SIGNATURES AND APPROVAL. Contractor
SIGNATURES AND APPROVAL. The Contractor IS or IS NOT a Business Associate under the Health Insurance Portability and
SIGNATURES AND APPROVAL. For employee: By signing below I, [Insert employee name], fully understand the terms of employment as described to me regarding a flexible work schedule: attendance, leave, overtime, work location, and termination of agreement.
SIGNATURES AND APPROVAL. Employee: Date:
SIGNATURES AND APPROVAL. The Contractor 🞏 IS or 🗷 IS NOT CURRENTLY a Business Associate under the Health Insurance Portability and Accountability act of 1996, as amended. Mount Sinai Genomics, Inc. By: Name: Xxxx Xxxxxx, CFO 5/20/2020 Date: By: Xxxxx Xxxxx Comptroller of the State of Connecticut 5/20/2020 Date: By: Xxxxxx Xxxxx Date: 5/21/2020 DocuSign Envelope ID: ECA2080F-F2BD-440A-B380-0243D9E67ACE Sema4 agrees to provide the following Services to the State:
SIGNATURES AND APPROVAL. Please ensure the signatories have appropriate delegation to authorise this request (e.g. data custodian, executive/Chief Executive or Minister).
1. Agency/Department/Entity Data Custodian Phone number Email Physical address Data recipient/data provider/both Signature Date
2. Agency/Department/Entity Data Custodian Phone number Email Physical address Data recipient/data provider/both Signature Date
3. Agency/Department/Entity
SIGNATURES AND APPROVAL. Please ensure the signatories have appropriate delegation to authorise this request (e.g. data custodian, executive/Chief Executive or Minister).
1. Agency/Department/Entity
2. Agency/Department/Entity Email
3. Agency/Department/Entity
SIGNATURES AND APPROVAL. CONTRACTOR
SIGNATURES AND APPROVAL. Employee: Date: Manager: Date: HR Professional: _ Date:
