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15-139 All City Management Services Inc , 2015 Contractual Crossing Guard Services-Rebid, Project #2015-25FIRST AMENDMENT TO AGREEMENT BETWEEN THE CITY OF CUPERTINO AND ALL CITY MANAGEMENT SERVICES INC. This First Amendment to the Agreement between the City of Cupertino and All City Management Services for reference dated October 4th, 2016 is by and between the CITY OF CUPERTINO, a municipal corporation (hereinafter "City") and All City Management Services a California Corporation ("Contractor") whose address is 10440 Pioneer Blvd., Suite 5 , Santa Fe Springs, CA 90670 and is made with reference to the following: RECITALS : A. On August 17th, 2015, an agreement was entered into by and between City and Contractor (hereinafter "Agreement") for crossing guard services at various locations throughout the City. The Agreement and the First Amendment are collectively referred to as the "Agreement" unless otherwise indicated. B. City and Contractor desire to modify the Agreement on the terms and conditions set forth herein. NOW, THEREFORE, it is mutually agreed by and between and undersigned patties as follows: 1. Paragraph 3 .1 -Contract Time of the Agreement is modified to read as follows: The Contract Time will commence to run on the date indicated in the Notice to Proceed . City may give a Notice to Proceed at any time within 30 Days after the Notice of Award . Contractor shall not do any Work at the Site prior to the date on which the Contract Time commences to run . With satisfactory perf01mance by the contractor, the term of this agreement shall be three (3) years from the start date of the agreement. The City shall retain the option to extend the term of the agreement for an additional two (2) years, for a possible total of five (5) years. Contractor perfo1mance will be documented weekly by the Street Supervisor, with deficiencies communicated to the Contractor. An annual review of contractor performance will be completed by March 3 I st of each year. Satisfactory performance will be achieved if annual liquidated damages are less than $1,500 for missed crossing guard events and $200 for improper staging of pedestrian flow . Compensation to Contractor shall be $15 .59 /hr for the 15 /16 school year; $16.01/hr for the start of I 6/17 school year ; $18.64/hr effective upon execution of this amendment through the end of the 16/17 school year, and $20.61/hr effective for the 17/18 school year. There will be no CPI adjustment during the remaining terms of the agreement. Any renewal after the first three years shall be accomplished by the City providing a written notice ofrenewal to the Contractor at least 30 days prior to expiration of the term. Any such renewal shall contain the same provisions as the original agreement with compensation adjustments limited to actual changes in minimum wage requirements plus 31. 5% labor burden added . Minimum wage payable to crossing guard staff for calendar year 2017& 2018 shall be $12/hr and $13 .50/hr, respectively. The City shall have the authority to suspend this agreement, wholly or in part, for such period as deems necessary due to unfavorable conditions or to the failure on the part of the Contractor to perf01m any provisions of this agreement. 2. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect. IN WITNESS WHEREOF , the parties hereto have caused this modification of Agreement to be executed. CONTRACTOR CITY OF CUPERTINO A Municipal Corporation ~it ~ sf fl.f.hC lJ<. ,k .5 RECOMMENDED FOR APPROVAL: ~it~e ~~ o,' ~[{ j/~ APPROVED AS TO FORM: w ~ City Attorney ATTEST: &,eScli'Jt City Clerk { f. 4. \ ~ DOCUMENT 00520 CONTRACT THIS CONTRACT, dated this\_7_~y of J:2 ..,,.,. , 2015, by and between ________ _ All City Management Services Inc., who's place ~sis located at 10440 Pioneer Blvd, Suite 5, Santa Fe Springs, CA. 90670 [Address of Contractor] (''Contractor"), and the CITY OF CUPERTINO, a Municipal Corporation of the State of California ("City") acting under and by vi11ue of the authority vested in the City by the laws of the State of California. ·7+-"'-·"'T"" \ WHEREAS, City, on the __ day of :\Lu f Project: , 2015 awarded to Contractor the following PROJECT NUMBER 2015-25 2015 CONTRACTUAL CROSSING GUARD SERVICES -REBID NOW, THEREFORE, in consideration of the mutual covenants hereinafter set forth, Contractor and City agree as follows: ARTICLE 1. WORK 1.1 Contractor shall complete all Work specified in the Contract Documents, in accordance with the Specifications and all other terms and conditions of the Contract Documents. ARTICLE 2. AGENCY AND NOTICES TO CITY 2.1 City has designated Roger Lee, Assistant Director of Public Works to act as City's Authorized Representative(s), who will represent City in performing City's duties and responsibilities and exercising City's rights and authorities in Contract Documents. City may change the individual(s) acting as City's Authorized Representative(s), or delegate one or more specific functions to one or more specific City's Representatives, including without limitation engineering, architectural, inspection and general administrative functions, at any time with notice and without liability to Contractor. Each City's Representative is the beneficiary of all Contractor obligations to City, including without limitation, all releases and indemnities. 2.2 All notices or demands to City under the Contract Documents shall be to City's Authorized Representative at: 10555 Mary Avenue, Cupe11ino, California 95014 or to such other person(s) and address( es) as City shall provide to Contractor. ARTICLE 3. CONTRACT TIME AND LIQUIDATED DAMAGES 3. l Contract Time. The Contract Time will commence to run on the date indicated in the Notice to Proceed. City may give a Notice to Proceed at any time within 30 Days after the Notice of Award. Contractor shall not do any Work at the Site prior to the date on which the Contract Time commences to run. With satisfactory performance by the contractor, the term of this agreement shall be three (3) years from the start date of the agreement. The City shall retain the option to extend the term of the agreement for an additional two (2) years, for a possible total of five (5) years. Contractor perfonnance will be documented City of Cupe11ino 2015 Contractual Crossing guard Services -Rebid DOCUMENT 00800-1 weekly by the Street I Fleet Supervisor, with deficiencies communicated to the contractor. An annual review of contractor performance will be completed by March 31 •1 of each year. Satisfacto1y pe1forma11ce will be achieved if annual liquidated damages are less than $1,500 for missed crossing guard events and $200 for improper staging of pedestrian flow. Any such renewal after the first three years shall be accomplished by the City providing a written notice of renewal to the Contractor at least 30 days prior to expiration of the term. Any such renewal shall contain the same provisions as the 01igi11al agreement, including an increase or decrease in compensation paid to the Contractor. Any increase or decrease in the previous contract price shall be based on the annual percentage change in the Consumer Price Index (CPI) as of June of the year the adjustment is being made. The CPI shall be the San Francisco/Oakland/San Jose Consumer Price Index for all urban wage earners. There will be no CPI adjustment during the first one-year tenn of the agreement. At the end of the initial twelve months of the contract period, and each anniversary thereafter for the duration of the contract, the unit prices on the Schedule of Bid Prices will be increased or decreased in direct proportion to the increase or decrease in the Consumer Price Index (CPI). The most recent CPI for June San Francisco/Oakland/San Jose area for all urban wage earners shall be used. The City shall have the authority to suspend this agreement, wholly or in part, for such period as deems necessary due to unfavorable conditions or to the failure on the part of the Contractor to perfo1111 any provisions of this agreement. 3.2 Liguidated Dama,g.es. City and Contractor recognize that time is of the essence of this Contract and that City will suffer financial Joss in the fonn of contract administration expenses (such as project management and consultant expenses), if all or any patt of the Work is not completed within the times specified above, plus any extensions thereof allowed in accordance with the Contract Documents. Consistent with Document 00700 (General Conditions), Contractor and City agree that because of the nature of the Project, it would be impractical or extremely difficult to fix the amount of actual damages incmTed by City because of a delay in completion of all or any part of the Work. Accordingly, City and Contractor agree that as liquidated damages for delay Contractor shall pay City: 3.2.l $500 for each and every day that services are not completed on time and/or designated crosswalk areas are omitted. 3.2.2 $50 for each event wl1ere it is observed over a 30 minute time pedod that the crossing guard is not properly staging pedestrians in a manner consistent with these contract documents. Liquidated damages shall apply cumulatively and, except as provided below, shall be presumed to be the damages suffered by City resulting from delay in completion of the Work. 3.3 Liquidated damages for delay shall only cover administrative, overhead, interest on bonds, and general loss of public use damages suffered by City as a result of delay. Liquidated damages shall not cover the cost of completion of the Work, damages resulting from defective Work, lost revenues or costs of substitute facilities, or damages suffered by others who then seek to recover their damages from City (for example, delay claims of other contractors, subcontractors, tenants, or other third-patties), and defense costs thereof. ARTICLE 4. CONTRACT SUM 4.1 City shall pay Contractor the Contract Sum for completion of Work in accordance with Contract Documents as set forth in Contractor's Bid, attached hereto: See Exhibit "A" attached City of Cupe1tino 2015 Contractual Crossing guard Services -Rebid DOCUMENT 00800-2 ARTICLE 5. CONTRACTOR'S REPRESENTATIONS In order to induce City to enter into this Contract, Contractor makes the following representations and warranties: 5.1 Contractor has toured the City streets and has examined thoroughly and understood t11e nature and extent of the Contract Documents, Work, Site, locality, actual conditions, as-built conditions, and all local conditions, and federal, state and local laws and regulations that in any manner may affect cost, progress, perfonnance or furnishing of Work or which relate to any aspect of the means, methods, techniques, sequences or procedures of crossing guards to be employed by Contractor and safety precautions and programs incident thereto. 5.2 Contractor has conducted or obtained and has understood all such examinations, investigations, explorations, tests, reports and studies and all other physical conditions at or contiguous to the Site or otherwise that may affect the cost, progress, performance or furnishing of Vlork, as Contractor considers necessary for the performance or furnishing of Work at the Contract Sum, within the Contract Time and in accordance with the other terms and conditions of the Contract Documents, including specifically the provisions of Document 00700 (General Conditions); and no additional examinations, investigations, explorations, tests, repo1ts, studies or similar information or data are or will be required by Contractor for such purposes. 5.3 Contractor has correlated its knowledge and the results of all such observations, examinations, investigations, explorations, tests, reports and studies with the terms and conditions of the Contract Documents. 5.4 Contractor has given City prompt written notice of all conflicts, en-ors, ambiguities, or discrepancies that it has discovered in or among the Contract Documents and actual conditions and the written resolution thereof through Addenda issued by City is acceptable to Contractor. 5.5 Contractor is duly organized, existing and in good standing under applicable state law, and is duly qualified to conduct business in the State of California. 5.6 Contractor has duly authorized the execution, delivery and performance of this Contract, the other Contract Documents and the Work to be performed herein. The Contract Documents do not violate or create a default under any instrument, contract, order or decree binding on Contractor. 5.7 Contractor has listed Subcontractors pursuant to the Subcontractor Listing Law, California Public Contracting Code §4100 et seq. in document 00340 (Subcontractors List) ARTICLE 6. CONTRACT DOCUMENTS 6.1 Contract Documents consist of the following documents, including all changes, addenda, and modifications thereto: City of Cupe1tino 2015 Contractual Document 00400 Bid Fonn Document 00430 Subcontractors List Document 00450 Statement of Qualifications Document 00455 Insurance Document 00460 Schedule of Crossing Guard Services Equipment Document 00481 Non-Collusion Affidavit Document 00482 Bidder Certifications Document 00510 Notice of Award Document 00520 Contract Document 00530 Insurance Forms DOCUMENT 00800-3 Crossing guard Services -Rebid Document 00550 Notice to Proceed Document 00610 Performance Bond Document 00650 Agreement and Release of Any and All Claims Document 00700 General Conditions Document 00800 Special Conditions Addenda(s) 6.2 There are 110 Contract Documents other than those listed in this Document 00520, A11icle 6. Document 00320 (Geotechnical Data, Hazardous Material Surveys and Existing Conditions), and the information supplied therein, are not Contract Documents. The Contract Documents may only be amended, modified or supplemented as provided in Document 00700 (General Conditions). ARTICLE 7. MISCELLANEOUS 7.1 Terms used in this Contract are defined in Document 00700 (General Conditions) and will have the meaning indicated therein. 7.2 It is understood and agreed that in no instance are the persons signing this Contract for or on behalf of City or acting as an employee, agent, or representative of City, liable on this Contract or any of the Contract Documents, or upon any warranty of authority, or otherwise, and it is fmther understood and agreed that liability of the City is limited and confined to such liability as authorized or imposed by the Contract Documents or applicable law. 7.3 Contractor shall not assign any portion of the Contract Documents, and may subcontract portions of the Contract Documents only in compliance with the Subcontractor Listing Law, California Public Contracting Code §4100 et seq. 7.4 The Contract Sum includes all allowances (if any). 7.5 In entering into a contract or a subcontract to supply goods, services or materials, Contractor or Subcontractor offers and agrees to assign to the awarding 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. § 15) or under the Cmtwright Act (Chapter 2 (commencing with Section 16700) of Part 2 of Division 7 of the Business and Professions Code), arising from purchases of goods, services or materials pursuant to the contract or the subcontract. This assignment shall be made and become effective at the time City tenders final payment to Contractor, without fmther acknowledgment by the parties. 7.6 Should any part, term or provision of this Contract or any of the Contract Documents, or any document required herein or therein to be executed or delivered, be declared invalid, void or unenforceable, all remaining patts, tenns and provisions shall remain in full force and effect and shall in no way be invalidated, impaired or affected thereby. If the provisions of any law causing such invalidity, illegality or unenforceability may be waived, they are hereby waived to the end that this Contract and the Contract Documents may be deemed valid and binding contracts, enforceable in accordance with their terms to the greatest extent permitted by applicable law. In the event any provision not otherwise included in the Contract Documents is required to be included by any applicable law, that provision is deemed included herein by this reference( or, if such provision is required to be included in any paiticular portion of the Contract Documents, that provision is deemed included in that pottion). 7.7 This Contract and the Contract Documents shall be deemed to have been entered into in the County of Santa Clara, State of California, and governed in all respects by California law (excluding choice of law rules). The exclusive venue for all disputes or litigation hereunder shall be in Santa Clara County. Both parties hereby waive their rights under California Code of Civil Procedure Section 394 to file a motion to transfer any action or proceeding arising out of the Contract Documents to another venue. Contractor City of Cupe1tino 2015 Contractual Crossing guard Services -Rebid DOCUMENT 00800-4 accepts the Claims Procedure in Document 00700, Alticle 12, established under the California Government Code, Title I, Division 3.6, Part 3, Chapter 5. 7.8 Contractor and all subcontractors shall comply with the Uniform Administrative Requirements for State and Local Governments set fo1th in the Code of Federal Regulations (CFR), Title 49, Part 18. In addition, the Contractor agrees to comply with the cost principles and procedures set fo1th in Office of Management and Budget Circular A-87. The Contractor agrees that a reference to either Office of Management and Budget (OMB) Circular A-87ofthe Code ofFederal Regulations, Title 49, Chapter 1, Patt 31, whichever is applicable, and the Code of Federal Regulations, Title 49, Part 18, will be included in any subcontracts entered into as a result of this contract. City of Cupe1iino 2015 Contractual Crossing guard Services -Rebid DOCUMENT 00800-5 IN WITNESS WHEREOF the parties have executed this Contract in quadrnplicate the day and year first above written. 2015 CONTRACTUAL CROSSING GUARD SERVICES -REBID CI1Y: CITY OF CUPERTINO, a Municipal Corporation of the State of California Attest:~ ~ · &Acft t1C:tr rtYCJefk:Gl1lCeSC11l1 I hereby ce11ify, under penalty of perjury, that David Brandt, City Manager of the City of Cupertino was duly authorized to execute this document on behalf of the City ofCupe11ino by a majority vote of the City Council on: avid Brandt, City Manager of the City of Cupertino, a Municipal Corporation of the State of California Designated Representative: Name: Roger S. Lee Title: Assistant Director of Public Works Address: 10555 Mmy Ave., Cupe11ino, CA 95014 Phone: 408-777-3350 Facsimile: 408-777-3399 AMOUNT: $ 179,596.80 ACCOUNT NUMBERS: 100-83-807-700-702 FILE NO.: CONTRACTOR: State Contractor's License No. Classification Expiration Date Taxpayer ID No. 9€-.3171511 Name: /};u'eJ1v hr-we.I/ Title: fi Lt It:/(~// 6 /-'( Address:/[} -'lc/o ~'.ee.,.,... (3/vc/ ~Z~) cf.;;,,,_r.e .FL .sr~LPi1.J, c/<'J 9o?-'70 Phone: ./ ~~-g~~~o~p~7<0--=c----..'7~.?-~9~o~~~- Facsimile: .;) /12 l7-0;-. .-~ 3 ;;.§ NOTARY ACKNOWLEDGEMENT IS REQUIRED. IF A CORPORATION, CORPORATE SEAL AND CORPORATE NOTARY ACKNOWLEDGEMENT AND FEDERAL TAX ID ARE REQUIRED. IF NOT A CORPORATION SOCIAL SECURITY NO. IS REQUIRED City of Cupe11ino 2015 Contractual DOCUMENT 00800-6 Crossing guard Services -Rebid DOCUMENT 00530 INSURANCE FORMS INSURANCE FORMS INSTRUCTIONS FOR ITEMS 3, 4 AND 5, THE FORMS PROVIDED BY THE CITY OF CUPERTINO MUST BE USED. FORMS OTHER THAN THESE WILL NOT BE ACCEPTED. ALL DOCU1vfENTS MUST BE ORIGINALS -SUB.MIT IN TRIPLICATE 1. Insurance Agreement -Must be signed by Contractor. 2. Ce11ificate of Insurance to the City of Cupertino -must be completed by the insurance agent m: must provide a certificate on the company's form. They must contain the same infonnation. 3. Endorsement of Additional Insured and Primary Insurance and Notice of Cancellation - must be signed by the insurance agent for general liability and automobile liability only. 4. Comprehensive general liability/commercial general liability endorsement of aggregate limits of insurance per project -must be signed by the insurance agent for general liability only. 5. Waiver of subrogation endorsement worker's compensation insurance -must be signed by the insurance agent for \vorker's compensation only. City of Cupe1tino 2015 Contractual Crossing guard Services -Rebid DOCUMENT 00530-1 INSURANCE AGREEMENT A. Contractor is aware of the provisions ofSection 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or undertake self-insurance in accordance with the provisions of that Code, and will comply with such provisions before commencing the performance of the work of this Contract. B. Contractor and all subcontractors will carry worker's compensation insurance for the protection of its employees during the progress of the work. The insurer shall waive its rights of subrogation against the City, the City's officers, agents and employees and shall issue an endorsement to the policy evidencing same. C. Contractor shall cany at all times, on all operations hereunder, commercial general liability insurance, automobile liability insurance and builder's all risk insurance. All insurance coverage shall be in amounts required by the City and shall be evidenced by the issuance of a ce1iificate in a form prescribed by the City and shall be underwritten by insurance companies satisfactory to the City for all operations, sub-contract work, contractual obligations, product or completed operations, all owned vehicles and non-owned vehicles. Said insurance coverage obtained by the Contractor, excepting worker's compensation coverage, shall name the City, its engineer, and each of its directors, officers, agents and employees, as determined by the City, as additional insureds on said policies. Insurers must be licensed to do business in the State of California. The Insurers must also have an "A" policyholder's rating and a financial rating of at least Class VII in accordance with the current Best's Guide Rating or that is otherwise acceptable to the City. D. Before Contractor performs any work at, or prepares or delivers materials to the site, Contractor shall furnish ce1iificates of insurance evidencing the foregoing insurance coverages and such certificates shall provide the name and policy number of each carrier and policy and that the insurance is in force and will not be canceled or modified without thi1ty (30) days written notice to the City. Contractor shall maintain all of the foregoing insurance coverages in force until the work under this Contract is fully completed. The requirement for carrying the foregoing insurance shall not derogate from the provisions for indemnification of the City by Contractor under this Contract and for the duration of the wananty period. Notwithstanding nor diminishing the obligations of Contractor with respect to the foregoing, Contractor shall maintain in full force and effect during the life of this Contract, the following insurance in amounts not less than the amounts specified and having a Best's Guide Rating of A, Class VII or better or that is otherwise acceptable to the City. City of Cupe1tino 2015 Contractual Crossing guard Services -Rebid DOCUMENT 00530-2 LIMITS Worker's Compensation & Employers' Liability General Liability -commercial general liability; including provisions for contractual liability, personal injury, independent contractors and products -completed operations hazard. Automobile Liability -comprehensive covering owned, 11011- owned and hired automobiles. In accordance with the Worker's Compensation Act of the State of California -Worker's comp "statutory" per CA Law; Employers' Liability $1,000,000 per occurrence. Combined single limit of $2.0 million per occurrence; $4.0 million in the aggregate Combined single limit of $1.0 million per occurrence. City of Cupertino 2015 Contractual DOCUMENT 00530-3 Crossing guard Services -Rebid ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~ 8/7/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ~~~~~CT Nysa Gallegos Knight Insurance Services wgN~o Extl: (818) 662-4234 I FAX IA/C Nol: (818) 662-9312 535 North Brand Boulevard ioMDA~~ss:NysaG@Knightins.net Suite 1000 INSURER(S) AFFORDING COVERAGE NAIC# Glendale CA 91203 INSURERA:Tokio Marine Soecialtv Ins Co. 23850 INSURED INSURER B :Depositors Insurance Company 42587 All City Management Services, Inc. INSURER c :National Union Fire Ins Co of Pitt 19445 10440 Pioneer Blvd # 5 INSURERD: INSURER E: Santa Fe Springs CA 90670 INSURER F: COVERAGES CERTIFICATE NUMBER:CL155400014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR ,~~liliYvV!vi ,~g~~%Yv~~Yi LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 f-----D CLAIMS-MADE w OCCUR DAMAGE TO RENTED A PREMISES IEa occurrence\ $ 100,000 x y PPK1316352 4/1/2015 4/1/2016 MED EXP (Any one person) $ Excluded - PERSONAL & ADV INJURY $ 1,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 =l ~PRO-DLOC PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 IEa accident\ f-----x ANY AUTO BODILY INJURY (Per person) $ B f-----ALL OWNED -SCHEDULED AUTOS AUTOS ACP7825954504 12/21/2014 12/21/2015 BODILY INJURY (Per accident) $ -f-----NON-OWNED PROPERTY DAMAGE x HIRED AUTOS x AUTOS (Per accident\ $ f-----f----- Underinsured motorist $ x UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ 8,000,000 - c EXCESS LIAB CLAIMS-MADE AGGREGATE $ 8,000,000 DED I x I RETENTION$ 0 BE065159478 4/1/2015 4/1/2016 $ WORKERS COMPENSATION Not Applicable I PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ Not Applicable DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Cupertino and its directors, officers, engineers, agents and employees are hereby declared to be additional insured under the terms of this policy with respects General Liability and required by written contract. Insurance is Primary & Non-Contributory. Waiver of Subrogation applicable. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10300 Torre Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Cupertino, CA 95014 AUTHORIZED REPRESENTATIVE Manny Mashhoud/NYSGAL ~-'?-----271 ~ © 1988-2014ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS0251?n1.in11 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PPK1316352 COMMERCIAL GENERAL LIABILITY NAMED INSURED: ALL CITY MANAGEMENT SERVICES INC. CG 24 04 05 09 EFFECTIVE: 04/01/15 -04/01/16 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 0 PRIMARY AND NON-CONTRIBUTORY WORDING POLICY NUMBER: PPK1316352 COMMERCIAL GENERAL LIABILITY NAMED INSURED: All City Management Services Inc. EFFECTIVE: 04/01/15-04/01/16 CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or OrQanization(s) As required by written contract: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. Section IV Commercial General Liability Conditions, 4. Other Insurance, a. Primary Insurance is with replaced with the following for this Additional Insured only: This insurance is primary except when it is excess as provided under part b., below. When this insurance is primary, we will not seek contribution from other insurance available to the person or organization shown in the schedule of this endorsement except for the gross negligence and or willful or wanton misconduct of the person or organization shown in the schedule of this endorsement. All other terms and conditions remain the same. CG 20 26 07 04 © ISO Properties, Inc., 2004 14-15 GL AI Primary PRIMARY AND NON-CONTRIBUTORY WORDING POLICY NUMBER: PPK1316352 COMMERCIAL GENERAL LIABILITY NAMED INSURED: All City Management Services Inc. EFFECTIVE: 04/01/15-04/01/16 CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) As required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. Section IV Commercial General Liability Conditions, 4. Other Insurance, a. Primary Insurance is with replaced with the following for this Additional Insured only: This insurance is primary except when it is excess as provided under part b., below. When this insurance is primary, we will not seek contribution from other insurance available to the person or organization shown in the schedule of this endorsement except for the gross negligence and or willful or wanton misconduct of the person or organization shown in the schedule of this endorsement. All other terms and conditions remain the same. CG 20 26 07 04 © ISO Properties, Inc., 2004 14-15 GL AI Primary POLICY NUMBER: PPK1316352 COMMERCIAL GENERAL LIABILITY NAMED INSURED: ALL CITY MANAGEMENT SERVICES INC. CG 24 04 05 09 EFFECTIVE: 04/01/15 -04/01/16 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against others To Us of Section IV -Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1of1 D ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) ~ 8/11/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ~2AA~~CT Trend Certificate Coordinator ROBERTS & CROW, INC. r.~.QN.t c • .,. {214) 553-5505 I FAX IAJC Nol: <214 > 553-5525 12221 Merit Drive E-MAIL ADDRESS: Suite 300 JNSURER{S) AFFORDING COVERAGE NAIC# Dallas TX 75251 INSURER A :Technoloqy Insurance Co. , Inc. 42376 INSURED INSURERS: Trendsetter HR, LLC INSURERC: L/C/F All City Management Services, Inc. INSURERD: 2701 Sunset Ridge Drive, Suite 500 INSURERE: Rockwall TX 75032 INSURER F: COVERAGES CERTIFICATE NUMBER:AH City Management REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER IMM/DDNYYYl IMM/DD/YYYYl GENERAL LIABILITY EACH OCCURRENCE $ ~ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES IEa occurrence\ $ -~ CLAIMS-MADE D OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ - GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 1 POLICY n ~rR-r nLOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I Ea accident) $ ~ ANY AUTO BODILY INJURY (Per person) $ ~ ALL OWNED -SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ ~ -NON-OWNED fp~?~~c~~l?AMAGE HIRED AUTOS AUTOS $ ~ - $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION x I T~~$IfJN;, I 10TH- AND EMPLOYERS' LIABILITY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE D NIA E.L. EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? 4/1/2015 4/1/2016 (Mandatory in NH) TWC34746BO E.L. DISEASE -EA EMPLOYEE $ 1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1.000 000 ~ocation Coverage Period: 4/1/2015 4/1/2016 Client #331371 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Coverage is provided for only those employees leased to but not subcontractors of All City Management Services, Inc. Waiver of Subrogation in favor of the Certificate Holder applies. Estimated payroll amount 125,000.00 CERTIFICATE HOLDER CANCELLATION ( ) -SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Cupertino ACCORDANCE WITH THE POLICY PROVISIONS. 10300 Torre Ave. Cupertino, CA 95014 AUTHORIZED REPRESENTATIVE Barry Crow/JKS ~~~ ~ ' © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) INS025 l?n1nn!i\ 01 Tho Ar:n~n n::aimo ::ainrl lnnn ::air£\ r£\nic+£\rorl m::airlcc nf Ar.:n~n Executed in Triplicate DOCUMENT 00610 PERFORMANCE BOND Bond No. 58729140 Premium: $1,594.00 THIS PERFORMANCE B01'.TD ("Bond") is dated August 13 ' 2015 , is in the penal sum of Seventy Nine Thousand Eight Hundred Twenty One and No/100 ($79,821.00) Dollars -------------------..,-------[which is four months of the total Contract Price], and is entered into by and between the paities listed below to ensure the faithful performance of the Crossing guard Services Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, paragraphs 1 through 12, attached to this page. Any singular reference to All City Management Services, Inc. ("Contractor"), western surety Company ("Surety"), the City of Cupe1tino, a Municipal Corporation of the State of California ("City") or other party shall be considered plural where applicable. CONTRACTOR: All City Management Services, Inc. Name 10440 Pioneer Blvd., Suite 5 Address Santa Fe Springs, CA 90670 City/State/Zip CONTRACT: SURETY: Western Surety Company Name 675 Placentia Ave. Principal Place of Business Brea, CA 92821 City/State/Zip 2015 CONTRACTUAL CROSSING GUARD SERVICES -REBID PROJECT NUMBER 2015-25 , 20 ~in the Amount of $ __ 7_9_,_8_2_1 _· 0_0 _______ (the SURETY Company: (Corp. Seal) Western Surety Com~ "Penal Signature: __ """"'.,_"""---!.f-~--'1---w--- BOND TERMS AND CONDITIONS 1. Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to City for the complete and proper performance of the Contract, which is incorporated herein by reference. 2. If Contractor completely and properly performs all of its obligations under the Contract, Surety and Contractor shall have no obligation under this Bond. 3. If there is no City Default, Surety's obligation under this Bond shall arise after: 3.1 City has declared a Contractor Default under the Contract pursuant to the terms of the Contract; and 3.2 City has agreed to pay the Balance of the Contract Sum: City ofCupe1tino 2015 Contractual DOCUMENT 00610-1 Crossing guard Services -Rebid 3.2.1 To Surety in accordance with the terms of this Bond and the Contract; or 3.2.2 To a contractor selected to perform the Contract in accordance with the terms of this Bond and the Contract. 4. When City has satisfied the conditions of paragraph 3, Surety shall promptly (within 30 days) and at Surety's expense elect to take one of the following actions: 4.1 AlTange for Contractor, with consent of City, to perform and complete the Contract (but City may withhold consent, in which case the Surety must elect an option described in paragraphs4.2, 4.3, or 4.4, below); or 4.2 Unde11ake to perform and complete the Contract itself, through its agents or through independent contractors; provided, that Surety may not select Contractor as its agent or independent contractor without City's consent; or 4.3 Unde11ake to perform and complete the Contract by obtaining bids from qualified contractors acceptable to City for a contract for performance and completion of the Contract, and, upon determination by City of the most qualified bidder, arrange for a contract to be prepared for execution by City and the contractor selected with City's concurrence, to be secured with performance bonds executed by a qualified surety equivalent to the bonds issued on the Contract; and, if Surety's obligations defined in paragraph 6, below, exceed the Balance of the Contract Sum, then Surety shall pay to City the amount of such excess; or 4.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with reasonable promptness under the circumstances, and, after investigation and consultation with City, determine in good faith its monetary obligation to City under paragraph 6, below, for the performance and completion of the Contract and, as soon as practicable after the amount is determined, tender payment therefore to City with full explanation of the payment's calculation. If City accepts Surety's tender under this paragraph4.4, City may still hold Surety liable for future damages then unknown or unliquidated resulting from the Contractor Default. If City disputes the amount of Surety's tender under this paragraph4.4, City may exercise all remedies available to it at law to enforce Surety's liability under paragraph 6, below. 5. If Surety does not proceed as provided in paragraph 4, above, then Surety shall be deemed to be in default on this Bond ten days after receipt of an additional written notice from City to Surety demanding that Surety perform its obligations under this Bond. At all times City shall be entitled to enforce any remedy available to City at Jaw or under the Contract including, without limitation, and by way of example only, rights to perform work, protect work, mitigate damages, advance critical work to mitigate schedule delay, or coordinate work with other consultants or contractors. 6. Surety's monetary obligation under this Bond is limited by the Alnount of this Bond identified herein as the Penal Sum. This monetary obligation shall augment the Balance of the Contract Sum. Subject to these limits, Surety's obligations under this Bond are commensurate with the obligations of Contractor under the Contract. Surety's obligations shall include, but are not limited to: 6.1 The responsibilities of Contractor under the Contract for completion of the Contract and correction of defective work; 6.2 The responsibilities of Contractor under the Contract to pay liquidated damages, and for damages for which no liquidated damages are specified in the Contract, actual damages caused by non- performance of the Contract including, but not limited to, all valid and proper back charges, offsets, payments, indemnities, or other damages; City of Cupertino 2015 Contractual DOCUMENT 00610-2 Crossing guard Services -Rebid 6.3 Additional legal, design professional and delay costs resulting from Contractor Default or resulting from the actions or failure to act of the Surety under paragraph 4 above (but excluding attorney's fees incurred to enforce this Bond). 7. No right of action shall accrue on this Bond to any person or entity other than City or its successors or assigns. 8. Surety hereby waives notice of any change, alteration or addition to the Contract or to related subcontracts, purchase orders and other obligations, including changes of time. Surety consents to all terms of the Contract, including provisions on changes to the Contract. No extension of time, change, alteration, modification, deletion, or addition to the Contract Documents, or of the work required there under, shall release or exonerate Surety on this Bond or in any way affect the obligations of Surety on this Bond. 9. Any proceeding, legal or equitable, under this Bond shall be instituted in any court of competent jurisdiction where a proceeding is pending between City and Contractor regarding the Contract, or in the courts of the County of Santa Clara, or in a court of competent jurisdiction in the location in which the work is located. Communications from City to Surety under paragraph 3.1 of this Bond shall be deemed to include the necessary contracts under paragraph 3.2 of this Bond unless expressly stated otherwise. 10. All notices to Surety or Contractor shall be mailed or delivered (at the address set forth on the signature page of this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract). Actual receipt of notice by Surety, City or Contractor, however accomplished, shall be sufficient compliance as of the date received at the foregoing addresses. 11. Any provision in this Bond conflicting with any statutory or regulatory requirement shall be deemed deleted here from and provisions conforming to such statutory requirement shall be deemed incorporated herein. 12. Definitions. 12.l Balance of the Contract Sum: The total amount payable by City to Contractor pursuant to the terms of the Contract after all proper adjustments have been made under the Contract, for example, deductions for progress payments made, and increases/decreases for approved modifications to the Contract. 12.2 Contract: The contract between City and Contractor identified on the signature page of this Bond, including all Contract Documents and changes thereto. 12.3 Contractor Default: Material failure of Contractor, which has neither been remedied nor waived, to pe1for111 or otherwise to comply with the tenns of the Contract including, but not limited to, "default" or any other condition allowing a termination for cause as provided in Document 00700 (General Conditions). 12.4 City Default: Material failure of City, which has neither been remedied nor waived, to pay Contractor progress payments due under the Contract or to perform other material terms of the Contract, if such failure is the cause of the asse1ied Contractor Default and is sufficient to justify Contractor termination of the Contract. 13. This bond is for the initial three year term. It may be renewed for an additional two year term by continuation certificate issued by the Surety. Provided, however, that non-renewal by the Surety shall not constitute default or forfeiture. City of Cupertino 2015 Contractual Crossing guard Services -Rebid END OF DOCUMENT DOCUMENT 00610-3 Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby make, constitute and appoint Mark Rosskopf, Lourdes Landa, Adriana Valenzuela, Michael Castaneda, Individually .. of Anaheim, CA, its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds, undertakings and other obligatory instruments of similar nature -In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney, pursuant to the authority hereby given, are hereby ratified and confinned. This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof, duly adopted, as indicated, by the shareholders of the corporation. In Witness Whereof, WESTERN SURETY COMP ANY has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on this 9th day of June, 2015. State of South Dakota County of Minnehaha WESTERN SURETY COMPANY On this 9th day of June, 2015, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMP ANY described in and which executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires February 12, 2021 S. Eich, Notary Public CERTIFICATE I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force, and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whe:_0 have hereunto subscribed my name and affixed the seal of the said corporation this ) sin day of dvl. QlA S' t ' d1J' ·~ WESTERN SURETY COMPANY Fonn F4280-7-2012 Authorizing By-Law ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the shareholders of the Company. Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile. California All-Purpose Certificate of 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 ____ o_r_an_g_e ________ _ S.S. On 08-13-15 beforeme, _____ M_a_r_il~yn_B_a~gb~y~,_N_o_ta_r~y_P_u_bl_ic _______ ~ Name of Notarv Publ1c. Title personally appeared _______ A_d_ri_an_a_V_a_le_n_zu_e_la ______________ _ Name of S1g11e1 ! 1 I Name of Signer (2) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s}, or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my han<! and official seal. Mt~ COMM. #2106019 z Notary Public · California ::o Orange County ~ M. Cqmm, Ex ires A r. G, 2019 OPTIONAL INFORMATION ------------- Although the information in this section is not required by law. it could prevent fraudulent removal and reattachment of this acknowledgment to an unaulhonzed document and may prove useful to persons relymg on the attached document. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titled/for the purpose of _________ _ containing __ pages, and dated _________ . 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