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ELENCO IMPRESE ESECUTRICI/LAVORATORI AUTONOMI EDILIPRESENTI IN CANTIERE SU INCARICO DIRETTO DEL COMMITTENTE(Dichiarazione del Committente/Direttore Lavori)SEZ. CIl sottoscritto _____________________________________________ in qualità <strong>di</strong> ______________________________C.F. ____________________________________________________ Partita IVA ______________________________in<strong>di</strong>rizzo Loc./Via ______________________________________________________________ n. _________________Comune _________________________________________________ Prov. ______________ CAP _______________sotto la propria <strong>di</strong>retta responsabilità fornisce i seguenti dati:IMPRESA N. 1Ragione Sociale __________________________________________________________________________________C.F. ____________________________________________________ Partita IVA ______________________________in<strong>di</strong>rizzo Loc./Via ______________________________________________________________ n. _________________Comune _________________________________________________ Prov. ______________ CAP _______________Recapiti: Tel. ____________________ Fax _____________________ e-mail _________________________________e-mail pec ________________________________________________• Importo lavori eseguiti (IVA esclusa) € ___________________• Tipologia specifica dei lavori eseguiti (evitare descrizioni generiche)_________________________________________________________________________________________________________________________________________________________________________________• Periodo <strong>di</strong> svolgimento dei lavori: dal __________________________ al ______________________________• specificare se trattasi <strong>di</strong> IMPRESA o LAV. AUTONOMO: ___________________________________________IMPRESA N. 2Ragione Sociale __________________________________________________________________________________C.F. ____________________________________________________ Partita IVA ______________________________in<strong>di</strong>rizzo Loc./Via _________________________________________________________________ n. ______________Comune _________________________________________________ Prov. _________________ CAP ____________Recapiti: Tel. ____________________ Fax _____________________ e-mail _________________________________e-mail pec ________________________________________________• Importo lavori eseguiti (IVA esclusa) € ___________________• Tipologia specifica dei lavori eseguiti (evitare descrizioni generiche)_________________________________________________________________________________________________________________________________________________________________________________• Periodo <strong>di</strong> svolgimento dei lavori: dal __________________________ al ______________________________• specificare se trattasi <strong>di</strong> IMPRESA o LAV. AUTONOMO: ___________________________________________IMPRESA N. 3Ragione Sociale __________________________________________________________________________________C.F. ____________________________________________________ Partita IVA ______________________________in<strong>di</strong>rizzo Loc./Via ______________________________________________________________ n. _________________Comune _________________________________________________ Prov. ______________ CAP _______________Recapiti: Tel. ____________________ Fax _____________________ e-mail _________________________________e-mail pec ________________________________________________• Importo lavori eseguiti (IVA esclusa) € ___________________• Tipologia specifica dei lavori eseguiti (evitare descrizioni generiche)_________________________________________________________________________________________________________________________________________________________________________________• Periodo <strong>di</strong> svolgimento dei lavori: dal __________________________ al ______________________________• specificare se trattasi <strong>di</strong> IMPRESA o LAV. AUTONOMO: ___________________________________________Data _________________________Firma _________________________________________<strong>Cassa</strong> <strong>E<strong>di</strong>le</strong> <strong>Terni</strong> – Zona Fiori 116/I, 05100 <strong>Terni</strong> (TR)fax 0744/443698 e‐mail sunico@cassae<strong>di</strong>leterni.it Pagina 7 <strong>di</strong> 10
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