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Item P5 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: August 20th. 2008 Division: Monroe County Bulk Item: Yes XX No Department: Fixed Asset Surplus Staff Contact Person: Mitch Hedman AGENDA ITEM WORDING: Approval to remove surplus equipment form inventory via disposal or advertise for bid. ITEM BACKGROUND: See attached schedule PREVIOUS RELEVANT BOCC ACTION: N/ A CONTRACT/AGREEMENT CHANGES: STAFF RECOMMENDATIONS: TOTAL COST: N/A BUDGETED: Yes No COST TO COUNTY: N/A SOURCE OF FUNDS: N/A REVENUE PRODUCING: Yes No AMOUNTPERMONTH_ Year APPROVED BY: County Atty _ OMB/Purchasing _ Risk Management _ DIVISION DIRECTOR APPROVAL: x~~~ (Kevin Madok, Assistant Finance Director) DOCUMENTATION: fucluded Yes Not Required_ DISPOSITION: AGENDA ITEM # Revised 8/08 Board of County Commisioner August 20th, 2008 SCHEDULE OF SURPLUS ITEMS ITEM BACKGROUND AMOUNT BOCC ACTION Original Estimated County 10 # Description Value value need approval to- 1 3854 Projector Non-functioni ng $ 3,102.00 $ - remove form inventory & dispose 2 3855 Dell Laptop Old/Obsolete/Replaced $ 3,010.00 $ - remove form inventory & dispose 3 1956 Cannon Printer Non-functionino $ 2,616.00 $ - remove form inventory & dispose 4 2674 Lexmark Printer Non-functioning $ 1,770.29 $ - remove form inventory & dispose 5 2675 Lexmark Printer Non-functioning $ 2,684.30 $ - remove form inventory & dispose 6 4853 Dell Desktop Old/Obsolete/Replaced $ 1,649.00 $ - remove form inventory & diSpose 7 3061 Dell Desktop Old/Obsolete/Replaced $ 1,513.00 $ - remove form inventory & dispose 8 3024 Dell Desktop Old/Obsolete/Replaced $ 1,540.00 $ - remove form inventory & dispose 9 4850 Toshiba Laptop Old/Obsolete/Replaced $ 2,195.00 $ - remove form inventory & dispose 10 5021 Dell Desktop Old/Obsolete/Replaced $ 1,654.28 $ - remove form inventory & dispose 11 1271 Dell Laptop Old/Obsolete/Replaced $ 2,932.17 $ - remove form inventory & dispose 12 5666 MOSQuito Maonet Non-functionino $ 1,295.00 $ - remove form inventory & dispose 13 U/K 53' Mobile Home at Fire Academv $ - $ - approve to advertise for bids 14 2161 90 Ford Tractor Old/Obsolete/Replaced $ 14,995.00 $ 8,500.00 approve to advertise for bids 15 2136 95 Ford Pickup Old/Obsolete/Replaced $ 41,419.00 $ 12,000.00 approve to advertise for bids 16 2806 99 Chevy Malibu Old/Obsolete/Replaced $ 14,850.00 $ 2,200.00 approve to advertise for bids 17 3866 01 Checw Malibu Old/Obsolete/Replaced $ 14,817.00 $ 2,700.00 approve to advertise for bids 18 1649 90 Mack Dump Old/Obsolete/Replaced $ 66,714.00 $ 23,500.00 approve to advertise fo( bids 19 1668 Leebov Trailer Old/Obsolete/Replaced $ 15,118.00 $ 5,500.00 approve to advertise for bids 20 1905 99 Ford Bus Old/Obsolete/Replaced $ 44,787.00 $ 8,000.00 approve to advertise for bids 21 1931 01 Ford Bus . Old/Obsolete/Replaced $ 53,917.00 $ 9,000.00 approve to advertise for bids 22 3346 99 Chevv Astro Old/Obsolete/Replaced $ 17,234.00 $ 1,850.00 approve to advertise for bids 23 1665 Cat Backhoe Old/Obsolete/Replaced $ 38,193.00 $ 16,900.00 approve to advertise for bids 24 1655 92 Ford Tractor Old/Obsolete/Replaced $ 15,912.00 $ 9,500.00 approve to advertise for bids 25 1941 99 Dodge Pickup Old/Obsolete/Replaced $ 13,261.00 $ 1,300.00 approve to advertise for bids 26 1770 97 Ford Taurus Old/Obsolete/Replaced $ 14,767.00 $ 1,300.00 approve to advertise for bids 27 1374 95 Ford Pickup Old/Obsolete/Replaced $ 16,602.00 $ 450.00 approve to advertise for bids 28 3814 98 GMC Pickup Old/Obsolete/Replaced $ 11,827.00 $ 1,600.00 approve to advertise for bids 29 3659 98 Olds Cutlass Old/Obsolete/Replaced $ 17,946.00 $ 2,000.00 approve to advertise for bids 30 2451 98 Chevy Lumina Old/Obsolete/Replaced $ 17,921.00 $ 1,900.00 approve to advertise for bids 31 1418 98 Dodoe Pickup Old/Obsolete/Replaced $ 13,977 .00 $ 775.00 approve to advertise for bids 32 1314 99 Chevy Cargo Van Old/Obso lete/Replaced $ 15,925.00 $ 3,000.00 approve to advertise for bids 33 1522 02 Dodge Pickup Old/Obso lete/Replaced $ 13,867.00 $ 3,600.00 approve to advertise for bids 34 4319 94 Ford Ranoer Wrecked $ 10,900.00 $ 900.00 approve to advertise for bids 35 1460 98 Dodoe Pickup Old/Obsolete/Replaced $ 8,740.00 $ 1,000.00 approve to advertise for bids 36 2147 02 Dodge Pickup Old/Obsolete/Replaced $ 13,867.00 $ 3,200.00 approve to advertise for bids 37 3953 99 Dodge Pickup Old/Obsolete/Replaced $ 13,261.00 $ 1,300.00 approve to advertise for bids 38 4738 02 GMC Pickup Old/Obsolete/Replaced $ 13,690.00 $ 3,200.00 approve to advertise for bids 39 4084 98 Chew Pickup Old/Obsolete/Replaced $ 20,917.00 $ 500.00 approve to advertise for bids 40 4465 #339664 Kohler Genset Non-functioning $ 17,300.00 $ - Donate to City of Key West 41 1139 92 New Holland Tractor Old/Obsolete/Replaced $ 15,912.00 $ 1,250.00 approve to advertise for bids 42 4078 96 Dodoe Pickup Old/Obsolete/Replaced $ 12,775.31 $ 200.00 approve to advertise for bids 43 1937 98 Ford Taurus Old/Obsolete/Replaced $ 14,443.00 $ - approve to advertise for bids 44 1346 96 Dodge Pickup Old/Obsolete/Replaced $ 12,900.75 $ 400.00 approve to advertise for bids 45 1643 97 Chevy Pickup Old/Obsolete/Replaced $ 14,219.00 $ 600.00 approve to advertise for bids 46 0940-449 97 Chevy Pickup Old/Obsolete/Replaced $ 14,219.00 $ 1,200.00 approve to advertise for bids 47 1306 99 Dodoe Pickup Old/Obsolete/Replaced $ 13,329.32 $ 650.00 approve to advertise for bids 48 4253 MSA Gas Detector Old/Obsolete/Replaced $ 1,672.80 $ - Donate to city of Marathon 49 4255 Draeger Unit Old/Obsolete/Replaced $ 2,530.00 $ - Donate to city of Marathon 50 3546 Computer Tower Old/Obsolete/Replaced $ 1,259.99 $ - remove form inventory & dispose 51 3426 Computer Tower Old/Obsolete/Replaced $ 1,065.64 $ - remove form inventory & dispose 52 3380 Computer Tower Old/Obsolete/Replaced $ 1,000.00 $ - remove form inventory & dispose 53 3475 Young Pumper Old/Obso lete/Replaced $ 213,036.00 $ 7,000.00 approve to advertise for bids 54 3390 Young Pumper Old/Obsolete/Replaced $ 203,957.00 $ 7,000.00 approve to advertise for bids 55 - 51d'/~~'~. TO: ~ Divildl Specr ~(~ \- :r., .,: . ";'-:- MONROE COUNTY "COMPUTER RELATED EQUIPMENT" INVENTORY DELETION REQUEST FROM tkJ~ ~ ft IfW 1I1 t1tr+- PROPERTY CLERK. FINANCE DEPT. DATE: S-/J-j -~y M.C. 1.0. NUMBER SERIAL NUMBER ASSET DESCRIPTION DATE ORIGINAL & EST. PURCHASED PRESENT VALUE 3/ /~.2.. J'~51 33SS- 19'0& CHECK ONE (I) APPROPRIATE LINE BELOW: APPROVAL TO ADVERTISE FOR BIDS. ~PROV AL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROVAL TO REMOVE FROM INVENTORY AND TRANSFER TO: REASON FOR REOUEST: PREPARED BY: . ~. ~ DATE: ~-/1' ~ "r DlvrSION DIRECTOR APPROVAL: ~ PRrNT~~/1drbcJ d. 1r/'ve.~~ TECHNICAL SERVICES APPROVAL: PRINT NAME: (J!\1A FOR.\1 REVISED 1O/211/201J3 MONROE COUNTY INVENTORY DELETION REQUEST TO: Michael Miller - Stop #8 Property Clerk, Finance Dept. FROM: Supervisor of Elections office DATE: r ,., ;-'f.:~ ~ . ..M.C.. i..... .... ........ i . ....... ...... ..... ........ ....Se...31<< ..........> . <l.ltNtlRlbe..>...... .........<. .<......NulIIbet>......< 2674 0701 211 Qrig....#1&1:8t. < . ..PresentValtle . ~.. zurf ]J) ~ If CHECK ONE (1) APPROPRIATE LINE BELOW: APPROV AL TO ADVERTISE FOR BIDS. xxx APPROV AL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROV AL TO REMOVE FROM INVENTORY AND DONATE TO: REASON FOR REQUEST: 4;jJf>U- PREPARED BY: ~ ~ DATE: PRINT NAMJOJr~ DIVISION DIRECTOR APPROV AL: ~ ~ PRINT NAME 08/0] /2008 OMB FORM REVISED 10/28/2003 MONROE COUNTY "COMPUTER RELATED EQUIPMENT" INVENTORY DELETION REQUEST TO: Mike Miller - Stop #8 Property Clerk, Finance Dept. FROM: HOLL Y ELOMINA, Manager Administrative Services DATE: M~C.. > S~ri;d Asset I).t~ . ~... . .. .... qrigimll.Est. ..... .I..D.Number .... Number . Descriptloll Pureba;s~4 ... . Present Value ... .. .. .... .. . '- ,- , . . "." . .~ '. . 4853 DOK 11 DELL DESKTOP 1/16/2000 $1649.00/ -0- 3061 HJ4Y201 DELL DESKTOP 9/28/2000 $1513.00 / -0- 3024 3TGJJ01 DELL DESKTOP 5/16/2001 $1540.00/-0- 4850 38599718 TOSHIBA LAPTOP 6/12/1998 $2195.00 / -0- 5021 CHY7J81 DELL DESKTOP 9/19/2005 $1654.28 / -0- CHECK ONE (1) APPROPRlA TE LINE BELOW: APPROV AL TO ADVERTISE FOR BIDS. XXX APPROV AL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROV AL TO REMOVE FROM INVENTORY AND DONATE TO: REASON FOR REQUEST: These items are beyond repair. APPROVED BY: ~?~ DATE: sl'i3~y PRINT NANfE: Gerald Land DMSION DlRECTORAPPROV AL: :r-wm.;o~i~ PRINT ~ Hol y lomina TECHNICAL SERVICES APPROVAL: PRINT NAME: OMS FORM REVISED 11/99 n}. , fl-. .'~ MONROE COUNTY "COMPUTER RELATED EQUIPMENT" INVENTORY DELETION REQUEST TO: Mike Miller - Stop #8 Property Clerk, Finance Dept. FROM: HOLL Y ELOMINA, Manager Administrative Services DATE: M.C. Serial Asset Date Original & Est. I.D. Number Number Description Purchased Present Value 4853 DOK1 J DELL DESKTOP 1/16/2000 $1649.00/-0- 3061 HJ4Y201 DELL DESKTOP 9/28/2000 $1513.00/-0- 3024 3T01101 DELL DESKTOP 5/16/2001 $1540.00 / -0- 4850 38599718 TOSHIBA LAPTOP 6/12/1998 $2195.00 / -0- 5021 CHY7J81 DELL .DESKTOP 9/19/2005 $1654.28/-0- ~A ~Jk (/ 7/t't/<t1( , . I . -.- -Y. . CHECK ONE (1) APPROPRIATE LINE BELOW: APPROVAL TO ADVERTISE FOR BIDS. xxx APPROVAL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROV AL TO REMOVE FROM INVENTORY AND DONATE TO: REASON FOR REQUEST: These items are beyond repair. APPROVED BY: ~7~ PRINT NMfE: Gerald Land , DATE: Sas/69 DIVISION DIRECTOR APPROVAL: PRINT OMB FORM REVISED 11199 7.'-"-" "1-^C"l'J.) t, ~:;-t'~ ~roJTS.c), wJ ~ s.~r~-oY MONROE COUNTY "C;OMPUTEIUWLATED EO~~ENT" INVENTORY DELETION REQUEST TO: Michael Miller p~ CJen, J"iJwIce Dept. DATE: os.. 03 - 2008 nOM: TECHNICAL SERVICES Marla Guerra CHECK ONE (I) APPROPRIATE LINE BELOW: APPROVAL TO ADVERTISE FOR BIDS. xxxxx APPROVAL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROVAL TO REMOVE FROM INVENTORY AND TRANSFER TO: REASON fURREOUEST: OCT DATCD I OLD PREPARED BY: Maria Guerra DATE: 05 - 03 - 2008 DMSIONDIkECTOR APPROVAL: J,J ~ T) l2-tt~ /Y) i tlee PRINT : NlA TECHNICAL SERVICES APPROVAL: ~~~ PRINT NAME: DruckemiH.' Sr. Administlator OMB FORM REVISED llJ99 TO: Stop #8 Property Clerk, Fbaaaee Dept (PI 1910 tj MONROE COUNTY INVENTORY DELETION REQUEST S'TO P 25 FROM: CAR..D 5ov~~ DATE: RECEIVEDJUN 2 3 200.8 <R - CHECK o~ (1) APPB.OPRIATE LINB BELOW: APPROVAL TO ADVERTISE FOR BIDS. ><.. APPROV AI.. TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROVAL TO REMOVE FROM INVENTORY AND DONATE TO: RBASON FOR REQUEU: iAAN uP Ac.. TV a&1C CA ec.u,..... boAR..b , 16 Ou' (Dj:" ~<JS I NESS.I VA) I r HAS ""f)GFEiC-T?J~ 'PAR..TS -AU. N'bT ~VA Ii-- A- a L-'C- PREPARED BY: €- ~OAJ,4L..b Gt<..o~I,#, DATE: to "9/0 f( PRINT NAME DMSION DIRECfORAPPROVAL: ~ tek"<< PRINTNAME . OMS fORM REVlSBD 1012811OO3 r.' I;~. ~ f"'.. r roo" .~ '. MONROE COUNTY INVENTORY DELETION REQUEST TO: Divina D. Speer - Stop #8 Property Clerk, Finance Dept. FROM: Jlii~ed)U--fo.t1 - stop J~ FI(Jl/REScWL DATE: CHECK ONE (1) APPROPRIATE LINE BELOW: v APPROVAL TO ADVERTISE FOR BIDS. e.B. APPROVAL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROVAL TO REMOVE FROM INVENTORY AND DONATE TO: OVerLUO(" ttoNOtlvCTCo () 78' -3n- .,,,~ .. REASON FOR REQUEST: ~ ~~o;': ~tft~~d~L!il~~i ~'~ 8' /~tJ /01 (l~.~ PREPARED BY: JUt ~ Ef)c..rqe.:rQA) PRINT NAME DATE: DIVISION DIRECTOR APPROVAL: PRINT NAME I!>.(; \ . 2 '\,$.{)4 OMB FORM REVISED 10/2812003 2(fJ, C.C.f,;]D MONROE COUNTY INVENTORY DELETION REQUEST ll.1iCLl \' / ~,,; 0 1 RfCll TO: Mitch Hedman, STOP #8 PROPERTY CLERK. FINANCE DEPT. FROM: Roy Sanchez, Director Fleet MJlfI~urement Department ~ DAlE: Julv 28. 2001 M.e. SDUAL ASSET DATE ORIGINAL & EST. LB. NUMBER DESCRIPTION PURCHASED PRESENT VALUE NUMBn 0940/257 BB80498 90 FORD/NH 2910 TRACTOR JUNE 1990 14.995.00 / 8.500.00 IFDXFSOCISV A02086 95 FORD F SERIES CREW CAB JUNE 1994 42 _ _.00 / 12.000.00 DUMP 1t r1fq- IGIND5217XY141313 99 CHEV MALlBU JUNE 1999 I.t 50.00 / 2.200.00 IG IND52J616 167385 01 CHEV MALIBU OCT 2000 14.817.99 / 2.700.00 CHECK ONE (I) APPROPRIATE LINE BELOW: XXX APPROVAL TO ADVERTISE FOR BIDS. APPROVAL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROVAL TO REMOVE FROM INVENTORY AND TRANSFER TO: REASON FOR REQUEST: The above items are no longer in use. have been replaced. and are beyond economical repair. Also. itelllS are located in Marathon. PREPARED BY: ~(fQ PRINT NAME: Ron hem' DATE: 7/28/2008 PRINT NAME: Dent Pierce ~~ 7/r/ICJY' DMSION DIRECTOR APPROVAL: OMB FORM REVISED 10/2812003 MONROE COUNTY INVENTORY DELETION REQUEST TO: feVihfYIrJd4-Stop #8 FROM: ;.I&/rt-h ~t4hA(W\f Property Clerk, Finance Dept. DATE: w-J..5-o~ .liLvL; , M.C. Serial Asset Date Original & Est. I.D. Number Number l/i/Jt; Description Purchased Present V,alue :l()()()-i3/ / t:rc.R!oA-XI?7/'M .r-II 191ft! krcl &lV;lf fJK/..:~,J J-/9tj ita ~a7~~/9OJ.g;. .:tttt~ l C\ v { CHECK ONE (1 ) APPROPRIATE LINE BELOW: V APPROVAL TO ADVERTISE FOR BIDS. AFPROV AL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROV AL TO REMOVE FROM INVENTORY AND DONATE TO: REASON FOR REQUEST: fehJl;./e /5 wteckcl Otnol cla.s, /1o<{- sla.4, PREPARED BY: ~~ DATE: (p-).:)-c;;t( PR1NT NAME 4 DIVISION DIRECTOR APPROVAL: .,() rk- _ __ _ PRrNTNAME~ OMB FORM REVISED 10/28/2003 'j QC( "~J~. : ,L.t I MONROE COUNTY INVENTORY DELETION REQUEST TO: Kevin Madok FROM: Freda Vaugbn_ PROPERTY CLERK. FINANCE DEPT.5ky:>1i ~ DATE: 07/17/08 Monroe County Health DeDartment M.C. SERIAL ASSET DATE ORIGINAL & EST. LD. NUMBER NUMBER DESCRIPTION PURCHASED PRESENT VALUE 4465 339664 Kohler Diesel Genemtor attached to 01/12/94 Original value City of Key West Frederick 17,300.00 Douglas Center, 103 Olivia St., Key Present value unknown. West Unit is not working. CHECK ONE (l) APPROPRIATE LINE BELOW: x APPROVAL TO ADVERTISE FOR BIDS. APPROVAL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROVAL TO REMOVE FROM INVENTORY AND TRANSFER TO: City ofKev West REASON FOR REOUEST: PREPARED BY: PRINT NAME: Freda DATE: 7/17/08 DIVISION DIRECTOR APPROVAL: PRINTN~" 7/dLjIoR . OMB FORM REVISED 1012812003 MONROE COUNTY INVENTORY DELETION REQUEST TO: Mitch Hedm.an. STOP #8 PROPERTY CLERK. FINANCE DEPT. FROM: Roy Sanchez, Director Fleet MansuJement Deoartment DATE: Julv 28. 2008 ,\'\ " .. t' ~' . , SI:RIAL ASSET DATE ORIGINAL & EST. NUMBI:R DESClUPTION PURCHASED PRESENT VALUE IB7HCI6XOWS6U3?2 98 DODGE 1500 PICKUP APRll. 1998 1 1 1,000.00 f1Lfo - ID7HA16KnJ22~753 02 DODGE 1500 PICKUP APRIL 1001 B.867.00 1 :UOO.OO IB7HCI6XOXS216689 99 DODGE 1500 PICKUP APRIL 1999 13 _ .00 1 1.300.00 t'Ull- IGTEC1~W62Z335067 02 GMC IS00 PICKUP JUNE 2001 13.690.00 13.200.00 BD 13048 91 FORDINEW HOLLAND 3930 JUNE 1992 15.912.00 11.250.00 TRACTOR . 1~1906-2 IFDLF~7M7REA.'-l9787 9~ FORD SDUlY AMBULANCE SEPT 1994 74.986.00 1 2.300.00 - , (2420) CHECK ONE (I) APPROPRIATE LINE BELOW: XXX APPROVAL TO ADVERTISE FOR BIDS. AFPROV AL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROVAL TO REMOVE FROM INVENfORY AND TRANSFER TO: REASON FOR REQUEST: The above items are no longer in use. have been replaced. are beyond economical repair. and ill numbers 3200/066 and 141902-2 have been previously advertised. Also. items are located in Plantation Key, PREPARED BY, ~~ DATR 7/2812008 PRINT NAME: Ron Che ' DMSION DIRECTOR APPROVAL: ~p~ PRINT NAME: Dent Pierce filllur- OMB FORM REVISED 1012812003 MONROE COUNTY INVENTORY DELETION REQUEST ~ Mitch Hedman. STOP #8 FROM: Roy Sanchez" Director PROPERTY CLERK. FINANCE DEPT. Fleet Mlm~l;tement Department TO: DATE: Ju1y28.200s M.e. SERIAL ASSET DATE ORIGINAL & EST. LD. NUMBER DESCRIPTION PURCHASED PRESENT VALUE NUMBER ;73/052 IMlBI97C3LMOO6989 90 MACK DM690S DUMP TK. FEB 1990 ~/23.500.00 \y. ~ '\ .. ulJJ1tt{.... :ll~~r{ lUYFSZ.J.52SA60990 1 95 LEEBOY FLAT DECK AUG 1995 15.118.00 15.500.00 TRAILER 1807/1905 IFDWE30F3XHCH 122 99 FORD E350 ELDORADO DEC 1999 +4.787.00 18.000.00 C~) Brn ,. ... 1807/1931 IFl))OE45F61EUL11529 01 FORD E450 AEROlECH HUS MARCH 2001 53.917.00 19.000.00 (l93lj J_ J. ...... ., -, - ~ 2-<<>1/292 lB7HCI6X8TS688102 96 DODGE 15UU l'l\...hur JUNE 19% 12.77531/200.00 ( iQ1a) R~4~ .,.J.. 24011310 IGCGC33R8WF061622 98 CHEV 3500 CREW CAB MAY 1998 20.917.00 1 500.00 (40~ PICKUP ~ 3000/171 IF~IWA165812 98 FORD TAURUS JAN 1998 14.+B.00 10.00 <l.2211 ~ 'r..c. Q, L"lq..,) CHECK ONE (1) APPROPRIATE LINE BELOW: XXX APPROVAL TO ADVERTISE FOR BIDS. APPROVAL TO REMOVE FROM INVENTORY AND DISPOSE OF IT. APPROVAL TO REMOVE FROM INVENTORY AND TRANSFER TO: REASON FOR REQUEST: The aboye items are no longer in use. have been replaced. are beyond economical repair. and ID numbers 240 11292 and 3000/171 ha,'e been pm:iously advertised. Also. items are located in Key West. PREPARED BY: \z. ()z..f DATE: 7/2812008 PRINT NAME: Ron Chern' DMSION DIRECrOR APPROVAL: PRINT NAME: Dent Pierce OMB FORM REVISED 1012812003