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or amendment submitted. (Section A) 1. L.U.(s) / System Council IVP District Name and Position of Person Submitting Form Date 2. Name of Company (Chapter, Div. OR Agency) If Company name was changed since last agreement, please list former name 3. Employer’s Location City State / Province 4. Parent Company or Association 5. Is this a: First Agreement Renegotiated Agreement 6. Total Employees Covered by this Agreement 7. Agreement Effective Date Amendment (A change during term of ag.

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