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Home My WebLink AboutWWP2700352(2) Kf P-27-0352 DA= AVE NE SAN. SAS LID #337 - Bid Info. 1 BEGINNING Of. FILE 4! FILE ime WW�gT�O35Z N AVE Ne SAN ITARI 56W �s - �,� 6„IU 433T �, $ I� INFO • 1 �� •► CITY OF RENTON Planning/Building/Public Works Department Earl Clymer,Meyer Cress Lint ,mien M,Arin:nittralar Nkry 17, 1994 Gar/Merlin Construction Cu„ Inc. 9115 - 10th Avenue South Seattle,WA 98108 AUDITION: BRIAN 1(ITTIESON SUBJE T: DAYTON AVENUE SANITARY SEWERS -LID 337 Doer Brien At its regular meeting of May 16. 1994, the Renton City Council accepted yout bid for the Dayton Avenue Sanitary Sewers Replacement in the amount of $106,794.43. To enable preparation of the contract documents, please submit the following: t) A h!it of names, addresses, telephone numbers and emergency telephone numbers for: Responsible Officer, Job Foremen and Bonding Agent. 2) Coraoration letter or Resolution giving names of those authorized to sign contract and sample of their signatures. 3) Photo copy of current State Contractor's License (not master license). 4) Photo copy of current City of Renton Business License 5) Two contract bonds on City of Renton forms (enclosed), UNDATED, data to be filled in when signed by the Mayor. 61 Two signed contracts(e, •Iosr o, also UN ^TED. 71 Two certificates of insurance. Language on this certificate L juff it 30 days written notice to the City prior to cancellation and not include Is, ip oge w,ie. ng the insurance company, its agents or representatives of obligation or liability to meet the 30 day requirement. 81 One executed City insurance information form (enclosed). 9! One executed City Insurance Endorsement Form (enclosed). 10) One copy of the declaration pages of relevant insurance policies. eAlm"nueSouth-Renton,Washington Sg055 �r Gary Marlino Construction Co., Inc. Pape 2. i a - I Also, to allow for starting construction as soon as possible after the contract is signed. I will need material submittals for approval. It you have any questions or need any acditionol information, please call me at 277-6206. Very truly yours. Michael A.A. Benoit Project Manager WWW/Dy AWD MAan AasMwnb CITY OF RENTON !r! PLAN HOLDER'S LIST f r Project Name: LID a337 Dayton Avenue Sewers Project Engineer: Michael A. Benoit, City of Renton. Telephone No. 277-6206 Bid Date: Tuesday, May 10, 1994 at 2:30 PM Place. Renton City Hall-3rd floor conference room Engineer's Estimate: $130,000- $150,000 SUBN IT BID TO CITY CLERK'S nFFn:E BEFORE BID OPENIN9 M. A. Segal@ Gary Merlin Construction King Construction P. O. Box 68050 9125- 1 Oth Avenue South 13313% Sin Street ! Tukwila, WA 98188 Seattle, WA 98108 Sumr,r,WA 98390 I 575-0150 762--9125 B38.4668 Fax: 763-4178 Fax: 863.4668 i Tri-State Construction Scocolo Construction Tydico Inc. 320- 106th Avenue NE 2625 South 1541h Sleet 17937 Cedar Grove Road Bellevue,WA 98009-3686 Seattle,WA 98188-2099 Maple Valley, WA 98038 455.2570 242-0633 413.1300 Fax: 633-5838 Fax: 413-1622 Pape end Son, Debco Construction Virginia L.Sent Cons,, 9512 State Hwy. 16 NW 20219 -991h Avenue SE P 0 Box 630 Gig Harbor, WA 98332- Snohomish,WA 98290 Revensdale, WA 98151 5701 486-1280 432.3306 Fax: 668.1533 Fax: 432-3704 Wastwater Const. Co. Taggart Construction Frank Colucclo Const. 16209 SE 173rd PI 19804 SE 32nd St 9600 M.L. King Wy S Renton, Wa. 98958 Issaquah,We 98027 Seattle.We. 98118 277-3137 391.7508 Fax: 277-3137 Fax: 557.375U Lakerioge Paving Shoreline Construction Co Kent,Wa, 98002 PO Box 358 631-8290 Woodinville We 98072 630-9709 483-0600 668-5133 j h; 0CS:a4-42a:MA6:ar h:WASTEWATER:OaNaxl qpa 1011 n4a,W.6.9N4 9:39 AM '_q1} 1 MC°M1� CITY OF RENTON MEMORANDUM DATE: May 11, 1994 TO: Marilyn Petersen, City Clerk FROM: Mike Benoit, Wastewater Utility 14 SUBJECT: Rios :or Dayton Avenue Sanitary Sewers (LID 237) We have reviewed the bids submitted for the above-mentioned construction project. The bids do not have any apparent irregularities. The low bidder, Gary Merfino Construction Co., Inc., hes submitted a bid that is below the Engineer's Estimate and under the estimated cost! used for the preliminary estimate of LID 337. The Wastewater Utility therefore recommends that the construction contract be awsrded to Gary Merlin!Construction Co.. Inc. Please forward this matter to Council, with our recommendaho t for approval, at your earliest convenience. It you have any questions, please caa me at EYE. 6206. ICI DAY-5V,MAear .. .�....anwl�a..,r...rv..•lr+e 1: 4 —_ Poject Title: LID 337 Dayton Ave Sanitery Solvent I� City of Renton Gary Merlinon BID DATE: May 10, 1994 2:30 PDT Em4mee Estimate Construction Co Inc awn gore Deem;lon UM Eat. um ge Unit ad m R_omr-o®� G�wa!y Pare Am Pr AA' _ 001 wolankon Lamp Sun 1 s4.WOW $100W.W fO,eN.N ��$9.000w 002 Tro Evcmtlon Sebty Sye Lunp Sun 1 S2,50DW $2.500e0 SI.ON40 s1.G = 003 a Gmity sever LF 6T0 $0 25 53T,62r 50 $27.09 923,460.W W4 Type A lAeremle Eec 3 S2AWW Sa,4W.W 112.1101.00 S7.5W.W W5 CaewG to Ewvxv Alerwol4 Ewe 1 $1,5W 00 $1.500.00 6t60.N $IWW 0W 6'$Waeeer LF 6M Slym sle.amw $26.0 315mzbo 1 WT Re a Rp'se al UreuteMe Alelella Tan 2W $15.00 S3pW.W ism S1,111Zm We Gm gerkal Srae-aSwM Ton W Sa.W 314,152m St.N $I.W 00 ow Aaphok Cancrelt `was SQ YC 640 $15.00 $12.000.011 913.611 $11,W.00 + 010 Aylul Car4:M Ovmby Ton 431 f3sC $15,005.W 542.111) S141,102.00 011 Tempolwy,Em m Sedmem O Luro Sun 1 j $1,11 m $1,S .m SIn.N $150,00 012 Flume;F.-a Lnds a SWen inv Lump Sur $2,a. l0 t2,000,0C 6f.N0.N III ODOM 1 019 CarcruNw M.ryaAsguWe Lump Sun 1 s2,CA.00 f2,000.00 S6.000.00 $5,00cm 014 TMlk Cotiml Lump Sun 1 f2.OWm $2,00000 smm 5500.0D 015 TV lnepw.ten Lump Sum 1 $150000 $1,500m S2.000.00 S2,WoM 016 Re.Eeblken Mwwmwae EeM 2 $2nW NNW SM.N S4Wm '. Sudalal 5131,ase.50 SSe ml W To 1110,014e4 11e.0e346 Tabl S142,70I.M SiM.M446 it 1 88 . 88 , ■ ns88 - � t | t § | 2 / k ! | | ) | | | | i 88 , 8888e89888888 ° � ! ! ■ § © | \ ® » ! ; § ! § | | | ! I, ■ � • . , . ■ . � � � • � � • � • | | ( 7 § - ) d 888888Ei 688888888 ? ! /| ! - | ! © s ' 22I § § I § « lf . � E \ . § ■ � , . � � � � , � \ : . � \ } i | ` j7 | ! ! ikl� ■ ■ ■ ! ■ , ■ ■ ■ = a ; ; : ; = � � - s s � a 8 $ R 8 8 8 8 8 8 = 8 8 8 8 8 8 o _ Y� r 8 8 0 8 8 8 8 8 8 8 8 8 8 8 8 8 - 8 R Ff 8 $ $ 8 8 $ 8 8 $ 8 8 8 8 o �. 4 3 4 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 M ' 4 o i g f t a � � {{� ,r S ICI • ` I`. 7 U a n € a 5 6 e + a ti • � N � W � f r r EE Q 4 p Q O a m . ! �. ■ ; a . • ■ • , ■ . . � . 88 | % ■ ■ ! # # ■ # K , # ! ! ; § | - 2 \ . \ l It . . . , � . . » � , , . ■ - « s � 2 | „ ■ \ . \ . \ . . , . . . , ■ a . - , ! R � ) ) |. . . . 882388888888 . � ! j| ! ■ f § : : ■ = � § 7 | § St \ \ � ! {- - l . - � ■ | 1 , . � � � � � } \ \ \ . \ \ � \�\. , . , , - - �I � ' I i • } ; | � k � � . � ® ' \ ! , !, /j , ■ ■ ■ ■ ■ „ § ■ la ; ; ! ! § \ [ � • • ! . , 88888888888888 # � ` , � | | | | | ! |_ § $ | | | | ) ! 2 | � � k ! 7 8888888a � ■ � , • • - 8888888 , 888 . � ■ ■ � � ! | | | § § § | | | ■ | ! | ■ ■ � ` � � \ . . . . k8 8 8 8 8 8 8 2 8 8 8 8 8 a 9 8 � � ■ ! ! | ■ § § ■ ! � » ! | | | | 22 , ! � . _ � . ■ ! ll , � . _ � � � � | }[ | ! s ƒ | } \ ! ! } f1 | § $ | �j !! ■ , ■ ■ ■ ■ ■ ! „ ; ; ; ; ; ; Noteot Title: LID 337 Dayton Ave Sanitary Sewers Virginia L. Seitz Lokeridge Paving BID DATE. May 10. 1394 2-.30 PDT Conab•xtion Co Inc. Company Iwm Ben DeeccnpW Urd Ew 11n1 lila Np No UM ale 001 alaplealmn OueMey Prea Ama11 p" Aneue r Lure,sun 1 113.00000 $13,0no 00 412.55COW 312.500.a5 002 Tmr21 EvW's1 Salary Syalam Lary Sun t $4.000 co 31.00000 $2,070.00 $2.070.00 OW a-Gna,Sew, LF e70 f1e.w SO� 00 sw 17 s31.1a7al 004 Tye,AAYnele Eaca 3 si.emo0 %+Moo f1,e1000 35,520.00 •� fAs Coined re Eeeanp marr l Eoo 1 f2.e50W 12.15(100 SZ112M S2j12W 1106 a'sklaawa LF S2S i]D.00 10e,7500p 11150 007 Rennes A Replace al lneigae,, Tat 200 5200 s1000 522 055 51,61000 i OOB Oewal 81cAIB snaae@e,a Tan 18M $2 OD S3 aae m St i m 521,2Be.20 000 Asphalt Canete Paid Se yd e10 $1200 slo.0e0.00 $10.35 fe,691w 010 Asp ad Canaew 0""" Tan 131 me.ao WINDS s3700 sts,e.7oo Oil Tempanv E.Savers Card Lump Sum 1 $1,20000 31.20000 11.15000 $1,150.00 012 Rennes)ReYa,Ln ace,a 31aad hrp Lump sum 1 $5,2m m s5.200.o0 51,01000 $7,0400o 013 ctnatn en swap a M BJb � O.rysua 1 s.3,00000 113.011)oao 92.e7s.ao u.87500 M1 Trelac C.0 lump sum 1 s3,eaono f3,e00,t10 f2,021.W 52.02100 a 015 TV Mepecnun tumpsum I SIAW 00 S1,o0000 Ote f1,250.00 31,2S0 ao Ra EeteewA/AoreAnas Ee 2 s37000 $?VW S3e500 $770W fI30,11e00 311U•711060 i SI1,132.11 $11,5M l3 61 W."Is 11 $152,311143 y.. 6 Y s . j � | � ■ | � ■ | | � ■ | | | | | ■ , ! a | f / | l , . , e � , , . ■ ! , ■ ■ § , ! � }} ; ■ | | ■ ; | | ■ ■ § | | | | ! ! ` ■ | � � , . < � ■ r � � l , � ■ ! , 2 ; � � | ■ § | | | | | ■ ■ | ■ r ■ ■ | | | | ! | ■ ; � , � , ■ . ■ , � 3RP9 � • - , ! . & | 623R6. .! a§ 1 . . ■ * , - a I ` � ■ ■ K � � , ■ | | \ � ) 2 k � k! | � - « . � ; ■ | , ■ � � � � � � � | � !@ � ! )s , ■ ■ ■ ■ B , ■ ! a § = ; ! § <!- >~ CITY OF RENTON City Clerk Y Marilyn J.Pereraea Earl Clymer, Mayor _ t I May 20, 1994 Mr.Gary Merlino Crary Merlmo Cons Co.,Inc. 9125-10th Ave.S. Seattle,WA 98108 RE: Dayton Ave NF Sanitary Sewers,Bid Opening 5/10/94 Dear Mr. Merlino: At its regular meeting on May 16, 1994, the Renton City Council accepted your low bid for the above-referenced project in the amount of$106,794.48,including 8.2%sales tax. Please contact Michael Benoit, Project Manager, for submission of required documents to complete the contract. These may include proof of City and State business licenses, undated performance bond,and insurance certificates. Sincerely, Brenda Fritsvold Deputy City Clerk /bf cc: Michael Benoit-Project Manage, 200 Mill Avenue South Renton,Washington 98055-(206)1— -2501 11 •�Y nA� ifYt J j..1 CITY OF RENTON :t City Clerk Earl Clymer, Mayor Marilyn J.Petersen May 20, 1994 Vince Columio Frank Coluccio Const.Co. %W M.L.King Jr.Way S. Seattle,WA 98118 RE: Dayton Ave NE Sanitary Sewers,Bid Opening 5110/94 Dear Mr. Coluccio. At its regular meeting on May 16, 1994, the Renton City Council accepted the bid submitted by Gary Merlin Construction Company for the'above-referenced project,in the amount of$106,79448, including 8.2%sales tax. Thank you for your interest and your bid. Sincerely, Q,, Brenda Fritsvold Deputy City Clerk cc: Michael Benoit-Project Manager 200 Mill Avenue South-Renton,Washington 98055 •(206)235.2501 r t" A CITY OF RENTON .R City perk Earl Clymer, Mayo: __.MarUyn J•Peleraen May 20, 1994 i Sharon Holt King Construction Co.,Inc. r; 13313.1/2 But St.E Stunner,WA 98390 RE: Dayton Ave NE Sanitary Sewers,Bid Opening 5/10/94 G Dear Ms.Holt b At its regular meeting on May 16, 1994, the Renton City Council accepted the bid submitted by Gary Merlino Construction Company for the above-referenced project,in the amcunl of$106,794.48,including 8.2%sales tax. r Thank you for your interest and your bid. p E Sincerely, Brenda Fritsvold Deputy City Clerk cc: Michael Benoit-Project Manager 200 Mill Avenue South-Renton,Washingtun 9g055-(206)235-2501 IJ 9; 4 aa y L j�->~ CITY OF RENTON City Clerk Earl Clymer, Mayor Marilyn J.Petersen i F May 20, 1994 i John Cheetham 2 Lakeridge Paving Company f„ PO Box 5430 Kent,WA 98034 RE: Dayton Ave NE Sanitary Sewers,Bid Opening 5/10/94 T Dear Mr. Cheetham: w At its regular meeting on May 16, 19,94, the Renton City Council accepted the bid submitted by Gary Merlino Construction Company for the above-referenced project,in the amount of S106,794.48,including 8.2%sales tax. Thank you for your interest and your bid. Sincerely, Brenda Fritsvold 1. Deputy City Clerk cc. Michael Benoit-Project Manager 200 Mill Avenue South-Renton,Washington 98055-(206)235-2501 A CITY OF RENTON City Clerk Earl Clymer, Mayor _Marilyn J.Peterua r k ` May 20, 1994 r r C r Gene K.Pape - Pape&Sons Const,Inc. 1 9512 State Hwy. I6 NW Gig Harbor,WA 98332-5701 RE'. Dayton Ave NE Sanitary Sewers,Bid Opening 5/10/94 Dear Mr.Pape. At its regular meeting on May 16, 1994, the Renton City Council accepted the bid submitted by Gary Merlin Construction Company for the above-referenced project,in the amount of SI06,794.48,including 8.2%sales tax. Thank you for your interest and your bid. �Sincerely, Brendo,'utsvold Dept ty City Clerk {,. cc. Michael Benoit-Project Manager 200 Mill Avenue South-Renton,Washington 98055-(206)235-2501 <, CITY OF RENTON lei City Clerk Earl Clymer, Mayor Marilyn J.feteraea May 20, 1994 Ammndo Scuccolo Scoccolo Const,Inc 2925 S. 154th St. Seattle,WA 98198-2099 RE: Dayton Ave NE Sanitary Sewers,Bid Opening 5/10/94 Dear Mr. Scoccolo: At its regular meeting on May 16, 1994, the Renton City Council accepted the bid submitted by Gary Merlin Construction Company for the above-referenced project,in the amount of$106,794 48,including 8.2%sales tax. Thank you for your interest and your bid. Sincerely, Brenda Fritsvold Deputy City Clerk cc: Michael Benoit-Project Manager 200 Mill Avenue South-Renton,Washington 98055-(206)235-2501 N, i} y CITY OF RENTON f .� City Clerk � Earl Clymer, Mayor Martlya I Peterrem y y. i May 20. 1994 j I Sharon Gillis Virginia L.S:itz Const.Co.Inc. P O Box 630 i Ra:ensdale,WA 98151 RE: Dayton Ave NE Sanitary Sewers,Bid Opening 5/10/94 Dear Ms. Gillis: At its regular meeting on May 16, 1994, the Renton City Council accepted the bid submitted by Gary Merlin Construction,Company for the above-referenced project,in the amount of$106,794.48,including 8 2%sales tax. Thank you for your interest and your bid. Sincerely, Brenda Fritsvold Deputy City Clerk cc. Michael Benoit-Project Manager t . 200 Mill Avenue South-Renton,Washington 98055-(206)235-2501 i !A }. CITY OF RENTON Earl Clymer, Mayority Clerk MarilynMWl J.Pttereen May 20, 199A fames Suzuki Shoreline Const.Co. PO Box 358 Woodinville, A 98072 RE: Dayton Ave NE Sanitary Sewers,Bid Opening 5/10/94 Dear Mr. Suzuki: At its regular meeting on May 16, 1994, the Renton City Council accepted the bid submitted by Gary Merlin Construction Company for the above-referenced project,in the amount of$106,794,48,including 8 2%sales lax. Thank you for your interest and your bid. Sincerely, Brenda Fritsvold Deputy City Clerk cc: Michael Benoit-Project Manager i 200 Mill Avenue South-Renton,Washington 98055-(2W)235-2501 Y 4 . .h'.t Jr ` Wit .� CITY OF RENTON Ci-y Clerk Earl Clymer, Mayor Marilyn J.Petersen May 20, 1994 p Scott 4-2ham Taggart Construction 19804 SE 32nd St Issaquah,WA 98027 RE Dayton Ave NE Sanitary Sewers,Bid Opening 5/10/94 Dear Mr. Graham: At its regular meeting on May 16, 1994, the Renton GtY Council accepted the bid submitted by Gary Merlino Construction Company for the above-referenced project,in the amount of$106,794.48,including 8,2%sales tax. Thank you for your interest and your bid. Sincerely, �" Brenda Fritsvold Deputy City Clerk L it cc: .vtichael Benoit-Project Manager ft 200 Mill Avenue South-Rento Washi ton 980055- 206 235.2501 i CITY OF RENTON E■rl Crymer, Mayor City Clerk MWlyal Peter■ea May 20, 1994 Ty Ribem Tydico,Inc. 17937 Cedar Grow Rd SE Maple Valley,WA 98038fi220 RE: Dayton A�e NE Sanitary Sewers,Bid Opening 5/10194 Dear Mr. Ribera At its regular meeting on May 16, 1994, the Renton City Council accepted the bid submitted by Gary Merlino Construction Company for the above-referenced project, in the amount of$106,794.48,including 8.2%sales tax. Thank you for your interest and your bid. �Sincerely, Brenda Fritsvold Deputy City Clerk cc: Michael Benoit-Project Manager 200 Mill Avenue South-Renton,Washi ton 980.55- 206 5-25(11 ,}) CITY OF RENTON City Clerk Earl Clymer, Mayor Marilyn J.Memo May 20, 1994 Thomas Caplis Westwater Const.Co. 31833 Kent-Black Diamond Rd Aubum,WA 98002 RE Dayton Ave NE Sanitary Sewers,Bid Opening 5/10194 Dear Mr.Caplis: At its regular meeting on May 16, 1994, the Renton City Council accepted the bid submitted by Gary Merlin Construction Company for the above-referenced project,in the amount of S106,794.48,including 8.2%sales tax. Thank you for your interest and your bid. Sincerely, Brenda Fritsvold Deputy City Clerk cc: Michael Benoit-Project Manager 200 Mill Avenue South•Renton, Washington 98055-(206)235-2501 l ,v. PLAN HOI DER'S U' Project Name;�nl rut A.,¢ .Sc�c05 INd:rrc .[�.q-r /U 19ti t Project Eng, M•ec a, Time A 4J K.-O:ef Phone M 2»•in 20(�2I A BUJ i P12ce_Te4 .R«e C. C•rt H+.. t Consultant �/d En(s's Estimate PhoneN_ •.%IA 1 SUBIIIIT HID TO CITY CJ"KS OFFICE.BEFORE BID OPENING Name �CU �O L(1K��rNtT10/1 - --- I Aden ISO, � i e14D-1/�C/ IJ.�c. qVI-Z'm City State gip Phone# 24o6- zVz.-c)03 Fax# i ( cur ro( 1 Address .. PJQ 1�-tti v City Stuc gip Phone# Iloc> Fasts 2"-41j- /L2-Z ff II II � u Address QSiz. i6 1Jt� C`i� H rNr• OL 3Z- iroi City State gip Phone M Fax N Name 4 ePVj� C )NSTQUCTT ,A1 }s) Address '1'0' >;OL <�: _ Si ln6a k � �q 'TD' 1`3 -) 't City State gip Phonca � 48b- 1'I'SD _ Fax nr7.uusT: t� PLAN HOLDERS LIST j Project Name fit.n.. Mc s<�,o s Bid Date rid + 10 /9 v t + Project Eng: r ,e c Qc v. Time 27 Pt-r NIb /l 4J W-OJoj Phone x 2»-te zo l0/23 7 i 1 Placr 7?O R sn a C..I. ,e• ti (,..r. Hs.. . Consultant NIA fi f Eng's Estimate /JU oc C. - /S`o eo u Phone x_ AJIA SUBMIT BID TO CITY CLERKS OFFICE BEFORE BID OPENING Natnc s / Addtcss Ciry State T ZZIP Phone#. -.9.30�N Fact x� Name to Adder _16 ;L09 � r_ttl>. 98oSs City State Lip phone#_ -3 ;t Fux 177-3 /37 Name 7� C C� qn. t 6 o.✓J.'I.✓C^/;,..� Address—L �Z fi c y S -?Z. t J Tf W e..'4rt�Ks4 9 "�Z s CRY State pip Phone _.�a_�(..-39/ - Say Fux ZJG-.ii73)s-u ,+ Name LICC!O Cc A/ IL Address t n'/Lye uA�r[ s. tSF.anzE lvFf 98/�� _. .. City State Tip Phone 7ZZ ' ,5 1/� FaxM�e7S - ��(p Yiar.. "A 'S �' r.rn.vrwyWyKwefP+RM ��yMe"MYYYNf':Mww..'..+•wr...r��..-._.•:- i. kv�t •' 1vY � I AA k;; i1'i I F ;�f� PLAN HOLDER'S LIST Project Name 0417v, A.,c Sr�=o3 Bid Date INA� iO /9ti l Pmieet Eng: f+,,ee 4c�a. Time Z7V faro /'.•o •.v_a_t1 PhoneN 271�4+2U(o/2I i-21.)I Place lea Amr l.v• Consultant NIA Eng's Estimatett N o c"). -A/Sb Oa c. Phone N A�1,4 SUBMIT BID TO CPdY CLERKS OFFICE BEFORE nM OPENING M Name Address I7Nk7- Ga/a Qfo eL City State yip / o PhoneN N �.�0 ' / 70 9 Name�1rL tr:,� ��o a�� C�\eta! co. 3 q ` Address �� S�'X 7 a \(L y"\11 LL �,.L/ A7 I City State Phone a FaxN d Name Address t City State Zip Phone a Fax M i Address .: City State Lp 'j. PhoneN Faa N nnrrusr.