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CITY OF CARLSBAD
MINOR PUBLIC WORKS CONTRACT
NEW FLOORING AT STAGECOACH COMMUNITY CENTER: CONT. NO. 4723
This agreement is made on the {'j -\1) day of (X:k::f;eC , 2016, by the City
of Carlsbad, California, a municipal corporation, (hereinafter called "City"), and Mobile Carpet Club, Inc., a
California corporation whose principal place of business is 518 W. Washington Ave., Escondido, CA 92025
(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 Carlsbad
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: Michael O'Brien
(City Project Manager)
WAGE RATES. The general prevailing rate of wages for each craft or type of worker needed to execute
the Contract shall be those as determined by the Director of Industrial Relations pursuant to Sections 1770,
1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the
applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said
specified prevailing rates of wages to all workers employed by him or her in execution of the Contract.
Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code
and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act."
The City Engineer is the City's "duly authorized officer" for the purposes of section 4107 and 4107.5.
The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the
Contract for work.
A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the
requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract
for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5.
This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations.
Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which
generally requires keeping accurate payroll records, verifying and certifying payroll records, and making
them available for inspection. Contractor shall require any subcontractors to comply with Section 1776.
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.
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CENTER CONT. NO. 4723 Page 1 of 9 City Attorney Approved 8/2/2016
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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.
Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to ~n
administrative debarment proceeding wherein the or m be prevented from further bidding on
public contracts for a period of up to five years d that debarme by ana r juris iction is grounds for
the City of Carlsbad to disqualify the Contrac r or sub ntractor om pa · ip ti 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 form approved by the California Insurance Commission.
The certificates shall indicate coverage during the period of the contract and must be furnished to the City
prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted
insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on
the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key
Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of
Insurance Commissioners (NAIC) latest quarterly listings report.
Commercial General Liability Insurance of Injuries including accidental death, to any one person in an
amount not less than ........ $1,000,000
Subject to the same limit for each person on account of one accident in an amount not less than
....... $1,000,000
Property damage insurance in an amount of not less than ........ $1 ,000,000
Automobile Liability Insurance in the amount of $1,000,000 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 Carlsbad as an additional insured. The full limits available to the named
insured shall also be available and applicable to the City as an additional insured.
WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY. Workers' Compensation limits as
required by the California Labor Code. Workers' Compensation will not be required if Contractor has no
employees and provides, to City's satisfaction, a declaration stating this.
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 performance
of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable
law, rules 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
NEW FLOORING AT
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CENTER CONT. NO. 4723 Page 2 of 9 City Attorney Approved 8/2/2016
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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 Work: Contractor agrees to start within ten (10) working days after receipt of Notice to Proceed.
Completion: Contractor agrees to complete work within twenty (20) working days after receipt of Notice to
Proceed.
CONTRACTOR'S INFORMATION.
Mobile Carpet Club, Inc.
(name of Contractor)
531713
(Contractor's license number)
Class C15 exp. 06/30/2018
(license class. and exp. date)
1000003523
(DIR registration number)
6/30/17
(DIR registration exp. date)
Ill
Ill
111
Ill
111
111
Ill
Ill
Ill
NEW FLOORING AT
STAGECOACH COMMUNITY
CENTER CONT. NO. 4723
518 Washington Ave
(street address)
Escondido/CA/92025
(city /state/zip)
760-7 40-9545
(telephone no.)
760-7 40-9648
(fax no.)
denis@carpetclub.com
(e-mail address)
Page 3 of9 City Attorney Approved 8/2/2016
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AUTHORITY. The individuals executing this Agreement and the instruments 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 terms and conditions of this Agreement.
CITY OF CARLSBAD, a municipal corporation
of the State of California
By:
If required by City, proper notarial acknowledgment of execution by Contractor must be attached. lf....g
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
Secretary,
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:
CELIA A. BREWER, City Attorney
BY: CL.ize~
Deputy City Attorney
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CENTER CONT. NO. 4723 Page 4 of 9 City Attorney Approved 8/2/2016
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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 the
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 for 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. of the
California Public Contract Code). ·
If no subcontractors are to be employed on the project, enter the word "NONE."
SUBCONTRACTORS
Portion of Project to Business Name and Address DIR Registration License No., %of
be Subcontracted No. Classification & Total
Expiration Date Contract
Nm~
Total% Subcontracted: _ .. _-ty;;;..· ____ _
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EXHIBIT B
The contractor will provide all equipment, materials and labor necessary to install new carpet, base and
vinyl in the City's Stagecoach Community Center located at 3420 Camino de los Coaches in Carlsbad.
This includes but not limited to demolition and removal of existing carpet, base, removal of old adhesive
and floor sand/fill (as needed}, applying of new adhesive, professional placement of new Contractor
provided carpet, base and vinyl. Contractor will clean-up all work spaces after each day of work/installation.
Furniture will be removed prior to installation and replaced after installation by City staff, but Contractor will
be responsible for moving and replacing furniture as needed per the direction of the Project Manager. Work
item description is as follows:
Item 1: Remove and replace carpet and base in front entry lobby, reception, front office and hall.
Skim coat and install vinyl over existing tile in entry lobby and bathroom entry.
Demo:
Prep:
Prep:
Material:
Labor:
Base:
Post:
Labor for carpet and base removal/recycle all eligible materials.
Floor prep to remove old glue if needed, fill holes, remove old adhesive, sand as needed
and apply new adhesive (Mannington Revol-133016 or equivalent).
Entry floor prep: sand and skim coat, fill holes, remove old adhesive if needed and apply
new adhesive (Mannington Revol -133016 or equivalent).
Provide Shaw double knit carpet: (color: Sterling) and Shaw Uncommon Whiskey Lobby Entry
and Bathroom Entry Vinyl Tiles or equivalent.
Labor to install carpet and vinyl (includes adhesive and reducers/transitions).
Labor and material to install new Burke 4" wall base and transitions (color: Mocha).
Clean flooring debris.
Item 2: Remove, sand, skim coat and replace vinyl in two (2) classrooms (and entry)
Demo:
Prep:
Materials:
Labor:
Base:
Post:
Labor for vinyl and base removal/recycle all eligible materials.
Floor prep: sand and skim coat, fill holes, remove old adhesive if needed and apply new
adhesive (Mannington Revol-133016 or equivalent).
Provide Shaw Uncommon Ground vinyl (color: Weathered Cherry) or equivalent.
Labor to install vinyl and adhesive.
Labor and material to install new Burke 4" wall base (color: Mocha) and transitions.
Clean flooring debris.
Item 3: Skim coat and install vinyl over existing side entrance tile
Prep: Side Entry Floor prep: sand and skim coat, fill holes, and apply new adhesive
(Mannington Revol-133016 or equivalent).
Material: Provide Shaw entry vinyl tiles (color; Uncommon Whiskey) Lobby Entry Vinyl Tiles or
equivalent.
Labor: Labor to install vinyl (and adhesive) of vinyl floor tiles.
Base: Labor and material to install new Burke 4" wall base and transitions, (color: Mocha) or
equivalent.
Post: Clean flooring debris
Item 4: Remove and replace carpet and base in back office and back hall. Skim coat and lay
vinyl over existing tile in restroom back entrance
Demo:
Prep:
Material:
Labor:
Base:
Post:
Labor for vinyl and base removal/recycle all eligible materials.
Floor prep: sand and skim coat, fill holes, remove old adhesive if needed and apply new
adhesive (Mannington Revol-133016 or equivalent).
Provide Shaw Uncommon Gray Classroom tiles or equivalent.
Labor to install vinyl and adhesive.
Labor and material to install new Burke 4" wall base and transitions (color: Mocha) or
equivalent.
Clean flooring debris.
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CENTER CONT. NO. 4723 Page 6 of9 City Attorney Approved 8/2/2016
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Item 5: Remove existing vinyl floor in gym restroom hall, skim coat and lay new vinyl
Prep: Floor prep to remove old vinyl, sand, fill holes if needed, remove old adhesive if needed
and apply new adhesive (Mannington Revol-133016 or equivalent).
Material: Provide Shaw Uncommon Gray Entry Tiles (color: Weathered Cherry) or equivalent.
Labor: Labor to install vinyl (and adhesive) of vinyl floor tiles.
Base: Labor and material to install new Burke 4" wall base and transitions (color: Mocha) or
equivalent.
Post: Clean flooring debris.
JOB QUOTATION
ITEM UNIT QTY DESCRIPTION PR1CE
NO.
1 LS 1 Remove and Replace Carpet, Base and Vinyl in Lobby, Hall, $10,116.00
Reception and Office
2 LS 1 Remove and Replace vinyl in Classrooms $8,671.00
3 LS 1 Skim Coat and Install Vinyl at Back Entrance
$1,375.00
4 LS 1 Back Office/Hall Carpet and Vinyl Replacement. Skim Coat and
Install Vinyl at Back Bathroom Entrance $7,325.00
5 LS 1 Gym Bathroom Entry Floor Vinyl Replacement
$1,540.00
TOTAL* $29,027.00
*Includes taxes, fees, expenses and all other costs.
NEW FLOORING AT
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CENTER CONT. NO. 4723 Page 7 of 9 City Attorney Approved 8/2/2016
Premium will be adjusted
based on final contract price
EXHIBIT C
LABOR AND MATERIALS BOND
Bond No. CE11511100071
Premium: $726.00
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WHEREAS, the City Council of the City of Carlsbad, State of California, has awarded to Mobile Carpet
Club, Inc., a California corporation (hereinafter designated as the "Principan, a Contract for:
NEW FLOORING AT STAGECOACH COMMUNITY CENTER
CONTRACT NO. 4723
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 matenals,
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, MOBILE CARPET CLUB, INC., as Principal, (hereinafter designated as the
"Contractor"), and Philadelphia Indemnity Insurance Company as
Surety, are held firmly bound unto the City of Carlsbad in the sum of twenty nine thousand twenty seven
dollars ($29,027.00), 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
NEW FLOORING AT
STAGiCOACH COMMUNITY
CENTER CONT. NO. 4723 Page 8 of 9 City Attorney Approved 8/212016
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In the event that Contractor is an individual. it is agreed that the death of any such Contractor shall not
exonerate the Surety from its obligations under this bond.
Executed by CONTRACTOR this ~Jh
day
of a cJ c) bsll ' 20~
CONTRACTOR:
By:-----~--:---,--------(sign here)
(print name here)
(title and organization of signatory)
Executed by SURETY this 28th day
of September , 20~.
SURETY:
Philadelphia Indemnity Insurance Company
(name of Surety)
4050 Crums Mill Road #201, Harrisburg, PA 17112
(address of Surety)
717-540-2837
(telephone number of Surety)
(printed name of Attorney-in-Fact)
(attach corporate resolution showing current power of
attorney)
(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
City Attorney By:~
Deputy City Attorney
NEW FLOORING AT
STAGECOACH COMMUNITY
CENTER CONT. NO. 4723 Page 9 of9 City Attorney Approved 8/2/2016
CALIFORNIA ALL-PURPOSE 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 San Diego
On Sepember 28, 2016 before me, Pam Davis , Notary Public,
Date ----c-1 n-se-rt-:-N:-am_e_o_f :..cNo-'-'ta-=ry::...ce::...cxa'-'-ct:..cly_a_s i:-t a-p-pe-ar-s-on-t.,-he-o-::-:ffi,.....cia-:-1-se-al:----
personally appeared Anne Wright
Place Notary Seal Above
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.
~itness my ha(n .. ~·
S1gnature \ , ~ 'JIA,.b-~
Signature of Notary Public Pam Davis
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of the 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(s)
Signer's Name: _____________ _
0 Individual
0 Corporate Officer -Title( s ): ________ _
0 Partner 0 Limited 0 General
[ti Attorney in Fact
0 Trustee
0 Guardian or Conservator
0 Other: _______ _
Signer is Representing:
RIGHT THUMBPRINT
OF SIGNER
Top of thumb here
Signer's Name: _____________ _
0 Individual
0 Corporate Officer -Title(s): ________ _
0 Partner 0 Limited 0 General
0 Attorney in Fact
0 Trustee
0 Guardian or Conservator
0 Other: _______ _
Signer is Representing:
RIGHT THUMBPRINT
OF SIGNER
Top of thumb here
PHILADELPHIA INDEMNITY INSURANCE COMPANY
231 St. Asaph's Rd., Suite I 00
BaJa Cynwyd, P A 19004-0950
Power of Attorney
1033
KNOW ALL PERSONS BY THESE PRESENTS: That PHILADELPHIA INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint CYNDJ BEILMAN, ANNE WRIGHT AND DANA MICHAELIS
OF SURETY ASSOCIATES OF SOUTHERN CALIFORNIA INSURANCE SERVICES, its true and lawful Attorney-in-fact with full authority to execute on its
behalf bonds, undertakings, recognizances and other contracts of indemnity and writings obligatory in the nature thereof, issued in the course of its business and to bind
the Company thereby, in an amount not to exceed $25,000,000.00.
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMNITY INSURANCE COMPANY at a meeting duly called the I '1 day of July, 201 I.
RESOLVED:
FURTHER
RESOLVED:
That the Board of Directors hereby authorizes the President or any Vice President of the
Company to: (I) Appoint Attorney(s) in Fact and authorize the Attomey(s) in Fact to
execute on behalf of the Company bonds and undertakings, contracts of indemnity and
other writings obligatory in the nature thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time, any such Attorney-in-Fact and revoke the
authority given. And, be it
That the signatures of such officers and the seal of the Company may be affixed to any
such Power of Attorney or certificate relating thereto by facsimile, and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and binding upon the Company in the future with the respect to any bond or
undertaking to which it is attached.
IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND
ITS CORPORATE SEAL TO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS I 0'11 DAY OF JUNE 2013.
(Seal)
Robert D. O'Leary Jr., President & CEO
Philadelphia Indemnity Insurance Company
On this I O'" day of June 2013, before me came the individual who executed the preceding instrument, to me personally known, and being by me duly sworn said that he
is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY; that the seal affixed to said instrument is the
Corporate seal of said Company; that the said Corporate Seal and his signature were duly affixed.
COf1!:10NWeA!.TH OP PENNSYLVAN~
Nottrillseal
Kimtl«1y A. K""lt<ld, Notary Public
LOWffc:r.~~~~.(=
Mf:MIER., PfHNSYl. VAN~ MsSOC!AllOO Cl NOTAAI!.S.
(Notary Seal)
Notary Public:
residing at: BaJa Cynwyd PA
My commission expires: December I 8 2016
I, Edward Sayago, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do herby certifY that the foregoing resolution of the Board of
Directors and this Power of Attorney issued pursuant thereto on this I OTI 1 day of June 2013 true and correct and are still in full force and effect. I do further certifY that
Robert D. O'Leary Jr., who executed the Power of Attorney as President, was on the date of execution of the attached Power of Attorney the duly elected President of
PHILADELPHIA INDEMNITY INSURANCE COMPANY,
In Testimony Whereof! have subscribed my name and affixed the facsimile seal of each Company this 28th day of September , 20_16_.
Edward Sayago, Corporate Secretary
PHILADELPHIA INDEMNITY INSURANCE COMPANY
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;? l'l ·
County of :::.a 1/1 Uf;} v
On _---L.../}=J-f/--=s-~1-=-~-t?_/_0 __ before me,
)
(insert name and titl of the office I I ~ffiooal~ap~ared ___ ~~e~n-~_1!_·~~~~~~·-b~·~e-~------------~
who proved to me on the basis of satisfactory evidenc 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.
WITNESS my hand and official seal.
{Seal)