HomeMy WebLinkAboutMINUTES - 05172005 - C5 TO: BOARD OF SUPERVISORS
FROM: MAURICE M. SHIU, PUBLIC WORKS DIRECTOR
DATE: May 17, 2005
SUBJECT: Acc2ting completion of improvements, San Ramon(Dougherty Valley) area.
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION('S :
ADOPT Resolution No. 2005 for Subdivision 01-08564,acceptmg completion of improvements for project
being developed by Shapell Industries of Northern California, a Division of Shapell Industries, Inc., San Ramon
(Dougherty Valley) area. (District III)
FISCAL IMPACT:
None.
BACKGROUND/REASON(S) FOR RECOMMENDATION(S):
The improvements are complete in accordance with the improvements plans and the ordinance code.
CONSEOUENCES OF NEGATIVE ACTION:
The improvements will not be accepted as complete.
Continued on Attachment: SIGNATURE:
ve�ECOMMENDATION OF COUNTY ADMINISTRATOR
RECOMMENDATION OF BOARD COMMITTEE
PROVE OTHER
SIGNATURE(S):
ACTION OF BO ON_ MAY 1-7, 9QQ5 APPROVED AS RECOMMENDED.Xx OTHER
I
VOTE OF SUPERVISORS NONE
xx UNANIMOUS(ABSENT
AYES: NOES:
ABSENT: ABSTAIN:
TR:rm I hereby certify that this is a true and correct
G:\GrpData\EngSvc\BO\2005105-171SD 01-08564 B045.doc copy of an action taken and entered on the
Originator: Public Works(ES)
Contact:Teri Fie(313-2363) minutes of the Board of Supervisors on the
I.D.95-2578030
cc: Public Works -T.Bell,Construction Div. date shown.
-M.Valdez,M&T Lab
-H.Finch,Maintenance Div.
-I.Bergeron,Mapping Div.
-J.Ysmael,Engineering Svc.
-T.—March 17,2006 ATTESTED: MAY 17 2005
Sheriff-Patrol Div.CommanderCHP,c/o Al JOHN SWEETEN, Clerk of the Board of
CSAA—Cartog Supervisors and County Administrator
Shapell Industries of Northern California,
a Division of Shapell Industries,Inc.
100 N.Milpitas Blvd.
Milpitas,CA 95035
Attn:S.Savage&S.Worden By /.0 Deputy
National Fire Insurance Company of Hartford
5820 Canoga Ave.,Ste 200
Woodland Hills,CA
CONTRA COSTA Cc Recorder Office
Recorded at the request of: STEPHEN L, WEIR Clerk=Recorder
Contra Costa County DOCS 2 �0179764 0 0
Board of Supervisors Thursday ,19 2005 10:40:39
Return to: Y: :
Public Works Department FRE $0.00
Engineering Services Division Tt 1 Pd $0100 Nbrm@@02704201
1rc/R9/1-13
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Resolution on May 17, 2005,by the following vote:
AYES: SUPERVISORS GIOIA, PIEPH09 DESAULNIER, GLOVER AND UILKEMA
NOES: NONE
ABSENT: NONE
ABSTAIN: NONE
RESOLUTION NO. 2005/ 294
SUBJECT: Accepting completion of improvements for Subdivision 01-08564, San Ramon
(Dougherty Valley)area. (District III)
These improvements are approximately located near Bollinger Canyon Road and Briar Oaks Road.
The Public Works Director has notified this Board that the improvements in Subdivision 01-
08564 have been completed as provided in the Subdivision Agreement with Shapell Industries of
Northern California, a Division of Shapell Industries, Inc., heretofore approved by this Board in
conjunction with the filing of the Subdivision Map.
NOW THEREFORE BE IT RESOLVED that the improvements have been COMPLETED as of
May 17, 2005 thereby establishing the six-month terminal period for the filing of liens in case of action
under said Subdivision Agreement:
TR:rm
G:1GrpData\EngSvc1B012005105-171SD 01-08564 B045.doc
Originator: Public Works(ES) I hereby certify that this is a true and correct copy of an
Contact:Teri Rie(313-2363)
Recording to be completed by COB action taken and entered on the minutes of the Board of
I.D.95-2578030 Supervisors on the date shown.
cc: Public Works -T.Bell,Construction Div.
-M.Valdez,M&T Lab
-H.Finch,Maintenance Div.
-I.Bergeron,Mapping Div. ATTESTED: MAY 173 2005
-J.YT—MaEngineering Svc.
-T. March
Clerk of the Board of Supervisors andh 17,2006 JOHN SWEETEN, p
Shriff-Patrol Div.Commander County Administrator
CUP,coAI
CSAA—Cartog
Shapell Industries of Northern California,
a Division of Shapell Industries,Inc.
100 N.Milpitas Blvd. BDeputy
Milpitas,CA 95035 y
Attn:S.Savage&S.Worden
National Fire Insurance Coripany of Hartford
5820 Canoga Ave.,Ste 200
Woodland Hills,CA
RESOLUTION NO.2005/ 294
SUBJECT: Accepting completion of improvements for Subdivision 01-08564, San Ramon
(Dougherty Valley) area. (District 111)
DATE: May 17, 2005
PAGE: 2
DATE OF AGREEMENT NAME OF BANK/SURETY
March 4, 2003 National Fire Insurance Company of Hartford
BE IT FURTHER RESOLVED the payment(labor and materials)surety for$2,102,800.00,
Bond No. 190 775 280 issued by the above surety be RETAINED for the six month lien guarantee
period until November 17,2005,at which time the Clerk of the Board is AUTHORIZED to release
the surety less the amount of any claims on file.
BE IT FURTHER RESOLVED that Briar Oaks Drive, Saturn Park Drive,Tiger Lily Drive,
Deldrin Court, Begonia Court, Graciosa Court, Brower Court, and a portion of Brower Way and
Saturn Park Court, the hereinafter described road(s), as shown and dedicated for public use on the
Final Map of Subdivision 01-08564 filed April 2, 2003,in Book 453 of Maps at Page 1-9, Official
Records of Contra Costa County, State of California, is/are ACCEPTED and DECLARED to be
County road(s).
Road Name Road-R/W Widths Lengths (Miles)
Briar Oaks Drive 36'-56' (varies 81.05 at Bollinger entry) .44
Saturn Park Drive 36'-56' .26
Tiger Lily Drive 36'-56' .09
Deldrin Court 36'-56' .04
Begonia Court 36'-56' .03
Graciosa Court 36'-56' .03
Brower Court 36)-56'p .11
Brower Way 36'-56' .03
Saturn Park Court 36'-56' .02
BE IT FURTHER RESOLVED that the beginning of the warranty period is hereby
established,and the$42,100.00 cash deposit(Auditor's Deposit Permit No.397647,dated December
18, 2002) made by Shapell Industries for Northern California and the performance/maintenance
surety bond rider for $624,525.00, Bond No. 190 775 280 issued by National Fire Insurance
Company of Hartford be RETAINED pursuant to the requirements of Section 94-4.406 of the
Ordinance Code until release by this Board.
Upon acceptance by the Board of Supervisors,the City of San Ramon shall accept Briar Oaks
Drive, Saturn Park Drive,Tiger Lily Drive,Deldrin Court,Begonia Court,Graciosa Court,Brower
Court,Brower Way and Saturn Park Court for maintenance in accordance with the Dougherty Valley
Memorandum of Understanding.
All deposit permits are on file with the Public Works Department.
RESOLUTION NO. 2005/294
CNASURETY Tract 8564, N-8,Coronado
INCREASE - DECREASE RIDER
TO BE ATTACHED TO and form part of Bond Number 190 775 280 issued by the
National Fire Insurance Company of Hartford as
Surety, on behalf of Shapell Industries of Northern California,a Division of Sha ell Industriesl Inc. of
Milpitas, CA hereinafter referred
to as the Principal, and in favor of County of Contra Costa
of Martinez, CA hereinafter
referred to as the Obligee, effective the 12th day of December . X002
IN CONSIDERATION of the premium charged for the attached bond and other good and valuable consideration it
is understood and agreed that effective the 14th day of March 1 2005 ,and
subject to all the terms, conditions and limitations of the attached bond, the penal sum thereof shall be and the
same is hereby "DECREASED*.A from the sum of
Four Million One Hundred Sixty Three Thousand Five Hundred No/1 00* Dollars($4,163,500.00** to the
SUM of Six Hundred Twenty Four Thousand Five Hundred Twenty Five No/100** - Dollars($ 624,525.00**
IT IS FURTHER UNDERSTOOD and agreed that subject to all the terms, conditions and limitations of the
attached bond, the aggregate liability of the Surety for any loss occurring prior to said date shall not exceed the
sum of Four Million One Hundred Sixty Three Thousand Five Hundred No/100* Dollars($ 4,163,500.00**
or for any loss occurring subsequent to said date shall not exceed the sum of
Six Hundred Twenty Four Thousand Five Hundred Twenty Five No/100** . Dollars($ 624,525.00**
In no event, however, shall the aggregate liability of the Surety exceed the larger of the aforementioned sums, it
being the intent hereof to preclude cumulative liability.
SIGNED,SEALED AND DATED this 16th day of March.,2005.
Accepted By: Sha ell Industries of Northern California,a Division
County of Contra%_Co of Shaped Industries, Inc.
(Principal)
By
By (Seal)
By ___ (Seal)
7��0 low
Natiq4'al Fir Insurance Company ofriliartford
Form F4763 (S Y)
,y (Seal)
Pamela L. Stocks Attorney-in-Fact
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents,That CONTINENTAL CASUALTY COMPANY,an Illinois corporation, NATIONAL FIRE
INSURANCE COMPANY OF HARTFORD,a Connecticut corporation,AMERICAN CASUALTY COMPANY OF READING,
PENNSYLVANIA, a Pennsylvania corporation(herein collectively called"the CCC Surety Companies"),are duly organized and existing
corporations having their principal offices in the City of Chicago,and State of Illinois,and that they do by virtue of the signature and seals
herein affixed hereby make,constitute and appoint
Pamela L. Stocks,Beverly A. Hall, Sandra V. Hanner, lndividua!!y
of Sherman Oaks,California
their true and lawful Aftomey(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on their behalf
bonds, undertakings and other obligatory instruments of similar nature
-In Unlimited Amounts-
and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their corporations
and all the acts of said Attorney, pursuant to the authority hereby given are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the BY-Laws and Resolutions, printed on the reverse
hereof,duly adopted,as indicated, by the Boards of Directors of the corporations.
In Witness Whereof,the CCC Surety Companies have caused these presents to be signed by their Group Vice President and their
corporate seals to be hereto affixed on this 7th day of January 1 2000
CONTINENTAL CASUALTY COMPANY
NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
COPPORAre AMERICAN CASUALTY COMPANY OF READING,PENNSYLVANIA
o
JULY 31. X4
SEAL Ism
Marvin J.Cashion Group Vice President
State of Illinois, County of Cook,ss:
On this 7th day of January 2000 ,before me personally came
Marvin J.Cashion,to me known,who, being by me duly sworn,did depose and say:that he resides in the City of Chicago, State of Illinois;
that he is a Group Vice President of CONTINENTAL CASUALTY COMPANY, NATIONAL FIRE INSURANCE COMPANY OF HARTFORD,
and AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA described in and which executed the above instrument;that he
knows the seals of said corporations;that the seals affixed to the said instrument are such corporate seals;that they were so affixed
pursuant to authority given by the Boards of Directors of said corporations and that he signed his name thereto pursuant to like authority,
and acknowledges same to be the act and deed of said corporations.
"OFFICIAL SEAL" •
DIANE FAULKNER
NoWy Public,SWO of MkW$
W rmom 9117101
My Commission Expires September 17,2001 Diane Faulkner Notary Public
CERTIFICATE
1, Mary A. Ribikawskis,Assistant Secretary of CONTINENTAL CASUALTY COMPANY, NATIONAL FIRE INSURANCE COMPANY OF
HARTFORD, and AMERICAN CASUALTY COMPANY OF READING,PENNSYLVANIA do hereby certify that the Power of Attorney herein
above set forth is still in force,and further certify that the By-Law and Resolution of the Board of Directors of each corporation printed on the
reverse hereof are still in forcn testimony whereof I have hereunto s ed my name and affixed the seals of the
said corporations this _lLp U
day of 14arch N!1).
CONTINENTAL CASUALTY COMPANY
NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
AMERICAN CASUALTY COMPANY OF READING,PENNSYLVANIA
JULY 31. C&
SEAL
1897
Mary A.Ribikawskis Assistant Secretary
(Rev.10/1/97)
Authorizing By-Laws and Resolutions
ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY:
This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the Board of
Directors of the Company.
"'Article IX—Execution of Documents
Section 3.Appointment of Attorney-in-fact.The Chairman of the Board of Directors,the President or any Executive, Senior or
Group Vice President may,from time to time, appoint by written certificates attorneys-in-fact to act in behalf of the Company in the
execution of policies of insurance, bonds,undertakings and other obligatory instruments of like.nature. Such attorneys-in fact,subject to
the limitations set forth in their respective certificates of authority,shall have full power to bind the Company by their signature and
execution of any such instruments and to attach the seal of the Company thereto.The Chairman of the Board of Directors,the
President or any Executive,Senior or Group Vice President or the Board of Directors,may, at any time,revoke all power and authority
previously given to any attorney-in-fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"Resolved,that the signature of the President or any Executive,Senior or Group Vice President and the seal of the Company may
be affixed by facsimile on any power of attorney granted pursuant to Section 3 of Article IX of the By-Laws,and the signature of the
Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and
any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so
executed and sealed and certified by certificate so executed and sealed shall,with respect to any bond or undertaking to which it is
attached,continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA:
This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the Board of
Directors of the Company.
"Article VI—Execution of Obligations and Appointment of Attorney-in-Fact
Section 2.Appointment of Attorney-in-fact.The Chairman of the Board of Directors,the President or any Executive, Senior or
Group Vice President may,from time to time,appoint by written certificates attorneys-in-fact to act in behalf of the Company in the
execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. Such attorneys-in-fact,subject to
the limitations set forth in their respective certificates of authority,shall have full power to bind the Company by their signature and
execution of any such instruments and to attach the seal of the Company thereto.The President or any Executive, Senior or Group Vice
President may at any time revoke all power and authority previously given to any attorney-in-fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"Resolved,that the signature of the President or any Executive,Senior or Group Vice President and the seal of the Company may
be affixed by facsimile on any power of attorney granted pursuant to Section 2 of Article VI of the By-Laws,and the signature of the
Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and
any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so
executed and sealed and certified by certificate so executed and sealed shall,with respect to any bond or undertaking to which it is
attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD:
This Power of Attorney is made and executed pursuant to and by authority of the following Resolution duly adopted on February 17,
1993 by the Board of Directors of the Company.
"RESOLVED:That the President, an Executive Vice President,or any Senior or Group Vice President of the Corporation may,from
time to time,appoint,by written certificates,Attomeys-in-Fact to act in behalf of the Corporation in the execution of policies of insurance,
bonds,undertakings and other obligatory instruments of like nature. Such Attorney-in-Fact,subject to the limitations set forth in their ,
respective certificates of authority, shall have full power to bind the Corporation by their signature and execution of any such instrument
and to attach the seal of the Corporation thereto.The President,an Executive Vice President,any Senior or Group Vice President or
the Board of Directors may at any time revoke all power and authority previously given to any Attorney-in-Fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"RESOLVED:That the signature of the President, an Executive Vice President or any Senior or Group Vice President and the seal
of the Corporation may be affixed by facsimile on any power of attorney granted pursuant to the Resolution adopted by this Board of
Directors on February 17, 1993 and the signature of a Secretary or an Assistant Secretary and the sea!of the Corporation may be
affixed by facsimile to any certificate of any such power, and any power or certificate bearing such facsimile signature and seal shall be
valid and binding on the Corporation.Any such power so executed and sealed and certified by certificate so executed and sealed,shall
with respect to any bond or undertaking to which it is attached,continue to be valid and binding on the Corporation."
Authorizing By-Laws and Resolutions
ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY:
This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the Board of
Directors of the Company.
"Article IX Execution of Documents
Section 3.Appointment of Attorney-in-fact.The Chairman of the Board of Directors,the President or any Executive,Senior or
Group Vice President may,from time to time, appoint by written certificates attomeys-in-fact to act in behalf of the Company in the
execution of policies of insurance,bonds, undertakings and other obligatory instruments of like.nature. Such attorneys-in-fact,subject to
the limitations set forth in their respective certificates of authority,shall have full power to bind the Company by their signature and
execution of any such instruments and to attach the seal of the Company thereto.The Chairman of the Board of Directors,the
President or any Executive, Senior or Group Vice President or the Board of Directors, may, at any time, revoke all power and authority
previously given to any attorney-in-fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"Resolved,that the signature of the President or any Executive,Senior or Group Vice President and the seal of the Company may
be affixed by facsimile on any power of attorney granted pursuant to Section 3 of Article iX of the By-Laws,and the signature of the
Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and
any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so
executed and sealed and certified by certificate so executed and sealed shall,with respect to any bond or undertaking to which it is
attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA:
This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the Board of
Directors of the Company.
"Article VI-Execution of obligations and Appointment of Attorney4n-Fact
Section 2.Appointment of Attorney-in-fact.The Chairman of the Board of Directors,the President or any Executive, Senior or
Group Vice President may,from time to time, appoint by written certificates attorneys-in-fact to act in behalf of the Company in the
execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. Such attorneys-in-fact,subject to
the limitations set forth in their respective certificates of authority,shall have full power to bind the Company by their signature and
execution of any such instruments and to attach the seal of the Company thereto.The President or any Executive, Senior or Group Vice
President may at any time revoke all power and authority previously given to any attorney-in-fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February,1993.
"Resolved,that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may
be affixed by facsimile on any power of attorney granted pursuant to Section 2 of Article Vi of the By-Laws,and the signature of the
Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and
any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so
executed and sealed and certified by certificate so executed and sealed shall,with respect to any bond or undertaking to which it is
attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD:
This Power of Attorney is made and executed pursuant to and by authority of the following Resolution duly adopted on February 17,
1993 by the Board of Directors of the Company.
"RESOLVED:That the President, an Executive Vice President, or any Senior'or Group Vice President of the Corporation may,from
time to time, appoint,by written certificates,Attorneys-in-Fact to act in behalf of the Corporation in the execution of policies of insurance,
bonds,undertakings and other obligatory instruments of like nature. Such Attorney-in-Fact, subject to the limitations set forth in their
respective certificates of authority,shall have full power to bind the Corporation by their signature and execution of any such instrument
and to attach the seal of the Corporation thereto.The President,an Executive Vice President, any Senior or Group Vice President or
the Board of Directors may at any time revoke all power and authority previously given to any Attorney-in-Fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of
Directors of the Company at a meeting duly called and held on the 17th day of February, 1993.
"RESOLVED:That the signature of the President, an Executive Vice President or any Senior or Group Vice President and the seal
of the Corporation may be affixed by facsimile on any power of attorney granted pursuant to the Resolution adopted by this Board of
Directors on February 17, 1993 and the signature of a Secretary or an Assistant Secretary and the spa!of the Corporation may be
affixed by facsimile to any certificate of any such power, and any power or certificate bearing such facsimile signature and seal shall be
valid and binding on the Corporation.Any such power so executed and sealed and certified by certificate so executed and sealed,shall
with respect to any bond or undertaking to which it is attached,continue to be valid and binding on the Corporation."
State of . California
County of Los Angeles
On March 16,2005 before me. Sandy Hanner-Notary Public
Oat* NAME.TITLE OF OFFICSR.. "JANE 006. NOTARY PUBLIC-
personally appeared - Pamela L.Stocks
NAME(S) OF SIGNER(S)
x) personally known to me—OR— (...) proved to me on the basis of satisfactory evidence to be
the person(g)whose name{*) is/mm subscribed to the within instrument and acknowledged to me that
he/she/Wexecuted the same in ft/her/*sir authorized capacifyoss), and that by kiw/her/Wak
signature(s) on the instrument the person(5), or the entity u on behalf of which the person(&) acted,
executed the instrument. I
K 'Alk WITNE my hand and q I seal.
SANDYHAN;ER
Commission#1362157
entity u
o,
JE m
y
n-w Notary Public-California 7SIGNATWRE OF NOTARY
Los Angeles County
My Comm. Expires Jul 2,2006 OPT'110NAL
Though the data belowis not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
INDIVIDUAL
CORPORATE OFFICER
TITLE(S)
TITLE OR TYPE OF DOCUMENT
PARTNER(S) LIMITED
GENERAL ........
(.!L) ATTORNEY-W-FACT NUM13ER OF PAGES
TRUSTEE(S)
GUARDIAN/CONSERVATOR
OTHER
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
National Fire InsuranCe CQ=any gf.-Hartford
SIGNERS) OTHER THAN NAMED ABOVE
(3.107426-8
NOTICE
In accordance with the Terrorism Risk Insurance Act of 2002, we are providing this
disclosure notice for bonds and certain insurance policies on which one or more of the
Writing Companies identified below is the surety or insurer.
To principals on bonds and insureds on certain insurance policies written by any one
or more of the following companies (collectively the "Writing Companies") as surety
or insurer: Western Surety Company,Universal Surety of America, Surety Bonding
Company of America, Continental Casualty Company, National Fire Insurance
Company of Hartford,American Casualty Company of Reading, PA, The Firemen's
Insurance Company of Newark, NJ, and The Continental Insurance Company.
DSCLC S11RE QF-PREWIUM
The premium attributable to coverage for terrorist acts certified under the Act was
Zero Dollars ($0.00),,
CE IRE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM
LOSSIMS
The United States will pay ninety percent (90%) of covered terrorism losses exceeding
the applicable surety/insurer deductible,
Form F7310
)j';' ., :•._ ,".rte _ ..`.; ^.%:i-..':/`.'',. •:;.!/`-`.,•-. ...!.�-%..'%././`./_ - .,
CALIFORNIAALL PURPOSE ACKNOWLEDGMENT
�
State of California <<
<� County of Santa Clara
On March 18,2005,before me, Janice T. Kruse,Notary Public personally appeared,
Robert D. Moore &J. L. Luedemann personally known to me to be the persons whose
s names are subscribed to the within instrument and acknowledged to me that they
d i
executed the same in their authorized capacity, and that by their signature on the
�
instrument theersons, or the entity upon behalf of which the persons acted, executed the
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instrument.
/
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�' JANICE I KRUSE >�
>� ri "!,�.. WITNESS my hand and official seal.
> Commission# 1318697
5
NotaryPublic-California ��'�� >>
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a Santa Clore County
» My Comm.Expires Aug 24.2005
Signature of Notary Public
Optional Information ;
Title or Type of Document: Increase/Decrease Rider Tract 8564
and Assistant Secreta of Capacity Claimed by Signer: Assistant Vice President a ry >
> p Y
Sha ell Industries Inc..
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