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SERVICE PRO IDER:.Please fill hz the spaces and sign in the box appropriate for <br />your hastiness entity. <br />Corporation <br />t a <br />Me#Vdo <br />u.indi <br />AssvUeAct- <br />d.zic... <br />[Service <br />Provider's <br />Complete <br />g <br />LegatName]' <br />Dy: <br />Type <br />Date: <br />d'ziyrn�a� <br />rated <br />Name: <br />! kamas <br />E• <br />i . ist/ <br />!I-2.5��El., <br />a <br />Partnersldp <br />(enera° <br />. . <br />[Service <br />a <br />By:• <br />Typed/PrintedName; <br />General <br />Date: <br />Washington <br />Provider's <br />CompleteLegalName] <br />general <br />partnership <br />Partner <br />• <br />Partnership <br />(limited° <br />[Service <br />a <br />By; <br />Typeci/PrintedName: <br />General <br />Date: <br />Washington <br />Provider's <br />Complete <br />limited <br />partnership <br />Legal <br />Name. <br />Partner <br />Sole <br />Propdetorditp <br />Typed/Printed-Name: <br />Sole <br />Date: <br />Proprietor: <br />. <br />.Limited <br />.Liability <br />Company <br />[Service <br />a <br />By. <br />Typed/Printed <br />Manams, <br />Date: <br />Washington <br />Provider's <br />limited <br />Complete <br />liability <br />Legal <br />company <br />Name] <br />Member <br />Name; <br />Page li <br />(Form Approved by City Attorney's Office January 7, 2010, updated August 16, 2319) <br />