PROVIDER ELIGIBILTY. The Provider agrees to the provisions of 7 AAC 81, Grant Services for Individuals (Appendix A), as well as all other applicable state and federal law; and declares and represents that it meets the eligibility requirements for a Service Provider for this Agreement. With the signed Agreement, the Provider must submit the following documentation: A. Proof of a Federal Tax Identification/Employer Identification Number (EIN); B. A current State of Alaska Business License; C. Alaska Native entities1 entering into a Provider Agreement with DHSS must provide a waiver of immunity from suit for claims arising out of activities of the Provider related to this Agreement using Appendix D. By submission of the signed Agreement, the Provider further agrees that they will comply with the following:
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
PROVIDER ELIGIBILTY. The Provider agrees to the provisions of 7 AAC 81, Grant Services for Individuals (Appendix A), as well as all other applicable state and federal law; and declares and represents that it meets the eligibility requirements for a Service Provider for this Agreement. With the signed Agreement, the Provider must submit the following documentation:
A. Proof of a Federal Tax Identification/Employer Identification Number (EIN);
B. A current State of Alaska Business License;
C. Alaska Native entities1 entering into a Provider Agreement with DHSS must provide a waiver of immunity from suit for claims arising out of activities of the Provider related to this Agreement using Appendix D. By submission of the signed Agreement, the Provider further agrees that they will comply with the following:
A. The provisions of Appendix C, Privacy & Security Procedures.
Appears in 1 contract
Samples: Provider Agreement
PROVIDER ELIGIBILTY. The Provider agrees to the provisions of 7 AAC 81, Grant Services for Individuals (Appendix A), as well as all other applicable state and federal law; and declares and represents that it meets the eligibility requirements for a Service Provider for this Agreement. With the signed Agreement, the Provider must submit the following documentation:
A. Proof of a Federal Tax Identification/Employer Identification Number (EIN);
B. A current State of Alaska Business License;
C. Alaska Native entities1 entering into a Provider Agreement with DHSS must provide a waiver of immunity from suit for claims arising out of activities of the Provider related to this Agreement using Appendix D.
D. By submission Proof of the signed Applicable Certificates of Insurance identified in Section Section IX (B) of this Provider Agreement, the Provider further agrees that they will comply with the following:
Appears in 1 contract
Samples: Provider Agreement
