|
|
- Juniper Cox
- 5 years ago
- Views:
Transcription
1
2
3
4
5
6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Risk Transfer Insurance Agency, LLC 219 E. Livingston Street Orlando, FL INSURED All Source Recruiting Group, Inc. dba Ardor Health Solutions 5830 Coral Ridge Drive, Ste 300 Coral Springs, FL INSURER F : COVERAGES CERTIFICATE NUMBER: KQ5GC8A4 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS B D C A B X X X X X COMMERCIAL GENERAL LIABILITY X X X Abusive Acts: 3M/3M EBL 1m/2m OTHER: CLAIMS-MADE AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS LIAB X CERTIFICATE OF LIABILITY INSURANCE OCCUR SCHEDULED AUTOS NON-OWNED AUTOS OCCUR CLAIMS-MADE DED RETENTION 0 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Professional Liability/Medical Professional Liability Crime Employment Practices Liability PRA PRA UMB WC (AOS) WC (CA Only) PRA PRA PRA PRA CONTACT NAME: Tami Bolling PHONE (A/C, No, Ext): ADDRESS: tbolling@risktransfer.com INSURER A : Commerce and Industry Insurance Company INSURER B : ZURICH AMERICAN INSURANCE COMPANY INSURER C : American Guarantee & Liability Insurance Company INSURER D : American Zurich Ins Co INSURER E : INSURER(S) AFFORDING COVERAGE 03/01/ /01/ /01/ /01/ /01/ /01/ /01/ /01/ /01/ /01/2017 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE X PER STATUTE E.L. EACH ACCIDENT FAX (A/C, No): E.L. DISEASE - POLICY LIMIT Prof Liab - Each Claim Prof Liab - Aggregate Employee Dishonesty EPLI - Each Claim EPLI - Aggregate 04/28/ ,000, ,000 10,000 1,000,000 3,000,000 3,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 3,000, ,000 1,000,000 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Stop Gap : 1m/1m/1m/ - Policy #PRA , term 3/1/16 to 3/1/17 (Ohio, Washington & Wyoming); Certificate holders are included as Additional Insured in addition to affording Waiver of Subrogation with respect to General Liability & Hired & Non-Owned Automobile; Primary & NonContributory applies with respect to General Liability & Hired & Non-Owned Auto; Waiver of Subrogation, Alternate Employer Endorsement also applies to certificate holder under Workers Compensation; all as required by written contract or agreement, subject to the terms, conditions and exclusions within the policy. GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY JECT LOC OTH- ER E.L. DISEASE - EA EMPLOYEE DATE (MM/DD/YYYY) NAIC # CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Collier County Public Schools 5775 Osceola Trail Naples, FL ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE Page 1 of ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
7
8
9
10
11 ^CCPS Coliisr County Public Schools Purchasing April 20, 2016 TO: Ali Relevant Awarded Vendors Re: Bid # 101-3/14 Speech Therapy Services (Renewal) To W h o m it May Concern: Collier County Public Schools (CCPS) has been under contract with your company for the referenced service/commodities for the past year, CCPS v/ouid like to renew this contract for another year in accordance with the renewal clause in the original agreement, at either the contract pricing or at a discounted rate. If you fail to indicate renewal intentions or a mutual agreement of new terms cannot be reached, the contract may not be renewed with your company and/or may be placed out for bid at the end of your existing contract term on June 30, Please indicate your intentions by checking/initialing the appropriate information as requested below. X! am agreeable to renewing the present contract under the same terms and conditions as the contract (bid tabulation from last year is attached). i am agreeable to renew, at a discounted rate from the contract pricing. I have attached a concise and thorough breakdown of new terms for review to include percentage of decrease. i do not wish to renew the contract. if you are agreeable to renewing the contract, then said renewal will be effective upon School Board/Purchasing approval, receipt of Purchase Order(s) for the renewal period, commencing July 1, 2016 and ending June 30, 2017 and the fuifiilment of any administrative requirements. Your prompt, urgent attention is requested. Please complete this form in full and return this letter, via fax to the Purchasing Department, (239) or via e-maii to: RobertPa@collierschools.com, with your response no later than Friday, April 29, If you have any questions or concerns, please do not hesitate to contact me. Sincerely, Patricia Roberts, CPPB Collier County Public Schools Acceptance: ContractorVvencor ' / >7 Todays Learners Tomorrow's Leaders 5775 Oii-i-c'r; Trail j Mspiss, F'orics 341 OS \ 239.3~ j 239, SifkoNsS'cofiierpchools.com! :,-.-A""o:iior"schoo!s.com
12 W-9 Form (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blani<. Comprehensive Therapy Consultants, Inc. 2 Business name/disregarded entity name, if different from above Give Form to the requester. Do not send to the IRS. 3 Checl< appropriate box for federal tax classification; check only one of the following seven Ixixes: I I Individual/sole proprietor or C I C Corporation [7] S Corporation d Partnership single-member LLC Trust/estate 0 Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate txix in the line above for the tax classification of the single-memtser owner. 1 I Other (see instructions) 5 Address (numt)er, street, and apt. or suite no.) PO Box City, state, and ZIP code Atlanta, GA List account number(s) here (optional) 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) {Applies to accounts maintained outside ttk U.S.) Requester's name and address (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it Is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. Part II Certification Under penalties of perjury, I certify that: Social security number or Employer identification number The numlser shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that 1 am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined lielow); and 4. The FATCA code(s) entered on this form (rf any) indicating that I am exempt from FATCA reporting is con-ect. Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are cun-ently 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 (IRA), 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 3. Sign Here General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at wwwjrs.govffwq. 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 numtser (SSN), individual taxpayer identificafion number (ITIN), adoption taxpayer identification numt>er (ATIN), or employer identification numtjer (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: Fonri 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) Fomi 1099-K (merchant card and third party network transactions) Date^ Form 1098 (tiome mortgage interest), 1098-E (student loan interest), 1098-T (tuition) Forni 1099-C (canceled debt) Fonn 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 witty a TW, you might be subject to tiackup withholding. See What is tmckup withholding? on page 2. By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not sut>ject to backup withholding, or 3. Claim exemption from backup withhouing if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) Indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. Cat. No X Form W-9 (Rev )
13
14
15
16
17
18
19
20
21
22
23
Countrywide Express Inc.
Countrywide Express Inc. CUSTOMER APPLICATION At Countrywide Express our mission is to establish long lasting partnerships with customers in North America by providing best in class transportation solutions,
More informationEstablished in 2006, serving US and Canada with TL, LTL. Our team working 24/7 to provide all the support that you need.
Mailing Address :- PO Box 4 Syosset, NY, 11791. Phone :- 716-337-5000/516-874-0909. Fax :- 716-772-3383 Website :- www.alg.us.com Corporate HQ:- 68 S Service Suite #100, Melville, NY, 11747. (A freight
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/8/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationForm W-9 (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Fo
Form W-9 (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. 1 Name
More informationRSS - Vendor Packet USA Excellence is not a skill. It is an attitude. ~Ralph Marston
RSS - Vendor Packet USA Excellence is not a skill. It is an attitude. ~Ralph Marston 1 Contents Security Guard Guidelines Paperwork Requirements Insurance Agreement W-9 Sample COI Vendor Form Credit Refrenece
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/5/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationPRS- Vendor Packet - USA
PRS- Vendor Packet - USA 1 Contents PRS Intro Letter Fax Cover Paperwork Requirements Insurance Requirements Indemnification W9 Sample COI Vendor Form Credit Refrences PG.3 PG.4 PG.5 PG.6 PG.7 PG.8 PG.9
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationSPECIAL EVENTS INSURANCE REQUIREMENTS
Permit Center 210 Lottie Street, Bellingham, WA 98225 Phone: (360) 778-8300 Email: pwpermits@cob.org Web: www.cob.org/permits SPECIAL EVENTS INSURANCE REQUIREMENTS Permit Applicant: Give this memorandum
More informationUMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR CLAIMS-MADE DATE (MM/DD/YYYY) 11/7/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF I
UMBRELLA LIAB EXCESS LIAB CERTIFICATE OF LIABILITY INSURANCE OCCUR CLAIMS-MADE DATE (MM/DD/YYYY) 11/7/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
More informationCONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F :
1 2 3 5 6 7 8 9 COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE
More informationCERTIFICATE OF LIABILITY INSURANCE
ACORDTM INSURED INSURER A : Travelers Property Cas Co of America INSURER B : Travelers Indemnity Company INSURER C : Berkley Insurance Company INSURER D : Travelers Indemnity Company of CT INSURER E :
More informationCERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationCERTIFICATE OF LIABILITY INSURANCE
ACORD CERTIFICATE OF LIABILITY INSURANCE Date (MM/DD/YR) Today s Date THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
More informationDocuSign Envelope ID: E7-5F1C-4156-BC4E C6B
INSURED CERTIFICATE OF LIABILITY INSURANCE COLUM-8 DATE (MM/DD/YYYY) INSURER A : National Fire Ins Co of Hartfo INSURER B : 20478 Midwest Employers Casualty Co INSURER C : INSURER D : INSURER E : INSURER
More informationCERTIFICATE OF LIABILITY INSURANCE
UMBRELLA LIAB EXCESS LIAB DED RETENTION CERTIFICATE OF LIABILITY INSURANCE OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE DATE (MM/DD/YYYY) 04/20/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
More informationINSURED INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: DATE (MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 6/09/2014 THIS
More informationNote on Idaho Private Investigator License
Note on Idaho Private Investigator License Idaho is one of five (5) states in the U.S. that do not require and do not provide any government-issued licenses for private investigators and private investigation
More informationCERTIFICATE.OF.LIABILITY.INSURANCE
CERTIFICATE.OF.LIABILITY.INSURANCE TIE R045 2/2/2018 DATE THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationInsurance Requirement Sheet
Insurance Requirement Sheet To ensure optimal protection for our guests as well as our own organization we ask our guests to provide sufficient insurance coverage. Most organizations are already covered
More informationCERTIFICATE OF PROPERTY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationNote on Alaska Private Investigator License
Note on Alaska Private Investigator License Alaska is one of five (5) states in the U.S. that do not require and do not provide any state-issued licenses for private investigators and private investigation
More informationSubcontractor Insurance Requirements
Subcontractor Insurance Requirements Project Name / #: Certificate Holder & Address: All Operations Back s Construction, Inc. 1602 Front Street, Suite 100 San Diego, CA 92101 Comprehensive General Liability
More informationArchitecture Historic Preservation Construction Management 224 South Michigan Avenue Suite 245 Chicago, Illinois 60604 312.922.2600 312.922.8222 Fax SMITH HARDING JV July 22, 2014 Ms. Jennifer Maul Risk
More informationSTATE OF ALABAMA ALCOHOLIC BEVERAGE CONTROL BOARD MONTGOMERY, ALABAMA
STATE OF ALABAMA ALCOHOLIC BEVERAGE CONTROL BOARD MONTGOMERY, ALABAMA LICENSE EXPIRES SEPTEMBER 30, 2019 RENEW LICENSE(S) BEFORE AUGUST 1, 2019 Confirmation Number: 20180725000010800 Renewal Period: June
More informationState of West Virginia Solicitation Response
Purchasing Division 2019 Washington Street East Post Office Box 50130 Charleston, WV 25305-0130 State of West Virginia Solicitation Response Proc Folder : 388532 Solicitation Description : ADDENDUM 2 -
More informationCrandall Corporation. Permit Package
Crandall Corporation Permit Package May 2018 Prepared by Crandall Corporation UNITED STATES OF AMERICA DEPARTMENT OF TRANSPORTATION PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION
More informationState of West Virginia Solicitation Response
Purchasing Division 2019 Washington Street East Post Office Box 50130 Charleston, WV 25305-0130 State of West Virginia Solicitation Response Proc Folder : 426521 Solicitation Description : Addendum 3-Williamson
More informationCERTIFICATE OF LIABILITY INSURANCE
GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC A AUTOMOBILE LIABILITY Y Y CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/30/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
More informationCONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : Gordon Chevrolet, Inc. INSURER C : 171 Great Road INSURER D : Acton, MA 01720 INSURER E : INSURER F : INSURER(S) AFFORDING
More informationYou can reproduce this certificate as needed. Ohio Bureau of Workers' Compensation. Required Posting
30 W. Spring St. Colum bus, OH 43215 Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law. Therefore,
More informationRequest for Taxpayer Identification Number and Certification. Go to for instructions and the latest information.
Form W 9 Request for Taxpayer Identification Number and Certification (Rev. October 2018) Department of the Treasury Internal Revenue Service Go to www.irs.gov/formw9 for instructions and the latest information.
More informationNOTICE OF AWARD. RE: Bid #4183RP-Painting & Pressure Washing Services-Contact Labor
LAKE COUNTY SCHOOLS Leading our Children to Success Procurement Services 29529 CR 561 Tavares FL 32778 (352) 253-6760 Fax: (352) 253-6761 http://lake.k12.fl.us Superintendent: School Board Members: Susan
More informationCommitted to Excellence Procurement Services 29529 CR 561 Tavares FL 32778 (352) 253-6760 Fax: (352) 253-6761 http://lake.k12.fl.us Superintendent: School Board Members: Susan Moxley, Ed.D. District 1
More informationCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFI
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationDear Transportation Manager:
Dear Transportation Manager: As the transportation manager, I am sure you are always looking for qualified help moving your freight. We, at ST Freight, LLC are eager to show you the advantages we offer
More informationPROGRESS MANAGEMENT COMPANY
Date: Vendor: Please fill out all paperwork and provide the necessary documentation and return it to the Property Manager from whom you received this packet. Packets received at the corporate office directly
More informationPEARL TRANPORT,INC PTI FREIGHT BROKERS PH: F X: FAX DATE:
PEARL TRANPORT,INC PTI FREIGHT BROKERS PH: 713-433-3252 F X: 972-293-0621 FAX TO: COMPANY- FROM: Ryan Roblee DATE: FAX NUMBER: 1OTAL NO Or 1'AGES INCLUDING COVER'. P'riONENUMBF.K' SENDER'S RF.FRRKNCK NUMBER:
More informationCERTIFICATE OF LIABILITY INSURANCE
ACORDTM CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY
More information[COMPANY INFORMATION]
2013 Damage Appraisers of North America [COMPANY INFORMATION] Contains coverage maps with rates, company Quick Facts, W-9 tax form, and copies of important corporation documents that could be of use to
More informationExhibit E-1: Insurance Requirements
Please produce separate Certificate(s) of Insurance for this project as detailed below: Certificate Holder: AllertonFox Construction LLC 110 W 40 th Street, Suite 1603 New York, NY 10018 CERTIFICATE# 1:
More informationChad M. Buchanan, C.F.O. (260) , Ext Alan Scherer, Operations Department
To: Transportation Department RE: Logistics Packet Thank you for the opportunity to service your transportation needs. Attached are documents that will assist you in establishing Circle Logistics as your
More informationPremier Finance Adjusters
Premier 2016 Finance Adjusters Thank you for choosing Premier Finance Adjusters for all of your repossession needs. We have been servicing repossession needs in Pennsylvania for over 20 years. We seek
More informationDecember 01, 2011 GREG CRAWFORD PURPOSE TRANSPORTATION CORP 8181 JETSTAR DRIVE SUITE 130 IRVING, TX 75063 CERTIFICATE OF STANDARD CARRIER ALPHA CODE (SCAC) ASSIGNMENT The Standard Carrier Alpha Code of
More informationEVIDENCE OF PROPERTY INSURANCE
Quail Creek La Paz Condominium Association 29b Technology Drive Suite 100 Irvine, CA 92618- EVIDENCE OF PROPERTY INSURANCE THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY
More informationThe City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions and the following:
DocuSign Envelope ID: 698692AA-34AA-4E87-B00D-5F810F0FFDD6 Financial Services Purchasing Division 215 N. Mason St. 2 nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707- fax fcgov.com/purchasing
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
More informationIndustrial Equipment Campers Flat Beds Mobile Homes Heavy Equipment RVs Motor Homes Trailers
We are a repossession company that specializes in difficult and hard to locate recoveries. Our team of recovery agents and investigators will locate and secure your collateral in a timely and professional
More informationVendor Management Program (VMP)
1 Vendor Management Program (VMP) Dear New Vendor Partner, Thank you for your interest in doing business with Summit Management Services, Inc. As a premier national residential real estate company, Summit
More informationPARADE APPLICATION RULES
PARADE APPLICATION RULES 1. All applicants for entry are subject to approval and acceptance by the Parade committee. For applications to be considered, they must be completed and received by December 1,
More informationSUBCONTRACTOR QUALIFICATION FORM For J. RAYMOND CONSTRUCTION CORP
SUBCONTRACTOR QUALIFICATION FORM For J. RAYMOND CONSTRUCTION CORP 465 W. Warren Rd. Phone#: (407) 862.6966 On the Web at www.jray.com Longwood, FL 32750 Fax #: (407) 571.3597 Instructions: Elaboration
More informationW-9: Please fill out. The IRS requires that we keep a W-9 form on file for whomever we do business with.
Dear Authorized Independent Contractor, Thank you for your desire to work with Gorilla Capital, Inc. and welcome! We invite you to take advantage of our website www.gorillacapital.com, as it will give
More informationJune 22, To the Owners of. Solair Wilshire Homeowners Association 3785 Wilshire Boulevard Los Angeles, CA Re: Insurance Renewal
HUB International Insurance Services June 22, 2018 580 California Street, Suite 1300 www.hubinternational.com Phone: 415.276-2812 Lic. No. 0757776 To the Owners of 3785 Wilshire Boulevard Re: Insurance
More informationThank you for your interest in joining the LiteGear family!
1 Thank you for your interest in joining the LiteGear family! In order to set up your LiteGear Account, return the following items. Please note, that it may take up to 24 hours to process and verify all
More informationCERTIFICATE OF LIABILITY INSURANCE
PRODUCER INSURED CONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : FAX (A/C, No): A UMBRELLA LIAB OCCUR N N 793001413 6/30/2016
More informationPlease complete and return to: University of Central Florida Florida Solar Energy Center Attn: Jeremy Nelson 1679 Clearlake Rd.
Please complete and return to: University of Central Florida Florida Solar Energy Center Attn: Jeremy Nelson 1679 Clearlake Rd. Cocoa, FL 32922 Fax: 321-638-1439 Homeowner Address Phone Number Email Form
More informationNew Provider Forms. If you have any questions, please us.
New Provider Forms Thanks for your interest in becoming a HAP provider. Following this page are three forms we ll need you to complete and return back to us at Providers_Recruitment@hap.org: Physician
More informationD.R. Horton, Inc. Vendor Insurance Requirements ALL STATES EXCEPT CA, WA, OR, ID, UT, AND HI
D.R. Horton, Inc. Vendor Insurance Requirements ALL STATES EXCEPT CA, WA, OR, ID, UT, AND HI For NEW VENDORS, your certificate should be returned to the division with your subcontractor agreement. For
More informationThe following documentation is an electronicallysubmitted vendor response to an advertised solicitation from the West Virginia Purchasing Bulletin
The following documentation is an electronicallysubmitted vendor response to an advertised solicitation from the West Virginia Purchasing Bulletin within the Vendor Self Service portal at wvoasis.gov.
More informationSCANA Corporation. AEGIS Insurance Services, Inc.
ESSENTIALS OF CONTRACTUAL RISK TRANSFER: INSURANCE ISSUES WITH CONTRACTORS, VENDORS, & SUPPLIERS David P. Abernathy, Esq. Vice President & General Counsel Spire, Inc. Bryony Bowers Hodges, Esq. Assistant
More informationState of West Virginia Solicitation Response
Purchasing Division 2019 Washington Street East Post Office Box 50130 Charleston, WV 25305-0130 State of West Virginia Solicitation Response Proc Folder : 332008 Solicitation Description : OSR Southern
More information- DATE (MM/DD!YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/5/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
More information18 November 2015
18 November 2015 No Search Results SAM Search Results List of records matching your search for : Record Status: Active DUNS Number: 015902943 Functional Area: Entity Management, Performance Information
More informationOctober 1, To all Owners of. 66 Cleary Court Condominium Owners Association 66 Cleary Court San Francisco, CA
CA DOI#0D08408 Tel 415.541.7900 Fax 415.541.7195 Toll Free 800.648.1600 October 1, 2012 To all Owners of 66 Cleary Court San Francisco, CA 94109 Re: Insurance Ladies & Gentlemen: Enclosed are the Evidence
More informationCERTIFICATE OF LIABILITY INSURANCE
UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under
More informationBLUEPRINT 2010 ACORD CERTIFICATE OF INSURANCE CHANGES CONSTRUCTION PRACTICE LIKELY ISSUES CONSTRUCTION CONTRACTS
CONSTRUCTION PRACTICE BLUEPRINT September 2010 www.willis.com 2010 ACORD CERTIFICATE OF INSURANCE CHANGES Many of you have heard that ACORD, the licensing company for insurance forms, has amended their
More informationSummit Management Services, Inc. Vendor Management Program Requirements
Summit Management Services, Inc. Vendor Management Program Requirements I/we agree to provide goods and/or services for Summit Management Services, Inc. and/or properties managed by Summit Management Services,
More informationPurpose of Training. Disclaimer
Purpose of Training The Council of Contracting Agencies (CCA) Committee on Risk Management and Insurance recommends that public entities have a program of risk management and insurance so as to minimize
More informationCERTIFICATE OF LIABILITY INSURANCE
X X X A- LOCKTON COMPANIES, INC. 1185 AVENUE OF THE AMERICAS, STE. 2010, NY, NY 10036 B- AON/ALBERT G. RUBEN & CO., INC. 15303 VENTURA BL., SUITE 1200, SHERMAN OAKS, CA WOODRIDGE PRODUCTIONS, INC. MISC
More informationKindly note, if you would like to establish credit for your company, this process can take 3-5 business days.
Dear Thank you for showing interest in Riviera Turf. As we set up your new account there are several forms that we need completed to establish an account with us. Please complete the attached forms in
More informationProposal For: 917 Alabama Avenue S. Bremen, Georgia Phone: (770) Fax: (770)
Proposal For: JEA Solicitation Title: The Point Meadows 230/26kV Substation and Transmission Circuits 946/956 Interconnect JEA Solicitation Number: 085-16 Silvey Proposal No. 16P028 917 Alabama Avenue
More informationCITY OF ROHNERT PARK CITY COUNCIL AGENDA REPORT
Mission Statement We Care for Our Residents by Working Together to Build a Better Community for Today and Tomorrow. ITEM NO. 7C1 Meeting Date: February 14, 2017 Department: Development Services Submitted
More informationTEL: TOLL FREE FAX: TOLL FREE ICC MC : FEDERAL ID:
TEL: 905-669-0481 TOLL FREE 877-212-0007 FAX: 905-669-0482 TOLL FREE 866-737-1117 CARRIER PROFILE ICC MC : 521228 FEDERAL ID: 98-0493370 US DOT : 1359813 C.V.O.R : 151-574-730 HAZMAT CERTIFIED Canada and
More informationKindly note, if you would like to establish credit for your company, this process can take 3-5 business days.
Dear Thank you for showing interest in Riviera Turf. As we set up your new account there are several forms that we need completed to establish an account with us. Please complete the attached forms in
More informationSOIL INVESTIGATION REPORT
SOIL INVESTIGATION REPORT Report Date: 11/9/16 Inspection Date: 8/25/16 Level of Study: 3 Site Location: 160 Monroe Drive, Lake Dow North, Lot 186 Job No. 16356.2 Client: Dave Aynes, Atlanta Leasing &
More informationRequest for Taxpayer Identification Number and Certification
Form W 9 Request for Taxpayer Identification Number and Certification (Rev. October 2018) Department of the Treasury Internal Revenue Service Go to www.irs.gov/formw9 for instructions and the latest information.
More informationACKNOWLEDGEMENT OF ADDENDUM
ACKNOWLEDGEMENT OF ADDENDUM BID NO. DATE Any interpretation, correction, or change to the invitation to bid will be made by ADDENDUM. Changes or corrections will be issued by the Harlingen Waterworks System.
More information29. Cisco Technology Products
City Council Agenda 29. Cisco Technology Products Action: A. Approve contracts for providing Cisco technology products and services for the term of five years in the estimated annual amount of $2,000,000
More informationExhibit A. Applicant/Property Owner Address Phone Number. Address City State Zip Code
Exhibit A Instructions: 1. Fill out the application, which includes a project map or diagram, a cost summary, a project schedule, a signed maintenance agreement form and a completed W9 form. 2. Submit
More informationMC DATH
Carrier Profile Corporate Name: Dalor Transit, Inc. Established: 1976 Federal Employer Identification: 39-1332520 ICC Identification: MC 147312 US DOT Number: 168179 SCAC Identification Code: DATH Address:
More informationWORLDWIDE EXPRESS TRUCKLOAD
WORLDWIDE EXPRESS TRUCKLOAD 2017 Worldwide Express is your full-service FTL service provider, with offices across the nation available to help you identify the right solution at the right price, letting
More informationCERTIFICATE OF LIABILITY INSURANCE
UMBRELLA LIAB OCCUR CERTIFICATE OF LIABILITY INSURANCE ECESS LIAB CLAIMS-MADE DED RETENTION 10,000 CUP8E78327A 7/15/2016 7/15/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EECUTIVE
More informationCARRIER SET-UP PACKET
CARRIER SET-UP PACKET Interstate Logistics Systems, Inc. * PO Box 10 * Mountain View, WY 82939 Phone 307-782-7779 * Fax 307-460-7351 or 307-782-8208 ***ATTENTION PLEASE READ*** Please fax or e-mail this
More informationWASHTENAW COUNTY ROAD COMMISSION Permit Engineering Section 555 N. Zeeb Road Ann Arbor, MI 48103
WASHTENAW COUNTY ROAD COMMISSION The following is (1) a list of the activities which utility companies will be allowed to undertake in Washtenaw County road Right-of-Way under a Blanket Permit ; and, (2)
More informationWASHTENAW COUNTY ROAD COMMISSION Permit Engineering Section 555 N. Zeeb Road Ann Arbor, MI 48103
WASHTENAW COUNTY ROAD COMMISSION Permit Engineering Section The following is (1) a list of the activities which utility companies will be allowed to undertake in Washtenaw County road Right-of-Way under
More informationNEW CAR DEALER REGISTRATION CHECKLIST
2668 US Highway 601 S, Mocksville, NC 27028 Phone: 336-284-4000 Fax: 336-284-4093 www.blackyardautoauctions.com SALES EVERY WEDNESDAY AT 2:30PM Welcome to Blackyard Auto Auctions We have included a checklist
More informationVirtual credit card payments
To: Accounts Payable Department Re: New Method of Settlement for Accounts Payable As part of an ongoing effort to streamline our purchasing process and improve the timeliness of payments to you, The Madison
More informationï
ï î í ì ë ê é è ç ïð ïï ïî ïí UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory
More informationTax ID: MC C SCAC: BWCD DOT:
Tax ID: 27-317881 MC-741798-C SCAC: BWCD DOT: 2129517 Blackwell Consolidation, LLC Mailing PO Box 3667 Central Point, OR 97502 Corporate Location 5656 Crater Lake Ave. Central Point, OR 97502 Hours: 7:00-5:00
More informationCERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) Month//Year PRODUCER SIR and WRAP Programs THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Insurnce Agent/Broker Name AND CONFERS NO RIGHTS
More informationTravel Demand Model Development and Improvements
Travel Demand Model Development and Improvements Volume II Cost Proposal submitted to Kalamazoo Area Transportation Study submitted by Cambridge Systematics, Inc. with Dunbar Transportation Consulting
More informationANC 1B TRANSPORTATION COMMITTEE Thursday, November 19, :00-8:15 p.m. Columbia Heights Recreation Center 1480 Girard Street, NW AGENDA
ANC 1B TRANSPORTATION COMMITTEE Thursday, November 19, 2015 7:00-8:15 p.m. Columbia Heights Recreation Center 1480 Girard Street, NW AGENDA 3rd and U Street Curb Cut (DDOT Tracking # 118364) Presenter:
More informationCONTRACTOR NETWORK. Application & Program Fundamentals
CONTRACTOR NETWORK Application & Program Fundamentals INTRODUCTION DCMG is extremely thorough in the credentialing process of our network members to ensure that our client base of insurance carriers, property
More informationApplication for Customer Status
Application for Customer Status TERMS AND CONDITIONS OF SALES: The terms and condition of sales by Perfect 10 (hereafter referred to as Perfect 10 ) to the below named Customer (hereafter referred to as
More informationNEW VENDOR INFORMATION
NEW VENDOR INFORMATION ENROLLMENT INSTRUCTIONS When you become a BH Management Compliant Vendor you are approved to offer your services to all properties managed by BH Management Services, LLC anywhere
More informationRFP - FCPA Conference Video
RFP - FCPA Conference Video Lead Contact Ben Powell ben@benpowellmedia.com 703-909-5682 305 Douglass Ave Falls Church, VA 22042 http://www.vimeo.com/79440842 www.benpowellmedia.com Ben Powell Media is
More informationCase KJC Doc 64 Filed 12/21/17 Page 1 of 16
Case 17-12913-KJC Doc 64 Filed 12/21/17 Page 1 of 16 UNITED STATES BANKRUPTCY COURT DISTRICT OF DELAWARE In re Dextera Surgical Inc., et al. Case No. 17-12913 (KJC) Debtor INITIAL MONTHLY OPERATING REPORT
More informationFreight Logistics Inc.
Freight Logistics Inc. MC # 452520-B Transportation Broker Federal ID# 51-0459282 Let s Start Building Our Partnership Today: 735 Cardley Ave Bldg 105 PO Box 1712 Medford OR 97504 800-866-7882 541-734-5617
More information