15-030 Installation agreement 10236 Lockwood Dr, APN 342-14-039 At
RECORDING REQUESTED BY:
DOCUMENT: 22910255 Pages: 14
City of Cupertino Fees. . . . * No Fees
Taxes. . .
WHEN RECORDED,MAIL TO: Cop i es.
AMT PAID
City Clerk's Office
City of Cupertino REGINA ALCOMENDRAS RDE # 005
10300 Torre Avenue SANTA CLARA COUNTY RECORDER 4/08/2015
Recorded at the request of
10:36 AM
Cupertino, CA 95014-3255
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Cit
i-tY ---- --- — --- --— ---- --- --
(SPACE ABOVE THIS LINE FOR RECORDER'S USE)
NO FEE IN ACCORDANCE
WITH GOV. CODE 27383
1
INSTALLATION AGREEMENT
10236 Lockwood Drive, Cupertino, CA
APN 342-14-039
Original.
O For Fast Endorsement
a
City of Cupertino
INSTALLATION AGREEMENT
,(.Cupertino Municipal Code Chapter 14.04)
10236 Lockwood Drive, Cupertino, CA
APN: 342-14-039 -
This INSTALLATION AGREEMENT ("Agreement") is made and entered into this ay
of 1 , 20 'i�j -by and between the CITY OF CUPERTINO, a municipal corporation
of the State of California, ("CITY"), and Lawrence C. Lei and Rebecca W. Lei ("DEVELOPER") for a
single family residence located at 10236 Lockwood Drive, Cupertino CA.
RECITALS
1. DEVELOPER has presented to the City an application for a development entitlement
consisting of sidewalk, curb and gutter, driveway approach, AC pavement, underground utility and
other auxiliary improvements (the "Development Entitlement") located at 10236 Lockwood Drive,
Cupertino CA (the "Property").
2. Chapter 14.04 of the Cupertino Municipal Code ("CMC") requires, as a condition
precedent to the erection, construction, addition, alteration or repair of any building or structure
in certain designated areas of the City with unimproved streets and for which a building permit is
required by the City, installation of certain types of public improvements and/or dedication where
deemed necessary by the City Engineer.
3. In consideration of City's approval of the Development Entitlement and pursuant to the
requirements of CMC Chapter 14.04, Developer desires to enter into this Agreement promising to
install and complete, at Developer's sole expense, all public improvement work required by the
City for the proposed development.
4. Developer has prepared and City has approved plans and related specifications (the
"Improvement Plans") for construction, installation and completion of improvements. The
Improvement Plans titled "Grading, Drainage and Street Improvement Plans for 10236 Lockwood
Drive, Cupertino CA", prepared by Ray H. Chen and dated December 24, 2013, are hereby
incorporated into this Agreement by reference.
NOW, THEREFORE, in consideration of the approval by City of the Development
Entitlement, City and Developer agree as follows:
Page 1 of 11
1. DEVELOPER'S OBLIGATION TO INSTALL IMPROVEMENTS
a: Completion of Improvements. Developer, at its own expense, shall furnish, install, and
-construct all 'improvements required by the City Engineer pursuant to Chapter 14.04 of the
Cupertino Municipal Code, or as amended, in a good and workmanlike manner and-as shown on
the';Improvement,Plains-as:approved by the City Engineer of Cupertino and in accordance with
..existing'ordinances and resolutions of the CITY and other applicable laws. The decision of the City
_- Engineer shall be final as to whether any material or workmanship meets the plans, specifications,
and standards as set forth-.
b. Compliance with applicable laws and rules. Developer shall complete the Work in
accordance.,with the.most current Standard Specifications of the Department of Public Works,
--
'' California -Department of Transportation, State of California, and in accordance with the
specifications of the.-Cupertino Sanitary District where applicable. Wherever the words "State" or
"California Division of Highways" are mentioned in the State Specifications, it shall be considered
as referring to the City of Cupertino; also wherever the "Director" or "Director of Public Works" is
mentioned; it shall be considered as referring to the City Engineer. In case of conflict between the
State Specifications and the specifications of the CITY, and/or the Cupertino Sanitary District, the
specifications of the CITY and/or the Cupertino Sanitary District shall take precedence over and be
--used in lieu of such conflicting portions.
c. Repair and replacement of damaged public facilities. Developer shall, at its own expense,
repair or replace all public improvements, public utility facilities, surveying monuments and other
public facilities that are destroyed or damaged as a result of any work under this agreement.
Developer shall promptly notify the City Engineer of such damage and shall obtain the City
Engineer's approval of all repair and replacement of damaged facilities.
d. Developer's responsibility until City's acceptance. Until City accepts the Improvements,
Developer shall be responsible for the care and maintenance of such improvements and shall bear
all risks of loss or damage to the improvements. City shall not have any liability for any accident,
loss or damage to the Improvements prior to their completion and acceptance by City. City's
acceptance of the Improvements shall not constitute a waiver of any defects in the Improvements
or Developer's obligation to repair such defects as provided in section 9 of this Agreement.
2. TIME FOR INSTALLATION OF IMPROVEMENTS
a. Required time of completion. DEVELOPER shall install and complete the Improvements
within one (1) year from the date of execution of this AGREEMENT, or such longer period as
may be specifically authorized in writing by the City Engineer. In the event the DEVELOPER
fails or refuses to complete the Work within the specified period of time, the CITY, at its sole
option, shall be authorized to complete the Work in whatever manner the CITY shall decide.
In the event the CITY completes the Work, the CITY may recover any and all costs incurred
thereby from the DEVELOPER or the DEVELOPER'S surety or both. No final inspection shall
Page 2 of 11
be granted or street improvements shall not be accepted unless all the requirements for
safety purposes are installed, such as sidewalks, handicap ramps, street lights, etc.
3..:. . DEDICATION OF EASEMENTS-.OR."RIGHTS OF WAY_
;. Xdedication-requir-ed. , .
7.
4. . . QUITCLAIM:DEED
DEVELOPER, when requested by the CITY, shall quitclaim all his/her rights and interests in, and
--.shall-grant:to CITY-authorization to extract water from the underground-strata lying beneath said
project:: DEVELOPER.agrees..to..execute.a "Quitclaim Deed and ,Authorization in favor of=CITY;
when presented.to him/her for signature: .
S. SECURITY
a. Required Security. Prior to execution of this Agreement, Developer shall provide the following
security to City in a form acceptable to the City:
(1) Faithful performance. Security for faithful performance in the amount set forth Part A
of the SCHEDULE OF BONDS, FEES AND DEPOSITS, attached and incorporated by reference
as Exhibit A.
(2) Labor and Materials. Security for labor and materials in the amount set forth Part B of
the SCHEDULE OF BONDS, FEES AND DEPOSITS, attached and incorporated by reference as
Exhibit A.
b. Form of Security. Developer shall provide as security, bonds executed by a surety company
authorized to transact a surety business in the State of California and approved by the City as to
sufficiency. In the event that the DEVELOPER shall fail to faithfully perform the covenants and
conditions of this AGREEMENT, or to make any payment, or any dedication of land, or any
improvements herein required, the CITY shall call on the surety to perform this AGREEMENT or
otherwise indemnify the CITY for the DEVELOPER'S failure to do so.
In lieu of a surety bond, the DEVELOPER may elect to secure this AGREEMENT by depositing with
the CITY (1) Cash; (2) A cashier's check, or a certified check payable to the order of the City of
Cupertino; or (3) A certificate of deposit, or instrument of credit acceptable to the City and
meeting the requirements of Government Code Section 66499 (b) or (c). The amount of said cash,
checks, certificate of deposit, or instrument of credit shall be as designated by the City Engineer,
and shall be the equivalent to that which would have been required had the DEVELOPER furnished
the CITY with a faithful performance surety bond. In the event that the DEVELOPER shall fail to
faithfully perform the covenants and conditions of this AGREEMENT, or to make any payment, or
any dedication of land, or any improvements herein required, the CITY may apply the proceeds of
said security thereto.
Page 3 of 11
c. Release of Security. No release of surety bond, cash deposit, check or certificate of deposit shall
be made except upon approval of the Director of Public Works. Schedule for bond and insurance
release-for paper bonds are as follows:
(1) Release of 90 percent of the faithful performance bond- upon acceptance by the Director of
Public Works.
(2)- Release of the remaining>10 percent of the performance bond at one year from acceptance
after all deficiencies have-been-corrected and in the absence of any claim against such bond.
(3) Release of the entire labor and material -bond at six months from acceptance after all
deficiencies have been corrected and in the~absence of any claim against such bond.. ....
(4) Liability insurance; provided by the DEVELOPER to hold -the CITY harmless in the event of
-.. liability arising from the project, to.be retiredat the end of one-year if.all deficiencies.have
been corrected and in the absence of any claim against such insurance.
6. PAYMENT OF REQUIRED FEES
a. Permits and licenses. Developer shall, at its sole expense, obtain all necessary permits and
licenses for the construction and installation of the Improvements, give all necessary notices, and
pay all fees required by City ordinance, including but not limited to the fees described in this
Agreement, and all taxes required by law.
b. Fees. Developer shall pay fees in the amounts set forth in Exhibit A, including but not limited to
the following, as required:
(1) Inspection Fees. DEVELOPER shall pay any and all necessary direct expenses for inspection,
checking, etc. incurred by CITY in connection with said Project, and that DEVELOPER shall
have deposited with CITY, prior to execution of this AGREEMENT. Should construction cost
vary materially from the estimate from which said sum is calculated, the City Engineer shall
notify DEVELOPER of any additional sum due and owing as a result thereof.
(2) Storm Drainage Fee. DEVELOPER shall deposit with the CITY, prior to execution of this
AGREEMENT, a storm drainage charge in connection with the said Project in accordance
with the requirements established in Resolution 4422, March 21, 1977.
(3) Map Checking Fee. DEVELOPER shall deposit with CITY, prior to execution of this
AGREEMENT, for office checking of final map and field checking of street monuments, in
compliance with Section 4:1 of Ordinance No. 47 (Revised 12/04/61) of CITY.
(4) Park Fee. DEVELOPER shall pay such fees and/or dedicate such land to the CITY, prior to
execution of this AGREEMENT, as is required within Section 18-1.602, Park Land
Dedication, Cupertino Municipal Code. Park fees are calculated in accordance with action
adopted by the City Council on March 19, 1991 and Chapter 14.05 or Section 18-1.602 of
the Cupertino Municipal Code.
(5) Reimbursement Fee. DEVELOPER shall deposit with the CITY, prior to execution of this
AGREEMENT, a reimbursement fee for any street improvements that have been installed
by the City, or by another property owner. Developer shall pay the City for the cost of the
land at the cost to the City, or another property owner, and shall pay a street improvement
Page 4 of 11
reimbursement charge for the improvements which the City or another property owner,
installed on the street abutting or included in the benefited property, in an amount equal
to the total improvement costs for each particular benefited property as set forth in a
reimbursement agreement. Payments for both land-and improvements shall include simple .
interest in the-amountof seven percerit per year,to be calculated in the following manner:
- _ (i'):Land-=Cost:- Interest to•.accrue :from the date the. street improvements :are. . .
r accepted by the City to the date the street_improvements reimbursement charge is
paid; or-Afi,:the"land is-.purchased by the: City for a City project, from the date of
purchase:to the date the charge is.paid.:
.(ii) Improvement.Cost: Interest:.to_accrue:'from the date the street:improvem'ents
are accepted-;byahe City to the date,the street-improvement reimbursement charge
is paid; or if installed by the City, from the date installation commenced to the date
the charge is paid.
(iii) Provided, however, that the interest shall be waived if the adjoining property
owner dedicates or has dedicated to the City land necessary for the street
improvements, or where no such dedication is necessary.
7. DEVELOPMENT MAINTENANCE DEPOSIT
DEVELOPER shall pay to the CITY, prior to execution of this AGREEMENT, the amount set forth in
Exhibit A as a development maintenance deposit. City may use the deposit at its discretion to
correct deficiencies and conditions caused by the DEVELOPER or his/her contractor that may arise
during or after the construction of the development, and to obtain copies of approved plans for
the CITY's files. If the costs exceed the amount deposited, DEVELOPER shall pay actual overage
prior to return of original plans. Any unexpended amount will be returned to the DEVELOPER at
the time all bonds are released in accordance with paragraph 5 of this agreement.
8. STREET TREE INSTALLATION
DEVELOPER shall fund the City for purchase and planting of street trees as deemed appropriate by
the City Engineer; or shall, at the discretion and at such time as deemed appropriate by the City
Engineer, plant street trees in conformance with the standards of the City of Cupertino. The
variety, number and location of trees are subject to City's prior approval.
9. MAINTENANCE AND WARRANTY
a. Developer guarantees and warrants the Improvements and agrees to remedy any defects,
damages, or imperfections in the Improvements arising from faulty or defective materials or
construction of the Improvements for a period of one year after City's acceptance of the
Improvements.
Page 5 of 11
b. If, within the warranty period, the Improvements or any part of the Improvements fail to fulfill
any of the requirements of this Agreement or the Improvement plans and specifications,
Developer shall repair,-replace or reconstruct any-defective or otherwise unsatisfactory parts of
the Improvements without-delay and-at=no cost to City. If (a) Developer fails to commence repairs
within thirty (30) days of the date,of mailed written notice from City, or (b) City determines that=
public safety requires repair-before Developer can be notified, City may, at its sole option, perform
the required-repair itself. Developer agrees to:pay the cost of any repairs City performs pursuant
to this agreement- and City may, at its option, recover that cost as a -Kien- against Developer's
property.
:. 10: . SANITARY DISTRICT = -
DEVELOPER,shall file with.the CITY, .upon execution. of this AGREEMENT, a letter from the
Cupertino Sanitary District stating that the DEVELOPER has submitted plans for review by the
District and that sanitary sewers are available to serve all lots within said Project.
11. GOVERNMENT COSTS
DEVELOPER shall file with the CITY, upon execution of this AGREEMENT, substantial evidence that
all provisions of Section 66493, Article 8, Chapter 4 of the Government Code, pertaining to special
assessments or bonds, have been complied with.
12. UTILITIES
DEVELOPER shall pay to Pacific Gas and Electric Company, AT&T, and/or appropriate utility
companies, any and all fees required for installation of overhead and/or underground wiring
circuits to all electroliers within said property and any and all fees required for undergrounding as
provided in Ordinance No. 331 of CITY when the DEVELOPER is notified by either the City Engineer,
Pacific Gas and Electric Company, AT&T, or appropriate utility companies that said fees are due
and payable.
13. EASEMENTS AND RIGHT-OF-WAY
Developer shall acquire any easement and right-of-way necessary for completion of the Project at
its own cost and expense. However, that in the event eminent domain proceedings are required,
the CITY for the purpose of securing said easement and right-of-way, DEVELOPER shall deposit
with CITY, a sum covering the reasonable market value of the land proposed to be taken and,to be
included in said sum, shall be a reasonable allowance for severance damages, if any. It is further
provided that in addition thereto, such sums as may be required for legal fees and costs,
engineering, and other incidental costs in such reasonable amounts as the CITY may require, shall
be deposited with the City of Cupertino.
Page 6 of 11
14. HOLD HARMLESS AND INDEMNIFICATION
DEVELOPER-shall indemnify and hold harmless CITY, its.officers, agents and employees from and
against an .or.all claims loss,,cost,'ex ense, dama e:or liability, resultin ..or in any way arising out
ofDeveloper-`s performance or nonperformance ofi-his her duties under this Agreement; or from,
;--negligent' acts -,oromissions or willful° misconduct of Developer's -agents, employees--and
contractors,:..or.subcontractors. Developer shall, athis/her own cost and.expense,.defend any-.and'.
ali:actions; suits or legal proceedings that may be brought against the City, it officers, agents-and
employees,resulting from-or:arising out of Developer's performance or nonperformance of his/h&
duties and.obligations.under this agreement; except to.the extent any.:of_the foregoing is caused
by the negligence or .willful misconduct 'of the CITY- or .the CITY'S agents, employees and
independent contractors.
15: INSURANCE
DEVELOPER shall maintain in full force and effect at all times during the term of this Agreement, a
policy of insurance naming the CITY and members of the City Council of the City of Cupertino
individually and collectively, and the officers, agents and employees of the CITY individually and
collectively, as additional insured. Said separate policy shall provide bodily injury and property
damage coverage to the foregoing named CITY and individuals covering all the Work performed
by, for, or on behalf of said DEVELOPER. Both bodily injury and property damage insurance must
be on an occurrence basis; and said policy or policies shall provide that the coverage afforded
thereby shall be primary coverage to the full limit of liability stated in the declarations, and if the
CITY, its members of the City Council individually and collectively, and the officers, agents and
employees of the CITY, individually and collectively, have other insurance against the loss covered
by said policy or policies, that other insurance shall not be called upon to cover a loss under said
additional policy.
The insurance carrier shall be licensed to do business in the state of California and provide proof of
their ratings. All ratings should be Best's Guide Rating of A, Class VII or better or that is acceptable
to the CITY. Each of said policies of insurance shall provide coverage in the following minimum
amounts: for general liability for bodily injury, personal injury and property damage $1,000,000
each occurrence, with an aggregate limit of not less than $2,000,000.
DEVELOPER shall file with the City Engineer at or prior to the time of execution of this AGREEMENT
by the DEVELOPER evidence of insurance coverage satisfactory to the City. Each policy or policies
shall bear an endorsement precluding the cancellation or reduction in coverage without giving the
City Engineer at least thirty (30) days advance notice thereof.
In the event that the Improvements are situated in or affect the area of jurisdiction of a separate
municipality or political subdivision of the State of California, the required insurance shall also
name the other jurisdiction(s) as additional insured.
Page 7 of 11
16. MAPS AND/OR IMPROVEMENT PLANS
Developer shall provide CITY with the following maps and/or plans at the.DEVELOPER'S expense:
A: A mylar-blackline and three,(-3) prints of fully executed-parcel map.
1.: '.A.mylar- blackline and-three (3)prints.of:fully executed.improvement plans .,:_. ,
C. •A scan:;in:raster format of all executed improvement plans and map.
D.. O-n:e--(1)% siie prints-of fully executed plans-and map.
The DEVELOPER agrees to pay-the CITY-from the-development maintenance deposit the.cost fo.r all
prints of plans and maps. If costs exceed the amount deposited the DEVELOPER is required to pay
actual overage prior to return of original plans.
17. SUCCESSORS AND ASSIGNS-COVENANT RUNNING WITH THE LAND
This Agreement shall inure to the benefit of, and be binding upon the heirs, administrators,
successors, assigns and transferees of the Parties, and shall be recorded in the Office of the County
Recorder and constitute a covenant running with the land. Upon any sale or division of the
Property, the terms, covenants, conditions and restrictions of this agreement shall apply to each
parcel, and the owner or owners of each parcel shall succeed to the obligations imposed upon
developer by this Agreement.
18. FAILURE TO PERFORM
In the event developer fails to perform one or more of the covenants and conditions of this
agreement, City at its option shall have recourse to the security given to guarantee the
performance of such acts. City may, at its option, door cause to be done, the acts required of
Developer and shall have recourse against as much of the security is necessary to discharge
Developer's responsibility. City shall also have recourse against developer for any and all amounts
necessary to complete the obligations of developer in the event that the security is insufficient to
pay such amounts. All administrative costs, including reasonable attorney's fees incurred by City in
addition to the costs of the improvements shall be proper charges against the security and
Developer.
19. NOTICES
All notices, demands, requests or approvals to be given under this Agreement shall be given in
writing and conclusively shall be deemed served when delivered personally or on the second
business day after the deposit thereof in the United States Mail, postage prepaid, registered or
certified, addressed as hereinafter
provided.
Page 8 of 11
All notices, demands, requests, or approvals from Developer to City shall be addressed to City at:
City of Cupertino
10300 Torre Ave..
Cupertino CA 95014. -
. Attention,: Public Works Director
,.- All notices,:demands,. requests,.,:or. approvals,-from City ,to ..Consultan_t:-shall-be addressed to..
Consultant at:
Ray.H.-Chen
384 Stowell Ave.
Sunnyvale; CA 94085
20. GOVERNING LAW AND ATTORNEY FEES . .
This Agreement shall beinterpreted under, and enforced by the laws.of the State of California
excepting any choice of law rules which may direct the application of laws of another jurisdiction.
The Agreement and obligations of the parties are subject to all valid laws, orders, rules, and
regulations of the authorities having jurisdiction over this Agreement (or the successors of those
authorities.) Any suits brought pursuant to this Agreement shall be filed with the courts of the
County of Santa Clara, State of California.
If City sues to compel Developer's performance of this Agreement, or to recover damages or costs
incurred in completing or maintaining the work on the Improvements, Developer agrees to pay all
attorney's fees and other costs and expenses of litigating incurred by the City, even if Developer
subsequently resumes and completes the work.
21. RELATIONSHIP OF PARTIES
Neither Developer nor any of its contractors, employees or agents shall be deemed to be agents of
the City in connection with the Performance of Developer's obligations under this agreement.
22. SEVERABILITY
The provisions of this Agreement are severable. If any portion of this Agreement is held invalid by
a court of competent jurisdiction, the remainder of the agreement shall remain in full force and
effect.
23. INTEGRATED AGREEMENT
This Agreement represents the full and complete understanding of every kind or nature
whatsoever between the parties hereto, and all preliminary negotiations and agreements of
whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be
held to vary the provisions hereof. Any modification of this Agreement will be effective only by
written execution signed by both City and Developer. All unchecked boxes do not apply to this
Agreement.
Page 9 of 11
IN WITNESS WHEREOF, the Parties have caused this agreement to be executed by their respective,
duly authorized officers on the date listed above.
CITY OF CUPERTINO:
Approved as to form:
Cit Attorney mm Borden, P.E.
Director of.Public Works
DEVELOPER:
Lawrence C. Lei
Rebecca W. Lei
Attach Notary acknowledgement
Exhibit:
Exhibit-A-Schedule of Bonds, Fees and Deposits
Page 10 of 11
Exhibit A
SCHEDULE OF BONDS; FEES, AND DEPOSITS-
Street Improvement Category:
PART A. ..,Faithful.P.erformance Bond:
110-2211 >. __ $23,034.50
PART B. Labor and Material Bond:
110-2211 $23,034.50
PART C. Checking and Inspection Fee:
110-4538 $2,707.00
PART D. Development Maintenance Deposit:
110-2211 $1,000.00
PART E. Storm Drainage Fee—Basin 2:
215-4072 $1,152.00
PART F. Street Improvement Plan
110-4538 $1,000.00
PART G. Map Checking Fee:
110-4539 $0.00
PART H. Park Fee-Zone II:
280-4082 $2,250.00
PART I. Reimbursement Fee: $0.00
Page 11 of 11
ACKNOWLEDGMENT
A notary public or other officer completing this certificate
verifies only the identity of the individual who signed the
document to which this certificate is attached, and not
the truthfulness, accuracy, or validity of that document.
State of California..�,,ff
County of �r�'v`Of
On b0' C g a-01g before me,
A Notary Public personally appeared
Rte , ,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)
are subscribed to within instrument and acknowledged to me thatjatana
they executed
the same in their uthorized capacity(ies), and that byc heir ure(,, on the
instrument the person s), or the entity upon behalf of which the person s acted, executed the
instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing paragraph is true and correct.
WITNESS my hand and official seal.
JACQUELINE T. LE
�'`' 9 COMM. #1942211
i
;5 Notary o Notary Public -California o
z" Santa Clara County
Signaure 41 My Comm.Expires June 25,2015
(Seal)
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California) )
County of r, ) /u
On �,°_ r�� 2- I S before me, f�i Yy7' , Rcc4ee- Sq -a✓`cr a . AJo'II
-Ckry P�6fi,c
Date Here Insert Name and Title of the Officer
personally appeared' r wi a rc r�
Name(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to be th erson($r whose namex is re
subscribed to the within instrument and ackno dged
to me that he she/they executed the same in
gher/their authorized capacity(iK,and that b his her/their signature on the instrument the person(,sj;
or the entity upon behalf of which the person(s) a ed, 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.
KIRSTEN RENEE SOUARCIA
Commission #2080884 L
���e
z;-o Notary Public -California > Signature ,
Z Santa Clara County
M Comm. Ex Signature of Notary P is
ires Oct 4,2018
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: 1�6K A ,�,4 Document Date: ���• 1. g, ��S
Number of Pages: // Signer(s) Other Than Named Above: Z_ w/-e c e C , L i
Capacity(ies) Claimed by Signer(s) /fid ecce JAI, L e
Signer's Name: Signer's Name:
❑Corporate Officer — Title(s): ❑Corporate Officer — Title(s):
❑Partner — ❑Limited ❑General ❑ Partner — ❑Limited ❑General
❑Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact
❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator
❑Other: ❑ Other:
Signer Is Representing: Signer Is Representing:
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