Telephone Number. Email Address:
Telephone Number. Facsimile: Email:
Telephone Number. Email Address: Submit with the bid or proposal or if submitting after award, submit to the MWBE Program Unit: New York State Governor’s Office of Storm Recovery 00 Xxxxxx Xxxxxx, 0xx Xxxxx Xxx Xxxx, XX 00000 Email to: XXXX_XXXXxxxxxxx@xxxxxxxxxxxxx.xx.xxx ******************** FOR AGENCY USE ONLY ******************** REVIEWED BY: DATE: Waiver Granted: YES MBE: WBE: Total Waiver Partial Waiver ESD Certification Waiver *Conditional Notice of Deficiency Issued *Comments: REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONS When completing the Request for Waiver Form please check all boxes that apply. To be considered, the Request for Waiver Form must be accompanied by documentation for items 1 – 11, as listed below. If box # 3 has been checked above, please see item 11. Copies of the following information and all relevant supporting documentation must be submitted along with the request:
Examples of Telephone Number in a sentence
Parties to the Agreement Applicant Name Consulting Veterinarian Name License Number Clinic Name Clinic Address City State ZIP Code Telephone Number E-Mail Address Veterinary Services Information Check all services you are willing to provide on a case-by-case basis for the Applicant.
Last Name First Name Unit Number Street Number Street Name PO Box City/Town Province Postal Code Telephone Number Home Mobile Business ext.
More Definitions of Telephone Number
Telephone Number. Fax Number: Email Address: CFO:
Telephone Number. Fax Number:
Telephone Number. (Area Code) (Number) Jurisdiction of Incorporation:_________________________________________ Date of Formation:_________________________________________________ Taypayer Identification Number:______________________________________ Number of Shareholders:____________________________________________
Telephone Number. E-mail: ...............................................................
Telephone Number. (Area Code) Number Fax Number: (Area Code) Number The full names of persons and firms interested in the foregoing bid as principals are as follows:
Telephone Number. Fax Number: Email Address: Signature of Authorized Representative Name of Authorized Representative/Title (please print) Date: Check here to confirm that the employment status reporting option has been selected in paragraph 5 of this agreement and that if you selected option (a) that you have identified the set reporting day of the week. Teamsters Local Union No: Signature Xxxx X. Xxxxxxxx /Executive Director Date: Signature of Authorized Representative Name of Authorized Representative/Title (please print) Date: