AUTHORIZATION AND RELEASE. CERTIFICATION I hereby authorize the Department of Defense and other authorized federal agencies to obtain any information required from the Federal government, state agencies, and/or foreign governments, including but not limited to, the Federal Bureau of Investigation (FBI), the Defense Counterintelligence and Security Agency (DCSA), the U.S. Office of Personnel Management (OPM), the Department of Homeland Security (DHS), (if applicable), and from the State Criminal History Repository for each state where I have resided. This authorization is valid for one year from the date this form was signed or until termination of my affiliation with the Federal Government, whichever is sooner. I have been notified of any employer’s or Agency's right to require a criminal history records check as a condition of employment, or affiliation with DoD Child Care Services Programs. I understand that I may request a copy of such records as may be available to me under the law. I understand that I have a right to challenge the accuracy and completeness of any information contained in the criminal history records check report. I also understand that pursuant to the Privacy Act, the information collected will be safeguarded, including for the purpose of conducting the background check. I release any individual, including records custodians, any component of the United States Government or the individual State Criminal History Repository supplying information, from all liability for damages that may result on account of good-faith compliance, or any good-faith attempts to comply with this authorization. This release is binding, now and in the future, on my heirs, assigns, associates, and personal representative(s) of any nature. Copies of this authorization that show my signature are as valid as the original release signed by me. I declare under penalty of perjury that the statements made by me on this form are true, complete and correct. In addition to the annual certification, I understand that it is my responsibility to immediately inform my employer/supervisor or Child and Youth Programs representative if I am apprehended, arrested, charged, or convicted by Federal, State, or local authorities for any violation of any Federal law (including the Uniform Code of Military Justice), State law, County law, or Municipal law with a crime referenced in block 6. (Do not include traffic fines of less than $300.). In addition, I will immediately report when I am aware of a current al...
AUTHORIZATION AND RELEASE. In no event shall the Vendor deliver goods or provide service until such time as a duly authorized release document is certified by the ordering Agency. A Direct Purchase Order (DPO) shall be created by the agency listing the items ordered, using the pricing and format set forth in the Master Blanket. All pricing State of Rhode Island Contract Purchase Agreement 3434343, 0 shall be as described in the Master Blanket and is considered to be fixed and firm for the term of the Agreement, unless specifically noted to the contrary herein. All prices include prepaid freight. Freight, taxes, surcharges, or other additional charges will not be honored unless reflected in Master Blanket. BLANKET PAYMENT DELIVERY OF GOODS OR SERVICES AS REQUESTED BY AGENCY. PAYMENTS WILL BE AUTHORIZED UPON SUBMISSION OF PROPERLY RENDERED INVOICES NO MORE THAN MONTHLY TO THE RECEIVING AGENCY. ANY UNUSED BALANCE AT END OF BLANKET PERIOD IS AUTOMATICALLY CANCELLED. EQUAL OPPORTUNITY COMPLIANCE THIS PURCHASE ORDER IS AWARDED SUBJECT TO EQUAL OPPORTUNITY COMPLIANCE.
AUTHORIZATION AND RELEASE. I hereby authorize all previous employers and references to release to the City of Groton, any and all employment and personnel information requested, including, but not limited to my personnel file(s). I hereby also specifically release and hold harmless the City of Groton, or any former employer and its employees and/or agents from any and all claims or liability as a result of releasing such information. APPLICANT’S SIGNATURE DATE (This employment application must be signed in ink or by electronic signature)
AUTHORIZATION AND RELEASE. Examiners should obtain an examinee’s agreement, in writing and/or on the audio/video recording, to a waiver/release statement. The language of the statement should minimally include 1) the examinee's voluntary consent to take the test, 2) that the examination may be terminated at any time, 3) a statement regarding the examinee’s assessment of his or her mental and physical health at the time of the examination, 4) that all information and results will be released to professional members of the community supervision team, 5) an advisement that admission of involvement in unlawful activities will not be concealed from the referring professionals and 6) a statement regarding the requirement for audio/video recording of each examination.
AUTHORIZATION AND RELEASE. The undersigned hereby represents and warrants that he or she is duly authorized to execute and deliver this application on behalf of its organization and agrees to assume all risks and responsibilities surrounding participation in the 2015 CultureFest and further to release the University of Denver and all departments and divisions thereof from any claims, demands, actions, causes of action, lawsuits, expenses, or losses (including court costs and all reasonable attorney fees) he or she may have on account of property damage or personal injury (including death) arising out of or attributable to participation in the 2015 CultureFest, unless such property damage or personal injury or death is caused by the negligence of the University of Denver, its trustees, employees or agents. The undersigned, on behalf of his or her organization has read, understands, and agrees with the enclosed rules and regulations and takes full responsibility for the activities conducted in the assigned booth area. The undersigned xxxxxx agrees that his or her organization will comply with the rules of the 2015 CultureFest. Upon acceptance by the CultureFest Planning Board, your booth application shall be a contract for participation at the 2015 CultureFest. You will be considered in default of your obligations under this agreement if you should fail to observe, to comply with, or to perform any term or condition contained in this agreement. Representative’s Signature: Date: Representative’s Printed Name: Initials: 2015 CultureFest Booth/Exhibit Policies, Rules, & Requirements Mission: The CultureFest, sponsored by the CultureFest Planning Board at the Colorado Seminary, which owns and operates, the University of Denver, University of Denver, is an event intended to support the sharing, celebration, and appreciation of diverse cultural backgrounds, customs, and experiences among members of the University of Denver and surrounding Denver community. The event seeks to support internationalization and to xxxxxx inclusivity along with a climate of respect and appreciation of differences. Below are the Colorado Seminary/University of Denver (also referred to as DU) policies and requirements for all booth applicants and CultureFest participants (also referred to as “you”, “your”, “applicant”, or “participant”). Please read and review these policies and requirements for participation carefully. Initial next to each number to indicate that you have read, understood, and consent to adhere t...
AUTHORIZATION AND RELEASE. In no event shall the Vendor deliver goods or provide service until such time as a duly authorized release document is certified by the ordering Agency. A Direct Purchase Order (DPO) shall be created by the agency listing the items ordered, using the pricing and format set forth in the Master Blanket. All pricing shall be as described in the Master Blanket and is considered to be fixed and firm for the term of the Agreement, unless specifically noted to the contrary herein. All prices include prepaid freight. Freight, taxes, surcharges, or other additional charges will not be honored unless reflected in Master Blanket. BLANKET PAYMENT DELIVERY OF GOODS OR SERVICES AS REQUESTED BY AGENCY. PAYMENTS WILL BE AUTHORIZED UPON SUBMISSION OF PROPERLY RENDERED INVOICES NO MORE THAN MONTHLY TO THE RECEIVING AGENCY. ANY UNUSED BALANCE AT END OF BLANKET State of Rhode Island Contract Purchase Agreement 3490627, 0 PERIOD IS AUTOMATICALLY CANCELLED. EQUAL OPPORTUNITY COMPLIANCE THIS PURCHASE ORDER IS AWARDED SUBJECT TO EQUAL OPPORTUNITY COMPLIANCE. CAMPAIGN FINANCE COMPLIANCE CAMPAIGN FINANCE: In accordance with RI General Law 17-27-2, Every person or business entity providing goods or services of $5,000 or more, and has in the preceding 24 months, contributed an aggregate amount in excess of $250 within a calendar year to any general officer, or candidate for general office, any member, or candidate for general assembly, or political party, is required to electronically file an affidavit regarding political contributions at: xxxxx://xxxxxx.xxxxxxxxxxxxxxxxx.xxx/RhodeIslandCF/Public/VendorAffidavit.aspx ARRA SUPPLEMENTAL TERMS AND CONDITIONS
AUTHORIZATION AND RELEASE. I authorize release of any information relating to my family’s dental claims to my insurance company of record during the period of such dental care. Signature of Parent or Guardian Date
AUTHORIZATION AND RELEASE. To obtain CARRIER's authorization for each Alternative Use of Equipment, CONTRACTOR shall take the following steps before accepting a trip:
AUTHORIZATION AND RELEASE. In no event shall the Vendor deliver goods or provide service until such time as a duly authorized release document is certified by the ordering Agency. A Direct Purchase Order (DPO) shall be created by the agency listing the items ordered, using the pricing and format set forth in the Master Blanket. All pricing shall be as described in the Master Blanket and is considered to be fixed and firm for the term of the Agreement, unless specifically noted to the contrary herein. All prices include prepaid freight. Freight, taxes, surcharges, or other additional charges will not be honored unless reflected in Master Blanket. EQUAL OPPORTUNITY COMPLIANCE THIS PURCHASE ORDER IS AWARDED SUBJECT TO EQUAL OPPORTUNITY COMPLIANCE. CAMPAIGN FINANCE COMPLIANCE CAMPAIGN FINANCE: In accordance with RI General Law 17-27-2, Every person or business entity providing goods or services of $5,000 or more, and has in the preceding 24 months, contributed an aggregate amount in excess of $250 within a calendar year to any general officer, or candidate for general office, any member, or candidate for general assembly, or political party, is required to electronically file an affidavit regarding political contributions at: xxxxx://xxxxxx.xxxxxxxxxxxxxxxxx.xxx/RhodeIslandCF/Public/VendorAffidavit.aspx ARRA SUPPLEMENTAL TERMS AND CONDITIONS
AUTHORIZATION AND RELEASE. In accordance with the Privacy Act, Freedom of Information Act, the Fair Credit Reporting Act, and any similar federal, state, or local statutory or common laws or regulations, Buyer expressly authorizes the above-named references, any credit reporting agency, any law enforcement agency (federal/state/local) and any person or entity with knowledge of information relevant to this request for credit to release Buyer information to Seller and its affiliated entities and their officers, directors, agents and employees (“Xxxxx Corning Affiliates”), each of whom may request, obtain and use such information under this Agreement, and Xxxxx expressly authorizes Seller to answer questions from third parties regarding its credit experience with Buyer. Buyer hereby agrees to release, indemnify, defend, and hold harmless each of the Xxxxx Corning Affiliates and all other persons or entities, including without limitation those providing information, from any and all liability for losses, claims, injuries, liabilities, and damages of whatever kind or nature, whether known or unknown, including without limitation those based upon defamation, invasion of privacy, and rights of publicity and personality, which may at any time arise or accrue to Buyer or Xxxxx’s heirs, successors, parents, affiliates, subsidiaries, assigns, officers, directors, employees, agents or other persons or entities claiming by or through any of the foregoing entities, on account of provision of such information, Seller’s answers to questions from third parties, or reliance on such information or on other information gathered pursuant thereto and hereto. Buyer represents and warrants to Seller that the information provided by Buyer to Seller under this Agreement is accurate and complete. Xxxxx acknowledges that Xxxxxx has the right to rely upon such information, and, subsequent to the execution of this Agreement, Buyer shall promptly notify Seller in writing should any such information no longer be accurate or complete.
