No Yes. If so, identify the job functions the employee is unable to perform:
No Yes. 9. Accounting Services (state "yes" or "no" as 10. Sale or purchase of the Vessel (state "yes" or "no" agreed) (Cl. 3.5) as agreed) (Cl. 3.6)
No Yes. If so, dates of admission: Date(s) you treated the patient for condition: Will the patient need to have treatment visits at least twice per year due to the condition? No Yes Was medication, other than over-the-counter medication, prescribed? No Yes Was the patient referred to other health care provider(s) for evaluation or treatment (e.g. physical therapist)? No Yes If so, state the nature of such treatments and expected duration of treatment:
No Yes. Buy/Sell Agreement (Contract No. 317708) dated December 2, 2008, as amended Sunoco, Inc. (R&M) Canadian Natural Resources By Its Managing Partner Canadian Natural Resources Limited No Yes Purchase Agreement (Contract No. 312023) dated October 7, 2003, as amended Sunoco, Inc. (R&M) Xxxxxx Oil Company, LTD No Yes Purchase Agreement (Contract No. 312000) dated September 18, 2003, as amended Sunoco, Inc. (R&M) Imperial Oil (The Partnership) No Yes Buy/Sell Agreement (Contract No. 314241; successor to Contract No. 306580) dated February 22, 2006, as amended Sunoco, Inc. (R&M) Suncor Energy Marketing Inc. No Yes Purchase Agreement (Contract No. 315961) dated May 3, 2007, as amended Sunoco, Inc. (R&M) Nexen Marketing No Yes Schedule 4.1.4(a)
No Yes. If the answer to this question is yes, please provide details of the offense, the date, disposition, etc., in an attachment.
No Yes. (a) 10% of the dwelling units in the project financed in part from the proceeds of the captioned Bonds were first occupied on , 20 and
No Yes. Cafeteria-Full Time School Cal Yes 4 11 3
No Yes. If so, explain: Based upon the patient’s medical history and your knowledge of the medical condition, estimate the frequency of flare-ups and the duration of related incapacity that the patient may have over the next 6 months (e.g., 1 episode every 3 months lasting 1-2 days): Frequency: times per week(s) month(s) Duration: hours or day(s) per episode ADDITIONAL INFORMATION: IDENTIFY QUESTION NUMBER WITH YOUR ADDITIONAL ANSWER: Signature of Health Care Provider Date APPENDIX D-2 COMMONWEALTH OF MASSACHUSETTS CERTIFICATION OF HEALTH CARE PROVIDER FOR FAMILY MEMBER’S SERIOUS HEALTH CONDITION (FMLA) SECTION I: For Completion by the EMPLOYER INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave to care for a covered family member with a serious health condition to submit a medical certification issued by the health care provider of the covered family member. Please complete Section I before giving this form to your employee. Your response is voluntary. While you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. §§ 825.306-825.308. Employers must generally maintain records and documents relating to medical certifications, recertifications, or medical histories of employees’ family members, created for FMLA purposes as confidential medical records in separate files/records from the usual personnel files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies. Employer name and contact:
No Yes. No Yes If a principal dies. If a principal is diagnosed with a medically diagnosed terminal illness. BUSINESS OWNERSHIP/DETAILS Director 1/Principal 1 Full name Name of related entity (If applicable) ACN/ ABN/ ARBN Structure of the interest-holder No Yes No Yes Discretionary/Family Trust Unit Trust Interest-holding details Self owned Hybrid Trust Company/corporate trustee Percentage Interest Class of interest held % Date of acquisition Number of interests held Has the principal or its related entity granted an interest in its interest in the business? If so, provide details Estimated value of the interest $ Paid up capital amount $ Insurance policy details 1. 2. Annual premium $ $ Yes No
No Yes. Breaking Bad s.1 e.5 No Yes
