Sample application for participation in a delegation to el salvador & hold harmless agreement title and dates of delegation trip: insert trip title here (ex: lets do fun stuff with our partners) insert trip dates here name your passport number and...
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This is a web-optimized version of this form. download the original, full . usa-federal-forms.com notice: this publication is available digitally on the air force electronic publishing site at: http://afpubs.hq.af.mil. opr: lgtv
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1. employee 's last name first name 3. name of employer contingent beneficiary to receive if no primary beneficiary is living. 2. date of birth month day year 5. employed full-time: month day year 4. employee 's job title 7. some one living in my...
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, re: notice of proposed premium rate change dear : unitedhealthcare insurance company of new york (uhic) is filing a request with the new york state department of financial services (dfs) to approve a change to your premium rates for 2015. new...
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Vehicle operators hold harmless agreementin consideration of being permitted to operate a motor vehicle subject to a vehicle owners hold harmlessagreement, (the vehicle), on the premises of the chattanooga metropolitan airport authority (cmaa),i...
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Waiver of liability, hold harmless agreement in consideration of being allowed to participate in a tour of the facilities of the solid waste authority of palm beach county and having access to areas not normally open to the public, i, , agree to...
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Waiver of liability/hold harmless agreement/release and indemnity agreement i for and on behalf of , (hereinafter referred to as indemnitor) for and in consideration of the acceptance by the rio grande valley chapterassociated general contractors...
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Hca contract number: k1101 contract contractor/vendor contract number: this agreement made by and between washington state health care authority, hereinafter referred to as "hca," and the party whose name appears below, hereinafter referred to as...
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Waiver, release and hold harmless agreement in consideration of permission granted by national marketing corporation, llc dba. passport america, allowing me to participate in the passport america caravan (the "activity "), which will occur on may...
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William carey univ. honor band clinic hold harmless agreement student name cell phone # address home phone# name, address, and phone number(s) of person to notify in case of an emergency: (please print) name: relation address home phone: work...
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Print application clear application general application* *to accompany supplemental applications submission requirements all brochures describing any and all services; or website address. the liability waiver/hold harmless agreement you require...
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Print application clear application consulting foresters special insurance program submission requirements all brochures describing any and all services; or website address. the liability waiver/hold harmless agreement you require your guests to...
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(to be completed only by the insurer or an authorized representative.) please read privacy act statement and instructions on back before completing. civil aircraft certificate of insurance 1. today's date (ymmdd) form approved omb no. 0701-0050...
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Deerfield insurance companyevanston insurance companyessex insurance companymarkel american insurance companymarkel insurance companyassociated international insurancecompanyapplication for paramedics, emts, nurse practitioners, ambulance services...
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Hold harmless agreementi, , as participant in the (name of event) (location/address of event) at gainesville, florida agree to indemnify and hold the gainesville housing authority harmless in the event of any injury sustained as a result of my...
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