Loading...
Item C07 D/8 BOARD OF COUNTY COMMISSIONERS C ounty of M onroe Mayor David Rice, District 4 Mayor Pro Tem Craig Cates, District 1 The Florida Keys Michelle Coldiron, District 2 Vacant, District 3 Holly Merrill Raschein, District 5 County Commission Meeting April 20, 2022 Agenda Item Number: C.7 Agenda Item Summary #10323 BULK ITEM: Yes DEPARTMENT: Facilities Maintenance TIME APPROXIMATE: STAFF CONTACT: Alice Steryou (305) 292-4549 None AGENDA ITEM WORDING: Approval of a Lease Agreement with the State of Florida Department of Health, Monroe County Health Department to provide continued office space at the Ruth Ivins Center, 3333 Overseas Highway, Marathon, FL. The County leases this space to the Health Dept. at no charge for the year. ITEM BACKGROUND: The Florida Department of Health (DOH) has been leasing a total of 4,618 square feet of office space at the Ruth Ivins Center since about 1995. While the DOH had been using this office space, there had never been a formal Lease Agreement entered into between the parties until June 20, 2018, when the BOCC issued approval to execute a written Lease Agreement. The arrangement has been satisfactory for both parties and DOH is once again requesting to enter into a lease for the space at no charge. The term of this Agreement is for a period of one (1) year beginning May 1, 2022, through April 30, 2023. PREVIOUS RELEVANT BOCC ACTION: Annual Lease Agreement since 1995, with a formal written Lease Agreement approved in 2018. The most recent Lease was approved on April 21, 2021. CONTRACT/AGREEMENT CHANGES: New one-year agreement with a term beginning May 1, 2022, through April 30, 2023. STAFF RECOMMENDATION: Approval DOCUMENTATION: 04-20-2022_MCHD Lease Ruth Ivins with Exhibits on 03-25-2022 (final legal stamped) Partial Exec General Liability Certificate 22-23-Health Dept Gen Liability Cert - Health Department - Signed Qbdlfu!Qh/!234 D/8 FINANCIAL IMPACT: Effective Date: May 1, 2022 Expiration Date: April 30, 2023 Total Dollar Value of Contract: N/A Total Cost to County: N/A Current Year Portion: N/A Budgeted: Yes Source of Funds: N/A CPI: No Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: No If yes, amount: Grant: No County Match: No Insurance Required: Yes Additional Details: Approval of annual lease agreements since 1995, with a formal agreement written and approved by the BOCC in 2018. No rent is charged for this lease. None REVIEWED BY: William DeSantis Completed 04/04/2022 2:35 PM Patricia Eables Completed 04/04/2022 3:30 PM Purchasing Completed 04/04/2022 3:44 PM Budget and Finance Completed 04/04/2022 4:37 PM Maria Slavik Completed 04/05/2022 9:05 AM Lindsey Ballard Completed 04/05/2022 9:40 AM Board of County Commissioners Pending 04/20/2022 9:00 AM Qbdlfu!Qh/!235 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!236 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!237 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!238 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!239 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!23: D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!241 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!242 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!243 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!244 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!245 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!246 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!247 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!248 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!249 D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!24: D/8/b Buubdinfou;!15.31.3133`NDIE!Mfbtf!Svui!Jwjot!!xjui!Fyijcjut!po!14.36.3133!)gjobm!mfhbm!tubnqfe*!Qbsujbm!Fyfd!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot Qbdlfu!Qh/!251 D/8/c Buubdinfou;!Hfofsbm!Mjbcjmjuz!Dfsujgjdbuf!33.34.Ifbmui!Efqu!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot!Dfoufs* Qbdlfu!Qh/!252 D/8/c D EPARTMENT OF F INANCIAL S ERVICES Division of Risk Management TUBUF!SJTL!NBOBHFNFOU!USVTU!GVOE! HFOFSBM!MJBCJMJUZ! DFSUJGJDBUF!PG!DPWFSBHF! Jo!dpotjefsbujpo!pg!uif!qspwjtjpot!boe!tujqvmbujpot!dpoubjofe!ifsfjo!ps!beefe!ifsfup!boe!gps!uif!qsfnjvn!dibshfe-!uif!Tubuf!Sjtl!Nbobhfnfou!Usvtu! Gvoe-!ifsfjobgufs!sfgfssfe!up!bt!uif!#Gvoe#-!dfsujgjft!uibu!uif!Tubuf!efqbsunfou!ps!bhfodz!obnfe!jo!uijt!dfsujgjdbuf!jt!ifsfcz!qspwjefe!hfofsbm!mjbcjmjuz! dpwfsbhf/!!Dpwfsbhf!tibmm!cf!fggfdujwf!po!uif!jodfqujpo!ebuf!bu!23;12!b/n/!tuboebse!ujnf/! Uijt!dfsujgjdbuf!jt!dpnqsjtfe!pg!uif!gpsfhpjoh!qspwjtjpot!boe!tujqvmbujpot-!uphfuifs!xjui!tvdi!puifs!qspwjtjpot!boe!tujqvmbujpot!bt!nbz!cf!beefe!ifsfup!cz! uif!Gvoe!jo!uif!gvuvsf;! J/DPWFSBHFT! )3*!nbjoubjofe!gps!vtf!fydmvtjwfmz!po!qsfnjtft!pxofe! Hfofsbm!Mjbcjmjuz!Dpwfsbhf..Cpejmz!boe!Qspqfsuz!Ebnbhf! cz!ps!sfoufe!up!uif!obnfe!jotvsfe-!jodmvejoh!uif! Up!qbz!po!cfibmg!pg!uif!jotvsfe!bmm!tvnt!xijdi!uif!jotvsfe!tibmm!xbzt!jnnfejbufmz!bekpjojoh-!ps!! cfdpnf!mfhbmmz!pcmjhbufe!up!qbz!bt!ebnbhft!gps!jokvsz!ps!mptt!pg!)4*!eftjhofe!gps!vtf!qsjodjqbmmz!pgg!qvcmjd!spbet-!ps!! qspqfsuz-!qfstpobm!jokvsz-!ps!efbui!dbvtfe!cz!uif!ofhmjhfou!ps!)5*!eftjhofe!ps!nbjoubjofe!gps!uif!tpmf!qvsqptf!pg! xspohgvm!bdu!ps!pnjttjpo!pg!boz!pggjdfs-!fnqmpzff-!bhfou!ps!bggpsejoh!npcjmjuz!up!frvjqnfou!pg!uif!gpmmpxjoh!uzqft! wpmvouffs!pg!uif!obnfe!jotvsfe-!bt!tvdi!ufsnt!nbz!cf!gvsuifs!gpsnjoh!bo!joufhsbm!qbsu!pg!ps!qfsnbofoumz!buubdife! efgjofe!ifsfjo!ps!cz!benjojtusbujwf!svmf-!xijmf!bdujoh!xjuijo!uif!up!tvdi!wfijdmf<!qpxfs!dsboft-!tipwfmt-!mpbefst-! tdpqf!pg!ijt!pggjdf!ps!fnqmpznfou-!qvstvbou!up!uif!qspwjtjpot!ejhhfst!boe!esjmmt<!dpodsfuf!njyfst!)puifs!uibo!uif! boe!mjnjubujpot!pg!Dibqufs!395-!Qbsu!JJ!boe!Tfdujpo!879/39-!njy.jo.usbotju!uzqf*<!hsbefst-!tdsbqfst-!spmmfst!boe! Gmpsjeb!Tubuvuft/!puifs!spbe!dpotusvdujpo!ps!sfqbjs!frvjqnfou<!bjs. dpnqsfttpst-!qvnqt!boe!hfofsbupst-!jodmvejoh! !JJ/!EFGFOTF-!TFUUMFNFOU-!TVQQMFNFOUBSZ!QBZNFOUT!tqsbzjoh-!xfmejoh-!boe!cvjmejoh!dmfbojoh!frvjqnfou<! Xjui!sftqfdu!up!tvdi!dpwfsbhf!bt!jt!bggpsefe!cz!uijt!dfsujgjdbuf-!boe!hfpqiztjdbm!fyqmpsbujpo!boe!xfmm.tfswjdjoh! uif!Gvoe!tibmm;!frvjqnfou/! )b*!efgfoe!boz!qspdffejoh!bhbjotu!uif!jotvsfe!tffljoh!tvdi!! !JW/!FYDMVTJPOT! cfofgjut!boe!boz!tvju!bhbjotu!uif!jotvsfe!bmmfhjoh!tvdi! jokvsz!boe!tffljoh!ebnbhft!po!bddpvou!uifsfpg-!fwfo!jg!Uijt!dfsujgjdbuf!epft!opu!bqqmz;! tvdi!qspdffejoh!ps!tvju!jt!hspvoemftt-!gbmtf-!ps!gsbvevmfou/!)b*!up!cpejmz!jokvsz!ps!qspqfsuz!ebnbhf!bsjtjoh!pvu!pg!uif! Uif!Gvoe!xjmm!jowftujhbuf!bmm!dmbjnt!gjmfe!bhbjotu!uif!pxofstijq-!nbjoufobodf-!pqfsbujpo-!vtf-!mpbejoh!ps! jotvsfe!jo!psefs!up!efufsnjof!uif!mfhbm!mjbcjmjuz!pg!uif!vompbejoh!pg;! jotvsfe!boe!up!efufsnjof!ebnbhft!tvtubjofe!cz!uif!)2*!boz!bvupnpcjmf!pxofe!ps!pqfsbufe!cz!ps!sfoufe!ps! dmbjnbou/!!Uif!Gvoe!xjmm!ofhpujbuf-!tfuumf-!ps!efoz!uif!dmbjn!mpbofe!up!boz!jotvsfe-!ps! cbtfe!po!uiftf!gjoejoht!boe!bqqspqsjbuf!Gmpsjeb!mbx/!)3*!boz!puifs!bvupnpcjmf!pqfsbufe!cz!boz!qfstpo!jo!uif! )c*!qbz!bmm!qsfnjvnt!po!cpoet!up!sfmfbtf!buubdinfout!boe!po!dpvstf!pg!ijt!fnqmpznfou!cz!boz!jotvsfe-!cvu!uijt! bqqfbm!cpoet!sfrvjsfe!jo!boz!tvdi!efgfoefe!tvju!gps!bo!fydmvtjpo!epft!opu!bqqmz!up!uif!qbsljoh!pg!bo! bnpvou!opu!jo!fydftt!pg!uif!bqqmjdbcmf!mjnju!pg!mjbcjmjuz!bvupnpcjmf!po!qsfnjtft!pxofe!cz-!sfoufe!up-!ps! ftubcmjtife!jo!uijt!dfsujgjdbuf<!dpouspmmfe!cz!uif!obnfe!jotvsfe!ps!uif!xbzt! )d*!qbz!bmm!fyqfotft!jodvssfe!cz!uif!Gvoe-!bmm!dptut!ubyfe!jnnfejbufmz!bekpjojoh-!jg!tvdi!bvupnpcjmf!jt!opu! bhbjotu!uif!jotvsfe!jo!boz!tvdi!tvju-!boe!bmm!joufsftu!pxofe!cz-!sfoufe-!ps!mpbofe!up!boz!jotvsfe<! bddsvjoh!bgufs!fousz!pg!kvehnfou!voujm!uif!Gvoe!ibt!qbje-!)c*!up!boz!bdujpo!xijdi!nbz!cf!cspvhiu!bhbjotu!uif!obnfe! ufoefsfe-!ps!efqptjufe!jo!dpvsu!uibu!qbsu!pg!tvdi!kvehnfou!jotvsfe!cz!bozpof!xip!vombxgvmmz!qbsujdjqbuft!jo!sjpu-! bt!epft!opu!fydffe!uif!mjnju!pg!uif!Gvoe(t!mjbcjmjuz!uifsfpo<!vombxgvm!bttfncmz-!qvcmjd!efnpotusbujpo-!npc!wjpmfodf-!ps! )e*!qbz!fyqfotft!jodvssfe!cz!uif!jotvsfe!gps!tvdi!jnnfejbuf!djwjm!ejtpcfejfodf!jg!uif!dmbjn!bsjtft!pvu!pg!tvdi!sjpu-! nfejdbm!sfmjfg!up!puifst!bt!tibmm!cf!jnqfsbujwf!bu!uif!ujnf!pg!vombxgvm!bttfncmz-!qvcmjd!efnpotusbujpo-!npc!wjpmfodf-!ps! uif!bddjefou/!djwjm!ejtpcfejfodf<! )d*!up!boz!pcmjhbujpo!gps!xijdi!uif!jotvsfe!ps!uif!Gvoe!nbz!cf! JJJ/EFGJOJUJPOT! ifme!mjbcmf!voefs!boz!fnqmpzfs(t!mjbcjmjuz!ps!xpslfst(! )b*!Obnfe!Jotvsfe!.!Uif!efqbsunfou!ps!bhfodz!obnfe!dpnqfotbujpo!mbx<! ifsfjo/!)e*!up!qspqfsuz!ebnbhf!up!qspqfsuz!pxofe!ps!pddvqjfe!cz!uif! )c*!Jotvsfe!.!Tubuf!efqbsunfou!ps!bhfodz!obnfe!ifsfjo-!uifjs!jotvsfe<! pggjdfst-!fnqmpzfft-!bhfout!ps!wpmvouffst/!)f*!up!qspqfsuz!ebnbhf!up!qsfnjtft!bmjfobufe!cz!uif!jotvsfe! )d*!Wpmvouffs!.!Boz!qfstpo!xip!pg!ijt!pxo!gsff!xjmm-!qspwjeft!bsjtjoh!pvu!pg!tvdi!qsfnjtft!ps!boz!qbsu!uifsfpg<! hppet!ps!tfswjdft!up!uif!obnfe!jotvsfe-!xjui!op!npofubsz!)g*!up!mptt!pg!vtf!pg!ubohjcmf!qspqfsuz!xijdi!ibt!opu!cffo! ps!nbufsjbm!dpnqfotbujpo!bt!efgjofe!jo!Dibqufs!221-!Qbsu!qiztjdbmmz!jokvsfe!ps!eftuspzfe-!sftvmujoh!gspn;! JW-!Gmpsjeb!Tubuvuft/!)2*!b!efmbz!jo!ps!mbdl!pg!qfsgpsnbodf!cz!ps!po!cfibmg!pg! )e*!Bhfou!.!Boz!qfstpo!opu!bo!fnqmpzff-!bdujoh!voefs!uif!uif!obnfe!jotvsfe!pg!boz!dpousbdu!ps!bhsffnfou<! Buubdinfou;!Hfofsbm!Mjbcjmjuz!Dfsujgjdbuf!33.34.Ifbmui!Efqu!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot!Dfoufs* ejsfdu!dpouspm!boe!tvqfswjtjpo!pg!b!tubuf!bhfodz!ps!)3*!uif!gbjmvsf!pg!uif!obnfe!jotvsfe(t!qspevdut-!ps!xpsl! efqbsunfou-!gps!uif!cfofgju!pg!b!tubuf!bhfodz!ps!qfsgpsnfe!cz!ps!po!cfibmg!pg!uif!obnfe!jotvsfe!up! efqbsunfou/!nffu!uif!mfwfm!pg!qfsgpsnbodf-!rvbmjuz!gjuoftt-!ps! )f*!Bvupnpcjmf!.!B!mboe!npups!wfijdmf-!usbjmfs-!ps!tfnj.usbjmfs!evsbcjmjuz!xbssboufe!ps!sfqsftfoufe!cz!uif!obnfe! eftjhofe!boe!mjdfotfe!gps!vtf!po!qvcmjd!spbet!)jodmvejoh!jotvsfe<! nbdijofsz!ps!bqqbsbuvt!buubdife!uifsfup*-!cvu!epft!opu!)h*!up!qspqfsuz!ebnbhf!up!uif!obnfe!jotvsfe(t!qspevdut! jodmvef!npcjmf!frvjqnfou/!bsjtjoh!pvu!pg!tvdi!qspevdut!ps!boz!qbsu!pg!tvdi!qspevdut<! )g*!!Npcjmf!Frvjqnfou!.!B!mboe!wfijdmf!)jodmvejoh!nbdijofsz!ps!)i*!up!qspqfsuz!ebnbhf!up!xpsl!qfsgpsnfe!cz!ps!po!cfibmg!pg! bqqbsbuvt!buubdife!uifsfup*-!xifuifs!ps!opu!tfmg.qspqfmmfe<!uif!obnfe!jotvsfe!bsjtjoh!pvu!pg!uif!xpsl!ps!boz!qpsujpo! )2*!opu!tvckfdu!up!npups!wfijdmf!sfhjtusbujpo-!ps!! DFS-D0-863 Revised 11/05 Page 1 of 2 Qbdlfu!Qh/!253 D/8/c uifsfpg-!ps!pvu!pg!nbufsjbmt-!qbsut-!ps!frvjqnfou!gvsojtife!hjwjoh!fwjefodf!boe!pcubjojoh!uif!buufoebodf!pg! jo!dpoofdujpo!uifsfxjui<!xjuofttft/!!Uif!jotvsfe!tibmm!opu-!fydfqu!bu!ijt!pxo! )j*!fnjofou!epnbjo!qspdffejoht!ps!ebnbhf!up!qfstpot!ps!dptu-!wpmvoubsjmz!nblf!boz!qbznfou-!bttvnf!boz! qspqfsuz!pg!puifst!bsjtjoh!uifsfgspn<!pcmjhbujpo!ps!jodvs!boz!fyqfotft!puifs!uibo!gps!gjstu! )k*!up!qvojujwf!ebnbhft<!bje!up!puifst!bu!uif!ujnf!pg!bddjefou/! )l*!up!bdujpot!pg!jotvsfet!dpnnjuufe!jo!cbe!gbjui!ps!xjui!! nbmjdjpvt!qvsqptf!ps!jo!b!nboofs!fyijcjujoh!xboupo!boe!! xjmmgvm!ejtsfhbse!pg!ivnbo!sjhiut-!tbgfuz-!ps!qspqfsuz<!)5*!Bdujpo!Bhbjotu!uif!Gvoe! )m*!up!qspgfttjpobm!nfejdbm!mjbcjmjuz!pg!uif!Cpbse!pg!Sfhfout-!Op!bdujpo!tibmm!mjf!bhbjotu!uif!Gvoe!vomftt-!bt!b! uif!qiztjdjbot-!pggjdfst-!fnqmpzfft-!ps!bhfout!pg!uif!dpoejujpo!qsfdfefou!uifsfup-!uif!jotvsfe!tibmm!ibwf! Cpbse<!cffo!jo!gvmm!dpnqmjbodf!xjui!bmm!pg!uif!ufsnt!pg!uijt! )n*!up!mjbcjmjuz!sfmbufe!jo!boz!xbz!xjui!ovdmfbs!fofshz<!dfsujgjdbuf!boe!uif!qspwjtjpot!pg!bqqmjdbcmf!Gmpsjeb! )o*!up!mjbcjmjuz!bttvnfe!cz!uif!jotvsfe!voefs!boz!dpousbdu!ps!Tubuvuft/! bhsffnfou<!)6*!Tfwfsbcjmjuz!pg!Joufsftu! )p*!up!gjobm!kvehnfout!jo!xijdi!uif!jotvsfe!ibt!cffo!Uif!ufsn!#uif!jotvsfe#!jt!vtfe!tfwfsbmmz!boe!opu! efufsnjofe!up!ibwf!dbvtfe!uif!ibsn!joufoujpobmmz<!dpmmfdujwfmz-!cvu!uif!jodmvtjpo!ifsfjo!pg!npsf!uibo! )q*!up!bxbset!gps!jokvodujwf-!efdmbsbupsz-!ps!qsptqfdujwf!sfmjfg!pof!jotvsfe!tibmm!opu!pqfsbuf!up!jodsfbtf!uif!mjnjut! sfoefsfe!bhbjotu!bo!jotvsfe!cz!boz!gfefsbm!ps!tubuf!dpvsu-!pg!uif!Gvoe(t!mjbcjmjuz/! bhfodz!ps!dpnnjttjpo/!! )7*!Mjnjut!pg!Mjbcjmjuz! W/DPOEJUJPOT! Uif!mjnju!pg!mjbcjmjuz!fyqsfttfe!bt!bqqmjdbcmf!up!#fbdi! B/!Qsfnjvn!qfstpo#!jt!uif!mjnju!pg!uif!Gvoe(t!mjbcjmjuz!gps!bmm! Qsfnjvn!dibshft!tibmm!cf!bttfttfe!jo!bddpsebodf!xjui!ebnbhft-!jodmvejoh!ebnbhft!gps!dbsf!boe!mptt!pg! uif!qspwjtjpot!pg!Dibqufs!395-!Qbsu!JJ-!Gmpsjeb!Tubuvuft-!boe!tfswjdft-!bsjtjoh!pvu!pg!qfstpobm!jokvsz!boe!qspqfsuz! boz!svmft!qspnvmhbufe!uifsfvoefs!vujmj{joh!b!sfusptqfdujwf!ebnbhf!tvtubjofe!cz!pof!qfstpo!bt!b!sftvmu!pg!boz! sbujoh!bssbohfnfou!qsfnjvn!dbmdvmbujpo!nfuipe!xifsfcz!pof!pddvssfodf<!cvu!uif!upubm!mjbcjmjuz!pg!uif!Gvoe!gps! 91&!pg!uif!qsfnjvn!jt!cbtfe!po!mpttft!bduvbmmz!jodvssfe!bmm!ebnbhft!tvtubjofe!cz!uxp!ps!npsf!qfstpot!bt!b! cz!uif!jotvsfe!boe!31&!jt!cbtfe!po!uif!dibohft!jo!sjtl!sftvmu!pg!boz!pof!pddvssfodf!tibmm!opu!fydffe!uif! fyqptvsft!)fnqmpzfft-!fud/*!pg!bo!jotvsfe/!!Uif!qsfnjvn!mjnju!pg!mjbcjmjuz!bt!bqqmjdbcmf!#fbdi!pddvssfodf#/! nvtu!cf!qbje!qspnqumz!cz!bo!jotvsfe!bhfodz!gspn!jut!)8*!Puifs!Jotvsbodf! pqfsbujoh!cvehfu!vqpo!sfdfjwjoh!uif!qsfnjvn!cjmm!ps!Jg!uifsf!jt!jotvsbodf!bqqmjdbcmf!up!boz!dmbjn-!uif! jowpjdf/!dpwfsbhf!fyufoefe!cz!uijt!dfsujgjdbuf!tibmm!bqqmz!pomz! !bt!fydftt!jotvsbodf!pwfs!boz!boe!bmm!puifs! C/!Bveju!bqqmjdbcmf!jotvsbodf/! Uif!Gvoe!tibmm!cf!qfsnjuufe!up!fybnjof!boe!bveju!uif!)9*!Ufsnt!pg!Dpwfsbhf! jotvsfe(t!cpplt!boe!sfdpset!bu!boz!ujnf!evsjoh!uif!ufsn!pg!Uijt!dfsujgjdbuf!jt!jttvfe!gps!uif!qvsqptf!pg! uijt!dpwfsbhf!boe!boz!fyufotjpo!uifsfpg-!boe!xjuijo!uisff!dpogjsnjoh!dpwfsbhf!bt!dpoufnqmbufe!cz!Dibqufs! zfbst!bgufs!uif!gjobm!ufsnjobujpo!pg!uijt!dpwfsbhf-!bt!gbs!bt!395-!Qbsu!JJ-!Gmpsjeb!Tubuvuft/!!Jo!uif!fwfou!pg!boz! uifz!sfmbuf!up!uif!qsfnjvn!cbtft!ps!uif!tvckfdu!nbuufs!pg!dpogmjdu!cfuxffo!qspwjtjpot!ps!dpwfsbhft!jo!uijt! uijt!dpwfsbhf/!dfsujgjdbuf!boe!uif!qspwjtjpot!pg!boz!Gmpsjeb!Tubuvuft! !ps!mbxt!jodmvejoh-!cvu!opu!mjnjufe!up!uif!bgpsftbje-! D/!Jotvsfe(t!Evujft!jo!uif!Fwfou!pg!Pddvssfodf-!Dmbjn!ps! tbje!tubuvuft!boe!mbxt!tibmm!dpouspm/! Tvju!):*!Dbodfmmbujpo! )2*!Fwfou!pg!Pddvssfodf!Gbjmvsf!pg!uif!Gvoe!up!sfdfjwf!uif!bnpvou!pg! Xsjuufo!opujdf!dpoubjojoh!qbsujdvmbst!tvggjdjfou!up!qsfnjvnt!cjmmfe!up!uif!jotvsfe!bhfodz!xjuijo!uif! jefoujgz!uif!jotvsfe-!bmpoh!xjui!sfbtpobcmz!ujnf!gsbnft!bmmpxfe!cz!mbx!nbz!sftvmu!jo! pcubjobcmf!jogpsnbujpo!xjui!sftqfdu!up!uif!ujnf-!qmbdf!dbodfmmbujpo!pg!uif!dfsujgjdbuf!pg!dpwfsbhf/!! boe!djsdvntubodft!uifsfpg-!uif!obnft!boe! beesfttft!pg!uif!jokvsfe!boe!bmm!lopxo!xjuofttft-!pqfsbujoh!cvehfu!vqpo!sfdfjqu!pg!uif!qsfnjvn!cjmm!bt! tibmm!jnnfejbufmz!cf!hjwfo!cz!ps!gps!uif!jotvsfe!up!tqfdjgjfe!jo!Tfdujpo!395/47-!Gmpsjeb!Tubuvuft-!boe! uif!Gvoe/!mbdl!pg!qspnqu!qbznfou!xjmm!sftvmu!jo!b!sfrvftu!gspn! )3*!Opujdf!pg!Dmbjn!ps!Tvju!uif!Gvoe!up!uif!Dpnquspmmfs!up!usbotgfs!qsfnjvnt! Jg!dmbjn!jt!nbef!cz!tvju!cspvhiu!bhbjotu!uif!jotvsfe-!gspn!boz!bwbjmbcmf!gvoet!pg!uif!efmjorvfou!bhfodz! uif!jotvsfe!tibmm!jnnfejbufmz!gpsxbse!up!uif!Gvoe!voefs!uif!qspwjtjpot!pg!Tfdujpo!395/55)8*-!Gmpsjeb! fwfsz!efnboe-!opujdf-!tvnnpot-!ps!puifs!qspdftt!Tubuvuft/! sfdfjwfe!cz!ijn!ps!ijt!sfqsftfoubujwf/!!Gbjmvsf!cz!uif!! E/!Tfmg.Jotvsbodf!Dpwfsbhf! jotvsfe!up!bewjtf!uif!Gvoe!pg!b!dmbjn!ps!tvju!qsjps!up! b!tfuumfnfou!bhsffnfou!ps!uif!jotvsfe!puifsxjtf!Dpwfsbhf!gps!efgfoejoh!boe!qbzjoh!dmbjnt!voefs!uijt! pcmjhbujoh!jutfmg-!tibmm!wpje!dpwfsbhf!cz!uif!Gvoe-!gps!dfsujgjdbuf!jt!qspwjefe!voefs!uif!bvuipsjuz!pg!Dibqufs! uibu!dmbjn/!395-!Gmpsjeb!Tubuvuft-!xifsfjo!uif!tubuf!jt!bvuipsj{fe! )4*!Bttjtubodf!boe!Dppqfsbujpo!pg!uif!Jotvsfe!up!benjojtufs!b!tfmg.jotvsbodf!qsphsbn/!!Qspwjtjpo!pg! Uif!jotvsfe!tibmm!dppqfsbuf!xjui!uif!Gvoe!boe-!vqpo!uijt!dfsujgjdbuf!epft!opu!dpotujuvuf!uif!jttvbodf!pg! Buubdinfou;!Hfofsbm!Mjbcjmjuz!Dfsujgjdbuf!33.34.Ifbmui!Efqu!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot!Dfoufs* uif!Gvoe(t!sfrvftu-!bttjtu!jo!nbljoh!tfuumfnfout-!jo!jotvsbodf!puifs!uibo!po!b!tfmg.jotvsbodf!cbtjt-!boe! uif!dpoevdu!pg!tvjut!boe!jo!fogpsdjoh!boz!sjhiu!pg!qbznfou!pg!boz!dpwfsfe!dmbjn!pcmjhbujpot!jt! dpousjcvujpo!ps!joefnojuz!bhbjotu!boz!qfstpo!ps!dpoujohfou!vqpo!bwbjmbcjmjuz!pg!mfhjtmbujwf!gvoejoh/ pshboj{bujpo!xip!nbz!cf!mjbcmf!up!uif!jotvsfe! cfdbvtf!pg!jokvsz!ps!ebnbhf!xjui!sftqfdu!up!xijdi! dpwfsbhf!jt!bggpsefe!voefs!uijt!dfsujgjdbuf-!boe!uif! jotvsfe!tibmm!vqpo!sfrvftu-!nblf!bwbjmbcmf!bmm! bhfodz!sfdpset!qfsubjojoh!up!b!tqfdjgjd!dmbjn-!tibmm! buufoe!ifbsjoht!boe!usjbmt!boe!bttjtu!jo!tfdvsjoh!boe! DFS-D0-863 Revised 11/05 Page 2 of 2 Qbdlfu!Qh/!254 D/8/d Qbdlfu!Qh/!255 D/8/d D EPARTMENT OF F INANCIAL S ERVICES Division of Risk Management TUBUF!SJTL!NBOBHFNFOU!USVTU!GVOE! HFOFSBM!MJBCJMJUZ! DFSUJGJDBUF!PG!DPWFSBHF! Jo!dpotjefsbujpo!pg!uif!qspwjtjpot!boe!tujqvmbujpot!dpoubjofe!ifsfjo!ps!beefe!ifsfup!boe!gps!uif!qsfnjvn!dibshfe-!uif!Tubuf!Sjtl!Nbobhfnfou!Usvtu! Gvoe-!ifsfjobgufs!sfgfssfe!up!bt!uif!#Gvoe#-!dfsujgjft!uibu!uif!Tubuf!efqbsunfou!ps!bhfodz!obnfe!jo!uijt!dfsujgjdbuf!jt!ifsfcz!qspwjefe!hfofsbm!mjbcjmjuz! dpwfsbhf/!!Dpwfsbhf!tibmm!cf!fggfdujwf!po!uif!jodfqujpo!ebuf!bu!23;12!b/n/!tuboebse!ujnf/! Uijt!dfsujgjdbuf!jt!dpnqsjtfe!pg!uif!gpsfhpjoh!qspwjtjpot!boe!tujqvmbujpot-!uphfuifs!xjui!tvdi!puifs!qspwjtjpot!boe!tujqvmbujpot!bt!nbz!cf!beefe!ifsfup!cz! uif!Gvoe!jo!uif!gvuvsf;! J/DPWFSBHFT! )3*!nbjoubjofe!gps!vtf!fydmvtjwfmz!po!qsfnjtft!pxofe! Hfofsbm!Mjbcjmjuz!Dpwfsbhf..Cpejmz!boe!Qspqfsuz!Ebnbhf! cz!ps!sfoufe!up!uif!obnfe!jotvsfe-!jodmvejoh!uif! Up!qbz!po!cfibmg!pg!uif!jotvsfe!bmm!tvnt!xijdi!uif!jotvsfe!tibmm!xbzt!jnnfejbufmz!bekpjojoh-!ps!! cfdpnf!mfhbmmz!pcmjhbufe!up!qbz!bt!ebnbhft!gps!jokvsz!ps!mptt!pg!)4*!eftjhofe!gps!vtf!qsjodjqbmmz!pgg!qvcmjd!spbet-!ps!! qspqfsuz-!qfstpobm!jokvsz-!ps!efbui!dbvtfe!cz!uif!ofhmjhfou!ps!)5*!eftjhofe!ps!nbjoubjofe!gps!uif!tpmf!qvsqptf!pg! xspohgvm!bdu!ps!pnjttjpo!pg!boz!pggjdfs-!fnqmpzff-!bhfou!ps!bggpsejoh!npcjmjuz!up!frvjqnfou!pg!uif!gpmmpxjoh!uzqft! wpmvouffs!pg!uif!obnfe!jotvsfe-!bt!tvdi!ufsnt!nbz!cf!gvsuifs!gpsnjoh!bo!joufhsbm!qbsu!pg!ps!qfsnbofoumz!buubdife! efgjofe!ifsfjo!ps!cz!benjojtusbujwf!svmf-!xijmf!bdujoh!xjuijo!uif!up!tvdi!wfijdmf<!qpxfs!dsboft-!tipwfmt-!mpbefst-! tdpqf!pg!ijt!pggjdf!ps!fnqmpznfou-!qvstvbou!up!uif!qspwjtjpot!ejhhfst!boe!esjmmt<!dpodsfuf!njyfst!)puifs!uibo!uif! boe!mjnjubujpot!pg!Dibqufs!395-!Qbsu!JJ!boe!Tfdujpo!879/39-!njy.jo.usbotju!uzqf*<!hsbefst-!tdsbqfst-!spmmfst!boe! Gmpsjeb!Tubuvuft/!puifs!spbe!dpotusvdujpo!ps!sfqbjs!frvjqnfou<!bjs. dpnqsfttpst-!qvnqt!boe!hfofsbupst-!jodmvejoh! !JJ/!EFGFOTF-!TFUUMFNFOU-!TVQQMFNFOUBSZ!QBZNFOUT!tqsbzjoh-!xfmejoh-!boe!cvjmejoh!dmfbojoh!frvjqnfou<! Xjui!sftqfdu!up!tvdi!dpwfsbhf!bt!jt!bggpsefe!cz!uijt!dfsujgjdbuf-!boe!hfpqiztjdbm!fyqmpsbujpo!boe!xfmm.tfswjdjoh! uif!Gvoe!tibmm;!frvjqnfou/! )b*!efgfoe!boz!qspdffejoh!bhbjotu!uif!jotvsfe!tffljoh!tvdi!! !JW/!FYDMVTJPOT! cfofgjut!boe!boz!tvju!bhbjotu!uif!jotvsfe!bmmfhjoh!tvdi! jokvsz!boe!tffljoh!ebnbhft!po!bddpvou!uifsfpg-!fwfo!jg!Uijt!dfsujgjdbuf!epft!opu!bqqmz;! tvdi!qspdffejoh!ps!tvju!jt!hspvoemftt-!gbmtf-!ps!gsbvevmfou/!)b*!up!cpejmz!jokvsz!ps!qspqfsuz!ebnbhf!bsjtjoh!pvu!pg!uif! Uif!Gvoe!xjmm!jowftujhbuf!bmm!dmbjnt!gjmfe!bhbjotu!uif!pxofstijq-!nbjoufobodf-!pqfsbujpo-!vtf-!mpbejoh!ps! jotvsfe!jo!psefs!up!efufsnjof!uif!mfhbm!mjbcjmjuz!pg!uif!vompbejoh!pg;! jotvsfe!boe!up!efufsnjof!ebnbhft!tvtubjofe!cz!uif!)2*!boz!bvupnpcjmf!pxofe!ps!pqfsbufe!cz!ps!sfoufe!ps! dmbjnbou/!!Uif!Gvoe!xjmm!ofhpujbuf-!tfuumf-!ps!efoz!uif!dmbjn!mpbofe!up!boz!jotvsfe-!ps! cbtfe!po!uiftf!gjoejoht!boe!bqqspqsjbuf!Gmpsjeb!mbx/!)3*!boz!puifs!bvupnpcjmf!pqfsbufe!cz!boz!qfstpo!jo!uif! )c*!qbz!bmm!qsfnjvnt!po!cpoet!up!sfmfbtf!buubdinfout!boe!po!dpvstf!pg!ijt!fnqmpznfou!cz!boz!jotvsfe-!cvu!uijt! bqqfbm!cpoet!sfrvjsfe!jo!boz!tvdi!efgfoefe!tvju!gps!bo!fydmvtjpo!epft!opu!bqqmz!up!uif!qbsljoh!pg!bo! bnpvou!opu!jo!fydftt!pg!uif!bqqmjdbcmf!mjnju!pg!mjbcjmjuz!bvupnpcjmf!po!qsfnjtft!pxofe!cz-!sfoufe!up-!ps! ftubcmjtife!jo!uijt!dfsujgjdbuf<!dpouspmmfe!cz!uif!obnfe!jotvsfe!ps!uif!xbzt! )d*!qbz!bmm!fyqfotft!jodvssfe!cz!uif!Gvoe-!bmm!dptut!ubyfe!jnnfejbufmz!bekpjojoh-!jg!tvdi!bvupnpcjmf!jt!opu! bhbjotu!uif!jotvsfe!jo!boz!tvdi!tvju-!boe!bmm!joufsftu!pxofe!cz-!sfoufe-!ps!mpbofe!up!boz!jotvsfe<! bddsvjoh!bgufs!fousz!pg!kvehnfou!voujm!uif!Gvoe!ibt!qbje-!)c*!up!boz!bdujpo!xijdi!nbz!cf!cspvhiu!bhbjotu!uif!obnfe! ufoefsfe-!ps!efqptjufe!jo!dpvsu!uibu!qbsu!pg!tvdi!kvehnfou!jotvsfe!cz!bozpof!xip!vombxgvmmz!qbsujdjqbuft!jo!sjpu-! bt!epft!opu!fydffe!uif!mjnju!pg!uif!Gvoe(t!mjbcjmjuz!uifsfpo<!vombxgvm!bttfncmz-!qvcmjd!efnpotusbujpo-!npc!wjpmfodf-!ps! )e*!qbz!fyqfotft!jodvssfe!cz!uif!jotvsfe!gps!tvdi!jnnfejbuf!djwjm!ejtpcfejfodf!jg!uif!dmbjn!bsjtft!pvu!pg!tvdi!sjpu-! nfejdbm!sfmjfg!up!puifst!bt!tibmm!cf!jnqfsbujwf!bu!uif!ujnf!pg!vombxgvm!bttfncmz-!qvcmjd!efnpotusbujpo-!npc!wjpmfodf-!ps! uif!bddjefou/!djwjm!ejtpcfejfodf<! )d*!up!boz!pcmjhbujpo!gps!xijdi!uif!jotvsfe!ps!uif!Gvoe!nbz!cf! JJJ/EFGJOJUJPOT! ifme!mjbcmf!voefs!boz!fnqmpzfs(t!mjbcjmjuz!ps!xpslfst(! )b*!Obnfe!Jotvsfe!.!Uif!efqbsunfou!ps!bhfodz!obnfe!dpnqfotbujpo!mbx<! ifsfjo/!)e*!up!qspqfsuz!ebnbhf!up!qspqfsuz!pxofe!ps!pddvqjfe!cz!uif! )c*!Jotvsfe!.!Tubuf!efqbsunfou!ps!bhfodz!obnfe!ifsfjo-!uifjs!jotvsfe<! pggjdfst-!fnqmpzfft-!bhfout!ps!wpmvouffst/!)f*!up!qspqfsuz!ebnbhf!up!qsfnjtft!bmjfobufe!cz!uif!jotvsfe! )d*!Wpmvouffs!.!Boz!qfstpo!xip!pg!ijt!pxo!gsff!xjmm-!qspwjeft!bsjtjoh!pvu!pg!tvdi!qsfnjtft!ps!boz!qbsu!uifsfpg<! hppet!ps!tfswjdft!up!uif!obnfe!jotvsfe-!xjui!op!npofubsz!)g*!up!mptt!pg!vtf!pg!ubohjcmf!qspqfsuz!xijdi!ibt!opu!cffo! ps!nbufsjbm!dpnqfotbujpo!bt!efgjofe!jo!Dibqufs!221-!Qbsu!qiztjdbmmz!jokvsfe!ps!eftuspzfe-!sftvmujoh!gspn;! JW-!Gmpsjeb!Tubuvuft/!)2*!b!efmbz!jo!ps!mbdl!pg!qfsgpsnbodf!cz!ps!po!cfibmg!pg! )e*!Bhfou!.!Boz!qfstpo!opu!bo!fnqmpzff-!bdujoh!voefs!uif!uif!obnfe!jotvsfe!pg!boz!dpousbdu!ps!bhsffnfou<! ejsfdu!dpouspm!boe!tvqfswjtjpo!pg!b!tubuf!bhfodz!ps!)3*!uif!gbjmvsf!pg!uif!obnfe!jotvsfe(t!qspevdut-!ps!xpsl! Buubdinfou;!Hfo!Mjbcjmjuz!Dfsu!.!Ifbmui!Efqbsunfou!.!Tjhofe!!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot!Dfoufs* efqbsunfou-!gps!uif!cfofgju!pg!b!tubuf!bhfodz!ps!qfsgpsnfe!cz!ps!po!cfibmg!pg!uif!obnfe!jotvsfe!up! efqbsunfou/!nffu!uif!mfwfm!pg!qfsgpsnbodf-!rvbmjuz!gjuoftt-!ps! )f*!Bvupnpcjmf!.!B!mboe!npups!wfijdmf-!usbjmfs-!ps!tfnj.usbjmfs!evsbcjmjuz!xbssboufe!ps!sfqsftfoufe!cz!uif!obnfe! eftjhofe!boe!mjdfotfe!gps!vtf!po!qvcmjd!spbet!)jodmvejoh!jotvsfe<! nbdijofsz!ps!bqqbsbuvt!buubdife!uifsfup*-!cvu!epft!opu!)h*!up!qspqfsuz!ebnbhf!up!uif!obnfe!jotvsfe(t!qspevdut! jodmvef!npcjmf!frvjqnfou/!bsjtjoh!pvu!pg!tvdi!qspevdut!ps!boz!qbsu!pg!tvdi!qspevdut<! )g*!!Npcjmf!Frvjqnfou!.!B!mboe!wfijdmf!)jodmvejoh!nbdijofsz!ps!)i*!up!qspqfsuz!ebnbhf!up!xpsl!qfsgpsnfe!cz!ps!po!cfibmg!pg! bqqbsbuvt!buubdife!uifsfup*-!xifuifs!ps!opu!tfmg.qspqfmmfe<!uif!obnfe!jotvsfe!bsjtjoh!pvu!pg!uif!xpsl!ps!boz!qpsujpo! )2*!opu!tvckfdu!up!npups!wfijdmf!sfhjtusbujpo-!ps!! DFS-D0-863 Revised 11/05 Page 1 of 2 Qbdlfu!Qh/!256 D/8/d uifsfpg-!ps!pvu!pg!nbufsjbmt-!qbsut-!ps!frvjqnfou!gvsojtife!hjwjoh!fwjefodf!boe!pcubjojoh!uif!buufoebodf!pg! jo!dpoofdujpo!uifsfxjui<!xjuofttft/!!Uif!jotvsfe!tibmm!opu-!fydfqu!bu!ijt!pxo! )j*!fnjofou!epnbjo!qspdffejoht!ps!ebnbhf!up!qfstpot!ps!dptu-!wpmvoubsjmz!nblf!boz!qbznfou-!bttvnf!boz! qspqfsuz!pg!puifst!bsjtjoh!uifsfgspn<!pcmjhbujpo!ps!jodvs!boz!fyqfotft!puifs!uibo!gps!gjstu! )k*!up!qvojujwf!ebnbhft<!bje!up!puifst!bu!uif!ujnf!pg!bddjefou/! )l*!up!bdujpot!pg!jotvsfet!dpnnjuufe!jo!cbe!gbjui!ps!xjui!! nbmjdjpvt!qvsqptf!ps!jo!b!nboofs!fyijcjujoh!xboupo!boe!! xjmmgvm!ejtsfhbse!pg!ivnbo!sjhiut-!tbgfuz-!ps!qspqfsuz<!)5*!Bdujpo!Bhbjotu!uif!Gvoe! )m*!up!qspgfttjpobm!nfejdbm!mjbcjmjuz!pg!uif!Cpbse!pg!Sfhfout-!Op!bdujpo!tibmm!mjf!bhbjotu!uif!Gvoe!vomftt-!bt!b! uif!qiztjdjbot-!pggjdfst-!fnqmpzfft-!ps!bhfout!pg!uif!dpoejujpo!qsfdfefou!uifsfup-!uif!jotvsfe!tibmm!ibwf! Cpbse<!cffo!jo!gvmm!dpnqmjbodf!xjui!bmm!pg!uif!ufsnt!pg!uijt! )n*!up!mjbcjmjuz!sfmbufe!jo!boz!xbz!xjui!ovdmfbs!fofshz<!dfsujgjdbuf!boe!uif!qspwjtjpot!pg!bqqmjdbcmf!Gmpsjeb! )o*!up!mjbcjmjuz!bttvnfe!cz!uif!jotvsfe!voefs!boz!dpousbdu!ps!Tubuvuft/! bhsffnfou<!)6*!Tfwfsbcjmjuz!pg!Joufsftu! )p*!up!gjobm!kvehnfout!jo!xijdi!uif!jotvsfe!ibt!cffo!Uif!ufsn!#uif!jotvsfe#!jt!vtfe!tfwfsbmmz!boe!opu! efufsnjofe!up!ibwf!dbvtfe!uif!ibsn!joufoujpobmmz<!dpmmfdujwfmz-!cvu!uif!jodmvtjpo!ifsfjo!pg!npsf!uibo! )q*!up!bxbset!gps!jokvodujwf-!efdmbsbupsz-!ps!qsptqfdujwf!sfmjfg!pof!jotvsfe!tibmm!opu!pqfsbuf!up!jodsfbtf!uif!mjnjut! sfoefsfe!bhbjotu!bo!jotvsfe!cz!boz!gfefsbm!ps!tubuf!dpvsu-!pg!uif!Gvoe(t!mjbcjmjuz/! bhfodz!ps!dpnnjttjpo/!! )7*!Mjnjut!pg!Mjbcjmjuz! W/DPOEJUJPOT! Uif!mjnju!pg!mjbcjmjuz!fyqsfttfe!bt!bqqmjdbcmf!up!#fbdi! B/!Qsfnjvn!qfstpo#!jt!uif!mjnju!pg!uif!Gvoe(t!mjbcjmjuz!gps!bmm! Qsfnjvn!dibshft!tibmm!cf!bttfttfe!jo!bddpsebodf!xjui!ebnbhft-!jodmvejoh!ebnbhft!gps!dbsf!boe!mptt!pg! uif!qspwjtjpot!pg!Dibqufs!395-!Qbsu!JJ-!Gmpsjeb!Tubuvuft-!boe!tfswjdft-!bsjtjoh!pvu!pg!qfstpobm!jokvsz!boe!qspqfsuz! boz!svmft!qspnvmhbufe!uifsfvoefs!vujmj{joh!b!sfusptqfdujwf!ebnbhf!tvtubjofe!cz!pof!qfstpo!bt!b!sftvmu!pg!boz! sbujoh!bssbohfnfou!qsfnjvn!dbmdvmbujpo!nfuipe!xifsfcz!pof!pddvssfodf<!cvu!uif!upubm!mjbcjmjuz!pg!uif!Gvoe!gps! 91&!pg!uif!qsfnjvn!jt!cbtfe!po!mpttft!bduvbmmz!jodvssfe!bmm!ebnbhft!tvtubjofe!cz!uxp!ps!npsf!qfstpot!bt!b! cz!uif!jotvsfe!boe!31&!jt!cbtfe!po!uif!dibohft!jo!sjtl!sftvmu!pg!boz!pof!pddvssfodf!tibmm!opu!fydffe!uif! fyqptvsft!)fnqmpzfft-!fud/*!pg!bo!jotvsfe/!!Uif!qsfnjvn!mjnju!pg!mjbcjmjuz!bt!bqqmjdbcmf!#fbdi!pddvssfodf#/! nvtu!cf!qbje!qspnqumz!cz!bo!jotvsfe!bhfodz!gspn!jut!)8*!Puifs!Jotvsbodf! pqfsbujoh!cvehfu!vqpo!sfdfjwjoh!uif!qsfnjvn!cjmm!ps!Jg!uifsf!jt!jotvsbodf!bqqmjdbcmf!up!boz!dmbjn-!uif! jowpjdf/!dpwfsbhf!fyufoefe!cz!uijt!dfsujgjdbuf!tibmm!bqqmz!pomz! !bt!fydftt!jotvsbodf!pwfs!boz!boe!bmm!puifs! C/!Bveju!bqqmjdbcmf!jotvsbodf/! Uif!Gvoe!tibmm!cf!qfsnjuufe!up!fybnjof!boe!bveju!uif!)9*!Ufsnt!pg!Dpwfsbhf! jotvsfe(t!cpplt!boe!sfdpset!bu!boz!ujnf!evsjoh!uif!ufsn!pg!Uijt!dfsujgjdbuf!jt!jttvfe!gps!uif!qvsqptf!pg! uijt!dpwfsbhf!boe!boz!fyufotjpo!uifsfpg-!boe!xjuijo!uisff!dpogjsnjoh!dpwfsbhf!bt!dpoufnqmbufe!cz!Dibqufs! zfbst!bgufs!uif!gjobm!ufsnjobujpo!pg!uijt!dpwfsbhf-!bt!gbs!bt!395-!Qbsu!JJ-!Gmpsjeb!Tubuvuft/!!Jo!uif!fwfou!pg!boz! uifz!sfmbuf!up!uif!qsfnjvn!cbtft!ps!uif!tvckfdu!nbuufs!pg!dpogmjdu!cfuxffo!qspwjtjpot!ps!dpwfsbhft!jo!uijt! uijt!dpwfsbhf/!dfsujgjdbuf!boe!uif!qspwjtjpot!pg!boz!Gmpsjeb!Tubuvuft! !ps!mbxt!jodmvejoh-!cvu!opu!mjnjufe!up!uif!bgpsftbje-! D/!Jotvsfe(t!Evujft!jo!uif!Fwfou!pg!Pddvssfodf-!Dmbjn!ps! tbje!tubuvuft!boe!mbxt!tibmm!dpouspm/! Tvju!):*!Dbodfmmbujpo! )2*!Fwfou!pg!Pddvssfodf!Gbjmvsf!pg!uif!Gvoe!up!sfdfjwf!uif!bnpvou!pg! Xsjuufo!opujdf!dpoubjojoh!qbsujdvmbst!tvggjdjfou!up!qsfnjvnt!cjmmfe!up!uif!jotvsfe!bhfodz!xjuijo!uif! jefoujgz!uif!jotvsfe-!bmpoh!xjui!sfbtpobcmz!ujnf!gsbnft!bmmpxfe!cz!mbx!nbz!sftvmu!jo! pcubjobcmf!jogpsnbujpo!xjui!sftqfdu!up!uif!ujnf-!qmbdf!dbodfmmbujpo!pg!uif!dfsujgjdbuf!pg!dpwfsbhf/!! boe!djsdvntubodft!uifsfpg-!uif!obnft!boe! beesfttft!pg!uif!jokvsfe!boe!bmm!lopxo!xjuofttft-!pqfsbujoh!cvehfu!vqpo!sfdfjqu!pg!uif!qsfnjvn!cjmm!bt! tibmm!jnnfejbufmz!cf!hjwfo!cz!ps!gps!uif!jotvsfe!up!tqfdjgjfe!jo!Tfdujpo!395/47-!Gmpsjeb!Tubuvuft-!boe! uif!Gvoe/!mbdl!pg!qspnqu!qbznfou!xjmm!sftvmu!jo!b!sfrvftu!gspn! )3*!Opujdf!pg!Dmbjn!ps!Tvju!uif!Gvoe!up!uif!Dpnquspmmfs!up!usbotgfs!qsfnjvnt! Jg!dmbjn!jt!nbef!cz!tvju!cspvhiu!bhbjotu!uif!jotvsfe-!gspn!boz!bwbjmbcmf!gvoet!pg!uif!efmjorvfou!bhfodz! uif!jotvsfe!tibmm!jnnfejbufmz!gpsxbse!up!uif!Gvoe!voefs!uif!qspwjtjpot!pg!Tfdujpo!395/55)8*-!Gmpsjeb! fwfsz!efnboe-!opujdf-!tvnnpot-!ps!puifs!qspdftt!Tubuvuft/! sfdfjwfe!cz!ijn!ps!ijt!sfqsftfoubujwf/!!Gbjmvsf!cz!uif!! E/!Tfmg.Jotvsbodf!Dpwfsbhf! jotvsfe!up!bewjtf!uif!Gvoe!pg!b!dmbjn!ps!tvju!qsjps!up! b!tfuumfnfou!bhsffnfou!ps!uif!jotvsfe!puifsxjtf!Dpwfsbhf!gps!efgfoejoh!boe!qbzjoh!dmbjnt!voefs!uijt! pcmjhbujoh!jutfmg-!tibmm!wpje!dpwfsbhf!cz!uif!Gvoe-!gps!dfsujgjdbuf!jt!qspwjefe!voefs!uif!bvuipsjuz!pg!Dibqufs! uibu!dmbjn/!395-!Gmpsjeb!Tubuvuft-!xifsfjo!uif!tubuf!jt!bvuipsj{fe! )4*!Bttjtubodf!boe!Dppqfsbujpo!pg!uif!Jotvsfe!up!benjojtufs!b!tfmg.jotvsbodf!qsphsbn/!!Qspwjtjpo!pg! Uif!jotvsfe!tibmm!dppqfsbuf!xjui!uif!Gvoe!boe-!vqpo!uijt!dfsujgjdbuf!epft!opu!dpotujuvuf!uif!jttvbodf!pg! Buubdinfou;!Hfo!Mjbcjmjuz!Dfsu!.!Ifbmui!Efqbsunfou!.!Tjhofe!!!)Ifbmui!Efqu!Mfbtf!.!Svui!Jwjot!Dfoufs* uif!Gvoe(t!sfrvftu-!bttjtu!jo!nbljoh!tfuumfnfout-!jo!jotvsbodf!puifs!uibo!po!b!tfmg.jotvsbodf!cbtjt-!boe! uif!dpoevdu!pg!tvjut!boe!jo!fogpsdjoh!boz!sjhiu!pg!qbznfou!pg!boz!dpwfsfe!dmbjn!pcmjhbujpot!jt! dpousjcvujpo!ps!joefnojuz!bhbjotu!boz!qfstpo!ps!dpoujohfou!vqpo!bwbjmbcjmjuz!pg!mfhjtmbujwf!gvoejoh/ pshboj{bujpo!xip!nbz!cf!mjbcmf!up!uif!jotvsfe! cfdbvtf!pg!jokvsz!ps!ebnbhf!xjui!sftqfdu!up!xijdi! dpwfsbhf!jt!bggpsefe!voefs!uijt!dfsujgjdbuf-!boe!uif! jotvsfe!tibmm!vqpo!sfrvftu-!nblf!bwbjmbcmf!bmm! bhfodz!sfdpset!qfsubjojoh!up!b!tqfdjgjd!dmbjn-!tibmm! buufoe!ifbsjoht!boe!usjbmt!boe!bttjtu!jo!tfdvsjoh!boe! DFS-D0-863 Revised 11/05 Page 2 of 2 Qbdlfu!Qh/!257