Effective Date of Certification. October 1, 2019 – September 30, 2020 Note: Each Contractor must complete a new certification form annually. If, after certification, you can no longer affirm that any of statements 1 – 4 are true, you must request an immediate termination of your AEP contract. Signature Printed Name: G1oria Tay1or Title: Execukive Direckor
Appears in 1 contract
Samples: Health And
Effective Date of Certification. October 1, 2019 – September 30, 2020 Note: Each Contractor must complete a new certification form annually. If, after certification, you can no longer affirm that any of statements 1 – 4 are true, you must request an immediate termination of your AEP contract. Signature Printed Name: G1oria Tay1or Xxxxxxx Xxx0xx Title: Execukive Direckor
Appears in 1 contract
Samples: Health And
Effective Date of Certification. October 1, 2019 – September 30, 2020 Note: Each Contractor must complete a new certification form annually. If, after certification, you can no longer affirm that any of statements 1 – 4 are true, you must request an immediate termination of your AEP contract. Signature Printed Name: G1oria Tay1or Xxxxx X. Xxxxx Title: Execukive Senior Direckor, Sponsored Programs
Appears in 1 contract
Samples: Health And
Effective Date of Certification. October 1, 2019 – September 30, 2020 Note: Each Contractor must complete a new certification form annually. If, after certification, you can no longer affirm that any of statements 1 – 4 are true, you must request an immediate termination of your AEP contract. Signature Printed Name: G1oria Tay1or Xxxxx Xxxxxx Title: Execukive DireckorChief Program Officer
Appears in 1 contract
Samples: Health And
Effective Date of Certification. October 1, 2019 – September 30, 2020 Note: Each Contractor must complete a new certification form annually. If, after certification, you can no longer affirm that any of statements 1 – 4 are true, you must request an immediate termination of your AEP contract. Signature Printed Name: G1oria Tay1or Xxxxx Xxxxx Title: Execukive Program Direckor
Appears in 1 contract
Samples: Health And
Effective Date of Certification. October 1, 2019 – September 30, 2020 Note: Each Contractor must complete a new certification form annually. If, after certification, you can no longer affirm that any of statements 1 – 4 are true, you must request an immediate termination of your AEP contract. Signature Printed Name: G1oria Tay1or Da1inda Gonza1ez-A1cankar Title: Execukive DireckorCEO
Appears in 1 contract
Samples: Health And
Effective Date of Certification. October 1, 2019 – September 30, 2020 Note: Each Contractor must complete a new certification form annually. If, after certification, you can no longer affirm that any of statements 1 – 4 are true, you must request an immediate termination of your AEP contract. Signature Printed Name: G1oria Tay1or Skephen Wi11iams Title: Execukive Direckor
Appears in 1 contract
Samples: Health And
Effective Date of Certification. October 1, 2019 – September 30, 2020 Note: Each Contractor must complete a new certification form annually. If, after certification, you can no longer affirm that any of statements 1 – 4 are true, you must request an immediate termination of your AEP contract. Signature Printed Name: G1oria Tay1or Xxx Xxxxxxxx Title: Execukive DireckorCEO
Appears in 1 contract
Samples: Health And