2016-420866 DOC# 2016-0420866
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I Aug 16, 2016 04:12 PM
(I ' OFFICIAL RECORDS
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Recording Requested B Ernest J COUNTY E O
9 q Y� SAN DIEGO COUNTY RECORDER
FEES: $63.00
City Engineer PAGES n
When Recorded Mail to:
City Clerk
City of Encinitas
505 South Vulcan Avenue
Encinitas, CA 92024
SPACE ABOVE FOR RECORDER'S USE
MAINTENANCE AGREEMENT FOR PRIVATE STORMWATER TREATMENT AND
STORMWATER POLLUTION CONTROL FACILITIES BY HOMEOWNER'S
ASSOCIATION
1 1 APN: 256-012-16J Case No.: 15-124 TPM/CDP/DR
Address: 151 W. Leucadia Blvd. Permit No.: 12899-G/PM
THIS AGREEMENT is between the City of Encinitas, a municipal corporation,
hereinafter referred to as the "City", and BEACON'S BEACH TRIAD, LLC, its heirs,
successors, and assigns, collectively hereinafter referred to as "Developer", 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, pollution control, and
hydromodification management 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, Hydromodification Management Plan (HMP) facilities,
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. The term Maintenance is defined in Paragraph 1 below.
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 described in Exhibit "B" benefit said
Property, the developer, and the future owners of the lots/parcels created per Planning
Case No. 15-124 TPM DR CDP, their heirs, successors, and assigns, collectively
hereinafter referred to as "Owners'; and
WHEREAS, City requires that Developer establish a homeowners association in
conformance with the California Civil Code Sections 1350 through 1376, hereinafter
referred to as "HOX, to be responsible for the Maintenance of Stormwater Facilities
into perpetuity; and
WHEREAS, it is the desire of the City, the responsibility of the Owners, HOA, and
Developer, herein after collectively referred to as "Parties", 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 by the
Parties in accordance with the minimum Maintenance requirements set forth in Exhibit
"C", which is attached hereto and made a part hereof, and in accordance with the City
of Encinitas Municipal Code, the Encinitas Stormwater Manual, and other related City
policies and requirements; and
WHEREAS, it is responsibility of the Developer and HOA to manage and oversee
Maintenance of Stormwater Facilities and to assign a single point of contact between
the City of Encinitas and HOA or Developer; and
WHEREAS, Developer's responsibility of Maintenance of Stormwater Facilities will
be transferred to HOA after the sale of all lots/parcels, the completion of development,
and the approval of the City; and
WHEREAS, following Developer's completion of the development and acceptance
by the City, the Owners are responsible to continuously have an HOA for purposes of
Maintenance of the Stormwater Facilities; and
WHEREAS, for the purpose of this agreement, Maintenance responsibilities
mentioned on this agreement equally and collectively apply to Owners and the HOA;
WHEREAS, it is requirement of development that this Agreement constitute a
covenant running with the land, binding upon each successive owner of all or any
portion of the Property into perpetuity;
NOW THEREFORE, IT IS HEREBY AGREED FOR VALUABLE
CONSIDERATION AS FOLLOWS:
1. This agreement establishes the Parties' Maintenance requirements for the
Stormwater Facilities. The term "Maintenance" wherever capitalized in this
agreement shall include, but shall not be limited to: inspection for purposes of
identifying operational deficiencies in the Stormwater Facilities, routine upkeep
and repair of the Stormwater Facilities in proper working order as determined by
the City, and preparation and submittal of the annual inspection report to the
City, all as set forth in subparagraph 1.i) through 1.iii). The Parties' requirements
for providing Stormwater Facilities Maintenance as stated in this agreement shall
mean Maintenance managed and paid for by the Parties, and performed by a
qualified contractor hired by the Parties.
i) The Parties shall inspect the Stormwater Facilities after all major storms. In
addition, the Parties shall inspect the Stormwater Facilities at the minimum
frequency specified in Exhibit "C", but not less than twice per year.
ii) The Parties shall provide upkeep and repair to keep the Stormwater Facilities
in good working order and shall repair all deficiencies identified in the Parties'
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 until such time as the
Facilities are repaired. 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 Parties shall ensure
that the Stormwater Facilities are in proper working order for the rainy
season, which starts on October 1.
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 Parties in accordance with the term and conditions of this
agreement and the plans and specifications identified in approved Grading Plan
Number 12899-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 Parties. The Parties' share of Stormwater Facilities Maintenance
costs is proportional to number of lots/parcels that Owners and Developer own
as a fraction of the total number of lots/parcels in the Property using and
benefiting from the Stormwater Facilities but excluding common ownership
lots/parcels.
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 included in
the existing HOA and be liable under this Agreement and with the HOA 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. Developer, Owners, and HOA are collectively responsible to the City for
Maintenance of Stormwater Facilities so long as either Developer or Owners own
any lots/parcels. Developer remains responsible for Maintenance of Stormwater
Facilities until such Facilities have been approved by the City, even if Developer
no longer owns any lots/parcels of the Property.
8. Upon establishment of an HOA and a management company to manage the
maintenance of the stormwater facilities, the Developer must notify the City of
the contact information for the HOA and management company within thirty (30)
days. At a minimum, contact information for HOA and management company
shall include: organization name, mailing address, email address, phone
number, contract person, contact person's phone number, and email address.
The above information must be provided to the City prior to occupancy of the
first unit (model home occupancy may be exempt from this requirement). If the
Developer is the acting HOA manager at the time of occupancy, the Developer's
current contact information shall be provided in lieu of the management
company information. Any future changes in HOA or management company
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 Parties for personal injury to any worker employed to provide
Maintenance under this Agreement, or to third persons, as well as any liability of
the Parties 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 Parties.
10. Parties 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 Parties agree 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 Parties 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 Parties hereby grant 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 Parties 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 Parties. 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 Parties 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 Parties
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:
?aconrotta for Date(
's Beach Triad, LLC
Signature of OWNER must be notarized. Attach the appropriate acknowledgement.
CITY OF ENCINITA
Masih Maher for Glenn Pruim Date
Director of Public Works
City of Encinitas
EXHIBIT "A"
Legal Description of Property
LOT 8 OF BLOCK 9 OF SOUTH COAST PARK NO. 2, IN THE CITY OF ENCINITAS,
COUNTY OF SAN DIEGO, STATE OF CALIFORNIA, ACCORDING TO MAP
THEREOF NO. 1859, FILED IN THE OFFICE OF THE COUNTY RECORDER OF SAN
DIEGO COUNTY, SEPTEMBER 21, 1925.
EXHIBIT 'B'
STORM WATER MAINTENANCE AGREEMENT
DROUGHT TOLERANT
INSTALL LARGE COBBLE OR OVERFLOW PIPE PLANTS (�.)
VEGETATION ON OVERFLOW EDGES TOP OF PIPE TO 2' HARDWOOD MULCH/
TO ENSURE EROSION DOES NOT HATCH ELEVATION GRASS COVER OR CITY
OCCUR TO THE S47ISFAC71ON OF OF OVERFLOW EDGE APPROVED EQUIVALENT
THE CITY INSPECTOR AND
ENGINEER OF WORK
I '
2% l I f
. . . . . . . . . . . . . .
III- 24' LAYER ENGINEERED SOIL
=III *SEE NOTE
l l IIEd
II _Illllllilll
=IIII 2' LAYER OF
-31 8' GRAVEL
12' LAYER OF
314' GRAVEL
4' PVC **SEE NOTE
UNDERDRAIN/
OUTLET PIPE
* BIORETENTION "ENGINEERED SOIL' LAYER SHALL BE MINIMUM 24' DEEP SANDY LOAM' SOIL MIX WITH NO MORE
THAN 5% CLAY CONTENT. THE MIX SHALL CONTAIN 50-60% SAND, 20-30% COMPOST OR HARDWOORD MULCH, AND
20-30% TOPSOIL, FREE OF STONES, STUMPS, ROOTS, OR SIMILAR OBJECTS, AND ALSO FREE OF NOXIOUS WEEDS.
** 314' CRUSHED ROCK LAYER SHALL BE A MINIMUM OF 12' BUT MAY BE DEEPENED TO INCREASE THE
INFILTRATION AND STORAGE ABILITY OF THE DETAIL THE EFFECTNE AREA OF THE BASIN SHALL BE LEVEL AND SHALL
BE SIZED BASED ON CALCULATION TYPICALLY, THE SURFACE AREA OF THE BIORETENTION BASIN IS 4% OF THE
IMPERVIOUS AREA DRAINING TO IT. ALL BIORETENTION PLANTERS TO BE DEPRESSED AT LEAST 6" BELOW ADJACENT
FINISHED SURFACE
BIORETENTION AREA DETAIL
NOT TO SCALE
OWNER/PERMITTEE
BEACON'S BEACH TRIAD L.L.C.
58 MCNEILL AVENUE
ENCINITAS, CA 92024
(760)415-1171
SITE ADDRESS
151 W. LEUCAD14 AVENUE
ENCINITAS, CA 92024
APN
256-012-16
EXHIBIT 'B'
STORM WATER MAINTENANCE AGREEMENT
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ROADSIDE PARK
PACIFIC
OCEAN
VICINITY MAP
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PRIVATELY MAINTAINED BIORETENTION
BASIN FOR BEST MANAGEMENT PRACTICE
NOT TO BE MODIFIED WITHOUT A PERMIT
FROM THE CITY. AREA=377 SF
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EXHIBIT `C'
MINIMUM MAINTENANCE REQUIREMENTS FOR STORMWATER
FACILITIES
Bioretention Areas
To preserve bioretention performance, the cells must be maintained. Like any landscape
feature, bioretention areas must be pruned, mulched, and even initially watered and
limed. Grassed bioretention cells are usually mowed. The need for rapid establishment
requires bioretention cells to be limed, if indicated by a soil test. Additionally, plants may
need to be spot-fertilized to ensure growth and survival in low P soils. Watering the
plants every 2 to 3 days for a month or two helps ensure vegetation survival. The
frequency of these tasks varies seasonally, with more frequent maintenance required in
summer than in winter. Maintenance tasks unique to bioretention include occasional
removal of mulch and the top layer of fill soil. Because clogging occurs most frequently
at the top of the soil column, the bioretention basin rarely needs to be completely
excavated. However, this has been necessary when the bioretention cell was located in an
unstable drainage area.
BIORETENTION MAINTENANCE TASKS
Task Frequency Maintenance Notes
Pruning 1 - 2 times/ year Nutrients in runoff often cause
bioretention vegetation to flourish.
Mowing 2 - 12 times/year Frequency depends upon location
and desired aesthetic appeal
Mulch accumulation reduces available
Mulching 1 - 2 times /year water storage volume.
Mulch Removal 1 time /2 - 3 years Removal of mulch also increases
surface infiltration rate of fill soil.
1 time / 2 - 3 days for first If droughty, watering after the
Watering 1 - 2 months. Sporadically initial year may be required.
after establishment.
One time spot fertilization for"first
Fertilization 1 time initially year" vegetation.
Within the first year, 10 percent of
Remove and Replace 1 time / year plants may die.
Dead Plants Survival rates increase with time.
Tasks include trash collection, spot
Miscellaneous weeding, and removing mulch from
Upkeep 12 times /year overflow device.
Bioretention and Landscape Areas
The operational and maintenance needs of a Bioretention Basin are:
• Vegetation management to maintain adequate hydraulic functioning and to limit
habitat for disease-carrying animals.
• Animal and vector control.
• Periodic sediment removal to optimize performance.
• Trash, debris, grass trimmings, tree pruning, and leaf collection and removal
to prevent obstruction of a Swale and monitoring equipment.
• Erosion and structural maintenance to prevent the loss of soil and maintain
the performance of the Swale.
Functional Maintenance
Functional maintenance has two components:
Preventive maintenance
Corrective maintenance
Preventive Maintenance
Preventive maintenance activities to be instituted at a Bioretention Basin are:
• Trash and Debris. During each inspection and maintenance visit to the site,
debris and trash removal will be conducted to reduce the potential for inlet
and outlet structures and other components from becoming clogged and
inoperable during storm events.
• Sediment Removal. Sediment accumulation, as part of the operation and
maintenance program at a Swale, will be monitored once a month during the
dry season, after every large storm (0.50 inch), and monthly during the wet
season. Specifically, if sediment reaches a level at or near plant height, or
could interfere with flow or operation, the sediment will be removed. If
accumulation of debris or sediment is determined to be the cause of decline
in design performance, prompt action (i.e., within ten working days) will be
taken to restore the Swale to design performance standards. Removal of
Standing Water. Standing water must be removed if it contributes to the
development of aquatic plant communities or mosquito breeding areas.
• Fertilization and Irrigation. The vegetation seed mix has been designed so
that fertilization and irrigation is not necessary. Fertilizers and irrigation
will not be used to maintain the vegetation.
• Elimination of Mosquito Breeding Habitats. The most effective mosquito
control program is one that eliminates potential breeding habitats.
Corrective Maintenance
Corrective maintenance is required on an emergency or non-routine basis to
correct problems and to restore the intended operation and safe function of a
Bioretention Basin. Corrective maintenance activities include:
• Removal of Debris and Sediment. Sediment, debris, and trash, which
impede the hydraulic functioning of a Swale and prevent vegetative growth,
will be removed and properly disposed.
• Structural Repairs. Once deemed necessary, repairs to structural
components of a Swale and its inlet and outlet structures will be done within
10 working days.
• Embankment and Slope Repairs. Once deemed necessary, damage to the
embankments and slopes of Swales will be repaired within 10 working
days).
• Erosion Repair. Where a reseeding program has been ineffective, or where
other factors have created erosive conditions (i.e., pedestrian traffic,
concentrated flow, etc.), corrective steps will be taken to prevent loss of soil
and any subsequent danger to the performance of a Swale. There are a
number of corrective actions than can be taken. These include erosion
control blankets, riprap.
Hazardous Waste
Suspected hazardous wastes will be analyzed to determine disposal options. Hazardous
wastes generated onsite will be handled and disposed of according to applicable local,
state, and federal regulations. A solid or liquid waste is considered a hazardous waste if
it exceeds the criteria list in the CCR, Title 22, Article 11.
Storm Water Storage System
• Periodic inspections of the inlet and outlet areas to ascertain correct operation of
system and to clean materials trapped on grates protecting catch basins and inlet
area should be required monthly.
o Routine sweeping and cleaning of impervious drainage areas will reduce
floatables and sediment loading to underground stormwater storage.
• The primary maintenance concerns are removal of floatables that become trapped
and removal of accumulating sediments within the system; this should be done at
least on an annual basis. Proprietary traps and filters associated with stormwater
storage units should be maintained as recommended by the manufacturer.
• Confined space safety procedures must be followed by workers entering
an underground stormwater storage facility.
• Sediments are best removed mechanically rather than flushing. If flushing
is the only option then great care must be taken not to flush sediments
downstream into native waters.
• Any structural repairs required to inlet and outlet areas should be addressed in a
timely manner on an as needed basis.
• Local authorities may require annual inspection or require that they carry out
inspections and maintenance.
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 San,�1 )
On JU I u I5r �I before me, y�l-Lia E .C.hay1C16r,No (4 61 ic,
Date WeI I '["[
W I�reeIInsert Name and Title of the Officer
personally appeared
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(e) whose name(a) is/ere
subscribed to the within instrument and acknowledged to me that he/she/t4ey executed the same in
Mis/her/their authorized capacity(ies), and that by 4s/her/0heir 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
eowaez is true and correct.
�sriMSi c
" No" -Coma Hal WITNESS my hand and official cseal.
q1
Signature �
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended docume
Description of Attached Document /7 4Lril6u � ���{cr �d �/'yl Li j�TjeJ
Title or Type of Document:TYP �f SOM 4bocurrfent bate: a &211fPn' '' iJ�fJS
Number of Pages: Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name: _
Corporate Officer — Title(s): Corporate Officer — Title(s): _
Partner — 7 Limited General Partner — ! Limited _ General
Individual Attorney in Fact Individual Attorney in Fact
- Trustee Guardian or Conservator Trustee Guardian or Conservator
Other: Other:
Signer Is Representing: Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907
ALL-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 sc n SS.
On (o -ZO)(o before me, 1\)a0_* CC' Jt M nh Notary Public,
DATE ^
personally appeared M G.S !`�/�,ake1— ,who proved to me on the
basis of satisfactory evidence to be the person(s) whose name(s)6:s re subscribed the within instrument
and ack ledged to me tha&she/they executed the
same ii her/their authorized capacity(ies), and that
by�her/their signature(s) on the instrument the
per on(s), or the entity upon behalf of which the
person(s) acted, executed the instrument.
ANGELA A. SIMON
N Comml 2009314 / I certify under PENALTY OF PERJURY under the
NOTARY PUBUUCAUfONNIA N
BAN DIEGO COUNTY — laws of the State of California that the foregoing
MY Cow.EAP.MAR.2,
paragraph is true and correct.
WITNESS my hand and official seal.
PLACE NOTARY SEAL IN ABOVE SPACE NOTARY'SSICNATL'RE
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
RIGHT
SIGNER(PRINCIPAL)IS REPRESENTING: THUMBPRINT =
NAME OF PERSON(S)OR ENTITYIIESI OF
SIGNER =
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