Attachment 3 - Base Safety Requirements.pdf
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- Attached to
- Fire Alarm Inspection, Testing, and Maintenance Federal contract opportunity
- Solicitation number
- FA441820RFIRE
About this file
This document contains a safety guide and briefing for contractors working at Joint Base Charleston. The guide outlines numerous safety requirements contractors must follow, including complying with OSHA standards, properly barricading and lighting work areas, using qualified equipment operators, restricting access to airfields, registering electronic devices, following confined space and lockout/tagout procedures, and immediately reporting any accidents or injuries. Contractors are also required to develop and provide various safety programs covering hazardous communications, lifting, respiratory protection, and excavation. The briefing highlights additional policies such as obeying traffic and speed laws, properly securing loads, coordinating welding permits, and wearing personal protective equipment.
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Other files for this federal contract opportunity
| File | Type | Posted |
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| Section C-H - Revised PWS 12 Dec 19.docx | DOCX document | |
| Amendment 001 Fire Alarm FY20.docx | DOCX document | |
| QA Fire Alarm FY20 13 Dec 19.pdf | ||
| Section B - Revised Price Sheet 12 Dec 19.xlsx | XLSX spreadsheet | |
| Section B - Pricing Sheet FY20 Fire Alarm.xlsx | XLSX spreadsheet | |
| Attachment 5 - Environmental Management Requirements.pdf | ||
| Attachment 2 - NPTU Contractor Special Conditions_05JUN18.pdf | ||
| Attachment 4 - Fire Prevention.pdf | ||
| Section C-H - Fire Alarm FY20 PWS.pdf | ||
| Attachment 6 - Green Procurement Form.pdf | ||
| Attachment 1 - Contractor Base Access Requirements_1JULY19.pdf | ||
| Attachment 7 - WD 2015-4427 Rev 12 16July.docx | DOCX document | |
| PPQ Fire Alarm.doc | DOC document | |
| Section A - Combo Fire Alarm FY20.pdf |
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628th AIR BASE WING
PRE-PERFORMANCE/PRE-CONSTRUCTION
SAFETY GUIDE FOR CONTRACTORS
JOINT BASE CHARLESTON, SOUTH CAROLINA
EMERGENCY TELEPHONE NUMBERS
NOTE* 911 Call may go to off base operator ensure to state location as Air Base or Weapon Station
FIRE REPORTING……………………………… 911
AMBULANCE…………………………………
SECURITY FORCES (POLICE)…...…………... (843)963-3600
SAFETY…..…………………..……………….….. (843)963-5594
BASE CONTRACTING ………………….……... (843)963-5155
CIVIL ENGINEERING……………..…………… (843)963-5027
2 Jan 2018
MEMORANDUM FOR GOVERNMENT CONTRACTORS
FROM: 628 ABW/SE
102 E. Hill Blvd
Joint Base Charleston SC 29404
SUBJECT: Mishap Prevention and Safety Standards
1. This is to familiarize you with the 628th Air Base Wing Safety (628th ABW/SE) Program and your responsibilities regarding safety during performance of your contract.
2. General: While working on Joint Base Charleston (JB CHS), you must comply with all applicable Air Force and OSHA regulations. If a safety discrepancy is discovered, the 628th
Contracting Squadron (628th CONS) Contracting Officer will be informed for corrective action.
3. Safety Equipment: Ensure all equipment applicable to the contract is available, serviceable, and properly used.
4. The Occupational Safety and Health Administration (OSHA) has a regional office in Columbia, SC and have access to your work site at any time.
5. Job Site Hazards: It is your responsibility to review and comply with all items on the attached checklist. This checklist is not all-inclusive but is provided as a quick reference to common issues and items. If you use any sub-contractors, you must provide them a copy of this checklist. You must make every effort to prevent injuries and protect government property from damage.
6. Seat Belts: Use of seat belts by vehicle operators and passengers is mandatory while operating on JB CHS. Violations will be reported to 628th CONS Contracting Officer.
7. Mishap Reporting: Contractor mishaps/incidents resulting in damage to any government equipment, property, or injury to Air Force personnel (including civilian employees) must be reported to and investigated by the 628th ABW/SE as soon as possible.
CHRISTOPHER ANDERSON, GS-13, DAFC
Director of Safety
Attachment: 1 Atch
Contractor Brief
CONTRACTOR SAFETY BRIEFING
1. This contractor’s safety brochure is provided to assist you in your accident prevention program during your work at Joint Base Charleston (JB CHS). As a contractor you are required to comply with the Occupational Safety and Health Act (OSHA) of 1970 and the portions of OSHA Standards
29 CFR 1910, 29 CFR1915, 29CFR 1917, 29 CFR 1918 and 29 CFR 1926 applicable to your operations.
2. When the 628th Contracting Squadron (628th CONS), Contracting Officer becomes aware of contractor non-compliance with safety standards, which may cause injury to JB CHS personnel or damage to JB CHS property or equipment, he/she will inform the contractor. The contractor will take immediate steps to correct the situation.
3. Some common contractor violations on Air Force installations include: Improper grounding of electrical equipment, failure to properly fence off excavations, parking vehicles improperly, using equipment that has unguarded moving parts, failure to provide safety data sheets (SDS) for chemicals used at the job site, failure to wear seatbelts, excessive speed, failure to yield to pedestrians, violating smoking regulations, improper scaffolding, no fall protection for personnel and inadequate shoring.
4. The following are requirements that often need special emphasis:
a. Air Force Instruction 91-207 The US Air Force Traffic Safety Program, requires the use of seatbelts by operators and all passengers in all vehicles being operated on JB CHS.
b. Building materials stored near the job site will be properly piled or stacked. No material will be piled higher than (6) feet, except in storage areas. Piles more than (4) feet in height will be arranged with the sides or ends of the materials tapered backward. All waste materials, especially those containing projecting nail points, will be continually removed from work areas or be placed in orderly piles where workmen will not be likely to step or stumble over them. All stairways, corridors, and passage ways will be kept free of loose materials, debris and other hazardous obstructions.
c. Trestles, ramps, scaffolds and similar structures will be designed and constructed to safely support the loads to be placed on them.
d. Suitable signs, barricades, and warning lights will be used at locations where workers are working close to streets or motor traffic.
e. All mechanized equipment will be inspected at frequent intervals and kept in safe operating condition. All moving parts of the equipment will be fitted with effective guards that must be in place at all times while machinery is in operation.
f. Mobile equipment operated on the streets will conform to all laws and regulations governing motor vehicles. All rubber tired vehicles licensed for the road must have fenders or mud guards.
Local regulations covering speeds, load limits and other traffic regulations will be strictly observed.
When construction proves hazardous to normal street and roadway users, traffic will be controlled or warned by flag persons, signs, or barricades. Flag persons are required to wear the bright orange reflective vests.
g. Only qualified and properly licensed operators will be permitted to operate powered construction equipment. Equipment will not be left with motors running.
h. Electrical powered equipment will be properly grounded at all times. All 120 volt, single phase, 15- and 20- ampere receptacle outlets on construction sites, which are not part of the permanent wiring of the building or structure and which are in use by employees, shall have approved ground-fault circuit interrupters (GFCIs) for personnel protection. Receptacles on two-wire, single phase portable or vehicle mounted generators rated not more than 5kw, where the circuit conductors of the generators are insulated from the generator frame and all other ground surfaces, need not be protected with GFCIs.
i. Operators must ensure equipment is not allowed to make contact with power lines and a minimum clearance of ten feet or more (between the power lines and any part of the equipment) is maintained in accordance with the requirements of OSHA Standards, 29 CFR 1910 and 1926.
j. When construction equipment is towed, safety chains will be used in addition to regular towing hooks. If equipment is towed after dark, lights will be placed at the rear of the tow.
k. Overhanging portions of loads moved by trailer or truck will be marked by warning flags or lights. The beds of vehicles will not be overloaded.
l. The walls of excavations and trenches will be shored or sloped in accordance with OSHA
Standard 1926. Particular caution will be taken when excavating around gas mains, oil tanks, gasoline or oil pipelines, sewers, water mains and electrical lines. The 628th Civil Engineering
Squadron (628th CES) will be consulted for location of underground lines at construction sites.
m. Adequate barricades and lighting will be used to identify and protect personnel against the hazards of open excavations.
n. The National Electrical Code (NEC) will govern the installation of all wiring and electrical work. Only qualified and certified electricians will perform work. Circuits will be de-energized and lock outs installed as needed.
o. Contractor personnel will not enter the airfield, i.e. runways, taxiways, or parking ramps without the expressed written permission of the 437th Operation Support Squadron (437th OSS)
Airfield Manager. The appropriate 628th CES Branch Chief will then be responsible to brief the escort contractor vehicle operators operating on the airfield.
p. Prior to welding, cutting and brazing operations outside approved shops, the activity supervisor will obtain a written permit from the 628th CES Fire Department (628th CEF) at extension (843)963-3121.
(1) This permit will be retained at the work site until the work is completed with a copy retained by the fire department.
(2) All personnel performing duties as a welder will be fully qualified and certified.
Trainees may perform welding operations only under the direct supervision of an instructor.
(3) The welding operation environment will be free of flammable liquids and vapors.
(4) Fire watcher procedures will be implemented whenever welding activities are conducted within 35 feet of combustible materials, regardless of protection provided. A qualified individual proficient in the operation of available fire extinguishing equipment and knowledge of fire reporting procedures will observe welding and cutting activities.
(5) Fire extinguishing equipment will be maintained, ready for use, while welding or cutting operations are being performed. Equipment may consist of pails of water, buckets of sand, or portable extinguishers depending on the nature and quantity of the combustible material exposed.
q. 628th Medical Group Bioenvironmental Engineering Section (628th BEE) ext. (843)963-
6289, must be advised of any contract operations which involve the use of industrial x-rays units, lasers or radioactive materials.
r. In accordance with OSHA Standard 29 CFR1910.1200 contractors working with chemicals are required to have a Hazardous Communications Program (HAZCOM) and the appropriate safety data sheets (SDS) for chemicals being used at a job site. The contractor is required to submit information on the use of hazardous chemicals according to FAR Clause 52.223-3, “Hazardous
Material Identification and Material Safety Data”. The contractor will also be advised by the 628th
CONS Contracting Officer (CO) at the Pre-Conference of hazardous chemicals used in Air Force operations they may encounter and protective measures needed in the normal course of their work on the premises.
s. All confined space operations must be coordinated with the Joint Base Wing Safety (JB
Safety) office prior to the initial start of work. At that time, Wing Safety will notify the contractor of all hazards associated with the space. The contractor must provide 628 ABW/SE with their written Permit Required Confined Space (PRCS) program and documentation of workers PRCS training. Contractors (to include subcontractors) entering confined spaces on Joint Base Charleston are responsible for the safety of their personnel and for their own permit required space program as outlined in OSHA 29 CFR1910.146/ 29 CFR 1926 subpart AA. The prime contractor is responsible for all sub-contractor confined space operations.
5. The requirements outlined under paragraph 4 above are items that require special attention.
However, it is strongly emphasized that contractors are legally obligated to comply with OSHA
Standards 29 CFR 1910 and 29 CFR 1926.
6. Attachment 1 contains items of special interest to be briefed to the contractor by safety personnel during the pre-construction briefing conducted at the Contracting Office.
SAFETY GUIDE FOR CIVILIAN CONTRACTORS OPERATING ON JOINT
BASE CHARLESTON AIR BASE OR JOINT BASE CHARLESTON WEAPONS
STATION CONTROLLED PROPERTY OR FACILITIES
628th ABW/SE DIRECTOR OF SAFETY PHONE NUMBER: (843)963-5594
OCCUPATIONAL SAFETY MANAGER’S PHONE NUMBER: (843)794-7668/
(843)963-5751
SAFETY REP GIVING BRIEFING: __________________________________________
PHONE NUMBER: (843)963-5596
Purpose: This information pamphlet is provided to assist you in your accident prevention program during your work on Joint Base Charleston (JB CHS). This handout/briefing is a reminder designed to reemphasize to the contractor their responsibility to protect not only their personnel/equipment from accidental injury/damage but also US. Air Forces.
1. This safety guide for civilian contractors is provided to assist you in maintaining an accident prevention program during your time on JB CHS.
2. As a civilian contractor, you are obligated to comply with the Occupational Safety and
Health Act of 1970 and 29 Code of Federal Regulations (CFRs), 1910, 1915, 1917, 1918 and 1926 and all the detailed provisions of the act for accident prevention that are applicable to your operations. Primary contractors are responsible for subcontractors hired by their firm.
3. 628th ABW Safety Office (628th ABW/SE) will not provide you with copies of the
CFR’s. We have access to the codes via internet and will assist in answering specific questions. 628th ABW/SE is located in Bldg. 16000, Room 215, @ 102 E. Hill Blvd. Joint
Base Charleston SC 29404.
a. Contractors have the responsibility of making certain all industrial safety provisions as stated in 29 CFR 1910, 1915, 1917, 1918 and 1926 are followed.
b. The Federal Occupational Safety and Health Administration (OSHA) has the right to inspect civilian contractor operations on JB CHS. The 628thABW/SE has no control over Federal OSHA visits to contractor work sites on the base.
(1) Answering of or correction of any notices of violations assessed by the
Federal OSHA inspector is strictly the responsibility of the contractor.
(2) Settlement of any fines assessed by the Federal OSHA inspector is strictly the responsibility of the contractor.
(3) The Base Staff Judge Advocate will not give an opinion or represent the contractor in any way.
4. The contractor will report any accidents involving Air Force property/equipment damage or contractor personnel injury occurring on the job. The contractor will report such accidents immediately to the 628th CONS, Contracting Officer who is responsible for notifying the 628th ABW/SE. Contractors must provide access to Air Force; Safety, Fire
Department and & Bioenvironmental Engineering (BE) officials to contractor workplaces to verify working conditions of exposed Air Force personnel and property. The 628th
CONS Contracting Officer must authorize this action.
a. The Contractor is required, to notify Federal OSHA in the event of a fatality or hospitalization of 3 or more employees (military, civilian employee or contractor employee).
b. 628th ABW/SE is required to make these notifications as well and such notifications are part of the Wing Safety checklist. Do not rely on the 628th ABW/SE to satisfy your requirement to notify Federal OSHA. Contractors should make available a copy of their mishap reporting procedures to the 628th ABW/SE if requested, through the
628th CONS Contracting Officer.
5. 628th ABW/SE personnel have the right and will periodically monitor the activities of the contractor to assure compliance with the CFR’s and Air Force Standards. If a safety procedure or condition exists which requires correction by the contractor, action will be initiated through the 628th CONS Contracting Officer. When contractor’s activities create a condition that presents imminent danger to Air Force personnel and assets, Air Force
Safety, Fire and BE can direct contractor activities to correct the situation.
a. When the 628th CONS Contracting Officer becomes aware of noncompliance with safety regulations, he/she will inform the contractor. The contractor will take immediate steps to correct the situation.
6. Common contractor violations on Air Force installations include: Failure to properly fence off excavations, parking vehicles improperly, excessive speed, failure to yield to pedestrians, violating smoking/fire regulations, not wearing seat belts, improper scaffolding, inadequate shoring/sloping of excavations/trenches and lack of fall protection.
7. The contractor will provide the 628th Civil Engineering Squadron (628th CES) (ext. 843-
963-4975) a listing of all chemicals brought on base. Contractors are responsible for proper handling, storage and disposal of hazardous material brought on the installation.
Contractors are responsible for proper response and cleanup of any spilled or released hazardous material into the environment.
8. Recommend the contractor be able to provide for review by base agencies and in the event of a Federal OSHA inspection a copy of the following programs, as a minimum. This is not an all-inclusive list of required written programs.
a. A written copy of the company’s Hazardous Communication Program to include documented training of employees.
(1) All applicable Safety Data Sheets (SDS)
(2) Emergency eye wash procedures and location.
(3) Correct Personal Protective Equipment and clothing provided for the type of chemical in use or procedure being conducted.
b. A written copy of the companies’ Lockout/Tagout Program to include documented training of all employees.
Note: In the event the contractor is required to use his Lockout/Tagout Program in facilities occupied by military personnel or civilian employees, the contractor must provide said employees with training on the companies' Lockout/Tagout Program.
c. A written copy of the company’s Manual Lifting Program to include documented training of employees.
d. A written copy of the company’s and/or sub contractor’s Confined Space Permit required entry program to include documented training of employees.
e. In the event of asbestos removal/abatement, a written copy of the company's program must be submitted and approved by the following base agencies: 628th Aero
Medical Support Squadron, Bioenvironmental Element, (628th ADOS/BE), 628th CES
Environmental Element & 628th ABW Safety Office.
f. In the event of lead base paint removal/abatement, a written copy of the company's program must be submitted and approved by base agencies: 628th BE, 628th CES
Environmental Element & 628th Safety Office.
g. A written copy of the company’s respiratory protection program to include documented training. This program is a necessity if one or more of the following actions are involved: Confined space entry, lead base paint removal, asbestos removal, and certain types of welding operations, use of organic solvents, spray painting, and sand/bead blasting.
h. A written copy of the company's excavation program to include documented training of employees.
i. A written copy of the company’s hearing conservation program to include documented training of employees if equipment is considered to produce hazardous noise.
9. The following items need special attention:
a. Outdoor operations will be adequately lighted and barricaded during the day and night.
b. Suitable warning signs will be posted at indoor and outdoor operations.
c. Material will be secured when doing high work or when working on the ground during high winds.
d. Mobile equipment and vehicles on JB CHS will conform to all base traffic laws and regulations governing such vehicles. All moving parts of equipment will be fitted with effective guards that must be in place at all time when the machinery is in operation.
Contractors will conform to all established travel and haul routes any deviations will be coordinated with the administrative Contracting Officer.
e. Traffic regulations will be strictly observed. When any construction project proves hazardous to normal street and roadway users, traffic will be controlled or warned by flagmen, signs, and/or barricades.
(1) Seat belts will be worn at all times. Violators may be cited by the 628th
SFS.
(2) Pedestrians have the right of way and special caution should be exercised when operating vehicles in base housing. There are many small children playing, riding bikes, walking to and from school bus stops etc.
(3) There are many types of military unique equipment and much of it is slow moving.
f. When construction equipment is towed on base roads or streets, safety chains will be used in addition to regular towing hooks. If equipment is towed after dark, lights will be placed at the rear of the tow.
g. Overhanging portions of loads moved by trailer or truck on base roads or streets will be marked by warning flags or lights.
h. Operators will be careful to avoid contacting high-tension lines with equipment such as cranes and cherry pickers. Booms will not be positioned closer than 10 feet to overhead high voltage lines. Only qualified and properly licensed operators will be permitted to operate powered construction equipment. Equipment will not be left unattended with the motor running.
i. Suitable signs, barricades, and warning lights will be used at locations when equipment is used close to highways or motor traffic.
j. Caution will be taken when excavating around gas mains, petroleum tanks, gasoline or oil pipelines, sewers, water mains, and electrical and data lines. The 628th CES will be consulted for location of underground lines at construction sites.
k. The National Electrical Code (NEC) will govern the installation of all wiring and electrical equipment.
l. Welding permits must be coordinated and approved through the 628th CES Fire
Department. Phone Number: (843) 963-3121.
m. Federal OSHA requires fall protection, to include the use of safety harnesses, from a height of 6 feet. Old requirements allowed a body belt and 10 foot fall distance.
n. The wearing of hard hats and safety shoes in construction sites.
o. The wearing of hearing protection near the flight-line and around jet engines is encouraged. Contractor personnel will not enter onto any airfield surface, i.e., runways, taxiways, or parking ramps without the expressed written permission of 437th Operations
Support Squadron (437th OSS/OSA), Airfield Manager or their Deputy, ext. (843) 963-
3024.
10. Safety personnel are available for technical advice and assistance on matters pertaining to accident prevention.
11. The speed limit on JB CHS is 25 mph unless otherwise posted.
12. There is no parking on yellow curbs or against the flow of traffic except for temporary loading or emergencies.
13. Motorcycle operator/passenger will wear approved helmets and eye protection.
Helmets will be properly fastened. In addition, headlights will be turned on while riding on base. Motorcycle operators should also wear brightly colored or contrasting vest or jacket as an outer upper garment during the day and reflective gear at night.
14. Air Force Instruction 91-202, The US Air Force Mishap Prevention Program.
This instruction applies to government-furnished facilities or equipment provided to a contractor when known hazards and interim control measures are contained within the contract requirements.
15. All contractors must obey all federal, state, and local wetlands regulations/permits.
16. All contractors must adhere to the “Joint Base Charleston Tree Preservation Standards” when working around existing trees on base.
17. In the event any archeological artifact is excavated during the course of construction, please contact 628th CES Natural/Cultural Resources @ (843) 794-7951
18. For each contract vehicle (contract, purchase order, blanket purchase agreement
(BPA), etc.) involving the use of hazardous materials (HAZMAT) on the installation, the contractor shall identify and report all HAZMAT usage to the HAZMART for subsequent 628th CES/CEIE review for applicability of entering the data into EESOH system. The HAZMAT information may be submitted using one AF Form 3952 for each HAZMAT item or a list with comparable information and with SDS attached prior to the start of the contract. Submission of either the AF Form 3952 or list with
SDS’s is for HAZMAT informational and tracking purposes only and shall not constitute Government approval for use of the HAZMAT. 628th CES/CEIEV can be reached @ (843) 963-1439).
19. On either side of JB CHS; Air Base or Weapon Station electronic frequency producing devices must be registered with the 628th ABW Weapon Safety Office & 628th
Communications Squadron, Spectrum Management prior to utilizing that equipment.
Reviewed 12 Dec 17 db/wm
CONTRACTOR BRIEFING
TITLE: ___________________________________________________________________________
CONTRACT NO: ___________________________________________________________________
The following items were briefed and the contractor was provided with a copy of the 628 ABW Safety
Guide for Civilian Contractors.
{ } The requirement to comply with: EM-385-1-1, OSHA Standards, National Electrical Code &
National Fire Codes.
{ } Housekeeping requirements.
{ } Requirement to provide employees with safety training and education.
{ } Do not ride in the bed of pick-up trucks.
{ } The requirement for vehicles to stop for pedestrians at crosswalks.
{ } The requirement to stop for emergency vehicles, convoys or Air Force vehicles that are responding.
{ } The requirement to use back up alarms on vehicles (rollers, compactors, front end loaders, bulldozers and similar equipment).
{ } The requirement to post signs and barricades in traffic areas and the barricading of unfinished work areas, and trenches/excavations.
{ } The requirement for persons directing traffic to wear high visibility/reflective vests.
{ } The use of personal protective equipment.
{ } Safety requirements for scaffolding and standard railing requirements.
{ } General fall protection requirements.
{ } The requirement to guard open sided floors, and wall and floor openings.
{ } Safety requirements for welding, cutting and brazing operations, contact the 628th CES/CEF (Fire
Dept) on the Air Base @ (843)963-3777, on the Weapon Station @ (843)794-78087.
{ } Safe storage of material and equipment.
{ } The requirement to prevent equipment and machinery from making contact with power lines.
{ } The requirement to provide proper grounding of tools and equipment.
{ } The requirement to use safety chains in addition to the regular towing hooks during towing operations.
{ } The requirement to use qualified and properly licensed operators for powered construction equipment.
{ } The requirement to keep personnel and equipment away from the airfield (i.e., runways, taxiways of parking ramp) without the expressed written permission of the 437th Operations Support Squadron’s (OSS)
Air Field Manager or his/her Deputy at (843) 963-3024.
{ } The requirement to register any electronic frequency producing device with 628 ABW Weapon Safety prior to utilizing that equipment on JB CHS, Air Base or Weapon Station.
{ } The requirement to comply with the Hazardous Communications Program. 29 CFR 1910.1200
{ } The requirement to comply with the Confined Space Entry Program. 29 CFR 1910.146/ 1926 subpart
AA
{ } Permit Required Confined Space contains the following hazards:
PRIOR TO THE START OF INITIAL CONFINED SPACE WORK, ALL CONFINED SPACE
OPERATIONS MUST BE APPROVED VIA 628th ABW/SE. 628th ABW/SE WILL NOTIFY
THE CONTRACTOR OF ALL HAZARDS ASSOCIATED WITH THE SPACE (S).
{ } The requirement to comply with the Lockout/Tagout Program. 29 CFR 1910.147
{ } Contract managed by 628 CONS/LGCB.
Contracting Officer is ________________________________________ at ____________________
Contract Specialist is ________________________________________ at _____________________
{ } 628th CES Project Manager is ______________________________________ at: _________________
{ } Safety Briefed by: ___________________________________________at: _____________________
SUBJECT: Contractor Briefing and 628th Air Base Wing Date: ______________________
Safety Guide for Civilian Contractors
TO: 628 ABW/SEG
Receipt of the above briefing and the 628 ABW Safety Guide for Civilian Contractors is acknowledged.
COMPANY: __________________________________________________________________________
PHONE: _____________________________________________________________________________
ADDRESS: ____________________________________________________________________________
CONTRACT START DATE: _____________________________________________________________
SIGNATURE: ________________________________________ Allotted Contract Time in Days: ______
NAME: ______________________________________ POSITION: __________________________
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