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APEX <br />HEALTH AND SAFETY PLAN ACKNOWLEDGEMENT AND AGREEMENT FORM <br />(Apex-SGI and Apex-SGI's subcontractor personnel must sign.) <br />I acknowledge I have reviewed a copy of the Site Health and Safety Plan for this project, <br />understand it, and agree to comply with all of its provisions. I also understand I could be prohibited <br />by the Site Health and Safety Coordinator or Apex-SGI personnel from working on this project for <br />not complying with any aspect of this Site Health and Safety Plan: <br />Name Signature Company Date <br />Name Signature Company Date <br />Name Signature Company Date <br />Name Signature Company Date <br />Name Signature Company Date <br />Name Signature Company Date <br />Name Signature Company Date <br />Name Signature Company Date <br />Name Signature Company Date <br />Name Signature Company Date <br />Name Signature Company Date