Additional Information Required. If additional information is required, a Service representative will generally contact the Plan Sponsor or the Plan Sponsor's representative and explain what is needed to complete the submission. The Plan Sponsor will have 21 calendar days from the date of this contact to provide the requested information. If the information is not received within 21 days, the matter will be closed, the compliance fee will not be returned, and the case may be referred to Employee Plans Examinations. Any request for an extension of the 21-day time period must be made in writing within the 21-day time period and must be approved by the Service (by the applicable group manager).
Additional Information Required. OWNERSHIP (%): Male Female RACE: (Voluntary) American Indian or Alaska Native Asian Black or African-American Native Hawaiian or Pacific Islander White ETHNICITY (Voluntary) Hispanic or Latino VETERAN STATUS: Veteran Non-Veteran Primary Business Activity: NAICS Annual Sales in Last Fiscal Year: Year Business Established: Total Full Time Employees (2 half time employees equals 1 full time employee): Estimated Jobs Created by this Loan over next 3 years: Estimated Jobs Retained by this Loan over next 3 years: Does the Borrower, including any parent or subsidiary or affiliated entity, in Virginia: have 250 or fewer employees? Yes No Current # OR have less than $10,000,000 in annual gross revenues over each of the last three (3) fiscal years? Yes No OR have less than $2,000,000 in net worth? Yes No If the answer to any of the following questions is “yes”, please furnish details on an attached sheet. Have any owners, officers, directors, guarantors, general partners, stockholders or limited partners owning 20% or more of the Borrower ever been charged with, or convicted of, any criminal offense, other than minor motor vehicle violations? Yes No Has the Borrower or management of the Borrower been informed of any current or on-going investigation of the Borrower with respect to possible violations of state or federal securities laws? Yes No Has the Borrower or any owners, officers, directors, guarantors, general partners, stockholders of limited partners owning 20% or more of the Borrower been in receivership or adjudicated as bankrupt? Yes No Is the Borrower or any of its owners, officers, directors, guarantors, general partners, stockholders or limited partners owning 20% or more of the Borrower involved in any pending lawsuits? Yes No Does the Borrower or any guarantors owe past due federal, state or local taxes of any nature? Yes No
Additional Information Required. Emergency Contact: Relationship: Telephone: Does student require any special accommodations to participate in the classroom portion of the course? Y / N If yes, please explain Is the student currently taking medication? Y / N If yes, please explain By signing below you agree that your student has completed a minimum of 30 hours of supervised behind the wheel driving, including two hours of nighttime driving, on a Level 1 license that has been held for at least three continuous months. This driving must be completed before your student can be accepted into a Segment 2 class. Supervised driving is defined as driving with a licensed parent, guardian, or parent designee age 21 or older. PARENT NAME PARENT SIGNATURE X DATE / / RELEASE, ASSUMPTION OF RISK AND INDEMNIFICATION AGREEMENT All Star Driver Education, LLC (ASDE) I make this release, assumption of risk and indemnification agreement as parent and natural guardian or legal guardian of (Student). In consideration of the Children’s participation in the driving instruction and/or road testing and any and all events or activities in relation thereto (collectively the “Activity”) permitted by ASDE and with the understanding that the Children’s participation in the Activity is only on the condition that I enter into this agreement for the Children and myself, our heirs and assigns, I hereby assume the inherent and extraordinary risks involved in the Activity, and any risks inherent in any other activities connected with the Activity in which the Children may participate. I expressly assume the risk of and accept full responsibility for any and all injuries (including death) which may occur as a result of the Children’s participation in the Activity and release from liability ASDE, its and their officers, directors, agents, representatives, heirs and employees. I hereby waive any and all claims I or the Children may hereafter have as a result of any and all injuries disease or sickness (including death) to the Children as a result of the Children’s participation in the Activity. I hereby agree to indemnify all of the above named persons for any and all claims, including attorney’s fees and costs, which may be brought against any of them by anyone claiming to have been damaged as a result of any injury, sickness or disease (including death) to the Children which may occur as a result of or during the Activity. I understand that the Activity may be dangerous and that physical injury, property damage or death may r...
Additional Information Required. 1. Does the student require any special accommodations to participate in the classroom phase (i.e., test being read to him/her, an interpreter, seating arrangements, etc.)? Yes No If Yes, please explain:
Additional Information Required. The parties acknowledge that associated with Level "B" and/or Level "C" Plan approvals more detailed information will be provided to the City to make an accurate determination of the long-term cumulative impacts of the development of the Level "A" Property, as well as to make a determination of the adequacy of basic services necessary to serve the future residents of the Level "A" Property.
Additional Information Required. (1) The Contractor shall, in addition to providing the information required by Federal Acquisition Regulation (FAR) 52.232-32, submit information for all payment requests using the following format: Current performance-based payment(s) event(s) addressed by this request: Contractor shall identify- Amount Totals (1a) Negotiated value of all previously completed performance-based payment(s) event(s); (1b) Negotiated value of the current performance-based payment(s) event(s);
Additional Information Required. The COUNTY may request reasonable additional information from METRA, if needed, to determine whether or not to approve an Additional Cost for payment. METRA shall cooperate with the COUNTY insofar as is necessary for the COUNTY to make its determination.
Additional Information Required. The Participant must provide the following additional information to the Administrator demonstrating that no portion of the rollover contribution contains after-tax contributions or earnings:
Additional Information Required. If Xxxxxxxx’s business is NOT incorporated, please submit the following TWO items: 🞏 a copy of sole proprietor’s valid government ID (i.e., driver’s license or passport) �� Business account void cheque If Merchant’s business is incorporated, please submit the following THREE items: 🞏 Business account void cheque 🞏 a copy of the Certificate of Incorporation 🞏 a copy of the authorized signing officer’s valid government ID (i.e., driver’s license or passport) Payment Platforms and Fee Schedule: Payment Platform Alipay WeChat Pay Union Pay Offline Transaction Charge Rate 🞏 % 🞏 % 🞏 % Online Transaction Charge Rate 🞏 % 🞏 % 🞏 % Settlement Currency (Choose one currency for each Payment Platform) 🞏USD 🞏CAD 🞏USD 🞏CAD 🞏USD 🞏CAD Hardware: Type Quantity Amount (per Terminal) Total Amount Leased Terminal(s) Monthly fee of $15.95 CAD (plus HST) Total monthly fee of $ CAD (plus HST) Purchased Terminal(s) Purchase price of $310.00 CAD (plus HST) Total purchase price of $ CAD (plus HST)
Additional Information Required. If required in the bid specifications,Contractor shall complete items I and/or II below: Statement of past three (3) years experience on public construction projects. Public Body/ Reference Name/ Original Price/ Project Name/Year Phone# Final price Subcontractors List any determinations by a court or governmental agency for violations of federal, state or local laws, including but not limited to violations of contracting or antitrust laws, tax or licensing laws, environmental laws, the Occupational Safety and Health Act (OSHA), the National Labor Relations Act (NLRA), or federal Xxxxx-Xxxxx and related Acts. Date N/A Law Determination Penalty Certificate No: ECC93439-18 Xxxx X Xxxxxxxxx, Mayor Certificate of Registration issued by the Department of Buildings of the City of Chicago This is to Certify that located at H & H ELECTRIC CO. - ECC93439 0000 XXXXXXXX XX. XXXXXXXX XXXX, XX 00000 having complied with the requirements of Ordinances passed by the City Council of the City of Chicago providing for the registration of electrical contractors is hereby recorded as a REGISTERED ELECTRICAL CONTRACTOR General Electrician and is entitled to perform electrical work in the City of Chicago under the Direction of Supervising Electrician provided that such work permits are subject to the provisions of all the Ordinances of the City of Chicago now in force or which may be hereafter passed. This certificateEXPIRES December 29, 2022. SUPERVISING ELECTRICIAN: XXXXX X XXXXXXXXX - SE6318 In Witness Whereof I have hereunto set my hand on October 4, 2021. File Number 0000-000-0 To all to whom these Presents Shall Come, Greeting:
