Signing a contract is a very common and common form of protecting ourselves after we work. No matter what we do, we need to keep a proof, as a proof of our future. The following is a "company engineering labor contract model general version", which is only for reference, welcome to read.
company engineering labor contract model generic version of aContract No.: __________
Party A: ____________________
Party B: ____________________
According to the "Chinese People's **** and the State of the Contract Law", "Chinese People's **** and the State of the Construction Law and other relevant laws and administrative regulations, Party A contracts part of the works and processes of the _______________ project to Party B. In order to clarify the rights and obligations of both parties, on the basis of fair and reasonable, through the consultation of both parties, to reach the following terms, hope that *** with compliance.
Article I Contract Documents
As an annex to this agreement, the following documents and this agreement *** with the composition of the contract documents, and with this agreement has the same effect:
1. Construction technical specifications for the project, technical instructions, work instructions, drawings;
2, Acceptance standards;
3. Construction safety standards of the project;
4. Construction organization design of the project;
5. Construction progress plan of the project (including nodal plan);
7. Documents of the owner, supervisor and Party A;
8. Supplementary agreements, minutes and commitments of both parties.
Article 2 Contracting unit price
See (Annex) for details, no price adjustment.
Article 3 Conventions
1. Party B is responsible to Party A, recognizes and strictly follows the standards signed between Party A and the owner on quality, safety, technology, environmental protection, civilized construction, etc., and completes the construction within the construction schedule (including nodal plans) issued by Party A.
2. Measurement and Payment
2.1 After Party B completes the contracted project, Party A will make measurement and payment based on the number of qualified works completed by Party B and the unit price of the bill of quantities (Annex 1).
2.2 Party B shall organize construction according to Party A's construction plan. If the construction plan is not completed due to Party B, Party A shall have the right to claim compensation from Party B for the delay incurred as a result (Compensation = ____‰ x Subject Amount x Days of Delay). The maximum limit of this compensation is ____% of the total price of the task volume. At the same time, Party A has the right to terminate this contract.
2.3 There is no advance payment for the project, Party B should have the ability to advance funds before settlement payment.
3. Supply of materials for the project
3.1 The main materials required are under the responsibility of Party B, and can be used only after Party A passes the inspection.
3.2 Party B shall not make any claim to Party A if the construction is affected by irresistible external forces such as road blockage and natural disasters, which cause the materials not to arrive in time.
4. Measurement, testing, inspection and other technical work
4.1 Party A, according to the need to carry out at any time in writing as the main form of technical delivery, measurement.
4.2 Party A is responsible for engineering test inspection work, Party B should be under the supervision of Party A with Party A laboratory inspection.
5. Party B shall not subcontract. Otherwise, Party A has the right to terminate the contract. Party B shall bear the loss caused by this and pay Party A the liquidated damages of _____% of the total price of this contract.
6. Concealed works can only be carried out after acceptance by Party A and Supervisor.
7. The unit price contracted by Party A to Party B covers the full cost of construction. Party B, as an economic entity, should fulfill all the social obligations stipulated by the state (labor, medical, work-related injuries and other kinds of insurance, various taxes and fees, etc.).
8. According to the Labor Law, Party B shall pay employees' labor remuneration on time and in full (not lower than the minimum wage standard announced by the local government). Party A has the right to monitor, if necessary, Party A has the right to pay on behalf of (directly to the wages paid to the hands of Party B employees).
9. The unit price of Party A's contract to Party B includes Party B's work injury insurance and third party liability insurance. Therefore, Party B's workplace accident costs and associated costs are fully borne by Party B.
10. Changes in Party B's on-site construction manager and technical manager need to be agreed by Party A, and Party A needs to fulfill the leave procedures for leaving the site.
11. Party B completed the workload (calculated according to the number of entities) by the Party commissioned a representative to sign the validity. Project payment by Party A technology, safety and quality, materials, contracts, finance and other departments responsible for signing, Party A captain approved payment.
12. Party A has the right to make an assessment of Party B's performance ability, if Party B is incapable of performance (especially quality, schedule, safety), Party A has the right to terminate the contract, and has the right to claim damages from Party B according to the total amount of the contract subject matter _____%.
13. After the signing of this contract, Party B's personnel and equipment must enter the construction site according to the promised time. Otherwise, Party A has the right to terminate the contract or make corresponding penalties for Party B's breach of contract (the penalty standard shall be determined by Party A according to the degree of Party B's breach of contract, and the penalty limit shall be ____% of the total price of Party B's task volume).
14. Party B is responsible for the safety of the project, equipped with the necessary safety protection facilities, and in accordance with the relevant state safety laws, administrative regulations, operating procedures, and submit to Party A's safety supervision and management, regardless of the reason, resulting in personal injury or death, mechanical accidents, Party B bears full responsibility, Party A does not bear any responsibility.
15. Party B must do on-site civilized construction and environmental protection, including the control of dust, reduce noise and other operations related to this, and equipped with a variety of signs to meet the construction of the project, signage.
16. Party B shall take measures to actively cooperate with Party A's owner or supervisory engineer's regular or unscheduled inspections and evaluations. If Party B, due to Party B's reasons, penalizes Party A in the owner's or supervisory engineer's inspections and evaluations or affects Party A's evaluation results, Party A will double Party B's fines or impose penalties on Party B according to the results of the evaluation. If Party B's cause causes events that seriously affect Party A's credibility, Party A has the right to terminate Party B's contract.
Article IV Dispute Resolution
If a dispute arises during the fulfillment of the contract, the two parties agree to settle it in the following ways:
1. Both parties shall, on the basis of voluntary and friendly, communicate with each other, understand each other, and solve the problem through negotiation;
2.Mediation. Under the auspices of a third party, through the third party's persuasion, guidance, mediation methods to resolve disputes and reach an agreement;
3. Arbitration. If the consultation and mediation fails, the arbitration shall be conducted by the Arbitration Commission of the City of ________.
Article V By-laws
1. This contract needs to be negotiated between the two sides to sign a supplementary agreement, the supplementary agreement and this contract have the same legal effect.
2. This contract shall enter into force upon signature and seal of both parties, and shall expire naturally upon completion of the project, settlement of the final payment, and expiration of the warranty period.
3. 2 copies of the original of this contract, each party 1; 2 copies, Party A 2 copies.
Party A: ______________ Party B: ______________
Representative: ____________ Representative: ____________
Phone: ______________ Phone: ______________
The contract Time of conclusion: ________ year ________ month ______
Company engineering labor contract model general version twoParty A (referred to as Party A): ________________
Party B (referred to as Party B): ________________
Risks to inform: Contractor and labor subcontractors Labor subcontracts should be strictly signed to avoid the construction company will be difficult to defend its rights and interests in the event of schedule and quality problems due to the absence of labor subcontracts or unclear contractual agreements despite the signing of labor subcontracts. Labor subcontractor legal operation must include two forms: one is with the labor qualification of the building construction enterprises that labor subcontractor (general contracting enterprises or professional contracting enterprises) to establish labor subcontracting relationship; two is with a number of pre-service training in a particular area of natural persons in each of the workers to sign a labor contract.
In accordance with the Contract Law of the People's Republic of China*** and the relevant laws and regulations, and following the principles of equality, voluntariness, fairness and honesty, the two parties enter into this contract by consensus on the matter of labor employment for the project.
Article 1, Project Overview
The project is a ___________________ project at ___________________, with the main content of ___________________.
Article 2, Contracting Method and Requirements
The project Party A takes the form of sub-trades, unit price combined into a lump sum, contracted to Party B in the form of package tax, package labor, package food and accommodation. Requirements for the contracting team with labor contracting qualifications, the main types of work to have a certificate of employment, and the preparation of a roster of personnel to the Party file for inspection.
Article 3, the project contract unit price and content
After consultation between the two sides, the _______ project according to the _______ yuan / (m2, m3, t) of the contract unit price contracted by the B side, the contract unit price includes the following: the completion of the construction party to provide a full set of construction drawings, minutes of the briefing, changes in all the contents of construction; site preparation and maintenance of all the contents of the construction; the construction of the site, the construction of the site and the construction of the site, the construction of the site and the construction of the site. The contract unit price includes the following: completion of the full set of construction drawings provided by the construction party, the minutes of the delivery, the changes related to the construction of all the contents; site regularization and cleanup; 200 meters within the ground level transportation; maintenance of production equipment, maintenance; material conservation; and other teams to cooperate with the content.
Article 4, the duration of the project
The date of the start of the employment of labor ______ ______, the date of the end of the employment of labor ______ ______, *** counted ______.
Article 5, civilized construction, standardized management
Construction site B must meet the requirements of ______ level civilized site; must meet the requirements of ______ level standardized site.
Article VI, project quality and safety
According to the owner's requirements, the quality of the project is required to achieve excellent, so the single contracting must ensure that excellent, such as the quality of the project was assessed as excellent engineering, Party A appropriately given incentives, such as contracting for a single evaluation for the unqualified, the Party B rework repairs until qualified, and all the reworking of the Economic losses borne by Party B, and deducted from Party B labor settlement.
Party B construction personnel must obey the arrangements of Party A management personnel, must strictly abide by the "safety regulations", in order to enable workers to enhance the awareness of safety, with the team and the team responsible for the daily arrangement of the workload, to carry out safety education, emphasize the safety of operation, with a good helmet, fitted with safety net fastened with a good seat belt, to do a good job of all the security work, to put an end to the occurrence of safety accidents. Any safety accidents caused by Party B are responsible for Party B, Party A does not bear any economic and legal responsibility.
Article VII, the payment method
The project B team into the field, its upfront costs by Party B is responsible for, Party A according to the progress of the project lent Party B a certain amount of cost of living, the main body of the top of the payment of ______% of the cost of labor. The completion of the project is paid to ______% of the labor fee. Pay the labor cost to ______% of the labor cost after the settlement of the project. Leave 10% to be paid within one month after the expiration of the warranty period. Due to the tight schedule of the project, and the owner's rewards and penalties, in order to ensure that the project is completed according to the completion of the completion date, so Party B to enter the site must pay the construction period of the deposit _______ million. Party B in the construction site must be determined in accordance with the Party A's schedule control points, careful organization, careful construction, to ensure the achievement of the schedule target, such as Party B causes delays in the construction period. In addition to the deduction of the schedule deposit, the penalty will be given according to the contract signed between Party A and the owner.
Article VIII, the responsibility of both parties
(a) Party A's responsibility
1, the preparation of the construction organization design and construction program, on-site delivery to Party B, the construction of the delivery and three levels of safety education, and provide construction drawings.
2, provide construction temporary facilities and water, power supply, provide accommodation for Party B personnel.
3, for Party B personnel to do temporary residence permit, badge and other relevant documents.
(B) Party B's responsibility
1, Party B shall enter the field after Party A's examination and approval, and before entering the field, must submit or apply for the relevant documents to Party A (ID card copies, temporary residence permits, labor certificates, certificates, etc.) to ensure the authenticity and validity of the documents provided.
2, before entering the field, Party B shall determine its responsible person, and enter into a power of attorney, authorized to entrust its responsible person on behalf of the Party and Party A to settle, receive wages, as well as to deal with matters related to them.
3, to ensure the authenticity of the information reported to Party A, to prohibit fraud, and to maintain the normal order of business management of the company.
4, strictly in accordance with the Party's construction design, delivery and program organization of construction, must be changed should seek written consent from the Party, otherwise the Party has the right to refuse acceptance and settlement of wages.
5, Party B personnel in and out of the site, living quarters must wear a badge, not to bring unrelated personnel in and out of the site and living quarters, non-operating time, may not enter the site.
6, Party B shall strictly according to Party A approved monthly node progress plan to organize construction, to ensure the progress of the project. If Party B can not complete the plan on schedule, Party A can take corresponding measures to ensure progress, the costs incurred by Party B. If Party B fails to complete the plan for two consecutive months, Party A shall not be allowed to enter the site during non-operating hours. If Party B fails to complete the plan for two consecutive months, Party A can unilaterally terminate this contract, and Party B will bear the losses incurred.
7, Party B shall obey Party A's management and command in construction, enhance self-management consciousness, and achieve safe construction, civilized construction.
8, Party B before entering the field must truthfully inform Party A of the health status, including the presence of disabilities, infectious diseases and other diseases affecting the construction of this type of work and the health of others. If the safety accidents caused by Party B's disability, all the consequences will be borne by Party B. After entering the site, Party A found that the health condition of Party B's personnel is not suitable for on-site construction work, it must unconditionally withdraw from the site.
9, Party B must comply with Party A's management system on labor, does not meet the requirements of Party A, Party A has the right to dismiss.
10, strictly in accordance with the construction process organization, without Party A acceptance shall not carry out the construction of the next process.
11, on the Party's request for the existence of objections, can take the consultation approach to deal with.
Company engineering labor contract model generic version of three
According to the "Chinese People's *** and State Contract Law" and "Construction Contract Regulations" of the relevant spirit, by the A and B negotiation, Party A agreed to the project of the project's labor contracted to Party B, in order to clarify the rights and obligations of the two sides, signed the following provisions of the agreement for both parties to *** together to comply with.
I. Project Name and Location
The project is ________________ project at ________________ .
Second, the contracting method and requirements
The project Party A to take the form of sub-trades, unit price combined into a lump sum, in order to package tax, package labor, package food and lodging way contracted to Party B. The contracting team is required to have a labor contracting qualification. Requirements for the contracting team with labor contracting qualifications, the main types of work to have a certificate of employment, and the preparation of a roster of personnel to the party archives for inspection.
Third, the project contract unit price and content
Labor contract model contract negotiated by the two sides, the ________________ project according to the yuan / (m2, m3, t) of the contract unit price contracted by the B side, the unit price of the contract includes the following: completion of the construction of a full set of construction drawings, minutes, changes to the construction of the relevant construction documents, minutes and changes to the contract. The contract unit price includes the following contents: completion of the full set of construction drawings provided by the construction party, the minutes, changes in the construction of all the contents; site preparation and cleaning and other contents. Before Party A pays, Party B shall provide Party A with the corresponding invoice in advance.
Four, project quality and safety
According to the requirements of the A, the quality of the project is required to achieve excellent, so the single contracting must ensure that the excellent, such as contracting a single evaluation for the unqualified, by the B rework repair until qualified, the reworking of all the economic losses borne by the B, and deducted from the labor settlement of the B party.
Party B construction personnel must comply with the arrangements of Party A management personnel, must strictly abide by the "safety regulations", in order to enable workers to enhance the safety awareness, the team and the team responsible for the daily arrangement of the workload, to carry out safety education, emphasize the safety of operation, with a good safety helmet, installed safety nets fastened with a good seatbelt, and do a good job of all the safety protection work, to eliminate the occurrence of safety accidents. Any safety accidents caused by Party B are Party B's responsibility, Party A does not bear any economic and legal responsibility.
Fifth, civilized construction and rewards and penalties
Party B into the construction site personnel must comply with the civilized construction manual, in the scope of their own contracted to do the work of the material end of the site clear, strictly put the material savings off, not allowed to sawing, littering, waste of materials, such as found in the responsibility of the separation of the fines given. At the same time, Party B strictly abide by the security management regulations, violators will be fined, Party B personnel must obey the command of the management staff, to comply with all the rules and regulations of the site.
Sixth, payment and duration
This project labor labor cost of all engineering prices have been included, no longer another project, if any, the scene according to the actual situation. After the project team B into the field, its upfront costs by Party B is responsible for, before the start of the project to pay the labor cost of ___________%. Payment of ___________% of the labor cost is made before the project is completed. Pay ___________% of the labor fee after the settlement of the project. Leave ___________% to be paid within one month after the expiration of the warranty period.
Party B's work period time is: ___________ ___________ month ___________ from ___________ to ___________ ___________ day.
VII, the two sides of the power and obligations
(a) Party A
1, Party A has the right to qualify Party B, Party B violation of the terms of the contract content of the implementation of penalties, economic compensation and the right to dismissal.
2, Party A in accordance with the requirements of the project, arrangements for Party B to implement the project contract content, Party B shall unconditionally comply with the implementation.
3, Party A to provide Party B as convenient as possible construction conditions, and according to the labor contract and the owner of the payment of labor fees.
4, Party A to Party B to provide construction workers to implement the real name system, the establishment of health status files, the disabled and mentally challenged workers are dismissed, shall not enter the construction.
(B) Party B
1, Party B must be submitted to Party A in line with the contracting qualifications and the right to put forward legitimate requirements of Party A, take the initiative to undertake all the work of the contract to ensure the quality of the project.
2, Party B must be in accordance with Party A's requirements for safe production, Party B shall not violate the safety regulations without authorization, for the violation of safety regulations for personal injury and fatal accidents, Party B must assume full responsibility, Party A is not responsible.
3, Party B has the right to reject Party A does not meet the safety requirements of the instructions, and put forward their own views for Party A's reference.
4. Party B shall not use disabled and mentally challenged workers, and shall not conceal and use them privately. At the same time, Party B shall provide a list of personnel, identity cards.
5, Party B should control their own team, not in the site and outside the illegal and criminal activities, such as gambling, prostitution, mistressing, etc.. Once caused by the consequences of the crime, Party A is not responsible.
6, in order to ensure that the work schedule, Party B must be required by Party A to ensure that the project enough labor, not passive.
VIII, breach of contract and other
1, the above terms and conditions must be strictly observed by both parties, any party to violate or cause the suspension of the project, the defaulting party must be held responsible.
2, such as Party B cause damage to the company's reputation, site equipment and the project caused some economic losses, Party A has the right to require Party B to compensate for all losses, and deducted from the contracted labor costs.
3, belonging to Party B's own equipment, bring their own tools and appliances, Party B must be their own custody, and shall not be put forward to Party A to make other requirements, and shall not find excuses to affect the quality and progress of the opening process, the resulting loss borne by Party B.
4, this contract in triplicate, Party A two, Party B one, signed by both parties to enter into force, with the same legal effect.
5, the disputes arising from this contract will be resolved through consultation between the two sides, and when the settlement fails, the people's court jurisdiction.
Party A: ________________
Responsible for: ________________
Authorized representative: ________________
Date of signing: ___________ year ___________ month ___________ day < /p>
Party B: ________________
Responsible person: ________________
Authorized representative: ________________
Date of signing: ___________ ___________ month ___________ day end < /p> Company Engineering Labor Contract Sample General Version IV
Party A: ___________
Party B: ___________
In accordance with the Contract Law of the People's Republic of China, the Construction Law of the People's Republic of China, as well as other relevant laws and administrative regulations, and in accordance with the principles of equality, voluntariness, mutual benefit, fairness, and honesty and credit, the two sides On this project construction labor contracting matters consensus, to enter into this contract.
I. Overview of the project
1. Name: ___________
2.
Second, the contract duration
1. Start date: ___________ ___________ month ___________ day
2. Completion date: ___________ ___________ month ___________ day
3. In the construction, in case of natural disasters of human force irresistible and cause damage, delayed schedule, etc., according to the construction unit of the relevant provisions of the Party A, and after the implementation of the Party A, the Party A to the Party B.
4. If in the construction, Party B did not follow Party A and the construction side of the relevant construction progress organization and arrangement of construction, resulting in the construction side of Party A's delay in the schedule for fines, Party A has the right to Party B contracted by the project to divide, and according to the penalty of double the cost of the penalty to Party B.
Three, the quality of labor
1. Party B must be in accordance with the design documents, the state and the relevant departments of the current technical specifications and construction unit requirements for construction.
2. Party B must obey the quality management of the supervisor and Party A on-site personnel.
3. The quality of all projects is qualified at ___________%.
4. Due to Party B's failure to meet the above standards resulting in unqualified quality of the project, Party A will not accept the work and has the right to order it to rework, all the costs borne by Party B until the quality requirements of the standard, the rework costs and the responsibility for breach of contract borne by Party B, and the construction period will not be postponed.
Four, safety construction and inspection
1. Party B must develop safety measures, strictly according to the relevant safety regulations and standards for construction to ensure construction safety.
2. Party B should comply with the relevant provisions of the project construction safety management, must obey the site safety management personnel instructions and safety management, and at any time to accept the industry safety inspectors in accordance with the implementation of the law supervision and inspection, to take the necessary safety measures, to eliminate accidents and hidden dangers.
3. In the construction, if Party B violates the safety operation regulations, or causes personal injury or death and other safety accidents and third-party liability accidents by Party B, the responsibility and costs are all borne by Party B.
All the construction work is carried out in accordance with the safety management system of the construction industry.
Fifth, safety protection
1. Party B in the power equipment, power lines, underground pipelines, flammable and explosive areas, as well as the street or across the traffic lanes when the construction should be taken in accordance with the provisions of the practical safety measures.
2. Party B in the construction site to use the safety protection supplies (such as helmets, safety belts, safety ropes and other protection supplies), the use of Party B proposed by the plan, Party A is responsible for the supply, the cost borne by Party B.
Sixth, the supply of materials
1. The main materials used in this labor contract (including steel, cement, cement concrete, etc.) supplied by Party A, other materials purchased by Party B, self-transportation, safekeeping, and responsibility for damage and loss.
2. Labor contracting, such as the need for other materials by Party B to purchase their own, all materials must meet the design standards and quality requirements, and submit to Party A material certificates (original), or cause adverse consequences of all the responsibilities and costs by Party B.
Seven, design changes, hidden works
Design changes, hidden works in the construction, design drawings and site geological inconsistencies, Party B should report to Party A in a timely manner, without the consent of the construction shall not be carried out. Concealed engineering inspection should be notified to Party A 24 hours in advance of the quality control engineer, without the signature of Party A quality control engineer, shall not carry out concealed engineering construction, or redo, inspection and rework costs are Party B is responsible for.
Eight, labor pull
1. The project does not implement the prepayment, the first month of construction costs by the labor party advances.
2. Check the price and project progress payment:
① check the price: the labor inspection by the two sides of the relevant person in charge of the scene of the design drawings within the scope of the completed project inspection and acceptance of the quality of those who are qualified to be accepted for measurement. At the end of each month by Party B to submit the number of projects, and then by the Party's Engineering Quality Inspection Department audit, the Contract Department according to the audit information and the agreement unit price for the price of labor inspection, signed by the person in charge of Party A after the establishment of the price of labor inspection.
② project progress payment: after the establishment of the monthly price inspection, Party A from the price of the price of the inspection of the materials advanced back to the payment and other agreed costs, and retained 20% of the total amount of the price of the price of the inspection of the project as a warranty, the remaining balance of the amount payable to the project progress payment.
③ If the construction unit due to a variety of factors caused by the arrears of the project, temporarily unable to pay, A and B shall **** the same risk.
IX. Party A's responsibility (according to the negotiation of responsibility)
1. Responsible for the review of construction drawings, technical delivery and site delivery.
2. Responsible for all the command and coordination of the construction site, responsible for the development of construction technology, construction techniques, safety and quality standards and measures, and supervise the implementation of Party B.
3. Responsible for the regular implementation of review measurements, daily construction measurements determined by mutual agreement.
4. Responsible for design changes in the number of calculations and technical briefings, all design changes are in writing to Party B, as an increase or decrease in the number of projects and the price of the project based on any verbal form of change is invalid.
5. Party A to strengthen on-site management, responsible for the progress of the project, quality, hidden works, inspection, acceptance, on behalf of the visa, to deal with construction matters should be dealt with by Party A.
6.
6. Assist Party B to carry out accident rescue.
7. Pay the project sales tax on time.
X. Party B's responsibility (according to the negotiation of the responsibility to be borne)
1. Party B must bear the obligations of Party A to the construction unit and the risk of contracting.
2. Party B must pay the civil workers' wages on time, and shall not have any behavior such as defaulting or withholding the civil workers' wages. Otherwise, Party A has the right to give financial penalties, until the termination of the contract.
3. If Party B causes reputational impact on Party A, it should actively restore the impact, otherwise Party A will impose a fine of ___________ yuan on Party B.
4. Party B should manage its own staff, often educate on folk customs and folklore, and should not have disputes with outsiders to affect the normal construction; otherwise, the consequences will be borne by themselves.
5. Party B should do a good job of labor management, proper storage, reasonable use of Party A provided or leased to Party B to use the machinery, swing materials and other facilities.
6. Party B shall not subcontract or subcontract the construction work, and any dispute between Party B and any third party shall have nothing to do with Party A, and shall be solved by Party B on its own responsibility.
7. Unconditional acceptance of Party A's work arrangements and workload adjustment.
Eleven, the contract dispute resolution agreement
In the event of disputes arising from this contract, the two sides to negotiate a solution, such as consultation can not be resolved, the dispute resolution organization: the People's Court of the location of Party A.
The contract shall be signed by both parties to the contract.
XII, other
1. This contract shall enter into force on the date of signing and sealing by both parties **** together.
2. If there are imperfections in the implementation of the contract, the two sides agreed to add a supplementary contract as a supplement to this contract, and this contract has the same effect.
3. The original contract in duplicate, A and B each party.
Party A (official seal): ___________ Supplier (official seal): ___________
Address: ___________ Address: ___________
Phone: ___________ Phone: ___________
___________ __________ ___________ ___________ ___________ ___________
Signed: ___________
Signed at: ___________
Signed at: ___________