[EXECUTED]

IN WITNESS WHEREOF, the Parties, acting through their respective duly authorized representatives, have caused this Agreement to be signed under their respective names on the date and at the place first above-written.

LGU NAME

[NAME OF WINNING BIDDER]

By:

By:

Name: _____________

Name: _________________

Title: Local Chief Executive

Title: _________________

APPROVED BY:

Local Sanggunian of ______________

Resolution No. ____, series of ______