H. ADDITIONAL INFORMATION

30. PROVIDE ANY ADDITIONAL INFORMATION REQUESTED BY THE AGENCY. ATTACH ADDITIONAL SHEETS AS NEEDED.

31. SIGNATURE

33. NAME AND TITLE

I. AUTHORIZED REPRESENTATIVE
The foregoing is a statement of facts.

32. DATE

STANDARD FORM 330 (1/2004) PAGE 5

1. SOLICITATION NUMBER (If any)

ARCHITECT-ENGINEER QUALIFICATIONS

PART II-GENERAL QUALIFICATIONS

(If a firm has branch offices, complete for each specific branch office seeking work.)

[48 FR 42637, Sept. 19, 1983, as amended at 68 FR 69231, Dec. 11, 2003]

53.301-1034 Standard Form 1034, Public Voucher for Purchases and Other Than Personal.

Services

When stated in foreign currency, insert name of currency.

If the ability to certify and authority to approve are combined in one person, one signature only is necessary; otherwise the approving officer will sign in the space provided, over his official title.

"When a voucher is receipted in the name of a company or corporation, the name of the person writing the company or corporate name, as well as the capacity in which he signs, must appear. For example: "John Doe Company, per John Smith, Secretary", or "Treasurer", as the case may be.

Previous edition usable

PRIVACY ACT STATEMENT

PER

TITLE

The information requested on this form is required under the provisions of 31 U.S.C. 82b and 82c, for the purpose of
disbursing Federal money. The information requested is to identify the particular creditor and the amounts to be paid. Failure
to furnish this information will hinder discharge of the payment obligation.

AMOUNT

NSN 7540-00-634-4206