Gentry Brothers0
BIDDER: GENTRY BROTHERS, INC
0 BID SCHEDULE
SCHEDULE OF PRICES FOR
MISSION DRIVE STREET RESURFACING PROJECT
FROM ROSEMEAD BOULEVARD TO VALLEY BOULEVARD
1 PROJECT No. 21015
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BASE BID SCHEDULE
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UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
1
Clearing & Grubbing per plans
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and specifications. See technical
�9IO o0
3 `{ o 00
provisions TP -2, TP -3 & TP-4.
2
Disposal of Waste Materials.
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1 6U
o cu
3
Cold mill 2.0- inches thick existing
SF
183,700
-
pavement.
4
Construct 1.5 inches thick
TONS
1,653
pavement overlay ARHM -GG -C
o 0
7
(PG 64 -16) as indicated on the
3 U S
plans.
5
Construct 1.0 inches thick
TONS
Asphaltic Leveling course D1
(PG 64 -10) as indicated the
1 02,
^=
7a 7 302 '
on
plans.
6
Remove 6- inches of existing
SF
500
pavement and replace it with 3.5-
inches of AC B -PG 64 -10 Base
o%
3 000 c
Course over compacted native.
7
Remove, Dispose and Construct
SF
7778
4- inches thick PCC Sidewalk per
SPPWC Std.
7
Plan 113 -1.
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8
Remove, Dispose and Construct
SF
2270
PCC Driveway Approaches per
H 3 f-0
SPPWC Std. Plan 110 -2.
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9
Remove, Dispose and Construct
LF
592
8- inches Curb and 24- inches
Gutter per SPPWC Std. Plan
120
3 D
q
-2.
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BIDDER: GENTRY BROTHERS, INC
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$
T AAa 6 g'ti., ,) tao / � l An•� vn �i ,"C Yy -� /r r/
Dollar amount in written form
CBF -3
UNIT OF
EST.
UNIT
ITEM
NO.
ITEM DESCRIPTION
MEASURE
QTY.
PRICE
COST
10
Remove, Dispose and Construct
EA
5
PCC Curb Ramps per SPPWC
' 00
Std. Plan 111-4.
11
Adjust Sewer Manhole to Grade
EA
29
_
per APWA Std. Plan 205 -1 and
206 -1.
12
Adjust Water Valve /Gas Valve to
Grade.
EA
32
�b vo
`(O
13
Install Survey Well Monument
EA
5
per City of Rosemead Std. Plan
S08 -001. See Section 2 -9
Surveying of the General
u —
1 5-0
—
a SO '
Provision -7 per details (Cover,
Sleeve & Dome will be provided
by the City at no cost).
14
Install Traffic Striping, Traffic
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Signal Loops, and Pavement
Markers ( Including 8" Raised
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y S oc0
Pavement markers per the
Striping Plans and Specifications
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Complete.
15
Prepare a Storm Water Pollution
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_
—
Prevention Plan (SWPPP)
16
Remove, Salvage and Install
EA
6
Street Name Signs on Existing
Poles; City
will provide the Signs.
}
17
Remove, Salvage and Install
EA
2
—
Street Name Signs on new
_O
y Y 0 .
Poles, City will provide the Signs.
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$
T AAa 6 g'ti., ,) tao / � l An•� vn �i ,"C Yy -� /r r/
Dollar amount in written form
CBF -3
BIDDER: GENT B I
18 Install Wrought Iron Fence 6 LF 320
feet, 1 1/2" rails and 3/4" pickets,
all tubing 100% galvanized inside I I
and out and powder coated and
2° post per Kingmetals or
approved equal.
3 S x -06 '
TOTAL ALTERNATE BID PRICE No. 1 (SCHEDULE BID PRICE):$ 35- �O U
Dollar amount in written form
TOTAL BASE & ALTERNATE BID PRICE
S
Dollar amount in written
I + z $ y4), .
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 bid bo n the amount of
° a Dollars ($ ) said amount being not less than en percent (10 %) of the Total
Bid Price. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
CBF -4
ITEM
NO. ITEM DESCRIPTION I M EA I SURE I QTY. I P RICE I COST
. 05/14/2013 12:47 FAX
MAYOR:
Pauv Low
MAYORPROTEM:
Wa tALAR O
f
COUNCIL MEMBERS:
SAmRAARMP A
MARGARE CLARK
SisvENLY
May 13, 2013
li" of 1�qsemead
8838 E. VALLEY BOULEVARD P.O BOX 3 399
ROSEMEAD, CALIFORNIA 91770
7ELEPIIONE (626) 569 -2100
FAX (626) 307 -9218
CITY OF ROSEMEAD
ROSEMEAD. CALIFORNIA
ADDENDUM NUMBER
To all prospective bidders under Bid Documents for the
MISSION DRIVE STREET RESURFACING PROJECT
Project No. 21015
1. You hereby informed that Alternate No. 2 shall be added to the Contract Bid
Schedule of Items:
Alternate No. 2
arorm
vraw wnau uoa.....
NO
UNIT OF
EST
UNIT
ITEM
2
ITEM DESCRIPTION
MEASURE
QTY
PRICE
COST
19
Install Storm Drain System as
indicated on the attached Plans
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e-
3f /6 0
35-16
Complete.
„e
TOTAL ALTERNATE BID PRICE No.2 (SCHEDULE BID PRICE):$ 3--T0
written form
2. The rest of Bid Documents as originally issued shall be used in submitting bids, and
an acknowledgement of receipt of this Addendum Number 2 shall be entered on the
page CBF — 5 of the Contract Bid Forms. Failure to provide such acknowledgement
shall render the bid as non - responsive and subject to rejection.
BY ORDER OF THE CITY OSEMEAD
By
Rafael Fajardo
-� Associate Civil Engineer
Page 1
a BIDDER: GENTRY BROTHERS INC
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.
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Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidder's California contractors 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.
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
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.
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BIDDER: GENTRY BROTHERS, INC
By:
Signature
k Ct d 17�N �li K
Type or Print Name
Title
384 LIVE OAK AVE.
IRWINDALE CA 91706
Business Street Address
City, State and Zip Code
6 Lc, 3,s7- 9 (o 3
Telephone Number
Bidder's /Contractor's State of Incorporation:
Partners or Joint Venturers:
Bidder's License Number(s): 35 7 6 0
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 -6
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BIDDER: GENTRY BROTHERS, INC
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 properly
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 Comoanv
' as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
ten oercem of the total amount of the bid _
($ 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 May 22, 2013
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 fixed by the
court.
SIGNED AND SEALED, this 9th day of May 201
Gentry Brothers, Inc. (SEAL) F ederal Insurance Company (SEAL)
Principal Surety
By: J �ay By:
Sig lure A f Signature ew J. Coats, Attorney- in- Facts
nk Sl
,
CBF - B
CALIFORNIA
On
ALL - PURPOSE ACKNOWLEDGEMENT
State of California
County of Orange
MAY 0 9 2013
before me, Summer L. Reyes, Notary Public
(insert name and title of the officer)
personally appeared Matthew J. Coats
who provcd to me on the basis of satisfactory cvidcncc to be the person(s) whosc namc( s) is/are
subscribed to the within instrument aitd acknowledged to me that hefsheAhey executed the
same in hi sr"nerrtitcit authorized capacity(ies), and that by hig4mTEtheir signature(s) on the
instrument the person(s), or the entity upon behalf of which the personf 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.
_ SUMMER L. REYES
• Commission # 1966627
i
; =o Notary Public • California i
Z ' Orange County
Signature
My Comm. Expires Jul 29. 2016
Chubb
POWER. ..
Federal Insurance Company
!Attn: Surety Department
Surety'
OF
ATTORNEY
Vigilant. Insurance Company
1 Mountain View Road
Padfic Indemnity Company
Warren, N.1.07059
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 Linda D. Coats and Matthew J. Coats of Laguna Hills, California ---------------- _----- - - - - --
each as their true and lawful Attorney. in. Fact to execute under such designation in their names and to affbi their corporate seals to and deliver for and on their behaa as surety
thereon or othemise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business. and any
instruments amending or altering the mind, and consents to the modification or alteration of any instrument referred to in said bonds or opigabons.
In witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed their corporate seals on this lst day of December, 2011.
ee
Kenneth C. Wendel, Assistant Secretary ' —_ ( DavitlB ;, Jr., Vice rep: aril
STATE OF NEW JERSEY
:
County of Somerset Se '
On this let day o! December, 2071 before m r
e, a Notary Public New Jersey; personally came Kenneth C. Wendel, to me
known M be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC'INOEMNITY COMPANY,. the companies which
executed the foregoing Pourer of Attorney, and the said Kenneth C: Wendel, Wng'by me duty sworn, ;did depose and say tndt he is secretary of FEDERAL
INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals Hereof. that the seals affixed to the
foregoing Power of Attorney are such corporate seals and.vere thereto affixed by authority of the By. Laws of mid Companies; and that he signed said Power of Attorney: as
Assistant Secretary of said Companies by like authority; and that he is acquainted w,th David S. Norris, Jr., and knows him to be Vice President of said Companies; and that the
signature of David S. 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 KATHERINE J. ADELAAR
NOTARY PUBLIC OF NEW IFkSFI
. NOTARY� NPr2316685
y
a.e a Cpmminion Expire, Ju1y'.16; 2014
pUBLI� Notary Public
�'tir rcPS�
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 eiecuted in the name and on-behalf of He Company; either by the Chairman or the
President air 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 Vim President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to arty power of aftomey or to any
certificate retailing thereto appointing Assistant Secretaries or Attomeys in- Fact for purposes only of executing and attesting bonds and undertakings and other
writings obligatory in He nature theme;, 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 so executed antl certified by such facsimile signature and facsimile Met shall be valid and binding upon the Company
with respect to any borci 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'Companiesl do hereby certify that
(i) the foregoing extract of Ere By- Laws of the Companies is true and cored,
to transact (ii) the Companies are duly licensed and authwak surely business in all 50 of the United States of Annelids and the District of Columbia and are
authorized by the U.S. Treasury DepartmerK; fuller, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Island_ s. and Federal is licensed in
Amemmn Samoa, Guam. and each of lire Provinces of Canada except Prince Edward Island; and
(ii) the foregoing Power of Attorney is true, correct and in full force and effem.
Given under u my,hand . and seals of said Comppa W Wanen, NJ this 9th
day of May, 2013
Ken�Tyyendel slsunt 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@chubb.com.
Form 15.1 D- 02256 -L (Ed. 5 -03) CONSENT
CALIFORNIA ALL - PURPOSE CERTIFICATE OF AKNOWLEDGMENT
State of: California
Countyof: L Ang
May 22, 2013 , before me, N. 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(§) islet
subscribed to the within instrument and acknowledged to me that he/jbe&ey executed the same in
hisNOWauthorized capacity ()M)) and that by his/buc2wk signature(g) on the instrument the person(3U
or the entity upon behalf of which the personQcacted, 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.
my hand and official seal
N. SMITH
N Comm.$ 2012524 rr
A _ NOTARY PUBLIC- CALIFORNIA II'
of Notary Public Lm AN ES Court'
M Y Comm. Exp. A PR. 4 1 2017 a (Notary Seal)
mmOPTIONAL INFORMATIONR. 1 11111
Information below is NO required bylaw however may deter fraudulent removal of this form.
Description of Attached Document
Number of Pages 1
Document Date: N / D
Bid Bond
type of document
Additional information
Capacity Claimed by Signer(s)
• Individual(s)
• Corporate Officer
• Partner
• Attorney -in -Fact
• Trustee(s)
• Other
BIDDER: GEN TRY BROTHERS, INC
' 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
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, otherthan 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 forthe 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.
1
1
CBF -9
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BIDDER: GENTRY BROTHERS, INC
2.6 LIST OF PROPOSED SUBCONTRACTORS (continued)
(• Next 2 Pages if needed for listing additional subcontractors `1
Name and Location Description of Work
of Subcontra to be Subcontracted
Name: J —b ant "l 0✓nTh 6& O // A vfC 1 3f 54 �9
Address: C�naES s , iA
Name and Location Description of Work
of Subcontractor / / to be Subcontracted
Name: J m, �( ro L cc,/' f c oo�S
Address A fie_
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name: V.Csvf 'z0 -1./ �Jpz /cS
Address: j q i v 7A 62 • r aNC( n-,
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Name and Location
of Subcontractor
Name:
Address:
CBF - 10
Description of Work
to be Subcontracted
1
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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:
1
and Address of
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
Contract amount
3.
and Address of Owner
with project
Type of Work
Date
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
9
and Address of Owner
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
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[1
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11
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1
BIDDER: GENTRY BROT INC
SECTION 3
NON - COL LUSION AFFIDAVIT
CBF - 12
I
1
1
[1
[1
[1
1
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1
BIDDER: GEN BROTHERS, INC
NC;N- 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.
Signature
- � �" J. ..r
Typed or P Name
,INKS /cl6 ^��
Title
GENTRY BROTHERS, INC
Subscribed and sworn before me
This _ day of
Bidder
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 Ange
May 22, 2013 , before me , N. 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 0) whose name(g) istm
subscribed to the within instrument and acknowledged to me that he/xffr executed the same in
hisMMgKauthorized capacity (Jt Kand that by his /hacbtefc signature(g) on the instrument the person(3 �r
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
hand and official seal
(Notary Seal)
=OPTIONAL INFORMATION —
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: Nf/n
Capacity Claimed by Signer(s)
❑ Individual(s)
❑ Corporate Officer
Non - Collusion Affidavit-- - - - - -- ❑ Partner
Tit e r type of document ❑ Attorney -in -Fact
r n� ❑ Trustee(s)
❑ Other
Additional information