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HomeMy WebLinkAbout1996-06-24 City Council (28)TO: FROM: AGENDA DATE: SUBJECT: City of Palo Alto City Manager’s Report HONORABLE CITY COUNCIL CITY MANAGER DEPARTMENT: Human Resources June 24, 1996 CMR:307:96 Approval of Consultant Agreement with Foundation Health PsychCare Services, Inc., d.b.a. Occupational Health Services (FHPS) for Employee Assistance Plan Services REQUEST This is a request for approval of a consultant agreement with Foundation Health PsychCare Services, Inc. (FHPS) for Employee Assistance Plan services. RECOMMENDATIONS Approve and authorize the Mayor to execute the attached consultant agreement with FHPS in the amount of: July 1, 1996 through June 30, 1997:$26,500 July 1, 1997 through June 30, 1998:$27,800 July 1, 1998 through June 30, 1999:$29,500 This agreement covers a three-year period. Funds for 1996-97 are included in the budget. Funding will be included in the proposed annual budget for each subsequent year of the agreement and will be subject to future City Council budget approval. POLICY IMPLICATIONS The approval of this agreement is consistent with existing policies. EXECUTIVE SUMMARY. Consultant Services Description The work to be performed under the agreement is for Employee Assistance Plan (EAP) services. The City has provided employees and their dependents with EAP benefits since 1982. Existing agreements with City employee representation units provide fo~" maintaining benefits to assist employees in dealing with many types of problems, including personal counseling, work and family counseling, stress management, substance abuse, etc. The program is designed to help promote the well-being and welfare of City of Palo Alto employees, and thereby reduce absenteeism and on-the-job distraction. Selection Process A Selection Advisory Committee, consisting of a representative from each of the employee representation units and an employee from the Finance Department, reviewed the draft scope of work prior to the issuance of a request for proposal. CMR:307:96 Page 1 of 2 Staff sent a request for proposals to ten firms on February 8, 1996. Firms were given 26 days to respond to the request. A total of four firms submitted proposals. Proposals were as follows: Vista $35,000 Concern 30,500 MCC 27,950 -. FHPS 26,500._ The Selection Committee referenced above reviewed the proposals, and three firms were invited to participate in oral interviews on March 12, 1996. The Committee carefully reviewed each firm’s qualifications, and two of the firms were invited to answer additional questions. On April 23, 1996, the Selection Committee met again and selected FHPS, the current provider who has performed these services since 1982. FHPS was selected because their program represented the best value. FHPS’s cost was the most competitive. In addition, they agreed that the number of seminars and training sessions will be expanded from 16 hours per year to 40 hours pe[ year. FISCAL IMPACT Fuhds for this project are included in the FY 1996-97 budget. Funding for the subsequent two years is contingent upon future City Council budget appropriations. ENVIRONMENTAL ASSESSMENT These services do not constitute a project for purposes of the California Environmental Quality Act. ATTACHMENTS Attachment A: Agreement PREPARED BY:Leonard Zucker ler of Employee Benefits DEPARTMENT HEAD REVIEW: CITY MANAGER APPROVAL: FLEi CMR:307:96 Page 2 of 2 AGREEMENT BETWEEN THE CITY OF PALO ALTO AND FOUNDATION HEALTH PSYCHCARE SERVICES~ INC., DBA OCCUPATIONAL HEALTH SERVICES, FOR ADMINISTRATION OF CITY EMPLOYEE ASSISTANCE PROGRAM THIS AGREEMENT, made and entered into this day of , 1996, by and between the CITY OF PALO ALTO, a municipal corporation of California, hereinafter referred to as "CITY", and FOUNDATION HEALTH PSYCHCARE SERVICES, INC., dba OCCUPATIONAL HEALTH SERVICES,(Taxpayer Identification Number 95- 2762150) a California corporation, with offices at 1600 Los Gamos Drive, Suite 300, San Rafael, CA 94903, hereinafter referred to as "OHS"; W I T N E S S E T H: WHEREAS, CITY desires to retain services related to the supervision and administration of CITY’s employee assistance program, hereinafter referred to as the "Program"; and WHEREAS, CITY desires to engage OHS to provide these services by reason of its qualifications and experience for performing such services, and OHS has offered to provide the required services on the terms and in the manner set forth herein; NOW, THEREFORE, in consideration of their mutual covenants, the parties hereto agree as follows: i.DEFINITIONS. Terms used in this agreement are as defined herein or in the Combined Evidence of Coverage and Disclosure Form ("Evidence of Coverage"), which is attached hereto as Addendum "A" and incorporated herein by reference; provided, that to the extent that any terms in the Evidence of Coverage are in conflict with the terms of this agreement, this agreement shall prevail. 2.PROJECT COORDINATION. (a) CitM. The City Manager shall be representative of CITY for all purposes under this agreement. The Director of Human Resources hereby is designated as the PROJECT MANAGER for the City Manager, and he shall supervise the progress and execution of this agreement. (b) OHS. OHS shall assign a single PROJECT DIRECTOR to have overall responsibility for the progress and execution of this .agreement for OHS. Elein Gallacher, LCSW, CEAP, is hereby designated as the PROJECT DIRECTOR for OHS. Should circumstances 960620 lac 0031342 1 or conditions subsequent to the execution of this agreement require a substitute PROJECT DIRECTOR for any reason, the PROJECT DIRECTOR designee shall be subject to the prior written acceptance and approval of the PROJECT MANAGER. 3.DUTIES OF OHS. (a) Services to be Furnished° specified services as set forth below: OHS shall provide all (i) OHS agrees to supervise and administer the Program as to all required counseling services during the term of this agreement, as provided in the "Evidence of Coverage." The services herein contemplated shall cover the operations of CITY involving its employees and their dependents° (2) OHS shall act as the representative of CITY in matters related to CITY’s administrative obligation concerning the Program and shall provide the services more particularly set forth below: A. Administer the Program in full compiiance with the requirements of accepted standards and administrative procedures of the State of California° B. Provide monthly to CITY a machine- tabulated report on all services provided under the Program, including but not limited to: The number of CITY employees who have or are participating in the Program; The utilization rate by location, department, and divisions in the utilities department; The gender; The age groups increments; in five-year Whether management referrals or self referrals; services. Problems stated by category. Provide semi-annual client evaluations of 960620 lac 0031342 2 D. Coordinate, consult, and fully cooperate with CITY Human Resources Department in the administration of said Program; notify the PROJECT MANAGER immediately as to any serious condition of current employees which could or may cause injury/ illness to themselves or others. (3) OHS shall provide counseling services in the areas described under "Covered Services" on pages 4 and 5 of the "Evidence of Coverage"° (4) OHS shall provide the following training as outlined on an annual.basis; annually. Employee orientations; eight (8) sessions annually. B°Supervisor training; four (4) sessions C. Wellness seminars; twelve (12) one-hour seminars annually, tO include one(l) two-hour AIDS awareness course. D. Forty-eight (48) additional clinical account management (CAM) hours per year, on topics to be mutually selected by CITY’s Project Manager and OHS’s Project Director. (5) OHS shall make available counseling sessions for all employees and their dependents as follows: A. Ten (i0) counseling sessions per family unit for sworn police and fire personnel. B.Management referral/consultation. Critical Incident debriefing as needed at no additional charge. (6)OHS shall furnish the following materials: A. Brochures shall be supplied to all police and fire department personnel and regular employees two (2) times annually. Brochures shall describe the applicable services afforded to each respective work group. B. Posters relating to the various benefits of employee assistance shall be supplied every calendar quarter with the quantity to be no less than twenty-five (25) copies per quarter. 960620 lac 0031342 C. Mailers for all respective work groups shall be supplied in quantities of nine hundred (900) per calendar quarter. D. Newsletter articles regarding the program shall be furnished on a monthly basis. ~E. Sufficient numbers ofsupervisory training manuals shall be supplied in conjunction with the supervisor training services required under Section 3 (a) (4) (B) of this agreement. Additional manuals shall be provided as part of on site stock of resource materials for supervisors. (7) OHS shall maintain a twenty-four (24) hour per day, seven (7) days-a-week telephone line for CITY use; said telephone system shall: A. Be staffed by OHS staff ten (i0) hours per day, Monday through Friday. B. Off hours and weekends the answering service shall be supplied with the names and numbers of appropriate OHS staff. C. When an off-hour caller indicates that he or she desires to talk to a counselor, the caller shall be automatically switched to an on-duty counselor. (8) OHS shall assure confidentiality of services performed at all times. Records, including any information whether recorded or not, pertaining to the identity, diagnosis, or treatment of any employee or dependents which are maintained in connection with the performance of this agreement shall be confidential and disclosed only under either of the following circumstances: A. When disclosure is authorized with the written and signed consent of the employee or dependent over the age of eighteen (18). Such consent must state: (i)The name of the person or organization to whom disclosure is to be made; (ii)The specific type of information to be disclosed; and (iii)The purpose or need for such disclosure. 960620 lac 0031342 B. When an employee’s records are subpoenaed and are not otherwise protected by professional, privileged, relationships. (9) OHS agrees to operate a system of records on individuals in accordance with the Privacy Act of 1974, Public Law 93-579. (b) Laws to be Observed. OHS is subject to regulation by the California Department of Corporations and this agreement is subject to the requirements of the Knox-Keene Health Care Service Plan Act of 1975 (the "Act", commencing with Section 1340 of the California Health and Safety Code) and the regulations promulgated thereunder (found at Chapter 3 of Title i0 of the California Code of Regulations). Any provision required to be in this agreement by either of these sources of law shall bind the parties whether or not provided hereunder. With respect to the obligations of the parties under the Act and other relevant laws, OHS shall: (i) Procure all permits and licenses, pay all charges and fees, and give all notices which may be necessary and incident to the due and lawful prosecution of the services to be performed by OHS under this agreement. (2) Upon notice, immediately report to the PROJECT MANAGER in writing any discrepancy or inconsistency in applicable state and federal laws, in relation to any provisions of this agreement. (c) Release of Reports and Information. Except as provided under Section 3 (a) (9) of this agreement, any reports, information, data, or other material, with the exception of proprietary information, OHS trade secrets and information protected by applicable trademark or copyright law, given to the City pursuant to this agreement shall be the property of CITY and shall not be made available to any individual or organization by OHS or its subcontractors, if any, without the prior written approval of the City Mana’ger. 4.ELIGIBILITY REQUIREMENTS. (a) Eligible Employees. All regular (part time and full time) employees of CITY, whether sworn or nonsworn, are considered -to be eligible for benefits under this agreement. Eligible employees are sometimes referred to as "Subscribers" and sometimes referred to as "Members" in the "Combined Evidence of Coverage." (b) Eligible Family Members. Family members ofeligible employees, who meet the following criteria, and who work or reside 960620 lae 0031342 in California, are considered to be eligible for benefits under this agreement. Eligible Family Members are: (i) The legal spouse of an Eligible Employee. (2) An individual who is an immediate family member of an Eligible Employee. (c) Loss of Eligibility. If a formerly Eligible Employee ceases to be eligible under the terms of this agreement, coverage under this agreement shall terminate for the individual and of his or her enrolled Family Members on midnight of the last day of the~month in which the loss of eligibility occurs. Coverage for an individual Family Member who ceases to be eligible according to the terms of this agreement, shall terminate on the last day of the month in which the loss of eligibility occurs. (d) Continuation of Coverage under COBRA. CITY agrees that it will be responsible for notification and other compliance requirements under the United States Consolidated Omnibus Budget Reconciliation Act ("COBRA"), Public Law, 99-272, with respect to continuing coverage for covered individuals who become ineligible for benefits under this agreement. CITY shall notify OHS of the occurrence and related date of any COBRA-qualifying event within 60 days of receiving notification of the incidence thereof. 5. COMPENSATION. For the full performance of the services by OHS under this agreement, CITY shall pay OHS the fees outlined below. The fees shall be calculated on a capitated basis based on the number of eligible employees enrolled as of the first day of each month during the term of this agreement, as follows: 1997: (a) For the period of July i, 1996 through June 30, $2.27 per employee per month. 1998: (b) For the period of July I, 1997 through June 30, $2.38 per employee per month. 1999: (c) For the period of July I, 1998 through June 30, $2.50 per employee per month. OHS shall invoice CITY for payment monthly, based upon the information provided to OHS by CITY as to the number of eligible employees of CITY. CITY shall pay the foregoing fees monthly on or before the first day of each month. If the invoice incorrectly states the actual number of eligible employees, CITY shall make payment based upon the correct number. Payment shall be made as follows: 960620 lae 0031342 6 Occupational Health Services Attn: Lockbox, Dept. 098-61, Box 45110 San Francisco, CA 94145-0110 CITY shall furnish accurate, current and timely eligibility information (including Medicare eligibility related information) to OHS. OHS shall not be required to refund any fee paid by CITY for an ineligible person if: (a) the request for such refund is made later than thirty (30) days after the receipt of payment by OHS for said ineligible person, or (b) covered services were received by the ineligible person during such period. OHS reserves the right to verify eligibility date maintained by CITY and to review all records maintained by CITY as they relate to establishment and maintenance of eligibility for coverage under this agreement, to the extend permitted by law and this agreement. Payments owing and unpaid for more than thirty (30) days shall be subject to an interest charge of one percent per month for all unpaid amounts. The parties acknowledge and agree that due to changes in eligibility, significant additions or deletions in the number of eligible employees could change the nature of the risk from which the above rates have been computed. Therefore, all eligibility provision changes proposed to be changed by CITY shall be subject to OSH’s prior written consent, which may be withheld for any reason at the sole discretion of OHS. 6. TERM. This agreement shall be effective retroactively to, and including, February 17, 1996, and continue in full force and effect until June 30, 1999, subject to the City Council’s continued appropriation of funds for such services for each fiscal year during the term of this agreement° 7. FORCE MAJEURE. In the event of any major disaster or epidemic, or if due to circumstances beyond the reasonable control of OHS, such as complete or partial destruction of facilities, war riot, civil insurrection, or similar causes, OHS shall make a good faith effort to provide or arrange for provision of services, but shall have no liability or obligation for delay or failure to provide any such services in such event. 8.SUSPENSION; TERMINATION. (a) Right to Suspend or Terminate. Either the City Manager or OHS may suspend or terminate this agreement without cause by giving thirty (30) days’ written notice thereof to the other party. 960620 lac 0031342 (b) Notice to Employees. In the event the agreement is terminated by either party, CITY shall provide mailed notice to each Eligible Employee of such termination. (c) Payment. Upon such suspension or termination, OHS shall be paid for all services actually rendered to CITY to the date of such suspension or termination, or until all employees have been transitioned to appropriate alternative care. (d) Other Riqhts. The rights granted to the parties under this agreement are in addition to any rights available to the parties under law. 9. ASSIGNMENT; SUBCONTRACTORS; EMPLOYEES. (a) Assignment. Both parties shall give their personal attention to the faithful performance of this agreement and shall not assign, transfer, convey, or otherwise dispose of .this agreement or any right, title, or interest in or to the same or any part thereof without the prior written consent of the other party, and then only subject to such terms and conditions as the other party may require, provided that OHS shall have the right to sell, transfer, convey or assign this agreement to any successor, subsidiary, parent or affiliate of OHS and such assignee shall acquire all of the rights, duties and obligations of OHS set forth herein. A consent to one assignment shall not be deemed to be a consent to any subsequent assignment. Any assignment without such approval shall be void and, at the option of the other party, shall terminate this agreement and any license or privilege granted herein. This agreement and any interest herein shall not be assignable by operation of law without the prior written consent of the other party. (b) Subcontractors; Employees. OHS shall be responsible for employing or engaging all persons necessary to perform the services of OHS hereunder. OHS shall give its personal attention to the fulfillment of the provisions of this agreement by all of its employees and subcontractors, if any, and shall keep the work under its control. (c) Quality of Covered Services. OHS shall require its subcontractors who are providers of covered services provided under this agreement to meet professionally recognized standards of practice. OHS’s professional review and credentialing committees shall monitor the quality of covered services rendered, and require that its subcontractors cooperate and comply with OHS’s internal quality of care review system and the decisions of OHS’s medical directors, and to abide by OHS’s policies and procedures for credentialing, prior authorization, utilization review, utilization management and quality management, which includes provisions for 960620 la¢ 0031342 8 records audit, peer review, provider appeals, and a grievance process for employees and family members who use covered services. The minutes of the quality management committee shall be available for review by applicable state and federal regulatory agencies as required by law or contract, and 0HS shall require its subcontractors to comply with all final determinations of 0HS’s peer review, provider appeal and grievance processes. i0. NOTICES. All notices hereunder shall be given in writing and mailed, postage prepaid, by certified mail, addressed as follows: To CITY:Office of the City Clerk 250 Hamilton Avenue Palo Alto, CA 94301 With copy to:Manager of Benefits 250 Hamilton Avenue Palo Alto, CA 95301 (Telephone:. 415-329-2235) (FAX: 415-327-3809) To OHS:Attention of the President at the address of OHS recited above. (Telephone: 415-491-7200) (FAX: 415-472-8184) ii. INTEREST OF 0HS. OHS covenants that it presently has no interest, and~shall not acquire any interest, direct or indirect, financial or otherwise, which would conflict in any manner or degree with the performance of the services hereunder. 0HS further covenants that, in the performance of this agreement, no subcontractor or person having such an interest shall be employed. OHS certifies that no one who has or will have any financial interest under this agreement is an officer or employee of CITY. It is expressly agreed that, in the performance of the services hereunder, OHS shall at all times be deemed an independent 0HS and not an agent or employee of CITY. 12. INDEMNITY. OHS hereby agrees to indemnify and save harmless CITY, its officers, agents, and employees, of and from: (a) Any and all claims and demands which may be made against CITY, its officers, agents, or employees, by reason of any injury to or death of any person or damage suffered or sustained by any person caused by, or alleged to have been caused by, any wilful or negligent act or omission of OHS; and (b) Any and all penalties imposed or damages sought on account of the violation of any law or regulation or of any term or 960620 lac 0031342 condition of any permit required for the performance of this agreement° OHS shall provide to CITY, upon reasonable request therefor, copies of certificates of insurance covering its subcontractors, which have been submitted to OHS pursuant to contract between OHS and said subcontractors. 13. WORKERS’ COMPENSATION. OHS certifies that it is aware of the provisions of the Labor Code of the State of California which require every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that code, and it certifies that it will comply with such provisions before commencing the performance of the work of this agreement. 14. INSURANCE. OHS, at its sole cost and expense, shall obtain and maintain in full force and effect throughout the entire term of this agreement the following described insurance coverage, insuring as additional insured not only OHS but also, with the exception of workers’ compensation, and employer’s liability insurance, CITY, its officers, agents, and employees, and each of them: POLICY MINIMUM LIMITS OF LIABILITY (a)WORKERS’Statutory COMPENSATION (b)COMPREHENSIVE AUTOMOBILE LIABILITY, in- including owned, hired, and non- owned automobiles Bodily Injury Property Damage $500,000 each person $500,000 each occurrence $500,000 each occurrence (c)COMPREHENSIVE GENERAL LIABILITY, including pro- tective, com- pleted opera- tions, broad form contractual, & personal injury Bodily Injury $500,000 each person $500,000 each occurrence $500,000 aggregate Property Damage - $i00,000 each occurrence $i00,000 aggregate Personal Injury - $500,000 each occurrence $500,000 aggregate (d)PROFESSIONAL LIABILITY, in- cluding errors, omissions, and negligent per- formance All Damages $i,000,000 minimum 960620 lac 0031342 10 Certificates of such insurance shall be filed with CITY concurrently with the execution of this agreement or, with CITY’s approval, within ten (i0) days thereafter. Said certificates shall be subject to the approval of CITY’s Risk Manager and shall contain an endorsement stating that said insurance is primary coverage and will not be canceled or altered by the insurer except after filing with the City Clerk thirty (30) days’ written notice of such cancellation or alteration, and that the City of Palo Alto is named as an additional insured. Current certificates of such insurance shall be kept on file at all times during the term of this agreement with the City Clerk. 15. AGREEMENT BINDING. The terms, covenants, and conditions of this agreement shall apply to, and shall bind, the heirs, successors, executors, administrators, assigns, and subcontractors of both parties. By this agreement, CITY makes OHS coverage available to eligible employees and family members. This agreement may be amended by CITY and OHS in accordance with the terms hereof, without the consent of any employee or family member. CITY accepts this agreement by making payments to OHS, and such acceptance renders all terms and provisions hereof binding on CITY and eligible employees and family members. By electing coverage or accepting benefits hereunder, all eligible employees and family members agree to all terms, conditions and provisions hereof. 16. WAIVERS. The waiver by either party of any breach or violation of any term, covenant, or condition of this agreement or of any provision, ordinance, or law shall not be deemed to be a waiver of any other term, covenant, condition, ordinance, or law or of any subsequent breach or violation of the same or of any other term, covenant, condition, ordinance, or law. The subsequent acceptance by either party of any fee or other money which may become due hereunder shall not be deemed to be a waiver of any preceding breach or violation by the other party of any term, covenant, or condition of this agreement or of any applicable law or ordinance. 17. MANDATORY ARBITRATION. Any dispute that may arise concerning coverage under this agreement shall be resolved by binding arbitration in accordance with the California Arbitration Act, California Code of Civil Procedure, sections 1280 et seq. This applies to any controversy involving coverage of Employees, Family Members, or subscribers under continuing coverage, or their representatives, but does not.include any dispute between CITY and OHS, except as specifically agreed to by both parties on a case-by- case basis. 960620 lao 0031342 11 18. COSTS AND ATTORNEYS FEES. The prevailing party in any action brought to enforce the terms of this agreement or arising out of this agreement may recover its reasonable costs and attorneys’ fees expended in connection with such an action from the other party. 19. NONDISCRIMINATION. No discrimination shall be made in the employment ~of persons under this agreement because of the race, color, national origin, ancestry, religion or sex of such person. If the value of this agreement is, or may be, Five Thousand Dollars ($5,000) or more, OHS agrees to meet all requirements of the Palo Alto Municipal Code pertaining to nondiscrimination in employment and to complete and submit the "Compliance Report: Non- discrimination Provisions of City of Palo Alto Contracts" on the form furnished by CITY. If OHS is found in violation of the nondiscrimination provisions of the State of California Fair Employment Practices Act or similar provisions of federal law or executive order in the performance of this agreement, it shall thereby be found in material breach of this agreement° Thereupon, CITY shall have the power to cancel or suspend this agreement, in whole or in part, or to deduct from the amount payable to OHS the sum of Twenty-five Dollars ($25) for each person for each calendar day during which such person was discriminated against, as damages for said breach of contract, or both. Only a finding of the State of California Fair Employment Practices Commission or the equivalent federal agency or officer shall constitute evidence of a violation of contract under this paragraph. If OHS is found in violation of the nondiscrimination provisions of this agreement or the applicable affirmative action guidelines pertaining to this agreement, OHS shall be found in material breach of’this agreement. Thereupon, CITY shall have the power to cancel or suspend this agreement, in whole or in part, or to deduct from the amount payable to 0HS the sum of Two Hundred Fifty Dollars ($250) for each calendar day during which OHS is found to have been in such noncompliance as damages for said breach of contract, or both. 20. ADMINISTRATION OF PLAN. OHS may adopt reasonable policies, procedures, rules and interpretations not inconsistent with this agreement to promote orderly and efficient administration of the coverage provided under this agreement° 21. CITY OBLIGATION TO NOTIFY OHS. Upon knowledge thereof, CITY’s Project Manager shall immediately notify 0HS as to any event which gives rise to OHS’s right to terminate this agreement or individual employee or family member’s coverage, including event 9606~20 lac 0031342 12 which would result in an employee or family member’s loss of eligibility. 22. AGREEMENT CONTAINS ALL UNDERSTANDINGS; AMENDMENT. This document represents the entire and integrated agreement between CITY and OHS and supersedes all prior negotiations, representations, or agreements either written or oral. This document may be--amended only by written instrument, signed by both CITY and OHS. All provisions of this agreement are expressly made conditions. Modifications of any provision of this agreement to conform to any applicable law or regulation shall not invalidate or alter any non-objectionable provisions and shall not give rise to any termination rights other than as provided herein. This agreement shall be governed by the laws of the State of California. IN WITNESS WHEREOF, CITY and OHS have executed this agreement the day and year first above written. ATTEST:CITY OF PALO ALTO City Clerk Mayor~ APPROVED AS TO FORM: Senior Assistant City Attorney APPROVED: FOUNDATION HEALTH PSYCHCARE SERVICES, INC. dba OCCUPATIONAL HEALTH SERVICES By : Its: City Manager Director of Human Resources Deputy City Manager, Administrative Services Risk Manager 960620 lac 0031342 13 CERTIFICATE OF ACKNOWLEDGMENT (Civil Code ~ 1189) STATE OF ) COUNTY OF ) On , 1996, before me,, a Notary Public in and for said County and State, personally appeared , personally known to me or proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on t~e instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature of Notary Public 960620 lac 0031342 14