ࡱ>  |bjbj <hhSSSgggglLg-"x@|@p!r!r!r!r!r!r!#G&r!uS"@r!K!:::<8Sp!:p!::;:y5g<:\!!0-":&:&::J&S:r!r!:-"& : Nebraska Department of Roads (NDOR) Highway Safety Improvement Program (HSIP) Public Information and Education Funding Request Please TypeDATE: FORMTEXT      APPLICANT:  FORMTEXT      CONTACT NAME: FORMTEXT      ADDRESS:  FORMTEXT      CITY, STATE, ZIP: FORMTEXT      TELEPHONE NO.:( FORMTEXT    )  FORMTEXT      FAX NO.: FORMTEXT      FEDERAL I.D. NO.: FORMTEXT      EMAIL: FORMTEXT      STARTING DATE: FORMTEXT      COMPLETION DATE: FORMTEXT      PROJECT DESCRIPTION: The purpose of this funding request is to provide funding assistance to the applicant for a specific public information and/or education campaign/activity in the emphasis area of: (Check One)  FORMCHECKBOX  Impaired Driving,  FORMCHECKBOX  Young Drivers, or  FORMCHECKBOX  Occupant Restraint. All activities funded by this request must be above and beyond the current level of activity. Please complete items 1-5 below using the definitions on the reverse side, and submit a copy of your organizations current seat belt policy and drug-free workplace policy.1. Baseline Information: FORMTEXT       FORMTEXT      2. Objective: FORMTEXT       FORMTEXT      3. Activity: FORMTEXT       FORMTEXT      4. Budget: FORMTEXT       FORMTEXT      5. Impact Evaluation: FORMTEXT       FORMTEXT      NDOR will fund approved projects at 90% of the project cost. The applicant/organization must provide the balance of funding. NDOR will finance this funding request on a reimbursement basis. The NDOR reserves the right to determine appropriate hard match contributions. The applicant/organization must receive written approval for the project from NDOR before applicant incurs any expenses in order to receive the federal share of the funding request. The applicant must request reimbursement from the NDOR within sixty (60) days of the conclusion of the activity. After sixty (60) days, NDOR will not honor reimbursements. Applicant will provide the following supporting documentation: 1) An invoice from the applicant to the NDOR requesting reimbursement. The invoice must itemize each expenditure. 2) Copy of the check(s) paid by the applicant for each line item expenditure on the invoice. 3) Copy of the invoice(s) from vendors for each expenditure. 4) An activity report and project summary. The applicant agrees to comply with all rules and regulations as set forth by the U.S. Department of Transportation, the Federal Highway Administration, the State of Nebraska, and the Nebraska Department of Roads.Authorized Signature of Applicant DatePrint or Type NameNebraska Department of Roads Representative DatePrint or Type NameReturn completed form to: Nebraska Department of Roads, Attn: Traffic Engineering, P.O. Box 94759, Lincoln, NE 68509-4759 Phone: (402) 479-4594  FAX: (402) 479-3606 TO BE COMPLETED BY NDORFUNDING ASSISTANCE: The NDOR will provide reimbursement for the expenditures outlined in the Budget not to exceed $_______________FOR NDOR USE ONLY:Project No.:          C.N.     AFE:   HJ   & ( < > @ J L P R h j l ȸ|jULE|| hZMh YhZMh YaJ(jhZMh6?CJUaJmHnHu#jhZMhF CJUaJhZMh6?CJaJjhZMhF CJUaJhZMh YCJaJhZMh Y5CJaJhgWhQCJaJh'hV5CJOJQJaJh@hV5CJaJhVh? 5CJaJhVhV5CJaJ%jhF 5CJUaJmHnHuJ   & N P $$Ifa$gdZM $$Ifa$gdZM $Ifgd'gdQ$a$gdV $(a$gd@P R h F=0 $IfgdZM $Ifgdxkdv$$Ifl\|)*    t0644 lap(ytZM         > @ T V X b d f h j ޾޳޾޳޾޳m޾޾#j=hZMhF CJUaJ#jhZMhF CJUaJ hZMh YhZMh YaJ#jhZMhF CJUaJhZMh6?CJaJhZMh YCJaJ(jhZMh6?CJUaJmHnHujhZMhF CJUaJ#jhZMhF CJUaJ& $Ifgd'$ $Ifa$gdZM$ $Ifa$gdZM .% $Ifgdxkdz$$Iflr|)*g    t0644 lap2ytZM    > f h YP $IfgdxkdZ$$IflF|)*g$  t06    44 laytZM $Ifgd' $IfgdZMh j   : of]THTTH $$Ifa$gdZM $Ifgd' $Ifgd+L $Ifgdxkd$$IflF|)*tt"  t06    44 laytZM        : < P R T ^ ` b d f ޾޳ތ޾޳zތ޾q޳_ތ޾qX hZMh Y#jhZMhF CJUaJhZMh YaJ#jnhZMhF CJUaJ(jhZMh6?CJUaJmHnHu#jhZMhF CJUaJhZMh6?CJaJhZMh YCJaJ(jhZMh YCJUaJmHnHujhZMhF CJUaJ#jhZMhF CJUaJ: b d f t Lkdx $$IflF*h t06    44 laytZM $$Ifa$gdZM $IfgdxFf $Ifgd'f t v   " , . 0 2 4 8 : ۇuleZQhZMhaNaJhZMhaNCJaJ hZMh YhZMh YaJ#j hZMhF CJUaJ#jM hZMhF CJUaJhZMh YCJaJ hZMh9KhZMh9KaJ(jhZMhX CJUaJmHnHu#j hZMhF CJUaJhZMhX CJaJjhZMhF CJUaJhZMh9KCJaJ  0 2 $Ifgd' $$Ifa$gdZM $$Ifa$gdZM2 4 6 8 : I@4@ $$Ifa$gdZM $Ifgd;Zjkd9$$Iflr<|)*t  @   t0644 laytZM: < > @ B ofZf $$Ifa$gdZM $Ifgd'kdb$$IflF|)* (  t06    44 laytZM: < @ B D l n  *+,?@NOPqrtuøҜ҈ҭygyyUyNN hZMhl#jhZMhF CJUaJ#jXhZMhF CJUaJjhZMhF CJUaJ&jhZMhF 5CJUaJ jhZMhF 5CJUaJhZMhxCJaJhZMhlCJaJjhZMhlCJUaJhZMhl5CJaJ hZMh@BDFH\žŭܢžܢ~žŭܢlžܢ#jhZMhF CJUaJ#jhZMhF CJUaJ#j6hZMhF CJUaJhZMh6?CJaJ jhZMhq?5CJUaJ hZMhq?hZMhq?5CJaJhZMhq?CJaJjhZMhF CJUaJ(jhZMh6?CJUaJmHnHu*^QHH $Ifgd' $If]gdZMkdF$$IflFh|)*(  t06    44 lapytZM^UUU $Ifgd'kd$$IflF|)* #  t06    44 lapytZM@B^ULL $Ifgd' $Ifgdxkd$$IflFh|)*(  t06    44 lapytZMBDFnp^UUU $Ifgd'kdx$$IflF|)*g$  t06    44 lapytZM\^`jlnprvx$޾ޏ}޾ޏk޾ޏ#jRTV`bdfhAiq޾ޠ޾wkw`UUN hZMhrhZMhrCJaJhZMhqCJaJhZMh/'5CJaJhZMhq5CJaJhZMhuCJaJ#j $hZMhF CJUaJhZMh6?CJaJ hZMhq?hZMhq?5CJaJhZMhq?CJaJ(jhZMh6?CJUaJmHnHujhZMhF CJUaJ#j"hZMhF CJUaJ8:<df^UUU $Ifgd'kd#$$IflF$ |)* X   t06    44 lapytZMfhU^J000$ h0$If^`0a$gdZM$ hx$Ifa$gdZMkd~$$$IflFh|)*(  t06    44 lapytZMQHHHH $Ifgd;Zj}kdn%$$Ifl 0|)*)  t0644 laytZM $Ifgd' $$Ifa$gdZM$ h0x$If^`0a$gdZM#$@3 $IfgdZMkd &$$Ifl\rd|)* h  t0644 laytZM $Ifgd;Zj89>?@qs"*,8HJL|~ʿ㿸ܭ{{{sh\hU hZMh2uhZMh2u5CJaJhZMh2uCJaJh:zJCJaJjhSCJUaJhSCJaJhQCJaJhShSCJaJhShQCJaJhSh] CJaJ hZMh;hZMh;CJaJ hZMhPa1hZMhPa1CJaJ hZMh!~hZMh!~CJaJ hZMh] hZMh!~CJaJ $789:;<@777 $Ifgd'kd"'$$Iflrd|)* h  t0644 laytZM $Ifgd;Zj<=>?@r@3 $IfgdZMkd($$Ifl\rd|)* h  t0644 laytZM $Ifgd'rs@kd4)$$Iflrd|)* h  t0644 laytZM $Ifgd'3kd/*$$Iflrd|)* h  t0644 laytZM $Ifgd' $IfgdZMJL|~ $$Ifa$gdZM $Ifgd;Zj $ <]^gd! $ <]^gd!~offf $Ifgd;Zjkd+$$IflF|)* (  t06    44 laytZMRh~~0~2~4~6~F~L~P~\~Ĺ~~~|~ui`WNhSJ 5CJaJh!5CJaJho5CJaJh!h!5CJaJ hZMhjYU jhZMh5CJUaJhZMh5CJaJhZMhjY5CJaJhZMhjYCJaJ hZMh2uhZMhCJaJhZMh8UCJaJhZMh2uCJaJjhZMhjYCJUaJhZMh2u5CJaJhZMh2uCJaJ2~4~offYf $If^gdZM $Ifgd;Zjkd+$$IflF|)* (  t06    44 laytZM Contract Approval Date:DR Form 516, Oct 08 Definitions BASELINE INFORMATION explains the following: Who is being affected by a specific injury problem What injuries are occurring (type, severity, and frequency of fatal and non-fatal injury) include at least 3years of data When the injuries are occurring (i.e., time of day, day of week) Where the injuries are occurring (specific geographic location) Why the injuries are occurring (contributing factors  i.e., alcohol, speed, lack of belt use, etc.) NOTE: The number of deaths is low in most communities. Non-fatal serious injury crash data may provide a more complete picture. OBJECTIVE Every public information and education campaign/activity must have an objective to reduce fatal and serious injury crashes as outlined by the baseline information. The objective states exactly how much injury reduction will be achieved in a specific period of time. The contributing factors must also be addressed (i.e., alcohol, speed, etc.). Every objective must be SMART: Specific, Measurable, Action oriented, Realistic, and have a Time frame. ACTIVITY The activity must coincide with the problems outlined in the baseline data and respond to the stated objective. The specific activities to be completed must be included. BUDGET The budget must include specific line item expenditures for the proposed campaign/activity. The total amount of funding assistance being requested must be supported in the budget. IMPACT EVALUATION answers the question  Did we reduce injuries? In the application, explain what you will evaluate. In the project summary (submitted after the completion of the activity), answer the following: Question #1: Did the activity reduce the types of injuries that were targeted? Question #2: Did the activity reduce those kinds of injuries by as much as predicted?  4~6~^~v~~\Q;%$ $ x]^a$gd6$ $ x]^a$gd!{ x^gd!kdt,$$Ifl\$ |)* pX   t0644 laytZM\~^~v~~~~:B2<€68@(4 46VXѾѶѶѶ{ppppph65>*^JaJjh6U^JaJh6^JaJh+^JaJhz^JaJhd?Yhd?Y5^JaJhd?Y56^JaJhd?Y^JaJh]o^JaJh!{56^JaJh!{^JaJh!{h!{5^JaJh!{h!{5CJ$^JaJ$h!h2u5CJaJ)~806zaz$ hh]^h`a$gd6$ hhh]^h`a$gdm$ hx]^`a$gd6$ hh]^`a$gdm$ h]^`a$gdmM$ h]^`a$gd6 z>@‹ċދprtvxz|ڽڽhr hF h]o j=-h ~h\UmHnHuhmhmM^JaJjhmMU^JaJhmM^JaJjhmU^JaJhm5^JaJhm^JaJhmhm5^JaJh6^JaJh65^JaJz$ċrvxz|$ |]^`|a$gdm$ hhx]^h`a$gdmM$ hhh]^h`a$gdm$ hhx]^h`a$gdm :PP&P:pr9/ =!"#$% vDM/d/yy$$If!vh55 5 5 #v#v #v #v :V l t06,,,55 5 5 / / p(ytZMtDText4tDText3j$$If!vh5g55 5 5 #vg#v#v #v #v :V l t06,,,,5g55 5 5 / / / / / p2ytZMtDText5$$If!vh5g5$5 #vg#v$#v :V l t06,,5g5$5 / / / ytZMtDText6$$If!vh5t5t"5 #vt#vt"#v :V l t06,,5t5t"5 / / ytZMtDText1tDText7tDText8tDText9$$If!v h5t55v5b55255T5  #vt#v#vv#vb#v#v2#v#vT#v :V l t06,,,,,, 5t55v5b55255T5  / / / / / / ytZMkdV$$Ifl  N:l(#|)*tvb2T  t06$$$$44 laytZMvDText10$$If!vh5h55#vh#v#v:V l t06,,5h55/ / ytZMvDText11vDText12'$$If!vh5t5 5 5@ 5 #vt#v #v #v@ #v :V l t06,,,,5t5 5 5@ 5 / / / / ytZM$$If!vh5 5(5 #v #v(#v :V l t06,5 5(5 / / ytZM$$If!vh5 5(5 #v #v(#v :V l t06,5 5(5 ytZMtDeCheck1tDeCheck2tDeCheck3$$If!vh5)5 #v)#v :V l4 t06+,5)5 ytZM$$If!vh5)5 #v)#v :V l48 t06+,5)5 ytZM$$If!vh5)5 #v)#v :V l48 t06+,5)5 ytZM$$If!vh5)5 #v)#v :V l48 t06+,5)5 ytZM$$If!vh5)5 #v)#v :V l48 t06+,5)5 ytZM$$If!vh5)5 #v)#v :V l48 t06+,5)5 ytZM$$If!vh5)5 #v)#v :V l48 t06+,5)5 ytZM$$If!vh5)5 #v)#v :V l4 t06+,5)5 ytZMtDText2$$If!vh5D 55 #vD #v#v :V l t06,,5D 55 / / pytZMtDText2$$If!vh55(5 #v#v(#v :V l t06,55(5 / / pytZMtDText2$$If!vh5 5#5 #v #v##v :V l t06,,5 5#5 / / pytZMtDText2$$If!vh55(5 #v#v(#v :V l t06,55(5 / / pytZMtDText2$$If!vh5g5$5 #vg#v$#v :V l t06,,5g5$5 / / pytZMtDText2$$If!vh55(5 #v#v(#v :V l t06,55(5 / / pytZMtDText2$$If!vh5g5$5 #vg#v$#v :V l t06,,5g5$5 / / pytZMtDText2$$If!vh55(5 #v#v(#v :V l t06,55(5 / / pytZMtDText2$$If!vh5 5X 5 #v #vX #v :V l t06,,5 5X 5 / / pytZMtDText2$$If!vh55(5 #v#v(#v :V l t06,55(5 / / pytZM$$If!vh5)5 #v)#v :V l t06,5)5 ytZM$$If!vh5 55h55 #v #v#vh#v#v :V l\ t06,5 55h55 / / / / ytZM$$If!vh5 55h55 #v #v#vh#v#v :V l t06,5 55h55 / / ytZM$$If!vh5 55h55 #v #v#vh#v#v :V l\ t06,5 55h55 / / / / ytZM$$If!vh5 55h55 #v #v#vh#v#v :V l t06,5 55h55 / / ytZM$$If!vh5 55h55 #v #v#vh#v#v :V l t06,5 55h55 ytZM$$If!vh5 5(5 #v #v(#v :V l t06,5 5(5 ytZM$$If!vh5 5(5 #v #v(#v :V l t06,5 5(5 ytZM$$If!vh5 5p5X 5 #v #vp#vX #v :V l t06,5 5p5X 5 ytZM`Ddb  A&?&logogray(official)Picture 1logogray(official)RRE(ߌۤ({P.-F&E(ߌۤ({PJFIF,,,Photoshop 3.08BIM,,Adobed        s!1AQa"q2B#R3b$r%C4Scs5D'6Tdt& EFVU(eufv7GWgw8HXhx)9IYiy*:JZjzm!1AQa"q2#BRbr3$4CS%cs5DT &6E'dtU7()󄔤euFVfvGWgw8HXhx9IYiy*:JZjz ?v*UثWb]v*UثWb]v*UثWb]v*UثWb]v*Ujf 꺍n#IHP Hxh=:^tuw?Td)Rί%CQhю*u?=khЮ-a$&fy)MUf:f%Җ__A0PKߗA$~Un*UثWb]v*UثWb]v*UثWb]v*UثWb]v*UثWb]v*UثWb]v*U"׼͠bnR:'KI% zq g~%x튾oWwV_4rwܟ _Ie5Pj8U-Ϋjw4gHPIM=WysoΚ]~d `-yRC**?)i譬u +zB@Bo!sNU~i0ZG b$}Tv*UثWb]v*UثWb]v*UثWb]v*UثWb]v*UثWb]v*UثWb]K5}kJlPut4`+?^)!T{ U?=e|Vy,AfY>NYB^)$7B*Uxy.e_ZGsmE4T楴p :8P u PIהajEp}JO\@ܥ;Z%w 1VWv*UثWb]v*UثWb]v*UثWb]v*UثWb]v*UثWb]v*UثWb]y'6?*$s&cWKVC mC¡WdV/׸%02HAE4w^m{_nysJ^,TzIbb [){ *IהajEp}JO\@ܥ;Z%w 1VWv*UثWb]v*UثWb]v*UثWb]v*UثWb_y~8] VG <wsh帯j#w0y_[H,T+)**7_?6|xU0֫hpk$#FN`ZIdTAVvU⯻Wb]Km[J4O]u;MDm&5 gN*? :󗗼ΛK5XyOu.;j6IHc@ʥVA98)/46<+KH//+}7Udn[LHdt9_$xHʼ8) 3'wpS/>gN**7_?6|xUToOl8|?qWҺ㷙[]_>aKG<Ӥ]M#J0;FcA̿0:ou[HͥqGsrN>Z, Ʌ+R]s͗hOpK\ݕaon4HiE튾'&DQTujQ;-8T*UثWb^aG+. Mi{yì_Ezr,Kٖ䑉zvȪAUUm O:eZMhk[ Xg u\ rV&J2rUU?ҡu8t/ƫGDd 6A,iI ff)ET_*6uv|=_z85i?L^RVrTe_WW1V=7s]YSyMH-nv'm2w$(r*QWw_iWt8ygTFyDP%x%nmH74e*wdW~wH~I8iZO%ZyK=&h 1 $!x՘4WToOl8|?qWQ? g]EFϙ8) 3'z:\kG--H|ɨY,cp@By(b*?lt+4+̺W};XrUx?s7Fd֕qw4 !pi\\:'~ qqq]ݬ:uN芆K{HRݥS'ɘ"I$oO׼+Вg% $=dYג9auQ²)U2$%+κkIJ\gӌqIn%JKnlv*UثY0``ʾM򭡼uDpEUT I#q<jʥW7Z?qsJǗlwXOns闑}^9 s%.Z /4^yo_2p6~y>qDE\ܼT^Lhl*?}9sDk<vAn.=ڜYcI! $(%Ϗ\M*kvkoE^$e%{˝B!`V bgrB iBKYHf]Y#(̗<@E__?>\|]qv5KB٥1/+lqW~N~r?y{ U6wޜS״[ ^OsN/F_OcB.2-t#~y}bNtV+򔾖3O*\[D?n;Sq2zn~H߾r|Q/)}CTi"2"7/X\:3KU_/9y~Un͞^$@+!d9H䍙$FY#fFV*U7*(5_0yf>?WZ=eΫqiߧ-/6dYj"7Oߕ_?9MSWusGȷ>a6tҝ$KVSJ0#lUWh_󖟓zg]+M)a6i[e9;QȫW֖H%8UثWbWϐj_C1W{Jt0y7L'-aKQk[IyjI43;ķH8 "U_/Ǟh~iee+ZϙBY{>qzǟJ^w]_|vLlW0^qoqIkmt}U AXy&#d93Pb*BUߔ4[ͥ4GfO}O|59>?]4?ߜϭ^* 縻XX4DDh3*^򯜼vl $2YY $ȌG$l"222UGv8ɦyu/˝n^JfIpacS\X' lx=hS'Vҵ+Lt-NZ5Ho}bdA,8kj'<q)#7 Y$޴aU_ث^?J.(5Y?ŏ-5眬ZӞV2R4 "+N֌[~H:Nfizַ]aˈ" I#UU \UvyWqSOֵm3~yҭMʓbI*s'rQvITUݏՠ5]&^ӷfCB{Prs$F`|UثWb]v*UثVUNʻoоվ"kϫqּ[*jגcSplO.iP}bP-gxNrȫTV@{X~8+wAy*Ҥ$7M[N T2ӧM:ZAoUOď=^^,6kZm- $ihW*UثcBƛ[<hi]CDU,VUU#ZU47mΰyoPwCj Ă0G}fa!g YWn*~/ռB=;ϩ\խ>ao[OKV%(>*@W>d>^_לu?/q>_:>X -۪)R9=p(ަ*_7Sy\&. i/4:*]iܲV^ x8 WeYt:[1B~ .^'(L7ڲ>/gU*UثV<~\v'oXt+]VK99QdT,TWkS_?-,| 蟜>_4}B/^ X.i5]B[`Ds[ˉAq#+Ӓ:Ώȿ?9M<ʚmu1Myt%H_OƏY矚t'_sPsUpe_ЖnNRTv*UثWb_ʟZW0$t2y]ѣ-Fc6TLC<.%UU~XoZ8_406+g;~Qi/j++J*N_ Pq_&*yOZ'W~ZsBf֩akz0R?vqW*UثW>MPMG'# Wyv*UثWb]yO̭[76w N)yI$%B 5^Jh]/ޭڅޕSr5k-+P=kKc% V ?o%jwд{Kk:dKtiιxcC="ʆeRX*Wb~g8g8(//_`gk-OGՖX>jJ#*~i|-yߢV[E?oJt',j]YM(Ww89'TGyo3LV I[Ymal?+vXJt(WW9X?7~c^s>pχ'͕E'Jӿ?(42_%uo E%kk=ˠYQrO+T_ثKo]*_sk{Yɧ"!K]N%s q# *Bɔ _?wJ'ϘZQ}_˓妁|{uZ 8m~**0Vu^Chk}u= Mj0L)Nc!Tjf * mK{{tX5((P]ZNHAZi/W,4}. *GhUT1VA8yj/u揩7s~eybk9 S2=E"GFd`U_7=:{KO/ưwPk>e0Om,kc1-Egf#U㊿ɟQ󊟔OӿGyUҗuI7Uפ bekŞS̬ 4U*UثWb]//+O5;y741蚾}k }>H})u;ы@W;4O\\]ZqqE7+ sϷVz֗rK˒pA}_<⯉韜1kލrUi^ktIN"H-$5hJ3_ϤsGqi 寗Mv;u[Y_CT \j1TpW<VUfb^9;8_ɿ4~QOF˞i UR7 %dlo5y^io'귚'V)0ZX~So_]ng"ҵ?O5蛇i wo"QWيlN5yξi)o8jߘ?J(>N73zP$q'9df⊪+Emǿ+kFWlEZ<ǦzO{?JՁK/$fSJ#|UUtO**2iH._fI\PƉBc rfBQ_W_ B<3z=RVQč#$@TPMhm UثWb]_:__ߘݦ:do#Ug'HEI@`шzO8\9i>\#Z~`hzſ1 wz/]gZyiq 5־zk6RFY&Y#朘*_/C򭆫k?z]WQ->i.>G].%0eӼ1PJΟil-6 שkO4І$'3z'IҴ +Lд-2E4[Hl4}AAAR8E )Wb]v*Uث/͏͏YfjG٘}jy]hߞ,|O?kZߦ.p}/ќr<ҋƬڿʚFO淜 sV>U򾙤<w&|Ϫ=6HEC>ڲȫY]~? n= _a5_XnK8?o0>?yuxV_VOO7V; 1WV 840~UO 7!d{"H80s+"WJ2˝ [4-WuGgG+jQ*Wb~_%|B=;Ϯ[iSm>aGP{V%̼*qKɯ+I񆟪~`y{7T3_Y)"ZG+Jث{]v*Uث? 2MG~liGwZjF򮩪?'aѶRXvbcIg.*1Ww U奏!kM{^k=֫m&krIRkr.-UJrtUcfi:V9gi7z6ՆYΩ `$區: /v*UثWb]?g|9jA}_<]?IyK:6 mWSf0/ȠQ(Abg--1|O],Z5 ,Mw2(PٵPUOOWE-#W]{+mWثV?+h^y|ҞYyyLems*sF^HµR9?0'7#jio?XLszPp}jX^8%9C.|gWݟw74tw6i=BX#wLy~~uY䪯gt*yB-Inuk%B}*Ul̪>JҼ98kv֖`̐f-XhHXƲ*PVV!v*;~e~t~o~chVv'GD+]WQ"TY%kF#|UOZ4|~ZdcwY%5K`iƫGsːUe_f*UثWb__K?+~MSH}?3~hiasιqoEmӧ:OO78~zjv1K}+|mlw%zI"8?1W\uFƭUثWb]clNo*ξi'Wߘ?JYa73zP$fiE튿_/:꿙^~6oii5[xbn Id5yHP Uz nމ0Gq -cѴ[ez$vB/W4`u{FҼyZҊ?Mj(ZJr||kUUW[]㖓:[CCMWPΊ}KId&9U*UثW?Q?)E:/kiCy4DĒ(,RIV>.QW*>n#?-2uK9I4_?ż.HֳsP%ވj#I/$UثWb]v*Kcc|{Zz40uvfo>گqWb]ϝO&!f+X[5WrEeB PopVouKIgΚ3)HXBlC<Ѕ _VSl~sH?Wef??U6*U?tʟ-[OSB.ܪ.IN86Ub8?1l~B:VZ叚ph:kY?O%<V^Mr w/0\jZcCߗηkVX5ޟOү51~^OnfI%~FҊ :Ϟ5-Q4{~dLZ|\$2:V{OLI3V?8 /)Uy2֮2=FIcKV^XӶGV R>W?+h^F򯖼k~Y~gysLe| mm;+5^NƕbNg/g*Ug} \ !х䯥2iK6Hvc"2Ƀr*Cp_2?Hy,SD2?X_OI˚Wb]v*U?{g7Fy[V:9? /*ڸ?B)#0[e< {Q*`W>Y~to}q.-5I<+Vwq|R[`%\[A9㺎DBɭ[J$ SִMk+͗>a2\R<Y$D`H`A?ſ:.S*f{~~z\Kqv*Uߓ)->2]ntJ_VNftմW@u= ].]oEX{kKg1OJ7RR"|7/V}=?zT^fާBލ彎 -W%t^Q*qWb]v*U?_?3x}^#vhaa>A}_<]b^~GȾtJ4G[Xk%ϣ?O.-Jև*YqW8ա^^~iq=3S.o%nKu3\O#-h(*Uث͏V.ܞiXjX)y#+ H;w][<(a2-Ο}C=Ib23Gσjy*^Vm<9[O>`|ix5 } U훓(VE,Uª_?4^_%u{jy|yZҖO_ë[j(і:Zirk͕YWG򆓥C8æZE?WvOkeR,sx{5cE2HTU_ثWbR[VҴ +SuNE4[IbdC,a ]\ $;UPK_gpW_MR6 Cߩ$OXTRdR{4Ȼ+~rySHѽ?,hPiա7ǣ Hoo9mӿ U&@__Eֳ{HF{ *jz stIY=Co$._G]v*Ώ&BWsO&Z%ƠhmmI&%.ʊX4W9/6~j֮O-hW=FId{*ْ(ӶGe ^gTqq_W%v>hV(i$EI*588櫯%ZX7GZƵy"Sksߴ-r;.dEݥrĪ1Wߚ"|qcyW4M#Se>s}Dެere,(C8e_*UثW'?Fl'步;y.$I5W MMI6kw0DfEG@GW󊿚_#&?2ZOa+־GBzSrvAZI{]v*Uث/͏͏YfjG٘}jy]v*UR"KIKli=6Rqtu1\CI';W󅊿ג_*ǮZ~ey[&I k\n4X,82\*N__?- /*T?[3^r>akbL\f$"T`_:? .t"z_1hij:CDU,VUU=v*~#8y>dC^f[Ʋ[h{wF U_ɣWUT?>)/*kEx-t%";k6X1$|eE*SWu+y+Z<ͪz##dn'1ۉ(2?˯?WNii?.]\[GyMrH j^Go (aVP_CPy~s\֓߶ngx#K"vHԗtVUu(_zg}-+R]6W9K2RzFGъI?뿜:W_<ޕ/O-bMH.aOZ)ͬ{YjxLN*LW>UYm]Wz*~]v*|:N8ծæZE6m5{['%YS4jƊdڪW8Y+wqS'R]꺎w[M+^5=kWC-jWsJedw+PUثWb6?6?IgWqūC Wfav*UثW_%y+v[-K[IdIgb fff`1e毘gg&$ZI(`#$+(,J}{?9OKA_#hPGcoM^$̎R%(hXR" q_%?}xGχǗ+AeWb)6?I[hr{Ej3oeco/%i_^AλqwiyHmdycEIIRUHjom>o#jV9Euwmb+44kDQ*ypqB.m/yi/AuT:)8Ǧ,` bs~q/-iV:onדEXA{g&o> 9{d0:柜5yWf]o2M!UP*GhqƪqX~*ο]Uʏo0yk+BX-oӝ]B7#ӸІue* |qWQ:⯗2 <9>Ϛku]Rm* =QZiťDa4b>U /?OVj~ ڿzX2^9S8S|9矯qyJXlo}Vd9= >;DuAz㡃1Wgwⶄt?-g?Z][[Kk1u,rAu" HU e_O]|9]8q9kq/0i^א<k Ȫ ,n-قʡHd!%_˟y7~jt74x d֥]B8g$w/NiyN_8~Z~jcMοt|kOMIW  ssk6 Ⓢ6_V\yB5m7:4z57^"ɥj}Մkۧ£'̫??Eʴ򯔽_Q9z~4OC/W%'?2??[Ӽ~W:&}y7Jߟ. opR@K{pV$rVյ]UwSֵjkcXn\<)gI31%$w禺ƾZ!i?7yKs QPYw2 V1 &so?+-Y<;ɞU.m $2qK4QG5U|?Mϕ< oX{Ĉ{[[],Ės;I3ߣ s h0ߝ^ro洂u ൶Ep,V(32/_W3i~|(Ca K*jf]׭yt-g( Dd1IJ5LU^#~w󎿖ioiViQk$B[>hڶw[axȌ8҈"3W_ACUʿ/҃_K~<}n8XWb6?6?IgWqūC Wfav*UثWb&b7v>굖c)m$ ޑ~.4gԴJ$s4aF_Nb]v*cռ拟'ZF)z,31vV?oگ&|8IcK>K#'~=>2[[4~$EK7V*x_O$Ҽi~ܮ4U!1~嶻6d@bs\ Û]D7-s8)3o3[wpS,gg*8 8mwSߕuW8}_Wy<9:򭦻cq_ȝWY'h\G8Ѿ58)VnVAQİuUV7#]mK:}+kzͤ6^Oϥi}ل'ģ$䬫/Əȋ5/{[ɪ6][IU亼7cUJ35*?v*O?έ)t˟/K=>mb)cQcm>,FԷFV B??c??W.?b>u]3XIo_y q",wJ#)#}:ViZh&i Bֶ" *GhUT1Tv*/ɿ .~p^^y9~GԖ l]oЕ=E^*%X9ylUKOsyتo/1?UޡzW [\oZ'm?U䯩qj:X*v*Kcc|{Zz40uvfo>گqWb]v*UثWb]v*UثWտ4\=5yOa}} v*UثWb]v*UثWb]v*UثWb]v*UثWb]v*U?_?3x}^#vhaa>A}_<]v*UثW??Ex t{T{oH-g?jW+Ǐ.ڪzEԩA?)SRL*)O_J{3򘫿?*ytbEԩA?)SRL*)O_J{3򘫿?*ytbEԩA?)SRL*C};J]?LԮ8kI,t?V] Ia YfZş5swqg_h]EYWZ1WjAVyUZş5swqg_h]EYWZ1WjAVyUZş5swqg_h]EYWZ1WjAVyUZş5swqg_h]EYWZ1WjAVyUZş5swqg_h]EYWZ1WjAVyUZş5swqg_h]EYWZ1WjAVyUZş5swqg_h]EYWZ1WjAVyUZş5swqg_h]EYWZ1WjAVyUZş5swqg_h_* /'U~E~/^Gp緩^!]7Yѣ{,8..9 1hox*UثWb]~dƼ<ʜy/^/Кu֡_g}Z98sۏ*WC2?B~z _NjOT'Y=9>*PedB~z _NjOT'Y=9>*PedB~z _NjO?(.aqJH'ۣ+ B ЧS4j*o_#u#]B9MndxS)5?w w7ONi7\گqWb]v*UثWb]v*UثWb]v*UثWb]v*UثWb]RnaFx$P⌬ 8o鼥4΍yf%ww4MIDs|T.ƱWb]v*UثWb]v*U7???y3it"QwYS~S}_V]v*UثWb?.?#2?#8j1$7ҵ .I2Ci=̢[M4m̾v|(bI 52Wb]v*UثWb]v*UثWbS 3[\—QA|m]7Yѣ{,8..9 1hox*UثWb]v*UثWb))I[hqKi2WuSv*UثWb]v*1?:z7_6/;Mߪ;;;BOP_L#וY aU[9'9MϦfkz,<U/3ijz stIY=Co$.]891旜,n^z?a淴kI$I}8UosʾU?94?GMiN]JRyo3j\q@5^?U'o旒<`hzH$[A=[KK~q惭Y}rWQNmQ+2~0q334bI U?WWeZج5[jokL߭V:qOo_O_7_~'?=?⯌~9uy3q{vy~]\jvHmcݞ[p%EKث?6~e~tϣ1+{Mu&k~V tIQdT V9O5]1*鿙s󭮢4+`-.mNpcy9aL}r o?.m?4>/퇙u[^[ؗ%-2B>6be6ʼO~9GysqrKJռãysZm];2wgm"JMO,J<Ǧz C604^hu-Wӎ@,ܢ|U4N}O?)|8__Nt>zl<];QYjKyjb, خ$_ HgzO?_Z姖)E`at5MSĈV>'d gʿ?^SҼ枽9d[rk~^D%.,>Nף=&su=*(fٯ9Em zIUl?~qf 8_Fz~y_*UثWb]v*UثWb]v*<5)qopHYMAqWߚ?yJi57ÎKRbh#&V]Wb]v*UثWb))I[hqKi2WuSv*UثWb]v*Uثqqssr^Fe5ysiԬmn幋ն/qn-Ao&:~Q~W ٰm=,5mX F$,1ƈ\C")U?>{o~Y6yV_mk[N=5]+[ZjGfW':u?ş&y⦱5 ݦ ,5(,NZ𳁡X + !__W ~a8+'8 aw[y cTt'\Eż1H,pAi Wgs7ʺ/*3V4ZMOAФ gm&\۸3\[3zƏ8{ZVUw?&-f [럢,fz|kźb?\7__4':׿H[vw_WZr*U{*UثWb]v*UثU)aK{hE(j Ѓ6SIѽǖnrZ{sAԘ4G?Bkv*U7???y3it"QwYS~S}_V]v*eo^r*|ں;KHBן?#F]<998+Yz_o1$4uϖ$_J[wE D*zss@t[MOGS,Miᳳ5==V{x)ؖkw|Uȏ_?+k'篘4H䶎liHf['Y_ƣuL?3?_>THV>y3m޵ sxDmXVM*oΥ9Yii(m;KHBן?#F]?,-៑󐿓ߔWO_0i.s}mm&5/-u NG+*9d|?UiVay5̑Zf5KFV<r꿠9j>A>hW_.c [};M>gX"p,1~wn9Qo/A˵4};AN%a҂ק,'a%_ߖ?=+?>t/kk8y?L#ݴ`{ y9Sw2+2([ʿ<rO~qLyi^W~kYy}fRmnKYe3;3W .*~S]cp^󯔿Fɺ7S-~jme="[Qo4Wkq ekxp */7?7?3|i}8OuiZDXb61Z\j ,2 "f3<*_r}G-eOWYV3qU׵5xb"`95^s9o?G`Ҽ9!{O2SKdt_!Di lo >$ݤ Wt̯ B<3̚=$wQZ궱@RJ"0W` ho UثWb]v*UثU)aK{hE(j Ѓ6SIѽǖnrZ{sAԘ4G?Bk} OOOhE]#H]imWոWb]xj9|>UYm]Wz*E*'qʖ3yU>pƪWFb1J_Kq|$WqU7&?P7+_V=k^j-|OQf,4.,-{(- ۲ !V_99խyɺ??t?,MՅy{[Z{+0#pZKZFZ)_@~eڮ?_%oltIU|}9GO͏9)=<3eyjBO,z-:֓hӍ!4{L!UwVr]^?8;݃{wZ}VOyWx7]wob,6t=s|c9L3!凞M*K~xbYXKZ;/mXpג:!Tr#sZt˟_/uo:~X TڴWa0F-ഗ- Su]k~8KgyV\?Nѓ_]O%iDp_B%iczZ⬿~;M>ͫ'<#8RO9bUiBE~e#}g?-z}_Z犼1WrdUj_ ,U//"~t5O̽ K2W֋?[q^A9`x7ⴡ C~W>agwg]uwi׺h7RH5f3]r}fZq$kα? @Ϧ˝"ZycE˗Z_gYH-nF UOWq+O~~>}c~~*t ;<89o8y3<#jk6FThK®c`Xx*YqC_(/a(4?’O7LN4ƚM.K6x-̋3UW),¼n>ơs󎺝Ǒ4+/ueK)Okdܢ12jh'*T?5jZ/Uc׭T-nӷetJ v?9uhZo%Ni?/>YeHWCLtUH""H"[[TUJ~hi__?:Ci/iwcuöU\]v%Ҿ-JIchb?eXgWv My?S .k2]^^[X\X[^=(Z$YY4Z9G%4'7?uO}+^HGZZ5嵣Xs"__R4(YdYef*j~D~[?;jKy;ܧZq}^ɽkVY5''e^?ww:57kw3h0K="K "Orrޭd^Kg_:O?_W|u;i|qsk2 6gӸ4NbWsYӿ?5?ϯg<Ծe5)aMk9i"~-MAQBG1«?)7/*ʲ֯Nyoz| ysʿ+Cޫnҥҵx#/X 5N(ʭŠprG?w|8][̟g5cQmn˧궉]X<EggREbU? 40Mʴʻ~]_[zFzW.?R~|ҫJE^? _俖?..u/ދ[/2]]yխmJ̅P @UawwO?˿o̗W׏w <։4wsM%ŽżeE`n +}9MksrJ>ymh0\ȳä--)q{;YYY 9#9Q_W~[t{e ~%{h0uX^u4Wv^Jrqߞ󇟘Phu2yXյ& $4E%xJ|T$~ҿ.|_*,\]i\̷:ԭ) WH%eW>*~V~Zy[ZZ򮍥yYgc YToZdw%P^L8?3ޞvҿ"2S~v:ޫC⾱ӢʶĉMY>zBr___w^ykBVHdcT2[^z7k*~WF~_%]o]..Yx5KGhby_y*~`Е~iIqOWUX}wP?k_jZyWΟuߖ|\iZh=eݷb$,Hѷ*#UqO}}O_5W_Ui>S5t1PKgXݕ5T32Hex-QWFU?O_ OWTm79{6ޮџ\ݯ!76g:VefOqsBE縼7t̫{+YЬaibe4dE…W/:~\y[qSrʶ_I> .lVm3Ka BF_|x~ioqSqG~U~c'y2__jY%kmleWu7 eBѲ*? 7BC*s/gY~[z?[__5y}_4Jҿ3-5]K\'Чd綷ia6[jJH2*5o/gG%mVIu.u^Yt;K[]ʐ[zh%i_A?΅qwwyg{I.ҭcxFHb@fWb]v*UثWb]v*UثWb]v*UثW'&Gq;5VPr_ثWb]v*UثWb]v*UثWb]v*UثWb]v*U^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH H`H 0Normal CJOJQJ_HaJmH sH tH DA`D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List j j ' Table Grid7:V04 @4 !Footer !HH :zJ Balloon TextCJOJQJ^JaJN!N :zJBalloon Text CharCJOJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]   f : uv\$\~| (-16=HJP h : 2 : B qtwz}XBp8f$<r~4~~|!"#$%&')*+,./02345789:;<>GIK +1EQUYekv+?O!',8>MY_dpvFFFFFFFFFFFFG G G FFFFFFFFFFL# AA@(  T  C  B S  ?LtText4Text3Text5Text6Text1Text7Text8Text9Text10Text11Text12Check1Check2Check3Text2 EZw@  2Vl,P 2EVYlv,?P(,?M`dw 2EVYlv,?P(,?M`dw %1/s(5dr_yu%q8qQSJ S Le  X k l F I  l%>t|I}=mM]od1gW.Xq-3? ce L"m#h%/'#r()q)3,B..<.i0Pa13B6468;rp;?$(?6?q?FCF9F4RF*G0UI:zJ|32uVa 9K>YM TfYSllZs?mZnVKBLW6cw0r96wV'S@$uqaN3lKl)u v!A]lY'vK/QIyju*r^[or@C+02J$9Dmpy$\No!j+!P,Or `|4d;]r T{] QuZM0lQ1p4dz?@ABCDEFGHIJKLNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FP 5Data M1Table&WordDocument<SummaryInformation(DocumentSummaryInformation8CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q