SPECIAL AGREEMENTS The following special arrangements have been made: City, Date City, Date Seller's signature Buyer's signature
Payment Authorization I authorize Xxxxx Management to collect payment of the application fee and application deposit in the amounts specified under paragraph 3 of the Disclosures.
Settlement Authority The Recipient will not enter into a settlement of any Proceeding against any of the Indemnified Parties unless the Recipient has obtained from the Province or Canada, as applicable, prior written approval or a waiver of this requirement. If the Recipient is requested by the Province or Canada to participate in or conduct the defence of any Proceeding, the Province or Canada, as applicable, will cooperate with and assist the Recipient to the fullest extent possible in the Proceeding and any related settlement negotiations.
AGENT AUTHORIZATION FORM I/We, (Print Bidder name) , Do hereby authorize (print agent’s name), , to act as my/our agent to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, (IFB NUMBER AND TITLE) , and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Signature of Bidder Date STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) LEASED EMPLOYEE AFFIDAVIT I affirm that an employee leasing company provides my workers’ compensation coverage. I further understand that my contract with the employee leasing company limits my workers’ compensation coverage to enrolled worksite employees only. My leasing arrangement does not cover un-enrolled worksite employees, independent contractors, uninsured sub-contractors or casual labor exposure. I hereby certify that 100% of my workers are covered as worksite employees with the employee leasing company. I certify that I do not hire any casual or uninsured labor outside the employee leasing arrangement. I agree to notify the County in the event that I have any workers not covered by the employee leasing workers’ compensation policy. In the event that I have any workers not subject to the employee leasing arrangement, I agree to obtain a separate workers’ compensation policy to cover these workers. I further agree to provide the County with a certificate of insurance providing proof of workers’ compensation coverage prior to these workers entering any County jobsite. I further agree to notify the County if my employee leasing arrangement terminates with the employee leasing company and I understand that I am required to furnish proof of replacement workers’ compensation coverage prior to the termination of the employee leasing arrangement. I certify that I have workers’ compensation coverage for all of my workers through the employee leasing arrangement specified below: Name of Employee Leasing Company: Workers’ Compensation Carrier: A.M. Best Rating of Carrier: Inception Date of Leasing Arrangement: I further agree to notify the County in the event that I switch employee-leasing companies. I recognize that I have an obligation to supply an updated workers’ compensation certificate to the County that documents the change of carrier. Name of Contractor: Signature of Owner/Officer: Title: Date: INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY If the bidder is submitting as a joint venture, please be advised that this form MUST be completed and the REQUESTED written joint-venture agreement MUST be attached and submitted with this form. HOWEVER, IF THE BIDDER IS NOT A JOINT VENTURE, CHECK THE FOLLOWING BLOCK: ( ) NOT APPLICABLE
FINANCIAL AGREEMENT In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “I certify that I have received the catalog, School Performance Fact Sheet, and information regarding completion rates, placement rates, license examination passage rates, salary or wage information, and the most recent three-year cohort default rate, if applicable, included in the School Performance Fact sheet, and have signed, initialed, and dated the information provided in the School Performance Fact Sheet.” “I understand that this is a legally binding contract. My signature below certifies that I have read, understood, and agreed to my rights and responsibilities, and that the Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 THE TOTAL CHARGES THE STUDENT IS OBLIGATED TO PAY UPON ENROLLMENT: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED ON-TIME COMPLETION RATES (GRADUATION RATES) Includes data for the two calendar years prior to reporting. Calendar Year Number of Students Who Began the Program Students Available for Graduation Number of On- Time Graduates On-Time Completion Rate 2018 N/A N/A N/A N/A 2019 N/A N/A N/A N/A Students Initials: Date: Initial only after you have had enough time to read and understand the information Job Placement Rates (includes data for the two calendar years prior to reporting) Calendar Year Number of Students Number of Graduates Graduates Available for Employment Graduates Employed in the Field Placement Rate % Employed in the Field Who Began Program 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. Gainfully Employed Categories (includes data for the two calendar years prior to reporting) Part-Time vs. Full-Time Employment Calendar Year Graduate Employed in the Field 20-29 Hours Per Graduates Employed in the Field at Least 30 Hours Per Week Total Graduates Employed in the Field Week 2018 N/A N/A N/A 2019 N/A N/A N/A Single Position vs. Concurrent Aggregated Position Calendar Year Graduates Employed in the Field in a Single Graduates Employed in the Field in Concurrent Aggregated Positions Total Graduates Employed in the Field Position 2018 N/A N/A N/A 2019 N/A N/A N/A Self-Employed / Freelance Positions Calendar Year Graduates Employed who are Self- Employed or Working Freelance Total Graduates Employed in the Field 2018 N/A N/A 2019 N/A N/A Institutional Employment Calendar Year Graduates Employed in the Field whoare Employed by the Institution, anEmployer Owned by the Institution, or an Employer who Shares Ownership with the Institution. Total Graduates Employed in the Field 2018 N/A N/A 2019 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) Calendar Year Number of Graduates in Calendar Year Number of Graduates Taking Exam Number Who Passed First Available Exam Exam Number Who Failed First Available Exam Passage Rate 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. Salary and Wage Information (includes data for the two calendar years prior to reporting) Annual salary and wages reported for graduates employed in the field. Calendar Year Graduates Available for Employment Graduates Employed in Field $20,001 - $25,000 $35,001 - $40,000 $40,001 - $45,000 $45,001 - $50,000 No Salary Information Reported 2018 N/A N/A N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A N/A N/A A list of sources used to substantiate salary disclosures is available from the school Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information.
AGREEMENT AMENDMENTS This Agreement may be amended at any time by written instrument duly approved by the President or President's designee and accepted by Faculty Member; provided, however, no such written instrument shall be required for any increase in Faculty Member's salary or any improvement to the fringe benefits of Faculty Member's employment, or for promotion in rank, any of which may be accomplished at any time by official action of the Board of Regents of the University of Nebraska (Board) without the necessity for written modification or amendment of this Agreement. This Agreement and Appendix “A” attached hereto constitute the entire agreement between the parties. This Agreement supersedes all previous agreements between or among the parties. There are no agreements, representations or warranties between or among the parties other than those set forth in this Agreement or the documents and agreements referred to in this Agreement.
