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ASSENT OF PARTICIPATION <br />To the Board of Trustees of: <br />Indiana Laborers Welfare Fund Indiana Laborers Pension Fund <br />Indiana Laborers Training Trust Fund Indiana Laborers Defined Contribution Trust Fund <br />The undersigned Employer hereby agrees to become a party to and bound by the Agreement <br />and Declaration of Trusts as amended and restated (the "Trust Agreements") of the Indiana Laborers <br />d Carriers Welfare Fund), <br />IneFund (f/h/a Indiana state District Laborers Pension Fun (91da Indiana State c <br />State District Council ofo <br />Indiauncil of na Laborers and Hod Carriers <br />Pension Fund), Indiana Laborers Training Trust Fund, and Indiana Laborers Defined Contribution <br />Trust Fund (the "Funds") entered into by and between the Laborers International Union of North <br />America (the "Union"), State of Indiana District Council and certain employers' associations and/or <br />employers. The Funds re for the purpose of providing Welfare, Pension and Training/Apprentice- <br />ship benefits for certain members of the Union and/or certain employees who are employed by <br />employers who enter into a contractual agreement with the Union whereupon the employers agree to <br />pay to the Funds specific amounts in order to enable the Funds to provide Welfare, Pension and <br />Training/Apprenticeship benefits. <br />It is the desire of the undersigned Employer to participate and become part in the same <br />manner and form as any other participating employer, and does hereby bind itself (or <br />myself/ourselves) to the terns and conditions of such Agreement and Declaration of Trusts of the <br />Funds; without reservation, either oral or in writing, and hereby waives any other manner or means to <br />associate or participate in said Funds. <br />The undersigned certifies that he/she is authorized to execute this Assent of Participation as <br />an Employer or on behalf the Employer. The undersigned Employer upon execution hereby assents <br />and consents itself (or myself/ourselves) to be an Employer as defined by the Trust Agreements and <br />agrees to the terms and conditions as stipulated in said Trust Agreements. <br />Signed this day of 1��� 2 n �4 <br />In the County of�w_ State of.::�J!,\_, <br />L, Ll <br />Signature of witness <br />Laborers Local Union No. So <br />( a C. � Ca�c�r 0,, <br />Name of Employer <br />(Signat re of Repree tivea� of Emp dyer and Title) <br />` Is- \T\°\0.%0 <br />Federal Identification Number r� <br />Address: V\\O NV�`l`E�.�ptC n \tix <br />City/State:h _ %- t !J <br />Zip Code: %,j►\\'>, <br />