KASA Construction1
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BIDDER:V,L'Sf1 l ,ons~r~c~on
BID SCHEDULE
SCHEDULE OF PRICES FOR
WALNUT GROVE BEAUTIFICATION AND TRAFFIC CONGESTION IMPROVEMENTS
PROJECT No. P82929
BASE BID SCHEDULE
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
UNIT
CITY.
PRICE
COST
1
Perform Clearing & Grubbing per
LS
1
plans and specifications.
1 I 1
I I
2
Disposal of Waste Materials.
LS
1
50D
750D
3
Remove existing and construct 8-
inch thick PCC Pavement over 6-
SF
600
5
inch CMB over compacted native
as indicated on the plans per
50
1
APWA STD. Plan 132-3.
4
Remove existing and construct 6-
inch PCC curb and 24-inch PCC
LF
120
OD
gutter per APWA STD. Plan 120-2utter per APWA STD. Plan 120-2.
5
Remove, dispose existing and
SF
5,175
construct 6" to 12" Diameter
Yakima River Rock Stone Veneer
by El Dorado Stone or approved
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eas
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Construction at (626) 359-9367.
I 1
Provide sample to City for approval
prior ordering.
6
Install Traffic Striping as indicated
on the plans
LS
1
1
SM)
~b
I
I
'
7
Remove, dispose existing and
LS
1
J~
Install new Landscape and
t!'11 q
~
'
Irrigation per plans and
~
ao
specifications complete.
TOTAL BASE BID PRICE (SCHEDULE BID
Dollar amount in written form ` U
Note: The City of Rosemead reserves the right to reduce or increase the quantities of any items in
the schedule of bid items above, within the limits define in Section 3-2.2.1 of the Standard
Specifications, to stay within the budgeted amount of this project.
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' BIDDER: KIZt l~ n~rylo~
The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which
cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and
' after the bid opening date, or until a Contract forthe Work is fully executed by the Owner and a third
party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the
written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall
' govern.
If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall be
added to or deducted from the Total Bid Price entered above. The owner can choose to
' include one or more of the alternates in the Total Bid Price of the Project. If any of the
Alternate Bids are utilized by the Owner, the resulting amount shall be considered the Total
Bid Price for the Project. _
Att h_ed herejjo is a certified check, a cashier's check or a bid bond in the amount of
L nit Dollars said amount being not less than ten percent (10%) of the Total
' Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
prepared by the Owner for execution, within five (5) Calendar Days following the Letter of Award for
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
' of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
' The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Ownerof Bidder's California contractor's license(s) in good standing; (2) evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
' therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
' Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
and subject to the terms and conditions described in the Contract Form and the Contract
Documents.
' Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be
incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder
further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data
submitted herewith into a contract arising out of this Bid.
' The undersigned acknowledges receipt, understanding and full consideration of the following
' addenda to the Contract Documents.
Addenda Nos. N
1
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1 BIDDER:M(5 n I U~D11
' The Bidder understands and agrees that the Total Bid Price is inclusive of all labor, materials, and
equipment or supplies necessary to complete the Work as described in the Bid Documents. If this
' bid is accepted, the undersigned Bidder agrees to enter into and execute the Contract with the
necessary bonds and accept the Total Bid Price as compensation in full for all Work under the
contract.
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BIDDER: Iby'
By: X l
Sign ture Business Street Address .
YY)
('6fib FCC. qy1 )
Typet Print Name City, State and Zip Code
V) ~f~sid~ml ( Cg) l I-l u-s
Title elephone Number
Bidder's/Contractors State of Incorporation:
Partners or Joint Venturers:
Bidder's License Number(s): "1 yl,7 LH cz l
NOTES:
1) By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the
representations made on the Contract Bid Forms.
2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address
3) If Bidder is a partnership or joint venture, give full names of all partners or joint
venturers.
As further discussed in the Instructions to Bidders, Bidder will be required
to provide evidence that the person signing on behalf of the corporation,
partnership or joint venture has the authority to do so.
V t
CBF - 4
CERTIFICATE OF CORPORATE RESOLUTION
Of
KASA CONSTRUCTION INC.
1, DIANA KASBAR President of KASA CONSTRUC'T'ION INC..
organized and existing under the laws of the State of California and having its principal place of business
at 6339 FELIX CT CHINO CA 91710 . hereby certify that the following is a true copy of a
resolution adopted by the Board of Directors of the Corporation at a meeting convened and held on
NOVEMBER 09. ?009, at which a quorum was present and voting throughout and that such resolution
is now in full force and effect and is in accordance with the provisions of the charter and by-laws of the
Corporation.
RESOLVED : That the DIRECTORS are hereby authorized and directed to certify to any
interested party that this resolution has been duly adopted, is in full force and effect, and is in
accordance with the provisions of the charter and by-laws of the Corporation.
I further certify that this Corporation is duly organized and existing, and has the power to take the action
called for by the foregoing resolution.
DIRECTORS
DIANA KASBAR t 7~, 11-09-09
President j Date
SAM KASBAR 1 11-09-09
Vice President
Date
a
SAM KASBAR 11-09-09
Secretary Date
DIANA KASBAR It1-09-09
Treasurer Date
i
Witness my hand seal of this Corporation on this 9°i day of November 2009
tr,`.. r
ter,:
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SECTION 2
'
BID DATA FORMS
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I BIDDER: ~oJ1 1 a oJV AC~10,()
2.13 LIST OF PROPOSED SUBCONTRACTORS
' In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100
through 4114 of the California Public Contract Code, and any amendments thereto, each
Bidder shall provide the information requested below for each subcontractorwho will perform
' work, labor or render service to Bidder in or about the construction of the Work in an amount
in excess of one-half of one percent (greater than 0.5 of the Bidder's Total Bid Price, or,
in the case of bids or offers for the construction of streets or highways, including bridges, in
excess of one-half of 1 percent of the Contractor's total bid or ten thousand dollars ($10,000),
t whichever is greater, and shall furt her set forth the portion of the Work which will be done by
each subcontractor. Bidder shall list only one subcontractor for any one portion of the Work.
' Pursuant to Public Contract Code Section 4104, the Owner has determined that it will allow
Bidders twenty-four (24) additional hours after the deadline for submission of bids to submit
the information requested by the Owner about each subcontractor, other than the name and
location of each subcontractor.
If the Bidder fails to specify a subcontractor for any portion of the Work to be performed
under the Contract, it shall be deemed to have agreed to perform such portion itself, and
' shall not be permitted to subcontract that portion of the Work except under the conditions
hereinafter set forth below.
' Subletting or subcontracting of any portion of the Work in excess of one half of one percent
(greater than 0.5%) of the Total Bid Price or, in the case of bids or offers for the construction
of streets or highways, including bridges, in excess of one-half of 1 percent of the
' Contractors total bid or ten thousand dollars ($10,000), whichever is greater, for which no
subcontractor was designated in the original bid shall only be permitted in cases of public
emergency or necessity, and then only after Owner approval.
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BIDDER:~Sn r" Ion
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
["Duplicate Next 2 Pages if needed for listing additional subcontractors. *1
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: SUUI'iGI~.~
Address
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: llYl Ct')Lr CC ✓reke
Address 1 /'tYl
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: Yl 1~ ~)n~
Address:
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
CBF-8
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BIDDER:Wffi1q l bA~Lrl
2.C REFERENCES
The following are the names, addresses and telephone numbers for three public agencies for which BIDDER
has performed similar work within the past two (2) years:
I*yU of ~l o
P
~h ~wD Oaa
~d3
~2~b3
1~I
NE
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,
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Named of Owner
lie n t
LAci~~-3311
Name and telephone number of person
familiar with project
a(0-1,1 t03. o~
M&I; an T
j.
gbo--l
Contract amount
Type of W rk
J
Date Completed
2. ~Ji~y~-S 0 n III ge. 1 ob
b v
.fin ~
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f3am
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ddre s of
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IZJ~V~IC/~ y~
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(U)L(A g1~ I-T1DC~lJ
Name and telephone number of person amiliar with project
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Sift
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Contra et air ount
Type of Work
Date Completed
3. C I u V \ l aQ l.~ 6~ I T1WC ~Y11~~LC~ EIJC I IV
Name an^ ddress of Owner \
~PASD-Y-) hiIsmo b
Name and telephone number of person fa iliar with project
Contract am nt Type of Work Date Completed
4. ~';ttU ca m» >n~ 1 In~l Il ~n n «rc~am~iv~J ~p~3
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me anki Address of Owner
Name and telephone number of person familiar with project
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BIDDER: f
SECTION 3
NON-COLLUSION AFFIDAVIT
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BIDDER: 1 I`) - EO'71S~c~IIc ion
NON-COLLUSION AFFICAVIT
In accordance with Public Contract Code Section 7106, the undersigned, being first duly
sworn, deposes and says that he or she holds the position listed below with the bidder, the
party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, association, organization, orcorporation; thatthe
bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced
or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly
colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid,
or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or
indirectly, sought by agreement, communication, or conference with anyone to fix the bid
price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the
bid price, or of that of any other bidder, or to secure any advantage against the public body
awarding the contract of anyone interested in the proposed contract; that all statements
contained in the bid are true; and, further, that the bidder has not, directly or indirectly,
submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged
information or data relative thereto, or paid, and will not pay, any We to any corporation,
partnership, company association, organization, bid "pository, or any member or agent
thereof to effectuate a collusive or sham bid. ~I A
Typed or Printed Name
\i Ce ~~eSicl~
Title
K1s i~ U v) Ucj~ 6n
Bidder
Subscribed and sworn before me
This 2bfi~ day of '~tCAY\ \ (4 , 20 10
Nfif'aTy ublic in and for
e State of California
My Commission Expires: lo' 2$ 2013
(Seal)
f
HECTOR ZAVALA
Commlaalon 1888453
Notary Public - California
Loa Angalea County
M Comm. Ez Ires Oct 28.2013
CBF - 11
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
cecrzrzr.~zre,Enercrch.~cN:F:carer•.er•dczr~.re~.Kr.Gc.~ezrrz~.~re~,ec~r -~rez~ycsz~.ce-r..c4~.~c~r.€r , .
State of California
County of San Bernardino
On i/zo/zolo before me, Hector Zavala, Notary Public
Date Here Insert Name and Tae of the Officer
personally appeared Sam Kasbar
Name(e) of signarfs)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name(a) is/are'subscribed to the
within instrument and acknowledged to me that
he/WNe'/HWexecuted the same in hisM, gf/t AW authorized
HECTOR LIVALA capacity( A), and that by his/Vefffikh signature(4 on the
Commksten ! 1866453 instrument the erson
Nowl public - California p ( or the entity upon behalf of
Los Angeles County which the person(s) acted, executed the instrument.
Comm. Expires Oct 28, 2013
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
WITNESS my han nd fficial seal.
Place Notary Seat Atwve Signature gignntura of Note, Publa
OPTIONAL
Though the information below is not required by law, it may prove vatua le to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
0 Individual
❑ Corporate Officer-Title(s):
CI Partner - D Limited L1 General
11 Attorney in Fact
U Trustee
❑ Guardian or Conservator
i 1 Other:
Signer Is Representing:
gowm Pa.
Top of thumb here
Number of Pages:
Signer's Nay
❑ Individual
❑ Corporate Officer-Title(s): _
G Partner - Limited ❑ General
❑ Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
Ll Other:
Signer Is Representing:
Top Or thumb here
.
02017 Nauonol NOtarY ASSOCiatbn•9a50De sold Aae.,P.0.Sox 2402•CMtsvnM,CA 9131S2402•wew NatipnalNCtery.org Item e5507 Reortlar: CeiITaLFrea 1-&IP8]1P882]
Iffu4m INSCO INSURANCE SERVICES, INC.
t~A~tCO Underwriting Manager for:
= o I Developem Surety and Indemnity Company
Indemnity Company of California
17780 Fitch, Suite 200 • Irvine, Califomis 92614 • (969) 263-3300
BID BOND
KNOW ALL MEN BY THESE PRESENTS,
BOND NO. 2598
That we, Rasa Construction, Inc.
as Principal, and Indemnity Company of California a corporation
authorized to transact a general surety business in the State of CA as Surety, are held and firmly
bound unto City of Rosemead
(hereinafter called the Obligee)
in the full and just sum of TEN PERCENT OF THE AMOUNT OF THE BID
Dollars, $ lox*********
( for the payment whereof in lawful money of the United States, we bind ourselves, our
heirs, administrators, executors, successors and assigns, jointly and severalty, firmly by these presents.
WHEREAS, the said PRINCIPAL has submitted the accompanying bid for
Beautification & Traffic Congestion Improvement
$2009-12
NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a
Contract with the Obligee in accordance with the terms of such bid, or in the event of the failure of the Principal to enter
such Contract, If the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the
amount spaded in said bid and such larger amount for which the Obligee may in good faith contract with another party
to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and
effect.
Signed and Sealed this
18th
day of January 2010
Yrna
Rasa Construction, Inc. Indemnity Company of Cal' ornia
c 1 k (J Sur 1
c
By: 4~1By:
Pdnapal' Attorney-In-Fact
Diana Kasbar - President` Les M. Mantle
110,1198 (Bid Bond) (REV.-pmt)..
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
County of Orange
On before me, Mary Martignoni - Notary Public
Date Here Insert Name and Title of me officer
personally appeared Les M. Mantle
Namefs) of Slgnarts)
tnaoww
MARY MARTIGNONI
COMM. # 1761251
• NOTARY PUBLIC - CALIFORNIA -
ORANCaE COUNTY
M Comm. makes Sept 9,-2011
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:
WITNESS my hand and official seal.
SignatuVe
Place Notary Seal npwe S' re o Notary Public
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 this 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: Les M. Mantle
Signer's Name:
❑ Individual
❑ Individual
❑ Corporate Officer-Title(s):
❑ Corporate Officer-Title(s):
❑ Partner - ❑ Limited ❑ General
❑ Partner - ❑ Limited ❑ General _
•
® Attorney in Fact
❑ Attorney in Fact
'
❑ Trustee Top of thumb here
❑ Trustee Top of thumb here
❑ Guardian or Conservator
❑ Guardian or Conservator
❑ Other:
❑ Other:
Signer Is Representing:
Signer Is Representing:
Indemmity Company of
_
California
02007 National Notary Aseoaaton•!XK0 De Seto Ave.,P.0.9ov 2402•CbelswoNh.GA 913132402• ev,vNetionalNotaryorg Item 45907 Reorder Ca0TOlifree L000E➢fi-892)
POWER OF ATTORNEY FOR
DEVELOPERS SURETY AND INDEMNITY COMPANY
INDEMNITY COMPANY OF CALIFORNIA
PO Box 19725, IRVINE, CA 92623 (949) 263-3300
KNOW ALL MEN BY THESE PRESENTS, that as except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do
each, hereby make, constitute and appoint: xi
Les M. Mantle, Ryan S. Mantle, jointly or severally
as their true and lawful Attorney(s)-in-Fact, to make, execute, deliver and acknowledge, for and on behatl of said corporations, as sureties, bonds, undertakings and contracts of surety-
ship giving and granting unto said Attorney(s}in-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of 1
said corporations could do, but reserving to each of said corporations full power of substitution and revocal and all of the ads of said Attorney(s)-in-Fad, pursuant to these presents,
are hereby ratified and confirmed.
This Power of Attorney is granted and is signed by facsimile under and by authorty of the following resolutions adopted by the respective Board of Directors of DEVELOPERS SURETY
AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2008.
RESOLVED, that the chairman of the Board, the President and any Vice President of the corporation be, and that each of them hereby is. authorized to execute Powers of
Attorney, qualifying the attorney(s) named in the Powers of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or
any Assistant Secretary of the corporations be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney,
RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such
Power of Attorney or ceNfic rte bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking
of contract of suretyship to which it is attached.
IN WITNESS WHEREOF. DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by
their respective Vice President and attested by their respective Assistant Secretary this January 1st, 2008,
By: 1.t .AN-,D- 46"", OpnP AN V O.c
Stephen T. Pate, Senior Vice President ; ypp;O'P ORyl :,`e, ~G ORPORF p
OC1
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6y. Charles L. Day, Assistant Secretary 193 6 i D~a O r =
S;9g~.,~05y P.:.wJL Zi 'qt, /FOPx~ a
State of California
County of Orange
On August 13th, 2008 before me, Jenny TT Nguyen Notary Public
Date Here Insert Name and Title of the Officer
personally appeared
T. Pate and Charles L. De
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islare subscribed to
'
the within instrument and acknowledged to me that helshethey executed the same in hismerltheir authorized
-
JENNY 1T NOt1Y81
capacity(tes), and that by hismer/their signature(s) on the instrument the person(s), or 0e entity upon behalf of
COMM. p 7761840
which the person(s) acted, executed the instrument.
NOTARY PUBLIC CALOCIPM
I cerfify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is
ORANGE COUWrV
we and correct.
My comm. expires Feb, i$ 2012
WITNESS my hand and official seal.
Place Notary Seal Above
CERTIFICATE
The undersigned, as Assistant Secretary, of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, does hereby certify
that the foregoing Power of Attorney remains in full force and has not been revoked, and furthermore, that the provisions of the resolutions of the respective Boards of Directors of said
corporations set forth in the Power of Attorney, are in force as of the date of this Certificate. I
This Certificate is executed in the City of Irvine, California, the 18 day of January, 2010
-r
~AtbertHillebrand, Assistant ecretary
ID-1380(Wet)(Rev.07107)
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
County of
San Bernardino
On 1/20/2010 before me, Hector Zavala, Notary Public
Dare Here I,uerl Name arb rte of me micer
personally appeared Sam Kasbar
Name(s) of Signegsl
HECTOR ZAVALA
Colnmleelon at 1868453
Notary Public - California
Loa Angeles County
" M Comm. Ex Tres Oct 28, 2013+
tie
who proved to me on the basis of satisfactory evidence to
be the person(g) whose name(s) WgVd subscribed to the
within instrument and acknowledged to me that
he/sh'd/tKe(/executed the same in hisA1 4/14t& authorized
capacity(jf g), and that by his4tak{tt(h signature(i) on the
instrument the person(), or the entity upon behalf of
which the person( 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 an cial eel.
Place Notary Seal Appve Signature
Y I ~gnamr o Notary Public
OPTIONAL
Though the information below is not required bylaw, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment or this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above: _
Capacity(ies) Claimed by Signer(s)
Number of Pages:
Signers Name:
Signer's Name: -
0
Individual
O Individual
0
Corporate Officer-Title(s):
0Corporate Officer -Title(s):
,71
Partner - 0 Limited 0 General
0 Partner -0 Limited 0 General
Attorney in Fact
0 Attorney in Fact
0
Trustee
Top of Numb here
0 Trustee
Top of numb ne:e
0
Guardian or Conservator
0 Guardian or Conservator
-1
Other:
0 Other:..
Signer Is Representing: ~ Signer Is Representing:
G2W)Naoc: a~NOUry ASSxatigr•9]SO De SOta A••e.,P.O.aw 2ap2•Ctumvnh.CA 913112a02•vrxw NationaV•lcfzry.org Ilemx5907 8e ..CeIITQO melA 876- 7