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Project Team Information (fill in all that apply) (add additional sheets if needed): <br />Property Owner(s): Name: Please see Exhibit O and V Phone: <br />Address: <br />Authorized Representative: (rf different fran owner) <br />Name: Old Castle SW Group. Inc. dba United Companies of Mesa Countv Phone: (970) 625-3738 (Local) <br />Address: PO Box 1556 Rifle. CO 81650 (Local Addressl <br />Developer/Subdivider: Name: NA Phone: NA <br />Address: NA <br />EngineeHs): Name: Greo Lewicki and Associates PLLC Phone: (7201 842-5321 <br />Address: 11541 Warrington Court Parker. CO 80138 <br />Billable party: ^ Owner ~ Representative ^ Developer ^ Engineer <br />Billable Party <br />The Billable Party, by signing below, hereby agrees to reimburse the City the actual costs to the City for engineering, <br />surveying, and legal services rendered in connection with the review of the Application. The Billable Party agrees that <br />interest shall be imposed at rate of 1.5% per month on all balances not paid within thirty (30) days of the date of the <br />statement. In addition to any and all remedies available to the City and in the event the City is forced to pursue <br />collection of any amounts due and unpaid, the City shall be entitled to collect attorneys fees and costs incurred in said <br />collection efforts in addition to the amount due and unpaid. <br />Craig Lambertv. Vice President of Old Castle SW Group. Inc. dba United Companies of Mesa Countv <br />Name (printed) <br />PO Box 3609 (Main Office) Grand Junction 81502 <br />Address City/Town Zip Code <br />970 2 -0900 Main Office (970) 243-5945 (Main Office) <br />Phone Fax <br />Signat e <br />Known <br />Type of Identification <br />County of Mesa ) <br />SS <br />State of Colorado ) <br />Sworn to and subscribed before me this 13th day of .lulu 2(lns <br />(fill in month) (fill in year) <br />By Craig Lamberts Q~nIjC <br />(name printed) .,,.•Ti .,.• ` <br />Q;: <br />Witness my hand and official seal. ~`~~ '. 0 <br />a..,-~ ~~~- ;o <br />Notary Public <br />;, Ov <br />My Commission expires 3/29/07 •S•.,,• • ,.-•'G <br />TAT E'OF <br />2/2 <br />{rev. 8-30) <br />