Examples of Subprovider in a sentence
Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page.
DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above.
Subprovider - IPF Subprovider - IRF Subprovider - (Other) Swing Beds - SNF Swing Beds - NF Hospital-Based SNF Hospital-Based NF Hospital-Based OLTC Hospital-Based HHA Separately Certified ASC Hospital-Based Hospice Hospital-Based Health Clinic - RHC Hospital-Based Health Clinic - FQHC Hospital-Based (CMHC) I Renal Dialysis Other ST.
Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller.
More than 5% of the total equity allocation invested in individual equity securities of any one company at market value2.
Subprovider - IRF Subprovider - (Other) Swing Beds - SNF Swing Beds - NF Hospital-Based SNF Hospital-Based NF Hospital-Based OLTC Hospital-Based HHA Separately Certified ASC Hospital-Based Hospice Hospital-Based Health Clinic - RHC Hospital-Based Health Clinic - FQHC Hospital-Based (CMHC) I Renal Dialysis Other ST.
DBE All Subproviders Category of Work Total Subprovider Amount % Total Contract Amount Amount Paid This Period Amount Paid To Date Subcontract Balance Remaining Fill out Progress Assessment Report with each estimate/invoice submitted, for all subcontracts, and forward as follows: 1 Copy with Invoice - Contract Manager/Managing Office 1 Copy – TxDOT, BOP Office, 000 X.
Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider: Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller.
Total DBE or HUB Commitment Dollars $ Total DBE or HUB Commitment Percentages of Contract % (Commitment Dollars and Percentages are for Subproviders only) EXHIBIT H-2 Texas Department of Transportation Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT).
Subprovider - (Other) Swing Beds - SNF Swing Beds - NF Hospital-Based SNF Hospital-Based NF Hospital-Based OLTC Hospital-Based HHA Separately Certified ASC Hospital-Based Hospice Hospital-Based Health Clinic - RHC Hospital-Based Health Clinic - FQHC Hospital-Based (CMHC) I Renal Dialysis Other UNION HOSPITAL, INC.