|
DR
<br />A
<br />W
<br />N
<br />
<br />B
<br />Y
<br />ST
<br />D
<br />
<br />I
<br />S
<br />S
<br />U
<br />E
<br />
<br />D
<br />A
<br />T
<br />E
<br />RE
<br />V
<br />I
<br />E
<br />W
<br />E
<br />D
<br />
<br />B
<br />Y
<br />DA
<br />T
<br />E
<br />
<br />I
<br />S
<br />S
<br />U
<br />E
<br />D
<br />SH
<br />E
<br />E
<br />T
<br />
<br />N
<br />O
<br />.
<br />TI
<br />T
<br />L
<br />E
<br />DE
<br />S
<br />C
<br />R
<br />I
<br />P
<br />T
<br />I
<br />O
<br />N
<br />SI
<br />T
<br />E
<br />
<br />I
<br />D
<br />SI
<br />T
<br />E
<br />
<br />A
<br />D
<br />D
<br />R
<br />E
<br />S
<br />S
<br />Project Management
<br />BY
<br />DE
<br />S
<br />C
<br />R
<br />I
<br />P
<br />T
<br />I
<br />O
<br />N
<br />DA
<br />T
<br />E
<br />RE
<br />V
<br />6(&7,21%±)/22',1685$1&(5$7(0$3 ),50 ,1)250$7,21
<br />6(&7,21$±3523(57<,1)250$7,21 )25,1685$1&(&203$1<86(
<br />3ROLF\1XPEHU
<br />&RPSDQ\1$,&1XPEHU
<br />$%XLOGLQJ2ZQHU<br />V1DPH 8<(1'2
<br />$%XLOGLQJ6WUHHW$GGUHVV LQFOXGLQJ$SW8QLW6XLWHDQGRU%OGJ1R RU325RXWHDQG%R[1R
<br />:.('*($9(
<br />&LW\ 6$17$$1$6WDWH &$=,3&RGH
<br />$3URSHUW\'HVFULSWLRQ HJ/RWDQG%ORFN1XPEHUVRU/HJDO'HVFULSWLRQ DQGRU7D[3DUFHO1XPEHU
<br />31
<br />$%XLOGLQJ8VH HJ5HVLGHQWLDO1RQ5HVLGHQWLDO$GGLWLRQ$FFHVVRU\HWF 1(:81,7
<br />$/DWLWXGH/RQJLWXGH /DW<br />1 /RQJ<br />:+RUL]RQWDO'DWXP 1$' 1$' :*6
<br />$$WWDFKDWOHDVWWZRDQGZKHQSRVVLEOHIRXUFOHDUSKRWRJUDSKV RQHIRUHDFKVLGH RIWKHEXLOGLQJ VHH)RUPSDJHVDQG
<br />$%XLOGLQJ'LDJUDP1XPEHU %
<br />$)RUDEXLOGLQJZLWKDFUDZOVSDFHRUHQFORVXUH V
<br />D 6TXDUHIRRWDJHRIFUDZOVSDFHRUHQFORVXUH V VTIW
<br />E ,VWKHUHDWOHDVWRQHSHUPDQHQWIORRGRSHQLQJRQWZRGLIIHUHQWVLGHVRIHDFKHQFORVHGDUHD"1R<HV
<br />F (QWHUQXPEHURISHUPDQHQWIORRGRSHQLQJVLQWKHFUDZOVSDFHRUHQFORVXUH V ZLWKLQIRRWDERYHDGMDFHQWJUDGH
<br />1RQHQJLQHHUHGIORRGRSHQLQJV (QJLQHHUHGIORRGRSHQLQJV
<br />VTLQG 7RWDOQHWRSHQDUHDRIQRQHQJLQHHUHGIORRGRSHQLQJVLQ$F
<br />VTIWH 7RWDOUDWHGDUHDRIHQJLQHHUHGIORRGRSHQLQJVLQ$F DWWDFKGRFXPHQWDWLRQ±VHH,QVWUXFWLRQV
<br />VTIWI 6XPRI$GDQG$HUDWHGDUHD LIDSSOLFDEOH±VHH,QVWUXFWLRQV
<br />$ )RUDEXLOGLQJZLWKDQDWWDFKHGJDUDJH
<br />VTIWD 6TXDUHIRRWDJHRIDWWDFKHGJDUDJH
<br /><HV 1R 1$E ,VWKHUHDWOHDVWRQHSHUPDQHQWIORRGRSHQLQJRQWZRGLIIHUHQWVLGHVRIWKHDWWDFKHGJDUDJH"
<br />F (QWHUQXPEHURISHUPDQHQWIORRGRSHQLQJVLQWKHDWWDFKHGJDUDJHZLWKLQIRRWDERYHDGMDFHQWJUDGH
<br />1RQHQJLQHHUHGIORRGRSHQLQJV (QJLQHHUHGIORRGRSHQLQJV
<br />VTLQG 7RWDOQHWRSHQDUHDRIQRQHQJLQHHUHGIORRGRSHQLQJVLQ$ F
<br />VTIWH 7RWDOUDWHGDUHDRIHQJLQHHUHGIORRGRSHQLQJVLQ$ F DWWDFKGRFXPHQWDWLRQ±VHH,QVWUXFWLRQV
<br />VTIWI 6XPRI$ GDQG$ HUDWHGDUHD LIDSSOLFDEOH±VHH,QVWUXFWLRQV
<br />%D1),3&RPPXQLW\1DPH &,7<2)6$17$$1$%E1),3&RPPXQLW\,GHQWLILFDWLRQ1XPEHU
<br />%&RXQW\1DPH 25$1*(&2817<%6WDWH &$%0DS3DQHO1R &%6XIIL[ -
<br />%),50,QGH['DWH %),503DQHO(IIHFWLYH5HYLVHG'DWH
<br />%)ORRG=RQH V % %DVH)ORRG(OHYDWLRQ V %)( =RQH$2XVH%DVH)ORRG'HSWK
<br />%,QGLFDWHWKHVRXUFHRIWKH%)(GDWDRU%DVH)ORRG'HSWKHQWHUHGLQ,WHP%
<br />),6 ),50 &RPPXQLW\'HWHUPLQHG 2WKHU 7&
<br />%,QGLFDWHHOHYDWLRQGDWXPXVHGIRU%)(LQ,WHP% 1*9' 1$9' 2WKHU6RXUFH
<br />%,VWKHEXLOGLQJORFDWHGLQD&RDVWDO%DUULHU5HVRXUFHV6\VWHP &%56 DUHDRU2WKHUZLVH3URWHFWHG$UHD 23$ "<HV 1R
<br />'HVLJQDWLRQ'DWH &%56 23$
<br />%,VWKHEXLOGLQJORFDWHGVHDZDUGRIWKH/LPLWRI0RGHUDWH:DYH$FWLRQ /L0:$ "<HV 1R
<br />1$
<br />,03257$17 0867)2//2:7+(,16758&7,216213$*(6
<br />&RS\DOOSDJHVRIWKLV(OHYDWLRQ&HUWLILFDWHDQGDOODWWDFKPHQWVIRU FRPPXQLW\RIILFLDO LQVXUDQFHDJHQWFRPSDQ\DQG EXLOGLQJRZQHU
<br />86'(3$570(172)+20(/$1'6(&85,7<
<br />)HGHUDO(PHUJHQF\0DQDJHPHQW$JHQF\
<br />1DWLRQDO)ORRG,QVXUDQFH3URJUDP
<br />(/(9$7,21&(57,),&$7(
<br />20%&RQWURO1R
<br />([SLUDWLRQ'DWH
<br />)(0$)RUP)))< IRUPHUO\ 3DJHRI
<br />6(&7,21'±6859(<25(1*,1((525$5&+,7(&7&(57,),&$7,21
<br />6(&7,21&±%8,/',1*(/(9$7,21,1)250$7,21 6859(<5(48,5('
<br />)25,1685$1&(&203$1<86(
<br />3ROLF\1XPEHU
<br />&RPSDQ\1$,&1XPEHU
<br />%XLOGLQJ6WUHHW$GGUHVV LQFOXGLQJ$SW8QLW6XLWHDQGRU%OGJ1R RU325RXWHDQG%R[1R
<br />:.('*($9(
<br />&LW\ 6$17$$1$6WDWH &$=,3&RGH
<br />&%XLOGLQJHOHYDWLRQVDUHEDVHGRQ &RQVWUXFWLRQ'UDZLQJV
%XLOGLQJ8QGHU&RQVWUXFWLRQ
)LQLVKHG&RQVWUXFWLRQ
<br />
$QHZ(OHYDWLRQ&HUWLILFDWHZLOOEHUHTXLUHGZKHQFRQVWUXFWLRQRIWKHEXLOGLQJLVFRPSOHWH
<br />&(OHYDWLRQV±=RQHV$±$$($+$2$ ZLWK%)( 9(9±99 ZLWK%)( $5$5$$5$($5$±$$5$+$5$2
<br />$ &RPSOHWH,WHPV&D±KEHORZDFFRUGLQJWRWKH%XLOGLQJ'LDJUDPVSHFLILHGLQ,WHP$,Q3XHUWR5LFRRQO\HQWHUPHWHUV
<br />%HQFKPDUN8WLOL]HG 6$9HUWLFDO'DWXP 1$9'
<br />,QGLFDWHHOHYDWLRQGDWXPXVHGIRUWKHHOHYDWLRQVLQLWHPVD WKURXJKK EHORZ
<br />1*9' 1$9' 2WKHU
<br />'DWXPXVHGIRUEXLOGLQJHOHYDWLRQVPXVWEHWKHVDPHDVWKDWXVHGIRUWKH%)(&RQYHUVLRQIDFWRUXVHG"
<br />,I<HVGHVFULEHWKHVRXUFHRIWKHFRQYHUVLRQIDFWRULQWKH6HFWLRQ'&RPPHQWVDUHD
<br /><HV 1R
<br />&KHFNWKHPHDVXUHPHQWXVHG
<br />D 7RSRIERWWRPIORRU LQFOXGLQJEDVHPHQWFUDZOVSDFHRUHQFORVXUHIORRU IHHW PHWHUV
<br />E 7RSRIWKHQH[WKLJKHUIORRU VHH,QVWUXFWLRQV IHHW PHWHUV
<br />F %RWWRPRIWKHORZHVWKRUL]RQWDOVWUXFWXUDOPHPEHU VHH,QVWUXFWLRQV IHHW PHWHUV
<br />G $WWDFKHGJDUDJH WRSRIVODE IHHW PHWHUV
<br />H /RZHVWHOHYDWLRQRI0DFKLQHU\DQG(TXLSPHQW 0 ( VHUYLFLQJWKHEXLOGLQJ
<br /> GHVFULEHW\SHRI0 (DQGORFDWLRQLQ6HFWLRQ'&RPPHQWVDUHD PHWHUVIHHW
<br />I /RZHVW$GMDFHQW*UDGH /$* QH[WWREXLOGLQJ 1DWXUDO )LQLVKHG IHHW PHWHUV
<br />J +LJKHVW$GMDFHQW*UDGH +$* QH[WWREXLOGLQJ 1DWXUDO )LQLVKHG IHHW PHWHUV
<br />K )LQLVKHG/$*DWORZHVWHOHYDWLRQRIDWWDFKHGGHFNRUVWDLUVLQFOXGLQJVWUXFWXUDO
<br />VXSSRUW IHHW PHWHUV
<br />7KLVFHUWLILFDWLRQLVWREHVLJQHGDQGVHDOHGE\DODQGVXUYH\RUHQJLQHHURUDUFKLWHFWDXWKRUL]HGE\VWDWHODZWRFHUWLI\HOHYDWLRQ
<br />LQIRUPDWLRQI certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any
<br />false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
<br />:HUHODWLWXGHDQGORQJLWXGHLQ6HFWLRQ$SURYLGHGE\DOLFHQVHGODQGVXUYH\RU"<HV 1R
<br />&KHFNKHUHLIDWWDFKPHQWVDQGGHVFULEHLQWKH&RPPHQWVDUHD
<br />&HUWLILHU<br />V1DPH /<3+$1 /LFHQVH1XPEHU &
<br />7LWOH &,9,/(1*,1((5
<br />&RPSDQ\1DPH
<br />$GGUHVV .((1$13/
<br />&LW\ 67$1721 6WDWH &$=,3&RGH
<br />([W (PDLO 7HOHSKRQH
<br />6LJQDWXUH 'DWH
<br />&RS\DOOSDJHVRIWKLV(OHYDWLRQ&HUWLILFDWHDQGDOODWWDFKPHQWVIRU FRPPXQLW\RIILFLDO LQVXUDQFHDJHQWFRPSDQ\DQG EXLOGLQJRZQHU
<br />&RPPHQWV LQFOXGLQJVRXUFHRIFRQYHUVLRQIDFWRULQ& W\SHRIHTXLSPHQWDQGORFDWLRQSHU&H DQGGHVFULSWLRQRIDQ\DWWDFKPHQWV
<br />,7(0&D,6))2)7+(352326('81,7,7(0&I$1'&J$5('(6,*1('/$*$1'+$*1(;7727+(
<br />352326('81,7
<br />%)( 7&
<br />)) :+,&+,6<br />+,*+(57+$1%)(
<br />3ODFH6HDO+HUH
<br />)(0$)RUP)))< IRUPHUO\ 3DJHRI
<br />(/(9$7,21&(57,),&$7(
<br />,03257$17 0867)2//2:7+(,16758&7,216213$*(6
<br />)25,1685$1&(&203$1<86(
<br />3ROLF\1XPEHU
<br />&RPSDQ\1$,&1XPEHU
<br />%XLOGLQJ6WUHHW$GGUHVV LQFOXGLQJ$SW8QLW6XLWHDQGRU%OGJ1R RU325RXWHDQG%R[1R
<br />:.('*($9(
<br />&LW\ 6$17$$1$6WDWH &$=,3&RGH
<br />6(&7,21(±%8,/',1*0($685(0(17,1)250$7,21 6859(<1275(48,5('
<br />)25=21($2=21($5$2$1'=21($ :,7+287%)(
<br />)RU=RQHV$2$5$2DQG$ ZLWKRXW%)( FRPSOHWH,WHPV(±()RU,WHPV(±(XVHQDWXUDOJUDGHLIDYDLODEOH,IWKH&HUWLILFDWHLV
<br />LQWHQGHGWRVXSSRUWD/HWWHURI0DS&KDQJHUHTXHVWFRPSOHWH6HFWLRQV$%DQG&&KHFNWKHPHDVXUHPHQWXVHG,Q3XHUWR5LFRRQO\
<br />HQWHUPHWHUV
<br />%XLOGLQJPHDVXUHPHQWVDUHEDVHGRQ
<br />
$QHZ(OHYDWLRQ&HUWLILFDWHZLOOEHUHTXLUHGZKHQFRQVWUXFWLRQRIWKHEXLOGLQJLVFRPSOHWH
<br />&RQVWUXFWLRQ'UDZLQJV
%XLOGLQJ8QGHU&RQVWUXFWLRQ
)LQLVKHG&RQVWUXFWLRQ
<br />(3URYLGHPHDVXUHPHQWV &DLQDSSOLFDEOH%XLOGLQJ'LDJUDP IRUWKHIROORZLQJDQGFKHFNWKHDSSURSULDWHER[HVWRVKRZZKHWKHUWKH
<br />PHDVXUHPHQWLVDERYHRUEHORZWKHQDWXUDO+$*DQGWKH/$*
<br />D 7RSRIERWWRPIORRU LQFOXGLQJEDVHPHQW
<br />FUDZOVSDFHRUHQFORVXUH LV PHWHUVIHHW DERYHRU EHORZWKH+$*
<br />E 7RSRIERWWRPIORRU LQFOXGLQJEDVHPHQW
<br />FUDZOVSDFHRUHQFORVXUH LV EHORZWKH/$*DERYHRUPHWHUVIHHW
<br />()RU%XLOGLQJ'LDJUDPV± ZLWKSHUPDQHQWIORRGRSHQLQJVSURYLGHGLQ6HFWLRQ$,WHPVDQGRU VHHSDJHV±RI,QVWUXFWLRQV WKH
<br />QH[WKLJKHUIORRU &ELQDSSOLFDEOH
<br />%XLOGLQJ'LDJUDP RIWKHEXLOGLQJLV EHORZWKH+$*DERYHRUPHWHUVIHHW
<br />($WWDFKHGJDUDJH WRSRIVODE LV EHORZWKH+$*DERYHRUPHWHUVIHHW
<br />(7RSRISODWIRUPRIPDFKLQHU\DQGRUHTXLSPHQW
<br />VHUYLFLQJWKHEXLOGLQJLV EHORZWKH+$*DERYHRUPHWHUVIHHW
<br />(=RQH$2RQO\ ,IQRIORRGGHSWKQXPEHULVDYDLODEOHLVWKHWRSRIWKHERWWRPIORRUHOHYDWHGLQDFFRUGDQFHZLWKWKHFRPPXQLW\<br />V
<br />IORRGSODLQPDQDJHPHQWRUGLQDQFH"<HV 1R 8QNQRZQ 7KHORFDORIILFLDOPXVWFHUWLI\WKLVLQIRUPDWLRQLQ6HFWLRQ*
<br />6(&7,21)±3523(57<2:1(5 252:1(5<br />6$87+25,=('5(35(6(17$7,9( &(57,),&$7,21
<br />7KHSURSHUW\RZQHURURZQHU<br />VDXWKRUL]HGUHSUHVHQWDWLYHZKRFRPSOHWHV6HFWLRQV$%DQG(IRU=RQH$ ZLWKRXW%)( RU=RQH$2PXVW
<br />VLJQKHUHThe statements in Sections A, B, and E are correct to the best of my knowledge
<br />&KHFNKHUHLIDWWDFKPHQWVDQGGHVFULEHLQWKH&RPPHQWVDUHD
<br />&RPPHQWV
<br />3URSHUW\2ZQHURU2ZQHU<br />V$XWKRUL]HG5HSUHVHQWDWLYH1DPH
<br />$GGUHVV
<br />&LW\ 6WDWH =,3&RGH
<br />([W (PDLO 7HOHSKRQH
<br />6LJQDWXUH 'DWH
<br />)(0$)RUP)))< IRUPHUO\ 3DJHRI
<br />(/(9$7,21&(57,),&$7(
<br />,03257$17 0867)2//2:7+(,16758&7,216213$*(6
<br />R2
<br />T1.4
|