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HomeMy WebLinkAboutC38330 RS Construction & Development, Inc. - TI for State Rehabilitation Office 774-18CONTRACT NO. C38330 STAFF REPORT CITY OF PALM DESERT PUBLIC WORKS DEPARTMENT MEETING DATE: January 9, 2020 PREPARED BY: Emily Roethler, Project Manager REQUEST: Award Contract No. C38330 in the amount of $215,000 to RS Construction & Development, Inc. of Upland, California, for the Tenant Improvements for the State Department of Rehabilitation at the Parkview Office Complex (Project No. 774-18). Recommendation By Minute Motion: 1. Award Contract No. C38330 in the amount of $215,000 to RS Construction & Development, Inc. of Upland, California, for the Tenant Improvements for the State Department of Rehabilitation at the Parkview Office Complex Project; 2. Appropriate $100,000 from the Parkview Office Complex Capital Fund to Account No. 5104195-4337020; 3. Authorize the Director of Finance to set aside a 10 percent contingency in the amount of $21,500; 4. Authorize the City Manager or designee to review and approve written requests for the use of contingency change orders for unanticipated conditions, per Section 3.30.170 of the Palm Desert Municipal Code; and, 5. Authorize the City Manager to execute the Agreement. Upon approval, funds will be available in Account No. 5104195-4337020, Parkview Office Complex Capital Account. Strateqic Plan The Tenant Improvement Project for the State at the Parkview Office Complex is a maintenance activity and, as such, does not contribute directly to the objectives of the City's Strategic Plan. Background Analvsis As part of the existing lease agreement between the State of California Department of Rehabilitation and the City of Palm Desert for Suite 102 at the State Building, as negotiated by Staff, the City is responsible for all items identified as the Base Bid Items of the Bid Documents. These improvements include professionally cleaning all flooring, window film and weather stripping, bracing all cabinets and files for seismic activity, and making the required ADA improvements to the Suite. January 9, 2020 - Staff Report Award Contract for Department of Rehabilitation Tenant Improvements (Project No. 774-18) Page 2of2 Staff is also recommending renovating both of the existing restrooms as they have ADA deficiencies, have outdated fixtures, and are becoming a maintenance issue. These improvements will be made at the sole cost of the City. The remaining items of work in the Bid Documents listed as Additive Alternates 1 through 6 (Ad. 1-6), are additional improvements to be paid for by the Tenant. The City will construct these improvements under the proposed construction contract and be reimbursed by the Tenant under the terms of the existing lease agreement. On November 21, 2019, after being duly advertised, sealed bids were opened and read aloud by the Office of the City Clerk with the following results: Contractor RS Construction & Development, Inc R Dependable Construction, Inc. Location Bid Amount Upland, CA $215,000.00 San Bernardino, CA $310,600.00 The Bid Documents list a cost of $215,000 for all improvements, with construction anticipated to take 75 calendar days. The City would enter into a contract for the bid amount of $215,000, and be responsible for $166,670 of the construction costs, with the State being responsible for $48,330, which would be reimbursed to the City under the terms of the lease agreement. Fiscal Analvsis After the contract is awarded, the City will pay for the costs of all the improvements. Upon completion of the project, the State will reimburse the City for the State's share of costs with their monthly rent, amortized over the initial term of the lease extension (normally 48 months), at an interest rate of approximately 6%. The anticipated gross rent during the life of the lease and its extensions will be $899,907. In addition the City will be reimbursed by the State of California for their cost of $48,330 paid in 48 installments. LEGAL REVIEW Approved as to Form DEPT. REVIEW N/A l �� Robert W. Hargreaves Tom Garcia, P.E. City Attorney Director of Public Works y`!Manager, Lauri Aylaian FINANCIAL ASSISTANT REVIEW CITY MANAGER e M. Moore ndy Firestine Director of Finance Assistant City Manager CONTRACTOR: RS Construction & Development, Inc. 1042 N. Mountain Avenue, Suitt-Fburgcm ,l2TION Upland, California 91786 APPROVED DEN", ATTACHMENTS: 1) Contractor's Bid RECEIVED OTHER 2) Agreement and Bonds MEETING DA �- ! ACI 3) Vicinity Map AYES- nkL 5 Whin .)q., toebp-LatO P NOES: h ITI)L ABSENT: n� ABSTAIN- MlVk- VERIFIED BY:.RCt�,ffl, Original on File with Ci Jerk's Office C- CONTRACTOR'S BID DEPARTMENT OF REHABILITATION TENANT IMPROVEMENT PROJECT NO.774-18 CONTRACT NO. C38330 TO: CITY OF PALM DESERT, `CITY" DATE: 11 /20/2019 BIDDER: RS Construction & Development, Inc. "CONTRACTOR" The UNDERSIGNED, "CONTRACTOR", having carefully examined the site and the Contract Documents for the construction of, DEPARTMENT OF REHABILITATION TENANT 1MPROVEMNT, PROJECT NO. 774-18, CONTRACT NO. C38330, hereby proposes to construct the work in accordance with the Contract Documents, including Addenda No(s). 1.2 for the amount stated in this Bid. By submitting this Bid, the Contractor agrees with the City: 1. That unless withdrawn in person by CONTRACTOR or some person authorized in writing by CONTRACTOR before the time specified in the Notice Inviting Bids for the public opening of bids, this Bid constitutes an irrevocable offer for 80 calendar days after that date. 2 The CITY has the right to reject any or all Bids and to waive any Irregularities or Informalities contained in a Bid. 3 That the contract shall be awarded only by the governing body of CITY. Said contract shall only be deemed awarded after the CONTRACTOR'S complete submission of all contract documents, bonds, Insurance documentation, and the CITY shall obtain all necessary signatures of the governing body, at which time the contract shall be deemed awarded. 4. To submit to CITY such information as CITY may require to determine the Bidder's financial standing experience and to perform the work. 5. That the accompanying cash, certified or cashier's check or Bid Bond constitutes a guarantee that if awarded the contract, CONTRACTOR will execute the Agreement and deliver the required bonds and certificates of insurance within 10 days after notice of award. If CONTRACTOR fails to execute and deliver said documents, the cash, check or B I d B on d is to be charged with the costs of the resultant damages to CITY, including but not limited to publication costs, the difference in money between the amount bid and the amount in excess of the bid which costs CITY to do or cause to be done the work involved, lease and rental costs, additional salaries and overhead, Increased interest and costs of funding the project, attorney expense, additional engineering and architectural expense C-1-2 and cost of maintaining or construction alternate facilities occasioned by the failure to execute and deliver said documents. a It Is understood that the quantifies shown hereon, except for those quantities marked *Lump Sum", are estimates and the final payment will be based upon the actual work performed, subject to such adjustment and alterations as elsewhere provided herein. 2 Professionally dean hard surface floors LS 1 $ $ 3,969.43 3,969.43 3 Existing Interior window covering to remain. LS 1 $ $ Provide and install window film and 3,133.87 3,133.87 weatherstripping. Provide window film samples to KELPS Planner for approval. Replace missing exterior door screen. 4 Brace all cabinets and fifes for seismic. LS 1 $ $ 1,955.28 1,955.28 5 %41scellaneou3 ADA repairs per Exhibit B of LS 1 $ $ he Specifications. Including preparation of any plans required for a Building Permit. 62,187.77 62,187.77 SUB=TOTAL: BASE BIDIPRICE $ 88,376.45 like -new condition. Match existing. 2,646.29 2,646.29 AD. 2 Add 4" wood chair rail to all walls. Paint to LS 1 $ $ match wall. Provide specification to RELPS Planner for approval. 2,681.35 2,681.35 AD. 3 Provide and install ADA compliant vision LS 1 $ panel. Patch, repair, and repaint door and frame as necessary for like -new 33,740.17 appearance. Paint to match existing. C-2-2 33,740.17 AD. 4 Add voice/data in wall. Match existing. LS 1 $ $ 3,969.43 3,969.43 AD. 5 Add dedicated 20 amp duplex outlet for LS 1 $ $ VPS. 27646.29 2,646.29 AD. 6 Add receptacle. Convert base feed as LS 1 $ $ !seeded, 2,646.29 2,626.29 AD. 7 Remove all existing tile in men's and LS 1 $ $ women's restrooms (floor, walls, counters, 7,919.02 7,919.02 etc.) AD. 8 Provide new wainscoting and paint for LS 1 $ $ men's and women's restrooms 17,094.03 17,094.03 AD. 9 Install ceramic tile for flooring In men's and LS 1 $ $ women's restrooms 15,460.94 15,460.94 AD.10 Remove existing partitions and install new LS 1 $ $ partitions in men's and women's restrooms 18,141.63 18,141.63 AD. 11 Replace existing faucets, sinks, and toilets LS 1 $ $ in men's and women's restrooms 14,963.77 14,963.77 AD. 12 Remove existing dispensers in men's and LS 1 $ $ women's restrooms; Re -Install If condition is 4,714.35 4,714.35 acceptable to the City. Provide and Install new if existing are damaged or irreparable. SUB -TOTAL -ALTERNATE BID PRICE $ 126,623.56 The costs of any work shown or required in the Plans and Specifications, but not specifically Identified as a Pay Item are Included In the related Pay Item(s), and no additional compensation shall be due CONTRACTOR by virtue of CONTRACTOR'S compliance with the Plans and Specifications. SUB TOTAL AMOUNT BASE BID IN FIGURES $ 88,376.45 SUB -TOTAL AMOUNT BASE BID IN WORDS Eighty -Eight Thousand Three Hundred Seventy Six and 45/100 SUB -TOTAL. AMOUNT ALTERNATE BID IN FIGURES $ 126,623.56 SUB -TOTAL AMOUNT ALTERNATE BID IN WORDS One Hundred Twenty -Six Thousand Six Hundred Twenty Three and 56/100 TOTAL BID AMOUNT (BASE BID AND ALTERNATES) IN FIGURES $ 215,000 C-3-2 TOTAL BID AMOUNT (BASE BID AND ALTERNATES) IN WORDS 'NO y Q N)-r)gn AND DoUASS 0 ti►rl � \ c�0 IN WITNESS WHEREOF CONTRACTOR executed this Bid as of date set forth on Page By:-:-- Signature (must be notarized) Title: President 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. State of Califomia County of San Bernardino on November 20 2p 19 before me, Adrian Cazares, Notary Public personally appeared Ricardo Serna who proved to me on the basis of satisfactory evidence to be the personW whose name($) IsIve subscribed to the within Instrument and acknowledged to me that he/shMbey executed the same In hislbed0Wr authorized capacityp"), and that by hWborlom t signatures(s) on the instrument the person(a), or the entity upon behalf of which the personM acted, executed the Instrument. I certify under PENALTY OF PERJURY under the laws of the State of Cai{fomla that the foregoing paragraph is true and correct. WITNESS my hand and official seal. dell Signature Notary Public C-4.2 ADRIAN CADRES j COMM. #2232867 z Notary Public • Califomla o San 8emarchno County !ly Comm. Expires Afar. 2.2022 f D — INFORMATION REQUIRED OF BIDDER TO ACCOMPANY BID The bidder is required to supply the following information. Additional sheets may be attached if necessary. Additional information may be required of the successful bidder. (1) Company Name RS Construction & Development. Inc. (2) Address 1042 N. Mountain Avenue, Suite B-552. Upland. CA 91786 (3) Telephone No. (909) 920-1144 (4) Type of Firm (Individual, Partnership or Corporation) Corporation (5) Corporation organized under the laws of the State of California (6) Contractor's License No. 1005429 Exp. Date 10/31/2021 (7) Department of Industrial Relations Contractor Registration number: 1000053445 (8) Email Address of Contractor's DIR Contact info(a),rscdinc.com (9) DIR Classifications General Building Contractor (10) Have you or any of your sub -contractors been debarred: Yes ❑ No X❑ If yes, provide additional information on a separate sheet. (11) List the names and addresses of all owners of the firm or names and titles of all officers of the corporation: (Use separate sheet if necessary.) Ricardo Serna - President 1042 N. Mountain Avenue, Suite B-552 Upland, CA 91786 (12) List at least three similar projects (on -going or recently completed): 1C6nt4*Ainount Cl@s&ofWork t bdte.Cothpletedi 1. $121,000 Remodel 05/2019 2. $90,000 Renovation 08/2019 3. $152,000 Remodel 08/2018 D-1 iNanie, A4dfpss & Telephone No.-df Owner Baldy View ROP 2890 Inland Empire Blvd., STE. 100 Ontario, CA 91764 (909) 980-6490 City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92702 (714)647-5400 City of El Monte 11333 Vally Boulevard El Monte, CA 91731 (626)258-8624 (13) Pursuant to California Public Contracting Code, Section 4100 et Seq., the following list gives the name, business address, the DIR Public Works Contractor Registration number, portion of work (description of work to be done) for each subcontractor that will be used in the work if the bidder is awarded the Contract, (Additional supporting data may be attached to this page. Each page shall be sequentially numbered, and headed "Proposed Contractors" and shall be signed.) The Bidder shall list all subcontractors who will perform work or labor or render service to the prime contractor In excess of one-half of one percent of the prime's bid. Notwithstanding the foregoing, if the work involves the construction of streets and highways, then the Bidder shall list each subcontractor who will perform work or labor or render service to the Bidder in or about the work in an amount in excess of one-half of one percent or $10,000, whichever is greater. Failure to include the subcontractor's MR regjstration number may result In the b being reieeted as non -responsive. Subcontractor's Name: CERAMIC TILE WORKS & DESIGNS INC License Number: 854604 DIR Contractor Registration No. 1000007884 Business Address: 470 E PRINCELAND COURT STE 3, CORONA, CA 92879 Telephone: (951) 340-9260 DIR email address: cindy@ctwdesignsinc.com Work Description: Tiling Subcontractor's Name: License Number: Business Address: Telephone: DIR email address: Work Description: Subcontractor's Name: License Number: Business Address: Telephone: DIR email address: Work Description: DIR Classifications: Tile Setter/Finisher Percent of Work: 6-5 '/- DIR Contractor Registration No. DIR Classifications: Percent of Work: DIR Contractor Registration No. DIR Classifications: Percent of Work: (14) List the name of the person from your firm who inspected the site of the proposed work: Ahmad Deeb D-2 (15) A financial statement or other information and references sufficiently comprehensive to permit an appraisal of your current financial condition may be required by the City. (16) Contractor hereby swears under penalty of perjury that this information provided is true and correct. By: Title: President Contractor's Signature D-3 E — PUBLIC WORKS CONTRACTOR DIR REGISTRATION CERTIFICATION Pursuant to Labor Code sections 1725.5 and 1771.11, all contractors and subcontractors that wish to bid on, be listed in a bid proposal or enter into a contract to perform public work must be registered with the Department of Industrial Relations. See htto://www.dir.ca.00v/Public- Works.html for additional information. No bid will be accepted nor anv contract entered into without proof of the Contractor's and Subcontractor's current registration with the Department of Industrial Relations to perform public work. Bidder herebv certifies that it is aware of the registration requirements set forth in Labor Code sections 1725.5 and 1771.1 and is currently registered as a contractor with the Department of Industrial Relations. NAME OF BIDDER: RS Construction & Development, Inc. DIR REGISTRATION NUMBER: 1000053445 DIR REGISTRATION NUMBER EXPIRATION DATE: 06/30/2020 DIR CERTIFIED PAYROLL EMAIL ADDRESS: infoArscdinc.com Bidder further acknowledges: 1. Bidder shall maintain a current DIR registration for the duration of the project. 2. Bidder shall include the requirements of Labor Code Sections 1725.5 and 1771.1 in its contract with any and all subcontractors and ensure that all subcontractors are registered at the time of the bid opening and maintain registration status for the duration of the project. 3. Failure to submit this form or comply with any of the above requirements may result in the bid being deemed non -responsive. 4. Within five days of award, Contractor will provide to the City all Labor Classifications that will be employed during the project, sorted by Contractor or subcontractor. Name of Firm: RS Construction & Development, Inc. �—`- Signature: Printed Name: Ricardo Serna Title: President Dated: 11 /20/2019 E-1 F — NONCOLLUSION DECLARATION To be Executed by Bidder and Submitted with Bid The undersigned declares: I am thep esid«iof RS Construction & Development. Inc. , the party making the foregoing bid. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a bidder 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 bidder. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on the 13th day of November 20 19 , at Upland. California city state CONTRACTOR By: -�==q � Signature Title: President F-1 G-BIDDER'S BOND To Accompany Bid KNOW ALL MEN BY THESE PRESENTS, That we, RS Construction & Development. Inc. as principal, and The Ohio Casualty Insurance Company as surety, are held and firmly bound unto the Cityof Palm Desert in the sum of $ lei Mercer cirnmoimt Bid (10% of bid) to be paid to the said City or its certain attorney, its successors and assigns; for which payment, well and truly to be made, we bind ourselves, our heirs, executors and administrators, successors or assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the certain bid of the above bounden principal to perform certain work described as follows: DEPARTMENT OF REHABILITATION TENANT IMPROVEMENTS Project No. 774-18 Contract No. C38330 And the general items of work to be done hereunder consist of {SPECIFIC TO JOB} and dated NOV. 21sT, 2019 is accepted by the City of Palm Desert. And if the above bounden principal shall duly enter into and execute a contract for such construction, and shall execute and deliver the Performance Bond and Payment Bond and insurance certificates as required by said contract, then this obligation shall become null and void; otherwise it shall be and remain in full force and effect. 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 attorney's fees, shall be awarded to the prevailing party. IN WITNESS WHEREOF, We hereunto set our Hands and Seals this 14TH day of NOVEMBER 20 19 Contractor's Name: B$ Construction & Development, Inc. Contractor's Signature: (Signature must be notarized) Title: President Address: 1042 N. Mountain Avenue, Suite B-552, Upland, CA 91786 Telephone: (909) 920-1 144 G-1 Surety's Name: The Ohio Casual nsurance Company Surety's Signature: (Signature must be notarized) Title: PHILIP E. VEGA, ATTORNEY -In- CT Address: 534 E. BADILLO ST. COVINA, CA 91723 Telephone: 116-a59-loco G-2 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. State of California County of San Bernardino On November 14 , 20 19 before me, Adrian Cazares. Notary Public personally appeared Ricardo Serna who proved to me on the basis of satisfactory evidence to be the person(s) whose name is/aK subscribed to the within instrument and acknowledged to me that he/W/they executed the same in his/hx-h>9ir authorizedcapacity�s), and that by his/ r/� signatures(al on the instrument the person�', 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 otary Public G-3 J ADRIAN CADRES COMM. #2232867 z Notary Public • California o = San Bernardino County My Comm. Expires Mar. 2.2022 1 Thb Power of Adomy crafts the acts of those named heron, anti thy have no wthorlty to bind the Company except In the manner and to the extent herein stated. Libei y'' Liberty Mutual Insurance Company Miitiialr The Ohio Casualty Insurance Company Certificate No.82o'1903-969677 SURETY West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty htsuranoe Company Is a corporation duty organized under the taws of the Slate of New Hampshire, that Liberty Mulual Insurance Company is a corporation duty organized under the laws of the Slate of Massaclusetts, and West American Insurance Company Is a corporation duly organized under the laws of the State of I dilare (herein Coffesthrety caled the 'Compeniesj, pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Britton Chrhsriansen, Myrna Smith, Philip E- Vega; Kevin E Vega al a the city of Covina state of California each Indiviol lly C there be more than area named, its true and lawful atbmey-In•fact to make, execute, seal, aduwwfedge and dealer, for and on its behalf as surety and as As act and deed, any and all undertakings, bonds, recopnizances and other surety obligations, in pursuance of these presents and she% be as binding upon the Companies as It they have been duty signed by the president and attested by the secretary of the Companies in that own proper PKSOns• IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 15th day of August , 2019 . Liberty Mutual Insurance Company ` %Hsu � tl( uwsu tnso'? The Ohio Casualty Insurance Company °Oroti�'on� y`�irp+�04r� � 3c°�0tir�a?(� WestAmeerricanlnsuranceCompany a 12 c c 1919 c 1991 0 / /A�W� ' N � r� tee�CMUf��Dr �O �M�rA�Dt, I MeuM�' D `Jyl/ °l By c David M. Carey, Assistant Secretary = State of PENNSYLVANIA :3 County of MONTGOMERY s3 m �m ru On this 15th day of August 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance o `0 3 Company, The 6W Casualty Company, and West American Insurance Company, and that he, as such, being autharzed so to do, execute the foregoing Instnunent for the purposes — H y > therein contained by signing on behalf of the corporations by himself as a duty authorized officer. �, w T M IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my noLYW seal at King of Prussia, Pennsytvanla, on the day and year first above written. E CL sib h'a.s� �r�i O` ;�/ :..,i^' i 1 P COMMONWEALTH f PENNSYLVANUI Q� �rY _ Tereae peNeae,lraery Berm O Upper Merm Tip . Maepanery CourxT By: C M �: r My ComNetlm EA0i sure, 26. 2021 3 E ?� ti n,t n• v� .r��+. �..m.eon a wiz +.. Teresa Pastells, Notary Pubic a m onur v+rry tw^J $ M `% —' N r err This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Auttartzatlons of The Ohio Casualty Insurance Company Liberty Mutual = o .E Insurance Company, and West American Insurance Company which resc'udons ore now In hA force and effect reading as follows: `o m E air ARTK:LE IV -OFFICERS: Section 12. Power of Attorney. it u o Any officer or other official of the Corporation authorized for that purpose in w Wg by the Chairman or the President, and subject to such imitation as fie Chairmen Of the au v_ > President may prescribe, shall appoint such atomeys-In•fac4 as may he necessary In act In behalf of the Corporation to make, execute, seal, acknowledge and delver as surety > o 'm any and all undertakings, bands, rewgnizances rino*dons other surety oalons Such atiomeys-In•fact, subject to one limitations set forth In their respective powers of attorney, She# L N 17- have full power to bind the Corporation by their Anabme and execution of any such Instruments and to attach thereto the seal of the Corporation. When so executed, such — kin Z u Instruments shall be as binding as # signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomy-inunder the a in provislons of this article may be revoked at any time by the Board, the Chairman, the Pres ded or by the officer or officers granting such power or authority o 0 ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings. L Any officer of the Company authorized for that purpose in wdttg by Me chairman or the presId 1, and subject to such limitations as the Chairman or the president may prescribe, '2 . shall appoint such adomeys•lndacL as may be necessary Do ad h behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds. recogrizances and other surety otil gdoru. Such anomeys-in-fact subject to the %mitatlons set forth In their respective powers of ahorney, shall have full power to bind the Company by their signabrre and execution of any such instruments and io attach thereto the seal of the Company. When so executed such instnunerhts shall be as binning as if signed by the president and alerted try the secretary. Certificate of Designation - the President of the Company, acing pursuant to the Bylaws of the Company, authorizes David M Cary, Assistant Secretary to appoint such attorneys -In - fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surely obligations. Authorization - By unanknous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signalure of any assistant secretary of the Company. wherever appearng upon a certified copy of any power of attorney issued by the Company In connection, wroth surety bonds, shall be valid and binding upon the Company with the same force and effect as Cougar, manualy affixed. 1, Ranee C. Jewdyn. the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do heeby certify Lhal the onginal power of attorney of which the loregoirhg is a full true &)it correct copy of line Power of Attorney executed by said Companies, is In full force aM effect and has not been revoked IN TESTWONY WHEREOF, I `ave hereunto set my hand and affixed the seats of sad Companies this 14TH day of NOVEMBER , 2019 �1 .ice �'O SIN f S ire "`LLLn G t r, s 1912 � c 1919 31991 r+, re s►`c ` t By: d�ej' °.ue*�aD O�Nl �w+F�abr 10 our! �,D Renee C Llewellyn, Assistant Secretary Li 12073 LMIC OC C WWVC Mac Co be201a CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 LOS ANGELES On NOV 1 4 7019 before me, KEVIN EDWARD VEGA. NOTARY PUBLIC Date Mere Insert Name and Title of the Officer personally appeared PHILIP E. VEGA Name(s) of Signer(s) 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. ;,.. KEVIN EDWARD VEGA .? >i Notary Public - California Los Argeles County Z Z Commission n 2151113 My Comm Expires Apr 29.2020# Place Notary Seat Above 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_afficiat s Signature Signature of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Tine or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited O General 0 Individual O Attorney In Fact ❑ Trustee O Guardian or Conservator • Other: Signer Is Representing: Signer's Name: O Corporate Officer — Title(s): ❑ Partner — C Limited ❑ General O Individual ❑ Attorney in Fact O Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: �rii-.i,�ri�r7i4�IW.Wr WJYv�M��IL r�LO�i L�IV�I.,i�J1.NL„U raOVdi+4�..M�...WMY�i•VIC.'if�iltrYiv�Yu41..aYW�W.YVJY..�tv�H.�YW.YM-O.r�Wi 02014 National Notary Association • www.NationaiNotaiy.org • 1-600-US NOTARY (1-600-876-6827) Item 1t5907 11/21/2019 Contractor Information hops://cadir.secure. force.com/ContraclorSearch/Prin tRegOetails Legal Entity Name RS CONSTRUCTION 8 DEVELOPMENT Legal Entity Type Corporation Status Active Registration Number 2000053445 Registration effective date 7/1/2019 Registration expiratlon date 6130/2020 Mailing Address 1042 N MOUNTAIN AVE SUITE B•552 UPLAND 91786 CA Uni .. Physical Address 1D42 N MOUNTAIN AVE SUITE B•552 UPLAND 91786 CA Uni . Email Address Trade Name/DBA Llcense Number(s) CSLB 1005429 Legal Entity Information Agent of Service Name: ANNA AGBINCOLA Agent of Service Mailing Address: 130 S MOUNTAIN AVE SUITE H UPLAND 91786 CA United States orAmerica Corporation Number. Federal Employment Identification Number. President Name: RICARDO SERNA Vice President Name: Treasurer Name: Secretary Name. CEO Name: Workers Compensation Do you lease employees No through Professional Employer Organization (PEOM Please provide your current workers compensation Insurance information below: PEO PEO PEO PEOlnformationName Phone Email Registration History Effective Date Expiration Date 5/18/2018 6/30/2019 10/23/2017 6/30/2028 7/1/2019 6/30/2020 Insured by Carrier Policy Holder Name:RS CONSTRUCTION & DEVELOPMENTInsurance Carrier:BERKLEY NETPolicy Number: BNUWC0142536Inception date: 12 / 12 /201BExpiration Date:12/12/2019 hops://cadir.secure.force.com/ContractorSearr.h/PdntRegDetals 1'j 11/21/2019 Contractor Information https J/cadir.secure.force.com[ContractorSearch/PrintRegDetails Legal Entity Name CERAMIC TILE WORKS 8 DESIGNS, INC. Legal Entity Type Corporation Status Active Registration Number 1000007884 Registration effective date 7/112019 Registration expiration date 6/30/2020 Mailing Address 470 E PRINCELAND CT STE 3 CORONA 92879 CA Un,ted Stat Physical Address 470 E PRINCELAND CT STE 3 CORONA 92879 CA Unted Slat Email Address Trade Name/DBA CTW 8 DESIGNS. INC License Number(s) Other854604 Legal Entity Information Corporation Number. 854604 Federal Employment Identification Number. President Name: ELDON MOON Vice President Name: Treasurer Name: JOHN MOON Secretary Name: CEO Name: Agent of Service Name: AMORELLi ROSEMANN ASSOCIATES INC Agent of Service Mailing Address: 3110 E Guasti Road Suite 500 ONTARIO 91761 CA United States of America Workers Compensation Do you lease employees No through Professional Employer Organization (PEO)?: Please provide your current workers compensation insurance Information below: PEO PEO PEO PEOlnformationName Phone Email Registration History Effective Date Expiration Date 5/10/2018 6130/2019 5/8/2017 6130/2018 5/23/2016 6/30/2017 7/1/2015 6/30/2016 2/2/2015 6/30/2015 7/1/2019 6/30/2020 Insured by Carrier Polity Holder Name:CERAMIC TILE WORKS & DESIGNS, INC.Insurance Carrier:ICW GROUPPolicy Number: W50502608405Inception date: 3121/2019Expiration Date:3121/2020 https://cadlr.secure.force.comJContractorSear h/PrintRegDe(ails ill CONTRACT NO. C38330 AGREEMENT THIS AGREEMENT is made and entered into this 9th day of January 2020, by and between City of Palm Desert, California; hereafter called "CITY," and RS Construction & Development. Inc. hereinafter called "CONTRACTOR." W I T N E S S E T H RECITALS: CONTRACTOR has submitted to CITY its Contractor's Bid for the construction of CITY Project, 1. DEPARTMENT OF REHABILITATION, PROJECT NO. 774-18; CONTRACT NO. C38330, in strict accordance with the Contract Documents identified below, and CITY has accepted said Bid. 2- CONTRACTOR states that it has re-examined its CONTRACTOR'S Bid and found it to be correct, has ascertained that its Subcontractors are properly licensed and possess the requisite skill and forces, has examined the site and Contract in accordance with the Contract Documents for the money set forth in its Bid to be paid as provided in the Contract Documents. AGREEMENT: IT IS AGREED BY THE PARTIES AS FOLLOWS: Contract Documents: The entire contract consists of the following: (a) The Agreement, (b) The Notice Inviting Bids, (c) The Instruction to Bidders, (d) The Contractor's Bid, (e) Public Works Contractor DIR Registration Certification, (f) Noncollusion Declaration, (g) The Bidder's Bond, (h) Performance Bond, (i) The Payment Bond, 0) General Specifications, (k) The Special Provisions, (1) The Standard Specifications as modified in other portions of the Contract Documents, (m) The Exhibits, (n) Any Change Orders issued, (o) Any additional or supplemental specifications, notices, instructions and drawings issued in accordance with the provisions of the Contract Documents (p) The Determination of Prevailing Wage Rates for Public Works, (q) Addenda No.(s) . All of said Documents presently in existence are by this reference incorporated herein as if here set forth in full and upon the proper issuance of their documents they shall likewise be deemed incorporated. 2. Contractor shall commence the work within ten calendar days after the date of the Notice to Proceed and will do all things necessary to construct the work generally described in Recital No. 1 in accordance with the Contract Documents and will complete said work within 75 Calendar Days from the Notice to Proceed date to the satisfaction of the Engineer. 3. Contractor agrees to indemnify, defend and save CITY and its officers, agents and employees, and the Engineer harmless from: a Any and all liability, claims, damages, losses or injuries to any person or other entity, including injury to Contractor's employees, and all claims which arise from or are connected with the negligent performance of or failure to perform the work or other obligations of this Agreement, or which are caused or which are claimed to be caused by the negligent or intentional acts or omissions of Contractor, its subcontractors, its agents or employees, and, all expenses of investigating and defending against same, b. Any and all liability, claims, damages, losses or injuries to any and all contractors, subcontractors, material -men, laborers, or any other person, firm or corporation furnishing or supplying work, services, materials or supplies in connection with the performance of the Agreement. c. Attention is directed to the General Specifications - Claims, Liability, and Indemnity Agreement/Hold Harmless sections, which specifications are made part of this Agreement as set forth in Agreement paragraph 1, above. d Attention is directed to Section 6-9, "Liquidated Damages" of the Standard Specifications and is hereby amended to substitute the "City of Palm Desert" in place of "Agency." Liquidated damages shall be $750.00 per calendar day of delay. 4. Should any litigation or arbitration be commenced between the parties concerning the works of improvements as referenced herein, the prevailing party in any such litigation, being the CITY or the Contractor, should be entitled to a reasonable sum for attorney's fees incurred in any such litigation relating to this Contract. 5. This Agreement shall be binding upon all parties hereto and their respective heirs, executors, administrators, successors, and assigns. 6. Contractor shall be paid in the manner set forth in the Contract Documents the amount of its Bid as accepted by CITY, subject to such additions and deductions as may be made pursuant to the Contact Documents and applicable law. Satisfactory Performance: The prime Contractor agrees to pay each Subcontractor under this prime contract for satisfactory performance of its contract no later than 10 days from the receipt of each payment the prime Contractor receives from City of Palm Desert. Any delay or postponement of payment from the above referenced time frame may occur only for good cause following written approval of the City of Palm Desert. Release of Retention: The prime Contractor agrees further to release retention payments to each Subcontractor within 30 days after the Subcontractor's work is satisfactorily completed. Any delay or postponement of payment from the above referenced time frame may occur only for good cause following written approval of the City of Palm Desert. 7. Provisions Required by Law and Contractor Compliance. Each and every provision of law required to be included in these Contract Documents shall be deemed to be included in these Contract Documents. The Contractor shall comply with all requirements of applicable federal state and local laws, rules and regulations, including but not limited to the provisions of the California Labor Code and the California Public Contract Code. 8. Execution of the Agreement by the parties constitutes their agreement to abide by all applicable provisions of the California Labor Code; constitutes contractor's certification that he is aware of the provisions of said Code and will comply with them; and further constitutes Contractor's certification asfollows: "I am aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the work of this contract." 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. CONTRACTOR: BY: (Signature to be notarized) TITLE: CITY: BY: TITLE: Citv Manager of Palm Desert, CA APPROVED AS TO CONTENT: TOM GARCIA, P.E. DIRECTOR OF PUBLIC WORKS ATTEST BY: TITLE: ATTEST BY: TITLE: Citv Clerk of Palm Desert, CA APPROVED AS TO FORM: ROBERT W. HARGREAVES CITY ATTORNEY CONTRACTOR 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. State of California ) 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 of Notary Public PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: That whereas the City of Palm Desert has awarded to RS Construction & Development, Inc. hereinafter designated as the "Principal", a contract for: DEPARTMENT OF REHABILITATION TENANT IMPROVEMENTS PROJECT NO. 774-18 CONTRACT NO. C38330 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, RS Construction & Development, 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 Two Hundred and Fifteen Thousand Dollars ($215.000.00), 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 Contractor, his or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions and agreements in the contract Documents and any alteration thereof made as therein provided, on its part, to be kept and performed at the time and in the manner therein specified, and in all respects according to their intent and meaning; and shall faithfully fulfill all obligations including the one (1) year guarantee of all materials and workmanship; and shall indemnify and save harmless the City, its officials, officers, employees, and authorized volunteers, as stipulated in said Contract Documents, then this obligation shall become null and void; otherwise it shall be and remain in full force an effect. As a part of the obligation secured hereby and in addition to the face amount specified therefore, there shall be included costs and reasonable expenses and fees including reasonable attorney's fees, incurred by the City in enforcing such obligation. As a condition precedent to the satisfactory completion of the Contract Documents, unless otherwise provided for in the Contract Documents, the above obligation shall hold good for a period of one (1) year after the acceptance of the work by the City, during which time if the Contractor shall fail to make full, complete, and satisfactory repair and replacements and totally protect the City from loss or damage resulting from or caused by a defective materials or faulty workmanship. The obligations of Surety hereunder shall continue so long as any obligation of the Contractor remains. Nothing herein shall limit the City's rights or the Contractor or Surety's obligations under the Contract, law or equity, including, but not limited to, California Code of Civil Procedure Section 337.15. Whenever the Contractor shall be, and is declared by the City to be in default under the Contract Documents, the Surety shall remedy the default pursuant to the Contract Documents, or shall promptly, at the City's option: a. Takeover and complete the Project in accordance with all terms and conditions in the Contract Documents; or b. Obtain a bid or bids for completing the Project in accordance with all terms and conditions in the Contract Documents and upon determination by Surety of the lowest responsive and responsible bidder, arrange for a Contract between such bidder, the Surety and the City and make available as work progresses sufficient funds to pay the cost of completion of the Project, less the balance of the contract price, including other costs and damages, for which Surety may be liable. The term "balance of the contract price" as used in this paragraph shall mean the total amount payable to the Contractor by the City under the Contract and any modification thereto, less any amount previously paid by the City to the Contractor and any other set offs pursuant to the Contract Documents. c. Permit the City to complete the Project in any manner consistent with California law and make available as work progresses sufficient funds to pay the cost of completion of the Project, less the balance of the contract price, including other costs and damages, for which Surety may be liable. The term "balance of the contract price" as used in this paragraph shall mean the total amount payable to the Contractor by the City under the Contract and any modification thereto, less any amount previously paid by the City to the Contractor and any other set offs pursuant to the Contract Documents. Surety expressly agrees that the City may reject any contractor or subcontractor which may be proposed by Surety in fulfillment of its obligation in the event of default by the Contractor. Surety shall not utilize the Contractor in completing the Project nor shall Surety accept a bid from the Contractor for completion of the Project if the City, when declaring the Contractor in default, notifies Surety of the City's objection to the Contractor's further participation in the completion of the Project. The Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract Documents or to the Project to be performed thereunder shall in any way affect its obligations on this bond, and it does hereby waive notice to any such change extension of time, alteration or addition to the terms of the Contract Documents or to the Project. 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 , 20 (Corporate Seal) Contractor/Principal Title: (Corporate Seal) Surety Attorney -in -Fact Signatures of those signing for the Contractor/Principal must be notarized and evidence of corporate authority attached. (Attach Attorney -in -Fact Certificate) Title: 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) Signatures of those signing for the Contractor/Principal and Surety must be notarized and evidence of corporate authority attached. A copy of the Power -of -Attorney to local representatives of the bonding company must be attached hereto. 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: Surety Agent or Representative for service of process in California if different than Surety Name: Name: Address: City/State/Zip Code: Telephone No.: Address: City/State/Zip Code: Telephone No.: NOTE: A copy of the Power -of -Attorney authorizing the person signing on behalf of the Surety to do so must be attached hereto. 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 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. 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 of Notary Public PRINCIPAL 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 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. 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 of Notary Public PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: THAT WHEREAS, the City of Palm Desert (sometimes referred to hereinafter as "City") has awarded to RS Construction & Development, Inc. (hereinafter designated as the "CONTRACTOR/PRINCIPAL"), an agreement dated January 9, 2020 described as follows: DEPARTMENT OF REHABILITATION TENANT IMPROVEMENTS, Project Number 774-18, Contract No. C38330 (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; WHEREAS, said Principal is required to furnish a bond in connection with said Contract; providing that if said Principal or any of its Subcontractors shall fail to pay for any materials, provisions, provender, equipment, or other supplies used in, upon, for, or about the performance of the work contracted to be done, or for any work or labor done thereon of any kind, or for amounts due under the Unemployment Insurance Code, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of said Principal and its Subcontractors with respect to such work or labor the Surety on this bond will pay for the same to the extent hereinafter set forth. NOW, THEREFORE, we, RS Construction & Development. 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 Two Hundred and Fifteen Thousand Dollars ($215,000.00), said sum being not less than one hundred percent (100%) of the total amount payable by the said City 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 subcontractors, heirs, executors, administrators, successors or assigns, shall fail to pay any of the persons named in Civil Code Section 9100, 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, 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 or Franchise Tax Board from the wages of employees of said CONTRACTOR and his or its Subcontractors pursuant to Revenue and Taxation Code Section 18663 with respect to such work and labor the Surety or Sureties hereon will pay for the same in an amount not exceeding the sum herein above specified, and also, in case suit is brought upon this bond, all litigation expenses incurred by the City in such suit, including reasonable attorney's fees, court costs, expert witness fees and investigation expenses. This bond shall inure to the benefit of any of the persons named in the Civil Code Section 9100 as to give a right of action to such persons or their assigns in any suit brought upon this bond. It is further stipulated and agreed that the Surety on this bond shall not be exonerated or released from the obligation of this bond by any change, extension of time for performance, addition, alteration or modification, in, to or of any contract plans, specifications, or agreement pertaining or relating to any scheme or work of improvement herein above described, or pertaining or relating to the furnishing of labor, materials, or equipment therefore, nor by any change or modification of any terms of payment or extension of the time for any payment pertaining or relating to any scheme or work of improvement herein above described, nor by any rescission or attempted rescission or attempted rescission of the contract, agreement or bond nor by any conditions precedent or subsequent in the bond attempting to limit the right of recovery of claimants otherwise entitled to recover under any such contract or agreement or under the bond, nor by any fraud practiced by any person other than the claimant seeking to recover on the bond and that this bond be construed most strongly against the Surety and in favor of all persons for whose benefit such bond is given, and under no circumstances shall Surety be released from liability to those for whose benefit such bond has been given, by reason of any breach of contract between the owner or the City and the original contractor or on the part of any obligee named in such bond, but the sole conditions of recovery shall be that the claimant is a person described in the Civil Code Section 9100, and has not been paid the full amount of his claim and that Surety does hereby waive notice of any such change, extension of time, addition, alteration or modification herein mentioned, including but not limited to the provisions of Sections 2819 and 2845 of the California Civil Code. IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of , 20 PRINCIPAUCONTRACTOR: (Typed Name of Principal/Contractor) SURETY: By: By: (Signature) (Signature to be Notarized) (Typed Name and Title) The rate of premium on this bond is $ (Typed Name of Surety) (Signature of Attomey-in-Fact) (Signature to be Notarized) (Typed Name of Attorney -in -Fact) 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). Signatures of those signing for the Principal/Contractor and Surety must be notarized and evidence of corporate authority attached. A copy of the Power -of -Attorney to local representatives of the bonding company must be attached hereto THIS IS A REQUIRED FORM Any claims under this bond may be addressed to: Agent or Representative for service of Surety process in California if different than Surety Name: Name: Address: Address: City/State/Zip Code: City/State/Zip Code: Telephone No.: Telephone No.: 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. State of California 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 of Notary Public PRINCIPAL 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. State of California 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. 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 of Notary Public