HomeMy WebLinkAboutCC AG PKT 2009-11-09 #QAGENDA STAFF REPORT
DATE: November 9, 2009
TO: Honorable Mayor and City Council
THRU: David Carmany, City Manager
FROM: Vince Mastrosimone, Director of Public Works
SUBJECT: APPROVE PLANS AND SPECIFICATIONS AND
AWARD A CONTRACT FOR THE ELECTRIC AVENUE
STORM DRAIN IMPROVEMENTS PROJECT NO
SD1001
SUMMARY OF REQUEST:
The City Council is asked to adopt Resolution No. 5942 approving the plans and
specifications and awarding a contract for the Electric Avenue Storm Drain
Improvements Project No SD1001 to Palp, Inc. DBA Excel Paving Company in
the amount of $1,653,458.00 and authorize the City Manager to execute the
contract.
BACKGROUND:
Per the 1999 adopted Storm Drain Master Plan and the Ad -Hoc Street & Storm
Drain Committee, 2 areas were identified as high priority areas that require
immediate storm drain improvement. They are Electric and Candleberry
Avenues.
Construction on the Candleberry Avenue Storm Drain Project is ongoing and is
expected to be complete by the end of Fall 2009.
The scope of work for this project includes storm drain and water utility
construction consisting of the installation of reinforced concrete pipes and boxes,
catch basins with debris filters, manholes, junction structures, ductile iron pipe
and water valves.
Engineering staff prepared a full bid package, advertised and solicited bids for
the Electric Avenue Storm Drain Improvements Project No. SD1001.
On October 27, 2009 the City Clerk's office received and opened 15 sealed bids
with the following results:
Agenda Item Q
Page 2
#
COMPANY NAME
BID AMOUNT
1
Palp Inc, dbe Excel Paving Company
$1,653,458
2
KZC Construction Inc.
$1,722,790
3
Boudreau Pipeline
$1,794,177
4
Garcia Juerez
$1,838,275
5
Steve Bubalo Construction
$1,895,901
6
Mike Bubalo Construction
$1,927,825
7
Southern California Pipeline Construction, Inc.
$1,963,270
8
MMC, Inc.
$2,008,810
9
Papac
$2,157,185
10
Sully Miller Contracting Company
$2,166,873
11
Vasilj, Inc.
$2,266,255
12
Cedro Construction
$2,285,895
13
Miramontes Construction Co.
$2,504,500
14
Kennedy Pipeline
$2,846,683
15
Blois Construction
$3,158,148
Based upon the references, qualifications, work experience and cost of the low
bidder, Palp, Inc. DBA Excel Paving Company, staff has found them to be
satisfactory for the improvements required for this project and recommends
awarding a construction contract amount of $1,653,458.00.
FINANCIAL IMPACT:
In the 09/10 Budget, $4,591,000 is available for various storm drain projects.
Currently in construction is the Candleberry Avenue Strom Drain Project. Staff
estimates $1,400,000 is required to complete the project which leaves a
remaining balance of $3,191,000. The cost for the Electric Avenue Storm Drain
Project is $1,653,458.
09/10 Budget $4,591,000
Candleberry Project - ($ 1,400,000)
Balance $3,191,000
Electric Project $1,653,458
Inspection (5 %) +$82,500
Contingency (10 %) +$165.000
Project Total $1,900,958
Balance
$1,290,042
The estimated remaining balance after the Electric Avenue Project is $1,290,042.
Page 3
RECOMMENDATION:
It is recommended that City Council adopt Resolution No. 5942 approving the
plans and specifications and awarding a contract for the Electric Avenue Storm
Drain Improvements Project No SD1001 to Palp, Inc. DBA Excel Paving
Company in the amount of $1,653,458 and authorize the City Manager to
execute the contract.
SUBM TT D B
Vince Mastrosimone
Director of Public Works
NOTED AND APPROVED:
David Carmany, City Manager
Attachments:
A. Resolution No. 5942
B. Signed Contract
RESOLUTION NUMBER 5942
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SEAL
BEACH, CALIFORNIA AWARDING THE BID FOR THE
ELECTRIC AVENUE STORM DRAIN IMPROVEMENTS
PROJECT NO. SDI 001
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF SEAL BEACH
DOES HEREBY RESOLVE:
Section 1. The City Council hereby approves the contract between the City of
Seal Beach and Palp, Inc. DBA Excel Paving Company for the Electric Avenue
Storm Drain Improvements Project No. SD1001, and ,
Section 2. The Council hereby directs the City Manager to execute the contract
for the Electric Avenue Storm Drain Improvements Project No SD1001.
PASSED, APPROVED AND ADOPTED by the City Council of Seal Beach, at a
regular meeting held on the 9th day of November , 2009 by the following
vote:
AYES: Council Members
NOES: Council Members
ABSENT: Council Members
ABSTAIN: Council Members
Mayor
ATTEST:
City Clerk
STATE OF CALIFORNIA )
COUNTY OF ORANGE } SS
CITY OF SEAL BEACH }
I, Linda Devine, City Clerk of the City of Seal Beach, do hereby certify that the
foregoing resolution is the original copy of Resolution Number 5942 on file in
the office of the City Clerk, passed, approved, and adopted by the City Council at
a regular meeting held on the 9th day of November , 2009.
City Clerk
AN AGREEMENT
FOR ELECTRIC AVENUE STORM DRAIN
IMPROVEMENTS
Project No. SD1001
between
City of Seal Beach
211 - 8th Street
Seal Beach, CA 90740
-
Palp, Inc. DBA Excel Paving Company
2230 Lemon Avenue
Long Beach, CA 90806
(562) 599 -5841
This Agreement is made and entered into this 9 1h day of November 2009 by and
between the City of Seal Beach, a California charter city ( "City "), and Palp, Inc. DBS
Excel Paving Company, a Corporation ( "Contractor ").
RECITALS
A. WHEREAS, the City Council has approved the plans and specifications for the
Electric Avenue Storm Drain Improvements Project No SD1001 ( "Project ") with respect to
design criteria; and
B. WHEREAS, Contractor has submitted a bid to City for the Project dated October
27, 2009 in the amount of $1,653,458.00 ( "Accepted Proposal" hereinafter). The Accepted
Proposal is attached hereto as Exhibit G and contains, among other things, provisions defining
the Project scope. ,
NOW, THEREFORE, in consideration of performance by the parties of the mutual
promises, covenants, and conditions herein contained, the parties hereto agree as follows:
AGREEMENT
1.0 Contractor's Services.
1.1 Scope and Level of Services For and in consideration of the mutual
promises set forth herein, and subject to the terms and conditions set forth in this Agreement,
Contractor shall perform and complete in good and workmanlike manner all work ( "Work ")
required by this Agreement and the documents listed in Subsection 1.2 for the Project.
1.2 Contract Documents The "Contract Documents" that comprise the
agreement between the City and the Contractor are the: Notice Inviting Bids, Instructions to
Bidders, Accepted Proposal, Non - Collusion Affidavit, Bid Schedule(s), List of Subcontractors,
Contractor's Industrial Safety Record, Contractor's Qualification Statement, Bid Security Forms
for Check or Bond, Specifications, General and Special Provisions and documents referenced
therein, all addenda as prepared prior to the date of bid opening setting forth any modifications
or interpretations of any of said documents, this Agreement, Exhibits attached to this Agreement,
including but not limited to the Performance Bond (Exhibit A), Payment Bond (Exhibit B),
Worker's Compensation Insurance Certificate (Exhibit C), Insurance Endorsements (Exhibit D),
Acknowledgment of Penal and Civil Penalties Concerning Contractor Licensing Laws (Exhibit
E), Labor Law Requirements (Exhibit F), Accepted Proposal (Exhibit G) and any and all
supplemental agreements executed amending or extending the work contemplated and that may
be required to complete the work in a substantial and acceptable manner. These Contract
Documents are hereby incorporated into this Agreement.
1.3 The Work shall be performed in accordance with the Plans, Specifications
and other Contract Documents. Contractor shall furnish at its own expense all labor, materials,
equipment and services necessary therefore, except such labor, materials, equipment and services
as are specified in the Contract Documents to be furnished by City.
1.4 In the event of any material discrepancy between the express provisions of
this Agreement and the provisions of the other Contract Documents, the provisions of this
Agreement shall prevail.
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2.0 Effective Date This Agreement is effective as of October 26, 2009 (the
"Effective Date "), and shall remain in full force and effect until Contractor has rendered the
services required by this Agreement.
3.0 Payment. For performing and completing the work in accordance with the
Contract Documents, City shall pay Contractor, in full compensation therefor, the amount of
$1,653,458.00, subject to any additions and deletions pursuant to the terms of the Contract
Documents. Said sum shall constitute payment in full for all work performed hereunder,
including, without limitation, all labor, materials, equipment, tools and services used or
incorporated in the work, supervision, administration, overhead, expenses and any and all other
things required, furnished or incurred for completion of the work as specified in the Contract
Documents. City shall make payments to Contractor on account of the contract sum at the time,
in the manner, and upon the conditions specified in the Contract Documents.
4.0 Contractor's Personnel
4.1 All Work shall be performed by Contractor or under Contractor's direct
supervision, and all personnel shall possess the qualifications, permits, and licenses required by
State and local law and by the Notice Inviting Bids /Instructions to Bidders to perform such
Services, including, without limitation, a City of Seal Beach business license as required by the
Seal Beach Municipal Code.
4.2 Contractor shall be responsible for payment of all employees' wages and
benefits, and shall comply with all requirements pertaining to employer's liability, workers'
compensation, unemployment insurance, and Social Security. Contractor shall fully comply with
the workers' compensation law regarding Contractor and Contractor's employees.
4.3 Contractor shall indemnify and hold harmless City and its elected
officials, officers and employees, servants, designated volunteers, and agents serving as
independent contractors in the role of city officials, from any and all liabilities, damages, claims,
costs and expenses of any nature to the extent arising from Contractor's alleged violations of
personnel practices.
4.4 Contractor is, and shall at all times remain as to City, a wholly
independent contractor. Contractor shall have no power to incur any debt, obligation, or liability
on behalf of City or otherwise act as an agent of City. Neither City nor any of its agents shall
have control over the conduct of Contractor or any of Contractor's employees, except as set forth
in this Agreement. Contractor shall not, at any time, or in any manner, represent that it or any of
its officers, agents, or employees are in any manner employees of City. Contractor shall pay all
required taxes on amounts paid to Contractor under this Agreement, and indemnify and hold City
harmless from any and all taxes, assessments, penalties, and interest asserted against City by
reason of the work performed pursuant to this Agreement.
4.5 City shall have the right to offset against the amount of any fees due to
Contractor under this Agreement any amount due to City from Contractor as a result of
Contractor's failure to promptly pay to City any reimbursement or indemnification arising under
this Section 4.
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5.0 Indemnification
5.1 Contractor's Duty Contractor shall indemnify and hold the City, its
elected officials, officers, employees, volunteers, agents, and those City agents serving as
independent contractors in the role of City officials (collectively "Indemnitees ") free and
harmless from and against any and all claims (including, without limitation, claims for bodily
injury, death or damage to property), demands, obligations, damages, actions, causes of action,
suits, losses, bid protests, stop notices, judgments, fines, penalties, liabilities, costs and expenses
(including, without limitation, attorney's fees, disbursements and court costs) of every kind and
nature whatsoever (individually, a "Claim;" collectively, "Claims "), in any manner arising out of
or incident to the performance of the Agreement, including without limitation the payment of all
consequential damages and attorneys fees and other related costs and expenses. Further,
Contractor shall appoint competent defense counsel, at Contractor's own cost, expense and risk,
to defend any and all such suits, actions or other legal proceedings of every kind arising out of or
incident to the performance of the Agreement that may be brought or instituted against
Indemnitees. Contractor shall pay and satisfy any judgment, award or decree that may be
rendered against City or the other Indemnitees in any such suit, action, or other legal proceeding
arising out of or incident to the performance of the Agreement. Contractor shall reimburse the
City and the other Indemnitees, for any and all legal expenses and costs incurred by each of them
in connection therewith or in enforcing the indemnity herein provided. Contractor's obligation
to indemnify shall not be restricted to insurance proceeds, if any, received by Contractor or
Indemnitees. This indemnity shall apply to all Claims and liability regardless of whether any
insurance policies are applicable.
5.2 Bid Protests In addition to its obligations pursuant to Section 5.1,
Contractor shall reimburse the City for all attorney fees and costs incurred by City in connection
with, arising out of or incident to any bid protest.
5.3 City's Sole Negligence Nothing in Section 5.1 shall be construed to
require Contractor to indemnify Indemnities for that portion of any Claim to the extent arising
from the sole negligence or willful misconduct of the Indemnities.
5.4 Nonwaiver of Rights Indemnitees do not, and shall not, waive any rights
that they may possess against Contractor because of the acceptance by City, or the deposit with
City, of any insurance policy or certificate required pursuant to this Agreement.
5.5 Waiver of Right of Subrogation Contractor, on behalf of itself and all
parties claiming under or through it, hereby waives all rights of subrogation against the
Indemnitees, while acting within the scope of their duties, from all claims, losses, and liabilities
arising out of or incident to activities or operations performed by or on behalf of the Indemnitor.
5.6 Survival The provisions of this Section 5 shall survive the termination of
the Agreement and are in addition to any other rights or remedies that Indemnitees may have
under the law. Payment is not required as a condition precedent to an Indemnitee's right to
recover under this indemnity provision, and an entry of judgment against an Contractor shall be
conclusive in favor of the Indemnitee's right to recover under this indemnity provision.
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6.0 Insurance
6.1 Liability Insurance Contractor shall procure and maintain in full force
and effect for the duration of this Agreement insurance against claims for injuries to persons or
damages to property and professional negligence which may arise from or in connection with the
performance of the services hereunder by Contractor, and its agents, representatives, employees
and subconsultants. The policy limits set forth below do not act as a limitation upon the amount
of indemnification to be provided by Contractor. Contractor shall complete and execute the
following documents attached as Exhibits hereto and incorporated herein by this reference:
6.1.1 Exhibit D -1: Additional Insured Endorsement - Commercial
General Liability
6.1.2 Exhibit D -2: Additional Insured Endorsement - Automobile
Liability
6.1.3 Exhibit D -3: Additional Insured Endorsement
6.2 Minimum Scope of Insurance Unless otherwise approved by City,
coverage shall be at least as broad as:
6.2.1 Insurance Services Office Commercial General Liability coverage
(occurrence form CG 0001).
6.2.2 Insurance Services Office form number CA 0001 (Ed. 1/87)
covering Automobile Liability, code 1 (any auto).
6.2.3 Insurance Services Office form number CG 20 10 11 85 (Ed.
11/85) covering Additional Insured — Owners, Lessees or Contactors (Form B).
6.2.4 Worker's Compensation insurance as required by the State of
California and Employer's Liability Insurance.
6.2.5 Professional Liability insurance. Contractor shall provide to City
the standard form issued by the carrier.
6.3 Minimum Limits of Insurance Contractor shall maintain limits no less
than:
6.3.1 General Liability: $2,000,000 per occurrence and in the aggregate
for bodily injury, personal injury and property damage. Commercial General Liability Insurance
or other form with a general aggregate limit shall apply separately to this Agreement or the
general limit shall be twice the required occurrence limit.
6.3.2 Automobile Liability: $2,000,000 per occurrence for bodily injury
and property damage.
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6.3.3 Employer's Liability: $1,000,000 per occurrence and in the
aggregate for bodily injury or disease and Workers' Compensation Insurance in the amount
required by law.
6.4 Deductibles and Self - Insured Retentions Contractor shall inform City of
any deductibles or self - insured retentions except with respect to any professional liability
insurance.
6.5 Other Insurance Provisions The general liability and automobile liability
policies are to contain, or be endorsed to contain, the following provisions:
6.5.1 City, its officers, officials, employees, designated volunteers and
agents serving as independent contractors in the role of city or agency officials, are to be covered
as additional insureds as respects: liability arising out of activities performed by or on behalf of
Contractor; products and completed operations of Contractor; premises owned, occupied or used
by Contractor; or automobiles owned, leased, hired or borrowed by Contractor. The coverage
shall contain no limitations on the scope of protection afforded to City, its officers, officials,
employees, designated volunteers or agents serving as independent contractors in the role of city
or agency officials which are not also limitations applicable to the named insured.
6.5.2 For any claims related to this Agreement, Contractor's insurance
coverage shall be primary insurance as respects City, its officers, officials, employees,
designated volunteers and agents serving as independent contractors in the role of city or agency
officials. Any insurance or self - insurance maintained by City, their officers, officials,
employees, designated volunteers or agents serving as independent contractors in the role of city
or agency officials shall be excess of Contractor's insurance and shall not contribute with it.
6.5.3 Contractor's insurance shall apply separately to each insured
against whom claim is made or suit is brought, except with respect to the limits of the insurer's
liability.
6.5.4 Each insurance policy required by this clause shall be endorsed to
state that coverage shall not be canceled or materially modified except after 30 days prior written
notice by first class mail has been given to City.
6.5.5 Each insurance policy, except for any professional liability policy,
required by this clause shall expressly waive the insurer's right of subrogation against City and
its elected officials, officers, employees, servants, attorneys, designated volunteers, and agents
serving as independent contractors in the role of city or agency officials.
6.6 Acceptability of Insurers Insurance is to be placed with insurers with a
current A.M. Best's rating of no less than ANII unless waived in writing by City's Risk
Manager.
6.7 Verification of Coverage All insurance coverages shall be confirmed by
execution of endorsements on forms approved by the City. The endorsements are to be signed
by a person authorized by that insurer to bind coverage on its behalf. All endorsements are to be
received and approved by City before services commence. As an alternative to City forms,
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Contractor's insurer may provide complete, certified copies of all required insurance policies,
including endorsements effecting the coverage required by these specifications.
7.0 Liquidated Damages Should the Contractor fail to complete the project, or any
part thereof, in the time agreed upon in the Contract, the Contractor shall reimburse the City for
the additional expense and damage for each calendar day that the Contract remains uncompleted
after the Contract completion date. It is agreed that the amount of such additional expense and
damage incurred by reason of failure to complete the Contract is the per diem rate $750 per
calendar day. Such amount is hereby agreed upon as liquidated damages for the loss to the City
resulting from the failure of the Contractor to complete the project within the allotted time and to
the value of the operation of the works dependent thereon. It is expressly understood and agreed
that this amount is a reasonable amount and is established in lieu of damages that are incapable
of calculation at the inception hereof, and this amount is not to be considered in the nature of a
penalty. The City shall have the right to deduct such damages from any amount due, or that may
become due to the Contractor, or the amount of such damages shall be due and collectible from
the Contractor or the Contractor's Surety. Progress payments made after the scheduled
completion date shall not constitute a waiver of liquidated damages.
8.0 Suspension City may, in writing, order Contractor to suspend all or any part of
the Contractor's Services for the convenience of City or for work stoppages beyond the control
of City or Contractor. A suspension of the Services does not void this Agreement.
9.0 Notices Any notices, bills, invoices, or reports authorized or required by this
Agreement shall be in writing and shall be deemed received on (a) the day of delivery if
delivered by hand or overnight courier service during Contractor's and City's regular business
hours or by facsimile before or during Contractor's regular business hours; or (b) on the third
business day following deposit in the United States mail, postage prepaid, to the addresses
heretofore set forth in the Agreement, or to such other addresses as the parties may, from time to
time, designate in writing pursuant to the provisions of this Section. All notices shall be
addressed as follows:
If to City: City of Seal Beach - City Clerk
211 8th Street
Seal Beach, California 90740
Telephone: (562) 431 -2527
Fax: (562) 493 -9857
With a copy to: Public Works Director
City of Seal Beach
211 8th Street
Seal Beach, California 90740
If to Contractor: Palp, Inc. DBA Excel Paving Company
2230 Lemon Avenue
Long Beach, CA 90806
Telephone: (562) 599 -5841
Fax: (562) 591 -7485
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10.0 Non - Assignability; Subcontracting Contractor shall not assign, transfer, or
subcontract any interest in this Agreement or the performance of any of Contractor's obligations
hereunder. Any attempt by Contractor to so assign, transfer, or subcontract any rights, duties, or
obligations arising hereunder shall be null, void and of no effect.
11.0 Compliance with Laws Contractor shall comply with all applicable federal,
state and local laws, ordinances, codes and regulations in force at the time Contractor performs
the Services.
12.0 Non - Waiver of Terms, Rights and Remedies Waiver by either party of any
one or more of the conditions of performance under this Agreement shall not be a waiver of any
other condition of performance under this Agreement. In no event shall the making by City of
any payment to Contractor constitute or be construed as a waiver by City of any breach of
covenant, or any default which may then exist on the part of Contractor, and the making of any
such payment by City shall in no way impair or prejudice any right or remedy available to City
with regard to such breach or default.
13.0 Attorneys' Fees In the event that either party to this Agreement shall commence
any legal action or proceeding to enforce or interpret the provisions of this Agreement, the
prevailing party in such action or proceeding shall be entitled to recover its costs of suit,
including all attorneys' fees incurred in connection therewith.
14.0 Construction The validity, interpretation, and performance of this Agreement
shall be controlled by and construed under the laws of the State of California. In the event of any
asserted ambiguity in, or dispute regarding the interpretation of any matter herein, the
interpretation of this Agreement shall not be resolved by any rules of interpretation providing for
interpretation against the party who causes the uncertainty to exist or against the party who
drafted the Agreement or who drafted that portion of the Agreement.
15.0 Entire Agreement This Agreement, including any other documents
incorporated herein by specific reference, represents the entire and integrated agreement between
Contractor and City. This Agreement supersedes all prior oral or written negotiations,
representations, or agreements. This Agreement may not be amended, nor any provision or
breach hereof waived, except in a writing signed by the parties which expressly refers to this
Agreement.
(Intentionally Left Blank)
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IN WITNESS WHEREOF, the parties, through their respective authorized
representatives, have executed this Agreement as of the date first written above.
CITY OF SEAL BEACH
CONTRACTOR:
By:
LIM
David N. Carmany, City Manager
Attest:
Linda Devine, City Clerk
Approved as to Form:
Quinn M. Barrow, City Attorney
Name
Title
r`
B. F - C", j 04 CA—/
Name: WHELE E. DRAKULICK
Title: W. SECRETAR
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CALIFORNIA ALL - PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County of LOS ANGELE
On /O — R'J `0`7 before me, MONA COVINGTON, NOTARY PUBLIC ,
(Here insert name and title of the officer)
personally appeared C. P. BROWN
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /ar-e subscribed to
the within instrument and acknowledged to me that he/sheAhey executed the same in his/her / thcir 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.
Signature of Notary Public
=WW"ARYPUBLIC GTON
405
IWPORNW NTY 27, 2012
(Notary Seal)
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
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2008 Version CAPA v12.10.07 800 -873 -9865 www.NotaryClasses.com
CALIFORNIA ALL - PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County of LOS ANGELES
On 'fi`:Z '— (n>9 before me, MONA COVINGTON, NOTARY PUBLIC
(Here insert name and title of the officer)
personally appeared MICHELE E. DRAKULICH
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /are subscribed to
the within instrument and acknowledged to me that he/sheAhey. executed the same in his/her /their authorized
capacity(ies), and that by hk/her /dwir 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.
J
Signature of Notary Public
MONA COVINGTON
COMM. 01798405
j NOTARY PUttlllc • CAIRORM
(Notary seep ORANGE COUNTY
Comm. Exp. MAY 27, 2012
ADDITIONAL OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
(Tide or description of attached document)
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Number of Pages Document Date
(Additional information)
CAPACITY CLAIMED BY THE SIGNER
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Corporate Officer
(Tide)
❑
Partner(s)
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Attorney -in -Fact
❑
Trustee(s)
❑
Other
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in California must contain verbiage exactly as
appears above in the rotary section or a separate acknowledgment form must be
properly completed and attached to that document. The only exception is if a
document is to be recorded outside of California In such instances, any alternattve
acknowledgment verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that is illegal for a notary in
California (i.e. certifying the authorized capacity of the signer). Please check the
document carefully for proper notarial wording and attach this form if required
• State and County 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
must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
• Indicate the correct singular or plural forms by crossing off incorrect forts (i.e.
4Wshe/tw) ;- is /aFe ) or circling the correct fortes. Failure to correctly indicate this
information may lead to rejection of document recording.
• The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges, re -seal if a
sufficient area permits, otherwise complete a different acknowledgment form.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
O Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type of attached document, number of pages and date.
e Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
• Securely attach this document to the signed document
2008 Version CAPA v12.1007 800- 873 -9865 www NotaryClasses.com