HomeMy WebLinkAbout5414RESOLUTION NO. 5414
A RESOLUTION ADOPTING A MINORITY BUSINESS,
DISADVANTAGED BUSINESS AND WOMEN'S BUSINESS
ENTERPRISE PLAN REQUIRED AS A CONDITION OF
RECEIPT BY THE CITY OF PUEBLO OF FEDERAL
FUNDING THROUGH THE UNITED STATES DEPARTMENT
OF TRANSPORTATION (AIRPORT IMPROVEMENT PROGRAM)
WHEREAS, the City of Pueblo receives federal funding
under the Airport and Airway Improvement Act of 1982 for the
Airport Improvement program, and,
WHEREAS, submission of an approved Minority,
Disadvantaged and Women's Business Enterprise Plan is a
requirement for continuance of such funding;
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL
OF PUEBLO, COLORADO, that:
The Minority Business Enterprise Plan is hereby
adopted and on file with the City Clerk.
INTRODUCED July 9 , 1984
By REIMAR VON KALBEN
Councilman
APPROVJ�p: ,✓ _
President of---the' City Council
MINORITY BUSINESS ENTERPRISE
PROGRAM
for
PUEBLO MEMORIAL AIRPORT
PUEBLO, COLORADO
Owned and Operated by
THE CITY OF PUEBLO, COLORADO
TABLE OF CONTENTS
Page
Introduction
Policy Statement
i
I.
MBE Liaison /Coordinator Officer
-1-
II.
Minority Business Enterprise Directories
-3-
III.
Procedures to Ensure Equitable Opportunities for MBEs
-3-
IV.
Certification of Eligibility of Minority Business Enterprise
-4-
V.
Percentage Goals for Dollar Value of Work to be Awarded
to MBEs
-5-
VI.
Procedures for Naming MBEs in Bids
-7-
VII.
Selection Criteria for Awarding Prime Contracts to Bidders
and Evaluating Good Faith Efforts
-7-
VIII.
Provisions to be Incorporated in Contracts
-9-
IX.
Leasing Goals
-10-
X.
Records and Reports
-11-
XI.
Terms of the MBE Program
-11-
INTRODUCTION
Department of Transportation (DOT) Regulation 49 CFR Part 23 requires that
certain recipients of DOT financial assistance must devise Minority Business
Enterprise (MBE) programs to increase MBE participation in the performance
of contracts financed with Federal funds.
All Grant Agreements issued under the Airport and Airway Improvement Act
of 1982 for Airport Improvement Program (AIP) projects require that the
recipient of Federal funds under such agreements implement a Minority
Business Enterprise (MBE) program. The program must meet the provisions of
DOT 49 CFR Part 23 and must be approved by the Regional Civil Rights Office
of the Federal Aviation Administration in order for the recipient to receive
and use Federal funds for airport projects.
The Minority Business Enterprise Program for Pueblo Memorial Airport is in
consonance with and incorporates applicable provisions of the Minority
Business Enterprise Plan, City of Pueblo, Colorado, dated April 1984.
POLICY STATEMENT
It is the policy of The City of Pueblo, Colorado, hereinafter referred to as the
SPONSOR, that Minority Business Enterprises (MBEs) as defined in DOT
Regulation 49 CFR Part 23 shall be afforded the maximum opportunity to
participate in the performance of contracts which are funded in whole or in
part through the Airport Improvement Program (AIP).
The SPONSOR will take necessary and reasonable steps in accordance with 49
CFR Part 23 to ensure that Minority Business Enterprises have the maximum
opportunity to compete for and perform contracts. The SPONSOR and its
contractors shall not discriminate on the basis of race, color, national origin,
or sex in the award and performance of DOT assisted contracts.
This Policy Statement will be made known to all activities of Pueblo Memorial
Airport, and to local business and community organizations, both minority and
non - minority.
Adopted July 9 , 1984, by resolution of The City Council
of The City of Pueblo, Colorado.
l,r
President
i
I. MBE Liaison /Coordinator Officer
The Transportation Coordinator of the City of Pueblo's Department of
Transportation has been designated the MBE Liaison Officer. The MBE
Liaison Officer shall report directly to the Director of the Pueblo
Department of Transportation, who in turn reports directly to the Pueblo
City Manager. The Transportation Coordinator has been granted full
authority and responsibility for developing, managing and implementing
the MBE program on a day - today basis; and for disseminating
information on available business opportunities so that MBEs are
provided an EQUITABLE opportunity to bid on the applicant's contracts.
The MBE Coordinator:
- Maintains a current registry of minority businesses qualified or
qualifiable to perform as contractors and subcontractors.
- Submits to minority contractors formal "Invitations to Bid" on
projects, goods and services as they become available.
- Encourages bid solicitation from MBEs; establishes sufficient lead -
time from the "request for bid" date to the date of bid opening with
a 20-day spread being the minimum.
- Advertises "Invitations to Bid" in various minority and female news
media.
- Meets with contractors, subcontractors and community action
groups to discuss procedures and policies with regard to Minority
Business Enterprise.
- Participates in pre -award and pre - construction conferences to
outline and review requirements and responsibilities of contractors
as they relate to participation in federally funded projects.
- Distributes list of minority businesses to construction contractors
at pre -award and pre - construction conferences.
- Provides assistance to MBEs in overcoming barriers such as the
inability to obtain bonding, financing or technical assistance.
- Provides information concerning insurance and bonding necessary
to carry out City projects for both potential and actual contractors
and subcontractors.
- Monitors purchasing activities and initiates steps to modify
purchasing regulations as required to achieve MBE goals and
objectives.
- Where allowable, encourages prime contractors to waive separate
subcontractors bonding /insurance requirements.
Be
Assures the legitimacy of MBEs for participation as bidders, in
partnerships and joint ventures. This procedure complies with
instructions of 49 CFR Part 23.
Convenes seminars for small businesses and minority businesses on
a semi - annual basis to discuss MBE requirements and respond to
questions and concerns.
Maintains records indicating special efforts used to identify and
award contracts to MBEs.
Tracks MBE participation until work is completed and final
payment made.
Prepares quarterly MBE reports and other forms, as required, by
UMTA.
- Makes available to UMTA pertinent records and reports, as
required.
Shall ensure that appropriate staff are familiar with the requirements of
49 CFR Part 23 and the City's MBE plan.
The Director of Pueblo Department of Transportation shall meet
periodically with the MBE Coordinator to: (1) review implementation of
the Plan, (2) ascertain the progress and achievements of the program, (3)
identify problems and /or deficiencies, and (4) make recommendations to
the City Council concerning changes and improvements in the program.
5AI
II. Minority Business Enterprise Directories
The City of Pueblo will maintain a current MBE vendor file with
information as to date of certification, type of business, and business
size.
The existing City of Pueblo MBE Directory of contractors and
subcontractors will be revised when needed.
In addition, the City of Pueblo will utilize national, State and local
resources, such as the Minority Contractors Directory, Program
Management Centers, SBA's Minority Business Development Centers,
Directory of Minority and Women -Owned Architectural and Engineering
Firms.
The MBE Coordinator will share these directories and resources with all
contractors and any other agency upon request for their use in soliciting
bids from MBE subcontractors.
III. Procedures to Ensure Equitable Opportunities for MBEs
In addition to the procedures listed in Section I - Liaison /Coordinator
Officer, the City of Pueblo shall implement the following procedures to
ensure MBE maximum opportunity:
1. Provide to MBE's projected procurement information or contracting
schedules.
2. Allow MBEs to review and evaluate successful bids and /or docu-
ments of similar procurements.
3. Use briefing sessions to explain why certain bids or proposals were
successful or unsuccessful.
4. Provide instruction on job performance requirements.
5. Identify bidders and proposers to MBE community in a timely
manner.
-3-
IV. Certification of Eligibility of Minority Business Enterprises
The SPONSOR shall certify the eligibility of MBEs and joint ventures
involving MBEs that are owned and controlled by minorities or women
and are named by firms bidding on contracts of the SPONSOR which are
Federally assisted. Eligibility standards are those listed in SEction 23.53,
49 CFR Part 23. The SPONSOR may accept certifications made by other
DOT grant applicants. Substitution of subcontractors by prime
contractors before bid opening and during contract performance must be
approved by the SPONSOR.
Upon award of the contract, the SPONSOR will require the prime
contractor to submit the list of MBE subcontractors for the project. Any
termination of a MBE will be reported to the SPONSOR. The contractor
will make a reasonable effort to replace the terminated MBE
subcontractor with a certified MBE. If efforts are not successful, the
prime contractor will provide evidence of such efforts to the SPONSOR.
Substitution of a non -MBE subcontractor must have the prior approval of
the SPONSOR.
Any business, including the partner in a joint venture, that desires to
participate as a MBE, shall complete and submit Schedule A (see
attached Exhibit 1) to the SPONSOR. Any business desiring to
participate as a joint venture MBE shall complete and submit Schedule A
and Schedule B (see attached Exhibit 2). The required schedules must be
signed and notarized and must accompany the MBE bid or proposal to the
SPONSOR at the time bids are opened.
A business desiring to participate as a MBE may not be required to
Submit Schedule A or B under the following circumstances:
1. The potential MBE contractor states in writing that it has previ-
ously submitted the same information to or has been certified by
the SPONSOR, any DOT element, or other Federal agency that uses
essentially the same definition and ownership and contract criteria
as the DOT.
2. The potential MBE contractor has been determined by the Small
Business Administration to be owned and controlled by socially and
economically disadvantaged individuals under Section 8(a) of the
Small Business Act, as amended.
-4-
V. PERCENTAGE GOALS FOR DOLLAR VALUE OF WORK TO BE
AWARDED TO MBES
Goals established for work to be awarded to MBEs will be based on the
following:
1. A review of past awards to contractors and identification of those
contractors that were MBEs.
2. Identification of past work which was or could have been done by
MBEs.
3. The types of contracts anticipated for award during the period of
this MBE program (one year from effective date).
The SPONSOR will use available data including directories of Federal,
State and local agencies to determine the availability of MBEs within the
immediately adjacent counties, and in a reasonably wider geographic
area, if a particular contract requires work for which no MBEs are
available in the immediate areas.
Goals are established as follows:
1. Overall Annual Goals (6/15/84 - 6/14/85) - The overall percentage
goal for the dollar value of work to be awarded to MBEs partici-
pating as prime or subcontractors will be determined by dividing
the estimated dollar total of work that could be performed by
available and qualified MBEs under the prime contract or subcon-
tract, by the estimated dollar total of the Federally funded
projects anticipated during the period.
Overall MBE _ Potential MBE Contracts (dollars
Percentage Goal Anticipated Federally Funded Contracts dollars
Separate overall percentage goals will be set for MBEs owned and
controlled by minorities, and those owned and controlled by women.
Ma
Intially, based on past experience, it is considered reasonable to
establish an overall goal of 4_5 percent of Federal funded projects
to be awarded to minority owned business firms and 0 percent to
women owned firms. The SPONSOR will publish a notice
announcing these goals, and a description of how they were
determined. This information will be made available for inspection
during normal business hours at the principal office of the SPON-
SOR for 30 days following the date of the notice and it will be
noted that the FAA and the SPONSOR will accept comments of the
public on the goals for 45 days from the date of the notice. The
notice shall include addresses to which comments may be sent, and
shall be published in general circulation media and available
minority -focus media and trade association publications, and shall
state that the comments are for informational purposes only.
2. Goals for Specific Contracts - The percentage goals for the dollar
value of work to be awarded to MBEs for a specific project will be
established at the time the grant application is submitted. Upon
determination of the total scope of work of the project, and the
estimates of the total project cost, the SPONSOR will identify the
work items which could be awarded to a prime contractor or
subcontractor, and the approximate dollar value of the prime
contract and each subcontract item. Using the MBE directory, and
other available information on the location, capability, and
availability of qualified MBEs, the potential subcontract items
and /or prime contract which could be performed by MBEs will be
noted. The goals for the dollar value of work to be awarded to
MBEs will then be determined by dividing the total estimated dollar
value of the contract.
Specific Contract
MBE Percentage = Potential MBE Contracts (dollars)
Goal Total Estimated Costs of Prime Contract dollarsT
-6-
Separate specific contract percentage goals will be set for
MBEs owned and controlled by minorities and those owned
and controlled by women.
VI. PROCEDURES FOR NAMING MBES IN CONTRACT BIDS
On all solicitations for bids on Federally funded contracts, the SPONSOR
shall state the goals for the use of MBEs. Solicitations shall require all
bidders to submit with their bids written assurance that sufficient
reasonable efforts will be made to meet the goals.
The solicitations will include a date, within a reasonable time after the
opening of bids and before the award of the contract, when the apparent
successful bidder will be required to submit the names of MBE
subcontractors, a description of the work each is to perform, and the
dollar value of each proposed MBE contract. At that time, the
SPONSOR will evaluate the reasonable and good faith efforts of the
apparent successful bidder to meet the MBE goals established for the
contract.
Agreements between a bidder and a MBE in which the MBE promises not
to provide subcontracting quotations to other bidders is expressly
prohibited by CFR 49 Part 23.
VII. SELECTION CRITERIA FOR AWARDING PRIME CONTRACTS TO
BIDDERS AND EVALUATING GOOD FAITH EFFORTS
Prime Contracts shall be awarded in the following order of preference.
1. The competitor offering the lowest and most reasonable price and
meeting the MBE contract goal.
2. The competitor offering a reasonable price and who in the judg-
ment of the SPONSOR has made a reasonable and good faith effort
to secure MBE participation, based on the following documented
information:
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VII. SELECTION CRITERIA FOR AWARDING PRIME CONTRACTS TO
BIDDERS AND EVALUATING GOOD FAITH EFFORTS (Continued)
a. Whether the contractor attended any pre -bid meetings that
were scheduled by the SPONSOR to inform MBEs of subcon-
tracting opportunities;
b. Whether the contractor advertised in general circulation,
trade association, and minority focus media concerning the
subcontracting opportunities;
C. Whether the contractor provided timely written notice (noti-
fication by regular U.S. mail at least two weeks before bid
opening, where feasible) to a reasonable number of specific
MBEs stating that their interest in the contract is being
solicited;
d. Whether the contractor negotiated in good faith with inter-
ested MBEs, not rejecting MBEs as unqualified without sound
reasons based on a thorough investigations of their capabili-
ties.
(NOTE: These procedures are based on the provisions of the final
rule amending 49 CFR Part 23 for Participation by Minority
Business Enterprises in the Department of Transportation Programs
(Federal Register, Monday, April 27, 1981, Volume 46, No. 80).)
To determine the reasonableness of a bidder's offer, the SPONSOR shall
use the same criteria it would use if the bidder had made the only offer
to perform the contract. In addition to price, the following criteria shall
be used to determine the lowest and best bidder:
1. The ability, capacity, and skill of the bidder to perform the con-
tract;
2. Whether the bidder can perform the contract within the time
specified, without delay or interference;
3. The character, integrity, reputation, judgment, experience, and
efficiency of the bidder;
4. The quality of performance of previous contracts;
5. Previous and existing compliance by the bidder with laws and
ordinances relating to the contract.
6. The sufficiency of the financial resources and ability of the bidder
to perform the contract or provide the service.
7. The quality, availability, and adaptability of the supplies or con-
tractual services to the particular use required.
8. The ability of the bidder to provide future maintenance and service
for the use of the subject of the contract.
-8-
VII. SELECTION CRITERIA FOR AWARDING PRIME CONTRACTS TO
BIDDERS AND EVALUATING GOOD FAITH EFFORTS (Continued)
9. The level of MBE participation achieved and the adequacy of the
best effort initiatives.
10. Compliance with the requirements of the bid proposal.
Bidders that fail to meet MBE contract goals and who, in the judgement
of the Sponsor, fail to demonstrate sufficient reasonable and good faith
efforts to secure MBE participation shall not be eligible to be awarded a
contract.
To ensure that all obligations under contracts awarded to MBEs are met,
the SPONSOR shall review the contractor's MBE involvement efforts
during the performance of the contract. The contractor shall bring to
the attention of the SPONSOR any situation in which regularly scheduled
progress payments are not made to MBE subcontractors.
The provisions of this section of the MBE Program for the SPONSOR
shall be reproduced and made a part of all bid proposals and invitations
for bid.
VIII. PROVISIONS TO BE INCORPORATED IN CONTRACTS
The City of Pueblo will include the following paragraphs in agreements
between the City of Pueblo and any subrecipient, and in all subsequent
Federally (DOT /FAA) assisted contracts and subcontracts: (Copy of
contract(s) is shown in Appendix C).
1. "Policy. It is the policy of the Department of Transportation that
minority business enterprises as defined in 49 CFR Part 23 shall
have the maximum opportunity to participate in the performance
of contracts financed in whole or in part with Federal funds under
this agreement. Consequently the MBE requirements of 49 CFR
Part 23 apply to this agreement."
-9-
VIII. PROVISIONS TO BE INCORPORATED IN CONTRACTS (Continued)
2. "MBE Obligation. The City of Pueblo or its contractor agrees to
ensure that minority business enterprises as defined in 49 CFR Part
23 have the maximum opportunity to participate in the perfor-
mance of contracts and subcontracts financed in whole or in part
with Federal funds provided under this agreement. In this regard
the City of Pueblo and its subrecipients, contractors, and
subcontractors shall take all necessary and reasonable steps in
accordance with 49 CFR Part 23 to ensure that minority business
enterprises have the maximum opportunity to compete for and
perform contracts. The City of Pueblo and their contractors shall
not discriminate on the basis of race, color, national origin, or sex
in the award and performance of DOT - assisted contracts."
The City of Pueblo MBE Plan is hereby incorporated by reference. This
program shall be treated as a legal obligation and failure to carry out the
MBE program requirements shall be treated as a violation of this
financial agreement, and any result in termination of the agreement or
contracts, or such remedy as the City of Pueblo deems appropriate.
IX. LEASING GOALS
The SPONSOR will establish goals for the participation of minority
owned firms and women owned firms in leases for space on the airport
for providing aviation related and other goods and services on the air-
port.
The goals for lessees will be reviewed annually and revised based on past
experience, the types of leases which will require execution in the
following year, and the potential MBE firms in a reasonable geographic
area which could provide the goods or services involved.
Initially, based on annual anticipated airport revenues and the types of
leases which might require execution or renewal over the period of this
MBE Program, goals of 0 percent for MBE and 7 percent for WBE
are established.
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X. RECORDS AND REPORTS
To monitor the progress of this MBE program, the SPONSOR will main-
tain adequate records which will reflect the following:
1. Efforts made to identify and award contracts to MBEs.
2. The percentage of dollar awards made to MBEs measured against
projected goals.
Records and reports will show information separately on MBEs owned and
controlled by minorities and those owned and controlled by women.
For those years in which a Federal Grant has been received, the SPON-
SOR will submit a report to the FAA Regional Civil Rights Office show-
ing the actual MBE percentage goals achieved for AIP contracts issued
that year, as compared to those goals listed in the MBE Program for the
year.
XI. TERMS OF THE MBE PROGRAM
This MBE Program is effective beginning June 15, 1984. The award of
any contract by the SPONSOR after that date, which involves Federal
monies issued under the AIP Program or other DOT assisted programs
requires compliance with this program. The provisions of this program
will be reviewed at least annually and revised or amended as required.
Notification of this review and the overall goals for the following year
will be submitted to the FAA Regional Civil Rights Office.
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Schedule A - Information for Determining
Disadvantaged Business Enterprise Eligibility
1. Name of Firm
2. Address of Firm
3. Phone Number of Firm
4. Indicate whether firm is sole proprietorship, partnership, joint venture, corporation
or other business entity (please specify)
5. Nature of
firm's business
6. Years firm
has been in business
7. Ownership
of firm: Identify those who own S percent
or more of the firm's ownership.
Columns e
and f need be filled out only
if the firm
is less than
100 percent
minority owned.
.a
b c
d
e
f
Name
Race Sex
Years of
Ownership
Voting
Ownership
percentage
percentage
With firms
less than 100 percent minority owned,list
the contributions of money,
equipment,
real estate, or expertise of
each of the
owners.
8. Control of firm: [a] Identify by name, race, sex, and title in the firm those
individuals (including owners and nonowners) who are responsible for day -to -day
management and policy decisionmaking, including but not limited to, those with
prime responsibility for:
(1) Financial decisions
(2) Management decisions, such as -
a. Estimating
b. Marketing and sales
c. Hiring and firing of management personnel
d. Purchase of major items or supplies
(3) Supervision of field operations
9. For each of those listed in question 8, provide a brief summary of the person's
experience and number of years with the firm, indicating the person's qualifica-
tions for the responsibilities given him or her.
10. Describe or attach a copy of any stock options or other ownership options that are
outstanding, and any agreement between owners or and third parties which restrict
ownership or control of minority owners.
11. Identify any owner (see item 7) or management official (see item 8) of the named
firm who is or has been an employee of another firm that has an ownership in or
a present business relationship with the name firm. Present business relationships
include shared space, equipment, financing, or employees as well as both firms
having some of the same owners.
A -1
12. What are the gross receipts of the firm of each of the last two years?
Year ending
Year ending
13. Name of bonding company, if any:
Bonding limit:
Source of letters of credit, if any:
14. Are you authorized to do business in the State as well as locally, including all
necessary business licenses?
15. Indicate if this firm or other firms with any of the same officers have previously
received or been denied certification or participation as an DBE and describe the
circumstances. Indicate the name of the certifying authority and the date of such
certification or denial.
Affidavit
"The undersigned swears that the foregoing statements are true and correct and include
all material information necessary to identify and explain the operation of
(name of firm) as well as the ownership thereof. Further, the undersigned agrees to provide
through the prime contractor or, if no prime, directly to the grantee current, complete and
accurate information regarding actual work performed on the project, the payment thereof and
any proposed changes, if any, of audit and examination of books, records and files of the
named firm. Any material misrepresentation will be grounds for terminating any contract
which may be awarded and for initiating action under Federal or State law concerning false
statements."
Note - If, after filing this Schedule A and before the work of this firm is
completed on the contract covered by this regulation, there is any significant
change in the information submitted, you must inform the grantee of the change
through the prime contractor, if no prime contractor, inform the grantee directly.
Signature
Name
Title
Date
Corporate Seal [where appropriate]
Date
State of
County of
On this day of , 19 _, before me appeared [Name]
, to me personally known, who, being duly sworn, did
execute the foregoing affidavit, and did state that he or she was properly
authorized by [Name of firm]
to execute the affidavit and did so as his or her free act and deed.
[Seal]
Notary Public
Commission Expires
A -2
Schedule B- Information For Determining
Joint Venture Eligibility
(This form need not be filled in if all joint venture firms are minority owned)
1. Name of joint venture
2. Address of joint venture
3. Phone number of joint venture
4. Identify the firms which comprise the joint venture. (The DBE partner must
complete Schedule A)
(a) Describe the role of the DBE firm in the joint venture
(b) Describe very briefly the experience and business qualifications of each
non -DBE joint venture
S. Nature of the joint venture's business
6. Provide a copy of the joint venture agreement.
7. What is the claimed percentage of DBE ownership?
8. Ownership of joint venture. (This need not be filled in if described in the
joint venture agreement, provided by question 6.)
(a) Profit and loss sharing
(b) Capital contributions, including equipment
(c) Other applicable ownership interests
9. Control and participation in this contract. Identify by name, race, sex and
"firm" those individuals (and their titles) who are responsible for day -to-
day management and policy decisionmaking, including, but not limited to, those
with prime responsibility for:
(a) Financial decisions
(b) Management decisions, such as:
(1) Estimating
(2) Marketing and Sales
(3) Hiring and Firing of management personnel
(4) Purchasing of major items or supplies
(c) Supervision of field operations
A -3
Note - if, after filing this Schedule B and before the completion of the joint venture's
work on the contract covered by this regulation, there is any significant change in the.
information submitted, the joint venture must inform the grantee, either directly or
through the prime contractor if the joint venture is a subcontractor.
Af f idavit
"The undersigned swear that the foregoing statements are correct and include all
material information necessary to identify and explain the terms and operation of our
joint venture and the intended participation by each joint venturer in the undertaking.
Further, the undersigned covenant and agree to provide to the grantee current, complete
and accurate information regarding actual joint venture work and the payment therefore
any proposed changes in any of the joint venture arrangements and to permit the audit
and examination of the books, records and files of the joint venture, or those of
each joint venturer relevant to the joint venture, by authorized representatives of
the grantee or the Federal funding agency. Any material misrepresentation will be
grounds for terminating any contract which may be awarded and for initiating action
under Federal or State laws concerning false statements."
Name of Firm Name of Firm
Signature Signature
Name Name
Title Title
Date Date
Date
State of
County of
On this day of 19 before me appeared (Name)
to me personally known, who, being duly sworn, did execute the foregoing affidavit,
and did state that he or she was properly authorized by (Name of Firm)
to execute the affidavit and did so as his or her free act and deed.
Notary Public
Commission Expires
(Seal)
Date
State of
County of
On this day of , 19 , before me appeared (Name)
to me personally known, who, being duly sworn, did execute the foregoing affidavit,
and did state that he or she was properly authorized by (Name of Firm)
to execute the affidavit and did so as his or her free act and deed.
Notary Public
Commission Expires
(Seal)
A -4