HomeMy WebLinkAboutAccess Connection M96-0137 - RAP Permit / Conditions - 6/20/1996 Washington State Olympic Region Headquarters
Department of Transportation 5720 Capitol Boulevard,Tumwater
Sid Morrison P.O. Box 47440
Secretary of Transportation Olympia,WA 98504-7440
(360)357-2600
Fax(360)357-2601
June 17, 1996 ;ti E C E I V E D
- J A 2 0 1996
"';`,SON CO. PLANNING DEPIL
Saint Andrew's House
c/o Diocese of Olympia, Inc.
P. O. Box 12126
Seattle,Washington 98102
SR 106, Mile Post 7.59, Right Side
Access Connection Permit M96-0137
ATTENTION: Mr. Gerald W. Porter
Attached is your executed Access Connection Permit allowing you to perform the indicated work
within the state highway right-of-way.
Before beginning work on this project, please contact both the area Maintenance Superintendent
and the Utility Underground Locate Center to advise them of your planned work, starting date, and
location. The area Maintenance Superintendent's phone number is on the front of the Special
Provisions page of the permit and the Utility Underground Locate Center phone number is 1-800-
424-5555.
No work is authorized within the state highway right-of-way until this notice is given.
If you have any questions regarding this permit please contact me at (360) 357-2736 or Trudy
Johnson at (360) 357-2667.
Sincerely,
DALE C. SEVERSON, P.E.
Development Services Engineer
DCS:TAJ
Attachment
cc: Mason Co. Planning Dept., P. O. Box 578, Shelton,WA 98584
Casey McGill, Area 2 Maintenance Superintendent, Mail Stop: W13-18.
i
� Washington State Access Connection Permit
VI/ Department of Transportation
Permit No. M96-0137 CS 2304 SR 106
Name and Address of Applicant: Region Olympic
SAINT ANDREW'S HOUSE
c/o Diocese of Olympia, Inc.
P. O. Box 12126
Seattle,Washington 98102
(206) 3254200, Ext. 313
The Applicant, hereinafter referred to as the"Grantee," having applied for a permit to
re-construct, upgrade, use and maintain within state right-of-way, a Category 1 Non-Conforming commercial Type
"D" road approach for a Class 3 Highway to serve a church conference center and residence at Mile Post 7.59, right
side, located in Government Lot 1 of Section 33, Township 22 North, Range 3 West,W. M.,
on a portion of State Route No. 106 In Mason County, Washington,
the Washington State Department of Transportation or its designee, herein after referred to as the "Department,"
hereby orders that this permit be granted, subject to the terms and provisions stated upon the General Provisions
hereof and Exhibits attached hereto and by this reference made a part hereof:
Exhibit "A"- Special Provisions for Highway Encroachments, Page(s) 1, 2 and 3.
Exhibit`B"- Site Plan, Page 1 of 1.
Exhibit "C" -Traffic Control Plan, Page 1 of 1.
This permit shall be void unless the construction herein
contemplated is started within 90 days of issuance and
completed within 120 days of issuance, unless otherwise
provided herein.
This permit is accepted and approved by the Grantee
subject to the terms and provisions as herein set forth.
GRANTEE DEPARTMENT OF TRANSPORTATION
By: t By: '& C-- _
Title: j1 Title: Development Services Engineer
Date: �I'n Date: 4�7 Z/7/�910
DOT Form 224-005 EF
Revised 7/95
General Provisions
1. The Grantee,its successors and assigns,agrees to protect the State of Washington,its officers and employees and save them harmless
from all claims,actions or damages of every kind and description which may accrue to or be suffered by any person, persons,or property
by reason of the acts or omissions of the Grantee,its assigns,agents,contractors,licensees,employees or any person whomsoever,in
connection with Grantee's,its assigns',agents',contractors',licensees'or employees' construction,installation,maintenance,operation,
use or occupancy of the right of way or in the exercise of this permit. In case any suit or action is brought against the State of Washington,
its officers and employees,arising out of or by reason of any of the above causes,the Grantee,its successors or assigns will,upon notice of
such action,defend the same at its sole cost and expense and satisfy any judgement against the State of Washington,its officers,or
employees: PROVIDED,that if the claims or damages are caused by or result from the concurrent negligence of(a)the State of
Washington's agents or employees and(b)the Grantee or Grantee's agents or employees,this indemnity provision shall be valid and
enforceable only to the extent of the negligence of the Grantee or the Grantee's agents or employees.
The Grantee,and on behalf of its assigns,agents,licensees,contractors and employees agrees to waive any claims for losses,expenses,
damages or lost revenues incurred by it or its agents,contractors,licensees,employees or customers in connection with Grantee's,its
assigns',agents',contractors',licensees'or employees'construction, installation,maintenance,operation,use or occupancy of the right of
way or in the exercise of this permit against the State of Washington,its agents or employees except the reasonable costs of repair to
property resulting from the negligent injury or damage to Grantee's property by the State of Washington,its agents,contractors or
employees.
2. During the progress of the work,such barriers shall be erected and maintained as may be necessary or as may be directed for the protection
of the traveling public;the barriers shall be property lighted at night.
3. Except as herein authorized,no excavation shall be made or obstacle placed within the limits of the State highway in such a manner as to
interfere with the travel over said road.
4. If the work done under this permit interferes in any way with the drainage of the State highway,the Grantee shall wholly and at its own
expense make such provision as the Department may direct to take care of said drainage.
5. Grantee hereby authorizes the Department to enter upon their lands where necessary to construct or reconstruct the permitted access
connection and/or construct and maintain traffic control devices and appurtenances.
6. The access connection shall be maintained between the right of way line and the shoulder line of said(highway,frontage service road of said
highway,highway and/or frontage service road,"=Line of said highway)by the grantee,their heirs,successors or assigns.
7. On completion of said work herein contemplated,all rubbish and debris shall be immediately removed and the roadway and roadside shall be
left neat and presentable and satisfactory to the Department.
8. The cost of construction or modification of a connection shall be the responsibility of the Grantee,including the cost of modification of any
connection required as a result of changes on property site use in accordance with WAC 468-51-110.
9. The Department hereby reserves the right to order the change of location or the removal of any structure or structures authorized by this
permit at any time,said change or removal to be made at the sole expense of the party or parties to whom this permit is issued,or their
successors and assigns.
10. Existing permitted connections impacted by the Department's work program and which,in the consideration of the Department,necessitate
modification,relocation,or replacement in order to meet current Department connection location,quantity,spacing,and design standards,
shall be modified,relocated,or replaced in kind by the Department at no cost to the Grantee.The cost of further enhancements or
modification to the altered,relocated,or replaced connections desired by the Grantee shall be the responsibility of the Grantee.
11. If any changes are made or proposed in the land use,intensity of development,type of traffic,or traffic flow of the property served by this
connection permit,the Grantee is required to contact the Department to determine if further analysis is needed to determine if the change is
significant and would require a new permit and modifications to the connection.
12. All such changes,reconstruction,or relocation by the Grantee shall be done in such manner as will cause the least interference with any of
the Department's work,and the Department shall in no wise be held liable for any damage to the Grantee by reason of any such work by the
Department,its agents or representatives,or by the exercise of any rights by the Department upon roads, streets,public places,or structures
in question.
13. This permit or privilege shall not be deemed or held to be an exclusive one and shall not prohibit the Department from granting other permits
or franchise rights of like or other nature to other public or private companies or individuals,nor shall it prevent the Department from using
any of its roads,streets,or public places,or affect its right to full supervision and control over all or any part of them,none of which is hereby
surrendered.
14. The Department may revoke,amend,or cancel this permit or any of the provisions thereof at any time by giving written notice to the Grantee.
The Grantee shall immediately remove all facilities from the right of way.Any facilities remaining upon the right of way 30 days after written
notice of cancellation shall
15. It is the responsibility of the applicant or Grantee to obtain any other local permits or other agency approvals that may be required,including
satisfaction of all environmental regulations.It is also the responsibility of the Grantee to acquire any property rights necessary to provide
continuity from the applicant's property to the Department's right-of-way if the Grantee's property does not abut the right of way.
16. The party or parties to whom this permit is issued shall maintain at its or their sole expense the structure or object for which this permit is
granted in a condition satisfactory to the Department.
17. Any breach of any of the conditions and requirements herein made,or failure on the part of the Grantee of this permit to proceed with due
diligence and in good faith after its acceptance,with construction work hereunder,shall subject this permit to cancellation as herein provided.
18.This permit is subject to all applicable provisions of 468-51 WAC,Chapter 47.50 RCW,Chapter 47.32 RCW,and/or Chapter 47.44 RCW,and
amendments thereto.
DOT Form 224-005 EF
Rev,sed 7195
Amok Washington State Special Provisions for
�
A Department of Transportation Highway Encroachments
g Y
Permit No. M96-0137
Applicable provisions are denoted by ( ® )
® 1. No work provided for herein shall be performed until the Grantee is authorized by the following Department representative:
Casey McGill,Area 2 Maintenance Superintendent
8293 Spring Creek Road S.E.
Port Orchard,Washington 98366-9613
(360)895-4753
® 2. Prior to the beginning of construction,a preconstruction conference shall be held at which the Department and the Grantee and Grantee's engineer,
contractor,and inspector shall be present.
® 3. Should the Grantee choose to perform the work outlined herein with other than its own forces,a representative of the Grantee shall be present at all times
unless otherwise agreed to by the Department representative.All contact between the Department and the Grantee's contractor shall be through the
representative of the Grantee.Where the Grantee chooses to perform the work with its own forces,it may elect to appoint one of its own employees
engaged in the construction as its representative.Failure to comply with this provision shall be grounds for restricting any further work by the Grantee
within the State right of way until said requirement is met.The Grantee,at its own expense,shall adequately police and supervise all work on the above
described project by itself,its contractor,subcontractor,agent,and others,so as not to endanger or injure any person or property.
® 4. A copy of the permit must be on the job site and protected from the elements at all times during any of the construction authorized by said permit.
® 5. This permit does not give the Grantee or any agent or contractor of the Grantee any rights to cut,spray,retard,remove,destroy,damage,disfigure or in
any way modify the physical condition of any vegetative material located on the highway right of way,except by written permission from the Department or
for purposes as described by No.6 if denoted below.All restoration shall be done to the satisfaction of the Department at the sole expense of the Grantee.
® 6. If necessary to increase sight distance,brush shall be removed from both sides of the access connection and stumps shall be removed.The
indiscriminate cutting of merchantable timber or disfiguring of any feature of scenic value shall not be permitted.
❑ 7. The access connection(s)shall be constructed in accordance with the attached
Sufficient length of -inch diameter culvert pipe shall be placed in ditch and laid to a true line and grade.
The access connection(s)shall be surfaced to the limits as shown on the plan with a 6-inch minimum compacted depth of gravel base material and a
3-inch compacted depth of crushed surfacing top course.Asphalt paving will not be required. Finished grade of the access connection shall be in
accordance with the profile control as shown on the attached plan. Directing of surface water from private property to Department right of way will not be
permitted,unless otherwise approved by the Department.
® 8. The access connection(s)shall be constructed in accordance with the attached TYPE"D" Template
Sufficient length of 12 -inch diameter culvert pipe shall be placed in ditch and laid to a true line and grade.
The access connection(s)shall be surfaced to the limits as shown on the plan with a 6-inch minimum compacted depth of gravel base material a 3-inch
minimum compacted depth of crushed surfacing top course and paved with a 3-inch minimum compacted depth of Asphaltic Concrete Class B unless
otherwise specified by the Department.Any existing oil mat on shoulder or roadway shall be removed and new pavement laid to a butt joint with existing
pavement.Finished grade of new pavement shall be in accordance with the profile control as shown on attached plan. Directing of surface water from
private property onto Department right of way will not be permitted,unless otherwise approved by the Department.
® 9. All buildings and appurtenances shall be so located at a distance from the right of way line of any State Highway that none of the right of way therefore is
required for use of the patrons or customers of any such establishment.Grantee shall comply with local building codes.Set-back requirements for the
location of buildings in relation to the right of way line are a function of local authorities,and they should be consulted regarding requirements that must be
adhered to.
DOT Form 224.713EF Page 1 Exhibit "A"
8194
❑ 10, The Grantee agrees to schedule the work herein referred to and perform said work in such a manner as not to delay the Department's contractor in the
performance of his contract.
® 11. Work within the right of way shall be restricted to between the hours of 7:30 AM and 3:30 PM ,and no work shall
be allowed on the right of way Saturday,Sunday,or holidays,unless authorized by the Department.Any lane closures must be submitted for approval
in advance of use.The hours of permitted closure may differ from the above noted hours.
® 12. The shoulders,where disturbed,shall be surfaced with crushed surfacing top course tluee(3) -inch minimum compacted depth,
or as directed by the Department.The surface of the finished shoulder shall slope down from the edge of pavement at the rate of 1/2 inch per foot unless
otherwise directed.The restored shoulder must not have any strips or sections less than 2 feet wide.The restored shoulder shall be surfaced with
asphalt concrete pavement.
® 13. The Grantee shall be responsible for constructing and maintaining the access connection(s)and appurtenances between the shoulder line of the
highway and the right of way line inclusive of surfacing and drainage.The Department has the right to inspect all installations at the time of
construction and at any time afterward and to require that necessary changes and repairs be made. Unsatisfactory work will be corrected by the
Department,at the Grantee's expense,or access may be removed at the Grantee's expense.Directing of surface water from private property onto
Department right of way will not be permitted.
® 14. The access connection shall be sufficiently surfaced back an adequate distance from the edge of the pavement to prevent any tracking of material onto
the highway.Any tracking of material onto the highway shall be subject to enforcement of Chapter 46.61.655 RCW and shall be immediately cleaned
up by the Grantee or the Grantee's agent.
❑ 15. Standard highway warning signs designated as'Truck Crossing"sign,plate W11-6,shall be placed and maintained at Grantee's expense on each
side of the access connection.Signs shall be in evidence only when access is actually being used. If necessary,flagmen shall be provided.Sufficient
parking space shall be provided by the Grantee outside Department right of way so no vehicles will be parked on said right of way.
® 16. All manholes,valve covers,and like appurtenances shall be constructed at such an elevation to conform to the shoulder slope from the edge of pavement
or as directed by the Department.
® 17. All slopes,slope treatment,top soil,ditches,pipes,etc.,disturbed by this operation shall be restored to their original cross section and condition.All
hazards shall be marked by warning signs,barricades,and lights. If necessary,flagmen shall be employed for the purpose of protecting the traveling
public. Roadside operations shall be specified by the Department's representative.
® 18. During the construction and/or maintenance of this facility,the Grantee shall comply with the Manual on Uniform Traffic Control Devices for Streets and
Highways.If determined necessary by the Department,the Grantee shall submit a signing and traffic control plan to the Department's representative for
approval prior to construction or maintenance operations.
❑ 19. Bond coverage required to ensure proper compliance with all terms and conditions of said permit will be furnished by a Blanket Surety Bond held at
Headquarters in Olympia.
® 20• A surety bond in the amount of$ 2,000.00 written by a surety company authorized to do business in the State
of Washington,shall be furnished to ensure compliance with any and all of the terms and conditions of this permit and shall remain in force until all work
under this permit has been completed and approved by the Department.
® 21. Relative to advertising adjacent to all State highways,we wish to call your attention to the Scenic Vistas Act of 1971,Chapter 47.42 RCW and
State Transportation Commission ruling Chapter 468-66 WAC.Violation of this section of the statutes will be sufficient cause for cancellation of
this permit.On-premise signs are allowed.
® 22. The Grantee shall notify the Department's representative upon completion of the work under this permit so that a final inspection can be made.
® 23. No lane closures shall be allowed except as approved by the Department representative.Approvals may cause revision of special provisions,including
hours of operation.
® 24. The responsibility of the Grantee for proper performance,safe conduct,and adequate policing and supervision of the project shall not be lessened or
otherwise affected by Department approval of plans,specifications,or work,or by the presence at the work site of Department representatives,or by
compliance by the Grantee with any requests or recommendations made by such representatives.
® 25. All material and workmanship shall conform to the Washington State Department of Transportation Standard Specifications for Road,Bridge and
Municipal Construction,current edition,and amendments thereto,and shall be subject to inspection by the Department.
DOT Form 224-713 EF �r
M4 Page 2 Exhibit rr A
M96-0137
St. Andrew's House
Diocese of Olympia, Inc.
P. O. Box 12126
Seattle, Washington 98102
(206) 325-4200, ext. 313
SPECIAL PROVISIONS (Continued)
X 26. A"Non-Conforming Connection" is a road approach, driveway,or turnout that does not meet current
Department location, spacing or design criteria. A non-conforming connection is temporary in nature and
may be removed when and if conditions change so that it is possible to construct a conforming connection to
the property. The removal of this non-conforming access and construction of the new conforming access in its
new location is the responsibility of the permittee, assignee, or the property owner at their expense. All non-
conforming connections will be examined during construction of future Department projects to determine if it
should be relocated,altered or closed in order to make the access conform to current design standards.
X 27. Any future development, subdivision, or change in land use of this property will require review and approval
by both Mason County and WSDOT for adequacy of this approach for the intended use.
X 28. This approach shall be re-constructed and upgraded to meet Type"D" road approach standards. The down
slope from the edge of pavement, out to the centerline of the culvert plus a foot shall be constructed at a minus
0.02 feet/foot down and away from the highway. The culvert shall be laid to the true flow line and have
beveled end sections. A Type 1 Catch Basin shall be installed within the ditch flow line connecting the culvert
pipes at a location specified by WSDOT Maintenance.
X 29. Asphalt concrete curbs (berms),2 inches high, one foot wide, and the width of the driveway shall be
constructed into the approach and placed at a V-shape across the entrance to channel water runoff into the
catch basin.
X 30. Special care should be taken during construction of this approach to insure that water from this approach will
not flow onto SR 106. Any problems created by surface water runoff directed toward the state highway right-
of-way shall be alleviated at the Grantee's expense.
X 31. The Grantee is responsible for obtaining construction, grading, and all other pertinent permits from Mason
County or other applicable agencies prior to beginning work.
Page 3 of 3 EXHIBIT "A"
t
� , � War � ;c �i�zc• r' �li--�*�-- F"�Gut
t
--- ---- ---- ------ --- -- ----
C
1 \
1 -
4 `
v
EXHIBIT B
i
. EtarcHlltlnp - �,u V•ct •�
Slpn Spoclfp • x Dow c• Spoc Ir.p I f I.1 vllo...... n w 1+ 0 1 +o e+
1401[1 FOR OPERATIOUS OF 15 NINNIES Oil LESS, ALL SIGHS T_ _ —opT er_ 1on4rnl Ilcl... l.luo{_o erono u.
AND CIIAIIUEL I ZAT IOU DEVICES MAY DE EL IMIUAIED. 65 ►rn isoo•1 w1 V1 K.C14 I,Q+ .K.4 pglyu ..
fra•roys 55 ►1ril IoOQt_ 40 so
FOR OPERAIIONS OF 60 MINUTES OR LESS, CIIAHUELIZAIIOH �or uuTCU Port 6. IoG1e VI-3etc i lulo.L111 w..K
DEVICES ARE REOUIREO SIGNS ARE RECOMMENDED. Ilur al(1oodD I.r1 IO+
urban 11liph spoea 40/55 UPII 500'1- 30 60
I I.IID 14 WO IS'
DUW II.u[.
Ilgl ..UD SIDfLK Ot Ur[1 .SSY.4'.l.
lS urn+n10 —0 DIII rnlNl.l-
,W I14CO•�t.O[D
NIINUU IAPEN LE146III ILI W FEEI
41 1`0e16d SpNd Im0n1
25 30 35 40 45 50 .•'55 65
Ic 265 450 500 550
41 o^ _
`got 1 295 495 5s0 605
++ FI1 320 540 600 660 iEo
7
2'mIn.
t1 q 11 0 l� rzz
0 ARE
x x x L/3_ ` r
ROAD 511DADEA 1500'MAX.
WORK CLOSED
AfIEAD Al1EA0 E� or reverse cone
ROAD �OfiK toper to show and
of work oreo
W20- 1 SHOULDER W20-302 " 2A
48•'X48" WORK 48'•X48' 4813/0
D�0 0/O GENERAL NOTES Duo
W21-5 I. HO ERCROACIIMEHT Oil TRAVELLED t_ARE. If EHCROACIIMERI
411"x48" IS NECESSARY, LAKE MUST BE CLOSLD.
D/0 2. DUFFER VEHICLE RECOMMENDED (MAY BE A WORK VEHICLE.)
LEGEND
R SIGII LOCATIOII
TRIPOD MODUI
0 0 13 CHANUELIZIUG DEVICES SHOULDER CLOSURE HIGH SPEED �c
(40 MPII Oil HIGHER) Irof f Ic Engineer
DUFFER VEHICLE - RECOMMEUDED T.C.P. 1 1 5 I 95
Plot/
EXHIBIT "C"
NOTES:
oa Q 4 D Frame and grate I. Catch Bosins to be constructed in accordance with ASTM
o (see Standard Pion C 478 (AASHTO M 199) & ASTM C 890, unless otherwise shown
o for details) on Plans or noted in the Standard Specifications.
2. As on acceptable alternate to rebor, welded wire fabric
having a minimum area of 0.12 square inches per foot
may be used. Welded wire fabric shall comply to ASTM
5 S'" A 497 (AASHTO M 221). Wire fabric shall not be placed
,JA �p-, in the knockouts.
3. The bottom of the precast base section may be rounded.
S - 6" Riser Section
4. Precast bases shall be furnished with cutouts or
knockouts. Knockouts shall have a wall thickness of
1 - 13 Bar hoop + 6 2" MIN. Knockouts may be on oil 4 sides either round
' or "D" shape. Pipe to be installed in factory supplied
knockouts. Knockout or cutout hole size is equal to
5 S, pipe outer diameter plus catch basin wall thickness,
�A 20" MAX.3O
2
`LA 01• 5. The maximum depth from the finished grode to the pipe
Invert is 5"-0 .
12"' Riser Section
6. The toper on the sides of the precast base section and
/ 12" riser section shall not exceed 1/2"/FT.
2 - 13 Bar hoop f •'/ 7. Frame and grate may be installed with flange down or
cast into riser.
\k%\k
/fN
6 Precast Bose Section
A (Measurement of the top1
a ( / / ` of the base JJ
13 Bar each corner /
Q CATCH BASIN TYPE 1
13 Bar each side 'I-
13 Bor each way
tri
t".R 1(YG fKrtll
r�a•11 Noy T, 1997
5-1-93 Rcvlsed Hates and resigned. SJD -
DATE REVISIDN 1UY APPR'D STANDARD PLAN B- 1
Groove and always laid upgrade
NOTES
--------------- ----------------
r 1. The culvert ends shollbe beveled to match
the side slope. Field cut of culvert ends is
permitted, when approved by the Engineer.
r
2. Alllield cut culvert pipe shollbe treated
-------------- -------------F-- with treatment as shown in the Standard
Specifications or Cenerol Special Provisions.
PLAN
Fnd section
Sea note 1
-------------- r -- -- -- ----- �1
-------- ' ------ ------------------------------------------------
Included In culvert length for payment'
ELEVATION 'I
CONCRETE PIPE
End section
V MIN
See nolo 1
�1
BEVELED END SECTION
Included In culvert length for payment ti yrwc
ELEVATION
METAL. PIPE 8-17-90 Revised 4" MAX dirnansion on Concrete Pipe Af3N � �.. wm ro,roar
9-29=89 Remove l MIN dlmenslon Irom Concrete Pipe ST f
6-12-88 Ravlsed note 1,oddcd note 2 ST STANDARD PLAN B-7e
12-4-86 Revised bevel title block 6 notes M2
T
• II
ASSIGNMENT OF ESCROW ACCOUNT
This assignment is for the purpose of fulfilling the requirement of bonding collateral for
Permit M96-0137 . The undersigned does hereby assign, transfer, and set over unto
the State of Washington all right, title and interest in and to $ 2,000.00
on 1,JW 11 12 a (9 9 4o /Account in the 2� �2WD2 4 7 Jam-u S f�'c/1�Bank, in the
name St. Andrew's House/Diocese of Olympia, Inc. full power and authority to demand,
collect, and receive said deposit and to give receipt and acquittance therefore for the uses and
purposes prescribed above. It is understood and agreed that CQCA .AJa W
Branch, Bank holds the Certificate covering said account in its
possession and agrees to hold $ 2,000.00 until a release of this assignment
from the State of Washington is received. The interest shall be payable to St. Andrew's House /
Diocese of Olympia, Inc.. /
Signed and dated at 1.3 IrUQG�(,�?Gu l SeaYk , Washington this day of
J lit y 199(" .
aL-a �
Account No. Signature
Signature 1/
Eo,
Address
ACCEPTANCE
The undersigned hereby accepts the foregoing Assignment of Escrow Certificate, Voucher
Number 4-a0e aye , in the amount of $2,000.00 this I a day of
J , 199L.
Z�l S c�n lC /2 Gt���sh��►�
F2D
fficer Bank
� 3N-3�, l3 ej
Phone No. of Bank Address of Bank
bAESCROW.DOC