Vendor Signature. Date: Questions? Email: XXXXxxxxxXxxxXxxxxx@xxxxx.xxx ROTARY SIGNATURE Accepted by a duly authorized representative of the Rotary Club of St. Cloud a Minnesota, nonprofit corporation, and its subsidiary Summertime by Xxxxxx! LLC. Signature: Print Name Title: Co-Chair of the Middle Town Market at Summertime by Xxxxxx Xxxx:
Vendor Signature. Date : …………………...................................
Vendor Signature. I certify that: • A valid Service Provider Agreement is on file with Goshen County School District #1 as required in The Plan; And • The required Calculation Worksheet, if applicable, is attached.
Vendor Signature. This information must match the information on the WV-48. The invoiced amount due can be less than the amount of the agreement. However, it cannot be greater than the amount of the agreement.
Vendor Signature. Date: As responsible party for the vendor, my signature indicates that I have read, understood and verify this document, including the sections on HIPAA and the HITECH Act and the St. Clair County Community Mental Health Authority Information Systems Policies/ administrative procedures. I will notify St. Clair County Community Mental Health Authority regarding change of the task list of this vendor, including termination, which requires a change to accessing the information systems. Vendor Name: (Vendor Supervisor Name) Vendor Signature: (Supervisor Signature) St. Clair County Community Mental Health Authority Approval: Date: Approved Disapprove Signature: Date: HIPAA The HIPAA Security Rule requires Covered Entities to implement a “Unique User Identification” standard for electronic systems with protected health information (ePHI). Unique user identification is a unique name or number used to identify and track specific individuals using ePHI systems, also referred to as “LOGIN ID” or “USER ID”. This provides a means to verify the identity of the person using the systems. The User ID should only be used by the intended person; use by someone other than the intended person is a violation of the HIPAA Security Rule and fraud. Licensed health professionals who share their password may also be in civil and criminal violation of licensure law. For more details see HIPAA Security Rule section 164.312 (Technical Safeguards).
Vendor Signature. Vendor hereby accepts this Salary Reduction Agreement and Agrees to abide by the terms of Billings Public Schools’ 403(b) Plan Document. Vendor Signature Vendor Name: Date Part 7. Employer Signature Employer hereby accepts this Salary Reduction Agreement
Vendor Signature. MRC Signature The completed application can be emailed to xxxxxx@XXXxxxxxx.xxx (or whatever correct email domain) or mailed to:
Vendor Signature. This information must match the information on the WV-48 and W-9. The invoiced amount due can be less than the amount of the agreement. However, it cannot be greater than the amount of the agreement. The Coordinator is to initial and date his/her approval of the invoice for payment and submit to the unit vice president. The unit vice president will forward the invoice for payment to the Accounting Assistant.
Vendor Signature. Date: Hydro Ottawa Approval (Office use only)
Vendor Signature. Date Oakland Unified School District Signature Date (If awarding contract)
