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ATTACHMENT A

JCP

COMPETENT PERSON DESIGNATION FORM

PROJECT EMPLOYER

DISCIPLINE / CRAFT JOB LOCATION

DESIGNATED RESPONSIBILITY

DESIGNATED COMPETENT PERSON(S)


LIMITED
NAME (PRINT) IDENTITY NUMBER / APPLICATION
ID BADGE NUMBER YES* NO

* EXPLAIN LIMITED APPLICATION DESIGNATIONS SHOWN ABOVE

COMPETENT PERSON(S) SIGNATURE HOME ADDRESS

PROJECT MANAGER/CONSTRUCTION MANAGER/SUPERINTENDENT SIGNATURE DATE

/conversion/tmp/scratch/481729213.doc
ATTACHMENT A

/conversion/tmp/scratch/481729213.doc

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