HomeMy WebLinkAboutContracts & Agreements_102-2015_CCv0001.pdf PUBLIC WORK CONSTRUCTION CONTRACT
This Public Work Construction contract ("Contract") is made and entered into this 19th day of May,
2015, by and between the City of Redlands, a municipal corporation, organized and existing under the
laws of the State of California (hereinafter "City"), and R Dependable Construction, 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 will perform all of the work for
the following: Development Services Department Office Improvement Project No. 01082,
complete, as required by the Contract Documents (as herein defined) and Specifications for City's
Development Services Department Office Improvement Project No. 01082 (the "Work").
2. CONTRACT SUM: City shall pay Contractor the sum of One Hundred Thousand Dollars
($100,000.00) 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 required to be withheld by City pursuant to an escrow agreement as set forth in Public
Contract Code section 22300.
3. TIME FOR COMPLETION: The Work shall be completed within sixty days(60) calendar days
from and after the date of the delivery to Contractor of the 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, or
have withheld from monies due to Contractor, the sum of Five Hundred Dollars ($500.00) for each
consecutive calendar day in excess of the specified time for completion of the work.
Execution of this Contract shall constitute agreement by City and Contractor that Five Hundred
Dollars ($500.00) 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 liquidated damages and shall not be
construed as a penalty, and may be deducted from payments due the Contractor if such delay
occurs.
5. CONTRACT DOCUMENTS: This Contract incorporates by reference the following: Notice
Inviting Bids, Instructions to Bidders, Contractor's Proposal, Bid Bond, Agreement Performance,
Labor and Material Bond, Plans, General Conditions, Special Provisions and Specifications, and
any addenda thereto (collectively the"Contract Documents").
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 Party 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.
1:\City Council Reports\Development Services12015 Reports105-19-151DSD Office Improvement Project\R Dependable Public
Work Contract 5-19-15.doc
7. RESOLUTION OF CONSTRUCTION CLAIMS: Any claims by Contractor in the amount of
Three Hundred Seventy Five Thousand Dollars ($375,000) 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 20104). All claims shall be in writing and include the
documents necessary to substantiate the claim. Nothing in Public Contracts Code Section 20104.2
shall extend the time limit or supersede the notice requirements provided for the filing of claims by
Contractor.
8. ELIGIBILITY OF CONTRACTOR/SUBCONTRACTOR: Contractor and all of its
subcontractors shall abide by Public Contract Code Section 6109 and Labor Code sections 1777.1
and/or 1777.7, and certify that they are not debarred and are eligible to perform the Work.
9. ASSIGNMENT OF AGREEMENT: No assignment by Contractor of any rights or interests
under this Contract shall be binding on the City without the prior written consent of the City.
10. SUCCESSORS AND ASSIGNS: City and Contractor each binds itself and their respective
successors and assigns in respect to all covenants, agreements, and obligations contained in the
Contract Documents.
11. 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.
J:\City Council Reports\Development Services12015 Reports105-19-151DSD Office Improvement ProjectlR Dependable Public
Work Contract 5-19-I5.doc
IN WITNESS WHEREOF, the Parties hereto have executed this Contract the day and year first
written above.
City of Redlands
(SEAL)
By:
Paul W. Foster, Mayor
ATTEST: 7
Sam Irwin, City)lerk
(SEAL)
R Dependable Construction, Inc.
Name of Contractor
By 2dz1/`Signature of Authori A nt
_Rosemary Padilla, President
Title
Signature of Authorized Agent(if necessary)
Title
944088
Contractor's License No.
J:\City Council Reports\Development Services\2015 Reports\05-19-15\DSD Office Improvement Project\R Dependable Public
Work Contract 5-19-15.doc
WORKER'S COMPENSATION INSURANCE CERTIFICATION
Description of Contract: Development Services Department Office Improvement Project No.01082
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 by one
or more insurers 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.
CHECK ONE
NI 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 provisions before
commencing the performance of the work and activities required or permitted under this
Agreement. (Labor Code §1861).
I affirm that at all times, in performing the work and activities required or permitted under
this Agreement, I shall not employ any person in any manner such that I become subject to the
workers' compensation laws of California. However, at any time, if I employ any person such that I
become subject to the workers' compensation laws of California, immediately I shall provide the
City with a certificate of consent to self-insure, or a certification of workers' compensation
insurance.
I certify under penalty of perjury under the laws of the State of California that the information and
representations made in this certificate are true and correct.
Dated this a ( day of l" ,G,� ,2015.
(Contractor)
7
(Signature)
res td n'Vf-
(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.)
]:\City Council Reports\Development Services\2015 Reports\05-19-15\DSD Office Improvement Project\R Dependable Public
Work Contract 5-I9-15.doc
• Bond#SXACSU 0665514
Premium: S 3,000.00
FAITHFUL PERFORMANCE BOND
Whereas, the City of Redlands ("City"). State of California. and R Dependable
Construction, Inc. (hereinafter designated as "Principal") have entered into an agreement dated May
19, 2015 ("Agreement") whereby Principal agrees to install and complete certain public
improvements (the "Work"), which said Agreement is identified as Development Services
Department Office Improvements Project and is hereby referred to and made a part hereof; and
Whereas, said Principal is required under the terms of the Agreement to furnish a bond for
the faithful performance of the Agreement, now, therefore, we, the Principal and
Allegheny Casualty Company , as Surety, are held and firmly bound unto the City in the penal sum of
One Hundred Thousand and No/100 Dollars (5 100,000.00 ) 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.
The condition of this obligation is such that if the above bounded Principal, his or its 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 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 in full force and effect.
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
obligation shall hold 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 Work, 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 default,or shall promptly, at the City's option:
1. Complete the Agreement in accordance with its terms and conditions; or
2. Obtain a bid or bids for completing the Agreement in accordance with its terms and
conditions, and upon determination by Surety of the lowest responsive and
responsible bidder, arrange for a contract between such bidder and the City, and
1:11.IANl i\DSI)Project\R Dependable Public Work Contract 5-19-15 Revised 5-27-15.doc
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. 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 a
bid from the Principal for completion of the Work if the City. when declaring the Principal in
default. notifies Surety of the City's objection to the Principal's further participation in the
completion of the Work.
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 suit under this bond
must be instituted within the applicable statute of limitations period.
The said Surety. for value received. 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 any way 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.
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
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 May 27 , 2015.
(SEAL) (SEAL)
R Dependable Construction,Inc. Allegheny Casualty Company
(Contractor)
BY:
(Sign ignature)
Rosemary Padilla,President Timothy C. Baker,Attorney-in-Fact
Address: 41856 Ivy Street#204
Murrieta,CA 92562
(Seal and Notarial Acknowledgment of Telephone( 951 ) 553-7400
Surety)
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ALLEGHENY CASUALTY COMPANY
ONE NEWARK CENTER, 20TH FLOOR NEWARK, NEW JERSEY 07102-5207 .'
KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY,a corporation organized and existing under
the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized arid existing under the laws of the State of
Pennsylvania,having their principal office in the City of Newark,New Jersey,do hereby constitute and appoint
MELODY L. SPAUR, TIMOTHY C. BAKER, KAREN A. EBY
Murrieta, CA.
•
their true and lawful attorney(s)-in-fact to execute,seal and deliver for and on its behalf as surety,any and all bonds and undertakings,contracts of indemnity
arid other writings obligatory in the nature thereof, which are or may be allowed,required or permitted by law,statute,rule,regulation,contract or otherwise,
and the execution of such instrurnent(a)_irl_pursuance of these presents,shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE
COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes,as if the same had been duly executed and
acknowledged by their regularly elected officers at their principal offices.
This Power of Attorney is executed,and may be revoked, pursuant to and by authority of the By-Laws of INTERNATIONAL FIDELITY INSURANCE
COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors
of INTERNATIONAL FIDEI..1TY INSURAICE COMPANY ata meeting duly held on the 20th day of July,2010 and by the Board of Directors of ALLEGHENY
CASUALTY COMPANY at a meeting duly held on the 15th day of August,2000:
"RESOLVED,that (1)the President,Vice President, Executive Vice President or Secretary of the Corporation shall have the power to appoint,and to revoke
the appointments of,Attorneys-in-Fact or agents with power and authority as defined or limited in their respective,powers of attorney,and to execute on behalf
of the Corporation and affix the Corporation's seal thereto,bonds,undertakings, recognizances, contracts of indemnity,and,other written obligations in the
nature thereof or related thereto; and (2)any such Officers,of the Corporation may appoint and revoke the appointments of joint-control custodians,agents
for acceptance of process,and Attorneys-in-fact with authority to execute waivers and consents on behalf of the Corporation;and (3)the signature of any
such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any
bond,undertaking,recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto,such signature and seals when
so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the
Corporation,to be valid and binding upon the Corporation with the same force and effect as though manually affixed."
IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and
attested these presents on this 22nd day of July,2014.
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(International Fidelity Insurance Company)
and President(Allegheny Casualty Company)
On this 22nd day of July 2014, before me came the individual who executed the preceding instrument,to me personally known,and, being by me duly
sworn, said he' is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY
COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies;that the said Corporate Seals and his signature were
duly affixed by order of the Boards of Directors of said Companies.
IN TESTIMONY WHEREOF, I have hereunto set rny hand affixed my Official Seal,
I idopt at the City of Newark,New Jersey the day and year first above written.
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CERTIFICATION
1,the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have
compared the foregoing copy of the Power of Attorney and affidavit and the copy of the Sections of the By-Laws of said Companies as set forth in said
Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof,and of the whole
of the said originals,and that the said Power of Attorney has not been revoked and is now in full force and effect IN TESTIMONY WHEREOF, I have hereunto set my hand this (9"-- day of /-)7) -( 6
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. CALIFORNIA ALL PURPOSE
;, CERTIFICATE OF ACKNOWLEDGMENT , 1;
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A notary public or other officer completing this certificate verifies only the identity
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cmporate officer.indicate title title(i CEO,CFO,Secretary), it
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``POW II.( OF ATTORNEY
' JNTERNATIQNAL FIDELITYIN
" SURANCE°COM'PANY
ALLEGHENY CASUALTY COMPANY"
ONE.NEWARK CENTER,20TH FLOOR NEWARK, NEW JERSEY 07102-5207
KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY,a corporation organized and existing under
the laws of the State of New Jersey, and ALLEGHENY.CASUALTY COMPANY a corporation organized and existing under the laws of the State of
Pennsylvania,having their principal office in the City of Newark,New Jersey;'do hereby constitute and appoint
MELODY L. SPAUR, TIMOTHY C. BAKER, KAREN A. EBY
Murrieta, CA.
their true and lawful attorney(s)-in-fact to execute,seal and deliver for and on its behalf as surety,any and all bonds and undertakings,contracts of indemnity
and other writings obligatory In the nature thereof, which are or may be allowed,required orpermitted by law,statute,rule,regulation,contract or otherwise,
and the execution of such instrument(s) inpursuance of these:presents,shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE
COMPANY and,ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes,as if the same had been duly executed and`
acknowledged by their regularly elected officers at their principal offices.
This Power of Attorney is executed and maybe revoked, pursuant to and by authority of the B -Laws of INTERNATIONAL FIDELITY INSURANCE
COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors
of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th day of July,2010 and by the Board of Directors of ALLEGHENY
CASUALTY COMPANY at a meeting duly held on the 15th day of August,2000:.
"RESOLVED,that (1)the President,Vice President Executive Vice President or Secretary of the Corporation shall have the: power to appoint,and to revoke
the appointments of,Attorneys-in-Fact or agents with power and authority as defined or limited in their respective powers of attorney,and to execute on behalf
of the Corporation and affix the Corporation's seat thereto,`bonds,undertakings, recognizances, contracts.of indemnity and other written obligations in the
nature thereof or related thereto; and (2),any such Officers of the Corporation may appointandrevoke the appointments of joint-control custodians,agents
for acceptance of process,and Attorneys-in-fact with authority to execute waivers and consents on behalf of the Corporation;and (3)the signature of any
such Officer of the Corporation and the Corporation's sealmay be affixed by facsimile to anypower of attorney or certification given for the execution of any
bond,undertaking,recognizance, contract of indemnity or other written obligation in the naturethereof or related thereto,such signature and seals when
so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the
Corporation,to be valid and binding upon the Corporation with the same force and effect as though manually affixed."
IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and
attested these presents on this 22nd day of July,2014.
�� STATE OF NEW JERSEY
-k. I.StIAL J I.C,
, County of Essex $ y:
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b` ROBERT W,MINSTER
;) ,, Executive Vice PresidenVChlef Operating Officer S-LVN
(International Fidelity Insurance Company)
-" and President(Allegheny Casualty Company) "' -
On this 22nd day of July 2014,;before me came the individual who executed the preceding instrument,to me personally known,and, being by me duly
sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY
COMPANY; that the seats affixed to said instrument are the Corporate Seals of said Companies;that the said Corporate Seals and his signature were
duly affixed by order of the Boards of Directors of said Companies.
IN TESTIMONY WHEREOF, I have hereunto set myhand affixed my Official Seal,
Si,4,NI Ft,444: at the:City of Newark,New Jersey the day and year frst above written.
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±'yru' ,'C(IR�,'�,..' 4 ' A NOTARY PUBLIC OF NEW JERSEY
q. My Commission Expires April 16,2019
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1.++1,, 4!b. CERTIFICATION
I,the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have
compared the foregoing copy of the Power of Attorney and affidavit,and the copy of the Sections of the By-Laws of said Companies as set forth in said
Power of Attorney, with the originals on file in the home office of said companies,-and that the same are correct transcriptsthereof,and of the whole
of the:sid originals,and that the said Power of Attorney has not been revoked and is now in full force and effect.
IN TESTIMONY WHEREOF, I have hereunto set my hand this day of ii) Itt 00 l S
MAMA BRANGO Assistant Secretary;
Brind4 SNACSU 0665514
LABOR AND MATERIAL BOND
Whereas. the City Council of the City of Redlands, State of Califontia. and R Dependable
Construction. Inc. (hereinafter designated as -Principal") have entered into an agreement (the -Agreement')
Mihereby Principal agrees to install and complete certain designated public improvements (the -Work"),
Alich said agreement, dated May 19„ 2015, and identified as the Devek)pittern Services Department
Improvement Project No. 01082 is hereby referred to and made a part hereof; and
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 NN hid) 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 unto
the City and all contractors, subcontractors, laborers, material men and other persons employed in the
performance of the Agreement and referred to in the aforesaid Code of Chi,il Procedure in the sum of
Dollars ($100.000,00) 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, NN ill
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
personscompanies and corporations entitled to file claims under Title 3 (conmiencing'Ns ith Section 9550)of
Part 6 of Division 4 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 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.
In witness whereof.this instrument has been duly executed by the Principal and surety above named,
on May2015.
(SEAL) (SEA Li
R Dependable Construction,Inc, Allegheny Casualty Cont I;
t raCior)
(Surety)
BY:
(SifanafOre) fry Padilla,President S gn atu re) Timothy C.Baker,Attorney-in-Fact
e
Address:
41856 Ivy Street 6 204
Murrieta CA 92562
(Seal and Notarial Acknowledgment of Telephone(951 ) 5534400
Surety)
FlAlist)Project\R ilcpendable Public Vvork ontract 5-19-15 Rex ised 5-27-15 dor.
CALIFORNIA ALL PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
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 ^ .2-3/C- 7.„,,- }
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On ,''' (-3 ' „M'e--1( before me,
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personally appeared / /1„;,,2, 1 ' ,' "'''
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who proved to me on the basis of satisfactory evidence to be the persons)-whose
name(s),Cislere-sulpscribeci to the within instrument and acknowledged to me that
Chei_.: they executed the same ii-i(isiMeritheir authorized capacity( - ); and that by
his/ - -Ir signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s)-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.
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... .. COMM. #183975
WITNESS my hand .. offici. sal. 2 t,,,"te,i'.pli Notary Public-California /73
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INSTRUCTIONS FOR COMPLETING THIS FORM
ADDITIONAL OPTIONAL INFORMATION /h, ,. , ,
is foon coralphes lytth cltrrent f alifornto stittttes regatTling natal'',wording and
DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the doctunent.cfcknowleciginents
Irvin other states into'be completed for doelintents being sent to that state so long
as the wording does not require the California notaly to violate C'aliforifia notaty ,1
law
(Title or description of attached document) e State and County information must be the State and County where the document
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signer(s)personally appeared before the notary public for acknowledgment,
i . a Date of notarization must be the date that the signer(s)personally appeared which
(Title or decor must also be the same date the acknowledgment is completed.
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of attached document continued)
* 'The notary public must print his or her name as it appears within Ins or her t,
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Number of Pages Document Date commission followed by a comma and then your title(notary public),
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O Individual (s) information may lead to rejection of di:ion/tient recording.
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impression must not cover text or lines If seal rinttression smudges,re-seal ifs
(Title) sufficient area permits,otherwise complete a different acknowledgment form.
* Signature of the notaixi public must match the signature on filewith the office of 1,
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tieknowledizinent ts Silty 1111$1.1sed or attached to a different doe ii.„.i
Indicate title or type of attached document,number of pages and date.
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Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(i.e,CEO,CFO Secretary).
e SeCtirely attat,h.tins doctiment to the signed docunient'with a staple,
,..,,
CALIFORNIA ALL PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
..,rr
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 ./.
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County of .1.1„,---r,,..4 of 6 ,,.. 2 1
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hi ( erftheilf signature*on the instrument the person*, or the entity upon behalf of
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(wc--„the perso5executed the instrument.
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I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
1 4,...,1,...,4, L. A.EBY 1.
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,t't-, COMM. #198391
... WITNESS myilang : d o.r cia sel '-,
ittrr-ii, Notary Public".California
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INSTRUCTIONS FOR COMPLETING THIS FORM
ADDITIONAL OPTIONAL INFORMATION - , .., ,
i hiS.101111 COM111188 lilth ow (GlifOraPel SiOrtfieS regarding notary ivordirw and,
DESCRIPTION OF THE ATTACHED DOCUMENT if needed.should be completed and attached to the document..,4eiatowiedginents 1,
film other states may he coinpleteddini ilocitments being sem to that state so lottg 1 i
as the wou'aing does 170f require the('‘ilifOrnia or to violate("qhfitnalla rotary
laud
(Ti)le or description of attached document) 6 State and County information must be the State and County where the document
.,
signer(s)personally appeared before the notary public for acknowledgment.
., * Date of notarization artist be the date that the signer(s)personally appeared which
(Title or description of attached document continued) must also be the same date the acknoviledgineni is emnplered.
0 The notary public must print his or her name as it appears within his or her
Number of Pages Document Date commission followed hy a comma and then your title(notary public),
Print the name(s) of document signer(s) who personally appear at the time of
notarization,
CAPACITY CLAIMED BY THE SIGNER '' Indicate the correct singular or plural forms by crossing off incorrect fonns(i.e.
heisliciltheys-is,Iittre)or circling the correct forms,Fail tile to correctly indicate this
0 Iriciividual (s) information may lead to iielection of docinnent recording,
0 Corporate Officer . The notary seal itripression must be clear and photographically reproducible.
Indtdresston must not cover text or lines. If seal impression smudges,re seal it a
(Title) sufficient aima permits,otherwise complete a different acknowledgrnent form,
0 Partner(s Signature of the notary public musi match the signature on Pie witir the office of
)
, . the county clerk.
D Attorney-in-Fact tc. Additional information is not required but could help to ensure this
0 Trustee(s) acknowledgment is not nu sused or attached to a different document,
ther t
,, dlid Indicate title or type of attached doe trier number of pages and date
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O +la Indicate the capacity clanned by the signer. II the claimed capacity is a
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corporate officer.indicate the title(i.e.CEO,CFO,Secretary),
Securely attach this document tulle signed docuinent dvitlii a staple.