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HomeMy WebLinkAboutContract 2166L1 _ .d __ r y TM ~. ~ °~ , ~ ~ -1992 PROJECT (Name anri crcicTr-ea~s): Columbia I-Ieights Public Sa#ety~ Center 825 41st Avenue Northeast Colombia I-leights, M7V 55421 TO CONT CTOR (~'rrrrze cxr?~aclcTi-es4). Brothers fire Protection. lnc. 9950 East 13ighway 10 Elk River, M1'~ 55330 CHANGE ORDER NUMBER: 050 CF13- IS-4-2 INITIATION DATE: September 24, 2009 PROJECT NUMBERS: BA 0806 / CONTRACT DATE: December 08, 2008 CONTRACT FOR: CH3-15-4 Fire Protection System OtiVNER: ~ cOIVSTRUCTIO~I I~ANACER: ARCHITECT: CO~ETRACTOR: FIELQ: ^ OTHER: ^ THE CONTRACT IS CHANGED AS FOLLOWS: Miscellaneous changes I€pr ceilings and storage unit The original C`orrtract Stun was Net change by previously authorized Change f}rders The Contract Sum prior to this (;h<mge f;7rder was "Che Contract Sum will be increased by this Chan4,?e order in the amtlurlt of` `The new C'oniract Sum including this Change Ordcr will be `I`he Contract .Time will be unehazlged by Zeco {0} days. 'T`he date; of"Substantial C;onlpletion as ol'the date of this C'haslge f)rder the;rel'ore is Add $1,628.70 89,700.00 -8,780.00 80,920.00 I ,628.70 82,548.70 NOTE: This summary does not reflect changes in the Contract. Sum, Contract 'l'ime. or Ciuasanteed Maximunl Price which have been authorized by Construction C`han~c Directive. NOT ~lAL1D UNTIL SIGNED B'~ THE OWNER, CONSTRUCTION MANAGER, ARCHITECT AND CONTRACTOR. FDS Builders. Inc I3uetow and Associates, Inc ARCHITECT (Firm name) 2345 Rice Str uite 210, St. Paul, MCI 55113 ADDRESS ,i ~ .,~ ~ __ _ BY (Sign v David Olds _ ('T'yped name) DATE: ' Brothers Fire I'rofection. lnc. CONTRACTOR {Firm name) 9950 East Highway 10, Elk River, MN 55330 _..r._„_ ~,. ~ ~~~ e~ _--''' B~`(~z2z ;,, ~~ ~ e~~,~~(~ e ~ a_ 1 P (Tv- p dame) ~ DATE: ~" City of Columbia I~leights OWNER (F'zrm name) 590 40th Avenue Northeast, Columbia Heights, MN 55421-3878 ADDRESS '~ ~ BY (.Signature" ~--~ f' Walter Fehst (Tvpecf name) DATE: AIA Document G701/CMaTM -1992. Copyright O 1992 by The American Institute of Architects, AiE rights reserved. _ @r al ~ =s. 'a d PS AIA software at 11:51:02 on 09/24/2009 under Order No.1000385206_1 which expires on 01!19/2010, and is not far resale. User Notes: This document was produced by ~ (1380D09081) ~-~;..~ ~} !91~ - ~., ~~. -----`"` Elk River t3ffice 9950 East Higharap 20 Ell,. River, \~iT+: 55330 Telephone: 763-4 ? I -229€7 Fax: 763-441.-5020 St. Cloud E}ffice 600 25~`~ rlve. S., Suite 204 St. Clcsud, tiL~~ 56301 Telephone: 320-229-2990 Fos. 320-229-2970 Duluth Telephone: 22 8-727-3996 Fax: ?63-4=1-1-5010 Propc3sal Submitted Yo: Date Proposal Issued: EIS Builders 6J3/09 3c~b Name, Date of Plans; Columbia Hei hts Public Safe Center 3/13/09 Job Number: Change Order Request No.: SC-OOf~274 ~1 General Contractor Rep.. ~avneryOwner Rep.: C3oc Smith Descrzp~ono€ttseVlfork: Reroute ~#" main in base€rient haSl~r~ay due to plumber's pipe See attached form. Total far atf material and lobar is below. Total for all material and lobar - a551.8E1 {labor = $~F03.00, mat'i = $18.801 We propose hereby to €urn#sh mater#a# and #abar -complete #n accordance yr#th spec#€#cat#ons far the sum of Ftve hundred F#ftY One Da##ars and 801100 DoE#ars 5551.84 I~AYME~#'r to be made t4Faritit#y as the vaark progre to the value of 14t)`Yo percent at a#t uror#c complete arEd nater#a1 an Irrb site. The ec€ttre an•,aunt of contract to Fie paid w#thin 34 days afrer aimpSetian. The fol#aw#ng sha## be made part of this agraemesrt: Ai# materia# rs guaranteed ~ be as spetrried. All wodc to be c~raap#eted in a wnrkman#ike manner accord#ng to standard practices. Any a#teration or deviation from above speoficat#ans #nssa#v#ng extra costs w#U be er,~5ed an€y upon vin orders, oral wifi betame an extra charge over arxi above the a_st#mate. Ati agreements cont#ncerrt upon stikes, acddents ar de#ays beyond our cantrrr#. Owner ~ tasay fire, tornado oral other ne~esaryvrsurance. Our vrarriers are ftslh~ covered by Workmen's Compensation Insurance. The above-quoted amount cavern the presently ascerta#nah#e d#rect casts of ttaEs change order. It exrJudes casts associated wri[fr the impact of this change order upon the prnjeck schedule, #abar productiv#ty or other factors affecting tfse cast of perfnrman~. Brothers E€re Prntecdan Company, themore, reserves ttte r#ght to amend th#s quotation when such impact ~s become r2asonab#y detetm#nab#e. Author#icd S#gnature Note: Cast tf this change order fs oat acceptedf Nate: This prapasa# may be ~+aidtdravan by us #f oat accepted w#G`s#n days. Note: This change wi## add days tts our cantrar~. AtfiTtaRZ1A'iEaH 7II PROCEEA The above referenced work is requested by !fie owner. Owner/Oxrner #tepresert#ative authorized the corstrttar to proceed with tfie above noted work. ©ate a€ Autharizatsan to Proc~aed: S'sgnature: Sa/es j Estimaiirzg / Deri~n / Irutallatiorr / Irz~rectiaru i 2~ Hear Emergency Service cf Repair -.. Equal Opportunity Emplaysr i ~~~ ~+UStOCi"!£1': Columbia N@i~i3te PtB~t{IC Safety ~}~{$ Project a tiff Set Branch Line in evidence room Complete f/3f2t1t19 Job Number Change Qrder Material List: descriptian: 4ty Price Per Unit Total 4" Grooved Couplings 8.00 14.35 114.80 4" Grooved 90 a.00 17.00 34.00 Material Tatai Total 148.8(1 Tax: Labor Hours Labor Rate To#al 6!3!2009 sake hrlytiing 4A0 90.00 380.00 8f11t2009 Paul Szafranski 0.50 88.010 43.00 Total Labor ,~.~~ ~03oa0 Truck and Tools Hour Rate Total Freight _ _ _ Equlprrtent _ Lift Rental Truck Charge- Sprinkler - 20.00 - Tota[ Trucl4 Tool _ _ Total EIk River Office 995Ci East Hi2h~car 1Cj ELIti RIi%eZ, !1Lj`v J~33~J Telephone: 163-441-2290 Fa,~: 763-442-5010 FORM FOR DAY St. Cloud Office 6001 ~7:j~;z~=e. S., Suite 205 St Cloud, ~Lhr 56301 Telephone: 320- 2 29_ 29 90 Faa: 320-229-2970 WORK I3uluth Telephone: 22 S-_~-_3996.., Faa: %63-441-~Ji~l BFP Jt36 NC}. 30b Na-ne; ~ x ~~ .~a __ ail[ To: ~ t'' ~; Address: `~ l ~ - - ~~°"1 ~ Address: „~ ~ , .~.~ Ctastonters Pt9 Rio: DESCRIPTION OF WORK: ~" ~' ~4~..r~-~ +/ f'`i P f _ .S ~ ... r•'~ ~ - rtg,. ~, l _ Phone: _ ~ tt.~~ .~- "~ t`~ ~. ~ _ ~. k +~ J a- 1~~~ ~-- ~ '~~ 9'.... O G.~~, . bw " _ ~r?. ~M~ DATES WORK WAS PERFORMED. ~ / :_. MATERIAL: - '~' ~') "~ ,. ~ y k i 4f~ _. HOURS: ~~-~ °t~ k'g ~~.*...~ ,~.-_ '~ G FOR AUTHORIZATION TO DO WORK SIG~I..NERE:, ~---5 , ,,. _ -..- ,.~ ~m_ -- ,_ y ., - ,_ - - ~-~ . BROTHERS FIRE PRTl:C7ION CO: F~REMAN SIGN HERE: ~ `; 2. f a - ~ f ~,; ~ ~ ,l Dafe: , t Date: Sales / Estinaatizz~ ,l Design / 7n.~tallativn j In.~ections j 24 .~Iorzr ~'mergency Seruice ~ ~ A~1~crir - Equa! Opportunity Employer ~ G~-'., >~6'S _'~~ ~ P tit Elk gtives i}ffice 9950 East Highway 10 Elk RiFes, tl~LN' 55330 Telephone: 763-441-2290 Fax: 763-441-5010 St. Cloud C7fftce G00 25u' eve. S., Suite 204 St. Claud,'~4N 56301 Telephone: 320-229-299t) Fax: 320-229-2970 Duluth Teleghan e: 218-727-3 996 Fay: 763--~1-501fl proposa6 Ss~lamattesf Tat: }ate Proposal Issued: ~ EDS Builders 613 09 Sob Name: Bate of Ptans: Columbia Flel his Public Safe Center 3/13109 3r3b Nufmberc Change Order Regcaest No.: SC-OOOZ74 #2 General Contractor Rep.: Owner/C}wner Rep.: Doc Smith i~ ~p#aonofi~e6i6iorl€• Change 2 upr`sght heads In nrsrth sta€rwe€€ tct Z cancealed_pendent heads. `~hls was due to the addlt€on of a dropped cel€Ing. See attached form. Tata€ far a€f mater€a€ and €abor is below. 'focal for act material and labor - ~313.2t# (labor = $223.00, mat'€ _ X90.10} We propose hereby to furnish material and labor -complete in accordance with specifications for the sum of Three Hundred Thirteen 13oiiars and i4/it3b l3oilars 5313.id PAYMENT to be made Cdartthly ~ €he work pragres~ to the value of IL°0°r~ percent of ail work complete and material an jala site. Tice entire amount of contract to be paid within 3f3 days attar camptetlan. The foflotving Shoff be made part of this agreement-. Ai) material is guaranteed to ire as spedfied. AN work in ire completed in a workmantike manner according to standard practices. Any altesatian or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, ao:ittents or delays beyond our central. Owner to carry fire, tornado and other necessaey insurance. Our workers are fully covered by Worfcmen`s Compensation Fnsurance. The above-quoted amount covers the preserstly ascertainable direct of this change order. It excludes costs associated vrith the impact of this change order upon the project ss~edule, tabor pnxiudivity or other factors affecting the cost of perfamratttce. Brothers dire Pratecrison Company, therefore, reserves Ute right to amend this quotation when such impact costs beoome reasonably determinable. Note: Cost if this change order is not accepted (lr^~ Note: This proposal may be w~tttdrawn by us if not accepted within days. ` Note: This change will add days to our contract. Authorized Signature Auattotuuir~ort TO PROC~D The shove reCr?renced work is requested by the owner. Owner/Uvmer Kepreserttative authorized the wnfractar tv proceed the above noted work. Date of Authorization tv Proceec[: Signature: ,S'crler j E'rtimatim~ j Z~e~a~n j In.~~allvtion / Inspecyioru j 2T HourErrizrgency Service E: I~ej~air --Equal Upporlufaity Employer ~~: Customer: Goiumbia Heights Public Safety Date F~roject : Change 2 UQright Heads in Ncsrth Stairway Complete 61312U09 Job Number Chan a Order litlaterial List: Description; ~ Priee Per Unat Total 1" Ci 90's 4.00 3.25 13.40 Rc 2.00 3.05 6.10 1/2 Cancea3or Sprtnkter Heads 2.Q0 22.50 45.40 1"XL Pipe 8.00 3.25 26.dd IVlaterial Total Total ~0,'I!~ Tax: Labor #-[Dues Labor Rate Total 6I3I2409 Jake Mytiing 2.d0 94.00 180.00 9/11t20d9 Pact Szaf+anski 0.50 86.40 48.40 Total Labor 2.5Q 223.00 Truck and Tools Hour Rate Total Freight _ _ _ Equipment _ Lift RentaE Truck Charge- Sprinkfer - 20.40 - Total Truck Toot _ _ Total $ ~~~.~~ EIII,,; River Office 9931) East Hi~hv,a~~ 1~1 Elk River; lL~ 35330 Telephone: 7 63-4=?1-2290 Fay: 763-~~1-501i~ St. Cloud Off ce 600 25~" Ave. S., Suite 105 St. Clow, II.L~T 56301 Telephone: 3 20-229-2990 Fax: 3 2(1-229-2970 FORM FOR DAY WORK Duluth Telephone: '? i g_ ~ ~- Raa: 763-a4"I-5s~1_~ ~~ BFP SOB NC}. r, ' 3sab Name: - Y ~^ . . BEI~ To. 4 ,3.. - ,f ~ ,., AdtICeSS: , a " ~' F' ~ .._ 3 e ~y Contact: e~ ~'' ~"q'¢ 4~ f t+ClrJt®m~~j PQ 740: . Phone: ~.~ -~ ~~~ ., E DESCRIPTION OF WORK: s "~' ~H ~~ v .y ~. "- , a' .~ c r F - ~'' . - br f~...~ y _ v 3 L[~ i Y S 4 sY E. .,. DATES WORK WAS PERFORMED° ~~ `~~' MATERIAL: r~ `~ F" .,?, . 4. riY .r; = . ~... r ,~ ~ .' ~ ~ , ,. ~. r ~- v ~ . ~ ~. HOURS: ~. <°a 4 t( =--'< m. R AUTHORIZATION TO D C ,,, t~.WORK fiIG[~1--k~ERE:~ ""° ~ , -- - a ; - ~. :~. ,- = `,-~~ Date: r ~.% BROTHERS FIRE.P4l2ECTION Cfl. FOREMAN SIGN HERE: ~a .. ~ - ~ Date ~~'' ~`~;~ ' _ S~lc.~ / Estimatizz~ j Desigal j I3zsta~lation / Ins~eez`ion.r / 2=~ ~ozcr Emergency Service ~~ ~epnir Equal Opportunity Employer ~~.: :~'~~ 9950 East Ktgbwa~ 10 Elk River, ibf'`i T 55330 'Telephone: 7G3-4=11-2290 Fax: 763-441-5010 s~. cl~ua a~~e 600 25a' .clue. S., Suite 204 St, Cloucl. l1N 56301 Telephone: 320-229-2990 Far.: 320-229-2970 ~t~lut~ Telephone: 22 8-727-3 996 Fa_~: X63-441-5010 Proposal Submitted To: t?ate Proposal Issued: EDS Builders 9 11(09 Sob Name: Qate of Plans: Columbia Hsi his Public Safe Center 3113109 Sob Number: Change ©rder Request No.; SC-000274 #3 General Contractor Rep,: C-wtterJcswner Rep.: Floc Smith Qescription of the Work; l3uctwork on east wail of apparatus bay was moved. Had to reroute 4" main, and Z~d2" branchiine to make things fit. See attached ft~rm. Total for aEF rrlateriai and labor is below. Total for alt material and labor - ~3a3. labor = ~3i3.00. mat'i = $50.90 1d`le Pao pose hereby to €urnish material and labor - camptete in accordance with specifications far the sum of Hundred Seventy Three t3ottars and 90 ~ailarS ~~~~.~~ PAYP~~N7' tea he made PRonthty as the work progresses to the value of if#G% percent of ai! work complete and material on lob site: Tice entire a~maunt of contract to be paid witlsln 3Q days afrar comptetian. The €oiEowing shaft be made part o€thss agreement: All mate~~ial "is guaranteed to be as spedfied. Alt work to be completed in a warkmantike marines according to standard practices. Any atteratian or deviation Pram abaue specifrca6ans invatving extra costs will tsa executed only upon written orders, and will become an extra charge over and above the estimate. A#l agreements arrstingerrk upon strikes, acddertts or delays beyarsd our contzol. C)wner ~ carry Errs, fvmada and other necessary insurance. t3ur wor=~ers ass fu{ty covered by wartcmen's Compensation Insurance. Tire above-quoted amount covers the presently ascertainable direct costs o€ this change order. Ft exdudes costs assodateci with the impact of this change order upon the projed: schedule, labor productivity ar other faders affecting the co,"t of performance. Srothers Fire Proladion Company, therefore, rese~ves the right tff amend this quotation where suds Impact cods becarr~ reasonably detemsinab~ Note: Cost if this change order is not accepted Note: This propasaf may 6e withdrawn by us if oat accepted wittrin days. ..~~f t ~""`" Note: Ttris change wilt add days to our contract. Authori4ed Signature Alm totuzA-aoreTO PROCEEp The at7~ae referenced work is requested by tits owner. CNmerJOwner Representative au#tor¢ed the contractor to proceed vsittr the abase noted work. C3ate of Atfiftoriaatsan fit3 Proceed: sigrsaLurea Sales / Estimating / Design j Lrsfallotion / InsfJecfivrrs J 24 ~IvrrrEmergenc~ Service e`v= l~¢ir Equal Oppc~atttnity Employer t ~.~ ~ t ~.~~ Customer: Cotumbra Ffeigfrts Pubfic Safety Date Project : Move Duct work on east waft of Complete 91'fi 109 Apparatus Bay ~tC}~ t~ttliClt3@C t~i~i~Il B gf'd~f" Material List: Desert tion: Gtty Price Per Unit Tatat 2 112" ~rocsved Couplings 2.44 13.98 27.94 2 112'° ~rroved 94 2.44 16.84 33.44 tUtateriat Total Tout 6q.9C? Tax: _ _ Labor Hours Labor Rate Tcstal 9/11/2448 Jake tutytirng 3.44 94A4 274.44 9/11120(}9 i'aui Szafranski 0.54 86.44 43.40 Tc?tal Labor 3.50 3fi3.00 Truck and Toots Hoerr Rate Totafi f=reight _ - _ Equipment _ Lift Rental Truck Charge- Sprinkler - 20.04 - TotafiTruck Toot ,Total 373.9Q .fob Name: Address Customers PO Noc DESCRIPTION OF WORK. ~> _z EII; River Offi ce ~3n50 Easy Hightray 10 Sx. Cloud Office EIh I'~s3er. ,,~,~~., 5533G GOfj Z~rt. ley , ~ e ~., quite l OS St. Cloud ~,~i SG30 Telephone: 7G~-442-229, F , 1 Telepho a.~: ; 63-44i-SC~IO ne: 320-2~9_~9c7a Fa~::;20-229-2970 FORM! F+DR C3AY V{/®RK Duluth Teiephaae: ^~ ~_- F~~: 76 ~- .. _-~ BFP 30B NO. ~ !` ____ _ -;_ Bill TO: ~n' ,,, .~ ~.; . - - r - ~ ~ -- ~, _ Address: ~ a _ •~ ~~ - ~: ,a.. 'hone: ~ ~r=~ ~- ` F"w ~ - - ~ - ~ ~ 5 ~ ,~.- ~ £ ,. -, r%' .-. x . DATES WQRK WAS PERFORNtEb: ~` r .`" h1ATERIAL: ~<~ i~ ~ . ~,~ ~ ~" ~ { i,,; 'tea ^,~ ...~ ~:. r~,r -_. ~h"r HOURS: FOR AUTHORIZATION TO DO WORK SIGN-HERE.. BROTHERS FIRE PRC3TE!"'(IO,t~1~~0. FOREMAN SIGN HERE: ,_..~ • - -_ ~ 3: ' P `~`~ ~F DetB: r• ~, 'f i • Date: / - ~,'` fZ' . Sates j Estinzatin~ f Design / Installatidzr / Inspections / 2=~ Hour Emergency Service ~- R_epaiy- Equal Opportunit}~ Employer ~~~ EIk River Offace 9950 East Highwa710 Elk River, ~h~t 55330 Telephone: 763-~-3-2290 Fax: 763-=i43-5010 St. Cloud €?ffiee 600 25a' Ave. S., Suite 204 St Cloud, 1.IN 56303 Telephone: 320-229-2990 Fas: 320-229-2970 I}uTutli Telephone: 21 &-72'r -3 9 9 6 Fay: 763-~1-5010 Proposal Sts6ntittetl To: Bate Proposal Issued: EDS Builders 9 11 09 Sob Name: Qate o€ Plans: Columbia Nei hts Public Safe Center 3 13 09 fob Number: Change Ort#er Request Crtcl~.: SC-fl00274 #4 General Contractor Rep.: Owner/owner Rep.: L?OC Sri'dltl'I Desc~iptian o€the Work: Nad to offset i7lz" branchline In the evidence roam. Recut the 3 springs an the line, and offset the 171x" pipe with 4 9(ls. See attached farm. Total far all materiaE and labor is below. __ _. Total €or all material and labor - $3S9.9t1 (lobar = X313.00, mat`i = X75.90} we propose hereby to furnisfa material and lafsor - oampfete In accordance with spedfications for the sum of Three l~aundred Efohty dYine Dollars and 9ol10f3 i3offars 5389.9ED PRY~fEPET to tre made hion~ly as rite work pragress?s to +~re valtae of IQO% percent o€ ail wcarfc complete and materal on job site. The entire amount of contract to tre paid within 3D days after camptetlon. The foffsnving shaft tae made part of the agn=enaent Aft material is guaranteed to tae as speeified. Ali work try com in a workmanlike martsaer according to standard pratt}ces. Rey alteration or deviation. from above speaf#cations invofvfng exfra cast, vaalt be eaceecitted only upon vvritterr orders, and will became an eactra rJrarge over and above the estimate. All agreements cntrtirtgent upon strikes, acciderris or delays beyond our szmtrol. E7wner to carry fire, tornado artd attter nec~ry insurance: €7tar worker; are toffy ctauerett by V~Jorkn-~en's Compensation Insurance. Tne atrave-rooted amount covers the presently ascertainable direct costs of this ctaange order. It excludes costs as~dated with ~e impact of this change order upon the praj~t schedule, iat>or producfiv'rty or other factors affecting ttrn cost of performance. Brottaers Fre Protection Company, therefore, reserves 4tae sight to amend this quotation when such impact costs fterzame reasonat~y determinable. ~\ ~ Authored Sgnature Note: Cost if this thange order is not accepted Nate: This proposal may be wltl3drawn lay us if not accepted varthin days. Nate: This change wffl add days to our contract AurrsoruznaoN ro Faacs:~a® r ire above referenced work is requested by the owner. thvnerl€3wner Representative auf3rorized the contractor t€a proceed with the above noted vrork. Date of Authoa-ization t[t Froceed: Signature: 5`ales J Esir'mating /Design / Znstallafian j Irs~ae7ions / 24 Hrrrtr Errrergency Service e: Ps~rair Equal ()pgcartunity Empls;`yer -- f.t Custorrter: Columbia Heights Public Safety Qate Project : Off Set Branch lane in evidence room Complete 91'I1/Za{}g Job Itlurnber Change Order Ntaterial List: C1eSCriptiOri: Qty Price Per Unit Total 2 i12" Grooved Couplings 2.0[3 9.95 i9.90 2 t12° Grroved 90 2.00 12.50 25.00 t tf2" Sched t 0 pipe 8.00 4.00 32A0 .Material Total Total 76.9f! TaX. Labor Hours Labor Rate Totai 9(tt12009 Jake Mytfing 3.00 90.00 270.00 9/t il2009 Pauf Szafrartski 0.50 86.00 43.00 Tots[ Labor 3.50 313.gU Truck and Tools Flour Rate Total Freight _ _ _ EGuiprnent _ Siff Rerrtal Trunk Charge- Sprinktsr - 20.00 - Total Truck Tool _ .. 'Tatal I7ulurl St. Cloud Office Elk River Office tl Tele Bone: 218-72 t-3996 9950 East HighwaS- 10 600 25 ,eve. S., Stute 105 P Fax: "163-441-5010 ~~~ EIk River, ~~ 55330 St. Cloud, ~fN 56302 ~~~~~ "-442-2290 Telephone: 320-229-2990 • Telephone: 76~ ^ Fax: 320-229-2970 Fax: 763-4 ~2-5010 Brothers Fice: P tst~ri State License No. C059 FORM F®R pAY WC3RK SFP 30B NO. ~`~ ~ '"j ~ ~ _ - Bill To: l=~- ~ ,~ ~ lob Name: _, - ~ `.. , ' r^ -. -~ - " Address: Address: ------ ----- ~ ~ ~ ai f Contact: P(+lOne: ~, ~ustarsaers PO No: - `~. ~' ~ , a DESCRIPTION OF WORK: r - ~,~ .• : _ ~ ~n L ~ f ~ c ~~ A 1 x°.o BATES WORK WAS PERFORMED: ~^, °~ MATERIAL: t¢ t ~ - -~~ ~' ~~~ ~`~ pO{2 q!lTHORIZATTD,4d TO DO WORK. SIGN HERE: BROTHERS FIRE PgTCTIG~fii ~C• FOREMAN SIGN HERE: ~ 71 _ ~. , Date' _. 7~ ~-,~',, Date: Sales l Estimating l Design /Installation / Inspeciions l 24 ~Iour Emergency Service e'~ kepair Equa[ E3pportunity Employer