HomeMy WebLinkAboutApplication Applicant 6/1/2023City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
SPRINOFIE�
LAND USE COMPATIBILIITY STATEMENT (LUCS), DEPARTMENT OF
MOTOR VEHICLES (DMV) and ZONING VERIFICATION LETTER
Application form
Permit Type
Dept of Motor Vehicles -New: Land Use Compatibility Statement: ❑
city: ❑
Dept of Motor Vehicles -Renewal: ❑ Zoning Verification Letter: ❑ UGB: ❑
Project Information
A licantName: Phone: 77767-7771.5-
7767-7771Com
aD : I)2L /Vloro,5 LSC
Company:
E-mail:
Address: 230' /S' 1(, s ,n r'e/c1 C9ft
7y7 7
r57f
Pro a Owner: /Z act,e l `morn { e1�
Phone:
�S�- %D'; -Y&/
Company:
E-mail:
Address: 2 3 5 7 /S 7� S� s �,'t Z e %l 6k
7 Ll 7 z
ASSESSOR'S MAP NO: /70325_220
TAX LOT NOS : 2.000
Property Address: 307 l.Sfti St s r;4
Description of proposal/request:
Record Information (Staff .complete)
Record No: 711725-5551757771
Date Received: t±'
I J oiuo'tiJ
0D
Application Fee: $2pp ✓
I05.
Technical Fee: $ S'.
°25
TOTAL FEES: $ 303. .2,5 Assigned Planner: AW
�J!DhI
Revised 2023 04 04 slm
REQUEST FOR DMV LOCATION
REQUIREMENT EXEMPTION
(OAR 735-150-0030)
DEALER CERTIFICATE # EXPIRATION DATE
INSTRUCTIONS(DEALER
Pursuant to OAR 735.150.0030 (2), DMV is only authorized to grant exemptions for restrictions based
on ordinance or zoning requirements. All other requests will be denied.
Complete (print or type) and submit to: Business Regulation, 1905 Lana Ave NE, Salem OR 97314.
A DMV Investigator or manager will review your request. A signed copy of the request will be returned to you.
An approved request must be kept at your business location. Failure to do so may subject you to a civil
penalty or administrative sanction.
Approved exemptions are valid only for the dealer certificate number and location listed. A new exemption
must be applied for if there is a change in name, address or dealer certificate number.
SECTION I — NAME AND LOCATION OF DEALER BUSINESS
DEALER CERTIFICATE# EMAIL ADDRESS
' L/✓`�,I'
".G /1'A
o/S
NAME OF DEALERSHIP
�Z L Mo�oi'S
LLC
STREET ADDRESS (BUSINESS LOCATION)
X3017 1s
clTr S sOR TATE zlCl'7 `�� ODE cauNL3��
SECTION 2 — EXEMPTION
Any dealer wanting an exemption from all or part of the requirements in (a) through (c) below MUST check
the appropriate box(es) below and provide a clear and complete reason for the request.
I am requesting an exemption from the requirement(s) listed below:
L a) Have sufficient space to display one or more vehicles of the type the dealer has been issued a
certificate to sell.
❑ b) Provide a means for the public to contact the dealer Gran employee of the dealer at all times during
the dealer's normal business hours.
C) Have displayed an exterior sign permanently affixed to the land or building which identifies the
dealership by the name shown on the dealers business certificate.
NOTE: You MUST attach to this form a letter or other evidence from the appropriate zoning authority which
specifically and clearly show the restriction the exemption request is based on.
SIGNATURE
I certify that I am an owner, a partner, a member of LLC or a corporate officer of this dealership. I understand
that Oregon Administrative Rules require a dealer business location to comply with each of the three
conditions listed above. However, the business location of the dealership, as shown in Sectionl, is unable to
meet the requirements. Copies of city or county ordinances or zoning requirements preventing compliance are
attached. I hereby request the exemptions marked in Section 2.
NOTE: This exemption does not constitute a variance on state, county or city land -use restrictions or laws.
Violation of zoning laws/restrictions could result in cancellation of your dealer certificate.
PRINTED NAME OF PERSON SIGNING THIS FORM TITLE
'DQa
N /LMS
SIGNATU DATE
X
(OMV Use Only)
Request in Section 2: a)LApproved Denied b)LApproved LDenied c)LApproved LDenied
(Investigator to check all applicable boxes). If applicable, the dealer must comply with reasonable alternatives (attached).
PRINTED NAME OF INVESTIGATOR I MANAGER
TITLE
INVESTIGATOR'S I MANAGER'S SIGNATURE
DATE
X
10
11
APPLICATION FOR
THREE YEAR VEHICLE DEALER CERTIFICATE
AS A DEALER OR REBUILDER OF VEHICLES
CUSTOMER NUMBERNr EFFECTIVE DATE
EXPIRATION DATE
DEALER NUMBER-----
yYJ ORIGINAL
❑ RENEWAL
If this is a renewal, do not complete the fee information. Use the
CERTIFICATE
FEE
attached billing list to calculate your fees. The billing list MUST be submitted
r
with your renewal application.
LATE
FEE
Original Certificate (Includes one plate) ................................. $ 1,187.00
SLIPPLEMENTALS
Additional Locations @S350.00 ..................... $ 0.00
RENEWAL
PLATES
(Supplemental Application Form 735-372 required for each
location) $ 0.00
ADDITIONAL
PLATES
r�.
Additional plates 12" x 6'. % or 7" x 4"-2—$54.50...
TOTAL
$
> TEMPORARY
PLATES
(Two sizes, standard and small, available) TOTAL = $ 1,187.00
BUSINESS NAME AND ADDRESS Any alteration of Line 3 voids location approval.
LEGAL NAMEOF APPLICANT(OWNER ,PARTNERSHIP , LLC OR CORPORATION NAME)
1 can C ti,-eti: r
FEDERAL ID NUMBER (FEIN)
`I2,3935-06
OREGON REGISTRY a(IF LLC OR CORPORATION)
BUSINESS NAME (IF A"S�UMED BUSINESS NAME, FILL IN REGISTRY NO.)
OREGON REGISTRY NO.
IY/-dso
BUSINESS TELEPHONE
>RL- /�'�o fv�5 L- L ic
-sal r
MAINBUSINE ICOCATION(STREET AND NUMBER)
CITY
SLa.,e
ZIP CODE
COUNTY
230 /g fh 5
MAILING ADORERS
CITY
STATE
ZIF COUE
1
:EMAIL &
TYPE OF OPERATION
It camrratirn, list the state under
CHECK ORGANIZATION TYPE:
❑Individual
I -pr �y;
❑Partnership
whim dullness is incorporated:
LLC ❑Corporation:
I /we primarily sell: L-1 New Vehicles ® Used Vehicles
I / we are a franchise dealer: ❑ Yes M No If "Yes," name the makes >
I /we sell NEW RECREATIONAL VEHICLES: ❑ Yes No
IF "YES' SERVICE FACILITY LOCATION (STREETAND NUMBER)
CITY
ZIP CODE
LOCATION APPROVAL (If renewal, required only if dealer is changing business location)
Certification of local Zoning. ORS 822.005 requires a vehicle dealer certificate, unless exempt under ORS 822.015, for any person
who.
(a) Buys, sells, brokers, trades or exchanges vehicles either outright or by means of any conditional sale, bailment, lease,
security interest, consignment or otherwise; OR
(b) Displays a new or used vehicle, trailer, or semitrailer for sale; OR
(c) Acts as any type of agent for the owner of a vehicle to sell the vehicle or acts as any type of agent for a person interested
in buying a vehicle to buy a vehicle.
THE CERTIFICATION BELOW IS TO BE COMPLETED BY THE LOCAL ZONING OFFICIAL. The approval below, should be based
upon whether the applicant can do ANY of the activities listed in (a) through (c) above under applicable ordinances, at the location
of the business given on Line 3. Pursuant to ORS 822.025, applicant shall meet requirements below.
As the zoning official for the junsdictlon where this business is located, I verify by my signature that the location of this business as stated on this application
complies with any land use ordinances of the jurisdiction pursuant to ORS 822 025.
❑ ❑
TELEPHONE NUMBER
CITY OF: COUNTY OF:
j
PRINT NAME
TITLE
SIGNATURE
DATE
X
❑ Check box if restrictions on the location
approval are in an attached letter from
the zoning authority.
Pare 1
1!
V
18
19
20
21
BUSINESS LOCATION INFORMATION:
2 Property is (check One): ®OWNED ❑LEASED/ RENTED: LEASE OR RENTAL PERIOD:
It properly is "Leased / Rented" complete the following:
PROPERTY OWNER'S FULL NAME (As shown on coumr Pnopeny P—no.)
3
TELEPHONE NUMBER
RO3LInL% ING
( )
'S MAILING ADDRESSi-
PROPERTY OWNERSMAI A
t5
CIN
S �,
STATE
fJ-e
ZIP�pOE
q��
7�0 -1-hSt.
;n �1d
n
7y7y
(Be sure to attach a separate sheet to show additional owners.)
• Lislthe primary owner, partners, LLC members or corporate officers.
• If a member of a limited liability company (LLC) is a corporation, the president must provide information below.
• If partner of a partnership is a corporation, the president must provide information below.
• If corporation or LLC, the Oregon registered agent name and addresses are required below.
OREGON REGISTERED AGENT NAME
TELEPHONE NUMBER
De L&~ X, i,,
(s_/l )GS'o -S- SrS
OR YG REO ISTE)EDAG'NT MAIN ADDRESS
CI?
STATE
ZIP CODE
Pr' ie
OREGON REGISTERED AGENT STREET ADDRESS
r
CIT
STATE
ZIP CODE
PRINCIPAL'S DEALER HISTORY
Information on the principals of this business is requested under Oregon Revised Statutes (ORS) 822.035 and Oregon
Administrative Rule (OAR) 735-150-0024.
OAR 735-150-0010(28) defines the principal of a dealership as "an owner, partner, corporate officer or other person who
controls or manages the business organization or employees or agents of the business organization." "Principal"
includes all owners, partners, members, corporate officers, or directors.
Please provide the following information about all owners listed on this application and other principal(s) of the
business:
Has any principal of this dealership been financially or operationally involved in any jurisdiction, including Oregon,
with a vehicle dealership whose certificate or right to apply for a certificate was revoked or is currently suspended?
LXJN ❑: YES, revoked or is currently suspended. If "YES," complete Section 19.
NAME OF DEALERSHIP
IJZL 10&�o�t
PRINCIPAL'S NAME(S)
man Ct
LLc
/
DEALER CERTIFICATE NUMBER
STATE WHERE SUSPENDED I REVOKED
DATE OF SUSPENSION I REVOCATION I
EXPIRATION OF SUSPENSION
Has any applicant ever been an owner or principal on a vehicle dealer certificate in Oregon (excluding current application)?
[2�140 ❑ YES: If "YES," complete Section 21.
NAME OF DEALERSHIP
PRINCIPAL'S NAMES)
DEALER CERTIFICATE NUMBER
OWNER INFORMATION AND CERTIFICATION
False certification is a Class B misdemeanor under ORS 162.085 and is punishable by six months in jail, a fine of up to
$2,500 or both. In addition, civil penalties and DMV sanctions against you or your dealer certificate may be imposed.
With this in mind ...
I CERTIFY ...
• 1 am an owner, a partner, limited liability company member or corporate officer of this dealership and my name is
listed on this application.
• ALL information on this application is accurate and complete.
• 1 deal in vehicles and conduct business at the location given on Line 3 of this application.
• The dealership will comply with all applicable laws and administrative rules.
• Ilwe hereby certify that the persons named in this application are not acting as the alter ego, in the place of, or on
behalf of, any other person or persons in seeking this certificate.
Pao. 2
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
DMV AGENT AGREEMENT
The dealer is granted the following options as a DMV agent and must comply with all applicable
laws and administrative rules. The dealer is not obligated to perform any of these options except
as required by law. *Snowmobile dealers must act as DMV agents for Oregon residents.
• *Accept applications and fees for titles and registrations of vehicles they sell, and only charge fee
amounts set by Oregon Revised Statutes (ORS) and Oregon Administrative Rules (OAR).
• Perform vehicle identification number inspections on vehicles they sell, except a dealer may not
perform an inspection under those situations described in OAR 735-022-0070(6)(A-G).
• Issue temporary registration permits for. unregistered vehicles they sell.
• Agent status can be placed on probation, suspension or revoked as allowed in OAR 735-150-0120
for non-compliance of any ORS of the Oregon Vehicle Code.
• By signing this application on Page 3, the dealer becomes an agent of DMV and agrees to comply
with all administrative rules and all dealer related statutes in the Oregon Vehicle Code.
OWNERSHIP INFORMATION
PRINT NAME OF OWNER,PARTNER, LLCMEMBER OR CORPORATE OFFICER
1J&an I
TITLE
I O .)�
TELEPHONE NUMBER
S11 / 65-0-5-5-15,
DATE OF BIRTH
09 .1
DRIVER LICENSIl EI //NUMBER
`i8S$7Jr
STATE OF ISSUANCE
qe an
EMAIL /�
RLAt, ILvS' 44a. tG G-4 �.
RESIDENCE ADDRESS
3o r5,
CITY
5 e (c/
STATE
A2
ZIP CODE
47 -" `�
MAILING ADDRESS (IF DIFFERENT)
CIT
STATE
ZIP CODE
CESIGNATBREOF NER SHO RT NON LINE 22 ABOVE DATE
X
PRINT NAME OF OWNER, PARTNER LLC MEMBER OR CORPORATE OFFICER
TITLE
TELEPHONE NUMBER
DATE OF BIRTH
DRIVER LICENSE NUMBER
STATE OF ISSUANCE
EMAIL
RESIDENCE ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS (IF DIFFERENT)
CITY
STATE
ZIP CODE
CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 27 ABOVE
X
DATE
PRINT NAME OF OWNERPARTNER, LLC MEMBER OR CORPORATE OFFICER
TITLE
TELEPHONE NUMBER
DATE OF BIRTH
DRIVER LICENSE NUMBER
STATE OF ISSUANCE
EMAIL
RESIDENCE ADDRESS
CITY
STATE
ZIPCODE
MAILING ADDRESS (IF DIFFERENT)
CITY
STATE
ZIPCODE
CERTIFYING SIGNATURE OF OWNER SHOWN ON LINE 32 ABOVE
X
DATE
PRINT NAME OF OWNER PARTNER, LLC MEMBER OR CORPORATE OFFICER
TITLE
TELEPHONE NUMBER
DATE OF BIRTH
DRIVER LICENSE NUMBER
STATEOF ISSUANCE
EMAIL
RESIDENCE ADDRESS
CITY
STATE
ZIPDODE
MAILING ADDRESS (IF DIFFERENT)
CITY
STATE
DECODE
CERTIFYING SIGNATURE OF OWNER SHOWN ONLINE 37 ABOVE DATE
X
---:M..3--ln".A in*PM1nlnln 1
Corporation Division
www.filinginoreaon.com
OREGON SECRETARY OF STATE
v
S.MANAGEMENT
This Limited Liability Company will be member -managed by one or more members
I declare, under penalty of perjury, that this document does not fraudulently conceal, fraudulently obscure,
fraudulently alter or otherwise misrepresent the identity of the person or any officers, managers, members or
agents of the limited liability company on behalf of which the person signs. This filing has been examined by me
and is, to the best of my knowledge and belief, true, correct, and complete. Making false statements in this
document is against the law and may be penalized by fines, imprisonment, or both.
By typing my name In the electronic signature field, I am agreeing to conduct business electronically with the
State of Oregon. I understand that transactions and/or signatures in records may not be denied legal effect solely
because they are conducted, executed, or prepared in electronic form and that if a law requires a record or
signature to be in writing, an electronic record or signature satisfies that requirement.
ELECTRONIC SIGNATURE
NAME
DEAN CHURCHILL
TITLE
ORGANIZER
DATE
05-03-2023
Page 2
ARTICLES OF ORGANIZATION
f Corporation Division E -FILED
May 03, 2023
www.filinginoreaon.com OREGON SECRETARY OF STATE
REGISTRY NUMBER
TYPE
211646997
DOMESTIC LIMITED LIABILITY COMPANY
1. ENTITY NAME
DRL MOTORS LLC
2. MAILING ADDRESS
230715TH STREET
SPRINGFIELD OR 97477 USA
3. PRINCIPAL PLACE OF BUSINESS
230715TH STREET
SPRINGFIELD OR 97477 USA
4. NAME & ADDRESS OF REGISTERED AGENT
DEAN CHURCHILL
230715TH STREET
SPRINGFIELD OR 97477 USA
5. ORGANIZERS
DEAN CHURCHILL
230715TH STREET
SPRINGFIELD OR 97477 USA
6. INDIVIDUALS WITH DIRECT KNOWLEDGE
DEAN CHURCHILL
230715TH STREET
SPRINGFIELD OR 97477 USA
7. INITIAL MEMBERSIMANAGERS
MEMBER
DEAN CHURCHILL
230715TH STREET
SPRINGFIELD OR 97477 USA
8. DURATION
PERPETUAL
Page 1
CERTIFICATE of ACHIEVEMENT
This is to certify that
Dean Churchill
License Number: 9858459
has completed the course
Oregon Auto Dealer Pre -License Training
Flo Your Pace Online, LLC
Pn itler ID: N/A
OnlineAutoDealerEtl com
1383 2nd Ave, Gold Hill, OR 97525
Credit H011(b:8
Completion Date: Ivey 16, 2023
v:,a �$y
carVtlN51H9j r.
IR
SURETY BOND pm
NOTE: TO BE COMPLETED BY BONDING COMPANY. FAILURE TO 100746891
ACCURATELY COMPLETE THIS FORM WILL CAUSE DELAY.
PI FASET'PE OR PRINT LEGIBLY WITH INK.
LET IT BE KNOWN:
THAT DRL MOTORS LLC
(INDIVIDUAL NAME OF OWNER, ALL PARTNERS UR MEMBERS, OR NAME OF CORPORATION)
DOING BUSINESS AS NIA
(BUSINESS NAME AS GIVEN ON THE OERTIFICAIE APPLICATION)
HAVING ITS PRINCIPAL PLACE OF BUSINESS AT 2307 15TH ST SPRINGFIELD, OR, 97477
(STREET ADDRESS, CITY, STATE, ZIP CODE)
WITH ADDITIONAL PLACES OF BUSINESS AT
(STREET ADDRESS, CIN, STATE, ]IP CODE)
(STREET ADDRESS, CITY, STATE, ZIP CODE)
AS PRINCIPAL(S), AND AMERICAN CONTRACTORS INDEMNITY COMPANY
(SURETY NAME)
Las Anaeles. CA 90017
A CORPORATION ORGANIZED AND EXISTING UNDER AND BY VIRTUE OF THE LAWS OF THE STATE OF California ,
AND AUTHORIZED TO TRANSACT A SURETY BUSINESS IN THE STATE OF OREGON, AS SURETY, ARE HELD AND FIRMLY
BOUND TO THE STATE OF OREGON IN THE PENAL SUM OF $50.000 FOR EACH YEAR THE CERTIFICATE IS VALID, FOR THE
PAYMENT OF WHICH THE PRINCIPAL(S) AND SURETY JOINTLY AND SEVERALLY BIND THEMSELVES, THEIR RESPECTIVE
SUCCESSORS, AND ASSIGNS. THE MAXIMUM AMOUNT PAYABLE UNDER THE BOND FOR PAYMENT OF CLAIMS BY PERSONS
OTHER THAN RETAIL CUSTOMERS OF THE VEHICLE IS $10,000.
WHEREAS, THE PRINCIPAL(S) IS APPLYING FOR A VEHICLE DEALER CERTIFICATE ISSUED BY THE OREGON DEPARTMENT OF
TRANSPORTATION;
THE CONDITION OF THIS OBLIGATION IS SUCH THAT WHEN THE ABOVE NAMED PRINCIPAL(S) IS ISSUED A VEHICLE DEALER
CERTIFICATE TO CONDUCT, IN THIS STATE, A BUSINESS AS A DEALER OR REBUILDER OF VEHICLES, SAID PRINCIPAL(S)
SHALL CONDUCT SUCH BUSINESS WITHOUT FRAUD OR FRAUDULENT REPRESENTATION, AND WITHOUT VIOLATION OF ANY
OF THE PROVISIONS OF THE OREGON VEHICLE CODE SPECIFIED IN ORS 822.030(2), THEN AND IN THAT EVENT THIS
OBLIGATION TO BE VOID, OTHERWISE TO REMAIN IN FULL FORCE AND EFFECT UNLESS CANCELLED PURSUANT TO ORS
822.030R)(a).
THIS BOND SHALL BECOME EFFECTIVE AS OF THE DATE THE PRINCIPAL(S) IS ISSUED A VEHICLE DEALER CERTIFICATE BY
THE OREGON DEPARTMENT OF TRANSPORTATION. THIS BOND SHALL BE DEEMED CONTINUOUS IN FORM AND REMAIN IN
EFFECT FOR THE ENTIRE PERIOD FOR WHICH CERTIFICATION IS GRANTED AND FOR EACH SUCCEEDING CERTIFICATION
PERIOD UPON RENEWAL OF THE VEHICLE DEALER CERTIFICATE, UNTIL DEPLETED BY CLAIMS PAID, UNLESS THE SURETY
SOONER CANCELS THE BOND. THIS BOND MAY BE CANCELED BY THE SURETY GIVING WRITTEN NOTICE OF SUCH
CANCELLATION TO THE DRIVER AND MOTOR VEHICLE SERVICES DIVISION OF THE OREGON DEPARTMENT OF
TRANSPORTATION.
THIS BOND SHALL BE ONE CONTINUING OBLIGATION AND THE LIABILITY OF THE SURETY SHALL BE LIMITED TO THE
AMOUNT OF THE PENALTY OF THIS BOND REGARDLESS OF WHETHER THIS BOND IS RENEWED OR OTHERWISE CONTINUED
IN EFFECT BEYOND THE ORIGINAL CERTIFICATION PERIOD, IRRESPECTIVE OF THE NUMBER OF YEARS IT IS IN EFFECT.
THIS BOND IS EFFECTIVE 5/12/2023
(MONTH, DAY, YEAR)
-- ANV ALTERATION VOIDS THIS BOND --
IN WITNESS WHEREOF, THE SAID PRINCIPAL(S) AND SAID SURETY HAVE EACH EXECUTED THIS BOND BY ITS AUTHORIZED
REPRESENTATIVE(S) AND HAVE AFFIXED THE SURETY CORPORATE SEAL HEREUNTO
THIS 111th DAV OF May 1 2023
Incur In 0 VAVQ Col AMnrRRV-I,FAUt
SURETY'S A OR REPRESENTATIVE MUST COMPLETE THIS SECTION:
PLACE SURxY SEAL BELOW
oAptMCORsi+,,
IN THE EVENT A PROBLEM ARISES CONCERNING THIS BOND, CONTACT:
NAME
H O NE NUMB OR
AMERICAN CONTRACTORS INDEMNITY COMPANY
TEE
310-649-0990
�sy SEm
.o a
ADDRESS
801 S. Figueroa Street, Suite 700
Cm, STATE, ZIP CODE
Los Angeles, CA 90017
B4',m1 APPROVED RY ATTORNEY GENFRAI :S OFFICE
TO_KIOMARINE
HCC
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint,
JOSHUA R. KAYSER
its true and lawful Attorney -in -Fact, with full authority to execute on its behalf bond number 100746891
issued in the course of its business and to bind the Company thereby, in an amount not to exceed
F'tv thousand and 00/100 ( $50,000.00 ).
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted
by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 1"t day of
September, 2011.
"Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be
and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and
act for and on behalf of the Company subject to the following provisions:
Attorney -in -Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge
and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings,
including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts,
and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed
by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate
Secretary.
Be if Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of
attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached."
The Attorney -in -Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this
bond and does not indicate whether the Attorney -in -Fact is or is not an appointed agent of the Company.
IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by
its President on this 18th day of April, 2022. „op�ro
State of California¢:' "`..`max= AMERICAN CONTI2pCT0 S INDEMNITY COMPANY
County of Los Angeles t '- k _ By: L .�
6 °T . Pessin, President
'�°o�ronMT�c°'•
A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which
this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
On this 18th day of April, 2022, before me, Sonia O. Carrejo, a notary public, personally appeared Adam S. Pessin, President of
American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is
subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his
signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.,
uxa�
_ xa�4we. IIo�4111vTe
II
�.
�..mmm.
Signature
Ln�
(seal) .. ........ „-.
nrl�mu. rcm
I, Kip Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the
resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that
neither the said Power of Attomey nor the resolution have been revoked and they are now in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand this 11th day of May 2023
,d�lpppipg9 �.;
Bond No. 100746891
Agency No. 13266 _ W
iii," ss"n Kic LoA, ii nt Secretary
a se n,
oma
"'f�42�F00.N\P�o"
HCCS0ZZP0PALICOGlAi2
visit [mhcc.com/surety for more information