High Risk Referrals Sample Clauses

High Risk Referrals. A vendor who is assessed thirty (30) points or more per federal fiscal year shall be referred to a federal, state, or local law enforcement agency for a compliance investigation. (40 Ky.R. 509; 835; eff. 10-16-2013.) The undersigned represents that he/she is an owner or has other legal authority to obligate the Second Party. SECOND PARTY Business Name (Print) Vendor Number Name of Authorized Official (Print) Signature of Authorized Official Date Signed FIRST PARTY Agency Name (Print) Signature of Authorized Official Date Signed APPROVED BY Signature of Authorized Official Date Signed Kentucky WIC Program Department for Public Health Cabinet for Health and Family Services VENDOR / DRUG STORE TRAINING CHECKLIST Purpose This form indicates items addressed in the training. When To Use This form is given to a vendor at the time of initial authorization and at subsequent training sessions. Instructions  Store Name is the name the vendor is going to use with that particular retail establishment.  Vendor Number is the unique number that has been or will be assigned by the State WIC Office.  Staff present and their positions is a list of store personnel present at the training session and their respective positions within that establishment.  1 – 17 Check Items Explained to Vendor. There is a list of seventeen (17) items that the vendor acknowledges as having been explained in a training session.  Signature/Title is the signature and title of the authorized representative of the vendor who was present at the training session.  Person Providing Training is the signature of the local agency person or State WIC Office person who provided the vendor training and that person’s title. STORE VENDOR WIC-39 Rev. 07/19 NAME NUMBER STORE REPRESENTATIVES AT TRAINING