SECTION C
PROPOSAL
for the
MAIN STREET AND CROWTHER AVE PARKING LOT IMPROVEMENTS PROJECT From
CITY PROJECT NO. 2204 & 2205
in the
CITY OF PLACENTIA
TO THE HONORABLE MAYOR AND MEMBERS OF THE COUNCIL OF PLACENTIA:
In compliance with the Notice Inviting Sealed Bids, the undersigned hereby proposes and agrees to perform all the work therein described, and to furnish all labor, material, equipment and incident insurance necessary therefor, in accordance with the plans and specifications on file in the office of the City Engineer of the City of PLACENTIA. The undersigned agrees to perform the work therein to the satisfaction of and under the supervision of the City Engineer of the City of PLACENTIA, and to enter into a contract at the following prices. The undersigned agrees to complete the work within 60 working days, starting from the date of the Notice to Proceed.
BIDDER declares that this proposal is based upon careful examination of the work site, plans, specifications, Instructions to Bidders and all other contract documents. If this proposal is accepted for award, BIDDER agrees to enter into a contract with AGENCY at the unit and/or lump sum prices set forth in the following Bid Schedule. BIDDER understands that failure to enter into a contract in the manner and time prescribed will result in forfeiture to AGENCY of the guaranty accompanying this proposal.
BIDDER understands that a bid is required for the entire work and that the estimated quantities set forth in the Bid Schedule are solely for the purpose of comparing bids, and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. THE AGENCY RESERVES THE RIGHT TO DELETE ANY ITEM FROM THE CONTRACT. It is agreed that the unit and/or lump sum prices bid include all appurtenant expenses, taxes, royalties, fees, etc., and will be guaranteed for a period of sixty days from the bid opening date. If at such time the contract is not awarded, the AGENCY will reject all bids and will re -advertise the project.
In the case of discrepancies in the amounts bid, unit prices shall govern over extended amounts, and words shall govern over figures.
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If awarded the Contract, the undersigned agrees that in the event of the BIDDER'S default in executing the required contract and filing the necessary bonds and insurance certificates within 10 working days after the date of the AGENCY'S notice of award of contract to the BIDDER, the proceeds of the security accompanying this bid shall become the property of the AGENCY and this bid and the acceptance hereof may, at the AGENCY'S option, be considered null and void.
Accompanying this proposal of bid, find in the amount of $ which said amount is not less than 10% of the aggregate of the total bid price, as required by the Notice Inviting Sealed Bids, payable to the AGENCY. (Please insert the words "Cash", "Certified Check", or "Bidder's Bond", as the case may be).
Bidder shall signify receipt of all Addenda here, if any:
Addenda No. Date Received Bidder's Signature
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BID SCHEDULE FOR MAIN STREET AND CROWTHER AVE PARKING
LOT IMPROVEMENTS PROJECT
ITEM
NO.
ITEMS DESCRIPTION
BID ITEMS
QUANTITY
UNIT
UNIT
PRICE
TOTAL
1. Parking lot improvements per 1 LS
Plan, Appendix I and Project $ Text $ Text
Specs.
2. Complete working Irrigation 1 LS
system per Plan, Appendix I,
Sheet 13
Sub -Grade Base Preparation,
3. Import and Compact (95%) 100 CY
Crushed Miscellaneous Base
(CMB) — Greenbook section 200-
2.4 4.
2" Water Service Line
1 LS
Allowance for GSW permits, water
meter, lateral installation, trench
and restoration.
BID SCHEDULE TOTAL PRICE: $
BID SCHEDULE TOTAL PRICE WRITTEN IN WORDS:
Text
$
Text
$
Text
$ Text $ Text
$ 15,000 $ 15,000
Text
Through submission on PlanetBids, the bidder certifies that he/she has followed the bidder instructions, acknowledges the requirements set forth in this proposal form for bid submission, and has thoroughly checked the figures set forth in the proposal and inputted into PlanetBids, that they are correct to the best of his/her knowledge and constitute his/her proposal to perform all the work called out and implied throughout these contract documents.
***BID ITEMS TO BE INPUTED ON-LINE VIA PLANETBIDS***
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City of Placentia
Notice Inviting Bids for Main Street and Crowther Avenue Parking Lot Improvements Project (NIB No. PW -22-08), bidding on 01/13/2023 2:00 PM (PST) Line Items
Discount Terms No Discount
Item # Item Code Type
Bid Schedule
2 3
4 1
2 3
4 Item Description
Parking lot Improvements per Plan, Appendix 1 and Project Specs.
Complete working Irrigation system per Plan, Appendix I, Sheet 13 Sub -Grade Base Preparation, Import and Compact (95%) Crushed Miscellaneous Base (CMB) — Greenbook section 200-2.4 2" Water Service Line - Allowance for GSW permits, water meter, lateral installation, trench and restoration.
PlanetBids, Inc.
Printed 01/17/2023
UOM QTY Unit Price Line Total Response Comment
$602,304.00
LS 1 $508,804.00 $508,804.00 Yes
LS 1 $70,000.00 $70,000.00 Yes
CY 100 $85.00 $8,500.00 Yes
LS 1 $15,000.00 $15,000.00 Yes
City of Placentia
Notice Inviting Bids for Main Street and Crowther Avenue Parking Lot Improvements Project (NIB No. PW -22-08), bidding on 01/13/2023 2:00 PM (PST) Line Item Subtotals
Bid Schedule
Section Title
Line Total
Grand Total
PlanetBids, Inc.
Printed 01/17/2023
$602,304.00
$602,304.00
LIST OF SUBCONTRACTORS
In accordance with Government Code Section 4104, the Bidder shall set forth the name and business address of each subcontractor who will perform work or render service to the bidder on said contract in an amount in excess of one-half of one percent of the total bid and the portion of the work to be done by such subcontractor.
Portion Name and Address of Subcontractor State License Class of Work Number
ac T. maus grading and paving 992056 A
electrical
Big Bear Electric 972582 C-10
By submission of this proposal, the Bidder certifies:
1. That he is able to and will perform the balance of all work, which is not covered in the above subcontractors listing.
2. That the AGENCY will be furnished copies of all subcontracts entered into and bonds furnished by subcontractor for this project.
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NONCOLLUSION AFFIDAVIT
TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID
State of California
ss.
County of Orange
TAMER KHALIL , being first duly sworn, deposes and says that he or she is PRESIDENT Of ANEEN CONSTRUCTION, INC. the party making the foregoing bid that the bid is not made in the interest of, or on the behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price, or that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid.
ANEEN CONSTRUCTION, INC.
Name of Bidder
Signature of Bidder
9860 INDIANA AVE #18 RIVERSIDE, CA 92503
Address of Bidder
Subscribed and sworn to before me this ay of 1 /L1 ., 41 20
NOTARY PUBLIC
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NOTAR Y SEAL.
K. DUNN
COMM. #2290617 z
Notary Public California o
Riverside County
My Comm. Expires June 24, 2023r
UTILITY AGREEMENT
HONORABLE MAYOR AND CITY COUNCIL
CITY OF PLACENTIA, CALIFORNIA
The undersigned hereby promises and agrees that in the performance of the work specified in the contract, known as ADA RAMP IMPROVEMENTS PROJECT, (I)(we)(it) will employ and utilize only qualified persons, as hereinafter defined, to work in proximity to any electrical secondary or transmission facilities. The term "Qualified Person" is defined in Title 8, California Administrative Code, Section 2700, as follows:
"Qualified Person: A person who, by reason of experience or instruction, is familiar with the operation to be performed and the hazards involved."
The undersigned also promised and agrees that all such work shall be performed in accordance with all applicable electrical utility company's requirements, Public Utility Commission orders, and State of California Cal -OSHA requirements.
The undersigned further promises and agrees that the provisions herein shall be and are binding upon any subcontractor or subcontractors that may be retained or employed by the undersigned, and that the undersigned shall take steps as are necessary to assure compliance by any said subcontractor or subcontractors with the requirements contained herein.
Date:
1-13-2023
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ANEEN CONSTRUCTION, INC.
Contractor
By
Title
TAMER KHALIL
PRESIDENT
DISQUALIFICATION QUESTIONNAIRE
In accordance with Government Code Section 14310.5, the Bidder shall complete, under penalty of perjury, the following questionnaire.
QUESTIONNAIRE
Has the Bidder, any officer of the Bidder or any employee of the Bidder who has a proprietary interest in the Bidder ever been disqualified, removed or otherwise prevented from bidding on or completing a Federal, State or local government project because of a violation of law or a safety regulation?
❑ Yes ® No
If the answer is yes, explain the circumstances in the space provided.
Note: This questionnaire constitutes a part of the Proposal, and a signature portion of the Proposal shall constitute signature of this questionnaire.
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COMPENSATION INSURANCE CERTIFICATE
Pursuant to Section 1861 of the State Labor Code, each contractor to whom a public works contract has been awarded shall sign the following certificate.
I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract.
Date:
01-13-2023
C-8
ANEEN CONSTRUCTION, INC.
Contractor
By
Title
TAMER KHALIL
PRESIDENT
UNDERGROUND SERVICE ALERT
IDENTIFICATION NUMBER
(To be completed only by the awarded Contractor prior to excavation) No excavation will be permitted until this form is completed and returned to the AGENCY.
Section 4216/4217 of the Government Code requires a Dig Alert Identification Number be issued before a Permit to Excavate will be valid.
To obtain a Dig Alert Identification Number, call Underground Service Alert at 1-800-422-4133 a minimum of two working days before scheduled excavation.
Dig Alert Identification Number:
Date:
1-13
ANEEN CONSTRUCTION, INC.
Contractor
TAMER
By
PRESID
Title
Note: This form is required for every Dig Alert Identification Number issued by U.S.A. during the course of the Work. Additional forms may be obtained from the AGENCY upon request.
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BIDDER'S INFORMATION
BIDDER certifies that the following information is true and correct:
ANEEN CONSTRUCTION, INC.
Bidder Name
9860 INDIANA AVE #18
Business Address
RIVERSIDE, CA, 92503
City, State Zip
909 ) 913-39024
Telephone Number
1004775 (A)
State Contractor's License No. and Class
JUNE, 2015
Original Date Issued
JUNE 30, 2023
Expiration Date
The work site was inspected by
TAMER KHALIL
of our office on
JAN 11
. 2023.
The following are persons, firms, and corporations having a principal interest in this proposal:
ANEEN CONSCTRUCTION, INC.
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The undersigned is prepared to satisfy the Council of the City of PLACENTIA of its ability, financially or otherwise, to perform the contract for the proposed work and improvements in accordance with the plans and specifications set forth.
ANEEN CONSTRUCTION
Company Name
Signature of Bidder
er114-(.t. c 2_ 1444 it -1 �` I
Printed or Typed Signature
Subscribed and sworn to before me this 13 day of
NOTARY PUBLIC
JAN
AA/L-
, 2023. _
K. DUNN
��d�•-:�,�_ z COMM. #2290617
m
cc=o
� Notary Public California
z ' � Riverside County
N Ptfly Comm. Expires June 24, 2023P
NOTARY SEAL
Listed below are the names, address and telephone numbers for three public agencies for which the bidder has performed similar work within the past two years:
1. CITY OF LAKE ELSINORE
Name and Address of Public Agency
Name and Telephone No. of Project Manager:
SCOTT RIPPSTINE 951-538-9116
327,000 CAMINO DEL NORTE 12-30-22
Contract Amount
2. CITY OF LAKE ELSINORE
Name and Address of Public Agency
Type of Work Date Completed
Name and Telephone No. of Project Manager:
390,000
Contract Amount
CARLOS NORVANI 909-996-3947
PARADICE ACRES DRAINAGE 06-30-22
Type of Work Date Completed
3. CALTRANS DIST 9
Name and Address of Public Agency
Name and Telephone No. of Project Manager:
167,000
Contract Amount
REST STOP IMPROVEMENT
Type of Work
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ENRICO DEJESUS 760-920-8442
ON-GOING
Date Completed
RESPONSIBLE BIDDER — SUPPLEMENTAL QUESTIONNAIRE
1. How many years has your organization been in business in California as a contractor under your present business name and license number? 8 Years
2. What is your firm's Average Gross Revenue for the last three years? $ 1,000,000 _
3. Is your firm currently the debtor in a bankruptcy case? ❑ Yes ®No
If " yes," indicate the case number, bankruptcy court, and the date on which the petition was filed.
Case Number
Bankruptcy Court Date Filed
4. Was your firm in bankruptcy any time during the last five years? (This question refers only to a bankruptcy action that was not described in answer to question 2, above.)
❑ Yes Ll No
If " yes," indicate the case number, bankruptcy court, and the date on which the petition was filed.
Case Number
Bankruptcy Court Date Filed
5. Has any CSLB license held by your firm or its Responsible Managing Employee (RME) or Responsible Managing Officer (RMO) been suspended within the last five years?
❑ Yes 0 No
6. At any time in the last five years, has your firm been assessed and paid liquidated damages after completion of a project, under a construction contract with either a public or private owner?
❑ Yes ® No
7. Has your firm ever defaulted on a construction contract? ❑ Yes 0 No
If "yes," explain on a separate page.
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8. In the last five years has your firm, or any firm with which any of your company's owners, officers or partners was associated, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing, any government agency or public works project for any reason?
❑ Yes ® No
If "yes," explain on a separate page. State the name of the organization debarred, the year of the event, the owner of the project, and the basis for the action.
9. In the last five years, has your firm been denied an award of a public works contract based on a finding by a public agency that your company was not a responsible bidder?
❑ Yes ® No
If "yes," on a separate page identify the year of the event, the entity denied the award, the owner, the project, and the basis for the finding by the public agency.
10. In the past five years, has any claim against your firm concerning your firm's work on a construction project, been filed in court or arbitration? ❑ Yes ®No
If "yes," on a separate page identify the claim(s) by providing the project name, date of the claim, name of the claimant, the name of the entity the claim was filed against, a brief description of the nature of the claim, the court and case number, and a brief description of the status of the claim (pending or, if resolved, a brief description of the resolution).
11.In the past five years, has your firm made any claim against a project owner concerning work on a project or payment for a contract, and filed that claim in court or arbitration?
❑ Yes ® No
If "yes," on a separate page identify the claim be providing the name of claimant, the project name, date of the claim, name of the entity (or entities) against whom the claim was filed, a brief description of the nature of the claim, the court and case number, and a brief description of the status of the claim (pending, or if resolved, a brief description of the resolution.
12.At any time during the past five years, has any surety company made any payments on your firm's behalf as a result of a default, to satisfy any claims made against a performance or payment bond issued on your firm's behalf in connection with a construction project, either public or private?
❑ Yes ® No
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13. In the last five years, has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm?
❑ Yes ® No
14. Has your firm or any of its owners, officers, or partners ever been liable in a civil suit, or found guilty in a criminal action, for making any false claim or material misrepresentation to any public agency or entity?
❑ Yes ® No
15. Has your firm or any of its owners, officers or partners ever been convicted of a crime involving any federal, state, or local law related to construction? ❑ Yes J No
If "yes," explain on a separate page, including identifying who was convicted, the name of the victim, the date of the conviction, the court and case number, the crimes, and the grounds for the conviction.
16. Has your firm or any of its owners, officers or partners ever been convicted of a federal or state crime of fraud, theft, or any other act of dishonesty? ❑ Yes ® No
If "yes," identify on a separate page, the person or persons convicted, the court and case number, the crimes, and the year convicted.
17. If your firm was required to pay a premium of more than one per cent for a performance and payment bond on any project(s) on which your firm worked at any time during the last three years, state the percentage that your firm was required to pay. You may provide an explanation for a percentage rate higher than one per cent, if you wish to do so.
18. During the last five years, has your firm ever been denied bond credit by a surety company, or has there ever been a period of time when your firm has no surety bond in place during a public construction project when on was required? ❑ Yes >] No
19. Has CAL OSHA cited and assessed penalties against the General Contractor or its associates for any "serious," "willful" or "repeat" violations of its safety or health regulations in the past five years?
(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.)
❑ Yes ® No
C-14
If "yes," on separate page describe the citations, the party against whom the citation was made, date of citation, nature of the violation, project on which the citation was issued, owner of project, and the amount of penalty paid, if any. State the case number and date of any OSHAB decision.
20. Has the Federal Occupational Safety and Health Administration cited and assessed penalties against the General Contractor or its associates in the past five years?
(Note: If an appeal of the citation has been filed and the Appeals Board has not yet ruled, or there is a court appeal pending, you need not include information about the citation.) ❑ Yes ® No
If "yes," on separate page describe the citation, the party against whom the citation was made, date of citation, nature of the violation, project on which the citation was issued, owner of project, and the amount of penalty paid, if any. State the case number and date of any decision.
21. Has there been more than one occasion during the last five years in which the General Contractor or its associates was required to pay either back wages or penalties for failure to comply with the state's prevailing wage laws? ❑ Yes G7 No
If "yes," on separate page, describe the violator, nature of each violation, name of the project, date of its completion, the public agency for which it was constructed, the number of employees who were initially underpaid an the amount of back wages and penalties that were assessed.
22. During the last five years, has there been more than one occasion in which the General Contractor or its associates have been penalized or required to pay back wages for failure to comply with the Federal Davis -Bacon prevailing wage requirements?
❑ Yes ® No
If "yes," on separate page, describe the violator, nature of each violation, name of the project, date of its completion, the public agency for which it was constructed, the number of employees who were initially underpaid an the amount of back wages and penalties that were assessed.
c-15
DESIGN ENGINEER MAY NOT BID ON
CONSTRUCTION CONTRACT
No engineering or architectural firm which has provided design services for a project shall be eligible to bid on the contract to construct the project. The firms ineligible to bid include the prime contractor for design, subcontractors of portions of the design, and affiliates of either. An affiliate is a firm which is subject to the control of the same persons(s), through joint ownership or otherwise.
ACKNOWLEDGED this
RIVERSIDE, CA
Authoriz6d Signature
PRESIDENT
Position
ANEEN CONSTRUCTION, INC.
Company
13 day of JAN
C-16
2023 at
NOTICE OF AFFIRMATIVE ACTION
"NOTICE"
By submitting a proposal on any job or entering into any contractual agreement with the City of Placentia, the undersigned agrees not to discriminate in employment decisions against any person on account of race, creed, national origin, ethnic background, color, sex, age, or handicap in performing the work required under this proposal.
ACKNOWLEDGED this
RICERSIDE, CA
Authorized Signature
PRESIDENT
Position
ANEEN CONSTRUCTION, INC.
Company
13TH
day of JAN
C-17
, 20 23 , at
BIDDER'S BOND
(To Accompany Contract Proposal)
KNOW ALL MEN BY THESE PRESENTS,
That
Aneen Construction, Inc. , as PRINCIPAL, and
The Gray Casualty & Surety Company , as SURETY, are held and firmly bound unto the City of Placentia in the sum of TEN PERCENT (10%) of the total amount of the bid of said PRINCIPAL, to be paid to the said City or its certain attorney, its successors and assigns; for which payment, well and truly to be made, we bind ourselves, our heirs, executors and administrators, successors or assigns, jointly and severally, firmly by these presents.
In no case shall the liability of said SURETY here under exceed the sum of $ (10%) Ten Percent of the Total Amount of the Bid .
THE CONDITION OF THIS OBLIGATION IS SUCH THAT,
WHEREAS, said PRINCIPAL has submitted the above mention bid to the City of Placentia for certain construction for which bids are to be opened at the City Hall of the City of Placentia, 401 East Chapman Avenue, Placentia, California on March 14, 2019 for:
MAIN STREET AND CROWTHER AVE PARKING LOT IMPROVEMENTS PROJECT CITY PROJECT NO. 2204 & 2205
NOW, THEREFORE, if the aforesaid PRINCIPAL is awarded the contract and within the time and manner required under the specifications, after the prescribed forms are presented to him for signature, enters into a written consent in the prescribed form in accordance with the bid, and files the two bonds with the City of Placentia, one to guarantee faithful performance and the other to guarantee payment for Labor and Materials as required by law, then this obligation shall be null and void; otherwise, it shall be and remain in full force and effect.
('-18
In the event suit is brought upon this bond by the Obligee and judgment is recovered, said SURETY shall pay all costs incurred by the Obligee in such suit, including a reasonable attorney's fee to be fixed by the Court.
BY:
IN WITNESS WHEREOF, we have hereunto set our hands and seals on this 13th day of January 20 23 .
rPRINCIPAL SURETY
Aneen
onstruction. Inc.
„
TaLer Khalil, President
Title
BY
The Gray Casualty & Surety Company
Pietro Micciche, Attorney -in -Fact
Title
BY: P.O. Box 6202
Address
Metairie, LA 70009
Title
(SEAL) (SEAL)
Instructions: If the Contractor is a corporation, the agreement must be executed in the corporate -name and signed by the President or Vice President and the Secretary or Assistant Secretary, and the corporate seal affixed. If the Contractor is an individual doing business under a fictitious name, it must be signed by all persons having an interest in the business, and the fictitious name must be signed also. All bond signatures must be notarized. The standard printed bid bond form of any bonding company approved by the City pursuant to Item 7, "Insurance Policies and Bonds", in the Instructions to Bidders may be used in lieu of the foregoing approved sample bond form provided the security stipulations protecting the City are in any way reduced by use of the surety company's standard printed form.
C-19
Preferred Bonding Services
12/13/2022 14:38 1001484039397
THE GRAY INSURANCE COMPANY
THE GRAY CASUALTY & SURETY COMPANY
GENERAL POWER OF ATTORNEY
Bond Number: WE> Principal: (��� oA5kyLAGhQh
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Project: 1,,A0, S�fGc ek Ph - C ra �..rft�n� _ IQr�/C► Pc0( L \. r~, \D (c,' V cw\L r• -.A's" 'Pr 5 cc --
KNOW ALL BY THESE PRESENTS, THAT The Gray Insurance Company and The Gray Casualty & Surety Company, corporations duly organized and existing under the laws of Louisiana, and having their principal offices in Metairie, Louisiana, do hereby make, constitute, and appoint: Patricia Zenizo, Elisabete Salazar, and Pietro Micciche of Los Angeles, California jointly and severally on behalf of each of the Companies named above its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its deed, bonds, or other writings obligatory in the nature of a bond. as surety, contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed the amount of $25,000,000.00.
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both The Gray Insurance Company and The Gray Casualty & Surety Company at meetings duly called and held on the 26th day of June, 2003.
"RESOLVED, that the President, Executive Vice President, any Vice President, or the Secretary be and each or any of them hereby is authorized to execute a power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds, undertakings, and all contracts of surety, and that each or any of them is hereby authorized to attest to the execution of such Power of Attorney, and to attach the seal of the Company: and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be binding upon the Company now and in the future when so affixed with regard to any bond, undertaking or contract of surety to which it is attached.
IN WITNESS WHEREOF, The Gray Insurance Company and The Gray Casualty & Surety Company have caused their official seals to be hereinto affixed, and these presents to be signed by their authorized officers this 4th day of November, 2022.
I;Michael T. Gray
President
The Gray Insurance Compam
State of Louisiana
Cullen S. Piske
President
The Gray Casualty & Surety Company
'A SEAL
o
ss:
Parish of Jefferson
On this 4th day of November, 2022, before me. a Notary Public, personally appeared Michael T. Gray, President of The Gray Insurance Company. and Cullen S. Piske, President of The Gray Casualty & Surety Company, personally known to me, being duly sworn, acknowledged that they signed the above Power of Attorney and affixed the seals of the companies as officers of, and acknowledged said instrument to be the voluntary act and deed, of their companies.
Le;h Arise Henican
Notary Public
Notary ID No.92653
Orleans Parish, Louisiana
Leigh Anne Henican
Notary Public, Parish of Orleans State of Louisiana
My Commission is for Life
1, Mark S. Manguno. Secretary of The Gray Insurance Company, do hereby certify that the above and forgoing is a true and correct copy of a Power of Attorney given by the companies, which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Company this day of
Vileit,%414"1#04.--06
I. Leigh Anne Henican, Secretary of The Gray Casualty & Surety Company , do hereby certify that the aboLeand forgoing is a true and correct copy of a Power of Attorney given by the companies, which is still in full force and effect. IN_WITNESS WHEREOF, 1 have set my hand and affixed the seals of the Company this day of
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Los Angeles
On \ 03 120 Z�
Date
personally appeared Pietro Micciche
before me,
Angel Nunez, Notary Public
Here Insert Name and Title of the Officer
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person%) whose name%) is/ttie subscribed to the within instrument and acknowledged to me that hetsbookwy executed the same in his/J : ( authorized capacity(M), and that by his/1ti NiXsignature() on the instrument the person%), or the entity upon behalf of which the person%) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of Califomia that the foregoing paragraph
is true and correct.
ANGEL NUNEZ
Notary Public . California
Los Angeles County
Commission 10 2321675
My Comm. Expires Mar 14, 2024
iIl.i' ii SII .1 Vr•.1 pili
WITNESS m an. and official se,
Signature
(d//y%
Signatureief1Vota ublic
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:
Number of Pages: Signer(s) Other Than Named Above:
Document Date:
Capacity(les) Claimed by Signer(s)
Signer's Name:
_; Corporate Officer — Title(s):
71 Partner — t: Limi
71,1 Individual
Trustee
Other:
Signer Is Representing:
ad H General
Attorney in Fact
LJ Guardian or Conservator
Signer's Name:
Corporate Officer — Title(s):
0 Partner — i 1 Limited Li General
El Individual H Attomey in Fact
0 Trustee L ; Guardian or Conservator
❑ Other:
Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907