ContractEmergency Facilities & Land Use Agreement • May 20th, 2013
Contract Type FiledMay 20th, 2013INCIDENT AGENCY (name, address, phone number) Page of AGREEMENT 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) DUNS:EIN/SSN:PAYMENT ADDRESS:[ ] Same as above, or _ INCIDENT NAME: INCIDENT NUMBER:RESOURCE ORDER NUMBER: TYPE OF CONTRACTOR ("X" APPROPRIATE BOXES) SMALL BUSINESS LARGE BUSINESS SMALL DISADVANTAGED OWNED WOMEN OWNED 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. Borough: State: Private: ORDINARY WEAR AND TEAR: Ordinary wear and tear is based on the customary use of the land/faci