HomeMy WebLinkAboutResolution - RDA 10-02 STATE OF CALIFORNIA ) RESOLUTION NO. RDA 10-02
COUNTY OF RIVERSIDE)ss
CITY OF SAN JACINTO )
A RESOLUTION OF THE CITY OF SAN JACINTO
REDEVELOPMENT AGENCY APPROVING THE
OPERATING COVENANT AGREEMENT WITH MSRE
INC. FOR THE ACQUISITION OF COVENANTS
RUNNING WITH THE LAND FOR THE PROPERTY
LOCATED AT 288 E. MAIN STREET, SAN JACINTO,
CALIFORNIA
WHEREAS, pursuant to the California Community Redevelopment Law (Health &
Safety Code Sections 33000, et seq.) ("CRL"), the City Council of the City of San Jacinto
("City") approved and adopted a redevelopment plan ("Redevelopment Plan") for the
redevelopment project area known as the San Jacinto Redevelopment Project Area ("Project
Area"); and
WHEREAS, the Governing Board ("Board") of the San Jacinto Redevelopment Agency
of the City of San Jacinto ("Agency") is engaged in activities to implement the Redevelopment
Plan for the Project Area pursuant to the provisions of the CRL; and
WHEREAS, MSRE Inc., a California limited liability company, is the fee owner of
certain real property generally located at 288 E. Main Street ("Owner") within the Project Area
("Property"), and further described in the Operating Covenant Agreement attached hereto as
Exhibit"A" and incorporated herein by reference; and
WHEREAS, the Owner has acquired the Property to facilitate and operate a realty and
the Owner now desires to sell interests in the Property to the Agency consisting of covenants
running with the land for the Property, which are more fully set forth in the Operating Covenant
Agreement (the "Covenants") attached hereto as Exhibit"A;" and
WHEREAS, the Agency is authorized under the CRL Section 33391 to acquire real
property or an interest in real property for purposes of redevelopment; and
WHEREAS, the Agency desires to purchase the Covenants from the Owner in
accordance with the terms and conditions set forth in the Operating Covenant Agreement.
NOW, THEREFORE, BE IT RESOLVED, determined and ordered by the Governing
Board of the San Jacinto Redevelopment Agency of the City of San Jacinto as follows:
Section 1. Recitals. The above recitals are true and correct.
Section 2. Approval of Agreement. The Agency hereby authorizes the purchase of
the Covenants and approves the Operating Covenant Agreement in the form attached hereto.
Section 3. Authorization. The Agency hereby authorizes the Agency's Executive
Director (with the concurrence of Agency Counsel) to execute and deliver on behalf of the
ONTARIOIRHERMANOWICZ 310112.3
Agency the Operating Covenant Agreement and such other documents and instruments as may
be necessary or convenient in the furtherance of the actions authorized in this Resolution.
Section 4. Filing. The Agency Secretary is hereby directed to file a copy of the
executed Operating Covenant Agreement with the City Clerk at City Hall.
Section 5. Direction. The Agency staff is hereby directed to do all that is necessary
to effectuate the intent of the Operating Covenant Agreement and consummate the acquisition of
the Covenants.
Section 6. CEQA Compliance. The Agency has determined that it can be seen with
certainty that there is no possibility that the conveyance the Covenants will have a significant
adverse effect on the environment. Thus, the adoption of this Resolution is exempt from the
requirements of the California Environmental Quality Act ("CEQA") pursuant to Section
15061(b)(3) of the CEQA Guidelines. The Agency hereby directs staff to file a Notice of
Exemption with the County Clerk of Riverside County within five (5) working days following
approval of this Resolution.
Section 7. Certification. The Agency Secretary shall certify the adoption of this
Resolution.
Section 8. Effective Date. This Resolution shall become effective upon its adoption.
PASSED,APPROVED AND ADOPTED this 3'd day of June, 2010 by the following vote:
AYES: Ayres, Di Memmo, Mansperger, Potts
NAYS: None
ABSTAINED: None
ABSENT: Stubblefield
San Jacinto Redevelopment Agency
,116ve Di Memm , Vice
ATTEST:
Richard Miller, Agency Secretary
ONTARIO?RHERMANO W ICZ1310112.3 2
APPROVED AS TO LEGAL FORM:
BEST BEST & KRIEGER LLP
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ONTARIO`,RHERMANOWICZA 10112.3 3
CERTIFICATION
I, Richard Miller, Secretary of the San Jacinto Redevelopment Agency of the City of San
Jacinto, do hereby certify that the foregoing Resolution No. RDA 10-02 was introduced and
adopted by the San Jacinto Redevelopment Agency of the City of San Jacinto at a regular
meeting thereof,held on the 3rd day of June, 2010,by the following vote:
AYES: Ayres, Di Memmo, Mansperger, Potts
NAYS: None
ABSTAINED: None
ABSENT: Stubblefield
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the official seal of
the San Jacinto Redevelopment Agency of the City of San Jacinto this the 3rd day of June, 2010.
Richard Miller, Agency Secretary
San Jacinto Redevelopment Agency
(SEAL)
ONTARIO`,RHERM ANO W ICZ1310112.3 4
Exhibit"A"
Operating Covenant Agreement
[SEE ATTACHED BEHIND THIS PAGE]
7
ONTARI&RHERMANOWICZ010112.3 5
AGENDA ITEM 5.6
0 ,
RECORDING REQUESTED BY ANDL�
WHEN RECORDED MAIL TO:
San Jacinto Redevelopment Agency
595 S. San Jacinto Avenue
San Jacinto, CA 92583
ATTN: Executive Director
SPACE ABOVE THIS LINE FOR RECORDER'S USE
EXEMPT FROM RECORDING FEES PURSUANT TO GOV. CODE § 27383
OPERATING COVENANT AGREEMENT
by and between the
SAN JACINTO REDEVELOPMENT AGENCY,
a public body,corporate and politic,
and
MSRE, INC.
a California corporation
[Dated June 3,2010 for reference purposes only]
PACKET PAGE: 91
AGENDA ITEM 5.6
1. Definitions. All initially capitalized terms used in this Agreement shall have the meanings set
forth in this Section I or, if not defined in this Section 1, where such term first appears in this Agreement,
unless the context of usage clearly requires another meaning.
1.1 Agency. The San Jacinto Redevelopment Agency, a public body,corporate and politic.
1.2 Agency Counsel. The attorney for the Redevelopment Agency.
1.3 Agency Parties. Collectively,the Agency, its elected officials, employees, attorneys and
other agents.
1.4 Agency Party. Individually, the Agency, its elected officials, employees, attorneys or
other agents.
1.5 Affiliate. In reference to any Person means any other Person Controlling or Controlled
by or under common Control with the specified Person. "Affiliated" shall have the correlative meaning.
1.6 Approval. Any license, permit, approval, consent, certificate, ruling, variance,
authorization, conditional use permit, or amendment to any of the foregoing, as shall be necessary or
appropriate under any Law to develop or operate the Project.
1.7 City. The City of San Jacinto, a California municipal corporation and general law city.
1.8 Claim. Any claim, loss, cost, damage, expense, liability, lien, action, cause of action
(whether in tort, contract,under statute, at law, in equity or otherwise), charge,award, assessment, fine or
penalty of any kind (including consultant and expert fees and expenses and investigation costs of
whatever kind or nature, challenge to the Agency's authority to enter into or perform this Agreement or
approval of this Agreement in any form, if an Indemnitor improperly fails to provide a defense for an
Indemnitee,then Legal Costs of counsel retained by the Indemnitee), and any judgment.
1.9 Covenant Payment. Two thousand five hundred dollars ($2,500).
1.10 Covenant Term. The time period beginning on the Effective Date and ending three (3)
years thereafter.
1.11 Default. Defined in Section 9.
1.12 Default Interest. Interest at an annual rate equal to the lesser of: (a) eight percent(8%)
per annum; or(b)the Usury Limit.
1.13 Downtown Sign Guidelines. Article 10A of the Zoning Ordinance of the City of San
Jacinto.
1.14 Effective Date. Defined in Section 2.1.
1.15 Executive Director. The Executive Director of the Agency or his or her designee or
successor in function.
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AGENDA ITEM 5.6
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1.28 Party. Individually, Owner or the Agency, as applicable.
1.29 Person. Any association, corporation, governmental entity or agency, individual,joint
venture,joint-stock company, limited liability company, partnership,trust, unincorporated organization or
other entity of any kind.
1.30 Property. That certain real property specifically described in Exhibit A attached to this
Agreement.
1.31 Sign Regulations. Article 16 of the Zoning Ordinance of the City of San Jacinto.
1.32 Unavoidable Delay. Delay in either Party performing any obligation under this
Agreement, except payment of money except when due to one of the causes described below that
prevents or materially limits the ability to transfer funds by or between financial institutions, arising from
or on account of any cause whatsoever beyond the Party's reasonable control, including strikes, labor
troubles or other union activities, casualty, war, acts of terrorism, riots, litigation, Government action or
inaction, regional natural disasters, or inability to obtain materials. Unavoidable Delay shall not include
delay caused by a Party's financial condition, illiquidity, or insolvency.
1.33 Usury Limit. The highest rate of interest, if any, that Law allows under the
circumstances.
2. Effective Date.
2.1 Definition. This Agreement shall not become binding on either Party, unless and until
the first date on which all of the following occur, if at all (the"Effective Date"):
(a) Signature and Delivery of Agreement by Owner. Three (3) originals of this
Agreement are signed by the authorized representative(s)of Owner and delivered to the Agency; and
(b) Approval of Agreement by Agency Board. This Agreement is approved by the
Agency Board at a public meeting of the Agency Board, following all legally required notices and
hearings; and
(c) Signature and Delivery of Agreement by Agency. One (1) original of this
Agreement is signed by the authorized representative(s)of the Agency and delivered to Owner.
2.2 Failure of Conditions. If the Effective Date does not occur on or before the Outside
Effective Date, then no part of this Agreement shall become binding on or enforceable against either
Party and any prior signatures or approvals of this Agreement by either the Agency or Owner shall be
void and of no further force or effect.
3. Operating Covenants.
3.1 Operating and Use Covenant. Owner covenants to the Agency to continuously operate
(no period of inoperation of more than forty-five (45) consecutive days) the Project on the Property
throughout the entirety of the Covenant Term. Owner shall, for the entirety of the Covenant Term, at
Owner's sole cost and expense, obtain and maintain all franchises, permits, contractual arrangements,
licenses, and registrations necessary for the continuous operation of the Project in a manner consistent
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AGENDA ITEM 5.6
lien or other encumbrance against the Property in the manner provided under Civil Code Sections 2924,
2924b and 2924c in the amount as reasonably necessary to restore the Fagade Improvements and the
Property to the maintenance standard required under this Section 3.2, including attorneys' fees and costs
of the Agency associated with the abatement of the Maintenance Deficiency or removal of graffiti and the
collection of the costs of the Agency in connection with such action. For the purposes of the preceding
sentence the words "reasonable attorneys' fees and costs of the Agency" mean and refer to the salaries,
benefits and costs of the Agency General Counsel and the lawyers employed in the office of the Agency
General Counsel. Nothing in this Section 3.2 shall be deemed to preclude the Owner from making any
alteration, addition, or other change to any structure or improvement or landscaping on the Property,
provided that such changes are in compliance with the City's zoning and development regulations and
other applicable laws.
3.3 Property Taxes. Owner covenants to pay, prior to delinquency, all ad valorem real
estate taxes and assessments assessed by the Riverside County Treasurer-Tax Collector for the Project.
3.4 Covenant to Maintain Property on Tax Rolls. Owner shall assure that the entire
Property shall remain on the County of Riverside, California secured real property tax rolls so long as the
Agency is authorized to receive property taxes from the Project Area pursuant to CRL Section 33670(b).
4. Obligation to Refrain from Discrimination. The Owner covenants and agrees for itself, its
successors, its assigns and every successor-in-interest to the Property or any portion thereof, that there
shall be no discrimination against or segregation of any person, or group of persons, on account of sex,
marital status, race, color, religion, creed, national origin or ancestry in the sale, lease, sublease, transfer,
use, occupancy, tenure or enjoyment of the Property nor shall the Owner, itself or any person claiming
under or through it, establish or permit any such practice or practices of discrimination or segregation
with reference to the selection, location, number, use or occupancy of tenants, lessees, sub-tenants, sub-
lessees or vendees of the Property. Owner acknowledges and agrees for itself, its successors, its assigns
and every successor-in-interest to the Property or any portion thereof that Community Redevelopment
Law (Cal. Health and Safety Code §§ 33000 et. seq.) establishes certain policies, covenants, provisions
and obligations related to the redevelopment of property and the inclusion of certain non-discrimination
and non-segregation covenants, provisions and obligations within deeds, leases, and contracts ("Non-
discrimination Covenants"). To the extent that these Non-discrimination Covenants, as may be amended
from time to time, are applicable to this Property as a result of this Agreement, Owner covenants and
agrees for itself, its successors, its assigns and every successor-in-interest to the Property or any portion
thereof that these Non-discrimination Covenants shall be complied with to the fall extent of the law. The
covenant of this Section 4 shall run with the land of the Property in perpetuity.
5. Owner Option to Defend this Agreement. The Owner acknowledges that the Agency is a"public
entity" and/or a"public agency" as defined under applicable California law. Therefore, the Agency must
satisfy the requirements of certain California statutes relating to the actions of public entities and
redevelopment agencies, including, without limitation, CEQA. Also, as a public body, the Agency's
action in approving this Agreement may be subject to proceedings to invalidate this Agreement or
mandamus. The Owner assumes the risk of delays and damages that may result to the Owner from any
third-party legal actions related to the Agency's approval of this Agreement or the pursuit of the activities
contemplated by this Agreement, even in the event that an error, omission or abuse of discretion by the
Agency is determined to have occurred. If a third-party files a legal action regarding the Agency's
approval of this Agreement or the pursuit of the activities contemplated by this Agreement, the Agency
may terminate this Agreement on thirty (30) days written notice to the Owner of the Agency's intent to
terminate this Agreement, referencing this Section 5, without any further obligation to perform the terms
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PACKET PAGE: 97
AGENDA ITEM 5.6
any reimbursement or other compensation from the Agency for any costs incurred by Owner in
performing or preparing to perform its covenants or other obligations under this Agreement.
9. Defaults. Subject to any extensions of time provided for in this Agreement for Unavoidable
Delay, and in addition to the terms and timeframes provided for in Section 3.2, the occurrence of any of
the following events shall constitute a"Default":
9.1 Monetary Default. The failure by any Party to perform any obligation of such Party
under this Agreement for the payment of money, if such failure is not cured within fifteen (15) days after
the non-performing Party's receipt of Notice from the injured Party that such obligation was not
performed, as and when due; or
9.2 Non-Monetary Default. Except as otherwise provided for in Section 3.2, the failure by
any Party to perform any of its obligations set forth in this Agreement, other than obligations subject to
Section 9.1, if such failure is not cured within thirty(30) days after the non-performing Party's receipt of
Notice from the injured Party that such obligation was not performed, as and when due, or, if such failure
is of a nature that cannot reasonably be cured within thirty (30) days, the failure by such Party to
commence such cure within thirty (30) days after receipt of such Notice and to, thereafter, diligently
prosecute such cure to completion.
10. Agency's Remedies.
10.1 For any Default, pursue any available legal or equitable action or remedy to (i) recover
damages to the Agency arising from such Default, including, without limitation, to collect any amount of
money due to the Agency from Owner, or (ii) preclude a breach of this Agreement or compel Owner to
perform in accordance with the requirements of this Agreement, following the notice and opportunity to
cure provided herein; and
10.2 For any Default, off-set any amount of money due to the Agency from Owner, following
the notice and opportunity to cure provided herein, as applicable, against any Covenant Payment(s)due or
becoming due to Owner; and
10.3 For any Default of an obligation arising under any of Section 3, suspend any Covenant
Payments due hereunder during any period during which such a Default exists. Additionally, Agency
may, at its option, elect to immediately terminate this Agreement and all of its obligations hereunder,
including any obligations concerning unaccrued and suspended Covenant Payments, without cost,
expense or liability; and
10.4 For any Default of an obligation arising under Section 3 that remains uncured as provided
herein, if Agency terminates this Agreement Agency shall be entitled to recover the prorated amount of
the Covenant Payment for the remainder of the Covenant Term. If the Agency does not terminate the
Agreement,Agency shall be entitled to recover the prorated rate amount of the Covenant Payment for the
period of the uncured Default; and
10.5 For any Default which consists of the failure by Owner to complete all material elements
of the Project, immediately terminate this Agreement and all of the Agency's obligations hereunder,
including any obligations concerning unaccrued and suspended Covenant Payments, without cost,
expense or liability.
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AGENDA ITEM 5.6
Executive Director has the authority to approve or consent to those matters in this Agreement requiring
the Agency's approval or consent and to make all other decisions on behalf of the Agency, subject to the
Executive Director's retained and reserved sole and absolute discretion to seek Agency Board approval of
any such matter.
14. Governing Law, Jurisdiction, Venue. This Agreement shall be deemed to have been made in the
State of California, and the validity of this Agreement, its construction, interpretation, and enforcement,
and the Parties' rights hereunder and concerning the Property, shall be decided under, governed by, and
construed in accordance with the laws of the State of California. The Parties agree that all actions or
proceedings arising in connection with this Agreement shall be tried and litigated only in the state courts
located in the County of Riverside, State of California, or the United States District Court with
jurisdiction in the County of Riverside, State of California. Owner waives any right Owner may have to
assert the doctrine of forum non conveniens or to object to such venue.
15. ' Rights and Remedies are Cumulative. Except as otherwise expressly stated in this Agreement,
the rights and remedies of the Parties under this Agreement are cumulative and the exercise by any Party
of one or more of such rights or remedies shall not preclude the exercise by it, at the same or different
times, of any other rights or remedies for the same default or any other default by another Party.
16. No Effect on Agency's Authority. Nothing in this Agreement shall limit or restrict the authority
of the Agency Board to take any other actions with respect to the Project or Property or Owner without
notice to or consent from Owner, except as may otherwise be expressly provided by applicable Law. The
approval of this Agreement by the Agency shall not be binding on the Agency Board, or any other
commission, committee, board or body of the Agency regarding any Approvals regarding the Property or
Project required by such bodies. No action by the Agency with reference to this Agreement or any related
documents shall be deemed to constitute issuance or waiver of any required Agency Approval regarding
the Property or Project.
17. Non-liability of Agency Officials and Employees. No elected official, officer, contractor,
consultant, attorney, employee or agent of the Agency shall be personally liable to Owner, any voluntary
or involuntary successor or assign of Owner, or any lender or other Person holding an interest in Owner,
in the event of any Default or breach of this Agreement by the Agency, or for any amount that may be or
become due to Owner or its successors or assigns under this Agreement, or on any obligations arising
under this Agreement. No shareholder, member, partner, principal, officer, attorney, employee or agent
of Owner shall be personally liable to the Agency, any voluntary or involuntary successor or assign of the
Agency, in the event of any Default or breach of this Agreement by Owner, or for any amount that may
be or become due to the Agency or its successors or assigns under this Agreement, or on any obligations
arising under this Agreement.
18. Notices.
18.1 Delivery. Any and all Notices submitted by either Party to the other Party pursuant to or
as required by this Agreement shall be in writing and addressed to the Agency or Owner (and their
designated copy recipients) as set forth in Section 18.2. Notices (including any required copies) shall be
delivered personally, by Federal Express, United Parcel Service or other nationally recognized overnight
(one-night) courier service or by registered or certified United States mail, return receipt requested and
postage prepaid, to the addresses set forth in Section 18.2, in which case they shall be deemed delivered
on the date of delivery (or when delivery has been attempted twice, as evidenced by the written report of
the courier service)to such address(es) or on the fourth(4'") day following deposit with the United States
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AGENDA ITEM 5.6
understanding or agreements between the Parties with respect to all or any part of the subject matter of
this Agreement.
23. Severability. If any term or provision of this Agreement or its application to any Person or
circumstance shall to any extent be invalid or unenforceable,then the remainder of this Agreement or the
application of such term or provision to Persons or circumstances, except those as to which it is invalid or
unenforceable, shall not be affected by such invalidity. All remaining provisions of this Agreement shall
be valid and be enforced to the fullest extent Law allows.
24. No Waiver. Failure by a Party to insist on any one occasion upon strict compliance with any of
the terms, covenants or conditions of this Agreement shall not be deemed a waiver of such term, covenant
or condition, nor shall any waiver or relinquishment of any rights or powers under this Agreement at any
one time or more times be deemed a waiver or relinquishment of such right or power at any other time or
times.
25. Time is of the Essence. Time is of the essence in the performance of the Parties' obligations
under this Agreement.
26. Unavoidable Delav: Extension of Time of Performance.
26.1 Notice. Performance by either Party under this Agreement shall not be deemed, or
considered to be in Default, where any such Default is due to an Unavoidable Delay. Any Party claiming
Unavoidable Delay shall Notify the other Party: (a) within ten (10) days after such Party knows of any
such Unavoidable Delay;and(b)within five(5)days after such Unavoidable Delay ceases to exist. To be
effective, any Notice of an Unavoidable Delay must describe the Unavoidable Delay in reasonable detail.
The extension of time for an Unavoidable Delay shall commence on the date of the occurrence of the
Unavoidable Delay and shall continue until the end of the condition causing the Unavoidable Delay. The
Party seeking to be excused from performance shall exercise its best efforts to cure the condition causing
the Unavoidable Delay, within a reasonable time.
26.2 Assumption of Economic Risks. ANYTHING IN THIS AGREEMENT TO THE
CONTRARY NOTWITHSTANDING, THE PARTIES EXPRESSLY ASSUME THE RISK OF
UNFORESEEABLE CHANGES IN ECONOMIC CIRCUMSTANCES OR MARKET
DEMAND/CONDITIONS AND WAIVE, TO THE GREATEST LEGAL EXTENT, ANY DEFENSE,
CLAIM, OR CAUSE OF ACTION BASED IN WHOLE OR IN PART ON ECONOMIC NECESSITY,
IMPRACTICABILITY, CHANGED ECONOMIC CIRCUMSTANCES, FRUSTRATION OF
PURPOSE, OR SIMILAR THEORIES. EACH PARTY AGREES THAT ADVERSE CHANGES IN
ECONOMIC CONDITIONS, EITHER OF SUCH PARTY SPECIFICALLY OR THE ECONOMY
GENERALLY, OR CHANGES IN MARKET CONDITIONS OR DEMANDS, SHALL NOT
OPERATE TO EXCUSE OR DELAY THE STRICT OBSERVANCE OF EACH AND EVERY OF THE
OBLIGATIONS, COVENANTS, CONDITIONS AND REQUIREMENTS OF THIS AGREEMENT.
THE PARTIES EXPRESSLY ASSUME THE RISK OF SUCH ADVERSE ECONOMIC OR MARKET
CHANGES,WHETHER OR NOT FORESEEABLE AS OF THE REFERENCE DATE.
INITIALS OF AUTHORIZED AGENCY INITIALS OF AUTHORIZED OWNER
REPRESENTATIVE(S) REPRESENTATIVES)
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AGENDA ITEM 5.6
SIGNATURE PAGE TO OPERATING COVENANT AGREEMENT
MSRE,Inc.,a California corporation SAN JACINTO REDEVELOPMENT
AGENCY,a public body,corporate and politic,
By: By:
Leticia Arciniega Interim Executive Director
Dated: Dated:
By: ATTEST:
Dated: By:
Agency Secretary
APPROVED AS TO LEGAL FORM:
BEST BEST&KRIEGER LLP
By:
Jeff Ballinger,Agency General Counsel
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AGENDA ITEM 5.6
ALL-PURPOSE ACKNOWLEDGMENT FOR CALIFORNIA
STATE OF CALIFORNIA
COUNTY OF
On , before me, ,
i i i
personally appeared lqame(s) of Signer(s)
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/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 ol 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
❑ Attorney-In-Fact Number Of Pages
❑ Trustee(s)
❑ Guardian/Conservator
❑ Other:
Date Of Document
Signer is representing:
Name Of Person(s) Or Entity(ies)
Signer(s) Other Than Named Above
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