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Pedestrian Counts $ 3 x1 x5 = $ <br />Assume: <br />* 4 -hour count (2 hours am & 2 hours pm) at one location <br />• Ono person counting <br />• 5 separately requested counts per year <br />NAME OF COMPANY <br />C/O L/AINU7 /q�,LeM <br />ESS ADDRESS <br />) "I'1 - -1 A <br />PRINTED <br />SIGNATURE <br />33 - <br />FEDERALID <br />AGENT <br />ORIZED AGENT <br />3 1- 7 <br />/2 -/() -) <br />191 81 <br />F '7 /Ll 36 /?. <br />PHONE AND PAX NUMBERS <br />N <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE FEE PROPOSAL, <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDPRFh NfIAIR fiprlr rQni� <br />v <br />CG � <br />