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9/3/2014 - STAFF REPORTS - 6
PALM SPRINGS PREMIER CARE 180 W. OASIS ROAD PALM SPRINGS, CA 92262 DR. JOSEPH MICHELSON DR. JAMES KAO June 16, 2014 •City of Palm Springs Office of the City Manager 3200 East Tahquitz Canyon Way Palm Springs, CA 92263-2743 Office: 760-323-8999 FAX: 760-323-8207 RE: APPLICATION FOR MEDICAL CANNABIS COOPERATIVE Dear Palm Springs City Planning Committee, We would like to submit our proposal for "PALM SPRINGS PREMIER CARE" cooperative. Palm Springs Patient Care (PS PC) would differentiate itself from other Dispensaries throughout the State by having the following: 1. Medical Advisory Consultants, experienced health care practitioners experienced in the field of medicinal cannabis. 2. Medical Advisory Panel of experienced Board-Certified, Fellowship trained physicians in various fields of medicine (Pain Management, Neurology, Internal Medicine, Family Medicine, and Gynecology) for chart review and education purposes. 3. High quality medicines: all of which have been lab-tested/results posted. All medicinal edible • products with MILLIGRAM (mg) dosing. 4. Staff trained in FIRST-AID/ Basic Life Support; documented staff training via oral/written proficiency examinations. 5. All Collective members provided with educational materials—reviewing proper, responsible and lawful usage. 6. Patient Education Center: including library/ reading center & educational videos. 7. Classroom for Conference/ Educational Seminars 8. Resource Center for referral for Specialists/ Community Support Thank you for the consideration of our application. Sincerely, Joseph Michelson, MD, FACS James o, DO, MD, MPH, PC 222 N Mountain Avenue, # 102A 4693 E. Ramon Road Upland, CA 91786 Palm Spring, CA 92264 • 626-340-6996 Direct 626-340-6996 Direct 951-331-5989 Office 760-622-7386 Office 909-982-0088 FAX 760-548-0226 FAX �`PALYN S,A I CITY OF PALM SPRINGS Office use Only • " Office of the City Manager.: .- :: •: Case No: i. ;_ •ae;.ri.:r :::•. Initials: APPLICATION FOR MEDICAL CANNABIS COOPERATIVE OR COLLECTIVE MCCC Please read carefully to ensure application is accurate and complete. Inaccurate or Incomplete applications may be rejected. TO THE APPLICANT: Your cooperation in completing this application and supplying the information requested will expedite City review of your application pursuant to local procedures. Applications submitted will not be considered complete until all submittal requirements are met. Please submit this completed application and ten (10)copes, including all attachments and related material to the Office of the City Clerk at 3200 East Tahqui Canyon Way. Palm Springs,CA 92262 Please complete the following In blue or black Ink. If additional space is needed, you may attach white single-sided 8 Ysx 11 paper using either MS Word or text-readable PDF format: 1) Address of the MCCC: AFO GV e, 074S/S A044P G9- �2� • "Please note that site location is prohibited within 00 feet of a school, public playground, park, residentially zoned property, child or day care',fai ity, youth center or religious institution. It is also prohibited within 1,000 feet of any other collective. The MCCC location is prohibited on properties in which the primary use of the property is commercial/retail. 2) MCCC site information: 423�D83 6h?S, Gross Square Footage of proposed business space: L"NA Assessor's Parcel # Zone: Section/7ownship/Range _/ / General Plan P g#mayO/� 2 Hours of Operation to , 7 If the MCCC is in a Multi-Tenant Building, please list other Businesses: /YlON — SR? Business Name Business Type 1. N 1A- 2. • 3. 987441.1 4. Al • 5. 6. 7. 3) The name and contact information of the applicant: *Please note that in the event the applicant is not the legal owner of the property, the application must be accompanied with a notarized acknowledglement from the owner of the property that a MCCC will be operated on his/her property. Name Address Email .D2 . 39SFpq M#?HF.LsoN lf( 3 F./ DN �a�rdRvaar®Y��ao r, `J,41yjE5�A r7 L -Crf z26 Residential # Business # Cell # Facsimile # (�2�0 6o qs/- 331-Szy89 G2�-34�0 909 -9�z-oo9 /,9 -76o-6zz--7�Er4 426- M-/R4 7(my -54�&-✓2?E If the Applicant is leasing the MCCC, please list the Property Owner's contact information: • *Please note that in the event the applicant is not the legal owner of the property, the application must be accompanied with a notarized acknoWledgement from the owner of the property that a MCCC will be operated on his/her property. 4) The name and contact Information of the Property Owner: Property Owner's Name Property Owner's Address Property Owner's Email me, CAgL plcA, I& Gy, 645ij R009D � xe ,4tn�sP,Qi/� sue— Z Residential # Business # Cell # Facsimile # 760 Silo 760 32.E/76? 5) The names and contact information of every person(s) who has a financial Interest In the MCCC: Name Telephone # Address Email O Olj f/� • 2. DCT 4+9 0-a �4(30V >Es • Lem 3. 4. 987441.1 8) The name and contact information of the on-site community relations or staff person or • other 'representative to whom one can provide notice If there are operating problems associated with the MCCC: Name Telephone# Address Email 1. P& 2;�KN�xnN S//9-277-/ool/RDA�Qz P � 2. S 3. Gf 6 9) An estimate of the size of the group of primary caregivers and/or qualified patients who will be served by the MCCC: / # of Primary Caregivers t Z # of Qualified Patients _ — 3p�/p� Will delivery service be provided? Y/ N If yes, please describe the extent of the delivery service: • 10) Will cannabis be cultivated on site? YDN If no, or if less than 100% of the cannabis will belgrown on site, please provide the name and contact information of the person(s) who will be cultivating the cannabis: Name Telephone# Address Email Member YIN 1. 2. /V I ZA 3. 4. 5. 6. • 7. 987441.1I, 5. • 6 7. 6 The names and contact Informatio n on of every principal officer, director, and/or operator: Name Telephone # Address Email PX-7", ADP 1. 41693 E. I/6D .-0 z. DK.� kflv �26 890 �8�ig A 3. 4. 5. 6. 7. II • 7) The name and contact information of any person who is managing or responsible for the M'CCC activities: Name Telephone # Address Email (W&IV 'f19-277-�ooZ p cAtc s� 2. �71TT/t'llF/L.CO1 3. 4. 5. 6. 7. 987441.1 �' 11) The names and addresses of any employees, if any, and a statement as to whether such person(s) has or have been convicted of a crime(s), the nature of such offense(s), . and the sentence(s) received for such conviction(s). Name Address IOffense Type (if any) Sentence 2. W0 vtZ 1V07 A-cc 6PT y //t/Di 0hVA-L S 3. W i7(-f fl- eel m 1/t/L 6 4. /Ve/Tff{2 1MVE 5. /jEEN eaA)V%G72�W ! OF AV V e4 fAjE 6. 7. The following information shall be submitted n one sheet of white paper no less than 11x17 inches and no larger than 24x36 inches. The information must be legible and reproducible. In addition to the paper document, an electronic file in PDF format may be submitted on compact disc (CD). • 1) An accurate site plan and floor plan of the premises that clearly labels all the use of areas on the premises, including (1) doors (2) entrances (3) windows (4) use of each area, including (5) storage (6) cultivation areas (7) exterior lighting fixtures (8) security cameras (9) restrooms (10) signage and (11) parking (including other tenant spaces if the MCCC is proposed for a multi-tenant building site); 2) Photographs of the existing site that show the front, back and sides of the building, lighting, parking, etc. 3) A security plan that includes the following:. a. Security cameras that have been !installed and maintained in good working condition, and used in an on-going manner with at least 240 continuous hours of digitally recorded documentation in a format approved by the City Manager. Please provide the number of security cameras and list the areas covered by each. The areas to be covered by the security cameras include, but are not limited to (1) the storage areas (2) cultivation area's (31� all doors (4) all windows, and (5) any other areas as determined by the City Manager. I b. A reliable and commercial alarm system that is operated and monitored by a lawfully operating security company or alarm business. Please provide the name and contact information of the sec'uritY,camera monitoring company. • c. Properly illuminated windows and doors that are in compliance with the City's lighting standards regarding fixture ty�e, wattage, illumination levels, shielding, etc. (Applicants may be required to secure the necessary approvals and permits.) 987441.1 4) A copy of the deed, lease, contract, or other document governing the terms and conditions of occupancy of the MCCC. • 5) !Suitable evidence of proof of lawful presence or residence in the city of Palm Springs (examples of this may include a copy of the applicant's current drivers license or a current copy of a utility bill). 6) ;A notarized acknowledgement from the owner of the property, if the applicant is not the Towner, that a MCCC will be operated on ''hisZr property. 7) A copy of the MCCC's articles of incorporation or articles of organization. 8) 'Evidence of authorization to do business as a non-profit within the State. CERTIFICATIONS AND DECLARATIONS 1) 1 declare under penalty of perjury, under the laws of the State of California, that all statements contained in this application and any accompanying documents is true and correct, with full knowledge that all statements made in this application are subject to investigation and that any false or dishonest answer to any question may be grounds for denial of the application or subsequent revocation of the permit. Signature: _ 44 �j Date:�7/NF1 14 I '7�I Signature: Date: �M)N F— 1 L( 7,01 • 2) 1 expressly authorize the City Manager of the City of Palm Springs to seek verification of the information contained within this application, including but not limited to, a comprehensive review of my i,background. I understand that this review rhay include verification of my personal social security number, credit reports, current and previoYs residences, employment history, education background, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions, driving records, birth records, and any other public records, Signature: � Date: � Signature: _ Ote: dUN I, 1 '2.0(W 3) 1 have received, read, reviewed, and understand all of the requirements of the City of Palm Spring's regarding the operation and management of medical cannabis cooperatives and collectives in the City, including without limitation the provisions of Chapters 3.35 and 5.35 and Section 93.23.15 of the Palm Springs Municipal Code, and I acknowledge that I am required to fully comply with these provisions. I also acknowledge that failure to comply with any of these requirements may subject me to administrative fines, criminal sanctions, and other penalties as provided in the Palm Springs Municipal Code, lincluding suspension or termination of my permit to operate a medical cannabis cooperative or collective in the City. • Signature: D te: �V�IG `f , Signature: /\ ��s to: VN-F— 1 , Zp j 987441.1 The, following items must be completed and accompany the Medical Cannabis Cooperative / Collective Application (MCCC). Please check off each item to ensure completeness. 1) Original completed application and $7,500 deposit fee. ❑ 2) An accurate site plan and floor plan of the premises that clearly labels all the use of areas on ❑ the premises, including (1) doors (2) entrances (3) windows (4) use of each area, including (5)storage (6) cultivation areas (7) exterior lighting fixtures (8) security cameras (9) restrooms (10) signage and (11) parking (including','other tenant spaces if the MCCC is proposed for a multi-tenant building site). 3) Photographs of the existing site that show the front, back and sides of the building, lighting, ❑ parking,etc. 4) A security plan that includes the following: ❑ a. Security cameras that have been installed and maintained In good working condition, and used in an on-going manner with at least 240 continuous hours of digitally recorded documen}atlon in a format approved by the City Manager. Please provide the number o security cameras and list the areas covered by each. The areas to be cover d by the security cameras Include, but are not limited to (1) the storage a�eas (2) cultivation areas (3) all doors (4) all windows, and (5)any other a eas as determined by the City Manager. b. A reliable and commercial alarm system that is operated and monitored by a lawfully operating security C¢mpany or alarm business. Please provide the name and contact informatiorti of the security camera monitoring company. C. Properly illuminated windows land doors that are in compliance with the City's lighting standards regarding fixture type, wattage, illumination levels, shielding, etc. (Applicants may be required to secure the necessary approvals and permits.) 5) A copy of the deed, lease, contract, or other document governing the terms and conditions of ❑ occupancy of the MCCC. 6) Suitable evidence of proof of lawful presence or residence in the city of Palm Springs ❑ (examples of this may include a copy of thef applicant's current driver's license or a current copy of a utility bill). I 7) A notarized acknowledgement from the owner of the property, if the applicant is not the ❑ owner,that a MCCC will be operated on his/h,er property. j8) A copy of the MCCC's articles of incorporatioh or articles of organization. ❑ 9) Evidence of authorization to do business'as a non-profit within the State. ❑ 987441.1 '.. I' BreEZe - State of California Page I of 1 • About BreEZe FAD's Help Tutorials 04 , Deparirmnt ofConsumerCoumer Alfabs BBEME $1up navigation Lotion I Contact Us License Details The Department of Consumer Affairs encourages you to verify the license statuses of any licensees that may appear in a'Related License'section below.You can verify these licensees by selecting'New Search'and conducting a new search using the'Search by Personal or Business Name'option.Please note that the'Relaled License'section wilt only appear below if this license is related to another license.Not all licensees have a related license. If the License Details below include'Date of Graduation',the north and date of graduation may not be available.In this instance it will be displayed as'01101YYYY where YYYY represents the year of graduation.Please note that not all license types disclose'Date of Graduation'on the License Details screen. Press"Previous Record"to display the previous license. Press"Next Record"to display the next license. Press"Search Results"to return to the Search Results list. Press"New Search Criteria"to do another search of this type. Press"New Search"to start a new search. License Number:7960 Current Date:06111/2014 07:29 PM Name: KAO,JAMES License Type: Osteopathic Physician and Surgeon License Status: License Renewed&Current Expiration Date: 04130/2016 Original Issuance Dale: 0611812001 Addresses • Address of Record Address aG m.eress IWNE.CA ORANGE .2.2.1 Us 1RR on a Public Record Actions Administrative Disciplinary Actions None found Court Order None found Misdemeanor Conviction None found Felony Conviction-Respondent None found Felony Conviction-Involved Parry None found Malpractice Judgment None found License Issued with Public Letter of Reprimand None found Administrative Citation Issued None found Administrative Action Taken by Other State or Federal Government None found Previous Record Next Record Search Results New Search Criteria New Search Print Back to Too I Conditions of Use I Privacy Policy I Accessibility Copyright®2013 State of California • https://www.breeze.ca.gov/datarnart/detaiIsCADCA.do?selector=false&selectorType=&sel... 6/11/2014 BreEZe - State of California Page 1 of 2 • About BreEZe FAO's Help Tutorials Oeporlmarrf W Consumer Allen;.�� BREC�E Skip nav' sho Lamon I Contact Us License Details The Department of Consumer Affairs encourages you to verify the license statuses of any licensees that may appear in a'Related License'seclion below.You can verify these licensees by seleding'New Search'and conducting a new search using the'Search by Personal or Business Name option.Please note that the'Relaled License section will only appear below d this license is related to another license.Not all licensees have a related license. If the License Details below include'Date of Graduation',the month and date of graduation may not be available.In this instance it will be displayed as'01101fYYYY' where YYYY represents the year of graduation.Please note that not all license types disclose'Date of Graduation'on the License Details screen. Press"Search Results"to return to the Search Results list. Press"New Search Chums"to do another search of this type. Press"New Search"to start a new search. License Number:27909 Current Date:08H 112014 07,31 PM Name: MICHELSON,JOSEPH BENNETT License Type: Physician and Surgeon G License Status: License Renewed S Current Expiration Date: 05131/2015 School Name: NY045-UNIVERSITY OF ROCHESTER SCHOOL OF MEDICI Date of Graduation: 01/01/1972 Original Issuance Date: 08121/1974 Addresses • License Specific Public(Mailing Address Address, arrs EDGEnEw DRME (Required) PASADENA.CA Los AVG " 8110]1➢OB V10W on erne Survey Information The following information is self-reported by the licensee and has not been verified by the Board. Are you retired? Not identified Activities in Medicine Patient Care-30-39 Hours Patient Care Practice Location Zip:90041 County: Patient Care Secondary Practice Location Not identified Telemedicine Practice Location Not identified Telemedcine Secondary Practice Location Not identified Current Training Status Not in Training Areas of Practice Ophthamology-Primary Board Certifications No board certifications Identified Postgraduate Training Years 6 Years Cultural Background Declined fo Disclose Foreign Language Proficiency Declined to Disclose Gender Declined to Disclose Public Record Actions Administrative Disciplinary Actions None found Court Order None found • Misdemeanor Conviction Nonefound Felony Conviction None found Malpractice Judgment None found Hospital Disciplinary Action None found License Issued with Public Letter of Reprimand Nona found Administrative Citation Issued None found https://www.breeze.ca.gov/datamart/detaiisCADCA.do?selector=false&selectorType=&set... 6/11/2014 BreEZe - State of California Page 2 of 2 Administrative Action Taken by Other State or Federal Government None found Arbitration Award Now found 1 i • Search Results New Search Criteria New Search Print Back to Too Conditions of Use I Privacy Policy I Accessibility Copyright®2013 State of California • https://www.breeze.ca.gov/datamart/detaiisCADCA.d0?selector—false&selectorType=&sel... 6/11/2014 • JOSEPH MICHELSON Joseph Michelson, a physician, (ophthalmologist: retina & uveitis specialist), teaches biologic sciences (CAS) and Jewish American history. (Whizin contin. ed.) Dr. Michelson is the author of 5 medical texts, over 50 professional articles, 2 paperback novels, and has had his nonfiction writing published in San Diego Magazine, Los Angeles TimE?s, the "J" and writes a weekly historic interest column for "rhe Jewish Observer, Los Angeles, an on-line newspaper. He has been on the medical school teaching faculty of both Stanford and Harvard medical schools. S / 4 r i V6S�pe n6 .:'@4 �\dey me nccd ` id a`\Yc Aoub so Psad enMN0 nn8 % cnW90 III Y w bg m a04 / mac wo yccP uwS 4 to..' JoaeP tn[ xed eoa4t [ 0[' µ yp° aeO Ln [aYe nas[ ,man eae you of a og Pac Son and esk ne°e to 9p6�Ltyte�Wd. to[-°att% y yam[F logo 61g yo o o + • OF ' O,p�� w 3 � ^o d dy � roo L U� 4v P I C (Formerly AMERICAN BOARD FOR OPHTH4A�LMIZ: EXAMINATIONS) i M� m b6AID, z�AVIV (9_0*alxrcologL', 155UEDny,p y�9� 1 �p$� gyp P//y�}Y$ Leai /V�j� yA1.N,`O� �ly.ygfJy/y .L s^' .b W +b` J((�1��"Y`-� ,�NA ////JJ ,J" yy�/I]�� SE<RETAR -TREASURED ``4``a0��\\\\\�11�1 -`/C E"CHAICCCRMAN ' `A»ISTANTSECRETA�RY / S URER __ ,.. ...., �Oyr �a� Q •'RPORq ��'�'��/� • , SEAL �A. •1'r i• �/I B�/K RQ! /(�Q A Colony-4110 of Atlante a color i clelle �•�J�r� Secoltd �'diCion Jehels Seconcla edizione ors Michelson z ILLUSTRATED HANDBOOK OF • DRUG �' ;r 'S--��:;`µ• �I ABUSE RECOGNITION AND DIAGNOI, R r::QiO S.RCPY V � ' I" nx Surgical Treaty ll Color Atl zr n Ocular I THE EYE I cula CLINICA Inflammatory MEDICIN Disease "z n 7 0 Joseph B Michels( Mitchell H Friedlaende Joseph B. Michelson Robert A. Nozik W'4Mosby Wulrc A'� �R B i 1982 MEMBERSHIP RESEARCH TO PREVENT BLINDNESS, INC. acknowledges with gratitude the participation of JOSEPH B. MICHELSON, M.D. as an OPHTHALMOLOGICAL ASSOCIATE whose contributions to the advancement of Eye Research are implementing the progress of botb basic and clinical investigations, producing important new knowledge of The Eye and its diseases and bringing hope to millions threatened with loss of sight. Lei ✓ ". _' �— 'y � ROBERI'E.A1cCORMICK ]ULES C. STEIN Co-founders RESEARCH TO PREVENT BLINDNESS,INC. O 4, 41-1 C7 I oard of 1irector5 presents this CElZTt tC.ATE OF /ARD TO � o5e _hj eniletrNlichelsonMIA otenfiFic Yrogt-am5 -�fxhl ifs - �onftnutns KSucation C�ours( JxtsErucfro�al Courses �--- - --, �Ncal " J r OBISPADO DE TIJUANA APARTADO rOSTAL 226 TIJUANA, B, C. OSEPH B. MICHELSON, M.D. F.A. C.S. Head, Division Of Ohpthalmology 10666 North Torrey Pines Road a La Jolla, California 92037 . i Estimado Mr. Joseph: Lo saludo atentamente pidiendo a Dios que bendiga su persona, familia y trabajo.. E1 Motivo de la Presente es para agrade cerle al Senor, por su labor tan humana y de asistencia _ social a las personas que requieren de sus servicios. La ayuda que Ud. ofrece es refle]o de esa apertura a los valores trascendentes que plenifican al - hombre y hacen de el una plataforma de vivacidad del Evangeli"' • en esa dimension cristiana que el Senor nos invita a vivir. Elevo a Dios mis ruegos para que to --- bendiga abundantemente y, le reitero, mi agradecimiento por '- esa labor tar. noble que realiza. Me desp'. v'andole:.mi..bendic'... : Tijuana, B.C. Junio 27 de 1989 .'. iY Emildo Carlos� er ie Belaunz ran _ III OBISPO DE TIJUANA • f ; .�� COS j VS PER AR, o utt to whom these presents shut( come , reeting lRe it known that by virtue of authority uestr6 in them the 3rgents of the American (rottege of Surgeons An hcrrhu u6mit �1�a�r�� ��enurtt �ir�el�mt I' VIM110TC 0w of the Lrul(egr , these letters being their trstimoniu( that he i=r 111ltt(ifteb in the ,art anfi Science of 'urgerg. �r (94nirnmtt $mra Shen Zit Chimp on the of �(rgruts tfaez> -eighth hnn of (October, �4jmteelt Xunbreb Imb X1$4t-ifno. Secrrtnr� UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER`` Francis J, Proctor gow1fdamm FOR RESEARCH IN OPHTHALMOLOGY Zlris is to certify alrat use NO Miclielsom . D has served as a Research Bellow 3row ganuaryl, /978 av�une30, I978 DIRSCrOX, Paocrm FouNDAT10N o x; ` i jjj fff CHANKILLOR ,Abel dos ee 1t nr �Mithirl sia 6 a1' � G G t�hil Kliplomn ninkes knotttn that } 4; shim, cil"111411 (to oil tl?lt Nolttirttttion of tllCjFttrultit hrrs rulmittct� to the dr.;rcc of from tl?e iculty of Arts and Iicirllmil and that ha is entitled to all fliv irtnnors, 'Riij Its aub 'firiuiltges to that let;ree nitltrrtttitrinq:- Qowivan itithe C�itLj of"Nultimomin the ^tatevfharulanb.this twenty f4tl hill) of ,§iVtcmtrrr its the near of Our .orb out= tbi,usand nine hundred and oixiV iei�E t: ," 'Witness «thereof tl)s .;peal of file hjuitrersitu and the fignaturr• oftip 'lirssibPitt tilereofare herauuto affixrh: Chairman of thr jtonrd of lt'rustFas:- --jlraail vld of thr. L•�niuvrsitu:- JAMES KAO James Kao is a licensed physician and resident of Coachella Valley. He is a Board- Certified, fellowship-trained physician experienced in the field of medical cannabis. He is the founder and Medical Director of Greensight Medical in Palm Springs, CA now serving the community in its third year. If accepted for the Collective permit, he will be resigning as medical director for the Palm Springs office. Currently the office has two other physicians on staff as well. Dr. Kao has seen, evaluated, and performed surgeries on patients in the Coachella Valley for the past 8 years. He has two medical degrees (DO and MD) and a Master's in Public Health (MPH). Prior to and during medical training, he was an HIV/STD counselor in various clinics thruout the United States. Additionally he has experience in the fields of Medicine, Infectious Diseases, and Osteopathic manipulation as well as herbology and acupuncture. In 2005 James Kao was honored with the Bravo for Bravery Award by the American Red Cross and received commendations from the Irvine Police Department. His father Deh-Liao Kao was a former Chief of Security for the United Nations. His mother Nancy Kao is a licensed Acupuncturist and former mid-wife and nurse. • • �I�Inte�n�fion�l � IIcirt� of ����� efrttctiue � urqer� or the �lmericttn �1ctt�em� of C��hfhttlmulo�� JaMC5 Sao , �De, AD, AVO k7i kC4�e' W/4 aa�lwa Z(ctibe Member 2O64 4dxgmj Ilk,kn Am- ISRSoAO ' t .4m ir 4 i as4ington, District of (golumbia A dw� �� ���, tired cam -, Jhmen Jin Wao de, 61 Muster of Public Nealt4 G�etet�rfa a�ietta,�irzGrz�. In fuitness fuhereof, uir Aw& 4mwze��, q4xd fib .a-,.alqe 7 and jm&t& d out nalrrze l �ff �ao6y", dro 46 4&d a ^odm/67, G erm ad p al gfawu , Ar& Y"wamd vice of �eDi rs am�XtutineePenn of the Mebiral Seuter�,`�la�y�.v,� �res�Dent of the �uibersitq �esu of the �$chool of ublic Xeulth m+D Aenith $rriiices CO ASCRS P-tv of Catar- I -* rid R ra �K a er y being an association of anterior segment ophthalmic surgeons approves and extends all the benefits as a 9 A IE11 BER to James Kao, Do, MD Secretary President jupartment of III /e.aj*4erojtp of Cincinnati College of ebirirre let it be bnotnn that guueofulip comptetco gubopetialip.0ti>nughip training in �.et��.ttbe trgerp att.jp , 1 � -�i�ion efx ttie; urgerp (Center afffCate��t�tt� tfje Unfber5itp of (Cincinnati Department of Opbtoarmofogp 3lulp 1, 2003 through 31une 30, 2004 jEs i gsbu erM.Dairman artment i i CERTIFICATE OF ACHIEVEMENT THIS IS TO CERTIFY THAT i i James Ka o, DO, MD, MPH HAS SUCCESSFULLY COMPLETED THE VISX® EXCIMER LASER SYSTEM, PRK WITH ASTIGMATISM, MYOPIA, HYPEROPIA, LASIK, HYPEROPIC ASTIGMATISM, BLEND ZONE, LASIK FOR HYPEROPIA & MIXED ASTIGMATISM TRAINING COURSE cflwarded I This certificate does not authorize treatment of patients in any state or country where the certificate holder is not otherwise licensed to perform refractive surgery. DECEMBER 2003 - CERTIFICATE NUMBER 55439 i I I I i i I it MEDI AL MONITOR EDUCATION MANAGER DECEMBER 2003 DECEMBER 2003 w[ MAKE r N rr c s c i a n QW r"" rooF , t (W(tttF at4F 7p 1� l tN ,� 1 . APPLICATION REQUIREMENTS 1. COPY OF $7500 APPLICATION FEE - ADDENDUM A 2. SITE PLAN / PARKING INFO/SIGNAGE - ADDENDUM B 3. PHOTOS OF EXISTING SITE - ADDENDUM C 4. SECURITY PLAN - ADDENDUM D 5. CONTRACT FOR PROPOSED SITE - ADDENDUM E NOTARIZED ACKNOWLEDGEMENT FROM OWNER - 6. EVIDENCE OF LAWFUL PRESENCE - ADDENDUM F BACKGROUND INFORMATION OF DIRECTORS BACKGROUND INFORMATION OF OFFICE MANAGER • 7. ARTICLES OF INCORPORATION - ADDENDUM G EVIDENCE OF NON-PROFIT STATUS • • ADDENDUM A- COPY OF APPLICATION FEE JAMES KAO OPHTHALMOLOGY CO. 803 e CRANE IRVINE,CA 92602-2417 r �1 n� na511218 cA DATE li b `/ 91070�p PAY , C�.�7/� (JG OR THE s (`/1 /l� ORDER OF_ -Q Jn( G V\ y` , DOLLARS e' Bankof America'W� ACN f21000358 FOR --...------- — ------------ "• ':, 1'0008031' l: L 2 L000358I: 00 10 1 5040 LG Iv JOSEPH B MICHELSON M. D. 397 KATE REED MICHELSON 16-24/12204393 3775 EDGEVIEW DRIVE 8708483519 PASADENA,CA 91107 �Ylo1� Pwaw,geeaxctia i: 1220002'47I: 8708483S1911' 0397 • ADDENDUM B -SITE PLAN / PARKING INFO / SIGNAGE LOCATION In researching for a location for a Collective it was determine very few locations qualified per the strict requirements set forth - not within 1000 feet from school, residential or community facilities; not within 1000 feet from another dispensary / collective; and not in a retail setting. The location chosen serves the western portion of Palm Springs and is not near any residential, retail or community facility. In fact there are empty lots in both the front, back, and side of the facility. The facility would be able to facilitate self-grow and thus alleviate the need for obtaining outside sources for medicine. 180 W Oasis Road Palm Springs, CA 92262 The property is currently in Escrow pending provisional approval of the Collective Permit Seller has been made aware of the requirement. • • �jcrS'7//�6 AOAJ S6ry - - - ----- -_---- i �J �iSTiNG �fyieXiiU6 Fe,2 �AM 5PI?IAJ6S, ?Z2� 2 le ,4-5 7f rcg A94F E'MP7/ GUTS vN AMIe7-P, 5'oU7-H 4t/5S7-S1DSS-. rroperry inrormation l-enrer Yage i or i Parcel Number:669444014-3 HOW TO READ THE ASSESSOR'S MAP PACE • ag Book: P M p Book: a44 The numerical parcel number on a map page consists of three main segments. The first three digits is the map Parcel:14 hook number. The second set of three numbers is the pagelblock number,and the third segment identifies the Check DI06:z parcel number. ..:,. POR SEC.34 T.SS,F 4E -. nu<eul� 669.44 l �^ +m' C 1 Y Of PXLN 9PXiX46 rNl.� ue veo" ROAD AG It RAmO ROAD .er. • •�� ' �y 443, i g » ® Coal `�%; is S o ROAD J , n.. • LOT EMP� GoT �©/ZJ �gp Gfi PSG �22� Z ��ICiNG f�'GFfc iG�T.�1� httn://nic.aarclkrec.cnm/Kview PalrelMans acnx?Parce]Niimher=669444014.? 6/1 1 17 01 4 Property Information Center Page 1 of 1 Wednesday,June 11,2014 SMidi Api11 • Property Information Center Property Information for the 2013.2014 tax year as of January 1,2013 Property Information Assessed Value Information Parcel Number: 669444014-2 7.144 Property Address: 180 OASIS RD structure 266,69 PALM SPRINGS CA 92262 Sull Vale 293,839 Legal Description: Lot 13 MIS 0231053 WRIGHT&LEONARD TR Full Value 293,839 Property Type: COMMERCIAL PROPERTY Total Net 293,839 Assessment Description: NIA Assessment Information Year Built NIA Assessment Number: 669444014-2 Square Feet: NIA Tax Rate Area: 011-044 Bedroom: NIA Taxability Code: 0-00 Bath: N/A Base Year: 1984 Pool: N Parcel Map Lot Size: NIA View Parcel Map Sales Information Last Recorded Document:05/1989 Recording Number: 9999998 Related Property Information City Sphere: PALM SPRINGS Tax Assessment District CITRUS PEST CONTROL 2 Supervisonal District: JOHN BENOIT CITY OF PALM SPRINGS DEBT SV Landuse Designation: CITY COACHELLA VALLEY RESOURCE CONSER Agriculture Preserve: NOT IN AN AGRICULTURE PRESERVE CSA 152 School District: PALM SPRINGS UNIFIED CV MOSQ&VECTOR CONTROL Water District: DWA DESERT COMMUNITY COLLEGE Ferns Flood Plan: FLOOD ZONE X PROTECTED BY DESERT HOSPITAL DESERT WATER AGENCY FLOOD CONTROL ADMINISTRATION FLOOD CONTROL ZONE • GENERAL GENERAL PURPOSE HIGHLAND-GATEWAY RDV PALM SPRINGS PUBLIC CEMETERY PALM SPRINGS UNIF B&11992-A PALM SPRINGS UNIFIED SCHOOL RIV CO REG PARK&OPEN SPACE RIV.CO.OFFICE OF EDUCATION • http://pic.asrclkree.com/KSearchDetails.aspx?Assessment=669444014 6/11/2014 • ADDENDUM C - PHOTOS OF EXISTING SITE r, F PSPC Ofivk-1 _ t r :r.rr S • 15 v r [ J/ /UO/zrwPtY®G4"T JZz6 z • ADDENDUM D -SECURITY PLAN r, • • III SECURITY SERVICES We will be utilizing one of the following Security companies and will have one armed and one unarmed security officer during OPEN HOURS. Security training will be provided as well. After Hours we will have an armed security officer. Premises will be secure 24-hours. COLLECTIVE PROTECTIVE SERVICES 909-614-1924 SECURITAS WWW.SECURITAS.COM 818-706-6800 SECURITY ALARM • We will be utilizing the services of ADT for security purposes. ADT Corporate Accounts Mike Ragan 714-326-6900 In the even that ADT may not be able to assist us, we will be utilizing DESERT ALARM INC for 24-hour security. DESERT ALARM INC 800-726-1779 760-322-1562 • SECURITY CAMERAS We will be utilizing cameras from MOBOTIX. These have extremely high quality resolution and utilized by various law enforcement and US Federal government. SECURITY CONSULTANTS We would seek the advice of the Security Companies listed above as well as the alarm companies. Additionally we would seek advisement from the following: Deh-Liao Kao, retired former Police Chief, United Nations Headquarters, New York, NY and SouthEast Asia Headquarters Louis Ari Wershaw, Security Consultant • SECURITY GATES All doors to the existing facility have roller door gates. Please refer to photos. LIGHTING Premises will be well lit at night - visibility of exterior will be visible front and back from at least one block away. • G�Gft7i%t�G � <li , - ° 6 5 CT DualDome Camera m PoF 4 G8 MicrcSO integroted 'exoandobie no to 64 08' One camera, two lenses. .: Seeing more is just not possible. , t w; D 4D DualDorne original image Tele lens leftl and wide angle lens Irightl-at lh�some timc in one image MOBOTIX HiRes video replaces up to 6 cameras ... • individual choice of lenses: tele/wide-angle, day/night, 1800 panorama function • integrated DVR (up to 64 GBI stores up to 520,000 HiRes images (6 days with 1 fps) • simple installation with only one network cable (data& power/PoE) • continuous digital pan, tilt and zoom (virtual PTZ function) • highest audio quality thanks to new codec and echo elimination • optimized interfaces: MxBus and MiniU5B for e.g. UMTS and GPS • robust, maintenance-free, IP65 weatherproof, from -30 to +60 T (-22 to +140 °FI g , starting at $1,328' incl. video management software `fISRPiM�� lnR,e e. --;r rrI P, saxes k,-t 1-1 .S-Ih(n-➢O SCt 11SA'[YM-rxduf WC Ilr ... I •f .c rb(I nT rFx,'rl F 11PrT Mn pPP'1rc, 014-Attractive Fixed Dome With Two lenses Two lenses, two HiRes image sensors, up to 64 GB internal storage and a dual image of a maximum of 6 mega- pixels make the D14D DualDome an efficient security solution: It is possible to secure two different areas using just one camera.All without vulnerable mechanical components! Technical Specifications • The HIRES Video Company MOBOTIX Technical Specifications D14 DualDorne Models IT,Sec,Sec-180°,Sec-Night-18T,Sec-DayNight Virtual FITZ Digital PanRR2oom,continuous 8x zoom Lenses 22 to 135 men formal, Alwm/Ewrks Triggering of events by inlegrated mulliple-window horizontal angle 90-to 15- motion deteclion,external signal,temperature sensor, Sensitivity Color:I lux 0=1/60 sl.O.OS lux 11=1/1 sl PIR,notification over email,FIP,IP telephony(VoIP, BAN 0.1 lux It=1/60 sl,0,005 lux It-1/1 sl SIPI,signal output,visual/acoustic alarm,pre-and 2 Sensors 2 x 1/2'CMOS,progressive scan post alarmimages Audio Integrated microphone and speaker,Line-In/Line-Out, Max.image resolution Color 2048 x 1536(3MEGA), lip-synchronous audio,two-way speaker. Black/White.1280 x 960(MEGA) audio recording Iwoge format 2048 x 1536,1280 x 960,1024 x 768,800 x 600, Interfaces Ethernet 1 D/100,RS232 Ma MXPnt(hBox),Minil158.MxILa 384 x 288 IDII,704 x 576 x 240,I.60 x s 0, Video one VoIP,SIP,two-way speaker,remote control via DTMF 3B4 x 288,352 x 288,320 x 240,160 x 120; Ph y p� free image format selection leg.1000 x 200 for sky(inell signaling,event notification Max home rate VGA 25 fps,MEGA 12 fps,3MEGA.4lps Security User-/Group management,HTTPS/SSL,IP address filter, 3 IM-JPEGI Ibve/Recording) IEEE 802 No intrusion defection,digital image signature video stream VvxPEG) VGA:30 fps,MEGA 30 fps,3MEGA 20 fps Certificates FMC 1EN55022,EN55024,EN610 0 0-6-2, FCC pari (Live/Recording/Audio) AS7N2535481 image compression MxPFG,M-Jof G,JPFG,H 264(only Video-VOIP) Power supply Power over Ethernet IIEEE 802.3af,Class 01, Nefpower-Adapter,typ.4 W _- Internal DVR Slot for MSucSD card lup to 64 GBI Operating conditiwn IP54AP65 OvElhout/with wall mount, External storage Dnerly on NAS and PC/Server without additional -30 to+60°C I-22 to+140'n recording cofware Dimensions 0 x H_20 1 x Il mi,Weight m 650 g SaFMveGnd+sivel Video management software MxEasy, Standard delivery Housing lhigh-reslslance composites-PBT-PCI,white, _ Control room software MxContrulCenler shockproof polycorbonote,dome(transparent), Image proeessirg Backlight compensation,automatic while balance,image meunling pans,often wrench,patch cable-50 cm, t distortion corrector,video sensor Implicit deteclion) manual,software a Standard Housing Vandalism Set wall Mount Pole and Comer Mount PoE-Injector RS232 imer/ace Mx-D14Di-Sec Mx-014D-Vandal-Kit MX-WH Dome MX-MH Dome E89S MX NPA-PoE-Sel • PxDOme camera with • Dome 13 mm Polyc.l • Weatherproof OP651 • 3 men stainless steel, • Power supply from • For connecting two independent,indi- for D14-DualDome while electrical power and external sensors vidually adjustable Stainless steel battery(12-02 V) image sensors vandalism housing in • Covers up RJ45 outlets • 2 stainless steel • Switching external polished,mott or in and Outdoor PotchBox straps fa pole dam- • For direct PC connec- devices le.g.,gate, • Simultaneously records powder-coaled white, Spare for expansion eter 60-180 mm,Ind. lion without a switch light,etc.1 an entire roan& silvergray or black modules IVJI AN) mounfing parts thanks to integrated • P5232 interface far selected details crossover function the camera L22 Super Wide Angle 90" L32 Wide Angle 60' L43 wide Angle 45' L65 Tole 31' L135 Tole 15' l t approx.90'Hx67'V approx.60'Hx45'V approx.45'H x 34'V approx.31'H x 23°V approx.15'H x 11'V allDmopfer:200xl33m at 10 in appr 115 x 8.2 in a110mappi 82x6lm allOmopprr 55x4Om allOmappo 26x1.9m D14-Attractive Fixed Dome With Two Lenses Two lenses, two HiRes image sensors, up to 64 GB internal storage and a dual image of a maximum of 6 mega- pixels make the' D14D DualDome an efficient security solution: If is possible to secure two different areas using just one camera.All without vulnerable mechanical components! • ADDENDUM E - NOTARIZED ACKNOWLEDGEMENT FROM OWNER r, • • O6/11/14 17: 27 HP LASERJET FAX p. 02 Acceptance of Offer: Seiler shall have two(2)days from date of this Offer to accept the terms. • and conditions outlined, Should same be acceptable to both parties, buyer shall deposit funds into LIBERTY ESCROW to commence the ownership transfer process. The above referenced terms and conditions reflect the understanding of the parties as to the business and legal points to be included Into escrow papers prior to close. Time being of the essence,the parties agree to move In accordance to the time-frame referenced above and agree to fully cooperate with all necessary requests of the parties. By executing below, both parties accept the terms and conditions of this Purchase Agreement and agree to move forward to complete the transfer In a timely manner, ACCEPTED AND AGREED; ACCEPT D AND AGREED: This 4-day of June,2014 This day of June,2 Dy; Buyer By: Seiler JAMES KAO ML DICK 026-890-1899 CLI,fi 760-567-3110 OF rice 760.622-7386 OFFICE 76"21-1768 FAX 951.653-7409 FAX JAMESKAOQAOLCOM CC! Daniel Robbins, BROKER ate �oCallfornia.County of Rlymide of 1 ` ,before ma. Stetq of .., Rbctihr(� V,� Marlm, NoGvy Public pnraon,fly y4mved In mo on Iile base of Gationrtoy eyl(Innrb to 11P IN? porron(s) QMW1.xMrPwKb,Q whae(!namL(s)fh'am subso ibool to Dn wthin in[tmroont anti rlknowlud ed to tr+'r't'" RICIIARUW Met Ii71N me that hofsh ,'they exocuted Choi Yam'm his.t+Gr,nGir aothOtf7Cd CApdrdy(i0&), �„�� ' CornmissfD 1 # 1993192 "nr S• Nolnr Pu and the[by hnlhDr7lhou sutnatunitsl bn the irviimo unt thr, p<lraon[G),or (ho a y y blln . Calllornia soli a nlxhnitul which ihl rt.7n't uwl G>teculaq then slrwnnllitt I w,,rlif a (tivarside Cauni H DU PG t ) f ' /...oroo that y J-�� "tag' y untlerpKNALTY QF pFR Il1RY undo:,'Ihr tws r,the ,torn of C,riihanin that the M�n �lmu Noy 2, 201$ toreaoing Daragraptl IS tnua Nllt(otruG Wsf/yly'. r� WITNESS mymnd anti nfld,l seal. • 06i11/14 17: 27 HP LASERJET FAX p.01 PURCHASE AGREEMENT Y.Wanou • Mr. Carl Dick 180 W. Oasis Rd Palm Springs,CA 92262 On behalf of my clients, 1 am submitting to you the terms and conditions acceptable to purchase your property: Building address; 180 W,OASIS ROAD,PALM SPRINGS,CA 92252 Purchase Price: $R50,000 purchase price,with finance Terms described below. Finance Terms: Seller to carry-back a note in the amount of$700,000 at 2,79%Interest fully amortized for 15 years(principal and Interest,$4763,69 per month commencing after initial lease period)with no prepayment penalty for early payoff of remaining balance after S years. Closing Date: 'Thirty(30)days based upon approval of inspection reports,title transfers,and provisional city permit for collective and other permitted uses. Initial Payments: Buyer to make Initial paymerns of$3000 per month for warehouse portion for term of FOUR(4)months to allow time for removal of equipment In other portion of property and remodeling. Payments thereafter shad reflect a fully amortized fixed monthly payment in the • amount of$4,763.69 until balance of purchase is paid(see above). Condition of Premisest Seiler will leave building in"broom-clean" condition and remove equipment,materials,supplies,etc.,currently In WAREHOUSE PORTION of facidty within a reasonable period of time but not to exceed thirty (30)days from date of close unless agreed to by the parties. Timetable for removal and cleaning of the rest of the facility is based on the initial period described above. Escrow: Upon acceptance of this offer,buyer or Its agent shalt deposit funds into LIBERTY ESCROW,or other acceptable escrow company,a check In the amount of$5,000, until such time as conditions are waived by buyer. After such removal,buyer shall deposit an additional funds Into escrow prior to closing for a total payment of$150,000. Items on premises: Air compressor,Spray booth to remain on premises. Storage container to remain on premises,unless City requests removal. Other pertinent and related Items per agreement by both parties. Consulting Fee,, Daniel Robbins or his nominee shall receive a fee in the amount of $25,000 for real estate consulting services In connection with th transaction through escrow at Close by Seller 4: =— .By; Buyer By, Seller • • ADDENDUM F - EVIDENCE OF LAWFUL PRESENCE CITY OF PALM SPRINGS BUSINESS LICENSE 3200 E TAHQUITZ CANYON WAY, PALM SPRINGS, CA 92262 (760) 323-8289 PLEASE NOTE THAT IT IS YOUR RESPONSIBILITY TO RENEW AND UPDATE THIS LICENSE ANNUALLY. BUSINESS NUMBER: 20015845 EXPIRATION TAX/ADMIN. FEE CERT NO BUSINESS TYPE: MEDICAL OFFICE 12/31/2014 67.00 53135.00 539 12/31//20142014 100.W 53 L40 OWNER NAME: DR. JAMES KAO 12/310. 40 12/31/2014 1.00 63832 BUSINESS NAME: GREENSIGHT MEDICAL BUSINESS ADDRESS: 4693 E RAMON ROAD PAI:M SPRINGS,CA 922(A GRF,ENSIGHT MEDICAL. ISSUANCE OF THIS LICENSE DOES NOT ENTITLE 72-780 COUNTRY CLUB THE LICENSEE TO OPERATE OR.MAINTAIN A #304 BUSINESS IN VIOLATION OF ANY OTHER LAW RANCHO MIRAGE CA 92270 OR ORDINANCE, THIS IS NOT AN ENDORSEMENT OF THE ACTIVITY NOR OF THE APPLICANT'S QUALIFICATIONS. NIUST BE POSTED IN A CONSPICUOUS PLACE • • City of Palm Springs NEW BUSINESS LICENSE Business License Division APPLICATION 320o E.Tahquitz Canyon Way • Palm Springs,California • 92262 Tel: (760)323-8289 • Fax: (760)322-8344 • Web:%+�+ne.palmsprings-ca.gov PLEASE FILL IN ALL APPLICABLE SPACES.FOR HELP WITH THIS FORM OR INFORMATION,PLEASE CALL 760 323.8289. TYPE OF OWNERSHIP W/ Sole Proprietorship LIPartnership Corporation LLC Trust (A Federal ID#Is required for all types of ownerships except Individual) BUSINESS NAME GREENSIGHT MEDICAL MAILINGADDRESS 72-780 COUNTRY CLUB#304 BUSINESS ADDRESS 4693 E. RAMON ROAD CITY,STATE,ZIP RANCHO MIRAGE, CA 92270 CITY,STATE,ZIP PALM SPRINGS, CA 92264 E-MAILADDRESS JAMESKAO@AOL.COM TELEPHONE 888-7444861 FEDERAL ID OR SS# 053-54-9858 EMERGENCY CONTACT NAME AND TELEPHONE DR. JAMES KAO OWNER 1 NAME DR. JAMES KAO OWNER 2 NAME '•�.r� � A ±' HOME ADDRESS 6 CRANE STREET HOME ADDRESS CA 92602 CITY,STATE,ZIP IRVINE, CITY,STATE,ZIP TELEPHONE 626-890-1899 TELEPHONE CITY OF {CAI M ot'lk";,i Fkjo.i TYPE OF BUSINESS ,/IService olesale/Relail ome Manufacturing Administrative Property Mgmt. RIPTION OF BUSINESS MEDICAL O K1 r✓ti NUMBER OF RENTAL UNITS NOT APPLICABLE CONTRACTOR LICENSE NO.ICLASS NOT APPLICABLE NUMBER OF FUEL PUMPS NOT APPLICABLE SELLER'S PERMIT NUMBER NOT APPLICABLE NUMBER OF VENDING MACHINES NOT APPLICABLE DRIVER'S LICENSE NUMBERICLASS CA U6128938/ CLASS C NUMBER OF SEATS NOT APPLICABLE NUMBER OF gQUARE FEET N1400 NUMBER OF IN-CITY PERSONNEL •� E� BUSINES�LIC� N THI FOFEE CALCULATi(*ry SECTION (Please refer to the Application Instructlon Sheet and Fee Scale to determin c. BUSINESS LICENSE FEE $ PLE RM ALONG WITH YOUR CHECK ADMINISTRATIVE FEE $ 28.00 PAYABL TO THE CITY OF PALM SPRINQIS TO THE FOLLOWING ADDRESS: BUSINESS IMPROVEMENT FEE BUSINESS LICENSE DIVISIO $ CITY OF PALM SPRINGS BUILDING INSPECTION FEE $ Gti—Nw�1 �1 FIRE&SAFETY FEE $ P.O.BOX 2743 /Vy_ HOME OCCUPATION FEE $ PALM SPRINGS,CA 9226 -2743 PENALTY % $ SIGNATURE AND DAT OVl C�R�/Y1 TOTAL AMOUNT DUE $ "" " k �-13 T .YSi #4 e 6E3 BL Application 11.10.08 e I �{ p_ L3A =-LA \1E. L 48386 i"g f iF ExF 07/.1212017 END NONE . . LN ,NIXON - FN PATRICKMICHAEL z 277 E ALEJO RD UNIT 223 � "PALM.SPRINGS, CA 92262 i pt} /1211976 NONE T 07121976 . h SEX - A EYES H �HGT 6, 10" WGT DD 1212W2612659037AAFD117. 6/2012 I.D. Card or '� Driver License No. Enter your new address below: Carry this change of address card with your I.D. or driver license. Do not tape or staple it to your driver license or ID. nod DL 43 (REV. 9/94) A Public Service Agency kw i Healthcare American Heart j Provider Associationm I PATRICK NIXON This card certifies that the above individual has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association BLS for Healthcare Providers (CPR and AED) Program. R~ '01/2013 01/2015 • Issue Date i Recoibmended Renewal Date` 1 • t5MC eot -I SrmsTC erg L CO yr I aka Sprr S Cf1 a'a-a-b7- q 103 t ue,4 & • California Residential Lease Aareement THIS AGREEMENT (hereinafter referred to as the "California Lease Agreement") is made and entered into this day of _Mare , 20�, by and between reA 1,. Siftp.— (hereinafter referred to as "Landlord") and nbnj-+ T .hp f�—A/rra (hereinafter referred to as "Tenant." For and in consideration of the covenants and obligations contained herein and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto hereby agree as follows; 1. PROPERTY.L ndlord owns certain real property and Improvements located at 111 1 �[►mnn�d herelnafter referred to as the "Property"). Landlord desires to lease the Premises to Tenant upon the terms and conditions contained herein. Tenant desires to lease the Premises from Landlord on the terms and conditions as contained herein. 2. TERM. This California Lease Agreement shall commence on 3 andshall continue as a lease for term. The termination date shall be on at 11:59 PM. Upon terminatlon date, Tenant shall be required to vacate th P emis s unless one of the following circumstances occur: (1) Landlord and Tenant formally extend this California Lease Agreement in writing or create and execute a new,written, and signed California Lease Agreement; or (II) Landlord willingly accepts new Rent from Tenant, which does not constitute past due Rent.. • In the event that Landlord accepts new rent from Tenant after the termination date, a month-to- month tenancy shall be created. If at any time either party desires to terminate the month-to- month tenancy, such party may do so by providing to the other party written notice of Intention to terminate at least 30 days prior to the desired date of termination of the month-td-monthtenancy. Notices to terminate may be given on any calendar day, Irrespective of Commencement Date. Rent shall continue at the rate specified in this Californla Lease Agreement, or as allowed by law. All other terms and conditions as outlined In this California Lease Agreement shall remain In full force and effect.Time Is of the essence for providing notice of termination (strict compliance with dates by which notice must be provided Is required). 3. RENT. Tenant shall pay to Landlord the sum of$ 1395. per month as Rent for the Term of the Agreement. Due date for Rent payment shall be the 1 at day of each calendar month and shall be considered advance payment for that month. Weekends and holidays do not delay or excuse Tenant's obligation to timely pay rent. A. Delincuent Rent. If not paid on the 1st, Rent shall be considered overdue and delinquent on the 2nd day of each calendar month. If Tenant Is to timely pay any month's rent, Tenant will pay Landlord a late charge of$ }` per day until rent is paid In full.-If Landlord ere elves the monthly rent by the 3' day of the month, Landlord will waive the late charges for that month. Any waiver of late charges under this paragraph will not affect or diminish any other right or remedy Landlord may exercise for Tenant's failure to timely pay rent. B. Prorated Rent In the event that the Commencement Date Is not the 1st of the calendar month, Rent payment remitted on the Commencement Date shall be prorated based on a 30-day period. • • Sex Offender Identification Line through which inquiries about individuals may be made. This is a "900" telephone service. Callers must have specific information about individuals they are checking. Information regarding neighborhoods is not available through the "900" telephone service. Additional information about sex offenders may be displayed on the Internet at http://www.meganslaw.ca.gov. 36. JOINT AND INDIVIDUAL OBLIGATIONS. If more than one Tenant signs this Agreement, each one shall be individually and completely responsible for the performance of all obligations of the Tenant under this Agreement, jointly with every other Tenant, and individually, irrespective of whether such Tenant is in possession. 37. FOREIGN LANGUAGE NEGOTIATION. If Landlord and Tenant have negotiated this Agreement primarily in Chinese, Tagalog, Korean, or Vietnamese, pursuant to the California Civil Code, Landlord shall provide Tenant a translation of this Agreement in the language used for the negotiation. As to Landlord this_o day of hfl&A '201, LANDLORD;8— Sign: Print:T �fi� M eo lk—Date: / As to Tenant,this day of ,20 • TENANT Sign: , _ Print: KQ[fr —ro Ie" Date: 3'eZ S TENANT: Sign: ` Pl iat: �i & /W 4,42A,/ Date: �le'l • M� Pagel of4 Time Ie Account 8498410850730544 • Warner Customer code 2006 Cable® Duedate service period Amountdue Apr 21,2014 04/01-04/30 $52.84 Service address Pat Nlxon Accou nt Phone 419-277-1002 1111 E Ramon Rd Unit 92 Palm Springs CA 92264.7711 Vkl Previous balance&payments Bala nce last statement 0.00 Current month Monthly services 65.98 Credits and one-time charges -13.14 Total due by Apr 21,2014 $52.84 ENJOY TWC BETTER We would like to welcome you as a customer and thank you for the opportunity to provide you with outstanding service. This statement includes installation charges and your first month of service. Watch Live TV on any device,at home or on-the-go,with the TWCTV®app. Win FREE tickets to sports,concerts,premiers a nd more.Visit twc.com/exclusives for access. ----------------------------------------_---- -------------'----------------------_- ------------------------------------------------------------------- Please enclose ttliscoupon wltb your payment. �\ Time Warder ••Pleaseallow7iodaysfordellvery and paymenl Cable IIIIIIIIIIIilllllll lll'IIIIII IIIIII processing. See reverse side for momconvenient 81.557 DR.CARREON gG71NDl0 CA 92201.5562 Payment due date _ Total amount due 8448 4 100 ZO RP of 04C22014 NNYNNYNN 01 014765 0052 Apr 21,2014 $52.84 PAT NIXON 1111 E RAMON RD UNIT 92 PALM SPRINGS,CA92264-7711 Account number Amount enclosed .Illtrlllllllllrrr�I��kllr�IltIIIltI����ll�llttrll�'lll�llltkll 8448410850730544 Please write your account number on ypur[tie[k. TIME WARNER CABLE • PO BOX 60074 CITY OF INDUSTRY CA 91716.0074 II' III'Illrllrlllrrrr��llll'rl�ll'I��Illlllrlrrlllrl llll"��I'll 844841085073054400052845 Page 3 of 4 PTIrne Account number 844B410650730544 Warner Customer code 2006 Cablee Ouedate Serviceperlod Amountdue May 06,2014 05/01 -05/31 $118.82 Service address Pat Nixon Account Phone 419.277.1002 1111 E Ramon Rd Unit 92 Palm Springs CA 92264.7711 ITEITS Previous balance&payments Balance last statement 52.84 Unpaid balance 52.84 Current month Monthly services 65.98 Total due by May 06,2014 $118.82 • ENJOY TWC BETTER NEW TWC SUBSCRIBER AGREEMENT It contains an arbitration clause,a clause that may limit the time you can bring a claim against us&other important terms.Review&'opt out of some of the clauses If you wish at Please note:.youraccount is past due.To avoida late fee,the http://help-twcable.com/policies.html UNPAID BALANCE must be paid by the 05102114.If unpaid balance Is not paid before 05115114 yourservice maybe Watch Live TV on any device,at home or on-the-go,with the interrupted.Theremaybe add'I fees to restore service.Thank T W C TV a app. you for your prompt payment. ----------------_----------------------------------------------------------------------------------------------------- Please enclose this coupon with your payment. 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