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HomeMy WebLinkAboutSolar Heating Specialists Inc; 2014-10-14; PWM15-15PEMPWM15-15PEM CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT ALGA NORTE COMMUNITY PARK SOLAR THERMAL REPAIRS CONTRACT NO. 10081 This agreennent is made on the /^"^ day of Qc^ob^Ar 2014, by the City of Carlsbad, Califomia, a municipal corporation, (hereinafter called "Gity"), and Solar Heating Specialists, Inc., a California corporation, whose principal place of business is 1350 Dodson Way, Riverside, CA 92507 (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 fumished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Jesse Zunke (City Project Manager). PREVAILING WAGES NOT REQUIRED. The City of Carlsbad is a Charter City. Carlsbad 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 COIVIIVIUNITY PARK Page 1 of 7 City Attorney Approved 2/7/13 SOU\R THERMAL REPAIRS CONT. NO. 10081 PWM15-15PEM Contractor hereby acknowledges that the filing of a false daim 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 Carlsbad to disqualify the Contractor or su^entractor from partipipating in contract bidding. Signature: Print Name: j/_ / -^^'^j^r^ ^^ypWgU 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 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 work. 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 Cartsbad 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 perfbrmance of the Contract or worit; or from any failure or alleged faiiure 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 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, Califomia. Start Work: Contractor agrees to start within five (5) working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within five (5) working days after receipt of Notice to Proceed. ALGA NORTE COMMUNITY PARK Page 2 of 7 City Attomey Approved 2/7/13 SOLAR THERMAL REPAIRS CONT. NO. 10081 PWM15-15PEM CONTRACTOR'S INFORMATION. SOLAR HEATING SPECIALISTS, INC 1350 DODSON WAY (name of Contractor) 337656 (street address) RIVERSIDE, CA 92507 (Contractor's license number) C36 Plumbing, C46 Solar (city/state/zip) 951 781-6520 (license class, and exp. date) Exp 12/31/15 (telephone no.) (fax no.) emery@warmpools.com (e-mail address) 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. CONTRACTOR SOLAR HEATING SPECIALISTS, INC., a Califomia corporation CITY OF CARLSBAD, a municipal corporation of the State of Califomia anfe/titi (print nanie/titie tk (print name/titl^^^^^^^ Assistant City Manager, Deputy City Manager or Doportmont Diroctor as authorized by the City Manager Kathryn B. Dodson ATTEST: BARBARA ENGLESON City Cleri< If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corooration. Agreement must be signed by one corporate officer from each of the fbllowing 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: CELIAA. BREWER, CityAttomey BY: Assistant City Attomey \ ALGA NORTE COMMUNITY PARK SOLAR THERMAL REPAIRS CONT. NO. 10081 Page 3 of 7 City Attomey Approved 2/7/13 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE §1189 State of California K)\)ll4^dJl County of } before me, Date Here Insert Name and Title of thk Officer personally appeared 7 u Name(s) of Signer(s) (J 1 X. CAMACHO Commistkm # 1966640 Notary PubNc • CHifoniia ^ San Diago Coim^ | Place Notary Seai Above who proved to me on the basis of satisfactq[v evidence to be the persoc^p whose name(^ is^^ subscribed to the within instrument and acknowledged to me that •-+»e/sb^^$> executed the same in bis/her/r^pl^authorized capacitijf^O? and that by bis/be^^^ signatur^^ on the instrument the persoim^or the entity upon behalf of which the perso™?^cted, 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 m: Signature: OPTIONAL ynature of Notary Public Tfiough 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 Attaohed Document Cj"H Dvf CUl l^^Cid. Title or Type of Document: ^nO<>llamCUml^ CmtCtChpocumenX Date: ^-^3^}+- Number of Pages: "/ Signer(s) Other Than Named Above: A/ ^^Vl£- Capacity(ies) Claimed by Signer(s) f> Signer's Name: ficer-Cq^itlefs): Sr^XAJl^FoVu v^.y,.... w •. . . • ...^ ^ Signer's Name: "^Corporate Officer — Titlefe): SJHS^vf- Corporate Officer —yitle(s): • Partner — • Limited • General • Partner — • Limited • General • Individual • Attorney in Fact • Individual • Attorney in Fact • Trustee • Guardian or Conservator • Trustee • Guardian or Conservator y • other: • Other: Signer Is Representing: Signer Is Representing: © 2013 National Notary Association • www.NationalNotary.org • 1 -800-US NOTARY (1 -800-876-6827) Item #5907 Check a License - License Detail - Contractors State License Board Page 1 of 2 DEPARTMENT OF CONSUIWER AFFAIRS . Contractors State License Board Contractor's License Detail - License # 337656 DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. 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 of the 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 Bonding 337656 Extract Date 8/19/2014 SOLAR HEATING SPECIALISTS INC Business Phone Number: (951) 781-6520^ 1350 DODSON WAY RIVERSIDE, CA 92507 Corporation 07/01/1977 12/31/2015 ACTIVE This license is current and active. All information below should be reviewed. CLASS 036 C46 DESCRIPTION PLUMBING SQLAR CONTRACTOR'S BOND This license filed a Contractor's Bond with AMERICAN CONTRACTORS INDEMNITY COMPANY. Bond Number: 100059632 Bond Amount: $12,500 Effective Date: 12/19/2008 Contractor's Bond Histon/ BOND OF QUALIFYING INDIVIDUAL https://www2.cslb.ca.gov/0nlineServices/ClieckLicensell/LicenseDe... 8/19/2014 Check a License - License Detail - Contractors State License Board Page 2 of 2 1. The Responsible Managing Officer (RMO) OSGOOD EMERY PERLEY JR certified that he/she owns 10 percent or more of the voting stock/equity ofthe corporation. A bond of qualifying individual is not required. Effective Date: 07/28/2008 2. The Responsible Managing Officer (RMO) PIRNIE DAVID MICHAEL certified that he/she owns 10 percent or more ofthe voting stock/equity ofthe corporation. A bond of qualifying individual is not required. Effective Date: 11/16/1982 WORKERS' COMPENSATION This license has workers compensation insurance with GRANITE STATE INSURANCE COMPANY Workers' Compensation Policy Number: WC005564785 Effective Date: 10/01/2012 Expire Date: 10/01/2014 Workers' Compensation History Personnel listed on this license (current or disassociated) are listed on other licenses. Personnel List Salesperson List Other Licenses Conditions of Use | Privacv Policv Copyright © 2010 State of California https://www2.cslb.ca.gov/0nlineServices/CheckLicensell/LicenseDe... 8/19/2014 PWMIS-ISPEM EXHIBITA LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sut)-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 Conti-actor understands that if it fails to specify a sub-contractor for any portion of tiie 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 provistons 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 tiie word "NONE." SUBCONTRACTORS Portion of Project to be Subcontracted Business Name and Address License No., Classification & Expiration Date %of Total Contract Total % Subcontracted: ALGA NORTE COMMUNITY PARK SOLAR THERMAL REPAIRS CONT. NO. 10081 Page 4 of 7 City Attomey Approved 2/7/13 PWMIS-ISPEM EXHIBIT B SCOPE OF WORK: • Fire Damage repairs to the Solar Thermal system at Alga Norte Community Park located at 6565 Alicante Rd. Cartsbad, CA 92009 • Contractor shall include all labor, materials, and equipment necessary to repair the Solar Thermal system. • Conti-actor includes the removal of damaged solar panels, and disposal of the damaged solar panels. • Contractor includes testing the solar thermal system to ensure that it is operating according to its intended design. Price: Not to Exceed (NTE) $45,000 JOB QUOTATION ITEM NO. UNIT QTY DESCRiPTiON PRICE 1 SF Appx. 4800 All Labor and Materials to replace the damaged portions of the Solar Thermal System. $9.25/SF NTE TOTAL* $45,000 'Includes taxes, fee's, expenses and all other costs. ALGA NORTE COMMUNITY PARK SOLAR THERMAL REPAIRS CONT. NO. 10081 Page 5 of 7 City Attomey Approved 2/7/13 PWM15-15PEM EXHIBIT C LABOR AND MATERIALS BOND Bond Number: FBI 1510701654 WHEREAS, tiie City Council of tiie City of Carisbad, State of Califbmia, has awarded to Solar Heating Specialists, Inc. (hereinafter designated as the "Prindpal"), a Contract for ALGA NORTE COMMUNITY PARK SOLAR THERMAL REPAIRS CONTRACT NO. 10081 in the City of Cartsbad, in strict confonnity with ttie drawings and specifications, and ottier Contract Documents now on file in the Office of tiie City Cleric ofttie City of Cartsbad and all of which are incorporated herein by tills reference. WHEREAS. Principal has executed or is about to execute said Contiact and tiie temis ttiereof require ttie fumishing of a bond, providing tiiat if Principal or any of its subcontractors shall fail to pay fbr any materials, provisk)ns, provender or ottier supplies or teams used in, upon or about the perfbrmance ofthe work agreed to be done, or for any wortc or labor done ttiereon of any kind, the Surety on this bond will pay ttie same to the extent hereinafter set fortti. NOW. THEREFORE. WE. SOLAR HEATING SPECIALISTS. INC.. as Principal, (hereinafter designated as ttie "Contractor"), and Philadelphia Indemnitv Insurance Companv as Surety, are heW finnly bound unto ttie City of Cartsbad in the sum of Forty Five Thousand Dollars ($45,000), sakl sum being an amount equal to: One hundred percent (100%) of ttie total amount payable under ttie terms of ttie Conttact by ttie City of Cartsbad, and for whfch payment well and tiiily to be made we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointiy and severally, finnly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH tiiat if ttie Contactor or his/her subconttactors fail to pay for any materials, provisions, provender, supplies, or teams used in, upon, for, or about the perfbmiance of ttie wortc conttacted to be done, or fbr any ottier wortc or labor thereon of any kind, consistent witti California Civil Code section 9100, or for amounts due under the Unemptoyment Insurance Code witti respect to tiie wortc or labor performed under this Conttact. or for any amounts required to be deducted, wittiheld, and paid over to ttie Employment Development Department from the wages of employees of the contractor and subconttactors pursuant to section 13020 of ttie Unemployment Insurance Code witfi respect to ttie woric and labor, that ttie Surety will pay for tiie same, and, also, in case suit is brought upon tiie bond. reasonat>le attomey's fees, to be fixed by the court consistent with Califomia Civil Code section 9554. This bond shall inure to the benefit of any of the persons named in Califomia Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon ttie bond. Surety stipulates and agrees that no change, extenston of time, alteration or addition to the terms of the Conttact. 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, extenston of time, alterations or addition to ttie tenns of tiie contract or to the woric or to tiie specifications. ALGA NORTE COMMUNrTY PARK Page 6 of 7 City Atlomey Approved 2/7/13 SOLAR THERMAL REPAIRS CONT. NO. 10081 PWMIS-ISPEM In the event that Contractor is an Individual, it is agreed that the death of any sucjh Contractor shall not exonerate the Surety from its obligations under this bond. Executed by CONTRACTOR ttiis day Executed by SURETY ttils. of *5g|9/iWtbt/^ _.20_i^. of .September Sth .day _.20 14 CONTRACTOR: Solar Heating Specialists, Inc. ame of Ccxitractor) SURETY: Philadelphia Indemnity Insurance Companv (name of Surety) 251 S Lake Avenue, Suite 360. Pasadena. CA 91101 (address of Surety) I die"A/ ) 626-639-1326 (print name here) (tifle and org< lamizatton m^natc inatory) (sign here, of Attomey-in -Fat:t) Michael Herranen (print name here) (titie and organizattorgof signatory) (printed name of Attomey-in-Fact) (attach corporate resolution showing current power of attomey) (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 onty one ofiicer signs, the corporation must attach a resolution certified by the secretary or assistant secretary uncler corporate seal empowering that ofiicer to bind the corporation.) APPROVED AS TO FORM: CELIAA. BREWER City Attomey BV: }^Ok(SL AssistanTcity Attomey \ ALGA NORTE COMMUNITY PARK SOLAR THERMAL REPAIRS CONT. NO. 10081 Page 7 of 7 City Attomey Approved 2/7/13 STATE OF Arizona COUNTYOF Maricopa ] , fjefo/e me,. Elizabeth Dekarske, Notary Of, 09/08/2014 (here insert name and tiSe of the officer), personally appeared Michael Herranen, Attorney:l n_-Fact personally l<nown to me (or proved to me on the basis of satisfactory mdence) to be ttie person(s) whose naine(s) is/are subscribed to the wiihin instrument and ad<nowledged to me thaf he/she^^ executed the same in his/her/their authorized capacity(ies), and mat by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the personfs) acted, executed the instrument. WITNESS my hand and official seai Sigiature___. (SEAL) Elizabeth Dekarske Notary Publlc-Arizona Maricopa County My Commiuion Expire* October 21,2014 This area for Official Notarial Seal m 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. CAPACfTY CLAIMED BY SIGNER INDIVIDUAL CORPORATE OFFICER • PARTNER(S) LJ LIMITED • GENERAL [Il ATTORNEY-IN-FACT TRUSTEE(S) • GUARDIAN/CONSERVATOR • OTHER: DESCRIPTION OF AmCHED DOCUMENT TITLE OF TYPE OF DOCUMENT NUMBER OFPAQES DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF FERSON(Si OR ENTITVllES) SIGNER(S) OTHER THAN NAMED ABOVE ID-1232 (REV. 12/05) ALL-PURPOSE ACKNOWLEDGEMENT 3961 PHILADELPHIA INDEMNITY INSURANCE COMPANY 231 St. Asaph's Rd., Suite 100 Bala Cynwyd, PA 19004-0950 Power of Attorney KNOW ALL PERSONS BY THESE PRESENTS: that PHILADELPHU. INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and existing under the laws ofthe Commonwealth of Pennsylvania, does hereby constitute and appoint i Kevin R. Cathcart, Steven A. SwartZ, Kelly Specht, Lorie Mandel, and Nicki Swartz, Michael Herranen and Thomas C. Buckner ofthe City of San Clemente, State of California; its true and lawful Attomey(s) 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 amoimt not to exceed i$25,000,000.00 j This Power of Attomey is granted and is signed and sealed by facsimile under and by the authority ofthe following Resolution adopted by the Board of Directors of PHILADELPHIA INDEMNITY INSURANCE COMPANY at a meeting duly called the 1" day of July, 2011. RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the Company to: (1) Appoint Attomey(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 obUgatoiy in the nature thereof and to attach the seal of the Company thereto; and (2) to remove, at any time, any such Attomey-in-Fact and revoke the authority given. And, be it FURTHER RESOLVED: That the signatiu-es of such officers and the seal of the Company may be affixed to any such Power of Attomey or certificate relating thereto by facsimile, and any such Power of Attomey so executed and certified by facsimile signatures and facsimile seal shall be valid and biding 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 SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 7™ DAY OF FEBRUARY 2013. (Seal) Robert D. O'Leary Jr., President & CEO Philadelphia Indemnity Insurance Company On this 7* day of February 2013, before me came the individual who executed the preceding instrument, to me personally known, and being by me duly swom said that he is the therein described and authorized officer ofthe 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. NOWRW-SEAt OAWEUE PORAm NdliijrPiMe Notary Public: (Notary Seal) residing at: My commission expires: Bala Cvnwvd. PA Mareh22.2016 I, Craig P. Keller, Executive Vice President, Chief Financial Officer and Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do herby certify that the foregoing resolution ofthe Board of Directors and this Power of Attomey issued pursuant thereto are 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 Attomey as President, was on the date of execution of the attached Power of Attomey the duly elected President of PHILADELPHIA INDEMNITY INSURANCE COMPANY, In Testimony Whereof I have subscribed my name and affixed the facsimile seal ofeach Company this day of ^^..pl^iYllQC^^. '^^lA Craig P. Keller, Executive Vice President, Chief Financial Officer & Secretary PHILADELPHIA INDEMNITY INSURANCE COMPANY CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE §1189 County On } State of California of ^^OmMA^iefore me, X ^ G^^Cib ^ iQgl^VU vjl^^ Here Insert Name and Title of he^Officer I {JN^I Date personally appeared Name(s) of Signer(s) JLCMNACHO Commitsion # 1966640 Nolary P^-CaiHomia SM Oiaoe CouMy ^ ftCowm. Bcpirat Ja« 14.20161 Piace Notary Seai Above who proved to me on the basis of satisfactorv evidence to be the perso(^5;>vhose namej^ ig^re^ subscribed to the within instrument and acknowledged to me that he/she^fRlyliexecuted the same in H=>ts/her>t^^?authorized capacity^^lp and that by his/hetr^^ signatur^^on the instrument the person^^or the entity upon behalf of which the person^^cted, 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 Signature: 'nature of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an uriintended document. nent ot tnis torm to an utiini Description of Attached Document M'' 1^^^^ Title or Type of Document: hYth) kitC/SUi0tf 6m^Document Date: ^-(7^-^/^ Number of Page^ fT^V^^^^^g^^^J'^^^^^^^ Named Above: Capacity(les) Claime Signer's Name: Signerfs) by sign( ,a^orporate Officer — Title(s): • Partner — • Limited • General • Individual • Attorney in Fact n Trustee • Guardian or Conservator • Other: Signer Is Representing: Signer's Name: /H" Corporate Officer —' • Partner — • Limited • General • Individual • Attorney in Fact • Trustee • Guardian or Conservator • Other: Signer Is Representing: © 2013 National Notary Association • www.NationalNotary.org • 1 -800-US NOTARY (1 -800-876-6827) Item #5907