Appears in 4 contracts

Samples: Independent Contractor Agreement, Caney Isd Checklist, Caney Isd Checklist

Appears in 2 contracts

Samples: gcuusa.com, gcuusa.com

Appears in 2 contracts

Samples: Independent Contractor Agreement, Independent Contractor Agreement

Appears in 2 contracts

Samples: Financing Agreement, Loan Agreement

Appears in 1 contract

Samples: Grant Agreement

Purpose of Form. An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 11-2017) ~~New Caney ISD Conflict~~ To: HSH Processors PA Workers Compensation Insurance Compliance Form (SWIF) Deer Processor: Please fill out and mail back with a copy of ~~Interest Instructions New Caney ISD~~ your insurance certificate if needed, to the address above. The business name should be the same as on form W-9. Thank you for helping HSH be in compliance. Statement: As a participating HSH Processor I hereby state that I am not an employee of Hunters Sharing the Harvest charitable venison donation program, but a subcontractor (sole proprietor) who has signed a valid agreement with HSH for donated deer meat processed and distributed to area Food Banks. I work my own schedule, supply my own tools and work in my own facility inspected and registered by the PA Dept of Agriculture Bureau of Food Safety. In addition, I am fully responsible for decisions on how best to complete the task for my customers, the hunters donating deer to the HSH program. Name Business Name Address City State Zip Code Phone County Email Please check one: I am Sole Proprietor w/o employees. No insurance certificate required. Sole Proprietor with employees. Enclosed is PA Workers Compensation Insurance Certificate. Definitions of Sole Proprietor from SWIF (State Workers’ Insurance Fund) website What If I Use Subcontractors? Pennsylvania Workers’ Compensation Act Section 302 (a) & (b) provides that a contractor is responsible for the payment of compensation benefits to employees of uninsured subcontractors. Contractors shall not subcontract all or any part of contract unless the subcontractors used have presented proof of insurance. Consequently, all contractors should keep workers’ compensation certificates of insurance on file to prove coverage. What If the Subcontractor is a Sole Proprietor? Sole Proprietors with no employees are not required to ~~comply~~ carry workers’ compensation insurance. However, detailed information must be provided to SWIF to prove that the individual is a true independent contractor. If SWIF determines that the sole proprietor is your employee, you will be charged for his/her payroll as per the appropriate classes on your policy. It is your responsibility to provide SWIF with ~~Texas Local Government Code Chapter 176~~all appropriate documentation to resolve their employment status. Currently workers compensation coverage for sole proprietor(s) is available through the State Workers’ Insurance Fund. 2012a Pennsylvania Department of Agriculture Bureau of Food Safety and Laboratory Services 000-000-0000 • xxx.XxxXxxxXX.xxx Dear Owner of a Deer Processing Establishment, ~~Disclosure~~ As a participant in the Hunters for Sharing the Harvest program your deer processing establishment must be compliant with federal and/or state laws. Enclosed are the necessary forms and applications for obtaining a Registration from the Pennsylvania Department of ~~Certain Relationships~~ Agriculture under the Food Safety Act of 2010 (3 C.S. §§5721 – 5737) as a custom deer processor. This registration application and inspection requirements has been specifically developed in partnership with ~~Local Government Officers~~and in consultation with the Hunters Sharing The Harvest Program’s deer processor/directors Xxxx Xxxxxx, Xxx Xxxxxxxx and Xxxxx Xxxxxx. ~~House Bill 23 significantly changed Chapter 176~~ Our goal is to minimize any inconvenience and make registration easy, while ensuring uniform food safety criteria and quality control in the future. Please note the integrity of the HSH venison charity is a foremost concern, and this is a state requirement that will yield long-term positive benefits for you as a deer processor, as well as for the ultimate consumers receiving food assistance. If your processing establishment is approved and inspected by USDA, (US Department of Agriculture), and those same processing facilities are used for custom deer processing, you do not need Registered with the PA Department of Agriculture (PDA). Only facilities not inspected by USDA and who are providing custom deer processing services require registration and inspection by PDA. If any additional retail food store or food processing operation exists at this same establishment, please contact the Department to discuss proper licensing. The enclosed material must be fully completed and returned to the appropriate Regional Office as listed below. Please note failure to provide all required ~~disclosure~~ information could delay your application approval. The Department of Agriculture, Regional Food Sanitarian and/or Supervisor, will review the application and contact you if further information or clarification is needed, or if approved to schedule a registration inspection prior to your opening for operation. If your application is disapproved, you will receive a written letter stating the ~~corresponding form~~reasons for the application disapproval. As Applications can be resubmitted at any time. Please allow 3 – 4 weeks for processing. DO NOT SEND MONEY WITH THIS APPLICATION. Registration fees will be collected at the time of ~~September 1~~the Inspection. NO CASH accepted-checks or money orders only, ~~2015~~payable to Commonwealth of PA. Initial registrations and annual renewals are $35.00 Sincerely, ~~any vendor who does business with NCISD or who seeks to do business with NCISD must complet~~ The Bureau of Food Safety & Laboratory Services Staff XXXXXXX ADDRESSES: The Pennsylvania Department of Agriculture Bureau of Food Safety and Laboratory Services Followed by the ~~new Conflict~~ address below…. Region 1 (Clarion, Xxxxxxxx, Elk, Erie, Forest, Xxxxxxxxx, McKean, Mercer, Venango and Xxxxxx) 00000 Xxxxxx Xx, Meadville, PA 16335 | 000-000-0000 | Fax: 000-000-0000 Region 2 (Cameron, Clinton, Columbia, Lycoming, Northumberland, Montour, Potter, Snyder, Tioga and Union) 000 Xxxxxx Xxxx Xx, Xxxxx #000, Xxxxxxxxxxxxx, XX 00000 | 000-000-0000 | Fax: 000-000-0000 Region 3 (Bradford, Carbon, Lackawanna, Luzerne, Monroe, Xxxx, Sullivan, Susquehanna, Xxxxx and Wyoming) Xx 00 Xxxxx, Xx Xxx X, Xxxxxxxxxxx, XX 00000 | 000-000-0000 | Fax: 000-000-0000 Region 4 (Allegheny, Armstrong, Beaver, Butler, Fayette, Xxxxxx, Indiana, Xxxxxxxx, Washington and Xxxxxxxxxxxx) #0 Xxxxxxxx Xx, Gibsonia, PA 15044 | 000-000-0000 | Fax: 000-000-0000 Region 5 (Bedford, Blair, Cambria, Centre, Clearfield, Fulton, Huntingdon, Juniata, Mifflin and Somerset) 0000 0xx Xx, Xxxxxxx Xxxxx Xxx, Xxxxxxx, XX 00000-4701 | 000-000-0000 | Fax: 000-000-0000 Region 6 (Adams, Cumberland, Dauphin, Franklin, Lebanon, Xxxxxxxxx, Xxxxx and Xxxx) Room G-12, 0000 Xxxxx Xxxxxxx Xx, Xxxxxxxxxx, XX 0000 | 000-000-0000 | Fax: 000-000-0000 Region 7 (Berks, Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton, Schuylkill, Philadelphia) 0000 Xxxxxx Xx, Xxxxxxxxxxxx, XX 00000 | 000-000-0000 | Fax: 000-000-0000 2012a Pennsylvania Department of ~~Interest Questionnaire (CIQ) whether or not a conflict~~ Agriculture Bureau of ~~interest exist. A conflict exists in the following situations:~~Food Safety and Laboratory Services 000-000-0000 • xxx.XxxXxxxXX.xxx

Appears in 1 contract

Samples: Processor Agreement

Purpose of Form. An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 11-2017) ~~New Caney ISD Conflict~~ To: HSH Processors PA Workers Compensation Insurance Compliance Form (SWIF) Deer Processor: Please fill out and mail back with a copy of ~~Interest Instructions New Caney ISD~~ your insurance certificate if needed, to the address above. The business name should be the same as on form W-9. Thank you for helping HSH be in compliance. Statement: As a participating HSH Processor I hereby state that I am not an employee of Hunters Sharing the Harvest charitable venison donation program, but a subcontractor (sole proprietor) who has signed a valid agreement with HSH for donated deer meat processed and distributed to area Food Banks. I work my own schedule, supply my own tools and work in my own facility inspected and registered by the PA Dept of Agriculture Bureau of Food Safety. In addition, I am fully responsible for decisions on how best to complete the task for my customers, the hunters donating deer to the HSH program. Name Business Name Address City State Zip Code Phone County Email Please check one: I am Sole Proprietor w/o employees. No insurance certificate required. Sole Proprietor with employees. Enclosed is PA Workers Compensation Insurance Certificate. Definitions of Sole Proprietor from SWIF (State Workers’ Insurance Fund) website What If I Use Subcontractors? Pennsylvania Workers’ Compensation Act Section 302 (a) & (b) provides that a contractor is responsible for the payment of compensation benefits to employees of uninsured subcontractors. Contractors shall not subcontract all or any part of contract unless the subcontractors used have presented proof of insurance. Consequently, all contractors should keep workers’ compensation certificates of insurance on file to prove coverage. What If the Subcontractor is a Sole Proprietor? Sole Proprietors with no employees are not required to ~~comply~~ carry workers’ compensation insurance. However, detailed information must be provided to SWIF to prove that the individual is a true independent contractor. If SWIF determines that the sole proprietor is your employee, you will be charged for his/her payroll as per the appropriate classes on your policy. It is your responsibility to provide SWIF with ~~Texas Local Government Code Chapter 176~~all appropriate documentation to resolve their employment status. Currently workers compensation coverage for sole proprietor(s) is available through the State Workers’ Insurance Fund. 2012b Pennsylvania Department of Agriculture Bureau of Food Safety and Laboratory Services 000-000-0000 • xxx.XxxXxxxXX.xxx Dear Owner of a Deer Processing Establishment, ~~Disclosure~~ As a participant in the Hunters for Sharing the Harvest program your deer processing establishment must be compliant with federal and/or state laws. Enclosed are the necessary forms and applications for obtaining a Registration from the Pennsylvania Department of ~~Certain Relationships~~ Agriculture under the Food Safety Act of 2010 (3 C.S. §§5721 – 5737) as a custom deer processor. This registration application and inspection requirements has been specifically developed in partnership with ~~Local Government Officers~~and in consultation with the Hunters Sharing The Harvest Program’s deer processor/directors Xxxx Xxxxxx, Xxx Xxxxxxxx and Xxxxx Xxxxxx. ~~House Bill 23 significantly changed Chapter 176~~ Our goal is to minimize any inconvenience and make registration easy, while ensuring uniform food safety criteria and quality control in the future. Please note the integrity of the HSH venison charity is a foremost concern, and this is a state requirement that will yield long-term positive benefits for you as a deer processor, as well as for the ultimate consumers receiving food assistance. If your processing establishment is approved and inspected by USDA, (US Department of Agriculture), and those same processing facilities are used for custom deer processing, you do not need Registered with the PA Department of Agriculture (PDA). Only facilities not inspected by USDA and who are providing custom deer processing services require registration and inspection by PDA. If any additional retail food store or food processing operation exists at this same establishment, please contact the Department to discuss proper licensing. The enclosed material must be fully completed and returned to the appropriate Regional Office as listed below. Please note failure to provide all required ~~disclosure~~ information could delay your application approval. The Department of Agriculture, Regional Food Sanitarian and/or Supervisor, will review the application and contact you if further information or clarification is needed, or if approved to schedule a registration inspection prior to your opening for operation. If your application is disapproved, you will receive a written letter stating the ~~corresponding form~~reasons for the application disapproval. As Applications can be resubmitted at any time. Please allow 3 – 4 weeks for processing. DO NOT SEND MONEY WITH THIS APPLICATION. Registration fees will be collected at the time of ~~September 1~~the Inspection. NO CASH accepted-checks or money orders only, ~~2015~~payable to Commonwealth of PA. Initial registrations and annual renewals are $35.00 Sincerely, ~~any vendor who does business with NCISD or who seeks to do business with NCISD must complet~~ The Bureau of Food Safety & Laboratory Services Staff XXXXXXX ADDRESSES: The Pennsylvania Department of Agriculture Bureau of Food Safety and Laboratory Services Followed by the ~~new Conflict~~ address below…. Region 1 (Clarion, Xxxxxxxx, Elk, Erie, Forest, Xxxxxxxxx, McKean, Mercer, Venango and Xxxxxx) 00000 Xxxxxx Xx, Meadville, PA 16335 | 000-000-0000 | Fax: 000-000-0000 Region 2 (Cameron, Clinton, Columbia, Lycoming, Northumberland, Montour, Potter, Snyder, Tioga and Union) 000 Xxxxxx Xxxx Xx, Xxxxx #000, Xxxxxxxxxxxxx, XX 00000 | 000-000-0000 | Fax: 000-000-0000 Region 3 (Bradford, Carbon, Lackawanna, Luzerne, Monroe, Xxxx, Sullivan, Susquehanna, Xxxxx and Wyoming) Xx 00 Xxxxx, Xx Xxx X, Xxxxxxxxxxx, XX 00000 | 000-000-0000 | Fax: 000-000-0000 Region 4N (Armstrong, Butler, Xxxxxx, Indiana, Xxxxxxxx, and Xxxxxxxxxxxx) Region 4S (Beaver, Allegheny, Washington,Greene, Fayette) 000 Xxxxxxx Xx. Xxx #000, Xxxxxxxxxx, XX 00000 | 000-000-0000 | Fax:000-000-0000 Region 5 (Bedford, Blair, Cambria, Centre, Clearfield, Fulton, Huntingdon, Juniata, Mifflin and Somerset) 0000 0xx Xx, Xxxxxxx Xxxxx Xxx, Xxxxxxx, XX 00000-4701 | 000-000-0000 | Fax: 000-000-0000 Region 6W (Adams, Cumberland, Xxxxxxxx, Xxxxx) Region 6E ( Dauphin, Lebanon, Schuylkill, Lancaster) Room 100, 0000 Xxxxx Xxxxxxx Xx, Xxxxxxxxxx, XX 0000 | 000-000-0000 | Fax: 000-000-0000 Region 7 (Berks, Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton, Schuylkill, Philadelphia) 0000 Xxxxxx Xx, Xxxxxxxxxxxx, XX 00000 | 000-000-0000 | Fax: 000-000-0000 1 2012b Pennsylvania Department of ~~Interest Questionnaire (CIQ) whether or not a conflict~~ Agriculture Bureau of ~~interest exist. A conflict exists in the following situations:~~Food Safety and Laboratory Services 000-000-0000 • xxx.XxxXxxxXX.xxx

Appears in 1 contract

Samples: Processor Agreement

Purpose of Form. An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 1110-~~2017~~2018) ~~New Caney ISD Conflict~~ (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx Employee Agreement for Acceptable Use of ~~Interest Instructions New Caney ISD~~ the District’s Technology Resources P a g e | 1 You are being given access to the District-provided technology resources listed below. It is ~~required~~ important that you read the applicable District policies, administrative regulations, and this agreement form. [See policies CQ and DH, and provisions on use of electronic media in the employee handbook.] Employees should contact the Technology at 000-000-0000 if you have questions or need help understanding this material. The following guidelines apply to ~~comply with Texas Local Government Code Chapter 176~~all District networks, ~~Disclosure~~ e-mail accounts, devices connected to the District’s networks, and all District-owned devices used on or off school property, whether connected to the District’s network or connected through a non-district network such as home internet or personal data plans or any other means of ~~Certain Relationships with Local Government Officers~~access. ~~House Bill 23 significantly changed Chapter 176~~ Additionally, the District prohibits harassment through electronic means regardless of the device used, the network used, or the location of use. [See District policies DH, DIA, and FFH] Inappropriate use of the District’s technology resources may result in suspension of access or revocation of the privilege of using these resources, as well as other disciplinary or legal action, in accordance with applicable District policies, administrative regulations, and laws. You are being given access to the ~~required disclosure~~ following technology resources: • A District e-mail account; • A District e-mail account, including access to cloud-based (online) document storage and collaboration space; • District computer hardware, software, and printers on your school campus; • District networks, including document storage space; • Access to District-owned technology resources for use at home; and • District-filtered Internet access. Please note that the Internet is a network of many types of communication and information networks. It is possible that you may run across some material you might find objectionable. While the District will use filtering technology to restrict access to such material, it is not possible to absolutely control access to all content. It will be your responsibility to follow the rules for appropriate use and report inappropriate internet sites to the Technology Department. If you are being issued a District-owned technology device that can be used off campus, you will be given additional materials addressing the proper use, care, and return of these devices. (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx Rules for Responsible Use P a g e | 2 • You will be assigned an individual account for access to approved District technology resources, and you are responsible for not sharing your password or other account information with others. • District technology resources are primarily for instructional and educational purposes. Limited personal use is allowed only if the rules in this agreement are followed and the ~~corresponding form~~use does not interfere with your assigned duties. As • You must comply with the Public Information Act, the Family Educational Rights and Privacy Act (FERPA), and any other applicable law or policy regarding records retention and confidentiality of ~~September 1~~student and District records. • You must maintain the confidentiality of health or personnel information concerning colleagues, ~~2015~~unless disclosure serves lawful professional purposes or is required by law. • Please remember that all communications sent through District e-mail accounts may be perceived as communications on behalf of the District. Consequently, ~~any vendor~~ all e-mails sent from District e-mail accounts are subject to the District’s acceptable use policy, and an employee who ~~does business~~ violates the policy may be disciplined accordingly. • When communicating through e-mail or other electronic means, you must use appropriate language and etiquette as you would when communicating face to face. Always be respectful. • Only authorized District staff may communicate with ~~NCISD or who seeks to do business with NCISD must complet the new Conflict of Interest Questionnaire (CIQ)~~ District students through electronic means, including social media, e-mail, and text messaging. If you are unsure whether or not you are authorized to communicate with a ~~conflict~~ student through electronic means, ask your supervisor. [See DH] • Before use on a District device or for a District purpose, digital subscriptions, online learning resources, online applications, or any other program must be approved by Technology or principal. District staff should not accept terms and conditions or sign user agreements on behalf of ~~interest exist~~the District without preapproval. ~~A conflict exists~~ • Copies of potentially sensitive or confidential District records should not be sent, viewed, or stored using an online application not approved by the District. • You must immediately report any suspicious behavior or other misuse of technology to your supervisor or other campus administrator. • You will be held responsible at all times for the proper use of your account, and the District may suspend or revoke your access if you violate the rules. (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx Inappropriate Use The following are examples of inappropriate use of technology resources: • Using the resources for any illegal purpose, including threatening school safety; • Accessing the resources to knowingly alter, damage, or delete District property or information, or to breach any other electronic equipment, network, or electronic communications system in violation of the law or District policy; • Damaging electronic communications systems or electronic equipment, including P a g e | 3 knowingly or intentionally introducing a virus to a device or network, or not taking proper security steps to prevent a device or network from becoming vulnerable; • Disabling or attempting to disable or bypass any Internet filtering device; • Encrypting communications to avoid security review; • Using someone’s account without permission; • Pretending to be someone else when posting, transmitting, or receiving messages; • Attempting to read, delete, copy, modify, or interfere with another user’s posting, transmission, or receipt of electronic media; • Using resources to engage in conduct that harasses others; • Sending, posting, or possessing materials that are abusive, obscene, pornographic, sexually oriented, threatening, harassing, damaging to another’s reputation, or illegal, including material that constitutes prohibited harassment and “sexting;” • Using inappropriate language such as cursing, vulgarity, ethnic or racial slurs, and any other inflammatory language; • Posting or transmitting pictures of students without obtaining prior permission from all individuals depicted or from parents of depicted students who are under the age of 18; • Violating others’ intellectual property rights, including downloading or using copyrighted information without permission from the copyright holder; • Wasting school resources through improper use of the District’s technology resources, including sending spam; and • Gaining unauthorized access to restricted information or resources. (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx Consequences for Inappropriate Use P a g e | 4 The following ~~situations:~~are possible consequences of inappropriate use of technology resources: • Suspension of access to the District’s technology resources; • Revocation of the account; or • Other disciplinary or legal action in accordance with the District’s policies and applicable laws.

Appears in 1 contract

Samples: core-docs.s3.amazonaws.com

Purpose of Form. An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 11-2017) ~~New Caney ISD Conflict~~ ® INSURANCE COMPANY XX Xxx 0000 Xxxxx, XX 00000 xxx.xxxx.xxx Toll-Free 0-000-000-0000 Producer Training Guide to Anti-Money Laundering Requirements under the USA Patriot Act The Patriot Act: What Is It? The USA Patriot Act was enacted to better protect the financial system from potential abuse by criminals and terrorists. Generally, the Act requires the Department of ~~Interest Instructions New Caney ISD~~ the Treasury to set standards for anti-money laundering (AML) programs. These standards were developed by the Financial Crimes Enforcement Network (FinCEN), the agency under the Department of the Treasury responsible for safeguarding the financial system from the abuses of financial crime. The regulations developed by FinCEN require insurance companies to establish AML programs meeting certain requirements, including the reporting of suspicious transactions. In issuing the regulations, FinCEN specifically noted that insurance agents and brokers (“producers”) are expected to play an important role in a financial institution’s AML program. What Is Money Laundering? Money Laundering is ~~required to comply with Texas Local Government Code Chapter 176, Disclosure of Certain Relationships with Local Government Officers. House Bill 23 significantly changed Chapter 176 as well~~ generally defined as the ~~required disclosure~~ process of using various techniques to move illegally acquired cash through financial systems so that it appears to be legally acquired cash. The goal of a money laundering operation is usually to hide either the source or the destination of the money. The money laundering process is comprised of 3 overlapping phases: Placement: this is the physical disposal of cash into the financial system. The simplest example is making a bank account deposit. Layering: this involves carrying out complex financial transactions to camouflage the illegal source of the cash. Integration: this is the final stage whereby the money is placed back into circulation in an apparent legitimate form. What Is Terrorist Financing? Terrorist activity financing may involve funds raised from legitimate sources to fund illegal activities. Because the transactions are often lawfully obtained and tend to be in smaller amounts than those associated with money laundering, they are generally more difficult to identify. However, many of the Red Flags for money laundering are the same as those for terrorist financing and will also help you discover this type of illegal activity. What Products Are Affected by AML Laws? FinCEN has identified the following categories of “covered products” that present risk for money laundering. These covered products include the following: • A permanent life insurance policy, other than a group life insurance policy; • An annuity contract, other than a group annuity contract; or • Any other insurance product with features of cash value or investment Term life insurance, health insurance, and other types of non-cash value products are excluded from the AML regulations. What Are “Red Flags”? You must notify the AML Compliance Officer if you detect any money laundering Red Flag activities so the Company can investigate and determine whether a suspicious activity report must be filed with the government. Examples of Red Flags include the following: • Multiple accounts sharing a beneficiary • Failure to properly identify the owner • The insurance product purchase appears to be inconsistent with the customer’s needs • The purchase or funding of a product appears to exceed a customer’s known income or liquid net worth • Any attempted unusual method of payment, particularly by cash or cash equivalents, such as money orders or cashier’s checks • Payment of a large amount broken into small amounts to avoid mandatory reporting thresholds • Customer shows little or no concern for the investment performance of the product, but much concern about the early termination features of the product • Reluctance from a customer to provide identifying information or providing minimal or seemingly fictitious information • Designation of benefits to an unrelated third party 43 115 3750 0418 US • The customer requests early termination of an insurance product, especially at a cost to the customer, or where cash was tendered and/ or the refund check is directed to an apparently unrelated third party • The transfer of the benefit to an unrelated third party • The borrowing of the maximum amount available soon after purchasing the product What Are My Responsibilities as a Producer? As a producer, you play an important role in discovering whether money is coming from an illegal source. Your direct contact with the customer places you in a unique position to gather information and detect suspicious activity using Red Flags. In fact, in the preamble of the regulations, Fin- CEN states, “insurance agents and brokers are an integral part of the insurance industry due to their contact with customers. Insurance agents and brokers typically are involved in sales operations and are therefore in direct contact with customers. As a result, the agent or broker will often be in a critical position of knowledge as to the source of investment assets, the nature of the client and the ~~corresponding form.~~ objectives for which the insurance products are being purchased.” As ~~of September 1~~a producer selling covered products, ~~2015, any vendor who does business with NCISD or who seeks to do business with NCISD must complet~~ you are responsible for the ~~new Conflict of Interest Questionnaire (CIQ) whether or not a conflict of interest exist. A conflict exists in the following situations~~following:

Appears in 1 contract

Samples: Agent Agreement

Purpose of Form. An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 1110-~~2017~~2018) ~~New Caney ISD Conflict of Interest Instructions New Caney ISD~~ LANCASTER IN D EP EN D EN T SC HOO L DIS T R IC T Xx. Xxxxxx Xxxxxxx Superintendent Confidential- Name Based Search The Independent School District is required ~~to comply with~~ by Texas ~~Local Government~~ Education Code Chapter ~~176~~22, ~~Disclosure~~ Subchapter C to review the criminal history of ~~Certain Relationships~~ applicants, employees, independent contractors, student teachers, and certain volunteers. The information requested below is necessary to obtain criminal history record information. Please print. Name Last First Middle Social Security Number Date of birth Driver’s License State and Number Xxxxxxx Xxxxxxx Xxxxxx Xxxx Xxxxx Zip Phone Number Sex:  Male  Female Ethnicity:  Black  White/Other I understand that the information I am providing about age, sex, and ethnicity will not be used to determine eligibility for employment but will be used solely for the purpose of obtaining criminal history record information.* Signature Date *This form will be removed from the application and filed separately in the HR office. Lancaster ISD Vision: All students achieve self-sustaining success and leave a lasting legacy. LANCASTER INDEPENDENT SCHOOL DISTRICT Department of Human Resources Educator Fingerprint Information Form Senate Xxxx 9 (SB9) also known as the “Fingerprinting Xxxx” was passed by the 80th Legislature and signed into law by Governor Perry on June 15, 2007. SB 9 authorizes and requires greatly expanded criminal history information reviews for most classes of educators and school employees, including national criminal history background checks based on the submission of fingerprints for all certified and currently employed educators. Please complete the information below which will be forwarded by Lancaster ISD to the Stat Board for educator Certification (SBEC). The District will be notified by SBEC which applicants have and have not been fingerprinted. Fast Fingerprint Passes and/or instructions will be generated and mailed to applicants needing fingerprinting. Please note: A Valid photo ID must be present along with ~~Local Government Officers~~your Fast Fingerprint Pass at your fingerprinting appointment, and the name on the photo ID and Fast Fingerprint Pass MUST MATCH, so please list your name on the form exactly as it appears on your Driver’s License/ID. ~~House Bill 23 significantly changed Chapter 176~~ You will be responsible setting up your own appointments and for paying the fingerprint fees. The cost for fingerprinting is $50.29, payable at the time of service. Please Print Legibly Certified: Non Certified: Substitute: Name: Last First Middle Mailing Address: Street/Apt: City State: ZIP: Social Security Number: Date of Birth: Email: Campus: Phone #: Driver’s License Number: DL State Issued: Phone #: I have NOT been fingerprinted for SBEC/TEA. I have been fingerprinted for SBEC in another school district. LANCASTER IN D E P E N D E N T SC H O O L DI S T R I C T 000 X. Xxxxxx Xxx. Xxxxxxxxx, XX 00000 (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx Xx. Xxxxxx Xxxxxxx Superintendent Agreement for Acceptable Use of the District’s Technology Resources by a Non-school User You are being given access to District-provided technology resources, meaning electronic communications systems and electronic equipment. It is important that you read the applicable District policies, administrative regulations, and this agreement form. Please contact the Chief of Technology at 972-218-1400 if you have questions or need help understanding this material. The following guidelines apply to all District networks, e-mail accounts, devices connected to the District’s networks, and all District-owned devices used on or off school property, whether connected to the District’s network or connected through a personal data plan or other means of access. Inappropriate use of the District’s technology resources may result in suspension or revocation of the privilege of using these resources, as well as other legal action, in accordance with applicable laws. You are being given access to the ~~required disclosure~~ following technology resources:  A District e-mail account;  A District e-mail account, including access to cloud-based (online) document storage;  District computer hardware, software, and printers;  District networks, including document storage space;  Access to District-owned technology resources for use at home; and  District-filtered Internet access. Please note that the Internet is a network of many types of communication and information networks. It is possible that you may run across some material you might find objectionable. While the District will use filtering technology to restrict access to such material, it is not possible to absolutely prevent such access. It will be your responsibility to follow the rules for appropriate use. Rules of Responsible Use  You will be held responsible at all times for the proper use of District technology resources, and the ~~corresponding form~~District may suspend or revoke your access if you violate the rules. As  If you are assigned an individual account, you are responsible for not sharing your password or other account information with others. Inappropriate Use The following are examples of ~~September 1~~inappropriate use of technology resources: LANCASTER IN D E P E N D E N T SC H O O L DI S T R I C T 000 X. Xxxxxx Xxx. Xxxxxxxxx, ~~2015~~XX 00000 (000) 000-0000 (000) 000-0000 FAX xxx.XxxxxxxxxXXX.xxx  Using the resources for any illegal purpose, ~~any vendor who does business with NCISD or who seeks to do business with NCISD must complet the new Conflict of Interest Questionnaire (CIQ) whether or not a conflict of interest exist~~including threatening school safety; Xx. ~~A conflict exists in the following situations:~~Xxxxxx Xxxxxxx