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HomeMy WebLinkAboutJJ Fisher Construction, Inc.All bid forms must forms and required forms together. BID FORMS be completed and submitted with your bid. Failure to submit these bid bond is cause to reject the bid as nonresponsive. Staple all bid THE UNDERSIGNED, agrees that they have carefully examined: 1. the location of the proposed work 2. the plans and specifications 3. read the accompanying instructions to bidders and propose to furnish all: 4. materials 5. labor to complete all the required work satisfactorily in compliance with 6. plans 7. specifications 8. special provisions for the prices set forth in the bid item list: BID ITEM LIST FOR 2022 PEDESTRIAN CROSSING IMPROVEMENTS, Specification No. 1000069 Item Item Unit of Estimated Item Price Total No. SSm Description Measure Quantity in figures) in figures) 1 7,12 Traffic Control Plan and LS 1 -_- $45, 574.00 Implementation 2 15 Regrade Brick Pavers to LS 1 __. $4, 951. 00 Finished Sidewalk Grade 3 15,73 Remove Concrete & Cobble SF 110 $25.00 $2, 750.00 Median - South St 4 15,19 Roadway Excavation - South St CY 2 $626.00 $1, 252.00 Median 5 39 Class 2 Aggregate Base - South CY 4 $581.00 $2, 324.00 St Median 6 39 Hot Mixed Asphalt Paveout - TON 3 $2, 940.00 South St Median $980.00 7 15 Remove and Dispose of Existing EA 1 --- $1, 069.00 Bench 8 15,73 Concrete Curb — South Street LF 10 $205.00 $2, 050.00 Median 9 15,73 Concrete Cross Gutter SF 400 $54.00 $21, 600.00 10 9,15, Concrete Curb and Gutter LF 40 73 Allowance $55.00 $2, 200.00 11 9,15, 73 Concrete Sidewalk Allowance SF 250 $34.00 $8,500.00 12 15,73 Bike Ramp - King St & Meadow LS 1 --- Park L1 $15,189.00 13 15,73 Curb Ramp 1 - Broad St & Islay LS 1 --- St SE Corner L2) $22, 730.00 BID FORMS A BID FORMS Item Item Unit of Estimated Item Price Total No. Ssm Description Measure Quantity in figures) (in figures) 14 15,73 Curb Ramp 2 - Broad St & Islay LS 1 --- $20, 340.00 St SW Corner 1-2 15 15,73 Curb Ramp 3 - Broad St & Islay LS 1 --- $22, 371.00 St NW Corner 1-2) 16 15,73 Curb Ramp 1 - Johnson Ave & LS 1 --- $26, 011.00 Sydney St SW Corner 1-4 17 15,73 Curb Ramp 2 - Johnson Ave & LS 1 --- $30, 985.00 Sydney St SE Comer 1-4 18 15,73 Remove and Replace ADA EA 2 $1, 050. 00 $2, 200. 00 Tactile Pad - King St & South St 19 15 Relocate Water Meter EA 1 --- $4, 226.00 20(S) 82,86 RRFB System - Broad St & Islay LS 1 --- St L2 $30,555.00 21(S) 82,86 RRFB System - Kings St & LS 1 --- South St L3) $38, 694.00 22(S) 82,86 RRFB System - Johnson Ave & LS 1 --- Sydney St 1-4 $38,694.00 RRFB System - Osos St & Islay 23(S) 82,86 St (L10) LS 1 --- $30, 555.00 24 84 Remove Thermoplastic Traffic LS 1 --- $33, 343.00 Stripe & Markings 25 84 Thermoplastic - 12" White LF 56 $13.00 $784.00 26 84 Thermoplastic — White Hi-Vis LF 170 $ 32.00 $5, 780.00 Crosswalk 27 84 Thermoplastic — Detail 39 LF 149 $7.00 $1, 043.00 28 84 Thermoplastic — Detail 39A LF 232 $7.00 $1, 624.00 Thermoplastic — Pavement 29 84 Markings/Legends (Arrows, SF 142 $20.00 $2, 982.00 Words, Symbols, etc. 30 84 Traffic Paint — 12" Yellow LF 142 6.00 $852.00 Dia onal 31 84 Traffic Paint — 4" White LF 223 $4.00 $1,115.00 Channelizing Lines 32 84 Traffic Paint - Yellow Hi-Vis LF 75 $13.00 $1, 050.00 Crosswalk 33 84 Traffic Paint - Detail 25 LF 410 $3.00 $1, 230.00 34 84 Traffic Paint - Detail 29 LF 712 $4.00 $3,560.00 35 84 Traffic Paint - Detail 32 LF 3,823 $3.00 $11, 469.00 36 84 Traffic Paint - Detail 38 LF 50 $7.00 $350.00 37 84 Traffic Paint - Detail 39 LF 3207 $2.00 $6, 414.00 38 84 Traffic Paint - Detail 39A LF 619 $3.00 $1, 857.00 39 84 Traffic Paint - Bike Buffer LF 6,564 $3.00 $19, 692.00 Traffic Paint — Pavement $7.00 $8,638.00 40 84 Markings/Legends (Arrows, SF 1,234 Words. Svmbols. etc. BID FORMS BID FORMS Item No. SS, Item Description Unit of Measure Estimated Quantity Item Price in figures) Total in figures) 41 84 Red Curb Paint LF 220 2.00 $440.00 42 84 Green Bike Lane Marking SealMaster Safe Ride)$14.00 SF 1,298 $18,172.00 43 84 Green Bike Lane Marking (Traffic Paint SF 4,743 $6.00 $28,458.00 44 82 Roadside Punch Post (12') EA 19 $267.00 $5, 073.00 45 82 Roadside Punch Post (16') EA 11 $401.00 $4,411.00 46 82 S1-1 Crosswalk Sign EA 6 $267.00 $1,602.00 47 82 W11-2 Crosswalk Sign EA 14 267.00 $3,738.00 48 82 W16-7P Downward Diagonal Arrow Sin EA 20 $201.00 $4, 020.00 49 82 S 1 `5 Yield Here to Pedestrians gn EA 10 $234.00 $2, 340.00 50 82 Relocate Existing Sign EA 6 $334.00 $2, 004.00 51 82 Traffic Logix Rubber Flex Curb EA 40 $234.00 $9, 360.00 52 82 Flex Post White Pexco FG300 EA 10 $134.00 $1, 340.00 53 5 Relocate City Benchmark EA 1 2 $2, 578.00 .$1,289.001 Bid Total 1 $ 563, 079.00 Company Name: A FISHER CONSTRUCTION, INC (1) refers to section in the Standard Specifications, with modifications in the Special Provisions, that describe required work. (S) indicates specialty items of work per section 5-1.13A of the Standard Specifications. BID FORMS C BID FORMS LIST OF SUBCONTRACTORS Pursuant to Section 4100 of the Public Contracts Code and section 2-1.33C of the standard specifications, the Bidder is required to furnish the following information for each Subcontractor performing more than 1/2 percent (0.5%) of the total base bid. Do not list alternative subcontractors for the same work. Subcontracting must not total more than fifty percent (50%) of the submitted bid except as allowed in section 5-1.13 of the standard specifications. For Streets & Highways projects, subcontractors performing less than ten thousand dollars ($10,000) worth of work need not be mentioned. Subcontractors required to pay prevailing wage, must be registered with the Department of Industrial Relations pursuant to Labor Code section 1725.5 to be listed. NOTE: If there are no subcontractors, write "NONE" and submit with bid. Name Under Which Subcontractor is Licensed TOSTE CONSTRUCTION INC License Number 879465 Attach additional sheets as needed. DIR Public Works Registration Number 1000001378 BID FORMS D Address and Phone Specific Number of Office, Mill or Description of Shop Subcontract 2651 GREEN PLACE PAVEMENT MARKINGS, ARROYO GRANDE, CA 93420 LEGENDS, SIGNAGE, (805) 473-0884 & TRAFFIC ACCS. % Of Total Base Bid -Ty BID FORMS PUBLIC CONTRACT CODE SECTION 10285.1 STATEMENT In compliance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder, or any subcontractor to be engaged by the bidder, has , has not X been convicted within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100, including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. NOTE: The bidder must place a check mark after "has" or "has not" in one of the blank spaces provided. The above Statement is part of the Bid. Signing this Bid on the signature portion constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE In compliance with Public Contract Code Section 10162, the Bidder must complete, under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on, or completing a federal, state, or local government project because of a violation of law or a safety regulation? Yes X No If the answer is yes, attach a letter explaining the circumstances PUBLIC CONTRACT CODE SECTION 10232 STATEMENT In compliance with Public Contract Code Section 10232, you hereby state under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against you within the immediately preceding two-year period because of your failure to comply with an order of a federal court which orders you to comply with an order of the National Labor Relations Board. LABOR CODE SECTION 1725.5 STATEMENTS The bidder has delinquent liability to an employee or the state for any assessment of back wages or related damages, interest, fines, or penalties pursuant to any final judgment, order, or determination by a court or any federal, state, or local administrative agency, including a confirmed arbitration award. Any judgment, order, or determination that is under appeal is excluded, provided that the contractor has secured the payment of any amount eventually found due through a bond or other appropriate means. BID FORMS E BID FORMS Yes X No The bidder is currently debarred under Section 1777.1 or under any other federal or state law providing for the debarment of contractors from public works. Yes X No NOTE: The above Statements and Questionnaire are part of the Bid. Signing this Bid on the signature portion constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. BID FORMS F BID FORMS i, JAYSON J FISHER lam CEO NON -COLLUSION DECLARATION . declare that of JJ FISHER CONSTRUCTION, INC 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 genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone refrained from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or 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 of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Executed on , 20 in ESL -t�C]'C 0 , Q � I declare under penalty of perjury under the laws_ofJhe State of_Caltfarnja that the foregoing is true and correct. (SEAL) (Signature and Title of Declarant) Subscribed and sworn to before me this day of , 20 23 Notary Public SEE AT i INGHED FORM Company Name: JJ FISHER CONSTRUCTION, INC FOR NOTARY CERTIFIWE BID FORMS G CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE § 8202 )XSee Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Luis Obispo *my ROBERT KATi1EW5 Notary Public • California San Luis Obispo County Commission # 2166148 Comm, Expires Aug 1a. 2025 Seal Place Notary Seal Above Subscribed and sworn to (or affirmed) before me on this 26 day of 20Za, by Date Month ' ] Yea r D� 0): C�YI Gi1'l�$ '1"'S 5 ►fir (and (2) Name(s) of Signer(s) proved to me on the basis of satisfactory evidence to be the persons o a eare ore me. Signature Signature of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: � a1 ��y�S� v► S �` Document Date: 0 Number of Pages: Signer(s) Other Than Named Above: 9QqqWW 02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5910 BID FORMS Bidder Acknowledgements By signing below, the bidder acknowledges and confirms that this bid is based on the information contained in all contract documents, including the notice to bidders, plans, specifications, special provisions, and addendum number(s) (Note: You are responsible to verify the number of addenda prior to the bid opening.) The undersigned further agrees that in case of default in executing the required contract, with necessary bonds, within eight days, (not including Saturdays, Sundays, and legal holidays), after having received a mailed notice that the contract is ready for signature, the proceeds of the check or bond accompanying his bid will become the property of the City of San Luis Obispo. Licensed in accordance with an act providing for the registration of contractors, License No93964 Expiration Date 04/30/2024 The above statement is made under penalty of perjury, an any bid n t containing this information "will be considered non -responsive and will be re ected" by t Signature of Bidder J ON J FISHER CEO (Print Name and Title of Bidder) DIR— Public Works Registration No: 1000003980 Business Name (DBA): JJ FISHER CONSTRUCTION, INC Owner/Legal Name: Indicate One: ❑Sole -proprietor ❑ Partnership IXCorporation List Partners/Corporate Officers: JAYSON J FISHER CEO Name Title MARK SCZBECKI CFO Name Title Name Title Business Address 261 W Dana St. Suite 102, Nipomo, Ca. 93444 Street Address 261 W Dana St. Suite 102, Nipomo, Ca. 93444 Mailing Address PO Box 2219 City, State, Zip Code NIPOMO, CA. 93444 Phone Number 805-723-5220 Fax Number 805-723-5221 Email Address JJ@JJFISHERCONSTRUCTION.COM Date 01/26/2023 BID FORMS H BID FORMS Qualifications Failure to furnish complete reference information ON THIS FORM, as specified in this project's Notice to Bidders and indicated below, is cause to reject the bid. Additional information may be attached but is not a substitute for this form. Reference Number 1 Customer Name & Contact Individual CITY OF GOLETA - JAMES WINSLOW Telephone & Email 805-961-7577 Project Name (Site Address): GOLETA FLASHING BEACONS CATHEDRAL OAKS RD AT BRANDON AVE Is this similar to the project being bid Describe the services provided and how this project is similar to and did this project include flashing that which is being bid: beacon installation? CONCRETE CURB, GUTTER, RETAINING CURB, SPANDREL, Yes rX No ❑ SIDEWALK, CURB RAMP. RRFB ASSEMBLY, POLE, FOUNDATION REFLECTIVE PAVEMENT MARKERS, RED CURB CONTINENTA Was this contract fora public agency? P CROSS WALK, PEDESTRIAN PUSH BUTTON, TRAFFIC SIGNAL PULL BOX Yes X No ❑ Date project completed: 6/2022 Reference Number 2 Customer Name & Contact Individual CITY OF SOLVANG Telephone & Email Project Name (Site Address): CITY OF SOLVANG 5TH STREET SIDEALK Is this similar to the project being bid Describe the services provided and how this project is similar to and did this project include curb ramp that which is being bid: installation? REMOVE AND REPLACE CONCRETE CURB, GUTTER, SIDEWALK, SPANDEL, Yes CX NO ❑ CURB RAMPS, DRIVEWAY APPROACH, ADA RAMPS. CMU RETAINING WALL, GRADING, REPLACEMENT OF LOOP DETECTORS, CONDUIT, AND CONDUCTORS Was this contract for a public agency? Yes iX No ❑ I Date project completed: 3/2021 Reference Number 3 Customer Name & Contact Individual City of Santa Maria - Chris Petro Telephone & Email 805-925-0951 EXT 481 Project Name (Site Address): PEDESTRIAN SAFETY AND ACCESSIBILITY IMPROVEMENT PROJECT Is this similar to the project being bid Describe the services provided and how this project is similar to and did this project involve curb ramp that which is being bid: installation? CONSTRUCTION COORDINATION, REMOVAL & REPLACEMENT OF CONCRETE Yes qK No ❑ CURB, GUTTER, SIDEWALK, ADA RAMPS. TREE ROOT TRIMMING AND REMOVAL Was this contract for a public agency? Yes N No ❑ Date project completed: 9/2022 BID FORMS I BID FORMS ATTACH BIDDER'S BOND TO ACCOMPANY BID Know all men by these presents: Thatwe JJ FISHER CONSTRUCTION, INC. AS PRINCIPAL, and THE OHIO CASUALTY INSURANCE COMPANY AS SURETY, are held and firmly bound unto the City of San Luis Obispo in the sum of: TEN PERCENT OF AMOUNT BID Dollars ( 10% OF B10to be paid to said City or its certain attorney, its successors and assigns; for which payment, well and truly to be made, we bind ourselves, our heirs, executors and administrators, successors or assigns, jointly and severally, firmly by these presents: THE CONDITION OF THIS OBLIGATION IS SUCH, that if the certain bid of the above bounden PRINCIPAL to construct 2022 PEDESTRIAN CROSSING IMPROVEMENTS (insert name of street and limits to be improved or project) dated ANUARY 26TH, 2023 is accepted by the City of San Luis Obispo, and if the above bounden PRINCIPAL , his heirs, executors, administrators, successors, and assigns shall duly enter into and execute a contract for such construction and shall execute and deliver the two bonds described within ten (10) days (not including Saturdays, Sundays, or legal holidays) after the above bounden, PRINCIPAL , has received notice by and from the said City of San Luis Obispo that said contract is ready for execution, then this obligation shall become null and void; otherwise, it shall be and remain in full force and virtue. IN WITNESS WHEREOF, we hereunto set our hands and seals this 25 day of JAN. , 2023 Bidder Principal: JJ FI$M5R CObL8r RUCT6N, INC. Cxa—O Surety: THE OHIO CASUALTY INSURANCE COMPANY BRITTON CHRISTIANSEN, ATTORNEY -in -FACT Bidder's signature is not required to be notarized. Surety's signature must be notarized. Equivalent form may be substituted (Rev. 6-30-14) BID FORMS J This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Liberty Mutual Insurance Company Mutual. The Ohio Casualty Insurance Company Certificate No:8201903-969577 SURETY West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Britton Christiansen: Myma Smith; Philip E. Vega: Kevin E. Vega all of the city of Covina state of Califomia each individually if there be more than one named, ils True and lawful attorr in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 15th day of August , 2019 Liberty Mutual Insurance Company The Ohio PC"R°aRRA�C West Am American any can Insurance a Compasualty Insurance ny r�1912mp o 1919 '2" 1991 rd �sAcksgwfi a y° `hhrnV a 'e 'NafAts� a e3 ��Nd s'�M d By: David M. Carey, Assistant Secretary 2 I State of PENNSYLVANIA � County of MONTGOMERY rn Cn a� c Cn a� On this 15th day of August , 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance U O `O Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes — m > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. LLI mO v co c U) O P (j O O a) C (0 N U) rnO to rnO O.E E ai o tLa IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. COMMONWEALTH OF PENNSYLVANIA C/ *.7' �•S y Notarial Seal Teresa Pastella, Notary Public Upper Marion Tvvp , Montgomery County By: v( My Commission Expires March 28, 2021 Member, Pennsylvania Association of Notaries Public This Power of Attomey is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV — OFFICERS: Section 12. Power of Attorney Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such allomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts: Section 5 Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 25TH day of JANUARY , 2023 IN %NSUP RvloQy4irq�[+ 1912 0 1919 2 1991 s w ❑ By Renee C. Llewellyn, Assistant Secretary 00 Q O C M E 0 m 0 rn o p U1 >o D fV 00 Lr-M c °I vo Ur 0 CD — LMS-12873 LMIC OCIC WAIC Multi Co 062018 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of LOS ANGELES On JAN 2 5 2023 Date personally appeared before me, Kevin Vega, Notary Public Here Insert Name and Title of the Officer Britton Christiansen, Attorney -in -Fact Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person{SL whose nameN is/m subscribed to the within instrument and acknowledged to me that he/sue/fhoy executed the same in his/ftew/their authorized capacity(bs) and that by his/her/theix signature(. on the instrument the personNI, or the entity upon behalf of which the personN acted, executed the instrument. °i • - KEVIN EDWARD VEGA Notary Public - California Los Angeles County 7 �- My Commission n 2326181 Comm. Expires Apr 29. 2024 Place Notary Seal Above certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and of ai s lJ Signature Sicd azure of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: ©2014 National Notary Association • www.NationalNotary.org - 1-800-US NOTARY (1-800-876-6827) Item #5907