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Of _ _a ", .. c-aw:sor. . <br /> <br />___"'f_"'- <br /> <br />~. _''"II. _ra.-.. ...."'nQ. _....,.Oft, .,.....no. ""'"""V ", _no ", _ __ - _ctI -- ~ THe P'OOl. CS II'I1..t.m WITH WATEA - -- <br />_,....... 0.;..... _ _l>e __ .. ___ _0 or __ en _IIIUI 01_ c:omr-. <br /> <br />CLAIM PROCEDURE <br /> <br />_ _...............-on.........'" l>e......._o.......c.:.m..c:s... aft.._ncnt'ca'.-....'... Pvn:-' _, ._.__.......c.or-w:aor. ~_.""......- <br />toe _ .. '""""0 .no __... __ '0 ,he Com,_' onnc:o_ _ t:JI _ -., - - ell ~ · .. me ClQIftrWCL <br /> <br /> <br />IGNATURE OF CONTRACTOR <br />OR CONTRACTOR'S AGENT <br />C ('C 6r.J-5~<.[J.- <br /> <br />~~ <br />~ .6~~ <br />- PURCHASER <br /> <br />BY' <br /> <br />PURCHASER <br />