To Complete. Please scan, sign and return the Trevelyan’s Packing Agreement commitment form as soon as possible. If you’re not able to do this, please email your grower representative stating you consent to the terms of this Packing Agreement. Xxxxxxxxx’s understands the 2020 harvest is far from normal due to Covid-19. Please be assured we intend to do an excellent job of packing your fruit. This year we can’t say ‘our doors are always open’ but we are only a phone call or email away. We welcome your feedback and questions, and want to support you in any way we can through harvest. Yours sincerely XXXXX XXXXXXXXX - MANAGING DIRECTOR XXXXXXX XXXXXX - GENERAL MANAGER A THOUSAND LITTLE DECISIONS CREATES BIG WINS - XXXXXXXXX.XX.XX 08
To Complete. The Trevelyan Packing Agreement commitment form needs to be signed and completed by the grower. A stamped, addressed envelope is included for your convenience. We at Xxxxxxxxx’s would like to take the opportunity to wish you a successful and prosperous harvest. Yours sincerely Xxxxx Xxxxxxxxx Managing Director Xxxxxxx Xxxxxx General Manager Respect our People
To Complete. Please complete all non-completed boxes in the chart below. Please add new lines for all separate budget/object/line of appropriations codes. Amount/ Member Total # of Member(s) Requested Total Agency Commitment to be transferred (Amount x # of members) Budget Code Object Code Line of Appropriati ons Member Stipend + Employer FICA $19,920.00 Below are listed the supervisor(s) for the program year. If there is a change in supervisor(s) the organization agrees to let NYC Service staff know at least 5 business days before the change. Supervisor Name: Supervisor Title: Supervisor E-mail Address: Supervisor Phone Number: Supervising following Position(s): _ All listed supervisors will need to sign a form at Supervisor Orientation acknowledging their participation in the role of supervisor and their adherence to the policies laid out in this agreement as well as in the supervisor handbook. Below is the fiscal point person for the agency in regards to this agreement: Fiscal Point Person Name: Fiscal Point Person Title: Fiscal Point Person E-mail Address: Fiscal Point Person Phone Number: Below is the OMB Task Force person for the agency in regards to this agreement: OMB Task Force Person Name: OMB Task Force Person Title: OMB Task Force Person E-mail Address: OMB Task Force Person Phone Number: By signing this agreement, the Host Site acknowledges that the finance point person has been informed of the fiscal implications for participation as a Host Site as well as the OMB Task Force Member for the agency. Members cannot begin serving at a host site until this agreement has been returned to NYC Service signed by the host site. Deadline is September 10, 2020. (Signature section is on the next page.) The below signatories all agree to this agreement: Agency Commissioner or Division Head where Member(s) will be serving: Title: Signature: Date: Name of Person Submitting Agreement: Title: Signature: Date: NYC Service Managing Director of Service Year Programs: Signature: Date:
To Complete. 3. The following shall be added to Clauses 1 and 2 of Schedule 3:
To Complete a Final Integrative Project;
To Complete. Total Claimed DBE Local Agency Contract Number Participation $ Federal-Aid Project Number: None Federal Share: $ [Enter 88.53% of Total Contract Amount] Contract Award: % Local Agency certifies that the DBE certifications have been verified and all information is complete and accurate. Print Name Signature Date Local Agency Representative (Area Code) Telephone No.
To Complete. If your organisation is a FI, please complete (a) or (b) below as appropriate: (a) Participating FFI or Registered Deemed Compliant (including Reporting Model 1 FFI) Please provide your Organisation’s Global Intermediary Identification Number (GIIN):
To Complete. If your organisation is a FI, please complete (a) or (b) below as appropriate:
To Complete. If your organisation is not a FI, please confirm your organisation’s status below: Active NFFE Passive NFFE Direct Reporting NFFE If you are a direct reporting NFFE, please provide your GIIN or the GIIN of your sponsoring entity and the name of the sponsoring entity: Please tick this box to confirm that the sponsoring entity has agreed with the entity identified above (That is not a non-participating FFI) to act as the sponsoring entity for this entity: For Passive NFFEs, please complete the table below in respect of Controlling Persons. Controlling Persons re defined as natural persons who exercise control over the entity or the shareholders of the entity based on local Anti- Money Laundering (AML) requirements. In the case of case of a trust, this means: • The settlor, • The trustees, • The protector (if any), • The beneficiaries or class of beneficiaries, and • Any other natural person exercising ultimate effective control over the trust. In the case of a legal arrangement other than a trust, it means persons in equivalent or similar positions. Controlling Persons (please continue on a separate sheet if necessary, signing, dating and attaching the sheet to this form): if the Controlling Person(s) are US Citizens then they should additionally complete a W9 form. NAME ADDRESS TAX RESIDENCE(S) (List all) TIN(S) Provide all PLACE (City/Town & Country) And DATE OF BIRTH (dd/mm/yyyy)
To Complete. Local Agency Contract Number Total Claimed DBE Participation $ % Federal-Aid Project Number: Federal Share: Contract Award: None $ [Enter 88.53% of Total Contract Amount] Local Agency certifies that the DBE certifications have been verified and all information is complete and accurate. Print Name Signature Date Local Agency Representative (Area Code) Telephone No. For Caltrans Review: Print Name Signature Date Caltrans District Local Assistance Engineer Signature of Proposer Date (Area Code) Tel. No. Person to Contact (Please Type or Print) FOR SCAG USE:
