Requested by. 9. Is every practice in the project categorized as having little or no potential to affect historic properties? Yes / No
Requested by. Incident Supervisor: Incident Position: (print/sign legibly) Contact Phone: Date: Approved By: Contractor/CRWB: Date: (print/sign legibly) Contact Phone: Team IC, Deputy IC or OSC: (print/sign legibly) Contact Phone: Date: DNR Wildland Fire Management Division OPS ADM or DNR CC Manager: _ _ _ _ _ _ _ (print/sign legibly) Contact Phone: Date: PRESEASON AGREEMENT NO. 93- Page 27 of 28 Version April 3, 2023
Requested by. Order Confirmed (For official use) Signature Signature Name Name Date Date Order ID Account No
Requested by. WSIB Claim: Yes No WSIB Claim Number: To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary.
Requested by. Fairfield-Suisun Unified School District Facility Requested Date Requested/Day of Week: _ Time: Beginning: _ Ending: _ _ NOTE: For multiple day usage, use attached schedule and specify dates. Dates checked are NOT available due to school usage. Event: _ _ _ Projected Attendance Requesting Organization/Program Name of Contact Person: _ _ Signature Equipment and Set-Up Request Person on Site Responsible for Program: Telephone: _ Telephone: _ _ For Office Use Only FSUSD Request Number: Route to the following for information: City of Fairfield City Facilities Staff City Division Manager City Master Scheduler Approval by: FEE INFORMATION: As established by the Joint Usage Agreement, the following is an estimate of fees for use of the will be _. Established fees listed in the Joint Use Agreement. The requesting organization will be billed at the end of the scheduled usage by City staff for City facilities and by the Fairfield-Suisun Unified School District Office for School facilities. City of Fairfield Staff/Site Approval: Name: Title: Date: Comments: Joint Use Agreement Facilities Usage Application Multiple Day Usage Schedule _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Not Available Contact Pers/Group Day of Week Date (m/d/y) Start Time End Time Joint Use Agreement Facilities Usage Application Multiple Day Usage Schedule _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Requested by. CPI Aerostructures, Inc. By: ____________________________ __________________________ Name: ______________________ Date Title: ______________________
Requested by. 3. Status: Unapproved, Approved, Rejected, or Implemented.
Requested by. OCA It is understood and agreed to by the above named individual that his/her agreement is based upon the following terms and conditions:
Requested by. The Borrower has caused this Request to be executed by its duly authorized officer as of the date and year first written above. The execution of this document guarantees that all information included has been reviewed, verified, and found to be accurate by the signatory. FAX TO: FAX:
