HomeMy WebLinkAboutAGENDA REPORT 2001 0801 CC REG ITEM 11HI i"-i. -Ioq
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Agenda Report
City of Moorpark
To: The Honorable City Council
From: Kenneth C. Gilbert, Director of Public Works
Date: July 20, 2001 (Council Meeting 8 -1 -01)
Subject: Notice of Completion for the 2000 Asphalt Overlay
Project [Including Spring Road & Los Angeles Avenue
Rehabilitation Projects]
BACKGROUND
On December 6, 2000, the City Council awarded a contract for the
subject project to Nye & Nelson, Inc. This contract included a
number of projects listed as follows:
Notes: x The cost for repairs to the parking lots at Peach Hill Park are
to be funded from the General fund [Fund 10001.
y This project is funded by Caltrans as a condition of the
relinquishment of this street segment to the City.
DISCUSSION
A. Project Scope
1. General Description: The map attached as
Exhibit 1 shows
the
location of the
asphalt overlay construction included in
the
subject project.
A summary of the affected streets is as
follows:
Segment
Limits
Project Note
A
Campus Park
Intersection only
8011
Marquette
B
L. A. Ave.
At Rail Crossing
8011
C
Condor Drive
North leg
8011 1
D
L. A. Ave. Rehab
Spring Rd. to Freeway
8025
Ac overlay 2000_cmp v a
Asphalt Overlay 2000: Completion
July 20, 2000
Page 2
Segment Limits Project Note
E Spring Rd. Rehab High St. to New L. A. Ave. 8021
F Science Drive 8011
G Peach Hill Rd. Just east of Spring Road 8011
H Granadilla North end 8011 2
I Misty Hollow 8011
J Talmadge South of Courtney Lane 8011 3
Notes:
1) Condor Drive: A portion of the costs for the resurfacing
the designated segment of Condor Drive, was funded by a
cash payment in the amount of $7,483.05 from the
developer of Lots 1 - 3 of Tract 3492 (Felsenthal). That
payment was made in lieu of constructing repairs to the
street required by utility cuts and other work done by
the developer.
2) Granadilla Drive: Added to scope of work via an addendum
during the bidding period. Approved by the City Council
at award of contract.
3) Talmadge Road: Added to scope of work via Change Order
No. 1.
2. Los Angeles Avenue Rehabilitation Project [ #8025]
a. North End / West End: The contract included the
construction of an asphalt overlay at the north end and
the west end of the street segment in the areas where the
street is fully improved with curbs, gutters and
sidewalks.
b. Central Portion: Work Deferred: The "narrower" street
between the above two street segments, is the subject of a
future street widening and re- alignment project: Los
Angeles Avenue East Project. Reconstruction and /or a
substantial overlay of this street segment is to be
deferred until that widening, realignment and
reconstruction project is undertaken.
c. Center Portion: Repair Areas: The contract did include,
however, the removal and replacement of pavement and base
material in areas of severe stress within this central
segment.
d. Medians: The contract included the construction of a
raised center median on Los Angeles Avenue at and south of
the freeway.
e. Median Landscaping: The contract included the installation
of a water service and the placement of sleeves for a
future irrigation system in the medians. The design for
the installation of the irrigation and landscaping is near
completion. It is anticipated that the construction
project for that landscaping will come to the City Council
in the very near future. The estimated cost of this
follow -up landscaping project is approximately $25,000.
f. Caltrans: All of the above work, except the medians, was
funded by Caltrans pursuant to an Agreement related to the
relinquishment of this street segment to the City.
Ac Overlay 2000_cmp 000:199
Asphalt Overlay 2000: Completion
July 20, 2000
Page 3
3. Spring Road Rehabilitation Project [ #8021]
a. Agreement: Per the Relinquishment Agreement for Spring
Road, Caltrans is to reimburse the City for the cost of
refurbishing this street segment, said costs not to exceed
$750,000.
b. Initial Deposit: Per the Agreement, Caltrans deposited
with the City $530,000 as an advance toward those costs.
C. Reimbursement: Per the Agreement, based on the costs as
reflected by the bid results, the City reimbursed to
Caltrans $103,482.52, leaving a net remaining advance of
$426,517.48.
b. Final Cost: As set forth in the Section below pertaining
to Fiscal Impact, the final cost to Caltrans for the
Spring Road rehabilitation effort is $520,078.68. It is
the intent of staff to bill Caltrans for the difference
between that amount and the advance received to date, that
additional amount being $93,561.20.
4. Peach Hill Park Parking Lot: The contract also included
the reconstruction of portions of the parking lots at
Peach Hill Road. As described in "Fiscal Impact" the cost
of that work exceeds the initial estimate.
B. Change Orders
Seven (7) Change Orders were issued for this project,
generally described as follows:
Change Order Description Cost ($) Note
1 Talmadge Road Street segment added to
scope of work
2 Equipment Parking Documented approval of
the parking of equipment
on L. A. Avenue.
3 Water Service
4 Spring Road
Centerline
5 Concrete Slab
Ac Overlay 2000 cmp
Revise the size of the
water meter for the
median
Change the cross - section
by shifting the crown of
the street to the east.
Revise the Irrigation
sleeves to accommodate
buried concrete slabs
1,742 a
-0- b
(3,523) c
1,236 a
9,097 d
Asphalt Overlay 2000: Completion
July 20, 2000
Page 4
Change Order Description Cost ($) Note
6 L. A. Ave at Adjust the elevation of 9,374 e
Freeway the final road surface to
yield a net zero increase
under the north bridge
7 High & Spring Cross - section -0- f
reconstruction required
by substandard condition
of base and sub -base
Total 17,926
Notes:
a) Added traffic control cost, plus costs generated by an
adjustment to the final quantities constructed of applicable
bid items.
b) No Cost.
c) Added cost [$1,175] for a cage for the backflow preventer,
less a credit [($4,689)] for reducing the size of the water
service, for a net credit of ($3,523).
d) Added costs for the extension of the irrigation sleeves, the
removal of a portion of a concrete slab under the pavement
surface and additional traffic control, plus additional
quantities for saw cutting and pavement grinding.
e) Change to elevation of street surface under the freeway.
Added cost for down time, cold mix, traffic control and
subsurface slab removal. Also additional quantities for
pavement grinding.
f) Additional quantities.
C. Quantity Adjustment
Invariably with Public Works projects the final actual
quantity required for each bid item will differ somewhat from
the engineer's estimate of quantities set forth in the bid
documents. Accordingly, the final contract cost will differ
from the bid amount, based upon the actual quantity of each
item required to complete the project.
The variance in project cost due to quantity adjustments is
summarized as follows:
Description
Total
a Talmadge Road [CCO #1]
31,329.00
b Spring Road centerline adjustment [CCO#4]
27,359.00
c Concrete Slab [CCO #5]
6,000.00;
d Grade Adjustment under Freeway [CCO #6]
3,700.00
e Spring Road structural reconstruction [CCO #7]
110,000.00
f Cost of other variations to the final quantities
(14.732.78)1
Total Cost of Additional Quantities 163,655.22
Plus Change Orders 17,925.50
Plus Bid Amount 1,224,667.73
Total Project Cost 1,406,248.45
Ac Overlay 2000_cmp
CA e' is
Asphalt Overlay 2000: Completion
July 20, 2000
Page 5
D. Fiscal Impact
1. Final Construction Cost: The final construction cost is
summarized as follows:
2. Change Orders Quantity Adjustments: The scope and cost of
Change Orders and Quantity Adjustments are summarized in
Sections B & C above.
3. L. A. Avenue Drain Line: A portion of the monies budgeted
for Project 8025 funded a prior contract for the design and
construction of a catch basin and storm drain on Los
Angeles Avenue east of High Street. This project was
constructed to correct a drainage problem prior to the
construction of the subject asphalt overlay project. A
summary of Project 8025 costs for both the subject Pavement
Rehabilitation contract and the prior storm drain
construction is as follows:
Project 8025
Descriation
Prior Year
Design
Construction
Inspection
Sub -Total Prior Year
FY 2000/01
Design
Construction
Inspection
Sub -Total FY 00/01
Total
LAAve LA Ave
Drain Pavement Rehab Total
7,942
7,942
21
20,965
1.000
21.986
29,928
22,994
22,994
24,608
361,514
11.854
�kYA1'Y1:1
420,970
30,936
30,936
24,629
382,479
12,854
419.962
450,898
Ac Overlay 2000 cmp , 0 s,6 .,
A/C Overlay
Spring Rd Rehab
L.A.Ave Rehab
Description
(Project 80111
IProiect 80211
[ Proiect 80251
Total _M
Bid Amount
574,193.68
362,405.22
288,068.83
1,224,667.73
Change Orders
1,742.00
1,236.00
14,947.50
17,925.50
Quantiby Adjustment
34,164.34
70.993.68
58.497.20
163,655.22
Total
610,100.02
434,634.90
361,513.53
1,406,248.45
Percent of Total
43.4%
30.9%
2507%
2. Change Orders Quantity Adjustments: The scope and cost of
Change Orders and Quantity Adjustments are summarized in
Sections B & C above.
3. L. A. Avenue Drain Line: A portion of the monies budgeted
for Project 8025 funded a prior contract for the design and
construction of a catch basin and storm drain on Los
Angeles Avenue east of High Street. This project was
constructed to correct a drainage problem prior to the
construction of the subject asphalt overlay project. A
summary of Project 8025 costs for both the subject Pavement
Rehabilitation contract and the prior storm drain
construction is as follows:
Project 8025
Descriation
Prior Year
Design
Construction
Inspection
Sub -Total Prior Year
FY 2000/01
Design
Construction
Inspection
Sub -Total FY 00/01
Total
LAAve LA Ave
Drain Pavement Rehab Total
7,942
7,942
21
20,965
1.000
21.986
29,928
22,994
22,994
24,608
361,514
11.854
�kYA1'Y1:1
420,970
30,936
30,936
24,629
382,479
12,854
419.962
450,898
Ac Overlay 2000 cmp , 0 s,6 .,
Asphalt Overlay 2000: Completion
July 20, 2000
Page 6
4. Los Angeles Avenue Rehab Cost Breakdown ( #80251: A
breakdown the components of the Los Angeles Avenue Rehab
Project portion of the contract is as follows:
--- - - - - -- __------------- - --- -- ------------ —..---- --------- .— . - - - -- -- - - - - -- - -- - - - - - -- --
r Description Total
Median Construction 147,367 {
Removal & Reconstruction: Center Portion 43,814
Sub -Total 191,181 I
I All Other Rehabilitation Work 228,781 ,
Total 419,962 It
5. Caltrans' Funding of Los Angeles Avenue Rehabilitation: The
City and Caltrans entered into a Cooperative Agreement
pertaining to the relinquishment of Los Angeles Avenue
south of the Princeton Avenue freeway ramps. That
agreement required the State to pay the City $1,116,000
in -lieu of constructing improvements to the street to
bring it up to a ten -year life. A summary of the status of
t'
11G Gls�J C11U11. U 1 C UL L.
-- ------ _...--- _— -----------------
1
—_—..-
C16 L011ows:
------------ --------------
In -Lieu
Description
Payment ($)
Overlay & Rehap
228,781
Medians
To Date ($)
Center Portion Patch Repairs
43,814
Sub -Total
272,595
Plus 20% Engineering
45,298
Sub -Total
317,893
Unexpended for Future Project
798,107
Total
1,116,000
� LV11VW.7_
Other
Sources ($)
147,367
147,367
Total
228,781
147,367
43,814
419,962
6. Caltrans' Funding of Spring Road Rehabilitation: The City
and Caltrans entered into a separate agreement relative to
the Relinquishment of Spring Road between New Los Angeles
Avenue and High Street. That Agreement provided that
Caltrans would fund all actual costs of that
rehabilitation up to a cap of $750,000. Caltrans paid an
advance toward these costs. Per the terms of the
Agreement, the amount of the Caltrans' advance was reduced
from $530,000 to $426,517.48 after the bid opening. The
final costs exceed the current amount of the advance.
Staff has invoiced Caltrans for the remainder due. A
Ul11111dLy UL l-ilC sLCtL_US
-------------------------------- - - -�.—
UL Lill" L- C_LULL)UL- sUU1U11L 1S
------------------------- - - - - -- - - --
C16 L011ows:
------------ --------------
Total
Paid
Remaining
Description
Cost
To Date ($)
To Be Paid
Construction
434,634.90
355,431.23
79,203.67
Engineering (20 %)
86,926.98
71,086.25
15.840.73
Total
521,561.88
426,517.48
95,044.40
Ac Overlay 2000_cmp ` :0
Asphalt Overlay 2000: Completion
July 20, 2000
Page 7
7. State Traffic Congestion Relief Program (TCRP): The City
has received $211,888.17 from the State's Traffic
Congestion Relief Program. Those monies will partially fund
Project 8011 - -A /C Overlay Selected Streets.
8. Total Project Cost Summary,
A/C Overlay
Spring Rd Rehab
L.A.Ave Rehab
211,888
'Description jProiect 80111
fProiect 80211
fProiect 80251
Total ($)
Design 536
22,095
24,629
47,260
Construction 610,100
434,635
382,479
1,427,214
Inspection 21.692
15.454
12,854
50,000
FY 2000/01 Total 632,328
472,184
419,962
1,524,474
Plus Prior Year Design 5.728
21.673
30,936
58,337
Project Total !� 638,056
493,857
450,898
1,582,811
9. Peach Hill Park Parking
Lot Reconstruction Line:
The
actual cost for the work necessary
to reconstruct
a
portion of the pavement in
the parking lots at Peach
Hill
Park, exceeded the amount
estimated at
the time
the bid
was awarded. The budgeted
amount was $18,700. The actual
costs were $38,423.54. The
cost increase
occurred
when the
area of the pavement and
base reconstruction
exceeded
initial estimate. Adoption
of the attached
Resolution
will
adjustment the appropriation from the
General
Fund to
cover these actual costs.
10 Budget Summary / Amendment: It is necessary to amend the FY
2000/01 Budget to fully fund all project costs. A
Resolution has been prepared for that purpose. A summary of
the recommended budget amendment is as follows:
Description
Project 8011: Overlay
Park Parking Lots
All Other Work
All Other Work
Sub -Total
Project 8021: Spring Rd
Project 8025: L. A. Ave
Total
Notes
Proposed Revised
Proposed FY 2000/01
Change Budget
19,724
38,424
Current
211,888
FY 2000/01
Fund
Note
Bud et
1000 - General Fund
45,494
18,700
2610 - State Grant
A
211,888
2603 - TDA Artical 3
B
484.261
714,849
2501 - L. A. Ave. AOC
C
430,188
2501 - L. A. Ave. AOC
C
374.468
D
1,519,505
Proposed Revised
Proposed FY 2000/01
Change Budget
19,724
38,424
-
211,888
484,261
19,724
734,573
41,996
472,184
45,494
419,962
107,214 1,626,719
A: State Traffic Congestion Relief Program.
B: The total appropriation exceeds actual costs by $97,781.
This surplus appropriation will be released to Funds after
all final costs are determined and the project is closed -
out.
C: Caltrans funding for Projects 8021 & 8025 was deposited in
the L. A. Ave. AOC Fund.
D: The best way to account for these changes is to amend last
year's Budget.
Ac Overlay 2000_cmp 000200
Asphalt Overlay 2000: Completion
July 20, 2000
Page 8
E. Final Inspection and Acceptance
The City has completed a final inspection of the project and
has found the work to be acceptable. At this time it would
be appropriate for the City Council to accept the project as
completed, direct the City Clerk to file a Notice of
Completion and authorize release of the retention.
F. Release of Retention
If the recommended action is taken, the Notice of Completion
will be forwarded to the County Recorder for recordation.
Absent the receipt of any Stop Notices from subcontractors
or suppliers, thirty -five (35) days after the date of the
recordation of the Notice of Completion, the ten percent
(10 %) retention will be released to the contractor.
RECOMMENDATIONS [Roll Call Vote]
Staff recommends that the City Council take the following
actions:
1. Adopt Resolution 2001 - approving an amendment to the
FY 2000/2001 Budget by revising the appropriation and
budget for the subject project as follows: General Fund
[Fund 10001: $19,724 increase; L. A. Ave. AOC [Fund
2501]: $87,490: Total Increase $107,214.
2. Accept the work as completed.
Attachments:
Exhibit 1:
Exhibit 2:
Ac Overlay 2000_cmp
Map of Overlay Streets
Resolution
e ow�$) s
Legend
A. Campus Park / Marquette Intersect
B. Los Angeles Ave at Rail Crossing
C. Condor Drive
D. Los Angeles Avenue Rehabilitation
E. Spring Road Rehabilitation
F . Science Drive
G. Peach Hill Road
H. Granadilla Drive
I. Misty Hollow Court
J. Talmadge Road.
0
I WO /\-/C
CITY OF MOORPARK
r:�
Exhibit 2
RESOLUTION NO. 2001 -
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF MOORPARK, CALIFORNIA, REVISING THE AMOUNT
OF THE APPROPRIATION AND BUDGET FOR THE 2000
ASPHALT OVERLAY PROJECT (PROJECTS 8011, 8021 &
8025) [FUND 1000 - GENERAL FUND; FUND 2501
L. A. AVE. AOC FUND]
WHEREAS, on June 21, 2000, the City Council adopted the
Budget for Fiscal Year 2000/01; and
WHEREAS, a staff report has been presented to the City
Council requesting a budget increase in the aggregate amount of
$107,214; and
WHEREAS, Exhibit "A ", attached hereto and made a part hereof,
describes said budget amendment and its resultant impacts to the
budget line item(s).
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF MOORPARK DOES
HEREBY RESOLVE AS FOLLOWS:
SECTION 1. That a Budget amendment in the aggregate increase
of $107,214, as more particularly described in Exhibit "A ", is
hereby approved.
SECTION 2. The City Clerk shall certify to the adoption of
this resolution and shall cause a certified resolution to be filed
in the book of original resolutions.
PASSED AND ADOPTED this
ATTEST:
day of , 2001.
Patrick Hunter, Mayor
Deborah S. Traffenstedt, City Clerk
Attachment:
Exhibit 'A': Appropriation and Budget Detail
Resolution No. 2001 -
Exhibit "A"
Page 1 Of 2
APPROPRIATIONS FOR
2000 Asphalt Overlay Project
Project 8011: Asphalt Overlay
Project 8021: Spring Rd. Rehab
Project 8025: L. A. Ave. Rehab
FUND
ACCOUNT NUMBER
APPROPRIATION REQUEST
General Fund
1000.0000.0000.5500
$ 19,724
Los Angeles Avenue AOC Fund
$ 38,424
2603.8310.8011.xxxx
Project 8021: Spring Rd Rehab
$ 0
$ 41,996
Project 8025: L A Ave Rehab
$ 211,888
$ 45,494
Total A AOC Fund
2501.0000.0000.5500
$ 87,490
TOTALS:
$ 472,184
$ 107,214
APPROPRIATION RE -CAP
ACCOUNT NUMBER
CURRENT
FY 2000 /01
APPROPRIATION
SUBJECT
APPROPRIATION
/ (REDUCTION)
REVISED
APPROPRIATION
1000.8310.8011.xxxx
$ 18,700
$ 19,724
$ 38,424
2603.8310.8011.xxxx
$ 484,261
$ 0
$ 484,261
2610.8310.8011.xxxx
$ 211,888
$ 0
$ 211,888
2501.8310.8021.xxxx
$ 430,188
$ 41,996
$ 472,184
2501.8310.8025.xxxx
$ 374,469
$ 45,494
$ 419,962
TOTALS:
$ 1,519,5051
$ 107,214
$ 1,626,719
i
1
Resolution No. 2001 -
Exhibit "A"
Page 1 Of 2
DISTRIBUTION OF APPROPRIATIONS TO EXPENSE ACCOUNT NUMBERS
ACCOUNT NUMBER
CURRENT
APPROPRIATION
SUBJECT
APPROPRIATION
/ (REDUCTION)
REVISED
APPROPRIATION
Design
1000.8310.8011.9601
0
0
0
2603.8310.8011.9601
$5,000
$(4,464)
$536
2610.8310.8011.9601
0
0
00
2501.8310.8021.9601
$25,392
$(3,297)
$22,095
2501.8310.8025.9601
$24,684
$(55)
$24,629
Sub -Total
$55,076
$(7,816)
$47,260
Construction
1000.8310.8011.9640
$18,700
$19,724
$38,424
2603.8310.8011.9640
$455,025
$7,008
$462,033
2610.8310.8011.9640
$211,888
0
$211,888
2501.8310.8021.9640
$390,975
$43,660
$434,635
2501.8310.8025.9640
$337,841
$44,638
$382,479
Sub -Total
$1,414,429
$115,030
$1,529,459
Inspection
1000.8310.8011.9650
0
0
0
2603.8310.8011.9650
$23,236
$(2,544)
$21,692
2610.8310.8011.9650
0
0
0
2501.8310.8021.9650
$13,821
$1,633
$15,454
2501.8310.8025.9650
$11,943
$911
$12,854
Sub -Total
$50,000
0
$50,000
Total
1000.8310.8011.xxxx
$18,700
$19,724
$38,424
2603.8310.8011.xxxx
$484,261
0
$484,261
2610.8310.8011.xxxx
$211,888
0
$211,888
2501.8310.8021.xxxx
$430,188
$41,996
$472,184
2501.8310.8025.xxxx
$3741468
$45,494
$419,962
TOTALS: 1 $ 1,519,505; $ 107,214 1 $ 1,626,7191
Approved as to form: &I
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO:
I
NAME City of Moorpark
STREET
ADDRESS 799 Moorpark Avenue
CITY. STATE 6 Moorpark, CA 93021
ZIP CODE
L Attn: City Clerk
SPACE ABOVE THIS LINE FOR RECORDER'S USE
�� ®/Jl / 1 I ®r , � n� a i � , � L � � � .`�. �1 /w � i \s' ra /. �!�s!!!n_ y \Z�� �uf!lafln' �: i \ � � ! \ �' � //� ', ! v 6 � ' r ' 1 %1 \ i ! l \ ��' �� /�i, A \ \� \� . .�1. /�fi p I!� . �\ \� \ � U /!!!!lln�� � � � T \ \ �' ✓�� ®d d I
i
NOTICE OF COMPLETION
Notice pursuant to Civil Code Section 3093, must be filed within 10 days after completion. (See reverse side for Complete requirements.)
Notice is hereby given that:
1. The undersigned is owner or corporate officer of the owner of the interest or estate stated below in the property hereinafter described:
2. The full name of the owner is Citv of Moorpark
3. The full address of the owner is 799 Moorpark Avenue, Moorpark, CA 93021
4. The nature of the interest or estate of the owner is: In fee.
Purchaser under contract of purchase
(IF OTHER THAN FEE, STRIKE "IN FEE" AND INSERT, FOR EXAMPLE, "PURCHASER UNDER CONTRACT OF PURCHASE," OR "LESSEE ")
5. The full names and full addresses of all persons, if any, who hold title with the undersigned as joint tenants or as tenants in common are:
NAMES ADDRESSES
6. The full names and full addresses of the predecessors in interest of the undersigned, if the property was transferred subsequent to the
commencement of the work or improvements herein referred to:
NAMES ADDRESSES
7. A work of improvement on the property hereinafter described was completed on August 1. 2001 The work done was:
asphalt overlay on various City streets.
8. The name of the contractor, if any, for such work of improvement was Nye & Nelson, Inc.
_ December 15, 2000
(IF NO CONTRACTOR FOR WORK OF IMPROVEMENT AS A WHOLE, INSERT "NONE ") (DATE. OF CONTRACT]
9. The property on which said work of improvement was completed is in the City of Moorpark
Countyof Ventura Stateof CA and is described as follows: asphalt overlay on various City streets.
10. The street address of said property is None
(IF NO STREET ADDRESS HAS BEEN OFFICIALLY ASSIGNED, INSERT "NONE'.)
Dated:
(SIGNATURE OF OWNER OR CORPORATE OFFICER OF OWNER NAMED IN PARAGRAPH 2 OR HIS AGENT)
VERIFICATION
1, the undersigned, say: I am the _ _ the declarant of the foregoing notice of completion;
( "PRESIDENT OF ", 'MANAGER OF ", "PARTNER OF ", "OWNER OF ", ETC.]
I have read said notice of completion and know the contents thereof; the same is true of my own knowledge. I declare under penalty of perjury
that the foregoing is true and correct.
Executed on
, at
(STATE)
SIGNATURE OF THE INDIVIDUAL WHO IS SWEARING THAT THE CONTENTS OF THE NOTICE OF COMPLETION ARE TP.UF.)
WOLCOTTS FORM 1114 - Rev. 8 -94 (price class 3A)
NOTICE OF COMPLETION
X01994 WOLCOTTS FORMS, INC. (See reverse side for additional Information)
7 7775 39114 5