Loading...
2016-54056 DOC# 2016-0054056 III I II II I III I III IIIII IIIII IIII IIIII IIIII II II IIIII IIII IIII Feb 08, 2016 08:56 AM OFFICIAL RECORDS Ernest J Dronenburg,Recording Requested BY: SAN DIEGO COUNTY RECORDER FEES: $48.00 City Engineer PAGES: 12 When Recorded Mail to: City Clerk City of Encinitas 505 South Vulcan Avenue Encinitas CA 92024 SPACE ABOVE FOR RECORDER'S USE AGREEMENT FOR MAINTENANCE OF PUBLIC STORMWATER TREATMENT AND STORMWATER POLLUTION CONTROL FACILITIES IN THE PUBLIC RIGHT-OF- WAY BY AGENT OF COMMERCIAL FACILITY APN:258-181-17 Project No.: 15-033 DR/CDP Site Address:850 S. Coast Highway 101 Grading Plan: 12509-G THIS AGREEMENT is between the City of Encinitas, a municipal corporation, hereinafter referred to as the "City", and ABP 850 Coast, LLC., its heirs, successors, and assigns, collectively hereinafter referred to as "Owner", owner(s) of that certain real property hereinafter referred to as "Property" that is described in Exhibit "A", which is attached hereto and made a part hereof. This Agreement is for the periodic Maintenance of certain private stormwater treatment and pollution control facilities, hereinafter referred to collectively as "Stormwater Facilities". Stormwater Facilities include but are not limited to Best Management Practices (BMPs), Integrated Management Practices (IMPs), Low Impact Development (LID) features, Structural stormwater treatment devices, and drainage facilities. The description and plat of Stormwater Facilities is set forth in Exhibit "B" which is, attached hereto and made a part hereof. WHEREAS, this Agreement is required by the City as condition of approval of a City permit pursuant to City of Encinitas Municipal Code Chapter 20.08 and Chapter 23.24 as well as the City of Encinitas Stormwater Manual; and WHEREAS, the Stormwater Facilities benefit said Property and are used by Owner and his/her tenants their heirs, successors, and assigns; and WHEREAS, it is the desire of the City, the responsibility of the Owner and tenants, and to the benefit of the Public that Maintenance of said Stormwater Facilities occur on a regular and periodic basis as necessary to preserve the Storm Water Facilities in good-working order in accordance with the minimum Maintenance requirements set •aeaA aad aoml uegj ssal jou Inq `„O„ jggx3 ui pogioads Aouanbaal wnwiuiw eql }e sal}liloe j aaIemwjolS eql loedsul llegs jaumO ayj `uoijlppe ul •swaojs aofew I I e aa:4e sail!lloe=l aa}eMwao}S aqj }oadsul IIegs jaumo aqj (I •aaumo aqj jo jlegaq uo juabV ayl Aq paaly `aoloealuoo paiplenb a Aq pawaojiad pue `aaumo Aq jol pled `juabV ay} Aq pabeuew aoueua}ulelN ueaw llegs }uawaaa6e slyJ uI pajejs se aoueua}uIeIN sal1Illoe� aajennwao}S 6ulpinoid aol sjuawaalnbai , s,aauAAO aqj (!q,l• gbnoayl (I.1, gdejbeaedgns uI y:pol jas se Ile `Aj!o aqj of podaa uoljoadsui lenuue eqj jo le:}Iwgns pue uoljeaedaid pue `Ajl0 aqj Aq paulwaa}ap se aapio buiNaom aadoid ul saljllloe j aa}emwao}S aqj jo aledaa pue deaNdn oul}noi `sallliloe=l aajemwaojS aqj uI saloualol}ap leuoljeaado bulApluapl jo sasodand aol uoljoadsul :oj palpil aq jou (legs Inq `apnloul llegs juawaaa6e slyj ul pazlle}Ideo aanaaagm „aoueualuleW„ weal ayl •saIjIlloe=I aaIemwaols aqj aol sjuawa.imbaa aoueuajulelN ,slueuel pue aaumo eqj segsllgelse juaweeibe s141 I. :SMO-1•10=1 S`d NOUV` J3aISNOO Eliov IVA b0=l 4332JOV J183?:13H SI ll `3b0=13?J3H1 MON •Apladaad olui A:p;Ddad aqj jo uoi:pod Aue ao Ile jo aaumo anlss000ns goea uodn bulpulq `puel eqj 43!m buluuna lueuanoo a a}n}Ilsuoo juawaaa6y sly} 1egj asn Ieloaawwoo ao pue }uawdolanap 10 }uawaalnbei sI jl `SVMJ3HM :Juabv ay} pue slueual `aaumo o} Aldde AIan11091100 pue Allenbe juawaaibe slyj uo pauoljuaw saij!IIglsuodsaa aoueua}ulen `juawawbe sigl jo asodind ay1 a01 `S`d3b3HM pue -joal aaenbs puesnogj Ajua/vq uegj ssal sI saI}IIIOej Ieloaawwoo ayj 10 a6e}ool aaenbs Iejol aqj se 6uol os juabV ay} se joe Aew aaumo auj `S` EIbAHM pue `aadolanaa ao saaunnO pue seP10u3 jo Aj!o aqj uaam4aq }oe}uoo jo julod albuls aqj aq llegs jua6y aqj •aoueuajulew Bons aasaano 01 „Iua6y„ se 01 paaJaJaa aa:}e ulaaay Ienpinlpul ao Auedwoo juawabeuew Apadoid paiplenb a julodde pue (iNVO) aoueuajulew eaae uowwoo o} saI}Illoe=I jajemwaolS jo aoueuajulelN ppe of aaumo aqj jo Ajlllglsuodsaa sI jI `SV3b3HM saljIlloej aa}emwaojS ay} buI}oedwl ao `woaj builgauaq `6uisn slueual aanjnj aqj Ile o} juawaaa6e slyl asoloslp o} jaumo ay1 jo Ajlllglsuodsaa sI 1! Sd32J3HM }uawaaa6e slyj 10 suoljlpuoo pue swaa} aqj aoaolue pue qj!m Aldwoo Ilp slueual aaq/sly ainsse of aaumo eqj jo Ajlllglsuodsaa sl 1! `Sd3233HM pue :s}uawaalnbai pue salollod AjlO pajelaa aagjo pue `lenue” aa}emwaolS sellulou3 941 `apoo ledlolunlN se}Iulou3 jo AjIO aqj ql!m aouepa000e uI pue joaaaq lied a spew pue ojaaaq pagoe:4e sI goigm „O„ Ilgl4x3 ul q:P0J ii) The Owner shall provide upkeep and repair to preserve the Stormwater Facilities in good working order and shall repair all deficiencies identified in the Owner's inspections no later than 30 days following the inspection or prior to the next anticipated rain event. Interim water quality control measures shall be utilized to protect damaged or deficient Stormwater Facilities during any storm event until such time as the Facilities are restored to good working order. The minimum upkeep and repair frequency shall be consistent with the Exhibit "C" but not less than once per year. To the satisfaction of the Director of Engineering Services, the Owner shall ensure that the Stormwater Facilities are in proper working order for the rainy season, which starts on October 1. iii) The Owner shall obtain the City of Encinitas Stormwater Inspection Report form from the City website or the City of Encinitas Civic Center, complete the inspection report form, and submit the inspection report to the City of Encinitas Department of Engineering Services. Prior to the submittal of the inspection report to the City, the Owner shall perform an inspection of the Stormwater Facilities, identify deficiencies, and repair and correct all deficiencies. The inspection report shall be submitted to the City once a year between August 1 and September 30. 2. The Property is benefited by this Agreement, and it is the purpose of the signatories hereto that this instrument be recorded to the end and intent that the obligation hereby created shall be and constitute a covenant running with the land. Any heirs, executors, administrators, assignees, and/or successors in interest to all or any portion of the Property, by acceptance of delivery of a deed and/or conveyance regardless of form, shall be deemed to have consented to and become expressly bound by these presents, including without limitation, the right of any person entitled to enforce the terms of this Agreement to institute legal action as provided in Paragraph 14 hereof, such remedy to be cumulative and in addition to other remedies provided in this Agreement and to all other remedies at law or in equity. 3. The Stormwater Facilities shall be constructed by and have Maintenance performed by the Owner in accordance with the term and conditions of this agreement and the plans and specifications identified in approved Grading Plan Number 12509-G which is on file as a permanent public record in the City of Encinitas. 4. The cost and expense of the Maintenance of the Stormwater Facilities shall be paid by the Owner. The owner is responsible to include necessary provisions in the lease agreement with any present and future tenants that cover the costs of all Stormwater Facilities Maintenance. 5. In the event the Property is subdivided in future, the owners, heirs, assigns, and successors in interest of each such newly created parcel(s) shall be liable under this Agreement for their then pro rata share of expenses reflecting such newly created parcels. 6. The Maintenance to be performed under this Agreement shall include upkeep, repair, and improvements to adequately ensure the Stormwater Facilities are in proper working order as determined by the City. Upkeep, repair, and improvements under this Agreement shall include, but are not limited to, repairing access roadbeds; repairing, preserving, and providing improvement for the upkeep of drainage structures; removing debris, sediment, oil, grease, and other pollutants as determined by the City; perpetually preserving adequate groundcover and/or other erosion control measures within the Property in order to prevent erosion; and the management of materials, pollutants, and hazardous waste to prevent pollution of the stormwater system or Municipal Separate Stormwater Sewer System (MS4) as referenced in local and State codes. Upkeep, repair, and improvement shall also include other work necessary to repair and preserve the Stormwater Facilities for their intended purposes as well as the restoration of the Stormwater Facilities following any non-permitted modification. The restoration shall be as required to restore the Stormwater Facilities to the condition existing prior to damage or alteration. 7. Under no circumstances shall any contract or agreement for service(s) to be provided as outlined in this agreement, and any additional Maintenance activities or services to be provided as outlined in subsequent attachments hereto, be terminated by the Owner, tenants, or Agent unless a replacement contract or agreement for the required Maintenance has already been executed. The Agent and the Owner shall be responsible for ensuring proper execution of the provisions of all contracts and/or agreements for the required Maintenance and for timely payments for said services. 8. Upon appointment of an Agent responsible for managing the maintenance of the stormwater facilities, the Developer must notify the City of the current contact information for the Owner and Agent within thirty (30) days. At a minimum, contact information for Owner and Agent shall include: organization name, mailing address, email address, phone number, contract person, contact person's phone number, and email address. The Agent must be established and the above information must be provided to the City prior to occupancy of the first unit. Any future changes in Owner or Agent contact information shall be provided to the City within thirty (30) days of the change being made. Contact information shall be provided in writing to the following address (or current City of Encinitas, Civic Center address): City of Encinitas Stormwater Division 505 S Vulcan Ave Encinitas, CA 92024 9. Any liability of the Owner, tenants, or Agent for personal injury to any worker employed to provide Maintenance under this Agreement, or to third persons, as well as any liability for damage to the property of any third persons, as a result of or arising out of Maintenance under this Agreement, shall be borne by the Owner, tenants, or Agent. 10. Owner and tenants shall jointly and severally defend, indemnify, and hold harmless City, City's engineer, its consultants, and each of its officials, directors, officers, agents, and employees from and against all liability, claims, damages, losses, expenses, personal injury, and other costs, including costs of defense and attorney's fees, to any contractor, any subcontractor, any user of the Stormwater Facilities, or to any other third persons arising out of or in any way related to the use, Maintenance, or the failure to provide Maintenance of the Stormwater Facilities. This Agreement imposes no liability of any kind whatsoever on the City and the Owner agrees to hold the City harmless from any liability in the event the Stormwater Facilities fail to operate properly. 11. Nothing in this. Agreement, the specifications, other contract documents, the City's approval of the plans and specifications, or the City's inspection of the work constitutes an acknowledgement of any City responsibility for any such item or the material contained therein, and the City, City's engineer, its consultants, and each of its officials, directors, officers, employees and agents, shall have no responsibility or liability therefore. 12. The Owner and tenants shall provide access to the Stormwater Facilities within the Property to the City's inspectors, employees, agents, and contractors within 48 hours of receipt of a written notification by the City. The access shall be provided unconditionally and without any obstruction, interference, or hazard. Any animals kept on the Property shall be secured outside of the area subject to the City's inspection. 13. The Owner hereby grants permission to the City, its authorized agents, and its employees, to enter upon the Property and to inspect the Stormwater Facilities following a 48-hour notice whenever the City deems necessary. The purpose of inspection is to evaluate the condition and performance of the Stormwater Facilities, to follow-up on reported deficiencies, to respond to citizen complaints, and/or to comply with State and City requirements for City inspection of such Facilities. The City shall provide the Owner with copies of the inspection findings and a directive to commence with any repairs deemed necessary. 14. In the event the Owner and tenants fail to preserve the Stormwater Facilities in good working condition as determined by the City Engineer, the City, its agents, employees, or its contractors, may enter upon the Property and take the steps deemed necessary to correct deficiencies and shall charge the costs of such repairs to the Owner. In the event the City pursuant to this Agreement, performs work of any nature, or expends any funds for attorney's fees, administrative costs, contractors, employees, consultants, materials, or other costs in the performance of said work, the Owner shall reimburse the City. Such reimbursement shall be due within thirty (30) days of receipt of a notification for all costs incurred by the City, including any administrative costs and attorney's fees. If said funds are not paid by the Owner within (30) days, City reserves the right to take legal action for cost recovery and to file with the County Recorder of San Diego County an assessment lien on the Property. It is expressly understood. and agreed that the City is under no obligation to perform Maintenance of said Stormwater Facilities, and in no event shall this Agreement be construed to impose any such obligation on the City. 15. The terms of this Agreement may be amended in writing following the Owner request and upon written approval by the City Engineer. 16. This Agreement shall be governed by the laws of the State of California. In the event that any of the provisions of this Agreement are held to be unenforceable or invalid by any court of competent jurisdiction, the validity, and enforceability of the remaining provisions shall not be affected thereby. IN WITNESS HEREOF, the Parties have executed this Agreement. OWNER: Michael Persall, Manager Date ABP 850 Coast, LLC. Signature of OWNER must be notarized. Attach the appropriate acknowledgement. CITY OF ENCINITAS: . //1 Z/ 4//to Masih Maher for Glenn Pruim Date Director of Public Works ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of SAN DIEGO On 2/4/16 before me, ALEXANDER LANGE M 0 TG✓/ �c�,Li�I`� (insert name and title of the officer) personally appeared MICHAEL PERSALL who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ALEXAMW FREDRM LAME WITNESS my hand an official seal. &Pan CORWAllien No.20i601 NOTARY PUBLIC•CALIFORNIA SAN DIEGO COUNTY 2 C0M"*$3ft Expires July 90,2017 Signature (Seal) EXHIBIT A LEGAL DESCRIPTION OF PROPERTY PORTIONS OF LOTS 6, 7, AND 8 IN BLOCK 8 OF ENCINITAS, IN THE CITY OF ENCINITAS, COUNTY OF SAN DIEGO, STATE OF CALIFORNIA, ACCORDING TO OFFICIAL MAP THEREOF NO. 148, FILED IN THE OFFICE OF THE SAN DIEGO COUNTY RECORDER ON JUNE 12, 1883. HEREIN ABOVE MENTIONED PORTIONS OF LOTS 6, 7, AND 8 ARE CONSOLIDATED INTO ONE PARCEL AND MAY NOT BE CONVEYED SEPARATELY WITHOUT FILING A PARCEL OR SUBDIVISION MAP. CONTAINS 12108 SQUARE FEET MORE OR LESS. EXHIBIT B SHEET 1 OF 2 DESCRIPTION AND PLAT OF STORMWATER FACILITIES 258-181-19 N 83'57'42' E 80.57' I I � O LLJ(n I D I N J M Go M I 1 oI ^Y i°n J Fo Q u' f—U I V O co J m 2 Lo N (n 3 Ncn W to cq N —————— —— ——— —— —— - W ZI p In V) LOT 8 Uu BLOCK 8 I C/) N 83'57'42° E 80.52' - — — — — — WATER POLISHER-UP-FLOW MEDIA FILTER WP-3-6 — C/L — — ��� W. H STREET I iandworks ivi 15 0 15 30 110 COPPERWOOD WAY,SUITE P,OCEANSIDE,CA 92058 CJtApgV SG." PH:760-908-8745•info @civillandworks.com sum r— 35, EXHIBIT B SHEET 2 OF 2 DESCRIPTION AND PLAT OF STORMWATER FACIUTIES BIoSorb HYDROCARBON BOOM BAFFLE WALL -OIL SKIMMER MEDIA FILTER HOUSING LL / LLLLLL INFLOW PIPE OUTFLOW PIPE 3.00' ACCESS HATCHES PLAN CONTRACTOR TO GROUT TO FINISHED GRADE PER INSTALLATION NOTE 5 4.00' X72.10 RIM 0.50' 3.00' 0.50' Lo CD — — THRU HOLE TREATMENT STATIC GROUT PIPE PER MEDIA WATER INSTALLATION NOTE 5 ,°n I CARTRIDGE ELEVATION 65,601 OUT o I if TT cm L _CHAMBER — — LL 0.50' -4.67'----0 - .33� 0.50' — — —� 6.00' 1.00 7.00' END VIEW SECTION Lq 0 WATER POLISHER-UP-FLOW MEDIA FILTER WP-3-6 BY BIOCLEAN NTS Li SPECIAL INSTALLATION NOTE: ivi anwor s WATER POLISHER AND MWS UNIT TO BE INSTALLED BY BIOCLEAN 110 COPPERWOOD WAY,SUITE P,OCEANSIDE,CA 92058 ENV. SERVICES APPROVED INSTALLER. PH:760-908-8745•info @civillandworks.com EXHIBIT C MINIMUM MAINTENANCE REQUIREMENTS FOR STORMWATER FACILITIES 1. BIO CLEAN ENVIRONMENTAL SERVICES, INC. RECOMMENDS THE SEPARATION CHAMBER AND OIL SKIMMER BE INSPECTED ANNUALLY AND CLEANED WHEN NEEDED DEPENDING ON LOADING. THE PROCEDURE IS EASILY DONE WITH THE USE OF ANY STANDARD VACUUM TRUCK. 0 REMOVE ALL MANHOLE COVERS (OR OPEN HATCHES) TO GAIN ACCESS TO THE SEPARATION CHAMBER. 0 USE A VACUUM TRUCK HOSE AND INSERT INTO THE MANHOLE OR HATCH OPENING. LOWER THE VACUUM HOSE INTO THE SEDIMENT CHAMBER. BEGIN VACUUMING OUT ACCUMULATED SEDIMENTS AND STANDING WATER UNTIL THE CHAMBER IS EMPTY. A PRESSURE WASHER MAY BE NEEDED TO ASSIST WITH REMOVING SEDIMENTS THAT ARE COMPACTED OR STUCK TO THE WALLS AND FLOOR OF THE SEPARATION CHAMBER. 0 REMOVE HYDROCARBON BOOMS FROM OIL SKIMMER AND REPLACE IF NEEDED. 0 ONCE THE CHAMBER IS CLEANED REMOVE VACUUM HOSE. 0 REMOVE VACUUM HOSE AND REPLACE MANHOLE COVERS OR HATCH DOORS. 0 WHERE POSSIBLE THE MAINTENANCE SHOULD BE PERFORMED FROM THE GROUND SURFACE. 0 NOTE: ENTRY INTO AN UNDERGROUND STORMWATER VAULT SUCH AS AN INLET VAULT REQUIRES CERTIFICATION OF CONFINED SPACE TRAINING. 0 TRANSPORT ALL DEBRIS, TRASH, ORGANICS AND SEDIMENTS TO APPROVED FACILITY FOR DISPOSAL IN ACCORDANCE WITH LOCAL AND STATE REQUIREMENTS. 2. BIO CLEAN ENVIRONMENTAL SERVICES, INC. RECOMMENDS THE UPFLOW FILTER MEDIA BE INSPECTED ANNUALLY AND CLEANED WHEN NEEDED DEPENDING ON LOADING. THE PROCEDURE WILL REQUIRE PRIOR MAINTENANCE OF SEPARATION CHAMBERS AND SCREENING BASKET. 0 REMOVE ALL MANHOLE COVERS (OR OPEN HATCHES) TO GAIN ACCESS TO THE SEPARATION CHAMBERS. 0 ENTER THE MANHOLE CLOSEST TO THE OUTFLOW PIPE. ALWAYS USE APPROPRIATE SAFETY GEAR AND PROCEDURES AND FOLLOW LOCAL REGULATIONS. 0 OPEN TOP DOORS OF THE UP FLOW MEDIA FILTER CAGE. THE LATCHES SLIDE BACK TO OPEN DOORS AND GAIN ACCESS TO MEDIA (BIOMEDIAGREEN). 0 REMOVE MEDIA EITHER BY HAND OR LIFT THEM INTO VERTICAL POSITION AND USE A VACUUM TRUCK HOSE TO REMOVE THE MEDIA. NO HEAVY EQUIPMENT IS NECESSARY TO REMOVE OR INSTALL NEW MEDIA. 0 ONCE ALL THE MEDIA IS REMOVED USE A PRESSURE SPRAYER TO WASH OF ANY ACCUMULATED DEBRIS ON THE SCREEN OF THE MEDIA CAGE. 0 INSTALL BIOMEDIAGREEN AND COMPACT. 0 CLOSE DOORS OF MEDIA FILTER CAGE AND SLIDE LATCHES INTO PLACE. 0 EXIT THE VAULT. 0 NOTE: ENTRY INTO AN UNDERGROUND STORMWATER VAULT SUCH AS AN INLET VAULT REQUIRES CERTIFICATION OF CONFINED SPACE TRAINING. 0 TRANSPORT ALL DEBRIS, TRASH, ORGANICS AND SEDIMENTS TO APPROVED FACILITY FOR ISPOSAL IN ACCORDANCE WITH LOCAL AND STATE REQUIREMENTS. 3. FOLLOWING MAINTENANCE AND/OR INSPECTION, THE MAINTENANCE OPERATOR SHALL PREPARE A MAINTENANCE/INSPECTION RECORD. THE RECORD SHALL INCLUDE ANY MAINTENANCE ACTIVITIES PERFORMED, AMOUNT AND DESCRIPTION OF DEBRIS COLLECTED, AND CONDITION OF THE SYSTEM AND ITS VARIOUS FILTER MECHANISM. 4. THE OWNER SHALL RETAIN THE MAINTENANCE/INSPECTION RECORD FOR A MINIMUM OF FIVE YEARS FROM THE DATE OF MAINTENANCE. THESE RECORDS SHALL BE MADE AVAILABLE TO THE GOVERNING MUNICIPALITY FOR INSPECTION UPON REQUEST AT ANY TIME. 5. TRANSPORT ALL DEBRIS, TRASH, ORGANICS AND SEDIMENTS TO APPROVED FACILITY FOR DISPOSAL IN ACCORDANCE WITH LOCAL AND STATE REQUIREMENTS. AY,L-PURPOSE ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this Certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of SS.aVA Di ey,o On -- —201 (0 , before me, Y QA 0, C__*�1 0 ,Notary Public, DATE \ personally appeared N\GSA V) �G�A e r— ,who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s re subscribed the within instrument and acZqle�ged to me thae)she/they executed the same ' ter/their authorized capacity(ies), and that by is er/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. ANGELA A.2009314 9314 I certif y under PENALTY OF PERJURY under the C004# N NOTARY PUBLIC DIEGO COUNTY IA U) laws of the State of California that the foregoing SAN DIEGO COUNTY b g MY CGNN.---MAR.z,2017- paragraph is true and correct. WITNESS my hand and official seal. A 1 PLACE NOTARY SEAL IN ABOVE SPACE NOTARY'S SIGNATURE OPTIONAL INFORMATION The information below is optional. However,it may prove valuable and could prevent fraudulent attachment of this form to an unauthorized document. CAPACITY CLAIMED BY SIGNER(PRINCIPAL) DESCRIPTION OF ATTACHED DOCUMENT INDIVIDUAL CORPORATE OFFICER TITLE OR TYPE OF DOCUMENT PARTNER(S) TITLE(S) ATTORNEY-IN-FACT NUMBER OF PAGES GUARDIAN/CONSERVATOR SUBSCRIBING WITNESS ❑ DATE OF DOCUMENT OTHER: OTHER SIGNER(PRINCIPAL)IS REPRESENTING: RIGHT s NAME OF PERSON(S)OR ENTITY(IES) THUMBPRINT s SIGNER o a 0 APA01/2015 NOTARY BONDS,SUPPLIES AND FORMS AT HTTP://WWW.VALLEY-SIERRA.COM ©2005-2015 VALLEY-SIERRA INSURANCE