Special Certification. The individual or officer signing this agreement certifies by his or her signature that he or she is authorized to sign this agreement on behalf of the responsible governing board, official or Grantee.
Special Certification. The individuals signing this agreement certify by their signatures that they are authorized to sign this agreement on behalf of the organization specified.
Special Certification. The individual or officer signing this Agreement certifies by his or her signature that he or she is authorized to sign this Agreement on behalf of the responsible governing board, official, or contractor. PROVIDER further acknowledges that they have reviewed MSHN's MSHN-SUDSP MANUAL. MSHN By: Its: Chief Executive Officer Printed Name:_Xxxxxx Xxxxxxx Date: «PROVIDER» By: Its: Printed Name:_ Date: ATTACHMENT A: STATEMENT OF WORK
Special Certification. The individuals signing this agreement certify by their signatures that they are authorized to sign this agreement on behalf of the organization specified. Signature Section: For the Michigan Department of Health and Human Services Xxxxxxxxx X. Xxxxxxx, Director Date Bureau of Grants & Purchasing For the CONTRACTOR: Name (print) Title (print) Signature Date
Special Certification. The Vendor, through signature of the owner or an authorized representative, accepts all terms of this contract. The individuals signing this contract certify that they are authorized to sign the contract on behalf of the Vendor and the Department, respectively, and that all information provided on the Vendor application is true, accurate and complete. This contract becomes valid only upon signature by an authorized representative of the Department.
Special Certification. The individual or officer signing this Agreement certifies by his or her signature that he or she is authorized to sign this Agreement on behalf of the responsible governing board, official, or contractor. PROVIDER further acknowledges that they have reviewed MSHN's MSHN-SUDSP MANUAL. «PROVIDER» MSHN By: By: Its: Its: Chief Executive Officer Printed Name:_ Printed Name:_Xxxxxx Xxxxxxx Date: Date: Witness By: Its: Witness By: Its: MSHN Contract Manager Printed Name:_ Printed Name:_ Xxxx Xxxxxxxx Date: Date: ATTACHMENT A: STATEMENT OF WORK
Special Certification. The individual or officer signing this agreement certifies by his or her signature that he or she is authorized to sign this agreement on behalf of the responsible governing board, official or Grantee. Signature Section: For the GRANTEE Name (Please print) Title Signature Date For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Xxx Xxxxxxx, Director, Bureau of Budget and Purchasing Date Date Part II
Special Certification. (Phase One)/Chief Executive Officer Leadership Development Program (CEOLDP), (Phase Two). In addition to the base salary, as permitted by section 1001.50(4), Florida Statues, the SUPERINTENDENT shall receive an annual performance salary incentive from the BOARD in the amount as provided for elected SUPERINTENDENTs, pursuant to sections 1001.47(4) and (5), Florida Statues. Upon completion of Phase One of the Special Certification Program, the SUPERINTENDENT shall be entitled to an additional $2000.00 per year. If the Certification is earned during a calendar year, the increase shall be prorated from the date the certification is received to June 30th of that initial year. Upon the successful completion of Phase Two of the Chief Executive Officer Leadership Development Program, the SUPERINTENDENT shall be compensated in accordance with Florida Statues 1001.47(5)(b) where he shall be paid a salary incentive of not less than $3000.00 nor more than $7,500.00 based upon his performance evaluation as determined by the Florida Association of District School SUPERINTENDENTs. After the SUPERINTENDENT is initially certified he must complete an annual renewal process, led by the FADSS leadership team to maintain certification and meet the yearly requirement of the CEOLDP. Completion of the annual certification renewal shall constitute eligibility for the award of the yearly salary incentive.
Special Certification. The individual or officer signing this 2019 Participation Agreement, effective January 1, 2019 through December 31, 2019, certifies by his or her signature that he or she is authorized to sign this agreement on behalf of the Participating Practices, responsible governing board, official and/or contractor(s), and agrees to abide by the specific responsibilities outlined herein. SIGNATURE SECTION For the Michigan Department of Health and Human Services: Name Title Signature Date «PO_NAME» Name Title Signature Date APPENDIX A PCMH INITIATIVE PAYMENT MODEL The PCMH Initiative payment model is designed to provide financial support to Initiative participants to enable the development and ongoing advancement of patient-centered care. PCMH Initiative participants simultaneously selected by CMS to participate in the Comprehensive Primary Care Plus (CPC+) program will receive payment from Medicare according to the CPC+ payment model. PCMH Initiative participants not participating in CPC+ will bill Medicare for applicable services according to the Medicare Physician Fee Schedule. PCMH Initiative payments from Medicaid Health Plans will be made according to the model below.
Special Certification. The individual or officer signing this amendment certifies by his or her signature that he or she is authorized to sign this amendment on behalf of the responsible governing board, official or contractor. Signature Section For the Michigan Department of Community Health Xxxx Xxxx Xxxxxxx, Deputy Director Date Operations Administration For the CONTRACTOR: Name (print) Title (print) Signature Date Medicaid Managed Specialty Supports and Services Concurrent 1915(b)/(c) Waiver Program FY 10 Amendment No. 2
