Insurance Acknowledgement definition

Insurance Acknowledgement. I acknowledge Kitsap County provides limited, secondary medical insurance to serve as a supplement to the volunteer’s primary medical insurance and will serve as primary coverage only in the event that the volunteer has no medical insurance coverage. Print Name Mailing Address Emergency Contact Phone # (Parent signature or attach V-7 if under 18) Signature Hours From To Kitsap County Staff Project Supervisor Name Date Signature Safety Orientation, if applicable, presented by: Staff OR Lead Volunteer Name * At least one volunteer should be first-aid trained.
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Insurance Acknowledgement means an acknowledgement (if any) in the form and terms of Schedule 1 to the relevant Assignment of Insurances;
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Insurance Acknowledgement. I acknowledge and understand that, aside from potential coverage which may be afforded by the District’s workers compensation program, the District does not provide liability or medical insurance coverage for me in connection with my participation in the above-described activity. I acknowledge that I have my own medical insurance, and that I agree to assume all responsibility for payment for any treatment I may receive. IN SIGNING BELOW, I HEREBY ACKNOWLEDGE AND REPRESENT THAT I AM AT LEAST 18 YEARS OF AGE OR OLDER, THAT I HAVE READ THIS ENTIRE DOCUMENT, THAT I UNDERSTAND ITS TERMS AND PROVISIONS, THAT I UNDERSTAND IT AFFECTS MY LEGAL RIGHTS, THAT IT IS A BINDING AGREEMENT, AND THAT I HAVE SIGNED IT KNOWINGLY AND VOLUNTARILY. Signature Date Name (Please Print) Medical Insurance Carrier (e.g., Blue Shield) Policy Number In the event of medical emergency, please contact: Name Relationship Telephone
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Examples of Insurance Acknowledgement in a sentence

  • Casual Xxxxx’s must complete the Casual User of Council Facilities Liability Insurance Acknowledgement and Declaration in the Hire Agreement Form.

  • I understand I will be required to return, prior to my tour departure, an Insurance Acknowledgement Form, and indicate to Group Tours Incorporated whether or not I have purchased travel insurance, and if so with who and when.

  • If you are unsure whether or not you are a business or casual hirer for the purpose of this application, please read Casual User of Council Facilities Liability Insurance Acknowledgement and Declaration and seek professional independent advice.

  • Specification Mandatory/ Optional/Preferred/NARespondent’s Compliance (see also WSIB & Insurance Acknowledgement below)1 WSIB Account #: ORCheck here if exempt from WSIB coverage as described in Section 3.2 of this document.

  • G-1Exhibit H: Insurance Acknowledgement............................................................................................

  • Insurance Acknowledgement - signed acknowledgement(s) through which each insurance carrier that will issue any policy required in the Insurance Provisions, shall acknowledge, warrant and represent that it possesses the ability to and shall furnish all the insurance endorsements prescribed in the Insurance Provisions.

  • The Contractors are required to complete the Insurance Acknowledgement form as part of the Proposal submittal.

  • Specification Mandatory/ Optional/Preferred/NARespondent’s Compliance (see also WSIB & Insurance Acknowledgement below)1WSIB (Section 3.2) Account #: ORCheck here if exempt from WSIB coverage as described in Section 2.2 of this document.

  • Face Sheet [ ] Checklist [ ] Table of Contents [ ] Program Narrative [ ] Operating Budget [ ] Budget Narrative [ ] Insurance Acknowledgement Form [ ] NH Contractual Documents [ ] New Hampshire Department of Safety Proposal Face Sheet 1.

  • SpecificationMandatory/ Optional/NAProponent’s Compliance(see also WSIB & Insurance Acknowledgement below)1 WSIB Account #: OR Check here if exempt from WSIB coverage as described in section1.16 of this document: WSIB and Insurance Acknowledgement By signing below, I , acknowledge thatName of individualhas the ability to provide the requested WSIB, or proofName of companyof exemption of coverage, and Insurance certificate(s) in accordance with this Proposal document.


More Definitions of Insurance Acknowledgement

Insurance Acknowledgement. I acknowledge and understand that, aside from potential coverage which may be afforded by the District’s workers compensation program, the District does not provide liability or medical insurance coverage for me in connection with my participation in the above-described activity. I acknowledge that I have my own medical insurance, and that I agree to assume all responsibility for payment for any treatment I may receive. IN SIGNING BELOW, I HEREBY ACKNOWLEDGE AND REPRESENT THAT I AM AT LEAST 18 YEARS OF AGE OR OLDER, THAT I HAVE READ THIS ENTIRE DOCUMENT, THAT I UNDERSTAND ITS TERMS AND PROVISIONS, THAT I UNDERSTAND IT AFFECTS MY LEGAL RIGHTS, THAT IT IS A BINDING AGREEMENT, AND THAT I HAVE SIGNED IT KNOWINGLY AND VOLUNTARILY. Full Name (print): Signature: Date: Medical Insurance Carrier: e.g., Blue Shield, Kaiser, etc. Policy Number: Pacto de Participación de Adultos en la Actividad de Voluntarios El subscriptor solicita participación como voluntario en la siguiente actividad: Descripción de Actividad (tipo de voluntario): Acompañante, Voluntario en el Aula, Jardín, etc.
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Related to Insurance Acknowledgement

  • Insurance Agreement means the insurance and indemnity agreement identified in the Adoption Annex.

  • Comprehensive agreement means the comprehensive agreement between the private entity and the responsible public entity that is required prior to the development or operation of a qualifying project.

  • Student with a disability is defined as an individual who: ● is still enrolled in secondary school and has not exited, graduated, or withdrawn; ● is at least 14 years old but less than 22; ● and has a disability (i.e., receives services under an IEP or 504 plan, or has a disability for purposes of section 504). The limited Pre-ETS that may be provided, based on identified need and the availability of services, include: ● Job exploration counseling ● Work-based learning experiences, which may include in-school or after school opportunities, experiences outside of the traditional school setting, and/or internships ● Counseling on opportunities for enrollment in comprehensive transition or post- secondary educational programs ● Workplace readiness training to develop social skills and independent living ● Instruction in self-advocacy Authorizations for Pre-ETS. DORS only pays for Pre-ETS services that have been previously authorized by a DORS official in writing. Pre-ETS Reporting: Completion of the Pre-Employment Transition Services Progress Report (Rs10f), Work Based Learning Experience Agreement (Rs10g), Work Based Learning Experience on site workplace readiness Training Report (Rs10e), or approved alternative form is required at the conclusion of the training or at agreed upon intervals.

  • policy of life insurance means any instrument by which the payment of money is assured on death (except death by accident only) or the happening of any contingency dependent on human life, or any instrument evidencing a contract which is subject to payment of premiums for a term dependent on human life;

  • Credit unemployment insurance means insurance:

  • Medical control means a person who provides medical supervision to an emergency medical service provider.

  • Medical malpractice insurance means insurance against legal liability incident to the practice and provision of a medical service other than the practice and provision of a dental service.

  • Reinsurance Agreement means any agreement, contract, treaty or other arrangement whereby one or more insurers, as reinsurers, assume liabilities under insurance policies or agreements issued by another insurance or reinsurance company or companies.