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S.H.E Engineering and Construction Group Inch' ' - S.H.E. ENGINEERING & CONSTRUCTION GROUP, INC., • • n U SECTION 1 - BID BIDDER: S.H.E. ENGINEERING & CONSTRUCTION GROUP, INC. • BID FOR GARVEY PARK AQUATIC FACILITY PROJECT NO. P53129 BASE BID SCHEDULE TOTAL BASE BID PRICE: $ 210$04000 i-- $ — Loo Mikkoh smK hmdred Ord �IO�hiVl `��� Dollars Dollar amount in written form 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 ("Green book"), 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 the Greenbook shall apply to this Project except as may be modified by other provisions of the Contract. is The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by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 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. CBF -1 S.H.E. ENGINEERING & BIDDER: CONSTRUCTION GROUP, INC. • 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 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. 1*1 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 -2 S.H.E. ENGINEERING 8 BIDDER: _CONSTRUCTION GROUP, INC. • By: Si na ure David shmafi ± Type or Print Name fl-eGtderrh Title MU49 Slr,armnn b)a✓� SUAfE 101 Business Street Address &606 p , CA G1112% City, State and Zip Code gtS-Otgto-21501 Telephone Number Bidder' s / Contractor's State of Incorporation: 0_aLI&,y-n i a Partners or Joint Venturers: rJ/A Bidder's License Number(s): Oo3-f-o?Id A, A, C-to, , Ito, C -4lo 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. CBF -3 BIDDER:... c- -... • u SECTION 2 BID DATA FORMS CBF -4 ' BIDDER: S.H.E. Engineering & Construction Group, Inc. I e. 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 B ND KNOW ALL MEN BY THESE PRESENTS: THAT S.H.E. Engineering & Construction Group, Inc. as Principal, and Massachusetts Bay Insurance Company , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of (10 %) Ten percent of the attached bid amount DOLLARS ($_10.0% 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 forthe Garvey Park Aquatic Facility as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated November 3, 2QI0 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 attomeys' fees to be fixed by the court. Joann GNED AND SEALED, this 28th day of October 20 10 E. Engineering & Construction Group, Inc. (SEAL) cipal y: By: By: Signature oA1110 - gtee-itttt, RWroEwf CBF -5 Massachusetts Bay _ Insurance Company Y -� it re 4cphanie Nam, Attomeytin =Fact . CALIFORNIA ALL- PURPOSE ACKNOWLEDGMENT >�ci3cZ,rc>c_..�_ ..:. __ • _. � _ _ _ • _ �o` �- �> �iiczi�ci, cc; �:• c<. �-- rt: �i�ii�. �5c_ •c-2•i.�.�.�ci>��ci�;�.�ie_<:�c STATE OF CALIFORNIA County of Orange On a'O ) d before me, Irene Luong, Notary Public Date. Here Insert Name and Title of the Officer personally appeared Stephanie Pham Name(s) of Signerts) IRENE LUGNG Commission # 1883838 i ® Notary Public - California z _ Orange County s My Comm. Expires Mar 22, 2014+ 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 o is al se k Signature Place Notary Seal Above 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. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signers) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Stephanie Pham ❑ Individual ❑ Corporate Officer— Title(s): ❑ Partner —.❑ Limited ❑ General Attorney in Fact ❑ Trustee ❑ Guardian or Conservator Top of thumb here ❑ Other: Signer Is Representing: Signer's Name: ❑ Individual ❑ Corporate Officer— Title(s):_ ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: RIGHTTHUMBPRINT OF SIGNER .. of i3c�icc.•ciiY`ism'�c""�: iii?= ii"_ �"_ c�i�; ?= c ,?.ii�i�= c- �>�,i;'�'c.�.�5cc>•t c-? i. ��; ��: ��` � >`�i'�•cE:�ci"re%�i��.`c�:'�L'� C.`ric.'cii�� X2007 National Notary Association • 9350 De Solo Avo, P.O. Box 2402 • Chalswerlh. CA 913132402 • www. Nationa INota ry.on Item 45901 Reorder: GII Toll -Free 1- 800 - 8'76 -682! THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY CERTIFIED COPY KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing under the laws of the State of Michigan, do hereby constitute and appoint MARK RICHARDSON, SHAWN BLUME, ERIC LOWEY, STEPHANIE PHAM of Costa Mesa, CA and each is a true and lawful Attomey(s) -in -fact to sign, execute, seal, acknowledge and deliver for, and on its behalf, and as its act and deed anyplace within the United States, a, if the following line be filled in, only within the area therein designated any and all bonds, recognizances, undertakings, contracts of indemnity or other writings obligatory in the nature thereof, as follows: Any such obligations In the United States, not to exceed Ten MNIIon and Noll 00 ($10,000,000) In any single Instance and said companies hereby ratify and confine all and whatsoever said Attomey(s) -in -fact may lawfully do in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions are still in effect: 'RESOLVED, That the President or any Vice President in conjunction with any Assistant vice President be and they are hereby authorized and empowered to appoint Attomeys -in -fact of the Company, in its name and as its acts, to execute and acknowledge for and on its behalf es Surety any and all bonds, recognizances, contracts of indemnity, waivers of citabon and all other writings obligatory in the nature thereof, with power to attach thereto the seal of the Company. Any such writings so executed by such Attorneys -in -fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons' (Adapted October 7, 1981 - The Hanover Insurance Company; Adopted April 14, 1982- Massachusetts Bay Insurance Company; Adopted September 7, 2001 - Citizens Insurance Company of America) IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by a Vice President and an Assistant Vice President, this 121h day of July, 2010. THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY -, rW,wltkx CITIZEtIS INSURANCE COMPANY OF AMERICA -. • � Mary Jeanne )ndq on. \ice Prc ^Itle t ` Robcn K. G'emmr. AS515ta11 Jiw ?resident C 1 THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER ) SS. On this 12th day of July , 2010 before me came the above named Vice President and Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and officers described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. aeuwlr, wal eeua ,�>C'�v � _ .�V 3, commission expires on c,,,o,,,�,a ` Novem i " "' bar 3, 2011 yc�rexrrram No78ry Public I, the undersigned Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect. This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America. 'RESOLVED, That any and all Powers of Attorney and Certified Copes of such Powers of Attorney and certification in respect thareto, granted and executed by the President or any vice Resident in conjunction with arty Assistant Vice President of the Company, shall be binding on the Company to the same extent as if all signatures therein were manually afraed, men though one or more of any such signatures thereon may be facstrmle' (Adopted October 7, 1981 - The Hanover Insurance Company; Adopted April 14, 1982 Massachusetts Bay Insurance Company; Adopted September 7, 2001 - Citizens Insurance Company ofAmedca) GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this 28th day of October , 20 IQ THE HANOVER INSURANCE COMPANY MASSACHUSETTS SAY INSURANCE COMPANY CITI SINSU gfJLE COMPANY OF ERICA Slvpv6 1. braui[ A-Sslsa'f,' vice Res BIDDER: S •H 6 . I� 4 ryc*.a', ��ZrK • 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. • CBF -6 BIDDER: S.H.E• FAW) CbnsCg�°,r -� • 2.113 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 Name: ENCIHO rz--tumotr4G S. Mc- pvoTCZ�noK PLUMt3i�G Address:_ 17434 cA1 tFA sr-, tt�laNO , cA q IU Name and Location Description of Work of Subcontractor to be Subcontracted Name: RAY V5EvN^SN ConlsTRuc -nok jztofImG Address: Ig'741 mApA sT�-�. NouTH -wc)ae 9t324 Name and Location • of Subcontractor Name: UL Name and Location of Subcontractor Name: 'D" 1C> Name and Location of Subcontractor Description of Work to be Subcontracted GbNST1Zl1GilON & E►.1UN0 Name: C k0., Co Mr�4 M PAC_L o, P �1 Address: 2265 e, Hato (o,-[v,,- • 2.0 REFERENCES FOR BIDDER (Dupl CBF -7 ELVZ-1rel(AI. 14j(, Description of Work to be Subcontracted C,Oncare. -te, G CC ., OaQ,Q, da no'lt i o,-� � �fi-rawlir,5 q�z�L C)Y1Aw 4 Description of Work to be Subcontracted Pool �rCA 1040 page as needed) BIDDER: S•14-E. frio,lga2�,'r,n. err Cons �' oI d J 2.13 LIST OF PROPOSED SUBCONTRACTORS (continued) [ "Duplicate Next 2 Pages if needed for listing additional subcontractors. "] Name and Location of Subcontractor Name: Addre: Name and Location of Subcontractor M Name and Location of Subcontractor Name: Name and Location of Subcontractor Nan Add Name and Location of Subcontractor Description of Work to be Subcontracted -?&l Vv Description of Work to be Subcontracted A (c, `5evL/k z Tnc . Description of Work to be Subcontracted Description of Work to be Subcontracted Description of Work to be Subcontracted Name: Address: 2.0 REFERENCES FOR BIDDER (Duplicate page as needed) CBF -7 IdSwAVA, -1, • 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: is 2. • 3. • cti`f OF PASADENA 100 0- GARFIELD AVE., 20o FtPOz , PArADVNA , CA 91101 Name and Address of Owner MARK PtA131KICK`j T: 626, 744, Name and telephone number of pubkagency person familiar with project LOke Ave.. - Cnk"cu elk Gcncrel -e, eltcf6c.", 4 2,'216, $75 , Io5 94uc.k.krn1 s44,e1, JouAd0.+ion JANUARY 2010 Contract amount Type of Work Date Completed 4 bl Name and Address of Owner VAuL pEDR02A Ts 213.922.4797 NCGFV WA_yQMZA, LOS A-N6VJK, CA ROO12 Name and telephone number of public a y person familiar with project ON 95L 19 Pain} enc P�Uildinys, ekOvIctl, AVAG 954 , 032 ,a9 U,"144 on,Conae -k, �u 4+orN Juut- 2608 Contract amount Type of Work Date Completed clTi of I-Ooeb 131t-A"k "1633 W. ocivA^1 tLvD., OntU $Bkc11 , CA c(0002 Name and Address of Owner 1ZtGlc VAT UNIGk T ' 5-62. 743. 34Q7 Name and telephone number of public agency person familiar with project Ma04inLu.4-4er klY%jJr• Ave. EIQ[jri ( , L- Z- dctdpe �3o a99.a2 Cencve/ -e Dect+vtr3>?R moo} Contract amount Type of Work Date Completed I7'-UM 11/01/2010 11:58 9093941630 CAL COMM POOLS PAGE 06/06 S•NE• ta.IGf�(�NC & BIDDER: _r,prJe•t-2 r�10i.t GRUUQ -r t, 2.D REFERENCE (Duplicate page as 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 pools. A swimming pool contractor shall be considered primarily engaged as required herein if the swimming 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) commercially designed municipal and public -use swimming pools, each of which shall have incorporated a minimum size of 5,000 square feet of water surface area with a concrete and ceramic tile Perimeter overflow gutter and self- modulating balance tank. The following are the names, addresses and telephone numbers for at least three completed projects as required: 1. lint 6, ._t�i ✓. G G2�t �;_ telephone number of public agency person familiar with 9 i� s+•. �-��rr� in and Address of Owner Name and telephc 3. Name and Address Name of d telephor Contract amount — I I I I - t number of public agency person familiar with A�z U I_ L M \0& A N /51iz11 Project Name Date Corr Owner mber of pu6N Project Name IQ�- 23GG agency person fami CSF -9 Date with project ral .. C1, • • • S•N-> =- �a�r1K�M1�nIG g� BIDDER: GanIST>zt&�DN G2oye, T"r. SECTION 3 NON - COLLUSION AFFIDAVIT CBF -10 BIDDER: Sat.E. SV%Ohhag4n a.- i conotwetyan Qmw r z„c . • 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, ordivulged 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 effectuate a collusive or sham bid. signature • jxt,nd 5h�t_ Typed or Printed Name P� Title Bidder • Subscribed and sworn before me This Q day of t4OVF,01;ieCL 201 p (Seal) Notary Public in and for HAMUTAL SHEETRIT the State of California J Commission • 1817518 No" Public - CaSlorMa Loa Ms" County My Commission Expires: 19 1 Ca-- Oau 2012 • CALIFORNIA JURAT WITH AFFIANT STATEMENT See 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) 1 2 3 4 5 --- --- ----- - - - - -- Signature of Document Signer No. 1 State of California County of A)e,5 M HAMM S1IEETAST CoorNUlon a 1817548 Le ft" Putik - CoOminlat Los AayNoa County Cann. Oct 14, 2012 + Place Notary Seal Above Signature of Document Signer No 2 (if any) Subscribed and sworn to (or affirmed) before me on this 1 "61 day of NOyEM&F-(L , 201© , by Date Month year (,> Davy hr'p,i -ki Name of Signer proved to me on the basis of satisfactory evidence to be the person who appeared before me (and r�1 \ proved to me on the to of satisfactory evidence to be the per who app Bred before e. Signature ,Z� l e Sigod.m of Notary Publi 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: Signers) Other Than Named Above: Number of Pages: RIGHTTHUMBPRINT RIGHTTHUMBPRINT OF SIGNER #1 OF SIGNER #2 02007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 -Chatsworth, CA 91313 -2402 • wwwNationalNotary.org Item #5910 Reorder. 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