CITY OF PEACHTREE CITY UNIFORM SERVICES

PURCHASING DEPARTMENT 151 Willowbend Road Peachtree City, GA 30269 Phone: 770-487-7657 Fax: 770-631-2505 www.peachtree-city.org CITY OF PEACHTREE CITY UNIFORM SERVICES ADDENDUM #1 The following questions and/or requests for clarification have been received. 1. QUESTION: In the description for trousers it states: Trousers - Traditional cut or jeans cut, color: Navy Blue Are you looking for traditional industrial work pants, jeans or a work pant with a jean cut? ANSWER: Industrial work pants. 2. QUESTION: In the description for Carhartt Style Cargo Pants it states: An option for Carhartt brush pants or approved equal must also be provided. The intent of this item is to provide a more durable pant for work that must be completed in areas with heavy brush which may include thorns. Carhartt Style #B240 The brand of pant, Carhartt B240, is a Canvas Cargo Pant my company is able to offer in a rental program. The problem is that style number is not offered in a Navy Blue? Are you looking to use the Carhartt B240 in one of the (2) colors that are available? (dark moss or golden khaki) Would you like to use a comparable Carhartt style, in navy blue that is not cargo style? (style # B159) http://www.carhartt.com/webapp/wcs/stores/servlet/productdisplay?nao=0&langid=- 1&Ntk=All&productId=53494&catalogId=10101&Nu=RollupKey&recordPerPage=24&Nty=1&Ntt=B159&storeId=1 0051&Ntx=mode+matchallpartial&y=0&N=0&Ns=IsOutletSKU%7C0&x=0&ddkey=http:CarharttSearchCmd ANSWER: B159 is an acceptable alternative. 3. QUESTION: On the Bid Tender Form, under Additional Items, there is an entry that states: 4XL Polo Shirt, s/s Are you looking for a purchase price or rental price? There is no quantity listed, are you looking for 11? I just want to be clear so we put the correct amount in for that item. ANSWER: This is a rental price at five per week with one extra so they can be rotated therefore, total is 11. Please contact Ms. Angela Egan if you have additional questions. 10/05/2012

PURCHASING DEPARTMENT 151 Willowbend Road Peachtree City, GA 30269 Phone: 770-487-7657 Fax: 770-631-2505 www.peachtree-city.org September 20, 2012 Ladies and Gentlemen: The City of Peachtree City will be accepting sealed bids at the office of the Purchasing Department, 151 Willowbend Road, Peachtree City, Georgia, 30269, until 1:30 p.m. on Thursday, October 18, 2012, for Uniform Rental. The bids will be opened and read aloud at that time and place. Bids received after the set time will not be considered. All bids must strictly conform to the plans, specifications, or other bid documents. Plans, specifications, directions, bid forms and other conditions are available on the City s website at www.peachtree-city.org. Bids are to be submitted in a sealed envelope, with the name of the project (Uniforms # 13-107BPW) clearly marked on the front. The date and time of opening are also to be included, along with the name of the company submitting the bid. The bid made by any company or firm must be signed in a legal manner in the name of such company or firm by a duly authorized officer, and the principal place of business must be shown (no post office boxes). State law, O.C.G.A. 36-60-13, provides that multi-year agreements for services must terminate as of December 31 of the year in which it was entered and at the end (December 31st) of each succeeding year. The agreement can automatically renew unless action is taken to terminate the agreement. The City expects to enter into a one year contract for services (January 1, 2013 through December 31, 2013), with the option of extending the contract for two (2) additional calendar years. No bids may be withdrawn for a period of ninety (90) days after the scheduled time to receive the bids. Any request for clarification must be submitted in writing (hand delivery, email, fax, or regular mail) to Angela Egan, Purchasing Agent, by the close of business, no later than five business days prior to the submission of bids. Any clarification issued will be in the form of an addendum to the bid instructions, plans, or specifications and will be issued to all potential bidders not later than seventy-two (72) hours prior to the time of submission of bids. Any addendums will also be placed on the City s website at www.peachtree-city.org. Although the Purchasing Department will take effort to send any addendum to known bidders, it is the bidder s ultimate responsibility to ensure that they have all applicable addenda prior to bid submittal. This may be accomplished via contact with the Purchasing Agent or by visiting the City s website prior to bid submittal. The City reserves the right to bid a project in phases and award the contract on the phases it deems to be in the City's best interest. The City will choose the lowest, best, responsible or responsive bidder. The City will exercise its discretion in awarding the contract to the bidder who best satisfies the needs of the City. The City reserves the right to negotiate with the firm awarded the contract, after the contract is signed. The City also reserves the right to reject any and all bids and to waive any and all irregularities. Bids will not be accepted from any person, firm or corporation who is in arrears in any debt or obligation to the City of Peachtree City or any other governmental entity. Sincerely, Angela Egan Purchasing Agent Enclosure ARE/UNIFORMS #13-107BPW

CITY OF PEACHTREE CITY UNIFORM RENTAL SPECIFICATIONS INTRODUCTION The City of Peachtree City is requesting sealed bids from qualified uniform service companies for Uniform Rental Service for Public Works, Building & Grounds and Stormwater Departments. The service required will be for supplying and cleaning of uniforms for approximately thirty-nine (39) employees. The firm chosen will supply eleven (11) sets of uniforms for each employee. This is a twelve (12) month contract (January 1, 2013 through December 31, 2013), with the option of extending the contract for two (2) additional calendar years. The City expects to award this by the first week in November. Complete uniforms will need to be delivered to the City no later than close of business, December 28, 2012. REQUIREMENTS A sample of all uniform components shall be submitted with bid. (Do not submit mops or rags.) Approval shall be by the Public Works Director prior to bid award. All samples will be returned if a self addressed envelope/box for returns is provided with bid. Bidders may submit more than one bid if more than one sample is submitted per required component. (For example, if a bidder wishes to submit two different types of standard uniform trousers, two samples and two bids would be required.) Each set of uniforms consists of the following: Trousers - Traditional cut or jeans cut, color: Navy Blue An option for Carhartt brush pants or approved equal must also be provided. The intent of this item is to provide a more durable pant for work that must be completed in areas with heavy brush which may include thorns. Carhartt Style #B240 Shirts long and short sleeve work shirts & short sleeve golf shirts as a possible alternative. (Two colors/styles will be chosen to distinguish between Supervisors and crews.) An option for short sleeve golf shirts shall be included as a possible alternative. An option for a highly reflective shirt meeting the most current ANSI safety standard must be provided. Fleet Manager s Shirt Short sleeved, navy blue polo, size 4X, comparable in quality to Lands End p/n 40151-5AD6. (The Lands End does not come in 4X, use as comparable quality only.) City patches (logo) and name patches will be embroidered. Samples will need to be provided for approval. Jacket with removable liner, color Navy Blue Include pricing for a jacket comparable to the Carhartt Style # CO3, Men s Duck Traditional Coat/Arctic Quilt-Lined (http://www.carhartt.com/webapp/wcs/stores/servlet/productdisplay?catalogid=10101&storeid=10051&pr oductid=32102&langid=-1&categoryid=10927) Shop Rags 200 18 x 18 100% cotton shop rags are to be provided weekly. The rags will be soiled in grease, oil, gas and other substances typically found in an auto shop environment. *Auto shop personnel uniforms to be 100% cotton. Five (5) employees *Upon award, firm is to submit samples of their shirts and the users will chose the color. ADDITIONAL ITEMS

In addition, the City requires the use of two (2) soils lockers, to be located at the Public Works Facility. The dimension should be approximately 80 tall x 24 wide x 21 deep. It will be the responsibility of the vendor to maintain these lockers and properly secure them in the vertical position. Should the lockers fall, bend, break in any way, the vendor will replace the lockers within 72 hours of notification. In addition the vendor will assume liability should the lockers fall and damage City property due to the vendor failing to properly secure the lockers. Approximately 200 18 x 18 100% cotton shop rags, are used weekly. 60 dry mops, approximately 15 per week, and handles, approximately 4 per week, are also needed. INCLUDE WITH BID The following items are to be included with the bid. Please use the following number system: 1. Explanation of the cleaning process used by the firm. 2. A clearly written statement that all uniforms provided at the beginning of the new contract shall be new uniforms. 3. A clearly written statement that any replacement uniforms shall be new. 4. Explanation of any recurring or replacement charges for lost or damaged uniforms. 5. List of ANY additional charges. 6. A clear breakdown of all charges per employee, per week. 7. A statement that as many as twenty-four (24) new hires (eight per year) will be covered during the contract year (or years if extended) at no prep charge (patches and set up charges included). 8. A statement indicating how any disputes over damaged or missing uniform parts will be resolved satisfactorily. 9. A clear statement that all uniforms will be returned substantially clean of all soils. 10. A clear statement that should the City determine that an article is not properly cleaned or unable to be cleaned to an acceptable level (as determined by the City,) that a new item will replace this item. 11. A clear statement that when a new item is warranted, it will be included in the next scheduled service stop when notified during a routine service. 12. If required, a copy of the agreement/contract used by each firm. Bids are to be submitted based on the weekly cost per employee and any recurring charges that will appear on the bill. NOTE: Firms should not add any conditions or qualifying statements to a bid or otherwise the bid may be declared irregular as being not responsive to the Invitation for bid. DELIVERY AND INVOICING All deliveries must be made to the Public Works facility at 209 McIntosh Drive between the hours of 8 am thru 3 pm. Invoices left with the end user shall not be considered. Invoices shall be mailed to Purchasing, (151 Willowbend Drive, Peachtree City, GA 30269) or emailed to Purchasing (purchasing@peachtree-city.org). Payment terms are net 30 from receipt of invoice (to Purchasing) and receive of product (to end user.)

BID TENDER FORM INCLUDING QUANTITIES BID #13-107BPW UNIFORMS SUBMITTED BY: NAME OF FIRM: PHONE: BIDDER'S NAME: FAX: ADDRESS: EMAIL: PRINT AUTHORIZED SIGNATURE: AUTHORIZED SIGNATURE: Note: By year, indicate weekly cost for uniforms and other items. UNIFORM DESCRIPTION EMPLOYEES AMOUNT PER EMPLOYEE PER WEEK STANDARD UNIFORMS - blue shirt, blue pants 2013 2014 2015 Eleven (11) Uniform shirts Short & long sleeved work shirts 22 $ $ $ ANSI Safety shirt - short sleeved, reflective 22 $ $ $ Short sleeved golf shirt 22 $ $ $ Eleven (11) Uniform trousers Traditional or Jean cut 22 $ $ $ Carhartt style cargo pants 22 $ $ $ Jackets With removable liner 22 $ $ $ Carhartt style as per bid 22 $ $ $ Environmental Charges 1 $ $ $ Any other charges - must explain in detail 1 $ If you wish to submit pricing for more than one sample, please include on separate bid sheet. UNIFORM DESCRIPTION EMPLOYEES AMOUNT PER EMPLOYEE PER WEEK SUPERVISOR UNIFORMS - blue shirt, blue pants 2013 2014 2015 Eleven (11) Uniform shirts Short & long sleeved work shirts 8 $ $ $ ANSI Safety shirt - short sleeved, reflective 8 $ $ $ Short sleeved golf shirt 8 $ $ $ Eleven (11) Uniform trousers Traditional or Jean cut 8 $ $ $ Carhartt style cargo pants 8 $ $ $ Jackets With removable liner 8 $ $ $ Carhartt style as per bid 8 $ $ $ Environmental Charges 1 $ $ $ Any other charges - must explain in detail 1 $ If you wish to submit pricing for more than one sample, please include on separate bid sheet.

PAGE 2 BID #13-107BPW UNIFORMS UNIFORM DESCRIPTION EMPLOYEES AMOUNT PER EMPLOYEE PER WEEK AUTO SHOP EMPLOYEES - blue shirt, blue pants 2013 2014 2015 Eleven (11) Uniform shirts - 100% cotton Short & long sleeved work shirts 5 $ $ $ ANSI Safety shirt - short sleeved, reflective 5 $ $ $ Short sleeved golf shirt 5 $ $ $ Eleven (11) Uniform trousers - 100% cotton Traditional or Jean cut 5 $ $ $ Carhartt style cargo pants 5 $ $ $ Jackets With removable liner 5 $ $ $ Carhartt style as per bid 5 $ $ $ Environmental Charges 1 $ $ $ Any other charges - must explain in detail 1 $ If you wish to submit pricing for more than one sample, please include on separate sheet. ONE TIME START UP COSTS QUANTITY ONE TIME CHARGE City Patches and Name Patches 39 $ Setup Charges 39 $ Total Start Up Costs $ ADDITIONAL ITEMS - DESCRIPTION QUANTITY AMOUNT PER UNIT PER WEEK 2013 2014 2015 4XL Polo Shirt, s/s $ $ $ 100% cotton wipes, ABOUT 18"x18", 100/bundle 2 $ $ $ 60" dry mop 15 $ $ $ 16/16" X 60" mop handle 4 $ $ $ Soil locker 2 $ $ $ A copy of the agreement used by each firm must be included with the price proposal.

BID CONDITIONS 1. CERTIFICATION. The Bidder hereby certifies that they have carefully examined all of the applicable Bid/Contract Documents for the material or service specified herein, understands the nature and scope of the work to be done, and that their Bid is based upon the terms, specifications, requirements and conditions. The Bidder further agrees that the performance time specified is a reasonable time. By their signature on the response to the bid or the bid Response Form, the Bidder certifies that their Bid is made without prior understanding, agreement, or connection with any corporation, firm or person submitting a Bid for the same materials, supplies, or equipment, and is in all respects fair and without collusion or fraud, so that all Bids for the purchase will result from free, open and competitive bidding among all vendors. Further, the Bidder certifies that they understand collusive bidding/proposing is a violation of Federal law and can result in fines, prison sentences, and civil damage awards. The Bidder further certifies that they are authorized to sign this Bid for the Bidder. 2. CONFLICT OF INTEREST. By submission of a bid, the Bidder agrees that at the time of submittal, they: (1) have no interest (including financial benefit, commission, finder s fee, or any other remuneration) and shall not acquire any interest, either direct or indirect, that would conflict in any manner or degree with the performance of Bidder s services, or (2) will not benefit from an award resulting in a Conflict of Interest. A Conflict of Interest shall include employment or elected office with Peachtree City or any of its component units. Bidders shall identify any interests, and the individuals involved, on separate paper with the response and shall understand that Peachtree City, at the discretion of the Purchasing Director in consultation with legal counsel, may reject their bid. 3. REBATES TO PEACHTREE CITY EMPLOYEES. Any employee or any official of the Peachtree City or any of its component units, elective or appointive, who shall take, receive or offer to take or receive, either directly or indirectly, any rebate, percentage of contract, money or other things of value, as in inducement or intended inducement, in the procurement of business, or the giving of business for, or to, or from, any person, partnership, firm or corporation, offering, bidding for, or in open market seeking to make sales to Peachtree City shall be deemed guilty of a felony and upon conviction such person or persons shall be subject to punishment or a fine in accordance with State and/or Federal laws. 4. BIDDER S OFFER. The Bidder responding offers to furnish all materials, labor, supplies, equipment and incidentals necessary to provide the equipment/materials/services described herein and in any applicable related documents (e.g., Notification of Solicitation, Request for Information, Addenda, Contract, Bonds, Insurance, Plans, etc.). It shall be understood that the Bidder's sureties and insurers are subject to the approval of the City of Peachtree City. 5. DISCUSSION WITH BIDDERS. Peachtree City may award a purchase contract, based on initial offers received, without discussion of such offers. A Bidder s initial offer should therefore be based on the most favorable terms available from a price and technical standpoint. Peachtree City may, however, have discussion with those Bidders that it deems in its discretion to fall within a competitive range. It may also request best and final offers from such Bidders, and make an award and/or conduct negotiations thereafter. The Peachtree City reserves the right to negotiate separately with any Bidder after the closing of this Bid when such action is considered in its best interest. Subsequent negotiations may be conducted, but such negotiations will not constitute acceptance, rejection, or a counteroffer on the part of Peachtree City. 6. CONTACTING PEACHTREE CITY PERSONNEL. Bidders shall make NO CONTACTS - either written or verbal - with any Peachtree City employee or elected official, with the exception of the Purchasing Agent, during the period beginning with the issuance of this document through approval of award unless authorized herein. Any attempt by a vendor/bidder to influence a member or members of the aforementioned may be grounds to disqualify the Bidder from participation in the selection process of this Bid. 7. RESPONSE SUBMITTAL. Return your signed Bid in a sealed envelope, marked with the Bidder name, Bid number, and Bid closing time and date. Bids shall be returned to the Purchasing Agent, Peachtree City, 151 Willowbend Road, Peachtree City, GA 30269, on or before the date and time specified. The time of receipt shall be determined by the clock in the City Hall lobby. Late Bids will not be accepted. A Public Bid opening will be held at the date and time stated in the bid or RFP. Peachtree City will not be held responsible for the failure of any mail/delivery service (e.g., U.S. Mail, hand-delivered, UPS, Federal Express, or other express mail delivery services) to deliver a Bid response prior to the stated Bid due date and time. 8. FACSIMILE RESPONSES. Peachtree City will NOT accept responses transmitted via facsimile unless stated to the contrary within this document. 9. PEACHTREE CITY RIGHTS. If determined to be in its best interest, the Peachtree City reserves the right to: (1) reject any Bid, if determined to be non-responsive in any form to this and/or related documents, (2) reject all Bids, (3) to accept any item or items in the Bids, and, (4) to waive any irregularity in the Bids.

10. SAMPLES. It shall be understood that ownership of all data, materials, and documentation prepared for and submitted to Peachtree City in response to this Bids shall belong exclusively to Peachtree City and will be considered a record prepared and maintained or received in the course of operations of a public office or agency and subject to public inspection in accordance with the Georgia Open Records Act, Official Code Annotated, Section 50-18-70, et.seq., unless otherwise provided by law. 11. BIDDER EXPENSES. Peachtree City will not be responsible for any expenses incurred by any Bidder in the development of a response to this Request for Bid including any onsite (or otherwise) interviews and/or presentations, and/or supplemental information provided, submitted, or given to Peachtree City and/or its representatives. Further, Peachtree City shall reserve the right to cancel the work described herein prior to issuance and acceptance of any contractual agreement/purchase order by the recommended Bidder even if the City has formally accepted a recommendation. 12. LOWEST RESPONSIBLE BIDDER. Peachtree City interprets the term "lowest responsible Bidder" as requiring the Peachtree City to determine which Bid is most suitable for its intended use or purpose. The Peachtree City can determine any differences or variations in the quality or character of the material, goods, wares, or services performed or provided by the respective Bidders. If there is any variance or conflict, the Bid specifications or requirements shall control. 13. PURCHASE ORDER. A purchase order constitutes the Peachtree City s offer to the Bidder upon the terms and conditions stated herein, and shall become a binding contract on the terms set forth herein when it is accepted either by acknowledgment or performance. Peachtree City will issue a purchase order/contract for the acquisition of products/services specified as a result of an award made in reference to this document. Contract documents shall be subject to any regulations governed by the laws of the State of Georgia and any local resolutions specifically applicable to the purchase. Any dispute arising out of the contract documents or their interpretation shall be litigated only within the courts of the State of Georgia. Contracts entered into on the basis of submitted Bids are revocable if contrary to applicable law. 14. CONTRACTS. If applicable, the Bidder agrees to execute and deliver to Peachtree City a contract in accordance with the Contract Documents (if applicable) within ten days of notice of the award to the Bidder. The Bidder agrees that the surety/deposit given concurrently herewith shall become the property of Peachtree City in the event the Bidder fails to execute and deliver such contract within the specified time. In the further event of such failure, the Bidder shall be liable for Peachtree City s actual damages that exceed the amount of the surety 15. TAXPAYER IDENTIFICATION NUMBER. A valid federal tax identification number must be provided to the Peachtree City before any purchase orders can be issued and/or payments can be made. 16. TERMINATION. If the Bidder refuses or fails to make delivery of the services within the times specified herein or in the purchase order or contract, Peachtree City may, by written notice, terminate the purchase order OR contract.

CITY OF PEACHTREE CITY QUESTIONNAIRE SHEET The undersigned guarantees the truth and accuracy of all statements and answers herein contained. 1. How many years has your organization been in the uniform rental business? 2. What is the last project of this nature that you were awarded? Give project name and describe the scope of the project, contact person, address and telephone number. 3. Have you ever failed to complete work awarded to you: if so, where and why? 4. List at least five (5) relevant government agencies, corporations or individuals for which you have performed work in the last three (3) years: (Give company name, contact person, address, telephone number and the project name). (use additional pages as needed) 5. Have you personally inspected the proposed work and have you a complete plan for its performance? 6. Will you sublet any part of this work? If so, specify all possible contractors, giving business name, phone, contact and type of work: (continued)

(use additional pages as needed) 7. State the true, exact, correct and complete name of the partnership, corporation, or trade name under which you do business, and the address of the place of business. (If a corporation, state the name of the President and Secretary. If a partnership, state the names of all partners. If a trade name, state the names of the individuals who do business under the trade name.) It is absolutely necessary that this information be furnished. Correct Name of Bidder (a) (b) The business is a (Proprietorship) (Partnership) (Corporation). The address of principal place of business is: (c) The telephone number and facsimile number are: (d) The names of the corporate officers, or partners, or individuals doing business under a trade name are as follows: Name Name Name Title Title Title Bidder (e) The name(s) of the agent of the corporation registered with the Secretary of State and address: Name Title Address

Revised 08-01-2011 CONTRACTOR AFFIDAVIT UNDER O.C.G.A. 13-10-91(b) (1) By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. 13-10-91, stating affirmatively that the individual, firm, or corporation ( Contractor ) which is engaged in the physical performance of services on behalf of the City of Peachtree City has registered with, is authorized to use and uses federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows: Federal Work Authorization User Identification Number https://e-verify.uscis.gov/enroll Date of Authorization Company Name / Contractor Name Name of Project I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on, 20 in (City) (State) BY: Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent of Contractor SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF, 20 Notary Public My Commission Expires:

2012 Calendar Year Affidavit Verifying Status for City Public Benefit Application By executing this affidavit under oath, as an applicant for a City of Peachtree City, Georgia Business License or Occupational Tax Certificate, Alcohol License, Taxi Permit, or other public benefit as referenced in O.C.G.A. Section 50-36-1, I am stating the following with respect to my application for a City of Peachtree City (circle one) Occupational Tax Certificate or Alcohol License, or other public benefit. I am stating the following for, (The name of person applying on behalf of business, corporation, partnership, or other private entity) As a representative of. (The name of the business, corporation, partnership, or other private entity) 1) I am a United States citizen 2) I am a legal permanent resident of the United States 18 years of age or older, please include Alien Registration Number below signature * 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years of age or older and lawfully present in the United States * * O.C.G.A. 50-36-1(e)(2) requires that aliens under the Federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provide their alien registration number. Because legal permanent residents are included in the federal definition of alien, legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identifying number below: *FORM OF ID/DOCUMENT SOURCE MUST BE COPIED & ATTACHED TO THIS FORM. FORM OF ID MUST BE PRESENTED EITHER IN PERSON OR ELECTRONICALLY- (EMAIL OR FAX) NO MAIL IN COPIES WILL BE ACCEPTED PER FEDERAL GUIDELINES. In making the above statement under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of OCGA Section 16-10- 20. This is an annual requirement. Please supply/verify email address(es) and additional information: ***** PLEASE COMPLETE THIS SECTION ***** Email for order placement: Email for this form if different from above: Phone number: Physical address: Signature of Applicant Printed Name *Alien Registration number for non-citizens NOTARIZATION REQUIRED: Return to purchasing@peachtree-city.org or fax # 770.631.2507. Federal guidelines prohibit the mailing of id/documents. Revised April 2012 Date of Birth of Applicant Date SUBSCRIBED AND SWORN BEFORE ME, ON THIS THE DAY OF, 20. Notary Public My Commission Expires: