HomeMy WebLinkAboutC38460 FYs19-20 and 20-21 Commercial Residential Street SweepingCONTRACT NO. C38460
STAFF REPORT
CITY OF PALM DESERT
PUBLIC WORKS DEPARTMENT
MEETING DATE: June 13, 2019
PREPARED BY: David Reyes, Streets Supervisor
REQUEST: Award Contract No. C38460 to M&M Sweeping, Inc. of Thousand
Palms, California, in a total amount of $304,551 for Fiscal Years
2019/20 and 2020/21 for Commercial and Residential Street
Sweeping Services (Project No. 754-20).
Recommendation
By Minute Motion:
Award Contract No. C38460 to M&M Sweeping, Inc. of Thousand Palms,
California, in a total amount of $304,551 for Fiscal Years 2019/20 and 2020/21
for Commercial and Residential Street Sweeping Services with an option to
renew for two additional years; and
2. Authorize the Mayor to execute the agreement.
Funds are available in General Fund Account No. 1104310-4332000, Street Repair and
Maintenance.
Strateqic Plan
This is an ongoing streets maintenance function, and as such has no impact on the
Strategic Plan.
Background Analvsis
The National Pollutant Discharge Elimination System (NPDES) permit requires the
reduction of pollutants by Source Control Best Management Practices (BMPs), and the
reduction of litter accumulation. In addition, the South Coast Air Quality Management
District (SCAQMD) requires that sediment be removed from paved public roadways.
Street sweeping is considered one of the most effective methods to achieve compliance
with the NPDES and SCAQMD requirements.
June 13, 2019 - Staff Report
Award Contract No. C38460 to M&M Sweeping, Inc. for Commercial and Residential
Street Sweeping Services for Fiscal Years 2019/20 and 2020/21 (Project No. 754-20)
Page 2 of 2
On May 14, 2014 City Council awarded a contract to M&M Sweeping, Inc. for a term of
two years, with two one-year extensions, which Council ultimately approved. With the
contract set to expire on June 30, 2019, staff put the contract through the competitive
bid process. On May 21, 2019 at 2:30 p.m. bids were opened, with the following results:
Contractor/Bidder
1. M&M Sweeping, Inc.
2. Clean Streets
Location
Thousand Palms, CA
Gardena, CA
Bid
$23.75 per curb mile
$27.49 per curb mile
Based on the proposals, staff recommends awarding the subject contract to M &M
Sweeping, Inc., of Thousand Palms, California in the amount of $23.75 per curb mile or
$152,275.50 annually ($23.75 x 246.6 curb miles) for a total two-year contract amount
of $304,551.00. This contract includes the biweekly sweeping of all public streets in the
City of Palm Desert.
Fiscal Analvsis
The annual impact to the General Fund is $152,275.50 and is included in the budget.
LEGAL REVIEW DEPT. REVIEW FINANCIAL REVIEW CITY MANAGER
N/A
Robert W. Hargreaves
City Attorney
CONTRACTOR
ATTACHMENTS
1.
Tom Garcia, P.E.
Director of Public Works
M&M Sweeping, Inc.
P.O. Box 878
Thousand Palms
Bid
Agreement
Payment Bond
Performance Bond
C�
i � U
Lauri Aylaian
City Manager
CITY OF PALM DESERT
COMMERCIAL AND RESIDENTIAL
STREET SWEEPING SERVICES FY 2020 through FY 2021
CONTRACT NO. C38460
PROJECT NO.754-20
CONTRACTOR'S PROPOSAL SUBMISSION FORM
TO: CITY CLERK
CITY OF PALM DESERT
73-510 FRED WARING DRIVE
PALM DESERT, CA 92260
The undersigned declares that he/she has carefully examined the Bid Terms and
Conditions, the General Terms and Conditions, and the Specific Terms and Conditions
accompanying the Notice Inviting Bids; that he/she is thoroughly familiar with the contents
thereof, and is authorized to represent the bidding firm and propose services to City of
Palm Desert.
It is understood that the price shown hereon includes all phases and types of work
described in the specifications. The unit cost per curb mile shall be indicated.
1. Total amount of base bid in figures: $ a 3-- 7X per curb mile (cm).
2. Total amounkof base bld n words:
dollars and.A ,,-e v'Cj —e4vcents per curb mile (cm).
3. Total annual value of contract for purposes of comparison is:
Q3.7Sper curb mile x 246.6 curb miles x 26 sweepings = $% 7,f.-S0x 2
-(years) = S3�y, 531 total for 24 months
Undersigned hereby acknowledges receipt of addenda as indicated
(CIrcie highest number that applies) ( DO 1 2 3 4
Company Name:
Cy--1
Company Address: `
ftce one: Cell Phone: Fax:
-( k Q-0'343 -3do3
Bid Prepared By:
signatu
rsan: Cell Phonz4a�;L-S-S4--�
VQAAf-sej )o-�- SX,
e:
4ci 4,?;� - ss 4--:� -7 coo 3�8 - I 1 z S
Date:
C34880 SECTION`1:CONTRACT DQCUMENTS�_�� _ ___ —__ - _ __ __Page,
s
INFORMATION REQUIRED OF BIDDEF(
In supplying the following information, additional sheets may be attached I needed.
Check if additional sheets are attached: ❑
Check if additional sheets are not attached: ❑
(1) Company Name and Address (V"*I ;-� rV\ -ef-e-,C) k
(2) Telephone No. `i CPS 39� -- 3 ® O --:Z'
(3) Type of Finn (Individual, Partnership or Corporation) �� C—cr-r 1
(4) Corporation organized under the laws of the State of
(5) Contractors license No. 4y Exp. Date
Contractor's License No. Exp. Date
Contractor's License No. Exp. Date
(6) List the names and addresses of all owners of the firm or names and tides of all
offi rs of the corporation:
(7) Number of years of experience as a street sweeping contractor 3C)—4--
(8) Number of years of experience with municipal street sweeping contracts 2-0
C348M SECTION_1,CONTRA-CT DOCUMENTS` -- =.M�
(9) Type and number of vehicies and other equipment to be used in the fulfillment of
this contract:
Motor vehicles:
TYPE:
HOW MANY:
TYPE: Y r n C, t. ,.���
HOW MANY:
TYPE--VV rYX .,ram n
HOW MANY:
Other equipment:
TYPE:
HOW MANY:
TYPE:
HOW MANY:
TYPE:
HOW MANY:
(10) Proposed facilities to be used in the fulfillment of this contract
List location/address of facilities from which work crews and equipment will be dispatched:
SUBCONTRACTOR LIST
List the names and addresses of each subcontractor who will perform work related
to this contract and indicate what portion 'of the work will be done by each
subcontractor. (If more than one subcontractor, please check the box below and
list all subcontractors on a separate sheet.)
❑ See Subcontractor List on Separate Sheet
No subcontractors will be used
Subcontractor's Name:
License Number.
Address:
Telephone:
Work to be performed:
F
C30M SECTION'tipot rWcT DQCUMENTS~_._._ -- - . _^� —�_ 'Pag`e 16
REFERENCES
Contract
Amount Scope of Work
1 $ a
Additional
Information:
Additional
Information:
3 $ t,4 /5Q2a
Additional
Information:
Initiation/
Completion Dates Contact Person
Business Name
no
7c� 3 4G- l 1ZZ
pww-
�...v� �b l • �.s ~7 3 5[ dfired lt�a`r\ s'
?aI V\A
Oj l Z��
Irv—
�s�l� �t itv BIstness Name
�
-T teo
Provide the name and title of the person who inspected the site of the proposed work for
your firm:
Name 77716e
C34M SECT{ON ItCQNTAACT,DOCUMENTSr_M-. ` _ _ �� �___ ._ __ _ �_ __Pgge 11
PROPOSAL AFFIRMATION
With regard to the information provided hereinabove, I affirm that:
• All information provided is true and correct to the best of my knowledge, and;
• 1 understand that a materially false statement willfully or fraudulently made in
connection with this Proposal may result in the terminktion of any contract between
the City of Palm Desert and s M C o, ray c rr�� , and
as a further result, the aforesaid Qm may 6e �a Z from p&Ric pat1on in future City
contracts as well as be subject to possible criminal prosecution, and;
• I have legal authority to bind IY1 4 fn' w -e =e;P �� 1 "� C., to
the terms of this affirmation. -
FOR PROPOSAL
MUST BE SIGNED
/-Z- 0 LCI
Date
Printed are
� t'C�
Title
M c- rn w
Company Name
c3486o SECTION;I;CONT -- _ _. _ .. ~�� _. page�l2
NON -COLLUSION DECLARATION
To Be Executed by Bidder and Submitted with Proposal
The undersigned declares:
I am the i'i 5' c��e of /* A A7 5"v o 1D /' ei , the
party making the foregoing Proposal. The Proposal Is not made in the interist of, or on
behalf of, any undisclosed person, partnership, company, association, organization, or
corporation. The Proposal is genuine and not collusive or sham. The Proposer(s) has
not directly or indirectly induced or solicited any other Proposer(s) to put in a false or
sham Proposal. The Proposer(s) has not directly or indirectly colluded, conspired,
connived, or agreed with any Proposer(s) or anyone else to put in a sham Proposal, or to
refrain from proposing. The Proposers) has not In any manner, directly or indirectly,
sought by agreement, communication, or conference with anyone to fix the Proposal price
of the Proposer(s) or any other Proposer(s), or to fix any overhead, profit, or cost element
of the Proposal price, or of that of any other Proposer(s). All statements contained in the
Proposal are true. The Proposer(s) has not, directly or Indirectly, submitted his or her
Proposal price or any breakdown thereof, or the contents thereof, or divulged information
or data relative thereto, to any corporation, partnership, company, association,
organization, Proposal depository, or to any member or agent thereof, to effectuate a
collusive or sham Proposal, and has not paid, and will not pay, any person or entity for
such purpose.
Any person executing this declaration on behalf of a Proposer(s) that is a
corporation, partnership, joint venture, limited liability company, limited liability
partnership, or any other entity, hereby represents that he or she has full power to
execute, and does execute, this declaration on behalf of the Proposer(s).
I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct and that this dec tion is ex uted on
f YJwf 20jEt at-
City State
By:
Signature
Printed Name
) 0-cz) 'k =--.
c3486o s9cMoN_i1cO06WDOCUMENTS'_ - _ -.__- �- - . - - _ V _ _.___`Page J 3
CITY OF PALM DESERT
COMMERCIAL AND RESIDENTIAL
STREET SWEEPING SERVICES FY 2020 through FY 2021
CONTRACT NO. C38460 - PROJECT NO. 754-20
AGREEMENT
THIS AGREEMENT is made and entered into in the City of Palm Desert on this 13th day
of June, 2019, by and between THE CITY OF PALM DESERT, a municipal corporation,
hereinafter referred to as "City," and M&M Street Sweeping, Inc. herein referred to as
"Contractor."
WITNESSETH:
WHEREAS, on April 30, 2019, City invited bids for commercial and residential street
sweeping; and
WHEREAS, pursuant to said invitation, Contractor submitted a bid, which was accepted
by City for said services on May 21, 2019.
NOW, THEREFORE, in consideration of their mutual promises, obligations, and
covenants hereinafter contained, the parties hereto agree as follows:
(1) TERM The term of this Agreement shall be from July 1, 2019, through June 30,
2021, with the option to renew for two additional years. This contract allows for an
option of two one-year contract extensions at the City's option and based on
Contractor's performance and mutual agreement.
(2) CITY'S OBLIGATIONS For furnishing services, as specified in this Agreement,
City will pay and Contractor shall receive in full compensation, therefore the total
sum of Three Hundred Four Thousand Five Hundred Fiftv One and 00/100 dollars
($304,551.00) as billed on a per -item monthly basis as set forth in the Contract
Documents and adopted by City.
(3) CONTRACTOR'S OBLIGATION For, and in consideration of, the payments and
agreements hereinbefore mentioned to be made and performed by City,
Contractor agrees with City to furnish the services and to do everything required
by this Agreement and the Contract Documents, Specifications and Conditions.
(4) HOLD HARMLESS AND INDEMNIFICATION Contractor agrees to defend,
indemnify, and hold harmless City of Palm Desert, its officials, officers, employees,
representatives, and agents from and against all claims, lawsuits, liabilities or
damages of whatsoever nature arising out of its connection with, or relating in any
manner to, any act or omission of Contractor, its agents, employees,
subcontractors and employees thereof in connection with, the performance or non-
performance of this Agreement. Contractor shall thoroughly investigate any and all
claims and indemnify City and do whatever is necessary to protect the City of Palm
Desert, its officials, officers, employees, agents, and representatives as to any
such claims, lawsuits, liabilities or damages.
(5) AMENDMENTS Any amendment, modification, or variation from the terms of this
Agreement shall be in writing, signed by Contractor and approved by the City
Council of the City.
(6) TERMINATION If, during the term of this Agreement, City determines that
Contractor is not faithfully abiding by any term or condition contained herein, City
may notify Contractor in writing of such defect or failure to perform; which notice
must give Contractor a three-day period of time thereafter in which to perform said
work or cure the deficiency. If Contractor fails to perform said work or cure the
deficiency within the three (3) days specified in the notice, such shall constitute a
breach of this Agreement and City may terminate this Agreement immediately by
written notice to Contractor to said effect. Thereafter, except as otherwise set forth
herein, neither party shall have any further duties, obligations, responsibilities, or
rights under this Agreement except, however, any and all obligation of Contractor's
surety shall remain in full force and effect, and shall not be extinguished, reduced,
or in any manner waived by the termination hereof. In said event, Contractor shall
be entitled to the reasonable value of its services performed from the beginning of
the period in which the breach occurs up to the day it received City's Notice of
Termination, minus any offset from such payment representing the City's damages
from such breach. City reserves the right to delay any such payment until
completion of confirmed abandonment of the project, as may be determined in the
City's sole discretion, so as to permit a full and complete accounting of costs. In
no event, however, shall Contractor be entitled to receive in excess of the
compensation quoted in its bid.
The City Council may terminate the contract with 30-days written notice for any
reason.
(7) INCORPORATED BY REFERENCE The Notice Inviting Bids; Bid Terms and
Conditions/Instructions to Bidders; Contractor's Proposal Submission Forms;
Addendum Nos. — 0 —; General Terms and Conditions; Specific Terms and
Conditions; Extra Work Pricing Schedule; Change Orders; additional or
supplemental specifications, drawing, maps or diagrams; and City -issued forms
relating to this project, are hereby incorporated in and made a part of this
Agreement.
(8) COMPLETE AGREEMENT This written Agreement, including all writings
specifically incorporated herein by this reference, shall constitute the complete
agreement between the parties hereto. No oral agreement, understanding, or
representation not reduced to writing and specifically incorporated herein shall be
of any force or effect, nor shall any such oral agreement, understanding, or
representation be binding upon the parties hereto.
(9) ANTI -DISCRIMINATION In the performance of the terms of this Agreement,
Contractor agrees that it will not engage in, nor permit such subcontractors as it
may employ, to engage in discrimination in employment of any person because of
the age, race, color, sex, national origin or ancestry, or religion of such persons.
Violation of this provision may result in the imposition of penalties referred to in
Labor Code Section 1735.
(10) AUDIT City shall have the option of inspecting and/or auditing all records and other
written material used by Contractor in preparing its statements to City as a
condition precedent to any payment to Contractor.
(11) NOTICE All written notices to the parties hereto shall be sent by United States
mail, postage prepaid by registered or certified mail, return receipt requested,
addressed as follows:
IF TO CITY:
Office of the City Clerk
CITY OF PALM DESERT
73-510 Fred Waring Drive
Palm Desert, CA 92260
IF TO CONTRACTOR:
M&M Sweeping, Inc.
PO Box 878
Thousand Palms, CA 92276
(12) LITIGATION COSTS In the event an action is filed by either party to enforce any
rights or obligations under this Agreement, the prevailing party shall be entitled to
recover reasonable attorney's fees and court costs, in addition to any other relief
granted by the court.
(13) AUTHORITY TO EXECUTE AGREEMENT Both City and Contractor do warrant
that each individual executing this Agreement on behalf of each party is a person
duly authorized.
IN WITNESS WHEREOF the parties hereto have executed or caused to be executed by
their duly authorized officials, this Agreement which shall be deemed an original on the
date first above written.
CITY OF PALM DESERT
A Municipal Corporation
SUSAN MARIE WEBER, MAYOR
CITY OF PALM DESERT, CALIFORNIA
CONTRACTOR
MICHAEL ZABLAN, PRESIDENT
M&M SWEEPING, INC.
ATTEST:
RACHELLE D. KLASSEN, CITY CLERK
CITY OF PALM DESERT, CALIFORNIA
APPROVED AS TO FORM:
CITY ATTORNEY
APPROVED AS TO CONTENT:
TOM GARCIA, P.E.
DIRECTOR OF PUBLIC WORKS
CONTRACTOR NOTARY ACKNOWLEDGMENT
State of California }
)SS
County of }
On , 20 , before me, , a Notary
Public, personally appeared , who
proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowledged to me that he/she/they
executed the same in his/her/their authorized capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s), or the entity upon behalf of which the
person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature (Seal)
CITY OF PALM DESERT
Payment Bond
KNOW ALL MEN BY THESE PRESENTS:
THAT WHEREAS, the City of Palm Desert (sometimes referred to hereinafter as
"Obligee") has awarded to (hereinafter designated as the
"CONTRACTOR"), an agreement dated described as follows:
COMMERCIAL AND RESIDENTIAL STREET SWEEPING SERVICES FY 2020
through FY 2021 CONTRACT NO. C38460 — PROJECT NO. 754-20, (hereinafter
referred to as the "Contract"); and
WHEREAS, said CONTRACTOR is required to furnish a bond in connection with said
Contract, and pursuant to Section 9100 of the California Civil Code;
NOW, THEREFORE, we, M&M Sweepinq, Inc., the undersigned CONTRACTOR, as
Principal, and
a corporation organized and existing under the laws of the State of
, and duly authorized to transact business under the laws of the State of California,
as Surety, are held and firmly bound unto the City of Palm Desert and to any and all
persons, companies or corporations entitled to file stop payment notices under Section
9100 of the California Civil Code, in the sum of Three Hundred Four Thousand Five
Hundred Fiftv One and 00/100 Dollars ($304,551.00), said sum being not less than one
hundred percent (100%) of the total amount payable by the said Obligee under the terms
of the said Contract, for which payment well and truly to be made, we bind ourselves, our
heirs, executors and administrators, successors and assigns, jointly and severally, firmly
by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, that, if said CONTRACTOR, his or
its heirs, executors, administrators, successors or assigns, or Subcontractors, shall fail to
pay for any materials, provisions or other supplies, implements, machinery or power used
in, upon, for or about the performance of the Public Work contracted to be done, or to pay
any person for any work or labor of any kind, or for bestowing skills or other necessary
services thereon, or for amounts due under the Unemployment Insurance Code with
respect to such work or labor, or for any amounts required to be deducted, withheld, and
paid over to the Employment Development Department from the wages of employees of
said CONTRACTOR and his or its Subcontractors pursuant to Section 13020 of the
Unemployment Insurance Code with respect to such work and labor as required by the
provisions of Section 9100 et seq. of the Civil Code, or for any amounts required to be
deducted, withheld, and paid over to the Franchise Tax Board or Internal Revenue
Service from the wages of employees of the CONTRACTOR or his or its Subcontractors,
the Surety or Sureties hereon will pay for the same in an amount not exceeding the sum
specified in this bond, otherwise the above obligation shall be void. In addition to the
provisions herein above, it is agreed that this bond will inure to the benefit of any and all
persons, companies and corporations entitled to serve stop payment notices under
Section 9100 of the Civil Code, so as to give a right of action to them or their assigns in
any suit brought upon this bond.
The Surety, for value received, hereby stipulates and agrees that no change, extension
of time, alteration or addition to the terms of the said Contract or to the work to be
performed thereunder or the Specifications accompanying the same shall in any way
affect its obligations on this bond, and it does hereby waive notice of any such change,
extension of time, alteration or addition to the terms of the Contract or to the
Specifications.
No final settlement between the Obligee and the CONTRACTOR hereunder shall abridge
the right of any beneficiary hereunder, whose claim may be unsatisfied.
CONTRACTOR and Surety agree that if the Obligee is required to engage the services
of an attorney in connection with the enforcement of the bond, each shall pay Obligee's
reasonable attorney's fees incurred, with or without suit, in addition to the above sum.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this
day of , 20
PRINCIPAVCONTRACTOR:
M&M Sweepinq, Inc.
(Typed Name of CONTRACTOR)
By:
(Signature)
(Typed Name and Title)
(Signature must be notarized)
SURETY:
(Typed Name of Surety)
By:
(Signature of Attorney -in -Fact)
(Typed Name of Attorney -in -Fact)
(Signature must be notarized)
The rate of premium on this bond is $ per thousand.
The total amount of premium charged: $
(the above must be filled in by corporate surety).
IMPORTANT: Surety companies executing bonds must possess a certificate of authority
from the California Insurance Commissioner authorizing them to write surety insurance
defined in Section 105 of the California Insurance Code, and if the work or project is
financed, in whole or in part, with federal, grant or loan funds, it must also appear on the
Treasury Department's most current list (Circular 570 as amended). THIS IS A
REQUIRED FORM.
Any claims under this bond may be addressed to:
(Name, Address and Telephone No. of Surety)
(Name, Address and Telephone No. of agent or representative for service of process in
California if different from above)
SURETY ACKNOWLEDGMENT
A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed
the document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of that
document.
County of
On
before me,
personally appeared
who proved to me on the basis of
satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within
instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature
CITY OF PALM DESERT
Performance Bond
KNOW ALL MEN BY THESE PRESENTS: That whereas the City of Palm Desert has
awarded to M&M Sweeping, Inc. hereinafter designated as the "Principal", a contract
for:
COMMERCIAL AND RESIDENTIAL
STREET SWEEPING SERVICES FY 2019 through FY 2020
CONTRACT NO. C38460 - PROJECT NO.754-20
WHEREAS, said Principal is required under the terms of said contract to furnish a
good and sufficient bond for the performance of said contract:
NOW THEREFORE, WE, M&M Sweeping, Inc., the Principal, and
as Surety, are held and
firmly bound unto the City of Palm Desert hereinafter called the City, in the penal sum of
Three Hundred Four Thousand Five Hundred Fiftv One and 00/100 Dollars
($304,551.00), being 100% of the contract amount in lawful money of the United States
of America for the payment of which sum well and truly to be made, we hereby bind
ourselves, our heirs, executors, administrators, and successors, jointly and severally,
firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that if the above bounded
Principal, his executors, heirs, administrators, and successors, or assigns, shall in all
things stand to and abide by, and well and truly keep and perform the covenants and
agreements in the said contract and any alterations thereof made as therein provided, on
his or their part, to be kept and performed at the time and in the manner therein specified,
and in all respects according to their true intent and meaning, and shall indemnify and
save harmless the City, its officers and agents, as therein stipulated, then this obligation
shall become null and void; otherwise, it shall be and remain in full force and virtue.
And the said Surety, for value received, hereby stipulates and agrees that no
change, extension of time, alteration or addition to terms of the contract or to the work to
be performed thereunder or the specifications accompanying the same shall in any wise
affect its obligations on this bond, and it does hereby waive notice of any such change,
extension of time, alterations or additions to the terms of the contract or to the work or the
specifications.
Should it become necessary for the City to institute a lawsuit or any other legal
proceeding to enforce the terms and conditions of this bond, then all costs of said
proceeding, including attorneys' fees, shall be awarded to the prevailing party.
IN WITNESS WHEREOF, identical counterparts of this instrument, each of which
shall for all purposes be deemed an original thereof, have been duly executed by the
Principal and Surety above named, on this day of , 2019.
SURETY
BY:
(Signature must be notarized)
INSURANCE COMPANY and/or AGENT
ADDRESS
TELEPHONE NUMBER
PRINCIPAL
BY:
(Signature must be notarized)
SURETY ACKNOWLEDGEMENT
A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed
the document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of that
document.
State of California
County of
92
before me,
personally appeared
who proved to me on the basis of
satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within
instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the
instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature