____________
____________
____________
____________
____________
____________
____________
____________ %
____________ %
____________
____________
____________
____________
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____________ %
____________
____________
____________
____________ %
____________
____________
(Calculated by DIME) %
(Calculated by DIME) %
(Calculated by DIME) %
(Calculated by DIME) %
(Calculated by DIME) %
(Calculated by DIME) %
(Calculated by DIME) %
(Calculated by DIME) %
(Calculated by DIME) %
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complies does not comply not applicable (Circle One)