scope

DOUGLAS COUNTY GEORGIA

TRAFFIC SIGN MATERIALS

Request for Quote (RFQ)

SOLICITATION NUMBER 23-023

Date of Issue: 07/06/2023

Closing: 08/08/2023, Time 02:00 PM (Eastern)

Single Point of Contact (SPC): LaTonya Ammons Director of Procurement

Address: 8700 Hospital Drive City, State, Zip: Douglasville, GA 30134 Phone (voice): 404-920-7247 Fax: 404-920-7219 E-mail: dcpurchasing@douglascountyga.gov

Douglas County Board of Commissioners promotes equal opportunity for all individuals without regard to age, color, disability, marital status, national origin, race, religion or creed, sex or gender, sexual orientation, or veteran status.

Douglas County, GA

23-023 Traffic Sign Materials (Federal)

SCOPE

The Douglas County Board of Commissioners is seeking bids for purchase of traffic sign materials. The initial term of this bid is August 1, 2023 - December 31, 2023, with options to renew for four (4) additional one-year terms.

The purchase of traffic sign materials will be made under a Purchase Order number, by Douglas County.

Each Purchase Order shall be a directive/authorization to purchase the required signing materials.

Prices bid shall be firm and valid during the initial term. The Douglas County Board of Commissioners has NO guarantee of any specific quantity, and the County will only purchase the quantity that is needed.

I. BACKGROUND

Douglas County is the only comprehensive government in Douglas County, providing all services to its citizens, including fire and emergency services, libraries, jail facilities, E-911, transportation planning, roadway signalization, signage and marking, vanpool and express bus service, informative and interactive website, a government access cable television channel, landfill and recycling programs, direct sponsorship and planning of events to bring our community together, and other traditional government services.

Located due west and 20 miles from Atlanta on Interstate 20, Douglas County is 200 square miles of gently rolling foothills of the Appalachian Piedmont bordered on the south by the Chattahoochee River, east by Cobb County, north by Paulding County, and west by Carroll County. The Dog River in the western portion of the County is the County’s potable water source (managed by the Douglasville- Douglas County Water and Sewer Authority, State-chartered). Other waterways include Sweetwater Creek, Anneewakee Creek, and Gothard’s Creek. Douglas County’s strategic location as the western gateway to Atlanta, and its proximity and ease of access to Atlanta’s Hartsfield-Jackson International Airport, make it the enviable place to live, work and play.

The County is managed by a five-member Board of Commissioners: A Chairman (full-time, four-year term) elected at large, and four District Commissioners (part-time, four-year terms).

II. RESTRICTIONS ON COMMUNCATION WITH STAFF

From the issue date of the solicitation and until a supplier is selected for contract award and the selection is made public, bidders are not allowed to communicate for any reason with members of the Board of Commissioners, Douglas County employees and/or contracted agents related to the solicitation except through the issuing officer (or his/her designee) named in the solicitation.

Prohibited communication includes all contact or interaction, including but not limited to telephonic communications, emails, faxes, letters, or personal meetings, such as lunch, entertainment, or otherwise. Exceptions to this restriction on communication include the following:

• Communication during pre-bid conference/meeting provided the issuing officer is present, or

• As necessary to perform under any existing contracts with the County, or

• With Douglas County pursuant to the protest process

A bidder’s violation of the restriction on communication can lead to disqualification of the supplier’s response from consideration for contract award and/or other disciplinary action such as suspension or debarment.

III. SCHEDULE

The following schedule is supplied as a guideline rather than a set of absolute deadlines. The County reserves the right to modify or alter the schedule as needed.

Event Date & Time Issue RFQ Thursday, July 6, 2023, 8:00 AM, EDT Questions Due Friday, July 14, 2023, 4:00 PM, EDT Addendum/Responses to Questions (if necessary) Wednesday, July 19, 2023, 5:00 PM, EDT Deadline for submittal of RFQ Tuesday, August 8, 2023, 2:00 PM, EDT

IV. QUESTIONS

Prospective Proposers must submit any questions regarding this solicitation Electronically in BidNet by the due date and time specified in the solicitation. Only questions submitted via BidNet will be accepted and addressed.

Responses to questions received during the solicitation time period are posted on the website at https://www.bidnetdirect.com/georgia/douglascounty in an addendum. Proposers who fail to report a known or suspected problem with this solicitation or who fail to seek clarification or correction of this solicitation do so at their own risk.

V. ADDENDUM

Any necessary additions or corrections will be made by addenda and issued electronically in BidNet.

The Addendum will become part of the solicitation. Failure to acknowledge any addenda shall not relieve Bidders of compliance with the terms thereof. The County assumes no responsibility for oral instructions. All requests for clarification and additional information must be made in writing in Bidnet.

Responses to questions will be posted as addenda in BidNet. It is the bidder’s responsibility to review BidNet periodically to determine if addenda have been prepared and posted.

The successful firm’s proposal and all the addenda will become a part of the agreement resulting from this document.

VI. Minimum Requirements:

All materials shall meet all applicable American Society of Testing Materials (ASTM) specifications, the American Association of State Highway and Transportation Officials (AASHTO) guidelines; and except as noted, this project will follow current Georgia Department of Transportation (GDOT) State of Georgia Standard Specification – Construction of Transportation Systems 2001 Edition, Supplemental Specifications 2008 Edition and the current version of the applicable Special Provisions (Specifications), along with the GDOT English Standards and Details.

https://www.bidnetdirect.com/georgia/douglascounty

All materials provided must be from vendors on GDOT’s Qualified Products Lists.

Bid Specifications:

1 Sign Blanks

1.1 The aluminum sign blanks shall be of the type size and shape specified by the County as set forth in this RFQ. All blanks shall meet the standards set forth by the Federal Highway Administration (FHWA) including hole locations and corner radii.

1.2 Base Metal: The base metal of Type I and II sign blanks shall conform to ASTM: B 209, Alloy 6061-T6 or 5052-H38.

1.3 Fabrication: All fabrication, including shearing, cutting, and drilling or punching of holes shall be completed prior to metal treatment and the application of the face material. The metal blanks shall be cut to size and shape and shall be free of buckles, warp, dents, cockles, burrs, and defects resulting from fabrication. Each face of the finished blank shall be a plain surface and flat. Special emphasis shall be given to ensure all edges and corners of the sign blank shall be smoothly finished without rough spots.

1.4 Metal Treatment: The metal shall be finished for painting or application of reflective sheeting by conversion coating or by alodizing. The finished sign blank or panel shall have a uniform, light colored appearance, with no splotches or stains. Where the finishing procedure produces an iridescent color, it shall have a uniform shade. The metal shall be thoroughly cleaned prior to finishing.

1.5 Cleaning: Initial cleaning shall be done by an etch type alkaline cleaner or by vapor degreasing with a trichloroethylene or perchloroethylene solvent. The cleaner shall be used according to the manufacturer’s specifications.

1.6 Desmutting: Where an alkaline etching cleaner is used, the metal shall be further treated with an acid solution or desmutting compound. The desmutting agent shall be used according to the manufacturer’s specifications.

1.7 Finish: The metal shall be finished with a chromate conversion coating using Alodine 1200 or equal or by alodizing with a chromic acid alodizing solution. The compound used for the conversion coating shall be used according to the manufacturer’s specifications.

1.8 Handling: Handling of the metal between all cleaning and finishing operations and the application of the finished material shall be done only by a device or with clean cotton gloves. Care shall be taken so that there shall be no opportunity for the metal to come in contact with grease, oils, dust or other contaminants prior to the application of the finish material.

1.9 Basis of Acceptance: Acceptance of these sign blanks will be based on results of chemical and physical tests of materials approval of methods and procedures for metal treatment, and acceptable workmanship of the finished sign blank. The successful Bidder may be requested to provide (at no cost to the County) samples of selected items at the County’s option prior to placement of any order to ensure compliance with all County specification and FHWA requirements. Sample sign blank requirements are set forth below.

2 Signs Complete

2.1 All signs shall be constructed using 3M Type 9 High Intensity grade sheeting.

2.2 All signs shall be constructed in accordance with the Federal Highway Administration’s (FHWA) Standard Highway Signs current edition.

2.3 Signs shall be constructed on aluminum blanks with thicknesses corresponding to those described in section 2.1 of this RFQ.

D 1"

1"

Al l h ol es a re to b e

0.

5" in d ia m et er

DE

TA

IL

A

C 0.

5"

0.

B 8"

8"

A 54

D 1"

B 8"

A 24

D 1.

1.

Al l h ol es a re to b e

0.

5" in d ia m et er

DE

TA

IL

B

B 12

A 72

2"

D 1.

B 12

A 36

3. BIDDER REQUIREMENTS

3.1 The Bidder shall provide all necessary materials required to meet the County’s Specifications for the products requested in this solicitation.

3.2 The Bidder shall replace all material at its expense if any material is found to be non-compliant with the Specifications; such costs shall include all handling and/or transportation charges.

3.3 Any variations and/or exception to the specifications must be stated on the Exception Sheet.

3.4 The County reserves the right to accept or reject any materials that do not conform to the Specifications contained in this RFQ.

3.5 The Bidder shall provide written certification that all required materials meet all specifications and performance requirements set forth in the RFQ or resulting Contract.

3.6 The Bidder may elect to bid on just the sign blanks, just the completed signs or both and the bids will be considered. The Bidder shall be aware and agreeable that the contract may be awarded to more than one vendor as a split award.

GENERAL CONDITIONS

A. PURPOSE

The purpose and intention of this invitation to bid issued by the Douglas County Purchasing Department is to afford all suppliers an equal opportunity to bid on all signing materials that are listed in the accompanying documents.

B. SPECIFICATIONS

Whenever standard Douglas County specifications are specified in any invitation to bid, or request for proposal, all bidders must comply with these specifications. Specifications other than standard specifications are to be considered as setting a standard of quality suitable to permit competition and at the same time protecting the integrity of the purchasing process. It is the overall intent of the specifications to ensure that the minimum needs of the County are met.

Brand or trade names used herein are intended to establish quality standards and are not intended to limit or eliminate competition.

The County does reserve the right to specify that particular specifications be strictly adhered to, and brand or trade names are not to be substituted.

C. PRICING

All prices should be quoted in the unit of measure as required and shall be firm until bid is awarded unless otherwise specified.

D. CANCELLATION OF CONTRACT

In any of the following cases the Purchasing Department has the right to cancel any contract entered under these Purchasing Rules and Regulations

1. Breach of Contract.

2. Failure of the contractor to make delivery within the time specified in the contract.

3. In the event any material is rejected for failure to meet specifications, non-conformity with sample or the items are not in good condition when delivered.

4. Wherever the contractor is guilty of misrepresentation.

5. Wherever the contract was obtained by fraud, collusion, conspiracy or other unlawful means, or the contract conflicts with any statutory and constitutional provision of the State of Georgia or the United States; or

6. Wherever Douglas County deems that a cancellation is in the best interest of the County provided that the Vendor be notified of such cancellation prior to production and/or shipment.

E. SUBSTITUTIONS

If bidding other than specified in the bid proposal, state brand, model number and submit illustrations and descriptive literature with bid in order that quality, suitability, and compliance with the specifications may be determined. Failure to do so may cause your bid to be disqualified.

F. QUANTITIES

Douglas County reserves the right to increase or decrease the quantity as necessary at the same prices and terms stated in sellers bid proposal.

G. DELIVERY

All deliveries shall be F.O.B. Douglas County, Georgia. If the vendor fails to make delivery within a satisfactory time, Douglas County reserves the right to cancel the item and to purchase elsewhere charging the re-procurement costs, i.e., increase in price, cost of handling (if any), to the original vendor making the unsatisfactory, late or non-delivery cause for cancellation.

H. PAYMENT

Payments will not be made in advance. Partial payments will be made monthly following the invoicing of goods that were satisfactorily delivered and accepted by Douglas County. Invoicing must be according to the unit prices submitted on the Bid Form. This supersedes any Payment/Unit Price included in the bid documents and specifications.

I. BID RESPONSE

Bids should be submitted on the forms provided for this purpose and should be filled out with ink or typewritten and signed in ink. Do not erase, correct, or white over any prices or figures necessary for the completion of this bid proposal. If any corrections are necessary, each one should be initialed.

Failure to comply with these requirements may cause your bid to be disqualified.

J. LOCAL PREFERENCE

Douglas County Board of Commissioners has approved the utilization of a local county preference to the Douglas County Code of Ordinance. The local preference may be used and allows for a local firm to be awarded the bid when not the lowest bidder, if the lowest bid is within 3% of the local company’s bid amount, except for construction services, and road project expected to exceed $20,000, which will be subject to Georgia State law. If all bidders are local firms, this section does not apply.

SECTION 1 – SIGN BLANKS PRICING

ITEM

NO DESCRIPTION DETAIL UNIT PRICE

DELIVERY IF

OTHER THAN 45

DAYS

1 .08 GA 6" x 12" Rectangular G 2 .08 GA 6" x 18" Rectangular G

3 .08 GA 8" x 24" Rectangular A

4 .08 GA 8" x 30" Rectangular A

5 .08 GA 8" x 36" Rectangular A 6 .08 GA 8" x 42" Rectangular A 7 .08 GA 8" x 48" Rectangular A 8 .08 GA 8" x 54" Rectangular A 9 .08 GA 8" x 60" Rectangular A 10 .08 GA 8" x 66" Rectangular A 11 .08 GA 8" x 72" Rectangular A 12 .08 GA 12" x 12" Square J 13 .08 GA 12" x 18" Rectangular G 14 .08 GA 12" x 36" Rectangular B 15 .08 GA 12" x 42" Rectangular B 16 .08 GA 12" x 48" Rectangular B 17 .08 GA 12" x 54" Rectangular B 18 .08 GA 12" x 60" Rectangular B 19 .08 GA 12" x 66" Rectangular B 20 .08 GA 12" x 72" Rectangular B 21 .08 GA 12" x 78" Rectangular B 22 .08 GA 12" x 84" Rectangular B 23 .08 GA 12" x 90" Rectangular B 24 .08 GA 12" x 96" Rectangular B 25 .08 GA 12" x 102" Rectangular B 26 .08 GA 18" x 18" Square J 27 .08 GA 18" x 24" Rectangular G 28 .08 GA 18" x 36" Rectangular C 29 .08 GA 18" x 48" Rectangular C 30 .08 GA 18" x 60" Rectangular C 31 .08 GA 18" x 72" Rectangular C 32 .100 GA 18" x 84" Rectangular C 33 .100 GA 18" x 96" Rectangular C 34 .100 GA 18" x 108" Rectangular C

SECTION 1 – SIGN BLANKS PRICING (continued)

NO DESCRIPTION DETAIL UNIT PRICE

DELIVERY IF

OTHER THAN 45

DAYS

35 .100 GA 18" x 120" Rectangular C 36 .08 GA 24" x 24" Diamond / Square J 37 .08 GA 24" x 24" Octagon Stop D 38 .08 GA 24" x 24" Interstate Shield M 39 .08 GA 24" x 30" Rectangular G 40 .08 GA 24" x 36" Rectangular G 41 .08 GA 24" x 48" Rectangular G 42 .100 GA 24" x 60" Rectangular H 43 .08 GA 30" x 30" Diamond / Square J 44 .08 GA 30" x 30" Octagon Stop D 45 .08 GA 30" x 30" Interstate Shield M 46 .08 GA 30" x 36" Rectangular H 47 .08 GA 30" x 40" x 40" Pennant N 48 .100 GA 30" x 48" Rectangular H 49 .100 GA 30" x 60" Rectangular H 50 .08 GA 36" x 36" Diamond / Square J 51 .08 GA 36" x 36" Octagon Stop D 52 .08 GA 36" x 36" Pentagon I 53 .08 GA 36" x 36" x 36" Triangle F 54 .100 GA 36" x 48" Rectangular H 55 .08 GA 36" x 48" x 48" Pennant N 56 .100 GA 48" x 54" Rectangular H 57 .08 GA 36" Round L 58 .100 GA 48" x 48" Diamond / Square K 59 .100 GA 48" x 48" Octagon Stop E

SECTION 2 – COMPLETED SIGNS (FINISHED SIGNS)

NO DESCRIPTION DETAIL UNIT PRICE

DELIVERY IF

OTHER THAN

45 DAYS

60 R1-1 30” Oct. (TP 9 Sheeting) (Stop) 61 R1-1 36” Oct. (TP 9 Sheeting) (Stop) 62 R1-1 48” Oct. (TP 9 Sheeting) (Stop) 63 R1-2 36” Tri. (TP 9 Sheeting) (Yield) 64 R1-4 18” x 6” Rec.(TP 9 Sheeting) (All Way) 65 R2-1 (25) 24”x30” Rec. (TP 9 Sheeting) (Speed Limit 25) 66 R2-1 (30) 24”x30” Rec. (TP 9 Sheeting) (Speed Limit 30) 67 R2-1 (35) 24”x30” Rec. (TP 9 Sheeting) (Speed Limit 35) 68 R2-1 (40) 24”x30” Rec. (TP 9 Sheeting) (Speed Limit 40) 69 R2-1 (45) 24”x30” Rec. (TP 9 Sheeting) (Speed Limit 45) 70 R4-7 24”x30” Rec. (TP 9 Sheeting) (Keep Right Symb.)

71 R5-1 30”x30” (TP 9 Sheeting) (Do Not Enter) 72 R5-1a 36”x24” (TP 9 Sheeting) (Wrong Way) 73 R5-2 24”x24” (TP 9 Sheeting) (No Trucks Symbolic) 74 R6-1L 12”x36” (TP 9 Sheeting) (One Way - Left) 75 R6-1R 12”x36” (TP 9 Sheeting) (One Way - Right) 76 R6-3 24”x30” (TP 9 Sheeting) (Divided Highway) 77 R6-3a 24”x30” (TP 9 Sheeting) (Divided Highway) 78 R8-3a 24” Sq (TP 9 Sheeting) (No Parking Symbol)

79 R10-12 30”x36” (TP 9 Sheeting) (Left Turn Yield on Green)

80 R10-3e 9”x15” Rec. (TP 9 Sheeting) (Countdown Ped.

W/Arrow)

81 R11-2 30”x48” (TP 9 Sheeting) (Road Closed) 82 R560-5 18”x24” (TP 9 Sheeting) (State Law Crosswalk) 83 S1-1 36” Pent. FYG (TP 9 Sheeting) (School Adv. Symbol)

84 S3-1 36” Diamond FYG (TP 9 Sheeting) (School Bus Stop Ahead Symbol)

85 S4-5 36” Diamond FYG (TP 9 Sheeting) (School Zone Ahead W/Speed)

86 S5-1 24”x48” Rec. FYG (TP 9 Sheeting) (School Speed Limit 25)

SECTION 2 – COMPLETED SIGNS (FINISHED SIGNS) (continued)

NO DESCRIPTION DETAIL UNIT

PRICE

DELIVERY IF

OTHER THAN

45 DAYS

87 S5-2 24”x30” (TP 9 Sheeting) (End School Zone) 88 W16-9p 36”x24” Rec. FYG (TP 9 Sheeting) (Ahead)

89 W16-7pl 36”x24” Rec. FYG (TP 9 Sheeting) (Arrow down to left)

90 OM-3L 12”x36” Rec. (TP 9 Sheeting) (Hazard Board) 91 OM-3R 12”x36” Rec. (TP 9 Sheeting) (Hazard Board)

92 W1-X series 30” Diamond (TP 9 Sheeting) (Curve Warning Signs)

93 W2-X series 30” Diamond (TP 9 Sheeting) (Intersection Warning Signs)

94 W1-X series 36” Diamond (TP 9 Sheeting) (Curve Warning Signs)

95 W2-X series 36” Diamond (TP 9 Sheeting) (Intersection Warning Signs)

96 W1-8 18”x24” Rec. (TP 9 Sheeting) (Chevron Signs) 97 W1-8 24”x30" Rec. (TP 9 Sheeting) (Chevron Signs) 98 W1-8 30”x36” Rec. (TP 9 Sheeting) (Chevron Signs) 99 W3-1 36” Diamond (TP 9 Sheeting) (Stop Ahead Sym.)

100 W3-3 36” Diamond (TP 9 Sheeting) (Signal Ahead) 101 W10-1 36” Diameter (TP 9 Sheeting) (Railroad Crossing) 102 W16-12P 24”x18” Rec. (TP 9 Sheeting) (Traffic Circle)

103 Special 30”x36” (TP 9 Sheeting) (Speed Checked By Detection Devices)

Company: _________________________________________________

Date:_____________________________________________________

Signature:_________________________________________________

Title:______________________________________________________

I certify that this offer is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a proposal for the same materials, supplies, equipment, or services and is in all respects fair and without collusion or fraud. I understand collusive bidding is a violation of State and Federal Law and can result in fines, prison sentences, and civil damage awards. I agree to abide by all conditions of the proposal and certify that I am authorized to sign this proposal for the proposer. I further certify that the provisions of the Official Code of Georgia Annotated, Sections 45-10-20 et. seq. has not been violated and will not be violated in any respect.

BIDDER’S QUALIFICATION SHEET

COMPANY NAME:

NAME _____________________________________________TITLE

ADDRESS

CITY ST ZIP

PHONE FAX

E-MAIL

1. Number of years’ experience Bidder has providing products as per specifications.

2. Name and address of government agencies/companies in the past five (5) years that you have provided products as per specifications. Indicate date/year of contracts and person to contact for reference.

Bidder must complete all information below.

REFERENCE ONE

Government/Company Name

Address

Contact Person and Title

Phone Fax

Contract Period Scope of Work

REFERENCE TWO

Government/Company Name

Address

Contact Person and Title

Phone Fax

Contract Period Scope of Work

BIDDER’S QUALIFICATION SHEET

Information of Person who prepared this form:

Printed Name Title

Signature Date

EXCEPTIONS TO SPECIFICATIONS SHEET

If there are any exception(s) or clarification(s) taken to the Specifications set forth in this RFQ use this sheet and list the specification’s description and page number to which an exception is taken. ANY exception(s) to the RFQ Specifications shall be explained in full. Douglas County will determine the Bidder’s compliance with the bid requirements based on the information submitted and its exceptions to the Specifications. Attach additional pages if more space is needed.

Item Description and Page Number

Description of Exception

COMPANY INFORMATION

COMPANY NAME:

Physical Address:

Mailing Address (if different):

AUTHORIZED INDIVIDUAL

Name:

Title:

Email Address:

Phone Number: Fax Number:

PROJECT CONTACT

PERSON

Name:

Title:

Email Address:

Phone number: Cell Number:

Conflict of Interest Statement

Except as may be identified and explained below, the undersigned hereby certifies that: (a) no member of the Board of Commissioners, elected, appointed, and employee of the Douglas County;

(b) no elected, appointed, and employed official or employee of the State of Georgia and of a governing body, instrumentality, or political subdivision; (c) no relative of any persons described above; (d) no member of and delegate to the Congress of the United States has an interest whatsoever (regardless of how indirect and how remote that interest may be) in bidder’s organization and in the proceeds of a Contract and agreement which might be made between bidder and the Douglas County Board of Commissioners as a result of the, quote, or qualification statement accompanied by this certification.

The undersigned certifies that he/she is legally authorized by the bidder to make the above representation, and that the representation is true to the best of his/her knowledge and belief and without deliberate omission of any inquiry which would to the best of his/her belief tend to change the above representation. The undersigned understands that any representation made knowing it to be false may disqualify the bidder from being awarded the Contract and future work by Douglas County Board of Commissioners.

NOTE: THIS CERTIFICATION MUST BE SIGNED AND SUBMITTED WITH THIS BID.

EXCEPTIONS: (Please explain)

Date: _____________________________________________________________

Company Name: ____________________________________________________

Authorized Representative Name: _______________________________________

Title: ______________________________________________________________

Signature: __________________________________________________________

NON-COLLUSION AFFIDAVIT

The undersigned bidder or agent, being duly sworn on oath, says that he/she has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding.

He/She further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee gift, commission or thing of value on account of such sale.

OATH AND AFFIRMATION

I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND

INFORMATION CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND

CORRECT.

Dated this ______________day of, ____, ____

(Name of Organization)

(Title of Person Signing)

(Signature)

(Bid Number)

ACKNOWLEDGEMENT

STATE OF_________________________ )

COUNTY OF_______________________ )

Before me, a Notary Public, personally appeared the above named and swore that the statements contained in the foregoing document are true and correct.

Subscribed and sworn to me this_______ day of ________________,_________.

Notary Public Signature My Commission Expires:___________________________________________________