Subj: OFFICIAL USE OF PRIVATELY OWNED VEHICLES (POV) BY CHILD DEVELOPMENT HOME (CDH) EMPLOYEES
|
|
- Olivia Craig
- 5 years ago
- Views:
Transcription
1 1700 PERS-659 From: Commander, Navy Personnel Command Subj: OFFICIAL USE OF PRIVATELY OWNED VEHICLES (POV) BY CHILD DEVELOPMENT HOME (CDH) EMPLOYEES Ref: (a) OPNAVINST D (b) COMNAVPERSCOM ltr 1700 PERS-659 of 15 Nov 02 (hereby canceled) Encl: (1) Sample Hold Harmless Agreement (2) Sample Letter Authorizing Long Term Use of POV (3) Sample Record of Occasional POV usage 1. Reference (a) requires Child Development Home (CDH) staff to visit homes at least monthly. The following information answers questions concerning the use of a privately owned vehicle (POV) by a CDH employee or a CDH provider while performing official duties. This policy letter replaces reference (b) and updates policy and guidance for official use of POVs by CDH employees. 2. CDH employees are afforded protection from third party liability under the Federal Tort Claims Act (FTCA), the Military Claims Act (MCA), as well as the Foreign Claims Act, when applicable, when using their POV while in the scope of their employment and carrying out official government business. Because state law determines scope of employment, the outcome of cases with similar facts may vary considerably from state to state. The factors routinely considered by the courts in determining whether an employee driving their POV is within the scope of employment are: a. Was POV use authorized; b. Was the employee engaged in government business at the time of the accident; c. Did the government exercise control or have the right to exercise control over the employee in the use of the vehicle; d. Did the employee deviate sufficiently from assigned duties to take him/her out of the scope of employment; and
2 Subj: OFFICIAL USE OF PRIVATELY OWNED VEHICLES (POV) CHILD DEVELOPMENT HOME (CDH) EMPLOYEES e. Was the employee s trip undertaken primarily for the benefit of the government, or was the trip at least as beneficial to the government as it was to the employee? 3. When CDH employees use their POV as a matter of personal preference or convenience to carry out official government business in lieu of the command's government furnished vehicle or deviate sufficiently from assigned duties that take him or her out of the scope of employment, that employee would not be afforded protection from third party liability under the FTCA/MCA. In this situation, the employee would assume personal responsibility and liability for any damages or injuries sustained resulting from operation of the POV. Enclosure (1) provides a sample Hold Harmless Agreement that employees must sign when they choose to use their own vehicle. 4. CDH employees, when accompanied by government employees or official guests performing official government business, are afforded liability protection under FTCA/MCA. However, if the passenger was not a government employee or official guest, the CDH employee would assume personal responsibility and liability for any damages or injuries sustained in the accident, consistent with the laws of that particular state. 5. CDH employees are afforded limited protection from financial loss when their POVs sustain damages while being used for official business. Claims for damages sustained to POVs while engaged on official government business must be made under the Military Personnel and Civilian Employees Claims Act (PCA). However, such claims may be payable only after they have been filed with their insurance company. Contributory negligence by the employee is also grounds to deny payment of a claim. For those claims determined to be meritorious, recovery is limited to a maximum of $3,000: a. For instance, PCA claims may only be allowed for damage to, or loss of, POVs if such motor vehicles were required to be used for official government business. It does not afford protection for accidents that occur during travel between quarters and office, or when POVs are used at the convenience of the owner. However, it does include coverage for accidents occurring during travel between quarters and assigned place of duty when specifically authorized by the employee's supervisor as being more advantageous to the government. 2
3 Subj: OFFICIAL USE OF PRIVATELY OWNED VEHICLES (POV) CHILD DEVELOPMENT HOME (CDH) EMPLOYEES b. Nonappropriated fund CDH employees who sustain personal injuries while performing official government business are protected by the Longshore and Harbor Workers Compensation Act, which provides compensation for injuries arising out of and in the course of employment. 6. Because CDH providers are not employees of the government or Navy MWR, but rather, independent contractors, they are not afforded any protection under the FTCA/MCA. As independent contractors, CDH providers must furnish their own insurance. Finally, the government will not furnish CDH providers legal representation in court, nor will the government pay any claims arising from any CDH provider s actions or omissions. 7. It is the policy of Navy MWR that: a. Government vehicles must be used as the primary source of transportation. b. When government transportation is not reasonably available for the foreseeable future, MWR Directors or CDH supervisors (when designated in writing by the Commanding Officer) may issue letters authorizing the use of POVs by CDH employees. Enclosure (2) provides a sample letter authorizing CDH staff long term use of POVs when there is no government vehicle available. (1) Such letters shall clearly state that there are no vehicles available for CDH employees and that CDH employees are authorized to use POVs to carry out their official duties. The official uses of POVs should be clearly stated to ensure clear guidelines are provided to all CDH employees. For example, use of POVs are authorized when conducting official inspections but not to go anywhere off base except to and from neighborhoods that have CDH providers. The authorizing letter should also provide clear guidelines regarding what type of POV vehicles are considered official. (2) These letters must be reviewed annually and maintained for two years after their last issuance. (3) When sufficient number of government owned or procured (e.g., leased, etc.) vehicles become available, the command must rescind such letters and cause CDH employees to use government conveyed transportation. 3 Subj: OFFICIAL USE OF PRIVATELY OWNED VEHICLES (POV) CHILD
4 DEVELOPMENT HOME (CDH) EMPLOYEES 8. When government transportation is available but time spent obtaining such transportation would unreasonably interfere with the mission, CDH employees may be authorized, in writing, by the MWR Director or CDH supervisor to use POVs on a case-by-case basis. Whenever a CDH employee uses their POV when government transportation is not reasonably available, a written record of POV usage (log book) must be maintained for a period of two years after date of last entry. Use of a POV registered/titled to anyone other than the CDH employee or their spouse is never authorized. Enclosure (3) provides a sample record of POV usage that must be completed when CDH staff use their POVs as addressed within. 9. Navy Personnel Command point of contact phone number is (C) /DSN 882. Deputy Director By direction Distribution: Regional and Installation Commanders Administering Child Development Programs Copy to: Appropriate Echelon II Commanders MWR Directors Administering Child Development Programs 4
5 SAMPLE HOLD HARMLESS AGREEMENT IMPORTANT: THIS IS A LEGAL DOCUMENT Please read and understand this document before signing. If you have any questions please ask us or consult an attorney. I, I assume full responsibility for myself for bodily injury, death and loss of personal property and any expenses as a result of my negligence or criminal act or omission while using my Privately Owned Vehicle (POV) to conduct official business. Read and initial the following: I understand that Navy MWR shall not be liable. I agree to indemnify and hold harmless Navy MWR [COMMAND], its staff, and the U.S. Navy and its member, agents and employees from all claims, damages, losses, injuries and expenses arising out of or resulting from my using my POV to conduct official business. I further agree to release, acquit and covenant not to sue Navy MWR [COMMAND], its staff, and the U.S. Navy and its members, agents and employees for all actions, causes of action, claims or damages, damages in law or remedies in equity of whatever kind, including the negligence of Navy MWR [COMMAND] and its staff or my family, myself, or my heirs, against Navy MWR [COMMAND] arising out of using a POV to conduct official business. In short, I cannot sue Navy MWR [COMMAND], its staff and if I do, I cannot collect any money. I agree to the site of any lawsuit and the law governing any such lawsuit shall be governed under the Federal Tort Claims Act, Military Claims Act, which ever is applicable. The terms of this agreement shall continue and be in effect after the term of my employment has ended. I understand that I am afforded limited protection from financial loss when my POV sustains damages while being used for official business. Claims for damages sustained to POVs while engaged in approved, official government business must be made under the Military Personnel and Civilian Employees Claims Act (PCA). However, I understand such claims may be payable only after they have been filed with their insurance company. Contributory negligence by the employee is also grounds to deny payment of a claim. For those claims determined to be meritorious, recovery is limited to a maximum of $3,000. Encl (1)
6 As liquidated damages, I hereby agree that if Navy MWR [COMMAND] is forced to defend any action, lawsuit or litigation by myself, my executors, or my heirs, on my family's or my behalf, my heirs or executors, and I agree to pay court costs and attorney fees if they successfully defend such action, lawsuit or litigation. Should a court of competent jurisdiction declare any paragraph or part of this agreement unenforceable, the remaining parts or paragraphs shall remain in full force and effect. A copy of this release can be used as if it was an original. I,, of my own free will, for my heirs and executors and myself, have read, understand and acknowledge the risks and liability for using my POV to conduct official business this day of I have read and understand this Hold Harmless Agreement. I am electing to use my POV as a matter of personal preference in lieu of the available government furnished vehicle. CDH EMPLOYEE SIGNATURE PRINTED NAME SSN MWR DIRECTOR/CDH SUPERVISOR (WITNESS) PRINTED NAME SSN 2
7 SAMPLE LETTER AUTHORIZING LONG TERM USE OF PRIVATELY OWNED VEHICLES LETTERHEAD COMMANDER NAVAL STATION SMOOTH SAILING From: MWR Director or CDH Supervisor To: CDH Director Subj: LONG TERM AUTHORIZED USE OF PRIVATELY OWNED VEHICLE (POV) Ref: (a) PERS-659 ltr of XXXXXXX Encl: (1) Written Record of POV Usage 1. Per reference (a), you are authorized to use your POV to perform official duties because there is no reasonable government transportation available. A copy of this signed letter shall be kept in your official personnel file. 2. You are required to complete enclosure (1) each time you use your POV for official business and return the completed record to me at the end of each month. The completed records will be kept on file in the MWR office for two years. 3. The command reserves the right to terminate this authorization should reasonable government transportation become available. 4. For additional questions you may contact the COMMAND Legal Officer at XXX-XXXX. MWR Director/CDH Supervisor By direction Encl (2)
8 MONTH OF AUGUST 2002 SAMPLE WRITTEN RECORD OF POV USAGE NAVAL STATION SMOOTH SAILING CHILD DEVELOPMENT HOMES DATE DEPARTED FROM/TIME ARRIVED AT/TIME MILEAGE OUT MILEAGE IN COMMENTS I,, certify that the above information is factual. CDH Director Signature Date * This record shall be turned in to the MWR Director monthly and kept on file in the MWR Office for a period of two years. Encl (1) of Letter Authorizing Long Term Use of Privately Owned Vehicles
9 MONTH OF 2003 SAMPLE RECORD OF OCCASIONAL POV USAGE NAVAL STATION SMOOTH SAILING CHILD DEVELOPMENT HOMES DATE DEPARTED FROM/TIME ARRIVED AT/TIME TOTAL MILEAGE EMPLOYEE S INITIAL SUPERVISOR S INITIAL CDH Director Signature Date * This record shall be turned in to the MWR Director monthly and kept on file in the MWR Office for a period of two years. Encl (3)
NAVY CHILD AND YOUTH PROGRAMS REGISTRATION FORM
NAVY CHILD AND YOUTH PROGRAMS REGISTRATION FORM START DATE: REQUIRING DIRECTIVE OPNAVINST 1700.9 NAME OF CHILD (LAST, FIRST, MIDDLE) SEX BIRTHDATE (DD/MM/YY) AGE SPONSORS NAME (LAST, FIRST, MIDDLE) RANK/RATE
More informationDepartment of Veterans Affairs VHA HANDBOOK Washington, DC May 24, 2007 VOLUNTEER TRANSPORTATION NETWORK (VTN)
Department of Veterans Affairs VHA HANDBOOK 1620.02 Veterans Health Administration Transmittal Sheet Washington, DC 20420 May 24, 2007 VOLUNTEER TRANSPORTATION NETWORK (VTN) 1. REASON FOR ISSUE. This Veterans
More informationMCBO B NHCLQINST B MCB (B 03) NHCL (B 103) 5 Jun 06. Subj: REQUESTS FOR MEDICAL SUPPORT ABOARD MCB QUANTICO
UNITED STATES MARINE CORPS MARINE CORPS BASE QUANTICO, VIRGINIA 22134-5001 and NAVAL HEALTH CLINIC QUANTICO, VIRGINIA 22134-6050 MCBO 6000.1B MCB (B 03) NHCL (B 103) MARINE CORPS BASE ORDER 6000.1B NAVAL
More informationDivision of State Fire Marshal Rhode Island Fire Academy 4 Green Lane, Exeter, RI Tel: (401) Certification Examination Application
Division of State Fire Marshal Rhode Island Fire Academy 4 Green Lane, Exeter, RI 02822 Tel: (401) 294-5417 Certification Examination Application PERSONAL INFORMATION Name: Address: City: Telephone: E-mail
More informationSPECIAL POWER OF ATTORNEY
PREAMBLE: This is a MILITARY POWER OF ATTORNEY prepared pursuant to Title 10, United States Code, 1044b, and executed by a person authorized to receive legal assistance from the military services. Federal
More informationName: Mr. /Mrs. /Ms. Last Name First Name Middle Initial Maiden Name
VOLUNTEER APPLICATION Please check which volunteer programs you are interested in: Birthday Cheer Friendly Shopper Mobile Foodshare C.A.R.E.S. Hello Neighbor Senior Center Office Food Bank Home Helper
More informationEmployee Telework Screening Survey
Employee Telework Screening Survey Each employee interested in participating in COMPANY s teleworking program must complete this screening survey. When you have finished completing this survey, please
More informationTown of Madison Beach and Recreation Department After/Before School Program 8 Campus Drive Madison, CT Phone: (203) /Fax: (203)
Per Connecticut General Statute 19a-77 we are required to disclose that our programs are not licensed by the State Office of Early Childhood. Dear Parent: To enroll your child(ren) in the, please complete
More informationTHERAPY ATTENDANCE POLICY
! THERAPY ATTENDANCE POLICY The primary focus of Dynamic Strides Therapy, Inc. s ( DST ) therapy program (the Program ) is to help the Patient named below to achieve his/her goals for therapy. We strive
More informationCross Cultural Retreat
Cross Cultural Retreat 2017 September 22-24, 2017 Cross Cultural Retreat CSUDH Cross Cultural Retreat September 22-24, 2017 What is the Cross Cultural Retreat? Fun, new-found friendships, awareness, and
More informationSummer 2018 IP Summer Contract
In consideration of my voluntary participation in the above International Program ( Program ), I, for myself, my heirs, personal representatives or assignees, agree as follows: 1. I agree to pay tuition
More informationStudy Abroad Checklist
Study Abroad Checklist Name: Cell: Email: Semester/Year of Interest: _ Host Program: _ Major: Home Phone: Year in College (circle): FR SO JR SR Academic Advisor: Host Country and City: 1. 2. 3. Meet with
More informationDepartment of Defense DIRECTIVE
Department of Defense DIRECTIVE NUMBER 1330.5 August 16, 1969 SUBJECT: American National Red Cross Adminisrative Reissuance Incorporating Through Change 4, December 20, 1991 ASD(FM&P) References: (a) DoD
More informationUNITED STATES MARINE CORPS RECRUITING STATION COLUMBIA 9600 TWO NOTCH RD, SUITE 17 COLUMBIA, SOUTH CAROLINA 29223
UNITED STATES MARINE CORPS RECRUITING STATION COLUMBIA 9600 TWO NOTCH RD, SUITE 17 COLUMBIA, SOUTH CAROLINA 29223 6 Aug 15 Dear Sir or Ma am, On behalf of the United States Marine Corps, I would like to
More informationCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF MINE SAFETY COAL MINE RESCUE TEAM AGREEMENT
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF MINE SAFETY COAL MINE RESCUE TEAM AGREEMENT This AGREEMENT entered into by and between the Commonwealth of Pennsylvania, Department
More informationHave a car No pets Years of Experience
92 Thompson Road Avon, CT 06001 : (860) 357-5333 Fax: (860) 629-0858 Check all that apply: ID Card Driver s License US Passport Want Live-out CNA (State ) HHA Want Live-in Want Live-out Have a car No pets
More informationLompoc Police Department Explorer Post #700
Lompoc Police Department Explorer Post #700 APPPPLIICATIION FOR MEMBERSSHIIPP Print legibly all information required and answer all questions as completely and truthfully as possible. After filling out
More informationSHAKTI Vinyasa Yoga 200 Hour Teacher Training Application
SHAKTI Vinyasa Yoga 200 Hour Teacher Training Application Today s Date: Date of Birth: Sex: Name: Street Address: City: State: Zip: Home Phone: Cell Phone: Email Address: Occupation: Emergency Contact
More informationEast Baton Rouge Parish Junior Deputy
East Baton Rouge Parish Junior Deputy 2018 Application Packet Sheriff Sid J. Gautreaux, III Captain Randy M. Aguillard Program Director raguillard@ebrso.org Junior Deputy Membership Rules All members of
More information2018 NEW HAMPSHIRE ELECTRIC COOPERATIVE (NHEC) COMMERCIAL WEATHERIZATION PROGRAM
2018 NEW HAMPSHIRE ELECTRIC COOPERATIVE (NHEC) COMMERCIAL WEATHERIZATION PROGRAM Applications must be fully completed, submitted and pre approved for incentives by NHEC before installation of any measures
More informationThe Alaska Youth Academy Application
The Alaska Youth Academy Application Email to katina.charles@tananachiefs.org by June 26 th, 2015 Personal Information Please write in or circle your answer. Name: (First) (Middle) (Last ) Date of Birth
More information2013 Morehouse College Summer China Study Abroad Program Participation terms and conditions, release, and waiver May 13, 2013 June 3, 2013
2013 Morehouse College Summer China Study Abroad Program Participation terms and conditions, release, and waiver May 13, 2013 June 3, 2013 I,, the undersigned applicant have agreed to participate in the
More informationThe Alaska Youth Academy Application
The Alaska Youth Academy Application Email to katina.charles@tananachiefs.org by June 30 th, 2016 Personal Information Please write in or circle your answer. Name: (First) (Middle) (Last ) Date of Birth
More informationTELECOMMUTING AGREEMENT
TELECOMMUTING AGREEMENT This Telecommuting Agreement exists in accordance with the UAB/UAB Medicine Telecommuting Guidelines. This Telecommuting Agreement specifies the conditions applicable to an arrangement
More informationSANTA ROSA POLICE DEPARTMENT APPLICATION FOR "RIDE-ALONG" PROGRAM
Date of application: SANTA ROSA POLICE DEPARTMENT APPLICATION FOR "RIDE-ALONG" PROGRAM Ride-Along Observers must be 16 years of age or older AND must reside within the jurisdictional limits of the City
More informationATTORNEY COUNTY OF. Page 1 of 5
STATE OF NORTH CAROLINA HEALTH CARE POWER OF ATTORNEY COUNTY OF (Notice: This document gives the person you designate your health care agent broad powers to make health care decisions, including mental
More informationGUEST TERMS OF AGREEMENT
GUEST TERMS OF AGREEMENT I agree for the initial evaluation in order to determine if I'm eligible for admission to Emedi Concierge (hereafter EC ) services. I request admission to the Agency and consent
More informationSouth Park Eagle Academy Application
South Park Eagle Academy Application First Name: Last Name: Gender: Male Female Date of Birth: Commitment Level: Part Time Full Time Address Street: City: State: ZIP: Student Contact Information Email
More informationSpringfield Police Department CITIZEN RIDE-ALONG PROGRAM
Springfield Police Department CITIZEN RIDE-ALONG PROGRAM Ever been curious what it s like to be a police officer? Here s your chance! The Springfield Police Department s ride-along program gives eligible
More informationCOUNTY OF SACRAMENTO Probation Department 3201 FLORIN-PERKINS ROAD, SACRAMENTO, CALIFORNIA TELEPHONE (916) FAX (916)
RULES AND REGULATIONS The Ride-Along Program offers members of the public the opportunity to interact with officers from our Department. The program seeks to increase public awareness regarding the functions
More informationADOPT-A-TRAIL APPLICATION
ADOPT-A-TRAIL APPLICATION INTRODUCTION RIVERSIDE COUNTY REGIONAL PARK & OPEN-SPACE DISTRICT ADOPT-A-TRAIL PROGRAM The Adopt-A-Trail (AAT) program was developed by the Riverside County Regional Park & Open-Space
More informationRegistry of CPE Providers Application
Registry of CPE Providers Application Please submit this application form and required course evidence to CPEProviders@theiia.org. Along with this completed application form, you must submit all required
More informationTWENTY BASIC RULES FOR PERSONNEL LEAVING THE ARMY RESTRICTIONS ON SEEKING EMPLOYMENT (BEFORE YOU LEAVE)
TWENTY BASIC RULES FOR PERSONNEL LEAVING THE ARMY The following 20 rules assume you are currently working for the Army and plan to seek employment with a non-federal entity. The categories of personnel
More informationFUNDING AGREEMENT FOR SECTION 5317 NEW FREEDOM PROGRAM GRANT FUNDS
FTA GRANT CA-57-Xxxx MOU.NF FUNDING AGREEMENT FOR SECTION 5317 NEW FREEDOM PROGRAM GRANT FUNDS This Funding Agreement for Section 5317 New Freedom Program Funds (the Agreement ) is dated as of (the Effective
More informationLIBRARY COOPERATIVE GRANT AGREEMENT BETWEEN THE STATE OF FLORIDA, DEPARTMENT OF STATE AND [Governing Body] for and on behalf of [grantee]
PROJECT NUMBER _[project number]_ LIBRARY COOPERATIVE GRANT AGREEMENT BETWEEN THE STATE OF FLORIDA, DEPARTMENT OF STATE AND [Governing Body] for and on behalf of [grantee] This Agreement is by and between
More informationBusiness Improvement Grant Program. Application
Business Improvement Grant Program Application Updated: February 21, 2017 APPLICATION for BUSINESS IMPROVEMENT GRANT PROGRAM I (We), hereinafter referred to as APPLICANT, on behalf of the identified entity,
More informationREQUEST FOR SELF-ADMINSTRATION OF MEDICATION AT SCHOOL (Only for Epi-Pen and Metered Dose Inhaler) School: Teacher: Grade:
REQUEST FOR SELF-ADMINSTRATION OF MEDICATION AT SCHOOL (Only for Epi-Pen and Metered Dose Inhaler) Student: Birth Date: School: Teacher: Grade: TO BE COMPLETED BY AUTHORIZED HEALTH CARE PROVIDER Medication
More informationADVANCE DIRECTIVE FOR A NATURAL DEATH ("LIVING WILL")
ADVANCE DIRECTIVE FOR A NATURAL DEATH ("LIVING WILL") NOTE: YOU SHOULD USE THIS DOCUMENT TO GIVE YOUR HEALTH CARE PROVIDERS INSTRUCTIONS TO WITHHOLD OR WITHDRAW LIFE-PROLONGING MEASURES IN CERTAIN SITUATIONS.
More informationCATHOLIC CAMPAIGN FOR HUMAN DEVELOPMENT GRANT AGREEMENT
CCHD GRANT # CATHOLIC CAMPAIGN FOR HUMAN DEVELOPMENT GRANT AGREEMENT This Agreement is executed by and between the United States Conference of Catholic Bishops ( USCCB ), 3211 Fourth Street, N.E., Washington,
More informationDecember, 2017 Request for Proposals for Airport Business and Financial Consultant At Savannah/Hilton Head International Airport
December, 2017 Request for Proposals for Airport Business and Financial Consultant At Savannah/Hilton Head International Airport Dear Proposer: The Savannah Airport Commission is requesting proposals for
More informationOPNAVINST C N4 31 May 2012
DEPARTMENT OF THE NAVY OFFICE OF THE CHIEF OF NAVAL OPERATIONS 2000 NAVY PENTAGON WASHINGTON, DC 20350-2000 OPNAVINST 4000.84C N4 OPNAV INSTRUCTION 4000.84C From: Chief of Naval Operations Subj: SUPPORT
More informationWhen used in this directive, the following terms shall have the meanings designated:
SPECIAL ORDER DISTRICT OF COLUMBIA Title Authorization and Accountability for Metropolitan Police Department Vehicles Number SO-10-11 Effective Date September 13, 2010 Related to: GO-OPS-301.04 (Motor
More informationAPPLICATION INSTRUCTIONS
APPLICATION INSTRUCTIONS The Gayatri Yoga Academy Teacher Training programs include a vigorous two-hour asana practice. We strongly recommend that applicants have one year of consistent asana practice.
More informationManufacturer Job Creation and Investment Program
CITY OF CRYSTAL LAKE Manufacturer Job Creation and Investment Program GRANT APPLICATION FORM ADMINISTERED BY: CITY OF CRYSTAL LAKE PLANNING & ECONOMIC DEVELOPMENT 100 W. WOODSTOCK STREET CRYSTAL LAKE,
More informationGRANT AWARD AGREEMENT XX-XXXX-XXX-XX
GRANT AWARD AGREEMENT XX-XXXX-XXX-XX THIS GRANT AWARD AGREEMENT ( Agreement ) is made and entered by and between The Missouri Foundation for Health ( Foundation ) and ( Grantee ). WHEREAS, Grantee has
More informationCamp Hero Registration 2017
Camp Hero Registration 2017 Camp Hero my child will be attending: June 5 9 (Joint Base Pearl Harbor Hickam location) June 26 30 (Marine Corps Base Hawaii location) I would like to register for the Extended
More informationinfodev Grant No. [Name of Project] Project
The World Bank 1818 H Street N.W. (202) 477-1234 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT Washington, D.C. 20433 Cable Address: INTBAFRAD INTERNATIONAL DEVELOPMENT ASSOCIATION U.S.A. Cable
More informationSECNAVINST ASN(M&RA) 21 Mar 2006
DEPARTMENT OF THE NAVY OFFICE OF THE SECRETARY 1000 NAVY PENTAGON WASHINGTON, D. C. 20350-1000 SECNAV INSTRUCTION 1770.4 SECNAVINST 1770.4 ASN(M&RA) From: Secretary of the Navy Subj: SECRETARY OF THE NAVY
More informationSubj: MORALE, WELFARE, AND RECREATION AND NAVY EXCHANGE BOARD OF DIRECTORS
DEPARTMENT OF THE NAVY OFFICE OF THE CHIEF OF NAVAL OPERATIONS 2000 NAVY PENTAGON WASHINGTON DC 20350-2000 OPNAV INSTRUCTION 1700.13C CHANGE TRANSMITTAL 1 From: Chief of Naval Operations OPNAVINST 1700.13C
More informationALL HANDS ON EVEREST, ISLAND PEAK REGISTRATION
Departure Date: 7 22 May 2017 ALL HANDS ON EVEREST, ISLAND PEAK REGISTRATION Personal Information Name Date of Birth Nationality Group/Affiliation Contact Information Email Phone Home Address City State
More informationSubj: ACCEPTANCE AND USE OF VOLUNTARY SERVICES IN THE NAVY
DEPARTMENT OF THE NAVY OFFICE OF THE CHIEF OF NAVAL OPERATIONS 2000 NAVY PENTAGON WASHINGTON, DC 20350-2000 OPNAVINST 5380.1D N170 OPNAV INSTRUCTION 5380.1D From: Chief of Naval Operations Subj: ACCEPTANCE
More informationPLEASE NOTE THAT YOUR APPLICATION WILL NOT BE REVIEWED OR CONSIDERED UNTIL WE HAVE RECEIVED ALL 6 PARTS.
Dear Grant Applicant, Thank you for your interest in the 's (UBCF) Individual Grant Program. On the following pages, you will find our Application Form as well as the terms and conditions of the Individual
More informationVOLUNTEER APPLICATION
VOLUNTEER APPLICATION Name: Age: Date of Birth: Social Security : Address: City: State: Zip Phone: Work: Cell: Email Address: How can we reach you? Home phone Cell phone Text Email Work phone Employer/School:
More informationPOLICY NO Volunteer Policy (Replaces Policy Adopted 12/13/2011)
POLICY NO. 28-01 Volunteer Policy (Replaces Policy Adopted 12/13/2011) Policy Statement Hernando County recognizes that volunteers are essential to the productivity, efficiency and cost effectiveness of
More informationTHIS AGREEMENT made effective this day of, 20. BETWEEN: NOVA SCOTIA HEALTH AUTHORITY ("NSHA") AND X. (Hereinafter referred to as the Agency )
THIS AGREEMENT made effective this day of, 20. BETWEEN: NOVA SCOTIA HEALTH AUTHORITY ("NSHA") AND X (Hereinafter referred to as the Agency ) It is agreed by the parties that NSHA will participate in the
More informationHigh School Theatre Camp Texas Tech University
High School Theatre Camp Texas Tech University July 8-21, 2018 THEATRE CAMP Audition, rehearse, and perform in a one act play in the Maedgen Theatre at Texas Tech. Work with three outstanding directors
More information2016 Multi-Jurisdictional Law Enforcement Explorer Academy
2016 Multi-Jurisdictional Law Enforcement Explorer Academy All questions must be answered. If something does not apply please indicate N/A. Note: If there are any un-answered questions on this application
More informationGrand Prairie Fire Department Applicant Identification Form
Revised 07/15 Grand Prairie Fire Department Applicant Identification Form Place Picture Name: Last First Middle DOB: Weight: Height: Hair Color: Eye Color: Social Security No.: D.L. #: Complete the areas
More informationSANTA BARBARA POLO & RACQUET CLUB
SANTA BARBARA POLO & RACQUET CLUB Application and Membership Agreement By my signature below, I hereby apply for a membership to the Santa Barbara Polo & Racquet Club. If accepted, my membership will be:
More informationPHILADELPHIA POLICE DEPARTMENT DIRECTIVE 4.16
PHILADELPHIA POLICE DEPARTMENT DIRECTIVE 4.16 Issued Date: 03-18-11 Effective Date: 03-18-11 Updated Date: 09-14-15 SUBJECT: MEDIA RELATIONS AND RELEASE OF INFORMATION TO THE PUBLIC 1. PURPOSE A. The purpose
More informationMEMORANDUM OF UNDERSTANDING. Between the
MEMORANDUM OF UNDERSTANDING Between the Richardson Independent School District and the Board of Directors of the RISD Excellence in Education Foundation This Memorandum of Understanding is between the
More informationTerms and Conditions of studentship funding
Terms and Conditions of studentship funding Any offer of PhD funding from Brain Research UK ( the Charity ) is subject to the following Terms and Conditions. By accepting the award, the Host Institute
More informationPOLICY NO Volunteer Policy (Replaces Policy Adopted 1/26/1998)
POLICY NO. 28-01 Volunteer Policy (Replaces Policy Adopted 1/26/1998) Policy Statement Hernando County recognizes that volunteers are essential to the productivity, efficiency and cost effectiveness of
More informationDEPARTMENT OF THE NAVY OFFICE OF THE JUDGE ADVOCATE GENERAL 1322 PATTERSON AVENUE SE, SUITE 3000 WASHINGTON NAVY YARD DC
JAG/CNLSC INSTRUCTION 1740.1C DEPARTMENT OF THE NAVY OFFICE OF THE JUDGE ADVOCATE GENERAL 1322 PATTERSON AVENUE SE, SUITE 3000 WASHINGTON NAVY YARD DC 20374-5066 IN REP!. Y REFER TO: JAG/CNLSCINST 1740.1C
More informationDEPARTMENT OF THE NAVY OFFICE OF THE CHIEF OF NAVAL OPERATIONS 2000 NAVY PENTAGON WASHINGTON DC
DEPARTMENT OF THE NAVY OFFICE OF THE CHIEF OF NAVAL OPERATIONS 2000 NAVY PENTAGON WASHINGTON DC 20350-2000 OPNAVINST 1754.5C N170 OPNAV INSTRUCTION 1754.5C From: Chief of Naval Operations Subj: FAMILY
More informationMOTHER BEAR CHARITABLE FOUNDATION, INC. CHARITABLE GRANT AGREEMENT. This Charitable Grant Agreement (this or the Agreement ) is entered into as of the
MOTHER BEAR CHARITABLE FOUNDATION, INC. CHARITABLE GRANT AGREEMENT This Charitable Grant Agreement (this or the Agreement ) is entered into as of the day of, 20, by and between MOTHER BEAR CHARITABLE FOUNDATION,
More informationCounty Transportation Infrastructure Fund Grant Program Implementation Procedures
County Transportation Infrastructure Fund Grant Program Implementation Procedures April 1, 2014 POST-AWARD AGREEMENT AND IMPLEMENTATION PROCEDURES County Transportation Infrastructure Fund Grant Program
More informationOlivieri Chiropractic Inc. AUTO ACCIDENT INFORMATION FORM IF YOU NEED MORE SPACE, WRITE ON THE BACK OF THIS PAGE
Olivieri Chiropractic Inc. AUTO ACCIDENT INFORMATION FORM IF YOU NEED MORE SPACE, WRITE ON THE BACK OF THIS PAGE NAME: AGE: DATE OF BIRTH: SEX: M F MARITAL STATUS HOME PHONE WORK PHONE ADDRESS E-MAIL ADDRESS
More informationEMPLOYEE FILES. Applying for the Job
EMPLOYEE FILES Applying for the Job 1 Assisted Living Center at Sendera Ranch 5406 Ranch Lake Dr Magnolia, Texas 77354 281.804.6182 Phone 936.441.8185 Fax alcsenderaranch@gmail.com email APPLICATION FOR
More informationGrant Seeking Grant Writing And Lobbying Services
REQUEST FOR PROPOSALS Grant Seeking Grant Writing And Lobbying Services FOR CITY OF SANGER, CALIFORNIA January 7, 2011 CITY OF SANGER TABLE OF CONTENTS This solicitation package includes the sections and
More informationReturn Completed Application To: ARISE & Ski, 635 James Street, Syracuse, NY 13203
ARISE & Ski Volunteer Application We consider applicants for all positions without regard to race, religion, creed, gender, age, disability, marital or veteran status, sexual orientation or any other legally
More information2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION
2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION Law Enforcement agencies from across Marshall County will sponsor and provide a Law Enforcement Youth Camp for students this year on the dates
More informationHEALTH CARE POWER OF ATTORNEY
HEALTH CARE POWER OF ATTORNEY NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR HEALTH CARE AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON BROAD AND SWEEPING POWERS TO MAKE HEALTH CARE DECISIONS
More informationUNITED STATES MARINE CORPS MARINE CORPS BASE PSC Box Camp Lejeune, North Carolina
UNITED STATES MARINE CORPS MARINE CORPS BASE PSC Box 20004 Camp Lejeune, North Carolina 28542-0004 BO 1101S.4A BEMD BASE ORDER 1101S.4A JUL 0 8 2IWM From: To: SUbj: Ref: Encl: Commanding General Distribution
More informationEmployment Application NOTICE OF POLICY
Shayne E. Heap, Sheriff Elbert County Sheriff s Office 751 Ute Avenue, P.O. Box 486 Kiowa, Colorado 80117 Ph: 303-621-2027 Fax: 303-621-2055 www.elbertcountysheriff.com Employment Application NOTICE OF
More informationGUIDELINES FOR BUSINESS IMPROVEMENT GRANT PROGRAM BY THE COLUMBUS COMMUNITY & INDUSTRIAL DEVELOPMENT CORPORATION
GUIDELINES FOR BUSINESS IMPROVEMENT GRANT PROGRAM BY THE COLUMBUS COMMUNITY & INDUSTRIAL DEVELOPMENT CORPORATION Section 1. Purpose. The purpose of this program is to promote the development and expansion
More informationCONDITIONS OF AGREEMENT
CONDITIONS OF AGREEMENT BETWEEN POLICE DEPARTMENT AND NORTH CENTRAL HIGHWAY SAFETY NETWORK, INC. PA AGGRESSIVE DRIVING ENFORCEMENT & EDUCATION PROJECT (PAADEEP) THIS CONDITIONS OF AGREEMENT made the day
More informationSubj: MISSION, FUNCTIONS, AND TASKS OF THE BUREAU OF NAVAL PERSONNEL
DEPARTMENT OF THE NAVY OFFICE OF THE CHIEF OF NAVAL OPERATIONS 2000 NAVY PENTAGON WASHINGTON DC 20350-2000 OPNAVINST 5450.354A DNS-33 OPNAV INSTRUCTION 5450.354A From: Chief of Naval Operations Subj: MISSION,
More informationClayton County Sheriff s Office Internship / Volunteer Program S.O.I.P. Sheriff s Office Internship Program
Clayton County Sheriff s Office Internship / Volunteer Program S.O.I.P. Sheriff s Office Internship Program 1 Clayton County Sheriff s Office Internship Program PACKAGE TABLE OF CONTENTS Topic Page(s):
More informationFIVEHEAD PARISH COUNCIL HEALTH & SAFETY POLICY
FIVEHEAD PARISH COUNCIL HEALTH & SAFETY POLICY Adopted 9 Nov 2016 Minute 2605 Amended Min 2738 Review date (annual) Annual meeting of the Parish Council (May) GENERAL STATEMENT OF POLICY Fivehead Parish
More informationU.S. Army Aeromedical Research Laboratory Gains in the Education of Mathematics and Science Program PARTICIPANT APPLICATION
To be considered for acceptance into the 2013 GEMS program, submit the following: 1. The Participant Application 2. The Participant Essay 3. The Participant Release Form 4. Participant Safety Information
More informationMartin County Parks & Recreation 2018 Summer Camp. Info Packet. #lovemcparks
Martin County Parks & Recreation 2018 Summer Camp Info Packet #lovemcparks volunteerparks@martin.fl.us MARTIN COUNTY PARKS AND RECREATION DEPARTMENT JOB DESCRIPTION SUMMER CAMP VOLUNTEEN - Description
More informationPATIENT ADVOCATE DESIGNATION FOR MENTAL HEALTH TREATMENT NOTICE TO PATIENT
PATIENT ADVOCATE DESIGNATION FOR MENTAL HEALTH TREATMENT NOTICE TO PATIENT As the Patient you are using this Patient Advocate Designation for Mental Health Treatment to grant powers to another individual
More informationDepartment of Defense INSTRUCTION
Department of Defense INSTRUCTION NUMBER 1330.09 December 7, 2005 USD(P&R) SUBJECT: Armed Services Exchange Policy References: (a) DoD Directive 1330.9, "Armed Services Exchange Policy," November 27, 2002
More information4.5 POLICY ON TELEWORK
(a) Purpose and Scope 4.5 POLICY ON TELEWORK (1) Purpose. The purpose of this policy is to provide the guidelines and define qualifications for use of telework as part of the Judiciary s work-life balance
More informationAuburn University Marching Honor Band 132 Goodwin Music Building Auburn University, AL
Congratulations! Based on your application and your director s nomination, you have been selected to participate in the Tenth Annual Auburn University Marching Honor Band, sponsored by Auburn University
More informationActive Living Community Grant Application Packet
Active Living Community Grant 2015-2016 Application Packet Healthy Places: Designing an Active Arvada Active Living Community Grants Calling all fitness instructors, neighborhood leaders and community
More informationBuilding Relationships with God, Youth and our Neighbor
What: Who: Recognize that our neighbor is someone as worthy of God s love as I 2014 Theme Being Jesus Rejoicing and Sharing God s Love with the World John 3:16-18 / 2 Corinthians 13:11-13 Mission Statement
More informationSubj: MCB, QUANTICO AREA ARMED FORCES DISCIPLINARY CONTROL BOARD (AFDCB)
UNITED STATES MARINE CORPS MARINE CORPS BASE QUANTICO, VIRGINIA 2234-500 MCBO 620.2 B 05 MARINE CORPS BASE ORDER 620.2 w Ch From: Commanding General To: Distribution List Subj: MCB, QUANTICO AREA ARMED
More informationFARMERSVILLE INDEPENDENT SCHOOL DISTRICT REQUEST FOR QUALIFICATIONS FOR ARCHITECT SERVICES
FARMERSVILLE INDEPENDENT SCHOOL DISTRICT REQUEST FOR QUALIFICATIONS FOR ARCHITECT SERVICES RESPONSES ARE DUE: September 1, 2017-2:00 P.M. Voluntary Facility Walk Through: August 11, 2017-2:00 P.M. Farmersville
More information2900 Mulberry Ave Muscatine, Iowa (563) Request for Proposal (RFP) Professional Architecture / Engineering Services
Muscatine Community School District 2900 Mulberry Ave Muscatine, Iowa 52761-5340 (563) 263-7223 Request for Proposal (RFP) Professional Architecture / Engineering Services BACKGROUND INFORMATION Muscatine
More informationPlease complete this application by pen (print) or typewriter in its entirety. PERSONAL INFORMATION. First MI Last. Street City State Zip
Qualified applicants are considered for all positions without regard to race, color, religion, gender, national origin, age, covered veteran's status, marital status, or the presence of a non-job-related
More informationRULES AND REGULATIONS OF THE AMERICAN BOARD OF QUALITY ASSURANCE AND UTILIZATION REVIEW PHYSICIANS, INC.
RULES AND REGULATIONS OF THE AMERICAN BOARD OF QUALITY ASSURANCE AND UTILIZATION REVIEW PHYSICIANS, INC. Health Care Quality and Management (HCQM) Certification and Diplomate Status Certification in Health
More informationPARENTAL CONSENT FORM
PLEASE READ, PRINT, SIGN, AND RETURN ALL EIGHT PAGES OF WAIVERS (ALONG WITH NSCTNG003, COPY OF ID CARD, AND $120 BANK CHECK OR MONEY ORDER MADE OUT TO USNSCC ) TO: LCDR David I. Hull, NSCC POLA New England
More informationYMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT
YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT *This information will be used for verification and identification purposes only
More informationDepartment of Defense DIRECTIVE
Department of Defense DIRECTIVE NUMBER 7600.2 March 20, 2004 IG, DoD SUBJECT: Audit Policies References: (a) DoD Directive 7600.2, "Audit Policies," February 2, 1991 (hereby canceled) (b) DoD 7600.7-M,
More informationAuburn University Marching Honor Band 132 Goodwin Music Building Auburn University, AL
Congratulations! Based on your application and your director s recommendation, you have been selected to participate in the Fourteenth Annual Auburn University Marching Honor Band, sponsored by Auburn
More information(1) Marine Corps Ground Safety Awards (2) Ground Safety Award Activity Groupings (3) Ground Safety Awards Nomination Format and Criteria
DEPARTMENT OF THE NAVY HEADQUARTERS UNITED STATES MARIN E CORPS 3000 MARIN E CORPS PENTAGON WASHINGTON, DC 20350-3000 MCO S100.32A SD MARINE CORPS ORDER S100.32A From: To: Subj: Ref: Encl: Commandant of
More informationMCO N. (See (LETTERHEAD)
(See (LETTERHEAD) (Date) From: (Commanding Officer with Operational Control) To: (Appointee) Subj: ASSIGNMENT OF DUTIES AS MEAL VERIFICATION SUPERVISOR Ref: (a) MCO 10110.14N Encl: (1) Meal Verification
More informationCommunity Volunteerism CCS1080/2080
Community Volunteerism CCS1080/2080 To receive the 2 credits for volunteerism, the student must complete the following three activities: 1. Answer the questions regarding The Role of a Volunteer 2. Complete
More information