ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED Sample Clauses

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, a...
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ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,…
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ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Proposer Date Printed Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . (Notary Seal) Signature of Notary Public Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form
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Related to ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED

  • AGREEMENT SIGNATURES The parties agree to all the terms and conditions in this Agreement by affixing their signatures below. The Participant signature is to acknowledge his/her responsibilities and terms and conditions of this Agreement, and does not imply contractual obligations on the part of the Service Provider and the Worksite. Print Worksite Supervisor’s Name Signature Date Print Participant’s Name Signature Date Print Provider Staff’s Name Signature Date [For minors, Xxxxxx’s/Guardian’s signature is required.] Print Parent’s/Xxxxxxxx’s Name Signature Date Rev 05/07/18 WORKSITE AGREEMENT TIMESHEET SIGNATURE CARD The supervisor or designee is responsible for reviewing the timesheet to ensure accuracy in recording total hours work, along with providing information on progress. Supervisor Name (Print or Type) Supervisor Signature Date Alternate Supervisor Name (Print or Type) Alternate Supervisor Signature Date Rev 05/07/18 Model Timesheet Participant’s Name Worksite Name Address Address ID Number Supervisor’s Name Program Name/Code Phone Number Hourly Pay Rate Alt Supervisor’s Name* Job Title Phone Number Start Date End Date Pay Period Start Date Pay Period End Date Column A B C D E F G Date Time Time Out Number of Break Total Hours Day of Week In Hours (meal) Worked: (Column E minus F) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Worksite Supervisor Rating of Employee Performance Please circle the appropriate ratings below Poor (P) Fair (F) Satisfactory (S) Good (G) Excellent (E) Job Knowledge P F S G E Work Quality P F S G E Attendance P F S G E Dependability P F S G E Communication/Listening Skills P F S G E Worksite Supervisor Please comment on your work experience participant’s progress and performance on the job Terms and Conditions: All parties certify that the number of hours worked are listed correctly; that the services of this employee were performed per the rating above; and that employer has reported any areas of concern to the Provider representative. Worksite Supervisor Signature and Date: Provider Staff Signature and Date: Participant Signature and Date: * Additional employer representatives authorized to sign this timesheet

  • Certification instructions You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (XXX), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. person ▶ Date ▶ General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an XXX. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:

  • Counterparts and Signatures The Agreement may be executed in multiple counterparts, each of which shall be deemed an original, but all of which taken together shall constitute one and the same instrument. A Party may evidence its execution and delivery of the Agreement by transmission of a signed copy of the Agreement via facsimile or email. In such event, the Party shall promptly provide the original signature page(s) to the other Party.

  • CERTIFICATION OF AGREEMENT In accordance with Division 4 of Part VIB of the Workplace Relations Act 1996, the Commission hereby certifies the attached written agreement in this matter. This agreement shall come into force from the date of certification, being 20 June 2003, shall operate in accordance with its terms and shall remain in force until 31 October 2005. Printed by authority of the Commonwealth Government Printer <Price code 72> MOBILE CRANE HIRE EBA 2003-2006 BETWEEN Small Crane Specialists and the CONSTRUCTION, FORESTRY, MINING AND ENERGY UNION (Victorian Construction & General Division, and the Victorian FEDFA Division) WORKPLACE RELATIONS ACT 1996 PART VIB, DIVISION 2 CERTIFIED AGREEMENT TABLE OF CONTENTS Subject Matter Clause No. Accident Pay 41 Air Conditioners 52 All-In Payments 45 Amenities 50 Annual Leave 15 Australian Materials 55 Cancellations of Overtime 33 Car Allowance 25 Classification Structure & Rates of Pay, Allowances 23 Clothing Issue & Safety Footwear 12 Co-Invest (Long Service Leave) 39 Commitments 3 Consultation 8 Cross Hiring 47 Dirty Work 28 Dispute Settlement Procedure 9 Drugs & Alcohol 52 Employment & Termination 21 Fares & Travel Allowance 24 First Aid Allowance 27 Heavy Outrigger Pads, Timbers and Lifting Gear 20 Hours Of work, Rostered Days Off, and Protection of Leisure Time 31 Inclement Weather 37 Income Protection & Trauma Insurance 40 Induction Procedures 18 Journey Accidents 42 Living Away from Home Allowance 26 Lunch Breaks 32 Maintenance of Plant and Equipment 13 Meal Allowance 29 Negotiation of a Subsequent Agreement 57 No Extra Claims 58 Objectives of the Agreement 2 Operation of Plant and Equipment 14 Parties and Persons Bound 4 Payment of Wages 34 Period of Operation 6 Personal Leave 16 Picnic Day 44 Public Holidays 43 Pyramid Subcontracting 46 Redundancy 22 Rehabilitation Program 54 Relationship to Parent Award and Victorian Building Industry Agreement 7 Reserved Matters 59 Safety Dispute Resolution 10 Scope & Application 5 Shift Work 17 Signatories 60 Start Time 30 Street Directories 51 Superannuation 38 Supplementary Labour 48 Title 1 Toxic Substances 19 Training & Related Matters 36 Union Delegates 49 Waste Minimisation, Recycling and Environmental Issues 56 Work Practices Review 35 Workplace Safety 11 APPENDICES Appendix A – Drugs & Alcohol Policy

  • Vendor Agreement Signature Form (Part 1)

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