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Home My WebLink About2017 - PO #8115 Electrical Vault - Daikin Mini SplitAA�RCOi M9%v Account 120063 Sebastian Airport 212 E Airport Drive Vault Build Sebastian FL 32958 Invoice Arnold Air Conditioning, Inc. 181 Sebastian Blvd. CAC 1816097 Sebastian FL 32958 772-589-1063 FAX: 772-589-2437 46-497-8622 Invoice # 321568 Date: 08/01/17 Page # 1 of 1 Service At: Sebastian Airport 212 E Airport Drive Sebastian FL 32958 Vault Build Service Date PO # Job # 220114 Contract # Claim # Description Of Service Quantity Unit Price ExtendedPriceTax Daikin Mini Split 3 ton First Year Check (#404913) Account #: P.O. #: 81i5-oo Project #: Amount: $ 8964, 00 Date: $8,964.00 $8,964.00 $0.00 $0.00 Balance Due $8,964.00 AM 03 PM10:51 Terms: Due Upon Receipt Please pay from this Invoice. Thank You ---------------------------------------------------------------------------------------------------- Please Detach and Return with Remittance Check Enclosed[ ] Method of Payment Master Card [ ] Visa [ ] AmExp [ ] Discover [ ] Acct # Exp Date Name on Card Signature Remit To: Arnold Air Conditioning, Inc. Arnold Air Conditioning 181 Sebastian Blvd Sebastian FL 32958 Invoice # 321568 Date : 08/01/17 Account# 120063 Sebastian Airport Amount Due $8,964.00 Amount Paid A 'L�;--' n Air Conditioning, Inc. PURCHASE AGREEMENT (772) 589-1063 (321) 952-5511 www.arnoldair.com SINCE 1972 CAC1916097 Owner Name G !Ty O F SFB,asTl)f Al, Date 7 • / 9- • / l DwnerAddress AIX Z Al✓21ADYEi dIQ City, Stag, Zip S�V.611$T1a4.- CG Phone 1 77 1-VS'3- '77-11 Phone EmaIITTEST OD GrTYDFSUAsT'AU— OAK- JobAddress VAIALY AgNL&A4. '97 '414 Pa27 SIZE Warranty: _Comp _Pads _labor Price Includes: Taxes, Permits, Discounts. Rebates and Fees. All work is done In accordance with ousting codes and permits, as required. SYSTEM ENHANCEMENTS O LAO O Equipment Pad O Sound Isolation Pads o Compressor Assist Kit o Ceiling Saver Kh *21 Coanect to Ezlrtrng ElacWal- O Surge Protection X Hurricane Anchor Kit ,xThermostat Weatherproof Disconnect AReconnect Drain tine O New Plywood Deck O Drain Safety Swrch O Line Push & Pressure Test )ffSeai New Connections O Insulate and Seal Retum Manneve Existing Equipment 24 Clean Up All Debris . O 1 Year Nta!ntenance Inspection OComacttoEalttiapRafdgeramLlae/' p(NewRetrigarardLinn X O Contract to Existing Dud Work, Supply, and Patent Plenams' 'All alterations needed to meet current budding codes and manufacturing requirements arta properly complete Installation are the respons@Iliry of the homeowner. ADDITIONAL a 6'_t 6(5 AVICA) Ly'kl a.�w.v Pama,rax ary Tenns:O Cash O Chack s O Financed O CC1 Exp ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as SpeCifled. Payment Vull be made as outlined above. Payment In full is due upon completion. ROVER'S RIGFfr To CANCEL, This Is a home sofic'Miinn sale, and Kyou do rot want the goods or services, you mry mo i this agreement try prRd^ir; rrtinen notice to the sdlzr in person, by amtll, or by mall This notice must Indloste that you do not vam the goods or services and must be dekvered or postmarked before midnight of the third bustness day arm you don this agrranent. If yvu cancel Vih; agreement de sailor my not I¢ep ap or put of any rash dawn payment ra cels ions ere suhtett to a 2a% restoddrig tee. t abed xed did AdIVEZI• LMZ Zi, Lnr CITY OF SEBASTIAN ATTN: ADMINISTRATIVE SERVICES 1225 MAIN STREET SEBASTIAN, FL 32958 Mail Invoices In Duplicate To Purchase order 00008115-00 FY 2017 Acct No: 010056-534610 The Above Purchase Order Number Must Appear on All correspondence - Packing Sheets And Bills of Lading Above Address I Page 1 ==vendor ------------------------------ ship =To Arnold Air conditioning, Inc. city of Sebastian 181 Sebastian Blvd. Sebastian, FL 32958 Tel 561-589-1063 Requisition 00004987 Date lvenaor (Date Ism p I ordered (Number IRequired Ivia (Terms 07/19/17 1 1 LN Description Account unit 001 EACH 1 Air conditioner needs to be replaced. 3 ton heat pump, 1 3 ton powerhead. 10 year conpresser, 10 year parts and 1 year labor. The Above Line Item Is For Department: ***** General Ledger Summary Section Account 010056-534610 chief Procurement Officer OVE UL z0i� . 100 Veterans Memorial way Sebastian, FL 32958 Department _ _CENTRAL GARAGE unit Price NetPrice 8964.00000 8964.00 Bldg Maint PO Total 8964.00 Amount 8964.00 T CITY OF SEBASTIAN ATTN: ADMINISTRATIVE SERVICES 1225 MAIN STREET SEBASTIAN, FL 32958 Purchase___________ order 00008115-00 FY 2017 Acct No: 010056-534610 The Above Purchase Order Number Must Appear On All Correspondence - Packing Sheets And Bills of Lading Mail Invoices In Duplicate To Above Address Page 1 ---------------------- ----------- vendor ship To Arnold Air conditioning, Inc. City of Sebastian 181 Sebastian Blvd. 100 veterans Memorial way Sebastian, FL Sebastian, FL 32958 32958 Tel 561-589-1063 Requisition 00004987 Date vendor lbate Iship I Ordered INumber IRequired Evia Terms Department 67f19/17 1016123 1 1 ICENTRAL GARAGE LN Description / Account Unit Qty Unit Price Net Prlce 001 EACH 1.00 8964.00000 8964.00 Air conditioner needs to be replaced. 3 ton heat pump, 1 3 ton powerhead. 10 year conpresser, 10 year parts and 1 year labor. The Above Line Item Is For Department: ***** General Ledger Summary section Account 010056-534610 chief Procurement Officer Bldg Maint PO Total Amount 8964.00 �- CITY OF SEBASTIAN, FLORIDA 1225 Main Street Sebastian, FL 32958 Ph: 772-589-5537 Fax: 772-589-2566 E -Mail : city@cityofsebastian.org 17-002704 MECHANICAL PERMIT Permit Type: MECHANICAL COMMERCIAL Class of Work: MECHANICAL Proposed Use: COMMERCIAL Sq. Feet: 384 Est. Value: 27,300.0( Cost: 8,964.00 Total Fees: 163.35 Amount Paid: 163.39 Date Paid: 8/01/2017 Addr: Phone: Lic: SEBASTIAN, FL Township: 30 Range: 38 Lot(s): Block: Section: 22 Book: Page: Subdivision: ROSELAND SATELLITE FIELD Parcel Number: 30382200001000000000.0 Address: 1225 MAIN ST SEBASTIAN, FL 329584165 Phone: MONTHS FROM ISSUANCE, OR IF CONSTRUCTION IS SUSPENDED, OR ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME. SPECIFICATIONS ARE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. ' NOTICE' IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY, AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT " WARNING TO OWNER " YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENDTO OBTAIN FINANCING, CONSULT YOUR LENDOR OR AN EBBE -OF-GOINMENGEM THIS PERMIT IS APPROVED ON THIS DATE PURSUANT TO THE FLORIDA BUILDING, WAYNE, ESELTINE, Contractor or Authorized Agent Date INSPECTIONS SHALL BE REQUIRED FOR ALL PERMITS. HOME OF PELICAN ISLAND BUILDING DEPARTMENT - 1225 MAIN STREET• SEBASTIAN. FLORIDA32958 TELEPHONE: (772) 589-5537 • FAX (772) 589-2566 AIR CONDITIONING REPLACEMENT f C�� Date: Permit # / 7%� 7 Trackiinng # 1 � 0DD � ' `rT Job Name (i(7 O FS�SfiG`%Address: 2a t% A i r 11od lo ile' Contractor: IV Y10 / (f A / v Ductwork to be replaced: YES v NO - Affidavit required for sealing NEW ductwork Existing Equipment (To Remain) Condenser SEER: Minimum Circuit Amps: Max. ent Protection: A.H.U. Make /Model #: ea ucuit Amps: Max. Overcurrent Protcction: New Eauiiopment (To Be Installed) Condenser Make/ Model #: +'X SEER: Minimum Circuit Amps: Max. Overcurrent Protection: G A.H.U. Make / Model #: TTX / - 3(y N VJ-'Heat Strip K.W. Minimum Circuit Amps: Max. Overcurrent Protection: Package Unit Make / Model #: EER: Minimum Circuit Amps: Max. Overcurrent Protection: For Condenser and A.H.U. replacements (total system replacement only): (1) Verify new system components "Match" by using one of the following methods per Florida Energy Code 101.4.7 for Residential and Commercial: 1) Data from AHRI for verification of energy rating 2) Obtain an energy rating from an accredited testing lab (example ARL labs) 3) Manufactures letter stating compatibility of two pieces of equipment for code purposes 4) Florida -registered Professional Engineer's verification letter Commercial Equipment Mounted on Roof: Provide engineered attachment details to curb or stands. Signature of Qualifier_ License No. CERTIFIED Certificate of Product Ratings AHRI Certified Reference Number: 10244275 Date: 7/20/2017 Product: Variable Speed Mini-Split Heat Pump, with Remote Outdoor Unit Air-Source, Free Delivery Outdoor Unit Model Number: RX36NMVJU Indoor Unit Model Number: FTX36NVJU Manufacturer: DAIKIN AC (AMERICAS), INC. Trade/Brand name: DAIKIN Series name: Manufacturer responsible for the rating of this system combination Is DAIKIN AC (AMERICAS), INC. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, Independent, third party testing: Cooling Capacity (Btuh): 34400 EER Rating (Cooling): 9.10 SEER Rating (Cooling): 15.90 Heating Capacity(Btuh) @ 47 F: 36000 Region IV HSPF Rating (Heating): 9.20 Heating Capacity(Btuh) @ 17 F: 22800 CERTIFIED RATINGS FOR VARIABLE-SPEED, MINI. AND MULTI-SPLIT SYSTEMS ARE VALID FOR ALL COMBINATIONS OF INDOOR UNITS (BASED ON COMBINATION TYPES) WITH THE SPECIFIC OUTDOOR UNIT LISTED ABOVE AND IN THE AHRI DIRECTORY OF CERTIFIED EQUIPMENT. VISIT W W W.AUHRIDIRECTORY.ORG TO VERIFY THAT THIS COMBINATION IS AN ACTIVE LISTING AND THE DATA LISTED ON TMCE Tl bTe leste^sk •' I�pTE� SEARCH ON THE -IRI RF,hFFhR�S10E # TO OUI PKI�Y L�CI�F THI ��MBINf1TION IN THF�DIRECTORY. Y. d ® a o un �ry re e e o/ els lie a a e, unless M p pu accom en ed a v n hales an nvoNnto rare , DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representatlons, warranties or guarantees as to, and assumes no roaponalblity for, the Product(s) listed on this Certificate. AHRI exprecMy dlsdalme all IlabllWor damages of any kind arising out of the use a performance of the product(s). or the unauthor7ed alteration of data listed on this Certificate. Certified ratings are valid onty, for models and wnfiguradons listed In the directory at www.ahrldirectury.erg. TERMS AND CONDITIONS This Cerdficets and its contents are proprietary products of AHRI.ThIs Certificate shall only be used for Individual, personal and cotam' dal reference purposes. The contents a}this Certificate may not, In whole ar In pert, be re In disseminated; an Into a computer detsbase; or otherwise utilized, In any form or manner or by any means, except for the user's individual, personal and confidential reference. AIR-CONDMONING, HEATINQ CERTIFICATE VERIFICATION 6 REFRIGERATION INSrMrrE The Information for the model cited on this certificate can be verified at www.ahrl Olrectory.org, click on Nerlfy Certificate' link ue make life bener- and enter the AHRI Certiled Reference Number and the data on which the certificate was Issued, which Is listed shown, and the Certificate No., which Is listed at bottom H&L 02014 Air-Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 131450253009628682 PERMIT # CMOF SESASTLAN HOME OF PELICAN ISLAND BUILDING DEPARTMENT 1225 MAIN STREET • SEBASTIAN, FLORIDA 32958 TELEPHONE: (772) 589-5537 • FAX (772) 589-2566 OWNE"UILDER PERMIT APPLICATION ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO FS 713.13' TRACKING # DATE: INDIAN RIVER COUNTY PARCEL ID # RECEIVED BY:— LOT:— Y: LOT: - BLOCK: SUBDIVISION: FLOOD ZONE: TYPE OF WORK: L)YEW STRUCTURE ❑ADDITION ❑ALTERATION ❑ REPAIR ❑DEMOLITION ❑ OTHER WORK INCLUDES: ❑STRUCTURAL []ELECTRICAL []PLUMBINGCHANICAL []ROOFING - SLOPE:_ ❑ POOL [—]ALUMINUM STRUCTURE ElSHEDDFENCE ❑ SLAB OR DECK ❑ OTHER WORK DESCRIPTION: Fl/C V°n %V 9� flgc ncae ESTIMATED JOB VALUE: $ v 1� C `' v y TOTAL SIF UNDER AIR JOBNAME: AIGZF02-I Ak°'C%r,,tA vq�A JOB ADDRESS: �.e=*16- (AIRNoR'r QRl Sce4,Tl,h F`- 3�4� PROPERTY OWNER'S NAME: CTI e{ SegDg5T14'N PHONE: --71x, ADDRESS: `Y,$ (' 111'rr' '5' CITY/STATE: k'OAtX egw FI ZIP CODE `$A .2 CONTRACTOR BUSINESS NAME: LICENSE#: I ADDRESS: I&% ", ehgltgo gcv CONTACT PHONE: CITY/STATE-7 1:®. ZIP CODE 'SXj S & CONTACT E-MAIL ADDRESS:5A SReeO SE2 VIt AQ wiy AIQ. c0^ ARCHITECT/ENGINEER: PHONE: ADDRESS: CITY/STATE: ZIP CODE: CONTACT E-MAIL ADDRESS: PRESENT USE: PROPOSED USE: OCCUPANT LOAD: NUMBER OF: STORIES []BAYS []UNITS []BEDROOMS []HEIGHT TYPE OF CONSTRUCTION: GROUP OCCUPANCY: AREA IS THE BUILDING PRESENTLY EQUIPPED WITH AN AUTOMATIC FIRE SPRINKLER SYSTEM? []YES []NO BONDDQG COMPANY: PHONE: ADDRESS: CITY/STATE: MORTGAGE LENDER: PHONE: ADDRESS: CITY/STATE: FEE SIMPLE TITLE HOLDER: PHONE: ADDRESS: CITY/STATE: `—Property i understand that I may not delegate the responsibility for supervising work to a contractor who is not licensed to perform the work being done. Any person wort building who Is not licensed must work under my direct supervision and must bi which means that I must comply with laws requiring the withholding of federal it social security contributions under the Federal Insurance Contributions Act (FIC provide workers compensation for the employee I understand that my failure to may subject me to serious financial risk. these laws I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern owner -builders as well as employers. I also understand that the construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. am of aware of construction practices and I have access to the Florida Building I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, the Florida Department of Financial Services, and the Florida Department of Revenue. I also understand that I may contact the Florida Construction Industry Licensing Board at 1-850-487-1395 or at www.mVflorida.com/dbpr/pro/cilb/ for more information about licensed contractors. i am aware of, and consent to, an owner -builder building permit applied for in my name and understand that I am the party legally and financially responsible for the proposed construction activity at the address listed below. I agree to notify the building department immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure or in the permit application package. �i�enbeu contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Construction Industry Licensing Board, the Department of Business and Professional Regulation and the building department may be unable to assist you with any financial loss that you sustain as a result of a complaint. Your only remedy against an unlicensed contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is property licensed and the status of the contractor's workers' comnencatinn rn,.nrnne of Owner-Buildei STATE OF FLORIDA COUNTY OF INDIAN RIVER hereby certify that on this day of who Type of identification produced: Official Signature of Notary Public Y q' personally known to me or has Notary Seal Date 20_ personally appeared produced identification. A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment not exceeding I year and/or a $1,000.00 fine in addition to any civil penalties. In addition, the local permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy for unlicensed activity against the owner and any person performing work that requires licensure under the permit issued. CnOF SE13AS g—_ �1 HOME OF PELICAN ISLAND BUILDING DEPARTMENT 1225 MAIN STREET • SEBASTIAN, FLORIDA 32958 TELEPHONE: (772) 589-5537 •FAX (772) 589-2566 •• `-r n f -DU11 JER DIN UL OSURESTATEMENT As an owner of your property you may act as your own contractor through a specific exemption to contracting law. contractor and to express any applicable restrictions and responsibilities as required by FlThe following disclosure statement is required to be filled out by any owner who wishes to act as their own orida Statute 489.103. IY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement) I understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. r unuerstann that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. I understand that, as an owner -builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that a contractor is required by law to be licensed in Florida and to list his or her license numbers on all permits and contracts. r-rruerstano that I may build or improve a one -family ortwo-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my own use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within in 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates this exemption. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. I understand that I may not hire an unlicensed individual supervise persoperson to act as my contractor or to ns working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the licenses required by law and by county ordinance. r unuerstand that it is a frequent practice of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. APPLICATION IS HEREBY MADE TO OBTAIN A PERMIT TO DO THE WORK AND INSTALLATIONS AS INDICATED. I CERTIFY THAT NO WORK OR INSTALLATION HAS COMMENCED PRIOR TO THE ISSUANCE OF A PERMIT AND THAT ALL WORK WILL BE PERFORMED TO MEET THE STANDARDS OF ALL LAWS REGULATING CONSTRUCTION IN THIS JURISDICTION. I UNDERSTAND THAT A SEPARATE PERMIT MUST BE SECURED FOR ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS AND AIR CONDITIONERS, ETC. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING ?WICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. A CERTIFIED COPY OF THE RECORDED NOTICE OF COMMENCEMENT SIGNED BY THE OWNER, SHALL BE FILED WITH THE PERMITTING AUTHORITY IF THE VALUE IS $2,500 OR MORE, EXCEPT HEATING OR AIR CONDITIONING CHANGE OUTS LESS THAT $7,500. NOTICE: IN ADDITION TO THE REQUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THE COUNTY, AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. ANY CHANGE IN BUILDING PLANS OR SPECIFICATIONS MUST BE RECORDED WITH THIS OFFICE. ANY WORK NOT COVERED ABOVE MUST HAVE A VALID PERMIT PRIOR TO STARTING. IN CONSIDERATION OF GRANTS, THIS PERMIT, THE OWNER, AND THE BUILDING CONTRACTOR AGREE TO ERECT THIS STRUCTURE IN FULL COMPLIANCE WITH THE BUILDING AND ZONING CODES OF THE CITY OF SEBASTIAN. NOTE: THIS PERMIT APPLICATION IS VOID AFTER 180 DAYS UNLESS THE WORK, WHICH IT COVERS, HAS COMMENCED. ALL CONTRACTORS MUST HAVE A VALID STATE CERTIFICATION, STATE REGISTRATION, OR COUNTY COMPETENCY PLUS A COUNTY—WIDE LICENSE PRIOR TO OBTAINING PERMIT •: OWN"/AGENT /AGENT SIGNATURE S.a.YI E i TC- 5-, 1 PRINTED NAME OF OWNER/AGENT DATE: ) - AN OWNER ACTING AS THEIR OWN CONTRACTOR MUST PERSONNALLY APPEAR AT THE BUILDING DEPARTMENT TO SIGN THE PERMIT APPLICATION. PER FS 489.103 Individuals who sign as the owner's agent must first obtain legal power of attorney to sign on their behalf. STATE OF FLORIDA COUNTY OF I hereby certify that on this day of . 20 personally appeared Type of identification produced: who is _ personally known to me or has _ produced identification. Official Signature of Notary Public Notary Seal