Bidder: Palp Inc DBA CITY OF ROSEMEAD
GARVEY AVENUE RESURFACING PROJECT
FROM DEL MAR AVENUE TO EASTERLY CITY LIMIT
PROJECT No.21026
CONTRACT BID FORMS
BIDDER: )c1a "¶A'"11;CM/WAIT'
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID SCHEDULE 1
SECTION 2 BID DATA FORMS 5
2.A BID BOND 6 6
2.B LIST OF PROPOSED SUBCONTRACTORS
SECTION 3 NON-COLLUSION AFFIDAVIT
10
PALP.INC.DaA
EKCEL PAVING COMPANY
BIDDER:
SECTION 1 -BID SCHEDULE
CBF - 1
ML?.. WC lib*
BIDDER: EXCEL PAVING COMPANY
BID SCHEDULE
SCHEDULE OF PRICES FOR
GARVEY AVENUE RESURFACING PROJECT
FROM DEL MAR AVENUE TO EASTERLY CITY LIMIT
PROJECT No. 21026
BASE BID SCHEDULE
UNIT OF EST. UNIT ITEM
NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST
1 Clearing &Grubbing per plans LS 1 15100„
and specifications. See technical
provisions TP-2, TP-3& TP-4.
2 Disposal of Waste Materials. LS 1 3600 ---
3
3 Cold mill 1,5-inches thick existing SF 553,200 0.tO Ir0(p4o. -
pavement.
4 Construct 1.5 inches thick TON 5,186 UZ - U2.czcz —
pavement overlay ARHM-GG-C
(PG 64-16) as indicated on the
plans.
5 Remove 6-inches of existing SF 5,000 6.- \10000
pavement and replace it with 4.5-
inches of AC B-PG 64-10 Base
Course over compacted native.
6 Remove Existing, Dispose and SF 3,885 8 , 31 oeo —
Construct 4-inches thick PCC
Sidewalk per SPPWC Std. Plan
113-1.
7 Remove Existing, Dispose and LF 100 —ls — —7 SZJO
Construct 8-inches Curb and 24-
inches Gutter per SPPWC Std.
Plan 120-2.
8 Remove Existing, Dispose and EA 1 5030— $D30
Construct PCC Curb Ramps per
SPPWC Std. Plan 111-4.
CBF - 2
'.C.Z M
^,Mr°!1 COMPANY
BIDDER:
2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
I**Duplicate Next 2 Pages if needed for listing additional subcontractors.**]
Name and Location Description of Work
of Subcontractor L- to be Subcontracted/ "
•
Name: 0 Ck 'NUM), ,4c 0A01‘_ M;
Address: RD C514 1)11lc \.4\ *+c. CA
License No.: 1S`'t (03
Department of Industrial Relation Registration No. 1 00003 6_422
Name and Location Description of Work
of Subcontractor bC ''pp to be Subcontracted
Name: a.'..�.M<.a:a — -yrs
640115
Address: *',0 �r� %i s SyJXW 'a Ave- I W'1_
er1
License No.: 'lt.6(.
Department of Industrial Relation Registration No. I Obaln¶'D3
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: S, 6WAi L., Lays
Address: tot30 V� i,IIA Aft- 0441— P""
License No.: IGrN rl5
Department of Industrial Relation Registration No. IOJOI3Ol Ia I O
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: C.L (S\Mitt rry`w y,,
Address: k 03S tJ (4 e GI Ymn.* Prl.US4 ("-
License No.: NOp,'12v
Department of Industrial Relation Registration No. 1.0000O11I1
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
License No.:
Department of Industrial Relation Registration No.
CBF - 9
Fk-F.. iNC.OBA
XGEI PAVING COMPANY
BIDDER:
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
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.
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.
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
License No.:
Department of Industrial Relation Registration No.
CBF- 9
?ALE WielklA
BIDDER ':10;74 "A4,ZNG C(JFAfrome
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. (\a0 1,)HU n hi1 )O Puny Sr
Name and Address of Owner
V1L,\1t_ C kicm Sldi) 931 qS I t
Name and telephone number of person familiar with project
1 D3 1/4-VA Prm k OA4.14 124 7.41
Contract amount Type of Work Date Completed
2. CX0 <,A 4.) ', Goff • D\'\ Cv v-V\ \Mkt. PI44.7 j
Name and Address of Owner
'FVamV- eXtrb.25 g 'x(02 432-1Name and telephone number of person f liar with project
1,01/4)3, GLO _ _ eAlilArt QVmr °OUR.
Contract amount Type of Work Date Completed
3. \)U0.141- gat) ‘"\311411414" 17v
Name and Address of Owner
2.a.1-0-6, Casllas UV() 3S'11°I31
Name and telephone number of person familiar with project
201 )\3 — UN Ldmas 112a16
Contract amountType of Work Date Completed
4. e,1.0 b 11 C UMf,1/ \Woo° C L Ca.-- 'bv
Name and Address of Owner
'me and) lone n� nla ij eDhI I4tik
Name and telephone n ber of person famml liar with project
1 .I q. 1341 - 91tal%Iaerr 144440 1 IMr6
Contract amount Type of Work Date Completed
CBF - 10
MLF.IAiClibA
BIDDER: MEL PRONG COMPAM*
SECTION 3
NON-COLLUSION AFFIDAVIT
CBF - 11
•
. INC.DBA
•
BIDDER. XCE PAVINn COAPANV
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.
enature
Curtis P. Brown III
President
Typed or Printed Name
Title
'AJY INC€A—
Bidder FXTP PAVING COMPANW
Subscribed and sworn before me
This day of %l II' ?''7 , 20
(Seal)
At
Notary Public n .� d forfr2t7O - ��
COM.tt2ll01]1
the Stale of Ca omia o LOS A GENES COmmY a
� �� �/ LOS ANGELES COUNTY
My Comm.Expires Oct 29 202 r
My Commission Expires: kOM rLO/U)
CBF- 12
ai9 NNNC.DBA
BIDDER: ''X1.'E' Alf NC CfIMPINY
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 Bidder's Total Bid Pdce,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
PAti Ut1C.UBA
BIDDER: OCCV PMVING rrIMPANV
•
UNIT OF EST. UNIT ITEM
NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST
9 Adjust Sewer Manhole to Grade EA 85 SCO 4 Z
per SPPWC Std. Plan 205-1 and
206-1.
10 Adjust Water Valve/Gas Valve to EA 100 two — 40 UTO—
Grade.
11 Install Survey Well Monument per EA 24 I
City of Rosemead Std. Plan 508-
001. See Section 2-9 Surveying of
the General Provision-7 per
details (Cover, Sleeve&Dome
will be provided by the City at no
cost).
12 Install Traffic Striping,Traffic LS 1 DWO. `IDGOD
Signal Loops and Pavement
Markers per the Striping Plans
and Specifications Complete.
TOTAL BASE BID PRICE (SCHEDULE BID PRICE): $ 11 £fl7
Severn \\k,L14t4o `o"4"'J tht IP-k nwa KA ,u W &Nemj neo
Dollar amount in written form Abati( e0/0O
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 eadier. 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.
CBF - 3
OltiA
BIDDER: ALP. .
Attached hereto is a certified check, a cashier's check or a bid bc_ind in the amount of
Dollars ($ ) said amount being not less than ten percent (10%) of the Total Bid Price. The
?EII
PVICinkjlafatigirsaid 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 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 protect is not completed in THIRTY(30) calendar days.The Contract Time will
begin to run ten (10) Working Days from the date of the Notice of Proceed and subiect 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 -4
PALP MGM
•
BIDDER: � .PAVING COMPANY
By: fwl,1 �"----�
'gnature Business Street Address
2230 LEMON AVENUE
urtis P Brown III President LO:“:E, C`1. .:A'3L'r
Type or Print Name City, State and Zip Code
(552) 529-554)
Title Telephone Number
CALIFORNIA
Bidder's/Contractor's State of Incorporation: -- \
Partners or Joint Venturers: N \is`
STATE LIC. 668659'A'
Bidder's License Number(s): _
Department Industrial Relations
Registered No. \3O 000 333
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 - B
CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT
I11 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.
I State of California it
'I
County of Los Angeles "
i
before me, C. Phillips, Notary Public II
,Notary Publiq
• (Here insert name and title of officer)
personally appeared Curtis. P. Brown Ill ,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/a(subscribed to
II
the within instrument and acknowledged to me that he/shl/tblt4 executed the same in his/bits/thoir authorized y
• capacity(ies), and that by his/hyk/tlpfjr 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. l
- - -•C PHILLIPS
WITNESS my hand and official seal. - - comm,#21.70177
Notary Publlegalifornl a p
•
\. 1 ,J LOS ANGELES COUNTY
4 \� -_-__' My Comm.Expires Oct 29.2020
(Notary Seal)
Signage of Notary Pu m ��--'
ADDITIONAL OPTIONAL INFORMATION
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly a• 1
DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be
property completed and attached to that document. The only exception is if a
document is to be recorded outside of Calf rnia In such instances,any alternative 1
(Title or description of attached document) acknowledgment verbiage as may he printed on such a document so long as the
•
verbiage does not require the notary to do something that is illegal for a notary in
{ Cdi is (ie. certifying the authorized capacity of the signer). Please check the
(Title or description of attached document continued)Document Date document carefully for proper notarial wording endattach th:sfornl if required.
Number of Pages • State and County information must be the State and County where the document i
- - . - signer(s)personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s)personally appeared which
must also be the same date the acknowledgment is completed.
1 (Additional information) • The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title(notary public).
• Print thename(s) of document signer(s)who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e.
h.l� is/are)or circling the correct f s.Failure to correctly indicate this
❑ Individual
(s) infomiation may lead to rejection of document recording.
O Corporate Officer • The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or Imes. If seal impression smudges,re-seal if a
(Title) sufficient area permits,otherwise complete a different acknowledgment form
❑ Partner(s) • Signature of the notary public must match the signature on file with the office of I
the county clerk.
❑ Attorney-in-Fact ? Additional information is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document
S Indicate title or type ofatached document,number of pages and date.
ID Other -- -- O Indicate thecapacity claimed bythe signer. If the claimed capacityI
is a
corporate officer,indicate the title(i.e.CEO,CFO Secretary/-
• Securely attach this d oar✓ s st
I'
C2004-21315 ROIank SlAmnk xrvi e.rnr.-.VI Gfrs Rc,nN www.IDrt'roLinkmm-Na ionwide Notary Seng
LR IMC.DBA
BIDDER: FWD_PAVING COMPANY
SECTION 2
BID DATA FORMS
CBF - 6
BIDDER: PALP Inc.dba Excel Paving Company
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 PALP Inc.dba Excel Paving Company ,as Principal,
and Federal Insurance Company
, 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 of the 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 GARVEY AVENUE RESURFACING PROJECT - FROM DEL MAR AVENUE TO
EASTERLY CITY LIMIT as set forth in the Notice Inviting Bids and accompanying Bid
Documents,dated August 30,2017 .
NOW,THEREFORE,if said Principal is awarded a Contract fertile 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 saki 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 24th day of August , 20 17 .
PALP Inc.dba Excel Paving Company (SEAL) Federal Insurance Company (SEAL)
Principal Surety
By: By: `e •
ignature • oneAttorney in Fact
C itis P. Brown III President
•
CBF -7
ACKNOWLEDGMENT
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 Orange
On August 24, 2017 before me, Debra Swanson. Notary Public
(insert name and title of the officer)
personally appeared Douglas A. Rapp
who proved to me on the basis of satisfactory evidence to be the person*)whose name(*)is/ere
subscribed to the within instrument and acknowledged to me that he,WAlrej executed the same in
hisftlilalailpeir authorized capacity4i*e), and that by his/h*e4h as signature*)on the instrument the
persontal), or the entity upon behalf of which the person(e)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. w Vim'°"a,. DEBRASWANSON
rq, COMM. #2170759 A
Cl q a NO1W PUB#c.CAOFORVU N
C' ' ORANGE COUNTY
rMYCOMM.EXPNo 10,2020N
Signature 1�- `—amu, "u\ (Seal)
Chubb POWER Federal Insurance Company Attn: Surety Department
OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059
ra
Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE
COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY a Wisconsin corporation, do each hereby constitute and
appoint Douglas A.Rapp and Timothy D. Rapp of Aliso Viejo, California --------------------------
each as their true and lawful Attorney-in-Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise,bonds and undertakings and other writings oba£ttory in the nature thereof(other than bail bonds)given or executed in Ore course of business,and any
instruments amending or altering the same,and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
In Witness Whereof.said FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed trier corporate seals on this 16th day of December,2011.
Kenneth Cis I Secretary C / Nonis Jr Vete President
STATE OF NEW JERSEY
County of Somerset ss
On this 16th day of December, 2011 before me,a Notary Public of New Jersey,personally came Kenneth C.Wendel,to me
known to be Assistant Secretary of FEDERAL INSURANCE COMPANY.VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the companies whlch
executed the foregoing Power of Attorney, and the sae Kenneth C. Wendel, being ay me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL
INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof,that the seals affixed to the
foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By-Laws of said Companies-,and that he signed said Power of Attorney as
Assistant Secretary of said Companies by like authority and that he is acquainted with David B.Ndrri,Jr,and knows him to be Vice President of said Companies,and that the
signature of David B.Norris,Jr.. subscribed to said Power of Attorney is in the genuine handwriting of David B Norris,Jr.and was thereto subscribed by authority Of said By-
Laws and in deponent's presence.
,Notarial Seal 3 AD KATHERINE..ADEIMR '
IL !yNOTARY PUBLIC 16 NEW 1Fk5F1 ��A �'_
,F is-
TA Nr.2316665 GLG�
�� is sO Commiuion&pima July 16,2014
- RUBY 4, Notary Public
gEw 3fF CERTIFICATION
Extract from the By-Laws of FEDERAL INSURANCE COMPANY.VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY:
'All powers of attorney for and on behalf of the Company may and shall be executed in the name and on oenalf of the Company,either by the Chairman or the
President or a Vice President or an Assistant Vice President.Jointly with the Seoelary or an Assistant Secretary, under their respective designatons The
signature of Such Officers may be engraved,printed or lithographed.The signature of each of the folowing officers Chairman,Pres dent,any Vice President.any
Assistant Vice President.any Secretary,any Assistant Secretary and the seal of the Company may be apexed by Facsimile to any Power of attorney or to any
certificate reladng thereto appointing Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other
writings obligatory in the nature thereof,and any sucn power N attorney or certificate bearing such facsimile signature or facsimile seal shall oe valid and binding
upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall he valid and binding upon the Company
with respect to any bond or undertaking to which it is attached.'
I.Kenneth C.Wendel.Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY
(the'Companies")do hereby certify that
(i) the foregoing extract of the By-Laws of the Companies is true and correct,
(ii) the Companies are duly licensed and authorised to transact surety business in all 50 of the United States of America and the District of Columbia and are
aulhonzed by the U.S Treassy Department.further,Federal and Vigilant are licensed in Puerto Rico and the U.S Virgin Islands,and Federal is licensed in
American Samoa,Guam,and each of the Provinces of Canada except Pnnce Edward Island,and
fief) the foregoing Power oAAlbrney is We,correct and in full face and effect.
Given under my hand and seals of said Companies at Warren.NJ this 24th day of August,2017
0u.
6040 �� eeM pie-
Kenneth C.We el,Assistant Secretary
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM,VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER
MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE,OR BY Telephone(908)903-3493 Fax(908)903-3656
e-mail. surety@chubbcom
Form 15-10-02256-U (Ed.5.03) CONSENT
-'
CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT
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A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document o
which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
it State of California 1
County of Los Angeles
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On mu:, e°il/ before me, C. Phillips, Notary Public ,Notary Public, n
(Here insert name and title of the officer)
personally appeared Curtis. P. Brown III
who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/s subscribed to
the within instrument and acknowledged to me that he/she/the* executed the same in his/lyfr/thy* authorized
capacity(ies), and that by his/hyst/th4r signature(s)on the instrument the person(s),or the entity upon behalf of •
which the person(s) acted,executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal. a Pu, 7
COMM.#2170]707
Notary publc0allbmla ¢
�' , LOS ANO EL ES CO 9,20 a
(Notary Seal) My Comm E+phes Oct 29,20201
Signature of Notary Pubo ��_
ADDITIONAL OPTIONAL INFORMATION
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California m contain verbiage exactly as
DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be
properly completed and attached to that document. The only exception is if a
document is to be recorded outside of California.In such instances,any alternative
(Title or description of attached document) acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that.5 illegal for a notary in 1
California (i.e. certifying the authorized capacity of the signer). Please check the I
(IStleo[desetlptlon of attached document continued) docurrmmcarefully forproper notanal wording and attach this/atm if required
• State and County information must be the State and County where the document
Number of Pages Document Date_ signer(s)personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s)personally appeared which
must also be the same date the acknowledgment is completed.
(Additional information) • The notary public must print his or her mune as it appears within his or her
commission followed by a comma and then your title(notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e.
heishe/Mey;is Ire)or circling the correct forms.Failure to correctly indicate this
❑ Individual(s) information may lead to rejection of document recording. I
❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges,re-seal if a
(Title) sufficient area permits,otherwise complete a different acknowledgment form.
U Partner(s) • Signature of the notary public must match the signature on file with the office of
the county clerk.
El Attorney-in-Fact O Additional information is not required hut could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document.
!' ❑ Other - ry Indicate title or type of attached document,number of pages and date.
•) Indicate the capacity claimed by the signer. If the claimed capacity is a
horporat officer,indicate thtitle(i.e.CEO,CFO,Secretary).GGSurely attach aricument to the signed document
III
C 2.004 2a 15 Pm Iard*mug&vacs lne.-Al Rghu Pemex naw TeeM1elaJaom-Nation wide Notary Semen