City of Bridgeport Connecticut Request For Proposals CDB238107 First Time Homebuyer Assistance Program August 19, 2009 I INTRODUCTION 2 II CRITICAL DATES 2 III BACKGROUND AND GENERAL DESCRIPTION OF PROGRAM 3 A) Objectives of the First Time Homebuyer program 3 B) Down payment Assistance Program Structure 3 C) Scope of work for the First Time Homebuyer and Down payment Assistance Program 3 IV SUBMISSION REQUIREMENTS 6 A) Interface with Stakeholders and Partners in HBE / DPA Program. 6 B) Approach to Client Intake Process 6 C) Curriculum, Design a Method of Delivery of Homebuyer Education Training 6 D) Method of Delivery of Case Management Counseling Services 7 E) Loan Ratio / Underwriting, Standards: 7 F) Home Inspections 7 G) Production Goals and Performance Measurements 7 H) Capacity to Administer the HBE / DPA Program 8 I) Staffing Plan 8 J) Budget Proposal 8 K) Match for City of Bridgeport Administrative Fee Investment 9 L) Training Venues 9 M) Financial Management Plan 9 V FORMS AND CERTIFICATIONS 10 A) Supplementary Information and Certifications Required July 8th 2009 10 B) Supplementary Information and Certifications Required at Interview 10 C) Nondiscrimination, Equal Opportunity, Affirmative Marketing, Minority Outreach 10 D) Conflict of Interest 11 VI SELECTION PROCESS 11 A) Scoring Criteria 11 B) Interviews & Negotiations 14 C) Provisions 14 VII ATTACHMENTS 16 A) HBE/DPA Program General Applicant Information Form 16 1
I. INTRODUCTION The City of Bridgeport request proposals from HUD approved housing counseling agencies to administer a First Time Homebuyer Assistance Program for the City of Bridgeport. It is strongly recommended that all applicants attend a Pre-bid conference on Wednesday July 22, 2009 at 10:00 am at 999 Broad Street, Bridgeport, CT 06604, 2nd Floor, Conference Room B, but attendance is not required to submit a proposal nor will failure to attend be used against the prospective bidder. The deadline for submissions for this RFP is Wednesday August 19, 2009 at 3:00 pm. Please submit eight (8) separate, sealed proposals with cover letter that specifies this RFP and the bidder to: BID NO., Department of Public Purchases, City of Bridgeport, 45 Lyon Terrace, Room 324, Bridgeport, CT 06604. Please direct questions to: Sean Archer Home Program Specialist Department of Central Grants & Community Development 999 Broad Street Bridgeport, CT 06604 T: (203) 576-8323 F: 203-332-5568 Email: sean.archer@ci.bridgeport.ct.us II. CRITICAL DATES (Note: Subject to adjustment) Release RFP July 5, 2009 Pre-bid Information Meeting July 22, 2009 Proposal Submission Deadline August 19, 2009 Interviews September 2, 2009 Selection September 9, 2009 Contract Negotiation & Processing September 16, 2009 Start of Work September 28, 2009 2
III. BACKGROUND AND GENERAL DESCRIPTION OF PROGRAM A). Objectives of the First Time Homebuyer program The City of Bridgeport has allocated $550,000.00 in HOME funds for a First Time Homebuyer Assistance Program that links homebuyer education and housing counseling with down payment, closing cost assistance and access to fixed rate mortgage loan products. The City seeks to create a seamless process for First Time Homebuyers in which they can receive HUD approved & certified HBE training and Down Payment Assistance. The principles on which this program will be based are outlined below: q Assist low and moderate income First Time Homebuyers navigate through the process of purchasing a home. q Establish a Citywide First Time Homebuyer Education and counseling service that produce certified homebuyers who qualify for fixed mortgage loans. q Create a Citywide Down payment Assistance Program that will be administered by HUD approved counseling agencies. q Provide uniform standards, program management and performance to effectively coordinate the First Time Homebuyer Education and Down payment Assistance program for the City of Bridgeport. q Customize the delivery of the First Time Homebuyer Education and Down payment Assistance to suit the needs of the prospective homebuyers while adhering to the rules and regulations of the HOME program. B). Down payment Assistance Program Structure The City of Bridgeport wishes to establish a DPA program that will consists primarily of HOME funds which will be used for Down Payment and closing cost assistance for First Time Homebuyers. The program structure will be designed by prospective counseling agencies and will be required to present this aspect of the program to a selection committee. Prospective contractors are encouraged to include the elements described in the RFP advertisement into their design. C). Scope of work for the First Time Homebuyer and Down payment Assistance Program PREFACE The City of Bridgeport seeks to create a seamless process for First Time Homebuyers where they can receive HUD approved & certified HBE training and Down Payment Assistance. The City of Bridgeport will make available $500,000.00 to support the new HBE / DPA program of this amount the City will allow 10% or $50,000.00 for administrative costs. Depending on the success and performance by the Sub-Recipient of HBE/DPA program, the Department of Central Grants & Community Development will submit a request to the 3
City Council for an additional allocation of HOME funds for PY 36 to support the continued progress for this program. The Department of Central Grants & Community Development will select contractors who will administer the HBE/DPA program to serve the City of Bridgeport. The Department of Central Grants & Community Development strongly recommends that the selected HBE/DPA Provider organize no less than ten (10) Homebuyer Education Workshops per year. Applicants are encouraged to raise additional funds to match the initial estimated administrative cost of $50,000.00. SCOPE OF WORK 1. Track, record, manage clientele intake and spearhead the marketing of the HBE and DPA programs in neighborhoods targeted by the Department of Central Grants and Community Development for revitalization as well as citywide. 2. Document Income and clientele eligibility for the City of Bridgeport HOME program using the Technical Guide to Determining Income and Allowances for the HOME Program, HUD 1780-CPD, January 2005, with annual income defined as adjusted gross income according to IRS 1040 series. 3. Coordinate the HBE curriculum, training design and provide HUD approved / certified trainers for the HBE training workshops. The curriculum design should contain the following: 4. Develop a budget for HOME funding with a fixed cost per family assisted for homebuyer education and housing counseling (including administration and overhead). The HOME Program will only provide compensation for homebuyer education and counseling for families that purchase a home and receive HOME down payment and closing cost assistance. i. How the City of Bridgeport HBE and DPA program works ii. iii. Role and responsibility of the Homebuyer, Realtor, Seller and the City of Bridgeport. Financial Feasibility v How much can the prospective client afford v How to manage expectations v How the mortgage financing process works and key indicators for lending agencies v How to identify credit issues and address them effectively v Family budgeting and how to meet financial goals v How to protect your investment and avoid predatory loans. v How to carry out preventive maintenance v Citizenship and accountability to your neighborhood 5. Coordinate, schedule venue and logistics for HBE training workshops. Training workshops should be arranged for a minimum of ten (10) times per year in neighborhood-based locations that is within close proximity to public transportation in the City of Bridgeport. The Department of Central Grants and Community Development requires all perspective agencies to have a physical location here in the City of Bridgeport. In addition, the City will negotiate with selected HBE/DPA agencies 4
to determine the amount of time and number of sessions per certified course will be necessary to achieve the City s goal and expectations. 6. Provide pre and post-purchase HBE counseling and case management services. The Department of Central Grants and Community Development intends to offer a sustained an coordinated HBE / DPA program that will provide continued monitoring over the course of three (3) years to ensure that mortgages remain in compliance. (Please note that this item is not HOME eligible and must not be calculated in the cost budget but would be preferred if included). 7. Process Applications for Down Payment Loans i. Help Clients gain an understanding and acceptance of the terms of the HBE/DPA financing process ii. Conduct income certifications according HOME program rule iii. Assemble and process loan application materials iv. Prepare DPA loan proposal and HOME program compliance forms for review and approval by The Department of Central Grants and Community Development staff. v. Draft a lists of HBE Affordability, use and terms of the City HOME program and any other subsidy and private debt source 8. Manage Loan Closings ii. Review Loan Documents with Client and make sure Client understands all services promised and loan and subsidy terms and conditions. 5
IV. SUBMISSION REQUIREMENTS BUSINESS PLAN / PROPOSAL The Department of Central Grants and Community Development are open to different ideas and suggestions to improve and achieve its objectives for the HBE/DPA program. It is imperative to note that all submitted proposal should illustrate how the HBE /DPA program will be managed and monitored over a period of three (3) years. In addition, prospective agencies should demonstrate the procedures for implementing the HBE program. The Department of Central Grants and Community Development may require the selected HBE agencies to revise there proposed plans as the program evolves to meet the needs of the citizens of the City of Bridgeport. The proposals selected will be used as the primary basis for annual monitoring of the HBE/DPA Sub-Recipient. All proposals should include the following: A). Interface with Stakeholders and Partners in HBE / DPA Program. 1. Discuss contractor approach working with: i. Homebuyer Clients who earn low- and moderate-incomes ii. The Department of Central Grants & Community Development iii. Lenders including CHFA and Fannie Mae iv. Supplemental Subsidy Sources v. Realtors 2. Customer Service i. Describe how applicants will provide appropriate customer service to prospective first time Homebuyers and how to low and moderate-income families will be identified. B). Approach to Client Intake Process 1. Describe how applicant will interface with prospective homebuyers in the neighborhoods of Bridgeport; 2. Describe how contractor will address the application process. 3. Describe how contractor will conduct program threshold criteria verifications for income eligibility and credit. 4. Describe how credit reports will be obtained, reviewed and translated to HBE/DPA prospective clients. C). Curriculum, Design a Method of Delivery of Homebuyer Education Training 1. Provide detailed description of how Applicant will design and administer the HBE/DPA program. Provide sample curriculum and training materials. 6
D). Method of Delivery of Case Management Counseling Services 1. Describe how case management counseling services will be structured. E). Loan Ratio / Underwriting, Standards: 1. All prospective contractors must outline the loan to value ratio s that will be used for this program and the complete underwriting process. In addition contractors must clearly identify the lending agencies that will be utilized to provide loan assistance and years of experience they have issuing these types of loans. 2. Provide documentation on the types of down-payment products that will be offered to perspective clients and how these loan products will be linked to the HBE program. Please note that the Department of Central Grants and Community Development will entertain only fixed mortgage rate products. 3. Provide a flow chart that shows the different processes. F). Home Inspections 1. Contractors should inform prospective homebuyer to be sure to conduct proper housing inspections that the homebuyer and its counsel deem necessary in order that the homebuyer becomes fully informed of the condition of the property and the costs to repair or replace items that have outlived their useful lives or are damaged or missing so that a fair price is ultimately paid for the property and limit repair requirements after sale is complete. G).Production Goals and Performance Measurements How will Applicant measure its success in managing the Homeownership Production Program? 1. Provide a three year Production Projection in terms of managing: i. Client intake for Homebuyer Education and Down Payment Assistance loans ii. Homebuyer Education Training iii. Case Management Counseling iv. DPA Loans Closed 2. Please consider using the following: i. Number of Intake applications & threshold reviews completed per month and year ii. Timeliness of processing of Client Intake Applications iii. Number and Enrollment of Participants in Homebuyer Education Training Courses iv. Timeliness of Delivery of Homebuyer Education Training courses v. Number of Clients served with Case Management Counseling vi. Leverage of Central Grants and Community Development Subsidy H). Capacity to Administer the HBE / DPA Program 3. Provide detail experience and skills in managing client intake, Homebuyer education training and counseling services in Bridgeport 7
i. Describe area(s) of expertise that qualifies Applicant to offer the service proposed; ii. Describe experience in providing this type of service, list past projects, clients and results; iii. If you are applying as a partnership of organizations provide detail in terms of who will do what and what are the benefits of this proposed partnership. 4. Provide proof of experience and skills in educating First Time Homebuyers in purchasing homes. I). Staffing Plan 1. Applicants should assume that if awarded a contract by The Department of Central Grants and Community Development, they would serve the entire City of Bridgeport. 2. Provide an organizational chart for providing Homebuyer Education and Counseling services for the HBE/DPA Program; 3. Describe the responsibilities of staff for various functions associated with the program; 4. Provide ranges of salaries and compensation incentives for all positions listed on the organization chart; 5. Provide resumes of HBE/DPA Program staff and list certifications and credentials; 6. Indicate previous experience your staff has with similar programs or functional areas (provide dates and program names). Each recipient must demonstrate the capacity to undertake the proposed program; 7. Indicate if consultants or outside contractors are performing any of the administrative functions associated with the HBE/DPA Program, please: i. Explain how they will be (or were) selected; ii. Specify their responsibilities with respect to the proposed program; iii. Indicate how much they will be paid to carry out these activities; 8. Outline the controls HBE/DPA provider will maintain over consultants and service contractors. J). Budget Proposal The Department of Central Grants and Community Development will provide $50,000.00 in administration funds. 1. Provide a complete Program Management Budget. 2. State the amount of funds requested from the Department of Central Grants and Community Development for Program administration and preferred method of payment; 3. Provide a narrative that details the assumptions of the Program Management Budget in terms of revenue sources and expenditures for services. K). Match for City of Bridgeport Administrative Fee Investment 1. Provide a plan that shows how applicants will raise Supplemental Funds to match the City of Bridgeport funds by PY36. 8
2. Indicate sources and form of Administrative Fee Match. L). Training Venues 1. List proposal for how Applicant will make training venues accessible to: i. Prospective clients who have mobility issues and challenges ii. Do not have a car and need access to public transportation iii. Prefer to attend training close to home in their neighborhoods iv. Provide names and addresses of potential training locations M).Financial Management Plan 1. Identify staff responsible for financial management, account tracking, annual reporting and related data collection; 2. Describe the recipient's fiscal management system, including: i. Financial reporting ii. Record keeping and accounting systems iii. Audit procedures; iv. Provide financial audits and information supporting financial soundness of agency 9
V. FORMS AND CERTIFICATIONS A). Supplementary Information and Certifications Required July 8 th 2009 1. HBE/DPA Program Contractor Information Form (see Attachment A ); 2. Financial Audits or Statements for last two years prepared by a reputable third party CPA that shows contractor viability. i. Financial Audits prepared by CPA ii. Compilation of Financial Statements prepared by CPA iii. Financial Statements with no CPA review 3. List of Board of Directors including names, addresses, profession and place of employment of each Board Member; 4. Certificate of Liability, Director s & Officers and Fidelity Bond Insurance as required by the City of Bridgeport; 5. Articles of Incorporation and Bylaws. Provide a statement that details how the Applicant complies with Bylaws in terms of Board Governance; 6. Evidence of Non-profit Status with IRS and State of Connecticut, if applicable B). Supplementary Information and Certifications Required at Interview 1. For Candidates selected as finalists to interview, must prior to interview submit one or more of the following certifications: i. Federal Debarment and Suspension Certificate ii. Federal Lobbying Certificate iii. Federal Drug Free Workplace Certificate iv. Applicable certifications, accreditations and licenses v. Federal Nondiscrimination and Equal Opportunity Requirements Certificate vi. Federal Fair Labor Standards Act Assurances C). Nondiscrimination, Equal Opportunity, Affirmative Marketing, Minority Outreach 1. Recipients are required to demonstrate that they will administer HBE/DPA Program in accordance with all State of Connecticut requirements concerning Equal Opportunity and Fair Housing, including provisions regarding age discrimination and equal employment opportunity, pursuant to 24 CFR 92.350, and described in 24 CFR 5.105(a). Recipients must also follow a minority/women-owned business (M/WBE) utilization plan that describes their policies and procedures for subcontracting and/or procurement of goods and services, and requires identification of any M/WBEs that will be solicited in connection with the program. Use of HOME funds is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968. The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD-assisted projects covered by Section 3, shall, to the greatest extent feasible, be directed to low- and very low-income persons, particularly persons who are recipients of HUD assistance for housing. Recipient must document and report on efforts 10
to provide employment and economic opportunities. All recipients are required to collect data that describes the effects of their program on equal opportunity, fair housing, and M/WBE participation in the local community. The Department of Central Grants and Community Development will assist recipients, as needed, to promote fair housing, equal opportunity, and M/WBE participation. D). Conflict of Interest Recipients must abide by procedures to avoid conflicts of interest and minimize the appearance of conflict in administering the HBE/DPA Program funds. The HBE/DPA Program is subject to regulations (24 CFR 92.356) intended to ensure a fair process for award of funds in the selection of owners, tenants, contractors, and other participants who may obtain a financial interest or benefit from program activities. Describe the procedures that will be followed to ensure that officers, employees, agents, Board Members or consultants of the Applicant, and their immediate family members, who have access to inside information with regard to the award of HOME HBE/DPA Program funds or influence on the policy or process by which funds are awarded, will be excluded from financial interest or benefit. The process must include the factors that will be considered in requesting exceptions from The Department of Central Grants and Community Development for the HBE/DPA Program and must provide for full public disclosure (including publication in a newspaper of general local circulation) in situations where an exception will be requested. VI. SELECTION PROCESS A). Scoring Criteria The Department of Central Grants & Community Development will select contractors to serve as Homebuyer Education and Down Payment Assistance Providers for the HBE/DPA Program based on the quality of proposals. A selection committee will select candidates based on the total score on the following criteria: 1 Program Operation: Ability to track, record, manage client intake, verify income and eligibility for the City s HOME program using the Technical Guide to Determining Income and Allowances for the HOME Program, HUD 1780-CPD, January 2005, with annual income defined as adjusted gross income according to IRS 1040 series; 10 2 Capability: Ability to provide Homebuyer Education and Counseling; 10 3 4 Expertise / Expertise: Demonstrate proof of experience working with the HOME program. The ability to determine minimum amount of HOME loan necessary to allow a family to purchase a home and to be able to provide suggestions for improving the proposed program; Business Plan Proposal: Design and approach to HBE/DPA program management, counseling and performance measurements. 15 15 11
5 6 7 Budget: Provide a budget for HOME funding with a fixed cost per family assisted and for homebuyer education and housing counseling for those that buy a home and receive HOME down payment and closing cost assistance and to provide monitoring of their mortgage compliance for up to 3 years. Additionally provide financial audit information and supporting documentation. MBE Goals: Firms that demonstrate that they are Minority Business Enterprises as defined in the City s Minority Business Enterprise Ordinance, Chapter 3.12.130, (i.e.) The Target Groups for city contracts for professional services include Asian Americans, Hispanic Americans, Caucasian females, MBEs, and minority female and Caucasian female minority business enterprises. Loan Ratio/Underwriting Standards; Products; Lenders: All applicants must outline the loan to value ratio and other criteria that will be used when reviewing loan applications. Must provide documentation on the types of down-payment product that will be offered and how they will be linked within the program and all prospective contractors must clearly identify all lenders that will be utilized to provide loan assistance. 10 10 20 8 Location: All prospective contractors must have a physical location where they provide counseling in the City of Bridgeport. 5 9 Home Inspections: Inform prospective homebuyer of housing inspection requirements. 5 Total Maximum Points: 100 12
Note: 1. EVALUATION CREDITS FOR PRIME CONTRACTORS THAT ARE TARGET GROUP MEMBERS : (10 points); Non-MBE Firms Forming Joint Ventures/Partnerships with Target Groups (maximum 5 points): Firms that demonstrate that they are Minority Business Enterprises that constitute Target Groups, as defined in the City s Minority Business Enterprise Ordinance, Chapter 3.12.130, shall be granted an additional ten points (10) as Evaluation Credits. The Target Groups for city contracts for professional services include Asian Americans, Hispanic Americans, Caucasian females, MBEs, and minority female and Caucasian female minority business enterprises. For further information about the MBE Ordinance, Target Groups or the assignment of Evaluation Credits, please call Deborah Caviness at 203-576-8473. i. Evaluation Credits. Evaluation Credits will be assigned to (a) firms who are Target Group firms defined in the MBE Ordinance or to (b) non-mbe firms who have entered into a joint venture or partnership with a Target Group for this RFQ/RFP. ii. iii. The points for Evaluation Credits that will be assigned shall be (a) ten (10) points to prime contractors that are Target Group firms or (b) up to five (5) points to non-mbe firms that have formed joint ventures or partnerships with Target Group firms determined by a formula that takes the percentage of the Target Group firm s ownership interest in such joint venture or partnership converted to a percentage (e.g.,.25 or 25% ownership interest x 10 = 2.5 points) to arrive at the number of points not to exceed 5. A Target Group firm seeking Evaluation Credits must provide a certification of its minority business status and state in its qualifications statement its desire to be recognized as a minority business enterprise and to receive Evaluation Credits. A non-mbe firm seeking Evaluation Credits must (A) state the basis for seeking Evaluation Credits, (B) identify the joint venture or partnership created with a Target Group firm, (C) identify the minority firm as one of the Target Groups for the type of services or work sought by the bid, (D) identify the Target Group s percentage ownership interest in the joint venture or partnership, (E) state whether such joint venture or partnership (i) was created only for this particular bid, (ii) is now and/or will in the future be utilized for bidding, (iii) is currently utilized for bidding on both public and private work, (iv) has bid on, undertaken or completed work in the past, together with a description of such work and customer contact information, and (F) describe the Target Group s active involvement in and dollar volume of the work that the Target Group will perform as part of the services that are the subject of the bid to ensure that the dollar volume of the work is reasonable equivalent to the Target Group s percentage ownership interest in the joint venture/partnership. Items (A) through (F) must be supported by documentation satisfactory to the City so that the City can independently verify the basis for the claim to Evaluation Credits, determine any entitlement to the award of Evaluation Credits, and determine the amount of Evaluation Credits to be awarded. 2. The RFP submissions will be reviewed and scored by a Selection Committee. The Selection Committee will determine the applicants that will be awarded HOME Program sub-recipient contracts. The Selection Committee members are: Deputy CAO of Central Grants and Community Development Sr. HCD Manager HOME Program Specialist Program Manager, Bridgeport Lead Free Families 13
B). Interviews & Negotiations The Department of Central Grants and Community Development will select finalist candidates for interviews. The interviews will provide an opportunity for the City to ask questions and get clarification on applicant proposals. The City may require candidates to provide additional detail or restructured plans based on information gathered during the interview process. The City may require the applicants selected to participate in negotiations, and to submit pricing, technical information, or other revisions of their applications depending on results from negotiations. The City shall hold all applications submitted in confidence pending completion of awards and negotiations. Following award, contracts and applications shall be available to the public. C). Provisions The City of Bridgeport adheres to HUD procurement standards found in 24 CFR Part 84 Sections 84.40 through 84.48 for nonprofit sub recipients for the RFP process and requires the Program Manager to adhere to this procurement regulation for its developers and contractors as well. The City of Bridgeport seeks a professional Program Manager for the First Time Homebuyer Education Training and Down Payment Assistance program that will provide services with performance benchmarks as identified by the Department of Central Grants and Community Development. This contract may be extended for up to two (2) additional years as determined by the Department of Central Grants and Community Development and availability of funds. Acceptance of a proposal by the Department of Central Grant and Community Development does not guarantee that a contract will be awarded. The Department of Central Grants and Community Development reserves the right to: i. The City of Bridgeport reserves the right to reject any and/or all responses, to waive any technicality, if deemed in the best interest of the City to do so. ii. Make no award of funds. iii. Negotiate adjustments in proposed funding levels and program activities. iv. Review past monitoring reports and references from other municipal and state agencies in evaluating applicant capacity to manage the HBE/DPA Program v. Use other approved methods to identify partners, consistent with the Department of Central Grants and Community Development policies. vi. Terminate contract or any extension, with or without cause, and without penalty, recourse or damages upon thirty days written notice. Upon said termination, the City and the Department of Central Grants and Community Development will only be responsible and pay for actual cost approved by the Department of Central Grants and Community vii. Development and expended by contractor. Neither City nor the Department of Central Grants and Community Development will be responsible for loss profits or damages sustained by contractor. All bid and proposed compensation terms submitted by Applicant shall be binding for no less than six (6) months before execution of HBE/DPA Provider contract. 14
Thank you for your interest in helping the City of Bridgeport to enhance the educational Level of First Time Homebuyers and the implementation of the Down payment Assistance program 15
VII. ATTACHMENTS A). HBE/DPA Program General Applicant Information Form First Time Homebuyer Education Training and Down Payment Assistance Program For the City of Bridgeport Legal name of the entity (or individual) submitting Income Tax Employer ID # (or Social application: Security #) Legal Status of entity (individual, incorporated?) Has this entity ever claimed bankruptcy? Last Audit (date) If so, when? Address: Name of contact person for this application: Contact telephone number: Contact fax number: Contact e-mail address: Women-Owned business? Minority-Owned Business? Credentials/certifications/accreditations/licenses: References: 1. 2. 3. To the best of my knowledge and belief, all of the information in this application is true and correct. The governing body of the applicant has authorized the document and the applicant will comply with the attached assurances if funding is awarded. Typed name of President, Chief Executive Officer or Individual Applicant: President or Chief Executive Officer or Authorized Signature: Date signed: 16