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,4 • . , . <br /> • • Washington Sate <br /> . Department of Transportation/North*est Region • . <br /> • <br /> • 15700 Dayton Avenue North;PO Box 330310 <br /> Seattle,WA 98133-9710 <br /> • <br /> • APPLICATION FOR JA ACCOUNT <br /> • <br /> .YA NO. 5127• . <br /> Date: March 22,2004 • <br /> PROJECT: General Maintenance(GM)Agreement 1391 <br /> . . <br /> City of Anacortes Signal Maintenance <br /> •DESCRIPTION OF WORK.: Operation and maintenance Of traffic signal systems,• • <br /> LOCATION:Intersections of: Commercial Avenueand 6th.Street; Commercial Avenue and <br /> 8th Street; Q Avenue and 17th Street. <br /> ESTIMATED COST: $12,270/year • <br /> (Actual Amount Will Vary) <br /> • <br /> • <br /> A IA account must be open. ed.by this office tospover our actual.and indirect cost related to this project.By • <br /> . signing this application you agree to pay all Department costs plus an administrative overhead. • <br /> A billing will be submitted each month with the charges that are Incurred,until the project is completed. <br /> Payment is due within 30 days of receipt of each invoice,to avoid any additional charges. <br /> • <br /> . • • • Please return this.completed application as soon as pcissible to avoid delays. <br /> City of Anacortes • • Robert W.Hyde <br /> • (CustomerName) (Authorized Representative:-Print or Type) <br /> • <br /> • <br /> P.O.Box•547 .41116.11 • . <br /> (Billing Address) Ofh•gna(u • <br /> • <br /> • Anacortes,WA 98221 1, - Director • • • <br /> • • (city,State,Zip Code) • • ele) • <br /> 360.293.1919 • • 91.6001227 <br /> . . . <br /> • <br /> (Telephone Number) • (FaxNumber) (Federal Tax ID Number) <br /> • <br /> FOR DEPARTMENT USE ONLY • <br /> • <br /> • <br /> • Department's Representative <br /> • • <br /> (Name) ' (04.No.) (Phone Number) <br /> • (Job Number) (Group No.) (Work Operation) <br /> . . <br /> • <br /> • <br /> • <br /> • • <br /> • <br /> za,/ di/ 4cf:d3 <br /> ; • <br />