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HomeMy WebLinkAboutContracts & Agreements_59-2017 32$1 E Guasti Road,Suite 440 First American Ontario,CA 41761 Title Insurance Company NATIONAL COMMERCIAL $ERVECE$ VESTING INSTRUCTION AND AMENDMENT RE, 1341 West Redlands Boulevard, Redlands, CA Escrow No.. NCS-835084-ONT1 (KS) NOTE: Please indicate your choice by checking the appropriate selection Please fill in the blanks completely and print names exactly as they should appear on all documents and as you will be signing your name PURSUANT TO THE ABOVE REFERENCED ESCROW, ESCROW HOLDER IS INSTRUCTED TO REFLECT MY/OUR NAME(S)AND VESTING AS FOLLOWS: 1 [ ] HUSBAND AND WIFE (Print names exactly as they should appear on documents including loan documents) AND A ( } As Joint Tenants B ( ) As Community Property C ( ) As Community Property with right of Survivorship D ( ) As Tenants In Common Each as to an undivided % interest- percentage or fraction (i.e., 1/2 or 50%) E { ) Other, please specify 2 [ ] MARRIED MAN -AS HIS SOLE AND SEPARATE PROPERTY [ ] MARRIED WOMAN -AS HER SOLE AND SEPARATE PROPERTY Print r4ame exactly as it should appear on documents,including loan documents PLEASE INDICATE THE FULL NAME OF THE SPOUSE FOR PREPARATION OF AN INTERSPOUSAL TRANSFER DEED Page 1 3 [ ] INDIVIDUAL(Print names exactly as they should appear on documents including loan documents) A. ( ) A SINGLE MAN (never married) D ( ) A SINGLE WOMAN (never married) B ( ) A WIDOWER (wife is deceased) E ( } A WIDOW (husband is deceased) C ( ) AN UNMARRIED MAN (divorced) F ( } AN UNMARRIED WOMAN (divorced) AND A { ) A SINGLE MAN (never married) D { ) A SINGLE WOMAN (never married) B ( } A WIDOWER (wife Is deceased) E ( ) A WIDOW (husband Is deceased) C { ) AN UNMARRIED MAN (divorced) F ( ) AN UNMARRIED WOMAN (divorced) ADDITIONAL VESTING IF MORE THAN ONE INDIVIDUAL A ( ) As Joint Tenants B ( ) As Tenants in Common Each as to an undivided % interest - percentage or fraction (i e , 1/2 or 50%) C. ( ) Other, please specify 4 [ ] TRUST(Please confirm with your lender if they will make a loan to the trust prior to completing this form) and (Name of Trustee) (Name of Trustee) dated (Name of Trust) (Date of Trust) 5 [X} OTHER A Municipal Corporation HOW YOU HOLD TITLE TO YOUR PROPERTY CAN HAVE SERIOUS TAX CONSEQUENCES. IT IS STRONGLY RECOMMENDED THAT YOU SEEK TAX AND/OR LEGAL COUNSEL WHEN COMPLETING THIS FORM City of Redlands, a munici I corporation sc 1N Paul W Foster Mayor ATTEST anne Donaldson City Clerk Page 2 First American Title Insurance Company 1171 , RevisodasofJahua 'L2605 . COMMON WAYS TO TAKE TITLE TO to include.California registered 3. CALIFORNIA RESIDENTIAL REAL PROPERTY domestic partnership law*.2 IGHT -.Com-m JOINT J. x.ry A% :r� COMMON ,T-,- sit T S -P Two or more persons'(may be Two or morepersons'(may be Husband and wife or domestic partners Husband and wife'dr domestic partners Parties spouses pouses or domestic paftners2) spouses or domestic partners) One:ori-Aor6convi*yandes'(LawSingle:6oiiVeyatice:(ereatingideriticaI Single conveyance of presumption fi-orn. Single conveyatice and spouses or Creation, presumes.interests are equal if intereks). Vesting milist svccifv joint. marriage or.domestic:pdftiiership. domestic partners must indicate consent not otherwise specified) tenancy which can be on deed Eclu'All ... ;Equal W E Each co-owner may transferor Each'.1;0`0'wrler may-transfer his/her: Both spixises or dodiegfic partners must Both spouses or domestic,partners must Transferability -mortgage their interest interest separately but tenancy y in consent to transferor mortgage consent to transfer or mortgage separately 3 : c Its 3&4 common results g" (C) Y W M .3 1 pjdet�tqk.ord �#A]153 x Unless married or domestic _ Co,owner's N 6& "MIN' proper, sats z 0 5 uz- elli ofeither spouse.ovclomeStic.i�. 0**Bco"-owner's interesV!, liens, qr.de1:)toV9dNWyner..-,. Uzi, (D Lens- �* 3' is Ssa .0 partner;f 'W. ifi i� I " --`—ri n not�§u Jeqtloliens ;of Owner forced:sale::.. ...owne�:s,d eat Wor:s. 'di t' V- . ... Death of Decedents interest.passm to- Decedeili?s'interest automatically.. Deccased's'%interest passes to surviving Decedent's V2 interest automatically heirs byVill or passes t6surviving.join -tenant spouse r his/her hei t o' domestic partner unless passes to surviving spouse or domestic Co-Owner intestacy ("Right of Survivorship') otherwise devised by will partner due to Right of Survivorship ............... IT .......... Rt gh ry Su i re transfer -a.1 h 0, rfierx P ,Ir r C4 alwo ar Po stage ad �tiiieo, a s� I 'Persons"includes a natural personas well as a validly form corporation,limited liability company or general partnership Trust property is vested in the trustee(usually a natural person or corporation) 2 dor domestic partners meeting Califiomia statutory requirements benefits are same as community property except certain tax benefits may not be available Note To unrelated persons who are either(a) same sex or(b)opposite sex if they meet age or disability requirements,may be domestic partners provided that they are not married or in a domestic partnership and comply with other statutory requirements 3 Transfers by married persons or domestic partners may require a quitclaim decd from spouse/partner for title insurance purposes 4 if co-owners are married or domestic partners property may be subject to legal presumption of"community property"requiring consent of both spouses/partners to convey or encumber title nowAthstandine ve%hniz as 'Inint lc:nnncv" THE FOREGOING IS PROVIDED FOR GENERAL INFORMATION ONLY FOR QUEST IONS OR FINANCIAL,1AX OR ESTArE PLANNING, AVE SUGGEST YOU CONTACT AN ATTORNEY OR CERTIFIED PUBLIC ACCOUNTANT Form No 7400(1105) 020115 First American Title Insurance Company Kelly Simoneau Escrow Officer 'i First American ksimoneauCtfirstam.com Title Insurance Company E Guash Road,Suite 440 Ontario,CA 91761 NATIONAL COMMERCIAL SERVICES Phone Number- (909)510-6206 FAX (877)461 2088 File No NCS-835084-ONT1 Buver / Borrower Information Reauest Please supply us the information below in order to expedite our escrow New Lender is: NnT APPI iC'ARI F Loan Officer Phone Fax E-Mail Name of Insurance Co is- Agent Phone Fax E-Mail Buyer/Borrower Contact Information: City of Redlands, a municipal corporation Mail Correspondence to Attn Mayor Paul Foster PO Box 3005, Redlands, CA 92373 Home Phone Office Phone 909-798-7631 Cell Fax E-Mail cboatman@cltyofredlands org *if the above address you've supplied is a P 0 Box, do you have a physical address should we need to overnight something in the future? Yes, the address is- 35 Cajon Street, Redlands, CA 92373 City of Redland's,laa municipal qqrporation By�_ ir&Z� Paul W Foster Mayor ATTEST. a3)144� nne Donaldson itClerk Clerk IMPORTANT INFORMATION ABOUT THE COMPLETION OF THIS FORM PENALTIES ASSESSED BY THE TAX COLLECTOR FOR NON-COMPLETION HAVE INCREASED CA Senate Bill 507 signed into Law and effective in 2012 amends Sections of the Revenue and Taxation Code relating to taxation, increasing the penalties imposed for failure to file a change of ownership report Because of the potential for significantly higher penalties, it is very important that you 1) Complete the Preliminary Change of Ownership Report ("PCOR") with all information, Z) Ensure that the mailing address for the grantee is complete and accurate to ensure that the Assessor can contact you with any inquiries. The Title Company/Escrow Officer cannot help you complete this document because of liability reasons If you are unable to complete the PCOR or it is rejected for filing, the County will charge an additional $20 fee and the Assessor will mail notification to you requesting completion of the PCOR If you don't complete and return the PCOR at that time,a penalty can be assessed and added to your tax ball BOE-502 A(P1)REV 12(05 13) I FOR RECORDER'S USE ONLY PRELIMINARY CHANGE OF OWNERSHIP REPORT To be completed by the transferee (buyer) prior to a transfer of subject property, in accordance with section 480.3 of the Revenue and Taxation Code A Preliminary Change of Ownershlp Report must be filed with each conveyance in the County Recorder's office for the county where the property is located NAME AND MAILING ADDRESS OF BUYER/TRANSFEREE (Make necessary corrections to the printed name and mailing address) ASSESSOR'S PARCEL NUMBER City of Redlands,a municipal corporation 0292 184 02 and 0292 184 05 and 0292 1B4-18 and 0169 35107 SELLER/TRANSFEROR Gonkira Properties LLC BUYERS DAYTIME TELEPHONE NUMBER BUYER`S EMAIL ADDRESS STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY 1341 West Redlands Boulevard Redlands CA MAIL PROPERTY TAX INFORMATION TO(NAME) Mayor Paul Foster ADDRESS CITY STATE ZIP CODE PO Box 3005,35 Cajon Street,Redlands,CA 92373 Redlands GA 92373 ❑YES XQ NO This property is intended as my principal residence If YES,please indicate the date I MO DAY YEAR of occupancy or intended occupancy PART 1 TRANSFER INFORMATION Please complete all statements- This tatementsThis section contains possible exclusions from reassessment for certain types of transfers YES NO ❑ A This transfer is solely between spouses(additron orremoval of spouse,death of spouse,divorce settlement,etc.) ® B This transfer is solely between domestic partners currently registered with the California Secretary of State(addition orremoval ofa partner death ofa partner termination settlement,etc.) ® *C This is a transfer ❑ between parent(s)and child(ren) ❑ from grandparent(s)to grandchild(ren) ❑ ® *D This transfer is the result of a cotenant's death Date of death ❑ ® *E This transaction is to replace a principal residence by a person 55 years of age or older Within the same county? F—] YES ❑ NO 0 *F This transaction is to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation Code section 69 5 Within the same county? ❑ YES ❑ NO ❑ FX-� G This transaction is only a correction of the name(s)of the person(s)holding title to the property(e.g.,a name change upon marriage) If YES,please explain ❑ F-11 H The retarded document creates,terminates,or reconveys a lender's interest in the property I This transaction is recorded only as a requirement for financing purposes or to create,terminate,or reconvey a security interest (e.g.,cosigner) If YES,please explain ❑ F)<-] 3 The recorded document substitutes a trustee of a trust,mortgage,or other similar document K This is a transfer of property ® 1 to/from a revocable trust that may be revoked by the transferor and its for the benefit of ❑ the transferor,and/or [::] the transferor's spouse F-� registered domestic partner 2 to/from a trust that may be revoked by the creator/grantor/trustor who is also a joint tenant,and which names the other joint tenant(s)as beneficiaries when the creator/grantorltrustor dies ❑ ❑ 3 to/from an irrevocable trust for the benefit of the ❑ creator/grantor/trustor and/or F-1 grantor's/trustor's spouse ❑ grantor's/trustor's registered domestic partner ® L This property is subject to a lease with a remaining lease term of 35 years or more including written options ❑ M This is a transfer between parties in which proportional interests of the transferor(s)and transferee(s)in each and every parcel being transferred remain exactly the same after the transfer ❑ ® N This is a transfer subject to subsidized low income housing requirements with governmentally imposed restrictions ® *0 This transfer is to the first purchaser of a new building containing an active solar energy system *Please refer to the instructions for Part 1 Please provide any other information that will help the Assessor understand the nature of the transfer THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION BOE-502 A(P2)REV.12(05 13) PART 2 OTHER TRANSFER INFORMATION Check and complete as applicable A Date of transfer,if other than recording date B Type of transfer Purchase ❑Foreclosure ❑Gift Trade or exchange ❑Merger,stock,or partnership acquisition(Form BOE-100 B) ❑Contract of sale Date of contract ❑Inheritance Date of death ❑Sale/leaseback ❑Creation of a lease ❑Assignment of a lease ❑Termination of a lease Date lease began Original term in years(including written options) Remaining term in years(including written opbonsf ❑other Please explain C Only a partial interest in the property was transferred ❑YES ❑NO If YES,indicate the percentage transferred % PART 3. PURCHASE PRICE AND TERMS OF SALE Check and complete as applicable A Total purchase price $ 1,000,000 00 B Cash down payment or value of trade or exchange excluding closing costs Amount$ C First deed of trust @ %interest for years Monthly payment$ Amount$ ❑ FHA(_Discount Points) ❑Cat Vet ❑VA(Discount Points) ❑ Fixed rate ❑Variable rate ❑ Bank/savings&Loan/Credit Union ❑ Loan carried by seller ❑ Balloon payment$ Due date D Second deed of trust @ D/o interest for_years Monthly payment$ Amount$ ❑ Fixed rate ❑Variable rate ❑Bank/Savings&Loan/Credit Union❑ Loan carried by seller ❑ Balloon payment$ Due date E Was an Improvement Bond or other public financing assumed by the buyer?❑YES QNO Outstanding balance$ F Amount,if any,of real estate commission fees paid by the buyer which are not included in the purchase price $ G The property was purchased ❑Through real estate broker Broker name Phone number ( ) LS Direct from seller ❑From a family member-Relationship ❑Other Please explain ii Please explain any special terms,seller concessions,broker/agent fees waived,financing,and any other information(e.g,buyer assumed the existing loan balance)that would assist the Assessor in the valuation of your property PART 4. PROPERTY INFORMATION Check and complete as applicable A. Type of property transferred ❑Single-family residence ❑Co-op/Own-your-own ❑Manufactured home ❑Multiple-family residence Number of units. ❑Condominium ❑Unimproved lot ❑Other Description (i e.,timber,mineral,water rights,etc.) ❑TimeshareX❑Commercial/Industrial B [:)YES E NO Personal/business property,or incentives,provided by seller to buyer are included in the purchase price Examples of personal property are furniture,farm equipment,machinery,etc Examples of incentives are club memberships,etc.Attach list if available If YES,enter the value of the personal/business property $ Incentives$ C ❑YES ©NO A manufactured home is included in the purchase price If YES,enter the value attributed to the manufactured home $ ❑YES N. NO The manufactured home is subject to local property tax If NO,enter decal number D ❑YES [El NO The property produces rental or other income If YES the income is from ❑Lease/rent ❑Contract F—]Mineral rights ❑Other E The condition of the property at the time of sale was ❑Good ❑Average ❑Fair Fj Poor Please describe CERTIFICATION I certify(or declare)that the foregoing and all information hereon,including any accompanying statements or documents,is true and correct to the best of my knowledge and belief SIGNATUK—_W8(JYE FER R OFFICER DATE TELEPHONE NAME OF BUYERITRANSFEREEILEGAL REPRESENTATIVE/CORPORATE OFFICER(PLEASE PRINT) TITLE E MAIL ADDRESS Paul W Foster Mayor City of Redlands cboatman@cityofredlands.org The Assessor's office may contact you for additional information regarding this transaction. BOE 502-A(P3)REV 12(05-13) ADDITIONAL INFORMATION Please answer all questions in each section,and sign and complete the certification before filing This form may be used in all 58 California counties If a document evidencing a change in ownership is presented to the Recorder for recordation without the concurrent filing of a Preliminary Change of Ownership Report,the Recorder may charge an additional recording fee of twenty dollars($20) NOTICE.The property which you acquired may be subject to a supplemental assessment in an amount to be determined by the County Assessor Supplemental assessments are not paid by the title or escrow company at close of escrow,and are not included in lender impound accounts You may he responsible for the current or upcoming property taxes even if you do not receive the tax bill NAME AND MAILING ADDRESS OF BUYER Please make necessary corrections to the printed name and mailing address Enter Assessor's Parcel Number,name of seller,buyer's daytime telephone number, buyer's email address and street address or physical location of the real property NOTE Your telephone number and/or email address is very important.If there is a question or a problem,the Assessor needs to be able to contact you MAIL PROPERTY TAX INFORMATION TO Enter the name,address,city,state,and zip code where property tax information should be mailed This must be a valid mailing address PRINCIPAL RESIDENCE To help you determine your principal residence,consider(1)where you are registered to vote,(2)the home address on your automobile registration,and(3)where you normally return after work If after considering these criteria you are still uncertain,choose the place at which you have spent the major portion of your time this year Check YES if the property is intended as your principal residence,and indicate the date of occupancy or intended occupancy PART I-TRANSFER INFORMATION If you check YES to any of these statements,the Assessor may ask for supporting documentation. C,D,E,F•If you checked YES to any of these statements,you may qualify for a property tax reassessment exclusion,which may allow you to maintain your property's previous tax base A claim form must be filed and all requirements met in order to obtain any of these exclusions Contact the Assessor for claim forms NOTE If you give someone money or property during your life,you may be subject to federal gift tax You make a gift if you give property(including money),the use of property,or the right to receive income from property without expecting to receive something of at least equal value in return The transferor(donor)may be required to file Form 709,Federal Gift Tax Return,with the Internal Revenue Service if they make gifts in excess of the annual exclusion amount G Check YES if the reason for recording is to correct a name already on title[e.g, Mary]ones,who acquired title as Mary] Smith,is granting to Mary ]ones] This is not for use when a name is being removed from title H Check YES if the change involves a lender,who holds title for security purposes on a loan,and who has no other beneficial interest in the property "Beneficial interest"is the right to enjoy all the benefits of property ownership Those benefits include the right to use,sell,mortgage,or lease the property to another A beneficial interest can be held by the beneficiary of a trust,while legal control of the trust is held by the trustee I A"cosigner"is a third party to a mortgage/loan who provides a guarantee that a loan will be repaid The cosigner signs an agreement with the lender stating that if the borrower fails to repay the loan,the cosigner will assume legal liability for it M This is primarily for use when the transfer is into,out of,or between legal entities such as partnerships,corporations,or limited lability companies Check YES only if the interest held in each and every parcel being transferred remains exactly the same N.Check YES only if property is subject to subsidized low income housing requirements with governmentally imposed restrictions, property may qualify for a restricted valuation method(i e, may result in lower taxes) O•If you checked YES,you may qualify for a new construction property tax exclusion A claim form must be filed and all requirements met in order to obtain the exclusion.Contact the Assessor for a claim form. PART 2 OTHER TRANSFER INFORMATION A.The date of recording is rebuttably presumed to be the date of transfer If you believe the date of transfer was a different date(e g,the transfer was by an unrecorded contract,or a lease identifies a specific start date), put the date you believe is the correct transfer date If it is not the date of recording,the Assessor may ask you for supporting documentation B.Check the box that corresponds to the type of transfer If OTHER is checked, please provide a detailed description Attach a separate sheet if necessary BOE 502 A(P4)REV 12(05-13) PART 3.PURCHASE PRICE AND TERMS OF SALE It is important to complete this section completely and accurately The reported purchase price and terms of sale are important factors in determining the assessed value of the property,which is used to calculate your property tax bill Your failure to provide any required or requested information may result in an inaccurate assessment of the property and in an overpayment or underpayment of taxes A Enter the total purchase price, not including closing costs or mortgage insurance "Mortgage insurance"is insurance protecting a lender against loss from a mortgagors default,issued by the FHA or a private mortgage insurer B Enter the amount of the down payment,whether paid in cash or by an exchange If through an exchange exclude the closing costs "Closing costs"are fees and expenses,over and above the price of the property,incurred by the buyer and/or seller,which include title searches,lawyer's fees,survey charges,and document recording fees C Enter the amount of the First Deed of Trust,if any Check all the applicable boxes,and complete the information requested A"balloon payment"is the final installment of a loan to be paid in an amount that is disproportionately larger than the regular installment D Enter the amount of the Second Deed of Trust,if any Check all the applicable boxes,and complete the information requested E.If there was an assumption of an improvement bond or other public financing with a remaining balance,enter the outstanding balance,and mark the applicable box An"improvement bond or other public financing"is a lien against real property due to property specific improvement financing,such as green or solar construction financing,assessment district bonds, Mello Roos(a form of financing that can be used by cities,counties and special districts to finance major improvements and services within the particular district)or general improvement bonds,etc Amounts for repayment of contractual assessments are included with the annual property tax bill F Enter the amount of any real estate commission fees paid by the buyer which are not included in the purchase price G If the property was purchased through a real estate broker,check that box and enter the broker's name and phone number If the property was purchased directly from the seller(who is not a family member of one of the parties purchasing the property),check the"Direct from seller"box If the property was purchased directly from a member of your family,or a family member or one of the parties who is purchasing the property,check the "From a family member box and indicate the relationship of the family member(e g,father,aunt,cousin,etc) If the property was purchased by some other means(e.g,over the Internet,at auction,etc),check the"OTHER"box and provide a detailed description(attach a separate sheet if necessary) H Describe any special terms(e g,seller retains an unrecorded life estate in a portion of the property,etc),seller concessions(e.g,seller agrees to replace roof,seller agrees to certain interior finish work etc) broker/agent fees waived(e g fees waived by the broker/agent for either the buyer or seller),financing, buyer paid commissions,and any other information that will assist the Assessor in determining the value of the property PART 4 PROPERTY INFORMATION A Indicate the property type or property right transferred Property rights may include water,timber, mineral rights,etc 8 Check YES if personal business property or incentives are included in the purchase price in Part 3 Examples of personal or business property are furniture,farm equipment,machinery,etc Examples of incentives are club memberships(golf,health,etc),ski lift tickets,homeowners'dues,etc Attach a list of items and their purchase price allocation An adjustment will not be made if a detailed list is not provided C Check YES if a manufactured home or homes are included in the purchase price Indicate the purchase price directly attributable to each of the manufactured homes If the manufactured home is registered through the Department of Motor Vehicles in lieu of being subject to property taxes check NO and enter the decal number D Check YES if the property was purchased or acquired with the intent to rent or lease it out to generate income,and indicate the source of that anticipated income Check NO if the property will not generate income,or was purchased with the intent of being owner occupied E. Provide your opinion of the condition of the property at the time of purchase If the property is in"fair"or"poor"condition,include a brief description of repair needed Form W-9 Request for Taxpayer Give Form to the (Rev December2014) Identification Number and Certification requester. Do not Treasury Department of the Treasury send to the IRS. Internal Revenue Service 1 Name(as shown on your income tax return) Name is required on this line,do not leave this line blank City of Redlands,a municipal corporation N 2 Business name/disregarded entity name,if different from above cu IM 3 Check appropriate box for federal tax classification,check only one of the following seven boxes 4 Exemptions(codes apply only to C: F-1Individual/sole proprietor or ❑C Corporation 71S Corporation [7]Partnership Trust/estate certain entities,not Individuals see m instructions on page 3). single member LLC Exempt payee code(if any) c, Limited liability company Enter the tax classification(C=C corporator,S=S corporation,P=partnership) 01Exemption from FATCA reporting a, H Note For a single-member LLC that is disregarded,do not check LLC,check the appropriate box in the line above for code(if any) W the tax classification of the single member owner fi V Other(see instructions) ► (Applirs(o attounls rrwintained auL�ide fhe U.S.) v 5 Address(number,street,and apt or suite no Requester's name and address(optional) a PO Box 3005 w 6 City,state,and ZIP code GJ GJ Redlands,CA 92373 7 List account riumber(s)here(optional) Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box The TIN provided must match the name given on line i to avoid ;Social security number backup withholding For individuals,this is generally your social security number(SSN) However,for a I m resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3 For other entities,it is your employer identification number(EIN) If you do not have a number,see How to get a TIN on page 3 or Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for employer identification number guidelines on whose number to enter FqT5_1 16 10 Io 101 - I `_I r (0 Certification (P Under penalties of perjury I certify that 1 The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2 I am not subject to backup withholding because (a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3 I am a U 5 citizen or other U S person(defined below),and 4. The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting Is correct. Certification instructions You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return For real estate transactions,item 2 does not apply For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN See the instructions on page 3 $IQnignature ati` }rete U.5 person (2 k ko l pate � �` � � � 1-7 • Form 1098(home mortgage interest), 1098-E(student loan interest), General Instructions Section references are to the Internal Revenue Code unless otherwise 1098 T(tuition) noted •Form 1099-C(canceled debt) Future developments Information about developments affecting Form .Form 1099-A(acquisition or abandonment of secured property) W 9(such as legislation enacted after we release it)is at Wwwirs,gov^9 Use Form W 9 only if you are a U S person(including a resident alien), Purpose of Form to provide your correct TIN An individual or entity(Form W-9 requester)who is required to file an If you do not return Form W-9 to the requester with a TTN,you might be information return with the IRS must obtain your correct taxpayer subject to backup withholding See What is backup withholding;lon page 2 identification number(TIN)which may be your social security number (SSN),individual taxpayer identification number(ITIN),adoption taxpayer By signing the filled-out form,you identification number(ATIN),or employer identification number(EIN),to 1 Certify that the TIN you are giving is correct(or you are waiting for a report on an information return the amount paid to you,or other amount number to be issued), reportable on an information return Examples of information returns 2 Certify that you are not subject to backup withholding,or include,but are not limited to,the following. • Form 1099-INT(interest earned or paid) 3 Claim exemption from backup withholding if you are a U S exempt • Form 1099-DIV(dividends,including those from stocks or mutual funds) payee If applicable,you are also certifying that as a U S person,your •Form 1099-MISC(various types of income, prizes,awards,or gross allocable share of any partnership income from a U S trade or business is proceeds) not subject to the withholding tax on foreign partners'share of effectively Form 1099-B(stock or mutual fund sales and certain other transactions connected income,and by brokers) 4 Certify that FATCA code(s)entered on this form(if any)indicating that •Form 1099 5(proceeds from real estate transactions) you are exempt from the FATCA reporting,is correct See Whatis FATCA •Form 1099-K(merchant card and third party network transactions) reporting?on page 2 for further information Cat No 10231X Form W-9(Rev.12 2014) ATTEST: �� nne Donaldson, City Clerk Form W 9(Rev 12-2014) Pace 2 Note. If you are a US person and a requester gives you a form other Payments you receive will be subject to backup withholding if. than Form W 9 to request your TIN,you must use the requesters form if I You do not furnish your TIN to the requester, it is substantially similar to this Form W 9 2 You do not certify your TIN when required (see the Part II Definition of a US person For federal tax purposes, you are instructions on page 3 for details), considered a U 5 person if you are 3 The IRS tells the requester that you furnished an incorrect TIN •An individual who is a U S citizen or U S resident alien, 4 The IRS tells you that you are subject to backup withholding •A partnership,corporation,company,or association created or because you did not report all your interest and dividends on your tax organized in the United States or under the laws of the United States, return(for reportable interest and dividends only),or •An estate(other than a foreign estate),or 5 You do not certify to the requester that you are not subject to •A domestic trust(as defined in Regulations section 3017701 7) backup withholding under 4 above (for reportable interest and dividend Special rules for partnerships Partnerships that conduct a trade or accounts opened after 1983 only) business in the United States are generally required to pay a withholding Certain payees and payments are exempt from backup withholding tax under section 1446 on any foreign partners' share of effectively See Exempt payee code on page 3 and the separate Instructions for the connected taxable income from such business Further, in certain cases Requester of Form W-9 for more information where a Form W 9 has not been received, the rules under section 1446 Also see Special rules for partner hipsabove require a partnership to presume that a partner is a foreign person, and What is FATCA reporting. pay the section 1446 withholding tax Therefore, if you are a U S. person The Foreign Account Tax Compliance Act(FATCA)requires a participating that is a partner in a partnership conducting a trade or business in the foreign financial institution to report all United States account holders that United States, provide Form W 9 to the partnership to establish your U S are specified United States persons Certain payees are exempt from status and avoid section 1446 withholding on your share of partnership FATCA reporting See Exemption from FATG4 reporting code on page 3 income and the Instructions for the Requester of Form W 9 for more information In the cases below, the following person must give Form W 9 to the Updating Your Information partnership for purposes of establishing its U S status and avoiding You must provide updated information to any person to whom you withholding on its allocable share of net income from the partnership claimed to be an exempt payee if you are no longer an exempt payee and conducting a trade or business in the United States anticipate receiving reportable payments in the future from this person •In the case of a disregarded entity with a U S owner the U S owner of For example you may need to provide updated information if you are a C the disregarded entity and not the entity, corporation that elects to be an 5 corporation,or if you no longer are tax •In the case of a grantor trust with a U S grantor or other U S owner, exempt In addition,you must furnish a new Form W 9 if the name or TIN generally, the U S grantor or other U S owner of the grantor trust and changes for the account, for example, if the grantor of a grantor trust not the trust, and dies • In the case of a U S trust(other than a grantor trust), the U S trust Penalties (other than a grantor trust)and not the beneficiaries of the trust Failure to furnish TIN If you fail to furnish your correct TIN to a Foreign person If you are a foreign person or the U S branch of a requester,you are subject to a penalty of$50 for each such failure unless foreign bank that has elected to be treated as a U S person, do not use your failure is due to reasonable cause and not to willful neglect Form W-9 instead, use the appropriate Form W 8 or f=orm 8233 (see Civil penalty for false information with respect to withholding If Publication 515, Withholding of Tax on Nonresident Aliens and Foreign you make a false statement with no reasonable basis that results in no Entities) backup withholding,you are subject to a$500 penalty Nonresident alien who becomes a resident alien Generally, only a Criminal penalty for falsifying information Willfully falsifying nonresident alien individual may use the terms of a tax treaty to reduce certifications or affirmations may subject you to criminal penalties or eliminate U 5 tax on certain types of income However, most tax including fines and/or imprisonment treaties contain a provision known as a saving clause" Exceptions Misuse of TINs If the requester discloses or uses TINS in violation of specified in the saving clause may permit an exemption from tax to federal w,the requester may be subject to civil and criminal penalties continue for certain types of income even after the payee has otherwise SpeClic Instructions become a U S resident alien for tax purposes Line 1 If you are a US resident alien who is relying on an exception You must enter one of the following on this line, do not leave this line contained in the saving clause of a tax treaty to claim an exemption from blank The name should match the name onyour tax return U S tax on certain types of income,you must attach a statement to Form If this Form W 9 is for a joint account, list first, and then circle, the W 9 that specifies the following five items name of the person or entity whose number you entered in Part I of Form 1 The treaty country Generally, this must be the same treaty under W 9 which you claimed exemption from tax as a nonresident alien a Individual Generally,enter the name shown on your tax return If 2 The treaty article addressing the income you have changed your last name without informing the Social Security 3 The article number(or location)in the tax treaty that contains the Administration(SSA)of the name change,enter your first name,the last saving clause and its exceptions name as shown on your social security card,and your new last name 4 The type and amount of income that qualifies for the exemption Note ITIN applicant Enter your individual name as it was entered on from tax your Form W 7 application line la This should also be the same as the 5 Sufficient facts to justify the exemption from tax under the terms of name you entered on the Form 1040/1040A/1040EZ you filed with your the treaty article application Example. Article 20 of the U S China income tax treaty allows an b Sole proprietor or single member LLC Enter your individual exemption from tax for scholarship income received by a Chinese student name as shown on your 1040/1040A/1040EZ on line 1 You may enter temporarily present in the United States Under U S law,this student will your business,trade,or"doing business as"(DBA)name on line 2 become a resident alien for tax purposes if his or her stay in the United c Partnership,LLC that is not a single member LLC,C States exceeds 5 calendar years However, paragraph 2 of the first Corporation,or 5 Corporation Enter the entity's name as shown on Protocol to the US China treaty (dated April 30, 1984) allows the the entity's tax return on line 1 and any business,trade,or DBA name on provisions of Article 20 to continue to apply even after the Chinese line 2 student becomes a resident alien of the United States A Chinese student d other entities Enter your name as shown on required U S federal who qualifies for this exception (under paragraph 2 of the first protocol) tax documents on line 1 This name should match the name shown on the and is relying on this exception to claim an exemption from tax on his or charter or other legal document creating the entity You may enter any her scholarship or fellowship income would attach to Form W 9 a business,trade,or DBA name on line 2 statement that includes the information described above to support that a Disregarded entity For U S federal tax purposes,an entity that is exemption disregarded as an entity separate from its owner is treated as a If you are a nonresident alien or a foreign entity, give the requester "disregarded entity"See Regulations section 3017701 2(c)(2)(ifi) Enter the appropriatg ompleted Form W 8 or Form 8233 the owner's name on line 1 The name of the entity entered on line 1 BaC up WltNoldingg should never be a disregarded entity The name on line 1 should be the What is backup withholding> Persons making certain payments to name shown on the income tax return on which the income should be you must under certain conditions withhold and pay to the IRS 28% of reported For example,if a foreign LLC that is treated as a disregarded such payments This is called "backup withholding' Payments that may entity for U S federal tax purposes has a single owner that is a U 5 be subject to backup withholding include interest, tax exempt interest, person,the U S owner's name is required to be provided on line 1 If the dividends, broker and barter exchange transactions, rents, royalties, direct owner of the entity is also a disregarded entity,enter the first nonemployee pay, payments made in settlement of payment card and owner that is not disregarded for federal tax purposes Enter the third party network transactions, and certain payments from fishing boat disregarded entity's name on line 2,"Business name/disregarded entity operators Real estate transactions are not subject to backup name"If the owner of the disregarded entity is a foreign person,the withholding owner must complete an appropriate Form W 8 instead of a Form W 9 You wi l not be subject to backup withholding on payments you This is the case even if the foreign person has a U 5 TIN receive if you give the requester your correct TIN make the proper certifications, and report all your taxable interest and dividends on your tax return Form W 9(Rev 12 2014) Paqe 3 Line 2 2However, the following payments made to a corporation and reportable If you have a business name, trade name, DBA name, or disregarded on Form 1099 MISC are not exempt from backup withholding medical egtity name,you may enter it on line 2 and health care payments, attorneys' fees, gross proceeds paid to an Line 3 attorney reportable under section 6045(f),and payments for services paid Check the appropriate box in line 3 for the U S federal tax classification by a federal executive agency of the person whose name is entered on line 1 Check only one box in Exemption from FATCA reporting code The following codes identify line 3 payees that are exempt from reporting under FATCA These codes apply Limited Liability Company (LLC) If the name on line 1 is an LLC to persons submitting this form for accounts maintained outside of the treated as a partnership for U S. federal tax purposes, check the"Limited United States by certain foreign financial institutions Therefore if you are Liability Company" box and enter"P" in the space provided If the LLC only submitting this form for an account you hold in the United States, has filed Form 8832 or 2553 to be taxed as a corporation, check the you may leave this field blank Consult with the person requesting this "Limited Liability Company"box and in the space provided enter"C"for C form if you are uncertain if the financial institution is subject to these corporation or"S"for S corporation If it is a single member LLC that is a requirements A requester may indicate that a code is not required by disregarded entity, do not check the 'Limited Liability Company" box, providing you with a Form W-9 with 'Not Applicable" (or any similar instead check the first box in line 3"Individual/sole proprietor or single indication)written or printed on the line for a FATCA exemption code member LLC" A—An organization exempt from tax under section 501(a) or any Line 4, Exemptions individual retirement plan as defined in section 7701(a)(37) If you are exempt from backup withholding and/or FATCA reporting, B—The United States or any of its agencies or instrumentalities enter in the appropriate space in line 4 any code(s) that may apply to C—A state, the District of Columbia, a U S commonwealth or you possession,or any of their political subdivisions or instrumentalities Exempt payee code. D—A corporation the stock of which is regularly traded on one or more • Generally, individuals (including sole proprietors) are not exempt from established securities markets,as described in Regulations section 11472 backup withholding 1(c)(1)(i) • Except as provided below, corporations are exempt from backup E—A corporation that is a member of the same expanded affiliated withholding for certain payments, including interest and dividends group as a corporation described in Regulations section 1 1472-1(c)(1)(i) • Corporations are not exempt from backup withholding for payments F--A dealer in securities, commodities, or derivative inancial made in settlement of payment card or third party network transactions instruments(including notional principal contracts, futures, forwards, and • Corporations are not exempt from backup withholding with respect to options)that is registered as such under the laws of the United States or attorneys'fees or gross proceeds paid to attorneys,and corporations that any state provide medical or health care services are not exempt with respect to G—A real estate investment trust payments reportable on Form 1099 MISC H—A regulated investment company as defined in section 851 or an The following codes identify payees that are exempt from backup entity registered at all times during the tax year under the Investment withholding Enter the appropriate code in the space in line 4 Company Act of 1940 1—An organization exempt from tax under section 501(a),any IRA,or I—A common trust fund as defined in section 584(x) a custodial account under section 403(b)(7) if the account satisfies the 3—A bank as defined in section 581 requirements of section 401(f)(2) K—A broker 2-The United States or any of its agencies or instrumentalities L—A trust exempt from tax under section 664 or described in section 3—A state, the District of Columbia, a U S commonwealth or 4947(a)(1) possession,or any of their political subdivisions or instrumentalities M—A tax exempt trust under a section 403(b) plan or section 457(g) 4—A foreign government or any of its political subdivisions, agencies, plan or instrumentalities Note You may wish to consult with the financial institution requesting 5—A corporation this form to determine whether the FATCA code and/or exempt payee 6—A dealer in securities or commodities required to register in the cgde should be completed United States, the District of Columbia, or a U S commonwealth or Line 5 possession Enter your address(number,street,and apartment or suite number) This 7—A futures commission merchant registered with the Commodity is where the requester of this Form W-9 will mail your information returns Futures Trading Commission Line 6 8—A real estate investment trust Enter your city,state,and ZIP cpde 9—An entity registered at all times during the tax year under the Part I Taxpayer Identsfkation Number(TIN) Investment Company Act of 1940 Enter your TIN in the appropriate box.If you are a resident alien and IG—A common trust fund operated by a bank under section 584(a) you do not have and are not eligible to get an SSN,your TIN is your IRS 11—A financial institution individual taxpayer identification number (ITIN) Enter it in the social 12—A middleman known in the investment community as a nominee security number box If you do not have an ITIN, see How to get a TIN or custodian below 13—A trust exempt from tax under section 664 or described in section If you are a sole proprietor and you have an EIN,you may enter either 4947 your SSN or EIN However,the IRS prefers that you use your SSN The following chart shows types of payments that may be exempt I€ you are a single member LLC that is disregarded as an entity from backup withholding The chart applies to the exempt payees listed separate from its owner (see Limited Liability Company aLQ on this above 1 through 13 page) enter the owner's SSN(or EIN if the owner has one) Do not enter IF the payment is for THEN the payment is exempt for the disregarded entity's EIN If the LLC is classified as a corporation or partnership,enter the entity's EIN Interest and dividend payments All exempt payees except Note. See the chart on page 4 for further clarification of name and TIN for 7 combinations How to get a TIN. If you do not have a TIN,apply for one immediately Broker transactions Exempt payees 1 through 4 and 6 To apply for an SSN,get Form SS 5,Application For a Social Security Card, through 11 and all C corporations S from your local SSA office or get this form online at wwmssa gov You corporations must not enter an may also get this form by calling 1 800 772 1213 Use Form W 7, exempt payee code because they are Application far IRS Individual Taxpayer Identification Number,to apply far exempt only for sales of noncovered an 1TIN,or Form SS 4,Application for Employer Identification Number,to securities acquired prior to 2012 apply for an EIN You can apply for an EIN online by accessing the IRS q p website at www�rs:gocbusrnessesand cUcking on Employer Identification Barter exchange transactions and Exempt payees 1 through 4 Number(EIN)under Starting a Business You can get Forms W 7 and SS patronage dividends 4 from the IRS by visiting IRS,gov or by calling 1 800-TAX FORM (1-800- 829 3676) Payments over$600 required to Generally exempt payees If you are asked to complete Form W-9 but do not have a TIN, apply be reported and direct sales over 1 through 52 for a TIN and write Applied For' in the space for the TIN, sign and date $5,0001 the form,and give it to the requester For interest and dividend payments, Payments made in settlement of Exempt payees 1 through 4 and certain payments made with respect to readily tradable instruments, payment card e third party generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments The 60 day network transactions rule does not apply to other types of payments You will be subject to 1 See Form 1099-MISC,Miscellaneous Income,and its instructions backup withholding on all such payments until you provide your TIN to the requester Note Entering "Applied For`means that you have already applied for a TIN or that you intend to apply for one soon Caution A disregarded U S entity that has a foreign ownermust use the appropriate Form W-B Form W 9(Rev 12-2014) Pa ece44 Part II Certification 3You must show your individual name and you may also enter your To establish to the withholding agent that you are a U S person, or business or DBA name on the `Business name/disregarded entity' name resident alien sign Form W 9 You may be requested to sign by the line You may use either your SSN or EIN (if you have one), but the IRS withholding agent even if items 1,4,or 5 below indicate otherwise For a joint account, only the person whose TIN is shown in Part I encourages you to use your SSN should sign (when required) In the case of a disregarded entity, the °List first and circle the name of the trust,estate,or pension trust (Do not person identified on line 1 must sign Exempt payees, see Exempt payee furnish the TIN of the personal representative or trustee unless the legal code earlier entity itself is not designated in the account title) Also see Special rules Signature requirements Complete the certification as indicated in for partnerships page 2 items 1 through 5 below p R P g 1 Interest,dividend,and barter exchange accounts opened *Note Grantor also must provide a Form W-9 to trustee of trust before 1984 and broker accounts considered active during 1983 Note. If no name is circled when more than one name is listed, the You must give your correct TIN,but you do not have to sign the number will be considered to be that of the first name listed certification Secure Your Tax Records from Identity Theft 2 Interest,dividend,broker,and barter exchange accounts ty opened after 1983 and broker accounts considered inactive Identity theft occurs when someone uses your personal information such during 1983 You must sign the certification or backup withholding will as your name, SSN, or other identifying information, without your apply If you are subject to backup withholding and you are merely permission to commit fraud or other crimes An identity thief may use providing your correct TIN to the requester,you must cross out item 2 in the certification before the form your SSN to get a jab or may file a tax return using your SSN to receive a signing 3 Real estate transactions You must sign the certification You refund may cross out item 2 of the certification To reduce your risk 4 Other payments You must giveyour correct TIN,but you do not . Protect your SSN, have to sign the certification unless you have been notified that you have . Ensure your employer is protecting your SSN,and previously given an incorrect TIN "Other payments"include payments ,Be careful when choosing a tax preparer made in the course of the requester's trade or business for rents, royalties,goods(other than bills for merchandise),medical and health If your tax records are affected by identity theft and you receive a care services(including payments to corporations), payments to a notice from the IRS, respond right away to the name and phone number nonemployee for services, payments made in settlement of payment card printed on the IRS notice or letter and third party network transactions,payments to certain fishing boat If your tax records are not currently affected by identity theft but you crew members and fishermen,and ross proceeds paid to attorneys think you are at risk due to a lost or stolen purse or wallet questionable (including payments to corporations Y R S Mortgage interest paid by you acquisition or abandonment credit card activity or credit report, contact the IRS Identity Theft Hotline of secured property,cancellation oidebt,qualified tuition at 1 800 908 4490 or submit Form 14039 program payments(under section 529),IRA,Coverdell ESA, For more information, see Publication 4535, Identity Theft Prevention Archer MSA or HSA contributions or distributions,and pension and Victim Assistance distributions You must give your correct TIN,but you do not have to Victims of identity theft who are experiencing economic harm or a sign the certification tY P 9 What Name and Number To Give the Requester system problem, or are seeking help in resolving tax problems that have For this type of account Give name and SSN of not been resolved through normal channels, may be eligible for Taxpayer F I Individual or th The individual Advocate Service(TAS)assistance You can reach TAS by calling the TAS 2 Two or more individuals(joint The actual owner of the account toll-free case intake line at 1 877 777 4778 or TTY/TDD 1 800 829-4059 account) or,iv combined funds,the first Protect yourself from suspicious emails or phishing schemes individual on the account' Phishing is the creation and use of email and websites designed to mimic 3 Custodian account of a minor(Uniform The minor Gift to Minors Act) legitimate business emails and websites The most common act is sending 4 a The usual revocable savings trust The grantor-trusteean email to a user falsely claiming to be an established legitimate (grantor is also trustee)b So called The actual owner` enterprise in an attempt to scam the user into surrendering private trust account that is not a legal or valid information that will be used for identity theft trust under state law 3 The IRS does not initiate contacts with taxpayers via emails Alsa 5 Sale proprietorship or disregarded The ownerr the entity owned by an individual IRS does not request personal detailed information through email or ask 6 Grantor trust filing under Optional Form The grantor' taxpayers for the PIN numbers, passwords, or similar secret access 1099 Filing Method 1(see Regulation section 16711k(b)(2,(i)(A)) information for their credit card, bank,or other financial accounts Fort is tv a of pccoun , Give name and EIN of If you receive an unsolicited email claiming to be from the IRS forward 7 Disregarded entity not ownedty an The owner this message to phrshmg@irsgov You may also report misuse of the IRS individual name, logo, or other IRS property to the Treasury Inspector General for 8 A valid trust,estate,or pension trust Legal entity a Tax Administration (TIGTA) at 1-800 366 4484 You can forward 9 Corporation ov or or LLC electing corporate The corporatcorporationsus suspicious emails to the Federal Trade Commission at s amguce. status on Form 6832 or Form 2553 P P 9 10 Association club,religious,charitable, The organization contact them at www.Acgov/idtheftor 1 877 IDTHEFT(1877-438-4338) educational,or other tax exempt Visit IRS.gov to learn more about identity theft and how to reduce your organization risk 11 Partnership or multi member LLC The pa€tnership 12.A broker or registered nominee The broker or nominee 13 Account with the Department of The public entity privacy Act Notice Agriculture in the name r l a public Section 6109 of the Internal Revenue Code requires you to provide our entity(such as a state or local q Y government,school district,or prison) correct TIN to persons(including federal agencies)who are required to that receives agricultural program file information returns with the IRS to report interest,dividends,or payments certain other income paid to you, mortgage interest you paid,the 14 Grantor trust filing under the Farm The trust acquisition or abandonment of secured property,the cancellation of debt, 1041 Filing Method or the Optional or contributions you made to an IRA,Archer MSA,or HSA The person Form 1099 Filing Method 2(ssee collecting this form uses the information on the form to file information Regulation section 1671-4(b)(2)(i)(g)) returns with the IRS,reporting the above information Routine uses of this 'List first and circle the name of the person whose number you furnish If information include giving it to the Department of Justice for civil and only one person on a joint account has an SSN, that person's number criminal litigation and to cities,states,the District of Columbia,and U S commonwealths and possessions for use m administering their laws The must be furnished z information also may be disclosed to other countries under a treaty,to Circle the minor's name and furnish the minor's SSN federal and state agencies to enforce civil and criminal laws,or to federal law enforcement and intelligence agencies to combat terrorism You must provide your TIN whether or not you are required to file a tax return Under section 3406,payers must generally withhold a percentage of taxable interest,dividend,and certain other payments to a payee who does not give a TIN to the payer Certain penalties may also apply for providing false or fraudulent information 3281 E Guasti Road,Suite 440 C. Ontario,CA 91761 '� FirstAmerican Ph (909)57.0 6206 Title Insuratice Company FAX {877)467 2088 NATIONAL COMMERCIAL SEFMCI`S DATE, March 15, 2017 Escrow #, NCS-835084-ONT1 TO Escrow Officer Kelly Slmoneau EXCHANGE INFORMATION We need the following information to process your escrow Please complete this form and return to our office. I/We request that First American Exchange Company contact us to discuss a 1031 Exchange Or, I/we may also contact First American Exchange directly at (877) 317-1031 to discuss a Tax- Deferred Exchange. I/We will contact My Exchange Company listed below regarding a Tax-Deferred Exchange I/We will ask them to contact you Accommodator Exchange Officer. Exchange Number Phone and Fax Number E-Mail Address Final Date to Exchange. AWe are certain that we will NOT be doing a 1031 Exchange Transaction for this property I/We hereby authorize you as Escrow Holder to discuss this file with my Exchange Company in order to process this escrow Name Paul W Foster, Mayor Signature Phone Number IZAI-- ( ) - Name Jeanne Donaldson, City Clerk i ature Phone Number PLEASE COMPLETE AND RETURN FANHD Commercial Property Disclosure Reports _._4649� Disclosure Report Signature Page Firi Natural Hazardazard Disclosures- For SAN BERNARDINO County Property Address- 1341 W REDLANDS BLVD APN• SEE ADDENDUM REDLANDS, SAN BERNARDINO COUNTY, CA 92373 Report Date- 03/14/2017 ("Property") Report Number' 2062783 Natural Hazard Disclosure ("NHD") Statement and Acknowledgment of Receipt DISCLAIMER This NHD Summary (a) is not valid unless delivered with the complete FANHD Disclosure Report which transferee must read and acknowledge before close of escrow and(b)is subject to the Terms and Conditions contained in that complete Disclosure Report. The transferor and his or her agent(s) or a third-party consultant disclose the following information with the knowledge that even though this is not a warranty, prospective transferees may rely on this information in deciding whether and on what terms to purchase the Property Transferor hereby authorizes any agent(s) representing any principal(s)In this action to provide a copy of this statement to any person or entity in connection with any actual or anticipated sale of the Property The following are representations made by the transferor and his or her agent(r)or a third party consultant based on their knowledge and maps drawn by the State This information is a disclosure and is not intended to be part of any contract between the transferee and the transferor THIS REAL PROPERTY LIES WITHIN THE FOLLOWING HAZARDOUS AREA(S) A SPECIAL FLOOD HAZARD AREA(Any type Zone"A or"V")designated by the Federal Emergency Management Agency Yes_ No X Do not know and information not available from local jurisdiction_ AN AREA OF POTENTIAL FLOODING shown on a dam failure inundation map pursuant to Section 8589.5 of the Government Code Yes_ No X Do not know and information not available from local jurisdiction_ A VERY HIGH FIRE HAZARD SEVERITY ZONE pursuant to Section 51178 or 51179 of the Government Code The owner of this Property is subject to the maintenance requirements of Section 51182 of the Government Code Yes No X A WILDLAND AREA THAT MAY CONTAIN SUBSTANTIAL FOREST FIRE RISK AND HAZARDS pursuant to Section 4125 of the Public Resources Cade The owner of this Property is subject to the maintenance requirements of Section 4291 of the Public Resources Code Additionaliy it is not the state's responsibility to provide fire protection services to any building or structure located within the wildlands unless the Department of Forestry and Fire Protection has entered into a cooperative agreement with a local agency for those purposes pursuant to Section 4142 of the Public Resources Code Yes_ No X AN EARTHQUAKE FAULT ZONE pursuant to Section 2622 of the Public Resources Code Yes— No X A SEISMIC HAZARD ZONE pursuant to Section 2696 of the Public Resources Code Yes(Landslide Zone)_ Yes(Liquefaction Zane)_ No_ Map not yet released by state X THESE HAZARDS MAY LIMIT YOUR ABILITY TO DEVELOP THE REAL PROPERTY TO OBTAIN INSURANCE OR TO RECEIVE ASSISTANCE AFTER A DISASTER THE MAPS ON WHICH THESE DISCLOSURES ARE BASED ESTIMATE WHERE NATURAL HAZARDS EXIST THEY ARE NOT DEFINITIVE INDICATORS OF WHETHER OR NOT A PROPERTY WILL BE AFFECTED BY A NATURAL DISASTER.TRANSFEREE(S)AND TRANSFEROR(S)MAY WISH TO OBTAIN PROFESSIONAL ADVICE REGARDING THOSE HAZARDS AND OTHER HAZARDS THAT MAY AFFECT THE PROPERTY Signature of Transferor(s) Date Signature of Transferor(s) Date Signature of Agent Date Signature of Agent Date Transferor(s)and their agent(s)represent that the information herein is true and correct to the best of their knowledge as of the date signed by the transferor(s) and agent(s) Transferor(s)and their agent(s)acknowledge that they have exercised good faith in the selection of a third-parly report provider as required in Civil Code Section 1103 7, and that the representations made in this Natural Hazard Disclosure Statement are based upon information provided by the independent third party disclosure provider as a substituted disclosure pursuant to Civil Code Section 1103.4 Neither transferor(s)nor their agent(s)(1)has independently verified the information contained in this statement and Report or(2)is personally aware of any errors or inaccuracies in the information contained an the statement. This statement was prepared by the provider below, Third Party Disclosure Provider(s)FIRST AMERICAN PROFESSIONAL REAL ESTATE SERVICES INC OPERATING THROUGH ITS FANHD DIVISION Date 14 March 2D17 Transferee represents that he or he h read and understands this document Pursuant to Civil Code Section 1103.8 the representations in this Natural Hazard Di "retem d of c ns e a nsferor s or agent's disclosure obligations in this transaction i� �� Signa Transferee(s) Date Signature of Transferee(s) Date TRANSFEREEfSI REPRESENTS ABOVE HE/SHE HAS RECEIVED READ AND UNDERSTANDS THE COMPLETE FANHD DISCLOSURE REPORT DELIVERED WITH THIS SUMMARY' A Commercial Natural Hazard Disclosure Report. B Additional Property-specific Statutory Disclosures Former Military Ordnance Site,Airport Influence Area Airport Noise San Francisco Bay Conservation and Development District Jurisdiction(in S.F Bay counties only) C Additional County and City Regulatory Determinations as applicable Airports Avalanche Blow Sand Coastal Zone DamlLevee Failure Inundation Debris Flow Erosion, Flood, Fault Zone, Fire,Groundwater, Landslide, Liquefaction, Methane Gas, Mines, Naturally Occurring Asbestos, Redevelopment Area Right to Farm Runoff Area,Seiche Seismic Shaking Seismic Ground Failure Slope Stability Soil Stability Subsidence TRPA,Tsunami. D General advisories Methamphetamine Contamination Mold Radon Endangered Species Act,Abandoned Mines Oil&Gas Wells Tsunami Maps(coastal only) Non-residential Building Energy Use E Government Guides in Combined Booklet with Report, Refer to Booklet: Commercial Property Owner's Guide to Earthquake Safety Government Guides are also availabte on the Company's"Electronic Bookshelf'at htto:/Mwww.clisclasures.com/ 02017- First American Real Estate Disclosures,LLC 200 Commerce,Suite 100,Irvine,CA 92602 Phone (800)527 0027 Fax (800)854-9825 � FANHD Commercial Property Disclosure Reports The Natural Hazard Disclosure Report ;rstAm"'sc° FOR SAN BERNARDINO COUNTY Natural Hazard Disclosures Property Address 1341 W REDLANDS BLVD APN: SEE ADDENDUM REDLANDS, SAN BERNARDINO COUNTY, CA Report Date 03/14/2017 ('Property") Report Number 2062783 ADDENDUM FOR ASSESSOR PARCEL NUMBERS This Addendum pertains solely to Report No 2062783 dated Tuesday, March 14, 2017 ("Report Date') for disclosure information with respect to the Property, situated in the County of San Bernardino, State of California, as collectively constituted by only those 4 assessor parcel numbers ( APN") and geographic boundaries thereof listed below as provided to the Company on said Report Date 0292-184-02-0000 0292-184-05 0000 0292-184-18-0000 0169-351-07-0000 Responses contained in this Report pertain only to Property as identified above and to no others pursuant to a Transaction This Report should not to be used for and liability shall not be applicable to, any transaction involving any fewer or any other parcels than those identified above For liability purposes a Report should be ordered for an individual parcel should it be sold separately from other parcels in a separate transaction This Addendum is attached hereto and made a part of Report No 2062783 as of this reference and is subject to the Methods and Limitations contained herein Page 1 of 1 to Addendum for Report No. 2062783