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Bidder: Kalban Inc. CITY OF ROSEMEAD SAFE ROUTE TO SCHOOL PROGRAM SAVANNAH ELEMENTARY PROJECT No. 21025 CONTRAT BID FORMS BIDDER. - i k AIi/ in C CONTRACT BID FORMS TABLE OF CONTENTS SECTION 1 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 BIDDER: Kci iI700, 21C. !SECTION 1 - BID SCHEDULE CBF - 1 BIDDER: reide44,14 L, BID SCHEDULE SCHEDULE OF PRICES FOR SAFE ROUTE TO SCHOOL PROGRAM SAVANNAH ELEMENTARY PROJECT No. 21025 BASE BID SCHEDULE UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 1 Clearing &Grubbing per plans LS 1 pc,0.0.0 - I 0 O('Cil'----- and �and specifications. 2 Disposal of Waste Materials. LS 1 $IS0003 03 03d- 3 Remove, dispose and Construct SF 45,570 _ o 4-inch thick PCC sidewalk per 41.L 3 f zt;GI s _ SPPWC Std. Plan 113-2. 4 Remove, dispose and Construct EA 28 q, PCC Curb Ramps per SPPWC UO U -Y I-,coo Std. Plan 111-5. 5 Remove, dispose and Construct SF 2,300 <e PCC driveway approach per p 12 2- .'150`` SPPWC Std. Plan 110-2. 6 Construct 8- 12-inch PCC LF 1,580A- = ,r;cc(. co0�,� variable retaining Curb. p 7 Furnish and Install In-road LS 1 Pavement Lighting System per . (7)-76-(1>1 �5 Q�� ��+, 7s sheet 15 and specifications complete. 8 Furnish and Install Flashing LS 1 f p �. Beacon System per sheet 15 and ,$�ir� Oy y lr specifications complete. • 9 Furnish and Install signage as LS 1 indicated on sheets 11, 12, 13& $28 OQ 1 e r 1/--72001 -: 14 and specifications complete. • 10 Furnish and Install Speed EA 2l)'- Feedback sign location to be lay f Z 1°; ��LCt- c! ' _, ) out on the field by the Public Works Inspector. CBF-2 BIDDER: /701140()LAI Ci UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 11 Install Pavement Striping, LS 1 Pavement Markers andEDD ,J C° miscellaneous as indicated on g� "I�) b vu sheets 11, 12, 13, & 14 complete. TOTAL BASE BID PRICE(SCHE9ULE BID PRICE):$'Q2 J � � ' I/�/ orf ld J/�� rturdl Nene rUl 1 ( e �l Y� / rriti Dollar amodnt in written form ,0((q n; em 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. 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. 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 Q) y e.) Dollars($ Gh'I[fA) said amount being not less than ten percent(10%) of the Total Bid Price. The undersigned grees 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 Owner of Bidder's California contractor's license(s)in good standing;(2)evidence CBF-3 BIDDER: (1 6/I AI$�l 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 of five hundred dollars ($500.00) if project is not completed in SIXTY (60) calendar days. The Contract Time will begin to run ten (10) Working Days from the date of the Notice of Proceed 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. Al A 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 BIDDER: f ik1✓1)t t i By: `'4 e - , 761150 1C wet-- ' * Un)�-Zeal y ignatu e Business Street Address , M+fan s, I • ' S� ✓4rAloz. � c4 G/35O Type or Print Name City, State and Zip Code Pmt ei,t 657i - roti 70A5-- Title Telephone Number Bidder's/Contractor's State of Incorporation: C Partners or Joint Venturers: N/4 4,7A Bidders License Number(s): YO 7 SS—O 741 Department Industrial Relations IOU �U `7 Z Registered No. 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. CBF -5 BIDDER: it-G1/ kat) rr SECTION 2 BID DATA FORMS CBF - 6 a BIDDER: Kalban, 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 Bidders name and page number. 2.A BID BOND KNOW ALL MEN BY THESE PRESENTS: THAT Kalban, Inc. ,as Principal, and The Guarantee Company of North America USA , as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of TEN PERCENT OF THE TOTAL AMOUNT BID DOLLARS ($ 10% ), 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 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 SAFE ROUTE TO SCHOOL PROGRAM — SAVANNAH ELEMENTARY asst forth in the Notice Inviting Bids and accompanying Bid Documents, dated 14 — I 1 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 end effect. In the event suit is brought upon this band 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 AN?S •LED,this 6th day of June 2017 Kalban, IOC The Guarantee Company SEAL) of North America USA (SEAL) Princip- Surety By: aALS- ilr/ /r Sign:ure J SionatureWilliam Syrkin, Attorney-In-Fact CBF-7 ,MThe Guarantee Company of North America USA GUARANTEE® Southfield, Michigan POWER OF ATTORNEY NOW ALL BY THESE PRESENTS:That THE GUARANTEE COMPANY OF NORTH AMERICA USA,a corporation organized and existing under the laws of the State of Michigan,having its principal office in Southfield,Michigan,does hereby constitute and appoint Millennium Corporate Solutions,LLC William Syrkin,Sergio D.Bechar',Rebecca Mn Haas-Bates,Richard Leroy Adair its true and lawful attomey(s)-in-fact to execute,seal and deliver for and on its behalf as surety,any and all bonds and undertakings,contracts of indemnity and other writings obligatory In the nature thereof,which are or may be allowed,required or permitted by law,statute,rule,regulation,contract or otherwise. The execution of such instrument(s)in pursuance of these presents,shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply,to all intents and purposes,as if the same had been duly executed and acknowledged by its regularly elected officers at the principal office. The Power of Attorney is executed and may be certified so,and may be revoked,pursuant to and by authority of Article IX,Section 9.03 of the By-Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31°day of December,2003. The President,or any Vice President,acting with any Secretary or Assistant Secretary,shall have power and authority: 1. To appoint Attomey(s)-in-lad,and to authorize them to execute on behalf of the Company,and attach the Seal of the Company thereto,bonds and undertakings,contracts of indemnity and other writings obligatory in the nature thereof,and 2. To revoke,at any time,any such Attorney-in-fact and revoke the authority given,except as provided below 3. In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and authority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages andror final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is hilly understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee,shall not relieve this suretycompany of any of its obligations under its bond. 4. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner—Department of Highways of the Commonwealth of Kentucky et least thirty(30)days prior to the modification or revocation. Further,this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the 6th day of December 2011,of which the following is a true excerpt: RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking,contracts of indemnity and other wndings obligatory in the nature thereof,and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF.THE GUARANTEE COMPANY OF NORTH AMERICA USA has mused this instrument to be signed and tut,coits corporate seal to be affixed by its authorized officer,this 2nd day of October,2015. it L THE GUARANTEE COMPANY OF NORTH AMERICA USA STATE OF MICHIGAN Stephen C.Ruschak,President S Chief Operating Officer Randall Musselman,Secretary County of Oakland On this 2nd day of October,2015 before me came the individuals who executed the preceding instrument,to me personally known,and being by me duly swom, said that each is the herein described and authorized officer of The Guarantee Company of North America USA;that the seal affixed to said instrument is the Corporate Seal of said Company;that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of said Cynthia A. Take! IN WITNESS WHEREOF,I have hereunto set my hand at The Guarantee Notary Pudic,State of Michigan Company of North America USA offices the day and year above written. County of Oakland elf /// " may/ - /� My Commission Expires February 27,2028 a. T i Acting In Oakland County I,Randall Musselman,Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA,which is still in full force and effect. l\\yrslaao� IN WITNESS WHEREOF,I have thereunto set my hand and attached the seal of said Company this 6th day of June , 2017 d` � Randall Musselman,Secretary CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT % ..a .d.. CIVIL CODE§ 1189 aslawalescgescacormi A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached and not the truthfulness,accuracy,or validity of that document. State of California ) Countt1yy1 of Los Angeles ) On V 1)11Qi L.0f 20 ITh-before me, Corinne L. Hernandez, Notary Public Date Here Insert Name and Title of the Officer personally appeared William Syrkin NameXof Signe?( who proved to me on the basis of satisfactory evidence to be the person whose name(s.is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/tbeirauthorized capacity(ies),and that by his/her/their signature ).on the instrument the person or the entity upon behalf of which the person(shacted, executed the instrument. I certify under PENALTY OF PERJURY under the laws CORINNE L. HERNANDEZ of the State of California that the foregoing paragraph E Commission it 2083563 is true and correct. Notary Public-California WITNESS ray nd and oOhallseal. > Los Angeles County lie Ny Comm.Expires Sep 27,2019 Signat re rtZCPn.�.w ......ra Jx Signature of Notary Pub.c Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of 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:William Syrkin Signer's Name: E Corporate Officer — Title(s): iTh Corporate Officer — Title(s): Eli Partner — ❑Limited ❑General Li Partner — . l Limited General Ti Individual xi Attorney in Fact L I Individual i I Attorney in Fact ❑Trustee i.i Guardian or Conservator 1±Trustee L.Guardian or Conservator Li Other: ❑ Other: •nor Is Representing: IL 0 a Y/ ✓•Q-signer Is Representing: 4 _ is f i ► .. LIS .� . �xAd11.-. 02014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item 45907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 :raCce tonfeScr sr - .onct cec ^--acew-c ire A notary public or other officer completing this certificate verities only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of Los Aeta Pi ) p C On (—)I — 11 before me, (t'UrHle� /1 it IfeiPI (nw/P/r/—e ^Wr rt / R.Z., Date keg Here Insert Name and Title of the Officer personally appeared , n keg/1)10 r1 Name0? of Signe,* who proved to me on the basis of satisfactory evidence 11 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 MATTHEW MIceAEr LFWPENCE is true and correct. NHEW Poblic—CalibrnM 5 2,;t� d nngei::coumy WITNESS myhand and official seal. 4;54 Comm Expirion e1 ay1,2 My Comm,Expires Maye,3031 �/ Signatur4*" ' 4' / ,r,zj "'CJs-'&,- - 2 Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: 0, Document Date: Number of Pages: Signer(s) Other Than Named Above: _ Capacity(ies) Claimed by Signer(;) Signer's Name: XII 0.1 toi/p t A"'\ Signer's Name: X Corporate Officer — Title(s): ✓f°6,),/e41— I Corporate Officer — Title(s): Partner — L Limited 7 General i Partner — I 1 Limited _I General — Individual H Attorney in Fact fl Individual I Attorney in Fact 7 Trustee I Guardian or Conservator ❑Trustee —I Guardian or Conservator L Other: _ L Other: _ Signer Is Representing: kg/km itvi( Signer Is Representing: z s.u.•w x,wy„-6ca,�crc:zs--c.�--csaca .:c�:zx-:c^szocfcc6fv, cR-v faux-.: ©2016 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907 BIDDER: V-01/frit Y.itC 2.B 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 Bidders 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. 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 BIDDER: fU j bGr. TN( . 2.B LIST OF PROPOSED SUBCONTRACTORS(continued) [-Duplicate Next 2 Pages If needed far listing additional subaonlractors.'1 Name and Location Description of Work of Subcontractor to be Subcontracted Name: ¶ fle7fU' /A'b'��"^PTt ! +I '7 Z� C P lnot Address:r 312 C yQe55 . (yroly 0/1 `WO 0 License No.: - 74 3O4 Department of Industrial Relation Registration No./0:-)00 V00 o/ 17b Name and Location Description of Work of Subcontractor to be Subcontracted Name: MS L 5led-✓1 t ezi- , 1\ woite- H�f 3� io (<t 6:44"1 ;lt�iMO ::/v":Address: �/�I.f1 L, License No.: C,q 2" 1 J !! _ Department of Industrial Relation Registration No. /OD0000 5 5�J Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: License No.: Department of Industrial Relation Registration No. Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: License No.: Department of Industrial Relation Registration No. CBF- 9 BIDDER: k4l/ e'n ,tnC, 2.0 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: 1. C oy 4F g(Ark;rn 27c F a/,we Ave, 6iUU,c.�K, (A rlIfo- Name and Address of Ow er AtJawt colleti ; 9/ -2-3g 11‘ Name and telephone number of person familiar with project NO6, 86o Sf eel- Ca/1S0✓wj-,b4 2o% Contract amount Type of Work Date Completed 2. ( ,'fr o-4 ") 11.-.044011 III s st $* , A I rrr•}„(A ,l l� gpo Name and Address of Owner AS'\e"101 IkAPk;II-9n - 6z6 Name and telephone number of person familiar with project 1' 7937 1 imi< PC c (<,% ,,w ;t° /1-2_ 01 -1 Contract amount Type of Work Date Completed s. C,ply O`- 41, dot I1-1 -)/ gU ,n Ifi.re LGV 11Fr>490266 Name and Address of Owner /"r4k( tik V° re - �/U — y73 - 7165— NameyarM telephone number of person familiar withproject /� -7 , (1(7C) 0,0 /1 t' / CC !_6J' I Contract arAount Type of Work Date Completed 4. Cl � � 0-4 w1, 4i /ear / 3 2 30 femi 51-, It-IL.A cr ( A 9a0-1-- Name and Address of Owner lfr&J /71-P1/21`1rc/c'1- Name and telephone number of person familiar with project 33V) Cdo R*k 1 Lsfre -olf`fRcad) c016 Contract amount Type of Work /Date Completed CBF - 10 BIDDER: _lick ail 6, SECTION 3 NON-COLLUSION AFFIDAVIT CBF - 11 BIDDER: 1/-L1/j�14+'L to 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 content hereof,or divulged information or data relative thereto, or paid, and w I not pay, any fez to any corporation, partnership, company association,organization, 02 depository, •r to -ny -mber or agent thereof to effectuate a collusive or sham bid., - ��.LAL A y Signa re far PAL' S hi ' Typed or Printed Name P Title -14/4aA1 1i4 �= Bidder Subscribed and sworn before me This /1 ht, day of ,,17rf✓1P ' 20 / 7 (Seal) 4449000u Ikirketcre_e Notary Public in and for the State of California _ MATTHEW MICHAEL LAWRENCE _ Notary Public—Call'omla r r ms Argeies County MyCommission Expires: — a Z,c�Z € ti Comm'.won xp1re 2196150 P j My comm.Expires May 8.2021 CBF- 12 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 r taro-rmcrcrs ,c _ _ -:rurcrsscc _ rScec,rvr A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California County of L05 iy c/c-R On 6— I ' )°/ before me, /le&'lew Micc[d/ GU w/P✓tG2 NOfr^'Y Date Here Insert Name and Title of the Officer personally appeared M,/an kq/y)i)id A - Name(s)of Signer(s) 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 theientity 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. MATTHEW MICHAEL LA MENCB ` WITNESS my hand and official seal. ryy Notary Public-Calaornm ;(Y±;' Los Angeles County r� mmmisnooeztvstsa 4146Mi 4. ,, .U/-- *Comm.Expires May B,2021 $Igndtllre r^ WW Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Ne -LJl/N.5,1/ (doe 1,} Document Date: (� - IS —) 1 _ Number of Pages: / Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Mr r2.171 ra1Ph 'rit^ Signer's Name: xG Corporate Officer — Title(s): .d(7/1t _ i Corporate Officer — Title(s): H Partner — H I Limited f General I Partner — Limited General Individual _'Attorney in Fact Individual C Attorney in Fact I I Trustee Guardian or Conservator Trustee C Guardian or Conservator Other: I Other: Signer Is Representing: kei iL .+,TT: C Signer Is Representing: S.W-(,`r/VOCOCX+-G'tX,t42.zICVC 'a4v'G�scCe4`e'(.'a%C r"-W4`c4•[_ i_ N%C. "4c'/OuC"OCCVCic4'r'4q_'C_ ©2016 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-B76-6827) Item #5907 6/14/2017 California Department of Industrial Relations-Contact DR ar. I Laborlaa Cal/O51 IR - t lety F H.ea11'r Sell in-ur nee 4 ro c; ;cshlp Hi.,. : or's O'ri,c Boa MS Ruth!Woks Public Works Cent2Cor(PWC)rL^n4mtion 5ronfi Public Works Contractor (PWC) Registration Search This In n nxlmg a curremaod active PWC rapista ons pursuant to Division 2 Part 7 Cbapler I avmmemmne with section 1720M the California Labor code.l Enter at lam1 y_y,.evJ metria to drspOy active registered public works conkanm6sl notching you seleco Registration Year: Current Fiscal Year 2016/19 PWC Registration Number: [ample:1234567890 r Contractor Legal Name: [example:ABC COMPANY _ License Number _07550 _ j Contractor License LoCcLp County: [select County sectio uesc. EYpon as E+ml I PDF Search Results One registered contractor found 1 Details Legal Name Registration County City Registration Expiration Number Date Date V ent NALOAN,INC 100]002721 105 ANGELES SANTA OS/25/2016 06/30/2017 CLARITA v2.20160101 About DIR WO v/ilh Us I Crn More ILL Ln . .. Inuea CI on h L [cciss Sit httpsY/e0Iing.drdca.gov/PWCR/Searchaction 1/1