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NIA 15-04; Hoefer, Michael and Linda; 2017-0030554; Neighborhood Improvement Agreement/Release
RECORDING REQUESTED BY: Land Development Engineering CITY OF CARLSBAD 1635 Faraday Avenue Carlsbad, CA 92008 WHEN RECORDED MAIL TO: City Clerk CITY OF CARLSBAD 1200 Carlsbad Village Drive Carlsbad, CA 92008 DOC# 2017-0030554 I \IIIII IIIII IIIII IIIII \Ill \IIIII IIIII IIIII IIIII IIIII IIIII IIIII Ill\ Ill\ Jan 19, 2017 03:55 PM OFFICIAL RECORDS Ernest J. Dronenburg, Jr, SAN DIEGO COUNTY RECORDER FEES $54.00 PAGES 14 Space above this line for Recorder's use. Permit No. Parcel No. NIANo. CITY OF CARLSBAD NEIGHBORHOOD IMPROVEMENT AGREEMENT CB 15-2998 156-052-11-00 NIA 15-04 ~ THIS AGREEMENT (the "Agreement") is made this \~ day of '-\e>""'~~ 20 \S by Michael L. Hoefer and Linda M. Hoefer and between the City of Carlsbad, a municipal corporation (the "City"), and, (the "Owner"). RECITALS 1. Owner is the owner of real property located in the City of Carlsbad, California and described in Exhibit 'A' attached hereto and incorporated herein by this reference (the "Property"). 2. Owner has applied to the City for issuance of the above identified permit to authorize the development of the Property (the "Development Permit"). 3. The City has determined that additional public improvements may be necessary in the future in order to allow Owner to proceed with development and, therefore, the Property would be suitable for development as requested by Owner if certain J\'15 BUILDING PLANCHECK\CB152998GR\LDE\NIA 15-04.doc 01/25/13 public improvements as described in Exhibit B attached hereto and incorporated herein by this reference (the "Improvements") are constructed. 4. The Municipal Code of the City of Carlsbad requires the dedication of the necessary rights-of-way for and the construction by Owner of the Improvements or an agreement for the same for certain developments or building projects such as that proposed by owner. 5. The Owner has requested that the City approve the Development Permit prior to the construction of the Improvements. 6. The City is willing to approve the Development Permit prior to the construction of the Improvements as requested by the Owner if Owner approves of and consents to the formation of an assessment district to include the Property for the purpose of financing the construction of the Improvements. 7. For properties subject to the Alternative Streets Design process adopted by City Council Resolution, no assessment district shall be formed until completion of the Alternative Streets Design process. NOW, THEREFORE, IT IS AGREED between the parties as follows: Section 1 . Recitals. The foregoing recitals are true and correct. Section 2. City's Obligations. The City shall approve the Development Permit promptly following the execution of this Agreement by the Owner and compliance with all applicable City ordinances and other requirements. Section 3. Owner's Obligations. Section 3.01. Owner's Consent to and Approval of Formation of an Assessment District and Levy of Assessments. In consideration for the approval of the Development Permit prior to the completion of the construction of the Improvements, Owner hereby consents to and approves of: A. the inclusion of the Property in an assessment district which may be formed by the City Council of the City for the purpose of financing the construction of the Improvements (the "Assessment District"); B. the levy of an assessment against the Property (the "Assessment") in an amount not to exceed the estimated cost of construction of the Improvements, together with the estimated incidental costs of such construction and the estimated costs of formation of the Assessment District and issuance of any bonds to be issued to represent the Assessment. The foregoing costs constituting the Assessment are set forth in Exhibit C attached hereto and incorporated herein by this reference. The Assessment shall be subject to adjustment for inflation from the date first written hereinabove until the date the Assessment is confirmed and levied by the increase in the Construction Cost Index J\'15 BUILDING PLANCHECK\CB152998GR\LDE\NIA 15-04.doc 01/25/13 2 for Los Angeles as contained in the Engineering News Record or, if the Construction Cost Index for Los Angeles is no longer published, an equivalent index reasonably selected by the City Engineer. In granting the consents and approvals set forth in this Section 3., Owner is acting for and on behalf of Owner, the Owner's successors, heirs, assigns, and/or transferees and intends that such consents and approvals shall be binding upon each and every such person. Except as otherwise provided for in this Agreement, the consents and approvals given by Owner shall be irrevocable. Section 3.02 Owner's Grant of a Proxy to the City for Assessment Ballot Procedure. Owner hereby grants to the City a proxy to act for and on behalf of Owner, the Owner's successors, heirs, assigns, and/or transferees for the limited purpose of completing and submitting an assessment ballot in support of the levy of the Assessment in the proceedings to form the Assessment District. In granting such proxy, Owner is acting for and on behalf of Owner, the Owner's successors, heirs, assigns, and/or transferees and intends that such proxy shall be binding upon each and every such person. Except as otherwise provided for in this Agreement, the proxy granted by Owner shall be irrevocable. Section 4. Owner's Representations and Waiver of Rights. Section 4.01 follows: Owner's Representations. Owner hereby represents as A. Owner understands and acknowledges that: 1. Article XIIID of the Constitution of the State of California ("Article XIIID") and the Proposition 218 Omnibus Implementation Act (Government Code Section 53750 and following) (the "Implementation Act") (Article XIIID and the Implementation Act may be referred to collectively as the "Assessment Law") establish certain procedures and requirements which apply when any agency such as the City considers the levy of assessments upon real property. 2. The requirements established by the Assessment Law include the following: a. The proportionate special benefit derived by each parcel to be assessed must be determined in relationship to the entirety of the capital cost of the improvement for which the assessment is to be levied; b. No assessment may be imposed on any parcel which exceeds the reasonable cost of the proportional special benefit J\'15 BUILDING PLANCHECKICB152998GRILDE\NIA 15-04 doc 01/25/13 3 conferred on that parcel from the improvement for which the assessment is to be levied; c. Only special benefits are assessable; and d. Parcels within an assessment district that are owned or used by any agency, the State of California or the United States of America shall not be exempt from assessment unless the agency proposing to levy the assessment can demonstrate by clear and convincing evidence that those publicly owned parcels in fact receive no special benefit from the improvement for which the assessment is being levied. 3. The procedures established by the Assessment Law include: a. The agency which proposes to levy an assessment (the "Agency") shall identify all parcels which will have a special benefit conferred upon them from the improvement for which the assessment is proposed to be levied and upon which an assessment is proposed to be imposed. b. All assessments must be supported by a detailed engineer's report prepared by a registered professional engineer certified by the State of California. c. Prior to levying a new assessment , the Agency must give written notice by mail (the "Assessment Notice") to the record owner, i.e., the owner of a parcel whose name and address appears on the last equalized secured property tax roll, of each parcel proposed to be assessed. The Assessment Notice must include: (i) the total amount of the proposed assessment chargeable to the entire assessment district, (ii) the amount chargeable to the record owner's parcel, (iii) the duration of the assessment payments, (iv) the reason for the assessment, (v) the basis on which the amount of the proposed assessment was calculated, and (vi) the date, time and location of a public hearing on the proposed assessment. d. The Assessment Notice must contain an assessment ballot that includes a place where the person returning the assessment ballot may indicate his or her name, a reasonable identification of the parcel, and his or her support or opposition to the proposed assessment. The Assessment Notice must also include, in a conspicuous place, a summary of the procedures for the completion, return and tabulation of assessment ballots. J\'15 BUILDING PLANCHECKICB152998GR\LDEINIA 15-04.doc 01/25/13 4 e. At the time, date and place stated in the Assessment Notice, the Agency shall conduct a public hearing upon the proposed assessment. At such public hearing, the Agency shall consider all objections or protests, if any, to the proposed assessment. At such public hearing, any interested person shall be permitted to present written or oral testimony. f. At the conclusion of the public hearing, the Agency shall tabulate the assessment ballots submitted, and not withdrawn, in support or opposition to the proposed assessment. If there is a majority protest against the imposition of a new assessments, the Agency may not impose the assessment. A majority protest exists if the assessment ballots submitted, and not withdrawn, in opposition to the proposed assessment exceed the assessment ballots submitted, and not withdrawn, in favor of the proposed assessment. In tabulating the assessment ballots, the assessment ballots shall be weighted by the amount of the proposed assessment to be imposed upon each parcel for which an assessment ballot was submitted. 4. The description of the requirements and procedures established by and contained in the Assessment Law set forth above are intended only to summarize certain of such requirements and procedures. 5. The City would not agree to issue the Development Permit prior to the construction of the Improvements unless the City is assured that it wiiJ be legally able to impose the Assessment on the Property. The assurance of the City's legal ability to impose the Assessment on the Property is both a material inducement to and a material consideration for the City to enter into this Agreement and agree to issue the Development Permit prior to the construction of the Improvements. B. Owner has had a reasonable opportunity to thoroughly read and review the Assessment Law in its entirety and has further had a reasonable opportunity to consult with Owner's attorney regarding the Assessment Law and the terms and conditions of this Agreement. Section 4.02 Waiver of Rights A. In consideration of the approval by the City of the Development Permit prior to the construction of the Improvements, Owner hereby waives Owner's rights under the Assessment Law to: J 1"15 BUILDING PLANCHECK\CB152998GRILDE\NIA 15-04 doc 01/25/13 5 1. object or protest the ordering by the City of the construction of the Improvements and the imposition of the Assessment at such public hearing so long as the amount of the Assessment does not exceed the amount set forth in Exhibit C hereto adjusted for inflation pursuant to Section 3.01 B above; 2. submit an assessment ballot in support of or in opposition to the imposition of the Assessment so long as the amount of the Assessment does not exceed the amount set forth in Exhibit C hereto adjusted for inflation pursuant to Section 3.01 B above; and 3. file or bring any protest, complaint or legal action of any nature whatsoever challenging the validity of the proceedings to form the Assessment District and/or the validity of the imposition of the Assessment on the Property. B. In order that the City may be assured of its ability to legally impose the Assessment on the Property and, therefore, be willing to enter into this Agreement and agree to approve the Development Permit prior to the construction of the Improvements, Owner represents and warrants that Owner has knowingly, intelligently and voluntarily waived for and on behalf of Owner, Owner's successors, heirs, assigns and/or transferees, each and every one of the rights specified in Section 4.02A above. C. For properties subject to the Alternative Streets Design process adopted by City Council Resolution, nothing in this waiver of rights section is intended to waive the owner's ability to participate in the Alternative Streets Design process. Section 5. Alternative Satisfaction of Owner's Obligations Owner's obligations under Section 3 above may be satisfied by paying the amount set forth in Exhibit "C" adjusted for inflation at any time prior to the formation of the assessment in which case a release of this Agreement shall be recorded in the office of the San Diego County Recorder. Section 6. General Provisions. Section 6.01 Conflict with Other Agreements or Requirements of the City. Except as specifically provided in this Agreement, nothing contained herein shall be construed as releasing Owner from any condition of development of the Property or requirement imposed by any other agreement with or requirement of the City. Section 6.02 General Standard of Reasonableness. Any provision of this Agreement which requires the consent, approval, discretion or acceptance of any party hereto or any of their respective employees, officers or agents shall be deemed to J.\'15 BUILDING PLANCHECK\CB152998GR\LDE\NIA 15-04.doc 01/25/13 6 require that such consent, approval or acceptance not be unreasonably withheld or delayed, unless such provision expressly incorporates a different standard. Section 6.03 Entire Agreement; Amendment. This Agreement contains all of the agreements of the parties hereto with respect to the matters contained herein and no prior or contemporaneous agreement or understandings, oral or written, pertaining to any such matters shall be effective for any purpose. No provision of this Agreement may be modified, waiver, amended or added to except by a writing signed by the party against which the enforcement of such modification, waiver, amendment or addition is or may be sought. Section 6.04 Notices. Any notice, payment or instrument required or permitted by this Agreement to be given or delivered to either party shall be deemed to have been received when personally delivered or seventy-two (72) hours following deposit of the same in any United States Post Office in California, registered or certified, postage prepaid, addressed as follows: Owner: City: Michael L. Hoefer and Linda M. Hoefer 1430 Forest Avenue Carlsbad, CA 92008 City of Carlsbad Attn: City Manager 1200 Carlsbad Village Dr Carlsbad CA 92008 Each party may change its address for delivery of notice by delivering written notice of such change of address to the other party. Section 6.05 Successors and Assigns. This Agreement shall be binding upon and inure to the benefit of the successors and assigns of the parties hereto. Section 6.06 Governing Law. This Agreement and any dispute arising hereunder shall be governed by and interpreted in accordance with the laws of the State of California. Section 6.07 Waiver. Failure by a party to insist upon the strict performance of any of the provisions of this Agreement by any other party, or the failure by a party to exercise its rights under the default of any other party, shall not constitute a waiver of such party's right to insist and demand strict compliance by any other party with the terms of this Agreement thereafter. Section 6.08 Singular and Plural; Gender. As used herein, the singular of any work includes the plural, and terms in the masculine gender shall include the feminine. J\'15 BUILDING PLANCHECKICB15299BGRILDE\NIA 15-04.doc 01/25/13 7 Section 6.09 Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original. Section 6.10 Construction of Agreement. This Agreement has been reviewed by legal counsel for both the City and the Owner and shall be deemed for all purposes to have been jointly drafted by the City and the Owner. No presumption or rule that ambiguities shall be construed against the drafting party shall apply to the interpretation or enforcement of this Agreement. The language in all parts of this Agreement, in all cases, shall be construed as a whole and in accordance with its fair meaning and not strictly for or against any party and consistent with the provisions hereof, in order to achieve the objectives of the parties hereunder. The captions of the sections and subsections of this Agreement are for convenience only and shall not be considered or referred to in resolving questions of construction. Section 6.11 Recitals; Exhibits. Any recitals set forth above and any attached exhibits are incorporated by reference into this Agreement. Section 6.12 Authority of Signatories. Each signatory and party hereto hereby represents and warrants to the other party that it has legal authority and capacity and direction from its principal to enter into this Agreement, and that all resolutions and/or other actions have been taken so as to enable such party to enter into this Agreement. Section 7. Covenant Running with the Land. The parties hereto intend that the burdens and obligations of the Owner under Section 3 above constitute a covenant running with the land and that such covenant shall be binding upon all transferees of the Property. [End of page. Next page is signature page.] J.\'15 BUILDING PLANCHECK\CB152998GR\LDE\NIA 15-04.doc 01/25/13 8 [Signature Page] Signed by the Owner this ___ ,_<¥-=----day of ~"'" ~'-'-...._ , 201~. 0 NER: Michael L. Hoefer and Linda M. Hoefer ::.• ~nd~ (Sign here)~ ~\~c..~""-L.~o~~'-- (Print name here) Owner (Title) By: b...9 f'r-.. W o.LH--- (Sign here) l U~OA.. \-\\ktf&: (Print name here) Owner (Title) (Proper notary acknowledgement of execution by Owner must be attached.) (Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. Otherwise, a corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation.) CITY OF CARLSBAD, A municipal corporation of the State of California k_EVt..J (...f2.h...Ui::::Va...D . GELDERT, P.E. City ngineer APPROVED AS TO FORM: 01/25/13 9 EXHIBIT A Description of the Property THE LAND REFERRED TO HERIN BELOW IS SITUATED IN THE COUNTY OF SAN DIEGO, STATE OF CALIFORNIA, AND IS DESCRIBED AS FOLLOWS: THAT PORTION OF THE CEDAR HILL ADDITION TO THE TOWN OF CARLSBAD, IN THE CITY OF CARLSBAD, COUNTY OF SAN DIEGO, STATE OF CALIFORNIA, ACCORDING TO MAP THEREOF NO. 532, FILED IN THE OFFICE OF THE COUNTY RECORDER OF SAN DIEGO COUNTY, APRIL 25, 1880, AND SPRUCE STREET NOW VACATED AND CLOSED TO PUBLIC USE, DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF TRACT NO.6 OF LAGUNA MESA TRACTS, ACCORDING TO MAP NO 1719, FILED IN THE OFFICE OF THE COUNTY RECORDER OF SAN DIEGO COUNTY, JUNE 20, 1921; THENCE ALONG THE EAST LINE OF SAID TRACT NO.6, SOUTH 1216.40 FEET TO THE SOUTHEAST CORNER OF THAT PARCEL OF LAND DESCRIBED IN DEED TO ROY F. LENNON AND WIFE, RECORDED DECEMBER 19, 1949, AS DOCUMENT NO. 117982 IN BOOK 3424, PAGE OF OFFICIAL RECORDS, BEING THE TRUE POINT OF BEGINNING; THENCE CONTINUING ALONG SAID EAST LINE OF TRACT NO. 6, SOUTH 259.74 FEET TO THE SOUTH LINE OF SAID ADDITION; THENCE ALONG SAID SOUTH LINE EAST 366.60 FEET TO THE SOUTHWEST CORNER OF THAT PARCEL OF LAND DESCRIBED IN DEED TO E.B SUTTON AND WIFE RECORDED OCTOBER 5, 1944, AS DOCUMENT NO. 74265 IN BOOK 1754, PAGE 175 OF OFFICIAL RECORDS; THENCE ALONG THE WEST LINE OF SAID LAND NORTH 257.74 FEET TO THE SOUTHEAST CORNER OF SAID LAND DESCRIBED IN DEED TO LENNON; THENCE ALONG THE SOUTHERLY LINE OF SAID LAND, WEST 366.00 FEET TO THE TRUE POINT OF BEGINNING. EXCEPTING THEREFROM THE WESTERLY 198.00 FEET THEREOF. ALSO EXCEPTING THEREFROM THE EASTERLY 147.50 FEET OF THE WESTERLY 345.50 FEET OF THE SOUTHERLY 140.00 FEET THEREOF. ALSO EXCEPTING THE SOUTH 30 FEET THEREOF AS DESCRIBED IN DEED TO THE CITY OF CARLSBAD RECORDED SEPTEMBER 15, 1964 AS FILE NO. 168302 OF OFFICIAL RECORDS. 01/25/!3 10 EXHIBIT B DESCRIPTION OF THE IMPROVEMENTS One half street improvements including but not limited to pavement preparation, sidewalks, curb and gutter, clear & grub, grading, fire hydrants, street light, driveway approach, relocation of utilities. 01/25/13 II Permit#: CB152998 EXHIBIT C THE ASSESSMENT Frontage:(LF) Date: November 2, 2015 Drive Way Width:(LF) Entered By: VN Sidewalk Width:(LF) Quantity PAVING 379.25 SF BASE 430.5 SF SIDEWALK 0 SF CURB & GUTIER 0 LF PAVEMENT PREP. 379.25 SF CLEAR & GRUB 615 SF UNDERGROUND UTL. p 20.5 LF SEWER r LF WATER r LF FIRE HYDRANT ~ 0.1 EA STREET LIGHT ~ 0.1 EA DRIVEWAY APROACH 205 SF SUBTOTAL DESIGN (15%) CONTINGENCY (20%) ASSESS. DISTRICT COST PLAN CHECK INSPECTION TOTAL 12 20.5 20.5 5.5 Cost $664 $301 $0 $0 $190 $215 $3,075 $0 $0 $273 $410 $1,435 $6,563 $984 $1,313 $2,500 $158 $79 $11,597 01/25113 CIVIL CODE§ 1189 A ....,. public or 011&' dlica' ccqllaling tia cartiicalle vtdiae my 1he idBnlily cl1ha ildwiduaJ 'Mio a9wd Ita documanl: 10 which dlia C8l1ilical8 iii aaacltad. and nat tllewdJfUnaaa.. acc:.vacy; (I" vaiclly of dlllt cfoluna1t. Slate of CalifarrWs ) Ccx.my of S o,0 }) ·1 ee;o ) an \\-\~ -rs befclnt me. _·Je...J..:;;;;e=s;..::>:.::.c;A.,_..::....cp....!...· ~ ..:;.ot=J4-1....:..'.:......,,,....· -=-N=cto..::..!,-..:..:.l...lfyj.q,_t.L....;~io::..l, b.....ul~i'c~..-· -~ DBle Here lnaBtt Ntlme fll1d Tdle of 1he Officer paraonally appaanKI Wndo... tv\. Hoe-£e£ god M\cto. eJ L,. Heel€-(' Nsme{I1J af ~ who proved to me en the basia of aalisfactory evidiBnce to be the pen!ICII'1(a) whose nama(B) ~ subacribed to tha within inBirumalt ..:I acknowledgad to me that ~ aucuted the sane in bialherllhair IILIIhDrizad capacilyfiiBIB). and thai: 17;' hiBI'hlr.Ah8ir llignalura(B) on the inalrumenl the paraon(B). or the entity upon behalf of which the pan!Ofl(a) aclad, axac:ul:ad the ir&na'nanL I CBftify undar PENM.TY OF PERJURY Wldar the lawa of the stsla of California that tha faregoing paragraph ia true IWid !COIRICL WITfoESS my hand and official aaaL ~gnm-~ Rft\, SignsfuRt of No filly Public -----------------------------~-----------------------------Though lhis aec&n Ia options/. compleling thit infonnsfion can d&taf' sll&nllion of lhe cloc:ument or ftautblent ~.mant af thia fonn fD an unintsnded dDciRnsnt Description of Atlacbed Document TIHB « Type of Doc:um8nt: Document Data: ------- N...-nbw of Pagaa: Signar(B) Other Than Named Above: ------------ Capacil:y(ieal Claimed by Signer(a) ~·Nam~-------------0 CorpondB Officer -TiUB4a): ------ 0 Partner -0 Umited 0 General 0 l!'ldivid!JBI 0 Atlomay in Fact 0 Truslse 0 Guarcian or Conaavslor Oother: ____________ _ ~gner Ia Rapreaenting: -------- ~gner·a Nama: ___________ _ 0 CorpondB Officer -TiUB4a): ------ 0 Partner -0 Umited 0 General 0 Individual 0 Attomay in Fact 0 Truslse 0 Guarcian or Conaavslor OOlhr. ___________ _ ~gner Ia Rapn188nting: -------- 02014 National Nolary Aaaociation • www.NaticndNolary.org • 1-BOO-US NOTARY (1-800-878-6827) ltam 15907 Ul/2)/lJ 13 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 • A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of Cali~rnia ) County of .:JO I'\ Dt e -%2 ) on <XJf\IAC{~ U,()ol~ before me, J2!Jf1i!J0f :Jo(J~ Nofar~ Pu!JIC Date Here Insert Name and Title of the Officer peffion~~ appeared ~~~~~~~~~~~-~-·~~=~~~~e~~~~~~~~~~~~~~ Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their 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. [ .............................................. , • ............. n .... R"oXANNE"jof.Jes······ COMM.#2107902 ~ NOTARY PUBLIC • CALIFORNIA !i SAN DIEGO COUNTY N l ComnillionExpiresApril20. 20191 WITNESS my hand and official seal. , ....... .,.::lf.-·.-.·.·-·.,.-... ·.·-·-·-·:.-••• -• .,.-••• -.-.----·:.·-·-····'\·.·-·-·-···-·-·-·- Place Notary Sea/ Above Signature _l< ............... "ftl~..,....Mt~"LL""--\C-..J--,hr=-V.--'-y<-(/~--- Signature &fNotary Publrc ------------------------------OPTIONAL------------------------------ Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: _______ _ Number of Pages: Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ___________ _ Signer's Name: ___________ _ 0 Corporate Officer -Title(s): ______ _ 0 Corporate Officer -Title(s): ______ _ 0 Partner-0 Limited 0 General 0 Partner - 0 Limited 0 General 0 Individual 0 Attorney in Fact 0 Individual 0 Attorney in Fact 0 Trustee 0 Guardian or Conservator 0 Trustee 0 Guardian or Conservator 0 Other: ______________ _ 0 Other: _____________ _ Signer Is Representing: ________ _ Signer Is Representing: ________ _ • ©2014 National Notary Association • www.NationaiNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907