Common Contracts
1 similar Emergency Facilities & Land Use Agreement contracts
June 2012 EMERGENCY FACILITIES & LAND USE AGREEMENTEmergency Facilities & Land Use Agreement • July 7th, 2012
INCIDENT AGENCY (name, address, phone number) Page 1 ofAGREEMENT NUMBER MUST APPEAR ON ALL PAPERS RELATING TO THIS AGREEMENTAGREEMENT NUMBER EFFECTIVE DATESa. beginning: b. ending: OWNER (name, address, phone number-include day/night/cell/fax) INCIDENT NAME: DUNS: INCIDENT NUMBER: EIN/SSN: See attached vendor code worksheet RESOURCE ORDER NUMBER: PAYMENT ADDRESS:[x ] Same as above, or JOB CODE (P No.) AND OVERRIDE: TYPE OF CONTRACTOR ("X" APPROPRIATE BOXES)□ SMALL BUSINESS □LARGE BUSINESS □SMALL DISADVANTAGED OWNED □WOMEN OWNED □HUBZONE □SERVICE DISABLED VETERAN The owner of the property described herein, or the duly appointed representative of the owner, agrees to furnish the land/facilities for use as DESCRIPTION OF LAND/FACILITIES: Address or specific location. If street or highway address is unavailable, use distance from nearest city, crossroads, or other significant landmark. The local description of how to get to the land/facilities is also acceptable. County: State:
