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Reliabuilt Fence Company; 2014-05-02; PWM14-32PEM
PWM14-32PEM CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT ALGA NORTE FENCE; CONT. NO. 38372 This agreement is made on the e>?A.^^ day of t^X^CJ , 2014, by the City of Carisbad, California, a municipal corporation, (hereinafter called City"), and and Reliabuilt Fence Company, whose principal place of business is 31916 Del Cielo Este #20, Bonsall, California 92003. (hereinafter called "Contractor"). City and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor's proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carisbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Patrick Vaughan (City Project Manager). PREVAILING WAGES NOT REQUIRED. The City of Carisbad is a Charter City. Carisbad Municipal Code Section 3.28.130 supersedes the provisions of the California Labor Code when the public work is not a statewide concern. Payment of prevailing wages is at Contractor's discretion. FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. ALGA NORTE FENCE Page 1 of 5 City Attorney Approved 2/7/13 CONT. NO. 3837 PWM14-32PEM Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debarment by another jurisdiction is grounds for the City of Carisbad to disqualify the Contractor or subcontraptor from particiggtiBfHn contract bidding. Signature: Print Name: REQUIRED iNSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a fom approved by the Califomia Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be fumished to the City prior to the start of wori<. The minimum limits of liability insurance are to be placed with insurers that have: (1) a rating in the most recent Best's Key Rating Guide of at least A-:V and (2) are admitted and authorized to transact the business of insurance in the State of Califomia by the Insurance Commissioner. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than $500,000 Subject to the same limit for each person on account of one accident in an amount not less than $500,000 Property damage insurance in an amount of not less than $100,000 Automobile Liability Insurance in the amount of $100,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non-scheduled. The automobile insurance certificate must state the coverage is for "any auto" and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that thirty (30) days written notice shall be given to the City prior to such cancellation. The policies shall name the City of Carisbad as an additional insured. INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the perfomiance of the Contract or wori<; or from any failure or alleged failure of Contractor to comply with any applicable law, ailes or regulations including those related to safety and health; and from any and all claims, loss, damages. Injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys' fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Wori<: Contractor agrees to start within (5) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete wori< within (4) & (5) worthing days after receipt of Notice to Proceed. ALGA NORTE FENCE Page 2 of 7 City Attomey Approved 2/7/13 CONT. NO. 38372 PWM14-32PEM CONTRACTOR'S INFORMATION. RELIABUILT FENCE COMPANY (name of Contractor) 948809 (Contractor's license number) C13-6/30/14 (license class, and exp. date) (name of Contractor) 31916 DEL CIELO ESTE #20 (street address) BONSALCA 92008 (city/state/zip) 760 295 8776 (telephone no.) 760 295 0678 (street address) (e-mail address) AUTHORITY. The individuals executing this Agreement and the instmments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the temis and conditions of this Agreement. CONTRACTOR RELIABUILT FENCE COMPANY (sign here) (print name/titl By: (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of Califomia By: Assistant City Manager, Deputy City Manappr or Dopartmont Director as authorized by the City Manager Kathy Dodson EST: BARBARA EN(BLE1S0N City Cleric If required by City, proper notarial acknowledgment of execution by Contractor must be attached. |f_a corporation. Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Seaetary, /Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIAA. BREWER, City Attorney^ BY: V M. DrMzvvcr^, Ol Assistant City Attorney ALGA NORTE FENCE CONT. NO. 38372 Page 3 of 7 City Attomey Approved 2/7/13 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT Stateof California County of -M^m'i- before me, lY^ CMc I Pf O-V^^ AJcWP^Iofcr. ^ ~~ (fter j insert name and title of the officer) Tj personally appeared who proved to me on the basis of satisfactory evidence to be the personf^^hose namei^^lysj^lre subscribed to the within instrument and acknowledged to me thatdig/sne/thcy execuled the same in^^ismer/their authorized capacity(iie^and thatj)>(^j^er/their signature^sfon the instrument the personjfs^r the entity upon behalf of which the person^^^ted, executed the instrument. I certify under PENALTY OF PERJURY under the iaws of the State of Califomia that the foregoing paragraph is true and correct. WITl^SS m>^hand4iid.»fflcial seal. —• Signature o Notary Puhlft / (Notary Seal) MARY PEARSON P Commission # 1887907 C Notary Public - California 1 San Dlego County ^ My Comni. Expires May 1 •^0''^^ ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title ortlescnptjo^ of attached document) fVMnrAT (kiHir "^(4^7 Qj/Mo\ (Title or description of attached document continued) . iDocumentDate^j^ Number of Pages; (Additional information) CAPACITY CLAIMED BY THE SIGNER • Individual (s) • Corporate Officer (Title) • Partner(s) • Attomey-in-Fact • Trustee(s) • Other INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgmenl completed in Califomia must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside ofCalifornia. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as Ihe verbiage does not require the notary lo do something that is illegal for a notary in California (i.e. certifying the authorized opacity ofthe signer). Please check the documenl carefully for proper notarial wording and attach this form ifrequired. • State and County information must be the State and County where the document signer(s) personally appeared before the notaiy public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. }ie/she/th^ is /are) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a suflicient area permits, otherwise complete a different acknowledgment form. • Signature of the notaiy public must match the signature on file with the office of the county clerk. <> Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a diflerent document. <• Indicate title or type of attached document, number of pages and date. <• Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document 2008 Version CAPA vl2.10.07 800-873-9865 www.NotaryClasses.com Check a License - License Detail - Contractors State License Board Page 1 of2 DEPARTMENT OF CONSUMER AFFAIRS . Contractors State License Board Contractor's License Detail - License # 948809 DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware ofthe foiiowing iimitations. CSLB complaint disclosure is restricted by law (B&P 7124.6) If this entity Is subject to public complaint disclosure, a link for complaint disclosure will appear below. Click on the link or button to obtain complaint and/or legal action Information. Per B&P 7071.17 , only construction related civil judgments reported to the CSLB are disclosed. Arbitrations are not listed unless the contractor fails to comply with the terms ofthe arbitration. Due to workload, there may be relevant Information that has not yet been entered onto the Board's license database. License Number Business Information Entity Issue Date Expire Date License Status Classifications Extract Date 2/14/2014 Bonding Workers' Compensation 948809 RELIABUILT FENCE COMPANY Business Phone Number: (760) 295-8776 31916 DEL CIELO ESTE #20 BONSALL, CA 92003 Partnership 06/15/2010 06/30/2014 ACTIVE This license is current and active. All information below should be reviewed. CLASS 013 DESCRIPTION FENCING CONTRACTOR'S BOND This license filed a Contractor's Bond with SURETEC INSURANCE COMPANY. Bond Number: 108732 Bond Amount: $12,500 Effective Date: 06/07/2012 Contractor's Bond Historv WORKERS' COIVIPENSATION This license has workers compensation insurance with WESCO INSURANCE COMPANY Policy Number: WWC3057127 Effective Date: 03/23/2013 Expire Date: 03/23/2014 Workers' Compensation History https://www2.cslb.ca.gov/OnlineServices/CheckLicenseII/LicenseDetaiLaspx?LicNiim=94... 2/14/2014 Check a License - License Detail - Contractors State License Board Page 2 of 2 Personnel List Conditions of Use j Privacv Policv Copyright © 2010 State of California https://www2.cslb.ca.gov/OnlineServices/CheckLicenseII/LicenseDetail.aspx?LicNum=94... 2/14/2014 PWM14-32PEM EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom ttie Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor fbr each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. ofthe Califomia Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to be Subcontracted Business Name and Address License No., Classification & Expiration Date %of Total Contract NONE Total % Subcontracted: ALGA NORTE FENCE CONT. NO. 38372 Page 4 of 7 City Attomey Approved 2/7/13 PWM14-32PEM EXHIBIT B (ENTER SCOPE OF WORK, SPECIFICATIONS, CONTRACTOR'S PROPOSAL, ETC.) JOB QUOTATION ITEM NO. UNIT QTY DESCRIPTION PRICE 1 LF 970' Furnish and install 970 linear feet of 5' tall black vinyl coated chain link fence - commercial grade. End posts with 1-7/8" line post-schedule 40 pipe. 1-5/8" top/bottom rail - schedule 20 pipe at 10' inten/als. 901b concrete, 24" footings. 9 gauge commercial grade wire. All material to be commercial grade. (1) single 4' gate -1-5/8" firame - commercial. (2) pathways to slope area, one at each comer. Planting, inigation and presen/e will not be disturbed. $36,690 TOTAL* $36,690 *lncludes taxes, fee's, expenses and all ottier costs. ALGA NORTE FENCE CONT. NO. 38372 Page 5 of 7 City Attorney Approved 2/7/13 Bond No.: 4395375 Premium: $358.00 PWM14-32PEM EXHIBIT C LABOR AND MATERIALS BOND WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Reliabuilt Fence Company (hereinafter designated as the "Principal"), a Contract for: ALGA NORTE WIRE FENCE INSTALLATION CONTRACT NO. 38372 in the City of Carlsbad, in strict conformity with the drawings and specifications, and other Contract Documents now on file in the Office of the City Clerk of the City of Carlsbad and all of which are incorporated herein by this reference. WHEREAS, Principal has executed or is about to execute said Contract and the terms thereof require the furnishing of a bond, providing that if Principal or any of its subcontractors shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon or about the performance of the work agreed to be done, or for any work or labor done thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth. NOW, THEREFORE, WE, RELIABUILT FENCE COMPANY, as Principai, (hereinafter designated as the "Contractor"), and SureTec Insurance Company as Surety, are held firmly bound unto the City of Carlsbad in the sum of Thirty Six Thousand Six Hundred Ninety Dollars ($36,690), said sum being an amount equal to: One hundred percent (100%) of the total amount payable under the terms of the Contract by the City of Carlsbad, and for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Contractor or his/her subcontractors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the performance of the work contracted to be done, or for any other work or labor thereon of any kind, consistent with California Civil Code section 9100, or for amounts due under the Unemployment Insurance Code with respect to the work or labor performed under this Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and subcontractors pursuant to section 13020 of the Unemployment Insurance Code with respect to the work and labor, that the Surety will pay for the same, and, also, in case suit is brought upon the bond, reasonable attorney's fees, to be fixed by the court consistent with California Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon the bond. Surety stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the work to be performed hereunder or the specifications accompanying the same shall affect its obligations on this bond, and it does hereby waive notice of any change, extension of time, alterations or addition to the terms of the contract or to the work or to the specifications. ALGA NORTE FENCE Page 6 of 7 City Attorney Approved 2/7/13 CONT. NO. 38372 PWM14-32PEM In the event that Contractor is an individual, it is agreed that the death of any such Contractor shail not exonerate the Surety from its obligations under this bond. Executed by CONTRACTOR this. day of 20 ll Executed by SURETY this. of April 21st .day 20 14 CONTRACTOR SURETY: SureTec Insurance Company (name of Contractor)- (sigpr^re) (name of Surety) 3033 Sth Avenue #300, San Diego, CA 92103 (address of Surety) 619-400-4100 id organization of signatory) (telephone number of Surety) By: (title and organii By: sign here) (signature of Attorney-in-Fact) David Melman, Attorney-in-Fact (printed name of Attorney-in-Fact) (attach corporate resolution showing current power of attorney) (print name here) (title and organization of signatory) (Proper notarial acknowledgment of execution by CONTRACTOR and SURETY must be attached.) (President or vice-president and secretary or assistant secretary must sign for corporations. If only one officer signs, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering that officer to bind the corporation.) APPROVED AS TO FORM: CELIA A. BREWER Assistant City Attorney See AttachedAcknowledgment ALGA NORTE FENCE CONT. NO. 38372 Page 7 of 7 City Attorney Approved 2/7/13 POAS: 510242 SureTec Insurance Company LIMITED POWER OF ATTORNEY Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws ofthe State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents make, constitute and appoint Ron H. Ballard, Gloria S. Becerra, Dave B. Roalkvam, David Melman its true and lawfiil Attorney-in-fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for: Five Million and 00/100 Dollars ($5,000,000.00) and to bind the Company thereby as fiilly and to the same extent as if such bond were signed by the President, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attomey-in-Fact may do in the premises. Said appointment shall contmue in force until 12/31/2014 and is made under and by authority of the following resolutions ofthe Board of Du-ectors ofthe SureTec Insurance Company: Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attoraey(s)-in-Fact to represent and act for and on behalf ofthe Company subject to the following provisions: Attorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liabilily thereunder, and any such mstruments so executed by any such Attoraey-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature ofany authorized officer and seal of the Company heretofore or hereafter affixed to any power of attomey or any certificate relating thereto by facsimile, and any power of attomey or certificate bearing facsimile signature or facsnnile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 2(f of April, 1999.) Jn Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its President, and its corporate seal to be hereto affixed this 21st day of March, A.D. 2013. SURETEC INSURANCE COMPANY State of Texas County of Harris ss; On this 21st day of March, A.D. 2013 before me personally came John Knox Jr., to me known, who, being by me duly sworn, did depose and say, that he resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument; that he knows the seal of said Company, that the seal affixed to said instrument is such corporate seal; that it was so affixed by order ofthe Board of Directors of said Company; and that he signed his name thereto by like order. JACQUELYN MALDONADO I •T^^M Notary Public ^*0*Vi, j State ol Texas ^^oF^ My Comm. Exp. 5/18/2017 I Jacquelyn Maldonado, Notary Public My commission expu-es May 18,2017 I, M. Brent Beaty, Assistant Secretaiy of SURETEC INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attomey, executed by said Company, which is still in fiill force and effect; and flirthermore, the resolutions ofthe Board of Directors, set out in the Power of Attomey are in full force and effect. Given under my hand and the seal of said Company at Houston, Texas this 21st day of April 2014 A.D. , Breot Beaty, Assistant Secretary Any Instrument Issued in excess of the penalty stated above is totally void and without any validity. For verification of the authority of this power you may call (713) 812-0800 any business day between 8:00 am and 5:00 pm CST. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of Califomia County of San Diego On 4/21/14 before me, J.E. Theodore , Notary Public personally appeared David Melman 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. J. i. TWiOOORf ' ;-rOMM #1963151 O SAN DlEGO COUNTY ^ My Commission Expires '"rj;cr'FMRF-R9,2015 I certify under PENALTY OF PERJURY under the laws of the state of Califomia that the foregoing paragraph is tme and correct. WITNESS my hand and official seal. -.J>fUd7/y^ 'e of Notary OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER • INDIVIDUAL • CORPORATE OFFICER • PARTNER(S) • MEMBER of LLC 1^ ATTORNEY-IN-FACT • TRUSTEE(S) • GUARDIAN/CONSERVATOR OTHER: SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) DESCRIPTION OF ATTACHED DOCUMENT 4395375 Title or Type of Document Number of Pages Date of Document Signer(s) other than named above CALIFORNIA ALL-PURPOSE ACKNOWLEDQMENT } State of Califomia r...,n.ynl'-nPi\^'\~>\<^Q Date personally appeared OFFICIALSEAL BREANA AGUIRRE 1 NOTARY PUBLIC-CALIFORNIA g COMM. NO. 1976745 SAN DIEGO COUNTY MY COMM. EXP. APR. 29. 2016 j vvho proved to me on the basis of 8ati8fEKA)ry evi^^ be the person^ whose name(s) iskg6 subscribed to the within InstROTient and acknowmdged to me that he^^Ke/lf)^ executed the same in Ns/hiiipi^ aulhorized capacity(te8]Cand that by his^)0l^Hwil'8ignature(^on the instaimera ttie person^, of^he Entity upon behalf of which the perscH)(^ acted, executed the InsbtimenL I certify under PENALTY OF PERJURY under ttie laws of the State of Califomia fliat the foregoing paragraph is true and correct. WITNESS my Plaoe Notary Seal Above Slgnatui OPTIONAL Though the information below is rtot required t)y law, it may prove valuable to persxms relying on the document and OHJklpiwetnimMbJtent removed OKI realkximaa of this kmm n of Attached Document of Document:. ate: Number of Pages: Description of Attadied TWe or Type Document Date: Signer(s) Other Thtin Named Above: Capacity(ie8) daimed by Signei<8) SlgneriB Name: • Individual • Corporale Officer—Title(s): • Partner—•Limited • General • Attomey in Fact • Trustee • Guardian or Conservator • Other: . Signer Is Representing: Ibp of-ltiunib here Signer%Name: • Individual • Corporate Oflioer—Tllie(s): • Partner—•Limited • General • Attomey in Fact •Tmstee • Guardian or Gonsen^tor • Other: •_ Signer Is RepresenMrig: Ibp of thumb here 02007NBIiarnlMtttyAs50Clalion*9350De8atoA»e.,P.O.B(«2402>CI^ Meinf5907 ReaRlerCal'Ri-n«e1-80a«78-68Z7