HomeMy WebLinkAbout1502 Bldg M E Lauridsen Blvd - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000947 Date 10/03/05
199728
1502 E LAURIDSEN BLVD
06-30-14-1-2-0000-0000-
DEMO BLDG. M
DEMOLITION
~
PUBLIC BUILDINGS & PARKS
206000
Owner
Contractor
STATE OF WASHINGTON
GEN ADMIN
OLYMPIA WA 985041000
L E IDDINGS & SONS INC
POBOX 2755
BELFAIR WA.
BELFAIR WA 98528
(360) 275-2454
Permit . . . . .
Additional desc .
Permit pin number
permi t Fee
Issue Date
Expiration Date
DEMOLITION
DEMO BLDG. M
61366
47.00
10/03/05
4/01/06
Plan Check Fee
Valuation
.00
o
Qty Unit Charge Per
Extension
47.00
BASE FEE
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 47.00 47.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 47.00 47.00 .00 .00
j
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Separate Permits are reqUired for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. ThiS permit becomes
null and void if work or construction authorized is not commenced within 180 days, If construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested Within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or I cal law gulating construction or the pe~rmance of
construction.
v-3-0r-
Signature of Contractor or AuthOrized Agent
Date
Signature of Owner (if owner IS builder)
T \Pohcles\1102_15 bUlldmg penmt mspectlOn record05 wpd [1/4/2005]
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BUILDING PERMit'. APPLICATION
www.eityofpa.us
Print out form and fill out COMPLETELY in INK. Your application and site
plan MUST BE COMPLETE to be accepted for review.
Questions? Call: PERMITS (360) 417-4815 Fax (360) 417-4711
FOR OFFIC~ USE 9NI. Y:
Date Rec.: Cf/;1..Ii lOT?
Permit#: tJb"Q41.
Date APProved/::t/ut joY
,
Date Issued:
ApplicantOl"Agent: . -~, j1I1A-rn+8J L~ ~€:S Phone: 1~o '1/7 c;rro
Owner.J~_.....1.... W~ Phone: '140 '(17 ~ .S'tl
Address: Ic)o1,. 6. L.(u". ;idj-e-Uf/J:ity:jJ~f ~~ S 41A- Zip: qj ~ ~ 2-
Architect/Engineer: l..Mf\J 4i.e H-fll4!Z.. P$ (trtH- .JDtItv.s(}~) Phone: ~ 6?!' 1'bl..-fp
ContractorJ- r!t>Lj)i)I".r{"J.SDr~ StateLiceDSe#:Lalj)DG.I~17 Exp: OS/o<:/l>( Phone:
~bo.. 'iiW~"('() eA., ilv1cL.aj>fO\..:e...7 "",1.-'
Address: j:>,o. \.~rc- 2'7~ City: gn: Fp.. tC2... Zip: <r~c{<;'"',2,f5
PROJECT ADDRESS:-L5"02 E. LIlIAI"~J.W~ "E Irld ZONING:
LEGAL DESCRIPTION: Lot: Block:: Subdivision:
CLALLAM COUNTY PARCEL NUMBER:
Credit Card Holder Name:
Billing Address: I f"02.- 6". 14M vi J~~ (j, f vd
Credit Card Type VISA MC #
TYPE OF WORK: SIZE/VALUATION:
o Residential 0 New Constr. 0 Re-roof a Stove SF. @ :&
a Multi-family Cl Addition Cl Move l:l Garage SF. @ $
l:l Commercial C Remodel J('Demolition 0 Deck SF. @ :s /SF. =:&
o Repair 0 Sign 0 Other TOTAL VALU~TION $ 2n41'Jt'Y)t!;'
BRIEFDESCR(PTIONOFTHEPROJECT: i).PM!,/~{to:. af;()~ (gIn:.. ~;c:; Ic~J.I. Jj/j?
City:
tlo /f 4-ktdu
/vir .
~f3"3
EXp. Date:
/SF. = :&
ISF. = $
COMMERCIAL/RESIDENTIAL: Occupancy Group:
Existing Sq. Ft.
Total lot coverage
Occupant Load:
& Proposed Sq. Ft.
Construction Type;
= TOTAL Sq. Ft.
No. of Stones;
Lot Size:
%
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESA/Wetland(s): lJ Ycs 0 No SEPA Checklist required? 0 Yes 0 No Otber.
BUILDING PERMIT APPLICATION SUB MITT AL: The BUilding Division clln provide you with information on the application and
plan submittal requirements if you have question!;.
V ALUA TION OF CONSTRUCTION; In all esses, a valuation amount must be entered by the applicant. This figure will bc reviewed
and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 4 ) 7 -4815 for assistance.
PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other pcrmit fees arc due at the timc of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date of application, the applieatioD will expire. The
Building Official can extend the time fot' action by the applicant up to 180 days upon written request by the applicant (see Section Rl 05.3.2
of the Intemational BuildinglResidential Code, 2003). No application can be extended more than once.
/ hereby certify that I have read and examIned this application and know /he
understand that it is my responsibility to determine what permits are required.
www.cityofpa.us ApplicantX
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3~H110~ V1ilSNIN3d
0999 L1t 0ge XVd 06:11 llRL 90/66/60
~ORTANGEtES
WAS H I N G TON, U. S. A.
'PUBLIC WORKS & UTILITIES DEPARTMENT
September 27,2005
Peninsula College
David Wegener
1502 East Lauridsen Blvd
Port Angeles, WA 98362
RE: Port Angeles Landfill Waste Disposal Application, WDA 05-3J; Building demolition at
Peninsula College Dormitory Building "M"
We have received your application for disposal of building demolition debris from the referenced
site and reviewed the testing results for lead and asbestos content. Based on the testing results
the debris appears to be acceptable for use in the landfill. A copy of your approved application
is attached. This approved application must be shown to the landfill scale attendant at the time
of disposal.
Please be advised that this disposal application is only for the materials and quantities listed in
the application. Materials not listed or in excess of the quantities noted may require separate
applications and approval.
Please call if you have questions.
Very truly yourt; _
J . ~-Jw
G~~enworthY, P.E. a
City Engineer
Deputy Director of Engineering Services
GWK tf
End WDA 05-31
Copy Ken Loghry
N IPWKS\ENGINEERIWDAPPUCI05-31 WPD
FILE Landfill Sohd Waste DIsposal Apphcallons
321 EAST FIFTH STREET · POBOX 1150 · PORT ANGELES, WA 98362-0217
PHONE 360-417-4805. FAX 360-417-4542. TTY 360-417-4645
E-MAIL publlcworks@cltyofpa US
119 1.2 2U05 o~; 06 FAX 3lH) 491 6JOa
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ORCAA
NOT APPROVED
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Notification'~IDem6iiti~n permit' . I, ... - .
It is wawfUI fOT allY person to cause or allow th~ demGlition (01' lhaJOl' reDo~tion) (If any nTUttllre unless 3D tibestos-
containing materials luLve been removed from 'the aru 10 be demolished. Work shdl not comlnencc on an ilSbestos project
or deIM1idOD unless ~he o","ner or operator- bas obula&d writtJm :zpprovaJ frOIn ORC.U. A written applicatio1l fOT 9.
demolition sbaU include a certification that there i5 no bown asbes1~tainIni material Telludning in the area of the
SVQc:tvR.
Project Site Address: J5t.)2 E- LIJdAIL'DS~
City: o(tf~"
S~ Date: ~ It.w(
- ~ I
-( here!' IS a 10 working day advQn~ notificatiotl pc1iod:fro
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I PERMIT# a5D~DC2J;ZlFZ-:
APPROve:.---=- ~tJ~
CONOrnONAllYAP~R VeD
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County:~
.. II? State. WA Zip: qJ=-~2-
Completion Date: At! nJfJ /J 61- , s-, ~
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ofpmnil application)
hoperty Owner.~~~
Mailing Address: ~
City: Po ~ ~ Ii d-eJ
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State License #:
Fax: '7~f) ..,/i 1- ~~
Zip: '1h (P2-
Demolition Cont:ra.ctor.
Mailing Address:
City:
Contact Person:
State:
Zip:
T elephon.e:
Fax.:
YES
...x.....
NO
Demolition by Wrecking or DismMlr1;ng? ($25.00 fee) check #
Training Fire Demolition? (If yes, atta~:tire departmeDt request for trai.n.ing fire)
Renovation, Alteration. Remodeling, Maintenance. or other CoIlSlruction'?
..L Asbestos fOllnd or S1lS~~'" I .
:& An OR-CM '"N ntKe of mleat tv Rl!lma~e ut :EGraplUlabr .Alb~ fonn 1IIl11 appro#azc fce IIIl'lSt be; snbmnrcd ptiar' ro rat! asbesms
T'emoval 'lU0Ik:. Asbl!Rlos removal projects mvlll"ling dcmoIi1:1ol1 must tK; pP:fimncd 'by J Cettified Asbmos CODIraaor aa4 aU fdi1bl., Dr'
pOlc:nl'.iillly fri~lc: :i8b=tO& railS( be Iellloved bcfor= all) demoliIiatl. b4lJins. ~fcr to PJlCAA lleguIatlOD 1 A%lid.e 14 fQJ I1dditiClllAl
reqairc:mc:n[S that nlD)' apply, . , i
I
Asbestos Survey Colllpleted by
ABERA Certified Inspector tV lb....,.. ~ Pi e.h. '
Certification # I J Mf' ~ 1'1 A 1: .. 0 if - 0 {'2-
,
This approved p=anit lllUSt
be availiible at the job site
E,.dose m
Proc.esslhg Fee
Certification of the Asbestos Survey l!1USt
~mpany this fom1
!lev. O?/ JU01
2940 B Lim;ted WIne NW, OIympi.. WlI9hiDpa. 98502 I D
361)...586-1044 · 8D0422-5623 - 1ilx 36004~l-6308
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0999 LIt 0ge !Vd 0<::11 llRl 90/6<:/60
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l,U.z:>A- os-31
PORTANGELESLANDFaL
WASTE DISPOSAL APPLICATION
Phone: (360) 417-4803
FAX: (360) 417-4709
City of Port Angeles, City Engineer
321 E Fifth Street
P.O. Box 1150
Port Angeles, Washington 98362
To:
NOTE:
All questions must be answered for waste to be approved.
1. Generator Information:
Company Name:
Mailing Address:
Contact:
Phone.
Project Name:
Project Location:
'?G-AJ \ ('vl';U' LA ~-tLvb,'L-
r~c2- G:.A-S, Llb.'-'RIl)~N (6LVI~
rCa:l A-tJ b ,{L~ ~ \ t,J p.. '1.~ ~ '1& ~b2-
DAve C> ~J G:-cc il,,J lUL-
417 ~ 7cr91:7
c;. ! ttl'\JL..-,i -.t- TIU-HNOLcl..,\.., GU\ Lo,;-, L-
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/?"C L (],0.~"\ L AvClj I~?o,v BLVj'\
2. Other Contacts (if applicable):
Consulting Firm:
Contact:
Phone:
Contractor Name:
Contact:
Phone:
Laboratory:
Contact:
Phone:
OR JON EN IJIR.NAtte1lTM-. SVc..--5
Page - 1
City of Port Angeles - Landfill Waste Disposal Application
13. Source of Waste:
Check the appropriate box below and briefly describe the project, process, and/or.cleanup that
will or has produced the waste requiring disposal. Include the gasoline service station number
(if applicable).
CERCLAlMTCA Remediation
Independent Remedial Action
Unused Chemical Product Spill
Agency Contact:
UST Removal
Other Source:
4. Waste Material Composition: (check all that apply and include percent of total)
Soil % Foundry Slag - %
X Concrete! Asphalt 10 % Dredge Sediments - %
Preserved Wood % Debris - %
Coal Ash % Other (list)
Wood Ash % - %
"Dlrt""-I: h I\L~ -Pe~, >} vJt>OI~ r r2aJfk. L-li~ .L\:Li ...1L%
.I '
NOTE: Total must equal 100%.
5. Waste Material Contaminants: (check all that apply)
Gasoline
Solvents
Unused Motor Oil
Other
Metals
Heating Oil
Used Motor Oil/Waste Oil
Other Petroleum Product
Diesel
PCBs
Unknown
NOTE:
Supply any MSDS information with application, if available.
City of Port Angeles - Landfill Waste Disposal Application
Page - 2
6. Estimated Quantity of Waste for Disposal:
~I t?LV
Cubic yards I
Drums /
~co
Tons (estimate both)
Tons (estimate both)
Other
NOTE:
Estimated quantity for disposal must be within 20% of the quantity actually disposed.
(10% for projects over 7,500 tons or 5,000 cubic yards.)
7. Frequency of Disposal:
One time
X Monthly
Annual
Other
8. Waste Sampling:
Proper characterization of the waste for disposal requires the collection of representative
samples. The methods and equipment necessary for obtaining representative samples of a
waste, and the frequency of sampling, will vary with the type and form of the waste. Check the
appropriate box and briefly describe how and where the waste was sampled. Include site maps
with sampling locations if possible.
Number of COMPOSITE samples _ & number of discrete samples per composite _
Number of DISCRETE samples
NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling
frequency will be used:
0-25
25 - 100
101 - 500
501 - 1000
1001 - 2000
>2000
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
=
1 composite sample
3 composite samples
5 composite samples
7 composite ~amples
10 composite samples
10 plus one sample for each additional 500
cubic yards
=
=
=
=
=
NOTE 2: One composite sample shall contain a minimum -of three/maximum of five discrete
samples.
city of Port Angeles - Landfill Waste Disposal Application
Page - 3
19. Waste Analysis:
The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to determine the
appropnate analytical requirements for waste characterization. Ecology Publication #91-30
(Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils" shall also be
used to characterize petroleum contaminated soils from UST releases. Submit all laboratory
analytical results, QAlQC data, and Chain of Custody sheets along with this application.
(NOTE: The laboratory must be accredited by the Washington State Department of Ecology.)
a) List all analytical test methods used:
b) Provide a narrative as to why the above analytical methods were selected:
NOTE:
Additional sheets attached:
YES
NO
10. Soil Classification: (**FOR PETROLEUM CONTAMINATED SOILS ONLY**)
Based on the analytical data and Ecology Publication #91-30, the soil classification is: (check
one)
Class 1
Class 2
Class 3
Class 4
Calculated Hazard Index
11. Dangerous Waste Affidavit:
Based on a review of the analytical test results, site history, and the applicable regulations, this
waste is classified as: (check one)
/ Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (EHW)
Dangerous Waste (OW) and Waste Code:
Extremely Hazardous Waste (EHW) and Waste Code:
City of Port Angeles - Landfill Waste Disposal Application
Page - 4
(12. Certification: I
We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All]
information provided IS correct and the enclosed analytical results represent the proposed waste
material to the best of our abilities.
Waste Gener~t:6 ~
b~J 'D W~b\2rJ\20-
Printed Name
---. '\
\;''GN \ l\J S~ ) l- k
Company
9' I'w 10 ~-----
Date I~
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Go 'u._~ Ii
p~ ,of Port .~~~$ App~~~;
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N:\POLlCY _P\1000_SW\1009_01'wPD
city of Port Angeles - Landfill Waste Disposal ApplicatIon
Page - 5
(
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Figure C.3
Problem Waste Disposal Acceptance Process
Generator contacts city
of Port Anaeles or
~ CCBHD-' requestins to
dispose of problem
wastes at the P ALf. .
City sends an approval
letter to the generator.
Upon receipt of the
waste at the landfill,
the pte attendant
verifies tb. the
quantity received is
within 20% of the
qllllltfty reputed In
the wDA (within, 10%
for >7500 tons or
SOOO f:'J ).
CCEHD or City of Port Anaeles
forwards the generator a ropy of
tile PALF WOA. (Anachment A
to Waste Aeceptanee Policy)
Yes
I
Generator completes '
I
Ind submhs to City the
WDA including !
laboratory analytical ~
rMulls and quality
control information.
City of Port Angeles Engineer, or
desJgMted representative signs WDA
and forwards a copy to CCEHD for I
their ~iew and authorization.. '
No
i'
City of Port Angeles, City
Engineer or clesipated
l..pe:.dJIltive reviews
WDA for completeness
and accuracy.
Yes
Ves
city notiftea pnerltor in wrilinl of
reason for d"lt8pI1roval and fot'Wards
copy to Cellfl'). Oetlenltor may
resubmit WDA .fter lddreuinS City
and or CCEHD conecms.
.CCEHD: a.IIMn Counth Environmental Health Division PALP: Port Anteles Landfill WDA: Waste Disposal Application
. .
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Orion Environmental Services
\\ IH.. W2F~l)12~_~5
34004 Q'h Avenue South. Buililine A Suite 5. Federlll Way, Wll'!lhingu1lI91111113-(.7411
Telephone Seattle (153) 874-8118 .TIlC.ontll (253) 952-6717 . Fll\~jmild2SJ) 927-.a71" +clnllil ORION6717@lIol
Total Lead Test Report
EPA Method 7420
Client
Nowicki & Assodatcs, Inc.
33516 9lh A venue Sourh. Bldg. #6
Fe..l~raJ W dY, W A 98003
Date
P~lge
Invoice
Date Rl'Ceivcd
June 27, 2005
Page 1 ofl
052100
June 26, 2005
Project Numher'
Project Name
L05-0207
Peninsula College -- D(mnl{ory Building "M"
Total Lead
Client ORION Material LOD (mg/kg) PPM % by Weight
N u mher Number Descripti.9D (Jng/kg)
.--
50726-64 E:\lcrior Door Painl RJ.I 1033.3 U.130
,..., 50726-65 Ap,lfIl1ll,;UI Wall Pednl 11.0 .:: 1l.1) <0.001
-
3 5072h-h6 i\parluKnt Door Frame Pamt ~5.0 40.0 l>.U04
of .<i0726-67 Donn Room Door frame Paint 29.4 <29.4 -:.0.003
5 .<i07:;6-68 Donn Romn Wall flame Paint 10.2 44.7 0.004
6 S072h-69 Dorm Hallway Wall Paint 26.3 73.7 0.007
7 S072h-70 Dorm Stair Well Paint 33.3 80.0 0.008
8 50726- 71 001 m Bathroom Wa]J Pamt 2'2.7 <22.7 "'0.00:2
9 S072/)- 72 Storage Room Wall Pamt 45.4 <45.4 <:0.005
10 S07::U)- 73 Cf\mmnns Wall Paint 26.3 378.9 0.0378
" 50726- 74 1:xtelior Siding Paint 27.7 161.1 0.0161
12 5072()- 75 1:xteriol- Trim l'aint 31.3 .'175 0.004
Qualit}, Assurance Information
1\lllhou 13hmJ.... ':'0.5 mglkg
Linear Kl"gre~slOIl Lower Linlil: 0 990
AClllall.hill'h llI1l"ar Regression: 0 997
Chl".ch. SlanJ!lrJ Per Sl"l: +0.5 mg!]
/.....} C-------
. I '-7 "-- ----
RevieWed'BYl . .' ;~:;; /......2~<----~ Mcmht.,., AOAC. ACS, AIHA
- - Df/ M1 N I Lea4111fJ tEnvitrmment4f Compliance Consvltirre Into tlie 21n Century
OllIla C t'3
LllboT<l.or)' Director
III I .: ~ X. Zl.111 ~, 1 1 : i 1.1:' M
N ',' 'Ii i ,~k jEll \ i r " II III .:: II t ," I ...., r \ I ,~.:: .)
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PENINSUlA
COLLEGE
1502 Ea.<:t Lauridsen Boulevard. Port ,Angeles. Washington 98362. (360)452-9277
Alan Olson
Nowicki Environmental Services inc.
33516 9th Avenue South
Bl1i 1 ding #6
Federal Way WA. 98003
July 22.2005
Alan
P1cnsc tind enclosed 12 paint samples from our Dormitory Building "M", a 1100r plan and
list of locations where 1 took the sdmples ITom. Thank you lor agreeing TO sample the
paint chips for lead contamination We are in the final days ofpTepaTation fOT t]1e
demolition ofthis building and the City OfP011 Angeles is requiIing paint samphng as a
condition of the demolition permit.
I e-mailed Jim Copland yesterday to let him know that you will be sending hin1 a
proposal for the testing of these samples He has given me the autholizatioll to have you
get the sampling done.
If you have any questions or nee.d further mfonnation about the samples, locations or
descriptions, give me a call or e-mail.
J:&:~
Man Gravcs, Director
Support Services
Pemnsula College
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General/Specialty Contractor
A business registered as a construction contractor with Lal to perform construction work within
of its specialty. A General or Specialty construction Contractor must maintain a surety bond or
of account and insurance.
License Information
License LEIDDEI950KE
Licensee Name L E IDDINGS a SONS INC
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602273124_~eLify Worke_[s_Comp Pr:emhtm
Status
Ind. Ins. Account
Id
Business Type CORPORATION
Address 1 PO BOX 2755
Address 2
City BELFAIR
County MASON
State WA
Zip 98528
Phone 3602752454
Status ACTIVE
Specialty 1 EXCAVATION/GRADING
Specialty 2 UNUSED
Effective Date 5/5/2005
Expiration Date 5/5/2007
Suspend Date
Separation Date
Parent Company
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9/29/05
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Business Owner Information
Name
Role
Effective Date Expiration Date
J PRESIDENT 05/05/2005
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
UntIl
#1 CBIC SF9366 01/06/2005 Cancelled $6,000.00 05/05/2005
Savings Information
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
WESTERN
NATIONAL
#1 ASSUR CO GL300007958 01/06/2005 01/06/2006 $500,000.00 05/05/2005
Summons / Complaints Information
No Matching Information
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