CONTRACTOR SIGNATURE. NOTICE: This attestation MUST be signed by an individual empowered to contractually bind the Contractor. If said individual is not the chief executive or president, this document shall attach evidence showing the individual’s authority to contractually bind the Contractor. PRINTED NAME AND TITLE OF SIGNATORY
CONTRACTOR SIGNATURE. The Contractor agrees to perform all the services set forth in the Agreement and Work Statement. This Contract shall henceforth be referred to as Xxxxxxxx Xx. XXX000000 The Contractor is hereby cautioned not to commence any billable work or provide any material, service or construction under this Contract until Contractor receives a fully executed copy of the Contract. Signature of Person Authorized to Sign Date Xxx English, Chair Board of Supervisors State of Arizona Signed this day of , 2021 Print Name and Title Procurement Officer CONTRACTOR ATTORNEY SIGNATURE: Pursuant to A.R.S. § 11-952, the undersigned Contractor’s Attorney has determined that this Intergovernmental Agreement is in proper form and is within the powers and authority granted under the laws of Arizona. Xxxxxxxx, Xx. XXX000000, is an Agreement between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney General, who has determined that it is in the proper form and is within the powers granted under the laws of the State of Arizona to those parties to the Agreement represented by the Attorney General. The Attorney General, BY: Signature Date Assistant Attorney General: Signature of Person Authorized to Sign Date Xxxx Xxxxxxx, Deputy County Attorney Print Name and Title CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT TERMS AND CONDITIONS CTR055990
CONTRACTOR SIGNATURE. BY:________________________________________ ------------------------------------------------------------- _________________________________________ (PRINT NAME UNDER SIGNATURE) TAX I.D.#____________________________________ TELEPHONE NUMBER__________________________
CONTRACTOR SIGNATURE. The Contractor agrees to perform all the services set forth in the Agreement and Work Statement. This Contract shall henceforth be referred to as Xxxxxxxx Xx. XXX000000 The Contractor is hereby cautioned not to commence any billable work or provide any material, service or construction under this Contract until Contractor receives a fully executed copy of the Contract. Signature of Person Authorized to Sign Xxx English, Chair Board of Supervisors Date State of Arizona Signed this day of , 20 Print Name and Title Procurement Officer
CONTRACTOR SIGNATURE. NOTICE: This attestation MUST be signed by an individual empowered to contractually bind the Contractor. Attach evidence documenting the individual’s authority to contractually bind the Contractor, unless the signatory is the Contractor’s chief executive or president. PRINTED NAME AND TITLE OF SIGNATORY DATE OF ATTESTATION ATTACHMENT B PEACE OFFICER STANDARDS AND TRAINING COMMISSION CONFIRMATION OF PSYCHOLOGICAL EVALUATION Refer to: Attachment B – PsychologicalEvaluation.pdf ATTACHMENT C BACKGROUND PACKET Refer to: Attachment C - Background Packet.pdf ATTACHMENT D IACP NATIONAL LAW ENFORCEMENT POLICY STANDARDS OF CONDUCT Refer to: Attachment D - IACP National Law Enforcement Ethics.pdf ATTACHMENT E GENERAL ORDER – GROOMING STANDARDS Refer to: Attachment E - Grooming Standards.pdf ATTACHMENT F TRAINING GUIDE Refer to: Attachment F - Training Guide.pdf ATTACHMENT G PEACE OFFICER STANDARDS AND TRAINING COMMISSION CONFIRMATION OF MEDICAL EXAMINATION Refer to: Attachment G- MedicalExamination.pdf ATTACHMENT H UNIFORMS Refer to: Attachment H- Uniforms.pdf ATTACHMENT I POST ORDER TEMPLATE Refer to: Attachment I- Post Order Template.pdf ATTACHMENT J FPO REQUEST FORM Refer to: Attachment J Part 1 - FPO Request Form.pdf INTER-AGENCY JOURNAL VOUCHER REQUEST FORM Refer to: Attachment J Part 2 - Inter-Agency Journal Voucher Request Form.pdf ATTACHMENT K FPO TRAVEL AUTHORIZATION FORM Refer to: Attachment K - FPO Travel Authorization Form.pdf ATTACHMENT L GRAND DIVISION MAP Refer to: Attachment L – Grand Division Map.pdf ATTACHMENT M PAYMENT BOND FOR LABOR AND MATERIALS This bond (the “Bond”) made date, by contractor name (“Principal”), a corporation organized under the laws of name of state, having its principal office at contractor’s address, as principal, and surety name (“Surety”), a corporation organized under the laws of name of state, and licensed to transact a surety business in the State of Tennessee, having its principal office at surety’s address, as surety.
CONTRACTOR SIGNATURE. Xx. Xxxxxxx Xxxxx Superintendent of Schools « TBD »« »
CONTRACTOR SIGNATURE. Xxxxx Xxxxxxxx, Mayor (Printed Name and Title) (Printed Name and Title)
CONTRACTOR SIGNATURE. Required general insurance provisions are provided in the checklist above. These are based on the contract and exposures of the work to be completed under the contract. Modifications to this checklist may occur at any time prior to signing of the contract. Any changes will require approval by the vendor/contractor, the department and County Risk Manager. To the degree possible, all changes will be made as soon as feasible. EXHIBIT C Contractor’s Projected Budget 6/1/2019 to 9/30/2019 AGENCY XXXXXXX XXXXX # Xxxxxxx Xxxxxx Prevention Coalition 000 X 0xx Xx, Xxxxx, XX 00000 FED ID # DETAILED BUDGET FOR NEXT BUDGET FROM THROUGH PERIOD--DIRECT COSTS ONLY 6/1/2019 9/30/2019 PERSONNEL (Applicant organization only) DOLLAR AMOUNT REQUESTED (omit cents) NAME ROLE ON PROJECT TYPE % EFFORT TOTALS APPT. ON SALARY FRINGE (MONTHS) PROJ. REQUESTED BENEFITS SUBTOTALS > - - - CONTRACTUAL COSTS EQUIPMENT (Itemized) SUPPLIES (Itemize by category) TRAVEL PATIENT CARE COSTS ALTERATIONS AND RENOVATIONS (Itemize by category) OTHER EXPENSES (Itemize by category) County Tobacco Compliance Checks 119 @ $15.00 not to exceed $1,785.00 Non-Synar checks 118 @ $15.00 “ “ $1,770.00 Synar checks 25 @ $15.00 “ “ $375.00 SUBTOTAL DIRECT COSTS FOR NEXT BUDGET PERIOD $3,930.00 CONSORTIUM/CONTRACTUAL DIRECT COSTS COSTS FACILITIES AND ADMINISTRATION COSTS $3,930.00 TOTAL DIRECT COSTS FOR NEXT BUDGET PERIOD > EXHIBIT D County / Non-Synar Tobacco Compliance Check Reimbursement Procedure
CONTRACTOR SIGNATURE. The Contractor may cancel this agreement for any reason upon thirty (30) days written notice sent to the School Readiness Office and the Business Office. President New Haven Board of Education Date Date Xxxx Xxxxxx, Director Contractor Printed Name & Title EXHIBIT A DETAILED SCOPE OF SERVICE AGREEMENT SPECIAL TERMS AND CONDITIONS FOR SCHOOL READINESS PROVIDERS (referred to as the “Contractor”) Overview of School Readiness The School Readiness Program was established in 1997 under P.A. 97-259, An Act Concerning School Readiness and Child Day Care and codified in the CT General Statutes (CGS) 10-16p–10- 16u. This legislation established a state grant program to provide spaces for eligible children in priority school districts and competitive grant municipalities in high-quality programs either accredited by the National Association for the Education of Young Children (NAEYC) or Head Start approved. The School Readiness Grant Program is administered by the CT Office of Early Childhood (OEC). The New Haven School Readiness grant provides over 1,000 spaces for three and four-year-olds in preschool programs across the city including community-based centers and classrooms within the New Haven Public Schools and Gateway Community College. New Haven Board of Education is the fiscal agent for the grant. The School Readiness Office (SRO), located in the New Haven Public Schools’ Early Childhood Department is the Board’s designee for the grant. The New Haven Early Childhood Council (NHECC), whose members are appointed by the Mayor and Superintendent, is responsible for making recommendations on issues related to the School Readiness Grant Program, including the application for School Readiness grants. The School Readiness Contractor will provide early care and education program for New Haven children ages 3 and 4 years old including the services listed below and as outlined in the OEC’s General Policies for State-funded Programs and its Licensing Unit, as the Policies and Procedures of the New Haven Early Childhood Council (NHECC).
CONTRACTOR SIGNATURE. ¨ I hereby certify that: I have provided the full rebate as an instant discount to the account holder listed on this application. I have explained to the customer that the rebate they qualify for has been applied as a discount off the purchase price, and they will not be eligible to receive a rebate for the same product(s) being submitted in the application. Submitted with this application is the required invoice clearly itemizing the amount of the rebate provided as a discount to the customer on the line item marked “Vectren Rebate Instant Discount.” Rebates are subject to change and may be discontinued at the sole discretion of Vectren. Rebate funds are limited and available on a first-come, first-served basis. Eligible customers may receive a rebate for each eligible piece of equipment installed. Equipment must be installed and in operation to be eligible for a rebate. Contractor signature Date
