WASHINGTON ALLIANCE FOR HEALTHCARE INSURANCE TRUST
|
|
- Lucy Lewis
- 8 years ago
- Views:
Transcription
1 WASHINGTON ALLIANCE FOR HEALTHCARE INSURANCE TRUST administered by Benefit Solutions, Inc th Street, SW Suite 601 Lynnwood, WA phone fax Locator # W/ Effective Date: IMPORTANT NOTICE TO: FROM: RE: Employers Responsible for COBRA* Continuation Administration in the Washington Alliance for Healthcare Insurance Trust. Benefit Solutions, Inc. COBRA Department, Administrative Office COBRA Administration It is important that each employer be aware of their responsibility with regard to the COBRA requirements. Generally, any employer who retains more than twenty employees is obligated to offer COBRA rights to their employees. There are other unique employer scenarios which also require COBRA compliance. If there is any doubt as to whether or not your company is required to comply with the COBRA regulations, you are encouraged to seek legal counsel. As a service provided to participating WAHIT employers, Benefit Solutions, Inc. is prepared to assume the administrative functions of COBRA notification and billings for your eligible COBRA employees at no extra charge. Attached is an agreement which you will need to review and sign if you desire to take advantage of the services. G YES, we wish to use the services of Benefit Solutions, Inc. for COBRA administration and hereby enclose the signed agreement. G NO, we do not want to use the services of Benefit Solutions, Inc. for COBRA administration and we understand that we will maintain our own COBRA procedures and policies with regard to terminated employees. If you have checked YES above, please complete and sign the attached COBRA Administration Agreement and return to our office as soon as possible. If you currently have Employees on COBRA, please complete an Employer Request for Employee Termination/and Employee Continuation of Coverage form for each Employee on Cobra. (One of these forms should be completed and forwarded to us for each Employee who elects COBRA in the future.) It is very important that we receive a response from each Employer so that our records are accurate. If an employer does not respond, it will be assumed that any COBRA administration that may be necessary is being handled by the Employer. *Consolidated Omnibus Budget Reconciliation Act of 1986
2 COBRA ADMINISTRATION AGREEMENT WHEREAS,, hereinafter referred to as the "Employer," has determined it wishes to engage the services of Benefit Solutions, Inc. hereinafter referred to as "," in order to comply with the requirements of the Consolidated Omnibus Budget Reconciliation Act of 1986, as amended from time to time ("COBRA"), as the same relates to the mandatory continuation coverage of health benefits as supplied by Employer to participants in its employee welfare benefit plan; WHEREAS, in furtherance Employer's determination to comply with the requirements of COBRA, Employer desires to delegate certain ministerial functions and authority to with regard to record keeping and accounting of qualified beneficiaries whose benefits have become terminated and who are entitled to continuation coverage under COBRA; WHEREAS, Employer is a participating Employer in the Washington Alliance for Health Insurance Trust and this Agreement is entered into in connection with the administration of Employer's employee benefit plan under the Washington Alliance for Health Insurance Trust; NOW, THEREFORE, in consideration of the mutual covenants, conditions and agreements as hereinafter set forth, the Employer and do hereby agree as follows: ARTICLE I Definitions 1.1 Unless otherwise defined herein, capitalized terms used herein have the same meaning as ascribed to them in the Agreement. 1.2 The term "Continuation Coverage" shall mean the extended health care coverage required by COBRA. 1.3 The term "Qualified Beneficiaries" shall mean those individuals who have experienced a "Qualifying Event" as defined by COBRA and who have elected Continuation Coverage under the Plan. 1.4 The term "Monthly Contribution Amount" means the amount the Qualified Beneficiary must contribute for Continuation Coverage. ARTICLE II Responsibilities of Employer 2.1 During the term of this Agreement, Employer will: (a) Provide eligibility information to. The Employer will notify of persons who have experienced a Qualifying Event within 30 days of the Qualifying Event. The notification will be 1
3 by noting termination or other changes of employment status on the monthly employer report, or by separate notification to. The information provided in the notification will include the following: Name, Social Security Number Date and Type of Qualifying Event 3.1 During the term of this Agreement, will: ARTICLE III Responsibilities or (a) (b) (c) provide standard COBRA election forms to Qualified Beneficiaries; bill Qualified Beneficiaries for the monthly contribution amounts; and collect and remit monthly contribution amounts from Qualified Beneficiaries. 3.2 will provide notification of the right to elect continuation coverage under the Employer's plan to persons who have been identified to by the Employer as having experienced a Qualifying Event. The notice will be mailed by first class mail to such persons at the mailing address provided to by the Employer. The notice will be mailed within fourteen (14) calendar days from receipt of the notification from the Employer. The notice will specify the plan(s) for which the Qualified Beneficiary is eligible and the premium rate and due date. 3.3 Unless otherwise notified in writing, will be entitled to conclusively presume that a Qualified Beneficiary's eligibility for continuation of coverage under the Employer's Plan has not terminated by reason of coverage under another group health plan or by becoming eligible for Medicare. 3.4 It is expressly understood that will not be the Plan Administrator or "Named Fiduciary" with respect to the Employer's Plan as those terms are defined by ERISA or the Internal Revenue Code as the result of this Agreement. ARTICLE IV Fees 4.1 will not charge the Employer a separate fee for the services described in this Agreement. ARTICLE V Indemnification 5.1 Employer agrees to indemnify and hold harmless against any loss, damage, or expense, including reasonable attorney 5 fees that may incur or be required to pay as a result of any claim, demand, cause of action, lawsuit or proceeding arising out of or in any way in connection with the services provided under this Agreement unless it is determined in a final judgement of a court competent jurisdiction that such loss, damage or expense was the result of 's willful 2
4 misconduct or neglect, fraud or bad faith. Employer agrees to indemnify and hold harmless against any penalty which is or will be imposed upon it under ERISA and pertinent regulations thereunder or the imposition of an excise tax upon under Section 4980B of the Internal Revenue Code or any other penalties which may be imposed by law or regulation in connection with COBRA, unless it is determined that the liability therefore was the direct consequence of the dishonest, fraudulent or criminal acts of or its employees. ARTICLE VI Notices 6.1 Any notices permitted or required by this Agreement shall be delivered in person to the intended recipient, or shall be sent to such person by first class mail or prepaid telegram at his or her last known address. ARTICLE VII Severability 7.1 If any term or provision of this Agreement is held to be unlawful or invalid for any reason, such unlawfulness or invalidity shall not affect the remaining portions of this Agreement. ARTICLE VIII Construction 8.1 This Agreement shall be construed and interpreted in accordance with the laws of the State of Washington, the Employee Retirement Income Security Act of 1974, the Internal Revenue Code and the regulations thereunder, and any other applicable federal and state statutes and regulations. ARTICLE IX Arbitration of Disputes 9.1 Any claim or controversy that arises out of or relates to this Agreement or breach of it will be settled by arbitration in the City of Seattle, in the State of Washington, in accordance with the rules then obtaining of the American Arbitration Association. Judgment upon the award rendered may be entered in the King County Superior Court in the State of Washington. Benefit Solutions, Inc. Name of Employer By: By: 3
5 Title: Date: Title: Date: Please do not write below this line For administrative use only Copy of accepted agreement returned to Employer on by 4
COBRA ADMINISTRATIVE SERVICES AGREEMENT
COBRA ADMINISTRATIVE SERVICES AGREEMENT This Administrative Services Agreement ( Agreement ) is hereby made between Providence Health Plan ( Providence ) and the Employer ( Employer ) and applies to all
More informationTo activate this service, read agreement and sign the Signature Page, and return it to CBIA.
INSTRUCTIONS: To activate this service, read agreement and sign the Signature Page, and return it to CBIA. CBIA COBRA / State Continuation Services 350 Church Street Hartford, CT 06103-1126 In addition,
More informationSURA/JEFFERSON SCIENCE ASSOCIATES, LLC COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN. Amended and Restated
SURA/JEFFERSON SCIENCE ASSOCIATES, LLC COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN Amended and Restated Effective June 1, 2006 SURA/JEFFERSON SCIENCE ASSOCIATES, LLC COMPREHENSIVE HEALTH AND WELFARE
More informationEXHIBIT A AMENDED AND RESTATED ARTICLES OF INCORPORATION OF ANTHEM INSURANCE COMPANIES, INC. ARTICLE I NAME
EXHIBIT A AMENDED AND RESTATED ARTICLES OF INCORPORATION OF ANTHEM INSURANCE COMPANIES, INC. Anthem Insurance Companies, Inc. (hereinafter referred to as the "Corporation"), duly existing under the Indiana
More informationCOLLABORATION AGREEMENT
COLLABORATION AGREEMENT This Collaboration Agreement ( Agreement ) is made by and between Microryza Inc., a Delaware corporation (the Company ) and, a Delaware Corporation (the University ) (together with
More informationBENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT
BENCHMARK MEDICAL LLC, BUSINESS ASSOCIATE AGREEMENT This BUSINESS ASSOCIATE AGREEMENT ( Agreement ) dated as of the signature below, (the Effective Date ), is entered into by and between the signing organization
More informationDEERFIELD COMMUNITY CODE: 671.3 SCHOOL DISTRICT DATE OF ADOPTION: 06-16-97
DEERFIELD COMMUNITY CODE: 671.3 SCHOOL DISTRICT DATE OF ADOPTION: 06-16-97 TAX SHELTERED ANNUITY PROGRAM Attached is the district s policy and supporting materials regarding Tax Sheltered Annuities. ADMINISTRATIVE
More informationINSURANCE AGENT AGREEMENT
INSURANCE AGENT AGREEMENT THIS INSURANCE AGENT AGREEMENT is made, 200_ by and between Athens Area Health Plan Select, Inc. ( AAHPS or the Plan ), and ( Agent ). RECITALS: WHEREAS, AAHPS is licensed to
More informationInsurance Market Solutions Group, LLC Sub-Producer Agreement
Insurance Market Solutions Group, LLC Sub-Producer Agreement This Producer Agreement is made and entered into effective the day of, 20, by and between Insurance Market Solutions Group, LLC a Texas Company
More informationFiduciary Liability Coverage Part
Fiduciary Liability Coverage Part In consideration of the payment of the premium and subject to all terms, conditions and limitations of this Coverage Part and the General Terms and Conditions for Liability
More informationAcceptance of Terms. Terms of Service. Privacy Policy. Terms Applicable to All Products and Services. Last Updated: January 24, 2014
Acceptance of Terms Last Updated: January 24, 2014 Terms of Service Please read this Terms of Service Agreement carefully. MedicaidInsuranceBenefits.com ("MedicaidInsuranceBenefits.com," "our," "us") provides
More informationBENTON COUNTY PERSONAL SERVICES CONTRACT
BENTON COUNTY PERSONAL SERVICES CONTRACT This is an agreement by and between BENTON COUNTY, OREGON, a political subdivision of the State of Oregon, hereinafter called COUNTY, and, hereinafter called CONTRACTOR.
More informationInvestment Advisory Agreement
This Investment Advisory Agreement ( Agreement ) is entered into by and between ( Client ), SPC Financial (SPC) a U.S. Securities & Exchange Commission ( SEC ) Independent Registered Investment Adviser,
More informationAbout Us! The Clear Solution For Your Auto Insurance Needs.
About Us! ClearSide General specializes in Personal Lines Automobile coverage. Our philosophy is to provide a select group of agents an exclusive opportunity to do business with an organization that values
More informationINDEPENDENT CONTRACTOR AGREEMENT. Currituck (hereinafter County ) and, RECITALS
INDEPENDENT CONTRACTOR AGREEMENT THIS AGREEMENT is made the day December, 2015, between the County of Currituck (hereinafter County ) and, (hereinafter Contractor ). RECITALS County is a body corporate
More informationLimited Agency/Company Agreement
Effective, this Agreement is entered into by and between Safepoint MGA, LLC and Safepoint Insurance Company Inc., hereinafter referred to as Company, and hereinafter referred to as Agent. It being the
More informationINDEPENDENT PRODUCER AGREEMENT
INDEPENDENT PRODUCER AGREEMENT and AGENT PROFILE 1123 North Causeway Boulevard Mandeville, LA 70471 Phone: (985) 612-1230 Fax: (985) 612-1240 lciwc.com IMPORTANT: The information requested on this page
More informationIDA INSURANCE TRUST PARTICIPATION AGREEMENT
EXECUTED VERSION IDA INSURANCE TRUST PARTICIPATION AGREEMENT THIS PARTICIPATION AGREEMENT (the Agreement ), made and entered into as of, by and between (the Participating Employer ) and the IDA Insurance
More informationThe Clear Solution For Your Auto Insurance Needs.
About Us! ClearSide General specializes in Personal Lines Automobile coverage. Our philosophy is to provide a select group of agents an exclusive opportunity to do business with an organization that values
More informationLimited Power of Attorney Credit Improvement Assistance. I/ We, [Name(s)], resident(s) of [Address, County, State]
Limited Power of Attorney Credit Improvement Assistance I/ We, [Name(s)], resident(s) of [Address, County, State] designate ecreditadvisor, also known as E.C.A. ( Agent ), of 815-A Brazos Street, Suite
More informationAMENDED AND RESTATED CERTIFICATE OF INCORPORATION OF EASTMAN CHEMICAL COMPANY
AMENDED AND RESTATED CERTIFICATE OF INCORPORATION OF EASTMAN CHEMICAL COMPANY ORIGINAL CERTIFICATE OF INCORPORATION FILED WITH SECRETARY OF STATE OF DELAWARE ON JULY 29, 1993; AMENDMENTS FILED ON DECEMBER
More informationAGREEMENT FOR INVESTMENT CONSULTING SERVICES AND MARIN COUNTY EMPLOYEES RETIREMENT ASSOCIATION
AGREEMENT FOR INVESTMENT CONSULTING SERVICES AND MARIN COUNTY EMPLOYEES RETIREMENT ASSOCIATION This Agreement for Investment Consulting Services (hereinafter referred to as the Agreement ) is made and
More informationHMSA s. COBRA Assist INSTRUCTION GUIDE C ONSOLIDATED O MNIBUS B UDGET R ECONCILIATION A CT
HMSA s COBRA INSTRUCTION GUIDE To assist employers in meeting their obligations under the final federal COBRA regulations, HMSA s COBRA contains sample notices that incorporate the new requirements. As
More informationI N V E S T M E N T A D V I S O R Y A G R E E M E N T
I N V E S T M E N T A D V I S O R Y A G R E E M E N T AGREEMENT, made this day of, 20 between the undersigned party,, whose mailing address is (hereinafter referred to as the CLIENT ), and TRADEWINDS CAPITAL
More informationCLS Investments, LLC Instructions for the Solicitor Application and Agreement
CLS Investments, LLC Instructions for the Solicitor Application and Agreement Please complete all fields on page 1 of the Solicitor Application and Agreement. Some general guidelines are set forth below.
More informationWEB HOSTING AGREEMENT
WEB HOSTING AGREEMENT This Hosting Agreement (this Agreement ) is made and entered into by and between Rotovac Corporation, a Washington corporation with offices at 17905 Bothell Everett Hwy, Mill Creek,
More informationSOLICITOR APPLICATION
Date: / / SOLICITOR APPLICATION General Information Name: Birth Date: / / Office Address: City: State: Zip: E-mail address: Business phone: ( ) - Fax number: ( ) - Assistant s Name: Registered Investment
More informationGroup Enrollment & Coverage Agreement - Conditions and Review
GROUP ENROLLMENT & COVERAGE AGREEMENT PART A - Group Letter of Agreement Federal Tax Identification # - McLaren Health Plan (MHP) will provide health care coverage to eligible persons enrolled through
More informationCLIENT SERVICE AGREEMENT
This Agreement is entered into this day of, 20 ( Effective Date ) by and between COBRA-Care Advisors, Inc. ( CCA ) and ( Client ). CCA and Client are hereinafter individually referred to as party or collectively
More informationBusiness Associate Agreement
This Business Associate Agreement Is Related To and a Part of the Following Underlying Agreement: Effective Date of Underlying Agreement: Vendor: Business Associate Agreement This Business Associate Agreement
More informationBUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT ( Agreement ) is entered into by and between (the Covered Entity ), and Iowa State Association of Counties (the Business Associate ). RECITALS
More information2 of 8 10/18/2012 1:12 PM
2 of 8 10/18/2012 1:12 PM Exhibit 10.11 EXECUTION COPY SALARIED EMPLOYEE LIABILITIES ASSUMPTION AGREEMENT This SALARIED EMPLOYEE LIABILITIES ASSUMPTION AGREEMENT ( Agreement ) is made on the 22nd day of
More informationCONTRIBUTION AGREEMENT of INCROWD ALABAMA FUND I, LLC
CONTRIBUTION AGREEMENT of INCROWD ALABAMA FUND I, LLC INSTRUCTIONS TO INVESTORS EACH PROSPECTIVE INVESTOR IN INCROWD ALABAMA FUND I, LLC (THE COMPANY ) SHOULD EXAMINE THE SUITABILITY OF THIS TYPE OF INVESTMENT
More informationTHE OHIO STATE TROOPERS ASSOCIATION CRIMINAL DEFENSE LEGAL EXPENSE REIMBURSEMENT INSURANCE POLICY
THE OHIO STATE TROOPERS ASSOCIATION CRIMINAL DEFENSE LEGAL EXPENSE REIMBURSEMENT INSURANCE POLICY I. BENEFITS 1) In consideration of the premium specified on the Declaration Page forming part of this Master
More informationINDEPENDENT CONTRACTOR AGREEMENT
INDEPENDENT CONTRACTOR AGREEMENT This Independent Contractor Agreement (this Agreement ) is made and entered into as of, 20, by and between [INSERT NAME OF CONTRACTING PARTY] (the Contracting Party ),
More informationCOBRA AND Cal-COBRA. What is COBRA?
COBRA AND Cal-COBRA What is COBRA? The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law enacted to help prevent gaps in healthcare coverage. COBRA applies in general to companies
More informationMISSISSIPPI LEGISLATURE REGULAR SESSION 1999
MISSISSIPPI LEGISLATURE REGULAR SESSION 1999 By: Senator(s) Turner To: Judiciary SENATE BILL NO. 2841 (As Passed the Senate) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 AN
More informationHOMEOWNERS LIMITED REPRESENTATIVE SERVICE AGREEMENT With SERVICE FIRST INSURANCE GROUP LLC. Of CYPRESS PROPERTY & CASUALTY INSURANCE COMPANY
HOMEOWNERS LIMITED REPRESENTATIVE SERVICE AGREEMENT With SERVICE FIRST INSURANCE GROUP LLC. Of CYPRESS PROPERTY & CASUALTY INSURANCE COMPANY This Agreement is made and entered into effective as of October
More informationCLIENT AGREEMENT RECITALS
CLIENT AGREEMENT This Agreement is made between Pushfit Inc., D/B/A Circadian Fitness, hereinafter referred to as Company, located at 23412 Pacific Park Dr. 17K, Aliso Viejo, CA 92656 and You, hereinafter
More informationVERIZON COMMUNICATIONS INC. RESTATED CERTIFICATE OF INCORPORATION
VERIZON COMMUNICATIONS INC. RESTATED CERTIFICATE OF INCORPORATION May 8, 2014 RESTATED CERTIFICATE OF INCORPORATION OF VERIZON COMMUNICATIONS INC. Verizon Communications Inc., a corporation organized and
More informationFINANCIAL RESCUERS, LLC
DEBT SETTLEMENT AGREEMENT Financial Rescuers, LLC (hereinafter the Company ), whose address is noted above, and (hereinafter Client ), residing at hereby agree as follows: 1. Client is retaining the Company
More informationAGENT / AGENCY AGREEMENT
AGENT / AGENCY AGREEMENT This Agreement entered into this day of, 20, by and between Guardian Legal Services, Inc. (GUARDIAN), and General Agent, hereinafter called GA. GUARDIAN has organized a Legal Insurance
More informationPlease fax, email or snail mail all five pages back to us at the above as soon as possible or by May 17 th at the latest.
Phone: 970.259.6960 Fax: 970.259.5331 2530 Colorado Ave, Suite 2B Durango, CO 81301 Email: info@payrolldept.biz Hello Payroll Department Client: We need your signature! Attached you will find changes to
More informationHIPAA BUSINESS ASSOCIATE AGREEMENT
HIPAA BUSINESS ASSOCIATE AGREEMENT This Agreement, dated as of, 2015 ("Agreement"), by and between, on its own behalf and on behalf of all entities controlling, under common control with or controlled
More informationVorpahl Wing Securities, Inc. Assets Management Agreement
Vorpahl Wing Securities, Inc. Assets Management Agreement Account : Account # IAR # This Assets Management Agreement together with the Schedules attached hereto, (collectively the Agreement ), is by and
More informationMiller Financial Services, LLC Advisory Services Agreement
Miller Financial Services, LLC Advisory Services Agreement This Agreement (the Agreement ) is made and entered into, by and between, Miller Financial Services, LLC (the Advisor ) and xx (the Client ),
More informationTHIRD AMENDED AND RESTATED CERTIFICATE OF INCORPORATION OF DYNEGY INC. Pursuant to Section 303 of the Delaware General Corporation Law
THIRD AMENDED AND RESTATED CERTIFICATE OF INCORPORATION OF DYNEGY INC. Pursuant to Section 303 of the Delaware General Corporation Law Dynegy Inc., a corporation duly organized and validly existing under
More informationTerms and Conditions for Tax Services
Terms and Conditions for Tax Services In the course of delivering services relating to tax return preparation, tax advisory, and assistance in tax controversy matters, Brady, Martz & Associates, P.C. (we
More informationSAMPLE MODEL LANGUAGE FOR EDWARD JONES TRUST COMPANY FOR THE USE OF LEGAL COUNSEL ONLY
SAMPLE MODEL LANGUAGE FOR EDWARD JONES TRUST COMPANY FOR THE USE OF LEGAL COUNSEL ONLY This sample model language is provided for the reference of the drafting attorney as an educational and informational
More informationInteractive Brokers Hong Kong Agreement for Advisors Providing Services to Interactive Brokers Clients
Interactive Brokers Hong Kong Agreement for Advisors Providing Services to Interactive Brokers Clients This Agreement is entered into between Interactive Brokers Hong Kong Ltd ("IB") and the undersigned
More informationHIPAA BUSINESS ASSOCIATE AGREEMENT
HIPAA BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement ( Agreement ) is entered into as of the day of, 2013 by and between RUTGERS UNIVERSITY, a Hybrid Entity, on behalf and for the
More informationFOR USE WITH A CA FULLY INSURED HEALTH CONTRACT
AGREEMENT FOR HEALTH REIMBURSEMENT ACCOUNTS This AGREEMENT (this Agreement ) is made effective as of the date set forth on [enter date here] (the "Effective Date") between {group name here} (hereinafter
More informationSample Business Associate Agreement (4. Other Bus. Assoc., Version 6-06-05)
Sample Business Associate Agreement (4. Other Bus. Assoc., Version 6-06-05) This Business Associate Agreement (the Agreement ) is entered into as of, 20, (the Effective Date ) by and between, (the Covered
More informationEMPLOYEE BENEFITS LIABILITY COVERAGE
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 04 35 12 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYEE BENEFITS LIABILITY COVERAGE THIS ENDORSEMENT PROVIDES CLAIMS-MADE COVERAGE.
More informationBUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT THIS BUSINESS ASSOCIATE AGREEMENT ( Agreement ) by and between OUR LADY OF LOURDES HEALTH CARE SERVICES, INC., hereinafter referred to as Covered Entity, and hereinafter referred
More informationEMERGENCY SERVICES CONTRACT BETWEEN THE CITY OF GEORGETOWN, TEXAS AND THE WILLIAMSON COUNTY SERVICES DISTRICT #8 (Amended September, 2010)
EMERGENCY SERVICES CONTRACT BETWEEN THE CITY OF GEORGETOWN, TEXAS AND THE WILLIAMSON COUNTY SERVICES DISTRICT #8 (Amended September, 2010) STATE OF TEXAS COUNTY OF WILLIAMSON THIS CONTRACT FOR SERVICES
More informationAGREEMENT FOR INDEPENDENT CONTRACTOR SERVICES
MBL 7 MBL Street Woods Hole, MA 02543 USA www.mbl.edu AGREEMENT FOR INDEPENDENT CONTRACTOR SERVICES This Agreement for independent contractor services is entered into by and between the Marine Biological
More informationINDEPENDENT CONTRACTOR SERVICES AGREEMENT
INDEPENDENT CONTRACTOR SERVICES AGREEMENT THIS AGREEMENT is entered into as of this day of, 2010, by and between the CITY OF MONTROSE, State of Colorado, a Colorado home rule municipal corporation, whose
More informationAMENDED AND RESTATED CERTIFICATE OF INCORPORATION OF GANNETT SPINCO, INC.
AMENDED AND RESTATED CERTIFICATE OF INCORPORATION OF GANNETT SPINCO, INC. Gannett Spinco, Inc., a corporation organized and existing under the laws of the State of Delaware, pursuant to Sections 242 and
More informationServices Agreement Instruction Sheet
Delta-T Group POB 884 Bryn Mawr, PA 19010 Phone: 800-251-8501 FAX: 610-527-9547 www.delta-tgroup.com Services Agreement Instruction Sheet We thank you for your interest in Delta-T Group. Below please find
More informationMemorandum of Understanding and Agreement NC Local Government Debt Setoff Clearinghouse Program
Memorandum of Understanding and Agreement NC Local Government Debt Setoff Clearinghouse Program Rev. 10/30/2014 This agreement is entered into this day of, by and between the ( CLAIMANT AGENCY ) and the
More informationClient Agreement - A Review of the Contract
FINANCIAL PLANNING AGREEMENT Name of Client: Mailing Address: City: State: Zip: Primary Phone: Secondary Phone : Email Address: This Financial Planning Agreement ( Agreement ) is entered into as of the
More informationPOLICY OF DISTRICT ON TAX SHELTER ANNUITY OPERATION
3013 POLICY OF DISTRICT ON TAX SHELTER ANNUITY OPERATION ESTABLISHMENT OF PROGRAM The Merton Community School District (the District ) sponsors a Tax Sheltered annuity Program ( Program ) intended to quality
More informationTERMS OF BUSINESS AGREEMENT
TERMS OF BUSINESS AGREEMENT 2525 E Camelback Rd, Suite 800 As used in this Agreement, The Keating Group, Inc. (tkg) shall refer to any business unit or entity that may be affiliated through common ownership
More informationEMPLOYMENT AGREEMENT
EMPLOYMENT AGREEMENT THIS EMPLOYMENT AGREEMENT (hereinafter referred to as Agreement ), is by and between the City of Hallandale Beach, Florida, a Florida municipal corporation (hereinafter referred to
More informationSETTLEMENT AGREEMENT AND GENERAL RELEASE OF ALL CLAIMS
SETTLEMENT AGREEMENT AND GENERAL RELEASE OF ALL CLAIMS THIS SETTLEMENT AGREEMENT AND GENERAL RELEASE OF ALL CLAIMS is entered into this day of 2012, by and between Michael Lacey (hereinafter "Lacey "'Employee")
More informationREVISITING DIRECTOR AND OFFICER INDEMNIFICATION: PROVISIONS IN THE NEW D.C. NONPROFIT ACT
Updated July 2015 REVISITING DIRECTOR AND OFFICER INDEMNIFICATION: PROVISIONS IN THE NEW D.C. NONPROFIT ACT 1. Initial Considerations The District of Columbia has recently modernized its statute dealing
More informationHeritage Specialty Insurance Agency, LP Producer Agreement
Heritage Specialty Insurance Agency, LP Producer Agreement This Agreement effective, 20, is between Heritage Specialty Insurance Agency, LP (hereinafter described as Heritage ), and, (hereinafter described
More informationHOURLY CONSULTING AGREEMENT
4245 Kemp Blvd., Suite 1007 Wichita Falls, Texas 76308 HOURLY CONSULTING AGREEMENT This is an agreement between Personal Money Planning ( Advisor ), and ( Client ). By this agreement, Client retains Advisor
More informationSECTION 403(b) TAX-DEFERRED ANNUITY PROGRAM ADMINISTRATIVE SERVICES AND HOLD HARMLESS AGREEMENT
SECTION 403(b) TAX-DEFERRED ANNUITY PROGRAM ADMINISTRATIVE SERVICES AND HOLD HARMLESS AGREEMENT WHEREAS, the governing board of Pueblo School District No. 70 (the "Employer") wishes to make available to
More informationInsurance Producer Agreement
Insurance Producer Agreement THIS AGREEMENT ( Agreement ) is made and entered into on this day of. (the Effective Date ), by and between KPS Health Plans (hereinafter referred to as KPS ), a duly licensed
More informationClient And Fiduciary Practices
INVESTMENT ADVISORY AGREEMENT THIS INVESTMENT ADVISORY AGREEMENT is made on the Effective Date identified below by and between Financial Telesis Inc. ( Advisor ), represented by W. Michael Montgomery,
More informationBUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT This HIPAA Business Associate Agreement ( BA Agreement ) amends, supplements, and is made a part of the Agreement ( Agreement ) entered with Client ( CLIENT ) and International
More informationVERSION 6.23.15 QUANTUM FINANCIAL ADVISORS
VERSION 6.23.15 Q F A NON- D I S C R E T I O N A R Y I A A G R E E M E N T ( D C ) QUANTUM FINANCIAL ADVISORS N O N D I S C R E T I O N A R Y I N V E S T M E N T A D V I S O R Y A G R E E M E N T THIS
More informationSCHEDULE J TECHNOLOGY ESCROW AGREEMENT. Account Number:
COM-NET JTF Radio System Contract State of Florida SCHEDULE J TECHNOLOGY ESCROW AGREEMENT Account Number: This Technology Escrow Agreement ( Escrow Agreement ) is effective this 28 th day of September
More informationAMENDED AND RESTATED CERTIFICATE OF INCORPORATION OF SUNCOKE ENERGY, INC.
AMENDED AND RESTATED CERTIFICATE OF INCORPORATION OF SUNCOKE ENERGY, INC. SunCoke Energy, Inc., a corporation organized and existing under the laws of the State of Delaware, pursuant to Sections 242 and
More informationAdvisory Agreement: Asset Management Services
Advisory Agreement: Asset Management Services This Investment Advisory Services Agreement for asset management services ( Agreement ) is made by and between MyWealthyOptions LLC ( MWO or Adviser ), a registered
More informationRecitals. NOW, THEREFORE, the parties hereto agree as follows: Agreement
THIS INDEPENDENT CONTRACTOR SERVICES AGREEMENT (this Agreement ) is made this day of, 20 (the Effective Date ), regardless of the date of execution, by and between Sierra Field Services, Inc., a Nevada
More informationPROVO CITY UTILITIES NET METERING LICENSE AGREEMENT
PROVO CITY UTILITIES NET METERING LICENSE AGREEMENT Customer-Owned Electric Generating Systems of 25kW or Less This NET METERING LICENSE AGREEMENT ( Agreement ) is between ( Customer ) and Provo City -
More informationASSET MANAGEMENT AGREEMENT. Focused Wealth Management, Inc. 216 Route 299, Suite 5 Highland, NY 12528 (845) 691-4035
ASSET MANAGEMENT AGREEMENT Focused Wealth Management, Inc. 216 Route 299, Suite 5 Highland, NY 12528 (845) 691-4035 This Agreement (hereinafter referred to as Agreement) is made and entered into by and
More informationHIPAA PRIVACY AND SECURITY RULES BUSINESS ASSOCIATE AGREEMENT BETWEEN. Stewart C. Miller & Co., Inc. (Business Associate) AND
HIPAA PRIVACY AND SECURITY RULES BUSINESS ASSOCIATE AGREEMENT BETWEEN Stewart C. Miller & Co., Inc. (Business Associate) AND City of West Lafayette Flexible Spending Plan (Covered Entity) TABLE OF CONTENTS
More informationASSOCIATE ATTORNEY EMPLOYMENT AGREEMENT
ASSOCIATE ATTORNEY EMPLOYMENT AGREEMENT Table of Contents Section Page 1. Employment and Duties 1 2. Compensation 1 3. Partnership 2 4. Facilities 2 5. Additional Benefits 2 6. Operation 3 7. Term 3 8.
More informationHEALTH SAVINGS CUSTODIAL ACCOUNT AGREEMENT
HEALTH SAVINGS CUSTODIAL ACCOUNT AGREEMENT Form 5305-C under section 223(a) of the Internal Revenue Code. FORM (December 2011) The account owner named on the application is establishing this health savings
More informationBusiness Associate Agreement Involving the Access to Protected Health Information
School/Unit: Rowan University School of Osteopathic Medicine Vendor: Business Associate Agreement Involving the Access to Protected Health Information This Business Associate Agreement ( BAA ) is entered
More informationWebsite Development & Hosting Agreement
Website Development & Hosting Agreement The following are terms of a Website Development & Hosting Agreement (the "Agreement") between you (the Customer or you ) and Agile Web Designs, LLC. ("Company",
More informationEMPLOYMENT AGREEMENT
EMPLOYMENT AGREEMENT THIS EMPLOYMENT AGREEMENT (hereinafter referred to as Agreement ), is by and between the City of Hallandale Beach, Florida, a Florida municipal corporation (hereinafter referred to
More informationAMERICAN INSURANCE ORGANIZATION AGENT AGREEMENT
AGREEMENT made this day of, 20, by and between American Insurance Organization, hereinafter referred to as AIO and, hereinafter referred to as Agent. The Agent is being offered the position of. RECITALS
More informationCLAIMS ADMINISTRATION SERVICES AGREEMENT
Attachment D.13 CLAIMS ADMINISTRATION SERVICES AGREEMENT This AGREEMENT is made and entered into by and between SANTA BARBARA SCHOOL DISTRICTS hereinafter referred to as "DISTRICT", and KEENAN & ASSOCIATES,
More informationAGREEMENT. Solicitor Without Per Diem Compensation
Solicitor Without Per Diem Compensation AGREEMENT Products underwritten by: American General Life Insurance Company Houston, Texas The United States Life Insurance Company in the City of New York New York,
More informationDATA USE AGREEMENT RECITALS
DATA USE AGREEMENT This Data Use Agreement (the Agreement ), effective as of the day of, 20, is by and between ( Covered Entity ) and ( Limited Data Set Recipient or Recipient ) (collectively, the Parties
More informationSECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM S-8 REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933. Delaware 61-1521161
As filed with the Securities and Exchange Commission on July 22, 2008 SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Registration No. 333- FORM S-8 REGISTRATION STATEMENT UNDER THE SECURITIES
More informationBUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( Agreement ) by and between (hereinafter known as Covered Entity ) and Office Ally, LLC. (hereinafter known as Business Associate ), and
More informationSERVICES AGREEMENT. In consideration of the rights and obligations herein set forth, the parties do hereby agree as follows:
SERVICES AGREEMENT THIS AGREEMENT is between, with offices at (hereinafter referred to as COMPANY ), and the University of Delaware, a nonprofit institution of postsecondary education chartered under the
More informationINDEPENDENT CONTRACTOR AGREEMENT
INDEPENDENT CONTRACTOR AGREEMENT This Agreement, made this day of, between, Florida Rock Stars Inc. hereinafter referred to as "Company", located at 205 N Flagler Ave, Homestead FL 33030 and hereinafter
More informationTHE STATE FARM INSURANCE COMPANIES GROUP HEALTH AND WELFARE PLAN FOR UNITED STATES EMPLOYEES SUMMARY PLAN DESCRIPTION. Effective January 1, 2012
THE STATE FARM INSURANCE COMPANIES GROUP HEALTH AND WELFARE PLAN FOR UNITED STATES EMPLOYEES SUMMARY PLAN DESCRIPTION Effective January 1, 2012 This document, together with the attached documents listed
More informationParticipation Agreement ETF Model Solutions Collective Investment Trust
Participation Agreement ETF Model Solutions Collective Investment Trust This Participation Agreement (the Agreement ), is made as of the day of, 2014, by Alta Trust Company, a trust company chartered under
More informationBUSINESS ASSOCIATE AGREEMENT
BUSINESS ASSOCIATE AGREEMENT Please complete the following and return signed via Fax: 919-785-1205 via Mail: Aesthetic & Reconstructive Plastic Surgery, PLLC 2304 Wesvill Court Suite 360 Raleigh, NC 27607
More information-1- -2- -3- -4- -5- INSURANCE REQUIREMENTS FOR DEVELOPER EXTENSION AGREEMENTS 1.1 The developer shall obtain and keep in force during the term of the contract, Commercial General Liability insurance policies
More informationAGREEMENT FOR SERVICES BETWEEN [INSTITUTION] AND [CONTRACTOR] THIS AGREEMENT is made by and between [INSTITUTION] ( Institution ), and ( Contractor ).
AGREEMENT FOR SERVICES BETWEEN [INSTITUTION] AND [CONTRACTOR] THIS AGREEMENT is made by and between [INSTITUTION] ( Institution ), and ( Contractor ). WHEREAS, the Institution anticipates that the Services
More informationHEALTH SAVINGS ACCOUNT AMENDMENT
HEALTH SAVINGS ACCOUNT AMENDMENT AMENDMENT TO YOUR HSA This Disclosure Statement and Health Savings Trust Account Agreement updates your health savings account (HSA) documents that we previously provided
More information