Incurred for treatment without prior authorization. 2. Incurred during additional hospital days without prior authorization; or
Incurred for treatment without prior authorization Sample Clauses
Related to Incurred for treatment without prior authorization
Absence Without Authorization A. Absence without authorization for three (3) consecutive working days shall be considered an automatic resignation.
REQUIRED FOR PART 2 JOC - PRICING OF Regular Hours Coefficient What is your regular hours coefficient for the RS Means Price Book? (FAILURE TO RESPOND PROHIBITS PART 2 JOC EVALUATION) Remember that this is a ceiling price proposed. You can discount lower than your proposed contract coefficient, but not higher. This is one of three pricing questions that are required for consideration for award on this solicitation. Please consider your answer carefully. An explanation of the TIPS scoring of pricing is included in the attachments for your information. The below is an Example of how pricing model works (not intended to influence your proposed coefficient, you should propose a coefficient that you determine is right for your business): To propose the exact pricing as the RS Means Unit Price Book, you would insert a 1.0 and to propose a 5% discount for the RS Means Price Book would be a .95 regular hours coefficient and so on.
SUB-CONTRACTORS TO BE UTILIZED FOR PROJECT PSP shall perform the services under this Assignment with its own forces unless otherwise specified. If the scope of services is less than $100,000.00, a HUB Subcontracting Plan (HSP) is not required. If the scope of services will exceed $100,000.00, PSP shall submit an HSP for approval pursuant to Section 11.2 of the Agreement.
Federal Requirements Pertaining to Grants and Subrecipient Agreements A. Requirement to Have a Single Audit: In the case that this Agreement is a Grant that is funded in whole or in part by federal funds, the Subrecipient will complete the Subrecipient Annual Report annually within 45 days after its fiscal year end, informing the State of Vermont whether or not a Single Audit is required for the prior fiscal year. If a Single Audit is required, the Subrecipient will submit a copy of the audit report to the granting Party within 9 months. If a single audit is not required, only the Subrecipient Annual Report isrequired. For fiscal years ending before December 25, 2015, a Single Audit is required if the subrecipient expends $500,000 or more in federal assistance during its fiscal year and must be conducted in accordance with OMB Circular A-133. For fiscal years ending on or after December 25, 2015, a Single Audit is required if the subrecipient expends $750,000 or more in federal assistance during its fiscal year and must be conducted in accordance with 2 CFR Chapter I, Chapter II, Part 200, Subpart F. The Subrecipient Annual Report is required to be submitted within 45 days, whether or not a Single Audit is required.
Required Forms If subcontractors are used under the contract that has no stated HUB goal, Exhibits H-1, H-2, H-4 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: Assigned Goal: % Federally Funded State Funded Prime Provider: Total Contract Amount: Prime Provider Info: DBE HUB Both Vendor ID #: DBE/HUB Expiration Date: (First 11 Digits Only) If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Subprovider(s) Contract or % of Work* Totals *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ Total DBE or HUB Commitment Percentages of Contract % (Commitment Dollars and Percentages are for Subproviders only) EXHIBIT H-2 Texas Department of Transportation Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: Date: Supplemental Work Authorization (SWA) #: to WA #: SWA Amount: Revised WA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider: Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). Contract No. EXHIBIT H-3 Texas Department of Transportation Subprovider Monitoring System for Federally Funded Contracts Progress Assessment Report for month of (Mo./Yr.) / Contract #: Original Contract Amount: Date of Execution: Approved Supplemental Agreements: Prime Provider: Total Contract Amount: Work Authorization No. Work Authorization Amount: If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. DBE All Subproviders Category of Work Total Subprovider Amount % Total Contract Amount Amount Paid This Period Amount Paid To Date Subcontract Balance Remaining Fill out Progress Assessment Report with each estimate/invoice submitted, for all subcontracts, and forward as follows: 1 Copy with Invoice - Contract Manager/Managing Office 1 Copy – TxDOT, BOP Office, 120 X. 00xx, Xxxxxx, XX 00000, 000-000-0000, toll free 000-000-0000, or Fax to 000-000-0000 I hereby certify that the above is a true and correct statement of the amounts paid to the firms listed above. Print Name - Company Official /DBE Liaison Officer Signature Phone Date Email Fax Contract No. EXHIBIT H-4 Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Contract Number: Total Contract Amount: $ Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of , 20 Notary Public County My Commission expires: 12/06 DBE-H4.A Contract No. EXHIBIT H-5 Federal Subprovider and Supplier Information The Provider shall indicate below the name, address and phone number of all successful and unsuccessful subproviders and/or suppliers that provided proposals/quotes for this contract prior to execution. You may reproduce this form if additional space is needed. Name Address Phone Number The information must be provided and returned with the contract. Signature Date Printed Name Email Phone # Contract No. HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html HSP-PAR Rev. 9/05
Treatment of Passthru Payments and Gross Proceeds The Parties are committed to work together, along with Partner Jurisdictions, to develop a practical and effective alternative approach to achieve the policy objectives of foreign passthru payment and gross proceeds withholding that minimizes burden.
Absence Without Permission (a) An Employee who is absent from her employment without permission for ten (10) consecutive days, shall be deemed to have resigned her position effective the first day of her absence.
COMPLIANCE WITH TAX LAW SECTION 5-a The following provisions apply to Contractors that have entered into agreements in an amount exceeding $100,000 for the purchase of goods and services:
Requirements Pertaining Only to Federal Grants and Subrecipient Agreements If this Agreement is a grant that is funded in whole or in part by Federal funds:
Unusual Job Requirements of Short Duration The nature of health care is such that at times it may be necessary for an employee to perform work not normally required in his/her job for the safety, health or comfort of a client or resident. It is understood that an employee shall not be expected to perform a task for which he/she is not adequately trained.
