Signed Date Clause Samples

Signed Date. Staff (and Volunteer) Acceptable Use Agreement (SAUA) This Acceptable Use Agreement is intended to ensure:

Signed Date. This Agreement shall become effective on the 1st day of June, 2017 and shall continue in force until midnight, May 31, 2020. If a change is desired by either party to this Agreement, a written notification shall be given at least sixty (60) days before the expiration date, other- wise the Agreement shall continue in force and effect from year to year. In Witness Whereof, the parties have hereunto set their hands and their seals as of this 1st day of June, 2017. FOR THE UNION President, Business Manager and Trustee Wisconsin Laborers’ District Council Laborers’ Local 113 FOR THE EMPLOYER ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Chairman, WUCA Labor Policy Committee Wisconsin Underground Contractors Assoc., Inc. ▇▇▇▇▇▇▇ ▇▇▇▇▇▇, President Wisconsin Underground Contractors Assoc., Inc.

Signed Date. The Insured is requested to read this Policy, and if incorrect, return it immediately for alteration. In the event of an occurrence likely to result in a claim under this insurance, immediate notice should be given to the Coverholder whose name and address appears above. All inquiries and disputes are also to be addressed to this Coverholder. For the purpose of the Insurance Companies Act (Canada), this Canadian Policy was issued in the course of Lloyd’s Underwriters’ insurance business in Canada. LSW1548B (amended) 14 December 2011 List of Insurers not of Open Market Insurers Syndicate Coverage(s) Insured Sum(s) Insured or Percentage CNP Syndicate under UMR: B0595PM8277420 Canopius Syndicate*: 4444 Travel Critical Illness, Accident Death, Disability, Dental Treatment, Loss of Limb or Use, Fracture or Dislocation, Medical Treatment & Transportation, and Medical Equipment 21.9375 % *Lead Syndicate HCC Underwriting Agency under UMR: B0595PM8277420 HCC Underwriting Agency Syndicate: 4141 Travel Critical Illness, Accident Death, Disability, Dental Treatment, Loss of Limb or Use, Fracture or Dislocation, Medical Treatment & Transportation, and Medical Equipment 56.250% ▇▇ ▇▇▇▇▇ under UMR: B0595PM8277420 ▇▇ ▇▇▇▇▇ Syndicate: 2001 Travel Critical Illness, Accident Death, Disability, Dental Treatment, Loss of Limb or Use, Fracture or Dislocation, Medical Treatment & Transportation, and Medical Equipment 10.00% Canopius under UMR: B0595PM8277420 AmTrust Syndicate: 1861 Travel Critical Illness, Accident Death, Disability, Dental Treatment, Loss of Limb or Use, Fracture or Dislocation, Medical Treatment & Transportation, and Medical Equipment 11.812% 07/05 LSW1546 At MSH INTERNATIONAL (CANADA) LTD., we recognize and respect every individual’s right to privacy. When You apply for coverage or Benefits, we establish a confidential file of personal information. We use the information to administer the group Benefit plan. This includes many tasks, such as: • Determining an Insured Person’s eligibility for coverage under the plan • Enrolling Insured Persons for coverage • Assessing an Insured Person’s claims and providing them with payment • Managing an Insured Person’s claims • Verifying and auditing eligibility and claims • Underwriting activities, such as determining the cost of the plan, and analyzing the design options of the plan • Providing the applicable Regulatory Forms and Tax Receipts, upon request We limit access to information in the Insured Person’s file to MS...

Signed Date. Any information you supply to the archive as a reader will be kept securely and treated in accordance with General Data Protection Regulation (GDPR) and Data Protection Act 2018. This information will be used only for administrative, statistical and security purposes. The information is kept for seven years and then destroyed unless there is an ongoing research relationship between the archive user and the Diocesan Archive. Please see the Archive’s Personal Data Policy for more information.  The archive is open to readers, by prior appointment, on Mondays and Tuesdays 8.30am- 1pm and 2pm-5.00pm.  All readers must complete this Archive User Agreement form before being granted access to the archive material. By signing a copy of this form you are agreeing to its terms.  Please be aware that there is no automatic right of access to the Diocesan Archive and the Diocesan Archivist reserves the right to refuse admission.  On your first visit to the archive, you will need to register as a reader. In order to do this, you must bring one form of photographic identification.  Readers should sign the visitors’ book on every visit.

Signed Date. If you feel your child is mature enough to understand the Agreement please ask them to sign below.

Signed Date. Any information you supply to the archive as a reader will be treated in accordance with the Data Protection Act (1998). It will be used only for administrative, statistical and security purposes.  The archive is open to readers, by prior appointment, on Mondays and Tuesdays 8.30am- 1pm and 2pm-5.00pm.  All readers must complete this Archive User Agreement form before being granted access to the archive material. By signing a copy of this form you are agreeing to its terms.  Please be aware that there is no automatic right of access to the Diocesan Archive and the Diocesan Archivist reserves the right to refuse admission.  On your first visit to the archive, you will need to register as a reader. In order to do this, you must bring two forms of identification:

Signed Date. HOUSING TRANSACTION LEAD RISK STATEMENT - LEASE RIDER "The Philadelphia Department of Public Health has determined that most housing built in Philadelphia before 1978 contains dangerous lead paint. This property was built before 1978. Therefore, without a comprehensive lead inspection, conducted by a certified lead inspector, showing there is no lead paint or there are no lead paint hazards, you can assume this property likely contains lead based paint." Pet Rider Address: Arts Condominium, Apartment # …………… Type of Pet: ……… Tenant may keep a pet in the Leased Unit if the following Rules are followed:

Signed Date. Medical and Health Information

Signed Date. This is the information we need to return your deposit. This will be returned seven days aGer the event.