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Home My WebLink AboutCORRESPONDENCE - PURCHASE ORDER - 9116064Page 1 of 1 John Stephen From: Angelina Sanchez -Sprague Sent: Thursday, March 15, 2012 9:40 AM To: John Stephen; Delynn Coldiron Subject: Heath Const Addendum to PO 9116064 Attachments: Addendum Part I does for JS PO 9116064.pdf; Addendum Part II does for JS PO 9116064.pdf Jolkn, here's the summary sheet/supporting documents you requested. It was a good exercise For me to undertake in that I Found I made a mistake in my First request. We, in fact, need an addendum for $21 6, O 1 6—$52,000 more tkan I initially tkouwht. Please take a loot at the attacked and let me know if you have any questions, then let us I6ow kow we can wet back into Requisition # +7' ,201 to revise tkc fiwure. Note: The one scan created tke attached two documents. Angelina 5anckez-5prague I asanclierspragueGtcgov.com City OF Port Collins i ro box 5so I Fort Collms, CQ so522 I C.15A Tel+I J70 ZZI 65Z5 I Fax +1 9702z+613+ I Fcgov.con, 3/15/2012 Mar 12 12 03:28p Wattle & Daub (970) 493-2229 PA RC Heath Construction Co. Cx.AINGE ORDER REQUEST 141 Racqueue Drive No. 00001 PO Drawer H Phone. 970-221-4193 �— Fort Collins, CO 80524 TITLE: Transom Framing PROJECT: L 1B0504 Avery Block Bldg Expansion TO: Attn: Spiro Palmer Avery Building, LLC 3711 IFK Parkway, Suite 340 Fort Collins, CO 80525 RE: To: Item Descriptlon Stock# 00001 Fmm nvnsm inlieu of base bid nheb iliwan of rxisUns fmminc. 00002 GC OH&ProfittIs%) By. Date: r,,N. e s From: Quantity Units 1A00 1.000 DATE: 9/30/2011 JOB: 1 L B0504 CONTRACT NO:001 Number: Unit Prlee Tax Rat* Tax Amount Net Amount S12,991.00 0.071. S0,00 S12,99100 SI.948.80 0.07/. Unit Cost: Unit Tax: Total: so.00 S1,948.10 $14,940.80 $0.00 S14,940.80 By: Shawn Anderson Date: RC ]Heath Construction CO. CHANGE ORDER REQUEST � 141 Racquette Drive No, 00002 PO Drawer H Phone: 970-2214195 Fort Collins, CO 90524 TITLE: Install Metal Band i � vnY - . � DATE: 9/30/2011 PROJECT: I IB0504 Avery BlockBldgExpansions �y JOB: 11 B0504 TO: Attn: Spiro Palmer CONTRACT NO: 001 Avery Building, LLC 3711 JFK Parkway, Suite 340 Fart Collins, CO 80525 RE: To: From: Number: Rem Description Stock# Quantity Units Unit price Tax Rate Tax Amount Net Amount 00001 W&D fume and,hcach fnr 1A00 maul bond per All. N2 S1,555.00 0.00°G Sam SI,585.00 00002 RMS 0Ibm4h&in11.11 mcW 1.000 band'per All. 42 31,200.00 0.00% 50.00 SI �OO.W 00000 GC (Ncrhn &Ym01O5%) 1.000 S417,75 a-W% $0.00 S417,7S Unit Cost: $3,202.75 Unit Tax: $0.00 Total: S3,262.75 By: By- —--✓ �— Spi brier Shawn A derson Date: Date: / Z e.r.aum e DR HISTORY<2,e.� January 10, 2012 Ms. Angelina Sancliez-Sprague City of Fort Collins Community Development and Neighborhood Services PO Box 580 Fort Collins, CO 80522 RE: Project #2010-02-048 Exterior Preservation and Reconstruction of Avery Block Contract Period: 3/1/2011 to73/1/2013 Dear Ms. Sanchez Sprague: % 114 oby JAN :.8 Enclosed is a fully executed copy of Amended Contract #2010-02-048A for the above State Historical Fund giant award. Please retain in your files. Please review the List of Submittals (revised Exhibit C of contact) for a fist of the required progress reports and deliverables and then due dates. We also ask that you attach a Project Deliverables Checklist (copy enclosed) when submitting deliverables; this helps us process your deliverables more efficiently. If you would like technical information or assistance regarding your project, please contact your SFIF Historic Preservation Specialist Anne McCleave at (303) 866-3536. If you have administrative of contractual questions, please contact Grant Staff: Contracts Officer, Janette Vigil at (303) 866-3067, Contracts Coordinator, Susan Frawley at (303) 866-3043, or Contract Specialist, Victoria Giannola at (303) 866-4028. Sincerely,, Victoria Giannola Grant Contracts Specialist VC: c:\docunrent\10161405.dac Appm.,,[/puny e.,maed a.,,&d contract HisTORY COLORADO CENTER 1200 BROADWAY DENVER COLORADO 80203 Form 6-AC-02A (R5/91) or the Colorado Historical APPROVED WAIVER FOIL\I -Amendment 837 CONTRACTAMENDMENT92010-02-048 A TH[S .-1MENDIvfEI�tT, made this %�� day of by and between the State of Colorado for the use and benefit of the Department of Higher Education, History Colorado, the Colorado Historical Society, 1200 Broadway, Denver, Colorado 80203, hereinafter referred to as the State and/or History Colorado, and the City of Fort Collins, 300 LaPorte Avenue, PO Box 580, Fort Collins, Colorado 80522, hereinafter referred to as the Grant Recipient, hereinafter referred to as the "Contractor', and Avery Building, LLC, Owner of Property, 3711 JFK Parlovay, Suite 240, Fort Collins, Colorado 80525, hereinafter referred to as the Property Owner FACTUAL RECITALS Authority exists in the Law and Funds have been budgeted, appropriated and otherwise made available and a sufficient unencumbered balance thereof remains available for payment; and Required approval, clearance, and coordination has been accomplished from and with appropriate agencies; and The Parties entered into a contract dated February 25, 2011, (the "Original Contract"), for SHF Project #2010-02-048, wherein die Contractor agreed to undertake the performance of certain work and services in consideration for which the State agreed to make certain payments; and The enactment of State laws effective July 1, 2009 concerning the monitoring of vendor performance on State contracts and inclusion of contract performance information in a statewide Contract Management System (CMS) require a new provision referenced in 3.6. of dris amendment to be added to the original contract; and The Project Budget is being revised to more adequately reflect die actual bid from the selected contractor, and The State and the Contractor both wish to bring die project to completion in order to fulfill the objectives of the Original Contract. NOW THEREFORE, it is hereby agreed that: 1. Consideration for this amendment to the original contract, C.E. Number 1002048, Contract Routing Number NIA Approved Waiver Form, dated Febmaqr 25, 2011, consists of the payments which shall be made pursuant to this amendment and the promises and agreements herein set forth. 2. It is expressly agreed by the parties that this Amendment is supplemental to the original contract, as amended Number #2010-02-048, dated Febmary 25, 2011, referred to as the 'original contract," which is, by this reference incorporated herein, that all terms, conditions, and provisions thereof, unless specifically modified herein, are to apply to this amendment as though they were expressly rewritten, incorporated, and included herein. , 3. It is agreed the original contract is and shall be modified, altered, and changed in the following respects only. a. Provision 45 of die original contract, the Project Budget is revised as reflected in die attached Revised Exhibit B: Project Budget. b. A new provision is added to the original contract as follows: STATEWIDE CONTRACT MANAGEMENT SYSTEM: If die maximum amount payable to Grantee under this Grant is $t00,000 or greater, either on the Effective Date or at anytime thereafter, this §3.b. applies. Grantee agrees to be governed, and to abide, by the provisions of CRS §24-102-205, §24-102-206, §24-103-601, §24- 103.5-101 and §24-105-102 concerning die monitoring of vendor performance on state contracts and inclusion of contract performance information in a statewide Contract Management System. Page 1 of 3 Grantee's performance shall be subject to Evaluation and Review in accordance with the terms and conditions of this Grant, State law, including CRS §2.4-103.5-101, and State fiscal riles, policies and guidance. Evaluation and Review of Grantee's performance shall be part of the normal Grant administration process and Grantee's performance will be systematically recorded in the statewide Contract Management System. Areas of Evaluation and Review shall include, but shall not be limited to quality, cost and timeliness. Collection of information relevant to the performance of Grantee's obligations under this Grant shall be determined by die specific requirements of such ohhgations and shall include factors tailored to match die requirements of Grantee's obhgadons. Such performance inforrnualin shall he entered into the statewide Contract Management System at intervals established herein and a final Evaluation, Review and rating shall be rendered within 30 days of the end of die Grant tern. Grantee shall be notified following each performance Evaluation and Review, and shall address or correct any identified problem in a timely manner and maintain work progress. Should the final performance Evaluation and Review determine that Grantee demonstrated a gross failure to meet die performance measures established hereunder, the Executive Director of the Colorado Department of Personnel and Adunuiistradon (Executive Director), upon request by CHS, and showing of good cause, may debar Grantee and prohibit Grantee from bidding on future grants. Grantee may contest the final Evaluation, Review and rating by: (a) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS §24-105-102(6)), or (h) under CRS §24-405-102(6), exercising the debarment protest and appeal tights provided in CRS §§24-109-106, 107, 201 or 202, which may result in the reversal of due debarment and reinstatement of Grantee, by din Executive Director, upon showing of good cause. 4. The effective date of this amendment is upon approval of the State Controller or December 15, 2011, whichever is later 5. Except for the "Special Provisions," in the event of any conflict, inconsistency, variance or contradiction between the provisions of this Amendment, and any of the provisions of the Original Contract, die provisions of this Amendment, shall in all respects supersede, govern, and control. The "Special Provisions" shall always be controlling over other provisions in the contract or amendments. The representations in the Special Provisions concerning die absence of bribery or corrupt influences and personal interest of State employees are presently reaffirmed. 6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL. YEAR ARE CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGE=, AND OTHERWISE bIADE AVAILABLE. Page 2 of 3 IN WITNESS WHEREOF, the parties hereto have executed this Amendment on the day fast above written. "Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's behalf and acknowledge that rite State is relying on their representations to that effect. CONTRLICTOR: (Grant Recipient) City of Fort Collins .Legal Name Contracting Entity yc *Signature of Authorized Officer Date II I�VL' r/'^Sf Print Name of Authorized Officer Pratt Title of Authorized Officer Avery Building, LLC egat Owner «�yanaq�_ j-Signature of Legal Own r l''jZ;� I W &AM M STATE OF COLORADO John W Flte enlooper, GOVERNOR BY: � Exectrilve Director or Designee - Edward C. Nichols, President History Colorado, the �C(olom o/H�storical Society Date: Department of I-hgher Education STATE HISTORICAL FUND BY: �C v�''°✓ S7 Director t5,13esignec Steve W. Turner, Vice President OAHP & SHF/Deputy SHPO Date: 12�2g ! 2-otI WAIVER CONTRACT REVIEWER Contracts Officer or Designee Janette Vigil, State Flistorical Fund Date: (7'[-7-ce ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller to approve all Snte Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performances or for any goods and/or services provided hereunder. Approvo s T orm Deputy City Attorney STATE CONTROLLER `Y David J. McD �rrgo it, CPA Susan S. Rielil CHS, Chief Financial Officer Date: / )- /z // / // - Page 3 of 3 Revised, September 27, 2011 c\Dom,mu\n I5495adoc Appm,il/C.rance Amendmrnr/Scope a(woek w/ Owner @Time G,cmiun City of Fort Collins Exterior Preservation and Reconstruction Projectl#2010-02-048 PROJECT BUDGET TASK PROJECT COST A. Architectural Services $ 25,000 B. Preservation and Reconstruction 1. Masonry Restoration Work $112,000 2. Window and Doors Work $ 77,271 3. Storefront Work . $ 211,154 4. Pressed Tui Cornice Work $ 24,880 Contractor Services $144,360 Includes: General Conditions, Contractor Overhead/Profit, Permits, Fees, insurance, taxes, payment and petformance bonding. Subtotal $594,665 Grant Administration"* $ 7,000 PROJECT SUBTOTAL*** $601,665 Contingency* $ 0 PROJECT TOTAL $601,665 Crash Match (64?4%) $386,530 Grant Request(35.76%) 5215,135 Easement Acceprance Fee $30,000 Grant Award Totals w/ easement fees $245,135 `Contingency - Must receive written approval from SHF Staff prior to use Exhibit B Revised 10/11/2011 **Gant Administration cannot exceed 15% of Subtatal:unount *"Grant payments will be based off Project Subtotal amount. $Easement Fees —Thus itern may not be used on other tasks and tray not exceed budgeted amount Fb\Conmacts\2UI0\IOU2048 Exhibit D_Re6,s d 111.112011.dac Background for support of request for addendum for PO 911606' SHF Grant $430,270 25,000 Less Slater Paull Architechts PO # 9112702 7,000 Less Grant Adm fee $398,270 Initial Heath Const. PO# 9116064 SHF Revised Contract Total 601,665 See. Rev 10/11111 Exhibit B 7,000 Less grant admih fee 25,000 Less architect's fee 569,665 See Draw 5 Schedule of Values Orig. Conti 44,621 Plus Change orders 1-5; see SV approved c 614,286 See Draw 5 Schedule of Values, Adjusted C< 398,270 Less initial PO 916064 216,016 Amount needed for Addendum 216,016.00 i 1841016.00 - 321000,-00 City of Fort Collins Exterior Preservation and Reconstruction Project #2010-02-048 PROJECT BUDGET TASK PROJECT COST A. Architectural Services $ 25,000 B. Preservation and Reconstruction 1. Masonry Restoration Work $ 75,325 2. Window and Doors Work $ 86,810 3. Storefront Work $ 90,846 4. Pressed Tin Cornice Work $ 23,716 Contractor Services $ 82,573 Includes: General Conditions, Contractor Overhead/Profit, Permits, Fees, insurance, taxes, payment and performance bonding. Subtotal $384,270 Grant Administration** $ 7,000 PROJECT SUBTOTAL*** $391,270 Contingency* $ 39,000 PROJECT TOTAL $430,270 Cash Match (50%) $215,135 Grant Request (50%) $215,135 $Easement Acceptance Fee $30,000 Grant Award Totals w/ easement fees $245,135 *Contingency - Must receive written approval from SHF Staff prior to use **Grant Administration cannot exceed 15% of Subtotal amount Exhibit B ***Grant payments will be based off Project Subtotal amount. $Easement Fees —This item may not be used on other tasks and may not exceed budgeted amount H:\Contracts\2010\1002048 Exhibit B.doc City of Fort Collins Exterior Preservation and Reconstruction Project #2010-02-048 PROJECT BUDGET TASK PROJECT COST A. Atchitecmral Services $ 25,000 B. Preservation and Reconstruction L. Masonry Restoration Work $112,000 2. Window and Doors Work $ 77,271 3. Storefront Work - $ 211,154 4. Pressed Tut Cornice Work $ 24,880 Contractor Services $144,360 Includes: General Conditions, Contractor Overhead/Profit, Permits, Fees, insurance, taxes, payment and performance bonding. Subtotal $594,665 Grant Administration** $ 7,000 PROJECT SUBTOTAL*** $601,665 Contingency* $ 0 PROJECT TOTAL $601,665 Cash Match (64.24%) $386,530 Grant Request (35.76%) $215,135 — #Easement Acceptance Fee $30,000 Grant Award Totals w/ casement fees 3245,135 Exhibit B Revised 10/11/201t *Contingency - Must receive written approval from SHF Staff prior to use **Grant Administration cannot exceed 15% of Subtotal arnount °**Grant payments will be based off Project Subtotal amount. $Easement Pees —This item. may not be used on other tasks and may not exceed budgeted amount 1-1:\Conrncm\2010\1002043 Eahibic 8—Revised 711.I I3011.doc s 0 G" S L A T E R P A U L L A I C A I T E C T S NOTES PROJECT. Pi�6J�y� yy7' DATE: 0" PAIR CENT PAL I3DITR 600 / ISIS ARAPAROI 3T l DENVSR CO 8090E 1 TELEPR ONE 303.6OI-nOn I FACST WILE 303A07.0767 I W W W.RLATRRPAOLL.CON Page 1 of 4 SCHEDULE OF VALUES AND CERTIFICATE FOR PAYMENT NO.05 v J PROJECT TITLE: City of Fort Collins - Exterior Preservation and Reconstruction OJ. PROJECTNUMBER: CHSISHF Project#2010-02-048 INSTITUTIONIAGENCY: Avery Building LLC For Period: 02/01112 - 02129112 SCHEDULE OF VALUES Attach supporting detall sheets: TOTAL VALUE VALUE OF WORN COMPLETED PERCENT COMPLETE PREVIOUS VALUE VALUE" THIS REPORT CURRENT VALUE TO DATE ' - A C 0=8+C E=01A ORIGINAL CONTRACT ( sum of P3 forms) 569,665-00 353,1300.00 46.019.75 409,019.75 T3.5% APPROVED CHANGE ORDERS ( sum of P2 forms . 43,772-47 19,619.52 22,202.75 41,82227 95,5% ADJUSTED CONTRACT TOTAL 61 .47 382.619.521 68,22250 450,842.02 73.5% LESS: RETAINAGE bm 18,G Al 38,261.951 5,822.25 45,084.20' _ NET REQUISTION AMOUNT 344,357.57 61.400.25 405,757.82. Amount This Certification The undersigned Contractor requests payment of (hat portion of the contract price shown on the last line of the foregoing Schedule of Values, and represents and warrants to (he Owner that (1) the data shown on the Schedule of Values is accurate and correct; (2) the Work covered by this Certificate hasbeen completed in eccardance with the Contact Documents; (3) all previous progress payments received from Owner on account of Work done under this Contract have been applied to discharge in full (exceptfor allowable re(ainage) all obligations of Contractor Incurred In connection with Work covered by prior Certificates for Payment numbered 00 through 0 inclusive; and (4) Lille to all materials and equipment for which payment is requested in this CerSfite, cawhether or not incorporated in said Work, will pass to Owner at time of payment free and dearof all liens, claims, security interests and encumbrances (except such materials and equipment which are covered by a Bond previously accepted by Owner), FEIN P. 84-073858T Contractor. Heath Construction and Wattle 8 Daub Contractors Date: 29 FE8. 2012.By: M30M Type Name: Byron McGough ARCHITECTIENGINEER CERTIFICATION This Is to certify that, in accordance with the terms of a contract for Project Number 2010-02- 049 executed the day of by and between, C N viP Far} CO U'S . the contractor, and Avery Building I.I.C. Owner, for work at AV" Nock gL1O�Mi'r\p rr�� , there 1is due to the Contraclor(heameunlof �M-OVIe'ihbosc 1C1 -GQr I�t?'�dy-ul 4Y1 1 /100 Dollars, let, $too•2$ A/E: `St.A1F.2.PAL)LL AyC-Ili+LCN% Type r-' By. , A1k Name: C,urglIG. Ford, ALAr Date: 3/5 u 2 Amount approved for payment this certificate is: By By: Title: AGENCY ACTION Dollars ( ) ,.eC— Date: Date: Page 2 of 4 SCHEDULE OF VALUES AND CERTIFICATE FOR PAYMENT NO. 05 (continued) APPROVED CHANGE ORDERS PROJECT TITLE: City of Fort Collins. Exterior Preservation and Reconstruction - Avery Building PROJECT NUMBER: CHS/SHF Project 42010-02-048 For Period: 02101/2012 - W2912012 CHANGE ORDER NUMBER CHANGE ORDER DESCRIPTION TOTAL VALUE VALUE OF WORK COMPLETED PERCENT COMPLETE PREVIOUS VALUE TO DATE VALUE THIS REPORT CURRENT VALUE TO DATE A - B C-0-8 D=AxE E 1 Transom Framing 14,940.80 14,940.80 14,940.80 100 2 Metal Band 320275 1,500.00 1.702.75 3,20275 100 3 Ext. Paint Extras 408.00 408.00 40B.00 100 4 Permit Credit -1,729.2B -1.729.28 .1.729.28 ' 100 5 Masonry Wall 27,798.95 4,500.00 20,500.00 25,000.00 90 UBTOTAL APPROVED CHANGE ORDERS 44,621.22- 19,619.521 22,202.75 417822.27r :. SCHEDULE OF VALUES AND CERTIFICATE -FOR PAYMENT NO. 05 (continued) Page 3 of4 ORIGINAL CONTRACT- ITEMIZED BREAKDOWN PROJECT TITLE: City of Fort Collins - Exterior Presorvation and Restoration -Avery Building PROJECT NUMBER: CHSJSHF Pro(eG MIO-02448 For Perlod: 02/01112, 02/29112 _ ITEM NO. ITEM DESCRIPTION CATE- GORY TOTAL VALUE VALUE OF WORK COMPLETED PERCENT COMPLETE PREVIOUS VALUE TO DATE VALUE THIS REPORT CURRENT VALUE I TO DATE -- A D C=D-D D=AxE E . Preservation and Reconstruction 0.1 MasonryRestoraltan Work HCNVD 112.000 f77,271 82.000.0 8.000.00 90,000.00 8D% 8.2 Wmda and Doors Work HCNVD _ 6t,350.D0 5,0110.00 66350.00 86% BA Storefront Work HCMJD 2111_54 13 000.0a 20,000.00 152,000.00 72% B.4 . Pressed Tin Comics Work HCJWD 24,880 Contractor Services HCMJD 144,360 87650.00 2,019.15100,689.75 70% CONTRCTTOTAL 'I 569,665 363,000.00 46,019.75 409,01.9.75 Page 4o14 SCHEDULE OF VALUES AND CERTIFICATE FOR PAYMENT NO. 05 PROJECT TITLE: City of Fort Collins • Exterior Preservation and Reconstruction PROJECT NUMBER: CHSISHF Project#2010-02-048 INSTITUTIOWAGENCY: Avery Building LLC For Period: 02/01/2012 - 02292012 SCHEDULE OF VALUES Attach supporting detail sheets: TOTAL VALUE VALUE OF WORK COMPLETED PERCENT COMPLETE PREVIOUS VALUE TO DATE VALUE THIS REPORT CURRENT VALUE TO DATE A 8 C 0=8.c c=DIA ORIGINAL CONTRACT ( sum of P3 farms) 569,665.00 363,000.00 46,019.75 409,019.75 73.5% APPROVED CHANGE ORDERS ( sum of P2 forms 43,772.47 19,619.62 22,202.75 41,822.27 95.5% ADJUSTED CONTRACT TOTAL 513,437.47 382,619.52 68,222.50 450,842.02 73.5% LESS: NEB' REQUISITION AMOUNT#3 344,357.57 00 61,4.25 405,757.82 RETAINAGE AMOUNT REQUISITION #3 77 38,261.95 3.822.25 45,084.20 Amount This Certification The undersigned Contractor requests oaymem of that portion of the contract price shown on the last the of the foregoing Schedule of Values, and represents and warrants to the Owner that (1) the data shown on the Schedule of Values is accurate and correct; (2) the Work covered by this Certificate has been completed in accordance with the Contract Oocuments; (3) all previous progress payments received from Owpw on account of Work done under this Contract have been applied to discharge in full (except for allowable retainage) all obligations of Contractor incurred in connection with Work covered by poor Certificates for Payment numbered Q D through 0-4- inclusive; and (4) fide to all materials and equipment forwhich payment is requested in this Certificate, whether or not incorporated in said Work, win pass to Owner at time of payment free and clear of an liens, claims, security interests and encumbrances (except such materials and equipment which are covered by Bond previously accepted by Owner). FEIN ik. 84-0738587 Contractor: Heatrhh Construction and Wattle & Daub Contractors Date: a9 r'E�i• By; Type Name: Byron McGough This is to certify that, in accordance with the terms of a contract for Project Number 2010- 01-048 executed by and between, CiiEj of Fco- - cplki t5 , the contractor, and Avery Building LLC, tt....__ t� Owner, for work at AyLV4 ?0%0c)r-. 1!aazGic�q there is dua4o.tho- YGlc.N rICAi ' -'n Contractor the amount of 5lX ---r Ascwt i ei ll k- KI,xldr¢-C1 }r nn}.4-Awo at,,4 "/tt4 Dollars, $ (o E�2-Z • ZS Are h TEtzph A t AVOW, E Type 1 "Rgnalk,,,.j1AIA Name: CaSiC )come- 4,r A)Rr Date: 315 ?Jot AGENCY ACTION Amount approved for payment this certificate is: Dollars ( ) By: Title: Date: By: rue: Date: