Designated College Representative. The designated College representative for purposes of monitoring and oversight of this contract is: Typed or Printed Name Telephone Email Address G/L: Budget Code: Signatures: CONTRACTOR Signature Date Title Printed Name COLLEGE Signature Date VPAF Xxxxxx Xxxxx Title Printed Name SYSTEM OFFICE Signature Date
Designated College Representative. The designated College representative for purposes of monitoring and oversight of this Contract is: Phone: Email:
Designated College Representative. The designated College representative for purposes of monitoring and oversight of this contract is: Typed or Printed Name Telephone Email Address Signatures: CONTRACTOR Signature Date Title Printed Name COLLEGE Signature Date Title Printed Name SYSTEM OFFICE Signature Date
Designated College Representative. The designated College representative for purposes of monitoring and oversight of this Contract is: Phone: Email: Signatures: CONTRACTOR COLLEGE SYSTEM OFFICE Signature Signature Xxxx Xxxxxxx Signature Printed Name Printed NameVice President Administration & Finance Printed Name Title Title Title Date Date Date
Designated College Representative. The designated College representative for purposes of monitoring and oversight of this Contract is: Xxxxxxx Xxxxxxxxx 000-000-0000 xxxxxxx0@xxx.xxx Typed or Printed Name Telephone Email Address 20. Signatures. CONTRACTOR Signature Date Title Printed Name COLLEGE Signature Date Vice President for Administration and Finance Xxxxxx Xxxxxxxxxxx Title Printed Name SYSTEM OFFICE Signature Date Title Printed Name United States Citizenship Attestation Form For the purpose of complying with Neb. Rev. Stat. §§ 4-108 through 4-114, I attest as follows: I am a citizen of the United States. I am a qualified alien under the federal Immigration and Nationality Act, my immigration status and alien number are as follows: , and I agree to provide a copy of my USCIS documentation upon request. I hereby attest that my response and the information provided on this form and any related application for public benefits are true, complete, and accurate and I understand that this information may be used to verify my lawful presence in the United States. PRINT NAME (first, middle, last) SIGNATURE DATE 1/19/2010 Clear Form STATE OF NEBRASKA W-9 & ACH ENROLLMENT FORM PLEASE SUBMIT FORM TO INVOICED AGENCY 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification; check only one of the following boxes: Individual Sole proprietor C Corporation S Corporation Partnership Trust/Estate Non-Profit Entity Government (Local, State or Federal) Limited Liability Company. Enter the tax classification (C = C Corporation, S = S Corporation, P = Partnership) Other (see instructions) Note: Enter the owner’s name on line 1 and xxxx the appropriate federal tax classification box for disregarded entities.
