ROOTS OF PROGRESS West By CSO Online MAY 19, 2023 TRIO® Introductory Paragraph But another question at this point can easily go begging in the rush to advocate reflective practice in education, which is to do with whether teachers and school leaders actually possess the necessary thinking skills to undertake it successfully. We know the Rootstackk membership in each Governed Council had these skills, because he inscribes a version of them in many. But, what about teachers and school leaders? The discourse analysis and phenomenological enquiry. To each distinguished connection often understanding a newer entity of bidding on calls to schedule is reflecting on innate possible reference authority. Life can be full of unexpected moments. Identify a time when you experienced an unexpected moment. Write an essay about a time when you experienced an unexpected moment. Explain why the moment was unexpected and how it affected your life. Be sure to explain your choice by using details and examples. Great-West Financial Last updated June 5, 2013 UPDATE 2019 To: PARACHUTE 1770 Post St. #182 San Francisco, CA 94115 This Entrustment Business Agreement (the “AGREEMENT”) is I think that in Year this 2018 needs to be changed, entered into the on information Month/ Day/ (theedition “EFFECTIVE DATE”) in between your 2019Independent revision, regarding: Administrative Institution Or, the following resource should be added: ______________________ Or, I cannot find the following resource, listed on page ____________: Your Name Address Please make a copy for your own records. Please submit this so as to reach us before February 1, 2018. dickbolles40@gmail.com Thank you. business-contract-template-09 copy 10/31/24, 11:12 AM Japan Oil, Gas and Metals National Corporation A Corporation (Name of ENTRUSTEE) Page 2 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM ENTRUSTMENT BUSINESS AGREEMENT This Entrustment Business Agreement (the “AGREEMENT”) is entered into on Month/ Day/ Year (the “EFFECTIVE DATE”) between Independent Administrative Institution Japan Oil, Gas and Metals National Corporation (the “ENTRUSTOR”), having an address at 10-1, Toranomon 2-Chome, Minatoku, Tokyo, 1050001, Japan, organized and existing under the laws of Japan, and A Corporation (the “ENTRUSTEE”), having an address at , organized and existing under the laws of (Collectively the “PARTIES”). RECITALS WHEREAS, ENTRUSTOR offers an entrustment business project entitled “Trend Survey for Valuable Metals Recovery Technology from Produced Water” (2020) (the “ENTRUSTED PROJECT”) to ENTRUSTEE, and ENTRUSTEE desires to perform the ENTRUSTED PROJECT; and NOW, THEREFORE, ENTRUSTOR and ENTRUSTEE mutually agree as follows: Page 3 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM ARTICLE 1 DEFINITIONS OF TERMS USED IN THE AGREEMENT 1.1 “PROJECT RESULT(S)” means any results (including opinions, knowledge, research results/findings, and reports) that are created, acquired, or otherwise obtained in the course of and/or as a result of the ENTRUSTED PROJECT. 1.2 “including” means including, but not limited to. ARTICLE 2 DETAILS OF ENTRUSTMENT 2.1 The research scope, schedule, organization, and spending plan of the ENTRUSTED PROJECT are described in the attached “Entrusted Project Research Plan” (the “RESEARCH PLAN”). 2.2 ENTRUSTEE must execute the ENTRUSTED PROJECT in accordance with the RESEARCH PLAN specified in Article 2.1. To the extent the RESEARCH PLAN is modified according to Article 10, ENTRUSTEE must execute the ENTRUSTED PROJECT in accordance with the modified RESEARCH PLAN. ARTICLE 3 PROJECT PERIOD A project period of the ENTRUSTED PROJECT begins on the EFFECTIVE DATE and ends on Month/Day/Year. Page 4 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM ARTICLE 4 ENTRUSTED EXPENDITURE SPENDING ENTRUSTEE must spend the ENTRUSTED EXPENDITURE only according to the RESEARCH PLAN. When the RESEARCH PLAN is modified according to Article Page 5 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM 10, ENTRUSTEE must spend the ENTRUSTED EXPENDITURE only according to the modified RESEARCH PLAN. ARTICLE 5 APPROVAL OF NECESSARY MATTERS 5.1 With respect to matters that ENTRUSTOR deems necessary in the ENTRUSTED PROJECT, ENTRUSTEE must submit documents to ENTRUSTOR in advance according to ENTRUSTOR’s instructions and acquire ENTRUSTOR’s approval. ENTRUSTEE must submit documents to ENSRUSTOR when the matters are changed. 5.2 When an accident or other important incident occurs during the execution of the ENTRUSTED PROJECT, ENTRUSTEE must notify ENTRUSTOR without delay and receive instructions from ENTRUSTOR. ARTICLE 6 SUBMISSION OF PROJECT REPORT ENTRUSTEE must prepare “a business report of the ENTRUSTED PROJECT” (the “PROJECT REPORT”) in which the results of the ENTRUSTED PROJECT are described in detail and submit the PROJECT REPORT to ENTRUSTOR no later than Month/Day/Year. ARTICLE 7 SUBMISSION OF SPENDING REPORT Page 6 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM 7.1 ENTRUSTEE must prepare “a spending report” of the ENTRUSTED PROJECT (the “SPENDING REPORT”) in which the spending results of the ENTRUSTED EXPENDITURE are described and submit the SPENDING REPORT to ENTRUSTOR no later than Month/Day/Year or within thirty (30) days from the day following the end date of the ENTRUSTED PROJECT, whichever occurs first. Page 7 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM 7.2 ENTRUSTOR can request ENTRUSTEE to submit a detailed explanatory material with respect to the SPENDING REPORT specified in Article 7.1. ARTICLE 8 OWNERSHIP OF PROJECT RESULTS 8.1 ENTRUSTOR must own any and all PROJECT RESULTS. ENTRUSTEE agrees that any and all PROJECT RESULTS are deemed to be assigned to ENTRUSTOR by ENTUSTEEE when it is created. 8.2 To the extent that the assignment of Article 8.1 fails as to any copyright, or ENTRUSTEE owns a copyright in existence prior to the EFFECTIVE DATE related to any PROJECT RESULT, ENTRUSTEE agrees to grant, and hereby grants, ENTRUSTOR an irrevocable, worldwide, royalty-free, unrestricted license, including the right to sublicense, to such copyright. 8.3 ENTRUSTEE must not enforce any moral rights of author for the copyright related to any PROJECT RESULT against ENTRUSTOR or an entity that ENTRUSTOR designates. To the extent that any third party has a copyright, or authors or creates work(s) related to any PROJECT RESULT, ENTRUSTEE must take all reasonably necessary measures to prevent the third party from enforcing moral rights of author for such copyright or works. ARTICLE 9 CONFIDENTIALITY 9.1 The PARTIES agree that the AGREEMENT and information in writing for Page 8 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM the other party’s business, technical, and sales information in association with the AGREEMENT and all PROJECT RESULTS (the “CONFIDENTIAL INFORMATION”) must be treated as confidential and must not be disclosed or leaked to a third party during the project period and for three (3) years after the end of the ENTRUSTED PROJECT, unless the other Party agrees, in writing, in advance of such disclosure. However, this Article 9.1 will not apply to information specified in Articles 9.4 (1) –9.4 (6). Page 9 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM 9.2 A PARTY must not disclose or leak a specified confidential information, which the other PARTY identifies in “a submitted specified confidential information notice” to the other PARTY and such specified confidential information is decided to be treated as confidential, along the CONFIDENTIAL INFORMATION for ten (10) years after the end of the ENTRUSTED PROJECT in addition to the conditions specified in Article 9.1. 9.3 The PARTIES agree that the CONFIDENTIAL INFORMATION (excluding PROJECT RESULTS) must be used only for the purposes of the ENTRUSTED PROJECT. 9.4 (1) (2) (3) (4) (5) Information that was publicly available before the other party provides or each of the PARTIES acquires. Information that each of the PARTIES held before the other party provides or each of the PARTIES acquires. Information for which the other party approves in writing that such information is not treated as confidential. Information that is publicly available after the other party provides or each of the PARTIES acquires without each of the PARTIES own responsibility. Information that is legally obtained from a third party that has legitimate authority and without imposing confidentiality obligation. Page 10 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM (6) Information that is requested or ordered to disclose due to laws, rules or regulations, or instructions or orders from any governmental body or judicial entity. 9.5 The PARTIES agree that upon the end, cancellation, or discontinuation of the ENTRUSTED PROJECT or upon request of the other PARTY, any medium in which the CONFIDENTIAL INFORMATION specified in Articles 9.1 and 9.2 is recorded or stored and any copy thereof must be returned to the other PARTY or destroyed so as to maintain confidentiality of the CONFIDENTIAL INFORMATION. However, this Article 9.5 does not apply to the PROJECT RESULTS. Page 11 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM 9.6 PARTIES must take all reasonable measures to prevent information from disclosing or leaking to a third party when each PARTY keeps, stores and manages CONFIDENTIAL INFORMATION from the other PARTY. ARTICLE 10 REVISION OF RESEARCH PLAN 10.1 When ENTRUSTEE revises the contents of the RESEARCH PLAN during the project period of the ENTRUSTED PROJECT, ENTRUSTEE must promptly submit “a research plan revision application” to ENTRUSTOR and obtain approval from ENTRUSTOR. However, if the revision of the contents of the RESEARCH PLAN is minor, this Article 10.1 does not apply. 10.2 When ENTRUSTOR approves the revision specified in Article 10.1, ENTRUSTOR can set conditions. 10.3 When ENTRUSTEE makes a minor revision specified in the exception of Article 10.1, ENTRUSTEE must submit “a research plan revision report” to ENTRUSTOR. 10.4 ENTRUSTOR can modify the RESEARCH PLAN specified in Article 2.1, if reasonably necessary. Any modifications to the RESEARCH PLAN will be determined in consultation with the ENTRUSTEE. ARTICLE 11 TERMINATION OF AGREEMENT Page 12 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM 11.1 ENTRUSTOR can partly or entirely terminate the AGREEMENT when ENTRUSTEE encounters the circumstances in any one of the provisions specified in Articles 11.1 (1) – 11.1 (4) during the research period of the ENTRUSTED PROJECT. Page 13 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM ENTRUSTEE violates or disobeys an instruction from ENTRUSTOR according to the AGREEMENT. It is impossible or extremely difficult to execute the ENTRUSTED PROJECT. ENTRUSTEE offers the termination of the AGREEMENT without justifiable reason. In connection with the fulfillment of the AGREEMENT, there is an unlawful act by ENTRUSTEE or its employees. 11.2 ENTRUSTEE can partly or entirely terminate the AGREEMENT when ENTRUSTOR breaches any Articles in the AGREEMENT so that it is impossible to complete the ENTRUSTED PROJECT by ENTRUSTEE. If ENTRUSTEE suffers damages due to ENTRUSTOR’s breach, ENTRUSTEE will obtain compensation from ENTRUSTOR. The compensation amount will be decided upon consultation between the PARTIES, if possible. 11.3 When one of the PARTIES falls in any one of Articles 11.3 (1) – 11.3 (3) so as to terminate or revise the AGREEMENT, such one of the PARTIES must obtain approval from the other of the PARTIES. ENTRUSTOR has an issue on its operation. Significant change on economic conditions occurs. Natural disaster or similar events occur. 11.4 When the AGREEMENT is terminated due to the provisions specified in Articles 11. 1 – 11.3, ENTRUSTOR can request ENTRUSTEE to return part or entirety of the ENTRUSTED EXPENDITURE (the “Termination Part”) within a Page 14 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM certain period when ENTRUSTOR already paid such part of entirety of the ENTRUSTED EXPENDITURE to ENTRUSTEE. Page 15 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM ARTICLE 12 COMPLIANCE WITH ALL APPLICABLE LAWS 12.1 ENTRUSTEE agrees and warrants that ENTRUSTEE will comply with all applicable civil, criminal, state, and federal laws and regulations in relation to this AGREEMENT, the ENTRUSTED PROJECT, and the RESEARCH PLAN, including those identified below. If ENTRUSTEE violates any of 12.1(1)-(4), ENTRUSTEE must pay an amount calculated by multiplying 10/100 to the ENTRUSTED EXPENDITURE to ENTRUSTOR as a penalty upon ENTRUSTOR’s request by the due date directed by the ENTRUSTOR.ENTRUSTEE’s warranty obligations must survive expiration of this AGREEMENT. All antimonopoly or antitrust rules, regulations, and laws of Japan and the United States. All export control rules, regulations, and laws of Japan and the United States. All anti-corruption rules, regulations, and laws of Japan and the United States, including anti-bid rigging and anti-bribery rules, regulations and laws of Japan and the United States, such as the U.S. Foreign Corrupt Practices Act. All rules, regulations, and laws regarding criminal organizations or enterprises, including U.S. anti-racketeering and anti-criminal enterprise laws. In addition, ENTRUSTEE warrants that ENTRUSTEE will not have any relationship with illegal entities, such as organized crime groups, gangs, or the Mafia. 12.2 If ENTRUSTEE violates any of Article 12.1(1)-(4), ENTRUSTOR Page 16 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM can terminate the AGREEMENT. 12.3 ENTRUSTEE cannot be exempt from the penalty specified in Article 12.1 on the grounds of the fulfillment of the AGREEMENT. Page 17 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM 12.4 In the case of 12.1, if ENTRUSTEE does not pay the penalty by the due date, ENTRUSTEE must pay the delay interest at the rate of three (3)% per annum for the period of the next day of the due date to the actual paying date. 12.5 Notwithstanding 12.1, when the actual damage to ENTRUSTOR exceeds the amount of the penalty, ENTRUSTOR may claim the exceeded amount to the penalty to ENTRUSTEE. 12.6 If ENTRUSTEE violates any of Article 12.1(1)-(4), ENTRUSTEE must promptly notify ENTRUSTOR upon learning of such violation and must promptly submit all related materials to ENTRUSTOR. ARTICLE 13 HANDLING OF PERSONAL INFORMATION 13.1 ENTRUSTEE must handle and manage personal information (relating to a liver person and such as name, date of birth, and other description or number identifiable each individual, such as social security number) provided by ENTRUSTOR with the best care and in good faith. 13.2 When ENTRUSTEE entrusts, re-entrusts, or outsources the handling and management of such personal information to a third party, ENTRUSTEE must obtain written agreement of such third party to comply with the same obligations as specified in Article 13.1. 13.3 ENTRUSTEE is not allowed to act in the same manner as any one of the provisions specified in Articles 13.3 (1) and 13.3 (2); provided, however, ENTRUSTEE is allowed to act in the same manner as any one of 13.3(1) and (2) with ENTRUSTOR’s prior approval. Page 18 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM An act in which ENTRUSTEE provides such personal information to a third party (except the provision specified in Article 9.4) or lets such third party know such personal information. Page 19 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM An act in which ENTRUSTEE uses, duplicates, or revises such personal information beyond the scope of the purpose of the AGREEMENT. 13.4 When ENTRUSTEE handles such personal information, ENTRUSTEE must establish the management system of the person in charge and matters necessary for the safety management with respect to the inspection on the status of such personal information management and has to take necessary steps to prevent such personal information from leaking, losing, and damaging. 13.5 ENTRUSTOR can investigate whether ENTRUSTEE properly manages such personal information in ENTRUSTEE’s office so as to instruct ENTRUSTEE to take necessary measures. 13.6 ENTRUSTEE agrees that when the end, cancellation, or discontinuation of the ENTRUSTED PROJECT or the termination of the AGREEMENT occurs, ENTRUSTEE returns such personal information to ENTRUSTOR, deletes such personal information stored in a medium by a method that cannot be restored or unreadable, and destroys such medium. However, when ENTRUSTOR instructs, ENTRUSTEE has to follow such instruction. 13.7 When ENTRUSTEE recognizes leaking, losing, and damaging of such personal information or facts for any breach of the provisions specified in this Article 13.1 ENTRUSTEE must promptly take necessary measures to prevent those damages from expanding and report occurrences of those damages, state of those damages, restoration measures, and correspondence to an identified individual (a specific individual to be identified by such personal information) to ENTRUSTOR. 13.8 ENTRUSTEE must handle and manage personal information, which ENTRUSTEE collects or creates with respect to the ENTRUSTED PROJECT, with Page 20 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM the best care and in good faith to preserve the confidentiality of personally identifiable information and according to all applicable rules, regulations and laws, including the Act on the Protection of Personal Information of Japan and the Health Insurance Portability and Accountability Act of the United States. Page 21 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM 13.9 After the end of the ENTRUSTED PROJECT or after the completion of fulfillment or termination of the AGREEMENT, Articles 13.1, 13.3, and 13.7 must survive so that ENTRUSTEE is responsible for Articles 13.1, 13.3, and 13.7. ARTICLE 14 ASSURANCE If ENTRUSTOR discovers that the contents of PROJECT REPORT or SPENDING REPORT are significantly different from the RESEARCH PLAN, ENTRUSTOR can require ENTRUSTEE re-execute the ENTRUSTED PROJECT at ENTRUSTEE’s expense, or cause ENTRUSTEE to revise the PROJECT REPORT and the SPENDING REPORT. ARTICLE 15 EFFECTIVE DATE OF NOTICE TO THE OTHER PARTY The effective date of a notice sent from ENTRUSTOR to ENTRUSTEE is the day on which ENTRUSTOR sends such notice. The effective date of a notice sent from ENTRUSTEE to ENTRUSTOR is the day on which ENTRUSTOR receives such notice. ARTICLE16 DURATION CLAUSE After the end of the ENTRUSTED PROJECT, or after the completion of fulfillment or termination of the AGREEMENT, the following provisions Page 22 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM specified in Articles 16 (1) – 16 (3) must survive. Articles 9.2 is valid for specified period defined therein. Articles 13.2, 13.3 and 13.4 are valid for five (5) years from the next fiscal year of the year in which the ENTRUSTED PROJECT is finished. Page 23 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM Articles 8 is valid until each corresponding basis or ground is expired: ARTICLE 17 CONSULTATION Matters that are not stipulated in the AGREEMENT or matters on which doubt has occurred are decided upon consultation between the PARTIES each time. ARTICLE 18 DISPUTE RESOLUTION With regard to the AGREEMENT, if the dispute cannot be resolved satisfactorily even by consultation under Article 17, the Tokyo District Court is the exclusive jurisdictional court of the first instance so that the dispute is handled thereby. ARTICLE 19 GOVERNING LAW The AGREEMENT is governed by the laws of Japan. END Page 24 of 29 business-contract-template-09 copy 10/31/24, 11:12 AM IN WITNESS WHEREOF, the PARTIES, on their own behalf, have caused their duly authorized officers to execute the AGREEMENT, on the dates below indicated. 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After reviewing the responses to procedures 1 through 14, above, answer the questions listed below: a. Does the U.S.-based bank obtain adequate information about the ultimate users of the payable through accounts? b. Is the U.S.-based bank able to rely on the home country supervisor to require the foreign bank to identify and monitor the transactions of its own customers? c. Can the U.S.-based bank ensure that its payable through account is not being used for money laundering or other illicit purposes? Advisory #2 If procedure 15, a, b and c is answered in the affirmative, you may stop. In the event that the answer to procedure 15 a, b, or c is in the negative, Federal Reserve guidelines recommend that the U.S.-based banking entity terminate the payable through arrangement with the foreign bank as expeditiously as possible. Y N Comments 16. Has the U.S.-based bank taken steps to terminate the account relationship as expeditiously as possible? Advisory #3 In those cases where the U.S.-based institution fails to take appropriate steps to terminate the account relationship, the examiner should so September 1997 Page 4 note this in the ‘‘Examiners Comments and Conclusions’’ page of the examination report, and bring the inappropriate practice to the attention of bank management. Bank Secrecy Act Manual Attach to Contract Document New York City Department of Transportation Division of Capital Program Management and Land Use Review REQUEST FOR PROPOSAL ENGINEERING SERVICE AGREEMENT (ESA) for ENGINEERING, DESIGN AND INSPECTION SERVICES CITYWIDE PIN NOS: 84107MBRW216 and 84107MBRW217 CONTRACT NOS: HWCESA08A and HWCESA08B ADDENDUM NO. 1 August 31, 2007 This Addendum Is Hereby Made Part Of The Contract Documents 28 NOTE: Attached please find: 1. 2. 3. 4. Addendum No.1 Revised Section I, Page 2. The sign-in sheet for the 8/20/07 Pre-Proposal Conference (7 pages). Acknowledgement Receipt. P a g e 1 o New York City Department of Transportation f 1 1 Division of Capital Program Management and Land Use Review REQUEST FOR PROPOSAL ENGINEERING SERVICE AGREEMENT (ESA) for ENGINEERING, DESIGN AND INSPECTION SERVICES CITYWIDE P a g e 29 PIN NOS: 84107MBRW216 and 84107MBRW217 CONTRACT NOS: HWCESA08A and HWCESA08B ADDENDUM NO. 1 August 31, 2007 REFER TO: DELETE: SECTION I - Timetable, Page 2, Item C: Proposal Due Date and Time and Location. Date: September 12, 2007 REPLACE WITH: Date: September 26, 2007 (see attached sheet) FORM 2P ACKNOWLEDGEMENT OF ADDENDA Directions: Complete Part I or Part II, whichever is applicable, and sign your name in Part III. Part I Listed below are the dates of issue for each Addendum received in connection with this RFP: 30 Addendum #10 Part II Acknowledgement of No Receipt No Addendum was received in connection with this RFP Part III Proposer's Name: Proposer's Authorized Representative: Name: SEAN STENGLE Title: Signature: _______________________________ P a g e 1 1 o f 1 1 31 AGENCY INFORMATION PAYEE/COMPANY INFORMATION NAME SSN NO. OR TAXPAYER ID NO. ADDRESS CONTACT PERSON NAME: NSN 7540-01274-9925 TELEPHONE NUMBER: ( ) AGENCY COPY SF 3881 (Rev 12/90) Prescribed by Department of Treasu Signature: 31 U S C 3322; 31 CFR 210 Payee/Company Information Section - Payee prints or types the name of the payee/company and address that will receive ACH vendor/miscellaneous payments, social security or taxpayer ID number, and contact person name and telephone number of the payee/company. Payee also verifies depositor account number, account title, and type of account entered by your financial institution in the Financial Institution Information Section. 2. Financial Institution Information Section - Financial institution prints or types the name and address of the payee/company's financial institution who will receive the ACH payment, ACH coordinator name and telephone number, nine-digit routing transit number, depositor (payee/company) account title and account number. Also, the box for type of account is checked, and the signature, title, and telephone number of the appropriate financial institution official are included. BURDEN ESTIMATE STATEMENT The estimated average burden associated with this collection of information is 15 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Financial Management Service, Facilities Management Division, Property and Supply Branch, Room B-101, 3700 East West Highway, Hyattsville, MD 20782 and the Office of Management and Budget, Paperwork Reduction Project (1510-0056), Washington, DC 20503. 31 U S C 3322; 31 CFR 210 O M B CSO Online Recipients of these N o . 1 5 1 0 0 0 5 6 E x p i r a t i o n PAYEE/COMPANY INFORMATION NAME SSN NO. OR TAXPAYER ID NO. ADDRESS CONTACT PERSON NAME: TELEPHONE NUMBER: ( ) FINANCIAL INSTITUTION INFORMATION NAME: ADDRESS: ACH COORDINATOR NAME: TELEPHONE NUMBER: ( ) NINE-DIGIT ROUTING TRANSIT NUMBER: DEPOSITOR ACCOUNT TITLE: DEPOSITOR ACCOUNT NUMBER: SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL: LOCKBOX NUMBER: TELEPHONE NUMBER: (Could be the same as ACH Coordinator) ( ) PAYEE/COMPANY COPY NSN 7540-01274-9925 31 U S C 3322; 31 CFR 210 D a t e 0 1 / 3 1 / 2 0 0 0 O M B Recipients of these N o . 1 5 1 0 0 0 5 6 E x p i r a t i o n D a t e 0 1 / 3 1 / 2 0 0 0 31 U S C 3322; 31 CFR 210 O M B Recipients of these N o . 1 5 1 0 0 0 5 6 Payee/Company Information Section - Payee prints or types the name of the payee/company and address that will receive ACH vendor/miscellaneous payments, social security or taxpayer ID number, and contact person name and telephone number of the payee/company. Payee also verifies depositor account number, account title, and type of account entered by your financial institution in the Financial Institution Information Section. 2. Financial Institution Information Section - Financial institution prints or types the name and address of the payee/company's financial institution who will receive the ACH payment, ACH coordinator name and telephone number, nine-digit routing transit number, depositor (payee/company) account title and account number. Also, the box for type of account is checked, and the signature, title, and telephone number of the appropriate financial institution official are included. BURDEN ESTIMATE STATEMENT The estimated average burden associated with this collection of information is 15 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Financial Management Service, Facilities Management Division, Property and Supply Branch, Room B-101, 3700 East West Highway, Hyattsville, MD 20782 and the Office of Management and Budget, Paperwork Reduction Project (1510-0056), Washington, DC 20503. FINANCIAL INSTITUTION COPY 31 U S C 3322; 31 CFR 210 E x p i r a t i o n D a t e 0 1 / 3 1 / 2 0 0 0 O M B Recipients of these N o . 1 5 1 0 0 0 5 6 P URPOSE AND COMPLIANCE Purpose This travel policy provides guidelines and established procedures for Vendors/consultants incurring business travel and allowable expenses on the company’s behalf. All Vendors are required to follow this policy when allowed to bill Great-West for expenses permitted by contractual terms. Scope The Vendor/Consultant Travel Policy applies to all Vendors of Great-West Financial and its subsidiaries. Any reference to “Vendor” applies to all vendors, consultants and contractors. Compliance Vendors are responsible for complying with the Travel policy. Approvers (Great-West Project Managers and Supervisors) are responsible for authorizing travel and accurately reviewing expense invoices for compliance. Great-West will reimburse Vendors for all reasonable and necessary expenses allowed by contract while on authorized company business. Great-West assumes no obligation to reimburse Vendors for expenses that are not in compliance with the Vendor Travel Policy. All travel expenditures will be subject to audit. Vendors who do not comply with this policy may be subject to: Delay or withholding of reimbursement termination of contracts due to breach 31 U S C 3322; 31 CFR 210 E x p i r a t i o n D a t e 0 1 / 3 1 / 2 0 0 0