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Resolution No. 9124i 9 r .. 2 3 4 5 6 7 8 9 10 11 12 13 14 1167 IM, Perm 18 19 20 21 22 23 24 25 26 27 28 RESOLUTION NO. 9124 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF VERNON APPROVING AND AUTHORIZING THE EXECUTION OF ENCROACHMENT LICENSE AGREEMENT NO. 401 BY AND BETWEEN THE CITY OF VERNON AND UNITED FOOD GROUP, LLC WHEREAS, United Food Group, LLC ("United") has filed an application for an encroachment license agreement pursuant to Vernon City Code Section 22.66 to operate, maintain, use, and/or replace two driveway sensors for the electric gates at 3461 Vernon Avenue in the City of Vernon described as follows: Vernon Avenue, approximately 280 feet west of Alcoa Avenue and eight (8) feet east of Alcoa Avenue (`nth( Encroachment"); and WHEREAS, the City Council is authorized to issue an encroachment license pursuant to Chapter 22, Article VI, Encroachments, of the Code of the City of Vernon which license shall be valid for a period of twenty-five (25) years unless otherwise stated; and WHEREAS, the City Council adopted Resolution No. 5088 on February 21, 1984, authorizing fees for encroachment licenses; and WHEREAS, United has provided proof of the required insurance, and has paid the issuance fee of $250.00 and the first annual renewal f of $49.19; and WHEREAS, the Director of Community Services & Water has recommended the approval of Encroachment License Agreement No. 401 with United for a period of twenty-five (25) years, subject to the terms and conditions of the aforesaid Article VI of Chapter 22 of the Code of the City of Vernon; and WHEREAS, the City Council believes it is in the best interest 0 I r 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 of the City of Vernon to enter into Encroachment License Agreement No. 401. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF VERNON AS FOLLOWS: SECTION 1.: The City Council of the City of Vernon hereby finds and determines that the recitals contained hereinabove are true and correct. SECTION 2: The City Council of the City of Vernon hereby approves the Encroachment License Agreement No. 401 with United, a copy of which is attached hereto as Exhibit "A" and made a part hereof. SECTION 3: The City Council of the City of Vernon hereby authorizes the Mayor to execute said Agreement for, and on behalf of, the City of Vernon and the Acting City Clerk is hereby authorized to attest thereto. SECTION 4: The City Council of the City of Vernon hereby directs the Acting City Clerk, or his designee, to send one fully executed Agreement to: United Food Group, LLC Attn: Todd Waldman 3425 E. Vernon Avenue Los Angeles, CA 90058-1878 - 2 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SECTION 5: The Acting 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 5th day of September, 2006. ATTEST BRUCE V. MALKENHORST, JR. Acting City Clerk i LEONIS C. MA BURG, ayor - 3 - ri 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 STATE OF CALIFORNIA ) ) ss COUNTY OF LOS ANGELES ) I, BRUCE V. MALKENHORST, JR., Acting City Clerk of the City of Vernon, do hereby certify that the foregoing Resolution, being Resolution No. 9124, was duly adopted by the City Council of the City of Vernon at an adjourned regular meeting of the City Council duly held on Tuesday, September 5, 2006, and thereafter was duly signed by the Mayor of the City of Vernon. (SEAL) BRUCE V. MALKENHORST, JR. Acting City Clerk - 4 - EXHIBIT A 2 M Ga 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ENCROACHMENT LICENSE AGREEMENT NO.401 THE CITY OF VERNON, a municipal corporation of the State of California, as Licensor (hereinafter referred to as "City") and United Food Group, LLC (hereinafter referred to as "Licensee") does hereby agree as follows: 1. Licensor has all requisite power of authority to enter into this Encroachment License Agreement. Subject to the right of the City of Vernon to terminate this license for reasonable cause, as defined below, the City hereby grants to Licensee a license for a term of twenty-five (25) years from and after the date of this license to operate, maintain, use, and/or replace the two driveway sensors for the electric gates at 3461 Vernon Avenue in the City of Vernon as shown on engineer's drawing marked Exhibit "A" attached hereto and made a part hereof as though fully set forth herein and described as follows: Vernon Avenue, approximately 280 Feet west of Alcoa Avenue and Eight (8) Feet east of Alcoa Avenue. 2. This license is granted subject to the terms and conditions set forth in the Code of the City of Vernon, Chapter 22 Article VI, and the acceptance hereof shall evidence the Licensee's agreement to all terms of said article and the additional conditions hereinafter contained. 3. Licensee shall pay to the City of Vernon the issuance fee of Two Hundred Fifty Dollars ($250.00), prior to the issuance of the license. Licensee shall also pay to the City the annual Renewal fee of Forty -Nine Dollars and Nineteen Cents ($49.19) payable each year during the term of the license on or before the anniversary of the date of this License Agreement. This annual renewal fee shall be revised in accordance with the changes in the Consumers Price Index published by the United States Department of Labor, Bureau of Labor Statistics for Urban Earners and Clerical Workers -Annual Average — Los Angeles— Anaheim - Riverside area, California — all items. In the event said Index, as of the anniversary date, is higher than said Index for the issuance date, the renewal fee shall be increased effective the anniversary date by multiplying said renewal fee by a fraction, the numerator of which is the Index for the current anniversary date and denominator of which is the Index existing on the issuance date. There shall be no reduction in fees by operation of this provision. If, in the 1 ' 2 3 4 5 6 7 8 a 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 future, said Index shall be changed so that the base year differs from that used as of the date of commencement of the term hereof, it shall be converted in accordance with the conversion factor published by the United States Department of Labor, Bureau of Labor Statistics. In the event said Index is discontinued or revised during the term of this Agreement, such other governmental Index or computation with which it is replaced, shall be used in order to obtain substantially the same result that would be obtained if said present Index had not been discontinued or revised. 4. Licensee shall secure and keep in full force and effect at all times during the term of this license, general liability insurance in the amounts determined by the City of Vernon on an annual basis and shall file proof thereof with the Acting City Clerk, which proof shall include the following: (1) A standard certificate of insurance. (2) An endorsement naming the City of Vernon, its officers, and employees as insured under this policy. (3) An endorsement providing the City of Vernon thirty (30) days otice of cancellation or material reduction of coverage. (4) Additional documents as required by Risk Management. 5. The grant of this license is effective only upon further consideration that Licensee shall file with and shall thereafter at all times during the life of this license keep on file with the City of Vernon a faithful performance bond in the penal sum of Forty Thousand Dollars ($40,000), the amount of which shall at the request of the City of Vernon be subject to an increase in accordance with the Consumer Price Index cited in Section 3, above. 6. Licensee shall maintain the City property in first class condition to the satisfaction of the City of Vernon, and Licensee shall not construct any structure without having received a permit therefore from the City of Vernon. Upon completion of the activities to be performed under the license, licensee shall return the City property to the condition it was in at the time of execution of this license. 7. Licensee shall obtain all necessary Federal, State, and Local Permits, including City of Vernon health permits, and no repair or construction shall be performed except 2 1 in accordance with the provisions of Chapter 22 of the Vernon City Code pertaining to ' 2 encroachments to the extent they are not in conflict with any paramount authority of the State or 3 Federal Government. In the event that Licensee shall fail to utilize the City's property covered b, 4 this license for a consecutive period of six (6) months during any period of time after it has been 5 placed in operation, the City Council of the City of Vernon shall have the right, at its sole 6 discretion, to declare this license terminated. 7 8. If, at any time during the term of this franchise, it becomes necessary to 8 remove or relocate the sensors in order to accommodate a construction project performed by or 9 on behalf of the City of Vernon, Licensee shall at its own cost and expense promptly remove or 10 relocate said facilities. If, at any time the operation of the sensors and/or gates restrict access to 11 the site thereby impeding traffic flow on Vernon or Alcoa Avenue, Licensee shall at its own cost 12 and expense promptly remove or relocate said facilities. 13 9. Licensee shall not sell, transfer, assign or lease this license, or any part 14 hereof, or any of the rights or privileges granted hereby. Licensee may not assign its duties 15 hereunder, and may not assign its rights hereunder to a public utility. 16 10. In the event Licensee fails to keep, fulfill or perform any of the terms or 17 conditions of this license and fails to remedy such default within thirty (30) days after written 18 notice from the City, the City may declare this license terminated. Upon such a declaration of 19 termination and failure to remedy such default this license shall be cancelled and all of the rights 20 and privileges of Licensee under this license shall be surrendered. The City may thereafter 21 exclude Licensee from further use of the street under this license. 22 11. In the event of the termination of this license, Licensee shall at its own 23 cost and expense, remove the encroachment facilities as the City in its reasonable discretion may 24 decide. This provision may be suspended by the City of Vernon at its sole discretion during such 25 period as licensee may be negotiating with the City of Vernon for renewal of this license. If 26 Licensee is directed to remove the encroachment facilities and fails to do so, City shall have the 27 right to remove them at Licensee's sole expense, and shall have recourse for recovery of cost 28 against the licensee and/or the performance bond. 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 12. Licensee shall preserve and save harmless the City and each officer and employee thereof from any liability or responsibility for any accident, loss or damage to persons or property happening or occurring as a proximate result of the encroachment or the construction operation and or maintenance thereof. 13. Any notice, communication, request, instruction or other document required or permitted hereunder shall be in writing and deemed given when hand -delivered or sent by confirmed facsimile or U.S. Mail service, to the following: CITY: CITY OF VERNON ATTN: ACTING CITY CLERK 4305 SANTA FE AVENUE VERNON, CA. 90058-0805 FAX: (323) 826-1438 LICENSEE: UNITED FOOD GROUP, LLC ATTN: TODD WALDMAN 3425 EAST VERNON AVENUE LOS ANGELES, CALIFORNIA 90058-1878 FAX: (323) 588-9284 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 EXECUTED IN DUPLICATE this day of , 2006. CITY OF VERNON LEONIS C. MALBURG, Mayor ATTEST: BRUCE V. MALKENHORST JR., Acting City Clerk APPROVED AS TO FORM: ERIC FRESCH, City Attorney UNITED FOOD GROUP, LLC C Pv,uxi N; A Title Print Name Title NOTE: Please type/print names below signatures. Signatures shall be notarized. 5 La )\3NM0Ci 5— — — HwS 1J/N 001 O'66+Z6 <4AS881y dd ,ZI 13/N 8'bZ 7'Y6+Z6 1 II I 1 II , II •},1 1 ON3, NMQAj }J,N }Ji,N b'�'SZaZ o'4p'9(:Zgg N;SVE'J U Z6 - �vll J - \I T \ 213Nti Y7 0: NItrIY �P HYiO }O,'N < I'1�\ 11I1 I Y_ (3i>.L 0'YY+ZB HY1A\ }Oi k C'ai a Zb+Z6 II II iIVJOSi24�.^, lJ/N 0.6 YOffZ6 II 1 i It NOSN3S dO 3NIl N31N3O O'bZ+ZB m II 1 ®'I AV L, 0 % � � i aN3ri:1N-0H 1^'N 0'S c�cl+t6� II t% �L �I Q•'?r HIVE. 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I 11 I I • 1� I II 11 II I II 11 II II I �1 to � Irj 1N IL I ii V I I Q ii t u I II I u I n u u I It 1 n u II 1 II 1 11 I II a n a 1 u u n i3;X.L S'OS+SA I II I 11 �JI 11 O II 1 11 II NOSN35 !0 3NIl 2131N3O O'Lf+69 ^ i it I 7 Ij 1 iMlXl L J II His }J,'N S" OO a'.1 +* 6F I I 11 11 it > 11 1 i3`•Xa S'f,'+69 I 1 II 1 ']/fir 171/,00 U) 0 U) Z W U) CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California / Ao&ew�;County of -I ss. �J On i tz),� before me, kU), 4 - ko6�ojk /Zvi (-g Fuate'c- Date Name and Title of .c„re.g., "Jane Doe, Notary P / lic"�, personally appeared r� �-� 1 ``� �+ & t�Ctx� &V — LUZ H. KOBAYASHI Commission # 1378993 Z "�� Notary Public - California DZ Z ' Los Angeles County My Comm. Expires Oct 5, 2006 Names) of Signer(s) C`personally known to me ❑ proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) +s/are subscribed to the within instrument and acknowledged to me that he4he/they executed the same in hisfFi,°r/their authorized capacity(ies), and that by h�/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNE my hand and official seal. Signature of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document -�- Title or Type of Document: Document Date: !tea Ga Number of Pages:{ ?� Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer Signer's Name: We ❑ Individual Top of thumb here ❑ Corporate Officer— Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Attorney -in -Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 01999 National Notary Association - 9350 De Soto Ave., P.O. Box 2402 - Chatsworth, CA 91313-2402 - www.nationatnotary.org Prod. No. 5907 Reorder: Call Toll -Free 1-800-876.6827 1 F 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ENCROACHMENT LICENSE AGREEMENT NO.401 THE CITY OF VERNON, a municipal corporation of the State of California, as Licensor (hereinafter referred to as "City") and UnitedFood Group, LLC (hereinafter referred to as "Licensee") does hereby agree as follows: t. Licensor has all requisite power of authority to enter into this Encroachment License Agreement.' Subject to the right of the City of Vernon to terminate this license for reasonable cause, as defined below, the City hereby grants to Licensee a license for a term of twenty-five (25) years from and after the date of this license to operate, maintain, use, and/or replace the two driveway sensors for the electric gates at 3461 Vernon Avenue in the City of Vernon as shown on engineer's drawing marked Exhibit "A" attached hereto and made apart hereof as though fully set forth herein and described as follows: Vernon Avenue, approximately 280 Feet west of Alcoa Avenue and Eight (8) Feet east of Alcoa Avenue. 2. This license is granted subject to the terms and conditions set forth in the Code of the City of Vernon, Chapter 22 Article VI, and the acceptance hereof shall evidence the l Licensee's agreement to all terms of said article and the additional conditions hereinafter contained. 3. Licensee shall pay to the City of Vernon the issuance fee of Two Hundred Fifty Dollars ($250.00), prior to the issuance of the license. Licensee shall also pay to the City the annual Renewal fee of Forty -Nine Dollars and Nineteen Cents ($49.19) payable each year during the term of the license' on or before the anniversary of the date of this License Agreement. This annual renewal fee shall be revised in accordance with the changes in the Consumers Price Index published by the United States Department of Labor, Bureau of Labor Statistics for Urban Earners and Clerical Workers -Annual Average --Los Angeles — Anaheim Riverside area, California -- all items. In the event said Index, as of the anniversary date, is higher than said Index for the issuance date, the renewal fee shall be increased effective the anniversary date by multiplying said renewal fee by a fraction, the numerator of which is the Index for the current anniversary date and denominator of which is the Index existing on the issuance date. There shall be no reduction in fees by operation of this provision. If, in the 9 10 11 1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 future, said Index shall be changed so that the base year differs from that used as of the date of commencement of the term hereof, it shall be converted in accordance with the conversion factor published by the United States Department of Labor, Bureau of Labor Statistics. In the event said Index is discontinued or revised during the term of this Agreement, such other governmental Index or computation with which it is replaced, shall be used in order to obtain substantially the same result that wouldbe obtained if said present Index had not been discontinued or revised. 4. Licensee shall secure and keep in full force and effect at all times during the term of this license, general liability' insurance in the amounts determined by the City of Vernon on an annual basis and shall file proof thereof with the Acting City Clerk, which proof shall include the following: (1) A standard certificate of insurance. (2) An endorsement naming the City of Vernon, its officers, and employees as insured under this policy. (3) An endorsement providing the City of Vernon thirty (30) days otice of cancellation or material reduction of coverage. (4) Additional documents as required by Risk Management. 5. The grant of this license is effective only upon further consideration that Licensee shall file with and shall thereafter at all times during the life of this license keep on file with the City of Vernon a'faithful performance bond in the penal sum of Forty Thousand Dollars ($40,000), the amount of which shall at the request of the City of Vernon be subject to an increase in accordance with the Consumer Price Index cited in Section 3, above. 6. Licensee shall maintain the City property in first class condition to the satisfaction of the City of Vernon, and Licensee shall not construct any structure without having received a permit therefore fromtheCity of Vernon. Upon completion of the activities to be performed under the license, licensee shall return the City property to the condition it was in at the time of execution of this license. 7. Licensee shall obtain all necessary Federal, State, and Local Permits, including City of Vernon health permits, and no repair or construction shall be performed except 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 in accordance with the provisions of Chapter 22 of the Vernon City Code pertaining to encroachments to the extent they are not in conflict with any paramount authority of the State or Federal Government. In the event that Licensee shall fail to utilize the City's property covered b,, this license for a consecutive period of six (6) months during any period of time after it has been placed in operation, the City Council of the City of Vernon shall have the right, at its sole discretion, to declare this license terminated. 8. If, at any time during the term of this franchise, it becomes necessary to remove or relocate the sensors in order to accommodate a construction project performed by or on behalf of the City of Vernon, Licensee shall at its own cost and expense promptly remove or relocate said facilities. If, at any time the operation of the sensors and/or gates restrict access to the site thereby impeding traffic flow on Vernon or Alcoa Avenue, Licensee shall at its own cost and expense promptly remove or relocate said facilities. 9. Licensee shall not sell, transfer, assign or lease this license, or any part hereof, or any of the rights or privileges granted hereby. Licensee may not assign its duties hereunder, and may not assign its rights hereunder to a public utility. 10. In the event Licensee fails to keep, fulfill or perform any of the terms or conditions of this license and faits to remedy such default within thirty (30) days after written notice from the City, the City may declare this license terminated. Upon such a declaration of termination and failure to remedy such default this license shall be cancelled and all of the rights and privileges of Licensee under this license shall be surrendered. The City may thereafter exclude Licensee from further use of the street under this license. 11. In the event of the termination of this license, Licensee shall at its own cost and expense, remove the encroachment facilities as the City in its reasonable discretion may decide. This provision may suspended by the City of Vernon at its sole discretion during such period as licensee maybe negotiating with the City of Vernon for renewal of this license. If Licensee is directed to remove the encroachment facilities and fails to do so, City shall have the right to remove them at Licensee's sole expense, and shall have recourse for recovery of cost against the licensee and/or the performance bond. 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 12.Licensee shall preserve and save harmless the City and each officer and employee thereof from any liability or responsibility for any accident, loss or damage to persons or property happening or occurring as a proximate result of the encroachment or the construction operation and or maintenance thereof. 13. Any notice, communication, request, instruction or other document required or permitted hereunder shall be in writing and deemed given when hand -delivered or sent by confirmed facsimile or U.S. Mail service, to the following: CITY: CITY OF VERNON ATTN: ACTING CITY CLERK 4305 SANTA FE AVENUE VERNON, CA. 90058-0805 FAX: (323) 826-1438 LICENSEE: UNITED FOOD GROUP, LLC ATTN: TODD WALDMAN 3425 EAST VERNON AVENUE LOS ANGELES, CALIFORNIA 90058-1878 FAX: (323) 588-9284 I i 4 1 i 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 EXECUTED IN DUPLICATE this day of , 2006. CITY OF VERNON EONIS C. MALAURG, Mayor ATTEST. 1 BRUCE V. NYALKENHORST JR., Acting City Clerk APPROVED AS TO FORM: ERIC FRESCII, City Attorney UNITED FOOD GROUP, LLC LOCH kuA Name /4-ue"a q e Title By: Si 6ature Print Name Title %— NOTE: Please type/print names below signatures. Signatures shall be notarized. 5 Glj >.3NM 0G ut.lt+Yol HAS 13/14 0'01 0'66�tZ6 N9O6l! dd .ZI 10/N S'YZ S'Y6 +Z6 pll 11 1 15+6'0 OHM1100/N7'SlZZ 6'991 tL6 SWIJ Vl 01 Nhn ',IS _9i A HY0 7J t+ _'cl S'SSt Z6 Wu 0'YY+Ze II 1 HYITt 1 ,'N 0'• 1 9'LV � Z6 U I� (TrJOS?FY10 l0/N.0'8 7'9ftZ6 li g . NOSN29 JO 3Nn'a3W30 O'tZ+Z6 W) 11 O iN3PmoLNi95m i 'NZ'OO. 1+L6N 4 II ,p I M.91,80.1�� n l HIVA hiN @'S S'ZO+z6 I I H-:;� Y70 OrN 6315'66+16 1 II � /�--- HY1i i1,1N S'00 0'dC+t6 1.. (M)XL 0'fz t16 II I I (I '.. dn•661; da .91. 17/N 0'YZ t'19+t6 1 I II I III • II W _ III _ II III I 111 I •11 II I. II NOII.:hY lO/N SZZ l'Sf+l6 I 11 I II I 3AWN u31VM JO/N YI SL'6Z+t6 I I I II II II IL 11 I IIt co rY II II. I\1. H150 i0/N 4'Gt f'Ofit06 / LLJ I I II 1 II ` ' II O W U, 11 i 1 dW661 6 dd .SI lJ/N ZW Z R-05 -0 II 431VM 3dIL'.9 'WIN Z'SZ t'fs+J6 II I I II I� II •„I WuI 11 II > in II I II 0 I II II II 11 II 11 ,I II. - (3)Xl S 0St65 I jj I II I II II a05N35 JO 3.Nf1HAW 30 0'GC+61? II ^I II I LL- 11 I II ■ . . n F'i 19,'N SOV Y4t469 11 II II 1 (3i'Il S'Si•t eS. L, C'I II It yL 44kII (n or O. z W L r�l N ep (n [7— CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of kus On J ' , o1CC before me, 11(,(, (f l 1JG2Fj�tjdt� / NUIu��� ILLVc, Data p(1 p Name and Title of O car e.g.,'Janraa ^Do�e,, Notary Pu/ fit l-cI personally appeared L t (iC f'4i a o 1 a,b `1 MC� (i( �pCIMG.v9 Name(s) of Signar(s) personally known to me ❑ proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Ware subscribed to the within instrument and AL AL — acknowledged to me that he/"they executed LUZ H.`KOBAYASHI b the same in b4e4w/their authorized Commission # 1378293 z capacity(ies), and that by .k3tsiger/their Z Notary Public - California ; signature(s) on the instrument the person(s), or Los Angeles County r the entity upon behalf of which the person(s) My Comm, Expires Oct 5, 2006 acted, executed the instrument. WITNE i my hand and official seal. 4 Signature of Notary Public OPTIONAL. Though the information below Is not required by law, It may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document Description of Attached Document Title or Type of Document.. r ltil tiy1 i vt C� trl%iV i j . Document Date: L,, Number of Pages: 4 i� Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer Signer's Name; ❑ Individual Top of thumb here ❑ Corporate Officer — Title(s): ❑ Partner — O Limited ❑ General ❑ Attorney -in -Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: (; Signer Is Representing: ©1099 National Notary Association 9350 De Solo Ave... P.O Box 2402 • Chalsworlh;.CA M13-2402 twww.nalionalnotary.org Prod. No 5907.. Reorder Call Toll -Free 1-B0¢8766827 -