HomeMy WebLinkAboutC29560 - LMA18 (918-10) Contract No. C29560
CITY OF PALM DESERT
PUBLIC WORKS DEPARTMENT
STAFF REPORT
REQUEST: WAIVE NON-SUBSTANTIAL BID IRREGULARITY AND AWARD
CONTRACT NO. C29560 FOR LANDSCAPE MAINTENANCE
AREA NO. 18 TO SIERRA LANDSCAPE COMPANY, INC., OF
PALM DESERT, CALIFORNIA, IN THE AMOUNT OF $50,112
AND INCLUDE REPAIR WORK AND SERVICES AT THE
SPECIFIED CONTRACT AMOUNT, NOT TO EXCEED 20% OF
CONTRACT AMOUNT OR $10,022 (PROJECT NO. 918-10)
SUBMITTED BY: Mark Greenwood, P.E., Director of Public Works
CONTRACTOR: Sierra Landscape Company, lnc.
73-771 Dinah Shore Drive, Ste. 200
Palm Desert, CA 92211
DATE: May 27, 2010
CONTENTS: Proposai
Agreement
Payment Bond
Performance Bond
Vicinity Map
Recommendation
By Minute Motion:
1. Waive non-substantial bid irregularity and award Contract No. C29560
for Landscape Maintenance Area No. 18 to Sierra Landscape
Company, Inc., of Palm Desert, California, in the amount of$50,112;
2. Include repair work and services at the specified contract amount, not
to exceed 20% of contract amount or$10,022; and
3. Authorize the Mayor to execute the contract.
Funds are available in the General Fund Account No. 110-4611-453-3320,
Repair/Maintenance Landscaping Service.
Contract No. C29560
Staff Report
Award Landscape Maintenance Area No. 18
May 27, 2010
Page2of4
Backqround
On April 21, 2010, the City Clerk advertised and called for bids for Landscape
Maintenance Area No. 18. Bids were opened and read aloud on Friday, May 7, 2010,
at 3:45 p.m. with the following results:
Contractor Location Price
1 Sierra Landscape Company, Inc. Palm Desert, CA $50,112
2 Kirkpatrick Landscaping Services Indio, CA $67,920
3 Merchants Landscape Services Palm Springs, CA $93,468
4 Hort Tech, Inc. Bermuda Dunes, CA $109,000
5 Vintage Associates, Inc. Bermuda Dunes, CA $119,400
Staff reviewed the bid documents of the lowest bidder, Sierra Landscape Company,
Inc., and determined that all bid requirements have been met with the exception of the
acknowledgement of Addendum No.1. Although Sierra Landscape Company, Inc., did
not clearly acknowledge the Addendum in their bid documents, they did acknowledge it
vocally during the bid opening. Sierra Landscape Company, Inc., is the current vendor
for Landscape Maintenance Area No. 4 and provides good service; therefore, staff
recommends this bid irregularity be waived.
Repair work and services covers unquantifiable activities necessary for landscape
maintenance, which are not part of the landscape maintenance contract. This repair
work and services includes, but is not limited to, repair and replacement of irrigation
equipment; repair, maintenance and replacement of lighting equipment; emergency tree
work; replacement of trees and shrubs; pest control; repair and maintenance of
playgrounds; athletic, repair and maintenance of sports and recreation turF; fertilizer and
soil amendment supplies; and accident and vandalism repair and replacement.
Therefore, staff recommends that, by Minute Motion, City Council waive a non-
substantial bid irregularity and award Contract No. C29560 for Landscape Maintenance
Area No. 18 to Sierra Landscape Company, Inc., of Palm Desert, California, in the
amount of $50,112, include repair work and services at the specified contract amount,
not to exceed 20% of contract amount or $10,022, and authorize the Mayor to execute
the agreement.
G:IPubWakslStaffReports120101May27N5Award Contractto Sierra P91&101Award C29560 to Sierra P918-10.doc
Contract No. C29560
Staff Report
Award Landscape Maintenance Area No. 18
May 27, 2010
Page 3 of 3
Fiscal Analysis
This is an on-going maintenance activity with no fiscal impact beyond the contract
amount.
Prepared� : Departme t e :
H. pen er 'ght Mark Green ood, P.E.
La sca e nager Director of Public Works
C1TY COUNCIL A�'�ION
APYROVF.D DENiED
aul S. Gibson, Finance Director
RF,CEIVED OTHER
MEET G A — a
�� AYES " 1' ' , ���' l`,
Approv I: NOES:
ABSENT:
't,, STAIN:
VERIFIED BY: �
o n M. Wohlmuth, City Manager Qriginal on File wit6 City erk'a Office
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G:IPubWorkslStaff Reportsl20101May 27115 Award Contracf to Siena P918-101Award C29560 to Sierra P918-10.doc
LANDSCAPE MAINTENANCE AREA NO. 18
C�NTRACT NO. C29560, PROJECT NO. 918-10
CONTRACTOR'S PROPOSAL
TCITAL BID AMOUNT AND ATTESTATION OF BIQ�ER
TO: CITY CLERK
City of Palm Desert
73510 ERED WARfNG DRIVE
PALM DESERT, CA 92260
The undersigned deciares that he/she has carefully examined the Bid Terms and
Conditions, the Generai Terms and Conditions, and the Specific Terms and Conditions
accompanying the lnvitation to Bid; that heishe is thoroughly familiar with the cantents
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 inciudes ail routine and seasonal
maintenance described in the speci�cations.
For each item, the averaged one-month maintenance cost shall be indicated and the
total of these costs shalf be extended for the term of the contract.
The costs af any work shown or required in the Speci�cations, but not specifically
identified as a Pay Item are included in the Pay Items, and no additional compensation
shall be due Contractor by virtue of Con#ractor's campliance with the Specifications.
- TOTAL ANNUAI AMOUNT BASE BID IN FIGURES $ so,iia.o0
TOTAL ANNUAL AMOUNT BASE B1D IN WORDS Fifty thousand, one hundred
twelve dollars.
Sierra Landscape Company, Inc.
Company
73-771 Dinah Shore Drive, Suite 200, Palm Desert, CA 92211
Address
� 760 328-8900 ( 760 } 328-8944
Telephone Fax
Paul vanLeeuwen VP Maintenance
Bid Pre ed By Title
s�-s'r° '
Signat re Date
O TRACTOR'S PROPOSAL CONTINUED ON NEXT PAGE
Page 8
LANDSCAPE MAINTENANCE AREA NO. 18
CONTRACT NA. C29560, PROJECT NO. 918-10
CON7IRACTOR'S PROPOSAL
CONTRACTOR'S PROPOSAL BY BID LOCAT{ON
ITEM DESCRIPTlON PRICE PRICE
MONTHL ANNUALLY
1. Ironwood Park � i,o6a.00 $ ia,si6.00 ''
2. Washington Charter Schoo! Park � 9�a.oo � ��,664.00 ✓�
3. CahuillaPark �a�o.00 �3,z4o.00 °''
4. Palm Desert Community G�rdens `P 534.00 �6,4os.oo ��
f
5. Homme-Adams Park $534.00 $6,4os.oo .��
8. Palma Viliage Park � �9s.oo $ 9,576.00 ''
TOTAL{must match totai on previous page) $4,��6.o o •�` $5 0,��a.o 0 1�
Page 9
LANDSCAPE MAINTENANCE AREA N0. 18
CONTRACT NO. C29560, PROJECT NA.918-10
CONTRACTOR'S PROPOSAL
EXTRA WORK PRICING SCHEDU�LE
LABI?R
Additional Laborer $ a 5.o o per hour
Additional Irrigator $ 37.50 per hour
Additional Supervisor � 37.50 �er hour
IRRIGaTION PARTS wiii be paid at a 15% mark-up.
PLANT MATERIAL REPLACEMENT
Unless otherwise desc�ibed, replacement plant mate�ial will be whatever is normal and
customary for the City of Palm Desert.
1-Gailon Shrub instalied $ 9.o0
5-Gallon Shrub InstaHed $ a i.o 0
15-Galion Shrub Installed $ 9 0.o 0
15-Gallon Tree installed" $ i i 5.o 0
24"-Box Tree Instalied'` � z�s.o0
30"-BoxTree Installed` $ 375.00
36"-Box Tree Installed* $ 6 5 0.0 0
Note: Anything over 36" box size will be paid at the contractual hourly rate for labor, and
materials at cost plus a 15% mark-up.
*Includes the following: dtgging of hole, setting of tree, backfilling, watering-in af tree, staking (if
needed), and securing with cinch ties
TURF MAINTENANCE
Aeration, Mechanical core Labor& Equipment $ 5.75 per 1,000 sq ft
Aeration, Deep time Labor& Equipment $ i�.aa per 1,000 sq ft
Hybrid Bennuda(sod only), instatled $ .�o per sq ft
Overseeding
(seed application only): Labor& Equipment $ 6.oo per 1,000 sq ft
Mowing: Labor 8�Equipment $ 3.oo per 1,000 sq ft
At City's discretion, additional work may be paid for using the contractual hou�y rate for labor,
and materiafs at cost plus a 15% mark-up.
Page 10
LANDSCAPE MAINTENANCE AREA N0. 18
C4NTRACT NO. C29560, PROJECT NA. 918-10
CONTRACTOR'S PROPOSAL
PROPOSED MAINTENANCE EQUIPMENT
Contractor must list the equipment being proposed for use at each location.
Equipment must be available fo�inspection prior to award of contract.
AREA MOWERS POWER E�1UIpMENT OTHER EQU{PMENT
SMALL
1. IRONWC30D PARK 5 gang reel mowers 2 Blowers Spray R.6
alk behind reel mower 2 String trimmers
Rotary mowers as needed Power Washer
Z. WASHINGTON 5 gang reel mowers 2 Blowers Spray R.6
CHARTER SCH00� walk behind reel mower 2 string trimmers
PARK Rotary mowers as needed Power Washer
3. CAHUILLA PARK s gang reel mowers z Blowers Spray R.6
Walk behind reel mower 2 String trimmera
Rotary mowers as needed Power Washer
4. PALM DESERT 5 gang reel mowers 2 slowers Spray R.6
COMMUNITY GARDENS Walk behind reel mower 2 string trirmners
Rotary mowers as needed Power Washer
5. HOMME-ADAMS PARK s gang reel mowers 2 slowers spray tt.5
alk behind reel mower 2 String trimmers
otary mowers as needed Power Washer
S. PALMA VILLAGE 5 gang reel mowers 2 slowers Spray R.6
PARK Walk behind reel mower 2 String trimmers
Rotary mowers as needed Power Washer
Page 11
LANDSCAPE MAINTENANCE AREA Nt). 18
CONTRACT NO. C29560, PROJECT NO. �18-10
CONTRACTOR'S PROPOSAL
WORK EXPERIENCE AND TECHNICAL ABILITY O�THE BIDDER
This project is located in a desert with extreme environmental conditions. Desert plant
materiai is therefore very specialized in nature. In addition, the City of Paim Desert has
adopted naturalistic pruning methods that must be foilowed by its landscape
maintenance contractors.
To be considered qualified to perform this contract, contractors must have adequate
experience performing a wide range of tandscape malntenance activities that include
the care of desert and desert-adapted plant materials. Such levels of experience and
skiii are typicaNy gained by performing landscape maintenance for a pubiic agency, for 3
of the last 5 years, and perfocmed in areas adjacent to streets and parkways.
The bidder is required to state al{ work of a similar charact�r to that included in the
proposed contract that he has pertormed in the last three years. In the space below,
pravide references with a contact persan, address, and phone number for verification of
said work.
Bidders may attach additional pages ta provide the information required by this portion
of the proposal, if necessary.
REFERENCES
Contract Completion
Amount Class of Work Date Contact Person
1 � 225,000.00 Maintenance District 2009 Robert Rivera Name
City of Coachella Business Name
1515 Sixth Street Address
(760)200-6513 Ph0118
2 $ 540,000.00 Medians, Parks, City Bldgs Past & Present Bill Oppenhiem Name
City of Rancho Mirage gusiness Name
69$25 Highway 111 AddreSS
(760)831-1063 PhOne
3 $ 2 4 0,0 0 0.0 0 HOA Common Area Present Barbara Temp Name
Casa Dorado Busmess Name
45005 Camino Dorado pddress
(760)346-4215 ' phpne
Page 12
LANDSCAPE MAINTENANCE AREA N0. 18
CONTRACT NO. C29560, PROJECT NO.918-10
CONTRACTOR'S PROPOSAL
FiNANC1AL STANDING OF THE BIDDER
The City Council of the City of Palm Desert reserves the ri�ht to reject bids from firms
that do not demonstrate adequate financial standing to execute the terms of the
contract.
U u i �' �'�
Due to the location, size/extent and maintenance requirements of the maintena
area, bidder is required to state how it wiil provide the necessary maintenance
services in the specifications. State the estimated manpower you� company wili
each �reek to fulfilt the contract. Include supervision, irrigation and general labor
categcries.
60 hours per week.
A financial statement or other information and references sufficiently compcehensive to
permi#an appraisal of your current financial condition may also be required by CITY.
Page 13
(14) Llst the names and addresses of each subc.ontractor who will perform work
related to this contract and indicate what portion of the work will be done by each
subcorrtractor. (if more than one subcontractor, please check the box below and
list a/!subcontractors on a separate sheet.)
❑ See Subcontractor List on Separate Sheet
�ubcontractor's Name: NIA
License Number:
Address:
1'elephone:
Wark to be performed:
(15) List the name of the person who inspected the site of the proposed work for yaur
firm Rafael Esctuivel
�
�16) This bid was prepared by: ,'
Name (print) Paul vanLe en �---
Signature
Telephone �60> aso-i 9a
(17) Contact person:
Name(print} Jerod Pannell
Telephone ��60� 250-7646
Contractor hereby swears under penalty of perjury that the information provided is true
and correct.
By: �.''
Title. President
ature Contractor
Page 'I 5
LANDSCAPE MAINTENANCE AREA N4. 18
CONTRACT NO. C2856�, PROJECT NrJ. 918-10
CONTRACTOR'S PROPOSAL
AFFIDAVIT OF NON-COLLUSION
TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID
STATE OF CALIFORNIA)
) SS
COUNTY OF RIVERSIDE�
George L. Gonzalez - President ,being first duly swarn,deposes and says that he/she is
of Sierra Landscape Company � �e party making the foregoing bid; that the bid is not made in
the interest of, or on behalf of, any undisclosed person, partnership, company, association,
organi?ation, or corporation; that the bid is genuine and neither collusive nor sham; that the
bidder has not directly or indirectly induced or solicited any other bidder to put in a faise or sham
bid and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or
anyone else to put in a sham bid, or that anyone shall refrain from bidding; that 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,or to secure any advantage against
the public body awarding the contract of anyone interested in the proposed contract; that all
statements contained in the bid are true; and, further, that the bidder has not, directly or
indirectly, submitted his or her bid price, or any breakdown thereof, or the contents thereof, or
diwlged information or data relative thereto, or paid, and will not pay, any fee to any
corporation, partnership, company, association, organization, bid depository, or to any member
or agent thereof to effectuate a coliusive or sham bid.
By. President
�.
atuce(Contractor) Title(Contractor)
Jurat Certificate
State of California )
. )
County of �1Vh•1r�J�'2- )
Subscribed and sworn ta(or affirmed)before me on this 6tn day of
May (month), 1� (year),by � L• �C�'171�1,��Z—,
proved to me on the b is 'sf evidence to be t e pe on(s)who appeared before me.
Signature of Notary (Seal of Notary)
� ERIN l.MEYER
Commfsslon#�1843850
Page 16 � � Nohry Public-cainorn�a �
Rirenki�County �
M Comm.Ex Ires r 9,2013
LANDSCAPE MAINTENANCE AREA N0. 18
CONTRACT NO. C29560� PR0.IECT NO. 918-10
CONTRACTOR'S PROPOSAL DOCUMENTS
AGREEMENT
This AGREEMENT is made and entered into this day of
20 , by and between City of Palm Desert, Califomia, hereafter called "Owner'
"Cit�'ar"Agent" and hereinafter called
°Contractor."
WITNESSETH:
WHEREAS, on , City invited bids for landscape maintenance
services for City-maintained properties known as L�ndscape Maintenance Area No. 18
per specifications; and
WHEREAS, pursuant to said invitation, Contractor submitted a proposal, which was
accepted by City for said services.
NOW, THEREFORE, in consideration of their mutuai promises, obiigations, and
covenants hereinafter contained, the parties hereto agree as follows:
TERM. The term of this Agreement shail be from July 1, 2010, through June 30, 2Q11,
or to such later date as may be agreed in writing between parties. This contract allows
for an option of two one-year contract extensians based on Contractar's perFormance
and mutual agreement.
CITY'S OBLIGATIONS. For furnishing services, as specified in this Agreement, City
wiil pay and Contrac#or shall receive in fuli compensation, therefore the total sum
($) as set forth in the Contract
Documents and adopted by City.
CONTRACTOR'S OBLIGATION For, and in cansideration of the payments and
agreements hereinbefore mentioned ta be made and pertormed by City, Contractor
agrees with City to fumish the services and to do everything required by this Agreement
and the Specific Terms and Conditions.
HOLD HARMLESS AND INDEMNIFICATION. Contractor agrees to defend, indemnify,
and hold harmless City of Paim Desert, its officials, officers, employees,
representatives, and agents from and against all ciaims tawsuits, liabilities or damages
of whatsoever nature arising out of our connection with, or relating in any manner to,
any act or omission of Con#ractor, his agents, employees, and subcontractors and
empioyees thereof in conne�tion with, the pertormance or non- performance of this
Agreement. The Contractor shall thoroughly investigate any and ail claims and
indemnify City and do whatever is necessary to protect City of Palm Desert, its official,
officers, empioyees, agents, and representatives as to any such claims, lawsuits,
liabilities or damages.
Page 17
AMENDMENTS. Any amendment, modification� or variation from the terms of this
Agreement �hall be in writing, signed by the Contractor and approved by the City
Council of the City.
TERMINATION. If, during the term of this Agreement, Ci#y 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 perFarm; which notice must give
Contra�tor a three-day notice of time thereafter in which to perform said work or cure
the deficiency. If Contractor faiis to perform said work or cure the deficiency within the
#hree (3) days specified in the natice, such shall constitute a breach of this Agreement
and City may terminate this Agreement immediately by written natice to Contractor to
said effect. Thereafter, except as otherwise set forth herein, neither party shall have any
further duties, obliga#ions, responsibilities, or rights under this Agreement except,
however, any and all obligation of Contractor's surety shali remain in full force and
effect, and shall not be extinguished, reduced, or in any mar�ner waived by the
termination hereof. In said event, Contractor shall be entitied to th� reasonable value af
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 City's damages from such breach. City reserves the right to delay any
such payment until completion of confirmed abandonment of the praject, as may be
determined in City's sole discretion, so as to permit a full and complete accounting of
costs. in no event, however, shali Contractor be entitied to receive in excess of the
compensation quoted in its bid.
The City Councii may terminate the contract with 30 days written notice for any reason.
INCORPORATED BY REFERENCE. The No#ice Inviting Bids; Bid Terms and
Conditions; Instructions to Bidders, General Terms and Conditions; Specific Terms and
Condi#ions; Contractor's Proposal Submission Forms; Addendum
Nos. ; 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.
COMPLETE AGREEMENT. This written Agreement, including all writings spec�cally
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.
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 discriminatwn 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 refeRed to in Labor Code Section 1735.
AUDIT. City shall have the option of inspecting and/or audi#ing all records and other
written material used by Contractor in preparing its statements to City as a condition
precedent to any payment to Contractor.
Page 18
NOTICE. All written notices to the parties hereto shall be sent by United States mail,
postage prepaid by registered or cert�ed mail, retum receipt requested, addressed as
foilows
To City: To Contractor:
Office of the City Clerk
City of Falm Desert
73-510 Fred Waring Drive
Palm Desert, CA 92260
LITIGATtON COSTS. In #he event an action is�led by either party to enforce any rights
or obligations under this Agreement, the prevailing party shail be entitied to recover
reasonable attorney's fees and court costs, in additian to any other relief granted by the
court.
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 caused this instrument to be
execu#ed #he day and year first hereinabove written.
CITY OF PALM DESERT
A Municipal Corporation Contractor
CINDY FINERTY, MAYOR
CITY OF PALM DESERT, CALiFORNIA
ATTEST: APPROVED AS TO CONTENT:
RACHELLE D. KLASSEN, CITY CLERK MARK GREENWOOD, P .E.
ClTY OF PALM DESERT, CALIFORNIA DtRECTOR OF P BLIC WORKS
APPROVED AS TO FORM: •
DAVID J. ERWIN, CITY ATTORNEY r a
U�
r�S �
� (
.� � �
�
Page 19
� �
LANDSCAPE MAINTENANCE AREA Nt3. 18
GONTRACT NC�. C29560, PRO.fECT NO.978•10
CC?�lTRACTOR'S PROPOSAL '
BID BONb
KN41N ALl. MEN BY THESE PRESENTS,
T�t WB! $IERRA LANDSCAPE C0. Ia8 PCIl1C)
$�}{� DEVELOPERS SURETY AND INDEMNITY C4MPANY � a$ S(Jf@�/, are held
firmly bound unto Cftyr of Palm Desert(Owner�in the sum of$Ten Percent t so��•(�p%
of Principal's bld�, to be p�d fo the said Owner or i#s certain a�tamey, its successors
and�ssigns;far which payment,well and truly to t�made,we bind ourselves, our heirs,
executors and adminlstrators, successars or assigns, Jointiy and severaEiy, firmly by
these presen�s.
THE C�NDITION OF TH1S �BLIGATION iS SUCH, tha# if the certain proposal of the
aborre bounden PrinciRa!ta perform certaln worlc descrlbed as faliows:
LANDSCAPE MAINTENANCE AREA '18: The genera! items of warfi to be done
hereunder conslst af, but are not limited to: landscape, Irrigation, hardscape, and
hardscape malntenance
and @ated May �, zo�o is accepted by City of Paim Desert, and
�f the above bounden Principal srER� L�scAeE co. sha11 duly enter Jnto and
. execute a contract for such cans#ructfon, and shail execute and deliver the PerFormance
Bor�d and Paymer�t 8and and insurance certi#icates as requlred by said contract� then
this obligation shall become nuN and void; otherwise it shall 6e and remain in tul!force
and effect.
Should it become necessary for City ta institute a lawsu(t, or any other tegai procesding
to er�force ttte terms and conditEons of this bond, then ali costs of said proceedtng,
includtng attomey's fees, shaU be awarded to the prevaUing party.
jRernalrrder of thJs pege has MfenttonaUy baen te�t blsnk
5lgnature blocks sre contarned on the next pagej
. PagQ 20
*of the Total Amount of the Bid
IN WITNESS WHEREQF,We hereur►to sct our Hands and Seais this �th day
Qf May 2010 --
.�.
• ;
Cantrac#or's Name: SIERRA: I7ANDSCAPE CO.,� �"�
r n ,f ,.�' °� 1.
,�
Contractors Signature:,�� t`T,�;,,�����`�� �.`-�"�
� � ;�
1 � "y °�.; ��,'I h
Title:_ `�,a� €..:� ,�x , �,� �
Address: 73-771 Dinah Shore Drive, Suite 200, Palm Desert, California 92211
Telephone: c�6oa 328-8900
.
Sll�t�l's Name: DEVELOPERS SURETY AND INDEMNIT COMPANY
Surety'sSignature: ��/l 'y C.�'`----.�_.--'
T�f�6: Attorney-in-Fact
AC�C�($SS:7800 South Elati Street, Suite 100, Littleton, Colorado 80120
Telephone: c�os� 225-8030
Page 21
STATE OF CALIFORNIA
}
COUNTY OF RIVERSIDE
ON �?�1 � , BEFORE ME, LINDA ROCHA, Notary Public
PERSONALLY APPF,ARED: Diane M.Nielsen
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 & acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity (ies), and that by his/her/their signatures (s) an 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 m hand and official seal. LINDA ROCHA
Y Commisston # 1777932
'< -�s „ Notary Pubiic -Californfa Z
- Z RlversidA County �
Signatu : (A(� MYComm•E�YesNov23,2011
L' da Rocha,Notary
ALL PURPOSE ACKNOWLEDGMENT
POWER OF ATTORNEY fOR
� DEVELOPERS SURETYAND INDEMNITY COMPANY
INDEMNRY COMPANY OF CALIFORNIA
PO Box 19725,IRVINE,CA 92623 (949)263-3300
KNOW ALL MEN BY THESE PRESENTS,that as except as expressly limited,DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA,do
each,hereby make,constitute and appoint
***Ann Willard, Diane M. Nielsen, Van G. Tanner, Paut W. Lewis, Sai C. Sandoval, Mathew S. Costello, jointly
or severally***
as their true and lawful Attomey(s)-in-Fact,to make,execute,deliver and acknowledge,for and on behalf of said corporatlons,as surebes,bonds,undertakings and contracts of surety-
ship giving and granting unto said Attomey(s)-in•Fact full power and authority to do and to perform every act necessary,requisite or proper to be done in connec6on therewilh as each of
said corpora6ons could do,but reserving to each of said corpora6ons full power of substitution and revocation,and ali of the acts of said Attomey(s)-in-Fact,pursuant to these presents,
are hereby ratified and confirmed.
This Power ofAttomey is granted and is signed by facsimlle under and by authority of Ihe foliowing resoiutions adopted by the respec6ve Board of Directors of DEVELOPERS SURETY
AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA,effective as of January tst,2008.
RESOLVEQ,that the chairman of the Board,the President and any Uce President of the corpwa6on be,and that each of them hereby is,authorized to execute Powers of
A�omey,qualitying the attomey(s)named in ihe Powers of Attomey to execute,on behalf af the corporaUons,bonds,undertakings and conVacts of suretyship;and that the Secretary or
any Assistani Secretary of the corporations be,and each of them hereby is,authorized to attest the execution of any such Power of Attwney;
RESOLVED,FURTHER,that the signatures of such officers may be afficed to any such Power of Attwney or to any certificate relaUng thereto by facsimile,and any such
Power of Attomey or certificate bearing such facsimile signatures shail be valid and bindfng upon the corpora6ons when so affixed and in the future with respect to any bond,undertaking
or contract of suretyship to which it is attached.
IN WITNESS WHEREOF,DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COM,PANY OF CALIFORNIA have se�erally caused these presents to be signed by
their respective Uce President and atfested by their respective Assistant Secretary this January tst,2008.
c� .�u»w�.r.��r,
gy: .�v •'¢�f;� AND ly�., D�,Q AfV y 0
Stephen t Pate,Senior Vce President J ��POR "' F• V PO ''�
,,`�r<,fl4 q ftn�?�= r\,� ��5� A9�.C�9
4` f,
z W�' �}p�, i�t g r OCT.5 � O
�Y: tioi i936 :ae W 1967 �
Charles L Day,Assistant Secretary :��''••. r b? �' C� Q:;�
:a�P.„oW A���,,.� �/ '�C7FOg�� �'
State of Cal'rfomia `�, * �
Counry of Orange �""""`ttl•� �
On January 1 st,2008 before me, _ Christopher J.Raach,Notary Pubiic
Date Here Insert Name and Title of the Officer
personaliy appeared Stephen T.Pate and Charles L.Day
Name(s)of Signer(s)
who proved to me on the basis of sa6sfactory evidence to be the person(s)whose name(s)is/are subscribed to
� � � fhe within instrument and acknowledged to me that helshe/they executed the same in hislherltheir aidhorized
������ capacity(ies),and fhat by hismedtheir signature(s}on ihe instrument the person(s),or the en6ty upon behalf of
which the person(s)acted,executed the insWment.
g t�tM,�tr�5�
� ������A� I certify under PENALTY OF PERJURY under the laws of the State of Califomia that the foregoing paragraph Is
��� true and correct.
carnRi.� tf�,?l�i1
WITNESS my hand and offi 'al seaL
Place Notary Seal Above Signature
Ch' er J.Roach
CERTIFICATE
The undersigned,as Assistant Secretary,ot DEVELOPERS SURETYAND INDEMNITY COMPANY and INDEMNIiY COMPANY OF CALIFORNIA,does hereby certify
that the foregoing Power of Attomey remains in iuii force and has not been revoked,and furthermore,that t�e provisions of ihe resolu8ons of the respecUve Boards of Directors of said
corpora6ons set forth in the Power of Attomey,are in force as of the date of this Certificate.
This Cer6ficate is executed in the Ciry of Irvine,Califomia,the � d�of �'�,� ,��D,
By:
Albert Hiliebrand,Assistant ecretary
iD-1380(Wet�(Rev.D7/07)
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
County of Riverside
On May 7, 2010 before me, Erin L. Meyer, Notary Public, personally
appeared Juan C. Gonzalez, who proved to me on the basis of satisfactory
evidence to be the person whose name is subscribed to the within
instrument and acknowledged to me that he executed the same in his
authorized capacity, and that by his signature on the instrument the person,
or the entity upon behalf of which the person 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.
ERIN�MEYE�
Commtasion#1843850 �
� Notary Pubtk-Caltfornta �
Rlver:lde County ..
M Comm.Ex lres r 9,2013
Signature
t
;
�,.d
Title or Type of Document: Bid Bond
Document Date: May 7, 2010 Number of Pages: 1
No Other Signers Than Listed Above
Capacity Claimed by Signer
Juan C. Gonzalez
Corporate Officer—Vice President of Business Development
epresenting Sierra Landscape Company
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?3-?71 DINAH SHOf�E DRNE�?OQ � � �� �-`7;=771 DINAH SHURE DR#200
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PALM DESERT,CA 922!f , ";,- ���� PALivI DESERT,CA 92211 �
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1. Please make sure the ulformatio�i oh your l�cens� is corr�ct.
2. No#ify'us immedsat�ly of any chan�es tr�y�ur busiaess(e g,�ariie,aiidress,insivancE carrier or qualif ec!
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�. For more inforinatiori,'please contact us at(916)4��=�038 or at<licensemait@cdpr.ca.gov>. Or yau may write to
Department.of Pestic�deRegalation
Pest iVlanagement arid Liceosuig Brarich
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Licensing and Certificat�on Program
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P.O.Bos 4015'`
Sacrarriento, California'95813-4015
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Knight, Spencer
From: Paul vanLeeuwen [pvanleeuwen@sierralandscape.com]
Sent: Monday, May 10, 2010 5:20 PM
To: Knight, Spencer
Cc: Rafael Esquivel
Subject: LMA 18 weekly hours clarification
Spencer, our estimated weekly staffing for LMA 18 wili be as follows (subject to change based on contract requirements
and actual performance—total estimated for ali parks below is 70.3):
Ironwood Park:
2 men, 1 hour daily perForming daily tasks as outlined in the RFP.
Gardening, includes mowing, 2 men x 2.5 hours per week.
Power washing, 1.5 hours per week.
Total hours per week is 20.5
This includes irrigation time as part of the above, as required. Daily employees will have irrigation knowledge. If repairs
are required beyond what their knowledge level is and required per contract, a dedicated irrigator will be provided at a no
charge basis (per contract specs).
Also,with the exception of the laborer performing power washing, a working supervisor will be part of the above hours, at
all times.
Washinqton Charter School Park:
2 men, 30 minutes daily performing daily tasks as outlined in the RFP.
Gardening, includes mowing, 2 men x 2 hours per week.
Power washing, 1.0 hours per week.
Total hours per week is 12.0
This includes irrigation time as part of the above, as required. Daily employees will have irrigation knowledge. If repairs
are required beyond what their knowledge level is and required per contract, a dedicated irrigator will be provided at a no
charge basis (per contract specs).
Also, with the exception of the laborer performing power washing, a working supervisor will be part of the above hours, at
all times.
Cahuilla Park:
2 men, 20 minutes daily performing daily tasks as outlined in the RFP.
Gardening, 2 men x 1 hour per week.
Power washing, 1.0 hours per week.
Total hours per week is 7.67 hours per week
This includes irrigation time as part of the above, as required. Daily employees will have irrigation knowledge. If repairs
are required beyond what their knowledge level is and required per contract, a dedicated irrigator will be provided at a no
charge basis (per contract specs).
Also, with the exception of the laborer performing power washing, a working supervisor will be part of the above hours, at
all times.
Communitv Gardens:
2 men, 30 minutes,three times per week as outlined in the RFP.
Gardening, 2 men x 1 hour per week.
Power washing, 1.0 hours per week.
1
�;
x
Total hours per week is 9.0
This includes irrigation time as part of the above, as required. Three times per week empioyees will have irrigation
knowledge. If repairs are required beyond what their knowledge level is and required per contract, a dedicated irrigator
will be provided at a no charge basis (per contract specs).
Also, with the exception of the laborer performing power washing, a working supervisor will be part of the above hours, at
all times.
Homme-Adams Park:
2 men, 20 minutes daily performing daily tasks as outlined in the RFP.
Gardening, 2 men x 1 hours per week.
Power washing, 1.0 hours per week.
Total hours per week is 7.67
This includes irrigation time as part of the above, as required. Daily employees will have irrigation knowledge. If repairs
are required beyond what their knowledge level is and required per contract, a dedicated irrigator will be provided at a no
charge basis (per contract specs).
Also, with the exception of the laborer performing power washing, a working supervisor will be part of the above hours, at
all times.
Palma Villaqe Park:
2 men, 30 minutes daily performing daily tasks as outlined in the RFP.
Gardening, includes mowing, 2 men x 2.5 hours per week.
Power washing, 1.5 hours per week.
Total hours per week is 13.5
This includes irrigation time as part of the above, as required. Daily employees will have irrigation knowledge. If repairs
are required beyond what their knowledge level is and required per contract, a dedicated irrigator will be provided at a no
charge basis (per contract specs).
Also,with the exception of the laborer performing power washing, a working supervisor will be part of the above hours, at
all times.
�fe�rr«a
�����
Paul vanLeeuwen
Vice President—Maintenance Division
73-771 Dinah Shore Drive,Suite 200
Palm Desert,CA 92211
Office: (760)328-8900
Fax: (760)328-8944
Cell: (760)250-1192
License#492834
pvanleeuwen(a�sierralandscape.com
2
Contract No. C29560
LANDSCAPE MAINTENANCE AREA NO. 18
CONTRACT NO. C29560, PROJECT NO. 918-10
CONTRACTOR'S PROPOSAL DOCUMENTS
AGREEMENT
This AGREEMENT is made and entered into this 27th day of May
2010, by and between City of Palm Desert, California, hereafter called "Owner" "City" or
"Agent" and Sierra Landscape Company, Inc., hereinafter called "Contractor."
WITNESSETH:
WHEREAS, on April 21, 2010, City invited bids for landscape maintenance services for
City-maintained properties known as Landscape Maintenance Area No. 18 per
specifications; and
WHEREAS, pursuant to said invitation, Contractor submitted a proposal, which was
accepted by City for said services.
NOW, THEREFORE, in consideration of their mutual promises, obligations, and
covenants hereinafter contained, the parties hereto agree as follows:
TERM. The term of this Agreement shall be from July 1, 2010, through June 30, 2011,
or to such later date as may be agreed in writing between parties. This contract allows
for an option of two one-year contract extensions based on Contractor's perFormance
and mutual agreement.
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 Fiftv
Thousand One Hundred Twelve Dollars 50112 as set forth in the Contract
Documents and adopted by City.
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 fumish the services and to do everything required by this Agreement
and the Specific Terms and Conditions.
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 our connection with, or relating in any manner to,
any act or omission of Contractor, his agents, employees, and subcontractors and
employees thereof in connection with, the performance or non- performance of this
Agreement. The Contractor shall thoroughly investigate any and all claims and
indemnify City and do whatever is necessary to protect City of Palm Desert, its official,
officers, employees, agents, and representatives as to any such claims, lawsuits,
liabilities or damages.
Page 1 of 3
Contract No. C29560
AMENDMENTS. Any amendment, modification, or variation from the terms of this
Agreement shall be in writing, signed by the Contractor and approved by the City
Council of the City.
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 notice 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 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 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.
INCORPORATED BY REFERENCE. The Notice Inviting Bids; Bid Terms and
Conditions; Instructions to Bidders, General Terms and Conditions; Specific Terms and
Conditions; Contractor's Proposal Submission Forms; Addendum Nos. 1 ; 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.
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.
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.
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.
Page 2 of 3
Contract No. C29560
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:
To City: To Contractor:
Office of the City Clerk
City of Palm Desert
73-510 Fred Waring Drive
Palm Desert, CA 92260
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.
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 caused this instrument to be
executed the day and year first hereinabove written.
CITY OF PALM DESERT SIERRA LANDSCAPE CO., INC.
A Municipal Corporation Contractor
CINDY FINERTY, MAYOR
CITY OF PALM DESERT, CALIFORNIA
ATTEST: APPROVED AS TO CONTENT:
RACHELLE D. KLASSEN, CITY CLERK MARK GREENWOOD, P .E.
CITY OF PALM DESERT, CALIFORNIA DIRECTOR OF PUBLIC WORKS
APPROVED AS TO FORM:
DAVID J. ERWIN, CITY ATTORNEY
Page 3 of 3
Contract No. C29560
LANDSCAPE MAINTENANCE AREA NO. 18
CONTRACT NO. C29560, PROJECT NO. 918-10
ATTACHMENT 5: PAYMENT BOND
(REQUIRED WITH EXECUTED AGREEMENT)
Payment Bond
KNOW ALL MEN BY THESE PRESENTS:
THAT WHEREAS, City of Palm Desert (sometimes referred to hereinafter as "Obligee") has
awarded to Sierra Landscape Company, Inc., (hereinafter designated as "Contractor"), an
agreement dated May 27, 2010 and described as follows: LANDSCAPE MAINTENANCE
AREA 18, PROJECT NO. 918-10, CONTRACT NO. C29560, (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 3247 of the California Civil Code;
NOW, THEREFORE, we, , 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 City of Palm Desert and to any and all persons, companies or
corporations entitled to file stop notices under Section 3181 of the California Civil Code, in
the sum of Fifty Thousand One Hundred Twelve Dollars ($50,112), said sum being not less
than one hundred percent (100%) of the total amount payable by said Obligee under the
terms of 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 3247 through
3252 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
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
notices under Section 3181 of the Civil Code, so as to give a right of action to them or their
assigns in any suit brought upon this bond.
Page 1 of 2
Contract No. C29560
The Surety, for value received, hereby stipulates and agrees that no change, extension of
time, alteration or addition to the terms of 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 Obligee and Contractor hereunder shall abridge the right of any
beneficiary hereunder, whose claim may be unsatisfied.
Contractor and Surety agree that if 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
PRINCIPAL/Contractor: SURETY:
(Typed Name of Contractor} (Typed Name of Surety)
By: By:
(Signature) (Signature of Attorney-in-Fact)
(Typed Name and Title) (Typed Name of Attorney-in-Fact)
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 lnsurance Commissioner authorizing them to write surety insurance
defined in Section 105 of the California lnsurance 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)
Page 2 of 2
Contract No. C29560
LANDSCAPE MAINTENANCE AREA NO. 18
CONTRACT NO. C29560, PROJECT NO. 918-10
ATTACHMENT 4: PERFORMANCE BOND
(REQUIRED WITH EXECUTED AGREEMENT)
Performance Bond
KNOW ALL MEN BY THESE PRESENTS: That whereas City of Palm Desert has
awarded to Sierra Landscape Company, Inc., (hereinafter designated as
"Principal"), a contract for:
LANDSCAPE MAINTENANCE AREA 18
PROJECT NO. 918-10
CONTRACT NO. C29560
and 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, the
Principal, and , as Surety, are held and
firmly bound unto City of Palm Desert, hereinafter called City, in the penal sum of Fiftv
Thousand One Hundred Twelve Dollars ($50,112), 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 bounden
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 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 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 anywise
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 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.
Page 1 of 2
Contract No. C29560
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
SURETY PRINCIPAL
BY: BY:
INSURANCE COMPANY and/or AGENT
ADDRESS
TELEPHONE NUMBER
Page 2 of 2
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