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CALTRANS - California Department of Transportation - 2011-08-10 (17)
STATE OF CALIFORNIA. BUSINESS,TRANSPORTATION AND HOUSING AGENCY EDMUND G. BROWN Jr. Governor DEPARTMENT OF TRANSPORTATION Division of Local Assistance 1120 N STREET P.O. BOX 942874, MS# 1 Sacramento, CA 94274-0001 TTY 711 (916)654-3151 Fax (916) 653-7621 August 10, 2011 Mr. Travis Hopkins Director of Public Works City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Attn: Ms. Joan Flynn Dear Mr. Hopkins: 4 File: 12-ORA-0-HNTB BPMPL-5181(171) Magnolia Street over Huntington Beach Channel, Br. No. 55C-0388 Enclosed is your fully executed copy of Program Supplement Agreement No. 046-N to Administering Agency -State Agreement No. 12-5181 R and an approved Finance Letter. Please retain the signed Finance Letter for your records. In accordance to Government Code 16304, Federal and State funds appropriated by the State budget are available for disbursement for limited periods of time. The attached Finance Letter shows the deadlines for liquidation as 'Reversion Dates". Please ensure that your invoices are submitted at least 60 days prior to the Reversion Date to avoid any lapse of funds. If your agency is unable to seek reimbursement by this date, you may request an extension through a Cooperative Work Agreement (CWA). A CWA is subject to the final approval of the State Department of Finance. If approved, the CWA may extend the deadline for up to one year to federal funds and up to three years for State funds. Please note that Government Code 16304 does not supersede any other more restrictive expenditure deadlines. Sincerely, �G RAY ZHANG, Chief Office of Project Implementation - South Division of Local Assistance Enclosure c: DLA AE Project Files (12) DLAE - Jim Kaufman DEPARTMENT OF TRANSPORTATION FINANCE LETTER Date: 08/08/2011 DIVISION OF ACCOUNTING Agency: 12-ORA-0-HNTB LOCAL PROGRAM ACCOUNTING BRANCH Project No: BPMPL-5181(171) EA No: Attention: City of Huntington Beach FINANCE ITEMS TOTAL COST OF WORK FEDERAL PART. COST FED. REIMB % FEDERAL FUNDS LICE LOCAL FUNDS OTHER FUNDS Agency Preliminary Engineering $193,591.00 $193,591.00 88.53% $171,386.00 $22,205.00 $0.0 Totals: $193,591.00 $193,591.00 0.0011. $171,386.00 $22,205.0 $0.0 Fed. Partic: 100.00% This Finance Letter was created based on specific financial information provided by the responsible local agency. The following encumbrance history is prepared by Local Assistance Accounting Office and is provided here for local agency's information and action. Signature: For questions regarding finance letter, contact: ,�. ,� , Title: HQ Local Assistance Area Engineer Printed Name : Patrick Louie Telephone No: (916) 653-7349 Remarks: Br. No 55C-0388 - Magnolia Street Bridge Preventive Maintenence. Reimbursement ratio = 88.53%. ACCOUNTING INFORMATION _ BPMPL-5181(171) Adv. Proj. ID Approp. Unit State Prog. Fed/State Encumbrance Amount Approp Year Expenditure Amount Ecumbrance Balance Reversion Date 1200020288 11102F 2030010300 F $171,386.00 1011 $0.00 $171,386.00 06 0/16 Page 1 of 1 PROGRAM SUPPLEMENT NO. N046 Date: June 30, 2011 to Location: 12-ORA-0-H NTB ADMINISTERING AGENCY -STATE AGREEMENT Project Number: BPMPL-5181(171) FOR FEDERAL -AID PROJECTS NO 12-5181 R E.A. Number: Locode: 5181 This Program Supplement hereby adopts and incorporates the Administering Agency -State Agreement for Federal Aid which was entered into between the Administering Agency and the State on 12/06/06 and is subject to all the terms and conditions thereof. This Program Supplement is executed in accordance with Article I of the aforementioned Master Agreement under authority of -Resolution No. eW/o -49 approved by the Administering Agency on #JV/L (See copy attached). The Administering Agency further stipulates that as a condition to the payment by the State of any funds derived from sources noted below obligated to this PROJECT, the Administering Agency accepts and will comply with the special covenants or remarks set forth on the following pages. PROJECT LOCATION: Magnolia Street over Huntington Beach Channel, Br. No. 55C-0388 TYPE OF WORK: Bridge preventive maintenance Estimated Cost Federal Funds L10E $171,386.00 LOCAL $193,591.001 j $22,205 CITY OF HUNTINGTON BEACH By Title Di c �r of Public Words Date — '2t—Z0U LENGTH: 0.0(MILES) Matching Funds OTHER $0.00 STATE OF CALIFORNIA Departure t of Transpo tion By �4— ,,�Chief, ©ffice of Project Implementation %) Division of Local Assistance (f � r , Date - '� J I hereby c fy upon my personal knowledge that budgeted funds are available for this encumbrance: Accounting Officer` �- Date '' $171,386.00 Chapter ;' Statutes i' Item Year Program BC Category j Fund Source AMOUNT Program Supplement 12-5181 R-N046- ISTEA Page 1 of 3 STATE OF CALIFORNIA DEPARTMENT OF TRANSPORTATION PROGRAM SUPPLMENT AND CERTIFICATION FORM PSCF (REV. 01/2010) Page __ of TO: STATE CONTROLLER'S OFFICE DATE PREPARED. PROJECT NUMBER. Clains Audits 06/29/11 1200020288 3301 "C" Street, Rm 404 REQUISITION NUMBER / CONTRACT NUMBER. Sacramento, CA 95816 RQS 120000000655 FROM Department of Transportation SUBJECT: Encumbrance Document VENDOR/LOCAL AGENCY: CITY OF HUNTINGTON BEACH CONTRACT AMOUNT: $171,386.00 PROCUREMENT TYPE Local Assistance I HEREBY CERTIFY UPON MY OWN PERSONAL KNOWLEDGE THAT BUDGETED FUNDS ARE AVAILABLE FOR THIS EMCUMBRANCE AND PURPOSE OF THE EXPEDNITURE STATED ABOVE. ADA Notii For individuals with sensory disabilities, this document is available in alternate formats. For information, call (915) 654-6410 of TDD (916) -3880 or write Records and Forms Management, 1120 N Street, MS-89. Sacramento, CA 95814, ,12-ORA-0-HNTB BPMPL-5181(171) SPECIAL COVENANTS OR REMARKS 06/28/2011 1. ADMINISTERING AGENCY agrees that it will only proceed with work authorized for specific phase(s) with an "Authorization to Proceed" and will not proceed with future phase(s) of this project prior to receiving an "Authorization to Proceed" from the STATE for that phase(s) unless no further State or Federal funds are needed for those future phase(s). 2. Any State and Federal funds that may have been encumbered for this project are available for disbursement for limited periods of time. For each fund encumbrance the limited period is from the start of the fiscal year that the specific fund was appropriated within the State Budget Act to the applicable fund Reversion Date shown on the State approved project finance letter. Per Government Code Section 16304, all project funds not liquidated within these periods will revert unless an executed Cooperative Work Agreement extending these dates is requested by the ADMINISTERING AGENCY and approved by the California Department of Finance. ADMINISTERING AGENCY should ensure that invoices are submitted to the District Local Assistance Engineer at least 75 days prior to the applicable fund Reversion Date to avoid the lapse of applicable funds. Pursuant to a directive from the State Controller's Office and the Department of Finance; in order for payment to be made, the last date the District Local Assistance Engineer can forward an invoice for payment to the Department's Local Programs Accounting Office for reimbursable work for funds that are going to revert at the end of a particular fiscal year is May 15th of the particular fiscal year. Notwithstanding the unliquidated sums of project specific State and Federal funding remaining and available to fund project work, any invoice for reimbursement involving applicable funds that is not received by the Department's Local Programs Accounting Office at least 45 days prior to the applicable fixed fund Reversion Date will not be paid. These unexpended funds will be irrevocably reverted by the Department's Division of Accounting on the applicable fund Reversion Date. 3. The ADMINISTERING AGENCY will advertise, award and administer this project in accordance with the current published Local Assistance Procedures Manual. 4. Award information shall be submitted by the ADMINISTERING AGENCY to the District Local Assistance Engineer within 60 days of project contract award and prior to the submittal of the ADMINISTERING AGENCY'S first invoice for the construction contract. Failure to do so will cause a delay in the State processing invoices for the construction phase. Please refer to Section 15.7 "Award Package" of the Local Assistance Procedures Manual. 5. ADMINISTERING AGENCY agrees, as a minimum, to submit invoices at least once every six months commencing after the funds are encumbered for each phase by the execution of this Project Program Supplement Agreement, or by STATE's approval of an applicable Finance Letter. STATE reserves the right to suspend future authorizations/obligations for Federal aid projects, or encumberances for State funded projects, as well as to suspend invoice payments for any on -going or future project by ADMINISTERING AGENCY if Program Supplement 12-5181 R-N046- ISTEA Page 2 of 3 12-ORA-0-H NTB BPMPL-5181(171) SPECIAL COVENANTS OR REMARKS 06/28/2011 PROJECT costs have not been invoiced by ADMINISTERING AGENCY for a six-month period. If no costs have been invoiced for a six-month period, ADMINISTERING AGENCY agrees to submit for each phase a written explanation of the absence of PROJECT activity along with target billing date and target billing amount. ADMINISTERING AGENCY agrees to submit the final report documents that collectively constitute a "Report of Expenditures" within one hundred eighty (180) days of PROJECT completion. Failure of ADMINISTERING AGENCY to submit a "Final Report of Expenditures" within 180 days of PROJECT completion will result in STATE imposing sanctions upon ADMINISTERING AGENCY in accordance with the current Local Assistance Procedures Manual. 6. The Administering Agency shall not discriminate on the basis of race, religion, age, disability, color, national origin, or sex in the award and performance of any Federal - assisted contract or in the administration of its DBE Program Implementation Agreement. The Administering Agency shall take all necessary and reasonable steps under 49 CFR Part 26 to ensure nondiscrimination in the award and administration of Federal -assisted contracts. The Administering Agency's DBE Implementation Agreement is incorporated by reference in this Agreement. Implementation of the DBE Implementation Agreement, including but not limited to timely reporting of DBE commitments and utilization, is a legal obligation and failure to carry out its terms_ shall be :treated as a violation of this Agreement. Upon notification to the Administering Agency of its failure to :carry out its DBE Implementation Agreement, the State may impose sanctions as provided for under 49 CFR Part 26 and may, in appropriate cases, refer the matter for enforcement under 18 U.S.C. 1001 and/or the Program Fraud Civil Remedies Act of 1986 (31 U.S.C. 3801 et seq.). 7. As a condition for receiving federal -aid highway funds for the PROJECT, the Administering Agency certifies that NO members of the elected board, council, or other key decision makers are on the Federal Government Excluded Parties List System (EPLS). Program Supplement 12-5181 R-N046- ISTEA Page 3 of 3 RESOLUTION NO. 20I0-29 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HUNTINGTON BEACH AUTHORIZING THE DIRECTOR OF PUBLIC WORKS TO EXECUTE PROGRAM SUPPLEMENTS TO THE CALIFORNIA DEPARTMENT OF TRANSPORTATION MASTER AGREEMENT FOR TRANSPORTATION PROJECTS WHEREAS, the City of Huntington Beach is eligible to receive federal and/or state funding for certain transportation projects through the California Department of Transportation; and California Department of Transportation requires the execution of Master Agreements, Program Supplemental Agreements, Fund Exchange Agreements and/or Fund Transfer Agreements prior to _claiming designated funds; and The City wishes to delegate authorization to the Director of Public Works to execute these agreements and any amendments thereto; NOW, THEREFORE, the City Council of the City of Huntington Beach does hereby resolve that the Director of Public Works is authorized to execute all Master Agreements, Master Agreements, Program Supplemental Agreements, Fund Exchange Agreements and/or Fund Transfer Agreements and any amendments thereto with the California Department of Transportation. PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a regular meeting thereof held on the 5TH day of APRI L ' 2010 • INITIATED AND APPROVED: "Director of Pu lic Works APP VED AS TO FORM: Attorny U C 43514 Res. No. 2010-29 STATE OF CALIFORNIA COUNTY OF ORANGE ) ss: CITY OF HUNTINGTON BEACH ) I, JOAN L. FLYNN the duly elected, qualified City Clerk of the City of Huntington Beach, and ex-officio Clerk of the City Council of said City, do hereby certify that the whole number of members of the City Council of the City of Huntington Beach is seven; that the foregoing resolution was passed and adopted by the affirmative vote of at least a majority of all the members of said City Council at a regular meeting thereof held on April 5, 2010 by the following vote: AYES: Carchio, Coerper, Hardy, Green, Bohr, Dwyer, Hansen NOES: None ABSENT: None ABSTAIN: None Ci Clerk and ex-offici lerk of the City Council of the City of Huntington Beach, California City ®f Huntington Beach 2000 Main Street ® Huntington Beach, CA 92645 (714) 536-5227 ® www.huntingtonbeachea.gov Office of the City Clerk :Joan L. Flynn, City Clerk July 21, 2011 Ray Zhang, Chief Office of Project Implementation Department of Transportation, Division of Local Assistance 1120 N Street P.O. Box 942874, MS #1 Sacramento CA 94274-0001 Dear Mr. Zhang: Enclosed please find Program Supplement Agreement No. 044-N, 045-N, and 046-N to Administering Agency -State Agreement No. 12-5181 R for various projects located in Huntington Beach. Attached to Program Supplement Agreement No. 044-N, 045-N, and 046-N is a copy of Resolution No. 2010-29. Upon execution by the state, please return a complete copy to: Joan L. Flynn City Clerk 2000 Main Street Huntington Beach CA 92648 Your attention to this matter is greatly appreciated. JF:pe Encl.: (2) Program Supplement Agreement 044-N, 045-N, and 046-N including copy of Resolution 2010-29. G: fo11owup:agrmtltr Sister Cities: Anjo, Japan ® Waitakere, New Zealand STATE OF CALIFORNIA. BUSINESS,TRANSPORTATION AND HOUSING AGENCY DEPARTMENT OF TRANSPORTATION Division of Local Assistance 1120 N STREET P.O. BOX 942874, MS# 1 Sacramento, CA 94274-0001 TTY 711 (916) 654-3151 Fax (916) 653-7621 July 8, 2011 Mr. Travis Hopkins Director of Public Works City of Huntington Beach 2000 Main St. Huntington Beach, CA 92648 Attn: Mr. Jonathan Claudio Dear Mr. Hopkins: EDMUND G. BROWN Jr. Governor 4 File: 12-ORA-0-HNTB BPMPL-5181(171) Magnolia Street over Huntington Beach Channel, Br. No. 55C-0388 Enclosed are two originals of the Program Supplement Agreement No. 046-N to Administering Agency -State Agreement No. 12-5181 R. Please note that federal funding will be lost if you proceed with future phase(s) of the project prior to getting the "Authorization to Proceed" with that phase. Please review the covenants and sign both copies of this Agreement and return both to this office, Office of Project Implementation - MS1 within 60 days from the date of this letter. If the signed Agreements are not received back in this office within 60 days, funds will be disencumbered and/or deobligated. Alterations should not be made to the agreement language or funding. Attach your local agency's certified authorizing resolution that clearly identifies the project and the official authorized to execute the agreement. A fully executed copy of the agreement will be returned to you upon ratification by Caltrans. No invoices for reimbursement can be processed until the agreement is fully executed. A copy of the State approved finance letter containing the fund encumbrance and reversion date information will be mailed to you with your copy of the executed agreement. Your prompt action is requested. If you have questions, please contact your District Local Assistance Engineer. Sincerely, RAY ZHANG, Chief Office of Project Implementation - South Division of Local Assistance Enclosure c: DLA AE Project Files (12) DLAE - Jim Kaufman PROGRAM SUPPLEMENT NO. N046 to ADMINISTERING AGENCY -STATE AGREEMENT FOR FEDERAL -AID PROJECTS NO 12-5181 R Date: Location: Project Number: E.A. Number: Locode: June 30, 2011 12-ORA-0-HNTB BPMPL-5181(171) 5181 This Program Supplement hereby adopts and incorporates the Administering Agency -State Agreement for Federal Aid which was entered into between the Administering Agency and the State on 12/06/06 and is subject to all the terms and conditions thereof. This Program Supplement is executed in accordance with Article I of the aforementioned Master Agreement under authority of Resolution No..U10 - Al approved by the Administering Agency on jl ft4 L J; 2610 (See copy attached). The Administering Agency further stipulates that as a condition to the payment by the State of any funds derived from sources noted below obligated to this PROJECT, the Administering Agency accepts and will comply with the special covenants or remarks set forth on the following pages. PROJECT LOCATION: Magnolia Street over Huntington Beach Channel, Br. No. 55C-0388 TYPE OF WORK: Bridge preventive maintenance LENGTH: 0.0(MILES) Estimated Cost Federal Funds Matching Funds L10E $193,591 $171,386.00 ( LOCAL CITY OF HUNTINGTON BEACH By Title Director of Puhl i r Work - Date �- 2-1 —Zc�t( r� $22, OTHER $0.00 STATE OF CALIFORNIA Department of Transportation By Chief, Office of Project Implementation Division of Local Assistance Date V hereby cert upon my personal knowledge that budgeted funds afie available for this encumbrance: Accounting Officer Date '' Q' $171,386.00 Chapter I Statutes I Item I Year I Program I BC I Category I Fund Source ; AMOUNT Program Supplement 12-5181R-N046- ISTEA Page 1 of 3 1 STATE OF CALIFORNIA. DEPARTMENT OF TRANSPORTATION PROGRAM SUPPLMENT AND CERTIFICATION FORM PSCF (REV. 01/2010) TO: Clain Audits 3301 "C' Street, Rm 404 Sacramento, CA 95816 FROM: Department of Transportation SUBJECT: Encumbrance Document VENDOR / LOCAL AGENCY: CITY OF HUNTINGTON BEACH CONTRACT AMOUNT: $171,386.00 PROCUREMENTTYPE: Local Assistance DATE PREPARED: 06/29/11 REQUISITION NUMBER / CONTRACT NUMBER: RQS 120000000655 Page _ of 1200020288 1 HEREBY CERTIFY UPON MY OWN PERSONAL KNOWLEDGE THAT BUDGETED FUNDS ARE AVAILABLE FOR THIS EMCUMBRANCE AND PURPOSE OF THE EXPEDNITURE STATED ABOVE. ADA Noti1 For individuals with sensory disabilities, this document is available in alternate formats. For information, call (915) 654-6410 of TDD (916) -3880 or write Records and Forms Management, 1120 N. Street, MS-89, Sacramento, CA 95814. s ' 12-ORA-0-HNTB 06/28/2011 BPMPL-5181(171) SPECIAL COVENANTS OR REMARKS 1. ADMINISTERING AGENCY agrees that it will only proceed with work authorized for specific phase(s) with an "Authorization to Proceed" and will not proceed with future phase(s) of this project prior to receiving an "Authorization to Proceed" from the STATE for that phase(s) unless no further State or Federal funds are needed for those future phase(s). 2. Any State and Federal funds that may have been encumbered for this project are available for disbursement for limited periods of time. For each fund encumbrance the limited period is from the start of the fiscal year that the specific fund was appropriated within the State Budget Act to the applicable fund Reversion Date shown on the State approved project finance letter. Per Government Code Section 16304, all project funds not liquidated within these periods will revert unless an executed Cooperative Work Agreement extending these dates is requested by the ADMINISTERING AGENCY and approved by the California Department of Finance. ADMINISTERING AGENCY should ensure that invoices are submitted to the District Local Assistance Engineer at least 75 days prior to the applicable fund Reversion Date to avoid the lapse of applicable funds. Pursuant to a directive from the State Controller's Office and the Department of Finance; in order for payment to be made, the last date the District Local Assistance Engineer can forward an invoice for payment to the Department's Local Programs Accounting Office for reimbursable work for funds that are going to revert at the end of a particular fiscal year is -May 15th of the particular fiscal year. Notwithstanding the unliquidated sums of project specific State and Federal funding remaining and available to.fund project work, any; invoice for reimbursement involving applicable funds that is not received by --the Department's Local Programs Accounting Office at least 45 days prior to the applicable fixed fund Reversion Date will not be paid. These unexpended funds will be irrevocably reverted by the Department's Division of Accounting on the applicable fund Reversion Date. 3. The ADMINISTERING AGENCY will advertise, award and administer this project in accordance with the current published Local Assistance Procedures Manual. 4. Award information shall be submitted by the ADMINISTERING AGENCY to the District Local Assistance Engineer within 60 days of project contract award and prior to the submittal of the ADMINISTERING AGENCY'S first invoice for the construction contract. Failure to do so will cause a delay in the State processing invoices for the construction phase. Please refer to Section .15.7 "Award Package" of the Local Assistance Procedures Manual. 5. ADMINISTERING AGENCY agrees, as a minimum, to submit invoices at least once every six months commencing after the funds are encumbered for each phase by the execution of this Project Program Supplement Agreement, or by STATE's approval of an applicable Finance Letter. STATE reserves the right to suspend future authorizations/obligations for Federal aid projects, or encumberances for State funded projects, as well as to suspend invoice payments for any on -going or future project by ADMINISTERING AGENCY if Program Supplement 12-5181 R-N046- ISTEA Page 2 of 3 12-ORA-0-HNTB BPMPL-5181(171) 06/2812011 SPECIAL COVENANTS OR REMARKS PROJECT costs have not been invoiced by ADMINISTERING AGENCY for a six-month period. If no costs have been invoiced for a six-month period, ADMINISTERING AGENCY agrees to submit for each phase a written explanation of the absence of PROJECT activity along with target billing date and target billing amount. ADMINISTERING AGENCY agrees to submit the final report documents that collectively constitute a "Report of Expenditures" within one hundred eighty (180) days of PROJECT completion. Failure of ADMINISTERING AGENCY to submit a "Final Report of Expenditures" within 180 days of PROJECT completion will result in STATE imposing sanctions upon ADMINISTERING AGENCY in accordance with the current Local Assistance Procedures Manual. 6. The Administering Agency shall not discriminate on the basis of race, religion, age, disability, color, national origin, or sex in the award and performance of any Federal - assisted contract or in the administration of its DBE Program Implementation Agreement. The Administering Agency shall take all necessary and reasonable steps under 49 CFR Part 26 to ensure nondiscrimination in the award and administration of Federal -assisted contracts. The Administering Agency's DBE Implementation Agreement is incorporated -by reference in this Agreement. Implementation of the DBE Implementation -Agreement, including but not limited to timely reporting of DBE commitments and utilization, is a legal obligation and failure to carry out its terms_ shall be =treated as a violation of this Agreement Upon notification to the Administering Agency of its failure to carry out its DBE Implementation Agreement, the State may impose sanctions as provided for under 49 CFR Part 26 and may, in appropriate cases, refer the matter for enforcement under 18 U.S.C. 1001 and/or the Program Fraud Civil Remedies Act of 1986 (31 U.S.C. 3801 et seq.). 7. As a condition for receiving federal -aid highway funds for the PROJECT, the Administering Agency certifies that NO members of the elected board, council, or other key decision makers are on the Federal Government Excluded Parties List System (EPLS). Program Supplement 12-5181 R-N046- ISTEA Page 3 of 3 RESOLUTION NO. 2010-29 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF HUNTINGTON BEACH AUTHORIZING THE DIRECTOR OF PUBLIC WORKS TO EXECUTE PROGRAM SUPPLEMENTS TO THE CALIFORNIA DEPARTMENT OF TRANSPORTATION MASTER AGREEMENT FOR TRANSPORTATION PROJECTS WHEREAS, the City of Huntington Beach is eligible to receive federal and/or state funding for certain transportation projects through the California Department of Transportation; and California Department of Transportation requires the execution of Master Agreements, Program Supplemental Agreements, Fund Exchange Agreements and/or Fund Transfer Agreements prior to.claiming designated funds; and The City wishes to delegate authorization to the Director of Public Works to execute these agreements and any amendments thereto, NOW, THEREFORE, the City Council of the City of Huntington Beach does hereby resolve that the Director of Public Works is authorized to execute all Master Agreements, Master Agreements, Program Supplemental Agreements, Fund Exchange Agreements and/or Fund Transfer Agreements and any amendments thereto with the California Department of Transportation. PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a regular meeting thereof held on the 51H day of APRI L , 20__1Q_• A '-r- a REV D APPROVED: INITIATED AND APPROVED: Ci nistrator �DircctorofPuic orks AP VED AS TO FORM: Attorn y �tc C 2 �� 43S14