Authorized Agent Signature Sample Clauses

Authorized Agent Signature. By signing this Agreement, the undersigned represents and warrants that he or she has received and read a copy of this Agreement, inclusive of attachments and exhibits, and that he or she is either (a) the Participant or, (b) if the Participant is an organization, an individual acting on the Participant’s behalf who is authorized to sign and enter into this Agreement.
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Authorized Agent Signature. Please have an authorized agent sign the report certification in the space provided. This must be completed in order for the report to be accepted by OHA. OREGON HEALTH AUTHORITY Public Health Division Agreement Expenditure Report Agency: Agreement #: Budget Period: to Reporting Period: to - % of Budget Period Elapsed If Applicable to Agreement: - - $ $ To-Date In-Kind To-Date Match Expenditures Expenditures Budget Report Period Expenditures To-Date Total Expenditures % Spent To-Date Salaries & Wages $ - $ - $ - - Position # 1 (list title) $ Position # 2 (list title) $ Position # 3 (list title) $ Position # 4 (list title) $ Position # 5 (list title) $ - $ - $ - - - $ - $ - - - $ - $ - - - $ - $ - - - $ - $ - - - - - $ - $ $ Fringe Benefits $ - $ - - - - $ - $ $ Travel $ - $ - In State Travel $ Out of State Travel $ - $ - $ - - - $ - $ - - - - - $ - $ $ Equipment $ - $ - - - - $ - $ $ Supplies $ - $ - - - - $ - $ $ Sub Agreements* $ - $ - *A 'Sub Agreement Detail Report' must be completed and attached if budget includes sub agreements - - - $ - $ $ Other $ - $ - Other # 1 (please list) $ Other # 2 (please list) $ Other # 3 (please list) $ Other # 4 (please list) $ - $ - $ - - - $ - $ - - - $ - $ - - - $ - $ - - - - - $ - $ $ Total Direct Charges $ - $ - - - - $ - $ $ Indirect $ - $ - Indirect Rate - - - - - - $ - $ $ Totals $ - $ - I certify to the best of my knowledge and belief that the report is true, complete and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the federal award. I am aware that any false, fictitious or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (2 CFR 200.415) Authorized Agent Signature Date Report Prepared By Phone OREGON HEALTH AUTHORITY Public Health Division Sub Agreement Detail Report (Attachment to Public Health Division Agreement Expenditure Report) Agency: Agreement #: Budget Period: to Reporting Period: to Sub Agreement #1 Agency % of Budget Period Elapsed - If Applicable to Agreement: Budget Report Period Expenditures To-Date Total Expenditures % Spent To-Date To-Date In-Kind Expenditures To-Date Match Expenditures Salaries & Wages $ - $ - $ - - $ - $ - Fringe Benefits $ - $ - $ - - $ - $ - Travel $ - $ - $ - - $ - $ - Equipment $ - $ - $ - - $ - $ - Supplies $ - $ - $ - - $ - $ - Sub Agreements $ - $...
Sample 1

Related to Authorized Agent Signature

  • AUTHORIZED AGENTS For the purpose of administering the terms and provisions of this Memorandum of Understanding:

  • Authorized Agent Authorized Agent means the individual(s) appointed in writing by the Depositor (or by the beneficiary following the Depositor's death) authorized to perform the duties and responsibilities set forth in the Agreement on behalf of the Depositor. Code. Code means the Internal Revenue Code.

  • Authorized Signatories The parties each represent and warrant to the other that (1) the persons signing this lease are authorized signatories for the entities represented, and (2) no further approvals, actions or ratifications are needed for the full enforceability of this Lease against it; each party indemnifies and holds the other harmless against any breach of the foregoing representation and warranty.

  • Authorized Signature Your signature on the Account Card authorizes your account access. We will not be liable for refusing to honor any item or instruction if we believe the signature is not genuine. If you have authorized the use of a facsimile signature, we may honor any check or draft that appears to bear your facsimile signature even if it was made by an unauthorized person. You authorize us to honor transactions initiated by a third person to whom you have given your account number even if you do not authorize a particular transaction.

  • Signatory Each signatory below represents and warrants that he or she has full power and is duly authorized by their respective party to enter into and perform under this Agreement. Such signatory also represents that he or she has fully reviewed and understands the above conditions and intends to fully abide by the conditions and terms of this Agreement as stated.

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