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Home My WebLink AboutASSI Security, Inc. - Citywide Card Reader Upgrade Project - 2026Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-lDB6-4A93-8040-BCF5F5D009B1 OWNER - CONTRACTOR AGREEMENT CIP 26-05 CITYWIDE CARD READER UPGRADE PROJECT This Owner -Contractor Agreement ("Agreement") is made by and between the City of National City, 1243 National City Boulevard National City, California 91950 and ASSI SECURITY ("Contractor"), 4901 MORENA BLVD., STE. 205, SAN DIEGO, CA 92117 on the 26th day of March, 2026, for the construction of the above referenced Project. In consideration of the mutual covenants and agreements set forth herein, the Owner and Contractor have mutually agreed as follows: 1. CONSTRUCTION The Contractor agrees to do all the work and furnish all the labor, services, materials and equipment necessary to construct and complete the Project in a turn -key manner in accordance with this Agreement and all documents and plans referenced in Exhibit "A", (hereinafter "Contract Documents"), in compliance with all relevant Federal, State of California, County of San Diego and City of National City codes and regulations, and to the satisfaction of the Owner. 2. CONTRACT PRICE Owner hereby agrees to pay and the Contractor agrees to accept as full compensation for constructing the project in accordance with these Contract Documents in an amount not to exceed the contract price as set forth in Exhibit "B" attached hereto and incorporated herein by reference. Payments to the Contractor shall be made in the manner described in the Special Provisions. 3. TIME FOR PERFORMANCE Time is of the essence for this Agreement and the Contractor shall construct the project in every detail to a complete and turn -key fashion to the satisfaction of the Owner within the specified duration set forth in the Special Provisions. 4. NON-DISCRIMINATION In the performance of this Agreement, the Contractor shall not refuse or fail to hire or employ any qualified person, or bar or discharge from employment any person, or discriminate against any person, with respect to such person's compensation, terms, conditions or privileges of employment because of such person's race, religious status, sex or age. Docusign Envelope ID: D"316C52E-B6CO-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 5. AUTHORIZED OWNER REPRESENTATIVES On behalf of the Owner, the Project Manager designated at the pre -construction meeting shall be the Owner's authorized representative in the interpretation and enforcement of all Work performed in connection with this Agreement. 6. WORKERS' COMPENSATION INSURANCE a) By my signature hereunder, as Contractor, I certify that I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for Workers' Compensation or to undertake self-insurance in accordance with the provisions of that Code, and 1 will comply with such provisions before commencing the performance of the Work of this Agreement. b) The Contractor shall require each subcontractor to comply with the requirements of Section 3700 of the Labor Code. Before commencing any Work, the Contractor shall cause each subcontractor to execute the following certification: "I am aware of the provisions of Section 3700 of the Labor Code, which requires 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 Agreement." 7. ENTIRE AGREEMENT; CONFLICT The Contract Documents comprise the entire agreement between the Owner and the Contractor with respect to the Work. In the event of conflict between the terms of this Agreement and the bid of the Contractor, then this Agreement shall control and nothing herein shall be considered as an acceptance of the terms of the bid conflicting herewith. 8. MAINTENANCE OF AGREEMENT DOCUMENTATION Contractor shall maintain all books, documents, papers, employee time sheets, accounting records and other evidence pertaining to costs incurred and shall make such materials available at its office at all reasonable times during the term of this Agreement and for three (3) years from the date of final payment under this Agreement, for inspection by Owner and copies thereof shall be furnished to Owner if requested. 9. INDEPENDENT CONTRACTOR At all times during the term of this Agreement, Contractor shall be an independent contractor and shall not be an employee, agent, partner or joint venturer of the Owner. Owner shall have the right to control Contractor insofar as the results of Contractor's Docusign Envelope ID: D"316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5Do09B1 services rendered pursuant to this Agreement; however, Owner shall not have the right to control the means by which Contractor accomplishes such services. 10. LICENSES AND PERMITS Contractor represents and declares to Owner that it has all licenses, permits, qualifications and approvals of whatever nature which are legally required to practice its profession. Contractor represents and warrants to Owner that Contractor shall, at its sole cost and expense, keep in effect at all times during the term of this Agreement, any licenses, permits, qualifications or approvals which are legally required for Contractor to practice its profession. 11. GOVERNING LAW, VENUE This Agreement and the Contract Documents shall be construed under and in accordance with the laws of the State of California, and the appropriate venue for any action or proceeding arising from this Agreement and/or the Contract Documents shall be had in the Superior Court of San Diego, Central Branch. 12. COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall for all purposes be deemed to be an original. 13. FALSE CLAIMS Contractor acknowledges that if a false claim is submitted to the Owner, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that the False Claims Act, California Government Code sections 12650, et seq., provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include within their scope false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. In the event the Owner seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorneys' fees. Contractor hereby acknowledges that the filing of a false claim may the Contractor to an administrative debarment proceeding wherein Contractor may be prevented from further bidding on public contracts for a period of up to five (5) years. I have read and understood all of the provisions of this Section 13, above: HG (Initial) (Initial) Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 14. AGREEMENT MODIFICATION This Agreement and the Contract Documents may not be modified orally or in any manner other than by an amendment in writing and signed by the Owner and the Contractor. IN WITNESS WFKREOF this Agreement is executed as of the date first written above. Owner: City Manage , fiof National City Attest: by: rDocuSigned Una City Clerk, City of National City Contractor: ASSI SECURITY Eh E:tt. (Owner/Officer signature) Matt Galey AR MGR Print name and title (Second officer signature if a corporation) Print name and title 09003626 Contractor's City Business License No. 683831 State Contractor's License No. and Class C10 C7 C28 Business street address 1370 Reynolds Ave., STE 201 Irvine, CA 92614 City, State and Zip Code Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 EXHIBIT A CONTRACT DOCUMENTS Applies to all contracts: 1. Owner/Contractor Agreement 2. Bid Schedule 3. Bid and Post Bid Documents 4. Pre -Bid Addenda, if any 5. National City General Conditions (NCGC) 6. Special Provisions (Specifications) 7. Permits issued by governmental, quasi -governmental and utility agencies 8. Plans, exhibits and drawings 9. Referenced standards, regulations and drawings 10. Applicable Federal and California Law 11. National City Regulations, Ordinances and Council Policies Applies to public right-of-way work: 1. National City Standard Drawings (NCSD) 2. San Diego County Regional Standard Drawings, when not in conflict with NCSD 3. Standard Specifications for Public Works Construction and Regional Supplements (Greenbook, latest edition at time of bid), as edited by NCGC 4. State Standard Specifications 5. State Standard Plans Applies to building and on -site work: 1. California Building, Mechanical, Plumbing and Electrical Codes Applies to work near, around or on public utilities: 1. SDG&E regulations, permits, standard plans and drawings 2. Sweetwater Authority permits, standard plans and drawings 3. Communication company standard plans and drawings shall only apply to work on their facilities. Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-8CF5F5D009B1 EXHIBIT B CONTRACT PRICE (Attached on the next page) Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 EXHIBIl B * . ASSI Proposal 12106-1-0-1 CITY OF NATIONAL CITY City Wide Card Reader Upgrade Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345Cb833 n....-1..., C..,—i....e In 7AC79'2CS_inRR-AAQ2-Andr)-P('Prp nnnciR1 PROJECT DESCRIPTION & INVESTMENT Client Information Site: 1243 NATIONAL CITY BLVD NATIONAL CITY CA Scope of Work ASSI will replace all existing readers with new HID Multi technology Slgno Readers. ASSI will provide 400 new HID Composite iClass SEOS Contactless Smart Card. ASSI will upgrade DSX SQL to its most current version of 6 1,15 Contact: John Saour (619)387-6310 Isaour@natlonalcityca gov Note All work to be performed during normal business hours ASSI assumes all existing Card Readers, Locking Hardware and associated devices including cable are in good working order Project Investment City Hall $21,482.99 QTY Manufacturer Part 8 Description 5200 HID 40NKS-00-000000 Signo40 Wall mount 13 56mHz &125kHz. OSDP,Wiegand. Pigtail Mobile Ready 40000 HID 5006PGGMN HID, Composite iClass SEOS Contactless Smart Card 8 KB Memory Prog . F-Gloss. B-Gloss Match Klass # No Slot Equipment Subtotal: $15,483 88 Labor Subtotal: $6,000 00 City Hall SubTotal: $21,482.99 MILK Building i. QTY Manufacturer Part 0 Description 1800 HID 40NKS-00-000000 Signo40 Wall mount '3 56mHz &125kHz OSDP/Wiegand Pigtail Mobile Ready Equipment Subtotal: $4,818.42 Labor Subtotal: $3,000.00 MILK Budding SubTotal $7,818.09 Library 1 QTY Muna"Um Part # Description 14.00 HID 40NKS-00-000000 Signo40, Wall mount, 13 56mHz &125kHz, OSDP/Wiegand, Pigtail, Mobile Ready Equipment Subtotal. S3 747 66 Labor Subtotal: S2 400 00 Library SubTotal Date: 7/22/2025 1 Proposal #: 12106-1-0-1 1 City Wide Card Reader Upgrade Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345Cb833 n-,.—i— Fn„ i— In 7RF792Fr-lnRR-dAQ2-RoAo-Rr prp,; 1MQR1 Fire Station 34 00is QTY Manufacturer Part f Description 900 HID 40NKS-00-000000 Sgno40 Wall mount 13 56mHz &125kHz OSDP/Wiegand Pigtail Mobile Ready Equipment Subtotal: $2,409.21 Labor Subtotal: $600.00 Fire Station 34 SubTotal: $3,009.08 Fire Station 31 1. 1 QTY Manufacturer Part # Description 600 HID 40NKS-00-000000 Signo40 Wall mount. 13 56mHz &125kHz, OSOP/Wiegand, Pigtail. Mobile Ready Equipment Subtotal: $1,606.14 Labor Subtotal: $600.00 Fire Station 31 SubTotal: $2,206.05 Public Works $1,670.69 QTY Manufacturer Part 0 Description 400 HID 40NKS-00-000000 Signo40 Wall mount 13 56MHz &125kHz, OSDP/Wiegand, Pigtail, Mobile Ready Equipment Subtotal: $1,070.76 Labor Subtotal: $600.00 Public Works SubTotal: $1,670.69 DSX Upgrade $2.328.69 QTY Manulachm Parts Descrfptlon 1 00 DSX DSX-WINDSX-SQLUPG DSX, WinDSXSQL Software Equipment Subtotal: $1,128.79 Labor Subtotal: $1,200.00 DSX Upgrade SubTotal: $2,328.69 Financial Summary Total Equipment: $30,264.86 Total Labor: $14,400.00 Total Proposal Investment: $44,663.00 Date 7/22/2025 1 Proposal # 12106-1-0-1 1 City Wide Card Reader Upgrade Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusian Envelope ID 78F723E5-lDB6-4A93-8040-BCF5F5D009B1 General Terms and Conditions 1. Pricing is based upon the assumption that all work will be performed during ASSI's normal business hours. If after hours work is requested, an additional charge will be incurred 2. ASSI carries the following insurance coverage • General Liability $1 mil per occurrence. • $2 mil gen aggregate, • W/C $1 mil per occurrence • $5 mil excess umbrella • Auto $2 mil combined single limit • Customer shall pay premiums for any additional coverage required 3 All materials and labor are subject to a preliminary notice and subsequent filing of mechanic's lien in the event of payment default. Customer must provide preliminary information prior to commencement of work 4 All canceled orders and/or returned materials are subject to a 25% restocking fee 5. A deposit is due upon acceptance of proposal Balance will be due in progressive net 30 day payments thereafter Deposit amount is based upon a percentage of the project total. Percentage is determined based upon thesize of the project (i e Proposals and change orders under $10k each require a 50% deposit. Those between $10,001-50,000 require a 35% deposit, and proposals in excess of $50,000 require a 25% deposit) 6 All new equipment is covered under warranty against defects for a period of one year from date of substantial completion of ASSI's work Associated labor is also covered during normal business hours. Date 7/22/2025 1 Proposal # 12106-1-0-1 1 City Wide Card Reader Upgrade Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Performance Items Include I Exclude ❑ 0 System Meets Plans/Specifications ❑ System is Design Build p ❑ Mounting/Termination of Proposed Devices ❑ System Programming p ❑ Customer Database Input/Programming ❑ p Training ❑ 2 Project Management ❑ 9 Engineering and Drawings ❑ p Record Documentation (As Builts) ❑ 0 Electrified Door Hardware ❑ 2 Door Coring/Certification/Recertification ❑ RI Servers/Workstations ❑ p POE Switches ❑ 0 Software Install on Servers/Workstation ❑ Z Installation of Wire and Cable ❑ p Installation of Cable Suspension p ❑ Regular Business Hours Installation ❑ 2 After Hours Installation (excl Sunday/Holidays) ❑ Z One Year Warranty Parts/Labor ❑ 2 Prevailing Wage Include I Exclude ❑ 9 Elevator Subcontractor ❑ O Conduit ❑ 2 JBoxes/Specialty Back Boxes ❑ 2 110/120VAC Power ❑ 2 Access Control Cards/Tags/Transponders ❑ 0 Patching and Painting ❑ Z Ceiling Tiles/Ceiling Grid Repairs ❑ 0 Vertical/Horizontal Core Drilling ❑ Z Lift Rental ❑ 2 Camera Poles ❑ R] 24 HR Central Station Monitoring ❑ Z Phone Lines ❑ Z Static IP Address ❑ 0 Network Connection ❑ p Payment Performance Bonds ❑ 0 Method B License/Permits ❑ 2 Alarm Monitoring License/Permits ❑ 2 Low Voltage License/Permits ❑ Z Fire/Life Safety Integration Date: 7/22/2025 1 Proposal #: 12106-1-0-1 1 City Wide Card Reader Upgrade `, ASSI Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID 78F723E5-lDB6-4A93-8040-BCF5F5D009B1 Proposal Acceptance: I have read the General Terms and Conditions and payment terms of the sale understand them fully and agree to abide by them I hereby certify that I am authorized by my company to sign this agreement ASSI Security is hereby authorized to perform the work as specified Accepted By: ASSI Security Accepted By: CITY OF NATIONAL CITY Name: Rudy Estopellan Name: John Saour Signature: Signature: Title: Title: Date Date: Date. 7/22/2025 1 Proposal # 12106-1-0-1 1 City Wide Card Reader Upgrade Docusign Envelope ID: D"316052E-B6G0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 CORPORATE CERTIFICATE certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that Contractor, was then who signed said contract on behalf of the of said Corporation; that said contract was duly signed for and in behalf of said Corporation by authority of its governing body and is within the scope of its corporate powers. certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that Contractor, was then who signed said contract on behalf of the of said Corporation; that said contract was duly signed for and in behalf of said Corporation by authority of its governing body and is within the scope of its corporate powers. Corporate Seal: Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 PARTNERSHIP CERTIFICATE STATE OF ss COUNTY OF On this day of , 20 before me, the undersigned, a Notary Public in and for said County and State, personally appeared: (Notary Seal) known to me to be of the partners of the partnership that executed the within instrument, and acknowledged to me that such partnership executed the same. Signature: Name (Type or Print): (Notary Public in and for said County and State) My Commission expires: Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-lDB6-4A93-8040-BCF5F5D009B1. PERFORMANCE BOND WHEREAS, the City Council of the City of National City, by Resolution No. passed the 26th day of March, 2026 has awarded to _ASSI SECURITY, hereinafter designated as the "Principal", the CIP 26-05 CITYWIDE CARD READER UPGRADE PROJECT. WHEREAS, said Principal is required under the terms of said contract to furnish a bond for the faithful performance of said contract. NOW, THEREFORE, we, the Principal and as surety, are held and firmly bound unto the City Council of the City of National City hereinafter called the "Council", in the penal sum of FORTY FOUR THOUSAND SIX HUNDRED SIXTY THREE ($44,663.00) lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT if the above bounden Principal, his/her or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions and agreements in the said contract any alteration thereof made as therein provides, on his or their part, to be kept and performed at the time and in the amount therein specified, and in all respects according to their true intent and meaning, and shall indemnify and save harmless the City of National City, the City Council, their officers, agents, and employees, as therein stipulated, then this obligation shall become null and void; otherwise it shall be and remain in full force and virtue. Docusign Envelope ID: 0316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the work to be performed herein or the specifications accompanying the same shall in any wise affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or additions to the terms of the contract or to the work or to the specifications. In the event suit is brought upon this bond by the City of National City and judgment is recovered, the surety shall pay all costs incurred by the Council in such suit, including a reasonable attorney's fee to be fixed by the Court. IN WITNESS WHEREOF three identical counterparts of this instrument, each of which shall for all purposes be deemed an original thereof, have been duly executed by the Principal and Surety above named, on the day of 20 EAL) (SEAL) EAL) (SEAL) EAL) (SEAL) Surety Principal Docusign Envelope ID: D"316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 PERFORMANCE BOND ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY STATE OF ) ss COUNTY OF On this day of , 20 , before me, the undersigned, a Notary Public in and for said County and State, personally appeared known to me to be the person whose name is subscribed to the within instrument as the attorney -in -fact of the , the corporation named as Surety in said instrument, and acknowledged to me that he subscribed the name of said corporation thereto as Surety, and his own name as attorney -in -fact. NOTE: Signature of those executing for NOTE: The Attorney -in -fact must attach a Surety must be properly certified copy of the Power of acknowledged. Attorney. Signature: Name (Type or Print): Notary Public in and for said County and State My Commission expires: Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 PAYMENT BOND WHEREAS, the City Council of the City of National City, by Resolution No. passed the 2611 day of March, 2026, has awarded ASSI SECURITY, hereinafter designated as the "Principal", the CIP 26-05 CITYWIDE CARD READER UPGRADE PROJECT. WHEREAS, said Principal is required by Chapter 5 (commencing at Section 3225) and Chapter 7 (commencing at Section 3247), Title 15, Part 4, Division 3 of the California Civil Code to furnish a bond in connection with said contract; NOW, THEREFORE, we, the Principal and as surety, are held and firmly bound unto the City Council of the City of National City, hereinafter called the "Council", in the penal sum of FORTY FOUR THOUSAND SIX HUNDRED SIXTY THREE ($44,663.00) lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if said Principal, his/her or its subcontractors, heirs, executors, administrators, successors, or assigns, shall fail to pay any of the persons named in Section 3181 of the California Civil Code, or amounts due under the Unemployment Insurance Code with respect to work or labor performed by any such claimant, or for any amounts required to be deducted, withheld, and paid over to the Franchise Tax Board from the wages of employees of the Contractor and his subcontractors pursuant to Section 18806 of the Revenue and Taxation Code, with respect to such work and labor the Surety will pay for the same in an amount not exceeding the sum hereinafter specified, and also, in case suit is brought upon this bond, a reasonable attorney's fee, to be fixed by the Court. This Bond shall inure to the benefit of any of the persons named in Section 3181 of the California Civil Code, so as to give a right of action to such persons or their assigns in any suit brought upon this bond. Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 It is further stipulated and agreed that the Surety on this bond shall not be exonerated or released from the obligation of this bond by any change, extension of time for performance, addition, alteration or modification in, to, or of any contract, plans, specifications, or agreement pertaining or relating to any scheme or work of improvement hereinabove described or pertaining or relating to the furnishing of labor, materials, or equipment therefore, not by any change or modification of any terms of payment or extension of the time for any payment pertaining or relating to any scheme or work of improvement hereinabove described, nor by any rescission or attempted rescission of the contract, agreement or bond, nor by any conditions precedent or subsequent in the bond attempting to limit the right of recovery of claimants otherwise entitled to recover under any such contract or agreement or under the bond, nor by any fraud practiced by any person other than the claimant seeking to recover on the bond and that this bond be construed most strongly against the Surety and in favor of all persons for whose benefit such bond is given, and under no circumstances shall Surety be released from liability to those for whose benefit such bond has been given, by reason of any breach of contract between the owner of Public Entity and original contractor or on the part of any obliges named in such bond, but the sole conditions of recovery shall be that claimant is a person described in Section 3110 or 3112 of the California Civil Code, and has not been paid the full amount of his claim and that Surety does hereby waive notice of any such change, extension of time, addition, alteration or modification herein mentioned. IN WITNESS WHEREOF three identical counterparts of this instrument, each of which shall for all purposes be deemed an original thereof, have been duly executed by the Principal and Surety above named, on the day of , 20 (SEAL) (SEAL) (SEAL) (SEAL) (SEAL) (SEAL) Surety Principal Docusign Envelope ID: D316C52E-B6C0-467F-BE64-7508345C6833 Docusign Envelope ID: 78F723E5-1DB6-4A93-8040-BCF5F5D009B1 ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY STATE OF ) ss COUNTY OF On this day of , 20 before me, the undersigned, a Notary Public in and for said County and State, personally appeared known to me to be the person whose name is subscribed to the within instrument as the attorney -in -fact of the , the corporation named as Surety in said instrument, and acknowledged to me that he subscribed the name of said corporation thereto as Surety, and his own name as attorney -in -fact. NOTE: Signature of those executing for NOTE: The Attorney -in -fact must attach a Surety must be properly certified copy of the Power of acknowledged. Attorney. Signature: Name (Type or Print): (Notary Public in and for said County and State) My Commission expires: ATTACH ALL BONDS