-9 may be accessed by TIPS Members for the purpose of making TIPS purchases from you in the event that you are awarded. If you wish to designate your required W-9 confidential, please do so according to the terms of the Confidentiality Claim Form which is an attachment to this solicitation. Bid Attributes Yes - No Disadvantaged/Minority/Women Business Enterprise - D/M/WBE (Required by some participating governmental entities) Vendor certifies that their firm is a D/M/WBE? Vendor must upload proof of certification to the ”Response Attachments” D/M/WBE CERTIFICATES section. NO Yes - No Historically Underutilized Business - HUB (Required by some participating governmental entities) Vendor certifies that their firm is a HUB as defined by the State of Texas at xxxxx://xxxxxxxxxxx.xxxxx.xxx/purchasing/vendor/hub/ or in a HUBZone as defined by the US Small Business Administration at xxxxx://xxx.xxx.xxx/offices/headquarters/ohp Proof of one or both may be submitted. Vendor must upload proof of certification to the “Response Attachments” HUB CERTIFICATES section. 2 No Yes - No The Vendor can provide services and/or products to all 50 US States? No
Contract Signature If the Original Form of Contract is not returned to the Contract Officer (as identified in Section 4) duly completed, signed and dated on behalf of the Supplier within 30 days of the date of signature on behalf of DFID, DFID will be entitled, at its sole discretion, to declare this Contract void. No payment will be made to the Supplier under this Contract until a copy of the Form of Contract, signed on behalf of the Supplier, is returned to the Contract Officer.
Consent to Electronic Delivery You agree that we may deliver all notices, tax reports and other documents and information to you by email or another electronic delivery method we choose. You agree to tell us right away if you change your email address or home mailing address so we can send information to the new address.
Counterpart Signatures For the purpose of facilitating the recordation of this Agreement as herein provided and for other purposes, this Agreement may be executed simultaneously in any number of counterparts, each of which counterparts shall be deemed to be an original, and such counterparts shall constitute but one and the same instrument.
Counterpart Signature This Agreement may be signed in counterpart, and the signed copies will, when attached, constitute an original Agreement.
Agreement to Use Electronic Signatures I agree, and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract to the State of Indiana. I understand that my signing and submitting this Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Contract and this affirmation. I understand and agree that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Contract will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xx00.xxxx.xx.xxx/psp/pa91prd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST In Witness Whereof, Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: By: Title: Title: Date: Date: Electronically Approved by: Department of Administration By: (for) Xxxxxx X. Xxxxx, Commissioner Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved by: State Budget Agency By: (for) Xxxxx X.Xxxxxx, Director Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx., Attorney General Refer to Electronic Approval History found after the final page of the Executed Contract for details.
