SIGNATURES AND APPROVAL. Contractor Contractor (Corporate/Legal Name of Contractor) Signature (Authorized Official) Date Typed/Printed Name and Title (Authorized Official) Agency Agency Name Signature (Authorized Official) Date Typed/Printed Name and Title (Authorized Official) Office of the Connecticut Attorney General (Approved as to form) [select the one that is applicable; remove section that does not apply and the word “OR”] Part I of this Contract having been reviewed and approved, as to form, by the Connecticut Attorney General, it is exempt from review pursuant a Memorandum of Agreement between the Agency and the Connecticut Attorney General dated [Enter Date], as may be amended from time to time. OR Signature Date
SIGNATURES AND APPROVAL. Please ensure the signatories have appropriate delegation to authorise this request (e.g. data custodian, executive/Chief Executive or Minister).
SIGNATURES AND APPROVAL. Employee: Date: Supervisor: Date: Department Head: Date: Department Head Name Printed: HR & Payroll Review: _ Date: Original signed document to be filed in Human Resources and Payroll Office. The employee and supervisor must keep copies. Flexible Work Agreements must be, at a minimum, reviewed annually with a new signed agreement submitted to HR & Payroll. New agreement Renewal. Start date of last agreement:
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. For employee, supervisor, and Vice President: By signing below, we agree to abide by the terms and conditions of this agreement. Employee Signature Date _ Supervisor Signature Date Divisional Vice President 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: Office of the State Comptroller By: Xxxxx Xxxxx Comptroller of the State of Connecticut 5/20/2020 Date: Connecticut Attorney General (Approved as to form) By: Xxxxxx Xxxxx Date: 5/21/2020 DocuSign Envelope ID: ECA2080F-F2BD-440A-B380-0243D9E67ACE EXHIBIT A SCOPE OF SERVICES Sema4 agrees to provide the following Services to the State:
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. Quest Diagnostics, LLC By: Xxxxxxxxxxx Xxxxxxxxx, Ph.D. Vice President and General Manager 5/29/2020 Date: Office of the State Comptroller By: Xxxxx Xxxxx Comptroller of the State of Connecticut 5/29/2020 Date: Connecticut Attorney General (Approved as to form) By: Xxxxxx Xxxxx 6/1/2020 Date: DocuSign Envelope ID: E287E3B9-1F78-4C42-B20B-404876BB92AA EXHIBIT A
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. Xxxxxxx Hospital By: Xxxxxxx Xxxxxxx President/CEO 7/31/2020 Date: Office of the State Comptroller By: Xxxxx Xxxxx Comptroller of the State of Connecticut 7/31/2020 Date: Connecticut Attorney General (Approved as to form) By: Xxxxxx Xxxxx Xxxxxx Xxxxx, Asst. Dep. A.G. Digitally signed by Xxxxxx Xxxxx, Asst. Dep. A.G. Date: 2020.07.31 17:12:20 -04'00' Date: EXHIBIT A
SIGNATURES AND APPROVAL. CONTRACTOR Signature (Authorized Official) CONNECTICUT STATE BOARD OF EDUCATION Date Signature (Authorized Official) OFFICE OF THE ATTORNEY GENERAL (Approved as to form) Date Signature Date
SIGNATURES AND APPROVAL. Employee: Date: Manager: Date: HR Professional: _ Date:
