Attachment 3(G) MAR.xls

XLS spreadsheet 365 KB Posted

Attached to
COURT SECURITY OFFICER SERVICES
Solicitation number
DJM-13-A32-R-0003
Issued by

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Attachment 3(G) DJM-13-A32-R-0003

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Other files

File Type Posted
Amendment_A0004.zip ZIP file
DJM-13-A32-R-0003_A0003.pdf PDF
DJM-13-A32-R-0003_A0002.pdf PDF
Section_K_(revised)_FAR_52.204-8__Annual_Representations_and_Certifications_(DEC_2012).pdf PDF
09_NCA_SPFPA_CBA_FY2013_(new).pdf PDF
J1(C)-Revised_Price_Summary_Sheets_(3_circuits).zip ZIP file
DJM-13-A32-R-0003_Questions_ _Responses.xlsx XLSX spreadsheet
DJM-13-A32-R-0003_A0001.pdf PDF
Attachment 9 —
Attachment 2(A) - CSO Form 001.pdf PDF
Attachment 1(C) 9th Circuit - Price Summary Sheets.xls XLS spreadsheet
Attachment 2(I) - CSO Form 014.pdf PDF
Attachment 1(G) Past Performance Survey.pdf PDF
9th_Circuit_CBA_(1_of_3).zip ZIP file
Attachment 1(H) Past Performance Survey Ratings Guidelines.pdf PDF
Attachment 4(A) - USMS Directive Use of Force.pdf PDF
Attachment 1(I) Past Performance Reference Sheet.pdf PDF
Attachment 4(C) - CSO Body Armor Requirements.pdf PDF
Attachment 1(B) 9th Circuit - Seniority List.pdf PDF
Attachment 3(F) - Standard Form 1035 Continuation Sheet SAMPLE.pdf PDF
SOLICITATION DJM-13-A32-R-0003.pdf PDF
Attachment 1(E) Table for Start Up Costs.xlsx XLSX spreadsheet
Attachment 7(A) CSO Semi-Auto Handgun Qualification Course.pdf PDF
Attachment 2(J) - FD-258.pdf PDF
Attachment 3(A) - CSO Form 002.pdf PDF
Attachment 2(H) - CSO Form 229.pdf PDF
9th_Circuit_CBA_(2_of_3).zip ZIP file
Attachment 3(C) - CSO Form 010.pdf PDF
Attachment 3(E) - Standard Form 1034 SAMPLE.pdf PDF
Attachment 1(B) 2nd Circuit - Seniority List.pdf PDF
Attachment 2(B) - CSO Form 004.pdf PDF
Attachment 9 —
Attachment 4(B) - USMS Directive Less-Than-Lethal Devices.pdf PDF
Attachment 1(F) Table for Body Armor Kits.xlsx XLSX spreadsheet
Attachment 2(L) - DOJ-555.pdf PDF
Attachment 6- List of Government Acronyms.pdf PDF
Attachment 2(K) - CSO Form 012.pdf PDF
2nd_Circuit_CBA_(1_of_3).zip ZIP file
Attachment 2(F) - CSO Form 008.pdf PDF
Attachment 2(C) - CSO Form 005.pdf PDF
Attachment 1(B) 10th Circuit - Seniority List.pdf PDF
Attachment 5 Interagency Acquisition Agreements.pdf PDF
2nd_Circuit_CBA_(2_of_3).zip ZIP file
Attachment 2(G) - CSO Form 009.pdf PDF
9th_Circuit_CBA_(3_of_3).zip ZIP file
Attachment 3(B) - CSO Form 003.pdf PDF
Attachment 1(J) CPARS Update Questionnaire.pdf PDF
10th_Circuit_CBA.zip ZIP file
2nd_Circuit_CBA_(3_of_3).zip ZIP file
Attachment 7(B) Section J Annual Training.pdf PDF
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Cover

UNITED STATES MARSHALS SERVICECOURT SECURITY OFFICER MONTHLY ACTIVITY REPORT
Judicial Protective Services
DISTRICT OF NEW MEXICO
1. CONTRACTOR'S INFORMATION:3. REPORTING PERIOD
NameVendor, Inc.MonthDayYear
Address9/01/11-9/30/11
City4. DATE SUBMITTED
StateMonthDayYear
Zip Code10102011
Office Telephone Number5. JUDICIAL CIRCUIT
Fax Telephone Number10th
Internet Address
2. CONTRACTOR'S INFORMATION:6. CONTRACT NUMBER
Contract ManagerJohn Doe
Site Supervisor(s) / District(s)District of Coloradoxxxxxxx, Site SupervisorDJMS-11-D-0000
District of Kansasxxxxxxx, Site Supervisor
District of New Mexicoxxxxxxx, Lead CSO
Eastern District of Oklahomaxxxxxxx, Lead CSO7. CONTRACT PERFORMANCE PERIOD
Northern District of Oklahomaxxxxxxx, Lead CSO
Western District of Oklahomaxxxxxxx, Site Supervisor10/01/10-09/30/11
District of Utahxxxxxxx, Lead CSO
District of Wyomingxxxxxxx, Site Supervisor
8. CONTRACTOR'S SIGNATURE
I hereby certify that the information provided in this report is true and accurate to the best of my knowledge.
xxxxxxx USMS Payroll/MAR Supervisor- Vendor, Inc.
NAME AND TITLE OF AUTHORIZED COMPANY OFFICIAL(TYPE OR PRINT)
10/07/11
SIGNATURE OF AUTHORIZED COMPANY OFFICIALDATE

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SAMPLE

Position Totals

DistrictNumber of Authorized PositionsMonthly Activity
No.DistrictFiscal YearCurrentAuthorizedComments
Full-timeSharedTotalEnhancementsVacanciesTransfers
Albuquerque-333 Lomas Blvd NW12315
Albuquerque-421 Gold Ave SW314
Albuquerque-500 Gold Ave SW426
Las Cruces-200 E Griggs Ave10414
Las Cruces-505 S Main St213
Roswell-500 N Richardson St.213
Santa Fe-106 S Fed Place325
51District of New Mexico3614500.52.50.0

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Albuquerque-333 Lomas Blvd NW

SECTION II - STAFFING INFORMATIONDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
Facility:
333 Lomas Boulevard, N.W., Albuquerque
LocationAuthorized Positions
District CodeFacility CodeFull-timeSharedTotal
51F1-LCSO12315
Actual Staffing On-BoardUniformWeapon'sDate of LastIn-DistrictOrientationStart Date
Full-timeSharedTotalEmployee's StatusIssueQual. DateMed. ExamTrainingPhase II
122.514.5Full-timeS1 or S2DatePhase I
1Last name, First nameLCSO-FT03/17/1109/07/1108/17/1109/27/0209/26/0309/23/02
2Last name, First nameFT03/17/1108/29/1109/14/1001/03/0312/09/0312/30/02
3Last name, First nameFT03/17/1108/29/1107/20/1112/10/9912/17/9912/06/99
4Last name, First nameFT03/17/1108/29/1108/12/1103/06/0312/12/0303/03/03
5Last name, First nameFT03/17/1108/30/1104/05/1103/31/0008/01/9704/21/97
6Last name, First nameFT03/17/1108/30/1101/18/1106/07/0611/15/0606/05/06
7Last name, First nameFT03/17/1108/30/1106/27/1112/21/0406/24/0512/20/04
8Last name, First nameFT03/17/1108/29/1103/16/1106/02/0006/13/0005/16/00
9Last name, First nameFT03/17/1108/29/1108/18/1110/25/0212/05/0310/21/02
10Last name, First nameFT03/17/1108/29/1108/05/1105/07/9908/10/9905/03/99
11Last name, First nameFT03/17/1108/30/1104/06/1107/16/0406/17/0507/01/04
12Last name, First nameFT03/17/1108/30/1103/31/1107/08/0507/25/0607/05/05
1Last name, First nameS103/17/1108/30/1107/29/1111/05/0901/15/1011/02/09
2Last name, First nameS103/17/1109/07/1103/28/1109/18/0209/18/0309/11/02
3Last name, First nameLOAS104/15/1007/21/1011/18/0904/22/1007/16/1004/19/10
1Last name, First nameS203/17/1108/30/1112/16/1005/27/1010/20/1005/24/10
2Doe - Applicant for EnhancementS2
3Last name, First nameS212/07/1009/07/1105/26/1112/15/1003/30/1112/13/10
Pending - Applicant for Vacancy SS
Note: Will update medical next month.

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SAMPLE

Albuquerque-421 Gold Ave SW

SECTION II - STAFFING INFORMATIONDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
Facility:
421 Gold Avenue S.W., Albuquerque
LocationAuthorized Positions
District CodeFacility CodeFull-timeSharedTotal
51E1-LCSO314
Actual Staffing On-BoardUniformWeapon'sDate of LastIn-DistrictOrientationStart Date
Full-timeSharedTotalEmployee's StatusIssueQual. DateMed. ExamTrainingPhase II
314Full-timeS1 or S2DatePhase I
1Last name, First nameLCSO-FT03/17/1108/29/1108/16/1112/24/0306/15/0412/22/03
2Last name, First nameFT03/17/1108/29/1108/11/1102/23/0306/18/0402/19/04
3Last name, First nameFT03/17/1108/29/1101/11/1103/07/0002/01/9311/02/92
Last name, First nameS102/24/1108/29/1103/09/1103/02/1105/04/1102/27/11
Last name, First nameS203/17/1109/07/1103/07/1109/10/0810/22/0809/08/08

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SAMPLE

Albuquerque-500 Gold Ave SW

SECTION II - STAFFING INFORMATIONDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
Facility
500 Gold Avenue, S.W., Albuquerque
LocatiAuthorized Positions
District CodeFacility CodeFull-timeSharedTotal
51A1-LCSO426
Actual Staffing On-BoardUniformWeapon'sDate of LastIn-DistrictOrientationStart Date
Full-timeSharedTotalEmployee's StatusIssueQual. DateMed. ExamTrainingPhase II
41.55.5Full-timeS1 or S2DatePhase I
1Last name, First nameLCSO-FT03/17/1108/29/1106/13/1102/29/0004/01/9207/22/91
2Last name, First nameFT03/17/1108/29/1107/05/1105/28/9908/21/9905/21/99
3Last name, First nameFT03/17/1108/29/1108/05/1102/20/0312/02/0302/18/03
4Last name, First nameFT03/17/1108/29/1105/09/1103/13/0010/01/8710/10/87
1Last name, First nameS103/17/1109/20/1107/18/1103/21/0709/11/0703/19/07
2Last name, First nameS103/17/1108/29/1104/04/1108/02/0603/01/0707/31/06
1Last name, First nameS205/23/1109/07/1106/23/1106/08/1108/05/1106/06/11
2Last name, First nameS206/20/1109/07/1109/09/1106/22/1109/16/1106/20/11

SAMPLE

Las Cruces-100 N. Church St.

SECTION II - STAFFING INFORMATIONDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
Facility:
100 N. Church Street, Las Cruces
LocationAuthorized Positions
District CodeFacility CodeFull-timeSharedTotal
51N1-LCSO10414
Actual Staffing On-BoardUniformWeapon'sDate of LastIn-DistrictOrientationStart Date
Full-timeSharedTotalEmployee's StatusIssueQual. DateMed. ExamTrainingPhase II
10313Full-timeS1 or S2DatePhase I
1Last name, First nameLCSO-FT03/17/1108/08/1109/01/1110/05/0406/24/0510/05/04
2Last name, First nameFT03/17/1108/08/1112/27/1003/18/0908/10/0903/16/09
3Last name, First nameFT03/17/1108/08/1112/08/1005/20/0209/23/0305/16/02
4Last name, First nameFT03/17/1108/08/1110/26/1003/25/0906/26/0903/23/09
5Last name, First nameFT03/17/1108/09/1108/02/1007/14/0605/11/0701/03/07
6Last name, First nameFT03/17/1108/08/1111/01/1004/01/0907/17/0903/30/09
7Last name, First nameFT03/17/1108/08/1102/04/1107/02/0810/22/0906/30/08
8Last name, First nameFT03/17/1108/09/1111/05/1003/25/0907/17/0903/23/09
9Last name, First nameFT03/17/1108/09/1105/04/1108/10/0901/13/1008/10/09
10Last name, First nameFT03/17/1108/08/1111/10/1003/16/1007/16/1003/15/10
1Last name, First nameS110/11/1008/08/1106/30/1110/14/1002/09/1110/12/10
2Last name, First nameS103/17/1108/09/1111/03/1003/18/1007/14/1003/17/10
3Last name, First nameS103/17/1108/09/1104/12/1108/24/1012/15/1008/23/10
4Last name, First nameS107/20/1108/09/1105/19/1108/04/11Pending08/01/11
1Pending - Applicant for VacancyS2
2Last name, First nameS207/30/1008/08/1105/31/1107/28/1012/15/1007/26/10
3Last name, First nameS203/17/1108/09/1101/03/1103/18/1007/23/1003/17/10
4Smith - Applicant for EnhancementS2
Note: Will update medical next month.
Task Order #DJMS-51-10-T000 Adds 3FT Positions and 1 SH Position

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SAMPLE

Las Cruces-505 S Main St

SECTION II - STAFFING INFORMATIONDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
Facility:
505 South Main St., Las Cruces
LocationAuthorized Positions
District CodeFacility CodeFull-timeSharedTotal
51I1-LCSO213
Actual Staffing On-BoardUniformWeapon'sDate of LastIn-DistrictOrientationStart Date
Full-timeSharedTotalEmployee's StatusIssueQual. DateMed. ExamTrainingPhase II
213Full-timeS1 or S2DatePhase I
1Last name, First nameFT-LCSO03/17/1108/09/1106/10/1108/30/0406/17/0508/26/04
2Last name, First nameFT03/17/1108/08/1102/04/1107/05/0705/21/0907/02/07
Last name, First nameS105/23/1108/08/1110/14/1006/08/11Pending06/06/11
Last name, First nameS204/26/1008/09/1111/18/1004/21/1007/21/1004/19/10

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SAMPLE

Roswell-500 N Richardson St.

SECTION II - STAFFING INFORMATIONDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
Facility:
500 N. Richardson St., Roswell
LocationAuthorized Positions
District CodeFacility CodeFull-timeSharedTotal
51C1-LCSO213
Actual Staffing On-BoardUniformWeapon'sDate of LastIn-DistrictOrientationStart Date
Full-timeSharedTotalEmployee's StatusIssueQual. DateMed. ExamTrainingPhase II
213Full-timeS1 or S2DatePhase I
1Last name, First nameLCSO-FT03/17/1108/12/1112/02/1009/08/1002/09/1109/07/10
2Last name, First nameFT01/11/1108/12/1105/23/1101/27/1103/30/1101/24/11
Last name, First nameS103/17/1108/12/1110/07/1002/11/0906/24/0902/09/09
Last name, First nameS212/31/0908/12/1105/25/1107/02/0803/28/0907/07/08

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SAMPLE

Santa Fe-106 S Fed Place

SECTION II - STAFFING INFORMATIONDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
Facility:
106 South Federal Place, Santa Fe
LocationAuthorized Positions
District CodeFacility CodeFull-timeSharedTotal
51B1-LCSO325
Actual Staffing On-BoardUniformWeapon'sDate of LastIn-DistrictOrientationStart Date
Full-timeSharedTotalEmployee's StatusIssueQual. DateMed. ExamTrainingPhase II
31.54.5Full-timeS1 or S2DatePhase I
1Last name, First nameLCSO-FT03/17/1109/30/1110/18/1003/21/0008/24/9501/17/95
2Last name, First nameFT03/17/1109/30/1104/01/1103/13/0008/10/9909/21/98
3Last name, First nameFT03/17/1109/30/1110/01/1002/24/0406/15/0402/19/04
1Last name, First nameS103/17/1109/30/1107/06/1103/13/0003/14/9610/10/95
2Last name, First nameS110/04/1009/30/1105/09/1110/08/1002/09/1110/06/10
1Last name, First nameS203/17/1109/30/1109/19/1101/06/1007/16/1001/04/10
2Last name, First name - Applicant for VacancyS2

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SAMPLE

Vacancies

SECTION III - VACANCIESDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
ReplacementReplacement
DistrictFacilityEmployment StatusVacancyReason for VacancyPackagePackage
NMCodeName of Person DepartingFull-timeS1 or S2DateDue On:Sent On:
51ILast name, First nameS104/21/11Transferred to FT, 100 N Church St. vacancy at (S1, Las Cruces, 505 S. Main)

On 5/20/11 Applicant Last name, First name withdrew; vacancy at (S1, Las Cruces, 505 S. Main St.)

On 6/6/11 Last name, First name assumed the above position; vacancy at (S1, Las Cruces, 100 N. Church St.)

Applicant: Last name, First name06/10/1105/26/11
51FLast name, First nameFT06/06/11Resigned; vacancy at (S2, Albuquerque, 333 Lomas NW)

On 6/6/11 Last name, First name assumed the above position; vacancy at (S2, Santa Fe, 106 S. Federal Pl.)

Applicant: Last name, First name6/27/1106/21/11
51FLast name, First nameSS-FT07/01/11Resigned; vacancy at (SS-FT, Albuquerque, 333 Lomas NW)
Applicant: Pending7/22/11Pending
51NLast name, First nameS209/26/11Terminated; vacancy at (S2, Las Cruces, 100 N. Church)
Applicant: Pending10/17/11Pending
SUMMARY OF VACANCIES
TOTAL NUMBER OF VACANCIES REPORTED LAST MONTH:2.0Comments
TOTAL NUMBER OF VACANCIES INCURRED THIS MONTH:0.5
TOTAL NUMBER OF VACANCIES FILLED THIS MONTH:0.0
TOTAL NUMBER OF VACANCIES REMAINING THIS MONTH:2.5

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SAMPLE

Enh

SECTION IV - ENHANCEMENTSDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
Task Order
DistrictFacilityContract DocumentType of PositionReceiptTotal NumberCSO PackageCSO Package
NMCodeReference NumberFull-timeS1 or S2DateEnhancements ReceivedDue On:Sent On:
51EOrder No. DJMS-51-10-T000
Increases 1 SH positionS111/02/09SH Enhancement (S1, Albuquerque, 421 Gold Ave S.W.)
On 04/14/10 Last name, Fist name was disqualified leaving a vacancy at (S1, Albuquerque, 421 Gold Ave. SW)11/23/0911/19/09
Note: on 11/20/09 Vendor submitted a 21 day rule extension to USMS.
Applicant: Last name, First name.04/28/1004/27/10
51NOrder No DJMS-51-10-T000
Increases 1SH positionS204/02/10SH Enhancement (S2, Las Cruces, 100 N. Church St.)

On 6/24/11 Applicant Last name, First name withdrew; vacancy at (S2, Las Cruces, 100 N. Church St.)

Applicant: Last name, First name.07/15/1107/20/11
`
SUMMARY OF ENHANCEMENTS
TOTAL NUMBER OF ENHANCEMENTS PENDING LAST MONTH:1.0Comments
TOTAL NUMBER OF ENHANCEMENT RECEIVED THIS MONTH:0.0
TOTAL NUMBER OF ENHANCEMENTS FILLED THIS MONTH:0.0
TOTAL NUMBER OF ENHANCEMENTS PENDING THIS MONTH:1.0
FY11
Oct0.5
Nov0
Dec0
Feb0
Mar0
Apr0
May0
Jun0
July0
Aug0
Sept0
TOTAL0.5

SAMPLE

New Hires

SECTION V - NEW HIRESDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
Official
DistrictFacilityEmployment StatusReportingIndividual Will Fill a:
NMCodeName of EmployeeFull-timeS1 or S2DateVacancyEnhancementComments
SUMMARY OF NEW HIRES
TOTAL NUMBER HIRED LAST MONTH:0.5Comments
TOTAL NUMBER HIRED THIS MONTH:0.0
TOTAL NUMBER HIRED DURING THIS CONTRACT PERIOD:6.0
OCT1
NOV0.5
DEC1
JAN1
FEB0.5
MAR0
APR0
MAY0
JUN1.5
JUL0
AUG0.5
SEP0
TOTAL6

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SAMPLE

OT

SECTION VI - OVERTIMEDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
OVERTIME CODES:
ATRIAL/JURY ACTIVITY
BEXTENDED HOURS OF COURT OPERATION NOT RELATED TO TRIAL/JURY ACTIVITY
COTHER (A detailed explanation is required when this code is used.)
Justification
AuthorizationDate OvertimeName of GovernmentName of theTotal Hours WorkedSelect the code that best describes the reason for the overtime. In addition, if the overtime effort was not worked by
DateWorkedOfficial Authorizing O/TCSO Authorized to Work"Shared" CSO personnel, please explain why.
SUMMARY OF OVERTIME WORKED
TOTAL NUMBER OF O/T HOURS LAST MONTH:0.50
TOTAL NUMBER OF O/T HOURS THIS MONTH:0.00
TOTAL NUMBER OF O/T HOURS WORKED DURING THIS CONTRACT PERIOD:33.75
FY11
Oct5.52
Nov3.06
Dec1.00
Jan0.00
Feb0.00
Mar0.00
Apr11.12
May10.30
June2.25
July0.00
Aug0.50
Sept0.00
TOTAL33.75

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SAMPLE

Travel

SECTION VII - TRAVELDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000Reporting Period:9/01/11-9/30/11
TravelName of Government
AuthorizationTravel PeriodOfficial AuthorizingName of EmployeeTravel Originated
DateFromToTravelAuthorized to TravelFrom:To:Purpose of Travel
Danny Whatley

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SAMPLE

Accidents & Narrative

SECTION VIII - ACCIDENTSDISTRICT OF NEW MEXICO
Contract Number:DJMS-11-D-0000REPORTING PERIOD:9/01/11-9/30/11
DateDetailsComments
Accident Occurred(Explain response or action taken to prevent performance interruptions.)
3/14/08
SECTION IX - NARRATIVE OF MAJOR ACCOMPLISHMENTS, PROBLEMS ENCOUNTERED,NM
FUTURE PLANS AND ACTS OF HEROISM
Contract Number:DJMS-11-D-0000REPORTING PERIOD:9/01/11-9/30/11

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SAMPLE

CSO Monthly Hours Worked

`MONTHLY HOURS WORKED REPORTPAGE1of1
DISTRICT/AGENCY:Circuit and DistrictCITY:CSO
BILLING FOR THE MONTH OF:October 2011POSITION: SITE SUPERVISOR
TOTALS
CALENDAR DAYS
MonTueWedThuFriSatSunMonTueWedThuFriSatSunMonTueWedThuFriSatSunMonTueWedThuFriSatSunMonTueWedCat 1
Officer Name12345678910111213141516171819202122232425262728293031REG
Last Name, First Name0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
PREPARED BY:DATE:WORK PHONE:

SAMPLE

LCSO Monthly Hours Worked

`MONTHLY HOURS WORKED REPORTPAGE1of1
DISTRICT/AGENCY:Circuit and DistrictCITY:LCSO
BILLING FOR THE MONTH OF:October 2011POSITION: SITE SUPERVISOR
TOTALS
CALENDAR DAYS
MonTueWedThuFriSatSunMonTueWedThuFriSatSunMonTueWedThuFriSatSunMonTueWedThuFriSatSunMonTueWedCat 1
Officer Name12345678910111213141516171819202122232425262728293031REG
Last Name, First Name0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
PREPARED BY:DATE:WORK PHONE:

SAMPLE

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