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HomeMy WebLinkAboutresolution.council.013-20I RESOLUTION #013 (Series of 2020) A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF ASPEN, COLORADO, APPROVING A CONTRACT BETWEEN THE CITY OF ASPEN AND EXCAVATION SERVICES INC., AND AUTHORIZING THE CITY MANAGER TO EXECUTE SAID CONTRACT ON BEHALF OF THE CITY OF ASPEN, COLORADO. WHEREAS, there has been submitted to the City Council a contract for concrete replacement and pedestrian improvements projects, between the City of Aspen and Excavation Services Inc., a true and accurate copy of which is attached hereto as Exhibit "A"; NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ASPEN, COLORADO, That the City Council of the City of Aspen hereby approves that Contract for concrete replacement and pedestrian improvements projects between the City of Aspen and Excavation Services Inc., a copy of which is annexed hereto and incorporated herein, and does hereby authorize the City Manager to execute said agreement on behalf of the City of Aspen. INTRODUCED, READ AND ADOPTED by the City Council of the City of Aspen on the 101h day of March 2020. 7fflg� Torre, Mayor I, Nicole Henning, duly appointed and acting City Clerk do certify that the foregoing is a true and accurate copy of that resolution adopted by the City Council of the City of Aspen, Colorado, at a meeting held, March 10th, 2020. Nicole Henning, City C er g C:IT`Y C)FASPEN CONTRACT FOR CONSTRUCTION THIS AGREEMENT, made and entered into on March 10. 2020 , by and between the CITY OF ASPEN, Colorado, hereinafter called the "City", and EXCAVATION SERVICES INC., hereinafter called the "Contractor". WHEREAS, the City has caused to be prepared, in accordance with the law, specifications and other Contract Documents for the work herein described, and has approved and adopted said documents, and has caused to be published, in the manner and for the time required by law, an advertisement, for the project: 2020-51251 2020 CONCRETE REPLACEMENT, and, WHEREAS, the Contractor, in response to such advertisement, or in response to direct invitation, has submitted to the City, in the manner and at the time specified, a sealed Bid in accordance with the terms of said Invitation for Bids; and, WHEREAS, the City, in the manner prescribed by law, has publicly opened, examined, and canvassed the Bids submitted in response to the published Invitation for Bids therefore, and as a result of such canvass has determined and declared the Contractor to be the lowest responsible and responsive bidder for the said Work and has duly awarded to the Contractor a Contract for Construction therefore, for the sum or sums set forth herein; NOW, THEREFORE, in consideration of the payments and Contract for Construction herein mentioned: 1. The Contractor shall commence and complete the construction of the Work as fully described in the Contract Documents. 2. The Contractor shall furnish all of the materials, supplies, tools, equipment, labor and other services necessary for the construction and completion of the Work described herein. 3. The Contractor shall commence the work required by the Contract Documents within seven (7) consecutive calendar days after the date of "Notice to Proceed" and will complete the same by the date and time indicated in the Special Conditions unless the time is extended in accordance with appropriate provisions in the Contract Documents. 4. The Contractor agrees to perform all of the Work described in the Contract Documents and comply with the terms therein for a sum not to exceed FIVE HUNDRED FIFTEEN THOUSAND FOUR HUNDRED THIRTY ONE ($ 515.431.00 ) DOLLARS or as shown on the BID proposal. 5. The term "Contract Documents" means and includes the documents listed in the City of Aspen General Conditions to Contracts for Construction (version GC97-2) and in the CC1-971.doc Page 1 "CC1 Special Conditions. The Contract Documents are included herein by this reference and made a part hereof as if fully set forth here. 6. The City shall pay to the Contractor in the manner and at such time as set forth in the General Conditions, unless modified by the Special Conditions, such amounts as required by the Documents. 7. This Contract for Construction shall be binding upon all parties hereto and their respective heirs, executors, administrators, successors, and assigns. Notwithstanding anything to the contrary contained herein or in the Contract Documents, this Contract for Construction shall be subject to the City of Aspen Procurement Code, Title 4 of the Municipal Code, including the approval requirements of Section 4-08-040. This agreement shall not be binding upon the City unless duly executed by the City Manager or the Mayor of the City of Aspen (or a duly authorized official in his/her absence) following a resolution of the Council of the City of Aspen authorizing the Mayor or City Manager(or a duly authorized official in his/her absence) to execute the same. 8. This agreement and all of the covenants hereof shall inure to the benefit of and be binding upon the City and the Contractor respectively and their agents, representatives, employees. Successors, assigns, and legal representatives. Neither the City nor the Contractor shall have the right to assign, transfer or sublet his or her interest or obligations hereunder without the written consent of the other party. 9. This agreement does not and shall not be deemed or construed to confer upon or grant to any third party or parties, except to parties to whom the Contractor or the City may assign this Contract for Construction in accordance with the specific written consent, any rights to claim damages or to bring suit, action or other proceeding against either the City or the Contractor because of any breach hereof or because of any of the terms, covenants, agreements or conditions herein contained. 10. No waiver of default by either party of any terms, covenants or conditions hereof to be performed, kept and observed by the other party shall be construed, or operate as, a waiver of any subsequent default of any of the terms, covenants or conditions herein contained, to be performed, kept and observed by the other party. 11. The parties agree that this Contract for Construction was made in accordance with the laws of the State of Colorado and shall be so construed. Venue is agreed to be kept exclusively in the courts of Pitkin County, Colorado. 12. In the event that legal action is necessary to enforce any of the provisions of this Contract for Construction, the prevailing party shall be entitled to its costs and reasonable attorney's fees. 13. This Contract for Construction was reviewed and accepted through the mutual efforts of the parties hereto, and the parties agree that no construction shall be made or presumption shall arise for or against either party based on any alleged unequal status of the parties in the negotiation, review or drafting of this Contract for Construction. 14. The undersigned representative of the Contractor, as an inducement to the City to execute this Contract for Construction, represents that he/she is an authorized CC1-971.doc Page 2 "CC1 representative of the Contractor for the purposes of executing this Contract for Construction and that he/she has full and complete authority to enter into this Contract for Construction for the terms and conditions specified herein. 15. This Agreement and any amendments hereto may be executed in several counterparts, each of which shall be deemed an original, and all of which together shall constitute one agreement binding on the Parties, notwithstanding the possible event that all Parties may not have signed the same counterpart. Furthermore, each Party consents to the use of electronic signatures by either Party. The Scope of Work, and any other documents requiring a signature hereunder, may be signed electronically in the manner agreed to by the Parties. The Parties agree not to deny the legal effect or enforceability of the Agreement solely because it is in electronic form or because an electronic record was used in its formation. The Parties agree not to object to the admissibility of the Agreement in the form of an electronic record, or a paper copy of an electronic documents, or a paper copy of a document bearing an electronic signature, on the ground that it is an electronic record or electronic signature or that it is not in its original form or is not an original. 16.Certification and Supplemental Conditions to Contract for Services - Conformance with §8- 17.5.101, et seq. Purpose. During the 2006 Colorado legislative session, the Legislature passed House Bill 06-1343 that added a new article 17.5 to Title 8 of the Colorado Revised Statutes entitled "Illegal Aliens— Public Contracts for Services." This new law prohibits all state agencies and political subdivisions, including the City of Aspen, from knowingly employing or contracting with an illegal alien to perform work under a contract, or to knowingly contract with a subcontractor who knowingly employs or contracts with an illegal alien to perform work under the contract. The new law also requires that all contracts for services include certain specific language as set forth in the statutes. This Certification and Supplemental Conditions has been designed to comply with the requirements of this new law. Applicability. The certification and supplemental conditions set forth herein shall be required to be executed by all persons having a public contract for services with the City of Aspen. Definitions. The following terms are defined in the new law and by this reference are incorporated herein and in any contract for services entered into with the City of Aspen. "Basic Pilot Program" means the basic pilot employment verification program created in Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th Congress, as amended, that is administered by the United States Department of Homeland Security. "Contractor" means a person having a public contract for services with the City of Aspen. "Public Contract for Services" means any type of agreement, regardless of what the agreement may be called, between the City of Aspen and a Contractor for the procurement of services. It specifically means the contract or agreement referenced below. CCI-971.doc Page 3 "CC1 "Services" means the furnishing of labor, time, or effort by a Contractor or a subcontractor not involving the delivery of a specific end product other than reports that are merely incidental to the required performance. PURSUANT TO SECTION 8-17.5-101, C.R.S., et. seq.: By signing this document, Contractor certifies and represents that at this time: (i) Contractor does not knowingly employ or contract with an illegal alien; and (ii) Contractor has participated or attempted to participate in the Basic Pilot Program in order to verify that it does not employ illegal aliens. The Public Contract for Services referenced below is hereby amended to include the following terms and conditions: 1. Contractor shall not knowingly employ or contract with an illegal alien to perform work under the Public Contract for Services. 2. Contractor shall not enter into a contract with a subcontractor that fails to certify to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under the Public Contract for Services. 3. Contractor has verified or has attempted to verify through participation in the Federal Basic Pilot Program that Contractor does not employ any illegal aliens; and if Contractor has not been accepted into the Federal Basic Pilot Program prior to entering into the Public Contract for Services, Contractor shall forthwith apply to participate in the Federal Basic Pilot Program and shall in writing verify such application within five (5) days of the date of the Public Contract. Contractor shall continue to apply to participate in the Federal Basic Pilot Program and shall in writing verify same every three (3) calendar months thereafter, until Contractor is accepted or the public contract for services has been completed, whichever is earlier. The requirements of this section shall not be required or effective if the Federal Basic Pilot Program is discontinued. 4. Contractor shall not use the Basic Pilot Program procedures to undertake pre- employment screening of job applicants while the Public Contract for Services is being performed. 5. If Contractor obtains actual knowledge that a subcontractor performing work under the Public Contract for Services knowingly employs or contracts with an illegal alien, Contractor shall: (i) Notify such subcontractor and the City of Aspen within three days that Contractor has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and (ii) Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to this section the subcontractor does not cease employing or contracting with the illegal alien; except that Contractor shall not terminate the Public Contract for Services with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. CC1-971.doc Page 4 "CCI 6. Contractor shall comply with any reasonable request by the Colorado Department of Labor and Employment made in the course of an investigation that the Colorado Department of Labor and Employment undertakes or is undertaking pursuant to the authority established in Subsection 8-17.5-102 (5), C.R.S. 7. If Contractor violates any provision of the Public Contract for Services pertaining to the duties imposed by Subsection 8-17.5-102, C.R.S. the City of Aspen may terminate the Public Contract for Services. If the Public Contract for Services is so terminated, Contractor shall be liable for actual and consequential damages to the City of Aspen arising out of Contractor's violation of Subsection 8-17.5-102, C.R.S. 8. This Agreement and any amendments hereto may be executed in several counterparts, each of which shall be deemed an original, and all of which together shall constitute one agreement binding on the Parties, notwithstanding the possible event that all Parties may not have signed the same counterpart. Furthermore, each Party consents to the use of electronic signatures by either Party. The Scope of Work, and any other documents requiring a signature hereunder, may be signed electronically in the manner agreed to by the Parties. The Parties agree not to deny the legal effect or enforceability of the Agreement solely because it is in electronic form or because an electronic record was used in its formation. The Parties agree not to object to the admissibility of the Agreement in the form of an electronic record, or a paper copy of an electronic documents, or a paper copy of a document bearing an electronic signature, on the grounds that it is an electronic record or electronic signature or that it is not in its original form or is not an original. IN WITNESS WHEREOF, the parties agree hereto have executed this Contract for Construction on the date first above written. ATTESTED BY: CITY OF ASPEN, COLORADO Title: APPROVED AS TO FORM: By: ity Attorney CONTRACTOR: By: M�L l 'Ris,ex- ��cu✓o ��nv c�`S Title: Vi("e,. IFCzsk & CC1-971.doc Page 5 **CC1 Note: Certification of Incorporation shall be executed if Contractor is a Corporation. If a partnership,the Contract shall be signed by a Principal and indicate title. CCI-971.doc Page 6 "CC1 CERTIFICATE OF INCORPORATION (To be completed if Contractor is a Corporation) STATE OFC1 COUNTY OF 6&A-91&' J) SS. On this day of M&C-uk , 200 , before me appeared ` r , to me personally known, who, being by me first dulyom, did say that s/he is of Lr L&Ut-hw—' , ;v�'c.�S Int– and that the seal affixed to said instrument is the corporate seal of said corporation, and that said instrument was signed and sealed in behalf of said corporation by authority of its board of directors, and said deponent acknowledged said instrument to be the free act and deed of said corporation. WITNESS MY HAND AND NOTARIAL SEAL the day and year in this certificate first above written. IE BUS'�I Gt NOTAR COLA IC Notary Public p OTAR o 20o64�24513 r TA ON EXPIIRES JULY 23 2021 �owa� - r C-0 Addres My commission expires: 6 c�-3 O CC1-971.doc Page 7 "Cc1 BID PROPOSAL FORM PROJECT NO. :2020-51251 BID DATE: 2-26-2020 PROJECT:2020 Concrete Replacement PROPOSAL SUBMITTED BY: Excavation Services Inc. CONTRACTOR CONTRACTOR'S PROPOSAL TO: The Governing Body of the City of Aspen,Colorado The undersigned responsible bidder declares and stipulates that this proposal is made in good faith,without collusion or connection with any other person or persons bidding for the same work, and that it is made in pursuance of and subject to all the terms and conditions of the advertisement for bid, the invitation to bid and request for bid,all the requirements of the bid documents including the plans and specifications for this bid, all of which have been read and examined prior to signature. The bidder agrees to keep this bid open for Sixty(60) consecutive calendar days from the date of bid opening. The Contractor agrees that construction shall start immediately following a mandatory pre-construction conference held by the Engineering Department,which also constitutes the Notice to Proceed. Submission of this proposal will be taken by the City of Aspen as a binding covenant that the Contractor will finish construction within the time specified in the Special Conditions of this contract document. The City of Aspen reserves the right to make the award on the basis of the bid deemed most favorable to the City,to waive any informalities or to reject any or all bids. The City shall not pay the Contractor for defective work and/or for repairs or additional work required for successful completion of the project. All work not specifically set forth as a pay item in the bid form shall be considered a subsidiary obligation of the Contractor and all costs in connection therewith shall be included in the prices bid for the various items of work. Prices shall include all costs in connection with furnishing the proper and success completion of the work, including furnishing all materials, equipment and tools,and performing all labor and supervision to fully complete the work to the City's satisfaction. Poor quality and workmanship shall not be paid for by the City. Such work product must be removed immediately and replaced properly at no cost to the City. All quantities stipulated in the bid form at unit prices are approximate and are to be used only as a basis for estimating the probable cost of work and for the purpose of comparing the bids submitted to the City. The basis of payment shall be the actual amount of materials furnished and work done. The Contractor agrees to make no claims for damages,anticipated profit,or otherwise on account of any differences between the amount of work actually performed and materials actually furnished and the estimated amount of work. BP1-971.doc *BPI Paqp 1 Conbactoes Initials The City reserves the right to increase or decrease the amount of work to be done on the basis of the bid unit price and up to plus or minus Twenty Five(25)Percent of the total bid. By signing this document,Contractor certifies and represents that at this time: (i) Professional shall confirm the employment eligibility of all employees who are newly hired for employment in the United States;and (ii)Professional has participated or attempted to participate in the Basic Pilot Program in order to verify that it does not employ illegal aliens. I hereby acknowledge receipt of ADDENDUM(s)numbered 1 through 5 ESTIMATED QUANTITY LIST L Park Circle Sidewalk Installation Section Item Unit Qty Unit Price Total 106 Materials Testing LS 1 $ 5,000.00 $ 201 Clearing and Grubbing CY 81 $ 100m $ -00 202 Removal of Concrete(Sidewalk)* SY 29 $ 100.00 $ 2.900.00 202 Removal of Curb and Gutter* LF 173 $ 27,00 $ 467100 202 Removal of Asphalt Material SY 727 $ $ (Roadway) 40.00 29 080.00 208 Erosion Control System Management AC 0.4 $ 6,500.00 $ 2.600.00 Erosion Control Temporary Sift 208 Fencin LF 174 $ 15.00 $ 2,610.00 Erosion Control Silt Fence Inlet EA 208Erosion 1 $ 500.00 $ 500.00 208 Erosion Control Rock Sock EA 45 $ 15.00 $ 675.00 208 Stockpile Management LS 1 $ 2,500.00 $ 2,500.00 208 Sediment Control Logs LF 233 $ 15.00 $ 3,495.00 208 Concrete Washout Area EA 1 $ 2,500.00 $ 2,500.00 208 Street Sweeping LS 1 $ 2.5ffl.00 $ 2,500.00 210 Reset Structure(Mailbox) LS 1 $ 500.00 $ 500.00 213 Topsoil(6"minimum depth) CY 80 $ 75.00 $ 6,000.00 214 Install Landscaping LS 1 $ 1850000 $ 18,500.00 304 Aggregate base course CY 37 $ 100,00 $ 3,700.00 403 Asphalt per Aspen Engineering Sy 328 $ 120.00 $ Design and Construction Standards 39,360.00 604 Irrigation System EA 1 $ 5,000.00 $ 5,000.00 604 Drain Inlet with Grate EA 1 $ 6,000.00 $ 6 000.00 607 Temporary Pedestrian Control LS 1 $ 5,000.00 $ 5,000,00 BPI-971.doe 'BP1 P 2 s Initials 608 Concrete Sidewalk(4") SY 253 $ 135.00 $ 34 155.00 608 Brick Pavers SF 156 $ 40.00 $ 6,240.00 608 Type 1 Accessible Curb Ramp(w/ EA 1 $ 4,000.00 $ 4,000.00 detectable warning) 608 Type 5 Accessible Curb Ramp(w/ EA 1 $ 10,500.00 $ 10,500.00 detectable warning) Type 12 Accessible Curb Ramp(w/ EA 608 detectable warning) 2 $ 10,500.00 $ 21,000.00 609 Curb and Gutter,Type 2(Section 11-8) LF 250 $ 60,00 $ 15,000.00 626 Mobilization LS 1 $ 15,000.00 $ 15000.00 713 Construction Zone Traffic Control LS 1 1 $ 35,000.00 $ 35,000.00 *Includes excavation TOTAL BID IN NUMBERS(Park Circle Sidewalk Installation): $292,086.00 Total Bill in Words: Two hundred ninety-two thousand,eighty-six dollers,and no cents II Dior Corner ADA Improvements Section Item Unit Qty Unit Price Total 106 Materials Testing LS 1 $ 5,000.00 $ 5,000.00 202 Removal of Concrete(Sidewalk) SY 89 $ 100,00 $ 8,900.00 202 Removal of Curb and Gutter LF 85 $27.00 $ 2,295.00 202 Removal of Asphalt Mat(Roadway) SY 19 $ 125.00 $2,375.00 208 Erosion Control LS 1 $5,000.00 $ 5,000.00 210 Reset Structure(Ground Sign) EA 3 $ 500.00 $1,500.00 210 Reset Structure(light post) EA 1 $ 1,500.00 $ 1,500.00 304 Aggregate base course(class 6) CY 18 $150.00 $2,700.00 403 HMA(Grade SX)(Roadway) SY 19 $ 120.00 $ 2,280.00 607 Temporary Pedestrian Control LS 1 $4,500.00 $ 4,500.00 608 Concrete Sidewalk(4") SY 89 $120.00 $ 10,680.00 608 Bi-Directional Curb Ramp(w/detectable EA 1 $ 10,200.00 $ 10,200.00 warning) BP1-971.doc 'BP1 — Page 3 � Contrai;Ws InWmis 609 Curb and Gutter Type 2(Section II-M) LF 8S $ 60.00 $ 5,100.00 626 Mobilization LS 1 $ 5,000.00 $ 5,000.00 713 Construction Zone Traffic Control LS 1 $ 10,000.00 $10,000.00 Lid tri Pole Base - $5,000.00 $ 5,000.00 Exposed Foundation Treaianeni LS _ 5,6,000 $E,CCO *Includes excavation TOTAL BID IN NUMBERS(Dior Corner ADA Improvements): $88,030.00 Total Bid in Words (Dior Corner ADA Improvements): Eighty-eight thousand,thirty dollers.and no cents III. Burlingame Park Trail Section Item Unit Qty Unit Total Price 106 Materials Testing LS 1 $5,000.00 $ 0 San Diego Buff Concrete Sidewalk(6"w/fiber SY 608 mesh) 88 $ 200.00 $ 17 600.00 608 Grey Concrete Sidewalk(6"with fiber mesh) Sy 89 $ 175.00 $ 15 575.00 626 Mobilization LS 1 $ 2,500.00 $ 2,500.00 609 Curb and Gutter Type 2(Section II-M) LF 88 $ 65.00 $ 5,720.00 *Excludes excavation TOTAL BID IN NUMBERS(Burligame Park Trail): $46,395.00 Total Bid in Words: Forty-six thousand,three hundred,ninety-five dollers,and no cents BP1-971.doc `BP1 Pag 4 Contractors Initials IV. Curb and Gutter Installation Section Item Unit Qty Unit Total Price 106 Materials Testing L5 1 $ 5 000.00 $ 5,000.00 202 Removal of Curb and Gutter LF 500 $ 27.00 $ 13,500.00 202 Removal of Asphalt Mat(Roadway) SY 56 $ 125.00 $ 7,000.00 208 Erosion Control LS 1 $ $ 5,000.00 304 Aggregate base course(class 6) CY 28 $ 150.00 $ 4,200.00 403 Asphalt per Aspen Engineering Design and S, 56 Construction Standards $ 120,00 $ 6,720.00 609 Curb and Gutter Type 2(Section li-M) LF 500 $ 60.00 $ 30,000.00 626 Mobilization LS 1 $ 7,500.00 $ 7,500.00 713 Construction Zone Traffic Control LS i $ 10,000. $ 10 000.00 `Excludes excavation TOTAL BID IN NUMBERS(Curb and Gutter Installation): $88,920.00 Total Bid in Words: Eighty-eight thousand,nine hundred,twenty dollars,and no cents BED SUMMARY The total bid amounts received in the bid summary supersede any and all other bids listed within this document. Ensure all numbers and text are legible and consistent. Park Circle Sidewalk Installation Provide and install all materials, labor and construction operations necessary to complete the intended work described and shown in the plan-drawings and technical specifications for the area depicted. I. Park Circle Sidewalk Installation $ 292,086.00 (Use Nambm only) Dior Corner ADA Improvements Provide and install all materials,labor and construction operations necessary to complete the intended work described and shown in the plan-drawings and technical specifications for the Southwest corner of Hopkins and Galena. IL Dior Corner ADA Improvements $ 88,030.00 BPI-971.doc *BPI g 5 Contractor's Oiia% (Use Numbers Only) Burlieame Park Trail Construction of park to be primarily completed by the City of Aspen Parks Department.The contractor will be responsible for forming and pouring concrete only. M. Burlingame Park Trail $ 46,395.00 (Use Numbers Only) Curb and Gutter Installation Provide and install all materials,labor and construction operations necessary to complete the intended work described and shown in the plan-drawings and technical specifications for the Southwest comer of Hopkins and Galena. IV.Curb and Gutter Installation $ 88,920.00 (Use Numbers Only) TOTAL BID IN NUMBERS:Park Circle Sidewalk Installation and Dior Corner ADA Improvements and Burlingame Park Trail and Curb and Gutter Installation Total(I+II+III+IV):S 515.431.00 (Use Numbers Only) Total Bid in Words: (Base Bid plus Additive Alternates) Five hundred,fifteen thousand,four hundred,thirty-one dollars,and no cents I acknowledge that in submitting this bid it is understood that the right to reject any and all bids has been reserved by the owner. Authorized Officer: Michael Buster ,Title: Vice President Full name signature: Company address: Excavation Services Inc.P.O.Box 1159 Carbondale CO 81623 Telephone number: 970-963-8355 Email: justin@excavationservices.biz BP1-971.doc 'BP1 P e B conhadoes Initials Attested by: Subcontractor& Material Supplier List Name: TI Concrete Phone#: 970-379-6300 Address: Carbondale CO Service or Product: Concrete Name: HP Kumar Phone#: 970-945-7988 Address: Glenwood Springs CO Service or Product: Testing Name: Al Traffic Control Phone#: 970-876-0738 Address: Silt CO Service or Product: Traffic control Name: Phone#: Address: Service or Product: Name: Phone#: Address: Service or Product: Name: Phone#: Address: Service or Product: BPI-971.doc 'BP1 P 7 Con dors Initials