RES 2011-0127 - Appoint D/Ann K Lonowski to Benson business improvement area board t
RECEIVED
ar .5%Yt '3 Office of the Mayor
z ►1' -t� 11 JAN 21 AM 11: 29 1819 Farnam Street,Suite 300
o••.= ���;,�.�^'•* Omaha,Nebraska 68183-0300
•
fit ,4N 8 1 (402)444-5000
rFn FE$R FAX:(402)444-6059
' ` OMAHA, NEBRASKA
City of Omaha
Jim Suttle,Mayor
Honorable President
and Members of the City Council,
Attached for your consideration is a Resolution appointing D'Ann Lonowski 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. Ms.
Lonowski meets the 'qualifications by being the operator of the President and Owner of Mint
Design Group located at 5916 Maple Street,, which is a "business operator and user of space
within the district. I would recommend,the appointment of Ms. Lonowski .to the board to serve
until her term shall expire on January 24, 2016.
Respectfully submitted,
•
Jim Suttle, Mayor
City of Omaha
p:\law-city council documents\2011\10014dae.doc
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
--D'Ann-Lonowski
" Mint Design Group
5916 Maple Street, Benson, NE 68104
402-330-2999 402-680-7314 (cell)
dann@mintdesigngroup.com
EXECUTIVE PROFILE •
Owner and Executive President of Mint Design Group, a marketing and graphic design firm located in Omaha,
NE. Proficient in the development of marketing strategies, creative concepts, and campaign oversight. Highly
adept at motivating marketing and sales teams to achieve extraordinary results. Recognized for enhancing
profits and reducing operational expenditures by dedicated process improvement measures and strategic
resource allocation. Committed client service specialist with a proven track record of optimizing client
retention. Strengths include; leadership, team building, creative, analytical, and strategic thinker.
Areas of expertise include:
• Creative Conceptualization
• Market Analysis and Demographic Profiling
• Brand Development
• Event Planning, Budgeting
• Program Management
• Cross-platform Graphic Design
• Printing and Product Rollout
• System Improvements
National and local clients include The City of Omaha,The Nebraska Furniture Mart, Berkshire Hathaway, Seiko
Corporation of America, The National Geographic Society, Consumer Reports, Physician's Mutual, Boys Town,
Canfield's Sporting Goods, Reward Wall Systems, Experian, and National Research Corporation.
BACKGROUND
Ms. Lonowski holds a degree in Graphic Design and Printing. For more than 20 years she has worked for
some of the region's leading direct response and traditional marketing agencies, as well as some of the
leading corporate brands in America. As such, she has developed specialized knowledge and experience in
such industries as: insurance, construction, building materials manufacturing and marketing, property
management, research, health care, retail sales, broadcast, event planning, and more.
COMPANY PROFILE
Mint Design Group is a graphic design/advertising agency located in Benson with seven employees. Mint
provides print design and marketing services to companies large and small both in the Omaha area and
nationwide. Mint opened for business in 2003 and immediately began focusing on the development of
exceptional work and paying attention to the very specific needs of the clients it serves. It's an approach that
has resounded with employees and clients alike—many who have been part of Mint since its founding in 2003.
It has also made Mint Design Group a trusted partner clients can turn to at any time. Mint moved its corporate
office to downtown Benson in 2008.
osal 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 for appointment to the
I submit the following information: ,D r,4 n n K Lo oosk-;
Name of Board or Commission: /--'.,2 ;/21201O e') 2:)%6 /e/
Last name: First name: Middle Initial:
Lon U r'r1 K
Home address:
7/Z/ S. fS3+h 5-tre -+ •
City: State: Zip:
Orn a.h N l✓ (o i 3(.1
Home Phone: Work Phone: Fax: .
tioz-84ii-qI ZS 1-toL` 33o _Z9ici •
E-mail:
dcnn Cda i'yi ii i+d GI sr) (Oct N. c'on-1
City Council District:.L Sex:;/'Race: ��
Business name: Y1'l;n f- D''5 15►) Cr r
Job title: 0. ���dPrtt 1 >
•
Business address: 5-11(0 Maple. S-t i eCt.-
City: State: Zip
Omaha_ 1VE. tp31 b�
Where would you like us to direct your correspondence? (check box)
Home ( ) or g 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 U Ann Lon
Date: y1.— 10
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
ign and Printing. For more than 20 years she has worked for
some of the region's leading direct response and traditional marketing agencies, as well as some of the
leading corporate brands in America. As such, she has developed specialized knowledge and experience in
such industries as: insurance, construction, building materials manufacturing and marketing, property
management, research, health care, retail sales, broadcast, event planning, and more.
COMPANY PROFILE
Mint Design Group is a graphic design/advertising agency located in Benson with seven employees. Mint
provides print design and marketing services to companies large and small both in the Omaha area and
nationwide. Mint opened for business in 2003 and immediately began focusing on the development of
exceptional work and paying attention to the very specific needs of the clients it serves. It's an approach that
has resounded with employees and clients alike—many who have been part of Mint since its founding in 2003.
It has also made Mint Design Group a trusted partner clients can turn to at any time. Mint moved its corporate
office to downtown Benson in 2008.
osal 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
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 D'Ann K. Lonowski, President and owner of Mint Design
Group located at 5916 Maple Street to be a member of the Benson Business Improvement
Area Board to serve until her 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 D'Ann K.
Lonowski, President and owner of Mint Design Group located at 5916 Maple Street, to
be a member of the Benson Business Improvement Area Board to serve a term from her
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:
.....S-2-i27
1 i3 1I
p:\law-city council documents\2011\10015dae.doc ASSISTANT CITY ATTORNEY DA IL
By
--. - 7' Councilmember
Adopted FEB 1- 2 11-. : o
V '' - DEP'.ti - .City lerk
Approved r. 4 /, 02 3-//
. : '' '.'., Mayor
oth in the Omaha area and
nationwide. Mint opened for business in 2003 and immediately began focusing on the development of
exceptional work and paying attention to the very specific needs of the clients it serves. It's an approach that
has resounded with employees and clients alike—many who have been part of Mint since its founding in 2003.
It has also made Mint Design Group a trusted partner clients can turn to at any time. Mint moved its corporate
office to downtown Benson in 2008.
osal 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