119-18 Attachment.pdf

AUTOZONE STORE DEVELOPMENT BOND REQUISITION DO NOT MAIL BOND FAX THIS FORM TO: Terri Morrison @ (713) 276-8538 (Phone: (713) 276-8776) Or Email to: Terri.L.Morrison@marsh.com Pond * Ol WOW Waar Bond Request Amount: $37,251.72 Duration of Bond: (ex. 1 yr, 2 yr, etc.) 1 Date Bond Needed: 6/1/15 “COMPLETE INFORMATION IS CRITICAL FOR RELEASING BOND DATE: 05-29-15 BOUND TO: Name: Township of West Orange NJ Address: 66 Main Street City,ST zIP: West Orange NJ 07052 CONTACT NAME: CONTACT PHONE # Robin Miller 973-325-4111 STORE # 4744 ADDRESS: 7 Main Street CITY, ST: West Orange , NJ AZENTITY: AutoZone Northeast, LLC Special Bond Form Attached? N/A Bond Purpose: General Construction Requested By: Carolyn Thaemert Extension: 8994 Description of Work: Restoration fee required by Township for clean up of site in case AZ renegs on the project after construction has started RETURN BOND TO MARILYN CLEAVES. ¢ DEPT. 8321 ¢ 901-495-8756 FOR SURETY COMPANY USE ONLY BOND # C:\Users\kmedona2\AppData\Local\Temp\Temp1_PRE-CON.zip\Bond_Requisition Form.doc Rev. 12-1-10