Backup Documents 06/12/2018 Item #16D 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 6 D 5
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents arc to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s)(List in routing order) ; Office Initials Date
2.
3. County Attorney Office County Attorney Office
4. BCC Office Board of County Commissioners ' '
(O\\Z\\ )
5. Minutes and Records Clerk of Court's Office 4'it 2-1(8
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one
of the addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Michelle Arnold/Joshua Thomas/Tessie Sillery Phone Number 252-8989 or 252-5840.
Contact/ Department PTNE Division(old
Agenda Date Item was 06-12-2018 I Dept)
Agenda� 4 Ada Item Number 16 D(ve). ID#5646
Approved by the BCC d�
Type of Document Memorandum of Agreement(MOA) Number of Original 1 Memorandum of
Attached Documents Attached Agreement CTD
PO number or account SEE MEMO ATTACHED FOR SPECIAL
number if document is to INSTRUCTIONS
be recorded
Special instructions: email a copy to ;michellc.arnold(ajcolliercountyfl.gov,brandy.otero@colliercountyfl.gov
And Tessie.Silleryrn;colliercountyfl.gov
INSTRUCTIONS&CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is appropriate. Yes N/A(Not
(Initial) Applicable)
1. Does the document require the chairman's original signature? \L
2. Does the document need to be sent to another agency for additional signatures? If yes,provide
the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by
the Chairman,with the exception of most letters,must be reviewed and signed by the Office of
the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's Office
and all other parties except the BCC Chairman and the Clerk to the Board \C r
5. The Chairman's signature line date has been entered as the date of BCC approval of the document
or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's signature
and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE. Some
documents are time sensitive and require forwarding to Tallahassee within a certain time frame or ��
the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 06-12-2018 and all changes made during the v. N/A is not an
meeting have been incorporated in the attached document. The County Attorney's Office option for
has reviewed the changes,if applicable. s is line.
9. Initials of attorney verifying that the attached document is the version approved by the BCC, . is not an
changes directed by the BCC have been made,and the document is ready for the Chairman's o' io'.for
signature. e.E:\ this lin,.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16D5
Ann P. Jennejohn
From: Ann P.Jennejohn
Sent: Wednesday,June 13, 2018 1:01 PM
To: Otero, Brandy; 'SilleryTessie'
Subject: MOU w/Commission for the Transportation Disadvantaged (Item #16D5 June 12, 2018
BCC Meeting)
Attachments: Backup Documents 06_12_2018 Item #16D 5.pdf
Good Aftervtoovt,
The original copy of the attached MOU is being sevtt (via FedEx),
to Mr. John Irvin w/State of Florida Commission for the
Transportation Disadvantaged, this afternoon.
As requested I also included a return FedEx Mailing Label
(to Collier County) in the FedEx envelope.
Ann Jennejohn, Deputy Clerk
Hoard Minutes & Records Department
Collier County Value Adjustewent 13oard
239-2.52.-8406
_ r
i Q
ottrity of (oilier 6 5
CLERK OF THE)CIR UIT COURT
Dwight E. Brock COLLIER COUIS'Y COLTHOUSE Clerk of Courts
Clerk of Courts 3315 TAMIAMI TRL E STE 102 , P.O. BOX 413044 Accountant
NAPLES,FLORIDA 1 NAPLES,FLORIDA Auditor
34112-5324 I- ,34101-3044 Custodian of County Funds
June 13, 2018
John Paul Irvine
FL Commission for the Transportation Disadvantaged
605 Suwannee Street, Mail Station No. 49
Tallahassee, FL 32399
Re: Memorandum of Agreement: State of Florida Commission for the
Transportation Disadvantaged: Contract No. TD-1803
Mr. Irvine,
Attached for further processing is an original copy of the MOA referenced above,
approved by the Collier County Board of County Commissioners June 12, 2018.
If your office requires further information regarding this mailing, please feel free to
contact me at 239-252-8406.
Thank you.
DWIGHT E. BROCK, CLERK
Ann Jennejohn,
Deputy Clerk
Attachment
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk@collierclerk.com
as
LIN
at
•0
PULE AND RETAIN THIS COPY BEFORE AFFIXING TO THE PACKAGE.NO POUCH NEEDED.
& e it s 2
u s �a e E 2M
s
dig ` - :
3 E ' - if
< 3 fa
, y .,
���jj^ LJ g V
oi
'ail u'S.S.1 `a� 1m g, E 91
f {: i O E yit I 4 - C 1 i$ o
I a %g
1111 .1
8 ' . 2 to R
Sill `i ; r I `.i =_ js 1 a ` 14
lC rQ ii c i Ey8 4 3 L ~ 8
6 5r TT, o.
.� - .
LLO W3 d .� cnZ I 1H
b€s'
I
- , 1 3W1 Nhhhi �
C6 , �J $iii _llii oil
...05. 3 ❑ ❑ CID ci
c
M M
M1� = `=' g \ SI
,...) IDi 4 . �. >.to
a.
It
‘,g1 , T,
az r, • II'N 89
. NI 41141- o
� ya .. `+.�to - r \ wear
m
.--1 L.. 1 v m i 4 gig i 1 '
0
Lt (\ a 4.1.
c Al S 1 Al, a,g r242 S aj i
N M t _
6EE££917'0081 X3P8i09'008'1 wo3 xapa4
.. ... _ .... _ ..... *NI
1—
.. ..
L —
16D5
Contract# TD-1803
Effective: 7/1/18 to 6/30/2023
STATE OF FLORIDA
COMMISSION FOR THE TRANSPORTATION DISADVANTAGED
MEMORANDUM OF AGREEMENT
This Memorandum of Agreement is between the COMMISSION FOR THE TRANSPORTATION
DISADVANTAGED, hereby referred to as the "Commission," and Collier County Board of County
Commissioners, Collier Area Transit, 3299 East Tamiami Trail, Naples, FL 34112 the COMMUNITY
TRANSPORTATION COORDINATOR, designated pursuant to Chapter 427, F.S., to serve the
transportation disadvantaged for the community that includes the entire area of Collier county(ies),
and hereafter referred to as the "Coordinator."
This Agreement is made in consideration of the mutual benefits to both parties; said consideration
acknowledged hereto by the parties as good and valuable consideration.
The Parties Agree:
The Coordinator Shall:
A. Become and remain totally apprised of all of the Transportation Disadvantaged resources
available or planned in their designated service area. This knowledge will be used to plan,
coordinate, and implement the most cost effective transportation disadvantaged transit
system possible under the economic and other conditions that exist in the designated service
area.
B. Plan and work with Community Transportation Coordinators in adjacent and other areas of
the state to coordinate the provision of community trips that might be handled at a lower
overall cost to the community by another Coordinator. This includes honoring any
Commission-approved statewide certification program that allows for intercounty
transportation opportunities.
C. Arrange for all services in accordance with Chapter 427, Florida Statutes, and Rule 41-2,
FAC, and as further required by the Commission and the local Coordinating Board approved
Transportation Disadvantaged Service Plan.
D. Return any acquired profits or surplus funds originating through the course of business as
the Coordinator that are beyond the amounts(s) specifically identified and approved in the
accompanying Transportation Disadvantaged Service Plan. Such profits or funds shall be
returned to the Coordinator's transportation system or to any subsequent Coordinator, as a
total transportation system subsidy, to be applied to the immediate following operational
year. The Coordinator will include similar language in all coordination contracts to assure
that transportation disadvantaged related revenues are put back into transportation
disadvantaged services.
Rev. 04/02/2012
1b05
E. Accomplish this Project by:
1. Developing a Transportation Disadvantaged Service Plan for approval by the local
Coordinating Board and the Commission. Coordinators who are newly designated to
a particular service area shall submit a local Coordinating Board approved
Transportation Disadvantaged Service Plan, within 120 calendar days following the
execution of the Coordinator's initial memorandum of agreement with the
Commission, for approval by the Commission. All subsequent Transportation
Disadvantaged Service Plans shall be submitted and approved with the
corresponding memorandum of agreement. The approved Transportation
Disadvantaged Service Plan will be implemented and monitored to provide for
community-wide transportation services for purchase by non-sponsored
transportation disadvantaged persons, contracting social service agencies, and other
entities that use local, state, or federal government funds for the purchase of
transportation for the transportation disadvantaged.
2. Maximizing the use of available public school transportation resources and public
fixed route or fixed schedule transit services and assuring that private or public transit,
paratransit operators, and school boards have been afforded a fair opportunity to
participate to the maximum extent feasible in the planning process and in the
development of the provisions of the Transportation Disadvantaged Service Plan for
the transportation disadvantaged.
3. Providing or arranging 24-hour, 7-day per week transportation disadvantaged service
as required in the designated service area by any Federal, State or Local Government
agency sponsoring such services. The provision of said services shall be furnished
in accordance with the prior notification requirements identified in the local
Coordinating Board and Commission approved Transportation Disadvantaged
Service Plan.
4. Complying with all local, state, and federal laws and regulations that apply to the
provision of transportation disadvantaged services.
5. Submitting to the Commission an Annual Operating Report detailing demographic,
operational, and financial data regarding coordination activities in the designated
service area. The report shall be prepared on forms provided by the Commission
and according to the instructions of said forms.
F. Comply with Audit and Record Keeping Requirements by:
1. Utilizing the Commission recognized Chart of Accounts defined in the Transportation
Accounting Consortium Model Uniform Accounting System for Rural and Specialized
Transportation Providers (uniform accounting system) for all transportation
disadvantaged accounting and reporting purposes. Community Transportation
Coordinators with existing and equivalent accounting systems are not required to
adopt the Chart of Accounts in lieu of their existing Chart of Accounts but shall
prepare all reports, invoices, and fiscal documents relating to the transportation
disadvantaged functions and activities using the chart of accounts and accounting
definitions as outlined in the above referenced manual.
Rev. 04/02/2012
2 0
1605
2. Assuming the responsibility of invoicing for any transportation services arranged,
unless otherwise stipulated by a purchase of service contract or coordination
contract.
3. Maintaining and filing with the Commission, local Coordinating Board, and all
purchasing agencies/entities such progress, fiscal, inventory, and other reports as
those entities may require during the period of this Agreement.
4. Providing copies of finance and compliance audits to the Commission and local
Coordinating Board as requested by the Commission or local Coordinating Board.
G. Retain all financial records, supporting documents, statistical records, and any other
documents pertinent to this Agreement for a period of five (5) years after termination of this
Agreement. If an audit has been initiated and audit findings have not been resolved at the
end of five (5) years, the records shall be retained until resolution of the audit findings. The
Coordinator shall assure that these records shall be subject to inspection, review, or audit
at all reasonable times by persons duly authorized by the Commission or this Agreement.
They shall have full access to and the right to examine any of the said records and
documents during the retention period.
H. Comply with Safety Requirements by:
1. Complying with Section 341.061, F.S., and Rule 14-90, FAC, concerning System
Safety; or complying with Chapter 234.051, F.S., regarding school bus safety
requirements for those services provided through a school board; and
2. Assuring compliance with local, state, and federal laws, and Commission policies
relating to drug testing. Conduct drug and alcohol testing for safety sensitive job
positions within the coordinated system regarding pre-employment, randomization,
post-accident, and reasonable suspicion as required by the Federal Highway
Administration and the Federal Transit Administration.
Comply with Commission insurance requirements by maintaining at least minimum liability
insurance coverage in the amount of $200,000 for any one person and $300,000 per
occurrence at all times during the existence of this Agreement for all transportation services
purchased or provided for the transportation disadvantaged through the Community
Transportation Coordinator. Upon the execution of this Agreement, the Coordinator shall
add the Commission as an additional named insured to all insurance policies covering
vehicles transporting the transportation disadvantaged. In the event of any cancellation or
changes in the limits of liability in the insurance policy, the insurance agent or broker shall
notify the Commission. The Coordinator shall insure that contracting transportation
operators and coordination contractors also maintain the same minimum liability insurance,
or an equal governmental insurance program. Insurance coverage in excess of $1 million
per occurrence must be approved by the Commission and the local Coordinating Board
before inclusion in the Transportation Disadvantaged Service Plan or in the justification of
rates and fare structures. Such coverage may be provided by a self-insurance program
established and operating under the laws of the State of Florida and written verification of
insurance protection in accordance with Section 768.28, Florida Statutes, shall be provided
to the Commission upon request.
Rev. 04/02/2012
3
fi
1605
J. Safeguard information by not using or disclosing any information concerning a user of
services under this Agreement for any purpose not in conformity with the local, state and
federal regulations (45 CFR, Part 205.50), except upon order of a court, written consent of
the recipient, or his/her responsible parent or guardian when authorized by law.
K. Protect Civil Rights by:
1. Complying with state and federal laws including but not limited to laws regarding
discrimination on the basis of sex, race, religion, age, disability, sexual orientation, or
national origin. The Coordinator gives this assurance in consideration of and for the
purpose of obtaining federal grants, loans, contracts (except contracts of insurance
or guaranty), property, discounts, or other federal financial assistance to programs or
activities receiving or benefiting from federal financial assistance and agreeing to
complete a Civil Rights Compliance Questionnaire if so requested by the
Commission.
2. Agreeing that compliance with this assurance constitutes a condition of continued
receipt of or benefit from federal financial assistance, and that it is binding upon the
Coordinator, its successors, subcontractors, transferee, and assignees for the period
during which such assistance is provided. Assure that all operators, subcontractors,
subgrantee, or others with whom the Coordinator arranges to provide services or
benefits to participants or employees in connection with any of its programs and
activities are not discriminating against those participants or employees in violation
of the above statutes, regulations, guidelines, and standards. In the event of failure
to comply, the Coordinator agrees that the Commission may, at its discretion, seek a
court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, to include assistance being terminated
and further assistance being denied.
L. To the extent allowed by Section 768.28, Florida Statutes, and only to the monetary and
other limitations contained therein, indemnify and hold harmless the Commission and all of
the Commission's members, officers, agents, and employees; purchasing agency/entity
officers, agents, and employees; and the local, state, and federal governments from any
claim, loss, damage, cost, charge or expense arising out of any act, action, neglect or
omission by the Coordinator during the performance of this Agreement, whether direct or
indirect, and whether to any person or property to which the Commission or said parties may
be subject, except that neither the Coordinator nor any of its sub-contractors will be liable
under this section for damages arising out of injury or damage to persons or property directly
caused or resulting from the sole negligence of the Commission or any of its members,
officers, agents or employees; purchasing agency/entity, officers, agents, and employees;
and local, state, or federal governments. Nothing herein is intended to serve as a waiver of
sovereign immunity by any agency/entity or Coordinator to which sovereign immunity may
be applicable. Nothing herein shall be construed as consent by a state agency/entity or
political subdivision of the State of Florida or the federal government to be sued by third
parties in any matter arising out of any Agreement or contract. Notwithstanding the
foregoing, pursuant to Section 768.28, Florida Statutes, no agency or subdivision of the state
shall be required to indemnify, insure, or assume any liability for the Commission's
negligence.
Rev. 04/02/2012
4
16D5
M. Comply with standards and performance requirements of the Commission, the local
Coordinating Board approved Transportation Disadvantaged Service Plan, and any
purchase of service contracting agencies/entities. Failure to meet the requirements or
obligations set forth in this MOA, and performance requirements established and monitored
by the local Coordinating Board in the approved Transportation Disadvantaged Service
Plan, shall be due cause for non-payment of reimbursement invoices until such deficiencies
have been addressed or corrected to the satisfaction of the Commission.
N. Comply with subcontracting requirements by executing or negotiating contracts for
transportation services with Transportation Operators and Coordination Contractors, and
assuring that the conditions of such contracts are maintained. The requirements of Part 1 ,
Paragraph E.S. through M are to be included in all contracts, subcontracts, coordination
contracts, and assignments made by the Coordinator for services under this Agreement.
Said contracts, subcontracts, coordination contracts, and assignments will be reviewed and
approved annually by the Coordinator and local Coordinating Board for conformance with
the requirements of this Agreement.
O. Comply with the following requirements concerning drivers and vehicles:
1. Drivers for paratransit services, including coordination contractors, shall be required
to announce and identify themselves by name and company in a manner that is
conducive to communications with the specific passenger, upon pickup of each rider,
group of riders, or representative, guardian, or associate of the rider, except in
situations where the driver regularly transports the rider on a recurring basis. Each
driver must have photo identification that is in view of the passenger. Name patches,
inscriptions or badges that affix to driver clothing are acceptable. For transit services,
the driver photo identification shall be in a conspicuous location in the vehicle.
2. The paratransit driver shall provide the passenger with boarding assistance, if
necessary or requested, to the seating portion of the vehicle. The boarding
assistance shall include opening the vehicle door, fastening the seat belt or utilization
of wheelchair securement devices, storage of mobility assistive devices, and closing
the vehicle door. In certain paratransit service categories, the driver may also be
required to open and close doors to buildings, except in situations in which assistance
in opening/closing building doors would not be safe for passengers remaining on the
vehicle. Assisted access must be in a dignified manner. Drivers may not assist
wheelchair up or down more than one step, unless it can be performed safely as
determined by the passenger, guardian, and driver.
3. All vehicles shall be equipped with two-way communications in good working order
and be audible to the driver at all times to the base.
4. All vehicles providing service within the coordinated system, shall have working air
conditioners and heaters in each vehicle. Vehicles that do not have a working air
conditioner or heater will be scheduled for repair or replacement as soon as possible.
Rev. 04/02/2012
5
1605
P. Comply with other requirements as follows:
1. Transport an escort of a passenger and dependent children as locally negotiated and
identified in the local Transportation Disadvantaged Service Plan.
2. Determine locally in the Transportation Disadvantaged Service Plan, the use,
responsibility, and cost of child restraint devices.
3. Transport with the passenger at no additional charge, passenger property that can
be carried by the passenger and/or driver in one trip and can be safely stowed on the
vehicle. Additional requirements may be negotiated for carrying and loading rider
property beyond this amount. Passenger property does not include wheelchairs,
child seats, stretchers, secured oxygen, personal assistive devices, or intravenous
devices.
4. Provide shelter, security, and safety of passengers at vehicle transfer points.
5. Post a local or other toll-free number for complaints or grievances inside each vehicle.
The local complaint process shall be outlined as a section in the local Transportation
Disadvantaged Service Plan including advising the dissatisfied person about the
Commission's Ombudsman Program as a step within the process as approved by the
local Coordinating Board.
6. Provide out-of-service-area trips, when determined locally and approved by the local
Coordinating Board, except in instances where local ordinances prohibit such trips.
7. Keep interior of all vehicles free from dirt, grime, oil, trash, torn upholstery, damaged
or broken seats, protruding metal or other objects or materials which could soil items
placed in the vehicle or provide discomfort for the passenger.
8. Determine locally by the local Coordinating Board and provide in the local
Transportation Disadvantaged Service Plan the billing requirements of the
Community Transportation Coordinator. All bills shall be paid to subcontractors within
7 calendar days after receipt of said payment by the Coordinator, in accordance with
Section 287.0585, Florida Statutes.
9. Maintain or have access to a passenger/trip database on each rider being transported
within the system.
10. Provide each rider and escort, child, or personal care attendant adequate seating for
paratransit services. No more passengers than the registered passenger seating
capacity shall be scheduled or transported in a vehicle at any time. For transit
services provided by transit vehicles, adequate seating or standing space will be
provided to each rider and escort, child, or personal care attendant, and no more
passengers than the registered passenger seating or standing capacity shall be
scheduled or transported in a vehicle at any time.
11. First Aid shall be determined locally and provided in the local Transportation
Disadvantaged Service Plan.
Rev. 04/02/2012
6
GAS
1605
12. Cardiopulmonary Resuscitation shall be determined locally and provided in the local
Transportation Disadvantaged Service Plan.
II. The Commission Shall:
A. Recognize the Coordinator as the entity described in Section 427.011(5), Florida Statutes,
and Rule 41-2.002(4), F.A.C.
B. Attempt to insure that all entities with transportation disadvantaged funds will purchase
transportation disadvantaged services through the Coordinator's system.
III. The Coordinator and the Commission Further Agree:
A. Nothing in this Agreement shall require the Commission to observe or enforce compliance
with any provision thereof, perform any other act or do any other thing in contravention of
any applicable state law. If any of the provisions of this Agreement is found by a court of
law to violate any applicable state law, the purchasing agency/entity will at once notify the
Commission in writing in order that appropriate changes and modifications may be made by
the Commission and the Coordinator to the end that the Coordinator may proceed as soon
as possible with the provision of transportation services.
B. If any part or provision of this Agreement is held invalid, the remainder of this Agreement
shall be binding on the parties hereto.
C. Termination Conditions:
1. Termination at Will -This Agreement may be terminated by either party upon no less
than thirty (30) days notice, without cause. Said notice shall be delivered by certified
mail, return receipt required, or in person with proof of delivery.
2. Termination for Breach - Unless the Coordinator's breach is waived by the
Commission in writing, the Commission may, by written notice to the Coordinator,
terminate this Agreement upon no less than twenty-four (24) hours notice. Said
notice shall be delivered by certified mail, return receipt requested, or in person with
proof of delivery. Waiver by the Commission of breach of any provision of this
Agreement shall not be deemed to be a waiver of any other breach and shall not be
construed to be a modification of the terms of this Agreement, and shall not act as a
waiver or estoppel to enforcement of any provision of this Agreement. The provisions
herein do not limit the Commission's right to remedies at law or to damages.
D. This agreement will expire unless an extension is granted to the Coordinator in writing by
the Commission, in accordance with Chapter 287, Florida Statutes.
E. Renegotiations or Modifications of this Agreement shall only be valid when they have been
reduced to writing, duly approved by the Commission, and signed by both parties hereto.
GAO
Rev. 04/02/2012
1605
F. Notice and Contact:
The name and address of the contract manager for the Commission for this Agreement is:
Executive Director, 605 Suwannee Street, MS-49, Tallahassee, FL 32399-0450. The
representative/position of the Coordinator responsible for administration of the program
under this Agreement is:
Ms. Michelle Arnold,
3299 East Tamiami Trail, Suite 103, Naples, FL 34112
In the event that either party designates different representatives after execution of this
Agreement, notice of the name and address of the new representative will be rendered in
writing to the other party and said notification attached to originals of this Agreement.
This document has been reviewed in its entirety and approved by the local Coordinating Board at
its official meeting Id on Ma 2018.
i
Coor inating Board Chairperson
WITNESS WHEREOF, the parties hereto have caused these presents to be executed.
COMMUNITY TRANSPORTATION STATE OF FLORIDA, COMMISSION FOR
COORDINATOR: THE TRANSPORTATION DISADVANTAGED:
Collier County Board of County Ccnmissioners
Collier Area Transit
Agency Name Printed Name of Authorized Individual
Andy Solis
Printed Name o ut i -• • •• • . . ,/ Signature:
Signature: Title: Executive Director
Title: Chairman
Approv fit and legality
Ill Pim, _ e.
Jeffrey A. Kla ko ounty Attorney
Item#
-ATTE Date v:.=/
DWIGHT E.BROCK,CLERK Date cow��� •
Rev. 04/02/2012 d."
Rec'
Arai i
'tteS at S to'C44' le 4 , [