The URL can be used to link to this page

Home My WebLink AboutBIG HORN VILLAGE II - Filed DCP-DEV. CONSTRUCTION PERMIT - 2003-05-28DEVELOPMENT CONSTRUCTION PERMIT Permit Number:t, — Issuance Date: ,� v Project Name: Big Horn Village II Project A. KA.: Project Location: City Park Ave, 1/2 block south of University Ave Permittee: Thomas Crow City and developer contacts: See attached Exhibit "A" for names and phone numbers of all contact persons for this project. Fees: Permit Application Fee (paid at the time of application) $ 300.00 Construction Inspection Fee (paid prior to issuance of this permit) $ 6359.20 Total $ 6659.20 Development Bond or other approved security: Amount of security deposited with the City to guarantee the completion of all public improvements to be constructed as shown on the approved plans for the development. $ 163,090.21 Form of security deposited with the City: PERFORMANCE REQUIREMENTS OF THIS PERMIT: 1. The Permittee shall be responsible to require their Project Engineer to incorporate into all design drawings and specifications the certification of all materials testing by an Engineer. The Permittee shall have an Engineer prepare revised design drawings and secure City approval for all revisions to the Utility Plans and related documents. The Permittee shall have an Engineer represent, as required by the City in the Development Agreement, that the improvements are constructed in conformance with the approved Utility Plans and the standards and specifications of the City. The Permittee shall provide "as -constructed" plans prepared by an Engineer prior to the City's acceptance of the constructed public improvements. (All references above to the terms "Project Engineer" and "Engineer" shall mean a Professional Engineer licensed in Colorado.) 2. All contractors who perform work on this project must be bonded and licensed in conformance with City requirements. Permittee (Person who is to sign the Development Construction Permit): Individual Name: '1-" C k AS C Cr! ct cc-; Company Name: z S T,4 u'; M t_ Art- — C i �'Z Es 7- Address: _ P , C o x 2- -12- l_ "1 Z � O_N -2 7 Phone number(s): Office: el I U Cellphone: e( 7 U 1 .- Fax number: I? 70 �2C 7 1 Email: Project Engineer (A Colorado licensed professional engineer who is the civil engineer, the person, responsible for the design of this project, responsible for certification that improvements are constructed in accordance with approved plans, responsible for making revisions to plans with City approval and for providing as -constructed plans): Individual Name: -► t'V k US L c�C� �i �4 ✓�� Company Name : I--vc °1 it; L A,',S v(_ . rty E-S N L ; Address: _ k to 3 S, 6_G, L L E 6 E- A Lr o Phone number(s): Office: 3.1 1�0 3 Cellphone: 1 Y L4 014 2— Fax number: yq Sq `7 3 S Email: Professional License Number: I C( I c( 1 Architect/Planner (The person responsible for the site design of this project) Individual Name:0 n1 A (- C r F L E' Company Name: (ZF-S t G � &.yt=- L-c 0A\E(\tTF C Address: �Z� Z7 �'Dt x%�i�V �— Rc� . Srt'i �S Phone number(s): _ Office: G c� Y.S Cellphone: �-) 2 70 ( Lf 2- Fax number: 2 �5 Z "1 ( Z 3 Email: Developer (The party or parties referenced in the Development Agreement who are responsible for the Developer's obligations contained in the Agreement —add additional names below): Individual Name: T 1y •'-k � 4~12.Cc.� s Company Name : 1A < < c ter_ C__$ I 1 c,: Address: P, (—` 1� k 7 Z Z 7 L- Phone number(s): Office: Lj 7C _SC> Cellphone: 7C ,Z I_9�)_! C' Fax number: C1 70 ,Zr✓ 7 fr &(_3 Emai I: L); General Contractor (The contractor in overall charge of the public infrastructure construction): Individual Name: E E L 6k1 Dow Company Name : c:xcR-A �- ►V Address: _ 1.3 \ S S �1 w\. / I E w fl fZ Phone number(s): Office: 4 `{ tea Si j Cellphone: Fax number: Emai I: If you have no General Contractor, list all other contractors below Grading contractor: Individual Name: Company Name : t Address: Phone number(s): Office: Cellphone: Fax number: Email: Utility contractor: Individual Name: Company Name: Address: _ Phone number(s): Office: Cellphone: Fax number: Email: Concrete contractor for flat work: Individual Name: Wit, `� E t-A mil? T Company Name: E Ll E K-T- -c-U e'l S ► , Address: _ Cl 33 CA - Phone number(s): Office: L4 .Z �15 Cellphone: 0 lc, 0q Fax number: q .2- Emai I: Concrete contractor for structures: Individual Name: Company Name: Address: _ Phone number(s): Office: Cellphone: Fax number: Email: Paving contractor: L� S G E Individual Name: Company Name : L}Al a I F7 L-L ES 01--t L Address: t7P tfr-f 2 �vt G ry is Phone number(s): Office: Cellphone: Fax number: 2 z 3 i c( j Emai I: Landscape contractor: Individual Name: C-;H+\- b ST' R Company Name: CD S'T�-R L-A N -D -Sc A PC Address: — 2 Sv.J D,A ( I AS �(Z mot✓ l� C'T , Phone number(s): Office: `16 -7 SL-� `i , Cellphone: Z Zl (, Fax number: �� (� 70 (< Email: Other contractors and parties involved in the project: SUBMIT THE FOLLOWING ITEMS (Required for all projects): • 81 /2"x 1 I" copy of the Site Plan Proposed Project Schedule Project quantities and cost estimate for all of the public improvements to be constructed. In addition, include all private improvements that are required to be inspected by the City Construction Inspectors. This information must be submitted in the format shown on the attached form titled "Project Quantities and Cost Estimate Sheet." ADDITIONAL SUBMITTALS (Required if checked): ❑ Traffic control plan(s) for the project ❑ Proposed haul routes shown on a City map ❑ Shop drawings ❑ Other CONSTRUCTION COORDINATION MEETING: A construction coordination meeting to discuss plans and special requirements for your project, is required for all development projects. The people required to attend the meeting are the Project Manager, Project Engineer, Developer, Architect/Land Planner and General Contractor (if no General Contractor, representatives for each of the contractors expected to work on this project) People to Attend: List the peoples names and titles for those who will attend the pre - construction meeting: Name Title ESTIMATED COST OF INFRASTRUCTURE IMPROVEMENTS: Provide the estimated value of all public infrastructure improvements that will be constructed and accepted by the City to own and maintain. In addition provide the value of all private infrastructure improvements that the City will inspect and require certification for. The estimate shall be in the same format as the attached sheet titled "Project Quantities and Cost Estimate Sheet." ( Q ZI Public infrastructure, estimated cost: $ 6 3 , 09 6, Private infrastructure, estimated cost: 1 certify that the information on this permit application along with the required additional submittals are true and correct to the best of my knowledge, and that in filing this application I am acting with the knowledge, consent, and authority of the owners of the property (including all owners having legal or equitable interest in the real property, as defined in Section 1-2 of the City Code; and including common areas legally connected to or associated with the property which is the subject of this application) without whose consent and authority the requested action could not lawfully be accomplished. Pursuant to said authority, I hereby permit City officials to enter upon the property for purposes of inspection and, if necessary, to enter upon such property to perform work required of the applicant if the applicant were to fail to perform the required work. Applicant Signature: _ ?�/J �4��Date: ( —.Z 9 --C).2_ PROJECT QUANTITIES AND COST ESTIMATE SHEET Big Horn Village II, PDP Description: Installation of public sanitary sewer, water service, street improvements Description: Units of Measure I Estimatedl I Quantity Insp. Cost I per unit Const. I costlunit Total est. Cost linspectionj Fee/unit Total I Insp. Fee Storm Sewer 18" RCP Cl III w/ 3/4" Rock LF 604 $ 60.00 $ 45.25 $ 27,331.00 $ 0.60 $ 362.40 15" RCP Cl III w 3/4" Rock LF 25 $ - $ 44.25 $ 1,106.25 $ 0.60 $ 15.00 Trench, LF 629 $ 60.00 na $ - $ 0.60 $ 377.40 Connection to exist. Type R Inlet ea 1 $ 90.00 $ 985.00 $ 985.00 $ - $ 90.00 4' Dia Manhole ea 3 $ 90.00 $1,255.00 $ 3,765.00 $ - $ 270.00 Subtotal zP JJ, 10l .LU .p , � ,- 8" SDR-35 Main w 3/4" rock LF 890 $ 60.00 $ 31.25 $ 27,812.50 $ 0.60 $ 534.00 Connect to exist. Main. ea 1 $ 60.00 $1,965.00 $ 1,965.00 $ - $ 60.00 4' Dia. Manhole ea 4 $ 90.00 $1,255.00 $ 5,020.00 $ - $ 360.00 8" x 6" service connection ea 5 $ 60.00 $ 65.00 $ 325.00 $ 0.60 $ 300.00 6" SDR service ea 5 $ 60.00 $1,045.00 $ 5,225.00 $ 0.60 $ 300.00 Trench LF 890 $ 60.00 $ - $ - $ 0.60 $ 534.00 y 4U,J4/.�U .y L,VVV.VV 8" CL-52 w/ sand bedding LF 1102 $ 60.00 $ 28.25 $ 31,131.50 $ 0.60 $ 661.20 Tapping saddle, 8" ea 1 $ 60.00 $2,965.00 $ 2,965.00 $ - $ 60.00 Tapping saddle, 6" ea 1 $ 60.00 $2,485.00 $ 2,485.00 $ $ 60.00 Fire Hydrant ea 3 $ 60.00 $2,115.00 $ 6,345.00 $ $ 180.00 6" DIP Hydrant run LF 4& $ 60.00 $ 24.25 $ 1,164.00 $ 0.60 $ 28-80 Valves ea 3 $ 60.00 $ 700.00 $ 2,100.00 $ - $ 180.00 Bend, Tee, Cross Fittings ea 8 $ 30.00 $ 321.87 $ 2,574.96 $ $ 240.00 Meter pit ea 1 $ 30.00 $ 345.00 $ 345.00 $ $ 30.00 1-1/2" Meter Pit w/yoke ea 5 $ 30.00 $1,850.00 $ 9,250.00 $ $ 150.00 Trench LF 1150 $ 60.00 $ - $ - $ 0.60 $ 690.90 8" x 1-1/2" service connection I ea 5 1 $ 60.00 $ 405.00 1 $ 2,025.00 $ $ 300.00 Subtotal Street System remove curb/sidewalk Is 1 $ 60.00 $ remove/replace Ashpalt ton 160 $ 90.00 $ Replace sidewalk I SF 780 $ 60.00 $ zo 0u")0D.40 130.00 $ 20,800.00 $ 10.00 $ 7,800.00 $ $ 29,170.00 Totals: $163,090.21 .� L, JOU. VU 0.60 $ 60.00 0.30 $ 90.00 0.80 $ 604.00 $ 754.00 $6;53B80 PROJECT QUANTITIES AND COST ESTIMATE SHEET Big Horn Village II, PDP Description: Installation of public sanitary sewer, water service, street improvements Description: Units of Measure Estimated Quantity Insp. Cost per unit Const. costlunit Total est. Cost Inspectio Fee/unit Total Insp. Fee Storm Sewer 18" RCP Cl III w/ 3/4" Rock LF 604 $ 60.00 $ 45.25 $ 27,331.00 $ 0.60 $ 362.40 15" RCP CI III w 3/4" Rock LF 25 $ - $ 44.25 $ 1,106.25 $ 0.60 $ 15.00 Trench, LF 629 $ 60.00 na $ - $ 0.60 $ 377.40 Connection to exist. Type R Inlet ea 1 $ 90.00 $ 985.00 $ 985.00 $ - $ 90.00 4' Dia Manhole ea 3 $ 90.00 $ 1,255.00 $ 3,765.00 $ - $ 270.00 Subtotal 8" SDR-35 Main w 3/4" rock LF 890 $ 60.00 $ 31.25 $ 27,812.50 $ 0.60 $ 534.00 Connect to exist. Main. ea 1 $ 60.00 $ 1,965.00 $ 1,965.00 $ - $ 60.00 4' Dia. Manhole ea 4 $ 90.00 $ 1,255.00 $ 5,020.00 $ - $ 360.00 8" x 6" service connection ea 5 $ 60.00 $ 65.00 $ 325,00 $ 0.60 $ 300.00 6" SDR service ea 5 $ 60.00 $ 1,045.00 $ 5,225.00 $ 0.60 $ 300.00 Trench LF 890 $ 60.00 $ - $ - $ 0.60 $ 534.00 8" CL-52 wl sand bedding LF 1102 $ 60.00 $ 28.25 $ 31,131.50 $ 0.60 $ 661.20 Tapping saddle, 8" ea 1 $ 60.00 $ 2,965.00 $ 2.965.00 $ - $ 60.00 Tapping saddle, 6" ea 1 $ 60.00 $ 2,485.00 $ 2,485.00 $ $ 60.00 Fire Hydrant ea 3 $ 60.00 $ 2,115.00 $ 6.345.00 $ $ 180.00 Valves ea 3 $ 60.00 $ 700.00 $ 2,100.00 $ $ 180.00 Bend, Tee, Cross Fittings ea 8 $ 30.00 $ 321.87 $ 2,574.96 $ $ 240.00 Meter pit ea 1 $ 60.00 $ 345.00 $ 345.00 $ $ 60.00 1-1/2" Meter Pit w/yoke ea 5 $ 60.00 $ 1,850.00 $ 9,250.00 $ $ 300.00 Trench LF 1 1102 1 $ 60.00 $ - $ $ 0.60 $ 661.20 Subtotal Street System remove curb/sidewalk Is 1 $ 60.00 $ 570.00 $ 570.00 $ 0,60 $ 60.00 remove/replace Ashpalt ton 160 $ 90.00 $ 130.00 $ 20,800.00 $ 0.30 $ 90.00 Replace sidewalk SF 780 $ 60.00 $ 10.00 $ 7,800.00 $ 0.80 $ 604.00 $ 29,170.00 $ 754.00 Totals: $ 159,901.21 $ 6,359.20 Development Construction Permit, Page 2/6 3. Construction time restrictions: 4. The applicant understands that additional permits may be required for this development project and the applicant shall secure those permits directly from the issuing departments. 5. This permit, along with a complete set of all approved plans and documents for this project (utility plans, site plan, landscape plan, development agreement, soils report, pavement design, traffic study, drainage report, plat easements and any other official documents), shall be kept on the development site available for use by City staff doing inspections. 6. Permit Expiration (in accordance with Section 29-12 of the Transitional Land Use Regulations or Section 2.6.3(K) of the Land Use Code, whichever is applicable): a. If construction has not begun within sixty (60) days from the date of issuance of this permit, this permit shall expire and the applicant will forfeit the permit fee paid for this permit, whereupon the applicant must re -apply for a new permit. b. In addition, this permit shall expire one year from the date of issuance. The applicant may apply for an extension by reapplication at least two weeks prior to the expiration date. Such application shall contain information sufficient to justify the granting of the extension. An extension may be granted for up to six months. 7. Building permits .and certificates of occupancy will only be issued when all conditions contained in the Development Agreement and Sections 3.3.2(C) and (D) of the Land Use Code or Sections 29- 678 and 29-679 of the Transitional Land Use Regulations, whichever is applicable, are met. If the Development Agreement does not specify times for completion of public improvements, or if there is no Development Agreement, then the improvement requirements specified in Section 24-95 of the City Code shall apply, which provides that construction of all improvements shall be required prior to the time of issuance of the first building permit. 8. Acceptance by the City of the public improvements shall be after (1) final inspection has been conducted by the City; (2) punch list items from the final inspection are completed and accepted by the City, and (3) required certifications from the licensed professional engineer that improvements arc completed to City standards, specifications and approved Utility Plans; and the "as -constructed" plans have been received and accepted by the City. 9. The warranty on street improvements is for five (5) years from the date of acceptance by the City of the completed improvements, in accordance with Sections 29-13 and 29-14 of the Transitional Land Use Regulations and/or Sections 2.2.3(C)(3)(g), 3.3.1(C)(2), and 3.3.2(C) of the Land Use Code, as applicable. 10. The City Erosion Control Inspector must be notified at least twenty-four (24) hours prior to any Development Construction Permit, Page 3/6 planned construction on this project. All required perimeter silt fencing and other erosion/sediment control best management practices (BMP's) that can be installed prior to construction must be in place and inspected by the City Erosion Control Inspector before any land disturbing activity begins. 11. No work (including grading) shall be started in State Highway right-of-way until a permit is issued by the Colorado Department of Transportation to allow such work to begin. 12. Other conditions: Permittee's acknowledgment signature: By signing this permit I acknowledges that I am acting with the knowledge, consent, and authority of the owners of the property (including all owners having legal or equitable interest in the real property, as defined in Section 1-2 of the City Code; and including common areas legally connected to or associated with the property which is the subject of this application) without whose consent and authority the requested action could not lawfully be accomplished. Pursuant to said authority, I hereby permit City officials to enter upon the property for purposes of inspection and, if necessary, to enter upon such property to perform work required of the applicant if the applicant were to fail to perform the required work. I also acknowledge that I have read this permit document with all its requirements and conditions, and I agree to all of the terms and conditions so stated in this permit. Applicant/Project Manager's Signature: Date: 2_--4' Approval for issuance: City Engineer Approval: '�'�� Date: �z - (Permit Issuance Date) Development Construction Permit, Page 5/6 Forestry: Tim Buchanan 215 N. Mason St, Ft Collins, CO 970 221-6641 Light and Power: Doug Martine 700 Wood Street, Ft Collins, CO 80521 970 224-6152 Developer' Contact Persons: Project Manager/Owner: Thomas Crow T&S Investments, LLC PO Box 272272 Fort Collins, CO 80527 Office: 970 225 0388 Cell: 970 215 2991 Fax: 970 207 1860 Developer: Thomas Crow Valley Crest Homes PO Box 272272 Fort Collins, CO 80527 Office: 970 225 0388 Cell: 970 215 2991 Fax: 970 207 1860 Architect/Planner: Donald Leffler Design Development Consultants 2627 Redwing Rd, St. 350 Fort Collins, CO Office 226 0585 Cell: 227 0142 Fax: 282 7123 Project Engineer: James Loonan Loonan and Associates, Inc. 1630 S. College Ave. Fort Collins, CO Office: 493 2808 Development Construction Permit, Page 4/6 EXHIBIT "A" DEVELOPMENT PROJECT CONTACT PERSONS Project Name: Big Horn Village II City Staff Contact Persons: Development Engineer: Construction Inspector: Current Planner: Katie Moore, 281 N. College Ave., Fort Collins, CO 80522 (970) 221-6605 Joe Crabill, 281 N. College Ave., 221-6605 Bob Barkeen, 281 N. College Ave., 221-6750 Water Utilities Engineer: Roger Buffington 700 Wood Street, Ft Collins, CO 80521 970 221-6854 Stormwater Utilities Engineer: Glen Schlueter 700 Wood Street, Ft Collins, CO 80521 970 221-6065 Erosion Control Inspector: Bob Zackley 700 Wood Street, Ft Collins, CO 80521 970 224-6063 Natural Resources: Doug Moore 281 N. College Ave, 221-6750 Traffic Operations: Eric Bracke 625 Ninth Street, Ft Collins, CO 80524 970 224-6062 Street closures: Syl Mireles 625 Ninth Street, Ft Collins, CO 80524 970 224-6815 Transportation Planning: Kathleen Reavis 215 N. Mason St, Ft Collins, CO 970 224-6104 General Contractor: Development Construction Permit, Page 6/6 Cell: 218 4042 Fax: 495 9735 Neeley Amidon JB Excavating, Inc. 1316 S. Summitview Dr. Office: 484 6593 Cell: 567 1601 Fax: 490 6115 Concrete contractor for flat work: Jose Fuerte Fuerte Construction 1933 Summit Ct Fort Collins, Co Office: 482 8506 Cell: 567 0901 Fax: 482 8506 Paving Contractor: Landscape Contractor: Trace Musgrave Connell Resources 4305 E. Harmony Rd. Fort Collins, CO Office: 2233151 Fax:2233191 Chad Oster Oster Landscape 2502 Dallas Creek Ct. Office: 567 5296 Cell: 567 2216 Fax: 686 7061 February 6, 2002 City of Fort Collins 300 LaPorte Avenue Fort Collins, CO 80521 Dear Sirs: NEW FRONTIER BANK We hereby establish, at the request and for the account of Valley Crest Homes, Inc., in your favor as hcneficiary, our Irrevocable Letter of Credit No. 218, in the amount of One Hundred Sixtv Three Thousand Ninetv One Dollars and No1100 (S163,091.00), as more fully described below, effective immediately and expiring at the close of banking business on February 6, 2003, at our offico at 1130 Main Street, Windsor, Colorado. 80550. This Letter of Credit is intended for the funding required for the Completion of infrastructure at City Park Avenue ("Development Project") for the assurance of the completion o C the construction and the maintenance and repair of the public infrastructure in connection with the aforesaid development project and its associated development agreement and development construction permit. Funds under this Letter of Credit are available to you_ for one or more drawings prior to the close of business on February 6, 2003 against sight drafts in an aggregate cumulative amount no to exceed S163,091.00, dated the date of presentment, drawn on our office referred to above, referring thereon to the numher of this Letter of Credit and accompanied by your written certificate signed by vo,i and acknowledged as therein provided in the form of Exhibit 1 hereto. Presentation of such draft and certificate shall be made at our office referred to above. Upon the earlier of (1) our honoring your draft(s) totaling $163,091.00 in the aggregate presented on or before this Letter of Credit expires pursuant to the terms herein or (ii) the surrender to us by you of this Letter of Credit for cancellation, this Letter of Credit shall automatically tcruninate. It is understood that the amount of this Letter of Credit may be reduced as public improvements are constructed and accepted by the City. As components of the infrastructure are satisfactorily completed in accordance with approved utility plans, the value of the completed components may be established from the Development Construction Pcnnit worksheet for determining costs of infrastructure construction and inspect ion fees. whereupon the amount of this Letter of Credit may be reduced by the value of the completed component(s), upon execution of a "Request for Amendment to Letter of Credit" in the form attached hereto as Exhibit 2. COPY 2425 35th Avenue 9 Greeley, Colorado 80634 • 970-339-5100 • Fax 970-339-5200 This letter of credit shall be subject to the Uniform Commercial Code as in effect in the State of Colorado, and, to the extent not inconsistent with the terms of this Letter of Credit and the Uniform Commercial Code, the Uniform Customs and Practice for Documentary Credits, 1993 revision, ICC publication number 500. This Letter of Credit will be automatically extend without amendments for one year from the present, and each future, expiration date thereof, unless Issuer delivers written notice at least sixty (60) days prior to anv such expiration date to the City of Fort Collins of its intent not to renew this Letter of Credit. Any such notice shall be in writing and shall be delivered with an acknowledged receipt, either in hand or by certified mail. Any amendments to tl-iis Letter of Credit shall be made in the form of Exhibit 2 hereto. The Citv may at anv time request that the Bank amend this Letter of Credit by submitting to the Bank a fully executed certificate in the form of Exhibit 2. The bank may thereafter promptly issue an amendment to the Letter of Credit corresponding to the change or changes requested in such certificate. This Letter of Credit is not transferable. This Letter of Credit sets forth in full our undertaking, and such undertaking shall not in any way be modified, amended, amplified or limited by reference to any document, instrument or agreement referred to herein, except only the certificate and draft(s) referred to herein; and any such reference shall not be deemed to incorporate herein by reference anv document, instrument or agreement except for such certificate and draft(s). Sincerely, 0 James R Rutz ,Senior Vice President :Te:. Frontier Bank 1130 Main Street Windsor, CO 80550 970-674-9080 DEVELOPMENT CONSTRUCTION PERMIT APPLICATION (2/ 16/99) For City use only: Application Number: h,% � pplication Date: Permit application fee: $ 300.00 INSTRUCTIONS: l . Complete this form (some questions may not apply to you) and attach all necessary documents and submit to the Development Engineering Section of the City. 2. If you have any questions contact Development Engineer Katie Moore at 221-6750. 3. Submit the Application and pay the Application Fee at the fee at the Engineering counter at 281 No. College Avenue. PROJECT INFORMATION: Project Name (as approved by the City): Project A.K.A. (Marketing name if different from Project Name): i Project Location: iT�r ��IA 12 (< V' t- l A t v E-2 C_, t`St.i f-1 V Property Owner(At the time of this permit issuance): Individual Name: -�+o e11 PS & , Company Name : T z' S :5+4 V t✓`4 -r-S Address: _ 0 , l S c3 x 2- 7 L 2- L, Phone number(s): Office: c( 1O — j O _.� Cellphone: c) 2. Fax number: G 70 :IC 1 1 Y6 G Emai I: Applicant/Project Manager (The primary contact person for all matters regarding this project, and the person responsible for all matters referencing "the Developer" in the Development Agreement for this project): Individual Name: Tt tc 'tip /ts t�G ` Company Name: i : A-t vC-5 i i t t C- vtkTS L C- C Address: _; B C x 2- 7 Z Z 12- % Phone number(s): Office: (? 7C ,2-� c S,'J' Cellphone: `f 7y Fax number: y7C 2 1 1 CU Email: