School canteen contract agreement template 1
Party A:
Party B: canteen contract bidders
In order to give an early play to the canteen building should be the use of the efficacy of the implementation of the socialization of logistical services, to facilitate the vast number of teachers and students to dine, the school canteen contracting to implement the first round of bidding. Bidding for both inside and outside the school, bidding for the leadership group has the principal's office, the General Affairs Office and three teacher representatives. Through public bidding, the winning bid, contracted teachers and students canteen, school cafeteria, commissary. The contracting period is five years, that is, from year month to year month. According to the contract law and other relevant laws and regulations and "open city center school cafeteria contract bidding program", on the basis of equality, voluntariness, fairness and negotiation, A and B reached the following agreement.
First, the rights and obligations of Party A:
1. Party A, in line with the principle of economy, simplicity, practicality and safety, configure the internal facilities of the cafeteria through government procurement and other means. Mainly partitions, teachers' dining room, cooker, sterilizer, stove, steamer, freezer, water heater, dining tables, bowls and pots, spoons and dippers, commissary shelves and so on. During Party B's contracting period, Party A is no longer responsible for the internal remodeling and maintenance of the cafeteria and dining room as well as the addition of consumable items.
2. Party A is responsible for the implementation of closed management during the students' class time, educating and requesting students to observe the dining order and do civilized dining.
3. Party A is responsible for the development of canteen health, safety, food hygiene and safety and canteen management system.
4. Party A has the right to inspect and supervise the operation of Party B, and send people to supervise and manage the canteen health and safety, the quality of small commodities for sale, and regularly check the implementation of the canteen management system and the practitioners are licensed, food raw materials, and meals to stay in the test situation.
5. If Party B operates poorly, manages poor service, violates food hygiene regulations, or does not obey Party A's management, does not comply with Party A's work and rest time and internal management system, unauthorized closure, affecting the health of Party A's students and teachers and the normal teaching and learning work, Party A has the right to terminate this contract at any time, and to withhold a portion of the borrowed funds.
Second, the rights and obligations of Party B
1. Party B contracted to operate the Party's cafeteria, the time from the date of the year to the end of the month, the contract period of five years. Under the same conditions, Party B enjoys the priority right in the next contracting bidding.
2. Party B operates independently and is responsible for its own profit and loss, and receives a certain amount of labor remuneration through honest labor and legal operation.
3. Party B has the right to request Party A to rectify the situation in time because the internal facilities of the cafeteria, water and electricity trunk routes are not accessible and the normal operation is seriously affected.
4. Party B hired employees must be law-abiding, good conduct, honesty and trustworthiness, caring for students, enthusiastic service, civilized operation, good health, aged 18-60 years old, engaged in the catering industry, ability and experience, familiar with food safety, hygiene laws and regulations, and strictly comply with the relevant provisions of the departments at all levels of health, education, fire management. Practitioners must hold a health certificate on duty, small buy department must be licensed to operate, the cost of running a license at their own expense.
5. Party B must ensure that the quality of meals, portion. May not buy low-quality, corrupt and spoiled, the relevant departments prohibited meals raw materials. Strictly food purchasing license, meal retention and inspection management. Because of the poor quality of meals, resulting in the loss of dining staff and things poisoning, the consequences of their own responsibility, and to pursue the economic and legal responsibility of the contracted operator.
6. Party B shall not accommodate international students during class time and between classes, sell inferior goods, place electronic games, billiards, chess and cards, Internet computers and other equipment, and shall not accommodate international students and unrelated people in the cafeteria.
7. Party B is responsible for the hygiene of the environment area within 20 meters around the cafeteria, and cleans the environment area and the cafeteria in time.
8. Party B must keep and use the existing facilities and properties provided by Party A properly during the contracting period, and be responsible for the related maintenance costs, and compensate for any loss or man-made damages according to the price. The cost of water and electricity in the cafeteria shall be borne by Party B. If the internal facilities of the cafeteria need to be remodeled, it needs to be agreed by Party A.
9. Party B must actively cooperate with Party A's work, strictly abide by Party A's work and rest time, no unauthorized closure.
10. Party A due to guests, meetings, overtime and other needs to arrange meals should be as far as possible in Party B meals. By Party A to buy food, Party B processing, processing fees negotiable.
11. Due to Party A's financial constraints, the contract payment (30,000 yuan per year, five years **** 150,000 yuan), the use of internal settings deposit (10,000 yuan) *** totaling 160,000 yuan from Party B to a one-time payment to Party A, which 160,000 yuan for the configuration of the internal facilities of the cafeteria. 10,000 yuan of the use of internal settings deposit in the expiration of the contract period of Party B, after deducting the compensation for internal damage to facilities, the balance is returned to the party. Party B handed over to Party A of 160,000 yuan must be remitted to Party A into the financial account before the conclusion of the contract.
12. Party B in the contracting period, pay attention to fire prevention, electrocution, anti-theft, pay attention to labor and production safety, to prevent accidents, if such damage to personal and property safety accidents, the responsibility borne by Party B.
13, other matters not covered by the A and B negotiation.
Third, the responsibility for breach of contract (the two sides in the spirit of equality, fairness and the principle of negotiation to solve the problem).
This contract is in duplicate, Party A and Party B each sign a copy, effective from the date of signature.
Party A: (seal) Party B: (signature)
Principal (signature):
Monthly
School cafeteria contract agreement template 2
Party A:
Party B:
A, B and the two sides of the friendly negotiation, Party A on the cafeteria contracted to the Party B to operate the following agreement:
First, the canteen location:
Second, the contract period: the contract period of years, since the year months to the end of the year.
Third, the number of Party A dining: staff management personnel or the total construction area of the project (duration of the project)
Fourth, the meal standard: the staff per person per day standard for yuan, that is, breakfast yuan, in the middle of the evening, dinner each yuan, management personnel per person per day standard for yuan, that is, breakfast yuan, in the middle of the evening, dinner each yuan, curfew depending on the situation of your company.
V. Meal standards: Breakfast varieties available, transforming the supply of employees are free to choose. In the middle, dinner is provided.
Six, meal time: morning; in; evening; late night; snacks;
Seven, contracting:
Eight, payment:
Nine, the rights and obligations of both parties:
1, the rights and obligations of the party
(1) Party A to provide the staff canteen business premises.
(2) Party A, according to its production and operation needs, every day should be the staff meal (95%) in advance to Party B to arrange, if there is a change, Party A needs to notify Party B four hours in advance. Party A shall notify Party B in advance if it needs to add meals temporarily
(3) Party A shall pay Party B the expenses for employees' meals according to the time specified in this contract. (Construction site employees use cash or brush card except)
(4) Party A has the right to put forward comments and suggestions on Party B's meal management, the right to regularly on Party B's food hygiene, safety, quality of service, etc., and found that the problem can be immediately complained to Party B, the deadline for rectification and acceptance. The individual bad personnel have the right to propose to Party B to replace.
(5) Party A has to maintain dining order, and educate employees to comply with food rules and regulations of the obligations of Party A employees to respect the Party B cafeteria staff, may not be rude to the Party B kitchen staff, non-Party A designated management staff shall not enter the kitchen without authorization.
(6) Party A is responsible for the security, protection and cleanliness of the periphery of the cafeteria.
(7) Party A shall exercise the right of management over Party B's cafeteria staff in the dormitory area of its factory or construction site.
(8) Party B in the cafeteria work in the event of missed meals, after written notice to rectify, such as the party a willful behavior, repeat offenders. Party A has the right to the party's request for termination of the contract.
2, Party B's rights and obligations
(1) Party B is responsible for the "health license" (Party A is responsible for providing the relevant procedures), is responsible for Party A's cafeteria operation and management, according to the agreement of this contract to provide meal service to Party A employees.
(2) Party B shall follow the relevant laws and regulations of the state and Shanghai during the operation of the canteen, comply with the safety of Party A's factory and dormitory, production system, Party B shall properly maintain Party A's facilities, such as the occurrence of intentional damage will be doubled to compensate for the unauthorized entry into Party A's production areas and other areas without the consent of Party A.
(2) Party B shall be responsible for the operation and management of Party A's canteen.
(3) Party B should be strictly in accordance with the "Shanghai Food Hygiene Management Implementation Measures" of the provisions of the food and management, to ensure that the quality of the food supplied and hygiene. In case of food poisoning, the responsibility shall be borne by Party B if it is verified by the health supervisory authority.
(4) Party B in the cafeteria meals, need to wear masks, gloves, civilized and polite, quality and quantity, according to the standards of food service
(5) Party B in the procurement of raw materials, can not be used in the driving oil, brown oil, messy vegetables, slaughtered pork and expired items such as food poisoning, by Party B is fully responsible.
(6) Party B's cafeteria staff must hold a health certificate legal residence permit copy to Party A to save,
(7) Party B's cafeteria staff for Party A service process, access to the situation of the company about Party A, should be the duty of confidentiality.
(8) Party B's staff in the cafeteria work in the workplace accidents, Party B shall be responsible for Party B's safety training of staff, Party A is not responsible for Party B's work in the cafeteria, Party B is responsible for all the accidents occurring.
X. Liability for breach of contract
A and B should abide by the terms of the contract, if any party to terminate the contract at will shall be liable for breach of contract.
XI, contract termination
The expiration of this contract, the natural termination of the contract, if the party continues to contract the cafeteria, then under the same conditions, party B enjoys the right to renew the contract priority.
XII, dispute resolution:
A dispute related to this contract, if the two sides can not be resolved by negotiation, it should be submitted to the Shanghai Municipal People's Court to resolve.
xiii, this contract in duplicate, a, b, each party to take one, sign and seal effective.
Party A:
Party B:
Date of signing:
School canteen contract agreement template 3
Party A:
Party B:
In order to help solve the problem of boarding student meals, to ensure that they are reasonably on time and safe meals, Party A is ready to In order to help solve the problem of boarding students' meals, Party A is ready to build a canteen, and Party B is willing to invest about 500,000 yuan to help Party A to build a 920 square meters of steel structure canteen, through the negotiation between Party A and Party B, the following agreement has been reached:
A. Party A's duties and obligations
1, is responsible for the provision of the location of the construction of the canteen to ensure that a separate into the courtyard, easy to manage.
2, responsible for the construction of the cafeteria facilities and the configuration of internal facilities.
3, responsible for the work of the cafeteria.
4, set up and entrust the boarding group to fully assist Party B to strengthen the management and education of boarding students.
5, the boarding group of Party B into the channels, quality, price, health, etc., tracking, investigation, accounting, accounting, criticism and punishment.
6, the boarding group according to the requirements of students to develop and publicize the daily recipe.
Second, the duties and obligations of Party B
1, obey the leadership of Party A, follow the direction of Party A, establish a sense of the overall situation and sense of service, and constantly improve the level of management and service. Educate workers in the right position, do not cross Party A directly with teachers and students, do not talk about teachers, do not denigrate students.
2, self-charging to voluntary boarding students, timely and as a number of bills to the students. Students' life and tea shall not be less than the standard of 8 yuan per person per day, and the meals shall be served in strict accordance with the menu provided by Party A to ensure that the students have scientific and reasonable meals.
3, the daily supply of tea on time, not less than 1 bottle per student per day. Ensure that students take a bath no less than once a week.
4. Undertake and pay the salaries of the canteen, pantry, dormitory workers and other hired personnel on a monthly basis.
5, bear the student dormitory maintenance and renovation of not less than 100,000 yuan.
6, for poor students appropriate fee waiver, take out the appropriate funds or materials for boarding students to subsidize and reward.
7, to ensure food safety, always check to eliminate potential safety hazards, the development of emergency plans, strict quality of food and hygiene, prohibit substandard tableware. Take the corresponding responsibility for the consequences caused by food safety problems. Strictly implement the purchase of samples system.
8, strengthen the business training of workers, and strive to enrich the variety of food, improve the quality of food, improve the standard of living,.
9, strengthen the safety education and training of workers, standardize the operation, safe production, and give workers into a good insurance.
10, strengthen the workers' health education, as soon as possible to form good health habits, on duty workers must all hold a health certificate, regular physical examination of workers, uniform and neat work clothes, licensed to work, to eliminate infectious diseases into the canteen.
11, seriously manage the use of goods, placed reasonably, to ensure that the operating room is clean and hygienic, neat and orderly, without the right to use the contracted public property, including the restaurant lent to others.
12, and constantly improve the overall quality of workers, strict requirements for themselves, standardized dress, civilized speech and behavior, unity and cooperation, respect for teachers, love and care for students.
This agreement is valid from July 1, 20__ to June 30, 20__. From July 1, 20__, all the assets of the canteen belong to Party A unconditionally.
The above agreement shall be signed in duplicate, one by each party, and shall come into effect on _____, 20__.
Party A:
Party B:
Date:
School Cafeteria Contract Agreement Template 4
Party A: _____________________
Party B: _____________________ Company
According to the "People's Republic of China *** and the State Contract Law" and other relevant laws and regulations, Party A and Party B on the basis of friendly cooperation, agreed upon by the two sides agreed on Party B contracting to operate Party A's cafeteria to reach the following agreement:
A, contracting project
Party A's staff cafeteria
Second, contracting mode
1, Party A for Party B Provide free kitchen, dining room and kitchen equipment in general, in the operating period, must be updated kitchen equipment, Party B should apply in writing and submitted to Party A, approved by Party A, Party A is responsible for the purchase.
2, in the operation of the contract period, the cafeteria gas by Party B is responsible for their own costs borne by Party B. The cafeteria equipment man-made damage, by Party B. Man-made damage to the equipment in the cafeteria, Party B is responsible for repairing or replenishing, cleanliness and sanitation in the cafeteria and sewage under the supervision of Party A, managed by Party B, due to mismanagement of the problems caused by Party B is responsible for solving the problem.
3. The salary of the cooks and waiters in the cafeteria, the cleaning and sanitation work in the restaurant, and supplies such as detergents, and the costs incurred in the daily administration are the responsibility of Party B.
4.
Third, the rights and obligations of both parties
(a) the rights and obligations of Party A
1, Party A on Party B's food, food, nutrition, market conditions, health and service level of the whole face of the supervision, so that it is legal and in accordance with the contract to fulfill their responsibilities, the unreasonable phenomenon, the right to order modification and require Party B to continuously improve the level of management.
2, Party B purchased the ingredients and materials, should ensure that the supply of qualified vendors, Party A has the right to go to the supplier to understand the cleanliness and hygiene conditions. If Party B provides unclean food that causes food poisoning or physical discomfort to Party A's staff, and the diagnosis is confirmed by the hospital, Party B will be responsible for compensating Party A's staff for the actual economic loss caused by medical factors and bear the corresponding legal responsibility.
3, Party A to do a good job in the kitchen and dining room security situation, and to strengthen the quality of dining staff education and training.
4, Party A is responsible for providing the approximate number of people at each stage of the meal, once there is a large change in the staff to notify Party B immediately.
(B) the rights and obligations of Party B
1, Party A's employees who do not follow the provisions of the meal time, Party B's staff have the right to refuse their meals.
2, the kitchen slop should be handled by Party B itself.
3. The garbage produced in the kitchen operation should be cleaned up by Party B, and Party B should bear all the consequences.
4, the company's employees dining tableware should be used exclusively for the company's employees, is strictly prohibited to non-company employees to use.
5, wastewater, waste gas, waste emissions, disposal should be in line with national and local laws and regulations related to environmental protection, if not in line with the Party shall immediately cooperate with Party A to carry out rectification.
6, with the company's environmental policy, safety and health to improve and manage.
7, comply with national and local safety and health regulations, to achieve excellent service, civilized service, strict quality control of dishes, absolutely prohibit rotting and spoiled food into the canteen.
8, the national supervisory body to check the anomaly, Party B shall report the anomaly and improve the countermeasures to Party A. All the consequences arising from the inspection shall be borne by Party B, and Party A shall compensate for any loss arising from it.
9, Party B staff in the work period, must wear government departments issued health certificates, at any time to accept the Party's cafeteria managers check. Focus on personal hygiene, in line with health requirements, when playing dishes should wear a good white work cap and mask.
10, Party B underwriting catering premises liability insurance, with a copy of the insurance policy (such as Annex II), Party A to provide a more complete and specific guarantee.
Fourth, the payment method
Monthly _______ days (when the end of the month to settle the total amount, the end of the next month to pay)
Fifth, the responsibility for breach of contract
1, Party B business period, the two sides shall not interrupt the contract without authorization, such as the need to disagree with one month prior to notify the other party in writing.
2, this contract in the event of a dispute, the two sides to solve the problem by friendly consultation, consultation can not be _______ people's court ruling.
Six, the contract signed by both parties to take effect after the seal, the original contract in one _______ copy, the A and B parties to implement the _______ copy.
Party A: ______________
Legal representative: ______
Address: ______________
Contracting representative: _________
______ year ____ month ____ day
Party B: ______________
Legal representative: ________
Address: ______________
Signed on behalf of: __________
______ ____ month ____ day
School Cafeteria Contract Agreement Template 5
Party A: __________________
Party B: __________________
After friendly consultation between the two parties, the following agreement has been reached on the specific matters of Party B's contracting of Party A's staff cafeteria:
I. Party A provides Party B with the cafeteria and the operating Equipment, water, electricity and fuel costs. Cafeteria staff wages, benefits by Party B is responsible for.
Second, Party A's cafeteria by Party B assigned professional managers and staff stationed in Party A's company for on-site operation, to provide dining services for Party A's employees.
Third, Party B in the contract period, must be added or need to replace equipment, appliances, etc., by Party B to submit an application, the Party agreed to be responsible for the purchase of Party A. Without Party B's consent to the purchase of equipment, equipment, appliances, etc., Party B is responsible for the purchase. Without Party A's consent to add equipment, Party A does not bear any costs.
Fourth, Party A employees per person per day meal standards for Chinese food ______ yuan (___________), dinner ______ yuan (___________), dining meals see menu; soup, rice buffet.
Fifth, Party A in the New Year festivals, such as meals, Party B are to provide Party A's dining services; such as the need to organize meals, should be in accordance with the standards proposed by Party A to be arranged to operate.
Six, by Party B advance Party A's meals, regular settlement; settlement with Party B to provide a daily checklist of the total amount and check with Party A after Party A should be paid in cash or by check in a timely manner.
VII, the contract period from ______ ______ month ______ day to ______ ______ month ______ day.
VIII. The rights and obligations of Party A:
1. Party A supervises Party B's legal operation in accordance with the contract and performs the contract and various administrative functions.
2. Party A supervises the food, seasoning and hygiene distributed by Party B and gives valuable advice in time.
3. Party B in other areas of breach of contract, Party A should be proposed to Party B to correct, Party B should be investigated as soon as possible to implement the results of the treatment to inform Party A.
4.
4. Party A should actively cooperate with Party B to implement the provisions of the relevant dining, screening the actual staff feedback issues, so that Party B to improve the operation in a timely manner to improve the quality of better service.
Nine, Party B's rights and obligations:
1. Party B should strictly follow the safety and fire safety, health and quarantine, security management and your company's regulations.
2. Party B's cafeteria staff must be in accordance with the requirements of the health department for health checks.
3. Party B must strictly abide by the "Shanghai Food Hygiene Management" to do a good job of purchasing the cafeteria, strictly control the quality of incoming food, to prevent spoiled food into the operation site.
4. Party B must start the meal on time according to Party A's regulations, must be on time, insulation, quality and quantity of supply of meals, to achieve fresh and delicious, renovated nutrition with uniform. If there is any change in the meal time, Party A's notice shall prevail.
5. Party A's kitchen equipment, Party B should be proper and reasonable use, proper storage, not man-made damage and loss, or pay compensation; at the same time should save water, electricity, fuel.
6. During the operation period, Party B's employees are strictly prohibited from entering Party A's production area.
7. If the health accident caused by improper operation or purchase, subject to the identification issued by the relevant health department, Party B is responsible for compensation for medical expenses.
X. Other
1. If one party intends to terminate the contract in advance, it should be negotiated by both parties and notify the other party in writing one month in advance.
2. Party A shall settle the remaining main and side food (according to the market price) together with the last meal fee in cash to Party B within three days after the termination of the contract.
XI, if there are outstanding matters, can be negotiated by both parties to supplement this agreement, the contract from the two sides to sign the seal of the date of entry into force. This agreement in duplicate, both sides of a copy.
Party A (seal): __________
Party A representative: ______________
Party B (seal): __________
Party B representative: ______________
______ ______ ______
______
School canteen contract agreement template 6
Party A according to the need for the original staff canteen contracted to Party B operation, management, A and B through friendly consultation special signing of this agreement, A and B *** with the same to comply with the implementation.
First, the contracting parties
Contractor: __________________ (hereinafter referred to as Party A)
Contractor: __________________ (hereinafter referred to as Party B)
Second, the contracting period
From ______ year ______ month ______ to ______ the end of the ______ month ______ of ______.
Second, the contracting method
Party A will contract the workers' canteen to Party B at ____________ price. Party B will take care of water, electricity and steam costs, of which, water ______ yuan/ton, electricity ______ yuan/degree, steam ______ yuan/ton. Party B is responsible for purchasing and installing water, electricity and steam measuring instruments according to Party A's designated location.
The contract is signed with a deposit of ______ yuan, otherwise this contract is null and void, and the deposit is refunded after the completion of the contract.
Third, the authority of Party A
1, Party A has the right to inspect, supervise Party B's business management, such as health, safety, security, fire, especially to prevent food poisoning accidents, once a similar accident occurred, after the health department review to confirm that the Party B is responsible for the Party A has the right to pursue the Party B's responsibility.
2, because of Party B's cafeteria staff negligence affects the normal work of Party A (except in special circumstances) Party A has the right to pursue Party B's responsibility.
3. Party A has the right to supervise and inspect Party B's safety, hygiene and service, etc. If Party B fails to meet the standards, Party A has the right to ask Party B to rectify and improve.
4, Party B purchased food and raw materials must have the relevant food hygiene inspection certificate for health quarantine unit inspection, if the violation of the provisions of all the consequences of Party B is responsible for.
5, Party B early termination of the contract, the deposit is not refundable.
Fourth, Party A's responsibility
1, to provide Party B with normal business premises and infrastructure.
2, shall not arbitrarily stop the contract and with the increase in fees.
V. Party B's authority
1, the right to operate independently of the employment, call the cafeteria staff.
2, Party A default, Party B has the right to terminate the contract.
Six, Party B's responsibility
1, Party B to arrange their own kitchen staff, and self-financing.
2, Party B is responsible for the operation and management of the cafeteria, including cafeteria safety, fire safety, dining environment hygiene, service and so on.
3, Party B must comply with national and local standards related to environmental and food hygiene. Strictly prohibit the provision of rotten and spoiled food, keep the dishes fresh and hygienic.
4, after the meal carefully wash tableware and disinfection work, the canteen interior, dining hall, kitchen health to: a meal a cleaning, a week a sweep, the plane every day sweeping, fa?ade week weekly engage in, keep the kitchen cabinet hygiene, tableware neat and tidy, regular extermination of the four pests, the environment in line with the requirements of the company and the health management department.
5, Party B staff regular health checkups (inspection costs paid by Party B) to ensure good health, no infectious diseases. If Party B does not follow the regulations for regular health checks, health does not meet the requirements of the health standards of the catering industry, Party A has the right to refuse Party B personnel to enter the cafeteria work.
6, Party B's kitchen staff must comply with Party A's rules and regulations, and shall not enter or leave Party A's office area, construction area or other prohibited areas, such as violation of the provisions of Party A to be dealt with.
7, the contract period Party B shall not be unauthorized to change the canteen, subcontracting nature or subcontract others, otherwise it will be a breach of contract.
8, Party B canteen utilities must be paid before the monthly ______, such as Party B did not pay Party A on time, overtime a week later, Party B should bear the corresponding late fees (according to the bank late payment processing).
9. In case of group food poisoning, the contractor should take the initiative to take the responsibility and pay the expenses incurred as a result.
10, in the contracting period of the canteen, the company regularly collects the dining staff on the canteen meal quality and price of the evaluation of the collection of opinions, when the dining staff on the canteen opinion is large, dissatisfaction rate of 30% or more, and asked to stop the contract, the company has the right to terminate the contract, the early termination of the contract for the production of additional costs borne by the contractor.
Seven, Party B should do other things
1, Party B is required to pay the company contracting deposit ______ as a security deposit. In the assessment of the deductions and emergencies occurring in the need for costs, Party B is unwilling to pay, you can first advance, but Party B is required to make up the amount of the deposit within 10 days.
2, each meal supply needs to be clearly marked price, not allowed to operate outside.
3. Party B's cafeteria staff pay their own wages.
4, the canteen goods in and out should accept the company's janitorial inspection, to comply with the company's rules and regulations.
8, the above as a canteen contract terms, the contract should be *** with both sides to comply with the signatures of the two sides valid, in duplicate, the contract between the two sides to hold a copy.
Party A representative [signature]: ____________ Party B representative [signature]: ____________
Unit [seal]: ________________ Unit [seal]: _________________
Phone: ______________________ Phone: _______________________
Date: ______ Date: ______ Date: _____ Date: ______ Date: _____ Date: _____