Resolution No. 77800
1 RESOLUTION NO. 7780
2
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
3 VERNON APPROVING AND RATIFYING THE EXECUTION OF AN
4 APPLICATION FOR AN ENFORCEMENT ASSISTANCE GRANT
FROM THE CALIFORNIA INTEGRATED WASTE MANAGEMENT
5 BOARD
6 WHEREAS, funds have been established by Public Resources Code
7 Section 43230, and are available from the Integrated Waste Management
8 Account through the California Integrated Waste Management Board
9 ("Waste Board") for grants to local enforcement agencies to support
10 solid waste facilities permit and inspection programs; and
11 WHEREAS, the City of Vernon Health Department has been
12 appointed as the solid waste local enforcement agency for the City of
13 Vernon and is eligible for an Enforcement Assistance Grant from the
14 Waste Board of just over Fifteen Thousand Dollars and No Cents
15 ($15, 000.00) ; and
16 WHEREAS, in order to receive the Enforcement Assistance
17 Grant, the Waste Board required the Grant Application to be submitted
18 prior to May 24, 2001, and the City Administrator executed the
19 Application subject to ratification by the City Council; and
20 WHEREAS, the Application was submitted to the Waste Board for
21 funds in the amount of Fifteen Thousand Six Hundred Dollars and No
22 Cents ($15,600.00) for equipment, training and technical support
23 expenses; and
24 WHEREAS, by letter dated May 31, 2001, Bruce V. Malkenhorst,
25 City Administrator/City Clerk, recommended that the execution of the
26 Application for the Grant be ratified; and
27 WHEREAS, the City Council desires to approve and ratify the
28 Application as executed by the City Administrator.
i
1 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
2 CITY OF VERNON AS FOLLOWS:
3 SECTION 1: The City Council of the City of Vernon hereby
4 finds and determines that the recitals contained hereinabove are true
5 and correct.
6 SECTION 2: The City Council of the:City of Vernon hereby
7 approves, authorizes and ratifies the submittal to the Waste Board of
8 an Enforcement Assistance Grant Application in the amount of Fifteen
9 Thousand Six Hundred Dollars and No Cents ($15,600.00), a copy of which
10 is attached hereto as Exhibit "A" and made a part hereof.
11 - SECTION 3: The City Council of the City of Vernon hereby
12 ratifies the execution of the Application by the City Administrator on
13 behalf of the City of Vernon and hereby authorizes the City
14 Administrator to execute any and all documents necessary for the
15 purpose of securing grant funds and to implement and carry out the
16 purposes specified in the Grant Application for, and on behalf of, the
17 City of Vernon.
18 SECTION 4: The City Council of the City of Vernon hereby
19 directs the City Administrator, or his designee, to send a certified
20 copy of this resolution to:
21 California Integrated Waste Management Board
22 EAG Program/Permitting and Enforcement Division
1001 - "I" Street
23 P.O. Box 4025
Sacramento, California 95812-4025
24
25 Attn: Ms. Sharon Anderson, Branch Manager (Acting)
LEA Support Services Branch
26
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SECTION 5: The City Clerk of the City of Vernon shall
certify to the passage of this resolution, and thereupon and thereafter
the same shall be in full force and effect.
APPROVED AND ADOPTED this 6th day of June, 2001.
ATTEST:
BRUCE V. MALKENHORST, City Clerk
4
LEONIS C. MALB RG, May r
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STATE OF CALIFORNIA )
)ss
COUNTY OF LOS ANGELES )
I, BRUCE V. MALKENHORST, City Clerk of the City of Vernon, do
hereby certify that the foregoing Resolution, being Resolution No.
7780, was duly adopted by the City Council of the City of Vernon at a
regular meeting of the City Council duly held on Wednesday, June 6,
2001, and thereafter was duly signed by the Mayor of the City of
Vernon.
(SEAL)
BRUCE V. MALKENHORST, City Clerk
- 4 -
EXHIBIT
0
I
STATE OF CALIFORNIA INTEGRATED mASTE mANAGEMEN'P BOARD
GRANT APPLICATION
LOCAL ENFORCEMENT AGENCY GRANT
FOR AGENCY USE ONLY:
FILE M
ELAGIBLE
AMOUNT
Name of Applicant (LEA) City of Vernon Health Department
Address 4305 S. santa Fe Avenue
Cit Vernon State CA Zip 90058
Y
Name & Title of Program Director Lewis J. Pozzebon Telephone 323-583-881 1
Director/HealthDirector/Health officer
FAX 323-588-4320
Name of Finance Officer Sharon Johnson . Telephone 323-583-881 1
Name of Program Manager Leonard Grossberg Telephone 323-583-8811
M.P.A., R.E.H.S.
A statement of how the money will be used to attain an improvement in the LEA% solid waste facilities
permit and inspection program must accompany the application for Grant funds. The application shall
also include a resolution that authorizes the person or position empowered to execute all necessary
documents for the jurisdiction.
Certification:
1 declare, under penalty of perjury, that all information submitted for the Board's consideration for the
allocation of grant funds, is true and accurate to the best of my knowledge and belief.
Name of Authorized Person Bruce V1 Malkenhorst
Title City Administrator
if
Signature
323-583-8811 FAX 323-581-7924
Date
CITY OF VERNON LEA
ENFORCEMENT AGENCY GRANT - 2001 TO 2002
RECOMMENDED EXPENDITURES:
SAMPLING EQUIPMENT EST. COST $$$$
-Assorted Equipment (New bags, tubing, sample gathering items, etc.) $1,500.00
SUBTOTAL ($1,500.00)
MISCELLANEOUS EQUIPMENT
-35mm Camera Equipment (carrying case, accessories, film & developing, etc.)
$ 300.00
MOBILE TELEPHONES FOR COMMUNICATION (1-2 new) $ 900.00
-MOBILE TELEPHONE MONTHLY SERVICE CONTRACT (5) $4,000.00
-Audio Visual Equipment (training, and presentations) $2,500.00
-VCR $ 500.00
-New Digital Camera (case and accessories) $1,700.00
-Laminator $ 400.00
SUBTOTAL ($10,300.00)
SAFETY EQUIPMENT
-MISCELLANEOUS ITEMS (shoes, vests, hats, coveralls) $1,000.00
SUBTOTAL ($1,000.00)
TRAINING
-COMPUTER TRAINING $ 200.00
-EQUIPMENT TRAINING $ 100.00
-SEMINARS $ 300.00
-CONFERENCES $1,400.00
SUBTOTAL ($2,000.00)
TECHNICAL SUPPORT
MAINTENANCE, TESTING, AND CALIBRATION $ 300.00
SUBTOTAL ($ 300.00)
OFFICE SUPPLIES
ASSORTED SUPPLIES $ 300.00
APRROX. TOTALS $151,400.00
(PLUS SALES TAX, S & H)
GRANT REQUEST FOR $15,600.00
9cLG:SOUDWASTEMAG20021RecEM=d.DOC
SUPPORTING
DOCUMENTS
CITY COUNCIL
LEONIS C. MALBURG
Mayor
THOMAS A. YBARRA
Mayor Pro—Tem
WM. 'BILL" DAVIS
Councilman
H. "LARRY" GONZALES
Councilman
W. MICHAEL MCCORMICK
Councilman
BRUCE V. MALKENHORST
City Administrator / City Clerk
FAX (323) 581-7924
City Council
City of Vernon
Honorable Members:
CITY HALL
4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (323) 583-8811
May 31, 2001
EDUARDO OLIVO
City Attorney
FAX: (562) 927-8722
KEVIN WILSON
Director of Community Services & Water
FAX: (323) 588-2761
KENNETH J. DeDARIO
Director of Municipal Utilities
FAX: (323) 583-1983
STEVEN E. PARKER
Fire Chief
FAX: (323) 581-1385
BRUCE W. OLSON
Police Chief
FAX: (323) 583-5236
The California Integrated Waste Management Board (CIWMB) annually
issues enforcement assistance grants to local enforcement agencies to
procure necessary equipment, supplies, and training to improve the
capability and performance of the agencies.
In order for the City to receive such grant an application for the
grant, a Resolution authorizing the application, and a recommended
list of expenditures are to be submitted to the CIWMB. Due to the
time frame it was necessary to sign and submit the application.
This has been reviewed by the Environmental Health Department and it
is hereby recommended that the executed application for a CIWMB Grant
in the amount of $15,600.00 be ratified and a resolution adopted.
Very truly yours,
Bruce V. Malkenhorst
City Administrator/City Clerk
BVM/ng
CITY COUNCIL
LEONIS C. MALBURG
Mayor
THOMAS A. YBARRA
Mayor Pro-Tem
WM. 'BILL" DAVIS
Councilman
H. "LARRY" GONZALES
Councilman
W. MICHAEL MCCORMICK
Councilman
BRUCE V. MALKENHORST
City Administrator / City Clerk
FAX (323) 581-7924
CITY HALL
4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (323) 583-8811
June 7, 2001
California Integrated Waste Management Board
EAG Program/Permitting and Enforcement Division
Attn: Ms. Sharon Anderson, Branch Manager (Acting)
1001 - "I" Street
P.O. Box 4025
Sacramento, CA 95812-4095
Re: Enforcement Assistance Grant
Dear Ms. Sharon Anderson:
EDUARDO OLIVO
City Attorney
FAX: (562) 927-8722
KEVIN WILSON
Director of Community Services & Water
FAX: (323) 588-2761
KENNETH J. DeDARIO
Director of Municipal Utilities
FAX: (323) 583-1983
STEVEN E. PARKER
Fire Chief
FAX: (323) 581-1385
BRUCE W. OLSON
Police Chief
FAX: (323) 583-5236
Transmitted herewith is a certified copy of Resolution No. 7780
approving and ratifying the execution of an application for an
Enforcement Assistance Grant from the California Integrated. Waste
Management Board approved and adopted at the Vernon City Council
meeting held June 6, 2001.
If you have any questions regarding this matter, please call Mr. Lewis
Pozzebon at 323/583-8811 ext. 229.
Very
truly yours,
loria J. rosco
Chief De ty City Clerk
GJO:ng
cc: Lewis Pozzebon
Resolution No. 7780
CITY COUNCIL
LEONTO C. MALBURG
Mayor
THOMAS A. YBARRA
Mayor Pro-Tem
WM. "BILL" DAVIS
Councilman
H. "LARRY" GONZALES
Councilman
W. MICHAEL MCCORMICK
Councilman
BRUCE V. MALKENHORST
City Administrator / City Clerk
FAX (323) 581-7924
CITY HALL
4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (323) 583-8811
July 11, 2001
California. Integrated Waste Management Board
EAG Program/Permitting and Enforcement Division
Attn: Ms. Sharon Anderson, Branch Manager (Acting)
LEA Support Services Branch
1001 "I" Street
P.O. Box 4025
Sacramento, CA 95812-4025
Re: Enforcement Assistance Grant
To Whom It May Concern:
EDUARDO OLIVO
City Attorney
FAX: (562) 927-8722
KEVIN WiLSON
Director of Community Services & Water
FAX: (323) 588-2761
KENNETH J. DeDARIO
Director of Municipal Utilities
FAX: (323) 583-1983
STEVEN E. PARKER
Fire Chief
FAX: (323) 581-1385
BRUCE W. OLSON
Police Chief
FAX: (323) 583-5236
Transmitted herewith is a certified copy of Resolution No. 7780,
approving and ratifying the execution of an application for an
Enforcement Assistance Grant from the California Integrated Waste
Management Board, approved at the Vernon City Council held June 6,
2001.
If you have any questions regarding this matter, please call Mr. Lewis
Pozzebon at 323/583-8811 ext. 229.
Very truly yours,
i
Gloria . 0c co
Chief Deputy City Clerk
GJO:ng
cc: Lewis Pozzebon
Resolution No 7780
Memorandum
To: Bruce V. Malkenhorst, City Administrator
From: Lewis J. Pozzebon, Director Environmental Health � J L p,
Date: September 17, 2002
Re: Solid Waste Local Enforcement Agency Assistance Grant EA -I I
On June 6, 2001 the City Council adopted Resolu6as
No. 77$0, w ' h approved the
City's application for the subject grant. The grant - mitted and approved by the
California Integrated Waste Management Board (Board). The Board provides funds
to local agencies to purchase equipment and train staff for solid waste inspections and
enforcement. The City received $15,611.47 for fiscal year 2001-2002 of which 10%
($1,561.14) was withheld until submittal of the final audit report.
We have used the entire grant amount and are in the process of submitting our final
audit accounting. In doing so, we are eligible to receive the 10% withheld from the
original grant.
The Board has forwarded a Grant Payment Request Form for signature so the funds
can be disbursed. Please sign the attached form where indicated and have the form
returned to our department for mailing.
Thank you.
Attachment
9cLUSOLIDWASTE/EAG2002/grant payment memo.doc
CERTIFICATE
STATE OF CALIFORNIA )
COUNTY OF LOS ANGELES)§
CITY OF VERNON )
I, Gloria J. Orosco, Chief Deputy City Clerk of the City of
Vernon, County of Los Angeles, State of California, do hereby
certify that the attached is a true and correct copy of
Resolution No. 7780, entitled:
Resolution No. 7780 - A Resolution Of The City Council Of
The City Of Vernon Approving And Ratifying The Execution Of
An Application For An Enforcement Assistance Grant From The
California Integrated Waste Management Board.
The original of said record has been retained in the
offices of the City Clerk of the City of Vernon, said offices
being in the City of Vernon, County of Los Angeles, State of
California.
IN WITNESS HEREOF, I have hereunto set my hand and affixed
the Official Seal of the City of Vernon, County"of Los Angeles,
State of California, this llh day of July, 2001.
SEAL:
0(- P1
/V�
Glor a J. Oro 0
Chief Deputy City Clerk
. a t
11 N' T E R`
9�
O F F I C E
MEMO
To: Bruce V. Malkenhorst, City Administrator
�.,qFrom: Lewis J. Pozzebon, Director, Environmental Health Department
Subject: Request for Permission to Apply for Enforcement Assistance Grant
Date: May 15, 2001
With this memo, I'm requesting permission to apply for an Enforcement Assistance Grant from the
California Integrated Waste Management Board (CIWMB). With the grant monies we hope to procure the
items on the attached list to help us meet our State -mandated responsibilities as a local enforcement
agency (LEA).
The CIWMB annually issues enforcement assistance grants to LEAs. Funds are available to improve the
capability of local agencies to inspect closed and active solid waste facilities. Our department has
successfully applied for and received grant monies from CIWMB for the last several years.
With one permitted solid waste facility and ten inactive sites within our jurisdiction, we, as the LEA, are
eligible for an Enforcement Assistance Grant from the CIWMB for just over $15,000 to procure necessary
equipment, supplies, and training.
In order to receive the Enforcement Assistance Grant, we must submit the following documents (see
attached forms) to the CIWMB by May 24, 2001:
■ Grant Application Cover Sheet
■ City of Vernon Resolution Authorizing Assistance Grant Application
■ LEA statement of intended use of money.
If you concur, please sign the Grant Application where indicated and have the application form returned to
our office. Considering your past approval of such requests, we've forwarded copies of the attachments to
the City Attorney for preparation of a suitable resolution (update of Resolution No. 7544). Because of the
short time frame, we have received authorization from the CIWMB to submit the resolution after the
deadline.
If you have any questions or concerns regarding the grant application, please let me know.
Attachments: (3)
c: Ed Olivo, City Attorney
1p\memo\sw\leagrant2001
t
STATE OF CALIFORNIA INTEGRATED !PASTE MANAGEMENT BOARD
GRANT APPLICATION
LOCAL ENFORCEMENT AGENCY GRANT
FOR AGENCY USE ONLY:
FILE r
ELIGIBLE
AMOUNT
Name of Applicant (LEA) City of Vernon Health Department
Address 4305 S. santa Fe Avenue
City Vernon State
CA
Zip 90058
Name&Title of Program Director Lewis J. Pozzebon Telephone 323-583-8811
Director/Health O icer
FAX 323-588-4320
Name of Finance Officer Sharon Johnson Telephone 323-583-8811
Leonard Grossberg 323-583-8811
Name of Program Manager Telephone
M.P.A., R,E.H.S.
A statement of how the money will be used to attain an improvement in the LEA's solid waste facilities
permit and inspection program must accompany the application for Grant funds. The application shall
also include a resolution that authorizes the person or position empowered to execute all necessary
documents for the jurisdiction.
Certification:
I declare, under penalty of perjury, that all information submitted for the Board's consideration for the
allocation of grant funds, is true and accurate to the best of my knowledge and belief.
Name of Authorized Person
Bruce Vl Malkenhorst
Title City Administrator Tel ne 323-583-881 1 FAX 323-581-7924
Signature Date
CITY OF VERNON LEA
ENFORCEMENT AGENCY GRANT - 2001 TO 2002
RECOMMENDED EXPENDITURES:
SAMPLING EQUIPMENT EST. COST $$$$
-Assorted Equipment (New bags, tubing, sample gathering items, etc.) $1,500.00
SUBTOTAL ($1,500.00)
MISCELLANEOUS EQUIPMENT
-35mm Camera Equipment (carrying case, accessories, film & developing, etc.)
$ 300.00
-MOBILE TELEPHONES FOR COMMUNICATION (1-2 new) $ 900.00
-MOBILE TELEPHONE MONTHLY SERVICE CONTRACT (5) $4,000.00
-Audio Visual Equipment (training, and presentations) $2,500.00
-VCR $ 500.00
-New Digital Camera (case and accessories) $1,700.00
-Laminator $ 400.00
SUBTOTAL ($10,300.00)
SAFETY EQUIPMENT
-MISCELLANEOUS ITEMS (shoes, vests, hats, coveralls) $1,000.00
SUBTOTAL ($1,000.00)
TRAINING
-COMPUTER TRAINING
-EQUIPMENT TRAINING
-SEMINARS
-CONFERENCES
TECHNICAL SUPPORT
MAINTENANCE, TESTING, AND CALIBRATION
OFFICE SUPPLIES
ASSORTED SUPPLIES
9cLG:SOLIDWASTE/EAG2002/RecExpend.DOC
$ 200.00
$ 100.00
$ 300.00
$1,400.00
SUBTOTAL ($2,000.00)
$ 300.00
SUBTOTAL ($ 300.00)
$ 300.00
APRROX. TOTALS $159400.00
(PLUS SALES TAX, S & H)
GRANT REQUEST FOR $15,600.00
It . t
' CITY COUNCIL
" LEONIS C. MALBURG
Mayor
THOMAS A. YBARRA
Mayor Pro-Tem
WM. `BILL" DAVIS
Councilman
H. "LARRY" GONZALES
Councilman
W. MICHAEL MCCORMICK
Councilman
BRUCE V. MALKENHORST
City Administrator / City Clerk
FAX (323) 581-7924
CITY HALL
4305 SANTA FE AVENUE, VERNON, CALIFORNIA 90058
TELEPHONE (323) 583-8811
HEALTH DEPARTMENT
MAY 16, 2001
California integrated Waste Management Board
LEA Grant Program/Permitting and Enforcement Division
1001 ' P' Street
P.O. Box 4025
Sacramento, California 95812-4025
EDUARDO OLIVO
City Attorney
FAX: (562) 927--8722
KEVIN WILSON
Director of Community Services & Water
FAX: (323) 588-2761
Attn: Ms. Sharon Anderson, Branch Manager/LEA Support Services Branch
Subject: Application for Local Enforcement Agency Grant 2001-2002
Dear Ms. Anderson:
KENNETH J. DeDARIO
Director of Municipal Utilities
FAX: (323) 583--1983
DAVE TELFORD
Fire Chief
FAX: (323) 581-1385
BRUCE W. OLSON
Police Chief
FAX: (323) 583-5236
As indicated in our Solid Waste Enforcement Program Plan (EPP) for the City of Vernon Health
Department, we have identified one permitted solid waste facility and ten (10) closed and/or
inactive landfill sites within our jurisdiction as the Local Enforcement Agency (LEA). As you
are aware, the LEA is required to investigate and inspect these sites pursuant to Title 14,
California Code of Regulations (14CCR), Sections 18083 and 18303. Part of our responsibility
at these sites is to assess the potential for the off -site migration of landfill gas and to document
surface conditions that may pose a potential threat to public health, safety and the environment.
In order to fulfill our state -mandated LEA responsibilities, we are therefor requesting an
Enforcement Assistance Grant (EAG) from the California Integrated Waste Management Board
(CIWMB) to procure the following equipment and training items:
Ms. Sharon Anderson, CIWMB
Mav 16. 200
Page 2 of 2
ITEM
PROPOSED
COST
USE
ESTIMATE
SAMPLING EQUIPMENT:
ITEM USED TO FACILITATE
-Misc. equipment (bags, tubing,
GATHERING OF DATA FROM THE
sample containers, evidence
FIELD WHILE
$1,500.00
gathering items, etc.)
SAMPLINGIINVESTIGATING.
MISC. EQUIPMENT:
FIELD EQUIPMENT NEEDED TO
-35mm CAMERA ACCESSORIES
MONITOR, MEASURE, AND RESTORE
-MOBILE TELEPHONES (1-2)
DATMINFORMATION GATHERED.
-MOBILE TELEPHONE SERVICE (5)
MOBILE COMMUNICATIONS WILL
$10,300.00
-AUDIO VISUAL PRESENTATION
FACILITATE IMMEDIATE RESPONSE
-NEW DIGITAL CAMERA
TO COMPLAINTS, EMERGENCY
-LAMINATOR
RESPONSE, ETC.
SAFETY EQUIPMENT:
ASSORTED SAFETY EQUIPT. NEEDED
-MISCELLANEOUS (Boots,
TO COMPLY WITH O.S.H.A. HEALTH
$1'o oo
Vests, Coveralls, etc.)
AND SAFETY REQUIREMENTS.
TRAINING:
OUTSIDE TRAINING TO OBTAIN A
-COMPUTER
WORKING KNOWLEDGE OF NEW
-EQUIPMENT
EQUIPMENT, UPDATED MATERIAL,
$2,000.00
-SEMINARS
AND NETWORKING.
-CONFERENCES
OFFICE SUPPLIES:
ASSORTED OFFICE SUPPLIES SPECIFIC TO
$300.00
-Assorted items
DOCUMENTING, PROCESSING, AND
MAINTAINING SOLID WASTE
ENFORCEMENT FUNCTIONAL
TECHNICAL SUPPORT:
ANNUAL SERVICE TO EQUIPMENT,
$300.00
-MAINTENANCE\CALIBRATION
ROUTINE CALIBRATION, AND TESTING.
TOTAL ESTIMATED COST:
$15 400.00
(NOT INCLUDING TAX, SHIPPING & HANDLING)
GRANT REQUESTED:
$15,600.00
Enclosed please find the completed Application Cover Sheet. We anticipate that the Vernon City
Council will adopt a resolution authorizing the Enforcement Assistance Grant Application within
the next few weeks. The resolution will be forwarded to you as soon as possible.
If you have any questions regarding this grant application, please contact Leonard Grossberg at
(323) 583-8811, ext. 231.
i er y,
Lewis J. Pozzeb
nE.H.S.
Director/Health Officer
Attachments: (l )
9cLG:S0LID WASTE/EAG 2002/grant application.doc
STATE OF CALIFORNIA
INTEGRATED WASTE MANAGEMENT BOARD
GRANT APPLICATION
LOCAL ENFORCEMENT AGENCY GRANT
FOR AGENCY USE ONLY:
FILE 8
EL GIBLE
AMOUNT
Nam of Applicant {LEA)
City of Vernon Health Department
' Address 4305 S. santa Fe Avenue
City Vernon
State
CA
Zip 90058
Name & Title of Program Director Lewis J . Po z z e bon
Telephone
3 2 3 - 5 8 3 - 8 81 1
Director/Health Otficer
FAX 323-588-4320
Name of Finance Officer
Sharon Johnson
Telephone
323-583-881' 1
Name of Program Manager
Leonard Grossberg
Telephone
323-583-8811
M.P.A., R.E.H.S.
A statement of how the money will be used to attain an improvement in the LEA's solid waste facilities
permit and inspection program must accompany the application for Grant funds. The application shall
also include a resolution that authorizes the person or position empowered to execute all necessary
documents for the jurisdiction.
Certification
I declare, under penalty of perjury, that all information submitted for the Board's consideration for the
allocation of grant funds, is true and accurate to the best of my knowledge and belief.
Name of Authorized Person Bruce Vl Malkenhorst
Title City Administrator TelpAdhe 323-583-8811 FAX 323-581-7924
Signature Date