The undersigned General Contractor and the undersigned Subcontractor hereby agree that the General Contractor



the cost of workers' compensation insurance coverage from the Subcontractor's contract price and that, for the purpose of providing workers' compensation insurance coverage, the General Contractor will be the employer of the Subcontractor and the Subcontractor's employees.

TERM (DATES) OF AGREEMENT
LOCATION OF EACH AFFECTED JOB SITE (OR STATE WHETHER THIS IS A BLANKET AGREEMENT):

THIS AGREEMENT SHALL TAKE EFFECT NO SOONER THAN THE DATE IT IS SIGNED. Texas Labor Code, Texas Workers' Compensation Act, Section 406.123

General Contractor's Affirmation
Subcontractor's Affirmation