RES 2011-0126 - Appoint James L Johnson to Benson business improvement area board RECEIVED
+('iw Office of the Mayor
JAN 21 AN 11: 29 1819 Farnam Street,Suite 300
o.•.- .. �' Omaha,Nebraska 68183-0300
Ao aryCITY CLERKAY (40)444-6059
R'reogBaUt'* OMAHA, NEBRASKA
City of Omaha
Suttle,Mayer
Honorable President
and Members of the City Council,
Attached for your consideration.is a Resolution appointing James L. Johnson to the Benson
Business Improvement Area Board.
The Nebraska Revised Statutes provide only that five or more board members serve on the board
and that the members of the Business Improvement Board shall consist of property owners,
residents, business operators, or users of space within the business area to be improved. Mr.
Johnson meets the qualifications by being the operator of the.Waiting Room Lounge located at
6212 Maple Street, which is a business operator and user of space within the district. I would
recommend the appointment of Mr. Johnson to the board to serve until his term shall expire on
January 24, 2016.
Respectfully submitted,
Jim Suttle,Mayor
City of Omaha
p:\law-city council documents\2011\10012dae.doc
Street to be a member of the Benson Business Improvement Area Board to serve until his
term shall expire on January 24, 2016.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF OMAHA:
THAT, the appointment by the Honorable Jim Suttle of Bill Carmichael,
owner of a restaurant at 6201 Maple Street, to be a member of the Benson Business
Improvement Area Board to serve a term from his appointment on January 25, 2011 until
such term shall expire on January 24, 2016, is hereby confirmed by the City Council.
APPROVED AS TO FORM:
---1 -1---2----- - ' . ------2-2
113 /1
p:vaw-city council documents\2011\10011dae.doc ASSISTANT CITY ATTORNEY DATE
By . .
R - / Colncilmember
Adopted FEB - 1 _Z O 1 1.J 9-o
. ` J d //
l� L" `Ci lerk
Approved _ .. .. .. a l/
Mayor
ll be returned to the bidder,
if and when he shall faithfully keep and perform all of the conditions set fourth in the advertisement and the requirements for bidding and instructions
to bidders,and furnish an acceptable surety bond. The surety company issuing said bond shall be licensed by the State of Nebraska,and listed on
111
the current edition of Circular 570 of the United States Dept.of the Treasury.
NOTICE: 11
Unless the foregoing proposal is free from alterations,additions and deductions and unless the name of the bidder as signed thereto is complete and
correct,in accordance with the instructions to bidders,it may be rejected as informal.
COMPLETION DATE:
The bidder agrees that construction will be completed within 3 Q calendar days after receiving the"Notice To Proceed"from the Park
111
Planner.
•
PERFORMANCE BOND_ I
Refer to Specification Section 00200, "Instructions To Bidders", Part 2.10, "Bond Submission" and Section 00400, "Performance, Payment
Maintenance Bond"requirements. 11
SIGN ALL COPIES Firm
By irie N ,1 7*-i Ni✓
Title Q f„/A/4-dr I
I
p
EL PARK WATER LINE,Omaha,Nebraska"in accordance with the provisions of this proposal and
contract documents to the satisfaction of the City of Omaha Parks,Recreation and Public Property Department for the lump sum of:
IBASE BID: .
INote: Refer to page 2 of 3 for Bid Bond,Completion Date&Performance Bond and page 3 of 3 for lnsurance'Requirements,Testing Allowance,Unit Prices&
Alternates(if applicable). Refer any questions regarding the Bid or Contract Documents directly to the Park Planning Division at 402.444-5900 or as noted in the
Contract Documents.
IAll bidders awarded a contract in the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on file with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shall be in effect for 24 months from the date received by the Human Relations Department.Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402-444-5055.�
I (Please Print Legibly or Type) Firm 77/ /114 �I1/7644" Incorpo lifebe'udr4
(State)
Name_ //:;k1 , .y7#/s,/ Signature
ITitle tilGr//✓ C Phone 947 3/,77 V77.2 Fax OW SO7 047f
Address/.7c25S7 ,,C/4° ir0 J/i V/8— A/Li o4
0/07,
I Street!P.O.Box �` jty State
ms/ Zip
E-Mail Address c17/�47 �`/�� A/G�v-�_ . coin
I
olitical entities and other'Divisions of Government. •„ar-- ,r<< • rrt 4•-r''' - :.
ALL EXCEPTIONS TO OPTIONS MUST BE CLEARLY
INDICATED. (Example: Units ordered with airbags may
not be available with a tilt wheel and automatic speed •
•
3460 OF 2011 1/2 Ton Regular Cab 2WD Base Truck 2 of 2
.:5.... ...2Sf.-.e.,,.�>3::Ca...
+.�+,_r-.1..e< 1.,j:..n>:: ._..a;:,:•.c.x�.��.r4:: �... %i: ;��x. ..Lz��riti%^�.:S:C:zr;C..�. .,�, 'd' _._ - .:,..,.:
9 lightis {• : :: zr.,:.;.,w ,><.;:: ;:.;::,- .
m Cargo us�:;-f.; � ��::�� .. .�.•, ::. �. .;�'w..�.
3460 OF 2011 .1/2 Ton Regular Cab 2WD Base Truck 1 of 2
Many units qualify for the Case Flexible Purchased Protection Plan.This plan gives the owner additional•coverage on select engine and
drive train components.Discuss the details with your Case dealer today.
Operator's Manual/Warranty Receipt Verification
The correct operator's manual has been reviewed with me by the selling dealer and will be given to me upon delivery of the product.
YES/NO
The correct operator's manual has been given to me.YES i NO
The selling dealer explained safety precautions to me.YES/NO
The selling dealer explained safety features of the product to me.YES/NO
The selling dealer explained the warranty terms and coverage to me.YES/NO
The answers circled above are correct.I acknowledge that I have read and I accept this warranty policy statement
Model- jProduct identification number
Operator's manual form number-
Customer name(Please Print)-
Purchaser
Address Dealer Name
City,State,Zip City,State,Zip
Purchaser
Signature Date
Dealer
Signature Date •
Mail original signed cog to 360 Services Inc.12623 Newburgh Road.Livonia,MI 48150.USA
BOARD/COMMISSION CANDIDATE RESPONSE FORM
. % In consideration for appointment to the
I submit the following information:
Name of Board or Commission:
at.,s 1310
• Last name: First name: Middle Initial:
Home address:
3'-Is- so 70y1, 11i41
City: State: Zip:
Orr, fV (0'313 7-
Home Phone: Work Phone: Fax:
6 9?2-g6,z4 2.0`6- 92s/ •
E-mail: '
one pu it4 • 0�+^1 •
City Council District: Sex: Race:
Business name:
Job title: •
Owner/
Business address:
(01,12 •
City: State: Zip
0 .A_, Nt (Pc6icy
Where would you like us to direct your correspondence? (check box)
Home ( ) or (uj Business
( ) My appointment to the above named Board or Commission and term of service to the City would not
conflict with my professional or personal interests.
Name—Print or Type --3"'""7 L �`'�"^s•�.�
Date: IZ-ZI-I
Please return this completed form along with a copy of your resume to:
Barb Velinsky
Community Director
Bvelinsky@ci.omaha.ne.us
or
1819 Farnam Street, Suite 300 .
Omaha, Nebraska 68183
Fax: 402-444-6059
term shall expire on January 24, 2016.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF OMAHA:
THAT, the appointment by the Honorable Jim Suttle of Bill Carmichael,
owner of a restaurant at 6201 Maple Street, to be a member of the Benson Business
Improvement Area Board to serve a term from his appointment on January 25, 2011 until
such term shall expire on January 24, 2016, is hereby confirmed by the City Council.
APPROVED AS TO FORM:
---1 -1---2----- - ' . ------2-2
113 /1
p:vaw-city council documents\2011\10011dae.doc ASSISTANT CITY ATTORNEY DATE
By . .
R - / Colncilmember
Adopted FEB - 1 _Z O 1 1.J 9-o
. ` J d //
l� L" `Ci lerk
Approved _ .. .. .. a l/
Mayor
ll be returned to the bidder,
if and when he shall faithfully keep and perform all of the conditions set fourth in the advertisement and the requirements for bidding and instructions
to bidders,and furnish an acceptable surety bond. The surety company issuing said bond shall be licensed by the State of Nebraska,and listed on
111
the current edition of Circular 570 of the United States Dept.of the Treasury.
NOTICE: 11
Unless the foregoing proposal is free from alterations,additions and deductions and unless the name of the bidder as signed thereto is complete and
correct,in accordance with the instructions to bidders,it may be rejected as informal.
COMPLETION DATE:
The bidder agrees that construction will be completed within 3 Q calendar days after receiving the"Notice To Proceed"from the Park
111
Planner.
•
PERFORMANCE BOND_ I
Refer to Specification Section 00200, "Instructions To Bidders", Part 2.10, "Bond Submission" and Section 00400, "Performance, Payment
Maintenance Bond"requirements. 11
SIGN ALL COPIES Firm
By irie N ,1 7*-i Ni✓
Title Q f„/A/4-dr I
I
p
EL PARK WATER LINE,Omaha,Nebraska"in accordance with the provisions of this proposal and
contract documents to the satisfaction of the City of Omaha Parks,Recreation and Public Property Department for the lump sum of:
IBASE BID: .
INote: Refer to page 2 of 3 for Bid Bond,Completion Date&Performance Bond and page 3 of 3 for lnsurance'Requirements,Testing Allowance,Unit Prices&
Alternates(if applicable). Refer any questions regarding the Bid or Contract Documents directly to the Park Planning Division at 402.444-5900 or as noted in the
Contract Documents.
IAll bidders awarded a contract in the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on file with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shall be in effect for 24 months from the date received by the Human Relations Department.Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402-444-5055.�
I (Please Print Legibly or Type) Firm 77/ /114 �I1/7644" Incorpo lifebe'udr4
(State)
Name_ //:;k1 , .y7#/s,/ Signature
ITitle tilGr//✓ C Phone 947 3/,77 V77.2 Fax OW SO7 047f
Address/.7c25S7 ,,C/4° ir0 J/i V/8— A/Li o4
0/07,
I Street!P.O.Box �` jty State
ms/ Zip
E-Mail Address c17/�47 �`/�� A/G�v-�_ . coin
I
olitical entities and other'Divisions of Government. •„ar-- ,r<< • rrt 4•-r''' - :.
ALL EXCEPTIONS TO OPTIONS MUST BE CLEARLY
INDICATED. (Example: Units ordered with airbags may
not be available with a tilt wheel and automatic speed •
•
3460 OF 2011 1/2 Ton Regular Cab 2WD Base Truck 2 of 2
.:5.... ...2Sf.-.e.,,.�>3::Ca...
+.�+,_r-.1..e< 1.,j:..n>:: ._..a;:,:•.c.x�.��.r4:: �... %i: ;��x. ..Lz��riti%^�.:S:C:zr;C..�. .,�, 'd' _._ - .:,..,.:
9 lightis {• : :: zr.,:.;.,w ,><.;:: ;:.;::,- .
m Cargo us�:;-f.; � ��::�� .. .�.•, ::. �. .;�'w..�.
3460 OF 2011 .1/2 Ton Regular Cab 2WD Base Truck 1 of 2
Many units qualify for the Case Flexible Purchased Protection Plan.This plan gives the owner additional•coverage on select engine and
drive train components.Discuss the details with your Case dealer today.
Operator's Manual/Warranty Receipt Verification
The correct operator's manual has been reviewed with me by the selling dealer and will be given to me upon delivery of the product.
YES/NO
The correct operator's manual has been given to me.YES i NO
The selling dealer explained safety precautions to me.YES/NO
The selling dealer explained safety features of the product to me.YES/NO
The selling dealer explained the warranty terms and coverage to me.YES/NO
The answers circled above are correct.I acknowledge that I have read and I accept this warranty policy statement
Model- jProduct identification number
Operator's manual form number-
Customer name(Please Print)-
Purchaser
Address Dealer Name
City,State,Zip City,State,Zip
Purchaser
Signature Date
Dealer
Signature Date •
Mail original signed cog to 360 Services Inc.12623 Newburgh Road.Livonia,MI 48150.USA
• James L. Johnson
345 S. 70th Ave. •
Omaha, NE 68132
402-208-9251
Objective: To assist with the development of the Benson Business District, and to work
closely with other members of the Board to help bring Benson to its' full potential.
Experience:
• Waiting Room Lounge: March 2008-present. Co-owner
• One Percent Productions: October 1997-present. Co-owner
• Revamp: January 2009-present. Co-owner
• Keystone Automotive: June 2003-July 2006. Sales representative
• Professional Automotive: June 1997-June 2003. Manager
• Johnson Carstar: May 1994-June 1997. Co-owner
• Triangle Body Shop: June 1993-May 1994. Collision Tech
• Great Plains Auto Body: June 1992-June 1993. Auto Body Porter
Education:
• Carstar Franchise Training: Overland Park Kansas
• Azko Management Courses: Kansas City Missouri
• Burke High School: Omaha Nebraska 1988-1992
Personal: My hobbies include restoring antique cars, motorcycles and scooters.
Collecting mid-century modern antiques, and collecting pop art.
References: Available upon request
Bvelinsky@ci.omaha.ne.us
or
1819 Farnam Street, Suite 300 .
Omaha, Nebraska 68183
Fax: 402-444-6059
term shall expire on January 24, 2016.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF OMAHA:
THAT, the appointment by the Honorable Jim Suttle of Bill Carmichael,
owner of a restaurant at 6201 Maple Street, to be a member of the Benson Business
Improvement Area Board to serve a term from his appointment on January 25, 2011 until
such term shall expire on January 24, 2016, is hereby confirmed by the City Council.
APPROVED AS TO FORM:
---1 -1---2----- - ' . ------2-2
113 /1
p:vaw-city council documents\2011\10011dae.doc ASSISTANT CITY ATTORNEY DATE
By . .
R - / Colncilmember
Adopted FEB - 1 _Z O 1 1.J 9-o
. ` J d //
l� L" `Ci lerk
Approved _ .. .. .. a l/
Mayor
ll be returned to the bidder,
if and when he shall faithfully keep and perform all of the conditions set fourth in the advertisement and the requirements for bidding and instructions
to bidders,and furnish an acceptable surety bond. The surety company issuing said bond shall be licensed by the State of Nebraska,and listed on
111
the current edition of Circular 570 of the United States Dept.of the Treasury.
NOTICE: 11
Unless the foregoing proposal is free from alterations,additions and deductions and unless the name of the bidder as signed thereto is complete and
correct,in accordance with the instructions to bidders,it may be rejected as informal.
COMPLETION DATE:
The bidder agrees that construction will be completed within 3 Q calendar days after receiving the"Notice To Proceed"from the Park
111
Planner.
•
PERFORMANCE BOND_ I
Refer to Specification Section 00200, "Instructions To Bidders", Part 2.10, "Bond Submission" and Section 00400, "Performance, Payment
Maintenance Bond"requirements. 11
SIGN ALL COPIES Firm
By irie N ,1 7*-i Ni✓
Title Q f„/A/4-dr I
I
p
EL PARK WATER LINE,Omaha,Nebraska"in accordance with the provisions of this proposal and
contract documents to the satisfaction of the City of Omaha Parks,Recreation and Public Property Department for the lump sum of:
IBASE BID: .
INote: Refer to page 2 of 3 for Bid Bond,Completion Date&Performance Bond and page 3 of 3 for lnsurance'Requirements,Testing Allowance,Unit Prices&
Alternates(if applicable). Refer any questions regarding the Bid or Contract Documents directly to the Park Planning Division at 402.444-5900 or as noted in the
Contract Documents.
IAll bidders awarded a contract in the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on file with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shall be in effect for 24 months from the date received by the Human Relations Department.Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402-444-5055.�
I (Please Print Legibly or Type) Firm 77/ /114 �I1/7644" Incorpo lifebe'udr4
(State)
Name_ //:;k1 , .y7#/s,/ Signature
ITitle tilGr//✓ C Phone 947 3/,77 V77.2 Fax OW SO7 047f
Address/.7c25S7 ,,C/4° ir0 J/i V/8— A/Li o4
0/07,
I Street!P.O.Box �` jty State
ms/ Zip
E-Mail Address c17/�47 �`/�� A/G�v-�_ . coin
I
olitical entities and other'Divisions of Government. •„ar-- ,r<< • rrt 4•-r''' - :.
ALL EXCEPTIONS TO OPTIONS MUST BE CLEARLY
INDICATED. (Example: Units ordered with airbags may
not be available with a tilt wheel and automatic speed •
•
3460 OF 2011 1/2 Ton Regular Cab 2WD Base Truck 2 of 2
.:5.... ...2Sf.-.e.,,.�>3::Ca...
+.�+,_r-.1..e< 1.,j:..n>:: ._..a;:,:•.c.x�.��.r4:: �... %i: ;��x. ..Lz��riti%^�.:S:C:zr;C..�. .,�, 'd' _._ - .:,..,.:
9 lightis {• : :: zr.,:.;.,w ,><.;:: ;:.;::,- .
m Cargo us�:;-f.; � ��::�� .. .�.•, ::. �. .;�'w..�.
3460 OF 2011 .1/2 Ton Regular Cab 2WD Base Truck 1 of 2
Many units qualify for the Case Flexible Purchased Protection Plan.This plan gives the owner additional•coverage on select engine and
drive train components.Discuss the details with your Case dealer today.
Operator's Manual/Warranty Receipt Verification
The correct operator's manual has been reviewed with me by the selling dealer and will be given to me upon delivery of the product.
YES/NO
The correct operator's manual has been given to me.YES i NO
The selling dealer explained safety precautions to me.YES/NO
The selling dealer explained safety features of the product to me.YES/NO
The selling dealer explained the warranty terms and coverage to me.YES/NO
The answers circled above are correct.I acknowledge that I have read and I accept this warranty policy statement
Model- jProduct identification number
Operator's manual form number-
Customer name(Please Print)-
Purchaser
Address Dealer Name
City,State,Zip City,State,Zip
Purchaser
Signature Date
Dealer
Signature Date •
Mail original signed cog to 360 Services Inc.12623 Newburgh Road.Livonia,MI 48150.USA
C-25A CITY OF OMAHA
LEGISLATIVE CHAMBER
Omaha,Nebraska
RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA:
WHEREAS, by virtue of Nebraska State Statutes, there now exists a 1
Benson Business Improvement Area Board created by the City Council; and,
WHEREAS, Section 19-4021 of the Nebraska Revised Statutes provides
for the appointments to the Business Improvement Board to be made by the mayor, with
approval of the city council; and,
WHEREAS, Section 19-4021 of the Nebraska Revised Statutes provides
further that the members of the Business Improvement Board shall consist of property
owners, residents, business operators, or users of space within the business area to be
improved; and,
WHEREAS, Section 19-4022 of the Nebraska Revised Statutes provides
that a Business Improvement Board shall consist of five or more members; and,
WHEREAS, the Mayor would like to appoint a new member to the
Benson Business Improvement Board; and,
WHEREAS, the City Council of the City of Omaha is being requested by
Mayor Jim Suttle to appoint James L. Johnson, owner of the Waiting Room Lounge
located at 6212 Maple Street to be a member of the Benson Business Improvement Area
Board to serve until his term shall expire on January 24, 2016.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF OMAHA:
THAT, the appointment by the Honorable Jim Suttle of James L. Johnson,
owner of the Waiting Room Lounge at 6212 Maple Street, to be a member of the Benson
Business Improvement Area Board to serve a term from his appointment on January 25,
2011 until such term shall expire on January 24, 2016, is hereby confirmed by the City
Council.
APPROVED AS TO FORM:
732'
. ---------(7-‘ - //Oki
p:Uaw-city council documents\2011\10013dae.docc ASSISTANT CITY ATTORNEY DATE
By 44447 44-44-4"44.
-Councilmember
Adopted FEB _ -1 =2f11. -,
..a**14.-Y'�y .t: _.„. City erk
Approved .
Mayor
lerk
Approved _ .. .. .. a l/
Mayor
ll be returned to the bidder,
if and when he shall faithfully keep and perform all of the conditions set fourth in the advertisement and the requirements for bidding and instructions
to bidders,and furnish an acceptable surety bond. The surety company issuing said bond shall be licensed by the State of Nebraska,and listed on
111
the current edition of Circular 570 of the United States Dept.of the Treasury.
NOTICE: 11
Unless the foregoing proposal is free from alterations,additions and deductions and unless the name of the bidder as signed thereto is complete and
correct,in accordance with the instructions to bidders,it may be rejected as informal.
COMPLETION DATE:
The bidder agrees that construction will be completed within 3 Q calendar days after receiving the"Notice To Proceed"from the Park
111
Planner.
•
PERFORMANCE BOND_ I
Refer to Specification Section 00200, "Instructions To Bidders", Part 2.10, "Bond Submission" and Section 00400, "Performance, Payment
Maintenance Bond"requirements. 11
SIGN ALL COPIES Firm
By irie N ,1 7*-i Ni✓
Title Q f„/A/4-dr I
I
p
EL PARK WATER LINE,Omaha,Nebraska"in accordance with the provisions of this proposal and
contract documents to the satisfaction of the City of Omaha Parks,Recreation and Public Property Department for the lump sum of:
IBASE BID: .
INote: Refer to page 2 of 3 for Bid Bond,Completion Date&Performance Bond and page 3 of 3 for lnsurance'Requirements,Testing Allowance,Unit Prices&
Alternates(if applicable). Refer any questions regarding the Bid or Contract Documents directly to the Park Planning Division at 402.444-5900 or as noted in the
Contract Documents.
IAll bidders awarded a contract in the amount of$5,000 or more must comply with the Contract Compliance Ordinance and have on file with the Human Relations Department the Contract
Compliance Report(Form CC-1).This report shall be in effect for 24 months from the date received by the Human Relations Department.Any questions regarding the Contract Compliance
Ordinance or PBEIDEB Listings should be directed to the Human Relations Department at 402-444-5055.�
I (Please Print Legibly or Type) Firm 77/ /114 �I1/7644" Incorpo lifebe'udr4
(State)
Name_ //:;k1 , .y7#/s,/ Signature
ITitle tilGr//✓ C Phone 947 3/,77 V77.2 Fax OW SO7 047f
Address/.7c25S7 ,,C/4° ir0 J/i V/8— A/Li o4
0/07,
I Street!P.O.Box �` jty State
ms/ Zip
E-Mail Address c17/�47 �`/�� A/G�v-�_ . coin
I
olitical entities and other'Divisions of Government. •„ar-- ,r<< • rrt 4•-r''' - :.
ALL EXCEPTIONS TO OPTIONS MUST BE CLEARLY
INDICATED. (Example: Units ordered with airbags may
not be available with a tilt wheel and automatic speed •
•
3460 OF 2011 1/2 Ton Regular Cab 2WD Base Truck 2 of 2
.:5.... ...2Sf.-.e.,,.�>3::Ca...
+.�+,_r-.1..e< 1.,j:..n>:: ._..a;:,:•.c.x�.��.r4:: �... %i: ;��x. ..Lz��riti%^�.:S:C:zr;C..�. .,�, 'd' _._ - .:,..,.:
9 lightis {• : :: zr.,:.;.,w ,><.;:: ;:.;::,- .
m Cargo us�:;-f.; � ��::�� .. .�.•, ::. �. .;�'w..�.
3460 OF 2011 .1/2 Ton Regular Cab 2WD Base Truck 1 of 2
Many units qualify for the Case Flexible Purchased Protection Plan.This plan gives the owner additional•coverage on select engine and
drive train components.Discuss the details with your Case dealer today.
Operator's Manual/Warranty Receipt Verification
The correct operator's manual has been reviewed with me by the selling dealer and will be given to me upon delivery of the product.
YES/NO
The correct operator's manual has been given to me.YES i NO
The selling dealer explained safety precautions to me.YES/NO
The selling dealer explained safety features of the product to me.YES/NO
The selling dealer explained the warranty terms and coverage to me.YES/NO
The answers circled above are correct.I acknowledge that I have read and I accept this warranty policy statement
Model- jProduct identification number
Operator's manual form number-
Customer name(Please Print)-
Purchaser
Address Dealer Name
City,State,Zip City,State,Zip
Purchaser
Signature Date
Dealer
Signature Date •
Mail original signed cog to 360 Services Inc.12623 Newburgh Road.Livonia,MI 48150.USA
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schedule and places for this training.
Other or Comments:
August 2010
9