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Opening of Proposals - MPAC Water Softener System - Canney's Water Solutions Inc
South Bend, IN 46615 12/07/2017 The Morris performing arts center Water Softener system project # 1026-2017 My name is Kevin C. Cainney I am third generation of a family water treatment company. My immediate Canney family currently operates (5) water treatment business (2) located in Michigan (2) located in Florida and one in South Bend Indiana. The Canney family has been in the water treatment industry since 1940 starting with my grandfather the late Bernard Canney. My uncles and cousins currently have water treatment companies, in Wisconsin, and in Minnesota. Canney's Water is A Better business, bureau AAA accredited water Treatment Company and our goals are to keep, the existing customers happy as much as looking for new customers to grow our company in the community. We currently have 42 Employees in our Michigan stores aind 29 employees in our Florida stores and 6 in our South Bend store (hopefully more in the near future). The Canney Family takes great pride in taking on and solving water treatment problems for people, and business in our communities. Thank you for taking your time to let me introduce myself. Kevin C. Canney Canney's Water Solutions IInc. 1205 Mishawaka Ave. South Bend, IN 46615 574-287-1549 office 269-207-6304 cell FK(()'Y'14A,TER a Y S E, M S. rmn.rw' [-En' &-exm Tf BTI -mvil-IL AND BOTTLED WATER Serving the South Bend and Mishawaka Area South Bend, IN 4661 7 Morris Performing Arts Center Water Softener System Project# �1026-2017 The water softener that vxe recommend for is a 2"Redh29�00 210/000grain Metered twin progressive Based on the information we received from our meeting at the Morris we feel that this is the best system for your water treatment needs. The reason wmdecided to go witha progressive system is because it will ruin from the primary tank during the, low water using days and when you have a full house and the water calls for more fUmvv it will open up the second tank., This solves the problem nf installing a system that would be sized to meet the highest amount of water used and when you aren't using much water you would still have to use high amount s of salt to regenerate a very large softener when it's not needed. Normal' flow rate of the system is 55 gallon per minute (gpm)per tank. Peak flow rate is77gpmper tank anwhen both tanks are running you will have 154 gpmwhich ismore than your requirements. Having two 2" units when they are both running you will have the equivalent of a 4" unit so you will have high flow when needed and no problems with your urinals asthey need high flows to shut off after they have been flushed Thank you for your time inreview cfthis system size sheet Kevin C. Canney Camoew'sWater Solutions Inc, 1205 Mishawaka Ave. South Bend IN. 46615 574-287-I549uffice 269-207-6304 cell rEC` WiXrEER S"=7="=~ AND OTHER FINE WATER TREATMENT PRODUCTS, SERVICES AND BOTTLED WATER 12/08/2017 Morris performing arts center Water Softening System Project # 1026-2017 salt: As all water softeners will regenerate with a salt base (Ion exchange process) you can use any type of salt but, some salts are not as good as others. Canney's Water Solutions uses a very high, grade salt that won't cake up or mush up in the salt tank like others do. Canney's Water Solutions has a "keep full' program. We will stop every month or two or three depending on how much salt you will use and fill the system with salt and check the, adjustments so you will never run out of salt. The Delivery of salt can be adjusted based on the water used with your water variation. The fee for the delivery is $4.00 Thank you for your time in reviewing this information Kevin C. Canney Canney's Water Solutions Inc, 1205 Mishawaka Ave. South Bend, IN 46615 5 74-287-1549 office 269-207-6304 cell Ex,qvw%:rE:R ea V 0 7 E M 0 Smrg UP25, %JCAM1WA`MVVVF1, I I ! I AND BOTrILED WATER Serving the South Bend and Mishawaka Area 1205 Mishawaka Avenue South Bend, IN 46615 12/08/2017 iiiiiiii��� qIIII IIIIIIIIIII qIII1 Water softener project # 1026-2017 Referral list City of South Ben 'I Streets dept. 731 S. Lafayette S • ffiffialm-mm mmumamm 27531 May St. Edward;sburg, MI 269-663-810O VVA�J'E R 7 F m 6 AND OTHER FINE WATER TREATMENT PRODUCTS, SERVICES, AND BOTTLED WATER 441%di g sulcr MRS. Serving the South Bend and Mishawaka Area Morris performing arts center Water softener project # 1026-2017 Referral list Don Troxel South Bend Woodworks 707 Scott St. South Bend, IN 574-386-0607 John Stratigos Barnaby's pizza 713 E Jefferson BLVD South Bend, IN 574-288-4981 )�' P E N'TA I R 01 FLECK'2900s ?-INCH CONTROL VALVE Fl,,ATU R ES/B E N EF1 TS Lead-free brass valve body for superior strength .and durability Continuous service flow rate of 106 GPM with a backwash of 36 GPM Backwash capability accommodates softener tanks up to 36" and filter up to 24" in diameter Fully adjustable 3- or 5-cycle, control for efficient and reliable water treatment system Designed for single or multiple tank systems OPTIONS Filter or softener control valves DownfLow co -current or upflow counter -current regeneration No hard water bypass piston Brine cam auxiliary switch Electromechanical timer auxiliary switch, MADE IN THE ME OF FOREIGN . O...M PARTS Environmental protective cover for water resistance, corrosion resistance, and UV stability Time -tested, hydraulically -balanced piston, for service and regeneration Rugged -built electromechanical timer designed with heavy duty 3/8" wide plastic gears NXT- Network controller uses on- board communication capabilities to Link multiple valves (via off -the -shelf CAT3, CATS, or better cables) for system types 4,5,6,7,9,and 14 XT- Offers a two-line, 16 character LCO backlit display for easy entering of master and user programing as well as view of diagnostics Hot water Electromechanical Timer- Simple to TESTED and CERTIFIED by the WQA to NSF/ANSI Standard 61 Treated water regeneration adjust and easy to service with quick Section 8 Material Safety only. Versatile top or side mount access to all internal components Electromechanical 7- or 12-day TESTED and CERTIFIED by the time clock, meter delayed, or meter WQA to NSF/ANSI Standard 372 for Lead Free Compliance, immediate regeneration BA V L:11'11 S F-1 i7Z C I F'l C A rIli WNS UL recognized to 979 . . . ..... Valve Material Lead-free brass** Restriction of Hazardous Substance Inlet/Outlet 2" NPTF/BSPF Substance Compliant utLet R /.H S Cycles 5 WATER O3AL11 11 Y SYS Ir E �114 S F 11 1 C K 2 9 C) 0 �, 2 1 N C [ I COki I R () L VA 1 ''/F Fl OW RATES (50 IDS1 INLE'll - VALVE Al .W Continuous 106 GPM (24.1 ml/hI 15 psi drop Peak 140 GPM (31.8 ml/h) 25 psi drop Cv 27,5 flow at I psi drop Max. Backwash 36 GPM [8.2 m1/hI 25 psi drop REGENERATION Downflow/Upflow Both Adjustable Cycles Yes Time Available Electromechanical: 0 - 164 min/regeneration NXT: 0 - 240 min/cycle XT: 0 - 240 min/cycle MEIIER MI�VIMATIDN Meter Accuracy 2" Paddle: 3 - 150 GPM ± 5% (,68 - 34 ml/h) Meter Capacity Range 2" Standard: 1,250 - 21,250 gal (5 - 75 mil 2" Extended; 6,250 - 106,250 gat [24 - 375 Fin') NXT: 1 - 9,9,00,000 gal 10 - 37,476 ml) XT: 1,000 - 9,900,000 gal (18 - 37,476 ml) [1114ENSIONS Distributor Pilot 1-9" O.D. 150 mm) Drain Line I" NPTM Brine Valve 1600 or 1650: 3/8" 1700 or 1710 1/2" Injector System 1600 or 1700 Mounting Base 4" - 8 UN �1�> P E N TA I �R Height from Top of Tank 12" (305 mm) Riser Tube Diameter 1-1/2" (38 mm) Riser Height 1/4" Below top of tank 1"YPICA1 APPLICATIONS, Water Softener 14 - 36" diameter Filter 14 - 24" diameter based on 10 GPM/ft1 ADDIT1014AL INI"'ORMATION Electrical Rating 24/110/220v; 50/60 Hz Estimated Shipping Weight Time Clock: 33 lbs Metered Valve: 40 lbs Pressure Hydrostatic: 300 psi 120 bar) Working; 20 - 125 psi (1.4 - 8.5 bar) Temperature Cold Water Valve; 34 - 11 OOF (1 - 43°C) Hot Wa te r Valve: 34 - 180OF [I - 820C1 Time Clock, 1600 Brine System Hot Water Valve: 34 - 150°F 11 - 66°C1 1700 Brine System **As defined in the U.S. EPA Safe Drinking Water Act; the product also meets California Proposition 65 Standards for lead-free brass. WATEIIt QUAIiJ iY'SYS u'EMS 573:0 NORTH GLEN PARK ROAD, MILWAUKEE, WI 53209 P: 262.238,4400 1 F: 261238.4404 WATERPURIFICATION.PENTAIR.COM CUSTOMER CARE: 800.279.9404 1 tech-support@pentaircom, (D 2015 Pentair Residential Filtration, LLC. All rights reserved, Fora detailed list of where Pentair trademarks are registered, please visit waterpurification.pe.ntair.com. Pentair trademarks and logos are owned by Pentaiir, Inc, or its affiliates. Third party registered and unregistered trademarks and logos are the property of their respective owners, 40�738 REV D AU 15 Commercial/Industrial Rotationally Molded Brine Tanks Commercial and industrial water softeners require a large volume of brine during each regeneration. From a capacity of 95 gallons to 500 gallons, our Rotationally Molded Brine Tanks are built to last. Molded out of durable, chemically resistant high density polyethylene, their 1/4" seamless walls won't bulge. Rotationally Molded Brine Tanks are strong enough to handle your toughest brine requirements. (All tanks and covers are black.) Operating Temperature Range: 40OF - 1250F (4.4°C - 51.6°C) 24" Plastic Grids 30" Plastic Grids TANK SI2E ORDER NUMBER DIAMETER HEIGHT SALT: VOLUME::: WEIGHT'.... CAPACITY 24 x 48 G22448CBIP00 24" 48" 800 lbs. 95 gal. 30 lbs. 24 x 60 G22460CBlP00 24" 60" 1000 lbs. 115 gal. 32 lbs. 30 x 48 G23048CBlP00 30" 48" 1200 lbs. 145 gal. 48 lbs. 30 x 60 G23060CBlP00 30" 60" 1600 lbs. 180 gal. 56 lbs. 39 x 48 G23948CBlP00 3911 48" 2200 lbs. 250 gal. 67 lbs. 39 x 60 G23960CBIP00 39" 60" 2700 lbs. 300 gal. 80 lbs. 42 x 60 G24260CBIP00 42" 60" 3100 lbs. 350 gal. 84 lbs. 50 x 60 G25060CBlP00 50" 60" 4500 lbs. 500 gal. 107 lbs. cl aC ,! ClcackCorporcation k- 4462 DURAEORMI.ANE • WINDSOR, WISCONSIN 53598-9716 USA WWW.clac Corp.coni PHONE (600) 846-3010 FAX ((M) 846-2586 SALES/CUNTONIER SF.PVICF FAx (800) 755-3010 Form No.1837 . 12/13/2016 m co C7 M co 3 x7 x7 n n o H m n r nCD Z © H _0 o Z © T] C) n 'T7 � m m:rTa r-+ 7 n m m m of f-� �--� r m 3 m O o H m :;a C-) m _0 Z 3 n r cr c� C) o -{ o r cn H z -I m; I c z r to m .. cn a in 3 n m y70 CD� z m n [ < n a n m z r m H, iv H m >x I z r r p .. m m z ;�O m z m� r, a rra a CD m r v m © cn N m m Cn r N w w N PI)�--` V FN-+ N m .. .A = _ _ = Ul = o a l0 cn a z m x cn CD N © n x -� N csa cra o a _ 'O LQ UD LO to r p In r+ N -0 'O N - w 0 LO 41 A a) ma H CD CD CD CD cn n n a saa m H H C) n c) ul CD z :D7 Z37 ri 131 A� ill c ct CT aj iL co sv an (n cn � Cn m - n n z r CD c m m � n o r CD 7 r C-) CD 3 m x Ln m rr- ;o m Z a C7 C7 N P m Z CD Z Cl G� cu n Ali p H m x7 x m CD m m o (CD M 0)cl) o v X z — co Z v v n m CD a z o z C,U m o v' m CD - 0 C Z n w o < o c -) m _ 3 O r Z Z m m1 ;10CA oM 0 �7 --IZ G) N M �')Z>0 3 m o m ,0mT N C n 0) 2 m 00 � ;LJ H Q� p m C) v N Z I� o E No O air CANNWAT441 KRLnssER AcoRO" CERTIFICATE OF LIABILITY INSURANCE `•� DATE(MMIODIYYYY) 12111 /2017 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 have ADDITIONAL INSURED provisions or 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($). PRODUCER 1st Source Insurance, Inc. 6909 Grape Road Mishawaka, IN 46545 CONTACT Kris Slosser PnHic°,N ;, Ext ; (574) 271-5200 �A' c,(574) 27 #-5240 ----___._ _..__ -...._ _-- �e[o�,$,blosserk@istsource.com D ,$, blosserk@lstsource.com INSURERS) AFFORDING COVERAGE _ _NAIC INSURER A: Frankenmuth Mutual Ins Co. 13986 INSURED INSURER B : ..109URERC:..,.....—.....- Canney's Water Solutions, Inc 1205 Mishawaka Ave South Bend, IN 46615 INSURER D : ......,____..... — — INSURER E INSURER F : 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 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, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _EXCLUSIONS INSR . _,.,.._.....,.,,_._—TYPE OF INSURANCE AODL SUER POLICY NUMBER POLICY EFF POLICY E.XP IMMIOVIYYYYI LIMITSLTR A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE L: OCCUR CPP6363066 07120/2017 07/2012018 EACH OCCURRENCE DAMAGE TO RENTED PREMISES E urrence $ 1,000,000 500,000 $ GEN'L X MED EXP An one_ erson ._, PERSONAL&ADV INJURY 5,000 $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS 2,000,000 _$— A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY _ AUTOS pp -- 2TOS ONLY Ai0i 05 ON Y BA 6363065 0712012017 0712012018 CEOMBINED SINGLE LIMIT 1,000,000 BODILY INJURY_(Per arson 8001LY INJURY Per accldeot $ (Pea Kent AMAGE_.,........__.,_ .$_.__....._......_ . ..._._._...__......... is A X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE CPP6363065 07/2012017 07/20/2018 EACH OCCURRENCE $ 2,000,000 AGGREGATE _ _-..,..,....__- _ 2,000,000 $ DED I X I RETENTION$ 0 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE WFICERIMEMS R EXCLUDED? andatory In NH) If s CDIPTION OF OPERATIONS below N I A WC 6363065 07/2012017 0712012018 7C PER OTH- E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYE 544,444 $ E.L, DISEASE - POLICY LIMIT 504,000 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached if more space is required) CFRTIFlr.ATF FIC]I r1FR CANCFI. LATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Morris Performing Arts Center 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 211 Dr. MLK Jr. Dr South Bend, IN 46601 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1205 Mishawaka Avenue South Bend, IN 46615 Morris performing arts center Water Softener system project # 1026-2017 Pricing: 1 Fleck 2900 Metered NXT 14 progressive twin 210,000 grain water softener $6457.00 Install, plumbing, parts, and removal of old equipment $2037.08 400 pounds of salt and startup of new system $ INCL Total $84,94.08 *Cannev's Water Solutions requires net 10 days on all commercial systems * Thank you for the opportunity to quote your water treatment needs Kevin, . Tanney ZCanney'4sWater Soluti ns Inc. 1205 Mishawaka Ave South Bend, IN 46615 574-287-1549 office 269-207-6304 cell 1,-C IfflICY-EF"l. 51 Y 1'.1 M q SiNce 1.91"I.S. KrA1#1—*f P41C I S,—S-EKHCES; AND BOTTLED WATER Serving the South Bend and Mishawaka Area 12/08/2017 When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF ) } SS: Sties COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: I . Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred; suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from tune -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. $. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program.. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any Employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBENME Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. 1, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). 1 hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry pkoducts made in the United States on this project if awarded. 1 understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. I hereby affirm under the penalties of per that the facts and information contained in the foregoing said for public works are true and correct. Dated this day of jQece 2�j—, 20— (ALVeV"� Contra t r[Bidd T Fir Sin re of Contractor/139 er or Its Agent Printed Nance and Title Subscribed and sworn to before me this day", My Commission Expires Notary Public 0[1 'Ny 4 County of Residence 5 -� - 3 &Ctek