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Maintenance Activity <br />Ability To Perform <br />Preventative Maintenance Schedule <br />❑ Yes ❑ No <br />© Yes ❑ No <br />Wheelchair Litt Maintenance Schedule <br />[9 Yes ❑ No <br />Front Brake Reline (Both Sides) <br />Front Brake Overhaul (Both Sides) <br />[� Yes ❑ No <br />Brake Rotor Replacement (One Each) <br />[y�Yes ❑ No <br />Rear Brake Reline (Both Sides) <br />EY Yes ❑ No <br />D'Yes ❑ No <br />Rear Brake Overhaul (Both Sides) <br />Minor EVAC and Recharge R134 AC System <br />EO' Yes ❑ No <br />9 Yes ❑ No <br />Alignment <br />[Yes ❑ No <br />Battery Replacement <br />[1Yes ❑ No <br />Fuel Injection Flush <br />Alternator <br />OV Yes ❑ No <br />Fuel Pump Module <br />❑ Yes ❑ No <br />[✓j Yes ❑ No <br />Window Motors <br />Shock Absorbers <br />Yes ❑ No <br />Transmission / Engine Oil Cooler Lines <br />Yes ❑ No <br />Tires <br />Yes ❑ No <br />Towing Services <br />❑ Yes No <br />Accident Repair / Body Work <br />❑ Yes No <br />This information is true and accurate to the best of my knowledge and ability. <br />Typed Name of Person Completing this Form: mm,rrIL /� A we <br />Title: 1/ T <br />Signature: <br />Date: 5 f q I- o <br />Contractors and consultants will need to provide the required information for their own workforce <br />as well as the workforce of all subcontractors that were active on their ARRA funded project(s) for <br />the reporting month. These reports are required monthly until the contract is completed or <br />September 2012 whichever occurs first. <br />The Contractor hereby agrees to comply with the Contract Provisions and Reporting Requirements as <br />indicated in the American Recovery and Reinvestment Act of 2009 and any amendments thereto. The <br />56 <br />__- _Attachment- number -1 <br />F -5 Page 126 <br />