Loading...
HomeMy WebLinkAbout05.M- Public Works 5.M RESOLUTION (ID #2900) DOC ID: 2900 A CITY OF SAN BERNARDINO—REQUEST FOR COUNCIL ACTION Agreement/Contract From: Robert Eisenbeisz M/CC Meeting Date: 02/18/2014 Prepared by: Michael Grubbs, (909) 384- 5140 Dept: Public Works Ward(s): 1, 3 Subject: Resolution of the Mayor and Common Council of the City of San Bernardino Awarding a Contract to GMZ Engineering Inc. for Removal of Existing Shoring and Installation of Replacement Temporary Shoring for Mount Vernon Avenue Overcrossing at the BNSF Yards, Bridge No. 54C-0066, Per Plan No 13007. (#2900) Current Business Registration Certificate: Yes Financial Impact: BEFORE BUDGET ADJUSTMENT Account No. 264-160-5504-7121-0025 Account Description: Mt Vernon Bridge Replacement Account Budgeted Amount: $624,265 Balance as of: December 31, 2013: $616,710 AFTER BUDGET ADJUSTMENT Balance after Budget Adjustment: $435,710 (Account No. 264-160-5504-7121-0025) Account No. 264-160-5504-7947-0025 (New Account) Account Description: Mt. Vernon Bridge Shoring Repair Account Budgeted Amount: $0 Balance as of December 31, 2013: $0 Balance after Budget Adjustment: $181,000 Balance after this Expenditure: $0 Please note this balance does not indicate available funding. It does not include non-encumbered reoccurring expenses or expenses incurred,but not yet processed. Motion: Adopt the Resolution. Synopsis of Previous Council Action: 06/07/04 Adopted Resolution No. 2004-154 awarding contract to Yeager Skanska for installation of temporary support for Mt. Vernon Bridge. 09/02/08 Adopted MC-1283 prohibiting all commercial vehicles except for commercial pickup trucks, vans, and passenger cars on Mt. Vernon Avenue between 5th Street and 2nd Street. 10/06/08 Adopted Resolution No. 2008-382 awarding a contract to Yeager Skanska for installation of additional temporary supports for Mt. Vernon Bridge. 06/18/12 Adopted Resolution No. 2012-175 approving an Agreement in the amount of Updated:2/12/2014 by Jolena E.Grider A I Packet Pg.227 2900 $340,104.00 with MCM Construction, Inc. for a Design and Build Project to remove existing shoring and install replacement temporary shoring for Mount Vernon Avenue Overcrossing at the BNSF Yards(Bridge No. 54C-0066). 05/06/13 Rejected All Proposals jUr a Design and Build Project to Remove Existing Shoring and Install Replacement Temporary Shoring for Mount Vernon Avenue Overcrossing at the BNSF Yards, Bridge No. 54C-0066. (#2363) Background: In 2004, during a fracture critical inspection by Caltrans bridge inspectors, cracks were discovered in the steel girders supporting the Mt. Vernon Bridge. The bridge was temporarily closed in June 2004 and temporary shoring was installed under permit from BNSF. The bridge was re-opened in October of 2004. In 2008, additional cracks were found in the girders and supplemental shoring was installed. The shoring was designed by Morris Engineering and consists of untreated timbers bearing on ground or pavement supporting steel girders which support the cracked bridge girders. Also in 2008, the City enacted an Ordinance prohibiting commercial trucks from using the bridge. This bridge is approximately 1,016 feet long, 49 feet wide and spans over 17 active railroad tracks owned by BNSF, Southern California Regional Rail Authority (SCRRA or Metrolink) and AMTRAK. The bridge carries approximately 20,000 vehicles per day. The structural value of the existing shoring is in question and the determination has been made that it must be replaced. The City has been seeking Proposals from Contractors to design new temporary shoring, remove the old shoring and install replacement temporary shoring. A contract in the amount of $340,104.00 was approved on June 18, 2012 with MCM Construction, Inc. to replace the shoring. However, due to delays mainly related to the bankruptcy, MCM Construction, Inc. did not execute the contract within the time limit specified in the Resolution; therefore, the contract became null and void. An updated Request for Proposals (RFP) for a Design and Build Project to remove existing shoring and install replacement temporary shoring was issued on March 6, 2013. Only one bid was received at a price of$998,000. The price for the single Proposal far exceeded the Engineer's Estimate of$340,000. The Mayor and Common Council rejected all bids on May 6, 2013. Staff issued a new Request for Bids on December 14, 2013, using plans previously prepared for the 2004 and 2008 shoring projects. The main difference was that timbers placed against the ground or pavement are to be replaced on concrete pads to alleviate the problems of decay and insect attack. Components of the existing shoring that, after inspection, are found to be structurally adequate will be reused. Copies of a Notice Inviting Bids were sent to the San Bernardino County Sun Newspaper, F. W. Dodge, Construction Data Hot Sheet, Reed Construction Data and Bid America, Construction Bid Source, the City's web sites and the San Bernardino Area Chamber of Commerce. Sealed bids were received and publicly opened on January 14, 2014. The results are as follows: Updated:2/12/2014 by 7olena E.Grider A Packet Pg.,i28,--, 2900 Company City Cost GMZ Engineering Inc. Agoura Hills $139,150.00 Sean Malek Engineering&Construction Riverside $183,750.00 Engineers Estimate $100,000.00 Based on review of bids, GMZ Engineering Inc. is the lowest responsible bidder; therefore, staff recommends award of a contract for this work to GMZ Engineering Inc. Cost Construction Contract $ 139,150.00 Construction Management(15%) $ 20,850.00 Contingency (15%) $ 21,000.00 Estimated Construction Cost $ 181,000.00 The shoring work is expected to start in early March 2014 and be completed in April 2014. While work is proceeding under the bridge, the Mt. Vernon Bridge will be closed to motor vehicle traffic; however, pedestrians and bicyclist will be allowed to cross. The bridge will be reopened to traffic at night,weekends and holidays. A detour route will be established with signs and markings that will be maintained by the contractor during periods of closure. Staff is continuing work on replacing the Mt. Vernon Bridge. Demolition of the existing structure is expected to begin in early 2016 and replacement of the bridge is expected to be completed in 2018. It will be necessary to close Mt. Vernon Avenue between 2nd Street and 5t' Street for approximately two years during replacement of the bridge. City Attorney Review: Supporting Documents: reso 2900 (PDF) agrmt 2900 (PDF) Mt Vernon Bridge Shoring Low Bid from GMZ Engineering (PDF) Updated:2/12/2014 by Jolena E.Grider A Packet Qg 229 '- i E 4 min r RESOLUTION NO. 1 2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO APPROVING A CONTRACT WITH GMZ ENGINEERING 3 INC. FOR REMOVAL OF EXISTING SHORING AND INSTALLATION OF 4 REPLACEMENT TEMPORARY SHORING FOR MOUNT VERNON AVENUE OVERCROSSING AT THE BNSF YARD, BRIDGE NO. 54C-0066, PER PLAN NO. -1,2nn17 LJVV 1. 6 WHEREAS, the City desires to remove the existing shoring and install replacement 7 temporary shoring for Mount Vernon Avenue Overcrossing at the BNSF Yard, Bridge No. c `o 8 54C-0066,per Plan No. 13007)(Project); and W W 9 WHEREAS, the City, on December 14, 2013, issued a request for bids for said m` 10 0 11 Project; and E d 12 WHEREAS, on January 14, 2014,bids were received from two (2) Contractors; and r 13 WHEREAS, the bid submitted by GMZ Engineering Inc. has been determined to be tom, o 14 the lowest responsible bid and the bid best meeting the needs of the City. o 15 NOWTHEREFORE, BE IT RESOLVED BY THE MAYOR AND COMMON 16 COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: a 0 0 17 SECTION 1, GMZ Engineering Inc., 5739 Kanan Road. #134, Agoura Hills, CA N 28 ° 91301, submitted the lowest responsive and responsible bid for Removal of Existing Shoring 19 ° N and Installation of Replacement Temporary Shoring for Mount Vernon Avenue Overcrossing 20 :.. 21 at the BNSF Yard, Bridge No. 54C-0066,per Plan No 13007. E 22 SECTION 2. The Director of Administrative Services is authorized and directed to a 23 amend the FY 2013/14 Budget to transfer $181,000.00 from Account No, 264-160-5504- 24 7121-0025 "Mt. Vernon Bridge Replacement, SSO4-012" to Account No. 264-160-5504- 25 7947-0025 "Mt. Vernon Bridge Shoring Repair." 26 27 28 1 PackelnPg 230;=; i i I SECTION 3. The City Manager is hereby authorized and directed to execute the 2 Contract with GMZ Engineering Inc., a copy of which is on file in the office of the City Clerk, 3 and incorporated herein by reference. 4 SECTION 4. Pursuant to this determination, the Director of Administrative Services 5 or his designee is hereby authorized to issue a Purchase Order for Removal of Existing 6 7 Shoring and Installation of Replacement Temporary Shoring for Mount Vernon Avenue L $ Overcrossing at the BNSF Yard, Bridge No. 54C-0066, per Plan No 13007, in the amount of s 9 $139,150.00 with a contingency amount of$21,000.00. L 10 m SECTION 5. The Purchase Order shall reference this Resolution and shall read, _ 11 ` "GMZ Engineering Inc. for Removal of Existing Shoring and Installation of Replacement > 12 Temporary Shoring for Mount Vernon Avenue Overcrossing at the BNSF Yard, Bridge No. 0 13 54C-0066,per Plan No 13007,not to exceed $139,150.00"and shall incorporate the terms and c 14 0 15 conditions of this Resolution. 16 SECTION 6. Said Agreement shall not take effect or become operative until fully a 0 17 signed and executed by the parties and no party shall be obligated hereunder until the time of N 18 such full execution. No oral agreements, amendments, modifications or waivers are intended N 19 y or authorized and shall not be implied from any act or course of conduct of any party. 24 r 21 SECTION 7. The authorization to execute said Agreement is rescinded if the parties E 22 fail to execute it within sixty(60)days of passage of this Resolution. Q 23 111 24 25 26 27 28 2 Packet Pg.231. WWI RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF 1 SAN BERNARDINO APPROVING A CONTRACT WITH GMZ ENGINEERING INC. 2 FOR REMOVAL OF EXISTING SHORING AND INSTALLATION OF REPLACEMENT TEMPORARY SHORING FOR MOUNT VERNON AVENUE 3 OVERCROSSING AT THE BNSF YARD,BRIDGE NO. 54C-0066,PER PLAN NO. I 4 13007. r uFRFRV CP..RTIFY that the foregoing Resolution was duly adopted by the Mayor 5 6 and Common Council of the City of San Bernardino at a meeting 7 thereof, held on the day of ,2014,by the following vote,to wit: 0 8 co i 9 o:r::el1 Members: AYES NAYS ABSTAIN ABSENT L 10 MARQUEZ m c L 11 JENKINS d s > I 12 VALDIVIA L 13 SHORETT o 14 NICKEL ° 15 JOHNSON 3 16 0 17 MULVIHILL ° ° 18 ° N 19 Georgeann Hanna, City Clerk 20 The foregoing resolution is hereby approved this day of ,2014. 21 22 w I a 23 Patrick J. Morris,Mayor City of San Bernardino 24 25 Approved as to form: GARY D. SAENZ, 26 City Attorney 27 By. 28 3 Packet Pg:232 i FILE N0, 1.7947 ACCT NOS. 264-160-5504-7947-01025 CITY OF SAN BER.NARDINO STATE OF CALIFORNIA BID AND CONTRACT DOCUMENTS PLANS AND SPECIAL PROVISIONS NO. 13007 FOR m REMOVAL OF EXISTING SHORING AND INSTALLATION OF 0 L d REPLACEMENT TEMPORARY SHORING FOR MOUNT VERNON AVENUE > OVERCROSSING AT THE BNSF YARDS. L 0 BRIDGE NO. 54C-0066 0 L Q O O a DEPARTMENT OF PUBLIC WORKS CITY OF SAN BERNARDINO DECEMBER 2013 BIDS WILL BE RECEIVED UP TO THE HOUR.OF 2:00 P.M. ON JANUARY 14 , 2014 Packet Pg.233 T5.Nf.b AGREEMENT: REMOVAL OF EXISTING SHORING AND INSTALLATION OF REPLACEMENT TEMPORARY SHORING FOR MOUNT VERNON AVENUE OVERCROSSING AT THE BNSF YARDS PER PLAN NO. 13007.BRIDGE NO.54C-0066. 4. CITY hereby promises and agrees with the said CONTRACTOR to employ, and does hereby employ the said CONTRACTOR to provide the materials and to do the work according to the terms and conditions herein contained and referred to, for the prices aforesaid, and hereby contracts to pay the same at the *,fire, in he s; manner, and upon the conditions above set forth; and the same parties for themselves, their heirs, executors, administrators,and assigns,do hereby agree to the full performance of the covenants herein contained. 5. It is further expressly agreed by and between the parties hereto that should there be any conflict between the terms of this instrument and the bid of said CONTRACTOR, then this instrument shall control and nothing herein shall be considered as an acceptance of said terms of said bid conflicting herewith. X,w }' U) IN WITNESS WHEREOF,the parties of these presents have executed this contract in four(4) counterparts, -o each of which shall be deemed an original in the year and day first above mentioned. m P O CONTRACTOR CITY OF SAN BERNARDINO r NAME OF FIRM: L BY: o ALLAN PARKER City Manager BY: 0 „` . o TITLE: ATTEST: a) MAILING ADDRESS: °CD N E GEORGEANN HANNA w City Clerk E s' Rf w PHONE NO.:�_) APPROVED AS TO FORM: ATTEST: GAR AENZ,City Attorney Secretary NOTE: Secretary of the Owner should attest. If Contractor is a corporation,Secretary should attest. ° Packet Pg.234 iM% D § E . 10 z z z o \ \ | | \ � �u§ ��I �� ' \ \U(n z Lz0 / | I m ^ e § Li ) k \ § \ | � 0; g Ln m§ R R GQ � 2 a� w � §� ° L L / kj U 7 ` CO kmw Lek - �� � \ \ ■ � — ` 4 0 z z � � ` ® Cl o@z � z < WW 5 S ) . § \ z 0 Q D o CL \ - z w o � 2 _ ® � Mo n_ 0 m \ � � \/ w [ k � ® §/ g/I / LL ` §} §§ g � § °° )ƒ z ~~ e k § B § § )§ EL « X ` -A O R § ( $\ �[ % 5 g!� .4 & LU 2 ! 2| | \§ re 29i m � k$ 20 2 ' \ � \ \ k$ 0# 2 KG §) ƒ) Co o° _ \ v /U 3/ o ¥ / 77 $/ / z ££ %E . o ij § § 0Z k ® ` K LL 0 L) I ; § }E2 �§ / 0 0.w Q�� C3 LU !) \ 0 Packet Pg. 235 AK 4i' 5.M.c BID FORM TO THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO o L ri+t__ 1____..__._.! L.,. L-- 1 ,11.. .--A 4kv 1nnntinn nftics nrnnnccsA .unrIr flint hp. m llle UnUe s1g'11GU UUUMIGS MUL 11G 1145 %,arc1U11.Y V A"L11111VU 611' Lvvuoavlx vi uav F.-4F—.-- has examined the Plan and read the accompanying instructions to bidders and hereby proposes to 0 furnish any and all required labor, materials,transportation_and service for the REMOVAL OF EXISTING SHORING AND INSTALLATION OF REPLACEMENT TEMPORARY SHORING FOR MOUNT VERNON AVENUE w OVERCROSSING AT 'tt':H.E BNSF YARDS. U -w BRIDGE NO. 54C-0066 0 L in strict conformity with Plans and Special Provisions No. 13007 of the Department of Public � Works for the City of San Bernardino and also in accordance with Standard Specifications for o Public Works Construction, latest edition.in effect on the first day of the advertised"Notice Inviting R Sealed Bids". The undersigned proposes and agrees if this bid is accepted, that he will contract with the City of San Bernardino, in the form of the copy of the contract annexed hereto, to provide all necessary machinery, tools, apparatus and other means of maintenance, and to do all the work and famish all the materials specified in the contract, in the manner and time therein prescribed, w and that he will take in full payment therefor the following unit prices or lump sum prices, to-wit: N 0 P 0 L r, y- 'a o J 4 -= -� VV 1 co > e d E Q B-1 Packet Pg. 236 S.M.c BID SCHEDULE PLANS&SPECIAL PROVISIONS NO. 13007 REMOVAL OF EXISTING SHORING AND INSTALLATION OF REPLACEMENT TEMPORARY SHORING FOR MOUNT VERNON AVENUE 0 OVERCROSSING AT THE BNSF YARDS. BRIDGE NO. 54C-0066 -o �L m C ITEM n UNJQ�:UANTIT MATFD TOTAL c NO. DESCRIPTIOri OF ITEMS Y IN FIGU RES > . e ..I MOBILIZATION L L TRAFFIC CONTROL INCLUDING MT.VERNON BRIDGE 2 CLOSURE/DETOUR PER PLANS AND SPECIFICATIONS NO. LS 13007 AND AS DIRECTED BY THE ENGINEER. - c REMOVE EXISTING SHORING AND REINSTALL PER PLANS � 3 AND SPECIFICATIONS NO.13007 AND AS DIRECTED BY THE LS 1 $ ENGINEER a 0 0 rn cm TOTAL BID $ ! 3�f d —co L d d O rte ��un r _j If �v dJ in¢ T vu�t s d . ne `� nC�t e� W Y lea E 0 L m 3 o c 0 Q� , coAL J 0 F L CCr G C d 11 E B-3 2 r a Packet Pg.237 BID SCHEDULE PLANS&SPECIAL PROVISIONS NO. 13007 REMOVAL OF EXISTING SHORING AND INSTALLATION OF REPLACEMENT TEMPORARY SHORING FOR MOUNT VERNON AVENUE 0 OV RCROSSING AT THE BNSF YARDS. BRIDGE NO. 54C-0066 -2 �L m_ c 0 BID NOTES: d All blank spaces appearing above must be filled in. In case of discrepancy in Bid Amo6ts, "UNIT" prices " shall govern over extended"TOTAL"amounts. ,. 0 Total bid price for the entire contract work shall include the cost of labor, materials, equipment parts, implements,taxes and supplies necessary to complete the project,as based on the City Engineer's estimate of v quantities of work. 0 3 L The total price must be extended for each item of work and the total of all items inserted in the space provided. 3 Bidders shall complete and submit entire BID DOCUMENTS section as their bid to the CITY. Failure to Q do so will result in the bid being non-responsive. oc rn Any situation not specifically provided for will be determined in the discretion of the City of San Bernardino (CITY), and that discretion will be exercised in the manner deemed by the CITY to best protect the public = interest in the prompt and economical completion of the work. The decision of the CITY respecting the amount of a bid,or the existence or treatment of an irregularity in a bid,shall be final. c a, c BIDDER declares that this Bid is based upon careful examination of the work site, Bid and Contract w Documents, including,but not limited to,the fees and expenses of other agencies involved with this project. The Contractor shall be responsible for BNSF and Metrolink Permit Fees and the cost of Railroad Insurance c acceptable to both companies.The Contractor is responsible for obtaining all required Railroad permits. Estimated quantities are for the purpose of comparison only, and payments will be made on a basis of actual 00 measurement of work completed except for Lump Sum (LS)and Final(F)pay quantities. Final pay quantities are bid items as described in Part II of these Special Provisions. L Specialty Bid Item(S) are bid items that are considered part of the Total bid but are not considered part of the s Contractor's obligation to perform at least fifty percent(50%)of the work as specified in Section 2-3.2, aD "Additional Responsibility,"of the Standard Specifications. a tM :ML W C 0 L ..r G d E V Q B-4 Packe c:238: BIDDER'S INFORMATION AND SIGNATURE: It is the understanding of the undersigned that the work hereinabove described shall be commenced within 10 working days from the date of the"Notice to Proceed", and shall be completed within 40 working days from the date of said notice,as directed in SECTION 4 of these Special Provisions.. 0 I The undersigned farther agrees that in case of default in executing the contract; or furnishing necessary bonds, all within the specified time, the proceeds of the Bidder's Guaranty accompanying this bid shall be paid to -0 the City of San Bernardino as liquidated damages. c , Licensed in accordance with an act providing for the registration of Contractor, c LICENSE EXPIRATION FEDERAL TAX ID NO.: _6 � CLASSIFICATION(S)_f tg DATE: 1 3 6!S ca FIRM NAME: M - G-A-81ne.C?r!ri `Y1 G ,,}� U BUSINESS ADDRESS: 5_ �q 1<4 qty. �C�• ?`) ULt _ o C 3dl � BUSINESSPHONE: CELL: 90cl—`-I4 qU9 o 0 rn If an individual, so state. If a firm or co-partnership, give the names of all individuals, co-partners N composing the firm. If a corporation,give the names of the president,secretary,treasurer and manager thereof L Co Y- owf;t 0}'\ Is Bidder currently a certified DBE? Yes C7 No � c Legal Status of Firm w NAMES ADDRESSCU Gl�z� r�ub��t<1Z t l 1 `fir s- f k t .rK �'t 13 o '71 _. ._a m 3 0 J C SIGNATURE OF BIDDER: `��._ Dated: `fin L'r ,20A 0 rn L BIDDER'S INITIALED ACKNOWLEDGEMENT OF ADDENDUMS: o d ADDENDUM NO. l DATE: P4,50/13 c ADDENDUM NO.2 DATE: ADDENDUM NO.3 DATE: r a ADDENDUM NO.4 DATE: C-1 " Packet Pg.239; 5.M.c SPECIAL NOTICE The bidder's attention is directed to the section entitled, "Required'Listing of proposed Subcontractors", in Section 2 of the special provisions regarding the requirement that proposed m subcontractors be listed in the bidder's Bid Documents. Instead of listing only subcontractors for o 1 lighting 1 d�..^ a E! 1-rnnt a ern - 4+ ias iin[at1' 4t! rt?v DeuigrEation of L signal and lighting work as in hue past, a.[ 3Uk);- 114LIUIJt is Fav cs�'� cU vv ai s__= rn ___ W Sub-Contractors for items of work or portions thereof to be subcontracted in excess of one-half of one percent of the total bid or$10,000.00,whichever is greater. The bidder shall provide the actual dollar "Sub-Contract Amount" as submitted by each listed sub-contractor, keeping in mind that the prime contractor for this project is required to provide or perform, with his own organization, except for "Specialty Items", contract work 0 imuUntinp, to at least 50% of the total Contract bid price: Material required for any of the contract m work of this project that is purchased directly by the prime contractor is considered as included in the prime contractor's 50% requirement. If material purchased directly by the prime contractor is o to be used by a listed sub-Contractor in perfor:nin- contract work, the dollar amount of such purchased material should not be included in the dollar amount listed for said sub-contractor. L ® In the case where a bidder claims an inadvertent clerical error in listing sub-contractors, a notice of the claim must be submitted to the Office of the City Engineer in writing within 2 working w days after the time of the bid opening and send copies of the notice to the subc,�r�trae s involved. r r 0 4- m 3 0 J G L 0 VJ Q� AML W C 0 L Q� C E U t C-2 .. Packet Pg.240 7 rr�RM ,yVe� DESIGNATION OF SUB-CONTRACTORS DEnNS SI'ECI�'I. PROVISIONS NO. 11007 in compliance with the provisions of section 41004114 of the Public Contract Code of the State of California and any m amendments thereof,each bidder shall set forth the name and location of each subcontractor who will perform work or labor or -0 render service to the Contractor. m c O Name&Address Agency&No.of Contractor's License# and L LTrder Which A94RI;;::'BE CURT. Sub-Con actor's Sub-Contract Work to Be Pcrfor::;ed 3 Licensed&License# (If Applicable) Phone-No. Amount f Includiniz Bid Item No.l: v O i 2. O C 3 c w C9 O 4. $ 'm 3 O J tM C O S. l __ W m C O C L 6. c d ' E .qg Q IF ADDITIQNAL SPACE IS REQUIRED,PLEASE DUPLICATE THIS SHEET DO NOT WRITE ON THE BACK C-3 5.M.c WORKERS' COMPENSATION INSURANCE CERTMICATION 0 r cn N I am_ aware of the provisions of section 5700 of the Labor Code requiring every employer to be m 0 IFi3[1fGai fsf iiiafiiifEy t(ii i°rvasfSeGfl.i 'vii3ffpiv R .°': .,. :`•' n. _� sa �? �n��agµt�r€� 2. Est•/� _t`�i�ri.-yy L 11SG�� :i•6Fa'C.E E:.:�r 1i S' V L� CLVfsL � with provisions of that code, and I will comply with such provisions before commencing the U fC L pviivEEiEaricc o LEv 6 Eir£s EPL LBEES contract. U v- 4 L 3 Q Contractor: . o 0 N1VIE OF FIRM: L F CD all c _ TITLE: '�>c�6%A eg�t w c� T)A TE: t 5-- 0 "I: E y.. �MM W 0 •L V V) •L co 0 L .Ar Fey E s c� w Q C-4 Packet Pg. 242 (This affidavit shall be executed by all bidders at the time of bid submittal. Failure to execute the affidavit on this page will result in rejection of bid.) NON-COLLUSION AFFIDAVIT f. ;F To the DEPARTMENT OF PUBLIC WORKS, CITY OF SAN BERNARDINO, STATE OF CALIFORNIA. ° The undersigned in submitting a bid for performing the following work by contract, being duly sworn, m deposes and says: m i That he or she is of the party making the foregoing bid,that the bid is not made in the interest of,or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is cc genuine and not collusive or sham;that the bidder has not directly or indirectly induced or solicited any other 5 bidder to put in a false or sham bid,and has not directly or indirectly colluded,conspired,connived,or agreed ME with any bidder or anyone else to put in a sham bid,or that anyone shall refrain from bidding;communication, or conference with anyone to fix any overhead,profit, or cost element of the bid price,or of that of any other bidder, or to secure any advantage against the public body awarding the contract on anyone interested in the v proposed contract;or take any action in restrains:of free competitive bidding in connection with such contract; o that all statements contained in the bid are true; and further, that the bidder has not, directly or indirectly, -P submitted his or her bid price or any breakdown thereof,or data relative thereto,or paid,and will not pay,any 3 fee to any corporation, partnership, company association, organization, bid depository, or to any member or B agent thereof to effectuate a collusive or sham bid. o ! N ` ,,, Finn Name (D c w ] Signatu f Bidder N o Printed Name and Title 4`- 0 C k 11 0 c i Business Address o 56D1 KULWC�A bf. C)AL�cw ,Cf} q13 Place of Residence ' a m Subscribed and sworn to(or affirmed)b e f o r e me this i � day of j/4 v t ter+r- ,20 l'-1 o the above proved to me on the basis of satisfactory evidence to be the person who appeared before me. Signe Notary Public in and for the County ofy . r, TRIMA PATRICE NERRMANM BOYCHENKO State of California. p a*i Las AnpW County My Commission expires on Comm.E L ices May 7,2016 Year C-s , ' Packet Pg.243 5.M.c I ' ;FORM—L)F )JID BOND KNOW ATI MFN BY THESE PRESENT& thatwe,the imdersigned,GMZ ENGINEERING, INC. 0 as Principal,and in NORTH AMERICAN SPECIALTY INSURANCE COMPANY _ as Surety, are hereby and -a rn+!il!,tn,nd icntn t?tr. tNiv !7r Can Rernarrtino 'State of Califbrnk hereinafter referred to as"(Obligee"in the penal , sum of ten percent 10°la of the total amount of tbo bid of the Principal submitted to the Obligee fvr the wrot'x described below. for the payment of which sum we hereby jointly and severally bind ourselves, our hens,executors,administrators, 0 successors and assigns. a) 5 TOE CCONDrIlON OF 'MS OBLIGATI914 1S SUCH THAT. 2 U Wk'LE;31;AS, the Principal has submitted to Obligee,a certain Bid,attached hereto and hereby made a part hereof fo P enter into a contract in wilting,for the REMOVAL OF EXISTMG SHORING AND INSTALLATION OF REPLACEMENT TEMPORARY SHORING FOR MOUNT VERNON AVENUE OVERCROSSTNG AT T-"BNJ1, U YARDS.BRIDGE NO,54C-0066, o (Copy here the dirle d—=^:p:ion of voek,including-locaflon,as it appears on the)31d turd Contrart Documents) JANUARY 14, 2014 d for which bids are to be opened on lei? 6Xb(;K)4X)(X _ (Imsert date of opening) 2v€W, iHERErORE, N� a. If said Bid shall be rejected,or in the alternate, � c b. If said Bid shat i be accepted and the Principal shall execute a contract in the Form of contract attached hereto(properly completed in accordance with said Bid) c and shall Furnish a bond for his faith ill performance of said comet, and shall in all otherrespects perform the agreement created by the acceptance of said Bid, w Pei then this obligation shall be void; otherwise, the same shall remain in force and effect; it being expressly understood and � agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated, o The Surety,for value received,hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way impaired or affected by any extension of the time within which the Obligee may accept such Bid;and said Surety does hereby m waive notice of any such extension, J Signed, this 1 O T H day of JANUARY , 2014 a' IN WITNM WBEiREAF, the Principal and the Surety have heretmto set their hands and.seals, and such of them as are � corporations have caused their cant oric seals to be hereto affixed and these p es to be signed by their proper officers,the va day and year first mentioned. t NORTH AMERICAN SPECIALTY GMZ ENGINEERING INC. (SEAT) INSURANCE COMPANY (SEAL;) m Principal Surety p By, Sig e _ Srgnawre 1 GHAZI MUBARAK, PRESIDENT MARK D. IATAROLA,ATTORNEY-IN-FACT Printed Name and Title ,Primed Name and 217t1e m E v NOTE:Notarization of Principal and Surety signatures and Power of.Attorney ofthe Sleety shall accompany th is form. Q C-6 Packet Pg.244 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT '`�.`.�S:�i��ti'.-`_-+�i�{��n_` `Z_`G'�5��:fr�`�.�6i`�`Z`�.`1.`4`_`�`�Ci-�.sSS�.'�'�G`�K✓�<r�s�.''�r.`,9�sG"` GG�-%4`�i'��`'`v"�`�v'4`+�'r'�4�JL�G�4C:C'1j` STATE OF CALIFORNIA a� S County of SAN DIEGO _ - Cn On 1/10/2014 before me, MI( HE LE M BASUIL NOTARY PUBLIC d Date Here Insert Name and Title of the Officer :2 L rn personally appeared MARK D. IATAROLA o Name(s)of Signer(s) C L T , who proved to me on the basis of satisfactory evidence to be the person(&) whose name(a) is/arm subscribed to the within instrument and acknowledged to me that he/she*Rj. tLa executed the same in his/f,e. authorized capacity(ies•), _ and that by his/HeF4ieir signatureM on the instrument the a person(, or the entity upon behalf of which the person(a) U acted,executed the instrument. o MICHEL M.BASUIL I certify under PENALTY OF PERJURY under the laws of s „ z COW#2034911 1407 RYYPUBLICCALIFOP.NIACD the State of California that the foregoing paragraph is true 00 SAN DIEGO COUNTY z and correct. CamQ+isnlon EzpMss 1 At,a,uz�,zoti """" My Witness my hand and official seal. Signature Place Notary Seal Above Signature of Notary Public 61 _ '... N OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document w and could prevent fraudulent removal and reattachment of this form to another document. N Description of Attached Document E Title or Type of Document: BID BOND o Document Date:1/10/2014 Number of Pages: 1 m 3 Signer(s)Other Than Named Above: ,° Capacity(ies)Claimed by Signer(s) ' L O Signer's Name: MARK D. IATAROLA Signer's Name: d ❑ Individual ❑ Individual ❑ Corporate Officer—Title(s): ❑ Corporate Officer—Title(s): L ❑ Partner—❑Limited❑General ❑ Partner—❑Limited❑General - G6 Attorney in Fact El Attorney in Fact F ❑ Trustee El Trustee ' U Guardian or Conservator 7Tpof mb here ❑ Guardian or Conservator 10P of thumb here � ❑ Other: ❑ Other: c d Signer Is Representing: Signer Is Representing: R @2007 National Nolary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402-www,NaltonalNotaryorg hero A5907 Reorder.Call Toll-Free 1-800-876-6827 i'. s Packet Pg:245` NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY ,,—WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty hmsurance Company,a corporation duly organized and existing undo M laws of the State of New Hampshire,and having its principal office in the City of Manchester,New Hampshire,and Washington International e Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of .o Schaumburg,Illinois,each does hereby make,constitute and appoint: JOHN G.MALONEY,HELEN MALONEY,MICHELLE M.BASUIL, GLENDA J.GARDNER,MARK D.IATAROLA and DEBORAH D.DAVIS a JOINTLY OR SEVERALLY m c 0 Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings C obligatory in the nature of a bond on belialf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted b, IV law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed tinder this authority shall exceed the y amount of: FIFTY MILLION(550,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of c Directors of both North American Specialty Insurance Company and Washington International Insurance Company;at meetings duly called and held U on the 9th of May,2012: O ..: "RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President,any Vice President,any Assistant Vice Presid 10 the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney nail cu in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is 0 FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or m an certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached" o _._. AU ,10!ryG� 7Y�N/4yyf 10H rv+rawiar '>_ �Q,��iF4liil�Gg� ,rI {' Y� By �4T'"GpRP61TJG.pp'q C !�t SEAL 'S g. (J.I SEAL n_. Steven 1'.Anderson,Senlor Vice President of Washington laternatinnat lusw-nnee Company ,=r e 'T t, 1973 4r O &Senior Vice President ar Nerth American Specialty Insnrunce Company a ;m W By navld 31.Layman,Vice Pr ddiul of�n international Insurance Company &Vice President of North American Speclaay Insurance Company 0 L IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused theil V official seals to be hereunto affixed,and these presents to be signed by their authorized officers thisl Oth day of December 2012 , pp 3 0 North American Specialty Insurance Company —t Washington International Insurance Company = L State of Illinois County of Cook Ss C5 as On this 10th day of December ,20 12 ,before me,a Notary Public personalty appeared Steven P.Anderson ,Senior Vice President of ` Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M.Layman, m Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, _ personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and 0 acknowledged said instrument to be the voluntary act and deed of their respective companies. d MA as SEAL" G�rt3'�t�ut �� 41 DONNA D.SKLENS Notary Public,State of Illinois Donna D.Sklens,Notary Public c My Commission Expires 10/061201 S I, Jeffrey Goldberg , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington E International Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said Not American Specialty Insurance Company and Washington Intemational Insurance Company,which is still in full force and effect. Q N WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this I Oth clay of JANUARY 20 14 . Jeffrey Goldberg;Vice President t,Assistant Secielary of Washington Intemational Insurance C'onpany&North Arne, C"A an' - ..Let.Dg 2AF s as.ncs,s y.�tv CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§1189 +�,•f;+.��-c;fistr,.i�ff '�rc��^.c;�'.c>rk<�cc�saR��;f�s•c>�2�>cc�.r;c',r:n,�t•,c�,c:t�c�',crc.t` h�^.r:C.�-.�e,fi,���:�k�re:�C�:c'. "..�";' State of California 1 y 0 County of... D ._ t �� Ito On l 1 L' before I�+f 0 t Date Here Insert Name and Title of the Officer 'r m personally appeared c c i1 Name(s)of Signer(s) L X x � who proved to me on the basis of satisfactory evidence to be the persono whose name(sl6s/gx4 R subscribed to the within instrument and acknowledged to me that he/�tr�y executed the same in 0 his /t it uthorized capacity(ii,". and that by o TRINAPATRICEHERRMANNB"CHENKQ hi h signature(o'on the instrument the (, Commissbn#1977547 person , the entity upon behalf of which the 'x 3 Nuy ? person( acted, executed the instrument. j a Allow CA" Comm.E tes Ais 7,2016 c I certify under PENALTY OF PERJURY under the N fi laws of the State of California that the foregoing paragraph is true and correct. c' !V d WITNESS my hand and official seal. 7 W f� Signature: Place Notary Seal Above Signature of Notary Public - ! ( OPTIONAL , c� Though the information below is not required by law,it may prove valuable to persons relying on the document E and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Dopuf9ep 'a Title or Type of Document: m f S �!! o Document Date: d ( a i l Number of Pages- 3 Signer's)Other Than Named Above: (iy =fTI Capacity(ies) Claimed by Signer(s) .f Signer's Name: kit A Zi r"I t/121­� Signer's Name: Corporate Officer— Title(s): ❑Corporate Officer— Title(s): -a ❑ Individual ❑Individual ❑ Partner—❑Limited ❑General Top or thumb here ❑Partner — ❑Limited ❑General Top of thumb here c c {t ❑ Attorney in Fact El Attorney in Fact ❑ Trustee ❑Trustee > (•r ❑ Guardian or Conservator L1 Guardian or Conservator "< w ❑ Other: ❑Other: I c ,t E i s ( Signer Is Representing: Signer Is Representing: w a.3'cC%4.^4'<%4.'� .Gr'S-Cat=�.4+°'UG.^�✓v^s'��k.'fi`�G'K`_fS�??v'is�sf . .- 'RrC?+^t'=14::"�i^.�''v^{y�." ,?f' K%C}'�=4�4._ '.._"�-' ^ft4."�'`4`;?h.'i '.�4.�4,^�`L�,r•5, ©2010 National Notary Association•NationalNotary.org•1-800-US NOTARY(1-800-876.6827) ,r -Item#5907 Packet Pg.247 i ,4L , BIDDER'S FIRM NAME MBEIWBE INFORMATION- GOOD FAITH EFFORTS PLANS & SPECIAL PROVISIONS NO. _ The City of San Bernardino has established a Minority Business Enterprise (MBE) Goal of 5% and a Women LG Business Enterprise (WBE) Goal of 0% for this project. The information provided herein shows that adequate U) good faith efforts were made. a, v fA'►. The males an dates Vf each p•ubiii+ativu iil rr6—t, N requeut lvr h'IBE/it'AE pai Clelpaiio;� fvr tlii.C, m project was placed by the bidder(please attach copies of advertisements or proofs of publication): o L Publications Dates ofAdvertisement > tSS . L Y G U a.- O L 3 B. The names and dates of written notices sent to certified MBEs/WBEs soliciting bids for this B project and the dates and methods used for following up initial solicitations to determine with c certainty whether the MBEs/WBEs were interested (please attach copies of solicitations, rn telephone records,fax confirmations,etc.): rn Names of MBEIWBE, Initial Solicitation Follow Up Methods Solicited Dates and Dater c c w __ t9 E O 4- E � O ! ! J _ L O co C. The items of work which the bidder made available to MBE/WBE firms, including, where aa) appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate m MBE/WBE participation. It is the bidder's responsibility to demonstrate that sufficient work to 0 facilitate MBE/WBE participation was made available to MBE/WBE firms. d Items of Work Breakdown of Items c Q E s � a P9"tl OEM i 4: 5 M.c D. The names, addresses and phone numbers of rejected MBE/WBE firms, the reasons for the bidder's rejection of the MBE/WBE, and the firms selected for that work (please attach copies of quotes from the firms involved): c 0 Firms Rejected in d a� o I L 9 ° U Firms Selected ° L 3 m q 0 , - rn h rn L m •a� c W hf E. Efforts made to assist interested MBE/WBEs in obtaining bonding, lines of credit or E insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which was provided to MBE/WBEs: m 3 0 C 0 •L m C 0 F C ✓ Q� E V w {{ F M'♦ F. Efforts made to assist interested MBE/WBEs in obtaining necessary equipment, supplies, materials or related assistance or services, excluding supplies and equipment the MBE/WBE subcontractor purchases or teases from the prime contractor or its affiliate: L 0 d R t •- m r _ L d C.F+ G M+ V G. The names of agencies, organizations or groups contacted to provide assistance in contactingy, recr,itinb and using certi-fied jVIBI?_s/WBE firms (t»lPace attach conics 0 f 0 requests to agencies or organizations, and any responses received, i.e., lists, Internet page download, etc.): -a L Name of Method/.Date Results a Agency/Organization of Contact o f Contact • o 0 rn N 0! _ _ y G? a3 _ uJ N E ' 0 L V� m H. Any additional data to support a demonstration of good faith efforts ( use additional c sheets if necessary): _ •L 0 y�yn� V/ AML W _ 0 _ L d C� C _ d E V SR Packet Pg.250;, i i COz r~f `rvLex�►n ,Y\,C BIDDER'S FIRM HAME, 0 c REFERENCES o PLANS & SPECIAL PROVISIONS NO. rn Im L M Date: n r- 0 F L The following are the names, addresses, and phone numbers for three public agencies for which BIDDER has > performed similar work within the past two years: r Public Agency's Contract Name,Title Na<•ne&Address Type of Project Contract Amount Date Completed &Phone Number 0 w 0 e. L A rcD 0 CA: gt13� � L B W N 11 2. C.G i�o 'a�ki f _ �_L D.0�4 X413._- Q �' res 0 m o � G50Ll 0 3. �GC-D t�ac I ` - $,,00(000 — 3 , d� S�rQ c� CO 6A I Winrdl�u l�ye �n '� ! �� -� Sir—g�43 F t �trp�ttLfttw+ pp tt °' cA g1311 E a Packet Pg.251 5.M.c FILE N0.SSO4-012 ; r ACCT N0. 264-160-5504-7121-0025 u a� � -� a t I lei j lin ino I 0 —.V P VtC_r',�AF V-1BL®C WORKS � tl3 DEPARTMENT OF DEVELOPMENT SERVICES CITY Or SAN BERNARDINO z STATE OF CALIFORNIA L i•+ !1 ADDENDUM N0. ONE 0 i FOR Q P ID AND CONTRACT DOCUMENTS CD 0 I'I.i91 V`J AND SPECIAL PROVISIONS ONS i OJ. 11.300`7 FOR c REMOVAL OF EXISTING SHORING AND INSTALLATION OF REPLACEMENT TEMPORARY SHORING FOR MOUNT VERN6N AVENUE OVERCR.OSSING AT THE BNSF YARD. w BRIDGE NO. 54C-0066 c� 1. The BID OPENING DATE is confirmed as "i--E 'DAY, TANUAFt�( 14, 2014, at o 2:00 P.M. in San Bernardino City Fall, 3"d Floor, 300 N. "U" Street, San Bernardino, a CA 92418. °7 0 2. -Le di g th Mana P B' ee g^ ja ,^,T 7, 2014 fr^m 9:00 AM to 11:00 i��'arulai e a aicuatGr`v` re- 1d Ill t1n un anUa, ,�� T AM, at the end of the last paragraph on page A-2 of the Special Provisions, the following statements are hereby added: `Attendees must bring with them all required Personnel Protective Equipment (PPE). Attendees who are not properly attired in the required PPE will NOT be allowed into BNSF's yard. Hard Hats, Safety m` glasses with side shields, Work Boots with safety toes and defined heels and orange reflective safety vests are the minimum PPE for this Pre-Bid Meeting. r The Prc-Bid Meeting will be held in the BNSF Rail Yard. Meet at the BNSF parking lot on the south side of Fourth Street west of Mt.Vernon Avenue. E I ;. U Packet Pg. 252 5.M.c Re: Addendum No.One,Page 2-Removal of existing shoring and installation of replacement temporary shoring for Mount Vernon Avenue Overcrossing at the BNSF Yard.Bridge No.54G0066 ALL BIDDERS SHALL INDICATE RECEIPT OF THIS A]DDENI)UM NO, ONE !".: AT THE BOTTOM OF THE BIDDER'S INFORMATION SHEET INCLUDED IN THE BID DOCUMENTS OF TI ESE SPECIAL PROVISIONS. L 0 m BY: �i`j`E; ROBI: �'G. ETSENBEISZ k�" :itv Engineer v L U W. O CD L N r L N- Q) 0 r W R 2 0 E O L- 4 co 3 0 J s �L 0 .0 f/1 AML W r- 0 F L d i� E V ADDR.NDUM ANC}.ONE PAGE 2 of 2 PLANS AND SPt?CTAf,PROVISIONS NO, 13007 t�r;rf.Ml�r; Packet Pg. 253 i CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§1184 ��,aircv�;c1.x�'�LC��.r�. �..cx� +.�:r•,cK?.c�-.i�.c;c,•�xx'i`�'��`;�.:.c:�,cC�.�c:rczrc;�sr;� :�c�,s.re�;fvfiu-:,.r.=�'-.ctes„C..v;��,%;rrc?,.r('e� �. State of California 0 County of On ( << ! �� before m6___, /Rf✓I/� r. d'72/L vy�7r►/1 °`ff e-r.Cc v Mate Here Insert Name and Title of the officer M I� personally appeared Z i ✓ / '�-tt <; C S Name(s)of Signer(s) F rr� ���///fffryryry 6 > who proved to me on the basis of satisfactory 1w, evidence to be the person whose name is/a>� M subscribed to the within instrument and acknowledged to me that he/,-h6/twy executed the same in v v his/h Melr authorized ca acit ie and that b ` {. p+ p y{'. Y o TRINAPAT MICE HERRMANNBOYCHENKO his/0r9fi signatureK on the instrument the a CoffeAllon 0 197M7 $ person( r-the entity upon behalf of which the 3 LOS p personK acted, executed the instrument, of Q MY Comm.E ir"Ma 7,2016 � o I certify under PENALTY OF PERJURY under the ° C}t N F.o laws of the State of California that the foregoing I, paragraph is true and correct. _ WITNESS my hand and official seal. S i g nattrre 4 Place Notary Seal Above Signature of gotaty Public I t OPTIONAL ; Though the information below is not required by law, it may prove valuable to persons relying on the document 'X and could prevent fraudulent removal and reattachment of this form to another document. c1 0 ( Description of Attached Docu t, Title or Type of Document: ' t L ic� a �L C-1 r Document Date: (_'5�k- I ZG, 1 Number of Pages: O J Signer's)Other Than Named Above: Capacity(ies) Claimed by Signer(s) h, Signer's Name: (4A4-z_1, k'-1 �jn,r A K- Signer's Name: ` �P,'Corporate Officer--- Title(s): C Q-121 __ ❑Corporate Officer— Title(s): ❑ Individual -. ❑Individual 7.f❑ Partner—❑Limited ❑General Tp of thumb here ❑Partner — ❑Limited ❑General mb here o (,, ❑ Attorney in Fact ❑Attorney in Fact m �p ❑ Trustee ❑Trustee ❑ Guardian or Conservator ❑Guardian or Conservator i* ❑ Other ❑Other: c t E Signer Is Representing: Signer Is Representing: =1 Q iia�e�<^e�rc��r,�crc���;?tc._° . °: ..y .v.. �'."��-S�E^�c^�"�sf:�.' w%4�: '�;�c�s'�'�c::�r�zt.^4�.:� x :•"mac.~ ~��: C�J 2010 National Notary Association•NationalNolary.org•1-800-US NOTARY(1-800-876-6827) m#59D7 Pac(iet Pg.254'..