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2017-599036 DOC# 2017-0599036 I11111111111IIIIIIIIIIIIII11111111111IIIIIIIIIIIIIIIIIIIIVIIIIIIIIIII Dec 20, 2017 04:29 PM n OFFICIAL RECORDS Ernest J. Dronenburg, Jr., �II'if SAN DIEGO COUNTY RECORDER Recording Requested By: FEES $54.00 PAGES 14 City Engineer 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 PRIVATE STORMWATER TREATMENT, STORMWATER POLLUTION CONTROL, AND HYDROMODIFICATION MANAGEMENT FACILITIES BY HOMEOWNER ����� ✓ APN: 264-223-24 Case #: 08-153 DR Grading Plan: 12476-G THIS AGREEMENT is between the City of Encinitas, a municipal corporation, hereinafter referred to as the "City", and KEITH G. JOHNSON AND DEANNE E. JOHNSON, HUSBAND AND WIFE AS JOINT TENANTS, 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, stormwater 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. WHEREAS, this Agreement is required by the City as a 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 WHEREAS, the Property benefits and uses the Stormwater Facilities, which are described in Exhibit "B"; and WHEREAS, it is the desire of the City and the responsibility of the Owner 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 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 the intention of the Owner and the City 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 Owner's 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). i) The Owner shall inspect the Stormwater Facilities after all major storms. In addition, the Owner shall inspect the Stormwater Facilities at the minimum frequency specified in Exhibit "C", but not less than twice per year. 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 12 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 terms and conditions of this agreement and the plans and specifications identified in approved Grading Plan Number 12476-G which is on file as a permanent public record in the City of Encinitas. 4) The cost and expense of Maintenance of the Stormwater Facilities shall be paid by the Owner. 5) In the event the Property is subdivided in the 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) Any liability of the Owner for personal injury to any worker employed to provide Maintenance under this Agreement, or to third persons, as well as any liability of the Owner 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. 8) Owner shall jointly and severally defend, indemnity, and hold harmless the 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 for 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. 9) 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. 10)The Owner shall provide access to the Stormwater Facilities within the Property to 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. 11)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. 12)ln the event the Owner fails to maintain 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 in full. 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 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 maintain or repair said Stormwater Facilities, and in no event shall this Agreement be construed to impose any such obligation on the City. 13)The terms of this Agreement may be amended in writing following Owner's request and upon written approval by the City Engineer. 14)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. S Keith 0. Johnson, Owner Da e /U,rt , �-- 17 Deanne E. Johnson, 9wner Date SEE ATTACHED FOR OFFICIAL ACKNOWLEDGMEN Signature of OWNER must be notarized. Attach the appropriate acknowledgement. CITY OF ENCINITAS: Christopher . Magdosku Date City Engineer Development Services Department City of Encinitas CALIFORNIA ALL- PURPOSE CERTIFICATE OF 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 ofY� � ) } On �_L_ before me, vain h e dmeow personally appeared bf, who proved to me on the basis of satisfactory evidence to a 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"rue and correct. I ON SCOTT ' rf CoMM.i 2073593 J.n" 4 WITNESS my hand a d official seal. N g xot"ayeue�w•°"t°°°"" - 9ui Dtto CNITY n, ` Mr CON.,Fv.JVtT",201" •! Notary Public Signature (Notary Public Seal) INSTRUCTIONS FOR COMPLETING THIS FORM ADDITIONAL OPTIONAL INFORMATION noform complies with current California statutes regarding notary wording and DESCRIPTION OF THE ATTACHED DOCUMENT Acknowledgments needed,should be completed and attached to the document.Acknowledgments from other stales may be compleiedfor documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title a description of attached document) • State and Comity information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (T�tla or descdpti m f attached document continued) most also be the same date the acknowledgment is completed. • The notary public must prim his or her name as it appears within his or her Number of Pages Document Date commission followed by a commit and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization- -C B HE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/shehhey,is/ere)or circling the correct forms.Failure to correctly indicate this ❑ Ind' al (s) information may lead to rejection of document recording ❑ orporate Officer • fie notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of ❑ Partner(s) the county clerk. ❑ Attorney-In-Fact Additional information is not required but could help to ensure this Trustee(s) acknowledgment is not misused or munched to a different document. ❑ Indicate title or type of attached document,number of pages and date. ❑ Other Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). 2015Ve!Sion VM-J £OC�8'�9R65 Securely attach this document to the signed document with a staple. EXHIBIT `A' LEGAL DESCRIPTION OF PROPERTY FOR STORM WATER FACILITIES PARCEL 4 OF PARCEL MAP NO. 4460, IN THE CITY OF ENCINITAS, COUNTY OF SAN DIEGO, STATE OF CALIFORNIA, FILED IN THE OFFICE OF THE COUNTY RECORDER OF SAN DIEGO COUNTY ON FEBRUARY 13, 1976; BEING A PORTION OF LOT 7 OF THE SUBDNISION OF RANCHO LAS ENCINITAS ACCORDING TO MAP THEREOF NO. 848, FILED IN THE OFFICE OF THE COUNTY RECORDER OF SAN DIEGO COUNTY ON JUNE 27, 1898. CONTAINS 2.49 ACRES, MORE OR LESS. Ds ft 7Me C4 ��CA� \ �\ EXHIBIT 'B- 1 ' N8733'21-441-ILL — (2A) BMP I - s AREA = 381 SE _1� G=2176'02' — — -- D' R=300.00' L=112.13' c LLB (2B) BMP II AREA = 750 SF `sutra (2C) BMP III a BEN y AREA = 212 SF NM \ ��q 7x66 9\\J" c,ua .,PG� (1D) BMP IV N • /���d' AREA = 169 SF \\P- ��, PERWOUS V=164.2.3' P — �A = 377 S� 1"=60' -q SAMPO ENGINEERING, INC. 1/1 MANY RVAU 51L 21J ENCYN1195; CA 92M 0 30 60 120 IEL: (760)436-0660 FAX (760)476-0659 M F5-121 JOHNSav 106A7 EXHIBIT 'B-2' DEEP ROOTED DENSE, DROUGHT CONCRETE CATCH BASIN W/STEEL TOLERANT ISLAMTNG SUITABLE GRATE TG 264.83 ORIRCE PLATE. MIN SQUARE FOR WELL DRAINED SOIL DIMENSIONS 1.0 FT GREATER 2-3"HARDWOOD THAN PIPE DIA. HOT-DIP MULCH ti° A GALVANIZED PLATE AFTER ti HOLES HAVE BEEN DRILLED 1p" WATERPROOF MEMBRANE PER SOIL ENGINEER MIN 6•(TYP) 4. 18"MIN. ENGINEERED SOIL •SEE NOTE BELOW 3•(TO 2° OF 318• CPA VEL 16. OF 3/4• CRUSHED ROCK o BiM 261.03 PRIVAIE OUTLET BW 260.5 i"MAX INROW PIPE SUB-DRAIN PIPE 013/32. ORIF7. IE 2603 o ORIRCE 9ZE.• SEE DTL 1"SHT 2 AREA= 0.141N' DIA HOLE(TYP) DIA. = 0.43 IN BIO-FlL IRA71ON DETAIL BMP 1-2A d NTS � 4010-INRL IRA BON ENGINEERED SOIL LAYER SHALL BE MINIMUM 18"DEEP SANDY LOAM SOIL MIX IWTH NO MORE FLOW--001 UTR� OI?IFlCE PLA IE THAN 5X CLAY CONTENT. THE MIX SHALL CONTAIN 50-60X SAND, 20-30X COMPOST OR HARDWOOD MULCH AND 20-JOX TOPSOIL. THE EFFECTIVE AREA OF 7HE BASIN IS 381 SF AND SHALL BE LEVEL. Ds L. d rdf•. �' •-® SAMPO ENGINEERING, INC. TEL: (760)4.K-0660 FAX (760)436-0659 JN,15-121 JOHNSON 07/19/17 EXHIBIT 'B-3' DEEP ROOTED DENSE DROUGHT CONCRETE CATCH BASIN W/STEEL TOLERANT PLANTING SUITABLE CRATE TG 2551 ORIRCE PLATE• MIN SQUARE FOR WELL DRAINED SOIL o DIMENSIONS 1.0 FT GREATER HAROHARDWOOD MULC H �h�' THAN PIPE DIA. HOT-DIP MULCH �y GALVANIZED PLATE AFTER R HOLES HAVE BEEN DRILLED /W I 10° I PER SOIL ENGINEERRANE MIN 6"(TYP) 1� 18•MIN. ENGINEERED SOIL 'SEE NOTE BELOW 3" (T)P) PRIVATE 2" OF 3 18' GRAVEL A F SlIB-DRAIN 16' OF 314' CRUSHED ROCK o B1M 2522 PIPE OUTLET BW 250.9 MAX INFLOW PIPE 0318- OR/RCE IE 252.2 SEE DIL V SST 2 o ORIFlCE SIZE.• AREA= 0.13IN2 BIO-R TRA HON DETAIL BMP 2-2B R �•DIA HOLE (TYP) DIA. = 0.41 IN Nis y '6I0-INRLTRAPON ENGINEERED SOIL LAYER SHALL BE MINIMUM 18"DEEP SANDY LOAM SOIL MIX {NTH NO MORE �IFlCE PLATE THAN 59 GAY CONTENT. THE MIX SHALL CONTAIN 50-60X SAND, 20-30X COMPOST OR HARDWOOD MULCH FLOW--COIII TRH AND 20-30X TOPSOIL tJ�'10 sp THE EFFECDVE AREA OF THE BASIN IS 750 SF AND SHALL BE LEVEL. Nm 7M �' ' �r •-® SAMPO ENGINEERING, INC. ACA IEL: (760)436-0660 FAX (760)436-0659 JN:15-121 "N5QN 06178117 EXHIBIT 'B-4 ' DEEP ROOTED DENSE, DROUGHT CONCRETE CATCH BASIN W/STEEL TOLERANT PLANTING SUITABLE GRA7E TG 2467 FOR WELL DRAINED SOIL ORIFICE PLATE.• MIN SQUARE 2-3'HARDWb00 ao0 DIMENSIONS 1.0 FT GREATER MULCH ti THAN PIPE DIA. HOT-DIP R GALVANIZED PLATE AFTER HOLES HAVE BEEN DRILLED Z/ 10" PER SSS� MEMBRANE W 24R i 18"MIN. ENGINEERED SOIL MIN 6" (11P) 'SEE N07E BELOW 2" OF 318' GRAVEL 3• (TYP) 16' OF 3/4" CRUSHED ROCK 0 PRIVATE PIPE OUTLET BW 244.4 SUB-DRAIN IE 244.9 ` ' ' }"MAX INFLOW PIPE /13/I . ORIFICE SEE�TL L'SHT 2 o ORIFICE 92E.- 8I0-RL TRA PON DETAIL W 3-2C AREA= 0.231Nz �'1 �"DIA HOLE (TIP) DIA. = 0.20 IN N15 V *810-INFILTRATION ENGINEERED SOIL LAYER SHALL BE MINIMUM 18'DEEPSANDY LOAM SOfL MIX WITH NO MORE THAN 59 CLAY CONTENT. THE MIX SHALL CQVTAIN 50-60X SAND, 20-30X COMPOST OR HARDWOOD MULCH f LOW/C��� �I�CE RA AND 20-30X TOPSOIL THE EFFECTIVE AREA OF THE BASIN IS 212 SF AND SHALL BE LEVEL No.7m •-® SAMPO ENGINEERING, INC. 1/1 SMMY MW 51L 21J DKXTA4 CA OUT— ACA 1E1.: (760)06-0660 FAX (760)IJ6-0659 JN,15-121 JOHNSON 06/19/77 EXHIBIT ORIRCE PLATE. MIN SQUARE DIMENSIONS 1.0 FT CREATER DEEP ROOTED DENSE, DROUGHT THAN PIPE DIA. HOT-DIP TOLERANT PLANTING SUITABLE CONCRETE CATCH BASIN W/STEEL GRAZE TG 1452 GALVANIZED PLATE AFTER FOR BELL DRAINED SOIL f� HOLES HAVE BEEN DRILLED WATERPROOF MEMBRANE PER 1-3"HARDWOOD I SOIL ENGINEER MULCH MAINTAIN 2" CLR. FROM WALL �k FACE TO PROPERTY LINE MIN 6" (IYP) � O 10 FOR FOOTING WA FG 245.5 loo PER SOI�GINEER ANE 3"(�) FG 44. 18"MIN. ENGINEERED SOIL 'SEE NOTE BELOW 1 1" " OF 3/8" GRAVEL ° PRIVATE 16" OF 314" CRUSHED ROCK SUB-DRAIN "MAX INFLOW PIPE R7U 2414 ORIFICE-72F.-240.9 OUTLET ° AREA= 0.02 IN' PIPE DIA. = 0.17 IN IE 241.4 "DIA HOLE(T)P) 011164 ORIFICE SEE D7L L SHT 2 810—FlL TRA 1101N DETAIL BMP 4-2D N>s � FLOW—CONTROL ORIFlCE PLATE *8I0-INFILTRATION ENGINEERED SOIL LAYER SHALL BE MINIMUM 18"DEEP SANDY LOAM SOIL MIX WITH NO MORE THAN 5X CLAY CONTENT 7HE MIX SHALL CONTAIN 50-60X SAND, 20-30X COMPOST OR HARDWOOD MULCH, AND 20-30X TOPSOIL THE EFFECII Vf AREA OF THE BASIN IS 169 SF AND -WALL BE LEVEL ►b.tees �a'cw� �e •-® SAMPO ENGINEERING, INC. R: (760)436-0660 FAX' (760)4,76-0659 JW 15-121 JOHNSON o�rer7 EXHIBIT `C' MAINTENANCE OF STORM WATER FACILITIES Maintenance of the on-site storm water facilities is the responsibility of the property owner and shall be maintained to the satisfaction of the City of Encinitas into perpetuity. The site consists of the following storm water facilities: four bio-infiltration basins for treatment and flow control; vegetated drainage swales; storm drain pipe; catch basins; and,permeable pavers in portions of the driveway. Each of the four bio-infiltration basins and the vegetated swales shall be inspected and kept free of trash and debris on a quarterly basis. The storm drain pipe system requires no regular maintenance, but should be repaired as needed; and, the system should be visually inspected during rain events to verify proper operation. The catch basins control flow though numerically-sized orifices located near the bottom of each basin. These orifices shall be inspected annually and cleaned as necessary to prevent blockage of flow through the orifice. The catch basins and their inlet grates shall be inspected annually and kept free of trash and debris. The permeable paver areas shall be swept clean as needed to prevent dirt and debris from collecting in the sand gap areas, and should be vacuumed quarterly. A street sweeper can be used to vacuum the pavers. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 FAnotary public or other officer completing this certificate verifies only the identity of the individual who signed the ent to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of V\ LC� p On �7 _ 2.c -- before me, \��� A �tV1Cr JV o' nrV t o0X Date —`� Here Insert\Name and Title of the fficer personally appeared ��" `S�Dh,eI— L- / "\c'c)Ac5ky Names) of Signer(s) who proved to me on the basis of satisfactory evidence to bet persons) whose name(s is/ re scribed to the within instrument and acknoy+lpdged to me th he she/they executed the sa?rfe in hi er/their authorized capacity(ies),and that b hi /her/their signature s)on the instrument the person(s), r 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 ,.�AComm. A. SIAION is true and correct. Z smpEGO C"n r WITNESS my hand and official seal. o„av W Caw. 2.2021 Signature - ignature 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 document. Description of Attached Document Title or Type of Document: Document Date: 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 — ❑ 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: ©2016 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907