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Gentry BrothersCITY OF ROSEMEAD MISSION DRIVE STREET RESURFACING PROJECT FROM WESTERLY CITY LIMIT TO ROSEMEAD BOULEVARD PROJECT No. 21007 BIDDER: GENTRY BROTHERS, INC 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 BIDDER: GENTRY BROTHERS. I SECTION 1- BID SCHEDULE CBF -1 GENTRY BROTHERS, INC BID SCHEDULE SCHEDULE OF PRICES FOR MISSION DRIVE STREET RESURFACING PROJECT FROM WESTERLY CITY LIMIT TO ROSEMEAD BOULEVARD PROJECT No. 21007 BASE BID SCHEDULE CBF -2 UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 1 Clearing & Grubbing per plans LS 1 and specifications. See technical G0 SS t} 0 provisions TP -2, TP -3 & TP-4. i 2 Disposal of Waste Materials. LS 1 - j GO j o o 3 Cold mill 2.0- inches thick existing SF 291,300 ° q S pavement. 4 Construct 1.5 inches thick TONS 2,735 pavement overlay ARHM -GG -C `' PG 64 -16 as indicated on the plans. 5 Construct 1.0 inches thick TONS 1,825 Asphaltic Leveling course D1 13 I `� 0 U ' (PG 64 -10) as indicated on the v� plans. 6 Remove 6- inches of existing SF 500 pavement and replace it with 3.5- inches AC B as S o 6 ` of -PG 64 -10 Base Course over compacted native. 7 Remove, Dispose and Construct SF 5,700 4- inches thick PCC Sidewalk per Q � / SPPWC Std. Plan 113 -1. b , 8 Remove, Dispose and Construct SF 820 PCC Driveway Approaches per � L/ D SPPWC Std. Plan 110 -2. 9 Remove, Dispose and Construct LF 423 8- inches Curb and 24- inches Gutter per SPPWC Std. Plan d 120 -2. 10 Remove, Dispose and Construct SF 1,500 � PCC Cross Gutter er SPPWC p Std. Plan 1 5 U 123 -2. CBF -2 BIDDER: GENTRY BROTHERS, INC TO TAL BASE BID PRICE (SCHEDULE BID PRICE):$ 0 0 y �7 6 h. , a d Si� �L �la• s Dollar amount in written form CBF -3 UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 11 Remove, Dispose and Construct PCC Curb Ramps SPPWC EA 3 goo /U per I 7 / Std. Plan 111 -4. 12 Adjust Sewer Manhole to Grade EA 58 , per APWA Std. Plan 205 -1 and 206 O0 ' 7 Y60 -1. 13 Adjust Water Valve /Gas Valve to EA 50 Grade. SO . 14 Install Survey Well Monument EA 13 per City of Rosemead Std. Plan SOB -001. See Section 2 -9 6 OU " -7 X06 Surveying of the General Provision -7 per details (Cover, Sleeve & Dome will be provided by the City at no cost). 15 Install Traffic Striping, Traffic LS 1 Signal Loops and Pavement Markers per the Striping Plans and Specifications Complete. 16 Prepare a Storm Water Pollution LS 1 — 3 Prevention Plan (SWPPP) _3 G0c� doh 17 Remove, Salvage and Install EA 47 Street Name Signs on Existing �� ? 7 0 , Poles; City will provide the Signs. 18 Remove, Salvage and Install EA 6 Street Name Signs on Existing d Poles; City will provide the Signs. 19 Furnish and Install Solar In -Road EA 2 Pavement Lighting System Complete per Plans and U 7 p Co Specifications. 2 Locations with oG total of 36 In -Road Pavement Lights. 20 Furnish and Install Solar Speed EA 2 Feedback Sign System 0a Complete per Plans and Specifications. TO TAL BASE BID PRICE (SCHEDULE BID PRICE):$ 0 0 y �7 6 h. , a d Si� �L �la• s Dollar amount in written form CBF -3 BIDDER: GENTRY BROTHERS, INC 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 J bid bRn - the amount of Dollars ($ said amount being not less than "terrpercent (10 %) of the Total Bid Price. The undersig d a rees 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 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 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 :I�i BIDDER: GENTRY BROTHERS, INC 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 -5 By: Signature 4d Type or Print Name �,k5 c � ✓�- Title Bidder's /Contractor's State of Incorporation: Partners or Joint Venturers: GENTRY BROTHERS, INC Business Street Address 384 LIVE OAK AVE. IRWINDALE CA 91706 City, State and Zip Code 62,(- 3S') '963\ Telephone Number , Bidder's License Number(s): 3 9 ) (o r 2- A 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, nartnershiu or ioint venture has the authority to do so. CBF -6 BIDDER: GENTRY BROTHERS, INQ SECTION 2 BID DATA FORMS CBF -7 BIDDER: Gentry Brothers, 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 property identified with the Bidder's name and page number. 2.A BID BOND KNOW ALL MEN BY THESE PRESENTS: THAT Gentry Brothers, Inc. 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 Mission Drive Street Resurfacing Project as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated June 5, 2012 NOW, THEREFORE, if said Principal is awarded a Contract for the Work by the OWNER and, within the time and in the manner required by the above- referenced Bid Documents, enters into the written form of Contract bound with said Bid Documents, furnishes the required bonds (one to guarantee faithful performance and the other to guarantee payment for labor and materials) furnishes the required insurance certificates and endorsements, and furnishes any other certifications as may be required by the Contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect. In the event suit is brought upon this bond by the OWNER and judgment is recovered, said Surety shall pay all costs incurred by the OWNER in such suit, including reasonable attorneys' fees to be fired by the court. SIGNED AND SEALED, this 31st day of May , 2012 Gentry Brothers, Inc. (SEAL) Federal Insurance Company (SEAL) Principal Surety By; '�� By: Si Lure f"" ,'(�" f Signature M oww J. Coats, Attorney in Fact CBF - a CALIFORNIA On ALL - PURPOSE ACKNOWLEDGEMENT State of California County of Orange who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/axc subscribed to the within instrument and acknowledged to me that he'ehetdtey executed the same in hisfherftheir authorized capacity(ies), and that by hisfhcrJdteir signature(s) on the instrument the person(s), or the entity upon behalf of which the persons) acted, executed the instrument. before me, Adelaide C. Hunter, Notary Public (insert name and title of the officer) personally appeared Matthew J. Coats MAY 3 X 2012 I certify under PENALTY OF PERJURY under the laws of the Stare of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature A. ADELAIDE C. HUNTER Commission # 1808793 Notary Public -- California Orange County d rwy Camm. Expires Aug 8 2012 1rj Chubb POWER Federal Insurance Company Attu: Surety Department OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY pacific Indemnity Company Warren, NJ 07059 tolliulta;� Know All by These Presents, That COMPANY, a New York corporation, and appoint Linda D. Coats and Matthew n Indiana corporation, VIGILANT INSURANCE consin corporation, do each hereby constitute and 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 obligatory in the nature thereof (other then bail bonds) given or executed in the course of business, and any instruments amending or altering the same; and consents to the modification or alteratioh of any Instrument refofred to in said bonds . or obligations. In Witness Whereof sold FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this list day of December, 2011. / f wLl Kenneth C. 'Wendel, Assistant at aetary - Oavld B: Is, Jr, Mce President STATE OF NEW JERSEY County of Somerset' On this 1St day or December, 2011 before Me. a Notary Public of New Jersey; personally came Kenneth C Wendel, fo me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the Companies which executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, . being, by 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 tie: signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he Is acquainted with David B. Nome, Jr., and knows him to be Vice President of said Companies; and that the signature of David 8. Noms, Jr., subscribed to mid Power of Attorney is in the genuine handwriting of David B. Norris, Jr, and was thereto subscribed by authority of said By- Lam and in deponent's presence. Notarial Seal KATHERINE J. ADELAAR F NOTARY PUBLIC OF NEW JFRSFI r. N Expires Jul � CommilnlonEttplrrluly1b,2014 6r Notary Public CERTIFICATION E*act 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 behalf of the Company, either by the Chairman or the President a a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary. under their respective designations. The signature of such officers may be engraved, printed or lithographed. The signature of each of the following Officers: Chairman, President. any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may affixed by facsimile to any power of attorney or to any certificate relating 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 such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power W executed and certified by such facsimile signature and facsimile seal shall be 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 (Iha 'Companies) do hereby certify that (i) the foregoing extract of the By- Laws of the Companies (a true ano correct, (ii) the Comparise are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in Puerto Pjw and 'the A.S. Virgin Islands and Federal is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (iii) the foregoing Power of Attorney is true,, comect and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 31 St day of g May, 2012 - Kenn ende nt 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 -mall: surety (Mchubb.eom Form 15 -10- 02256- U (Ed. 5- 03) CONSENT CALIFORNIA ALL- PURPOSE CERTIFICATE OF AKNOWLEDGMENT State of: California Countyof: Los Angeles On June 6, 2012 ,beforeme, Smith, Notary----------------- - - - - -- (name and title of the officer) personally appeared Rodney J. Gentry------ - - - - -- who proved to me on the basis of satisfactory evidence to be the person (9) whose name(tl) is/RM subscribed to the within instrument and acknowledged to me that he/m executed the same in hisMKM Kauthorized capacity W)� and that by his /bo[let[ signature(1I) on the instrument the person(o or the entity upon behalf of which the person fS)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 Public a N. SMITH � Curt,+.,# 1843001 r5IARY PUBLIC CALIFORNIA _V ANGELES COUNTY .:.� MY COlw, E XP. APR. 02, 2019 i (Notary Seal) ._� ra= ....m��n ._ - - ='OPTIONAL INFORMATION•. r .... ��a� a._ xv -. e "-- Information below is NOT required by law however may deter fraudulent removal of this form. Description of Attached Document Number of Pages 1 Document Date: N /p Bid Bond - - - - -- or type 1 o n f A document b6 YVUQ � Additional information Capacity Claimed by Signer(s) • Individual(s) • Corporate Officer ❑ Partner ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other BIDDER: GENTRY BROTHE INC 23 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. 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 -9 BIDDER: GENTRY BROTHERS, INC 2.13 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 h^ a �AA �r 5 �avrS Name: 5 lYl iS � �,� Address , m t � n . Name and Location Description of Work of Subcontractor to be Subcontracted Name: S k a, P Address: d4tir Name and Location of Subcontractor Name: Address Description of Work to be Subcontracted Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address: Name and Location Description of Work of Subcontractor to be Subcontracted Name: Address CBF -10 BIDDER: GENTRY BROTHERS, INC 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: Name and Address Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 2. 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. Name and Address of Owner Name and telephone number of person familiar with project Contract amount Type of Work Date Completed CBF -11 d CD CD CD Cn N O L 0 n 0 �z n n n n n n n n 0 n n n 0 0 o n -' n `Z n `G ` z `G n `f D z o m o o m D o m 0 o m 3 o A 0 0. ao n O m C3 n o - o v > m 0 > n A o m o `" o c 3 d ° o- S' = n " 2 o 0 o 0 d N 0 0 s 0 f0 W (O W W W v (O W W W W W [D W f0 t0 t0 W W e O N O N O N O N N j N N N p O O O O N N - (O Ot t0 W (O 1p A (O W W V W W W W W W 6 W N ry b V J T J W (O tp W J N lD W W N N (p N W N W A A V 1 N Oo Oo V N W N O J W W O O W 6 Oo V W W W po N Oo Oo W W A N J V N N p N A O W N V n c p N 3 0 m m V 3 O N E 00 O O O O 2 Co 0 ( O G c N 0 O d = T d 0 0 S 0 0 0 N � ,. C O O O a F O O. 0 � 0 0 O Q m 2 0 S f. y 3 O co m O ° U 0 z W o m' d< m O n< O m O < T o m 'm 3 m m m m O o m c m c_ m 0 0 0 3 Q < m —. o r ro o c m 0< r 3 m D a° m u m c m' o m CO m m r o A m m 3 m 'm < w < 3 m y m y w # o C7 O ti c # 0 v 0 is 0 N . O S a < m o W K a O d �- — N , 3 O, m N v < W m m O. m m 'O m W' (� ° m D 3 00 3, in 3 N N F - N N 01 N Ol ^ N O p N - 3 3 3 Z < Fi 0 [� .�i. A S f ^ 0 0 7_ .41 1D O N . A (J1 _ _ 0 O N V O C iO O f Q N W . d N O S 3 N O -0 a # m 3 m m N x `" w E m o c Qw v < m 3 , N a < - G) 2 w m o o a O A 0 0 0 O ~ V N 2 N 0 G 3 m in V m 0 N O V O 0 j 0 N ° 3 W N 7 O O ID N W O N W A c A '- D n D m fn (n O 3 3 N m O o O < �^ c _ m W N W N N W N Ut Ut W N N N N V J V W W W V V V W W W W J EA EA E9 EA fA fA EA E9 fH fA fA E9 E9 EA fA fA fA EA fA fA fA N A t0 W N N N A A N f0 N W W N W -- W - N N l0 J W W A t0 t0 N W N W N N W W W O N W O W O N W O p N W V W A W W = O O O O t0 V Vt J O O O A O O _ J O W p O O O _- O O O O O IV O O O O O O O O O O O O O O O O O O O O 0 0 0 O O O O O O O O O O O O O N W O O N O N - N W N J N N N N N N Oo O N W W N N W j p j N O O N O O O O � N N J W � N N+ N N I N N N A N W p R3 �j O O O N O O O O O pl m 47 L) D y co o D o ti m D co D > > a a < < c < c n < < < m < < m a' GENTRY BROTHERS, INC BIDDER: SECTION 3 NON - COLLUSION AFFIDAVIT CBF -12 BIDDER: GENTRY BROTHERS, INC NON - COLLUSION AFFIDAVIT In accordance with Public Contract Code Section 7106, the undersigned, being first duly sworn, deposes and says that he or she holds the position listed below with the bidder, the parry 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. Signature e Typed or Printed Name g Title GENTRY BROTHERS, INC Bidder Subscribed and sworn before me This _ day of 1 20 (Seal) Notary Public in and for the State of California My Commission Expires: CBF -13 CALIFORNIA ALL- PURPOSE CERTIFICATE OF AKNOWLEDGMENT State of: California Countyof: Los Angeles On June 6, 2012 , beforeme N. Smith, Notary----------------- - - - - -- (name and title of the officer) personally appeared R od n ey J. Gent ry-------------------- ---------- - - - - -- who proved to me on the basis of satisfactory evidence to be the person (g) whose name(g) is/Roe subscribed to the within instrument and acknowledged to me that hem executed the same in hisMKMirauthorized capacity (rand that by his /hur&wk signature(g) on the instrument the person( or the entity upon behalf of which the person(dpcted, 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 N. SMITH Cn ^.ra.# 1843001 r � NOTARY PUBLIC - CALIFORNIA Lei ANGELES COUNTY `�,.a�✓ MY Cella, EXP. APR. 02, 2019 (Notary Seal) Information below is NOT required by law however may deter fraudulent removal of this forth. Description of Attached Document Number of Pages 1 Document Date: N/A Non - Collusion Affidavit - - - -- le or type of document Additional information Capacity Claimed by Signer(s) ❑ Individual(s) ❑ Corporate Officer ❑ Partner ❑ Attomey -in -Fact ❑ Trustee(s) ❑ Other