Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract to the State of Indiana. I understand that my signing and submitting this Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Contract and this affirmation. I understand and agree that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Contract will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xx00.xxxx.xx.xxx/psp/pa91prd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST
Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract to the State of Indiana. I understand that my signing and submitting this Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Contract and this affirmation. I understand and agree that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Contract will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Databas e: xxxxx://xxxxxx.xx.xxx/apps/idoa/contractsearch/. By: By: Printed Name: Printed Name: Title: Date: Manager of Safety and Resources 1/5/2023 | 13:49 PST Title: Date: Chairman 1/10/2023 | 16:31 EST _ Electronically Approved by: Department of Administration By: (for) Xxxxxxx Xxxx xxxx, Commissioner Electronically Approved by: State Budget Agency By: (for) Xxxxxxx X. Xxxxxxx, Director Approved as to Form and Legality: Office of Attorney General Form approval has been granted by the Office of the Attorney General pursuant to IC 4-13-2-14.3(e) on April 4, 2022 FA 22- 20
Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract to the State of Indiana. I understand that my signing and submitting this Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Contract and this affirmation. I understand and agree that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Contract will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xx00.xxxx.xx.xxx/psp/pa91prd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST In Witness Whereof, Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] [Indiana Agency] By: By: Title: Title: Date: Date: Electronically Approved by: Department of Administration By: (for) Xxxxxx X. Xxxxx, Commissioner Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved by: State Budget Agency By: (for) Xxxxx X.Xxxxxx, Director Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx., Attorney General Refer to Electronic Approval History found after the final page of the Executed Contract for details.
Agreement to Use Electronic Signatures. By checking the “I accept the terms of service” check box you are electronically signing this E-Sign Agreement and the Terms of Use related to the Services. You specifically agree that any electronic signatures that you provide through this online process are valid and enforceable as your legal signature. You acknowledge that these electronic signatures will legally bind you to the terms and conditions contained in the E-Sign Agreement and Terms of Use documents just as if you had physically signed the same documents with a pen.
Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract to the State of Indiana. I understand that my signing and submitting this Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Contract and this affirmation. I understand and agree that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Contract will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xx.xxxx.xx.xxx/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_XXXXXXX.XX L Coordinated Care Corporation Indiana Family and Social Services Administration, d.b.a Managed Health Services Office of Medicaid Policy and Planning By: By: Title: CEO Title: Medicaid director Date: 2/9/2023 | 08:55 PST Date: 2/10/2023 | 12:23 EST Electronically Approved by: Indiana Office of Technology By: (for) Xxxxx X. Xxxxxx, Chief Information Officer Electronically Approved by: Department of Administration By: (for) Xxxxxxx Xxxx erda, Commissioner Electronically Approved by: State Budget Agency By: (for) Xxxxxxx X. Xxxxxxx, Director Electronically Approved as to Form and Legality by: Office of the Attorney General By: (for) Xxxxxxxx X. Xxxxxx, Attorney General 1.0 Background 30 2.0 Administrative Requirements 31 2.1 State Licensure and Compliance with Applicable Laws, Rules, and Regulations 31 2.2 National Committee for Quality Assurance (NCQA) Accreditation 31 2.3 Administrative and Organizational Structure 31 2.3.1 Staffing 32 2.3.2 Key Staff 32 2.3.3 Other Required Staff Positions 38 2.3.4 Suggested Staff Positions 39 2.3.5 Staff Training and Qualifications 40 2.3.6 Debarred Individuals 41 2.4 FSSA Meeting Requirements 42 2.5 Financial Stability 43 2.5.1 Solvency 43 2.5.2 Insurance Requirements 43 2.5.3 Reinsurance 43 2.5.4 Financial Accounting Requirements 45 2.5.5 Reporting Transactions with Parties of Interest 46 2.5.6 Medical Loss Ratio (MLR) 47 2.5.7 Reserved 48 2.6 Subcontracts 48 2.7 Confidentiality of Member Medical Records and Other Information 52 2.8 Internet Quorum (IQ) Inquiries 52 2.9 Material Change to Operations 52 2.10 Future Program G...
Agreement to Use Electronic Signatures. Process In Witness Whereof, the Grantee and the State have, through their duly authorized representatives, entered into this Grant Agreement. The parties, having read and understood the foregoing terms of this Grant Agreement, do by their respective signatures dated below agree to the terms thereof. In
Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract to the State of Indiana. I understand that my signing and submitting this Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Contract and this affirmation. I understand and agree that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Contract will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xx.xxxx.xx.xxx/psp/guest/SUPPLIER/ERP/c/SOI_CUSTOM_APPS.SOI_PUBLIC_CNTRCTS.GBL By: By: Title: Title: Date: Date: Electronically Approved by: Electronically Approved by: Department of Administration State Budget Agency By: (for) Xxxxxx X. Xxxxx, Commissioner By: (for) Xxxxxxx X. Xxxxxxx, Director
Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract to the State of Indiana. I understand that my signing and submitting this Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Contract and this affirmation. I understand and agree that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Contract will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xx.xxxx.xx.xxx/psp/paprd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST Anthem Insurance Companies Inc. Indiana Family & Social Services Administration By: Xxxxxxxx Xxxx, MD, MBA By: Xxxxxxx Xxxxxx Title: President, Anthem IN Medicaid Title: Medicaid Director Date: August 22, 2019 Date: August 23, 2019 Electronically Approved by: Indiana Office of Technology By: (for) Xxxxxx Xxxxx, Chief Information Officer Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved by: Department of Administration By: (for) Xxxxxx X. Xxxxx, Commissioner Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved by: State Budget Agency By: (for) Xxxxxxx X. Xxxxxxx, Director Refer to Electronic Approval History found after the final page of the Executed Contract for details. Electronically Approved as to Form and Legality: Office of the Attorney General By: (for) Xxxxxx X. Xxxx, Xx., Attorney General Refer to Electronic Approval History found after the final page of the Executed Contract for details. Table of Contents
Agreement to Use Electronic Signatures. You specifically agree that any electronic signatures that you provide through this online process are valid and enforceable as your legal signature. You acknowledge that these electronic signatures will legally bind you to the terms and conditions contained in the related documents just as if you had physically signed the same documents with a pen.
Agreement to Use Electronic Signatures. I agree, and it is my intent, to sign this Contract by accessing State of Indiana Supplier Portal using the secure password assigned to me and by electronically submitting this Contract to the State of Indiana. I understand that my signing and submitting this Contract in this fashion is the legal equivalent of having placed my handwritten signature on the submitted Contract and this affirmation. I understand and agree that by electronically signing and submitting this Contract in this fashion I am affirming to the truth of the information contained therein. I understand that this Contract will not become binding on the State until it has been approved by the Department of Administration, the State Budget Agency, and the Office of the Attorney General, which approvals will be posted on the Active Contracts Database: xxxxx://xx.xxxx.xx.xxx/psp/pa91prd/EMPLOYEE/EMPL/h/?tab=PAPP_GUEST In Witness Whereof, the Contractor and the State have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof. [Contractor] Indiana Department of Administration By: _________________________________ By: _______________________________ _____________________________________ ___________________________________ Name and Title, Printed Name and Title, Printed Date: _____________________________ Date: ___________________________ Indiana Office of Technology Indiana Department of Administration By: __________________________________ (for) By: ______________________________ (for) Xxxxxx Xxxxx, Chief Information Officer Xxxxxx X. Xxxxx, Commissioner Date: _________________________________ Date: ______________________________ State Budget Office of the Attorney General By: ________________________________(for) By: _______________________________ (for) Xxxxx X. Xxxxxx, Director Xxxxxx X. Xxxx, Xx. Attorney General Date:________________________________ Date: _________________________________ This document is an exhibit to the Professional Services agreement, and is deemed to be attached to and incorporated within the Professional Services Agreement by reference. Any inconsistency, conflict, or ambiguity between this exhibit and the Professional Services agreement shall be resolved by giving precedence and effect to the Professional Services agreement. TBD
