FORM

WP-21-01
SERIES OF 2021

BONIFACIO ESTATE SERVICES CORPORATION

2nd Floor Bonifacio Technology Center, 31st Street 2nd Avenue, Bonifacio Global City, 1634
BESC Hotline Number: 88162372 / 09178162372

W O R K P E R M I T
A P P L I C A T I O N I N F O R M A T I O N
Application Number: 23-3709 Permit Number: 1222-23
Application Date: May 10, 2023 Payment Date: May 16, 2023
Approved Date: May 16, 2023
Project Name: BHS Central Square (Cinema)
Property Manager: Contact Number:
Company Name:
Purpose of Activity: to conduct Annual Electrical Preventive Maintenance
Applicant Name: Flores, Marvin P. Contact Number: 9663400917
Company Name: Tegimenta Chemical Philippines, Inc.
E-mail Address: be.bhscentralsquare@gmail.com
Representative: Veridiano, Daniel V. Contact Number: 9178988711
E-mail: veridiano.daniel@ayalaproperty.com.ph
Activity Type: Site Maintenance
Sub-activity Type: Annual Preventive Maintenance
Activity Description: Annual Electrical Preventive Maintenance
Activity Location: 30th Street Cor 5th Avenue
Lane Used/Area Occuppied: N/A
Commencement Date: May 18, 2023 Duration of Work: 1 day
End Date: May 19, 2023 Time/Hours: 2023-05-18 22:00 to 2023-05-19 06:00
Total Payment Fees: 1,000.00

C O N D I T I O N S OF A P P R O V A L
Bonifacio Estate Services Corporation, (BESC) hereby grants this Work Permit to the Applicant stated above subject to
but not limited on the following conditions:

1. Secure separate BESC Work Permit for use of sidewalk and/or road.
2. Install caution tape/ board up and safety signs during activity.
3. All noisy activities must comply with MC DC 2016-03 Guidelines on Standard Noise Level and Installation of Noise
Meter Devices in BGC.

Applicant's Declaration:
I hereby certify and acknowledge that I have read this application and affirm that the above statements, information and other
attached documentation are true, complete to the best of my knowledge.

I further confirm that the safety precautions, conditions and requirements herein stipulated will be observed. I agree to comply
with all the Bonifacio Global City rules and regulations.

In cases of violation by my agent, or myself, I hereby acknowledge the authority of BESC to revoke this permit, impose
penalties/sanctions and/or shutdown work, without prejudice to legal remedies and claim for damages by FBDC/BCDA/BESC.

I further authorize representatives of BESC to enter the site at all times for inspection purposes.

In case there is a need to relocate/renovate the above-mentioned project because of future city developments, I agree to
undertake all the responsibility and cost arising from the said relocation/renovation.

Construction Deposit Guarantee: I hereby acknowledge that any such fines or costs charged against the deposit/bond shall be
without prejudice to whatever works or actions that may be required of me by BESC to rectify the violation, breach or infraction
so comitted at my sole cost and expenses.

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 I have the authority to sign on behalf of and therefore to bind, the corporation/partnership/principal.

Contractor's / Safety Officer's Declaration:

I hereby affirm that I am aware of the job to be done and all the necessary precautions to be taken, and I confirm that the
minimum safety precautions specified above will be observed and implemented prior to commencement and during the entire
work duration to protect the workers and the general public from the dangers and hazards of work.

I checked and certify that all precautions and minimum safety equipment highlighted are adequate to protect all workers and
the general public alike.

Additional precautions shall be taken as the exigencies of the work may require.

I have the authority to sign on behalf of and therefore to bind, the corporation/partnership/principal.

This document is electronically generated and does not need any signature for
authentication. The approval of this permit is specific to this application only. Any
duplication in any form shall be sanctioned according to BESC policies. This document is
monitored by electronic system and is regularly checked by the management.

Bonifacio State Services Corporation

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