CONTRACT RECEIPT FORM Sample Clauses

CONTRACT RECEIPT FORM. (Please fill out neatly and completely.) Return to Oregon Nurses Association, 00000 XX Xxxxxx Xxxxx Xxxx Xxx 000, Xxxxxxxx XX 00000-0000 or fax to 000-000-0000. Thank you. Your Name: I certify that I have received a copy of the ONA Collective Bargaining Agreement with Saint Xxxxxxx Medical Center - Redmond, December 1, 2016, until November 30, 2019. Signature: Today’s Date: Your Mailing Address:
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CONTRACT RECEIPT FORM. (Please fill out neatly and completely.) Return to Oregon Nurses Association, 00000 XX Xxxxxx Xxxxx Xxxx Xxx 000, Xxxxxxxx XX 00000-0000 or by Fax 000-000-0000. Thank you. Your Name: I certify that I have received a copy of the ONA Collective Bargaining Agreement with Samaritan Lebanon Community Hospital Collective Bargaining Agreement 2019 – 2022 Signature: Today’s Date: Your Mailing Address: Home Phone: Work Phone: Email: Unit:
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CONTRACT RECEIPT FORM. Please fill out neatly and completely, and return to Oregon Nurses Association 00000 XX Xxxxxx Xxxxx Xxxx, Xxxxx 000 Xxxxxxxx, XX 00000-0000 Or, fax to ONA at 000-000-0000. Thank you. Your name I certify that I have received a copy of the ONA Collective Bargaining Agreement with Samaritan Pacific Communities Hospital, Nov. 16, 2017, until June 30, 2020. Signature Today’s date Your mailing address Cell phone Home phone Personal email Unit
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CONTRACT RECEIPT FORM. 2 (Please fill out neatly and completely.) 3 Return to Oregon Nurses Association, 5 or by Fax 000-000-0000. Thank you. 7 Your Name:
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CONTRACT RECEIPT FORM. 70 1 AGREEMENT 2 THIS AGREEMENT is made and entered into by and between St. Xxxxxxx Health 4 hereinafter referred to as the “Hospital,” and the Oregon Nurses Association 5 (ONA), hereinafter referred to as the “Association.” 6
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Related to CONTRACT RECEIPT FORM

  • CONTRACT FORM Observe the Contract and confirm the form number on the Contract is on the List of Approved Contract Forms.

  • BILLING FORM The SUDRF shall use the Centers for Medicare and Medicaid Services (CMS) 1450 UB-04 billing form (or subsequent editions) for inpatient services, and the CMS 1500 Claim Form for outpatient services. The SUDRF shall identify SUDRF care on the billing form in the remarks block by stating “SUDRF care”.

  • Instructions for Certification 1. By signing and submitting this CONTRACT, the prospective lower tier participant is providing the certification set out below.

  • Stop Payment Request You may ask the Credit Union to stop payment on any check drawn upon or ACH debit scheduled from your checking account. You may request a stop payment by telephone, by mail, or in person. For checks, the stop payment will be effective if the Credit Union receives the order in time for the Credit Union to act upon the order. For ACH debits, the stop payment order must be received at least three (3) banking days before the scheduled date of the transfer. You must state the number of the account, date, and the exact amount of the check or item and the number of the check or originator of the ACH debit. If you give the Credit Union incorrect or incomplete information, the Credit Union will not be responsible for failing to stop payment on the item. If the stop payment order is not received in time for the Credit Union to act upon the order, the Credit Union will not be liable to you or to any other party for payment of the item. If we recredit your account after paying a check over a valid and timely stop payment order, you agree to sign a statement describing the dispute with the payee, to transfer all of your rights against the payee or other holders of the check to the Credit Union, and to assist the Credit Union in legal action taken against the person.

  • Contractor Certification The Department may, at its option, terminate the Contract if the Contractor is found to have submitted a false certification as provided under section 287.135(5), F.S., or been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or been engaged in business operations in Cuba or Syria, or to have been placed on the Scrutinized Companies that Boycott Israel List or is engaged in a boycott of Israel.

  • Contract Forms This Section contains forms which, once completed, will form part of the Contract. The forms for Performance Security and Advance Payment Security, when required, shall only be completed by the successful tenderer after contract award.

  • Resume Self-Certification Form When submitting a response to an RFQ the Contractor shall submit with its response a completed and signed Resume Self-Certification Form (Contract Exhibit F) to the Customer for each proposed Staff member identified in the RFQ response.

  • Purchase Order A Customer may use purchase orders to buy commodities or contractual services pursuant to the Contract and, if applicable, the Contractor must provide commodities or contractual services pursuant to purchase orders. Purchase orders issued pursuant to the Contract must be received by the Contractor no later than the close of business on the last day of the Contract’s term. The Contractor is required to accept timely purchase orders specifying delivery schedules that extend beyond the Contract term even when such extended delivery will occur after expiration of the Contract. Purchase orders shall be valid through their specified term and performance by the Contractor, and all terms and conditions of the Contract shall survive the termination or expiration of the Contract and apply to the Contractor’s performance. The duration of purchase orders for recurring deliverables shall not exceed the expiration of the Contract by more than twelve months. Any purchase order terms and conditions conflicting with these Special Contract Conditions shall not become a part of the Contract.

  • Notice of Testing The Contractor shall give the ODR and the A/E timely notice of its readiness and the date arranged so the ODR and A/E may observe such inspection, testing or approval.

  • Notice of Enrollment Said meeting and conferring shall not be subject to the impasse procedures in Government Code Section 3557. The Department sponsoring the NEO shall provide the foregoing information no less than five (5) business days prior to the NEO taking place. The Department will make best efforts to notify the Union NEO Coordinator of any last-minute changes. Onboarding of individual employees for administrative purposes is excluded from this notice requirement.

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