Additional Contacts. In addition to the Primary and Secondary Advocates, permission is granted to contact and share information with the following should the need arise (optional): Mr. Mrs. Ms. Address: City: State: Zip: Home Phone: Work Phone: Cell Phone: Email Address: Relationship to Beneficiary:
Additional Contacts. Contacts for Starr Indemnity & Liability Company and its agent, Xxxxx MMA are available for guidance and question regarding the required application form and submission requirements: - Xxxxx Xxxxxxx (Xxxxx) xxxxx.xxxxxxx@Xxxxxxxxxxxxxx.xxx Telephone: 000-000-0000 - Xxxxx Xxxxxx (Xxxxx) xxxxx.xxxxxx@xxxxxxxxxxxxxx.xxx Telephone: 000-000-0000 - Xxxx Xxxxx (Xxxxx MMA) xxxx.xxxxx@xxxxxxxx.xxx Telephone: 000-000-0000 - Xxxxx Xxxxxxx (Xxxxx MMA) xxxxx.xxxxxxx@xxxxxxxx.xxx Telephone: 000-000-0000 For instructions on the required application form and submission requirements, please refer to AAPD 22-01. Pursuant to AIDAR 752.228-70, medical evacuation is a separate insurance requirement for overseas performance of USAID funded subcontracts; the Defense Base Act insurance does not provide coverage for medical evacuation. The costs of DBA insurance are allowable and reimbursable as a direct cost to this Subcontract. Before starting work, the offeror must provide Chemonics with a copy of the DBA coverage policy that covers each of its employees.
Additional Contacts. In addition to the Primary and Alternate Representatives, permission is granted to contact and share information with the following individuals should the need arise (optional): Name: Please indicate level of Organization: access granted: Address: City, State, Zip: Home Phone: Work Phone: Cell Phone: Email: Relationship to Beneficiary*: Verbal Communication Online Account Access Request Benefit Recertification Documents Name: Please indicate level of Organization: access granted: Address: City, State, Zip: Home Phone: Work Phone: Cell Phone: Email: Relationship to Beneficiary*: Verbal Communication Online Account Access Request Benefit Recertification Documents Name: Please indicate level of Organization: access granted: Address: City, State, Zip: Home Phone: Work Phone: Cell Phone: Email: Relationship to Beneficiary*: Verbal Communication Online Account Access Request Benefit Recertification Documents Name: Please indicate level of Organization: access granted: Address: City, State, Zip: Home Phone: Work Phone: Cell Phone: Email: Relationship to Beneficiary*: Verbal Communication Online Account Access Request Benefit Recertification Documents GRANTOR INITIALS
Additional Contacts. In addition to the Primary and Secondary Advocates, permission is granted for CCT to contact and share information with the following people should the need arise.
Additional Contacts. Please list all people at your operation authorized to conduct inspections, meet with inspectors, modify the OSP, or otherwise act on behalf of the company. Check the CC box for contacts that should receive all communication along with the Primary contact listed above. Attach an additional list if necessary. No Change CC: Name/Title Phone number Email CC: Name/Title Phone number Email CC: Name/Title Phone number Email Certification Program Information Does this business produce, manufacture or distribute: Both OCal and non-OCal product(s) OCal product(s) only Is the new business currently certified organic, certified OCal by another certifier, or certified by a third-party cannabis certification company (i.e. Sun and Earth, Certified Kind, Envirocann, etc.)? No Yes, provide name of certifier: Has the new business ever applied for, or been granted, OCal certification? No. Skip to section F. Yes. Complete this section and provide name of certifier: Was your certification or the certification of fields or products ever suspended or revoked? Yes No Did you surrender your certification with outstanding non-compliances or conditions? Yes No Was your application for OCal certification ever issued a denial? Yes No Did you withdraw your application for certification with outstanding non-compliances? Yes No If you answered yes to a, b, c, or d above, please list the years and agencies, attach a copy of all relevant letter(s) and a description of all corrective actions: Year(s): Letters Attached Corrective actions taken:
Additional Contacts. Local Solid Waste Mgmt District See Local Listing Ohio EMA (000) 000-0000 (Recycling) (Response and Recovery) Local Department of Health See Local Listing Ohio Historic Preservation Off (000) 000-0000 Ohio Department of Health (000) 000-0000 (Environmental/Historic) (Private Drinking Water) Attorney General (000) 000-0000 Ohio Department of Agriculture (000) 000-0000 (Consumer Protection) (Dead Animals) Ohio Dept. Natural Resources (000) 000-0000 U.S. Corp of Engineer (000) 000-0000 (Recycling, Floodplain Mgmt.) (Regulatory-Great Lakes Division) Ohio Environmental Protection Agency – Management Options for Disaster Related Wastes
