HomeMy WebLinkAboutAeration Blower System Pre-Qualification Control System Integrators
SOUTH TAHOE PUBLIC UTILITY DISTRICT
PREQUALIFICATION POLICY FOR CONTROL SYSTEM INTEGRATORS
WASTEWATER TREATMENT PLANT AERATION BLOWER SYSTEM
IMPROVEMENTS PROJECT
APPROVED: OCTOBER 17, 2024
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1. Introduction
Pursuant to California Public Contract Code Section 20101, Control System
Integrators (hereinafter “Contractor” or “Applicant”) bidding as subcontractors on the
South Tahoe Public Utility District’s (hereinafter “District”) Wastewater Treatment Plant
Aeration Blower System Improvements Project (hereinafter “Project”) shall be subject to
this Pre-Qualification Policy. Contractors shall be required to furnish sufficient proof of
experience in control systems integration, including experience implementing and
modifying supervisory control and data acquisition (SCADA) systems and programmable
logic controller (PLC) programming for public works water and wastewater facilities, by
completing and submitting standard pre-qualification documents and providing specified
supporting documentation, which submission is verified under oath by the Contractor in
the manner in which pleadings in civil actions are verified.
A Contractor is either pre-qualified in accordance with the limits contained herein or not
pre-qualified based on the District’s uniform rating system described herein. No rating
other than a positive or negative pre-qualification determination shall be established by
this process. No Contractor other than those pre-qualified through this process shall bid
on the Project, in accordance with California Public Contract Code §20101.
The anticipated Pre-Qualification and Bid schedule is summarized as follows (the Bid
schedule is likely to change and will be included in the Bid Documents):
Date Milestone
January 10, 2025 District issues invitation for Pre-qualification
January 30, 2025 Last day for applicants to ask questions or submit
objections
February 5, 2025 District receives Pre-qualification Packages
February 12, 2025 District staff issues recommendation of qualified bidders
list for Control System Integrators.
February 18, 2025 Last day for applicants to appeal District's decision with
respect to pre-qualification ratings.
February 25, 2025 Last day for appeals to be heard by the District
March 6, 2025 District Board considers adoption of qualified bidders list
for Control System Integrators.
Board authorizes Staff to bid project.
March 14, 2025 District begins advertising for bids.
March 27, 2025 District holds Mandatory Pre-Bid Meeting and Site Walk
April 17, 2025 District opens bids
May 1, 2025 District Board considers award of project contract
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2. Project Description
The District anticipates, subject to change in the District’s sole discretion, that the Project
shall consist of the following: Installation of a new hybrid positive displacement screw
blower to replace an existing diesel engine driven blower, new motor control centers
(MCC’s) in the Blower Building, new aeration system controls and instrumentation, new
aeration control valves and flow meters for Aeration Basins Nos. 1, 2, and 3, new motor
operated control valves for existing blower air inlets, power monitoring and integration
into SCADA for various existing MCC’s, a new fire alarm control panel for the Blower
Building, replacement of other electrical gear throughout the plant including MCC’s and a
transformer, and other ancillary equipment and demolition work as indicated in the
Contract Documents. The project is located at the District’s Wastewater Treatment Plant
at 1275 Meadow Crest Drive in South Lake Tahoe, El Dorado County, California. The
Wastewater Treatment Plant shall remain in service at all times while the new facilities
are being constructed. The Engineer’s Estimate for all improvements associated with
this the Project is approximately $8,000,000.00.
Under subcontract to the General Contractor, the Contractor shall provide PLC, SCADA
programming and software integration services to complete the Project for the South
Tahoe Public Utilities District, including approximately:
• 102 hardwired I/O points, 40 analog and 62 discrete
o 9 equipment control loops monitored and controlled on the HMI
o 19 instruments monitored on the HMI
o 3 HVAC equipment items monitored on the HMI
• 15 Networked I/O blocks with ~30 registers each for 270 soft I/O
o 10 power monitors to be displayed on the HMI
o 3 FVNR electronic overload relays
o 1 VFD
o 1 Blower control panel
In summary, Contractor will be expected to do the following:
• Participate in Control Strategy refinement during the project submittal process
with the District and the Design Engineer;
• Participate in HMI Design Review meetings with the District and the Design
Engineer, following the District’s established programming and screen styles;
Select, furnish, construct, install (and/or supervise installation), configure,
calibrate, test, and place into operation transmitters, instruments, programmable
controllers, control panels, motor controls, alarm equipment, communications,
monitoring equipment, and accessories;
• Coordinate software programming requirements with the General Contractor, the
District, the Design Engineer, and the blower vendor control panel;
• Construct and test control panels bearing a UL 508A label at the Contractor’s
panel fabrication facilities;
• Program PLCs to implement the signal processing and logic required for the
Project, not including PLCs provided by equipment suppliers;
Page 3 of 17
• Modify and upgrade existing SCADA system to incorporate work associated with
aeration blower improvements, without jeopardizing the function of the existing
system;
• Program and configure human machine interfaces (HMI);
• Provide startup and testing services for the above items; and
• Provide warranty, training, O&M Manuals, and record documents for the above
items.
The expected duration of the project is 760 Calendar Days, with an approximate
completion date of June 21, 2027. The Contractor will be required to provide a 3-year
service contract for the installed SCADA systems following the acceptance of Work.
Page 4 of 17
3. Pre-qualification Process
Contractors seeking pre-qualification are required to submit to the District completed
Pre-Qualification Packet, including the following:
1. Contractor’s General Information (Part 5)
2. Criteria Essential for Pre-Qualification (Part 6)
3. Pre-Qualification Questionnaire (Part 7)
4. Contractor’s Certification (Part 8)
The Pre-Qualification Packet will be the basis for determining which Contractors are
qualified to bid on the Project. Pursuant to Public Contract Code §20101, all information
contained in the pre-qualification documents and submitted financial statements are
NOT public records and are NOT open to public inspection. However, the contents may
be disclosed to third parties for purpose of verification, or investigation of substantial
allegations, or in the appeal hearing. State law requires that the names of contractors
applying for pre-qualification status shall be public records subject to disclosure, and the
first page of the questionnaire will be used for that purpose.
All pre-qualification submittals will be received only by electronic submission using the
District’s electronic bidding system; paper applications will not be accepted. To
download pre-qualification documents, applicants must register as a vendor at:
https://vendors.planetbids.com/portal/21516/portal-home.
All correspondence regarding pre-qualification, including questions, comments and
addenda, shall be sent and received only through the electronic bidding system. It shall
be the Contractor’s sole responsibility to confirm that it has received and reviewed any
and all updates and addenda issued electronically by the District prior to submission of
the Pre-Qualification Packet.
Any question or objection to the pre-qualification materials, or explanation desired by a
prospective Contractor regarding the meaning or interpretation of the Pre-qualification
Package and related materials, must be requested electronically before 5:00 p.m. on
Thursday, January 30, 2025. Oral explanations or instructions will not be binding
unless issued as a formal addendum to the Pre-qualification Package. Any information
provided to any prospective Contractor concerning a solicitation will be furnished to all
prospective contractors who requested a Pre-qualification Package. All prospective
Contractors must acknowledge the receipt of any/all addenda on the form and in the
manner required with each addendum. By submitting a completed Pre-qualification
Package, the prospective Contractor waives any and all objections to the form and
content of the Pre-qualification Package, or the evaluation criteria.
The Pre-Qualification Packet (Parts 5 through 8) shall be submitted to the District’s
electronic bidding system no later than 5:00 pm on Wednesday, February 5, 2025.
The Pre-Qualification Packet must be organized and identified in accordance with the
requirements defined herein. Attach additional sheets as needed to provide complete
responses.
The Contractor’s submittal must be signed under penalty of perjury by an individual who
has the legal authority to bind the Contractor on whose behalf that person is signing.
The Contractor shall provide only complete and accurate information. The Contractor
Page 5 of 17
acknowledges that the District is relying on the truth and accuracy of the responses
contained therein.
The pre-qualification of prospective bidders will be determined by evaluation of the
information submitted by prospective bidders. The District may verify any or all
information provided in completed Pre-qualification Package, consider information
provided by sources other than the prospective bidder, and conduct such interviews and
investigations as the District deems appropriate to assist in the evaluation of contractor's
responsibility, qualifications and financial capacity. Except where information related to
former entities is expressly required herein, for purposes of evaluation, scoring and
prequalification, all required Contractor's information, including but not limited to
experience, personnel and finances, must be provided for the entity holding the
Contractor's license. If the Contractor seeking pre-qualification has not been in business
for the time period for which information is requested, it shall submit information on
predecessor entities covering that time period.
The District will evaluate all completed Pre-qualification Packages on a Pass/Fail basis
as well as a points-based rating system. In order to pre-qualify for this Project,
Contractor must obtain a “Pass” rating on all of the criteria set forth in Part 6, and meet
the minimum rating requirements of the District for Part 7. Those Contractors who do
not obtain a “Pass” rating for all criteria in Part 6 will not be pre-qualified to participate in
bidding for the contract to construct the Project regardless of the scores obtained in Part
7.
The contract for construction of the Project, in whole or in part, may be awarded, if at all,
to the responsible General Contractor submitting the lowest responsive bid. Neither
issuing the Notice, nor any other activity related to the pre-qualification process,
obligates the District to award a contract for construction of the Project, in whole or in
part, to a particular General Contractor, or at all. The District reserves the right to reject
any or all Pre-qualification Packages and to waive any irregularities in any Pre-
qualification Package submittal. The District reserves the right to determine that any
Contractor is not qualified at any time before or after the Pre-qualification Packages are
received and evaluated if it finds that information provided in the response to the Notice
is materially inaccurate or false, or upon evidence of collusion or other illegal practices
on the part of a contractor. If any information provided by a prospective Contractor
becomes inaccurate, the party who provided the information must immediately notify the
District and provide updated accurate information in writing and under penalty of perjury.
In addition to disqualification for failure to meet the District’s criteria and minimum score,
the Contractor may also be automatically disqualified for falsification of information
required in the pre-qualification documentation. In addition, the District reserves the right
to automatically disqualify any Contractor who fails to provide any portion of the
requested information.
The Pre-Qualification Packet will be reviewed and assessed by Staff of the District’s
Engineering Department. The District anticipates that it will inform Contractors, in writing
via electronic mail, of staff’s determination no later than 5:00 p.m. on Wednesday,
February 12, 2025. The notification will include the basis for disqualification and any
supporting evidence received from other or adduced by the District as a result of its
investigation. If the review process requires more time, the District will notify Contractors
of the extension of the review period in writing.
Page 6 of 17
4. Appeal Procedures
Contractors will be allowed to appeal a negative pre-qualification determination in
accordance with California Public Contract Code §20101.d. If a Contractor decides to
appeal a negative pre-qualification determination, any such appeal must be received by
the District in writing within four (4) business days of the date of the notice of negative
determination. There is no appeal from a refusal for an incomplete or late application.
Without a timely appeal, the Contractor waives any and all rights to challenge the
decision of the District, whether by administrative process, judicial process or any other
legal process or proceeding.
In conjunction with this Pre-Qualification Policy, the District hereby establishes a Bidder
Pre-Qualification Appeals Panel (“Appeals Panel”), consisting of the following three
members, or their designee(s):
• The District’s General Manager,
• The District’s Chief Financial Officer, and
• A member of an outside agency.
The sole issue before the Appeals Panel shall be the scoring of a Contractor. The
decision of the Appeals Panel shall be the District’s final administrative decision. The
decision of the Appeals Panel will be presented to the District’s Board of Directors for
approval at the next following Board Meeting, but in no event shall the decision of the
Appeals Panel be presented for approval less than 4 days prior to the deadline to submit
bids for the Project.
If the Contractor gives the required notice of appeal and requests a hearing by the
Appeals Panel, the hearing shall be conducted so that it is concluded no later than five
(5) business days after the District’s receipt of the notice of appeal. The hearing shall be
an informal process conducted by the Appeals Panel to whom the District’s Board of
Directors has delegated responsibility to hear such appeals. At or prior to the hearing,
the Contractor will be advised of the basis for the District’s pre-qualification
determination and any supporting evidence that has been received from others or
adduced as a result of an investigation by the District. The Contractor will be given the
opportunity to present information and present reasons in opposition to the rating.
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5. Contractor’s General Information
This form is to be submitted with the Pre-Qualification Packet, along with the submittals
required in Part 6 through 8 completed. The Pre-Qualification Packet must be received
by the District no later than: 5:00 PM on Wednesday, February 5, 2025.
Company Name:
______________________________________________________________________
Owner of Company (if sole proprietorship): ____________________________________
Contact Person: _________________________________________________________
Address:
______________________________________________________________________
______________________________________________________________________
Phone: _____________________________ Fax: ______________________________
E-Mail: _____________________________ Contractor’s License No.: ______________
(if applicable)
Has any owner, partner or (for corporations) officer of your firm operated a Control
Systems Integration firm under any other name in the last five years?
_____ Yes _____ No
If “yes,” explain on a separate signed page, including the reason for the change.
Page 8 of 17
6. Criteria Essential for Pre-Qualification
In order to be considered by the District for pre-qualification for the Project, the Contractor must answer all
of the following questions.
Contractor will be immediately disqualified if any answer to Questions 6.1- 6.4 is “NO”.
Contractor will be immediately disqualified if the answers to Questions 6.6-6.7 is “YES”. If the answer to
Question 6.5 is “YES” and if debarment would be the sole reason for denial of pre-qualification, any pre-
qualification issued will exclude the debarment period.
6.1 Does Contractor have at least 5 years of experience in the
installation and programming of all of the following hardware
and software?
Allen-Bradley ControlLogix PLCs
Rockwell Studio 5000
AVEVA System Platform/Wonderware Window Viewer
running in a Terminal Services Environment
Microsoft Terminal Services
Yes __ No __
6.2 (1) Does Contractor have a home office for systems
integration/programming personnel within 150 driving miles
from the District’s Customer Service Facility, or
(2) Can the Contractor otherwise demonstrate an ability for
personnel to reach the project site within 3 hours of
receiving a request for emergency response for the duration
of the project and 3-year warranty period?
If the answer to (1) is Yes then mark “Yes”. If the answer to
(1) is No, but the answer to (2) is Yes, then mark “Yes” and
provide explanation on a separate sheet. If the answer to
both (1) and (2) is No, then mark “No”.
Yes __ No __
6.3 (1) Does Contractor have a fabrication panel shop within
150 driving miles from the District’s Customer Service
Facility, or
(2) Can the Contractor otherwise demonstrate an ability for
fabricated items to reach the project site within 3 hours of
receiving a request for emergency response for the duration
of the project and 3-year warranty period?
If the answer to (1) is Yes then mark “Yes”. If the answer to
(1) is No, but the answer to (2) is Yes, then mark “Yes” and
provide explanation on a separate sheet. If the answer to
both (1) and (2) is No, then mark “No”.
Yes __ No __
Page 9 of 17
6.4 Has the firm completed within the past five (5) years controls
integration work within existing systems for at least three (3)
Public Works infrastructure projects valued at least $1
million each in California or Nevada?
For purposes of this question, controls integration work shall
include those activities bulleted in Part 2 of this document.
Contractor will be required to provide information regarding
the three projects in response to question 7.16.
Yes __ No __
6.5 At the time of submittal of the Pre-qualification Packet, has
the Contractor been found ineligible to bid on or be awarded
a public works contract, or perform as a subcontractor on a
public works contract pursuant to either Labor Code section
1771.1 or Labor Code section 1777.7?1
If the answer is “Yes,” state the beginning and ending dates
of the period of debarment:
Yes __ No __
____________
6.6 In the last ten (10) years, has your firm or any of its owners,
officers or partners, ever been found liable in a civil suit, or
convicted/found guilty in a criminal action: (a) involving the
awarding of a contract of a government construction project,
(b) involving the bidding or performance of a government
contract, or (c) involving fraud, theft or any other act of
dishonesty, including but not limited to the California False
Claims Act, or Federal False Claims Act?
Yes __ No __
6.7 Has the Contractor been cited and assessed by CAL OSHA
penalties for any “serious,” “willful,” or “repeat” violations of
its safety or health regulations in the past five (5) years?2
Yes __ No __
1 This does not include ineligibility based upon any violations prior to January 1, 1998, if the violation was based on a
subcontractor’s failure to comply with these Labor Code provisions and the Contractor had no knowledge of the subcontractor’s
violations.
2 NOTE: If you have filed an appeal of a citation, and the Occupational Safety and Health Appeals Board has not yet ruled on your
appeal, you need not include information about it.
Page 10 of 17
7. Pre-Qualification Questionnaire (Attach Explanations as Necessary)
7.1 Association Membership: Is Contractor a member of the Control System Integrators Association
(CSIA)?
Yes / No Level of Membership: ___________
7.2 Training and Certification: Is Contractor a Certified Member of CSIA?
Yes / No Date: ___________
7.3 Training and Certification: Has the Contractor been Endorsed or Certified by
AVEVA/Wonderware in Systems Integration?
Yes / No Date: ___________
7.4 Training and Certification: Has the Contractor been Certified by AVEVA/Wonderware for Systems
Platform Integration?
Yes / No Date: ___________
7.5 Training and Certification: Has the Contractor been Certified by AVEVA/Wonderware for InTouch
Integration?
Yes / No Date: ___________
7.6 Training and Certification: Has the Contractor received formal training by AVEVA/Wonderware for
InTouch Integration?
Yes / No
7.7 Security: How many times in the last 5 years has the Contractor been denied work because its
staff has failed to pass a required background check?
Number of instances: ___________
7.8 Security: How many times in the last 5 years has the Contractor had to change the members of a
project team because its staff has failed to pass a required background check?
Number of instances: ___________
7.9 Security: How many times in the last five years has the Contractor been denied work because it
has refused to sign a confidentiality agreement?
Number of instances: ___________
7.10 Financial Capacity: In the past 10 years has Bidder reorganized under the protection of
bankruptcy laws?
Yes __ No __ If yes, please state when __________________________
Page 11 of 17
7.11 Staffing: How many full-time engineers and programmers does the firm currently staff from local
offices (within 150 miles)?
Number of Engineers: ___________ Number of Programmers: _____________
7.12 DBE/MBE/WBE Status: Is your firm a qualified Disadvantaged Business Enterprise (DBE); Minority
Business Enterprise (MBE); and/or a Women’s Business Enterprise (WBE) with a US
Environmental Protection Agency (EPA) accepted certification? If Yes, please provide the certifying
agency and certificate number in the spaces provided below.
Certifying Agency: ________________________________ #:_______________
7.13 Insurance: In the last five years has any insurance carrier, for any form of insurance, refused to
renew the insurance policy for the contractor?
Yes __ No __ If “yes,” explain on a separate signed page. Name the insurance carrier, the
form of insurance and the year of each refusal.
7.14 Prevailing Wage: During the last five years, has there been any occasion in which the contractor
was required to pay either back wages or penalties for the contractor’s own firm’s failure to comply
with California’s prevailing wage laws?
Yes __ No __ If ”yes,” attach a separate signed page or pages, describing the nature of
each violation, identifying the name of the project, the date of its completion,
the public agency for which it was constructed, the number of employees who
were initially underpaid and the amount of back wages and penalties that the
contractor was required to pay.
7.15 Prevailing Wage: During the last five years, has there been any occasion in which the contractor’s
own firm has been penalized or required to pay back wages for failure to comply with the federal
Davis-Bacon prevailing wage requirements?
Yes __ No __ If “yes,” attach a separate signed page or pages describing the nature of the
violation, identifying the name of the project, the date of its completion, the
public agency for which it was constructed, the number of employees who
were initially underpaid, the amount of back wages the contractor was
required to pay along with the amount of any penalty paid.
Page 12 of 17
7.16 Controls Integration Experience
The unique nature of the Project requires that the Control Systems Integrator have experience within the past five (5) years in
controls integration within existing systems for at least three (3) Public Works infrastructure projects similar to the Project of at least
$1 million each in California or Nevada. Please provide the requested information for the 3 projects most similar to the Project which
the Contractor has COMPLETED in the last 5 years.
Project Name/Owner
Owner’s Contact / Phone Number
Project
Amount
($M)
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Years: Started
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Name of Contractor’s
Project Manager
Name of Contractor’s
Programmer
Type of Project (Check all that apply)
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If Other, Specify
1.
A. Did project require integration of new controls into an existing system? Yes ____ No ____
B. Did the project include programming control strategies for aeration
blower systems including blower vendor control panels? Yes ____ No ____
C. Approximately how many PLC I/O were required for the Project? Number ______
D. Approximately how many equipment loops were programmed for the Project? Number ______
E. Approximately how many equipment tags were used for the Project? Number ______
F. Which of the following products were used in the Project? (Check all that apply)
AVEVA/Wonderware InTouch AVEVA/Wonderware Historian Rockwell Studio 5000
Microsoft SQL Server Microsoft Terminal Services Allen Bradley ControlLogix PLCs
Page 13 of 17
Project Name/Owner
Owner’s Contact / Phone Number
Project
Amount
($M)
%
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Years: Started
and Completed
Name of Contractor’s
Project Manager
Name of Contractor’s
Programmer
Type of Project (Check all that apply)
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If Other, Specify
2.
A. Did project require integration of new controls into an existing system? Yes ____ No ____
B. Did the project include programming control strategies for aeration
blower systems including blower vendor control panels? Yes ____ No ____
C. Approximately how many PLC I/O were required for the Project? Number ______
D. Approximately how many equipment loops were programmed for the Project? Number ______
E. Approximately how many equipment tags were used for the Project? Number ______
F. Which of the following products were used in the Project? (Check all that apply)
AVEVA/Wonderware InTouch AVEVA/Wonderware Historian Rockwell Studio 5000
Microsoft SQL Server Microsoft Terminal Services Allen Bradley ControlLogix PLCs
Page 14 of 17
Project Name/Owner
Owner’s Contact / Phone Number
Project
Amount
($M)
%
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P
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Years: Started
and Completed
Name of Contractor’s
Project Manager
Name of Contractor’s
Programmer
Type of Project (Check all that apply)
Wa
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If Other, Specify
3.
A. Did project require integration of new controls into an existing system? Yes ____ No ____
B. Did the project include programming control strategies for aeration
blower systems including blower vendor control panels? Yes ____ No ____
C. Approximately how many PLC I/O were required for the Project? Number ______
D. Approximately how many equipment loops were programmed for the Project? Number ______
E. Approximately how many equipment tags were used for the Project? Number ______
F. Which of the following products were used in the Project? (Check all that apply)
AVEVA/Wonderware InTouch AVEVA/Wonderware Historian Rockwell Studio 5000
Microsoft SQL Server Microsoft Terminal Services Allen Bradley ControlLogix PLCs
Page 15 of 17
7.17 Recent Past Experience
Identify the most recent 3 projects AWARDED to the Contractor, regardless of type.
Project Name/Owner
Owner’s Contact / Phone Number
Project Amount
($M)
% of Project Cost for
Controls Integration
Name of Contractor’s
Project Manager
Name of Contractor’s
Programmer
Type of Work
1.
2.
3.
Note: The District will select at least three (3) of the six (6) identified projects (questions 7.16 and 7.17) for a scored interview,
following the process and questionnaire included in the scoring packet. Responses to the interviews will be considered as part of the
prequalification evaluation.
Page 16 of 17
8. Contractor’s Certification
CERTIFICATION UNDER PENALTY OF PERJURY
I, the undersigned, certify and declare that I know the contents of all documents
submitted pursuant to the Pre – Qualification Policy, have read all the foregoing answers
to the Criteria Essential for Pre-Qualification and the Pre – Qualification Questionnaire
included in the Pre – Qualification Packet and any attached sheets and know their
contents. The matters contained in, or submitted pursuant to the Pre – Qualification
Policy, and all answers to the Criteria Essential for Pre-Qualification and the Pre –
Qualification Questionnaire are true of my own knowledge and belief, except as to those
matters stated on information and belief, as to those matter I believe them to be true.
I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct.
Date: _________________________________________________________________
Signed: ________________________________________________________________
Name: ________________________________________________________________
Title: __________________________________________________________________
(Signature must be notarized)
Page 17 of 17
Notary 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 ______________
On , 20___, before me, _______________________________, Notary Public, personally
Date Name And Title Of Officer (e.g. “Jane Doe, Notary Public”)
appeared , who proved to me on the basis of satisfactory
Name(s) of Signer(s)
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.
WITNESS my hand and official seal.
Place Notary Seal Above Signature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
Individual
Corporate Officer
Title(s) Title or Type of Document
Partner(s) Limited
General Number of Pages
Attorney-In-Fact
Trustee(s)
Guardian/Conservator Date of Document
Other:
Signer is representing:
Name Of Person(s) Or Entity(ies)
Signer(s) Other Than Named Above