Contact Phone Number. E-mail address
Contact Phone Number. Project Description (provide a brief description of the actual scope of work not just “housing rehab”) Project Address (Street, City, Zip): Project County: Reason Project Activity is Excluded from Review (use Appendix B of the PA): Section 1, 2 or 3: Qualifying Criteria a. or b.: OR Specific Excluded Activity (include which specific activity): Notes: (include date of construction) Pictures: Take a before picture of the primary façade of any buildings directly impacted by project activities. Attach them to this form.
Contact Phone Number. Ext: Email Addresses for Remittance Advice (Up to 2 email addresses may be specified):
Contact Phone Number. We may contact you to verify that this application is authorised by the applicant organisation Contact Email * Must be an email address. Date * Must be a date Feedback You are now nearing the end of this form. Before you review your application and click the SUBMIT button please take a few moments to provide some feedback. Overall, to what extent did you find collating the information required for the application difficult? ○ Not difficult ○ Somewhat ○ Difficult ○ Very difficult ○ Don't know / difficult not applicable Please provide some reasons to explain your rating above. Overall, to what extent did you find the online application portal easy to use? ○ Very easy to ○ Somewhat ○ Somewhat ○ Very difficult to○ Don't know / use easy to use difficult to use use not applicable Please provide some comments to help us understand your experience with the application portal Overall, to what extent were the requirements of the of the program effectively communicated to you: eligibility, information on the assessment process, project reporting requirements? ○ Very ○ Somewhat ○ Somewhat ○ Very ○ Don't know / effectively effectively ineffectively ineffectively not applicable Please provide some reasons to explain your ratings Were you aware that agency staff were available to answer your questions and provide information during the application process? ○ Yes ○ No How satisfied were you with the time in which responses were provided, the usefulness of responses provided? ○ Very satisfied ○ Somewhat ○ Somewhat ○ Very ○ Don't know / satisfied unsatisfied unsatisfied not applicable How did you first hear about the CBDs Revitalisation Program?
Contact Phone Number. Event/Purpose Date of Event/Purpose Targeted Audience Estimated Number of Attendees Purchases from Items to Purchase Estimated Cost Purchases from Items to Purchase Estimated Cost Purchases from Items to Purchase Estimated Cost Purchases from (List names of vendor s/stores you are purchasing items from) Items to Purchase Estimated Cost MUST obtain approval from Cardholder prior to release of P-Card. Index Number Authorized amount not to exceed $ Index Number Authorized amount not to exceed $ Index Number Authorized amount not to exceed $ Index Number Authorized amount not to exceed $ Approved Cardholder (Signature) (Date) Gift Card Log Required Yes No Gift Card Log Submitted (if applicable) Yes No Individual has permission to use the P-card assigned to P-Card Number Date Signed Out Date Returned Receipts Submitted Comments Yes No Individual agrees to conditions and is responsible for P-Card.
Contact Phone Number. (Signature) If you are the parent or court appointed legal guardian of the person being registered, please complete the following. Printed (Full Legal Name) Signature I am the ☐ Parent of the registrant Send Completed registration forms to: Drop Off: at your local Police Dept. Mail to: VCOM, 000 X. Xxxxxxx Ste. B, Pontiac, IL 61764 or Email to: xxxxxxxxxxx@xxxxxxxxxxxxxxxxxx.xxx or FAX to 815‐844‐7399 ☐ Legal guardian of the registrant * By registering into the Premise Alert Program, I also agree to the terms/conditions (on back): 11/05/2020 Xxxxxxxxxx County Premise Alert Program Terms and Conditions By registering for this program, I agree to the following terms/conditions.
Contact Phone Number. The telephone number on the employee’s overtime contact information will be the only phone number used unless the employee is called on-duty or at the station or work assignment.
Contact Phone Number. I, will be responsible for all CBA transactions in the amount of: $ associated with my travel.
Contact Phone Number. As the owner/tenant of the above address of Silver Creek of Clay County HOA, I request pool membership to be granted to those members of my household listed below. We have read and understand the Swimming Pool Rules and Guidelines governing the swimming pool and hereby agree to abide by said rules.
Contact Phone Number. The Contractor shall furnish a report of all Fleet Maintenance Services provided under the Contract during each quarterly period, no later than fifteen (15) days following the close of the quarterly period. Quarterly periods will end on March 31st, June 30th, September 30th and December 31st. Purchases by all Authorized Users under the Contract shall be reported in the same report and be indicated as required. All fields of information shall be accurate and complete. The report is to be submitted electronically via electronic mail utilizing the template provided, in Microsoft Excel 2010, or newer (or as otherwise directed by OGS), to the attention of the individual shown on the front page of the Contract Award Notification and shall reference the OGS group number, award number, Contract Number, sales period, and Contractor's (or other authorized agent) name, and all other fields required. OGS reserves the right to amend the report template during the Contract term. Tabs included in this workbook: Tab Instructions FMS Management Fees FMS Service Summary State Agency Listing Monthly Enrollment Plan Monthly Enrollment Plan Per Occurrence Plan Light Duty Vehicles (< or = to 16,000 lbs. GVWR) Medium to Heavy Duty Vehicles (= to or >16,001 lbs. GVWR) Maintenance and Repair Service (Light Duty Vehicles) Contractor Invoice Number Contractor Invoice Run Date Contractor Invoice Due Date Authorized User Client Code "1" for State Agency or "2" for Non-State Entity (see "State Agency" tab) Authorized User Entity Name Vehicles Billed Per Vehicle Fee Total Invoiced Fee Vehicles Billed Per Vehicle Fee Total Invoiced Fee # of Occur. Billed Per Occur. Fee Total Invoiced Fee 123456 04/01/20 05/01/20 AB123 1 NYS Department of Transportation 60 $5.35 $321.00 10 $22.00 $220.00 75 $20.70 $1,552.50 123457 04/01/20 05/01/20 AB246 2 Town of Ballston 60 $5.35 $321.00 10 $22.00 $220.00 75 $20.70 $1,552.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Contractor Name: 0 Contract Reporting Period: 0 Contract Number: PS...
