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All American Asphalt Inc.Q Q CITY OF ROSEMEAD D ANNUAL 2010 -2011 SLURRY SEAL PROJECT i D D '° YL r eSo?� ':,A'•+ISO �CONTRACT�� I I CONTRACT BID FORMS TABLE OF CONTENTS SECTION1 BID SCHEDULE ....................................................................... ............................... 1 SECTION 2 BID DATA FORMS ................................................................... ............................... 5 2.A BID BOND ................................................................................. ............................... 6 2.B LIST OF PROPOSED SUBCONTRACTORS .......................... ............................... 7 SECTION 3 NON - COLLUSION AFFIDAVIT ............ ............................... .. 10 CBF -13 I SECTION 1 - BID SCHEDULE CBF -1 � � i � Iii _l.• � • � BID SCHEDULE SCHEDULE OF PRICES FOR ANNUAL 2010 -2011 SLURRY SEAL PROJECT CDBG PROJECT No. P84129 BASE BID SCHEDULE TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ �> Z L I Oq o Dollar amount in written form CBF -2 UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 1 Clearing & Grubbing per plans and specifications. LS 1 IS600 - — '-3000 • — 2 Disposal of Waste Materials LS 1 000 , — 3 Crack Sealing LS 1 51000• 2 4 Slurry Seal Type 11 — See exhibit "A" & "B" per street locations & areas. ELT 1,050 - 5 Traffic Striping and Pavement Markers — See exhibit "C" per details. LS 1 LA 3060•' 1 c� 3 000• — 6 Paint Home Addresses (Curb Numbering) EA 1,980 X5,50 C5 TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ �> Z L I Oq o Dollar amount in written form CBF -2 hi ALTERNATE BID ITEM 1 NO. ITEM DESCRIPTION UNIT OF MEASURE EST. QTY. UNIT PRICE ITEM COST 7 Furnish and Install Street and Regulatory Signs, See Exhibit D on Appendix A per Quantities and Types. Contact Erick Gustafson at 213- 798 -7024 from Zumar or approved equal. LS I 1 000-- 4 bq6 , — TOTAL ALTERNATE BID # 1 PRICE (SCHEDULE BID PRICE): $ 11600- Dollar am6unt in written F&- TOTAL AMOUNT INCLUDING BASE PRICE AND ALTERNATE: $ ' J O5 0 0 1 D• amount in written form The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract for the Work is fully executed by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. 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 Attached hereto is a eertified— check, a -- he 2 k -of a bid bon in the amount of b%. Dollars f$ ---- -) 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. CBF -3 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 amount of $500.00 per calendar day and subject to the terms and conditions described in the Contract Form and the Contract Documents if project is not completed in 45 calendar days. 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 -4 I Signatu(e / Raw+ 8na�t� Type or Print Name Vi v Pro_siA-AA - Title Lttoo C COi,4yl �tr ae t Business Street Address Corona &4 g avel City, State and Zip Code LgSJ) 731e �lar�n Telephone Number Bidder's /Contractor's State of Incorporation: _ Cd Li &M iC4 Partners or Joint Venturers: Bidder's License Number(s): - W - a u:J 0 NOTES: 1) 2) 3) By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the representations made on the Contract Bid Forms. If Bidder is a corporation, enter State of Incorporation in addition to Business Address 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. CBF -5 CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT State of California County of f i yey i fA On IVl2r.'In ltil and I before me, 7nbbi A. Ma }�PVI Nn Pu b1 l! ate O "— Here Insert Name e tl T I(e o it he 07ice1 personally appeared R O + LXal Name( I o tl f Signer(j) DEBBIE A. MATSEN Commission # 1775685 < , -o Notary PublIC • California = Riverslda County MyComrn. Spites NOV 22, 2011 Place Notary Seal and /or Stamp Above who proved to me on the basis of satisfactory evidence to be the person(g) whose named) is/are- subscribed to the within instrument and acknowledged to me that he /sheAhey executed the same in his /her/iheir authorized capacity#es+, and that by hislf4erftlleir signature(a) on the instrument the person(g), 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 and official seal. Signature: —L�. V�i1t7 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: �f 6 `Jl�1P�xI u_0-4 Document Date: bnlr/ 1 I Li 171 I. Number of Pages: Signer(s) Other Than Named Above: — (VCY77­ — Capacity(ies) Claimed by Signer(;if) Signer's Name: Signer's Name: K, Corporate Officer — Title(O: V 1 C i ❑ Corporate Officer — Title(s): • Individual ❑ Individual • Partner — ❑ Limited ❑ General Top of thumb here ❑ Partner — ❑ Limited ❑ General Top of thumb here ❑ Attorney in Fact ❑ Attorney in Fact ❑ Trustee ❑ Trustee ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing All AMPv i Alg PM,�ln.l }- u 02008 National Notary Association • 9350 De Soto Ave.. P.O. Box 2402 • Chatsworth, CA 913132402 • w .NauonalNoiary.org Item #5907 Reorder.. Cell Toll -Free 1- 800-816-6a27 ALL AMERICAN ASPHALT ALL AMERICAN A P.O. BOX 2229, CORONA, CA 92878 -2229 STATE CONTRACTORS LICENSE #267073 -A CORPORATE RESOLUTION Resolved, that this Corporation, All American Asphalt, on March 7, 2011 designated Robert Bradley to represent our Corporation in the capacity of President. Mark Luer Secretary TELEPHONE: 951- 736 -7600 • FAX: 951- 739 -4671 :•• Guy <.C..i , SECTION 2 BID DATA FORMS G GPI dn 2.B LIST OF PROPOSED SUBCONTRACTORS t l In compliance with the "Subletting and Subcontracting Fair Practices Act," Sections 4100 kl 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 V 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 Contractor's 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. CBF -8 r, 2.13 LIST OF PROPOSED SUBCONTRACTORS (continued) I °Duplicate Neat 2 Pages if needed for listing additional subcontractors. Name and Location Description of Work of Subcontractor to be Subcontracted Name: QJ19berIZ -°Ok CracV-PI II-ZY Address 6 WvtlhJ u1t PV fon I W t Name and Location of Subcontractor Name: SC-f- ?a\Iew^eh - F - Address: 1466 Nr k tz . p � CP Name and Location of Subcontractor Name: Address: cYacl� ft 1 }gym #3 Description of Work to be Subcontracted S+ri�e"" J 4-t°M j 5 Description of Work to be Subcontracted Name and Location of Subcontractor Name: Address: Description of Work to be Subcontracted Name and Location of Subcontractor Name: Address: Description of Work to be Subcontracted CBF -9 Me I ,a ,1, 2 2.c 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: 5r t r4 iac-V) F0cie9. 1. Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 2. Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 3. Name and Address Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 4. and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed CBF -10 "2009" PAST WORK REFERENCES City of Costa Mesa 77 Fair Drive P.O. Box 1200 Costa Mesa, CA 92628 -1200 Contact: Tom Banks, (714) 536 -5431 City of Dana Point 33282 Golden Lantern Dana Point, CA 92628 Contact: Archie Rempher, (949) 248 -3500 City of Beverly Hills 345 Foothill Road Beverly Hills, CA 90210 Contact: Juan Martinez, (310) 285 -2521 County of San Bernardino 825 East Third Street San Bernardino, CA 92415 -0835 Contact: Sri Srirajan, (909)387 -7935 City of Redondo Beach 415 Diamond Street Redondo Beach, CA 90277 Contact: Javier Urista, (310) 318 -0661 City of Westlake Village 31200 Oak Crest Drive Westlake Village, CA 91361 Contact: Roxanne Hughes, (805) 653 -6597 Department of Transportation 12975 Culver Blvd. Los Angeles, CA 90066 Contact: Sixto Ramin, (213) 216 -4406 City of Rialto 150 South Palm Avenue Rialto, CA 92376 Contact: Eddie Chan, (909) 820 -2651 Prop 1 B Street Maintenance Contract Amount: $993,993.00 Start: 7/2009 On -going — not completed yet Annual Roadway Resurfacing Project Contract Amount: $3,982,982.00 Start: 4/2009 On -going — not completed yet 2008 -09 Street Resurfacing Contract Amount: $4,085,000.00 Start: 1/2009 Completed: 8/2009 Arrow Route Contract Amount: $1,980,000.00 Start: 2/2009 Completed: 7/2009 Public Improvement Package Contract Amount: $1,678,000.00 Start: 1/2009 Completed: 9/2009 Joint Cities Pavement Rehab. Project Contract Amount: $1,242,241.11 Start: 6/2009 Completed: 9/2009 Route 27, Contract No. 07- 2Y4904 Contract Amount: $915,511.00 Start: 6/2009 Completed: 9/2009 Route 210 Detour Contract Amount: $1,983,548.00 Start: 6/2009 Completed: 9/2009 "2010" PAST WORK REFERENCES City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 Contact: Edward Torres, (714) 647 -5018 City of Chino 13220 Central Avenue Chino, CA 91790 Contact: Emani Naghmeh, (909) 464 -8367 City of Costa Mesa 77 Fair Drive Costa Mesa, CA 92628 -1200 Contact: Thomas Banks, (714) 754 -5222 Segerstrom Avenue Rehabilitation Contract Amount: $2,094,618.00 Start: 11/2009 Completed: 3/30/2010 Street Rehabilitation Project FY 08/09 Contract Amount: $2,127,501.00 Start: 11/2009 Completed: 5/31/2010 Rehabilitation of Vanguard Way Contract Amount: $517,646.00 Start: 12/2009 Completed: 2/30/2010 City of Westminster City -wide Overlay 09 -10 St. Improvement Project 8200 Westminster Boulevard Contract Amount: $1,171,416.00 Westminster, CA 92683 Start: 2/1/2010 Contact: Tuan Pham, (714) 898 -3311 ext. 209 Completed: 5/30/2010 City of Paramount 16400 Colorado Avenue Paramount, CA 90723 -5012 Contact: Ed Cox, (562) 908 -6205 Resurfacing in Rosecrans Avenue Contract Amount: $572,209.00 Start: 10/1/2009 Completed: 5/30/2010 City of Cerritos 18125 Bloomfield Avenue Cerritos, CA 90703 -3130 Contact: Rash Syed, (562) 916 -1221 City of Anaheim 200 South Anaheim Boulevard Anaheim, CA 92805 Contact: Sean Ramsey, (714) 765 -5059 City of Garden Grove 11222 Acacia Parkway Garden Grove, CA 92842 Contact: (714) 741 -5180 Bloomfield Avenue Improvements Contract Amount: $1,103,000.00 Start: 3/1/2010 Completed: 6/20/2010 Magnolia Avenue Street Improvements Contract Amount: $868,000.00 Start: 4/1/2010 Completed: 7/20/2010 Harbor Boulevard Street Rehabilitation Contract Amount: $919,000.00 Start: 3/1/2010 Completed: 6/30/2010 SECTION 3 NON - COLLUSION AFFIDAVIT CBF -11 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 effectuate a collusive or sham bid. / 1 0 0 - 1 i 8ouff± ac►ey Typed or Printed Name i�I 51 Subscribed and sworn before me This _ day of 20_ Notary Public in and for the State of California My Commission Expires: * 5 e� vj r,,v,ed Nuivnal Ste' (Seal) CBF -12 CALIFORNIA JURAT WITH AFFIANT STATEMENT N 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) 2 3 4 5 \ ------------------------------------------ Signature of Document Signer No. 1 1 Signature of Document Signer No. 2(if any) State of California County of f IYFYSIde_ Subscribed and sworn,to (or affirmed) before me on this I yih day of 7h 20 by Date Month ear (1) �AO)eitr4 , Name of Signe proved to me on the basis of satisfactory evidence DEBBIE A. MATSEN to be the person who appeared before me Commlaslon # 1775685 o M1 Notary Public - California = (and Riverside County £ (2) MyConvn.E�tres NCA' 22,2011 Name of Signer proved to me on the basis of satisfactory evidence to be the person who appeared before me.) Signature OA49Aie G - ! 4alzyw Signature of Notary Public Place Notary Seal Above 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. Top of thumb here Top of thumb here Further Description of Any Attached Document Title or Type of Document: Document Date: Moon w an u Number of Pages: Signer(s) Other Than Named Above: Mc ° . ✓ 02007 National Notary Assoaation• 9350 De Soto AVe., P.O. Box 2402•Chalsv rth, CA 91313- 2402•w .NationalNotary.org Iterni Reorder Call Toll-Free 1- 800-875 -61127 BIDDER: All Amerman Asphalt Bid Bond No: 08591423 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 tb adequately provide the information required. Bidder shall ensure that every page of its Bid DatalForms are properly identified with the Bidder's name and page number. 2.A SID BOND KNOW ALL MEN BY THESE PRESENTS: THAT All American Asphalt and of as ' as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of Ten Percent of Total Bid Price in --- - - - - -- DOLLARS ($ 10% of Total Bid Price ) being not less than ten percent (10 %) of the Total Bid Price; for the payment of which sum will and truly to be made, we bi6d 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 pemfbrm all Work required for the Annual 2010 -2011 Slurry Seal Protect as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated March 16, 2011, 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) fumishes 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 9th day of March 20 11 All American Asphalt (SEAL) Fidelity and Deposit Company of Maryland(SEAL) Principal Surety By: By: ignature 2 I;0 2• in Signature Rebecca Haas-Bat s, Attorney -ih Faci. ' I CBF -7 EXTRACT FROM BY -LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice - President, or any of the Senior Vice - Presidents or Vice- Presidents specially authorized so to do by the Board of Directors or by the Executive Committee, shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice - Presidents, Assistant Vice - Presidents and Attorneys -in -Fact as the business of the Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations, policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages,... and to affix the seal of the Company thereto CERTIFICATE I, the undersigned, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that the Vice - President who executed the said Power of Attorney was one of the additional Vice - Presidents specially authorized by the Board of Directors to appoint any Attorney -in -Fact as provided in Article VI, Section 2, of the By -Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice - President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed." IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company, this 9th day of March 2011 4a -7 Assistant Secretary CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT State of California 1 County of Orange J O 03/09/2011 before me, A. Wilkison, Notary Public , Date Here Insert Name and Title of the Officer personally appeared Rebecca Haas -Bates who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Were subscribed to the within instrument and acknowledged to me that hefshe/t" executed the same in his /her/their authorized capacity(ies), and that by his/her/their signature(O on the instrument the persons,, or the entity upon behalf of which the person(s} acted, executed the instrument. _ A. WILKISON Commission # 1866283 Z 1 certify under PENALTY OF PERJURY under the laws ublic Notary P - California n of the State of California that the foregoing paragraph is T Orange County J true and correct. My comm. Expires Sep 26, 2013 WITNESS my hand and official seal. 1 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: Bid Bond Document Date: 03/09/2011 Number of Pages: One (1) Signer(s) Other Than Named Above: All American Asphalt Capacity(ies) Claimed by Signer(s) Signer's Name: Rebecca Haas -Bates Signer's Nat ❑ Individual ❑ Individual Corporate Officer — Title(s): — ❑ Partner — ❑ Limited ❑ General 0 Attorney in Fact ❑ Trustee Guardian or Conservator Other: Signer Is Representing: Fidelity and Deposit Company of Maryland WGHTTMUMBPRINT. OF SIGNER 1 � ❑ Corporate Officer — Title(s): _ Ell Partner — © Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: RIGHTTMUMSPRWT OF SIGNER 0 02007 National Notary Association• 9350 De Solo Ave.. P.O Box 2402 • Chalsworlh, CA 91313 -2402• vrr w,NationalNclaryerg Item #5907 Reorder: Call Toll-Free 1.800.876 6827 CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT State of California 1 County of f11YA - 5iAlc J i On M mrrh 1`•1. �n11 before me, Dbhi2 A• Ma ryq 1[7� ar l P ln1iL Dat �aT - ' ° �� Here Insert Name�ntl itle of tha fl¢ r personally appeared t3rn� ll Neme(R) of Sig r�) who proved to me on the basis of satisfactory evidence to be the person) whose name(g) is /are- subscribed to the within instrument and acknowledged to me that he /sheMtey executed the same in his /her/theiT authorized capacity(ies), and that by his /he6the+ signature() on the instrument the DEBBIE A. MATSEN person( j), or the entity upon behalf of which the Commission '1177568: acted, executed the instrument. -® - Notary Public - California Riverside County MyCorrm.Bpres Nov22,2o11 j 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. Signature Place Notary Seal an Vor Stamp 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: D,cl ? )fV_ r �_('2-4 Qr]6prYlp� Document Date: Iv n W r/- Number of Pages: Signer(O Other Than Named Above: Flaebt I an f.,2,IC, of YJ Vld Capacity(49e) Claimed by Signer Signer's Name: 162fliC ' Signer's Name: X(; Corporate Officer — Title(V): V ❑ Corporate Officer — Title(s): ❑ Individual wip woo ❑ Individual ❑ Partner — ❑ Limited ❑ General Top of thumb here ❑ Partner — ❑ Limited ❑ General Top of thumb here ❑ Attorney in Fact ❑ Attorney in Fact ❑ Trustee ❑ Trustee ❑ Guardian or Conservator ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: All Aryieyi AnOw l-+ 02008 National Notary Association • 9350 be Soto Ave., R0, Box 2402 •Chao,vorth, CA 91313 -2402 • w ,NationalNotaryc g Item #5907 Reorder: Call Toll -Free 1- 800 - 876-6827