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PREILI> VIE I~AT~ U[IT t BUIE~IU fF I,~S~R ANA I~V~~IT~~~ t <br />F~►: ~7~ For f~ix~1s;n~p;' x~f.$¢~K. <br />jt D8 ; <br />~~J~~ F~ IIFIi'~Il lli <br />Ear ~r~ ~ p~bli ~~n~i~ that h~v~ or~tr~~te~ with a contractor on a public ~vnrks projcct reulat~d by <br />7~~00 to '7.70 in ompli~n~~ with f Alsu for use b pnb~ic agencies that are ~ <br />p~rt~r t~ ~ public works project pur~u~r~t ~o f '7~DOa~~~ or ~Ii~, <br />Pi~BLI fJEIE: i~leas~ ~ornpl~tc and mail this form t~ III the a~~v l~r~g pith t>~~ ~ub~~~ <br />v~orks f~~ of one-tcnth of ~n~ pcr~nt of the contrast pri~~ contract am~~nt .~~1~} p~~bi t~ ~I~I. ~'h~ <br />minimu~ fee is o.ll~; the maximum f~~ is 7,hh.hh. Without the folio~rin complct~~ ~nfOration, tl~~ <br />b~rc~u rna}~ b~ unable to properl}~ crcdit }rou for pa}~mcnt rec~iv~d. <br />~[1~LI ~1E1V its ~F ~u~~n~ - En~in~ri~~ f~E l~~ <br />E I~~ ~~~E 99 E, ~roa~y uit~ 400 <br />[T~', STATE, ZIP; Eu~n~;r~~~n 7401 <br />AE 1TT PERI: L~rnn iro~dcn FI~II~; ~4~~ - <br />FI,IET IIrI~►~1E lir: Adam t~tT~n F~E~ ~4~~ -04~ <br />F1JET 1~lIE: ~lnut rnvc ~rl~ ph~s~ at 101 Avenue <br />f~'f]TAf~T >~iE cif ~~rt ~f l~rer proj~t~ l~lnut f~ro~~ mark this is the last phase} <br />1~R~JE'~ LOTIf 1~~ H~tt~r► v~~~~ <br />I~I~.ll;f~T NSF SATE I~''T1~4f~'F FAT A~ITIE~]: 14100 <br />1]TE 1VTIT wAI~Ei~: 1]~II~~ TAT twl~ 40 <br />ITII~T ~~i1E IVII~ ~~8~►~ f~ lr~. dba , onstru~tion <br />f~T"I' 1~~E; fox 1175 <br />ITS ~~l~a CIF; E~~n~, X7440 <br />tab <br />f~1T1AT AII~I~'I': ~,~1.1 FEE ~41~l~1T ~UEI1~~41~: cam, <br />If l~~s than DI, is it part of ~ Earger project? []no ~~trct ~rnouttt .0~~ = fey dui <br />Phase duplicatc this form for future used <br />f + ! ~ <br />