Signatures and Certifications. The information contained in this evaluation form represents, to the best of my knowledge, a true and accurate analysis of the Contractor’s performance record on this Contract; and,
Signatures and Certifications. By signing below, under penalties of perjury, I certify that: 1) The number shown on this form is my correct taxpayer identification number, and 2) I am not subject to back up withholding because; (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, 3) I am a U.S. person (including a U.S. resident alien), and 4) I am exempt from FATCA reporting. I further acknowledge that I have the sole responsibility for my investment choices and that I have received and read a current prospectus for the Xxxxxxxx Funds. I release the Fund and their agents and representatives from all liability and agree to indemnify them from any and all losses, damages or costs for acting in good faith in accordance with instructions, including telephone instructions, believed to be genuine. I certify that I have the authority to establish this account and the information provided herein is accurate and complete. I agree to notify the Xxxxxxxx Funds promptly in writing if any information contained in this application changes. If I have indicated a Traditional IRA Rollover or Direct Rollover above, I certify that, if the distribution is from another Traditional IRA, that I have not made another rollover within the one-year period immediately preceding this rollover; that such distribution was received within 60 days of making the rollover to this Account; and that no portion of the amount rolled over is a required minimum distribution under the required distribution rules or a hardship distribution from an employer qualified plan or 403(b) arrangement or eligible 457 plan. If I have indicated a Conversion, Transfer or a Rollover of an existing Traditional IRA to a Xxxx XXX, I acknowledge that the amount converted will be treated as taxable income (except for any prior nondeductible contributions) for federal income tax purposes, and certify that no portion of the amount converted, transferred or rolled over is a required minimum distribution under applicable rules. If I have elected to convert an existing Traditional IRA with Constellation Trust Company as custodian to a Xxxx XXX and have elected no withholding, I understand that I may be required to pay estimated tax and that insufficient payments of estimated tax may result in penalties. If I have in...
Signatures and Certifications. SIGNATURES – The application must be signed in ink by: CERTIFICATION – Each person whose signature is required must appear before and establish identification to the satisfaction of an authorized certifying individual. The signatures to the form must be signed in the certifying individual’s presence. The certifying individual must affix the seal or stamp which is used when certifying requests for payment. Authorized certifying individuals are available at most banking institutions, including credit unions. Certification by a notary isn’t acceptable. Examples of acceptable seals and stamps:
Signatures and Certifications. I, __________________ FURTHER AGREE AND CERTIFY THAT [initial each]: I HAVE CAREFULLY READ THIS ENTIRE DOCUMENT I HAD AT LEAST 21 3 DAYS WITHIN WHICH TO CONSIDER THIS AGREEMENT BEFORE SIGNING IT I HAD AN ADEQUATE OPPORTUNITY TO CONSULT WITH AN ATTORNEY OF MY CHOICE PRIOR TO SIGNING THIS AGREEMENT THE CITY HAS PROVIDED NO INFORMATION CONCERNING POSSIBLE TAX CONSEQUENCES OF THIS AGREEMENT AND RELEASE OF PAYMENTS THEREUNDER I INTELLIGENTLY, KNOWINGLY AND VOLUNTARILY AGREE TO THE TERMS OF THIS AGREEMENT AND RELEASE I AM SIGNING THIS AGREEMENT AND RELEASE VOLUNTARILY AND WITH THE FULL INTENT OF RELEASING THE CITY FROM ALL CLAIMS RELATING TO, OR ARISING OUT OF, MY EMPLOYMENT WITH THE CITY OF PORTLAND. I UNDERSTAND THAT IF I EVER ASSERT ANY CLAIM AGAINST THE CITY ARISING OUT OF MY EMPLOYMENT WITH THE CITY THAT EXISTED OR OCCURRED BEFORE THE EFFECTIVE DATE OF THIS AGREEMENT, THIS AGREEMENT MAY BE PLEADED AS AN ABSOLUTE DEFENSE TO THE CLAIM. I UNDERSTAND THIS AGREEMENT COVERS NOT ONLY KNOWN LOSSES AND DAMAGES, BUT ANY FURTHER LOSSES, DAMAGES AND CONSEQUENCES RESULTING FROM MY CITY EMPLOYMENT EVEN IF THEY ARE NOT NOW KNOWN, ANTICIPATED, DEVELOPED OR DISCOVERED. NO ONE HAS MADE ANY PROMISE OR REPRESENTATION TO INDUCE ME TO SIGN THIS AGREEMENT THAT IS NOT CONTAINED IN THIS AGREEMENT. I HAVE NOT RELIED ON ANY PROMISE OR REPRESENTATION THAT IS NOT CONTAINED IN THIS AGREEMENT IN DECIDING TO SIGN THIS AGREEMENT.
Signatures and Certifications. The Qualified Issuer covenants and agrees that the Qualified Issuer Application, Guarantee Application, Bond Documents, Bond Loan Documents, certificates, reports, notices, communications, and financial statements required under this Agreement to Guarantee shall be signed and certified as correct by the Authorized Representative(s) of the Qualified Issuer.
Signatures and Certifications. 23 Section 6.10. Amendments and Waivers to Bond Documents and Bond Loan Documents 23
Signatures and Certifications. A. AUDIT CERTIFICATION: As the Network Provider, we expect to expend less than $750,000 from all Federal Financial Assistance sources including commodities, during our fiscal year. Therefore, we are not subject to the audit requirements of 2 CFR 200 and do not need to submit our audited financial statements to DHHS. C-22-0689 As the Network Provider, we expect to expend $750,000 or more from all Federal Financial Assistance sources, including commodities in our current fiscal year. Therefore, we are subject to the single audit requirements of 2CFR 200. If this information changes, and Network Provider is subject to a Single Audit or no longer subjected to a Single Audit, Network Provider shall notify the Region immediately.
B. EXECUTIVE COMPENSATION REPORTING REQUIREMENT: At the time of execution of this Contract, Network Provider must notify DHHS, in writing, if it is required to report executive compensation pursuant to the Federal Funding Accountability and Transparency Act. Pub. L. 109- 282, as amended by section 6202 of Pub. L. 110-252, and associated regulations at 2 CFR §§ 170 et seq. This is required for Network Providers who receive more than $25,000,000 or more in annual gross revenue in federal contracts, subcontracts, awards or subawards, and meet the other regulatory criteria listed in those sections. If Network Provider meets these criteria, it must fill out an executive compensation disclosure attachment. Network Provider shall notify DHHS immediately if funding it receives changes such that it must report salaries under this requirement. As the Network Provider, we receive more than $25,000,000 or more in annual gross revenue in federal contracts, subcontracts, awards or subawards, and meet the other regulatory criteria listed in those sections. -or- As the Network Provider, we DO NOT receive more than $25,000,000 or more in annual gross revenue in federal contracts, subcontracts, awards or subawards, and meet the other regulatory criteria listed in those sections. Date Regional Administrator Date Regional Governing Board Representative REGIONAL BEHAVIORAL HEALTH AUTHORITY Date Director Board of Directors Date MENTAL HEALTH CRISIS CENTER IN WITNESS THEREOF, the parties have duly executed this agreement hereto, and each party acknowledges the receipt of a duly executed copy of this agreement with original signatures. DocuSign Envelope ID: 8D0D7CDD-7EE9-4579-ADC3-9D1309DD0059 July 1, 2022 FY23 Fee Schedules xxxxxxxxxxxxxxxxx@xxxxxx0xxxxxxx.xx...
Signatures and Certifications. By signing below, under penalties of perjury, I certify that: 1) The number shown on this form is my correct taxpayer identification number, and 2) I am not subject to back up withholding because; (a) I am exempt from backup withholding, or
Signatures and Certifications. SIGNATURES – The application must be signed in ink by: • All competent persons listed in Part C, Item 1, and Part D, Item 1. • The legal guardian or similar representative of the estate of any person under legal disability listed in Part C, Item 2, or Part D, Item 1; and • A parent on behalf of any minor listed in Part C, Item 1, or Part D, Item 1. CERTIFICATION – Each person whose signature is required must appear before and establish identification to the satisfaction of an authorized certifying individual. The signatures to the form must be signed in the certifying individual’s presence. The certifying individual must affix the seal or stamp which is used when certifying requests for payment. Authorized certifying individuals are available at most banking institutions, including credit unions. Certification by a notary isn’t acceptable. Examples of acceptable seals and stamps: • The financial institution’s official seal or stamp, including: Signature Guaranteed seal or stamp; Endorsement Guaranteed seal or stamp; Corporate seal or stamp (a corporate resolution isn’t required); or Issuing or paying agent seal or stamp (including name, location, and four-digit identification number or nine-digit routing number). • The seal or stamp of Treasury-recognized Signature Guarantee Programs or other Treasury-approved Medallion Programs.
Signatures and Certifications. To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, social security number/ Tax ID number and other information that will allow us to identify you. We may also ask to see other identifying documents. Until you provide the information or documents we need, we may not be able to open an account or effect any additional transactions for you. By signing below, under penalties of perjury, I certify that: 1) The number shown on this form is my correct taxpayer identification number, and 2) I am not subject to back up withholding because; (a) I am exempt from backup withholding, or
