In the dynamic and meticulous world of architectural and engineering services, the Department of Accounting and General Services of the State of Hawaii has introduced the DPW Form 120 to ensure a comprehensive and standardized procedure for firms looking to provide professional services. This form, last revised in June 1999, serves not just as an application but as a detailed dossier of the firm's credentials, experience, personnel, and professional ethos. It asks for exhaustive information starting from the basic, such as the firm's name, type of organization, business address, and the age of the firm, to the more detailed specifics including federal ID number, details of principals and associate members, personnel distribution across technical disciplines, and licensing details within Hawaii. Furthermore, it extends into gathering personal history statements of principals and associates, a clear indication of the depth of background check and validation done by the state. The form also inquires about outside associates and consultants regularly employed, insurance details reflecting on the firm's readiness against professional risks and liabilities, and a summary of the firm’s completed and current projects, giving a comprehensive overview of the firm’s capabilities and achievements. This procedural rigor underscores the state’s commitment to ensuring that only the most competent, reliable, and ethically sound professional services are engaged in public projects.
Question | Answer |
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Form Name | Dpw Form 120 |
Form Length | 9 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 2 min 15 sec |
Other names | hawaii state dpw 120 form, form dpw 120, state form dpw 120, dpw120 form hawaii |
DPW FORM 120 (Rev. 6/99)
STATE OF HAWAII
DEPARTMENT OF ACCOUNTING AND GENERAL SERVICES
QUESTIONNAIRE FOR ARCHITECTS, ENGINEERS AND OTHER PROFESSIONAL SERVICES
QUESTIONNAIRE FOR: (LIST DISCIPLINE) |
OTHER QUESTIONNAIRES SUBMITTED: (LIST DISCIPLINES) |
DATE |
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FIRM NAME |
ESTABLISHED |
TYPE OF ORGANIZATION (Underline) |
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YEAR STATE |
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INDIVIDUAL |
PARTNERSHIP |
CORPORATION |
JOINT VENTURE |
OTHER |
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BUSINESS ADDRESS, TELEPHONE & FAX NO. OF HAWAII OFFICE |
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AGE OF FIRM |
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FEDERAL ID NO. |
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YEARS |
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ESTABLISHED IN |
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HAWAII |
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PRINCIPALS OF FIRM: (NAMES) |
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ASSOCIATE MEMBERS OF FIRM: (NAMES) |
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PRESENT BRANCH OFFICE(s): (ADDRESS, TELEPHONE & FAX NO.)
PERSON IN CHARGE: (NAMES)
NUMBER OF PERSONNEL IN YOUR PRESENT ORGANIZATION
LOCATED |
PRINCIPALS & KEY |
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OTHER PERSONNEL |
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TOTAL |
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PERSONNEL |
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AT |
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Architect |
Engineer |
Others |
Architect |
Engineers |
Draftsmen |
Spec. |
Estimator |
Inspector |
Surveyor |
Balance |
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Mech. |
Electri |
Civil |
Others |
Writer |
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HOME OFFICE
BRANCH IN
TOTAL
TECHNICAL PERSONNEL:
NUMBER OF PERSONNEL WITH HAWAII LICENSES
NUMBER OF PERSONNEL WITHOUT HAWAII LICENSES
Page 1 of 9
DPW FORM 120 (Rev. 6/99)
PERSONAL HISTORY STATEMENT OF PRINCIPALS AND ASSOCIATES WITHIN YOUR FIRM
NAME |
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RESIDENT OF |
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TITLE |
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YEARS OF |
AS PRINCIPAL |
AS PRINCIPAL |
OTHER THAN |
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EXPERIENCE |
IN THIS FIRM |
IN OTHER FIRMS |
PRINCIPAL |
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EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION) |
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MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS |
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REGISTRATION (TYPE, YEAR, STATE) |
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NAME |
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RESIDENT OF |
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TITLE |
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YEARS OF |
AS PRINCIPAL |
AS PRINCIPAL IN |
OTHER THAN |
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EXPERIENCE |
IN THIS FIRM |
OTHER FIRMS |
PRINCIPAL |
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EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)
MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS
REGISTRATION (TYPE, YEAR, STATE)
NAME |
RESIDENT |
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TITLE
YEARS OF |
AS |
PRINCIPAL |
AS PRINCIPAL IN |
OTHER THAN |
EXPERIENCE |
IN |
THIS FIRM |
OTHER FIRMS |
PRINCIPAL |
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EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)
MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS
REGISTRATION (TYPE, YEAR, STATE)
NAME |
RESIDENT OF |
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TITLE
YEARS OF |
AS |
PRINCIPAL |
AS PRINCIPAL IN |
OTHER THAN |
EXPERIENCE |
IN |
THIS FIRM |
OTHER FIRMS |
PRINCIPAL |
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EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION)
MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS
REGISTRATION (TYPE, YEAR, STATE)
Page 2 of 9
DPW Form 120 (Rev. 6/99)
PERSONAL HISTORY STATEMENT OF TECHNICAL PERSONNEL WITHIN YOUR FIRM
NAME |
STATUS (Underline) |
NAME |
STATUS (Underline) |
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TITLE OR POSITION |
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YEARS OF EXPERIENCE |
TITLE OR POSITION |
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YEARS OF EXPERIENCE |
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WITH THIS FIRM |
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WITH LAST FIRM |
WITH OTHER FIRMS |
WITH THIS FIRM |
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WITH LAST FIRM |
WITH OTHER FIRMS |
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(NAME & NO. OF YEARS) |
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(NAME & NO. OF YEARS) |
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EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION) |
EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION) |
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REGISTRATION (TYPE, YEAR, STATE) |
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REGISTRATION (TYPE, YEAR, STATE) |
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NAME |
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STATUS (Underline) |
NAME |
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STATUS (Underline) |
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TITLE OR POSITION |
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YEARS OF EXPERIENCE |
TITLE OR POSITION |
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YEARS OF EXPERIENCE |
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WITH THIS FIRM |
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WITH LAST FIRM |
WITH OTHER FIRMS |
WITH THIS FIRM |
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WITH LAST FIRM |
WITH OTHER FIRMS |
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(NAME & NO. OF YEARS) |
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(NAME & NO. OF YEARS) |
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EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION) |
EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION) |
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REGISTRATION (TYPE, YEAR, STATE) |
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REGISTRATION (TYPE, YEAR, STATE) |
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NAME |
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STATUS (Underline) |
NAME |
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STATUS (Underline) |
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TITLE OR POSITION |
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YEARS OF EXPERIENCE |
TITLE OR POSITION |
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YEARS OF EXPERIENCE |
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WITH THIS FIRM |
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WITH LAST FIRM |
WITH OTHER FIRMS |
WITH THIS FIRM |
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WITH LAST FIRM |
WITH OTHER FIRMS |
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(NAME & NO. OF YEARS) |
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(NAME & NO. OF YEARS) |
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EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION) |
EDUCATION (COLLEGE, DEGREE, YEAR, SPECIALIZATION) |
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REGISTRATION (TYPE, YEAR, STATE) |
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REGISTRATION (TYPE, YEAR, STATE) |
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Page 3 of 9
DPW FORM 120 (Rev. 6/99)
OUTSIDE ASSOCIATES AND CONSULTANTS USUALLY EMPLOYED
DISCIPLINE
NAME OF FIRM OR INDIVIDUAL
DISCIPLINE
NAME OF FIRM OR INDIVIDUAL
ERRORS AND OMISSIONS INSURANCE
DOES YOUR FIRM HAVE ERRORS & OMISSION (E&O) INSURANCE? (Underline)
AMOUNT OF COVERAGE
PER CLAIM
AMOUNT OF DEDUCTIBLE
YES
NO
PROJECT INSURANCE
$
$
Submit proof of insurance or insurability from your insurance carrier with this form.
Page 4 of 9
DPW FORM 120 Rev. 6/99)
SUMMARY OF YOUR FIRM’S COMPLETED AND PRESENT PROJECTS DURING THE LAST TEN YEARS
AS A PRIME A/E CONSULTANT
TOTAL NUMBER OF COMPLETED PROJECTS
TOTAL ESTIMATED CONSTRUCTION COST OF COMPLETED PROJECTS
TOTAL NUMBER OF PRESENT PROJECTS
TOTAL ESTIMATED CONSTRUCTION COST OF PRESENT PROJECTS
$
$
AS AN ASSOCIATE WITH OTHER A/E CONSULTANTS
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TOTAL NUMBER OF COMPLETED PROJECTS |
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TOTAL ESTIMATED CONSTRUCTION COST OF COMPLETED PROJECTS (ONLY THE PORTION OF WORK FOR WHICH YOUR FIRM WAS |
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$ |
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RESPONSIBLE) |
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TOTAL NUMBER OF PRESENT PROJECTS |
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TOTAL ESTIMATED CONSTRUCTION COST OF PRESENT PROJECTS (ONLY THE PORTION OF WORK FOR WHICH YOUR FIRM IS |
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$ |
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RESPONSIBLE) |
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CLASS OF WORK AND PROJECT TYPE SPECIALIZATION |
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TYPE OF PROJECT
TOTAL NO. OF COMPLETED
PROJECTS
TOTAL ESTIMATED CONSTRUCTION COST
TOTAL ESTIMATED PROJECT
SIZE (G.S.F.)
Categorize your firm’s class for work during the last ten years by project type. Examples of project types include Educational, Commercial, Industrial, Residential, Health Care, Correctional and Judicial Facilities. Work may also be categorized as planning, civil sitework, renovation/alteration, architectural barrier removal, fire alarm system, etc.
Page 5 of 9
DPW FORM 120 (Rev. 6/99)
PRESENT/COMPLETED PROJECTS IN WHICH YOUR FIRM IS/WAS DESIGNATED THE PRIME CONSULTANT (BY TYPE)
(LIST A MAXIMUM OF 10 PROJECTS FOR EACH DISCIPLINE/TYPE OF WORK BEING APPLIED FOR. LIST PROJECTS THAT REFLECT YOUR ABILITY TO PROVIDE QUALITY
WORK FOR YOUR REQUESTED PROJECTS.)
TYPE:
YEAR
NAME AND LOCATION
OF THE PROJECT
NAME OF LEAD
DESIGNER
NAME, ADDRESS, PHONE & FAX NO.
OF THE OWNER
ESTIMATED
CONST. COST
($)
DURATION FOR
DESIGN
(MONTHS)
%COMPLETED
DESIGN CONST.
Page 6 of 9
DPW FORM 120 (Rev. 6/99)
PRESENT/COMPLETED PROJECTS THAT YOUR FIRM IS/WAS ASSOCIATED WITH OTHERS (BY TYPE)
(LIST A MAXIMUM OF 10 PROJECTS FOR EACH DISCIPLINE/TYPE OF WORK BEING APPLIED FOR. LIST PROJECTS THAT REFLECT YOUR ABILITY TO PROVIDE QUALITY
WORK FOR YOUR REQUESTED PROJECTS.)
TYPE: |
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NAME AND LOCATION |
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ESTIMATED CONSTRUCTION COST |
DURATION FOR |
% COMPLETED |
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NAME, ADDRESS, PHONE & |
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YEAR |
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DESIGN |
PRIME FIRM ASSOCIATED |
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ENTIRE |
YOUR FIRM’S |
WITH |
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OF THE PROJECT |
FAX NO. OF THE OWNER |
(MONTHS) |
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DESIGN |
CONST. |
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PROJECT |
WORK |
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Page 7 of 9
DPW FORM 120 (Rev. 6/99)
Explain firm’s individual project assignment, project management structure, project execution (work flow and
responsibilities) and quality control process. In the event the spaces provided on this form are not sufficient for
entries, or if you wish to furnish additional information, it may be inserted here or on separate sheets, with appropriate references.
As of this date ____________________________ the foregoing is a true statement of facts.
NAME OF FIRM OR INDIVIDUAL SUBMITTING QUESTIONNAIRE
TYPE NAME AND TITLE OF PERSON SIGNING
SIGNATURE
NOTE: It is to a firm’s advantage to maintain its experience record on a current basis. This may be accomplished by periodically forwarding current data to DAGS.
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Page 8 of 9 |
DPW FORM 120 SUPPLEMENT 1 |
(Rev. 6/99) |
PRINCIPALS ONLY - ADDITIONAL INFORMATION
NAME |
TITLE AND POSITION |
YEARS WITH FIRM |
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MAJOR RESPONSIBILITIES WITH THIS FIRM |
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PRIOR EMPLOYMENT
(START WITH LATEST EMPLOYMENT PRIOR TO JOINING THIS FIRM AND PROVIDE SIMILAR INFORMATION FOR EACH SEPARATE
EMPLOYMENT OR MAJOR CHANGES IN DUTIES WITH THE SAME EMPLOYER.)
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FIRM: |
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DATE |
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FIRM: |
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DATE |
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FROM: |
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TO: |
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FROM: |
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TO: |
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ADDRESS: |
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ADDRESS: |
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JOB TITLE: |
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JOB TITLE: |
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SUPERVISOR’S NAME AND TITLE: |
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SUPERVISOR’S NAME AND TITLE: |
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MAJOR DUTIES: |
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MAJOR DUTIES: |
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FIRM: |
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FIRM: |
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FROM: |
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ADDRESS: |
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ADDRESS: |
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JOB TITLE: |
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JOB TITLE: |
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SUPERVISOR’S NAME AND TITLE: |
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SUPERVISOR’S NAME AND TITLE: |
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MAJOR DUTIES: |
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MAJOR DUTIES: |
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Page 9 of 9