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PROOF OF INSURANCE (2016) CLOSED
Policy Number: 0400701436 Date Entered: 01/14/15 e .,.. CERTIFICATE OF LIABILITY INSURANCE L1 /14/IODl15 1/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME Diane DeSllva _ Mary Barnard Insurance PHONE FAX 2190 Stokes Street t,C..NR.11i, Iru,dag, �MAIt_ (408) 286 1334 (408) 286-6425 ...... ... . Suite 201 r+DRESs _ San Jose CA 95128 INSURER A, Caitlan Specialty lN NAIr Insurance � ar .. — aasoaRrr .. �. INSURED Range Maintenance Services L.L.C, John and Donna Fo iato M i 44 NSURkI1 C' P. O. Box 2270 INSURER D: Arnold, CA 95223 INSURER E : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PE F T � — INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ids ... r.. _.......LIMI INSR I.TR GENERAL LIABILITY INSURANCE ^ Ate SOHN POLICY NUMBER MMIDIDNYYV AffldDUAk!_',.. Ts _ EACH OCCURRENCE $1,000,000 A ✓�,,,, COMMERCIAL '.,� GENERAL OCCUR 0400701436 /20/2015 /20/2016 MEN PS person) ^mm,,., $ ^.. „105,000 PERSONALBADVINJURY $1,000,000 __ . - » ...... GENERAL AGGREGATE s2,000,000 E.. INCLUDED .... G N'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ Ix i POLICY q�. Lt7C $ AUTOMOBILE LIABILITY Dhti1 SFr :usurldgpn,KJ BODILY INJURY (Por per ANY AUTO son) $ ALL OWNED SCHEDULED BDDILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PRCIPERTYDAMrh4"L $. ._ HIREDAUTOS AUTOS w(Pu)rauddentliIT ..... _ -...$ UMBRELLA LIAB H OCCUR RRE EACH OCCUNCE EXCESS LIAR CLAIMS•MADE AGGREGATE $ DED RETENTION $ $ ®ate......... WORKERS COMPENSATION WC STATU• 1 O'rH- AND EMPLOYERS' LIABILITY Y t'"' Ems, ANY PROPRIETORIPARTNER/EXECUTIVE � EACH ACCIDENT $ OFFICERNEMBEREXCLUDED' N r A _ .._._ .,_,....... .,,, (Mandatory in NH) E L DISEASE EA EMPLOYEE $ If yyes, describe under DISEASE DESCRIPTION OF OPERATIONS beloW E.L. DISEASE - POLICY LIMIT $ DESCRIPTION F *TEN DAYS NOTICES LOCATIONS OF (Attach t Additional Remarks CANCELLATIN APPLIES FORNONPAYMENT I more OF PsRPaEMIrequired) M 0 DAYS FOR ALL OTHER RE: ALL CALIFORNIA OPERATIONS. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGIJNDO, CITY CLERK ACCORDANCE WITH THE POLICY PROVISIONS. ATTENTION: BRIAN EVANSKI thli� l 350 MAIN STREET aw�N AUTHORIZEDREPRES N�T TVE EL SEGUNDO, CA 90245 ©1988 -2010 RD CORPORATION. All rights reserved, ACORD 25 (2010105) The ACORD name and logo are registered marks of ACO PV Produced using Farms Boss Plus software .. ww,v.FormsBoss.com; Impressive Publishing 800- 208 -1077 Policy Number: BAP0165200 Date Entered: 12/03 /2012 Ate' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 11/30/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER �.e�nw.ea. CD'T Diane IDeSilya Mary Barnard Insurance 2190 Stokes Street Suite 201 San Jose CA 95128 .. INSURED Maintenance So ......,Ran ................. ..rvices _...,_..,,,...�.....,, Range L.L.Cv John and Donna Foggiato P. O. Box 2270 Arnold, CA 95223 COVERAGES CERTIFICATE NUMBER: mn• (408)28 ,. 86 -1334 c: F CENTURY NATIONAL INSURANCE COMPANY REVISION NUMBER: (408)286 -6425 NAIC 11 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ICMXSP . . - .� ..._.. ...... -. ..,.�_ -.L.� POLIO POCLILCAY I` _ - ADDL 6(fBIR. ET IM ITS R TYPE OF INSURANCE I R WVD POLICY NUMB R MMIDDfYYYY. G1MDDYYYY GENERAL LIABILITY EACH OCCURRENCE $ A '�ii 'I"i1 R 'NTL GENERAL L ABILITY (- a o�IarLenre)_ $ -COMMERCIAL CLAIMS -MADE OCCUR „jiEMISES MED XXP (Any on p.2!Fn) • $ . PERSONAL & ADV INJURY $ GENERALAGGREGATE $ GEN% AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG $ PRO- PO LOC LICY $ AUTOMOBILE LIABILITY comaiNT) SINGER 001 r 000 , -0. 0..0 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ A AUTOS NON OWNED BAP01655200 11/24/2019 1/24/2015 PROPERTY AI47Ar)L $ HIRED AUTOS AUTOS (Peraccldenl II S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I RETENTION $ $ WORKERS COMPENSATION - WC STATU 0TH' ANI7 EMPLOYERS' LIABILITY YIN TQI�XIII41Ia .__.n.,wFR ...... _..., ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FFICE NIA EACHACCIDENT I=.. E w $ o m NH (Mandatory ) E (L• _. DI EP�SEEaM1f iWPLOY E .. ".........__.� If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Thirty Days Notice of Cancell.ation;Ten Days Notice Due To Non- Payment Of Premium CITY OF EL SEGUNDO, CITY CLERK ARE NAMED AS ADDITIONAL INSURED AS PER ADDITIONAL INSURED ENDORSEMENT ATTACHED. CITY OF EL SEGUNDO - CITY 350 MAIN STREET EL SEGUNDO, CA 90245 a ffffIII SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED @1988-2010 ACORD 25 (2010105) The ACORD name and logo are registered marks of A!COI e -1 -1 --- -_ n_<_ np -....r.... ----------------- ; n ®.ekia.l.:.....- - 9 ®T3 RD CORPORATION. Al) rights reserved. Policy Number: 1760432 -1.4 Date Entered: 12/21/20:1.2 J �ATE(MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/29/2034 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Mar Barnard Insurance s PRODUCER 2190 Stokes Street I- Diane._ 408) 286" NAME DeSi _ Y �tIr�'tL. (408)286-1334 _t ,rl i -6425 Suite 201 A( DRESS? PA N COVERAGE NNC N IN9tYiiE6i .. San Jose CA 95128 _..._ STATE COMPENSATION INSURANCE FUND ....._._, .:.... t.en ..nce Services, INSURED Range Main a ices, L.L.C. INSCURE6tD ...W ..... John and Donna Foggia o INSCtrEy "c,, P. O. BOX 2270 INSU.RERD: Arnold, CA 95223 1 SURER E COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW WAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. mlm _ 0dW t.VEr IC XP MMrDDIYYYY _. LIMITS L7H TYPE OF INSURANCE VVd POLICYNUMBER MMfDDlYYYY GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY iMtl.S..ES � aame,a dErnm,mo, _ CLAIMS -MADE 1:1 OCCUR MEP EXP Anone person) $ W „, - ._..___... r PERSONAL &ApV INJURY $ GENERAL AGGREGATE $ GEW. A(IOREGATE LIMIT APPLIES PER: ,µPRODUCTS GOMPlOP AGG m POL 1CY PRO- LOC $ .0 4NCrLL41'.. I.. AUTOMOBILE LIABILITY (” ..$ ANY AUTO $ BODILY INJURY (Per p ers on) - ....,. ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PFOPER'IY' DAMhG $ HIRED AUTOS AUTOS II?Pr_acc�danl ^ UMBRELLA LIA9 OCCUR EACH OCC URRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE TE $ DED RETENTION $ .. $ _ WORKERS COMPENSATION OR STATU- OTH- Fes_ AND ROPRIETORIP RTNFY YIN ANY PROPRIETORIPARTNERlEXECUTIVE N rA 1760432 -13 17./01/2014 '.1/01/2015 E. EACH ACCIDENT EN L EACHA 1 000 000 3 1 OFFICER /MEMBER EXCLUDED? EMPLOYEE $1,000,000 (Mandatory In NH) E.L pISEASECIDENT If yes, describe under bESCRIPTION OF OPERATIONS below E.L. DISEASE ASE POLICY LIMIT $ 1,000,000 p _ DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more Is required) s ace _ CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. CITY CLERK 350 MAIN STREET AUTHORIZED REPRT / I EL SEGUNDO, CA 90245 -3813 `� (GG GCfVJi 0 1988 -2010 ORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of AC0 Produced using Forms Boss Plus software, www.FormsBoss.com: Impressive Publishing 800- 208 -1977 POLICY NUMBER: 0400701 43& COMMERCIAL GENERAL LIABILITY • CG 2010 04 13 A. Section II -- Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury ", "property damage" or "personal and adveftising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. G. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This Insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG20100413 ©Insurance Services Office, Inc., 2012 Page 1 oft C. With respect to the insurance afforded to these additional insureds, the following is added to Section III -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the arnount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less: This endorsement shall not increase the applicable Limits of Insurance shown in -the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 CENTURY NATIONAL WSUaANCE C0[4PANY P.O. Box 3999 o North Hollywood, CA 91609 -0599 For Service Call YourSrolcer. For Claims Calk 800- 733 -1980 ---] —Endo—rsenient Effective Date Name of Ins �� 11/24/2 4 1 � 4 at 1101 AM d Time: RANGE MAINTENANCE uzed: SVCS LLC B - _ Policy e.._v Number: Policy Number: AP01 Term covers from 0 11/24/2015 at 12:0IAM Endorsement 0- a of —. enc �. 65200 .... _ry 12:Q1 AM on 11/24/2014 to .._1/2....� Agency N "�lo HAIX & ASSOC INS BROKERS INC 122800 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ lT CAREFULLY. IN CONSIDERATION ION O THE RATION OF I HE ADD[ T IONAL PREMIUM LISTED BELOW, CENTURY- NATIONAL NSURANCE COMPANY AGREES TO ISSUE A CER T IFICA T E, REQUIRED BY AN ENTITY DOING BUSINESS WITH THE INSURED THAT IS NOT A STANDARD CERTIFICATE FORM. (OR AGREES TO ISSUE AN ACORD CERTIFICATE WITH ITS STANDARD LANGUAGE DELETED OR ALTERED), TO THE ENTITY LISTED BELOW. BECAUSE THIS IS NOT STANDARD CERTIFICATE AND GENERATES ADDITIONAL PROCESSING TIME, THERE IS A FEE FOR THIS CERTIFICATE AS SET OUT BELOW. � CERTIFICATE HOLDER / PREMIUM $60 CITY OF EL SEGUNDO CITY CLERK ATTN: BRIAN EVANSKI 360 MAIN STREET EL SEGUNDO CA 90245......... ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Date Printed: 12/02/2014 Orton MCDAI TA C*E IDL RY._m- NAMONAL INSURANCC COMPANY P.O. [lox 3999 -North Hollywood, CA 91609 -0599 For Service Call Your Broker, For Claims Call: 800 -733 -1930 CHAIX & ASSOC INS BROKERS INC 3200 EL CAMiNO REAL STE 290 IRVINE CA 92602 -1382 (949) 722 -4177 RANGE MAINTENANCE SVCS LLC JOHN & DONNA FOGGIATO DBA PO BOX 2270 ARNOLD CA 95223 RANGE MAINTENANCE SVCS LLC -_ .... ......... Name of Tiisurecl. 'Endorsement Effective Date and Time: _ MAINTENANCE 11/24/2014 at 12 :01 AM .-....__.____ Policy Number: BAPO15200 � 12 01 AM erin on 11/24 2 6 014 to 11/24/2015 at 12 :01AM �ndoz'ser 000 Number �..... -.. Naane of Agency: .T . CHAIX & ASSOC INS BROKERS INC 122800 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured Endorsement IT IS AGREED THAT INSURANCE AFFORDED BY THE ABOVE POLICY SHALL APPLY TO THE PARTY(S) NAMED BELOW, AS THEIR INTEREST MAY APPEAR BUT SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE COMPANY'S LIABILITY. ANY ADDITIONAL INSURED LANGUAGE ON A CERTIFICATE OF INSURANCE IS VOID. The additiorial Insured named below is only an insured for liability which is the result of an act or omission of the "NAMED INSURED" of the policy and shall have no coverage under this endorsement or the policy for its own acts or omissions, those of its agents or employees" or those of any other person or entity for which it is vicariously liable, save for acts of omissions of the "NAMED INSURED " of the policy. Further, any insurance provided oy, this endorsement shall be excess to all other insurance available to any person or entity who becomes an insured by reason of this endorsement whether the other insurance is primary or excess and whether or not the other insurance is collectible. In the event the other insurer has a duty to defend any person or entity added to our policy by reason of this endorsement, we will have no duty to defend that person or entity however, we may elect to do so, and, if we do, we will be entitled to the rights of any person or entity we do defend against the other insurer. ADDITIONAL. INSURED CITY OF EL SEGUNDO CITY CLERK ATTN: BRIAN EVANSKI 350 MAIN STREET EL SEGUNDO CA 90245 ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Date Printed: 12/0212014 _ SARA PERALTA HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 1760432 -14 RENEWAL NA 6- 17- 16.03 PAGE 1 OF 2 EFFECTIVE DECEMBER 30, 2014 AT 12.01 A.M. AND EXPIRING NOVEMBER 1, 2015 AT 12.01 A.M. RANGE MAINTENANCE SERVICES, LLC PO BOX 2270 ARNOLD, CA 95223 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF EL SEGUNDO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED— Y, RANGE MAINTENANCE SERVICES, LLC`' IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03 %. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JANUARY 2, 2015 2570 AUTHORIZED RF RESENT IVE PRESIDENT AND CEO --% Mn om, y