SIGNATURES AND APPROVALS. Contract # 20DSS6001FB Amendment # 1 The Contractor Is Not currently a Business Associate under the Health Insurance Portability and Accountability Act of 1996 as amended. Contractor Connecticut Association of Community Action, Inc. Contractor Signature 7/21/2020 | 7:06 PM EDT Date Xxxxxxx Xxxxxxx Board Chairman Name and Title of Authorized Official Connecticut Department of Social Services Signature 7/22/2020 | 11:24 AM EDT Date Xxxxxxxx X. Xxxxxxx Name and Title of Authorized Official Deputy Commissioner Connecticut Attorney General approved as to form: Signature 7/29/2020 | 2:22 PM EDT Date Xxxxxx Xxxxx, Associate AttorAnsesyisGteannetraDleputy Attorney General
SIGNATURES AND APPROVALS. I verify that the information contained in this application is true and complete: Employee’s Signature Date Supervisor: If Part B is completed, please provide your assessment of the information supplied and the need for or usefulness of bilingual skills of the type requested: Supervisor’s Name: Supervisor’s Signature: Date: Second-Level Manager’s Name: Signature: Date: For Human Resources Action:
SIGNATURES AND APPROVALS. The parties to this Agreement hereby certify by their signatures that the respective information each has provided is true to the best of their knowledge and belief and that they agree to the terms and conditions stated herein and will comply with their respective duties and responsibilities under this Agreement. STEP UP Employer: Signature of Employer’s Authorized Officer Title Date I certify that the above-named authorized officer held said title at the time he/she signed this Agreement on behalf of the Employer and I also certify as keeper of the records of this Employer that this Agreement was duly signed on behalf of said Employer by authority of its governing body and within the scope of the Employer’s organizational powers. Signature of Employer’s Certifying Officer Title Date Approval by WIB: Signature Title Date Approval by The Workplace, Inc: Signature Title
SIGNATURES AND APPROVALS. Contract # 20DSS8903JU The Contractor Is Not a Business Associate under the Health Insurance Portability and Accountability Act of 1996 as amended. Contractor The North Highland Company, LLC Contractor Signature 4/6/2021 | 6:59 AM CDT Date Xxxxx Xxxxxxx Vice President Name and Title of Authorized Official Connecticut Department of Social Services 4/6/2021 | 8:31 AM EDT Signature Date Xxxxxxxx X. Xxxxxxx Deputy Commissioner Name and Title of Authorized Official Connecticut Attorney General approved as to form: 4/8/2021 | 11:16 AM EDT Signature Date Xxxxxx Xxxxx Asst. Dep. Attorney General
SIGNATURES AND APPROVALS. Contract # 19DSS4603JF Amendment # 1 The Contractor Is Not currently a Business Associate under the Health Insurance Portability and Accountability Act of 1996 as amended. Contractor New London Homeless Hospitality Center Contractor Signature 4/29/2020 | 9:35 AM PDT Date Xxxxxxxxx Xxxx Ex. Director Name and Title of Authorized Official Connecticut Department of Social Services Signature 5/11/2020 | 9:58 AM EDT Date Xxxxxx X. Xxxxxxx, MD, MPH Commissioner Name and Title of Authorized Official Connecticut Attorney General approved as to form: Xxxxxx Xxxxx Digitally signed by Xxxxxx Xxxxx Date: 2020.05.13 10:13:44 -04'00' Signature Date
SIGNATURES AND APPROVALS. Agency P-Card Administrator: By signing this agreement, I acknowledge that I have reviewed, understand, and will oversee compliance with the State of New Hampshire Department of Administrative Services Manual of Procedures (MOP) Chapter 1625, the P-Card Users Manual, and all other applicable laws, rules, policies and procedures relating to the use of P-Cards. Date: Signature Printed Name Submit this completed form to: DAS P-Card Manager Department of Administrative Services - Xxxxx Xxxxx Xxxxx 00 Xxxxxxx Xxxxxx, Xx 000 Xxxxxxx, XX 00000 E-mail: xxxxxx@xxx.xx.xxx Phone: (000) 000-0000, (000) 000-0000 Fax: (000) 000-0000 DAS Action: □ Approved □ Not Approved Comments/Instructions: Date:
SIGNATURES AND APPROVALS. Contract # 19DSS4801OJ Amendment # 2 The Contractor Is a Business Associate under the Health Insurance Portability and Accountability Act of 1996 as amended. Contractor Jewish Federation Association of Connecticut, Inc. Contractor Signature 4/13/2021 | 2:03 PM EDT Date Xxxxxxx Xxxxx Name and Title of Authorized Official Connecticut Department of Social Services Executive Director Signature 4/19/2021 | 1:37 PM EDT Date Xxxxxxx Xxxxxxx Name and Title of Authorized Official Deputy Commissioner Connecticut Attorney General approved as to form: Signature 5/17/2021 | 4:21 PM EDT Date Xxxxx XxXxxxxx, Assistant AttorTnaenyyaGeDneeMraatltia
SIGNATURES AND APPROVALS. Engineer’s design documents shall be complete for bidding purposes and include all required seals, signatures and approvals.
SIGNATURES AND APPROVALS. Contract # 19DSS1303JI Amendment # 1 The Contractor Is Not currently a Business Associate under the Health Insurance Portability and Accountability Act of 1996 as amended. Contractor Bridgeport Caribe Youth Leaders Contractor Signature 5/15/2020 | 5:08 PM EDT Date Xxxx Xxxxxx Name and Title of Authorized Official Executive Director Connecticut Department of Social Services Signature 5/15/2020 | 5:34 PM EDT Date Xxxxxxxx X. Xxxxxxx Name and Title of Authorized Official Commissioner Connecticut Attorney General approved as to form: Signature 5/18/2020 | 11:27 AM EDT Date Xxxxxx Xxxxx Assistant Deputy Attorney General
SIGNATURES AND APPROVALS. Employee P-Card Cardholder: I acknowledge, understand and agree to the foregoing, and acknowledge that I have received a copy of the DAS P-Card Users Manual and relevant statutes. Date: Signature of Cardholder Printed name
