HomeMy WebLinkAboutContracts & Agreements_161-2002_CCv0001.pdf AGREEMENT
THIS AGREEMENT,made and entered into this 17th day of September, 2002,by and between the City of
Redlands, a Municipal Corporation, organized and existing under the laws of the State of California,
hereinafter referred to as the "City", and
a partnership consisting of .IDC Inc.
or an individual trading as
of the City of Rancho Cucamonga, County of San Bernardino, State of California,hereinafter referred to
as the "Contractor".
WITNESSETH: That the City and the Contractor,for the consideration hereinafter named,agree as follows:
I. SCOPE OF WORK: The contractor will furnish all materials and will perform all of the work for the
following:
To perform construction of Street Trees and Tree Wells on Citrus Avenue from Orange Street to Sixth
Street project,complete, all as shown, specified,and made a part of Contract No.236166-7150/15008.
2. THE CONTRACT SUM OF: $124.500.00 in accordance with the terms and conditions of the Contract
Documents.
Pursuant to Section 22300 of the California Public Contract Code, 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.
3. TIME FOR COMPLETION: The work shall be completed within thirty(30)'work days from and after
the date of the Notice to Proceed.
4. LIQUIDATED DAMAGES: Failure of the Contractor to complete the work within the time allowed will
result in damages being sustained by the City. Such damages are,and will continue to be,impracticable
and extremely difficult to determine. The Contractor shall pay to the City,or have withheld from monies
due it, the sum of$1,000-00 for each consecutive calendar day in excess of the specified time for
completion of work.
Execution of the Contract shall constitute agreement by the City and Contractor that$1,000-00 per day
is the minimum and actual damage caused by the failure of the Contractor to complete the work within
the allowed time. Such sum is liquidated damages and shall not be construed as a penalty, and may be
deducted from payments due to the Contractor if such delay occurs.
5. CONTRACT DOCUMENTS: The complete contract includes all of the contract documents set forth
herein, to wit; Notice Inviting Proposals. Instructions, Proposal and Proposal Forms, Agreement,
Performance Bond,Payment Bond, Plans and Specifications, Special Provisions,General Provisions,
Technical Provisions, all referenced drawings and specifications, and any Addenda thereto.
6. ATTORNEY FEES: In the event any legal action is commenced to enforce or interpret the terms or
conditions of this contract the prevailing party shall,in addition to any costs and other relief,be entitled
to recovery of its reasonable attorney's fees.
Page 15
7. DEFENSE OBLIGATION: The contractor shall defend, indemnify and hold harmless the City, its
elected officials, officers, agents,and employees from and against any and all claims,losses, damages,
and causes of action,including death,brought by any person or persons for or on account of any act or
omission of the contractor, its employees or agents in connection with the performance of the
contractor's obligation under this contract.
8. INSURANCE: All policies of insurance required and set forth in the general provisions including
general liability and business automobile insurance shall name the City, its elected officials,employees,
and agents as additional insureds. Any insurance required under this contract shall be primary with
respect to City and non-contributing to any insurance or self-insurance maintained by the City.
9. RESOLUTION OF CONSTRUCTION CLAIMS. Claims by the Contractor in the amount of
$375,000.00 or less shall be made by Contractor and processed by the City pursuant to the provisions
of Part 3, chapter 1. article 1.5 of the Public Contracts Code (commencing with Section 20100. All
claims shall be in writing and include the documents necessary to substantiate the claim. Nothing in
subdivision(a)of Public Contracts Code section 201042 shall extend the time limit or supersede the
notice requirements provided in this case from filing claims by Contractor.
10. ELIGIBILITY OF CONTRACTORYSUBCONTRACTOR. Contractor and any subcontractors agree to
abide by California Public Contractor's Code section 6109 and California Labor Code sections 1777.1
and/or 1777.7 and certify that they are not debarred and are eligible to work on this project.
ll. ASSIGNMENT OF AGREEMENT. No assignment by a party hereto of any rights or interests under
this agreement will be binding on another party without the written consent of the party sought to be
bound.
12. SUCCESSORS AND ASSIGNS. City and Contractor each binds itself, its partners, successors,assigns
and legal representatives in respect to all covenants, agreements, and obligations contained in the
Contract Documents.
13. SEVERABILITY. Any provision or 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 Contractor.
Page 16
i
IN WITNESS WHEREOF,the parties hereto have executed this Agreement in duplicate on the day and year
first written above.
CITY SEAL
By:
Mayor,City of Redlands
County of San Bernardino,California
ATTEST:
itv cle <<y o e a s
-CALIFORNIA ALL-PURPOSE ACKNOYLEDGMEN,.--
State of California }
} ss.
County of Orange
On September 25 2002 before me, Brad L.Settgast Notary Public ,
Date Name and Title of officer(e.g.,'Jane Doe,Notary Public')
Personally appeared James De Armond
® personally known to me
[-I pFgved to mg nn the hark; Af ratisfaGto`ly
evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and
acknowledged to me that he/she executed
the same in his/her/their authorized
capacity(ies), and that by his/her/their
r- BRAD L.SEITGAST D signature(s) on the instrument the person(s),
Q COMM#1253598
LU NOTARYPUBLIC-CALIFORNIA m or the entity upon behalf of which the
Q
ORANGE COUNTY person(s)acted, executed the instrument.
jj MY CanM"W EVIM Feb.14,204
ir{N{iH►N{{r{rrrrrr a{{r r•••k{{{{{r
IT S - n nd official seal.
Puce Notary Seal Above of Notary Public
ii /
WORKERS' COMPENSATION INSURANCE CERTIFICATION
Description of Contract:
City of Redlands
Public Works Department
STREET TREES AND TREE WELLS ON CITRUS AVENUE FROM ORANGE STREET TO SIXTH
STREET PROJECT
CONTRACT NO. 236166-7150/15008
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 fiunishing 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 Workers' Compensation or to undertake self-insurance in accordance
with the provisions of that Code, and I will comply with such provision before commencing the
performance of the work of this contract. (Labor Code Section 1861)
Date:
kill I
Name of Contractor
i
By: 01
Supervisor or Authorized Agent
Title:
leo,
Contractor's License No.:
J
Page 18
EXECUTED IN DUPLICATE
PERFORMANCE BOND
WHEREAS, the City Council of the City of Redlands, State of California(hereinafter designated as City),
and JDC Inc. (hereinafter designated as Principal)have entered into an agreement whereby Principal agrees
to install and complete certain designated public improvements,which by said agreement dated September
17, 2002, and identified as Contract No. 236166-7150/15008, is hereby referred to and made a part hereof,
and
WHEREAS, under the terms of said agreement,Principal is required before entering upon the performance
of the work,to furnish a good and sufficient faithful performance bond with the City.
NOW,THEREFORE, said Principal and the undersigned as corporate surety,are held and firmly bound unto
the City in the sum of One Hundred TwentvFour Thousand Five Hundred dollars (S 124,500.00 ) for the
payment of which sum well and truly to be made, we bind ourselves, our heirs, successors, executors and
administrators,jointly and severally, firmly by these presents.
The condition of this obligation is such that if the above bounded Principal, his or her heirs, 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 said agreement and any alteration thereof made as
therein provided,or his or her 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 defend, indemnify and save harmless
the City, its elected officials,officers, agents,and employees, as therein stipulated,then this obligation shall
become null and void; otherwise it shall be and remain in full force and effect.
As a part of the obligation secured hereby and in addition the face amount specified therefor,there shall be
City ini
the
included costs and reasonable expenses and fees, including attorney's fees incurred by C
successfully enforcing such obligation, all to be taxed as costs and included in any judgment rendered.
The surety hereby stipulates and agrees that no change,extension 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 anywise affect its obligations on this bond, and it does hereby waive notice of any such change,
extension of time,alteration or addition to the terms of the agreement or to the work or to the specifications.
IN WITNESS WHERE-OF,this instrument has been duly executed by the Principal and surety named,
o SEPTEMBER 25 2002. Bond No. 08627086
n A
FIDELITY DIPEPOSIT
{SE, L)
- I I ISE,4L�
JDC, INC;- A
h
Princ;ipal Suret By A
By: 42 —
Signiture J.W. JOHNSON, ATTORNEY—IN—FACT
ignatur
255 S. LAKE AVE. , STE. 700
Address- PASADENA, CA 91101
(Notanal Acknowledgmnts of Principal and Surety) Telephone: (_6�26 792-2311
Page 19
EXECUTED IN DUPLICATE
LABOR AND MATERIAL PAYMENT BOND
WHEREAS,the City Council of the City of Redlands,State of California(hereinafter designated as "City").
and JDC Inc. (hereinafter designated as "Principal") have entered into an agreement whereby Principal
agrees to install and complete certain designated public improvements, which by said agreement dated
September 17,2002,and identified as Contract No. 236166-7150/15008 known as the"PROJECT"which,
is hereby referred to and made a part hereof, and
WHEREAS,under the terms of said agreement,Principal is required before entering upon the performance
of the work,to furnish a good and sufficient labor and materials payment bond with the City to secure the
claims to-which reference is made in Title 15 (commencing with Section 3)082)of Part 4 of Division 3 of the
Civil Code of the State of California.
NOW,THEREFORE, said Principal and the undersigned as corporate surety,are held and firmly bound unto
the Citv and all contractors, subcontractors, laborers,materialmen, and any other persons employed in the
performance of the aforesaid agreement and referred to in the aforesaid Civil Code of the State of California
in the sum of One Hundred Twenty Four Thousand Five Hundred dollars ($ 124,500.00 ) for materials
furnished 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 in an amount not exceeding the amount
hereinabove set forth,and also in case suit is brought upon this bond,will pay,in addition to the face amount
thereof, costs and reasonable expenses and fees, including reasonable attorney's 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 inure to the benefit of any and all persons,
companies and corporations entitled to file claims under Title 15 (commencing with Section 3082) of Part
4 of Division 3 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought
upon this bond.
Should the condition of this bond be fully performed, then this obligation shall become 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 to the work to be performed thereunder or the specifications accompanying the same
shall in agnosia affect its obligations on this bond, and it does hereby waive notice of any such change,
extension of time,alteration or addition to the terms of the agreement or to the work or to the specifications.
IN WITNESS WHEREOF,this instrument has been duly executed by the Principal and surety named,
on SEPTEMBER 25 i2002. Bond No. 0840186
FIDELITY AND!1 EPOSIT
JDC, INC. (SEAL) C OMP ANt iO F r',MiiY LAND (SEAL)
ifif
Surety J ll
Principa�,--,-,-
By;' By:
Sinature S�ignaxiitre i.w. JOHNSON, ATTORNEY—IN—FACT
Address:225 S` LAKEAVE. , STE. 700 — PASADENA, CA
91101
(Notarial Acknowledgments of'Principal and Surety) Telephone: (.626 ) 722-2311.
Page 20
Power of Attorney
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
HOME OFFICE: P.O. BOX 1227, BALTIMORE, MD 21203-1227
Know ALL MEN, BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a
corporation of the State of Maryland, by W. B. WALBRECHEice-Preside d T.
E.
SMITH, Assistant Secretary,
in pursuance of authority granted by Article VI, Section 2, of .4%, il s Company, which are set forth on the
reverse side hereof and are hereby certified to be in full effe e date hereof, does hereby nominate,
constitute and appoint J. W.Johnson, of Fullerton,Cali its hve wful agent and Attomey-in-Fact,to make,
execute, seal and deliver, for, and on its behalf as sure as its a deed: any and all bonds and undertakings
and the execution of such bonds or undertakings in p e of the encs,shall be as binding upon said Company,as
fully and amply,to all intents and purposes, as if t been d cuted and acknowledged by the regularly elected
officers of the Company at its office in Baltimor in the proper persons. This power of attorney revokes that
issued on behalf of J.W.Johnson,dated Janu 998.
The said Assistant Secretary does hereb that th ct set forth on the reverse side hereof is a true copy of
Article VI,Section 2,of the By-Laws of mpany, now in force.
IN WITNESS WHEREOF, the saii -Presiden Assistant Secretary have hereunto subscribed their names and
affixed the Corporate Seal of the
he sai DELIT D DEPOSIT COMPANY OF MARYLAND, this 19th day of
November,A.D. 1999.
ATTEST- FIDELITY AND SIT COMPANY OF MARYLAND
By:
T E.Smith Assistant Secretary W. B. Walbrecher Vice-President
StateofMaryland ss:
County of Baltimore I
On this 19th day of November, A.D. 1999, before the subscriber, a Notary Public of the State of Maryland, duly
commissioned and qualified, came W. B. Walbrecher. Vice-President and T. E. Smith, Assistant Secretary of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers
described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and
being by me duly sworn, severally and each for himself deposeth and saith,that they are the said officers of the Company
aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said
Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the
authority and direction of the said Corporation.
IN TESTIMONY WHEREOF. I have hereunto set my hand and affixed my Official Seal the day and year first above
written.
Carol J Fa r Notary Public
My Commissi / Expires: August 1,2000
L1428-0124152
Client#: 32943 J DCI NC
CIOR CERTIFICATE OF LIABILITY INSURANCE 09/25/02°""'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Armstrong/Robitaille Bus&InsSv ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
680 Langsdorf Drive#100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 34009
Fullerton, CA 92834-8409 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Westchester Fire Insurance Co.
J.D.C., INC. INSURER B: American States Insurance Company
13061 Shasta Court
INSURER G: Preferred Employers Insurance Co
PO Box 3448 -
INSURER o: Hartford insurance Company
Rancho Cucamonga,CA 91739 INSURER E: Westchester Fire Insurance Company
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR -TYPE OF - POLICY NUMBER -.. POLICY EFFECTIVE POLICY EXPIRATION . LIMITS
LTR DATE MM/DD/YY DATE MMIDDIYY
A GENERAL LIABILITY GLS683688 07/01/02 07/01/03
EACH OCCURRENCE $1,000,000
-—
}( ;COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anyone fire) $50,000
CLAIMS MADE X OCCUR MED EXP(Any one Person) $5,000
X BI/PD Ded:1,000 ___
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'LAGGREGATE LIMITAPPLIESPER: PRODUCTS -COMP/CP AGO $1,000,000
X POLICY X JE� LOC
B AUTOMOBILE LIABILITY O1GG1857231 O7IO1/O2 07/01/03 COMBINED SINGLE LIMIT $1,000,000
X ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS {Peraccitlent}
__- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTOOTHER THAN EA ACG $
AUTO ONLY: AGG
E EXCESS LIABILITY GUS225623 07/01/02 07/01/03 EACH OCCURRENCE_ 51,000,000
X OCCUR CLAIMS MADE AGGREGATE $1,000,000
DEDUCTIBLE $
RETENTION $ $
C. WORKERS COMPENSATION AND WKN1113181 07101/02 07/01/03 X 'WCSTATU- OTH-
TORY LIMITd ER ;
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1,000,000
E.L.DISEASE-EA EMPLOYEE $1,000,000
EL.DISEASE-POLICY LIMIT $1,000,000
D OTHER Equipment 72MSUR2643 07!01/02 07/01/03 $1,000 Deductible
Scheduled $105,806
Rented/Leased $50,0001$100,000 Max
DESCRIPTION OF OPERATIONSfLOCATtONSIVEMCLESIEXCLUSiONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
30 Days Notice of Cancellation Except 10 Days for Non Payment of Premium
**RE: Contract No. 236166-7150/15008, Street Trees and Tree Wells on Citrus Avenue from Orange Street to Sixth
Street"The City, its elected officials,employees and agents are named additional insureds as respects all
(See Attached Descriptions)
CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION Ten Day Notice for Non-Payment of Premium
SHOULD ANYOFTHE ABOVE DESCRIBED POLICIESBE CANCELLED BEFORE THE EXPIRATION
City of Redlands DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYSWRITTEN
P.O. Box 3005 NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUT FAILURE TODOSOSHALL
Redlands, CA 92373 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRES VE
ACORD 25-S(7197)1 of 3 #S182640/M174977 LKC 0 AC CORPORATION 1988
DESCRIPTIONS (Continued from Page 1)
policies including general liability and automobile liability. Such insurance is primary and noncontributory
as required by written contract.
AMS 25.3(07/97) 3 of 3 #S182640/MI74977
POLICY NUMBER: GLS683688 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES or
CONTRACTORS (FORM 13)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Redlands
P.O. Box 3005
Redlands, CA 92373
(if no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of"your work"for that insured by or for you.
**RE: Contract No. 236166-7150/15008, Street Trees and Tree Wells on
Citrus Avenue from Orange Street to Sixth Street** The City, its
elected officials, employees and agents are named additional insureds
as required by written contract .
PRIMARY INSURANCE :
IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY
AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED
SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS
INSURANCE.
CG 20 10 11 85
^ m� ` SAFEC(3'
CO%IWERC|ALAUTO
POLICY NUMBER: 0ICCl857231
~
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
INSURED �*�����F�� �� ���� ��������������������7�
UV�����K`����� CONTRACT" ~° .~_ . __' _-_ _ _ __
This endorsement modifies insurance provided under the kdlowing�
BUSINESS AUTO COVERAGE FORM
With respect tocoverage providedbvihiao»dorsennen|. {hoProv3ions0[thaCoverageFormamdyunkasamodi8ed
bythe endorsement.
1' BLANKET WAIVER OFSUBROGATION 3. BLANKET ADDITIONAL INSURED
Section \y--BUSINESS AUTO CONDITIONS X5 Any person ororganization for whom you are
is amended bythe addition o[the [oUmvi»g� 'uqui/uu under u" mau.=" ^°, ~,� to provide
insurance sconsidered o*v/uu /v. u°u".y
yyewaive ony'i=htofreoovnrywmrnayhoveegain»i Cove/aga, but only bothe extent that person or
organization because of payments organization qualifies asanlnsunad^under the VVho
any person ornoq]Uy injury" or "property damage" Is An Insured provision unnie|nad in Section || of
w� make '~ --- i� nofacovered ,auto
''««h»n the Form.
�hoingoutofthooPera»oi\yfor »uch ''bodUyin'�ury^ r '
you have assumed o�ux ( i . 4 PRIOR NOT|CEOF �ANCELLAT|ON
or^propedydarnago^ under an "insured con /an . �
|nthe event ufoanceUuhonorroduoUoninthe Limits
2. BL�N>{�TPR|K8ARY |N�UR/\NCE ofInsurance ofthe Coverage Form, wowill mail a(
This insurance is considered primary and wc will least thirty (30) days prior written notice to any
not seek contribution from any other insura»ce person ororganization for whom you are required
available h> you for any person »rorganization for tnprovide such notice under an"insured cnninad.^
whom you are required under a«"insured contract" provided you notify usofsuch contract requirement
improvide insurannc but only\othe extent that this aileast[od'�hva (45)days prior iothe canceUaiimn
isprovided under Section |V--BUSINESS AUTO or reduction.
CONDITIONS B.5.Other ins urnoca.
^ em"m*"" x°��*wskFccocmWfdv�
m^,a^ `mx
State of California }
] as.
County of Orange
e
On September 25 2002 before me, Brad L. 5ettgast. Notary Public
pay NamR and Tia d off-,w to t; -Jarr Do@ NoWy Pubh
Personally appeared James De Armond
® personally known to me
D
to be the person(s) whose name(s) islare
� N+M11► ►,a„a,.a,a.� subscribed to the within instrument and
t BRAD L.SEMAST > acknowledged to me that he/she executed
r COMM M 1253598 M the same in his/her/their authorized
NorANr PUBUC•GILIFOPINIA Ca aci (iesy, and that b hislherAheir
W ORANGE C..OUNTY .a
a p ty y
M,CommisW�Fa 11,21VA s signature(s)on the instrument the person(s),
..,..�«.�..►++++*+++++++`►•+++"•`+• or the entity upon behalf of which the
person(s)acted, executed the instrument-
1TV1T fr+ 'ar+d and offiaaI seat,
r -
OPTIONAL
Though the information below is not required by raw.it may prove valuable to persons relying on Me document
and Co"Id preyenl fraudulent removal and reaffaChmenr of this form to another 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
Signer's Name:
❑ Individual
❑ Corporate Officer—Title(s).
❑ Partner---[--]Limited ❑General
❑ Attomey-in-Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other
Signer is Representing
c
01997 National Notary Assoaation.9350 Desoto Ave-,P.O.Box 2402.Chatsworth,CA 91313-2402