FORSYTH COUNTY BOARD OF EDUCATIONREQUEST for PROPOSALS from

PREQUALIFIED CONSTRUCTION MANAGERS forNORTH FORSYTH HIGH SCHOOL PROJECT

PROPOSAL FORMAT AND FORMS

INVITATION

Competitive sealed proposals from Prequalified Construction Managers for Construction Management At-Risk for the construction of the North Forsyth High School will be received by the Forsyth County Board of Education no later than 2:00 PM on March 4, 2015 at the following address:

Forsyth County Board of Education (FCS)1120 Dahlonega HighwayCumming, GA 30040

A mandatory pre-proposal conference will be held on February 17, 2015 at 1:00 PM. The meeting will be held at Forsyth County Board of Education, Professional Development Center, 1120 Dahlonega Highway, Cumming, GA 30040, in Room 380.

OWNER: Forsyth County Board of Education

ARCHITECT: Foreman, Seeley and Fountain Architecture

A. PROJECT: North Forsyth High School

Additions and Renovations

3635 Coal Mountain Road

Cumming, GA 30028

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B. PROJECT TIMELINE

RFPIssue RFP February 4, 2015Mandatory Pre-Proposal Conference February 17, 2015RFP Responses due March 4, 2015Interviews March 25 and 26, 2015Final Selection April 16, 2015CM to Begin Preconstruction Services April 17, 2015

CAMPUS PREP (Bus Parking, Site Utilities, Corridor Renovations, Selective Building Demo)Construction Documents (Final GMP Set) April 24, 2015Final Permit Approvals May 29, 2015Groundbreaking June 1, 2015Substantial Completion August 1, 2015Final Completion August 15, 2015

BUILDING PACKAGE PHASE I (New Cafeteria, Kitchen, Food Court, Administration, Gym)Groundbreaking June 1, 2015Substantial Completion July 15, 2016Final Completion August 1, 2016

BUILDING PACKAGE PHASE II (Renovation Band Suite, Labs, Chorus)Groundbreaking June 1, 2016Substantial Completion December 1, 2016Final Completion January 4, 2017

C. CONTRACT DOCUMENTS

The architectural and engineering contract documents for the project are in progress. The project Design Development documents prepared by the Architect, Foreman, Seeley, Fountain Architecture, can be viewed online beginning February 4, 2015 by emailing pallansch@FSFarchitecture.com. Only firms, both already prequalified and attending the Pre-Proposal Conference, will be eligible to propose.

D. SEALED COMPETITIVE PROPOSALS

This procurement is being conducted as a competitive sealed proposal in accordance with State of Georgia Code Sections 36-91-20 and 36-91-21. Proposals will be received and evaluated accordingly.

E. SELECTION PROCESS and SELECTION CRITERIA

Responses to this Request will be reviewed by the FCS selection committee, scored, and a selected number of firms with the highest scores will be invited to interview.

F. EVALUATION OF PROPOSALS

The following evaluation factors and relative weights will be used to rate each proposal. The selection committee will rate each firm according to the points listed below. The numerical value will be totaled to achieve the total rating of each Proposal.1. Firm History & Capability 102. Relevant Experience/References 203. Project Personnel 204. Financial Information 55. Project Approach 106. Design Phase (Preconstruction) Fee and Reimbursable Expenses,

Construction Phase Reimbursable (General Conditions/Overhead) ExpensesCM Construction Phase Fee 20

7. Initial Guaranteed Maximum Price Estimate / Contract Agreement 15

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G. ORAL INTERVIEW / PRESENTATION /BEST AND FINAL OFFER PROCESS

After reviewing the information submitted in the evaluation of proposals, the owner will interview the highest ranked firms. All responsible offerors found by the owner to have submitted proposals reasonably susceptible of being selected for award shall be given an opportunity to participate in the oral interviews/presentations.

H. REQUIREMENTS FOR PROPOSALS

Proposals should be provided in the following order, with each section clearly identified:

1. Firm History and CapabilityProvide the following basic company information (please limit to three pages per firm):

a) Address of corporate and branch offices. State which office location would be responsible for the management of this project. Provide project Principal in Charge (Project Executive) contact, telephone and email information.

b) Form of ownership and number of years in business (corporate and responsible branch office). Office performing the work shall have been in existence for no less than ten years.

c) Organizational chart of the company indicating structure and depth of resourcesd) Number of employees by professional discipline and locatione) Litigation history for the past five years f) Safety record and experience modification ratings for the past three years (attach OSHA 300 log

for 2011 - 2013). List any OSHA fines and jobsite fatalities in the past three years.g) List Offeror’s total annual CM at Risk billings for the past 5 years.

2. Relevant ExperienceEach Offeror shall submit at least three (3) similar CM at Risk projects of $15,000,000 construction value completed by the Construction Manager in the last 5 years. Each selected project should be similar in size, budget and scope to the project. Projects should also be representative of team member experience. Offerors that have not completed three (3) $15,000,000 similar construction projects should submit the three (3) most revelant projects. For each project, the following information shall be submitted:

a) Name of the projectb) Telephone number, fax number and e-mail of the representative of the architect in charge of construction

contract administrationc) Name, telephone number, fax number and e-mail of the representative of the Ownerd) Square Foot Area of the projecte) Construction cost of the project (including both final contract value and initial contract value)f) Schedule Information (including contract execution date, contract initial substantial completion date and

actual substantial completion date)g) Contract Delivery Methodh) Proposed team members that participated on each project and their respective roles

Each Offeror shall also list all projects in excess of $15,000,000 that the proposer has completed in the last five years. For each project, the following information shall be submitted:

a) Name and description of the projectb) Telephone number, fax number and e-mail of the representative of the architect in charge of construction

contract administrationc) Name, telephone number, fax number and e-mail of the representative of the Ownerd) Proposed team members that participated on each project and their respective roles

Each Offeror shall also list all projects currently under contract, including value and size.

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3. Project Personnela) Organizational chart of the team with titles and roles of key team membersb) Resumes of each key team member indicating relevant experience. Positions should include Project

Executive, Preconstruction Services Manager, Project Manager, Cost Estimator, Superintendent(s) and Safety Manager. Indicate the relevant project experience for each position the individual has already served in the same capacity as that being proposed. Should your company be selected as a finalist, the individuals submitted as your key team members will be expected to participate in the selection committee interviews. (Should your company be selected as the Construction Manager, you should not replace or change personnel for the duration of the Project without Owner’s prior written consent. Construction Manager shall be liable for liquidated damages in the amount of $350.00, for each day the Construction Manager fails to comply with this requirement).

c) Current and planned availability for each proposed team member, percentage of time each will spend on the project, and length of commitment for each.

4. Financial Informationa) Bonding Company Information

Provide contact information for your bonding company, a letter from the surety indicating current unused available bonding capacity, and the A.M. Best rating for the surety. Inability to bond the project will mean disqualification of respondents.

b) Insurance Provide a current certificate of insurance detailing the firm’s present coverage and limits. Insurance agent shall certify that you are licensed to perform business in the State of Georgia. The certificate of insurance should be addressed to FCS and be dated within 30 days of the proposal date.

c) Provide last 3 fiscal years of financial statements and current Dunn & Bradstreet report. If you want your financial information to remain confidential, please mark “confidential”.

5. Project Approacha) Preconstruction Services

Provide a description of your approach to managing preconstruction services specific to this project. Your description should include the following at a minimum:1) Successful management tools and techniques2) Describe your approach for the preparation of Assumptions and Clarifications. 3) Process for establishing the GMP4) Constructability Review Process5) Identification of specific potential project impediments and your proposed solutions.6) Voluntary Cost Savings suggestions

b) Construction ServicesProvide a brief description of your approach to managing construction services for this project to insure that the project will be completed on time within your initial Guaranteed Maximum Price and quality levels. Your description should include the following:

1) Subcontractor procurement 2) Budget Control3) Quality Assurance/Quality4) Schedule Control5) Project Accounting 6) Safety7) Change Management8) Commissioning, Close Out, Warranty

c) Demonstrated Ability to meet this Project Schedule1) Provide a Project Schedule which clearly shows the logical steps necessary to deliver each of the

projects phased area substantial completions and final completions on schedule.

d) Provide a proposed site layout, logistics, phasing, temporary facilities and security plan.

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6. Fee Proposal

The construction manager shall be compensated for the cost of the work plus a fee. The fee shall be based on the scope of work included in the design development documents and the Guaranteed Maximum Price. Submit a Design Phase (Preconstruction) Fee and Reimbursable Expenses, Construction Phase Reimbursable (General Conditions/Overhead) Expenses, and CM Construction Phase Fee Proposal in a sealed envelope at the time of the submission.

7. Initial Guaranteed Maximum Price Estimate / Contract AgreementOfferors shall submit a proposed Initial Guaranteed Maximum Price “IGMP” in a sealed envelope at the time of submission. The IGMP is based on the highest intent of the scope of work included in the design development documents, the existing site conditions, and your experience as a Construction Manager at Risk. An associated supplemental IGMP “Assumptions and Clarifications” narrative is allowed to be included.

Also indicate your agreement to the attached “Staged Project Form of Contract for Construction Management Services including construction for a Guaranteed Maximum Price” between Forsyth County Schools and the Construction Manager (as attached).

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CM at Risk (CMAR) FEE PROPOSAL(Submit in a Sealed Envelope)

1. CMAR’s FEE:

Basis of Fee. The CMAR’s fee is the amount, established by and agreed to by both parties, which is the full amount of compensation due to the CMAR as gross profit, and for any and all expenses of the Project not included and identified as a Cost of the Work, provided that the CMAR performs all the requirements of the Contract Documents within the time limits established.

A. DESIGN PHASE (PRECONSTRUCTION) FEE:

Design Phase (Preconstruction) Fee. For the design phase (preconstruction) consulting services provided by CMAR as set forth in the Construction Management Services Contract. Owner shall pay to CMAR a Preconstruction Fee, proposed by CMAR as:

Total

Design Phase (Preconstruction) Fee

B. CONSTRUCTION PHASE FEE:

Construction Phase Fee: For the construction services provided by CMAR as set forth in the Construction Management Services Contract. Owner shall pay to CMAR a Construction Fee, proposed by CMAR as:

Total

Construction Phase Fee

2. CMAR’S REIMBURSABLE EXPENSES DESIGN PHASE (Preconstruction and Construction):

The CMAR’s Overhead Costs. The maximum amount for the CMAR’s proposed Preconstruction Costs and Expenses and Construction Overhead Costs is inclusive of all direct and incidental expenses.

Maximum Design Phase (Preconstruction) Reimbursable Expenses

$

Maximum Construction Phase Reimbursable (General Conditions/Overhead) Expenses

$

Total Maximum CMAR Reimbursable Expenses

$

* Note: Total Anticipated Monthly Total Maximum Reimbursable Expenses Exclusive of Insurance may be less than Maximum Monthly reimbursable expenses multiplied by the Anticipated Months in the Construction Schedule, but cannot exceed it.

Attach the “Total All Design Phase Reimbursable Expenses”, “Total All Construction Phase Reimbursable Expenses” and “Initial GMP” to this CMAR Fee Proposal in the same sealed envelope.

_____________________________________________________Company NameAuthorized Signature: _____________________________________ Date: ____________________

Printed Name and Title: ________________________________

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DESIGN PHASE (PRECONSTRUCTION) REIMBURSABLE EXPENSES

Description Qty Unit Labor* Mat'l** SubLabor

SubtotalMat'l

SubtotalSub

Subtotal Total NotesA. Preconstruction - Supervision & Management:1 Senior Project Mgr. mos $0 $0 $0 $02 Project Mgr. mos $0 $0 $0 $03 Preconstruction Manager mos $0 $0 $0 $04 Project Supt. mos $0 $0 $0 $05 Cost Control mos $0 $0 $0 $06 Scheduling mos $0 $0 $0 $07 Secretary mos $0 $0 $0 $08 Consultant mos $0 $0 $0 $09 Other (Identify) mos $0 $0 $0 $0

Subtotal $0

B. Preconstruction - Miscellaneous10 Office Supplies mos $0 $0 $0 $011 Postage & Shipping mos $0 $0 $0 $012 Blueprint/Photostat. ls $0 $0 $0 $013 Phone Charges mos $0 $0 $0 $014 Phone Charges-Long Dist. mos $0 $0 $0 $015 Courier Service mos $0 $0 $0 $016 Travel Expenses mos $0 $0 $0 $017 Other (Identify) mos $0 $0 $0 $0

Subtotal $0

DESIGN PHASE (PRECONSTRUCTION) REIMBURSABLE EXPENSES EXEXexEXPENSES

$0

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Fill-in all applicable costs, any attempts to recategorize any of these items as "Fee", "Cost of Work", or "By Others" will be treated as a non-responsive proposal.

CONSTRUCTION P H A S E R E I M B U R S A B L E E X P E N S E S ( G E N E R A L C O N D I T I O N S / O V E R H E A D )Description Qty Unit Labor* Mat'l** Sub

LaborSubtotal

Mat'lSubtotal

SubSubtotal Total Notes

Site Supervision & Management:1 Senior Project Mgr. mos $0 $0 $0 $02 Project Mgr. mos $0 $0 $0 $03 Project Supt. mos $0 $0 $0 $04 Asst. Project Supt. mos $0 $0 $0 $05 Area Supt. mos $0 $0 $0 $06 Secretary mos $0 $0 $0 $07 Project Engineer mos $0 $0 $0 $08 Engineer or Eng. Company mos $0 $0 $0 $09 Cost Control mos $0 $0 $0 $0

10 Safety Engineer mos $0 $0 $0 $011 Scheduling mos $0 $0 $0 $012 Purchasing mos $0 $0 $0 $013 Project Accountant mos $0 $0 $0 $01415

Subtotal $0

Site Office Expense:18 Job Office Trailer Rent mos $0 $0 $0 $019 Office Jobsite Build Out ls $0 $0 $0 $020 Office Jobsite Set-up ls $0 $0 $0 $021 Temp. Const. Trailer/Storage ea $0 $0 $0 $022 Office Furniture ls $0 $0 $0 $023 Office Machines/Equip. mos $0 $0 $0 $024 Copy Machines/Maintenance mos $0 $0 $0 $025 Office Supplies mos $0 $0 $0 $026 Janitor/San. Supplies mos $0 $0 $0 $027 Postage & Shipping mos $0 $0 $0 $028 First Aid/Med. Treat. mos $0 $0 $0 $029 Telephone System ls $0 $0 $0 $030 Phone Installation ls $0 $0 $0 $031 Phone Charges mos $0 $0 $0 $032 Phone Charges-Long Dist. mos $0 $0 $0 $033 Radio Communications ea $0 $0 $0 $034 Radio Maintenance ls $0 $0 $0 $035 Computer-PCS mos $0 $0 $0 $036 Computers mos $0 $0 $0 $037 Software allow $0 $0 $0 $038 MIS Charges mos $0 $0 $0 $039 Temp. Electric-Office mos $0 $0 $0 $040 Security-Office mos $0 $0 $0 $0

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CONSTRUCTION P H A S E R E I M B U R S A B L E E X P E N S E S ( G E N E R A L C O N D I T I O N S / O V E R H E A D )Description Qty Unit Labor* Mat'l** Sub

LaborSubtotal

Mat'lSubtotal

SubSubtotal Total Notes

41 Water - Field Office mos $0 $0 $0 $04243

Subtotal $0

Safety & Security:43 Safety Incentives ls $0 $0 $0 $044 Watchman/Guard Ser. ls $0 $0 $0 $045 Traffic Control ls $0 $0 $0 $046 Safety Equipment ls $0 $0 $0 $047 Rainwear/Hardhats, etc. ls $0 $0 $0 $048 Drug Testing ea $0 $0 $0 $049 $0 $0 $0 $050 $0 $0 $0 $0

Subtotal $0

Bonds & Insurance:51 Perform. & Payment Bonds mos $0 $0 $0 $052 Workers Comp. Insurance mos $0 $0 $0 $053 Liability Insurance mos $0 $0 $0 $054 Fed. & State Unemployment mos $0 $0 $0 $055 FICA mos $0 $0 $0 $056 Builders Risk Insurance mos $0 $0 $0 $05758

Subtotal $0

Miscellaneous59 Off-Site Parking mos $0 $0 $0 $060 Ceremony Expense ls $0 $0 $0 $061 Vehicle for On-Site Project Manager mos $0 $0 $0 $062 Vehicle for On-Site Superintendent mos $0 $0 $0 $063 Vehicle Repairs/Maintenance ls $0 $0 $0 $064 Water - Coolers mos $0 $0 $0 $065 Water Barrels mos $0 $0 $0 $066 Ice Machine mos $0 $0 $0 $067 Ice and/or Cups ls $0 $0 $0 $068 Temporary Toilets Install ea $0 $0 $0 $069 Temporary Toilets mos $0 $0 $0 $070 Cold Weather Protection ls $0 $0 $0 $071 Temp. Heat for Bldg. ls $0 $0 $0 $072 Job Signs ea $0 $0 $0 $073 Progress Photos ea $0 $0 $0 $0

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CONSTRUCTION P H A S E R E I M B U R S A B L E E X P E N S E S ( G E N E R A L C O N D I T I O N S / O V E R H E A D )Description Qty Unit Labor* Mat'l** Sub

LaborSubtotal

Mat'lSubtotal

SubSubtotal Total Notes

74 Extra Plans & Specs. ea $0 $0 $0 $075 Blueprint/Photostat. allow $0 $0 $0 $076 Temp. Electric -Building mos $0 $0 $0 $077 Building Permit ls $0 $0 $0 $078 Plan Check Fees ls $0 $0 $0 $07980

Subtotal $0

TOTAL ALL CONSTRUCTION PHASE REIMBURSABLE EXPENSES(GENERAL CONDITIONS/OVERHEAD) $0

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Initial Guaranteed Maximum Price Proposal FormPROJECT: North Forsyth High School Additions and RenovationsACKNOWLEDGEMENT OF ADDENDA -___________________ THRU ____________________ACKNOWLEDGEMENT OF CONTRACT AGREEMENT (EXHIBIT D)-________________________INITIAL GMP SUMMARY BREAKDOWN

DESIGN PHASE (PRECONSTRUCTION) FEE $DESIGN PHASE (PRECONSTRUCTION) REIMBURSABLE EXPENSES $

SUBTOTAL DESIGN PHASE (PRECONSTRUCTION) $Line Item Div Description

2 Division 2 Site Work $3 Division 3 Concrete $4 Division 4 Masonry $5 Division 5 Metals $6 Division 6 Woods, Plastics, and Composites $7 Division 7 Thermal and Moisture Protection $8 Division 8 Openings $9 Division 9 Finishes $

10 Division 10 Specialties $11 Division 11 Equipment $12 Division 12 Furnishings $13 Division 13 Special Construction $14 Division 14 Conveying Equipment $15 Division 21 Fire Suppression $16 Division 22 Plumbing $17 Division 23 Heating Ventilating and Air Conditioning $18 Division 26 Electrical $19 Division 27 Communications $20 Division 28 Electronic Safety and Security $21 Division 31 Earthwork $22 Division 32 Exterior Improvements $23 Division 33 Utilities $24 Sub Total Division -2-33 $

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Construction Phase Reimbursable (General Conditions/Overhead) Expenses $

26 CM Construction Phase Fee $27 Contingency $28 TOTAL INITIAL GMP $

Submitting Company Name __________________________________________________________Authorized Individual Name and Title (Printed): __________________________________________ Authorized Signature: ____________________________________ Date: __________________

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I. The Owner reserves the right to reject any and all proposals and to waive technicalities and formalities, and to award the contract in the best interest of the Owner. The Owner will evaluate each proposal, interview the short-listed firms, make a final evaluation of the evaluation factors and determine a selected firm. If necessary, negotiations with the selected firm will be conducted. Should contract and/or pricing negotiations fail, FCS may enter into negotiations with one of the other highly ranked firms and make a contract award decision prior to disclosing the contents of the proposals in accordance with Georgia State law.

Submissions shall be submitted with 5 bound copies and one electronic copy on a CD in PDF format: Submittals must be confirmed to have been received by, no later than 2:00 PM on March 4, 2015 at the following address:

Forsyth County Board of EducationAttn: Facilities Department1120 Dahlonega HighwayCumming, GA 30040

J. QUESTIONS ABOUT THE REQUEST

Questions about this Request will be welcomed via E-mail through February 24, 2015 by 2:00 pm. Questions should be emailed to Kathy Pallansch to pallansch@FSFarchitecture.com at Foreman, Seeley and Fountain Architecture. Written responses to questions will be distributed via addendum by February 26, 2015 by 2:00 pm. It is the responsibility of each respondent to provide a contact person who will receive any addenda and distribute them to their respective teams.

K. MANDATORY SUBMITTALS

All of the following mandatory submittals must be included in all responses to this Request. Responses that do not include these documents will be considered non-responsive and will not receive further consideration.

1. Acknowledgement of Addenda Responses to this Request shall include acknowledgment of receipt of addenda (if any) in their sealed proposal.

2. Non-Collusion Affidavit Responses to this Request must include the signed Non-Collusion Affidavit.

L. USE OF SUBMISSIONS and COMPENSATION

All proposals and accompanying materials will become the property of FCS and will not be returned. Neither reimbursement nor compensation will be made to Offerors for submissions.

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ACKNOWLEDGEMENT of ADDENDA

The undersigned hereby acknowledges receipt of the following Addenda:[Insert the number and date of each Addendum; if none, insert "None"].

_________________________________________________

[COMPANY NAME]

_________________________________________________

[NAME AND TITLE OF AUTHORIZED INDIVIDUAL]

_________________________________________________

[SIGNATURE]

_________________________________________________

[DATE]

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OFFEROR’S and INDIVIDUALS’ AFFIDAVIT OF NONCOLLUSION(This affidavit to be executed in accordance with O.C.G.A. § 36-91-21(e))

STATE OF ______________________

COUNTY OF ____________________

COMES NOW, _________________________________________________________ (“Offeror”), [name of Offeror]

appearing by and through __________________________________ , it’s _________________________[insert name of individual with [title] authority to bind Offeror]

(averring both individually and in his or her representative capacity on behalf of Offeror) (the “Individual And

Representative Affiant”), and _____________________________________________________________[in these blanks insert the names of all those required to give the oath under O.C.G.A. § 36-91-21(e)]

_____________________________________________________________________________________

_____________________________________________________________________________________

______________________________________________________________________________________

_____________________________________________________________________________________

______________________________________________________________________________________

_______________________________________________________________________________________

_____________________________________________________________________________________

(collectively, the “Individual Affiants”), and each of the Individual And Representative Affiant and the Individual

Affiants, after first being duly sworn, deposes and says that:

1. He, she or it, as applicable, has not directly or indirectly violated subsection (d) of the Official Code of Georgia Annotated

Section 36-91-21, which subsection provides as follows:

(d) Whenever a public works construction contract for any governmental entity subject to the requirements of this chapter is to be let out by competitive sealed bid or proposal, no person, by himself or herself or otherwise, shall prevent or attempt to prevent competition in such bidding or proposals by any means whatever. No person who desires to procure such work for himself or herself or for another shall prevent or endeavor to prevent anyone from making a bid or proposal therefor by any means whatever, nor shall such person so desiring the work cause or induce another to withdraw a bid or proposal for the work.

2. If the Offeror is a partnership, then the Individual And Representative Affiant, together with the

Individual Affiants, constitute all of the partners and any officer, agent or other person who may have

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represented or acted for them in bidding or proposing for or procuring the contract for the Forsyth County

Board of Education Project for ________________________________________________ (the “Project”).

3. If the Offeror is a corporation or other entity, then the Individual And Representative Affiant,

together with the Individual Affiants, constitute all officers, agents, or other persons who may have acted

for or represented the corporation or other entity in bidding for or procuring the contract for the Project.

Further, the Individual And Representative Affiant and the Individual Affiants sayeth not.

This _______ day of _______________, 2____

_____________________________________[insert name of Offeror]

and ___________________________________________ [insert name of Individual And Representative Affiant]

By: ___________________________________, both individually and on behalf of Offeror as its[signature]

_________________________________[insert title]

Individual Affiants’ signatures and names:

x_____________________________________ x____________________________________Name: Name:

x_____________________________________ x____________________________________Name: Name:

x_____________________________________ x____________________________________Name: Name:

x_____________________________________ x____________________________________Name: Name:

x_____________________________________ x____________________________________Name: Name:

x_____________________________________ x____________________________________Name: Name:

Sworn to and subscribed before me this ___ day of _______________, 2____.

Notary Public: _____________________ My commission expires: __/__/__.

(SEAL)

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CORPORATE CERTIFICATE(Proposals)

STATE OF _______________________COUNTY OF _____________________

I, ________________________________, certify that I am the Secretary of the corporation named as offeror in the foregoing

proposal; that _____________________________________ who signed said proposal on behalf of the offeror was then

_______________________ of said corporation; that said proposal was duly signed for and in behalf of said corporation by authority

of its Board of Directors, and is within the scope of its corporate powers; and that said corporation is organized under the laws of the

State of ____________________.

_____________________________________[signature]

_____________________________________[typed name]

Subscribed and sworn to before me this ___ day of _______________, 2_____.

(SEAL)

_____________________Notary Public

My Commission Expires:___/___/___

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