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05%18/2004 12:14 FAX 9093500290 G.W.D. INC. Z02 <br /> MAY.16.2004 7:EIAM RMCPMT EMIRONMENTAL NO.752 P.2 <br /> Jos„umm 333 so~ S. lid f4b <br /> LICENSED CONTRACTORS DECLARATION <br /> I h s!rRpl Ilfrtl am Ilancod uodsr lh.p—.lslmu ofCbKpur D(eomrararlop wiry G"g,,n 7000)0FDi—F r J a[mr f siftmi ord➢eahrlalu COde apd L�7 Iromr i■ <br /> ul Ill <br /> Lis o G 5 7 5 i (0 49 raper dns Inco J un c 30, /X0 5 <br /> Dam 115 ! ctsnfrsacor was+ <br /> OW§eik ER DECLARATfON <br /> lame%MVt&S7 W som"!M rites ft-CBr-a%='a Ltomad L&W AL eft tpttareMe R'ar=MCCbm 76315.Bma:aw aid Pro6-3aw Cadts Ary gm ar caart3r ohioh <br /> 114WI I s primA m mm"w.alaat.Ivtorta,v,dtsemUGN Cr rapd�r Wv,aumm.ptlor 0 iia ieitarlq ahe aquieu The 9101MIC ft SM p rm t to We i B=Cd BfelaSiaeR that <br /> 6s a Ue�d Daremt rSs <br /> DPW= ori Irre Carbmaa�Jaapaa la.(Cfaspar P(�olns arLslf aysrlot 700Th n173Mt)m�oc eo Agra and 2 tela Cndc1 <br /> er NR to 4 cusilwsrrttaw tmd One fasts mr the dkCed t=avdae.Arq.ntuumr o'lml+9 7037 S any aFP FQ>parrd cesll�s,dw aopFmtau a ot+�1➢GftidBr <br /> oFes cmaa•C,s E.o amrdrad chaser(wow, <br /> 01,as coups+of" m^b Ifs W"wW my Yrttc too aa,tIDaFYa <br /> mo,will do IN.dL ad pa r.-Jou"is sa moodw or anew am sale l�1eR 7063, <br /> es <br /> RoAh ,aa he, Cuda 7Le tanesatseLIee�1��i� .oe s to,a euw of 9to0m+ty,I,a bratda ar i rR�*a=%"d wft do"40:&Wom yffyp d <br /> u-Mk t 4—4"P/cm w-,Ided tea sos:b rwt tnfcaded a offbred 0r sale, 1C hvc.� he Ou <br /> ,ttWit:e or tva roarraf to maid wits%vu,Tsar et <br /> avaglaoQp,tt#D Danto�hd:Qstvil!nave the Red—of mikir tau ye did 1ldt kn Id to htgtvw ftrr the papas e!ealeJ <br /> I.v camw of the ten Oul"vely occuscum with 34c'aaod comnemn memoir=tha rr"t t Mood 7044,HI1t1n=and <br /> 'PtvdaO®a coda C3& License Law faea not apply in sm omee of Frope Y Who bods lor imprmus here=ud <br /> Wt-0 ceestruchi fax&Wh packja0 witb a oaaesotoetl;L-=acd p=usit tC the Lew-, <br /> Q!atm r undir 6e1'eiCO , 84AL for tbis r=E= <br /> Dant Owner Av if G I�.�tRj61�S <br /> WORKERS'COMPENSATION DECLAI ATIOIN <br /> cry dnm Sm r pTt s sarellaau of omsotlt m sol Ilrsum ar t tdrlfsmm eir Inturomm or a=Wed ropy lntnaf Orvlum u0t,Lu w <br /> Retplradan Dots Company <br /> O t�sa6 Dopy b Z1eabY%misbod <br /> O CWtlflod oeDy Y Cold wkTh the aov#+e==cLl Idetsht+Departmcat <br /> CERTIFICATE OF MCDOTION FROM WORKRRSa COMPENSATION INSURANCE <br /> fmia aasnrs ever ens es raeelssd?f�e�yLler ed f .,.+ dellae rt1001 ee le a\ <br /> I ctotaly sW tome pti>mfmmro or Pm Two Rin Mild oils pateh it am>d,r shall not eaaivy no'per,a7'rmsma so Is.m Imo ern to ft Wivikorv' <br /> Cemvsrdm Loans of 4hh"is. <br /> Date: Applicant <br /> NOT==APVWJCAMr,It.sAw mom, Chis Cwtflasm of 8:ntopriam,yeu tQlgW bo0M=%joa Ia ft W=k=,nMTMsmm <br /> prvrbbm cf lbs Labor 02d4 you t f=a-if�rm�7 tri Seat provaiaea ar Qrc+pd�lt th+t8 ba eaeer tv1 Lx p9�Cd. <br /> CONSTRUCTION LUMING AGENCY <br /> ha*y RTM tba th"u a lmoP/tru cn lan ding open Wr Fbr rite VW*9111111116 of rya oarl;Ipr~Nlti lov,tt Is 121111011(1 1S W Ull SOH,Civil CaMIC). <br /> Leader's:Name <br /> E.mdt'A�1"Ru. <br /> *Mmdn <br /> DIVISION OFE%TDUSTRLkL SAFETY PER IIT CERTICATION <br /> WmJ*Put N ROOttaaar 0"(1)0e PufS 01st le�Ie. oAtV&o per'men,I!teaahLd U McMd,PriB be mode in marualon rvhh wtl,w4orled 16•mdant rlo 6Yf1d41r PPvaalt9.70LibldlclCNoomm le or d,avlu4 L 29fa L OYf @mu Admit=s i.e t3mko- <br /> 0 N MW-bWde,2 will 0Mc V1cV arry=v W do W9sii wstab wotild rcgmc s pr>mit from cho Dlv�®of IaQ1:e0ie1 6a�gr,ea nctsL+ <br /> %ba g unl®a ruc.>z gc6-bas a p-11 C1 ft sorb\Decode ftp the dtviasoa <br /> Q MoD ciffox5sehl Safcry Pcrmkt a <br /> 1 eeraft*0Sf =roti Ola offummoss WA o2:010 meas mbo"Itrm"u"roo PM i gem amytry WIA mA e4 me C-M4 arft s tree tensIffsco <br /> 1t-ft ve low cap ix"maet aid sw aesw lar"s mommovttso m,and Sseo!p rsa W r"nmo rtrnam 111 Eli"am to anise=M me apesn+emeem-d pvepeety <br /> M Mj,eaitn� <br /> Date Ap�iie�rtt <br /> W7 Loa cr t]arovama tla�ltrro.,aa <br /> e�or�eo3 <br />