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This information is true and accurate to the best of my knowledge and ability. <br />Typed Name of Person Completing this Form: <br />Title: <br />Signature Date <br />1.4 Shop Description <br />Shop Hours (M -F) <br />Shop Hours (Saturday) <br />Perform Warranty Work? <br />Number of Lifts <br />Lift Capacity �ies) <br />Towing Equipment <br />Describe <br />Number of Bays <br />Bay Sizes <br />Height <br />Length <br />Width <br />Experience & Certifications <br />Engine Repair <br />Auto Transmission <br />Drive Train <br />Steering & Suspension <br />Brakes <br />Electrical System <br />Heating & A/C <br />Federal A/C Recovery <br />Wheels & Tires <br />Hydraulic Lift <br />State Inspections <br />1.5 References <br />77 A n► m <br />No Describe: O% Ar• Waik oi- - a mA - lio riz <br />'5 arCr r"tQa�r <br />lq ' yoo lbs <br />N�0 <br />^3 <br />If Yes, list Certification type(s): <br />Wj Yes ❑ NoC: Sc�t <br />g Yes ❑ No ,►q-e <br />0 <br />Yes <br />❑ No L� <br />F,� <br />Yes <br />❑ No � S & r ur1 el <br />© <br />"Yes <br />El No At <br />�-] <br />Yes <br />❑ <br />No tf5 <br />P <br />Yes <br />❑ <br />No C� <br />Yes <br />❑ <br />No L: <br />✓❑ <br />Yes <br />❑ <br />No g5S c� r� <br />[✓ <br />Yes <br />❑ <br />No 6- <br />Yes <br />❑ <br />No PeI <br />Q <br />Provide the names and contact information of at least three (3) references that we may contact to help <br />us get to know you as a service provider. These references should help us determine your timeliness, <br />accuracy, cost effectiveness, and customer service. <br />Reference Name <br />#1; \'� ti" <br />Phone — ItiIA `112 - 2 � <br />Relationship <br />Reference <br /># Name <br />2: d �rnaS2 ❑�� -�e 5 rE1 ti <br />51 <br />Attachment number 1 <br />F -5 Page 173 <br />