HomeMy WebLinkAboutMINUTES - 05172005 - C6 TO: BOARD OF SUPERVISORS
FROM: MAURICE M. SHIU,PUBLIC WORKS DIRECTOR
DATE: May 17, 2005
SUBJECT: AcceEting completion of improvements, San Ramon(Douagrty Valley) area.
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
ARECOMMENDATION(S :
ADOPT Resolution No. 2005/ 295 — for Subdivision 03-08690,accepting 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
The improvements are complete in accordance with the improvement plans and the ordinance code.
CONSEQUENCES OF NEGATIVE ACTION:
The improvements will not be accepted as complete.
Continued on Attachment: SIGNATURE: eVA
COMMENDATION OF COUNTY ADMINISTRATOR
,"RECOMMENDATION OF BOARD COMMITTEE
APPROVETHER
SIGNATURES):17.4
ACTION OF BO A*0 ON. MAY 170 2005 APPROVED AS RECOMMENDED xx OTHER
V
I hereby certify that this is a true and correct
copy of an action taken and entered on the
VOTE OF SUPERVISORS minutes of the Board of Supervisors on the
XX UNANIMOUS(ABSENT NONE date shown.
AYES: NOES:
ABSENT: ABSTAIN:
TR:sr MAY 171 2005
G:\GrpData\EngSvc\BO\2005\05-I 7\SD 03-08690 B045.doc ATTESTED:
Originator: Public Works(ES) JOHN SWEETEN, Clerk of the Board of
Contact:Teri Rie(313-2363)
Tax I.D.95-2578030 Supervisors and County Administrator
cc: Public Works -T.Bell,Construction Div.
-M.Valdez,M&T Lab
-J.Ysmael,Engineering Services
-T.—3/17/06
Sheriff-Patrol Div.Commander By Deputy
CHP,c/o,Al
CSAA—Cartog
Steve Savage,Shapell Industries of Northern CA
100 N.Milpitas Blvd.,Milpitas,CA 95035
Sam Worden,Shapell Industries of Northern CA
100 N.Milpitas Blvd.,Milpitas,CA 95035
Pamela Stocks,National Fire Insurance Company of Hartford
5820 Canoga Ave.,Ste 200,Woodland Hills,CA 91367
CONTRA COSTA Co Recorder Office
Recorded at the request of: STEPHEN L e �JEIR
ClerkR d
Contra Costa County
�� ,,,,�C200 �O 1 79765" 00
Public Works Department Thursday, MAY 190 2005 10:40:44
Engineering Services Division FRE $0.00
Return to: TtlPd@,@@Public Works DepartmentNbr•0002704202
Engineering Services Division Irc/RS/1-8
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
Adopted this Resolution on May 17, 2005 by the following vote:
AYES: SUPERVISORS GIOIA, PIEPHO, DESAUINIER, GLOVER AND UILKEMA
NOES: NONE
ABSENT: NONE
ABSTAIN: NONE
RESOLUTION NO. 200 . 295
SUBJECT: Accepting completion of improvements, Subdivision 03-08690, San Ramon
(Dougherty Valley) area. (District III)
These improvements are approximately located near Japonica Road and North Monarch
Road.
The Public Works Director has notified this Board that the improvements in Subdivision 03-
08690 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.
I hereby certify that this is a true and correct
TR:sr copy of an action taken and entered on the
G:\GrpData\EngSvc1B012005\05-171SD 03-08690 B0-45.doc
Originator: Public Works(ES) minutes of the Board of Supervisors on the
Contact:Teri Rie(313-2363) date shown.
Recording to be completed by COB
Tax I.D.95-2579030
Cc: Public Works -T.Bell,Construction Div.
-M.Valdez,M&T Lab
-J.Ysmael,Engineering Services ATTESTED: MAY 17, 2005
-T.—3/17/06
Sheriff-Patrol Div.Commander JOHN SWEETEN., Clerk of the Board of
CHP,c/o M
CSAA—Cartog Supervisors and County Administrator
Steve Savage,Shapell Industries of Northern CA
100 N.Milpitas Blvd.,Milpitas,CA 95035
Sam Worden,Shapell Industries of Northern CA
100 N.Milpitas Blvd.,Milpitas,CA 95035
Pamela Stocks,National Fire Insurance Company of Hartford By LTZMOA-�l Deputy
5820 Canoga Ave.,Ste 200,Woodland Hills,CA 91367 "'1000,01,107
RESOLUTION NO.2005/ 295
•
SUBJECT: Accepting completion of improvements, Subdivision 03-08690, San Ramon
(Dougherty Valley) area. (District III)
DATE. May 17, 2005
PAGE: 2
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:
DATE OF AGREEMENT NAME OF BANK/SURETY
June 8, 2004 National Fire Insurance Company of Hartford
BE IT FURTHER RESOLVED the payment (labor and materials) surety for$698,650.00,
Bond No.929-299-740 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 Tulip Way, Tulip Court, Calico Drive, Calico Court,
Glory Lily Court and Violetta Court the hereinafter described roads, as shown and dedicated for
public use on the Final Map of Subdivision 03-8690 filed June 2004,in Book 465 of Maps at Page
39-47, Official Records of Contra Costa County, State of California, are ACCEPTED as
COMPLETE.
Road Name Road-R/W Widths Lengths (Miles)
Tulip Way 56' .09
Calico Court 56' .18
Glory Lily Court 56' .18
Tulip Court 56' .05
Violetta Court 56' .07
Upon acceptance by the Board of Supervisors, the City of San Ramon shall accept Tulip
Way,Calico Court,Glory Lily Court,Tulip Court,and Violetta Court for maintenance in accordance
with the Dougherty Valley Memorandum of Understanding.
BE IT FURTHER RESOLVED that the beginning of the warranty period is hereby established,
and the$14,000.00 cash deposit(Auditor's Deposit Permit No.423931,dated May 3,2004)made by
Shapell Industries of California and the performance/maintenance surety bond rider for$207,495.00,
Bond Number 929-299-740 issued by National Fire Insurance Company of Hartford be RETAINED
pursuant to the requirements of Section 94-4.406 of the Ordinance Code until release by this Board.
All deposit permits are on file with the Public Works Department.
RESOLUTION NO. 2005/295
CNASURETY Tract 8690, N-4, Gallery, Gale Ranch II
INCREASE - DECREASE RIDER
TO BE ATTACHED TO and form part of Bond Number 929 299 740 issued by the
National Fire Insurance Company of Hartford as
Surety,on behalf of Shapell Industries of Northern California,a Division of Shapell Industries, Inc. of
Milpitas, CA , hereinafter referred
to as the Principal, and in favor of County of Contra Costa
of Martinez, CA , hereinafter
referred to as the Obligee,effective the 20th day of April 2004 .
IN CONSIDERATION of the premium charged for the attached bond and other good and valuable consideration it
is understood and agreed that effective the 15th day of March , 2005 ,and
subject to all the terms, conditions and limitations of the attached bond, the penal sum thereof shall be and the
same is hereby **DECREASED*" from the sum of
One Million Three Hundred Eighty Three Thousand Three Hundred No/100** Dollars($ 1,383,300.00** ),to the
sum of Two Hundred Seven Thousand Four Hundred Ninety Five No/100** Dollars ($ 207,495.00** ).
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 One Million Three Hundred Eighty Three Thousand Three Hundred No/100** Dollars($ 1,383,300.00** )
or for any loss occurring subsequent to said date shall not exceed the sum of
Two Hundred Seven Thousand Four Hundred Ninety Five No/100** Dollars($ 207,495.00** }.
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,\By:
D DATED this 16th day of March,2005.
Accepted Shapell Industries of Northern California, a Division
County osta _ of Shapell Industries, Inc.
(Principal)
f
r
By By .- (Seal)
0 4-
J L
B (Seal)
Natio_ ir6 Insurance Company of Hartford —
f ,
Buret
Form F4763
By' -- -- (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, Individually
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 2000
0s AM ap CONTINENTAL CASUALTY COMPANY
9- NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
0"Are W AMERICAN CASUALTY COMPANY OF READING,PENNSYLVANIA
JULY 3 1.
SEAL Isu
4
State of Illinois, County of Cook,ss: Marvin J.Cashion Group Vice President
On this 7th day of January 1 2000 ,before me personally came
Marvin J. Cashion,to me known,who, being by me duly sworn,did depose and say:that he res—ides 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 00,
* Maty Puibik�.Sme of Mwels
• 4;7ZQ
oewWedon Exams 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 force. In testimony whereof I have hereunto subscribed my name and affixed the seals of the
said corporations this 16thday of March 2005
1111111111111111000111 wi CONTINENTAL CASUALTY COMPANY
NATIONAL FIRE INSURANCE COMPANY OF HARTFORD
►OpArr AMERICAN CASUALTY COMPANY OF READING,PENNSYLVANIA
SEAL JULY 31
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 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 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 attomeys-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,Atto meys-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 seal 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 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 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 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 V{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 seal 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 Angele
March-16,2005 before me. Sandy Hanner--Notary Public
On Date NAME. TITLS OF OFFICER.."JANE DOE. NOTARY PUBLIC'
Pamela L.Stocks
personally appeared NAME(S)OF SIGNER(S)
(-x ) personally known to me-OR- (...) proved to me on the basis of satisfactory evidence to be
theperson($) whose name(&) is/** subscribed to the within instrument and acknowledged to me that
No/she/Wft executed the same in fts/her/tair authorized capacity(Wa)v and that by kWher/VtW*
signature(s) on the instrument the person(f), or the entity pon behalf of which the person(s) acted,
executed the instrument.
WITNES my hand and ial seal.
SANDYHMNER
Commission S 1362167- SIGNATURE OF NOTARY
Notary Public-Colftrfife
Los Angeles County OPTIONAL
MY Comm..Expires Jul 2,20=06
Though the data below is 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
NUMBSR OF PAGES
ATTORNEY-IN-FACT
TRUSTEE(S)
GUARDIAN/CONSERVATOR
OTHER
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF PERSON(S)OR ENTITY(IES)
blatio'nal Firp.-Ingurance QQMDany,of Hartford
SIGNER(S) OTHER THAN NAMED ABOVE
G-107426-5
•
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.
DIS CLOSURE QF PREMIUM
The premium attributable to coverage for terrorist acts certified under the Act was
Zero Dollars ($0.00).
DISCLQSURE OF FEDERAL PARTICIPATION IN PAYMENYOF TERRORISM
LOSSipio
The United States will pay ninety percent (90%) of covered terrorism losses exceeding
the applicable suretylinsurer deductible,
Form F7310
<X, 1�
?i
IV
CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT
State of California
County of Santa Clara r1
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
names are subscribed to the within instrument and acknowledged to me that they
<' executed the same in their authorized capacity, and that by their signature on the
instrument the persons, or the entity upon behalf of which the persons acted, executed the
> instrument.
}
JANICE I KRUSE WITNESS my hand and official seal.
Commission# 1318697 ,
l
Notary Public-California
' Santa Clara County - >>
My Comm.Expires Aug 24,2005 ; " Signhture of Notary Publicell
?<
Optional Information
Title or Type of Document: Increase/Decrease Rider Tract 8690
?� Capacity Claimed by Signer: Assistant Vice President and Assistant Secretary of
l/
{ Shapell Industries,Inc.,