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HomeMy WebLinkAboutContracts & Agreements_235A-2016 PUBLIC WORKS CONSTRUCTION CONTRACT This Public Woiks Construction contract ('Contract") made and entered into this 15th day of Novembei, 2016, by and between the City of Redlands, a municipal corporation organized and existing under the laws of the State of California, (hereinafter "City"), and MCC Pipeline, Inc (hereinafter "Contractor") City and Contractor are sometimes individually referred to herein as a"Party" and, together, as the "Parties " In consideration of the mutual promises contained herein, City and Contractor agree as follows 1. SCOPE OF WORK Contractor shall furnish all materials and perforin all of the work fol the following Campus Drive Non.-Potable Pipeline Project, complete all items as required by the Contract Documents(as herein defined) and Specifications for City's Campus Drive Note-Potable Pipeline Protect, Protect No 71270. 2. THE CONTRACT SUM City shall pay Contractor the sum of $189,913 00 as consideration for its performance of the Work in accordance with the terms and conditions set forth in the Contract Documents Pursuant to Public Contract Code Section 22300, Contractor has the option to deposit securities with an escrow agent as a substitute for retention of earnings requirement to be withheld by City pursuant to an escrow agreement as set forth in the Public Contract Code Section 22300 3 TIME FOR COMPLETION The Work shall be completed within 30 calendar days from and after the date of the delivery to Contractor of a written Notice to Proceed by City 4 LIQUIDATED DAMAGES Contractor's failure to complete the work within the time allowed will result in damages being sustained by City Such damages are, and will continue to be, impracticable and extremely difficult to determine Accordingly, Contractor shall pay to City, of have withheld from monies due to Contractor, the sum of$500 for each consecutive calendar day in excess of the specified time for completion of Work Execution of the Contract shall constitute agreement by City and Contractor that $500 per day is the estimated damage to City caused by the failure of the Contractor to complete the Work within the allowed time Such sum is for liquidated damages and shall not be construed as a penalty, and may be deducted from payments due Contractor if such delay occurs 5 CONTRACT DOCUMENTS This Contract includes all of the Contract documents set forth herein, to wit, Notice Inviting Bids, Instructions to Bidders, Contractor's Proposal, Bid Bond, Agreement, Performance Bond, Labor and Material Bond, flans, General Conditions, General Requirements, Technical Specifications, and any addenda thereto 6 ATTORNEYS'FEES• In the event any legal action is commenced to enforce or interpret the terms or conditions of the Contract documents,the prevailing Parry in such action,in addition to any costs and other relief, shall be entitled to recover its reasonable attorneys' fees, including fees for use of in-house counsel by a Party CD 1 7 RESOLUTION OF CONSTRUCTION CLAIMS Claims by Contractor in the amount of $375,000 or less shall be made by Contractoi and processed by the City pursuant to the provisions of Part 3, Chapter 1, Article 15 of the Public Contract Code (commencing with Section 20104) All claims shall be in writing and include the documents necessary to substantiate the claim Nothing in subdivision (a) of Public Contract Code Section 20104 2 shall extend the time limit of supersede the notice requirements provided in this case from filing claims by Contractor 8 ELIGIBILITY OF CONTRACTOR/SUBCONTRACTOR Contractor and all of its subcontractors shall abide by California Public Contract Code, Section 6109, and California Laboi Code Sections 1777 1 and/or 1777 7, and certify that they are not debarred and are eligible to work on this project 9 ASSIGNMENT OF AGREEMENT No assignment by a Party of any rights of interests under this Contract shall be binding on another Party without the written consent of the Party sought to be bound 10 SUCCESSORS AND ASSIGNS City and Contractor each binds itself and thea respective successors and assigns in respect to all covenants, agreements, and obligations contained in the Contract Documents 11 SEVERABILITY Any provision of part of the Contract documents held to be void or unenforceable under any law or regulation shall be deemed stricken, and all remaining provisions shall continue to be valid and binding upon City and Contractoi CD 2 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first written above City of Redlands (SEAL) (Owner) Mayor, City of Redlands, County of San Bernardino, California ATTEST el- City Cle , ity of Redlands County of San Bernardino, California (SEAL) Name of Contractor By Sign e of Authorized Agent t a/( Title Signature of Authorized Agent(1f necessary) Title ©10139 L!9 Contractor's License No. CD 3 WORKER'S COMPENSATION INSURANCE CERTIFICATION Description of Contract City of Redlands Municipal Utilities&Engineering Department Campus Drive Non-Potable Pipeline Project, Project No. 71270 Labor Code, Section 3700, provides, in part that- "Every employer except the State shall secure the payment of compensation in one or more of the following ways (a) By being insured against liability to pay compensation in one or more insurer duly authorized to write compensation insurance in this State (b) By securing from the Director of Industrial Relations a certificate of consent to self- insure, either as an individual employer, or as one employer in a group of employers which may be given upon furnishing proof satisfactory to the Director of Industrial Relations of ability to self- insure and to pay any compensation that may become due to his or her employees I am aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the work of this contract (Labor Code section 1861) Dated this day of NO&Jlft 016 cc 41'P,0_1,'ne (Contractor) aJD �'J (Signature) (Official Title) (SEAL) (Labor Code Section 1861 provides that the above certificate must be signed and filed by the Contractor with the Owner prior to performing the work of the contract) CD 4 BOND No. 024068890 PREMIUM•$2,735.00 EXECUTED IN DUPLICATE FAITHFUL PERFORMANCE BOND Whereas, the City of Redlands ("City"), State of California, and MCC Pipeline, lnc (hereinafter designated as "Principal") have entered into an agreement dated I November 15, 2016 ("Agreement") whereby Principal agrees to install and complete certain public improvements (the "Work"), which said Agreement is identified as Campus Drive Non-Potable Pipeline Proiect, Protect No 71270 and is hereby referred to and made a part hereof, and 5 Whereas, said Principal is requited under the terms of the Agreement to funaush a bond for the faithful performance of the Agreement, now, therefore, we, the Principal and TEE OHIO CA5[JALTY * as Surety, are held and firmly bound unto the City in the penal sum of One hundred eithty nine thousand, nine hundred and thirteen Dollars ($ 189,913 00) lawful money of the United States, for the payment of which sum we bind ourselves, and our heirs, successors, executors and administrators, ,jointly and severally, firmly by these presents *INSURANCE COMPANY The condition of thus obligation is such that if the above bounded Principal, his or its hens, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform, the covenants, conditions and provisions in the Agreement and any alteration thereof made as therein provided,on his or its part, to be kept and performed at the time and in the manner therein specified, and in all respects according to their true intent and meaning, and shall faithfully fulfill the one-year guarantee of all materials and workmanship, and shall defend, indemnify and save harmless the City and its elected officials, officers, agents and employees, as therein stipulated, then this obligation shall become null and void,otherwise it shall be and remain m full force and effect E As a part of the obligation secured hereby and in addition to the face amount specified therefor, there shall be included costs and reasonable expenses and fees, including reasonable attorneys' fees, incurred by the City in successfully enforcing such, obligations, all to be taxed as costs and included in the judgment rendered As a condition precedent to the satisfactory completion of the Agreement, the above obhgation shallhold good for a period of one (1) year or longer if required by the Agreement after the acceptance of the work by the City, during which time if the Principal shall fail to make full, complete, and satisfactory repair and replacements and totally protect the City from loss or damage made evident during this period from the date of completion of the Wo g g F p rk, and resulting from or caused by defective materials or faulty workmanship, the above obligation in penal sum thereof shall remain in full force and effect. The obligations of Surety hereunder shall continue so long as any obligation of the Principal remains Whenever the Principal shall be, and is declared by the City to be, in default under the Agreement,the City having performed the City obligations thereunder,the Surety shall promptly remedy the def&ihAplih1Hq ft ihm63qd&nqtrnnth its terms and conditions, or f 2 Obtain a bid or bids for completing the Agreement in accordance with its terms and z conditions, and upon determination by Surety of the lowest responsive and responsible bidder, arrange for a contract between such bidder and the City, and make available as work progresses sufficient funds to pay the cost of completion of the Work less the balance of the Agreement price, but not exceeding, including other costs and damages for which Surety may be liable hereunder, CD 5 the amount set forth above The term"balance of the Agreement price,"as used in this paragraph, shall mean the total amount payable to the Principal by the City under the Agreement and any modifications thereto, less the amount previously properly paid by the City to the Principal Surety expressly agrees that the City may reject any contractor or subcontractor which may be proposed by Surety in fulfillment of its obligations in the event of default by the Principal Surety shall not utilize the Principal in completing the Agreement nor shall Surety accept i a bid from the Principal for completion of the Work if the City, when declaring the Principal in j default, notifies Surety of the City's objection to the Principal's further participation in the ! completion of the Work i No right of action shall accrue on the bond to or for the use of any person or corporation other than the City named herein or the successors or assigns of the City Any sort under flus bond must be instituted within the applicable statute ofhinitations period The said Surety, for value received,hereby stipulates and agrees that no change,extension f of time, alteration or addition to the terms of the Agreement or to the work to be performed thereunder or the Specifications accompanying the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or T addition to the terms of the Agreement or to the work or to the specifications No final settlement between the City and the Principal shall abridge the right of any beneficiary hereunder whose claim may be unsatisfied The Principal and Surety agree that if the City is required to engage the services of any i attorney in connection with the enforcement of this bond, each shall pay the City's reasonable attorneys' fees incurred, with or without suit, in addition to the above sum In witness whereof, this instrument has been duly executed by the Principal and Surety above named, on NJVEMBER 23rd , 2016 (SEAL) (SEAL) MCC PIPELINE, INC / THE OHIO CASUALTY INSURANCE COMPANY ' 1 A Q 0 13Y V(Sn (Signature) MICHAEL D )ATiU Y�— FAGT Addres 790 'THE-° CITY 'DR. SO SUITE 200 Seal and Notarial Acknowledgement of Surety) ORANGE. CA 92858 Telephone (7.14 ) 634-3311 CD 6 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached and not the truthfulness accuracy,or validity of that document State of California ) County of Riverside ) On �/Z 3 1+!o before me, R NaDD1 "Notary Public" Date Here Insert Name and Title of the Officer personally appeared MICHAEL D STONG Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(o is/we subscribed to the within Instrument and acknowledged to me that he/slice/they executed the same in his/hoer/their authorized capacity(ies), and that by his/hear/their signature(o on the instrument the person(, or the entity upon behalf of which the person(x) acted, executed the instrument I certify under PENALTY OF PERJURY under the laws R.HAPp( of the State of California that the foregoing paragraph I c� .- �� COMMA 2157fi52 Is true and correct � Z , NOTARY PUBLIC CALIFORNIA z WITNESS my hand and official seal RIVERSIDE COUNTY , ( my Comm Exp June 7 2420 t Signature Signa urt a of Notary Public Place Notary Seat Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document Description of Attached Document Title or Type of Document Document Date Number of Pages Signer(s) Other Than Named Above- Capacity(ies) Claimed by Signer(s) Signer's Name Signer's Name ❑Corporate Officer — Title(s) ❑Corporate Officer — Title(s) ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other ❑ Other Signer Is Representing Signer Is Representing 02014 National Notary Association •www NationalNotary org - 1-800-US NOTARY(1-800-876-6827) Item#5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness,accuracy, or validity of that document State of California ) County of SAN Bcc��ERNARDINO )YASHESH C PATEL, NOTARY PUBLIC On�t)V6MJgeP cV� a016 before me, Date n Here Insert Name and Title of the Officer personally appeared �A,UI ,LE 4�lZl/V Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person{) whose name(j) is/are subscribed to the within instrume t and acknowledged to me that Hie/she/they executed the same n 4Wher/t*eeir authorized capacity(), and that y Isis/her/#reir signature on the instrument the person), or the entity upon behalf of whic the person{) acted, executed the instrument I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph _ is true and correct YASfiESH C PATEL WITNESS my han n ff' ial seal Commission #2066258 u Notary Public California z ' San Bernardino County Signature My Cornm Expires Oct 16 2018 Sig ture of Notary Public Place Notary Seat Above OPTIONAL Though this section is optional completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document Description of Attached Document Title or Type of Document Document Date. Number of Pages Signer(s) Other Than Named Above Capacity(les)Claimed by Signer(s) Signer's Name Signer's Name ❑Corporate Officer — Title(s) ❑Corporate Officer — Title(s) ❑ Partner — ❑Limited ❑ General ❑ Partner -- ❑ Limited ❑General ❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other ❑ Other Signer Is Representing Signer Is Representing ��� w��c� a�o�+o �.�:�-��o-�o��.mow•-vw��,e�c��<=�..����s � 02014 National Notary Association • www NationalNotary org 1-800-US NOTARY(1-800-876-6827) Item #5907 BOND No 024068890 PREMIUM INCLUDED IN PERFORMANCE EXECUTED IN DUPLICATE LABOR AND MATERIAL BUND Whereas,the City Council of the City of Redlands,State of Cahfonua,and(hereinafter designated as "Principal")have entered into an agreement (the "Agreement")whereby Principal agrees to install and complete certain designated public improvements(the "Work"), which said I agreement,dated November 15 2016, and identified as Campus Drive Non-Potable Piueline Proiect.Prosect No 71270 is hereby referred to and made a part hereof,and j Whereas, under the terms of the Agreement,Principal is required before commending the performance of the Work,to file a good and sufficient Labor and Material bond with the City of Redlands to secure the claims to which reference is made in Title 3 (commencing with Section 9550) of Part 6 of Division 4 of the Civil Code of the State of California Now, therefore, said Principal and the undersigned as corporate surety, are held firmly bound onto the City and all contractors, subcontractors, laborers,material men and other persons employed in the performance of the Agreement and referred to m the aforesaid Code of Civil Procedure in the sum of One hundred eighty nine thousand. nine hundred and thirteen Dollars ($189 913 00) for materials famished or labor thereon of any kind, or for amounts due under the Unemployment Insurance Act with respect to such work or labor,that said surety will pay the same 1 in an amount not exceeding the amount hereinabove set forth, and also in case suit is brought upon i this bond,will pay,in addition to the face amount thereof;costs and reasonable expenses and fees, including reasonable attorneys' fees, incurred by the City in successfully enforcing such obligation,to be awarded and fixed by the court,and to be taxed as costs and to be included in the judgment therein rendered It is hereby expressly stipulated and agreed that this bond shall insure to the benefit of any and all persons,companies and corporations entitled to file claims under Title 3 (commencing with Section 9550)of Part 6 of Division 4 of the Civil Code,so as to give a right of action to them E or their assigns in any suit brought upon this bond e e Should the condition of this bond be fully performed,then this obligation shall become I null and void, otherwise it shall be and remain in full force and effect The surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Agreement or the specifications accompanying the same shall in any manner affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition 1 t s E f 1 CD 7 3 In witness whereof,flus mstrurnent has been duly executed by the Principal and surety above named,on NOVIIKBER 23rd , 2016 (SEAL) (SEAL) MCC PIPELINE, INC THE OHIO CASUALTY I URANCE COMPANY ntrac or/� � BY (8ignature) MICHAEL D (Sig e} ATTOR�TEYJ-FACT Address 790 THE CITY DR. SO SUITE 200 (Sea] and Notarial Acknowledgement of Surety) ORANGE, CA 92868 Telephone (714 ) 634-3311 CD 8 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND This,P.ower of Attomey limits the acts of those named herein and they have no authority to bind the Company except in the manner and to the extent herein stated Certificate No 7274097 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS That American Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts and WestAmerican Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies%pursuant to and by authority herein set forth,does hereby name,constitute and appoint Jeremy Pendergast Michael 0 Stonq, Rosemary Napp1 all of the city of Riverside state of CA each individually if there be more than one named its true and lawful attorney-in-fact to make,execute,seal,acknowledge and deliver for and on its behalf as surety and as its act and deed,any and all undertakings,bonds recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by ihe.president and attested by the secretary of the Companies in their own proper persons IN WITNESS WHEREOF this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 1st day of March 1 2016 Pio CA',s ,IY INS IN.V'R ,,NSt,a American.Fire and Casualty Company �9y� The Ohio Casualty Insurance Company c [906 0 0 1919 o a ° Liberty Mutual Insurance Company a 1912 u_ o r 1991 3 _ a N a Zestmericann(Insurance Company By d STATE OF PENNSYLVANIA ss David M Carey'-Assistant Secretary COUNTY OF MONTGOMERYca s dOn this 1 st day of March 2016 before me personally appeared David M Carey, who acknowledged himself to be the Assistant Secretary of American Fire and [- 0 4) Casualty Company,Liberty Mutual Insurance Company The Ohio Casualty Insurance Company,and West American Insurance Company,and that he as such being authorized so to do >,V p R execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer d 9 IN WITNESS WHEREOF,l have hereunto subscribed m name and affixed my notarial seal at Plymouth Meeting Pennsylvania,on the day and year first above written O s A COMMONWEALTH OF PENNSYLVANIA �.+C eti o"w�+Tt�C[ Notarial SeaE 1, gar v Teresa Pastella,Notary Public By O G $D of Plymouth Twp.,Montgomery County Teresa Pastella Notary Public &_T L � My Commission Expires March 2a 2017 ' j � 0,4$ L4 Member Pennsylvania Associalion of Notaries a C This Power of Attorney is made and executed pursuant to an by authority of the following Bylaws and Authorizations of American Fire and Casualty Company The Ohio Casualty Insurance m c 6, Company,Liberty Mutual Insurance Company and West American Insurance Company which resolutions are now in full force and effect reading as follows Z C ARTICLE IV-OFFICERS-Section 12.Power of Attorney Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President and subject p a; to such limitation as the Chairman or the President may prescribe shall appoint such aftomeys-in fact,as may be necessary to act In behalf of the Corporation is make execute seal +a O.� acknowledge and deliver as surety any and all undertakings bonds recognizances and other surety obligations Such attorneys in fact,subject to the limitations set forth In their respective E powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation When so - t executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary Any power or authority granted to any representative or attomey-m-fact under 9 c ,a the provisions of this article may be revoked at any time by the Board the Chairman,the President or by the officer or officers granting such power or authority = ARTICLE XIII-Execution of Contracts-SECTION 5 Surety Bonds and Undertakings Any officer of the Company authorized for that purpose in writing by the chairman or the president iand subject to such limitations as the chairman or the president may prescribe shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute L r _ seal,acknowledge and deliver as surety any and all undertakings bonds recognizances and other surety obligations Such attorneys in fact subject to the limitations set forth In their =a respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company When so 0 Cr executed such instruments shall be as binding as if signed by the president and attested by the secretary O al Certificate of Designation-The President of the Company,actin pursuant to the Bylaws of the Company,authorizes David M Carey,Assistant Secreta to appoint such attorneys-in in F T 9g p YY Secretary PP Ys- fact as may be necessary to act on behalf of the Company to make,execute,seal acknowledge and deliver as surety any and all undertakings bonds recognizances and other surety obligations Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company wherever appearing upon a cerbfied copy of any power of attorney issued by the Company in connection with surety bonds shall be valid and binding upon the Company with the same force and effect as though manually affixed I,Gregory W Davenport,the undersigned Assistant Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company Liberty Mutual Insurance Company and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and has not been revoked Q l IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this Z ITS day of ! cv"be r 2Q 0CAS4 V11NSO �0N$u)? PNlNSURR a 1906 q a 1419 n 1912 1991 k gY HaD Gregory W Davenport,Assistant Secretary l'b, '1�M �'S `P.y 'u,hlSy � ) RCH1fi t- Rd`,IANT Y 450 of 500 LMS 12873 122013 4 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness,accuracy, or validity of that document State of California ) County of SAN BERNARDINO )YASHESH C PATEL, NOTARY PUBLIC On IdU6MI30 .2R',e2016 before me, Date Here Insert Name and Title of the Officer personally appeared AI�[ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person) whose name) is/are subscribed to the within instrumej�t and acknowledged to me that late she/they executed the same in itis/her/*#6r authorized capacity(ij ), and that y by/her/##�w signatures on the instrument the person, or the entity upon behalf of whit the personO acted, executed the i strument I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct YASHESH C PATEL. WITNESS my hand d I seal Commission#2086258 •'' s Notary Public-California z San Bernardino County i Signature My Comm Expires Oct i6,2018 Sign ure of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document Description of Attached Document Title or Type of Document Document Date Number of Pages Signer(s) Other Than Named Above Capacity(ies) Claimed by Signer(s) Signer's Name Signer's Name ❑Corporate Officer — Title(s) ❑Corporate Officer — Title(s) ❑ Partner -- ❑ Limited ❑ General ❑ Partner --- ❑ Limited ❑General ❑Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑ Guardian or Conservator ❑ Other ❑ Other Signer Is Representing Signer Is Representing ©2014 National Notary Association - www NationalNotary org • 1-800-US NOTARY(1-800-876-6827) Item#15907