Examples of Line 1 in a sentence
Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank.
N/A * 3 Identify all applicable assumed names or DBA names of the Proposer or Proposer's subsidiaries in Line 1 or Line 2 above.
N/A - no subsidiary entities * 3 Identify all applicable assumed names or DBA names of the Proposer or Proposer's subsidiaries in Line 1 or Line 2 above.
FEDERAL TAX ID#: 00-0000000 DUNS#: 000000000 EXACT CORPORATE NAME: AIDS Resource Center of Wisconsin dba Vivent Health CORPORATE ADDRESS: 000 X Xxxxxxxxxx Xxx, Suite 200 Address Line 1 Address Line 2 City State Zipcode CORPORATE WEBSITE: xxx.xxxxxxxxxxxx.xxx AGENCY TYPE: Community-Based Organization OWNERSHIP TYPE: Private, Nonprofit FAITH-BASED: No I CERTIFY THAT COSTS HAVE BEEN DETERMINED ALLOWABLE ACCORDING TO CITY AND APPROPRIATE FEDERAL PRINCIPLES AND STANDARDS AS LISTED ON FORM A-2.
FFATA-1-04-A Address Line 1 10 S XXXXX Physical location as listed in Central Contractor Registration.
None * 3 Identify all applicable assumed names or DBA names of the Proposer or Proposer's subsidiaries in Line 1 or Line 2 above.
Tiger Corporation * 3 Identify all applicable assumed names or DBA names of the Proposer or Proposer's subsidiaries in Line 1 or Line 2 above.
Therefore, the term “Director” in all cases shall mean “Director or his/her designee.” **********THIS SECTION INTENTIALLY LEFT BLANK********** DocuSign Envelope ID: D64567F1-E189-4272-807A-E34148259387 EXHIBIT G-3: Behavioral Health Invoice Form EXHIBIT G-3: Behavioral Health Invoice Form Invoice Number : Contractor : Harmony at Home Address Line 1 Address Line 0 0000 Xxx Xxxx Xxxxx Xxxxxx PO No.: Carmel, CA 93923 Invoice Period : Tel.
Line 1: Enter the provider’s/supplier’s legal business name or the name of the physician or individual practitioner, as reported to the Internal Revenue Service (IRS).
Signature: Date: Title: Telephone: Send to: XXXXXXXxxxxxx@xx.xxxxxxxx.xx.xx Behavioral Health Authorization for Payment Authorized Signatory Date EXHIBIT G-3: Behavioral Health Invoice Form Invoice Number : Contractor : Harmony at Home Address Line 1 Address Line 0 0000 Xxx Xxxx Xxxxx Xxxxxx PO No.: Carmel, CA 93923 Invoice Period : Tel.