Landowner/Agent Affidavit Sample Clauses

Landowner/Agent Affidavit. By my signature below, I certify that I am the landowner of the above described property or a specifically authorized agent for the landowner. Authorized agent is defined as any person with verbal or written authorization to make decisions on behalf of the landowner. I also certify that the above information is true and correct to the best of my knowledge. Landowner/Agent Signature Printed Name Date Signed TEXAS PARKS AND WILDLIFE DEPARTMENT CERTIFICATION Circle One: Approved Disapproved Authorized TPWD Signature Date Name: Title: Certification provides that this Wildlife Management Plan was reviewed and is found to be biologically and technically sound with regard to management of wildlife populations and habitats.
Sample 1
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Landowner/Agent Affidavit. By my signature below, I certify that I am the landowner of the above described property or a specifically authorized agent for the landowner. Authorized agent is defined as any person with verbal or written authorization to make decisions on behalf of the landowner. I also certify that the above information is true and correct to the best of my knowledge. I authorize TPWD to use this information for its purposes, but not to release it to other parties or agencies without my approval. Landowner/Agent Signature Printed Name Date Signed TEXAS PARKS AND WILDLIFE DEPARTMENT CERTIFICATION Circle One: Approved Disapproved Authorized TPWD Signature Date Name: Title: Certification provides that this Wildlife Management Plan was reviewed and is found to be biologically and technically sound with regard to management of wildlife populations and habitats. Appendix C. GLOSSARY OF TERMS as referenced in the Candidate Conservation Agreement with Assurances for the Lesser Prairie Chicken (Tympanuchus pallidicintus) Between the Texas Parks and Wildlife Department and the US Fish and Wildlife Service Candidate Conservation Agreement with Assurances: Formal agreement between the USFWS and one or more parties to address the conservation needs of proposed or candidate species, or species likely to become candidates, before they become listed as endangered or threatened. This approach provides non-Federal property owners who voluntarily agree to manage their lands or waters to remove threats to candidate or proposed species assurances that their conservation efforts will not result in future regulatory obligations in excess of those they agree to at the time they enter into the agreement.
Sample 1
Landowner/Agent Affidavit. Consultant Certified Wildlife Biologist By my signature below, I certify that I am the landowner of the above described property or a specifically authorized agent for the landowner. Authorized agent is defined as any person with verbal or written authorization to make decisions on behalf of the landowner. I also certify that the above information is true and correct to the best of my knowledge. TEXAS PARKS AND WILDLIFE DEPARTMENT CERTIFICATION Circle One: Approved Disapproved Authorized TPWD Signature Date Name: Title: Certification provides that this Wildlife Management Plan was reviewed and is found to be biologically and technically sound with regard to management of wildlife populations and habitats. Landowner/Agent Signature Printed Name Date Signed
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Related to Landowner/Agent Affidavit

  • FIRPTA Affidavit A non-foreign affidavit, properly executed and in recordable form, containing such information as is required by IRC Section 1445(b)(2) and its regulations.

  • Special Certification The individual or officer signing this agreement certifies by his or her signature that he or she is authorized to sign this agreement on behalf of the responsible governing board, official or Grantee.

  • AFFIDAVIT The undersigned swear or affirm that the foregoing statements are correct and include all material information necessary to identify and explain the terms and operation of our joint venture and the intended participation by each joint venturer in the undertaking. Further, the undersigned covenant and agree to provide to the County current, complete and accurate information regarding actual joint venture work and the payment therefore and any proposed changes in any of the joint venture. Also, permit authorized representatives of the County to audit and examine records of the joint venture. Any material misrepresentation will be grounds for terminating any contract which may be awarded and for initiating action under Federal or State laws concerning false statements." Name of Firm: Name of Firm: Signature: Signature: Name: Name: Title: Title: Date: Date: INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY – PAGE 4 Date State of County of AFFIDAVIT STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐ Personally Known; OR ☐ Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) ORANGE COUNTY, FLORIDA Procurement Division CONTRACT NO. Y22-1022 SHUTTLE BUS SERVICES FOR OCCC This contract is not valid unless bilaterally executed. Subject to mutual agreement Orange County, Florida, hereby enters into a contract subject to the following:

  • Management Certifications In addition to the responsibilities set forth in this CIA for all Covered Persons, certain employees for the U.S. Healthcare Supply DMEPOS Companies (Certifying Employees) are expected to monitor and oversee activities within their areas of authority and shall annually certify that the applicable department for the U.S. Healthcare Supply DMEPOS Companies is in compliance with applicable Federal health care program requirements and the obligations of this CIA. These Certifying Employees shall include, at a minimum, the following individuals at U.S. Healthcare Supply, LLC, Spectrum Diabetic Services, LLC, Heritage Diabetic Supply, Inc, and Dependable Diabetic Supply, LLC: any Covered Person with the title and job responsibilities of Chief Executive Officer, President, Compliance Officer, Chief Operating Officer, Chief Financial Officer, director, or manager. For each Reporting Period, each Certifying Employee shall sign a certification that states: “I have been trained on and understand the compliance requirements and responsibilities as they relate to [insert name of department], an area under my supervision. My job responsibilities include ensuring compliance with regard to the [insert name of department] with all applicable Federal health care program requirements, obligations of the Corporate Integrity Agreement, and [insert name of applicable entity] policies, and I have taken steps to promote such compliance. To the best of my knowledge, the [insert name of department] of [insert name of applicable entity] is in compliance with all applicable Federal health care program requirements and the obligations of the Corporate Integrity Agreement. I understand that this certification is being provided to and relied upon by the United States.” If any Certifying Employee is unable to provide such a certification, the Certifying Employee shall provide a written explanation of the reasons why he or she is unable to provide the certification outlined above. Within 90 days after the Effective Date, the U.S. Healthcare Supply DMEPOS Companies shall develop and implement a written process for Certifying Employees to follow for the purpose of completing the certification required by this section (e.g., reports that must be reviewed, assessments that must be completed, sub-certifications that must be obtained, etc. prior to the Certifying Employee making the required certification).

  • Owner Certification During the term of this Contract, the Owner certifies that:

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  • Estoppel Certificate Tenant shall from time to time, upon written request by Landlord or any Lender execute, acknowledge and deliver to Landlord or such Lender, within ten (10) business days after receipt of such request, a statement in writing certifying, without limitation: (i) that this Lease is unmodified and in full force and effect (or if there have been modifications, identifying such modifications and certifying that the Lease, as modified, is in full force and effect); (ii) the dates to which Rent and any other charges have been paid; (iii) that Landlord is not in default under any provision of this Lease (or if Landlord is in default, specifying each such default) and that, if true, no events or conditions exist which, with the passage of time or notice or both, would constitute a default on the part of Landlord hereunder, (iv) the address to which notices to Tenant shall be sent; (v) the amount of Tenant’s security deposit and (vi) such other factual statements as may be reasonably requested by Landlord; it being understood that any such statement so delivered may be relied upon in connection with any lease, mortgage or transfer. Tenant’s failure to deliver such statement within such time shall be conclusive upon Tenant that: (i) this Lease is in full force and effect and has not been modified except as Landlord may represent; (ii) not more than one (1) month’s Rent has been paid in advance; (iii) there are no defaults by Landlord; (iv) notices to Tenant shall be sent to Tenant’s Address as set forth in Article 1 of this Lease; and (v) that all other statements contained in such estoppel are true and correct. Notwithstanding the presumptions of this Article, Tenant shall not be relieved of its obligation to deliver said statement.

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

  • Exhibit D - Debarment Certification By signing and submitting this Contract, the Contractor is agreeing to abide by the debarment requirements as set out below. • The certification in this clause is a material representation of fact relied upon by County. • The Contractor shall provide immediate written notice to County if at any time the Contractor learns that its certification was erroneous or has become erroneous by reason of changed circumstances. • Contractor certifies that none of its principals, affiliates, agents, representatives or contractors are excluded, disqualified or ineligible for the award of contracts by any Federal agency and Contractor further certifies to the best of its knowledge and belief, that it and its principals: • Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal Department or Agency; • Have not been convicted within the preceding three-years of any of the offenses listed in 2 CFR 180.800(a) or had a civil judgment rendered against it for one of those offenses within that time period; • Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses listed in 2 CFR 180.800(a); • Have not had one or more public transactions (Federal, State, or Local) terminated within the preceding three-years for cause or default. • The Contractor agrees by signing this Contract that it will not knowingly enter into any subcontract or covered transaction with a person who is proposed for debarment, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction. • Any subcontractor will provide a debarment certification that includes the debarment clause as noted in preceding bullets above, without modification.

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