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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017089
Report Date: 02/27/2026
Date Signed: 02/27/2026 03:10:50 PM

Document Has Been Signed on 02/27/2026 03:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LITTLE ACORN MONTESSORI ACADEMYFACILITY NUMBER:
198017089
ADMINISTRATOR/
DIRECTOR:		SUSIE SAYEAHFACILITY TYPE:
850
ADDRESS:1957 W. HUNTINGTON DR.TELEPHONE:
(626) 289-2873
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY: 92TOTAL ENROLLED CHILDREN: 92CENSUS: 65DATE:
02/27/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:SUSIE SAYEAH, DirectorTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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On Friday, February 27, 2026, Licensing Program Analyst (LPA) Staicy Perry conducted an unannounced annual inspection and met with SUSIE SAYEAH, Director who guided LPA Perry on a tour of the facility. FACILITY LICENSED FOR 69 PRESCHOOL CHILDREN, AGES 2 UNTIL ENTRY INTO KINDERGARTEN. TODDLER OPTION ATTACHED FOR 23 CHILDREN AGES 18-36 MONTHS. APPROVED WAIVER ON FILE. This program operates Monday to Friday 7:00 a.m. – 6:00 p.m. Sign in and out takes place on an app called ProCare. LPA Perry was able to verify that all children were signed in. All areas identified on the facility sketch were toured and inspected both indoors and outdoors. Teacher and child ratio were observed, and present staff are fingerprinted cleared. LPA observed a total of 47 preschool children and 18 toddler children during inspection. Per director their is a total of 92 children enrolled.

LPA Perry entered all preschool classrooms (4) and (1) toddler classroom. LPA Perry observed a total of 47 preschool children in total with 7 staff present supervising the children and a total of 18 toddler with 4 staff present. LPA Perry observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. However, in Primary 1 preschool classroom LPA Perry did observe carpet to be lifting at the corner which can potentially pose a tripping hazard. LPA Perry informed Director Susie and during inspection carpet was removed. Technical was provided and photo was taken; LPA Perry observed a cubby for children to store their personal belongings. LPA Perry observed cleaning solutions stored inaccessible form children. LPA Perry observed a step trash bin with a lid. During the inspection for the Toddler option LPA Perry did review safe sleep regulations. LPA Perry discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage. LPA also informed licensee director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LITTLE ACORN MONTESSORI ACADEMY
FACILITY NUMBER: 198017089
VISIT DATE: 02/27/2026
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Heating, lighting, and ventilation were evaluated by LPA Perry. LPA Perry observed central AC/heater and vents located on the ceiling. LPA observed the thermostats located in classrooms and temperatures to be between 70-71 degrees. LPA observed the fire extinguishers located throughout the facility and the valve on the required 2A10BC fire extinguishers indicating fully charged and serviced on April 16, 2025. Smoke detectors were not tested during this visit due to the detectors being wired to the emergency pull down fire alarm system. Carbon monoxide detectors in were observed in the classrooms and LPA Perry tested and heard the sounds and is operable. The last emergency drill was conducted on 2/20/2026. LPA Perry observed the restrooms to be in good condition with working toilets, sinks, hand soap dispenser and paper towels. LPA observed napping equipment cots to be in good condition and stored in the classrooms. First aid kit supplies are kept inside the classrooms and LPA Perry observed the kits to be fully equipped. LPA Perry asked if there were any poisons, firearms, weapons, or bodies of water. SUSIE SAYEAH, Director stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. SUSIE SAYEAH, Director stated the ill isolation area takes place in the director’s office and children will utilize staff restroom.

During this visit, Director, stated that facility currently has children with medication or severe food allergies. LPA Perry also observed in the Primary 1 preschool classroom which serves ages 2–6-year-olds that sunscreen, nonprescription was not made inaccessible to the children in care. LPA reminded director Susie that all prescription and nonprescription medications shall be centrally stored in accordance with the 22 regulations and shall be kept in a safe place inaccessible to children. During the inspection, LPA Perry observed the Director Susie immediately removed the nonprescription sunscreen and placed it inaccessible to the children. Per director they were supposed to be given to the families to take home the day prior and that she understood. Technical was provided. Photo was taken. LPA Perry reviewed all medication the facility has. LPA did observe medications to be stored correctly and all children’s IMS Plan on file. LPA also advised assistant on PIN for IMS for reference. During naptime at around 1:53pm LPA Perry observed Primary 1 preschool to have a total of 15 children with a total of 1 staff and of that 15 children 10 were awake. LPA did inform director and assistant director right away and director was able to place a staff member in preschool class 2 to assist. LPA did review with director that a teacher-child ratio of one teacher supervising 24 napping children is permitted provided that the remaining teachers necessary to meet the overall ratio are immediately available at the center. LPA did observe a staff immediately go into preschool classroom 2 to assist. Technical provided.

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LITTLE ACORN MONTESSORI ACADEMY
FACILITY NUMBER: 198017089
VISIT DATE: 02/27/2026
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LPA Perry entered the outdoor play area. LPA Perry observed 1 play structure that was not in a safe condition, free of sharp, no lose or pointed parts. During today’s inspection, LPA Perry observed that the metal playground structure had visible damage and deterioration at the seam/joint area. The material, metal appears worn and separated and missing, with exposed nails and splinters with dark discoloration and cracking present along with the structure appears to be leaning to the side as well as visible cob webs, which may create a potential hazard due to sharp edges, exposed nails, splinters, structural damage and further deterioration. LPA Perry also observed the play structure to be all metal and was unable to determine the age appropriateness of the structure due to no manufacture label not on the structure. Per director the play structure has been there since before 2013. This poses a potential risk to the health and safety of children in care, as required under Title 22 regulations, in which outdoor play equipment shall be maintained in a safe condition and free from hazards. LPA Perry immediately brought this to the attention to the director. Director agreed to refrain from having children play on it or have access to the affected play structure until it is repaired or replaced. Photo was taken. Per Director, playground structure broke about 1 week ago on 2/19/2026 and a work order was placed. Per director they did not have the work order to provide the department. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Area around or under high climbing equipment, are cushioned with granulated rubber mat that may absorb a fall. For adequate shade, LPA Perry observed hip roof shade structure. LPA observed the playground yard to be fenced and the side gates closed and locked with a keypad lock. LPA observed 2 trash bins with tight lids. For outdoor water drinking, staff bring children's water bottles.

This program provides AM snacks, lunch, and PM snacks. Meals and snacks are provided by the facility. LPA Perry informed director that any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA Perry observed water pitchers and children’s water bottles in the classrooms. LPA Perry observed the food preparation area to be clean and free of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including movable bins with tight-fitting covers that are kept on, and in good repair. The facility was observed to be free of flies, other insects, and rodents. Lead testing was conducted on 12/8/2022 and was when samples were taken and analysis date is 12/12/2022 and no lead exceedance. Lead results were observed to be visible for parents to see.

The following documents were posted in a prominent, publicly accessible area at the facility: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and Earthquake Preparedness (LIC 9148). PUB 269 Child Passenger System Poster, and Daily Schedule. LPA Perry observed sign in/out

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LITTLE ACORN MONTESSORI ACADEMY
FACILITY NUMBER: 198017089
VISIT DATE: 02/27/2026
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was reviewed and observed all children present to be signed in. Waiver was not observed posted. During the inspection LPA provided director with waiver and observed director put it up. LPA Perry reviewed the children’s roster, children’s files and staff files and observed the files to be completed.

LPA Perry observed director Susie Seygeh Red Cross Pediatric First Aid/CPR certification which expires on 6/2026 Preventative Health and Safety certification not on file, per director the course certificate was completed and will submit to LPA by end of day. Director has proof of immunization against Pertussis, MMR, and Influenza declination. Director has completed the mandated reporter (AB 1207) training which expires on 4/2/26. Director was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

Items discussed during this visit:

1. The following items are prohibited by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.



4.LIC 311A - Records to be Maintained at the Facility: LPAs advised that forms, regulations, and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.

5.Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR and EMSA approved must be present.

6.Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.
NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LITTLE ACORN MONTESSORI ACADEMY
FACILITY NUMBER: 198017089
VISIT DATE: 02/27/2026
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7.Qualifications: Educational background, training, and/or experience for each staff present must be available for review

8. Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles or influenza declination

9.Children’s Records: must be available for review; including but not limited to, the following: Name, address, and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

10.Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee Rights, LIC 501 Personnel Record, AB 1207 Mandated Child Abuse Certification, MMR, TDAP, TB, influenza or influenza declination.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.). LPA verified that the lead testing was completed in accordance to the Written Directives (Interim Licensing Standards) outlined in PIN 21-21.1-CCP. LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information). CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES.

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LITTLE ACORN MONTESSORI ACADEMY
FACILITY NUMBER: 198017089
VISIT DATE: 02/27/2026
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 2202-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 5140383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.aa.gov/resources/child-care-centers/.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Currently the facility is not in compliance with Title 22 Regulations. The deficiency listed on the following page was observed by LPA Perry and is cited in accordance with California Code of Regulations Title 22. One type B deficiency is being issued today. Please see attached LIC 809-D for citation.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and report was reviewed with Director, Susie. Appeal rights provided and discussed.

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/27/2026 03:10 PM - It Cannot Be Edited


Created By: Staicy Perry On 02/27/2026 at 02:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LITTLE ACORN MONTESSORI ACADEMY
FACILITY NUMBER: 198017089

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in playground structure had visible damage and deterioration at the seam/joint area. The material, metal appears worn and separated, with exposed nails and splinters with dark discoloration and cracking present along with the structure appears to be leaning to the side, which may create a potential hazard due to sharp edges, exposed nails, splinters, structural damage and further deterioration. LPA Perry also observed the play structure to be all metal and was unable to determine the age-appropriateness of the structure due to no manufacture label not on the structure, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/27/2026
Plan of Correction
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LPA Perry obtained a declaration from director statating that the children will not be using the play structure until it is repaired and or replaced. Per facility director structure will be repaired in a safe manner and or replaced. Director will submit the correction by POC date to LPA via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Brandi VanOosten
NAME OF LICENSING PROGRAM MANAGER:
Staicy Perry
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/27/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2026


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