COMPENSATION CERTIFICATION Labor Code Section 3700 in relevant part provides: Every employer except the State shall secure the payment of compensation in one or more of the following ways: • By being insured against liability to pay compensation by one or more insurers duly authorized to write compensation insurance in this State. • By securing from the Director of Industrial Relations a certificate of consent to self-insure, which may be given upon furnishing satisfactory proof to the Director of Industrial Relations of ability to self-insure and to pay any compensation that may become due to its employees. I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the Work of this Contract. Date: Name of Consultant: Signature: Print Name and Title: (In accordance with Article 5 – commencing at Section 1860, Chapter 1, part 7, Division 2 of the Labor Code, the above certificate must be signed and filed with the District prior to performing any Work under this Contract.)
Employee Certification Employee hereby certifies that he has had an adequate opportunity to review, and understands all the terms and conditions of, this Agreement.
Lodgement of SWS wage assessment agreement C.6.1 All SWS wage assessment agreements under the conditions of this schedule, including the appropriate percentage of the relevant minimum wage to be paid to the employee, must be lodged by the employer with Fair Work Australia.
Instructions for Certification - Lower Tier Participants (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200)
Instructions for Certification – First Tier Participants a. By signing and submitting this proposal, the prospective first tier participant is providing the certification set out below.
Owner Certification During the term of this Contract, the Owner certifies that:
Cost Certification Redeveloper shall submit authentic documentation to the City on approved forms or format for payment of any expenses related to construction of the eligible Redeveloper Priority Expenses. Redeveloper shall timely submit receipts, invoices, or proof of payment concurrently with the request for reimbursement of eligible Redeveloper Priority Expenses. The City shall approve or reject the request for reimbursement with reasons stated, based on the review within ten (10) business days of receipt of the same. The foregoing notwithstanding, the City reserves the right during said ten (10) day period to request additional information and documentation related to a request for reimbursement from Redeveloper, and such a request by the City shall have the effect of restarting the ten (10) day period upon receipt of all requested information. Failure of the City to reject the request for reimbursement within said ten
Resume Self-Certification Form When submitting a response to an RFQ the Contractor shall submit with its response a completed and signed Resume Self-Certification Form (Contract Exhibit F) to the Customer for each proposed Staff member identified in the RFQ response.
Contractor’s Federal Employment Verification Certification The Contractor is registered with, authorized to use, is using and will continue to use, the federal work authorization program throughout the term of the contract, and holds the following authorization: User Identification Number: Date of Authorization: Date WITNESSETH, that the Contractor and the Owner, for the consideration set forth herein, the adequacy and sufficiency of which is hereby acknowledged by each party, agree as follows:
Management Certifications In addition to the responsibilities set forth in this CIA for all Covered Persons, certain employees for the U.S. Healthcare Supply DMEPOS Companies (Certifying Employees) are expected to monitor and oversee activities within their areas of authority and shall annually certify that the applicable department for the U.S. Healthcare Supply DMEPOS Companies is in compliance with applicable Federal health care program requirements and the obligations of this CIA. These Certifying Employees shall include, at a minimum, the following individuals at U.S. Healthcare Supply, LLC, Spectrum Diabetic Services, LLC, Heritage Diabetic Supply, Inc, and Dependable Diabetic Supply, LLC: any Covered Person with the title and job responsibilities of Chief Executive Officer, President, Compliance Officer, Chief Operating Officer, Chief Financial Officer, director, or manager. For each Reporting Period, each Certifying Employee shall sign a certification that states: “I have been trained on and understand the compliance requirements and responsibilities as they relate to [insert name of department], an area under my supervision. My job responsibilities include ensuring compliance with regard to the [insert name of department] with all applicable Federal health care program requirements, obligations of the Corporate Integrity Agreement, and [insert name of applicable entity] policies, and I have taken steps to promote such compliance. To the best of my knowledge, the [insert name of department] of [insert name of applicable entity] is in compliance with all applicable Federal health care program requirements and the obligations of the Corporate Integrity Agreement. I understand that this certification is being provided to and relied upon by the United States.” If any Certifying Employee is unable to provide such a certification, the Certifying Employee shall provide a written explanation of the reasons why he or she is unable to provide the certification outlined above. Within 90 days after the Effective Date, the U.S. Healthcare Supply DMEPOS Companies shall develop and implement a written process for Certifying Employees to follow for the purpose of completing the certification required by this section (e.g., reports that must be reviewed, assessments that must be completed, sub-certifications that must be obtained, etc. prior to the Certifying Employee making the required certification).
