STATEMENT OF ACKNOWLEDGEMENT. LICENSEE hereby acknowledges and agrees to adhere to the Lansing Municipal Airport premises IGQ Rules & Regulations, copies of which may be obtained online at xxx.xxxxxxxxxxxxxxxx.xxx or at the Airport Administrative Office upon request.
STATEMENT OF ACKNOWLEDGEMENT. On [ ], [ ] (the “Transferor”) entered into a Restricted Stock Agreement (the “Agreement”) with Republic Services, Inc. (the “Company”), pursuant and subject to the provisions of the Company’s Amended and Restated 2007 Stock Incentive Plan, as it may be amended from time to time (the “Plan”). Pursuant to Section 17(g) of the Plan and Section 3(c) of the Agreement, on [ ] the Transferor (or the Transferor’s estate) transferred for no value [ ] shares of Restricted Stock granted under the Agreement to [ ] (the “Transferee”). The Transferee hereby acknowledges and agrees that the Transferee is a permitted transferee under to Section 17(g) of the Plan and Section 3(c) of the Agreement. The Transferee further acknowledges and agrees that the Transferee’s rights and obligations with respect to the transferred shares of Restricted Stock shall be governed by the terms and conditions set forth in the Agreement and the Plan, as they are or would have been applicable to the Transferor, and that the Transferee will comply with such terms and conditions, including, without limitation, those provisions relating to the dates on which the shares of Restricted Stock may vest, and those relating to the forfeiture and repayment of benefits in the event that the Transferor engages in any Detrimental Activity, as defined in the Plan. TRANSFEREE Signature Print or Type Name Street Address City, State, Zip Telephone Number Tax Identifying Number Date: [ ] EXHIBIT C STOCK POWER FOR VALUE RECEIVED, pursuant to a certain Restricted Stock Agreement between Republic Services, Inc. and the undersigned dated [ ], I hereby sell, assign and transfer unto Republic Services, Inc. all shares of the restricted Common Stock of Republic Services, Inc. awarded to me on this date and in the future under said Agreement and do hereby irrevocably constitute and appoint the Secretary of Republic Services, Inc. as my attorney-in-fact to transfer the said shares of stock on the books of Republic Services, Inc. with full power of substitution in the premises.
STATEMENT OF ACKNOWLEDGEMENT. On [ ], [ ] (the “Transferor”) entered into a Stock Option Agreement (the “Agreement”) with Republic Services, Inc. (the “Company”), pursuant and subject to the provisions of the Company’s Amended and Restated 2007 Stock Incentive Plan, as it may be amended from time to time (the “Plan”). Pursuant to Section 17(g) of the Plan and Section 10 of the Agreement, on [ ] the Transferor (or the Transferor’s estate) transferred for no value [ ] Options granted under the Agreement to [ ] (the “Transferee”). The Transferee hereby acknowledges and agrees that the Transferee is a permitted transferee under to Section 17(g) of the Plan and Section 10 of the Agreement. The Transferee further acknowledges and agrees that the Transferee’s rights and obligations with respect to the transferred Options shall be governed by the terms and conditions set forth in the Agreement and the Plan, as they are or would have been applicable to the Transferor, and that the Transferee will comply with such terms and conditions, including, without limitation, those provisions relating to the dates on which the Options may be exercised and terminate, and those relating to the forfeiture and repayment of benefits in the event that the Transferor engages in any Detrimental Activity, as defined in the Plan. TRANSFEREE Signature Print or Type Name Street Address City, State, Zip Telephone Number Tax Identifying Number Date: [ ]
STATEMENT OF ACKNOWLEDGEMENT. A statement specifying the extent of agreement with all terms, conditions, and provisions of the RFP, and a statement of agreement to furnish and deliver the items or perform services set forth in the RFP in consideration for offerors proposed price(s) set opposite each item. Any exceptions taken to the attachments, exhibits, enclosures, or other solicitation terms, conditions, or documents may be determined to be a Deficiency or grounds for the Government to reject the proposal from further consideration in the source selection process (Reference M.2.1).
STATEMENT OF ACKNOWLEDGEMENT. I/We have read and understand the rules and regulations including the Municipal Alcohol Policy (if applicable), of the Township of Blandford-Blenheim pertaining to the rental of the above Community Hall, and I/We agree to abide by them. I/We further agree to exercise the utmost care in the use of the facilities and to reimburse the cost of repairing any damage, arising for any reason, from our occupancy. Signature Print Name Date Township Representative Print Name Date $ $ Rental Fee Paid Security Deposit Paid Receipt # LIONS HALL RENTAL RULES AND REGULATIONS
STATEMENT OF ACKNOWLEDGEMENT. I agree to abide by the terms of this Agreement. I also understand that this Agreement is revocable at any time and agree to surrender the key at the request of the Division Director or his/her designee. I understand that I may appeal the revocation of this Agreement to the PRGC Board of Directors but agree to surrender the key pending the outcome of the appeal. By signing below, I acknowledge that I have read and understand this Agreement and that I have received a copy of the Steel Practice Bay rules and have had a range orientation from the Practical Division Director or his/her designee. Signed: Date:
STATEMENT OF ACKNOWLEDGEMENT. I agree to abide by the terms of this Agreement. I also understand that this Agreement is revocable at any time and agree to surrender the key at the request of the Division Director or his/her designee. I understand that I may appeal the revocation of this Agreement to the PRGC Board of Directors but agree to surrender the key pending the outcome of the appeal. By signing below, I acknowledge that I have read and understand this Agreement; that I have received a copy of the Practical Division Range Rules, as revised; and that I have received a range orientation from the Practical Division Director or his/her designee. Signed: Date: Division Director: Date: Appendix A Certification Methods Issuance of a Practical Division Range Key Member’s Name: To be eligible to receive a key to the Practical Range, you must complete one (1) of the below listed methods. 1, Participate in four (4) Practical Division sponsored matches: Only one (1) of the four (4) matches can be Thursday Night Steel and Only one (1) of the four (4) matches can be Steel Challenge. The other matches must be either IDPA, USPSA or ICORE. You must receive the match director’s signature after shooting each match. In order to obtain the match director’s signature, when you check in for the match, you MUST notify the match director that you will need his/her signature. If you fail to notify the match director upon check in, the match director will not be allowed to sign your certification for that match. Match 1: Type of Match: Date of Match: Match Director Name: Match Director Signature: Match 2: Type of Match: Date of Match: Match Director Name: Match Director Signature: Match 3: Type of Match: Date of Match: Match Director Name: Match Director Signature: Match 4: Type of Match: Date of Match: Match Director Name: Match Director Signature: 2. Certification of two (2) safety officers, AS APPOINTED by the Division Director, that you have demonstrated that you can safely handle a firearm and can operate in accordance with the rules of the Practical Division Range, as revised. 1st SO Sign-off: SO Name: Date: SO Signature: 2nd SO Sign-off: SO Name: Date SO Signature:
STATEMENT OF ACKNOWLEDGEMENT. By signing below, I acknowledge that I have received a copy of the Enrollment Agreement and the ICDS at Sober College Policy and Procedure Catalog. I further acknowledge that all of the information I have provided is true and correct, and I understand all statements contained within this document. Signature of Student Signature of Parent/Guardian (if applicable) Signature of School Official
STATEMENT OF ACKNOWLEDGEMENT. A statement specifying agreement with all terms, conditions, and provisions included in the solicitation or any exceptions. Any exceptions taken to the drawings, specifications, attachments, exhibits, enclosures, or other solicitation terms, conditions, or documents must be fully explained; however, any such exceptions may be grounds for the Contracting Officer to reject the proposal from further consideration. HQ-AMC LEVEL PROTEST PROCEDURES Complete AMC Protest Procedures can be found at: xxxx://xxx.xxx.xxxx.xxx/Connect/Legal-Resources/ An agency protest may be filed with either the contracting officer or to HQAMC but not both following the procedures listed on the website above. Electronic Bids/Proposals/Commercial Offers Required in Response to this Solicitation (November 2019) ACC- WRN (WVA)
STATEMENT OF ACKNOWLEDGEMENT. I/We have received, read and understand the rules and regulations including the Municipal Alcohol Policy (if applicable), of the Township of Blandford-Blenheim pertaining to the rental of the above Community Hall, and I/We agree to abide by them. I/We further agree to exercise the utmost care in the use of the facilities and to reimburse the cost of repairing any damage, arising for any reason, from our occupancy. Signature Print Name Date Township Representative Print Name Date $ $ Rental Fee Paid Security Deposit Paid Receipt # *Booking Deposit (If applicable): $150 Per Event; $20.00 for Fireside Room ** RATES are subject to change without notice. Bookings made in advance of a general rate change will be required to pay the new rate. RENTAL RULES AND REGULATIONS
