ACE Angineering Inci
BIDDER: Ace Engineering, Inc.
BID FOR
ROSEMEAD PARK AQUATIC FACILITY
PROJECT NO. P53129
BASE BID SCHEDULE
TOTAL BASE BID PRICE:
ORIGINAL
$ 4.53 4 � zz
-Two
Dollar amount in written form.
ALTERNATE BID ITEM NO. 1, 2, 3, & 4
VDMVS- avid Fovttf- (.111n�
NO.
ITEM DESCRIPTION
UNIT OF
EST.
UNIT
TOTAL
ITEM
MEASURE
QTY.
PRICE
COST
1
Shade Structures
SF
20
3�,44b,95
6 °B,g35 °o
20'x 20' Module
2
Solar System
LS
1
4iDIqK00
3
Bleachers
EA
$
19 442 5o
4
Entry Marquee
LS
1
36 Sao -0O
I111730.00j
Sign /Supports
TOTAL ALTERNATE BID ITEMS PRICE: $ 3 �.3 • t 0
Nilte, Null� 1- lIy- evt -MOO Sct Three ltuhdVed hft�.-T Vet 00llaVs CtK�
Dollar amount in writteh form I Tevl Gevt3
Note: The City of Rosemead reserves the right to reduce or increase the quantities of any
items in the schedule of values above, within the limits define in Section 3 -2.2.1 of the
Standard Specifications, to stay within the budgeted amount of this project.
INCORPORATION BY REFERENCE
Notice Inviting Bids, Instructions to Bidders, General Conditions, Technical Specifications,
Geotechnical Study Report (September 3, 2010) and addenda, Asbestos and Lead Paint
Survey Report . (August 5, 2010) and addenda, Bidder's Proposal, Plans, Standard
Specifications for Public Works Construction 2009 Edition ( "Greenbook "), Drawings, Project
Manual, Required Bonds and Forms, Permits, Addenda, and all applicable codes and
regulations are hereby incorporated in and made part of this Contract. The provisions of
CBF -1
BIDDER: Ace Engineering, Inc.
the Greenbook shall apply to this Project except as may be modified by other provisions of
the Contract.
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which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting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 for the 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.
Attached hereto is a certified check, a cashier's check or a bid bond in the amount of
Ten Percent of Bid Amount Dollars ($rofaiaamaU.1) 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.
CBF -2
BIDDER: Ace Engineering, Inc.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
i 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 Owner of 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.
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.
CBF -3
1�
BIDDER:ACe Engineering, Inc.
By: J
Signa ure
Simon Jeon
Type or Print Name
Vice President
Title
Bidder's /Contractor's State of Incorporation:
1880 Wright Avenue
Business Street Address
La Verne, CA 91750
City, State and Zip Code
(909) 392 4600
Telephone Number
lifornia
Partners or Joint Venturers:
Bidder's License Number(s): 613320
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.
1
CBF -4
C,
BIDDER: Ace Engineering,_ Inc.
SECTION 2
BID DATA FORMS
CBF -5
BIDDER: Ace Engineering, Inc.
Bidder shall submit its Bid data in accordance with the format shown on each of the
following Bid Data Forms. Bidders shall prepare and use as many sheets as are necessary
to adequately provide the information required. Bidder shall ensure that every page of its
Bid Data Forms are properly identified with the Bidder's name and page number.
2.A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT Ace Engineering, Inc.
as Principal, and Western
, as Surety, are held firmly bound unto
the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
Ten Percent of Bid Amount ----------------------------------------------- ----------------------------------
----------------------------------------- -- -- ------------------- - - - - -- ------------------ - - - - -- DOLLARS
($ 10 °% of Bid Amount ), being not less than ten percent (10 %) of the
Total Base Bid Price; for the payment of which sum will and truly to be made,
we bind ourselves, our heirs, executors, administrators, successors, and
assigns, jointly and severally, firmly by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all
Work required for the Rosemead Park Aquatic Facility as set forth in the
Notice Inviting Bids and accompanying Bid Documents, dated November 3,201Q
NOW, THEREFORE, if said Principal is awarded a Contract for the Work by
the OWNER and, within the time and in the manner required by the above -
referenced Bid Documents, enters into the written form of Contract bound
with said Bid Documents, furnishes the required bonds (one to guarantee
faithful performance and the other to guarantee payment for labor and
materials) furnishes the required insurance certificates and endorsements,
and furnishes any other certifications as may be required by the Contract,
then this obligation shall be null and void; otherwise it shall remain in full
force and effect. In the event suit is brought upon this bond by the OWNER
and judgment is recovered, said Surety shall pay all costs incurred by the
OWNER in such suit, including reasonable attorneys' fees to be fixed by the
court.
SIGNED AND SEALED, this 25th day of October 2010
Ace Engineering, Inc. (SEAL) western Surety Company (SEAL)
Principal Surety
By: By:
Si ature
CBF -6
Signature _ A._.
Edward N. Hackett, Attorney-in-,Fact
ri
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and Stale of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Christine M Maestas, Edward N Hackett, Individually
of Irvine, CA, its true and lawful Attorney(s) -in -Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to
be hereto affixed on this 9th dayof September, 2010.
WESTERN SURETY COMPANY
wPFrYC
»p+paogq �S
�yioo rry=.
s4,N ork °rP
Paul IrBruflat, Senior Vice President
State of South Dakota l
County of Minnehaha
1 ss
On this 9th day of September, 2010, before me personally came Paul T. Bruflat, to me known, who, being by me duly swom, did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Senior Vice President of WESTERN SURETY COMPANY described in and
which executed the above instrument; that he knows the seal of said corporation; that the seat affixed to the said instrument is such corporate seal; that it was
so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires
D. . KRELL KRELL '
November 30, 2012
+ NOTARY PUBLIC '
EAL SOUTH DAKOTA SEAL i
♦rrrrrrrrr +rrrrrrrrrrrrr
—� D. Krell, Ncitry Public
CERTIFICATE
1, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on thIhe reverse It 9 s still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this — 0C day2f 5 �� "
WESTERN SURETY COMPANY
e
W,`Sffb,• .
r.Y baX f/i�Y) /i
L. Nelson, Assistant Secretary
Form F4280-09 -06
ACKNOWLEDGMENT
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
State of California
County of Orange Iss.
OCT 2 5 LUIIJ On before me, C. Maestas ,Notary Public, personally
appeared Edward N. Hackett
who proved to me on
the basis of satisfactory evidence to be the person(s) whose name(s) islefe subscribed to the within
instrument and acknowledged to me that he%gelthey executed (he same in hls/Mefkheir authorized
capacily(ies), and that by his/begtheif signatures(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 Stale of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
�ft-
C. MAESTAS
COMM16710in • 17188"
y Notary Public - Callfomla
` Orange County
Canon. = All 11011
(seal)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I
Date of Document
Type or Title of Document
Number of Pages in Document
Document in a Foreign Language
OPTIONAL INFORMATION
OCT 2 5 2010 Thumbprint of Signer
Type of Satisfactory [vidence:
^_ Personally Known with Paper Identification
Paper Identification
Credible Witness(es)
Capacity of Signer:
Trustee
X Power of Attorney
_ CEO/CFO /Coo
_ President / Vice - President / Secretary / Treasurer
Other:
Other
Check here 11
no thumbprint
or firx,Ierpdnt
is available.
BIDDER: Ace Engineering, Inc.
2.6 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
subcontractor who 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),
whichever is greater, and shall further 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 and description of work to
be subcontracted.
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
one percent of the Contractor's total bid or ten thousand ($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.
MA]
OBIDDER: /1w ewcoli 1k 4N6, INC/
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
[ "Duplicate Next 2 Pages if needed for listing additional subcontractors. "]
Name and Location
of Subcontractor
NtA cot
E, 'AUTO
Name and Location
of Subcontractor
Name: AQUATtG
Address: 32244
Name and Location
of Subcontractor
Name: 000tj00T -, I
Address:3ocr> au
of Subcontractor
Description of Work
to be Subcontracted
POO 1_ C-C N TRa GTOK-
6 LFN C)O RA , CA, 91740
Is U1
I
Description of Work
to be Subcontracted
COOL CON T'RaCIV jZ
SAN Z V6N CAPIS T7AN0, CA • 92rn)'j
Description of Work
to be Subcontracted
P00 L COPT-VACTVZZ
vE., EL MONT"E I CA -91-�22,
Description of Work
to be Subcontracted
WA7Vk_ S L I D E
Name: WHITE WR-TM WEST IN13UXTP4< LT.b ,
Address: 519 S. FovRTH sT. COLUmay -t, OHlo g32o .
Name and Location
of Subcontractor
dAR
Address:
2.0 RI
Description of Work
to be Subcontracted
rad L
kP F-NA , (.'�X. 9u09 -4Zasr
(Duplicate page as needed)
BIDDER: A<,-e E"OGINEE2I00G, IPJG
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
[* *Duplicate Next 2 Pages if needed for listing additional subcontractors. * *]
Name and Location Description of Work
of Subcontractor to be Subcontracted
00NGRe.T6
Name: clvt\- WOP-VS comP.
Address:9348 oAk sT. meg -Fww" . CA 070(0
Name and Location Description of Work
of Subcontractor to be Subcontracted
Copmr-Te /- Mw VJALt,1"A4DNj
Name: 81-'IyGI -I
Address:5241 U NCAL�N k F,, A- 6 CYPRESS I C1t , 90630
Name and Location Description of Work
of Subcontractor to be Subcontracted
� s-r>r�t_ F�NoE
Name: G 1=NGE
Address: 112118 t- nE:LQ ^VrR. FE QPIZOJ492 % CA . 9067D
Name and Location
of Subcontractor
Name: c
Address:
C'OUNT'IES , GZVAV -I
F.oMMEw STA ,
Description of Work
to be Subcontracted
M/4SONfZy
MASONR
CA . C1 70
Name and Location
Description of Work
of Subcontractor
to be Subcontracted
t4ASONR�.
Name: Lt M NR INC,
Addre: SOS sg,o.nE on1E,
's
Nvv FOUR pe, CA-RI32v
2.0 REFE ENCES OR BIDDER
(Duplicate page as needed)
UBIDDER: ACE W&
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
[ "Duplicate Next 2 Pages if needed for listing additional subcontractors. "]
Name and Location
of Subcontractor
Description of Work
to be Subcontracted
ABATE /AEMouirio/J
HINT
Name: F. E. SeRV1cES, Iy%C..
Address: 8891 M1ss1ON SLVD, RIVE941PE, Cp,g2,M'f
Name and Location
of Subcontractor
Name: F
Address:
Name and Location
of Subcontractor
AQ C- vo N Nu
,t3 vjeeCy -twC , ING
LE1 AVE • SOVTN EL
Name and Location
of Subcontractor
Name: AG�K V-00FIOG
Address: 2.SZr w. Z1-W sT-
Description of Work
to be Subcontracted
M AOI -ITto N
. x1405
Description of Work
to be Subcontracted
DEM0 w Ttv Q
Gk733
Description of Work
to be Subcontracted
T-GpPlvv,,
k C/1 • 9 (7057
Name and Location Description of Work
of Subcontractor to be Subcontracted
FENGE/ N11SGEi,��- InE01/S
M�I.S
Name: CRAMPION F'BNC)� & I¢ON
Address: 210G W. QL4XSEU, ORAP4PE, CA.12 - "f
2.0 REFERENCES FOR BIDDER (Duplicate page as needed)
Cam?
BIDDER: AGE ENGkV'%%L1fJG, 1AC
2.6 LIST OF PROPOSED SUBCONTRACTORS (continued)
[* *Duplicate Next 2 Pages if needed for listing additional subcontractors. * *]
Name and Location
of Subcontractor
r_3r11ILTM
Description of Work
to be Subcontracted
S 11AnE STRvcTU TZI
1-1U4
Name and Location Description of Work
of Subcontractor to be Subcontracted
S�+apJF STi.VCTVRk
Name: sEUECf STEIFU VREC7rtJI" ,Inc.
Address: 23O w. AvE'NV1= L"t I.- aNcAQTViQ, C4-• 93 �
Name and Location
of Subcontractor
Description of Work
to be Subcontracted
COL-ATZ.
Name:So1.,M RV.ATI'06 S'FW-k .t -1S'T, IKI
Address: 155D nopSoN why. RI ytW "3E CA, 91.11)7
Name and Location
of Subcontractor
Address:
Name and Location
of Subcontractor
2.0
, (No
Description of Work
to be Subcontracted
IrANrOsCAPIVt&
11
Description of Work
to be Subcontracted
L-4rt aO CA- pIw6 /ITLR1CrhJ�p
?tEIzR� t�NOSCA'P� � sPR- I,NI�I,ETt
;s: 47- 5 • 1AYTtTLE e • sT E too , M001LO v to ,
REFERENCES FOR BIDDER (Duplicate page as needed)
CA• g101f
i
BIDDER: Ace Engineering, Inc.
The following are the names, addresses and telephone numbers for at least three public
agencies for which BIDDER has performed similar work within the past four (4) years:
t. 8400 Lakeknoll Dr..
City of Buena Park Buena Park, CA 90621
Name and Address of Owner
Nabil Henein, (714) 562 -3685
Name and telephone number of public agency person familiar with project
$10,936,395.26 Heavy Civil January 8, 2008
Contract amount Type of Work Date Completed
2. 900 South Fremont Ave.
County of Los Angeles Alhambra CA 91803
Name and Address of Owner
Jonathan Ko, (626) 383 -5224
Name and telephone number of public agency person familiar with project
4,000,000.00
Hospital Upcarade
November 30, 2008
Contract amount Type of Work Date
3 GS =1 -1 30th- CES /CECS, Bldg. 11432
1172 Iceland Ave.
US Air Force Vandenberg AFB. CA 93437
Name and Address of Owner
Mark Barnick, (805) 605 -4759
Name and telephone number of public agency person familiar with project
$33,000,000.00 General Construction October 15 2010
Contract amount Type of Work Date Completed
CBF -9
11/01/2010 11:11
9093941630
CAL COMM POOLS
AIDDF ,R:L.�..1�N \li�1�RG�ACL ?O'L S
2.D
page as
PAGE 06/06
All of the work in sections 13151 -13158 (of the Project Manual for City of Rosemead
Project No, P53129 Garvey Aquatic Center) is to be the responsibility of one experienced
swimming pool contractor with a C -53 license, which can be either the bidder or a
subcontractor, primarily engaged in the construction of commercial public-use swimming
here , Atha mmingswimming Pool contractor shall be considered primarily engaged as required
pool contractor derived 50% of its annual revenue during the past
five years from public -use swimming pool construction. The swimming pool contractor
must have also, in the last five years, constructed at least three (3) commeroially designed
municipal and public -use swimming pools, each of which shall have incorporated e
minimum size of 5,000 square feet of water surface area with a concrete and ceramic tile
perimeteroverflow gutter and self- modulating balance tank. The following are the names,
addresses and telephone numbers for at least three completed projects as required:
1.
UCL A° c -tnt,C AvF
Name and Address of Owner rl �?� at G2q
Name and
number of public agency person
2.
and Address of
Name and telephone number of ag
ublic _ v t
p ency person familiar with
43
Name and
one number of public
TA~rT U ,v
Project Name
agency person
CBF -9
G
with project
6
I CA,
d
BIDDER: ACV, tiNG1�EERII� JOC,,
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
[ "Duplicate Next 2 Pages if needed for listing additional subcontractors."]
Name and Location
of Subcontractor
Description of Work
to be Subcontracted
Name: C�NQ FLV M>3un,G I I N G
Address: 7Z3] ORANCvt Tk10RFE /<VE• 1�,VV a YA(2.K C4 • 90&2 —/
Name and Location
of Subcontractor
Name: I
Address:
Name and Location
of Subcontractor
IM
V
Name and Location
of Subcontractor
Name and Location
of Subcontractor
w
N
Description of Work
to be Subcontracted
?LUm -�)I , p
C4. 91441
Description of Work
to be Subcontracted
EL-E-C R.tC^I_
FvLLE2Tvt• , CA .92.835
Description of Work
to be Subcontracted
Description of Work
to be Subcontracted
Address:
2.0 REFERENCES FOR BIDDER (Duplicate page as needed)
BIDDER: Ace Engineering, Inc.
SECTION 3
NON - COLLUSION AFFIDAVIT
CBF -11
BIDDER: Ace Engineering, Inc.
NON - COLLUSION AFFIDAVIT
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, or corporation; that the 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 fee to any corporation, partnership, company association, organization, bid
depository, or to any member or agent thereof to effectual,) collusive or sham bid.
�1
Signa ure
Simon Jeon
Typed or Printed Name
Vice President
Title
Ace Engineering, Inc.
Bidder
Subscribed and sworn before m -e� 7 644-a-
This day of
Notary P c in and for
the Sto of California
My Commission Expires:
20
� e4Lsea_
�'t
CALIFORNIA JURAT WITH AFFIANT STATEMENT
'�'i- ,;_�ttct n:.cc.2 �' - �= �Y', ��'= e) c— r�, r.. cr.. c�c�-'<: � ..n,Fr.,n�,i= P.c-- rinh,�r.,c�f^. ±�.,r;�a!;�,C�, cry ..r�.,ru,-- ^:- r;:•pi- 2Fr..nci =rte
❑e Attached Document (Notary to cross out lines 1 -6 below)
❑ See Statement Below (Lines 1 -5 to be completed only by document signer(s], not Notary)
2
3 -- - -- - - - - - - - - - - - - - - - - - - - - - - - - -
4 _._ .. __ ---- - --- --- -. _., - --- - -- -- -- - - - - -- ------- --
5 --- --- ✓-- -- --- ------- ---- ---- --- -- ------- - - - - --
Signature of Document Signer No. 1
State of California
County of 1-05'
m a� (Uf) .. RIIIA� TY n C012 �
Place Notary Seal Above
Signature of Document Signer No.2 (if any)
Subscribed and sworn to (or affirmed) before me on this
4k-day of CC444er 20-11111 by
Date Month year
(1) SFmon GTeori._
Name of Signer
proved to me on the basis of satisfactory evidence
to be the person who appeared before me (.) (,)
(and
Name of Signer
proved to me on the basis of satisfactory evidence
to be the person who appeared b a me.)
Signature
of 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.
Further Description of Any Attached Document
Title or Type of
Document Date:
Signer(s) Other Than
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02037 National Notary Associaton• 9350 De Soto Ay , PO. Bay 2402•Chatewodh, CA 91313- 2402•w ,NationalNotaryorg Item #5910 Reorder: Call Toll -Free 1 -800 -876 -682]