Requirement Certifications Sample Clauses
Requirement Certifications. Under penalties or perjury, the undersigned certifies that the name, taxpayer information number and legal status listed below are correct. Name: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇-▇▇▇▇▇▇▇▇.▇▇▇ Taxpayer Identification Number: ▇▇-▇▇▇▇▇▇▇ Legal Status (check one): Individual Government entity Nonresident alien individual Estate of legal trust Foreign Corporation and/or health care services Other – not-for-profit _X _ Corporation NOT providing or billing organization: medical and/or health care services The Service Provider acknowledges that the individual signing below is authorized to execute this Agreement and that each signature constitutes the acceptance of this Agreement. Service Provider: By: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, Executive Director ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇-▇▇▇▇▇▇▇▇.▇▇▇ McHenry County Board By: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇, Chairman Date McHenry County Workforce Network Board By: ▇▇▇▇▇ ▇. ▇▇▇▇▇▇, Chairman Date PROGRAM: WIOA (Workforce Innovation and Opportunity Act) – Youth Program NAME OF Service Provider/Subrecipient: Parents Alliance Employment Project APPLICATION GRANT NUMBER: Grant 22-681002 PROJECT DURATION: BEGIN DATE: 1 July 2023 END DATE: 30 June 2024 SUMMARY OF PROJECT – BY BUDGET/COST CATEGORY Cost Category Description Funding Request Personnel $96,945.11 Fringe $15,087.26 Travel $1,572.00 Other/Payroll Processing and Professional Development $2,660.54 Total $116,264.91
Requirement Certifications. Under penalties or perjury, the undersigned certifies that the name, taxpayer information number and legal status listed below are correct. Name: ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇, President Taxpayer Identification Number: ▇▇-▇▇▇▇▇▇▇ Legal Status (check one): Individual Government entity Nonresident alien individual Estate of legal trust Foreign Corporation and/or health care services Other – not-for-profit _ Corporation NOT providing or billing organization: medical and/or health care services The Service Provider acknowledges that the individual signing below is authorized to execute this Agreement and that each signature constitutes the acceptance of this Agreement. Draft Service Provider: By: Date ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇, President McHenry County College ▇▇▇▇ ▇.▇. ▇▇▇▇▇▇▇ ▇▇, ▇▇▇▇▇▇▇ ▇▇▇▇, ▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ ▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇.▇▇▇ McHenry County Board By: ▇▇▇▇ ▇. ▇▇▇▇▇▇, Chairman Date McHenry County Workforce Network Board By: ▇▇▇▇▇ ▇▇▇▇▇▇, Chairman Date PROGRAM: WIOA (Workforce Innovation and Opportunity Act) NAME OF Service Provider / Subrecipient: McHenry County College APPLICATION GRANT NUMBER: 19-681002 Draft PROJECT DURATION: BEGIN DATE: 07/01/2020 END DATE: 06/30/2021 SUMMARY OF PROJECT – BY BUDGET/COST CATEGORY Cost Category Description Current Approved Budget In-Kind New Budget Amount Employability Training (12 sessions x $660) $7,920.00 Job Search Preparedness Bootcamp (4 Sessions x $2,100) $8,400.00 Industry Career Opportunities Series (12 Sessions X $330) $3,960.00 Total $20,280.00
Requirement Certifications. Under penalties or perjury, the undersigned certifies that the name, taxpayer information number and legal status listed below are correct. Name: ▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Taxpayer Identification Number: SS# 352/42/9628 Legal Status (check one): X_ Individual Government entity Nonresident alien individual Estate of legal trust Foreign Corporation and/or health care services Other – not-for-profit _ _ Corporation NOT providing or billing organization: medical and/or health care services The Service Provider acknowledges that the individual signing below is authorized to execute this Agreement and that each signature constitutes the acceptance of this Agreement. DRAFT Service Provider: By: ▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Date ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ McHenry County Board By: ▇▇▇▇ ▇. ▇▇▇▇▇▇, Chairman Date McHenry County Workforce Network Board By: ▇▇▇▇▇ ▇▇▇▇▇▇, Chairman Date PROGRAM: WIOA (Workforce Innovation and Opportunity Act) NAME OF Service Provider / Subrecipient: ▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ APPLICATION GRANT NUMBER: 19-681002 DRAFT PROJECT DURATION: BEGIN DATE: 07/01/2020 END DATE: 06/30/2021 SUMMARY OF PROJECT – BY BUDGET/COST CATEGORY Cost Category Description Current Approved Budget In-Kind New Budget Amount Twelve NTS Sessions $3,600.00 Preparation time for 12 sessions $1,800.00 New Presentation Materials if Requested $1,000.00 Total $6,400.00