ࡱ> i ʆbjbjKK  !\!\?[ TTTTT$xxxPxd4@! 0/(X/X/X/0146bbbbbbbfqibqT81"0188bTTX/X/Adc@c@c@8TX/TX/bc@8bc@c@]~aX/O;W+9.`6bWd0dL`2jY9tjl~ajT~a<7"7c@88777bb;777d8888j777777777 > :  CONTRACTORS AND CONSULTANTS APPLICATION ENVIRONMENTAL SERVICE PROVIDERS PLEASE ANSWER ALL QUESTIONS COMPLETELY NOTICE: For certain policies and coverage parts issued, the limit of liability available to pay judgments for settlements shall be reduced by amounts incurred for legal defense. Further note that amounts incurred for legal defense shall be applied against the deductible or retention amount. ALL APPLICANTS MUST SUBMIT THE FOLLOWING INFORMATION IN ADDITION TO THE APPLICATION: Completed Acord Application Qualification including resumes, brochures, and a listing of previous projects. Most recent income statement and balance sheet. Five years of currently valued loss runs including pollution and professional, if applicable. I. APPLICANT INFORMATIONInsured:  FORMTEXT      Date:  FORMTEXT      Address:  FORMTEXT      E-Mail:  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT   Zip Code:  FORMTEXT      Phone:  FORMTEXT      Company is:  FORMCHECKBOX  Individual  FORMCHECKBOX  Partnership  FORMCHECKBOX  Corporation  FORMCHECKBOX  Joint Venture  FORMCHECKBOX  Other  FORMTEXT       . (please describe)II. REQUESTED COVERAGE1. Coverage Requested: (please clearly state what coverage(s) you are requesting)  FORMCHECKBOX  New Business  FORMCHECKBOX  Renewal2. Proposed Effective Date:  FORMTEXT       Proposed Retroactive Date:  FORMTEXT       Expiring Retroactive Date:  FORMTEXT       FORMCHECKBOX  Commercial General Liability  FORMCHECKBOX  Contractors Pollution Liability( FORMCHECKBOX  Occurrence, or ( FORMCHECKBOX  Occurrence, or  FORMCHECKBOX  Claims Made)  FORMCHECKBOX  Claims Made)3. Limits Of Liability/Deductible: Limits Requested:  FORMTEXT       Deductible Requested:  FORMTEXT       4. Other Coverages and Endorsements:  FORMTEXT      .  FORMCHECKBOX  Errors and Omissions (Claims Made Only)  FORMCHECKBOX  Pollution Legal Liability (Claims Made Only)  FORMCHECKBOX  Third Party Pollution Liability  FORMCHECKBOX  On-Site Clean Up  III. GROSS RECEIPTS Please indicate gross receipts for the prior three years: Prior Year Revenues (Past 12 Months)Current Year Revenues (Current 12 Months)Estimated Revenues (Upcoming 12 Months)$ FORMTEXT      $ FORMTEXT      $ FORMTEXT      Indicate Month/Date below:  FORMTEXT       to  FORMTEXT      Indicate Month/Date below:  FORMTEXT       to  FORMTEXT      Indicate Month/Date below:  FORMTEXT       to  FORMTEXT      Note: Gross Receipts are the total of all receipts, invoices and/or billing without any deductions of any kind. Please list your estimated receipts including subcontracted work for the next 12 months next to the appropriate category. List services not described below under  Other (please be specific):4. Environmental Contracting6. Consulting/LaboratoryAbove Ground Storage Tank Installation$ FORMTEXT      Air Monitoring$ FORMTEXT      Above Ground Storage Tank Removal$ FORMTEXT      Analytical Laboratories$ FORMTEXT      Asbestos Abatement$ FORMTEXT      Civil Engineering$ FORMTEXT      Bio Remediation$ FORMTEXT      Environmental Compliance$ FORMTEXT      Drilling (not oil/gas)$ FORMTEXT      Environmental Impact Studies$ FORMTEXT      Emergency Response$ FORMTEXT      Environmental Permitting$ FORMTEXT      Haz Mat Clean Up$ FORMTEXT      Environmental Sampling$ FORMTEXT      Haz Mat Packing / Pickup$ FORMTEXT      Expert Witness$ FORMTEXT      Lead Abatement$ FORMTEXT      Geophysical (i.e. drilling, sampling, etc.)$ FORMTEXT      Liquid Waste Remediation$ FORMTEXT      Geotechnical (i.e. foundation, retaining wall, slope stability, etc.)$ FORMTEXT      Mold Remediation$ FORMTEXT      PCB Removal / Remediation$ FORMTEXT      Haz Mat Consulting$ FORMTEXT      Soil Removal / Remediation$ FORMTEXT      Hydrogeological Investigations$ FORMTEXT      Soil Excavation  other than petroleum$ FORMTEXT      Indoor Air Quality$ FORMTEXT      Tank &/or Pipe Cleaning$ FORMTEXT      Industrial Hygiene / HASP$ FORMTEXT      Underground Storage Tank Installation$ FORMTEXT      Litigation Support$ FORMTEXT      Underground Storage Tank Removal$ FORMTEXT      Manual Preparation$ FORMTEXT      Wetlands Contracting$ FORMTEXT      Mold Evaluation / Consulting$ FORMTEXT      5. Non-Environmental ContractingPhase I Environmental Assessments$ FORMTEXT      Carpentry$ FORMTEXT      Phase II & III Environmental Assessments$ FORMTEXT      Demolition$ FORMTEXT      Project Management$ FORMTEXT      Electrical$ FORMTEXT      Remedial Investigation / Studies$ FORMTEXT      Fire / Water Restoration$ FORMTEXT      Remedial Design$ FORMTEXT      General Contractor$ FORMTEXT      Remediation Oversight$ FORMTEXT      Grading Contractor$ FORMTEXT      Safety Training$ FORMTEXT      Industrial Cleaning$ FORMTEXT      Underground Storage Tank Testing$ FORMTEXT      Maintenance/Janitorial$ FORMTEXT      Wetlands$ FORMTEXT      Masonry$ FORMTEXT      Mechanical Construction$ FORMTEXT      Other  Consulting / LaboratoryMetal Erection$ FORMTEXT      Describe: FORMTEXT      $ FORMTEXT      Painting$ FORMTEXT      Describe: FORMTEXT      $ FORMTEXT      Paving$ FORMTEXT      Pipeline Installation$ FORMTEXT      Plumbing$ FORMTEXT      Roofing$ FORMTEXT      Oil and Gas$ FORMTEXT      Street and Road$ FORMTEXT      Other  ContractingDescribe: FORMTEXT      $ FORMTEXT      Describe: FORMTEXT      $ FORMTEXT      Describe: FORMTEXT      $ FORMTEXT      Describe: FORMTEXT      $ FORMTEXT      Total Projected Contracting Gross Receipts: $ FORMTEXT       Total Projected Consulting/ Laboratory Gross Receipts: $ FORMTEXT       IV. SUBCONTRACTED SERVICES1. Please identify the services that are subcontracted:2. Applicable Cost:Description: FORMTEXT      $ FORMTEXT      Description: FORMTEXT      $ FORMTEXT      Description: FORMTEXT      $ FORMTEXT      Description: FORMTEXT      $ FORMTEXT      3. Are all subcontractors licensed and accredited? FORMCHECKBOX  Yes FORMCHECKBOX  No4. Does the applicant collect certificates of insurance from all subcontractors? FORMCHECKBOX  Yes FORMCHECKBOX  No5. Are the subcontractors required to name the applicant as an additional insured?  FORMCHECKBOX  Yes FORMCHECKBOX  No6. Is a standard written contract used with the applicants clients and/or subcontractors, including hold harmless and limitation of liability clause?  FORMCHECKBOX  Yes FORMCHECKBOX  NoV. GENERAL INFORMATION1. Does the applicant directly or indirectly perform work on residential properties? FORMCHECKBOX  Yes FORMCHECKBOX  NoIf yes, what percentage of the applicants overall sales are associated with this operation? FORMTEXT      %2. Are more than 50% of the applicant s services subcontracted? FORMCHECKBOX  Yes FORMCHECKBOX  No3. Is the applicant applying for project specific coverage? FORMCHECKBOX  Yes FORMCHECKBOX  NoIf yes, please attach a copy of the contract for the project and project supplemental application.4. Does the applicant conduct more than 10% geotechnical or geophysical operations? FORMCHECKBOX  Yes FORMCHECKBOX  NoIf yes, what percentage of the applicants overall sales are associated with this operation? FORMTEXT      %Please submit the following: A detailed list of the applicant s geotechnical and geophysical operations & detailed resumes of employees who conduct these operations.5. Does the applicant install any type of liner, i.e. landfill, lagoons, etc.? FORMCHECKBOX  Yes FORMCHECKBOX  NoIf yes, what percentage of the applicant s overall sales are associated with this operation? FORMTEXT      %Please submit the following: Resumes and certifications of employees installing the liners, in+,KLMRy  |rc[QrC2!h#5B*OJQJ\^Jphh;>CJOJQJ^JaJhnOJQJ^Jh;>CJaJh h;>CJ OJQJ^Jh;>OJQJ^Jh;>5>*OJQJ\^Jh;>5OJQJ\^J"h#h;>5CJ OJQJ\^Jh#OJQJ^Jh#CJ OJQJ^JaJ h#h#CJ OJQJ^JaJ h;>CJ OJQJ^JaJ hECJ OJQJ^JaJ !jhcnh'OJQJU^J+,LMyz  b    $Ifgd# & F 8v>^v`> $]^a$^$p^p`a$gdEgdE$a$gdE      $ %    0 2 4 > @ B D V µyo[yNh5OJQJ\^J'jh;>5OJQJU\^Jh;>OJQJ^J,jh;>5OJQJU\^JmHnHu'j#h;>5OJQJU\^J!jh;>5OJQJU\^Jh;>5OJQJ\^JhPe5OJQJ\^Jh;>CJOJQJ^JaJ!h#5B*OJQJ\^Jph!h;>5B*OJQJ\^Jph   B (($Iftkdj$$Ifl4 Z+>+   0>+64 laf4p B D ~ y $IfgdP (($Ifskd$$Ifl0ZX +@ 0>+64 laV X l n p z | ~ {m`O`;O'jgh;>5OJQJU\^J!jh;>5OJQJU\^Jh;>5OJQJ\^JhCJOJQJ^JaJ jh5U\mHnHuj1h5U\jh5U\ h5\hOJQJ^J,jh5OJQJU\^JmHnHu'jh5OJQJU\^Jh5OJQJ\^J!jh5OJQJU\^J  X yy$If (($Ifvkd$$Ifl0ZX +@ 0>+64 laytP       0 2 F H J T V f h | ~ ˷˰raSIh;>OJQJ^Jh;>CJOJQJ^JaJ jh;>5U\mHnHujh;>5U\jh;>5U\jh;>UmHnHujah;>Uh;>jh;>U h;>5\'jh;>5OJQJU\^Jh;>5OJQJ\^J!jh;>5OJQJU\^J,jh;>5OJQJU\^JmHnHu 6f\P  ! $If  $Ifkdm$$Ifl\Z4X +xb$ @ 0>+64 la 02NPRrttfPt*jqh;>5>*OJQJU\^Jh;>5>*OJQJ\^J$jh;>5>*OJQJU\^Jh;>>*OJQJ^J!jh;>OJQJU^J!jh;>OJQJU^J!jh;>OJQJU^J!jh;>OJQJU^J!j-h;>OJQJU^Jh;>OJQJ^Jjh;>OJQJU^J $679<?RSjkɻp_pRE4R!jh;>5OJQJU\^Jh;>6OJQJ]^Jh;>5OJQJ\^J!h#5B*OJQJ\^Jph!h;>5B*OJQJ\^Jph!h#5B*OJQJ\^Jphh;>CJOJQJ^JaJ h;>6CJOJQJ]^JaJh;>OJQJ^Jh;>B*OJQJ^Jphh;>>*OJQJ^J$jh;>5>*OJQJU\^J/jh;>5>*OJQJU\^JmHnHu67RS"tkdy$$Ifl4 Z+>+   0>+64 laf4p $Ifbkd$$IflZ+>+0>+64 laSzHxkd $$Ifl80Z<+\ 0>+64 laytK:x$Ifx$If^` !hZx$If^Z !Zx$If^Z`    NPRfhjtvzбТЗt_ТL_$jh;>>*OJQJU^J)jh;>>*OJQJU^JmHnHu$jh;>>*OJQJU^Jjh;>>*OJQJU^Jh;>>*OJQJ^JhK:h;>@OJQJ^J!jh;>OJQJU^Jjh;>OJQJU^Jh;>OJQJ^J!jh;>5OJQJU\^J'j2h;>5OJQJU\^Jzܹ̤̗saHs5$jhK:h;>@UmHnHu1jf!hK:h;>5@OJQJU\^J"hK:h;>5@OJQJ\^J+jhK:h;>5@OJQJU\^Jh;>CJOJQJ^JaJh5OJQJ\^J)jh>*OJQJU^JmHnHu$j, h>*OJQJU^Jjh>*OJQJU^Jh>*OJQJ^JhK:h@OJQJ^JhOJQJ^JB.nN> Px$IfVx$If^V`gdK:x$If x$If] !:x$If]:Zx$If]^Z BD`bd  .02NPRnprɰqX1j:#hK:h;>5@OJQJU\^J+j"hK:h;>@OJQJU^J+jP"hK:h;>@OJQJU^J%jhK:h;>@OJQJU^J1j!hK:h;>5@OJQJU\^J"hK:h;>5@OJQJ\^J+jhK:h;>5@OJQJU\^JhK:h;>@OJQJ^J"$&:<>HJLXtatTPh;>h;>5OJQJ\^J$j$h;>>*OJQJU^J)jh;>>*OJQJU^JmHnHu$j&$h;>>*OJQJU^Jjh;>>*OJQJU^Jh;>>*OJQJ^Jh;>OJQJ^JhK:h;>@OJQJ^J+jhK:h;>5@OJQJU\^J1j#hK:h;>5@OJQJU\^J  ",.0<>@B^`bdĽsiZK7'j_'h;>5OJQJU\^JhK:h;>@OJQJ^JhK:hn@OJQJ^Jh;>OJQJ^J'j&h;>5OJQJU\^Jh;>5OJQJ\^J!jh;>5OJQJU\^Jh;>CJOJQJ^JaJh >*B*ph h h h;>>*B*phjh;>>*UmHnHuj(%h;>>*U h;>>*jh;>>*U h h;>>@BEF^RRRRH & F$If Zx$If^Zkd%$$Ifl4~\Z <+\ b$ `\ 0>+64 laf4ytK:048<>@\^`b,-./?AƷmcYcEcc'jK(hK:5OJQJU\^JhOJQJ^JhK:OJQJ^J'j'hK:5OJQJU\^JhK:5OJQJ\^J!jhK:5OJQJU\^JhK:@OJQJ^JhK:@OJQJ^JhK:hK:@OJQJ^JhK:h;>@OJQJ^JhK:h#@OJQJ^Jh;>OJQJ^J!jh;>5OJQJU\^JABEFGHKL^_`!"ɸ~s~s~l^M^!j,hOJQJU^JjhOJQJU^J h5\h5OJQJ^Jhh5OJQJ^Jh5CJ\aJhM!CJOJQJ^JaJhM!B*phhM! h#hM! h#hM!B*OJQJ\phh;>5CJ\aJh;>CJOJQJ^JaJh;>OJQJ^JhOJQJ^Jh OJQJ^JFGH_r  :$IfgdR $a${kd($$Ifl40Z<+ \ 0>+64 laf4ytK:_`| <$Ifgdpwkd)$$Ifl4 Z+>+   0>+64 laf4p ytR {{{{$<$Ifa$gdP$<$Ifa$gdhkde*$$Ifl4Z+>+0>+64 laf4ytg8K5$ ($If^a$gdP$ ($If^a$gdkd +$$Ifl4FZ.+jjj 0>+6    4 laf4pytg  &(*46:<PRT^`bd>@TԲԫvobvj.h d>*U h dh djh d>*UmHnHuj .h d>*U h d>*jh d>*Uh dOJQJ^J h5\!j,hOJQJU^J!jv,hOJQJU^JhOJQJ^JjhOJQJU^J&jhOJQJU^JmHnHu#8bd>M???$<$Ifa$gdP$<$Ifa$gd dkdb-$$Ifl4FZ.+jjj0>+6    4 laf4ytP$ ($If^a$gdPTVXbd(*>@BLNPR|(*zΪΝ鷖xtptptfhAOJQJ^JhAhM! hM!5\hM!5OJQJ\^JhM!OJQJ^J h d5\jX0h d>*Uj/h d>*Uh dOJQJ^Jjl/h d>*U h d>* h dh djh d>*UmHnHujh d>*Uj.h d>*U&PRcZ $IfgdR kd0$$Ifl4FZ.+jjj0>+6    4 laf4ytP$<$Ifa$gdP( $IfgdR hkdv1$$Ifl4Z+>+ 0>+64 laf4ytR (*xzgXX |($IfgdR  ($If^gdR  ($IfgdR vkd2$$Ifl0Z+0>+64 layt<z|2 4 H J L V X !!,!.!B!D!F!P!R!x!~m!jP7hAOJQJU^J!j6hAOJQJU^J!jD5hAOJQJU^J!j4hAOJQJU^J!j83hAOJQJU^J&jhAOJQJU^JmHnHu!j2hAOJQJU^JhAOJQJ^JjhAOJQJU^J*0 Z aR?00  ($IfgdR  ($If^gdR  ($IfgdR kd3$$Ifl \Z&+d@0>+64 layt  !*!T!aR?00 ($IfgdR  ,($If^gdR  ,($IfgdR kd5$$Ifl \Z&+d@0>+64 layt T!V!v!!!aR?0 ,($IfgdR  T($If^gdR  T($IfgdR kd7$$Ifl \Z&+d@0>+64 layt x!z!!!!!!!!!!!!!0"2"F"H"J"T"V""""""""""""# # #B#D#X#Z#\#f#h##~m!jt=hAOJQJU^J!j<hAOJQJU^J!jh;hAOJQJU^J!j:hAOJQJU^J!j\9hAOJQJU^J&jhAOJQJU^JmHnHu!j8hAOJQJU^JhAOJQJ^JjhAOJQJU^J*!!!."X"PA. |($If^gdR  |($IfgdR kd9$$Ifl \Z&+d@0>+64 layt  !,($IfgdR X"""""#RC0 ($If^gdR  ($IfgdR kd;$$Ifl \Z&+d@0>+64 layt  D($IfgdR #@#j#l###RC0 ($If^gdR  ($IfgdR kd=$$Ifl \Z&+d@0>+64 layt  T($IfgdR ##########$$ $$F$H$\$^$`$j$l$$$$$$$$$$$$$$$Z%\%p%r%t%~%%%~m!jChAOJQJU^J!j"ChAOJQJU^J!jAhAOJQJU^J!jAhAOJQJU^J!j?hAOJQJU^J&jhAOJQJU^JmHnHu!j ?hAOJQJU^JhAOJQJ^JjhAOJQJU^J*##$$D$n$RC0 ($If^gdR  ($IfgdR kd?$$Ifl \Z&+d@0>+64 layt  ($IfgdR n$$$$$%RC0 D($If^gdR  D($IfgdR kdB$$Ifl \Z&+d@0>+64 layt  ($IfgdR %X%%%%%RC0 D($If^gdR  D($IfgdR kdD$$Ifl \Z&+d@0>+64 layt  ($IfgdR %%%%%%%p&r&&&&&&&&&&&&&"'$'8':'<'F'H'r't'''''''''''''<(~m!jJhAOJQJU^J!jfIhAOJQJU^J!jHhAOJQJU^J!jMGhAOJQJU^J!jEhAOJQJU^J&jhAOJQJU^JmHnHu!j.EhAOJQJU^JhAOJQJ^JjhAOJQJU^J*%@&n&&&2kdF$$Ifl4 \Z&+d@`0>+64 layt  ($IfgdA ($IfgdR  ($IfgdR &&&&& |($IfgdR  ($IfgdR  p($If^gdR  p($IfgdR && 'J'p'_P=) pp($IfgdR  ($If^gdR  ($IfgdR kdG$$Ifl4 \Z&+d@  0>+64 layt p'''''M>+ \($If^gdR  \($IfgdR kdI$$Ifl \Z&+d@0>+64 layt  pp($IfgdR ':(d(f(((RC0 4($If^gdR  4($IfgdR kdK$$Ifl \Z&+d@0>+64 layt  ($IfgdR <(>(R(T(V(`(b(f(((((((()))) )*),)0)b)d)x)z)|)縪tj\jK\!jOh3%OJQJU^Jjh3%OJQJU^Jh3%OJQJ^J!j~MhDOJQJU^J&jhDOJQJU^JmHnHu!jMhDOJQJU^JjhDOJQJU^JhDOJQJ^J&jhAOJQJU^JmHnHu!jrKhAOJQJU^JhAOJQJ^JjhAOJQJU^J().)0)`)C/ p ($IfgdR kdM$$Ifl \Z&+d@0>+64 layt  ($Ifgd&E  ($IfgdR |))))))))))8*:*N*P*R*\*^********** +++++F+H+\+^+`+j+l+++++++ԲԡԐn!j8Uh3%OJQJU^J!jSh3%OJQJU^J!j,Sh3%OJQJU^J!jQh3%OJQJU^J!j Qh3%OJQJU^J!jOh3%OJQJU^Jh3%OJQJ^Jjh3%OJQJU^J&jh3%OJQJU^JmHnHu+`)))))+kdP$$Ifl \Z&+d@0>+64 layt  ($Ifgd&E  ($Ifgd&E p ($If^gdR )6*`****0kd R$$Ifl \Z&+d@0>+64 layt  ($Ifgd&E ($If^gdR  ($IfgdR **+D+n+p+0kdT$$Ifl \Z&+d@0>+64 layt  ($Ifgd&E ($If^gdR  ($IfgdR p++++(,*,0kd$V$$Ifl \Z&+d@0>+64 layt   ($Ifgd&E p($If^gdR  p($IfgdR ++,,,,,$,&,*,n,,,,,,,,,, - ----p-r-------------...p!jZh3%OJQJU^J!jYh3%OJQJU^J!jXh3%OJQJU^J!jDWh3%OJQJU^JhAh3%5OJQJ^J&jh3%OJQJU^JmHnHu!jUh3%OJQJU^Jh3%OJQJ^Jjh3%OJQJU^J)*,n,,,,,RC ($IfgdR kdW$$Ifl FZ&+0>+6    4 layt  ($Ifgd&E ($If^gdR ,-n----?. !($IfgdR kdY$$Ifl \Z&+d@0>+64 layt  ($Ifgd&E ($If^gdR --.*.,.+kd[$$Ifl \Z&+d@0>+64 layt  ($Ifgd&E pp($Ifgd&E ($If^gdR ...&.(.D.F.Z.\.^.h.j........//$/&/(/2/4/X/Z/n/p/r/|/~////////000± ~m!j`h3%OJQJU^J!j<_h3%OJQJU^J!j^h3%OJQJU^J!j0]h3%OJQJU^J!j\h3%OJQJU^Jh3%OJQJ^J&jh3%OJQJU^JmHnHujh3%OJQJU^J!j$[h3%OJQJU^J*,.B.l....0kd]$$Ifl \Z&+d@0>+64 layt  ($Ifgd&E ($If^gdR  p($IfgdR . /6/V///.kd_$$Ifl \Z&+d@0>+64 layt  \($Ifgd&E ($If^gdR  ($IfgdR ////(0*00kda$$Ifl \Z&+d@0>+64 layt  4($Ifgd&E ($If^gdR  ($IfgdR 000$0&0R0T0h0j0l0v0x000000000011 111\1^1r1t1v1111111111112± ~m!jfh3%OJQJU^J!j`eh3%OJQJU^J!jdh3%OJQJU^J!jTch3%OJQJU^J!jbh3%OJQJU^Jh3%OJQJ^J&jh3%OJQJU^JmHnHujh3%OJQJU^J!jHah3%OJQJU^J**0P0z0000.kdc$$Ifl \Z&+d@0>+64 layt  D($Ifgd&E ($If^gdR  !($IfgdR 001Z111.kde$$Ifl \Z&+d@0>+64 layt  ($Ifgd&E ($If^gdR  !($IfgdR 11112 ($Ifgd&E 4($Ifgd&E ($If^gdR  ($IfgdR 2 2 2222.202D2F2H2R2T2Z2\22222222222233.30323<3¸pbQ!j lhDOJQJU^Jh<hD5OJQJ^J!jjhDOJQJU^JhD&jhDOJQJU^JmHnHu!jihDOJQJU^JjhDOJQJU^JhDOJQJ^Jh3%OJQJ^J&jh3%OJQJU^JmHnHujh3%OJQJU^J!jlgh3%OJQJU^J22,2V2X2Z2aR?00 ($IfgdR  ($If^gdR  4($IfgdR kdg$$Ifl \Z&+d@0>+64 layt Z2\2222aP=. ($Ifgd&E ($If^gdR  !($IfgdR kdxi$$Ifl \Z&+d@0>+64 layt 223@3T3|3cR?44 ($Ifgd&E ($If^gdR  !($IfgdR kdk$$Ifl FZ+d@0>+6    4 lapyt&E<3>3T3V3j3l3n3x3z3~333333333333333344444"4$484:4<4F4H4J4L4\4^4r4~zhD!johDOJQJU^J!j@ohDOJQJU^J!jnhDOJQJU^J!jlhDOJQJU^J&jhDOJQJU^JmHnHu!jlhDOJQJU^JhDOJQJ^JjhDOJQJU^J)|333)kdkm$$Ifl rZ&+d@ 0>+64 lap(yt  ($Ifgd&E3333 4J4 ($Ifgd&E ($Ifgd&E ($If^gdR  !($IfgdR J4L4Z48) p($IfgdR kd,p$$Ifl rZ&+d@ 0>+64 lap(yt r4t4v444444444444445555 5:5<5P5R5T5^5`5555¾p_!jvh5OJQJU^J!jth5OJQJU^J&jh5OJQJU^JmHnHu!jdsh5OJQJU^Jjh5OJQJU^Jh5OJQJ^JhDhDOJQJ^J&jhDOJQJU^JmHnHujhDOJQJU^J!jqhDOJQJU^JZ4444 ($Ifgd&E ($Ifgd&E ($If^gdR 4444P?, ($If^gdR  !($IfgdR kdr$$Ifl \Z&+d@0>+64 lapyt 44444"5RA. ($If^gdR  !($IfgdR kds$$Ifl \Z&+d@0>+64 layt  ($IfgdR "5$5&5(585b5RA. ($If^gdR  !($IfgdR kdpu$$Ifl \Z&+d@0>+64 layt  ($IfgdR b5d5f5h555RA. ($If^gdR  !($IfgdR kdw$$Ifl \Z&+d@0>+64 layt  ($IfgdR 5555555555556 606:6N6P6d6f6h6r6t6x6z66±¢rarMrr&jh( OJQJU^JmHnHu!j}h( OJQJU^Jjh( OJQJU^Jh( OJQJ^JhAOJQJ^JhA5>*OJQJ\^JhxhpCJOJQJ^J!jyh5OJQJU^Jh5OJQJ^J&jh5OJQJU^JmHnHujh5OJQJU^J!j&xh5OJQJU^J55555R> p ($IfgdR kdx$$Ifl \Z&+d@0>+64 layt  ($IfgdR 55556?kd2z$$Ifl \Z&+d@0>+64 layt  ($IfgdR  ($If^gdR 66666 d$If[$gd d$If[$^gd !d$If[$gd6 626466686aP=.. ($IfgdR  ($If^gdR  !($IfgdR kdR{$$Ifl\Z&+d@0>+64 layt 86:6N6v666aPPA2 ($IfgdR  ($IfgdP !($IfgdR kdr|$$Ifl \Z&+d@0>+64 layt 6666666666666666667 7$7&7(7<7>7@7J7L7P7R7f7h7j7t7v77777´£’Ž}lŽ!jBh( OJQJU^J!j́h( OJQJU^Jh( !j"h( OJQJU^J!jh( OJQJU^Jh( 5>*OJQJ\^Jh( OJQJ^J&jh( OJQJU^JmHnHujh( OJQJU^J!j~h( OJQJU^J&66666?00 ($IfgdR kd~~$$Ifl rZ&+.6 @0>+64 layt  ($IfgdR 6 77770kd$$Ifl rZ&+.6 @0>+64 layt  ($IfgdR  ($IfgdP7&7N7x7z7|7 ($IfgdR  ($IfgdP !($IfgdR ($IfgdR |7~777NC2 !($IfgdR ($IfgdR kd$$Ifl rZ&+.6 @0>+64 layt 7777777777777@8F8H8\8^8`8j8l8r88888889 99±¤{gVg!jvhAOJQJU^J&jhAOJQJU^JmHnHu!jhAOJQJU^JjhAOJQJU^JhAOJQJ^JhA5OJQJ\^J!j\h( OJQJU^Jh( OJQJ^J&jh( OJQJU^JmHnHujh( OJQJU^J!jh( OJQJU^J777770kd҄$$Ifl rZ&+.6 @0>+64 layt  ($IfgdR  ($IfgdP7"8B8D8n8p8r8888 999 $IfgdR  !($IfgdR ($IfgdR  !($IfgdtGJ ($IfgdtGJ !($IfgdR 99N9:-  $IfgdR kd$$Ifl4ֈZ  !)+      0>+64 laf4yttGJ9999L9N9P999999 ::":$:&:0:2:8:::<:P:R:T:tctOtt>t!jh5OJQJU^J&jh5OJQJU^JmHnHu!jmh5OJQJU^Jjh5OJQJU^Jh5OJQJ^Jh5CJOJQJ^JaJh5>*OJQJ^Jh55>*OJQJ\^Jh55OJQJ\^Jh5CJOJQJ^JaJh5B*phh5 h#h5h5B*OJQJ\ph h#h5B*OJQJ\phN9P99999yyyy  !$IfgdR wkd$$Ifl4 Z+>+    0>+64 laf4p ytR 99 :4:6:::b:^ODD6D$<$Ifa$gdp <$IfgdpZ<$If^ZgdpkdO$$Ifl4\\Z&+V /   0>+64 laf4yt T:^:`:::::::::::::::::: ; ;;;; ;";$;8;:;<;F;H;J;h;j;~;;;;;;;;;ԿԮԝԿԌ޿{Կ!jMh5OJQJU^J!j}h5OJQJU^J!jh5OJQJU^J!j7h5OJQJU^Jh5!jh5OJQJU^Jh5OJQJ^Jjh5OJQJU^J&jh5OJQJU^JmHnHu,b:d:f::2#Z<$If^ZgdpkdY$$IflֈZ~&+/j 0>+64 layt <$Ifgdp::::::$<$Ifa$gdp <$Ifgdp !<$Ifgdp:::;=.# <$IfgdpZ<$If^Zgdpkd$$IflֈZ~&+/j 0>+64 layt ;;";J;L;$<$Ifa$gdp <$IfgdpL;N;h;;=.# <$IfgdpZ<$If^Zgdpkd$$IflֈZ~&+/j 0>+64 layt ;;;;;$<$Ifa$gdp <$Ifgdp;;;;;;<<<#<$<%<)<*<+<9<:<;<<<<<<<<<<<<<==ȾȭȭxȭdȭP'jh55OJQJU\^J'jh55OJQJU\^J'j h55OJQJU\^J'jh55OJQJU\^Jh55OJQJ\^J!jh55OJQJU\^Jh5OJQJ^Jh5&jh5OJQJU^JmHnHujh5OJQJU^J!jÑh5OJQJU^J;;<*<=,$($Ifa$gd( H$If^Hgdykd9$$IflֈZ~&+/j 0>+64 layt *<?<@<<<<fUH$If^Hgdykd$$IflFZ(#&+"0>+6    4 layty$($Ifa$gd( <<='=<=veWW$($Ifa$gd( H$If^Hgdykdu$$IflFZ(#&+"0>+6    4 layt == =!="=&='=(=6=7=8=============>>>>>>s>t>>ÿÿÿunfXh5CJOJQJ^JaJh5B*ph h#h5h5B*OJQJ\ph'jh55OJQJU\^J'jmh55OJQJU\^J'jh55OJQJU\^Jh5h5OJQJ^J'j{h55OJQJU\^Jh55OJQJ\^J!jh55OJQJU\^J<=====>vaSS$($Ifa$gd( = $If^=` gdykdg$$IflFZ(#&+"0>+6    4 layt >>>tg  "$IfgdR kdY$$IflFZ(#&+"0>+6    4 layt >>s>>>tdd$(($Ifa$gd( Z$If^Z`gdywkdc$$Ifl4 Z+>+   0>+64 laf4p ytR >>>>>>>>>>>>>>>>>>??@ @ @@@@@@@ڿНГГІ~n\~ڿH'jƟh55OJQJU\^J#jhh5>*UmHnHujhh5>*Uhh5>*jhh5>*Uh OJQJ^Jh h 5OJQJ^J'jh55OJQJU\^Jh55OJQJ\^Jh5h5OJQJ^J!jh55OJQJU\^J'j"h55OJQJU\^J>>>@@@veYPG $IfgdR $Ifgd $$Ifa$gd L$If^ `Lgd kd$$IflFZ(#&+"0>+6    4 layt @@@@@`O??$$Ifa$gdyH$If^Hgdykd$$Ifl4\Z(#&*+"0>+64 laf4yt @@@@@@@dAfAhAAAAAAAAAAAABBBCBBBBԜԈwm]L!jh ^5OJQJU\^Jh ^56OJQJ\]^Jh ^OJQJ^J h55CJOJQJ\^JaJ'j.h55OJQJU\^J'jh55OJQJU\^Jh556OJQJ\]^J'j<h55OJQJU\^Jh55OJQJ\^J!jh55OJQJU\^Jh5h5OJQJ^J@@fAAAveUU$$Ifa$gdyH$If^Hgdykd$$IflFZ(#&+"0>+6    4 layt AABBqbZ($If^ZgdR kd$$Ifl4FZ(#&+"0>+6    4 laf4yt BBCBBBBss$($Ifa$gd(  != ($If^=` gd fkd$$Ifl4Z+>+0>+64 laf4ytPeBBBBBBBBBBBB C!C+C,CD D DDDLDdEFFĞo]SChn56OJQJ\]^JhnOJQJ^J#jhh >*UmHnHujDhh >*Uhh >*jhh >*Uh OJQJ^Jh h 5OJQJ^J'jȤh ^5OJQJU\^Jh ^h ^OJQJ^J!jh ^5OJQJU\^J'jRh ^5OJQJU\^Jh ^5OJQJ\^JBB CDDveYP $Ifgdi $$Ifa$gdi L$If^ `LgdPkd>$$IflFZ(#&+"0>+6    4 layt DDbEvgV($If^Vgdikd$$IflFZ(#&+"0>+6    4 layt bEdEF.FXFtt$($Ifa$gd(  != (($If^=` gd ckd$$IflZ+>+0>+64 laytPeFF F"F$F,F.F0FLFNFPFZFfFGG*G,G.G8G:G*UmHnHujThh >*Uhh >*jhh >*Uh OJQJ^Jh h 5OJQJ^J'jԨhn5OJQJU\^JhnhnOJQJ^J'j^hn5OJQJU\^Jhn5OJQJ\^J!jhn5OJQJU\^JXFZFG+6    4 layt @GBGLteV($If^Vgdikdʪ$$IflFZ(#&+"0>+6    4 layt stallation procedures & testing procedures for the installed liner.6. Does the applicant conduct tank installation work? If yes, please answer the following: FORMCHECKBOX  Yes FORMCHECKBOX  Noa) What percentage of the applicants overall sales are associated with this operation:  FORMTEXT      %b) Are the installed tanks precision tightness tested before being released to owner? FORMCHECKBOX  Yes FORMCHECKBOX  Noc) Does the applicant apply any type of corrosion protection? FORMCHECKBOX  Yes FORMCHECKBOX  Nod) Are tanks tested and certified by a registered professional before use? FORMCHECKBOX  Yes FORMCHECKBOX  NoPlease submit the following: Resumes and certifications of all tank installation employees, type of tanks applicant installs, type of corrosion protection applicant installs & installation procedures.7. Are any of the applicant s revenues generated by contracting services performed in New York City? FORMCHECKBOX  Yes FORMCHECKBOX  NoIf yes, what percentage of the applicant s overall sales are associated with this operation? FORMTEXT      %8. Does the applicant conduct any type of mold contracting or mold consulting work? FORMCHECKBOX  Yes FORMCHECKBOX  NoIf yes, please complete and attach a Supplemental Mold Contractors and Consultants Application. If no, but the applicant is interested in being considered for mold coverage for claims that may arise from the applicant s contracting operations, please complete and attach a Supplemental Mold Application.9. Does the applicant conduct any Phase I or Real Estate Transfer Assessments? If yes, please answer the following: FORMCHECKBOX  Yes FORMCHECKBOX  Noa) What percentage of the applicants overall sales are associated with this operation:  FORMTEXT      %b) Does the applicant follow ASTM-1527 guidelines? If no, please attach a sample contract of the applicant s format. FORMCHECKBOX  Yes FORMCHECKBOX  No 10. Total personnel (List each person only once, by primary function):a) Architects, Engineers, Geologists, Hydrogeologists  FORMTEXT      b) Industrial Hygienists, Toxicologists, CIHs or CSPs FORMTEXT      c) Supervisors/Foremen/Leadmen FORMTEXT      d) Draftsmen, Technicians FORMTEXT      e) Laborers FORMTEXT      f ) AHERA, Hazwopers FORMTEXT      g) Other (please specify primary function and count per primary function): FORMTEXT      VI. CLAIMS INFORMATION11. Has any claim, suit or notice of incident been made against the firm or any staff member? FORMCHECKBOX  Yes FORMCHECKBOX  NoIf yes, please provide full details on each incident: FORMTEXT      12. Is the applicant aware of any circumstances, which may result in any claim, suit or notice of incident against him, the firm, his predecessors in business, any of the present or past partners or officers, or any staff member and/or has any claim, suit or notice of incident been made against the firm or any staff member?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf yes, please provide full details on each incident: FORMTEXT      VII. HISTORY OF COMPANY1. Date Company Was Established:  FORMTEXT       .5. Is the applicant a successor of any other business? If yes, please list predecessor in the area below. FORMCHECKBOX  Yes  FORMCHECKBOX  No2. Is the applicant, or any affiliated, related predecessor entity currently involved with sharing office space, use of employees or commingling of affiliated or related operations or services of any kind? If yes, please provide an explanation in the area below. FORMCHECKBOX  Yes  FORMCHECKBOX  No6. Has the applicant, or any affiliated, related predecessor entity or any officer or owner ever been convicted of a crime? If yes, please provide an explanation in the area below. FORMCHECKBOX  Yes  FORMCHECKBOX  No3. Is work done through or by any affiliated or related company(s)? If yes, please provide an explanation in the area below. FORMCHECKBOX  Yes  FORMCHECKBOX  No7. Has the applicant, or any affiliated, related predecessor entity ever been (or currently is) the subject of bankruptcy, reorganization, solvency, dissolution or other debtor related proceedings and/or has made assignment for the benefit of creditors? If yes, please provide an explanation in the area below. FORMCHECKBOX  Yes  FORMCHECKBOX  No4. Is the applicant, or any affiliated, related predecessor entity currently involved in any litigation, administrative or arbitration proceeding(s) or subject to any court or agency order or injunction? If yes, please provide an explanation in the area below. FORMCHECKBOX  Yes  FORMCHECKBOX  No8. If you answered  yes to any of the questions listed above, please include a detailed explanation:VII. PRIOR LIABILITY CARRIER INFORMATION (Past three years)Coverage FormCarrierReceiptsLimit of LiabilityDeductibleType of PolicyRatePremium 1. FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       2. FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       3. FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       4. Has any policy or coverage been declined, cancelled and/or non-renewed during the prior three years? FORMCHECKBOX  Yes (If yes, please explain): FORMTEXT       FORMCHECKBOX  No FRAUD WARNING: APPLICABLE TO ALL STATES Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. WARRANTY STATEMENT The signatory declares that (s)he is authorized by the Applicant to sign this application on behalf of all prospective Insureds and that to the best of his/her knowledge the statements herein are true. The signatory agrees that if the information supplied in this application and the materials submitted therewith should change between the date this application is signed and the effective date of the proposed insurance, the signatory shall immediately notify the Insurer of such and shall provide the Insurer with information that would complete, update or correct the application or materials submitted therewith. The Insurer may withdraw or modify any of the terms or conditions of coverage accordingly. NOTICE TO APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any false information, or conceals for the purpose of misleading, information concerning fact material thereto, commits a fraudulent insurance act, which is a crime. Signature:Date: FORMTEXT      Print Name: FORMTEXT      Title: FORMTEXT           CONTRACTORS AND CONSULTANTS APPLICATION Page  PAGE 2 of  NUMPAGES 4 LLL@MlMMn^^$(($Ifa$gd(  !=($If^=gd! !H $If^Hgdyekdԫ$$IflZ+>+0>+64 laytPeL@MBM^M`MbMjMlMnMMMMMHNJN^N`NbNlNnNpNxN$O&OBODOFONOҾߴҜߴ}m[}Gߴ'jh55OJQJU\^J#jhh>*UmHnHujlhh>*Uhh>*jhh>*UhOJQJ^J'jh55OJQJU\^Jh5h5OJQJ^J'jvh55OJQJU\^Jh55OJQJ\^J!jh55OJQJU\^Jh556OJQJ\]^JMMHNpNtNvNtg[RR $IfgdR $$Ifa$gdR  $If^ gdR kdb$$IflFZ(#&+"0>+6    4 laytyvNxN$OPOzOcVHH$($Ifa$gd( $If^gdR kd$$Ifl\Z(#&*+"0>+64 layt NOPOROnOpOrOOOPPP"P$P&PBPDPFPPPQQQQQQ0Q2Q4Q>QvQRSSެޘބpfU!jh ^5OJQJU\^Jh ^OJQJ^J'j\h55OJQJU\^J'jh55OJQJU\^J'jjh55OJQJU\^J'jh55OJQJU\^Jh5OJQJ^J'jxh55OJQJU\^Jh55OJQJ\^J!jh55OJQJU\^Jh5 zO|OO$PNPvi[[$($Ifa$gd( $If^gdR kd$$IflFZ(#&+"0>+6    4 layt NPPPPQ+6    4 layt QRvgV($If^Vgd,gkdҴ$$IflFZ(#&+"0>+6    4 layt RRSSSxx$(($Ifa$gd( V$If^V`gdofkdص$$Ifl4Z+>+0>+64 laf4ytPeSSSSSSSSSSSTTTTTTTTTTUUĞo]SChn56OJQJ\]^JhnOJQJ^J#jhh >*UmHnHujrhh >*Uhh >*jhh >*Uh OJQJ^Jh h 5OJQJ^J'jh ^5OJQJU\^Jh ^h ^OJQJ^J!jh ^5OJQJU\^J'j|h ^5OJQJU\^Jh ^5OJQJ\^JSSTTTt`TK $Ifgdi $$Ifa$gdi$ L$If^ `La$gd( kdh$$IflFZ$n(+$*0>+6    4 laytyTTUUUteSS$($If]a$gd( H($If^Hgdukd$$IflFZ(#&+"0>+6    4 layt( UUUUUUUUUUUUUUUVVBXX(Y*YFYHYJYRYTYVYrYÿÛÛÑpcOpKpch5'jh55OJQJU\^Jh55OJQJ\^J!jh55OJQJU\^Jh556OJQJ\]^Jh5OJQJ^Jhn56OJQJ\]^J'jhhn5OJQJU\^JhnhnOJQJ^J'jhn5OJQJU\^Jhn5OJQJ\^J!jhn5OJQJU\^JUUV>Xt^F$VZ(($If]V^Za$gdi$VZ($If]V^Za$gdikd޺$$IflFZ(#&+"0>+6    4 layt >X@XX(YTY~Ypbb$<$Ifa$gd(  !=($If^=gdbz !H(($If^Hgdbzekd$$IflZ+>+0>+64 laytPerYtYvYY0Z2ZFZHZJZTZVZXZ`ZZJ[L[h[j[l[t[v[x[[[[[ƹr^ZrF'jh55OJQJU\^Jh5'jh55OJQJU\^Jh55OJQJ\^Jh556OJQJ\]^J#jhhn>*UmHnHujzhhn>*Uhhn>*jhhn>*UhnOJQJ^Jh5OJQJ^J!jh55OJQJU\^J'jh55OJQJU\^J~YY0ZXZ\Z^ZtcWNC ($IfgdR $IfgdR $$Ifa$gdi (($If^ gdR kdp$$IflFZ(#&+"0>+6    4 layt ^Z`ZZJ[v[[`SF88$($Ifa$gd( $If^gdR  $If^ gdR kd$$Ifl4\Z(#&*+"0>+64 laf4yt [[2\vf !<$Ifgdbzkd$$IflFZ(#&+"0>+6    4 layt( [[\\\\\\\\\\:]<]P]R]T]^]`]b]d]f]]]]]]]]]]]^^^ѻߣуߣmߣ*jhh5>*OJQJU^J*j"hh5>*OJQJU^JhOJQJ^J/jhh5>*OJQJU^JmHnHu*jhh5>*OJQJU^Jhh5>*OJQJ^J$jhh5>*OJQJU^Jh5OJQJ^Jh"2\4\\\\yi !<$Ifgdbz<$If]gdbzV<$If^Vgdbzhkd$$Ifl4Z+>+0>+64 laf4ytbz\\:]b]d]qbSH ($IfgdR ($If]gdR V($If^VgdR kd $$Ifl4FZrP+H0>+6    4 laf4ytbzd]f]]]]sdUE !($IfgdR ($If]gdR V($If^VgdR kd$$Ifl4FZrP+H0>+6    4 laf4yt]]^,^.^sdUE !($IfgdR ($If]gdR V($If^VgdR kd $$Ifl4FZrP+H0>+6    4 laf4yt^^^(^*^,^.^0^H^J^^^`^b^l^n^p^r^t^^^^^^^^^^d_f_z_|_~_׿ױױ׿ױױq׿ױcRc!jhOJQJU^JjhOJQJU^J*jhh5>*OJQJU^J*j~hh5>*OJQJU^JhOJQJ^Jh5OJQJ^Jhh5>*OJQJ^J/jhh5>*OJQJU^JmHnHu$jhh5>*OJQJU^J*j hh5>*OJQJU^J.^0^H^p^r^sdUJ ($IfgdR ($If]gdR V($If^VgdR kd$$Ifl4FZrP+H0>+6    4 laf4ytr^t^^^^sdUJ ($IfgdR ($If]gdR V($If^VgdR kd$$Ifl4FZrP+H0>+6    4 laf4yt^^`_sh ($IfgdR kdh$$Ifl4FZrP+H0>+6    4 laf4yt`_b_d__ x$IfgdR  x$If^ gdR fkdf$$Ifl4Z+>+0>+64 laf4ytR ~___________~````````ïwgVI5V1h'jh5OJQJU\^Jh5OJQJ\^J!jh5OJQJU\^Jh56OJQJ\]^JhxCJOJQJ^JaJ!hx5B*OJQJ\^Jphhx5OJQJ\^Jhxh#hx5'h#hx5B*OJQJ\^Jph!hx5B*OJQJ\^JphhOJQJ^JjhOJQJU^J&jhOJQJU^JmHnHu___{ $Ifgd){kd$$Ifl40Z%+s(0>+64 laf4ytx__```zhZ$($Ifa$gd( $($If]a$gd( (($IfgdR wkd^$$Ifl4 Z+>+   0>+64 laf4p yt)``````@aFaHaJa^a`abalanaraccdddóᩛvl_[J_!jhp5OJQJU\^Jhphp5OJQJ\^JhpOJQJ^J&jh:@UOJQJU^JmHnHu!jh:@UOJQJU^Jjh:@UOJQJU^Jh:@UOJQJ^Jh56OJQJ\]^JhOJQJ^J'jh5OJQJU\^Jh5OJQJ\^J!jh5OJQJU\^J``Davb !V($If^VgdR kd $$IflFZ(#&+"0>+6    4 layt DaFaHapa  !$IfgdR fkd $$Ifl4Z+>+0>+64 laf4ytparad,dVdmYD$If]^`gd !($If]gdV($If]^V`gdp{kd#$$Ifl4 0Z%+s(0>+64 laf4ytR d d"d,d.dJdLdNdTdVdXddddddddddddïЫЛvevQv@!h5B*OJQJ\^Jph&jh:@UOJQJU^JmHnHu!jQh:@UOJQJU^Jjh:@UOJQJU^Jh:@UOJQJ^Jh5OJQJ\^Jh56OJQJ\]^Jhp'jkhp5OJQJU\^Jhp5OJQJ\^JhpOJQJ^J!jhp5OJQJU\^J'jhp5OJQJU\^JVdXdds !V($If^VgdR xkd$$Iflw0Zn(+(*0>+64 laytdddd  !$IfgdR fkd$$Ifl4Z+>+0>+64 laf4ytdd&e~$If{kd$$Ifl4 0Z%+s(0>+64 laf4ytR dddde$e&e(ejeleneeeeeeenVn*@OJQJU^JmHnHu.jRhxh,5>*@OJQJU^J(jhxh,5>*@OJQJU^Jhxh,5>*@OJQJ^Jhxh,5@OJQJ^JhCJOJQJ^JaJ!h5B*OJQJ\^Jphh5OJQJ\^Jhh#h5!hx5B*OJQJ\^Jph'h#h5B*OJQJ\^Jph&e(eepffftaM7 !$If^`gdi !($If]gdi ($If^ `gdi !$If^`gd,5tkd$$Ifl4 Z+>+   0>+64 laf4p eepfrfffffffffffhhhhhii$iǵǍǵtǍjǵQǍǵ1jhxh,55@OJQJU\^Jh,5OJQJ^J1jRhxh,55@OJQJU\^Jhxh,5@OJQJ^J1jhxh,55@OJQJU\^J"hxh,55@OJQJ\^J+jhxh,55@OJQJU\^Jhxh,5@OJQJ^J%hxh,5@B*OJQJ^Jphffhi0ivcO9 !$If^`gdi !($If]gdi ($If^ `gdikd$$IflFZn(+V*0>+6    4 layt $i&i(i0ijjjjjjjjjjjjkklll l"l>lРРndРKР1jhxh,55@OJQJU\^Jh,5OJQJ^J1jhxh,55@OJQJU\^J1jhxh,55@OJQJU\^J"hxh,55@OJQJ\^Jhxh,5@OJQJ^Jhxh,5@OJQJ^J+jhxh,55@OJQJU\^J1j.hxh,55@OJQJU\^J0ijjj !$If^`gd,5 !($If]gd,5 ($If^ `gd,5jjk lH5! !($If]gdi ($If^ `gdikd$$Ifl4\Zdn(+ L*0>+64 laf4p(yt >l@lBlJlnnnnnnnoo oooo q"q$q@qBqDqNqPqlqРРnd[РBР1jhxh,55@OJQJU\^Jhxh,5@h,5OJQJ^J1jIhxh,55@OJQJU\^J1jhxh,55@OJQJU\^J"hxh,55@OJQJ\^Jhxh,5@OJQJ^Jhxh,5@OJQJ^J+jhxh,55@OJQJU\^J1j]hxh,55@OJQJU\^J lJlnno$If^`gd,5 !($If]gd,5 ($If^ `gd,5 !$If^`gdioo"qNqxqaN:%$If]^`gdi !($If]gdi ($If^ `gdikd$$Ifl4\Zdn(+ L*0>+64 layt lqnqpqvqxq~qNrTrVrrrr~sssssss}oh`YNY@Njlh5U\jh5U\ h5\huCJaJ hu5\hCJOJQJ^JaJhB*phh h#h h#hB*OJQJ\phh5OJQJ\^Jh,5OJQJ^Jhxh,5@hxh,5@OJQJ^J+jhxh,55@OJQJU\^J1jdhxh,55@OJQJU\^Jxqzq|q~qLr>1  !($Ifkd$$Ifl4\Zdn(+ L  *0>+64 layt  !$If^` ($If^ `LrNrr  $Ifgd#hkd $$Ifl4Z+>+0>+64 laf4yturrrr s0sFsdsns~s~~~~~~~~ $$Ifa$gdutkd$$Ifl4 Z+>+   0>+64 laf4p ~sskdj$$Ifl4ִZa h~#&+ZE%0>+6    4 laf4yt<sssssssssssssssssstttt"t$t&t(tt@tJtLtNtPtdtfthtrtttvtxttttttttttݳݥݗ݉{jh5U\j$h5U\jh5U\j8h5U\jh5U\jXh5U\jh5U\ h5\jh5U\ jh5U\mHnHu0ssss&tNtvttt$Ifttttttttttttttt uuuuuu u4u6u8uBuDuFuHu\u^u`ujulunupuuuuuuuuuuuuuuuܵܧܙ܋}j`h5U\jh5U\jth5U\jh5U\jh5U\jh5U\h5CJ\aJ h5\ jh5U\mHnHujh5U\1ttkd$$Ifl4ִZa h~#&+ZE%0>+6    4 laf4yt<ttuFunuuuuv$Ifuuuuuuuuuuv v vvvvv,v.v0v:vv@vTvVvXvbvdvfvhv|v~vvvvvvvvvvvvvvj&h5U\jh5U\j:h5U\jh5U\hCJaJjLh5U\ jh5U\mHnHujh5U\jh5U\ h5\-vvkd$$Ifl41ִZa h~#&+ZE%0>+6    4 laf4ytuv>vfvvvvw.wVw$Ifvvvvvvvvvvwwwwww w*w,w.w0wDwFwHwRwTwVwXwZw`w(x*x,x.x0xLxβΤΙΒΎuhh5OJQJ\^J!jh5OJQJU\^JhCJaJh h88-5\h5CJ\aJjh5U\jh5U\jh5U\ h5\ jh5U\mHnHujh5U\jh5U\#VwXwkdt$$Ifl4ִZa h~#&+ZE%0>+6    4 laf4yt<Xw*x,x.xxxx ($If]($Ifekdv$$Ifl4Z+>+0>+64 laf4$IfLxNxPxxxxxxxxxxxxxxxxxxx5CJOJQJ\^Jh;>h;>5CJ\aJ"huhu5CJOJQJ\^J'jDh5OJQJU\^Jh5OJQJ\^Jh5CJ\aJ jh5U\mHnHujh5U\jh5U\ h5\hOJQJ^J!jh5OJQJU\^J'jh5OJQJU\^Jxxxxx^VII  !($If($Ifkd $$Ifl4\Zh )+ 0>+64 laf4yt,gxxx+6    4 laf4yt,g|} } ~~~ĀҀ ؂8:PT`bvxzą఩p\Xh &jhm=h8n5U\mHnHu!jhm=h8n5U\hm=h8n5\jhm=h8n5U\hm=hA5hAh;> h;>5\"huhu5CJOJQJ\^JhAhA56OJQJ^JhAhA6OJQJ^JhAhAOJQJ^Jh;>5CJ\aJh;>CJaJ }8:PRT`x$If]gdm=]"]^`"gdugdA rlllll$Ifkd.$$Iflr4P+g9  t(,644 laytm=օ؅paaaaax$If]gdm=kd$$Iflr4P+g9  t(,644 laytm=ąƅȅ҅ԅ؅   $&*xƆȆʆඥȡtjtjjh;>U*hmmHnHu*jh;>Uh;>CJOJQJ^JaJh wjh wUh;>!jhm=h8n5U\hm=h8n5\hm=hA5hA&jhm=h8n5U\mHnHujhm=h8n5U\!j^hm=h8n5U\&"$(*rigggggggg]gdukdJ$$Iflr4P+g9  t(,644 laytm= *†ĆƆȆʆ]gdu  !>+x^A 0P&P/ =!@"@#h$%0 +DpD 00P&P/ =!@"@#h$h%0 +DpjDdleS[r  C NA6CFI-Tagline-NoRegistration2zmBev<D`!xzmBev#R!ɖJT:{νy_wm;leM5jn[qA-cHZ&yێUYG99V{NRD(a!Q H7\㦩 զt{N!];>=, Ez^-1tAkh뎃&DC;nhvnubCgn9!C c[7X9&^ttjZi !)LI$ E'$zZnsG@-ɝl"@N>p';Nxzg]WY) d@TjdR.S) ~!=i!'KĞȬA,̶Zxk@6l `πtP*Ρ\욑9/ )b&PR(hF ښV:Evi}4'XszQ81Q]@2$D1f}8UNd~_|%Ħ=MAQ7j\xd\ƹ_ St wWs4W ݫ*{E*xt3Ps~`k Ua*0|&Xь )TݙNPbʮh:">wZzi郬Y'_B*y$ _)y\!s\\yS/O3ԤYHEjG<}55{9j6ar5ݐogcPF d5S`*92' }$tj(JKOOЛf.w<ƕk4ӑ?߯KȨyy5 }vM9&y^y N97 Y7`%]Io>`%Lu&*,74LexPbx k /?׵4kӼY,#:Ox֐`@?Գ| %lEފ^>OG?=ʰ}o5蚳H]k/_ڃf/#A*Cf?|C'_ Dszߑ)`ص8jΰg HR _99g|Y;O %_$I((u}4PX6SyeWʼn4WɆ~ VM4C3?ydGF~2A B 9/RW4i^r\c q*"&PjTU]SkV 5RCMiȵti z;:i `πtC;"wr"Np5t' DtBUG8&UHNщ ke5uMv35=!f}ȭ釜n+q5{-4}*Md.Efvtb Nj0>܁ֽT)3J# !貰eL. "Tө@E5t?, -T4x|BtE؊iDoH7Ʉ!>K\h&[}~aĝDH^Jβr!R 8d6?y$f=ΥǨ!j̄霗/91gLjL9k-׀|| [Dbãȳqi0(<2cWK>:^t> +#'Zbd^6+ܯe*q{\c~,!9=,wI1:U^Kthbr7ˋp+υ\twK"+zeUom j1CEdᝐ7%E T:GBxLeِ"r~HW9l7$M2YŻu9T* r9N<'bX,2J,rxYn;jK| w 3×!{D~$N/r R*l.k6U8r΋hר]:i%feԮF2|@=!q@ Rϋr!WmP>G򙐹X'6< >\QS,ԕ#lq-T&?5ўcGtuUD7'|q* 3qA=&ڙo5kEs]2`|.gGM!{ie:9^k(E,>"sPfe>bȰOYs[ =cWRv*"O+)vEU}Y"Y*utw]O-XZv;U`7 gm@oRw-ժ'7 v]Ů:-T-e}N z{T[v=ygkrz\.dL 9-dϢ_j(_Wȗuo7UZc W3tbo'ᨽW 9i?33X-&;eg&req~ Ľ( JJV*: }՝Ei;mT4Ci;T]ԁ*&fz8nt\uSATR7;1p@?䯠XjsNfcڢ +:]gaC~l+/0$gWg<|&/8_ʋWBe@u˛pkZA.<$!v˛~8NQ1P'8 'j;T\-~}9CKFm/ RsN ;#S{6rA~HjC&C< xN9Xc9񤰍p8>$}0t঵$$If!vh#v>+:V l4    0>+6,5>+/ 4af4p tDText1DText7 MM/dd/yyyy$$If!vh#v#v@ :V l0>+6,55@ / 4atDText2DText6 ###-###-####$$If!vh#v#v@ :V l0>+6,,55@ / 4aytPtDText3DText4 UPPERCASEDText71#####DText6 ###-###-####$$If!vh#vx#vb#v$ #v@ :V l0>+6,,5x5b5$ 5@ / 4atDeCheck1tDeCheck2tDeCheck3tDeCheck4tDeCheck5tDText8$$If!vh#v>+:V l0>+6,5>+/ 4a$$If!vh#v>+:V l4    0>+6,5>+/ 4af4p tDeCheck6tDeCheck7DText9 MM/dd/yyyyDText10 MM/dd/yyyyDText10 MM/dd/yyyy$$If!vh#v#v\ :V l80>+655\ /  / 4aytK:tDeCheck8vDeCheck11tDeCheck9vDeCheck12vDeCheck10vDeCheck13vDText11DText12 $##,###,###vDText13I$$If!vh#v\ #vb#v$ #v\ :V l4~0>+6+,,,5\ 5b5$ 5\ / / / / / / /  / / 4af4ytK:vDeCheck14vDeCheck15vDeCheck15vDeCheck15$$If!vh#v#v\ :V l40>+6+55\ / / / / / 4af4ytK:$$If!vh#v>+:V l4    0>+6,5>+/ 4af4p ytR $$If!vh#v>+:V l40>+65>+/ /  4af4ytg$$If!vh#vj:V l4 0>+65j/ / 4af4pytgvDText44vDText44vDText44$$If!vh#vj:V l40>+65j/ / 4af4ytPvDText13vDText13vDText13vDText13vDText13vDText13$$If!vh#vj:V l40>+65j/ / 4af4ytP$$If!vh#v>+:V l40>+65>+/  / 4af4ytR $$If!vh#v#v:V l0>+6,55/ 4ayt<vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText441$$If!vh#vd#v@#v#v:V l4 0>+6++,5d5@55/ / /  / / / /  / 4ayt vDText44+$$If!vh#vd#v@#v#v:V l4 0>+6++5d5@55/ / /  / / / / /  4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44$$If!vh#v#v#v:V l 0>+6555/ / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / / / / / / 4ayt vDText44$$If!vh#vd#v@#v:V l 0>+65d5@5/ / /  / /  4apyt&EvDText44vDText50vDText44]$$If!vh#vd#v@#v#v #v:V l 0>+6,5d5@55 5/ / /  / / / / /  4ap(yt vDText44vDText49vDText44k$$If!vh#vd#v@#v#v #v:V l 0>+6,5d5@55 5/ / /  / / / / /  / 4ap(yt vDText44S$$If!vh#vd#v@#v#v:V l 0>+6,5d5@55/ / /  / / / / /  / 4apyt vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText44$$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt $$If!vh#vd#v@#v#v:V l0>+65d5@55/ / /  / / / /  / 4ayt $$If!vh#vd#v@#v#v:V l 0>+65d5@55/ / /  / / / /  / 4ayt vDText45vDText44,$$If!vh#v.#v6 #v@#v#v:V l 0>+65.56 5@55/ / /  / / / /  / 4ayt vDText46vDText442$$If!vh#v.#v6 #v@#v#v:V l 0>+6,5.56 5@55/ / /  / / / /  / 4ayt vDText47vDText44,$$If!vh#v.#v6 #v@#v#v:V l 0>+65.56 5@55/ / /  / / / /  / 4ayt vDText48vDText44,$$If!vh#v.#v6 #v@#v#v:V l 0>+65.56 5@55/ / /  / / / /  / 4ayt vDText44vDText44$$If!vh#v #v#v#v #v#v:V l40>+6,,,5 555 55/ /  /  / / / / /  /  / /  / / 4af4yttGJ$$If!vh#v>+:V l4    0>+6,5>+/  / 4af4p ytR $$If!vh#vV#v/#v #v:V l4\0>+6,5V5/5 5/ / / / /  / / 4af4yt vDText51vDText55f$$If!vh#v#v#v/#v#vj #v:V l0>+6,555/55j 5/  / / / / / / /  / / / 4ayt vDText52vDText55X$$If!vh#v#v#v/#v#vj #v:V l0>+6,555/55j 5/  / / / / / / /  / / 4ayt vDText53vDText55X$$If!vh#v#v#v/#v#vj #v:V l0>+6,555/55j 5/  / / / / / / /  / / 4ayt vDText54vDText55X$$If!vh#v#v#v/#v#vj #v:V l0>+6,555/55j 5/  / / / / / / /  / / 4ayt vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ /  / /  / / / 4aytyvDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ /  / /  / / / 4ayt vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ /  / /  / / / 4ayt vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ /  / /  / / / 4ayt $$If!vh#v>+:V l4    0>+6,5>+/ 4af4p ytR vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ / / / /  / / 4ayt vDText56:$$If!vh#v"#v#v#v:V l40>+6,,5"555/  / / / / / / / / 4af4yt vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ /  / /  / / / 4ayt vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l40>+65"55/ / / / /  / / 4af4yt $$If!vh#v>+:V l40>+65>+/ / 4af4ytPevDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ / / / /  / / 4ayt vDText56$$If!vh#v"#v#v:V l0>+6,5"55/ / / / / / / 4ayt $$If!vh#v>+:V l0>+65>+/ / 4aytPevDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ / / / /  / / 4ayt vDText56$$If!vh#v"#v#v:V l0>+6,5"55/ / / / / / / 4ayt $$If!vh#v>+:V l0>+65>+/ /  4aytPevDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ / / / /  / / 4aytyvDText56$$If!vh#v"#v#v#v:V l0>+6,,,5"555/ / / / / / / 4ayt vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ / / / / / / 4ayt vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ / / / / / / 4ayt vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ / / / / / / 4ayt $$If!vh#v>+:V l40>+65>+/ / 4af4ytPevDeCheck22vDeCheck23$$If!vh#v$#v#v*:V l0>+6,5$55*/ / / / /  / / 4aytyvDText56$$If!vh#v"#v#v:V l0>+6,5"55/ / / / / / / 4ayt( vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+65"55/ / / / /  / / 4ayt $$If!vh#v>+:V l0>+65>+/ /  4aytPevDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ / / / /  / / 4ayt vDText56$$If!vh#v"#v#v#v:V l40>+6,,5"555/ / / / / / / 4af4yt vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+6,5"55/ /  / / / /  / 4ayt( $$If!vh#v>+:V l40>+65>+/  / 4af4ytbzvDText62$$If!vh#v#v#vH:V l40>+6,555H/  / /  / / / 4af4ytbzvDText63$$If!vh#v#v#vH:V l40>+6,555H/  / /  / / / 4af4ytvDText64$$If!vh#v#v#vH:V l40>+6,555H/  / /  / / / 4af4ytvDText65$$If!vh#v#v#vH:V l40>+6,555H/  / /  / / / 4af4ytvDText66$$If!vh#v#v#vH:V l40>+6,555H/  / /  / / / 4af4ytvDText67$$If!vh#v#v#vH:V l40>+6,555H/  / /  / / / 4af4yt$$If!vh#v>+:V l40>+6,5>+/ /  4af4ytR vDText68$$If!vh#v#vs(:V l40>+6,55s(/  / / /  4af4ytx$$If!vh#v>+:V l4    0>+6,5>+/ 4af4p yt)vDeCheck22vDeCheck23$$If!vh#v"#v#v:V l0>+65"55/ / / / /  / / 4ayt $$If!vh#v>+:V l40>+65>+/ /  4af4ytvDText69$$If!vh#v#vs(:V l4 0>+655s(/  / / /  4af4ytR vDeCheck18vDeCheck19$$If!vh#v(#v*:V lw0>+65(5*/ /  /  / 4ayt$$If!vh#v>+:V l40>+65>+/ /  4af4ytvDText70$$If!vh#v#vs(:V l4 0>+655s(/  / / /  4af4ytR $$If!vh#v>+:V l4    0>+6,5>+/ 4af4p DText14 MM/dd/yyyyvDeCheck16vDeCheck17$$If!vh#vV#v#v*:V l0>+6,,5V55*/ / / /  / 4ayt vDeCheck16vDeCheck17vDeCheck16vDeCheck17U$$If!vh#v #vL#v#v*:V l40>+6,5 5L55*/ / /  / / / / /  4af4p(yt vDeCheck16vDeCheck17vDeCheck16vDeCheck17-$$If!vh#v #vL#v#v*:V l40>+6++,5 5L55*/ / /  / / / /  / 4ayt vDeCheck18vDeCheck19-$$If!vh#v #vL#v#v*:V l40>+6++,5 5L55*/ / /  / / / / /  4ayt $$If!vh#v>+:V l40>+65>+/  / 4af4ytu$$If!vh#v>+:V l4    0>+6,5>+/ 4af4p $$If!vh#v#v#v#vZ#v#vE#v%#v:V l40>+6,5555Z55E5%5/ 4af4yt<vDText16vDText19vDText22jDvDText28vDText31vDText34vDText37$$If!vh#v#v#v#vZ#v#vE#v%#v:V l40>+6,5555Z55E5%5/ 4af4yt<vDText17vDText20vDText23vDText26vDText29vDText32vDText35vDText38$$If!vh#v#v#v#vZ#v#vE#v%#v:V l410>+6,5555Z55E5%5/ 4af4ytuvDText18vDText21vDText24vDText27vDText30vDText33vDText36vDText39$$If!vh#v#v#v#vZ#v#vE#v%#v:V l40>+6,5555Z55E5%5/ 4af4yt<$$If!vh#v>+:V l40>+6,5>+/  / 4af4vDeCheck20vDText438$$If!vh#v#v #v#v:V l40>+6,55 55/ / / / / /  / / / 4af4yt,gvDeCheck21$$If!vh#v#v3(#v:V l40>+6,553(5/  / /  / /  / 4af4yt,gvDText72$$If!vh#vg#v9#v#v#v :V l t(,65g59555 / / ytm=$$If!vh#vg#v9#v#v#v :V l t(,65g59555 / / ytm=vDText72vDText72$$If!vh#vg#v9#v#v#v :V l t(,65g59555 / / ytm=s2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH 8`8 Normal_HmH sH tH N@N  Heading 1$$@&a$CJOJQJ^JaJTT  Heading 2$$d@&a$CJOJQJ^JaJNN  Heading 3$@&5CJOJQJ\^JaJ<<  Heading 4$@&CJaJF@F  Heading 5$@&5OJQJ\^J^@^  Heading 6$$"@&^`"a$CJOJQJ^JaJd@d  Heading 7$$"@&^`"a$5CJOJQJ\^JaJNN  Heading 8$@&5CJOJQJ\^JaJ^ @^  Heading 9 $ @&^5CJOJQJ\^JaJDA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List :>@: Title$a$5CJ\aJNC@N Body Text Indent$a$ OJQJ^J4@4 Header  !4 @"4 Footer  !\R2\ Body Text Indent 2  ^ CJOJQJ^JaJ<BB< Body Text$a$CJaJTJRT Subtitle$`a$5CJOJQJ\^JaJ.)a. Page Number\S@r\ Body Text Indent 3"^`" OJQJ^Jjj A Table Grid7:V0PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VvnB`2ǃ,!"E3p#9GQd; H xuv 0F[,F᚜K sO'3w #vfSVbsؠyX p5veuw 1z@ l,i!b I jZ2|9L$Z15xl.(zm${d:\@'23œln$^-@^i?D&|#td!6lġB"&63yy@t!HjpU*yeXry3~{s:FXI O5Y[Y!}S˪.7bd|n]671. tn/w/+[t6}PsںsL. J;̊iN $AI)t2 Lmx:(}\-i*xQCJuWl'QyI@ھ m2DBAR4 w¢naQ`ԲɁ W=0#xBdT/.3-F>bYL%׭˓KK 6HhfPQ=h)GBms]_Ԡ'CZѨys v@c])h7Jهic?FS.NP$ e&\Ӏ+I "'%QÕ@c![paAV.9Hd<ӮHVX*%A{Yr Aբ pxSL9":3U5U NC(p%u@;[d`4)]t#9M4W=P5*f̰lk<_X-C wT%Ժ}B% Y,] A̠&oʰŨ; \lc`|,bUvPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!R%theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] | ? C  XXXXZZZZZ] V zATzx!#%<(|)+.02<3r45679T:;=>@BFLNOSUrY[^~_`dde$i>llqstuvLx|ąʆ$&)+-.1245689>@DHLPVX]aeimqw}   B 6S>F_8( T!!X"##n$%%&&p''(`))*p+*,,-,../*0012Z22|33J4Z444"5b5556686667|7779N99b:::;L;;;*<<<=>>>@@ABBBDbEXF@GLMvNzONPX~Y^Z[2\\d]].^r^^`___`DapaVddd&ef0ij loxqLrr~ssttvvVwXwxx }*ʆ%'(*,/037:;<=?ABCEFGIJKMNOQRSTUWYZ[\^_`bcdfghjklnoprstuvxyz{|~   %+3?EQ]cmy ->N_o'39\hn*:L\l|8DJTdQ a J V \ _ k q t    % + H T Z k w }  & 8 D J p | %AMSo{ +1KW]z3?E"AMSu7CIs %17Wci!0<BXdjy,8>Wci2>DP\bnz "(5AGS_ehtz$*@LR~  ,25AGz]iot ".4k{hx~,<BRS_e#)9  !!!!"#")"-#=#C#S####$/$5$E$$$$$%%%&%\&l&r&&&&&P'`'f'v'!)1)7)G))))2*B*H*X*****+6+<+_+k+q++++++++++?,K,Q,,,,,1-=-C-....../C/O/U/////0 11 11112222233445.545D5P6\6b6d6p6v6x6666666666666666666777777(7.707<7B7D7P7V7X7d7j7l7x7~777777777777777777778888"8$808688888888=?I?O?d?p?v?????FFFFFFFFG,G,G,G,G,FG,G,FFFG,G,G,G,G,G,FFFG,G,G,G,FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFG,G,G,G,G,G,G,G,G,G,FG,G,G,G,G,G,FG,G,FG,G,FG,G,G,G,G,G,G,G,FG,G,G,G,FG,G,FFFFFFFG,G,FG,G,FFG,G,G,G,G,G,G,G,G,G,G,G,FFFFFFFFFFFFFFFFFFFFFFFFG,FG,FFF:ACHSU]!@ @H 0(  (  zB  6D1#" ?B S  ??t@@Text1Text7Text2Text3Text4Text71Text6Check1Check2Check3Check4Check5Text8Check6Check7Text9Text10Check8Check11Check9Check12Check10Check13Text11Text12Text13Check14Check15Text51Text55Text52Text53Text54Check22Check23Check18Check19Text25Text16Text19Text22Text28Text31Text34Text37Text17Text20Text23Text26Text29Text32Text35Text38Text18Text21Text24Text27Text30Text33Text36Text39Check20Text43Check213Q>_'\*Ll8T]t k545N6P6d6x6666667707D7X7l777777778$8888?  !"#$(%&')*+,-./0123456789:;<=>?,Fd.Op:o;]} Kep|/5E5c6w666666677/7C7W7k777777778#878888? z zM&M&?Z&Z&?9*urn:schemas-microsoft-com:office:smarttagsplace8*urn:schemas-microsoft-com:office:smarttagsCity W+^+++????????????????????????LLRR   u v v tt4ILL}}AAQR(( # !!!!!"."."B#B#4$4$$$%%[&[&q&q&&&&&e'e'6)6)G*G*T,o,,,/ / / /??????????Kf c j k p q s | |HL}AT !Q`(;  % & ) + / 0 : ; = > A B M N U V [ \ _ ` j k o p t u ~ !!!!!!!!!!!!!!!!!!!!!!!!"""" " ""$"*"+"4"5"B#U#4$G$$$%(%Z&n&q&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&e'x'6)I)G*Z*T,o,,,/ / / /???????????????A {nk[l-Ζ?l8 szVJ >Nnw"Ol;H. D9JI?*tB:P&CK tpG qoLN6 TZ0hUz/([V̵tMG \x"Nf%gkhPh>viy&1t{$y#~}T*hh^h`.88^8`5o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L. 88^8`5o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.  ^ `5o(.z^`zo(.vv^v`o(.88^8`o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.hh^h`o(.l^`l5o(.h^`.h^`.hpLp^p`L.h@ @ ^@ `.h^`.hL^`L.h^`.h^`.hPLP^P`L.vv^v`o(. hh^h`CJaJo()hh^h`o()^`OJPJQJo(^`OJQJ^Jo(opp^p`OJQJ^Jo(@ @ ^@ `OJQJ^Jo(^`OJQJ^Jo(o^`OJQJ^Jo(^`OJQJ^Jo(^`OJQJ^Jo(oPP^P`OJQJ^Jo(^`OJPJQJo(^`OJQJ^Jo(opp^p`OJQJ^Jo(@ @ ^@ `OJQJ^Jo(^`OJQJ^Jo(o^`OJQJ^Jo(^`OJQJ^Jo(^`OJQJ^Jo(oPP^P`OJQJ^Jo(rr^r`o()BB^B`. L ^ `L.  ^ `.^`.L^`L.RR^R`.""^"`.L^`L.rr^r`o()BB^B`. L ^ `L.  ^ `.^`.L^`L.RR^R`.""^"`.L^`L.rr^r`o()BB^B`. L ^ `L.  ^ `.^`.L^`L.RR^R`.""^"`.L^`L./^`/5o(.0^`05o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.^`o(.^`o()ff^f`o()66^6`. L ^ `L.  ^ `.^`.vLv^v`L.FF^F`.^`.L^`L.%gpG?viD9sz1t{P&ChUG \[Vy#~J A;H.Bkh-{nkqoLNnw"TJI?XW @hh^h`CJOJQJ^JaJo((U @hh^h`OJQJ^Jo(<        F        . )                  G        Ie        nn        IH AW w'yiD3( R #Z$3%*88-2,59K:m=;>&EYG:]HtGJ)P:@U&Ia,gQl8nru<4`PeE )p{FhP,H,bzgR ^m{,!<M!P d3ox5A`dIy8n}qg??@l&&&4444 W W W WWWWWWWWWWWWWW`` !"?@  @0@ "$&(*,.02468:x@@@DFLUnknown G.Cx Times New Roman5Symbol3. *Cx Arial=Arial BoldABook Antiqua?Wingdings 3?= *Cx Courier New;WingdingsA$BCambria Math"h\Ǚ\Ǟ"} 6 s} 6 s!4v?v?2QXR ?gR*!xx 'Contractors and Consultants ApplicationJF Gabe Carrieril                   Oh+'0   @ L X dpx(Contractors and Consultants ApplicationJFNormalGabe Carrieri3Microsoft Office Word@@$,|@GW@GW} 6՜.+,D՜.+,T hp|  IUMs v? (Contractors and Consultants Application TitleP <D_NewReviewCycle  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FA^;WData 1TablesjWordDocument SummaryInformation(DocumentSummaryInformation8CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q