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A8692 - ECOSENSE CONSTRUCTION CORP.
to Recording Requested By: � ,� City of Palm Springs When Recorded Mail To: Name Anthony J. Mejia, City Clerk Street Address 3200 E. Tahquitz Canyon Way City & State Palm Springs, CA 92262 NOTICE IS HEREBY GIVEN THAT: a 3. 4. 5. 6. 7. 8. 9. 10. 2021-0712420 12/02/2021 11:07 AM Fee: $ 0.00 Page 1 of 2 Recorded in Official Records County of Riverside Peter Aldana Assessor —County Clerk —Recorder 1111WEAdyly",�i SPACE ABOVE THIS LINE FOR RECORDERS USE NOTICE OF COMPLETION (CA Civil Code §§ 8180-8190, 8100-8118, 9200-9208) The undersigned is an owner of an interest of estate in the hereinafter described real property, the nature of which interest or estate is: Fee (e.g. fee, leasehold, joint tenancy, etc.) The full name and address of the undersigned owner or reputed owner and of all co -owners or reputed co -owners are: Name Street and No. City State of Palm Springs 3200 E. Tahquitz Canyon Way Palm Springs CA 92262 The name and address of the direct contractor for the work of improvement as a whole is: Ecosense Construction Corp, P.O. Box 734, Morongo Valley, CA 92256 This notice is given for (check one): 0 Completion of the work of improvement as a whole. ❑ Completion of a contract for a particular portion of the work of improvement (per CA Civ. Code § 8186). If this notice is given only of completion of a contract for a particular portion of the work of improvement (as provided in CA Civ. Code § 8186), the name and address of the direct contractor under that contract is: Not Applicable The name and address of the construction lender, if any, is: Not Applicable On the 7th day of July 20 21 , there was completed upon the herein described property a work of improvement as a whole (or a particular portion of the work of improvement as provided in CA Civ. Code § 8186) a general description of the work provided: City Project 19-13, Sunrise Park Restroom The real property herein referred to is situated in the City of Palm Springs County of Riverside State of California, and is described as follows: 401 S. Pavilion Way The street address of said property is: 401 S. Pavilion Way If this Notice of Completion is signed by the owner's successor in interest, the name and address of the successor's transferor is: Not applicable I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: /l— 2 Z — 24 By: Signa ure of Owner or Owner's Authorized Agent Joel Montalvo/City Engineer City of Palm Springs #221 Page 1 of 2 MM09TWOR I, Joel Montalvo , state: I am the City Engineer ^ ("Owner", "President', "Authorized Agenf, "Partner", etc.) of the Owner identified in the foregoing Notice of Completion. I have read said Notice of Completion and know the contents thereof; the same is true of my own knowledge. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on &-- 2- L , 2 / (date), at Palm Springs (city), CA (State). Signature of 0 er or 0 er Authorized Agent Joe�vlontalvo) ity ngmeer City of Palm Springs 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. TERRI HINTZ h Notary Public -California Riverside County �Commission # 2359495 My Comm. Expires Jun 26. 2025 •11 STATE OF CALIFS*NIA COUNTY OF hw, .,2"42 (date), before me, Notary Public (name and title of officer) personally appeared I / oh 74V, 14O 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 PURJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal Page 2 of 2 Signature $"4�� EA CITY OF PALM SPRINGS V N CONTRACT CHANGE ORDER `gI1proR��P . To: Ecosense Construction Corp. Date: November 6, 2021 PO Box 734 Project No: CP 19-13 Morongo Valley, CA 92256 Project: Sunrise Park Restroom Change Order 2 Purchase Order 21-0906 CHANGES IN WORK/COST: Drain Maintenance and Sewer Cleaning Services Lump Sum/Agreed Cost Total Change Order/Net Increase Amount: SUMMARY OF COSTS: Original Contract Amount: $ 249,231.00 This Change Order: $ 1,239.00 Previous Change Order(s): $ 17,067.32 Revised Contract Amount: $ 267,637.32 [SIGNATURES ON NEXT PAGE] $1,239.00 $1,239.00 CP 19-13, Sunrise Park Restrooms Contract Change Order No. 2 Page 2 I have received a copy of this Change Order and the above AGREED PRICES are acceptable to Ecosense Construction Corp. 4/'M 11/5/2021 SignAturie Date Andrea Ramirez, President Printed Name and Title City of Palm Springs Recommended By: 11 Id-- Z( MNLA- )� 151 Zr oel Montalvo, City Engineer ADate 86°Iz Attest By: Distribution: Original Conformed Copy: Contractor (1) City Clerk (1) Mej Conformed - File Co Engineering Pay File (1) Project City File (1) Purchasing (1) Finance (1) I' L. &2, Da e Adt 4AVY1,gie4rZ CITY OF PALM SPRINGS CONTRACT CHANGE ORDER col IRbAN�P To: Ecosense Construction Corp. Date: August 27, 2021 PO Box 734 Project No: CP 19-13 Morongo Valley, CA 92256 Project: Sunrise Park Restroom Change Order 1 Purchase Order 21-0906 CHANGES IN WORK/COST: This change order consists of raw material cost inflation for Structural Steel and Concrete products and includes additional costs for modifications to structural footings and walkways in order to meet ADA requirements. Structural Steel Cost Inflation Lump Sum $10,350.00 Concrete Cost Inflation Lump Sum $ 2,511.86 Additional Concrete in Structural Footings Lump Sum $ 1,469.96 Construction of Additional Concrete Walkways Lump Sum $ 2,736.00 Total Change Order/Net Increase Amount: $17,067.32 SUMMARY OF COSTS: Original Contract Amount: $ 249,231.00 This Change Order: $ 17,067.32 Previous Change Order(s): $ 0.00 Revised Contract Amount: $ 266,298.82 [SIGNATURES ON NEXT PAGE] CP 19-13, Sunrise Park Restrooms Contract Change Order No. 1 Page 2 I have received a copy of this Change Order and the above AGREED PRICES are acceptable to Ecosense Construction Corp. ~'r / 09/08/2021 Signature Date Andrea Ramirez, President Printed Name and Title City of Palm S rin s Recommended By: * �► \J'x Approved By: APPROVED BY C17Y MANAGER glad aoa l )-H q w: Attest By: Distribution: Original Conformed Cosy: Contractor (1) City Clerk (1) Joel Montalvo, City Engineer Date �A& Juidin Clifton, Cit Manager , +,AAhony Meji�, City Conformed - File Co Engineering Pay File (1) Project City File (1) Purchasing (1) Finance (1) Date a 124-wz,4 Date AGREEMENT (CONSTRUCTION CONTRACT) THIS AGREEMENT made this 6f day of Mach , 20Z(, by and between the City of Palm Springs, a charter city, organized and existing in the County of Riverside, under and by virtue of the laws of the State of California, hereinafter designated as the City, and Ecosense Construction Corporation, a California Corporation, hereinafter designated as the Contractor. The City and the Contractor, in consideration of the mutual covenants hereinafter set forth, agree as follows: ARTICLE 1 -- THE WORK For and in consideration of the payments and agreements to be made and performed by City, Contractor agrees to furnish all materials and perform all work required to complete the Work as specified in the Contract Documents, and as generally indicated under the Bid Schedule(s) for the Project entitled: SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 The Work is comprised of the demolition and disposal of the existing restroom facility and the construction of a new restroom facility in its place. This will include but is not necessarily limited to: Identification, location, preservation and reconnection of existing utilities including water service, electrical service and sewer laterals; demolition, removal and disposal of the existing facility; grading/unclassified excavation of site for construction of new facility including any necessary import or export of soils; placement of concrete walkways, slabs and structure foundations; construction of masonry walls; construction of structural steel canopy; construction of plumbing and bath fixtures; construction of electrical system and fixtures; tiling; installation of doors and associated hardware; Installation of ADA grab bars and signage; installation of water station fixture and water supply; and any/all appurtenant work necessary for the construction of a complete, in place, fully functional restroom facility in accordance with the approved plans, specifications and applicable code. ARTICLE 2 -- COMMENCEMENT AND COMPLETION The Work to be performed under this Contract shall commence on the date specified in the Notice to Proceed by the City, and the Work shall be fully completed within the time specified in the Notice to Proceed. The City and the Contractor recognize that time is of the essence of this Agreement, and that the City will suffer financial loss if the Work is not completed within the time specified in Article 2, herein, plus any extensions thereof allowed in accordance with applicable provisions of the Standard Specifications, as modified herein. They also recognize the delays, expense, and difficulties involved in proving in a legal proceeding the actual loss suffered by the City if the Work is not completed on time. Accordingly, instead of requiring any such proof, the City and the Contractor agree that as liquidated damages or delay (but SUNRISE PARK RESTROOM AGREEMENT FORM CITY PROJECT NO. 19-13 AGREEMENT AND BONDS - PAGE 1 DECEMBER 2020 not as a penalty), the Contractor shall pay the City the sum specified in Section 6-9 of the Special Provisions for each calendar day that expires after the time specified in Article 2, herein. In executing the Agreement, the Contractor acknowledges it has reviewed the provisions of the Standard Specifications, as modified herein, related to liquidated damages, and has made itself aware of the actual loss incurred by the City due to the inability to complete the Work within the time specified in the Notice to Proceed. Termination Prior to Expiration of Term. City may terminate this Agreement for its convenience at any time, without cause, in whole or in part, upon giving Contractor written notice, pursuant to Section 6-8 of the Special Provisions. Where termination is due to the fault of Contractor and constitutes an immediate danger to health, safety, and general welfare, the period of notice shall be such shorter time as may be determined by the City. Upon such notice, City shall pay Contractor for Services performed through the date of termination in accordance with the Contract Documents. Upon receipt of such notice, Contractor shall immediately cease all work under this Agreement, unless stated otherwise in the notice or by written authorization of the Contract Officer. After such notice, Contractor shall have no further claims against the City under this Agreement. Upon termination of the Agreement under this section, Contractor shall submit to the City an invoice for work and services performed prior to the date of termination. ARTICLE 3 -- CONTRACT PRICE The City shall pay the Contractor for the completion of the Work, in accordance with the Contract Documents, in current funds the Contract Price(s) named in the Contractor's Bid Proposal and Bid Schedule(s), and any duly authorized Construction Contract Change Orders approved by the City. The amount of the initial contract award in accordance with the Contractor's Bid Proposal is Two Hundred and Forty -Nine Thousand Two Hundred and Thirty One Dollars ($249,231.00). Contractor agrees to receive and accept the prices set forth herein, as full compensation for furnishing all materials, performing all work, and fulfilling all obligations hereunder. Said compensation shall cover all expenses, losses, damages, and consequences arising out of the nature of the Work during its progress or prior to its acceptance including those for well and faithfully completing the Work and the whole thereof in the manner and time specified in the Contract Documents; and, also including those arising from actions of the elements, unforeseen difficulties or obstructions encountered in the prosecution of the Work, suspension of discontinuance of the Work, and all other unknowns or risks of any description connected with the Work. ARTICLE 4 -- THE CONTRACT DOCUMENTS The Contract Documents consist of the Notice Inviting Bids, Instructions to Bidders, the prevailing rate of per diem wages as determined by the Director of the California Department of Industrial Relations, the accepted Bid and Bid Schedule(s), List of Subcontractors, Local Business Preference Program — Good Faith Efforts, Non - Discrimination Certification, Non -Collusion Declaration, Bidder's General Information, Bid Security or Bid Bond, this Agreement, Worker's Compensation Certificate, Performance SUNRISE PARK RESTROOM AGREEMENT FORM CITY PROJECT NO. 19-13 AGREEMENT AND BONDS - PAGE 2 DECEMBER 2020 Bond, Payment Bond, Standard Specifications, Special Provisions, the Drawings, Addenda issued during bidding (if any), and all Construction Contract Change Orders and Work Change Directives which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto. ARTICLE 5 -- MUTUAL OBLIGATIONS For and in consideration of the payments and agreements to be made and performed by the City, the Contractor agrees to furnish all materials and perform all work required for the above stated project, and to fulfill all other obligations as set forth in the aforesaid Contract Documents. City hereby agrees to employ, and does hereby employ, Contractor to provide the materials, complete the Work, and fulfill the obligations according to the terms and conditions herein contained and referred to, for the Contract Price herein identified, and hereby contracts to pay the same at the time, in the manner, and upon the conditions set forth in the Contract Documents. Contractor specifically acknowledges and agrees to be bound by the Wage Rates and Labor Code requirements specified in the Contract Documents, including the requirement to furnish electronic certified payroll records directly to the Labor Commissioner (via the Division of Labor Standards Enforcement), and shall pay the general prevailing rate of per diem wages as determined by the Director of the Department of Industrial Relations of the State of California. ARTICLE 6 -- PAYMENT PROCEDURES The Contractor shall submit Applications for Payment in accordance with the Standard Specifications as amended by the Special Provisions. Applications for Payment will be processed by the City Engineer as provided in the Contract Documents. ARTICLE 7 -- NOTICES Whenever any provision of the Contract Documents requires the giving of a written Notice between the parties, it shall be deemed to have been validly given if delivered in person to the individual or to a member of the firm or to an officer of the corporation for whom it is intended, or if delivered at or sent by registered or certified mail, postage prepaid, to the last business address known to the giver of the Notice. ARTICLE 8 -- INDEMNIFICATION The Contractor agrees to indemnify and hold harmless the City, and all of its officers and agents from any claims, demands, or causes of action, including related expenses, attorney's fees, and costs, based on, arising out of, or in any way related to the Work undertaken by the Contractor hereunder. This Article 8 incorporates the provisions of Section 7-15 "Indemnification," of the Special Provisions, which are hereby referenced and made a part hereof. SUNRISE PARK RESTROOM AGREEMENT FORM CITY PROJECT NO. 19-13 AGREEMENT AND BONDS - PAGE 3 DECEMBER 2020 Prevailing Wages. Contractor agrees to fully comply with all applicable federal and state labor laws including, without limitation California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq. ("Prevailing Wage Laws"). Contractor shall bear all risks of payment or non-payment of prevailing wages under California law, and Contractor hereby agrees to defend, indemnify, and hold the City, its officials, officers, employees, agents and volunteers, free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. ARTICLE 9 -- NON-DISCRIMINATION In connection with its performance under this Agreement, Contractor shall not discriminate against any employee or applicant for employment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin (i.e., place of origin, immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition (each a "prohibited basis"). Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to any prohibited basis. As a condition precedent to City's lawful capacity to enter this Agreement, and in executing this Agreement, Contractor certifies that its actions and omissions hereunder shall not incorporate any discrimination arising from or related to any prohibited basis in any Contractor activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship; and further, that Contractor is in full compliance with the provisions of Palm Springs Municipal Code Section 7.09.040, including without limitation the provision of benefits, relating to non-discrimination in city contracting. ARTICLE 10 -- MISCELLANEOUS Terms used in this Agreement which are defined in the Standard Specifications and the Special Provisions will have the meanings indicated in said Standard Specifications and the Special Provisions. No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound, and specifically, but without limitation, monies that may become due and monies that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. The City and the Contractor each binds itself, its partners, successors, assigns, and legal representatives, to the other party hereto, its partners, successors, assigns, and legal representatives, in respect of all covenants, agreements, and obligations contained in the Contract Documents. SIGNATURES ON NEXT PAGE SUNRISE PARK RESTROOM AGREEMENT FORM CITY PROJECT NO. 19-13 AGREEMENT AND BONDS - PAGE 4 DECEMBER 2020 IN WITNESS WHEREOF, the City and the Contractor have caused this Agreement to be executed the day and year first above written. CITY OF PALM SPRINGS, CALIFORNIA B / David H. Read City Manager ATTEST: By Ll Anth y J. Me C le APPROVED AS TO FORM: 'Jeffrey anger, City Attorney RECOMMENDED: y Marcus L. Fuller, P.E., P.L.S. Assistant City Manager/City Engineer APPROVED BY THE CITY COUNCIL: Date 'z — 215 '-2 f Agreement No. A � �q2` SUNRISE PARK RESTROOM AGREEMENT FORM CITY PROJECT NO. 19-13 AGREEMENT AND BONDS - PAGE 5 DECEMBER 2020 [IF CORPORATION, TWO NOTARIZED SIGNATURES, PRESIDENT OR VICE PRESIDENT AND SECRETARY OR TREASURER REQUIRED.] CONTRACTOR : P-nsQ &nSk(0CV0n LDrl Firm/Company Name By: ,.emsRA4-11- 4'-�et Signat (notarized) Name:,& ,AA (QA Title: yck3i 8P A By Signature (notarized) Name: -5cx. n Title -.- 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. (This Agreement must be signed in the above space by one having authority to bind the Contractor to the terms of the Agreement.) State of CAI, Fbrtj I A County of R,uvs, )ss On c� I Z) before me, Sko-u,,i h 6t FF jj6- j P,61,c- personally appeared hr,lArac- Rftrl,r47L- 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 signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. (This Agreement must be signed in the above space by one having authority to bind the Contractor to the terms of the Agreement.) State of CA fr 1 " County ofScv, 15err%ocdin6 )ss On 03//o /2021 before me, o & 91 ft personally appeared SA4r" Ckc""i who proved to me on the basis of satisfactory evidence to be the person�Kwhose name�s'j Is are subscribed to the within instrument and acknowledge to me that he he ey executed the same in his er/ eir authorized capacity), and that by hi he heir signatures on the instrument the personA, or the entity upon behalf of which the personKacted, executed the instrument. I certify under PENALTY OF PERJURY under the I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand fficia se I. WITNESS my hand and official seal. Notary Signature: Notary Signature: M Notary Seal: Notary Seal: 2 f M. CUMMINGS p, Q0ff CoWNC COMM. #2217172 TARY PUBLIC - CALIFORNIA s AN BERNARDINO COUNTY NOTARY PUBLIC• CALIFOFMA Comm. Expires October 7, 2021 RIVERSIDE COUNTY My Comm. Expires September 1, 2023 SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 DECEMBER 2020 AGREEMENTFORM AGREEMENT AND BONDS — PAGE 6 BOND No. 65415259 PERFORMANCE BOND — PUBLIC WORKS KNOW ALL MEN BY THESE PRESENTS, WHEREAS, the City of Palm Springs, a charter city, organized and existing in the County of Riverside, California, as Obligee, (hereinafter referred to as the "City"), has awarded to the undersigned Contractor, (hereinafter referred to as the "Contractor"), an agreement for the work described as follows: SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 (hereinafter referred to as the "Public Work); and WHEREAS, the work to be performed by the Contractor is more particularly set forth in that certain Agreement (Construction Contract) for the said Public Work awarded to the Contractor and approved by the City for the Project hereinabove named, (hereinafter referred to as the "Contract"), which Contract is incorporated herein by this reference; and WHEREAS, the Contractor is required by said Contract to perform the terms thereof, and to provide a bond both for the performance and guaranty thereof. NOW, THEREFORE, we, the undersigned Contractor, as Principal, and: WESTERN SURETY COMPANY a corporation organized and existing under the laws of the State of South Dakota and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the City in the Sum Of Two Hundred Forty Nine Thousand Two Hundred Thirty One and no/100 Dollars ($ 249,231.00 ), said sum being not less than 100 percent of the total amount payable by the City under the terms to the said Contract, for which amount well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that if the bounden 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 said Contract and any alteration thereof made as therein provided, on his or its parts, 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 the one year guarantee of all materials and workmanship; and indemnify and save harmless the City, its officers and agents, as stipulated in said Contract, then this obligation shall become null and void; otherwise it shall be and remain in full force and effect. The said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition to the terms of the 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 of addition to the terms of the Contract, or to the Public Work or to the Specifications. No final settlement between the City and the Contractor shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. SUNRISE PARK RESTROOM PERFORMANCE BOND CITY PROJECT NO. 19-9 3 AGREEMENT AND BONDS - PAGE B DECEMBER 2020 PERFORMANCE BOND — PUBLIC WORKS (CONTINUED) Contractor and Surety agree that if the City is required to engage the services of an attorney in connection with enforcement of the bond, each shall pay City's reasonable attorneys fees incurred, with or without suit, in addition to the above sum. It SIGNED AND SEALED, this th day of March , 20 21. CONTRACTOR: Ecosense Construction Corp Check one: individual,_ partnership, X corporation (This Performance Bond must be signed by representatives and/or officers having appropriate authority to bind the Contractor and Surety to the terms of the Performance Bond.) CONTRACTOR: Ecosense Construction Corp By: signature (NOTARIZED) Print Name and Title: Air, �-0,M'Ire.t-,VrP-a-IgJ SURETY: WESTERN SURETY COMPANY By C,�L ji slgna ur (NOTARIZED) Print Name and Title: C. Bendt, Assistant Secretary Byple se see attached. signature (NOTARIZED) Print Name and Title: By submitting this Performance Bond, the Contractor and Surety acknowledge the provisions of the Contract Documents with regard to Section 6-4 "Default by the Contractor", as further amended by the Special Provisions. SUNRISE PARK RESTROOM PERFORMANCE BOND CITY PROJECT NO. 19-13 AGREEMENT AND BONDS - PAGE 9 DECEMBER 2020 PERFORMANCE BOND — PUBLIC WORKS (CONTINUED) The rate of premium on this bond is $ 30.00 per thousand. The total amount of premium charged: $ 7,477.00 (The above must be filled in by corporate surety). IMPORTANT: Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in Section 105 of the California Insurance Code, and if the work or project is financed, in whole or in part, with Federal, grant, or loan funds, it must also appear on the Treasury Department's most current list (Circular 570 as amended). THIS IS A REQUIRED FORM. Any claims under this bond may be addressed to: (dame and Address of Surety) (Name and Address of Agent or Representative for service of process in California if different from above) (Telephone Number of Surety and Agent or Representative for service of process in California) SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 DECEMBER 2020 WESTERN SURETY COMPANY 151 N. Franklin, 17th Floor Chicago, IL 60606 SURETY FIRST INSURANCE SERVICES, INC. 2201 FRANCISCO DR. STE 140-343 ELDORADO HILLS CA 95762 605-336-0850 916-673-6906 PERFORMANCE BOND AGREEMENT AND BONDS - PAGE 10 PERFORMANCE BOND — PUBLIC WORKS (CONTINUED) ALL-PURPOSE 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 A11'(V County of On 3� //��%%/ before me, _ / l �l �}/ril Dilra, {1%d/zt`r7 pub/�C Date �/ �jNamTi of Officer personally appeared /�!?d��o, L Dim/rt s, ,2 0AnrlYa rtiLON NAME(S) OF SiGNER(S) who proved to me on the basis of satisfactory evice to be the person whose a Isl�r subscribed to the within instrume d acknowledged to me that he/she/ a xecuted the same in his/her ei u orized capacity es , and that by his/her! ei ignatureS& on the instrument the person s) or the entity upon behalf of which the person6acted, executed the instrument I certify under PENALTY OF PERJURY under the laws of the State identified herein, that the foregoing paragraph is true and correct. Witness my hand and official seal. Si n ture of Notary Amaya Duro �Y COMM. #2280537 x x NOTARY PUBLIC - CALIFORNA RIVERSIDE COUNTY My Comm. Expires March 12, 2023 ATTENTION NOTARY: Although the information requested below is OPTIONAL, it could prevent fraudulent attachment of this certificate to unauthorized document. Q /� THIS CERTIFICATE Title or Type of Document MUST BE ATTACHED TO THE DOCUMENT Number of Pages i DATE of DOCUMENT DESCRIBED AT RIGHT: Signer(s) Other Than Named Above SUNRISE PARK RESTROOM PERFORMANCE BOND CITY PROJECT NO. 19-13 AGREEMENT AND BONDS - PAGE 11 DECEMBER 2020 STATE OF SOUTH DAKOTA ss COUNTY OF MINNEHAHA On this B th day of ACKNOWLEDGMENT OF SURETY (Corporate Officer) March 2021 , before me, a Notary Public in and for said County, personally appeared C. Bendt Assistant Secretary personally known to me, who being by me duly sworn, did say that he/she is the aforesaid officer of WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws of the State of South Dakota, that the seal affixed to the foregoing instrument is the corporate seal of said corporation, that the said instrument was signed, sealed and executed on behalf of said corporation by authority of its Board of Directors, and further acknowledge that the said instrument and the execution thereof to be the voluntary act and deed of said corporation. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal the day and year last above written. My commission expires: t aya�OtiaaoatibabbwSShhtibtieti4 F fit- M. a BENT ay Notary Public r NOTARY PUBLIC s i S SOUTH DAKOTA SEAL i taao,reyvlbwb�e�ey�o�ol4°0�o�o'otia t My Commission Expires March 2, 2026 Form F1 1692 -11-2020 Western Surety Company POWER OF ATTORNEY - CERTIFIED COPY Bond No. 65415259 Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company"), does by these presents make, constitute and appoint C . Bendt its true and lawful attorney(s)-in-fact, with full power and authority hereby conferred, to execute, acknowledge and deliver for and on its behalf as Surety, bonds for: Principal: Ecosense Construction Corp Obligee: City of Palm Springs Amount: $1, 000, 000. 00 and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Vice President, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s)-in-fact may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety Company which remains in full force and effect. "Section 7. All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." If Bond No. 65 415 25 9 is not issued on or before midnight of June 25, 2021 all authority conferred in this Power of Attorney shall expire and terminate. a %, Western Surety Company has caused these presents to be signed by its Vice President, Paul T. Bruflat, and its Lthis Bth day of March 2021 WEST R Cam- /-SUUR`E COMPANY S F. I tA,_A Paul T. ruflat, Vice President -a .m8e• ....e a ss AHA On this B th day of March in the year 2021 before me, a notary public, personally appeared Paul T. Bruflat, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of WESTERN+ SURETY COMPANY and acknowledged said instrument to be the voluntary act and deed of saidaid rp� bbhbb4bbbbbbbbbbbbbbbbbb + M. BENT 8 REAL NOTARY PUBLIC SEAL y Notary Public - South Dakota jSOUTH DAKOTA(RB tb!vbbbbbbbbbkbbb�bbbbbbb t My Commission Expires March 2, 2026 I the undersigned officer of Western Surety Company, a stock corporation of the State of South Dakota, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable, and furthermore, that Section 7 of the bylaws of the Company as set forth in the Power of Attorney is now in force. In testimony whereof, I have hereunto set my hand and seal of Western Surety Company this B th day of March 2021 WEST R SURE COMPANY Paul T. truflat, Vice President To validate bond authenticity, go to www.cnasuretv.com > Owner/Obligee Services > Validate Bond Coverage. Forth F5306.11-2020 BID DOCUMENTS Only the following listed documents, identified in the lower right corner as 'Bid Forms" shall be fully executed and submitted with the Bid at the time of opening of Bids. Bid (Proposal) Lump Sum Bid Schedule List of Subcontractors Local Business Preference Program Good Faith Efforts Non -Collusion Declaration Non -Discrimination Certification Bid Bond (Bid Security Form) Bidder's General Information Public Integrity Disclosure Form Failure of a Bidder to fully execute and submit all of the listed documents with the Bid will render a Bid as non -responsive and subject to rejection. The following listed documents shall be fully executed and submitted with the Bid not later than seven (7) calendar days of bid opening. Base Lump Sum Bid Schedule — Schedule of V SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 COVER SHEET DECEMBER 2020 BID FORMS PAGE 1 BID PROPOSAL BID TO: CITY OF PALM SPRINGS, CALIFORNIA The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with the City in the form included in the Contract Documents (as defined in Article 4 of the Agreement) to perform the Work as specified or indicated in said Contract Documents entitled: SUNRISE PARK RESTROOM CITY PROJECT NO.19-13 Bidder accepts all of the terms and conditions of the Contract Documents, including without limitation those in the Notice Inviting Bids and the Instructions to Bidders dealing with the disposition of the Bid Security. This Bid will remain open for the period stated in the Notice Inviting Bids, unless otherwise required by law. Bidder will enter into an Agreement within the time and in the manner required in the Instructions to Bidders, and will furnish the insurance certificates, Payment Bond, Performance Bond, and all Permits required by the Contract Documents. Bidder has examined copies of all the Contract Documents, including the following Addenda (receipt of which is hereby acknowledged): Number 1 Date 01 /21 /2021 Number Date Number Date Number Date Number Date Number Date Number Date Bidder has familiarized itself with the nature and extent of the Contract Documents, the Work, the site, the locality where the Work is to be performed, the legal requirements (federal, state, and local laws, ordinances, rules, and regulations), and the conditions affecting cost, progress, or performance of the Work, and has made such independent investigations as Bidder deems necessary. SUNRISE PARK RESTROOM BID PROPOSAL CITY PROJECT NO. 19-13 BID FORMS - PAGE 2 DECEMBER 2020 In conformance with the current statutory requirements of California Labor Code Section 1860, et seq., the undersigned confirms the following as its certification: I am aware of the provisions of Section 3700 of the Labor Code, which require every employer to be insured against liability for worker's compensation, or to undertake self- insurance in accordance with the provisions, before commencing the performance of the Work of this Contract. To all the foregoing, and including all Bid Schedule(s), List of Subcontractors, Non -Collusion Declaration, Bidder's General Information, and Bid Bond contained in these Bid Forms, said Bidder further agrees to complete the Work required under the Contract Documents within the Contract Time stipulated in said Contract Documents, and to accept in full payment therefor the Contract Price based on the Lump Sum or Unit Bid Price(s) named in the aforementioned Bidding Schedule(s). Dated: 01 /27/2021 Bidder: Ecosense Construction Corp By: 7 rem. (S nature) Title: President SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 BID PROPOSAL DECEMBER 2020 BID FORMS -PAGE 3 LUMP SUM BID SCHEDULE SUNRISE PARK RESTROOM CITY PROJECT NO.19-13 Description This Lump Sum Bid is comprised of the demolition and disposal of the existing restroom facility and the construction of a new restroom facility in its place in accordance with the Project Drawings and Construction Documents. This will include but is not necessarily limited to: Identification, location, preservation and reconnection of existing utilities including water service, electrical service and sewer laterals; Demolition, removal and disposal of the existing facility and indicated walkways; Unclassified Excavation, Unclassified Fill and Grading of the project site for construction of new facility including any necessary import or export of soils and preparation of subgrade; Placement of concrete walkways, slabs and structure foundations; Construction of masonry walls; Construction of structural steel canopy; Construction of plumbing system and fixtures; Construction of electrical system and fixtures; Tiling; Construction of doors and associated hardware; Construction of ADA grab bars and signage; Procurement and Installation of drinking water station fixture and connection to water supply; Any/all project materials and appurtenant work necessary for furnishing and constructing a complete, in place, fully functional restroom facility in accordance with the, project drawings, specifications and applicable codes. SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 DECEMBER 2020 DEDUCTIVE LUMP SUM BID SCHEDULE NO. 5 BID FORMS - PAGE 4 TOTAL BID PRICE For the lump sum price of: $ 249,231.00 (Price in figures) Two hundred forty-nine thousand two hundred thirty-one (Price in words) SPECIAL ACKNOWLEDGEMENT: The Lump Sum Price identified in this Bid Schedule identifies and commits the Bidder to a "Firm Fixed Price" cost, and all other incidental or additional costs required to complete the work as identified in the technical specification requirements. The Lump Sum Price is inclusive of all other costs, including all materials, supplies, labor, vehicles, equipment and ancillary costs required to complete the work. Ecosense Construction Corp Name of Bidder or Firm SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 DECEMBER 2020 DEDUCTIVE LUMP SUM BID SCHEDULE NO. 5 BID FORMS - PAGE 5 BIDDER'S LIST OF SUBCONTRACTORS As required under Section 4104 of the Public Contract Code, the Bidder shall list below the name and the location of the place of business of each subcontractor who will perform work or labor or render service to the prime contractor in or about the construction of the work or improvement, or a subcontractor licensed by the State of California who, under subcontract to the prime contractor, specially fabricates and installs a portion of the work or improvement, in an amount in excess of one-half of 1 percent of the prime contractor's total bid or, in the case of bids for the construction of streets or highways, including bridges, in excess of one-half of 1 percent of the prime contractor's total bid or ten thousand dollars ($10,000), whichever is greater. After the opening of Bids, no changes or substitutions will be allowed except as otherwise provided by law. The listing of more than one subcontractor for each item of Work to be performed with the words "and/or' will not be permitted. Failure to comply with this requirement will render the Bid as non -responsive and may cause its rejection. Special Note: The Prime Contractor shall perform not less than 50% of the Work identified in this Bid. In the event a Bidder lists subcontractors who will perform Work under this Bid in excess of 50% of the Work identified in this Bid, the Bid shall be considered non -responsive. A. BIDDER'S PORTION OF WORK Page 1 of 2 1. Name of Prime Contractor: Ecosense Construction Corp 2. Bid Items / Portion of Work to be Self -Performed (if less than 100% of the contract): General Requierements, Demolition, Utility Services, Concrete, Mansory Walls and Footing, Structural Steel and Roofing Dors & Hardware, Plumbing System and Fixtures, Electrical System and Furnishings, ADA Fixture and Signage, Drinking Water Station, Miscellaneous 3. Dollar Amount of Work Self- 4. Percentage of Work Self- 5. Date: Performed: Performed: $ 224,307.90 90% 01/27/2021 By signing the Bid Form, Contractor hereby certifies that it will perform not less than 50% of the Contract Work with its own forces. B. LIST OF SUBCONTRACTORS 1. Type of Subcontractor (Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; *X Service Contractor (e.g. Trucking) 2. Subcontractor Name: Del's Flooring Contractors, Inc. 3. Address: 42120 State Street, Palm Desert, CA 92211 4. Bid Items/Portion of Work: Tiling 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: 760-568-0060 ext 213 486540 p < $1 M ❑ < $5M ❑ < $10M ❑ < $15M ❑ > $15M 8. Amount of Contracted Work: 9. DIR Public Works Contractor $ 24,923.10 Registration No: 1000008727 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes ® No 12. DBE Certification No.: 10% SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 LIST OF SUBCONRACTORS DECPM13ER 2020 BID FORMS - PAGE 6 BIDDER'S LIST OF SUBCONTRACTORS - (Continued) Copy this page as needed to provide a complete listing. Page 2 of 2 1. Type of Subcontractor (Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor (e.g. Trucking) 2. Subcontractor Name: Not applicable 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ < $1 M ❑ < $5M ❑ < $10M ❑ < $15M ❑ > $15M 8. Amount of Contracted Work: 9. DIR Public Works Contractor Registration No: 10. Percentage of Contracted Work: 11 DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: 1. Type of Subcontractor (Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor (e.g. Trucking) 2. Subcontractor Name: Not applicable 3. Address: Not applicable 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ < $1M ❑ < $5M ❑ < $10M ❑ < $15M ❑ > $15M 8. Amount of Contracted Work: 9. DIR Public Works Contractor Registration No: 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: 1. Type of Subcontractor (Check One) ❑ First Tier; ❑ Second Tier; ❑ Supplier; ❑ Service Contractor (e.g. Trucking) 2. Subcontractor Name: Not applicable 3. Address: 4. Bid Items/Portion of Work: 5. Phone No.: 6. Contractor's License No.: 7. Annual Gross Receipts: ❑ < $1M ❑ < $5M ❑ < $10M ❑ < $15M ❑ > $15M 8. Amount of Contracted Work: 9. DIR Public Works Contractor Registration No: 10. Percentage of Contracted Work: 11. DBE Firm? ❑ Yes ❑ No 12. DBE Certification No.: SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 LIST OF SUBCONRACTORS DECEMBER 2020 BID FORMS - PAGE 7 LOCAL BUSINESS PREFERENCE PROGRAM - GOOD FAITH EFFORTS City Project No. 19-13 Bid Opening Date 01/27/2021 The contract for this project is subject to the provisions of Palm Springs Ordinance No. 1756, and Section 7.09.030 of the Palm Springs Municipal Code, "Local Business Preference Program", subsection (5) "Local Preference in Public Works Contracts (Sub -Contracting)", which states: The prime contractor shall use good faith efforts to sub -contract the supply of materials and equipment to local business enterprises and to sub -contract services to businesses whose work force resides within the Coachella Valley. The prime contractor shall submit evidence of such good faith efforts at the time of submission of bids. Good faith efforts may be evaluated by placing advertisements inviting proposals in local newspapers, sending request for proposals to local sub- contractors, or by demonstrating that no local sub -contracts are qualified to perform the work or supply the materials or equipment. Any notice inviting bids which may require the use of sub- contractors shall include notification of this subsection. The City Council or Director may reject as non -responsive the bid of any contractor proposing to use sub -contractors that fail to comply with the requirements of this subsection. FAILURE TO IDENTIFY GOOD FAITH EFFORTS ON THESE FORMS MAY BE SUFFICIENT CAUSE TO FIND THE BID NON -RESPONSIVE. BIDDERS SHALL ENSURE ALL APPROPRIATE GOOD FAITH EFFORTS ARE IDENTIFIED. Bidders shall provide sufficient information to demonstrate that they have made good faith efforts to comply with Palm Springs Ordinance No. 1756. In the event no local firm (as defined in Ordinance No. 1756) is listed as a subcontractor on the "List of Subcontractors" submitted with its Bid, Bidders shall identify local subcontractors not required to be identified on the List of Subcontractors, and/or shall identify local firms with whom the Bidder has solicited to furnish materials and supplies for incorporation into the work of this project. Local Subcontractors not listed on the List of Subcontractors: Local firms that will furnish materials or supplies to the Bidder for this project: C & M Building Materials, Inc Smith Pipe & Supply SUNRISE PARK RESTROOM LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO. 19-13 GOOD FAITH EFFORTS DECEMBER 2020 BID FORMS - PAGE 8 LOCAL BUSINESS PREFERENCE PROGRAM - GOOD FAITH EFFORTS (CONTINUED) In the event no local firms (as defined in Ordinance No. 1756) will provide services, or furnish materials and supplies to the Bidder for this project, the Bidder shall provide information sufficient to demonstrate good faith efforts to do so. Examples of information accepted by the City to demonstrate good faith efforts shall be included below: A. The names and dates of each publication in which a request for participation by local firms for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement Not applicable B. The names and dates of written notices sent to local firms soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the local firms were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of Date of Follow Up Methods firms Initial and Dates Solicited Solicitation Palm Springs Welding, Inc. 01/19/2021 Email White's Steel, Inc. 01/20/2021 Email SUNRISE PARK RESTROOM LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO. 19-13 DECEMBER 2020 GOOD FAITH EFFORTS BID FORMS -PAGE 9 1/24/2021 Sunrise Park Restroom Bldg/Bid prposal - ecosenseconstructioncorp@gmail.com - Gmail Sunrise Park Restroom Bldg/Bid prposal Andrea Ramirez <ecosenseconstructioncorp@gmail.com> Jan 19, 2021, 1:07 PM (5 days ago) to info, chacon.sandra Hello, We're bidding for the Sunrise Park Restroom City Project No.19-13. Please provide us with a proposal if you would like to proceed. The services needed are metals, structural steel framing, and roofing for this project: Attached please find bid specs for your review. Thank you and best regards Andrea Ramirez, General Contractor Ecosense Construction Corp (954) 598-5946 ecosenseconstructioncorp mail.com SPECIAL PROVISIONS CP 19.13 Special P... Chantal <Chantal@palmspringsweldin g.com> to me Jan 19, 2021, 1 .16 PM (5 days ago) Thank you for reaching out. At this time, we are not registered as a DIR public works contractor, and we cannot take on new projects due to a large workload. Best of luck on your project, Chantal Francisco, CFO Palm Springs Welding Inc 760-323-8451 direct line https://mail.google.com/mail/u/2/#sent/QgrcJHsTnPztFzgTjwjmJFBNCICwRcwpmNb 1 A 1/2412021 Sunrise Park Restroom Bldg/Bid proposal - ecosenseconstrucdoneorp@gmail.com - Gmail Sunrise Park Restroom Bldg/Bid proposal Inbox Andrea Ramirez<ecosenseconstructioncorp@gmail.com> Wed, Jan 20, 4:50 PM (4 days ago) to ej, pwatson Hello, We're bidding for the Sunrise Park Restroom City Project No.19-13. Please provide us with a proposal if you would like to proceed. The services needed are metals, structural steel framing, and roofing for this project: Attached please find bid specs for your review. Thank you and best regards Andrea Ramirez, General Contractor Ecosense Construction Corp (954) 598-5946 ecosenseconstructioncorp@gmail.com SPECIAL PROVISIONS aw�ae ruu wmoa Vj CP 19-13 Special P... E.J. Neumeyer <ei@whitessteel.com> to me Hi Andrea, Wed, Jan 20, 5:22 PM (4 days ago) Given that this bid is needed in a week and affords us no time for BFI's and little time to review specs and prepare quote, we may unfortunately have to pass on this one. Please advise if there's been any addenda or extension to the bid date. Thanks, E.J. Neumeyer Estimator White's Steel, Inc. P.O. Box 846 Thermal, CA 92274 (760) 541-5709 direct t5j@whitessteel.com CL#477294 A, B, C23, C51 Califomia DIR #1000002742 LA City Fabricator #2014 AISC Member #876764 https://mail.google.com/mail/u/2Ntsent/KtbxLvHcMPPTCZmnpdpjDHMNNQVZQvPBsB 1/1 C. The items of work which the bidder made available to local firms, including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate participation by local firms. Items of Work Bidder Breakdown of Items Amount Percentage Normally M Of Performs Item Contract (Y/N) Concrete Concrete Walkway, Slabs $ 24,923.10 10% Y & Structure Foundations Steel Y Structural Steel Canopy $ 29,907.72 12% D. The names, addresses and phone numbers of rejected local firms, the reasons for the bidder's rejection of the local firms, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each firm if the selected firm is not a local firm: Names, addresses and phone numbers of rejected local firms and the reasons for the bidder's rejection of the local firms: Not applicable Names, addresses and phone numbers of firms selected for the work above: C & M Building Materials, Inc 68355 Kieley Rd, Cathedral City, CA 92234 760 328-6543 Endura Steel 72470 Varner Rd. Thousand Palms, CA 92276 760 343-3100 NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. SUNRISE PARK RESTROOM LOCAL BUSINESS PREFERENCE PROGRAM CITY PROJECT NO. 19-13 DECEMBER 2020 GOOD FAITH EFFORTS BID FORMS -PAGE 10 NON -COLLUSION DECLARATION The undersigned declares: I am the President of Ecosense Construction Corp , the (Title of Officer) (Firm/Company) 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 induced or solicited any other bidder to put in a false or 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 01/27/2021 , at Palm Springs CA (Date) (City) (State) Signature SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 DECEMBER 2020 NON -COLLUSION DECLARATION BID FORMS - PAGE 11 CERTIFICATION OF NON-DISCRIMINATION BY CONTRACTORS In connection with its performance under this Agreement, Contractor shall not discriminate against any employee or applicant for employment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin (i.e., place of origin, immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition (each a "prohibited basis"). Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to any prohibited basis. As a condition precedent to City's lawful capacity to enter an agreement with Contractor, and in executing this Agreement, Contractor certifies that its actions and omissions hereunder shall not incorporate any discrimination arising from or related to any prohibited basis in any Contractor activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship; and further, that Contractor is in full compliance with the provisions of Palm Springs Municipal Code Section 7.09.040, including without limitation the provision of benefits, relating to non-discrimination in city contracting. We agree specifically: 1. To establish or observe employment policies, which affirmatively promote opportunities for minority persons at all job levels. 2. To communicate this policy to all persons concerned, including all company employees, outside recruiting services, especially those serving minority communities, and to the minority communities at large. 3. To take affirmative steps to hire minority employees within the company. FIRM Ecosense Construction Corp NAME OF PERSON SIGNING Andrea Ramirez TITLE OF PERSON SIGNING President DATE 01/27/2021 Please include any additional information available regarding equal opportunity employment programs now in effect within your company. Not applicable SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 NON-DISCRIMINATION CERTIFICATION DECEMBER 2020 BID FORMS -PAGE 12 BIDDER'S GENERAL INFORMATION The Bidder shall furnish the following information. Failure to complete all Items will cause the Bid to be non -responsive and may cause its rejection. 1. BIDDER/CONTRACTOR'S Name and Street Address: Ecosense Construction Corp 200 E Francis Drive, Unit 240, Palm Springs, CA 92262 N 3 Telephone Number: (954 ) 598-5946 Facsimile Number: ( ) E-Mail: ecosenseconstructioncorp@gmail.com Tax Identification Number: 83-1122134 TYPE OF FIRM Individual Partnership Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Small Disadvantaged Business (SDB) Veteran Owned Business Disabled Veteran Owned Business Corporation (State CA ) CONTRACTOR'S LICENSE: Primary Classification State License Number(s) # 1061632 GENERAL BUILDING Supplemental License Classifications Not applicable 4. BUSINESS LICENSE: Yes v No License No.: 5. Surety Company and Agent who will provide the required Bonds: Name of Surety Surety First Insurance Services, Inc. Address 1024 Iron Point Road, Suite 100, Folsom, CA 95630 Surety Company Western Surety Company Telephone Numbers: Agent (916) 673-6906 SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 DECEMBER 2020 Surety (800 ) 331- 6053 BIDDER'S GENERAL INFORMATION BID FORMS - PAGE 18 all Department of Industrial Relations STATE OF CALIFORNIA APPLICATION FOR PUBLIC WORKS CONTRACTOR REGISTRATION Registration Information Type: New Period: January 27, 2021—June 30, 2021 Contractor Information Contractor Name: Ecosense Construction Corp Trade Name: License Type Number: PW-LR-1000710730 Contractor Physical Address Physical Business Country: United States of America Physical Business Address: 8929 Fox Trail Contractor Mailing Address Mailing Business Country: Mailing Business Address: Contact Info Daytime Phone: Mobile Phone: Physical Business City/ Province: Morongo Valley Physical Business State: CA Physical Business Postal Code: 92256 Mailing Business City/ Province: Mailing Business State: Mailing Business Postal Code: Daytime Phone Ext.: Business Email: ecosenseconstructioncorp@gmail .com Applicant's Email: ecosenseconstructioncorp@gmail .com Registration Services:: Page 1 of 2 1/27/202111:30:13 AM Home n CONTRACTORS STATE LICENSE BOARD 0- 11 OContractor's License Detail for License # 1061632 DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. . CSLB complaint disclosure is restricted bylaw (B&P7124.6) If this entity is subject to public complaint disclosure click on link that will appear below for more information. Click here for a definition of disclosable actions. r Only construction related civil judgments reported to CSLB are disclosed(B&P 7071.17). Arbitrations a re not listed unless the contractor fails to comply with the terms. Due to workload, there may be relevant information that has not yet been entered into the board's license database. Data current as of 1/27/2021 12:21:36 PM ECOSENSE CONSTRUCTION CORP 200 E FRANCIS DR UNIT 240 PALM SPRINGS, CA 92262 Business Phone Number:(954) 598-5946 Entity Corporation Issue Date 12/23/2019 Expire Date 12/31/2021 This license is current and active. All information below should be reviewed. 8- GENERAL BUILDING CONTRACTOR Contractor's Bond This license filed a Contractor's Bond with BUSINESS ALLIANCE INSURANCE COMPANY. Bond Number: G101005383832 Bond Amount: $15,000 Effective Date: 10/09/2020 Contractor's Bond History Bond of Qualifying Individual The qualifying individual ANDREA LORENA RAMIREZ certified that he/she owns 10 percent or more of the voting stock/membership interest of this company; therefore, the Bond of Qualifying Individual is not required. Effective Date: 12/23/2019 This license is exempt from having workers compensation insurance; they certified that they have no employees at this time. Effective Date: 12/21/2019 Expire Date: None Copyright © 2021 State of California BIDDER'S GENERAL INFORMATION (Continued) 6. List the names and addresses of the principal members of the firm or names and titles of the principal officers of the corporation or firm; also include all natural persons who have a financial interest greater than 5% in the Bidder's business entity. (Use additional sheet if required). Andrea Ramirez President Sandra Chacon Secretary Andres Ramirez CFO 7. Number of years experience as a contractor in this specific type of construction work: _ 6 8. List at least three related projects completed to date: a. Owner Leafy Jungle Corp Address 15852 Little Morongo Rd, Desert Hot Springs, CA 92240 Contact Project Manager Class of Work Commercial Plumbing Phone (786) 531-3772 Contract Amount $ 25,000.00 Plumbing System Project & Fixtures 03/31/2020 Date Completed Contact Person Herman Scholtz Telephone number (786) 531-3772 City of South Miami b. Owner Florida Address 6350 S Dixie Hwy, South Miami, FL 33143 Contact Division of Purchasing Construction of the SW 78th Street Roadway Class of Work and Drainage Improvements at Do a Park Phone (305) 663 6339 Contract Amount $ 98,662.44 Project PO-012713 Date Completed 01/15/2016 Contact Person Ricardo Ayala Telephone number (305) 403-2063 City of Pembroke Pines C. Owner Florida Address 8300 S Palm Drive, Pembroke Pines, FL 33025 Contact City Manager Class of Work Road Resurfacing and Turn Lane of Holly Lake Phone (954) 431- 4884 Contract Amount $ 231,974.00 Project PSEN-14-04 Date Completed 06/10/2015 Contact Person Ricardo Rose Telephone number (954) 518-9043 Andrea Ramirez 9. Name of Project Manager/Superintendent: 10. Name(s) of person(s) who inspected job site: Andrea Ramirez & Sandra Chacon SUNRISE PARK RESTROOM BIDDER'S GENERAL INFORMATION CITY PROJECT NO. 19-13 BID FORMS - PAGE 19 DECEMBER 2020 PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM 1. Name of Entity Ecosense Construction Corp 2. Address of Entity (Principle Place of Business) 200 E Francis Drive, Unit 240, Palm Springs, CA 92262 3. Local or California Address (if different than #2) 8929 Fox Trail # 734, Morongo Valley, CA 92256 4. State where Entity is Registered with Secretary of State If other than California, is the Entity also registered in California? ❑ Yes d No 5. Type of Entity F!� Corporation .� Limited Liability Company Partnership Trust ❑ Other (please specify) 6. Officers, Directors, Members, Managers, Trustees, Other Fiduciaries (please specify) Note: If any response is not a natural person, please identify all officers, directors, members, managers and otherhduciariesforthemember, manager, trust orotherentity Andrea Ramirez �f Officer Director ❑ Member YManager [name] General Partner ❑ Limited Partner Other Sandra Chacon LvOfficer Director Ei Member Manager [name] General Partner ❑ Limited Partner Other Andres Ramirez 'Officer E Director ❑ Member Manager [name] General Partner ❑ Limited Partner Other CITY OF PALM SPRINGS — PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM Page 1 of 2 SUNRISE PARK RESTROOM PUBLIC INTEGRITY DISCLOSURE FORM CITY PROJECT NO. 19-13 BID FORMS - PAGE 20 DECEMBER 2020 7. Owners/Investors with a 5% beneficial interest in the Applicant Entity or a related entity A. Not applicable [name of owner/investor] [name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP A, EXPLANATION OF THE RELATIONSHIP: B. [name of ownerfinvestor] [name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP B, EXPLANATION OF THE RELATIONSHIP: C. [name of owner/investor] [name of official with whom owner/investor has material financial relationship] FOR RELATIONSHIP C, EXPLANATION OF THE RELATIONSHIP: I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. ichea- IJC�,,., /QZ I AY)S(Q, C,'rf) i,& / 01/27/2021 VUV CQSiAP-oi CITY OF PALM SPRINGS — PUBLIC INTEGRITY DISCLOSURE APPLICANT DISCLOSURE FORM Page 2 of 2 SUNRISE PARK RESTROOM PUBLIC INTEGRITY DISCLOSURE FORM CITY PROJECT NO. 19-13 BID FORMS - PAGE 21 DECEMBER 2020 BID BOND KNOW ALL MEN BY THESE PRESENTS, That Ecosense Construction Corp Bond No. 65358185 as Principal, and WESTERN SURETY COMPANY as Surety, are held and firmly bound unto the City of Palm Springs, California, hereinafter called the "City" in the sum of: Ten Percent of Amount Bid (10% of amount bid) dollars (not less than 10 percent of the total amount of the bid) for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. WHEREAS, said Principal has submitted a Bid to said City to perform the Work required under the Bid Schedule(s) of the City s Contract Documents entitled: SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 NOW THEREFORE, if said Principal is awarded a Contract by said City, and within the time and in the manner required in the "Notice Inviting Bids" and the "Instructions to Bidders" enters into a written Agreement on the Form of Agreement included with said Contract Documents, furnishes the required Certificates of Insurance, and furnishes the required Performance Bond and Payment Bond, then this obligation shall be null and void, otherwise it shall remain in full force and effect. In the event suit is brought upon this Bond by said City, and City prevails, said Surety shall pay all costs incurred by said City in such suit, including a reasonable attorney's fee to be fixed by the court. SIGNED AND SEALED, this 27th day of January EXECUTED FOR THE PRINCIPAL: By Z4 r nature (N TARIZED) Print Name and Title: Q A n A fQ,;�\ [,tim1uZ M Signature (NOTARIZED) Print Name and Title: 20 21 EXECUTED FOR THE SURETY: WESTERN SURETY COMPANY By Signature (NOTARIZED) Print Name and Title: IA SUNRISE PARK RESTROOM BID BOND (BID SECURITY FORM) CITY PROJECT NO. 19-13 DECEMBER 2020 BID FORMS -PAGE 13 Western Surety Company POWER OF ATTORNEY - CERTIFIED COPY Bond No. 65358185 Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company"), does by these presents make, constitute and appoint C Bendt its true and lawful attorney(s)-in-fact, with full power and authority hereby conferred, to execute, acknowledge and deliver for and on its behalf as Surety, bonds for: Principal: Ecosense Construction Corp Obligee: City of Palm Springs Amount: $1, 000, 000. 00 and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Vice President, sealed with the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s)-in-fact may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety Company which remains in full force and effect. "Section 7. All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." If Bond No. 65358185 is not issued on or before midnight of April 27, 2021 all authority conferred in this Power of Attorney shall expire and terminate. yeW1QA n—i I�Qta' OVA` 4 YV+Ii egf, Western Surety Company has caused these presents to be signed by its Vice President, Paul T. Bruflat, and its cg rateeal'to,be xed this 27th day of January 2021 WES SURE Y COMPANY w STI 1 SOUTH D�Q�fA Paul T. ruflat, Vice President COU®�0�.. � ss jA L;44a —Ai 0 On this 27th day of January , in the year 2 021 , before me, a notary public, personally appeared Paul T. Bruflat, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of WESTERN SURETY COMPANY and acknowledged said instrument to be the voluntary act and deed of sa' corporation. 45 Shyyy�s4aS4hy645544�s54�s�s + i M. BENT s ^ NOTARY PUBLIC s SEAL SOUTH DAKOTA (SEALIS Notary Public - South Dakota +yh�ayShhh�i4�iy�ayyhh4hyy4h + My Commission Expires March 2, 2026 I the undersigned officer of Western Surety Company, a stock corporation of the State of South Dakota, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable, and furthermore, that Section 7 of the bylaws of the Company as set forth in the Power of Attorney is now in force. In testimony whereof, I have hereunto set my hand and seal of Western Surety Company this 27th day of January 2021 WEs& SURE Y COMPANY Paul T. ruflat, Vice President To validate bond authenticity, go to www.cnasurety.com > Owner/Obligee Services > Validate Bond Coverage. Form F5306-11-2020 ACKNOWLEDGMENT OF SURETY (Corporate Officer) STATE OF SOUTH DAKOTA ss COUNTY OF MINNEHAHA On this 27th day of January 2021 , before me, a Notary Public in and for said County, personally appeared C . Bendt Assistant Secretary personally known to me, who being by me duly sworn, did say that he/she is the aforesaid officer of WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws of the State of South Dakota, that the seal affixed to the foregoing instrument is the corporate seal of said corporation, that the said instrument was signed, sealed and executed on behalf of said corporation by authority of its Board of Directors, and further acknowledge that the said instrument and the execution thereof to be the voluntary act and deed of said corporation. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal the day and year last above written. My commission expires: ++ s M. BENT NOTARY PUBLIC Q-SEAL�sSAES AE LSOUTH DAKOTAs +hhhhyS'oh�iSy�shy�a4hy�ay yh�a + My Commission Expires March 2, 2026 Forth F11692-11-2020 Notary Public California All -Purpose Certificate of Acknowledgment A notary public or other officer completing this certificate verges 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 & vtrs . �-c S.S. On before me, 715�('0L 64)v11 A1.4,ti /"C- personally appeared 14//d re-l Cpe- e4 eN � �,' r e a:; - 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. OPTIONAL INFORMATION the information in this secdc. this acknowledoment to an unaothnn7ad document and may pro.. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a document titledtfor the purpose of i�T v_ r"L containing pages, and dated The signer(s) capacity or authority is/are as: ❑ Individual(s) ❑ Attomey-in-fact ❑ Corporate Officer(s) ❑ Guardian/Conservator ❑ Partner - Limited/General ❑ Trustee(s) ❑ Other: representing: 1-6 COWA 023.29190 NOTARY PUBLIC o CALIFORNIA RIVERSIDE CotN TY Carr*dmE*w1lMY3p, 224 Method of Signer Identification i Proved to me on the basis of satisfactory evidence: form(s) of identification ❑ credible witness(es) Notarial event is detailed in notary journal on: Page # Entry # Notary contact: Other ❑ Additional Signer ❑ Signer(s) Thumbprints(s) wua-zuio ivotary Learning center - All Kights Keserved You can purchase copies of this foi ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) F03/10/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NO Hassle Insurance Agency 1400 E. Cooley Dr. Ste. 202-A Colton, CA 92324 NAME: CONTACT NAME; ANTHONY ROJAS FAX ' (888)440-4094 Arc No : (909)783-7900 E-MAIL ADDRESS: anthony.r@nohassloins.net INSURERS AFFORDING COVERAGE NAIC # License #: OE74924 INSURERA: HISCOX INSUURANCE INSURED INSURER B : INSURERC: ECOsense Construction Corp. INSURERD: 8929 Fox Trail Morongo Valley, CA 92266 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 00006474-8475 REVISION NUMBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM DDY /YYYY MMDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y UDC-4761648-CGL-21 03108/2021 0310812022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE NIOCCUR DAMAGE T RENTED PREMISES Ea occurrence $ 100000 ME EXP (Any one person) $ rJ 000 PERSONAL & ADV INJURY $ 2,600,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRO -CT LOC )( POLICY D JE PRODUCTS -COMP/OP AGG $ 1,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR d OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N I A E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The City of Palm Springs, its officials, employees, and agents (as respects City of Palm Springs City Project No.19-13) are named as an additional insured as required by a legally enforceable written agreement entered into prior to commencement of the Named Insured's as respects to a specific contract for the General Liability policy. 30 days notice of cancellation to the Named Certificate Holder, "10 Days notice for non-payment." City of Palm Springs Engineering Services Department 3200 East Tahquitz Canyon Way Palm Springs, CA 92262 t.:ANI:tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1988-201 S ACORD CORPORATION. All riahts reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by ACR on March 10, 2021 at 02:03PM POLICY NUMBER: UDC-4761648-CGL-21 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ izations : Locations Of Covered Operations PROJECT: ALL CA OPERATIONS. The City of Palm Springs, it's officals, employee and agents. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: CNA106405602-001 COMMERCIAL GENERAL LIABILITY CG20101001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Palm Springs Engineering Services Department 3200 East Tahquitz Canyon Way Palm Springs, CA 92262 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the additional insureds, added: 2. Exclusions insurance afforded to these the following exclusion is This insurance does not apply to "bodily in- jury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi- tional insured(s) at the site of the cov- ered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 10 01 © ISO Properties, Inc., 2000 Page 1 of 1 ❑ POLICY NUMBER: UDC-4761648-CGL-21 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): The City of Palm Springs, its officers, officials, employees and agents. Location(s) of Covered Operations: City of Palm Springs Engineering Services Department 3200 East Tahquitz Canyon Way, Palm Springs, CA 92262. Description of Work Performed for the Additional Insured: A. Section 11 - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured at the location(s) designated in the Schedule, but only for occurrences or coverages not otherwise excluded in the policy to which this endorsement applies. B. With respect to the insurance afforded to the additional insured, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The following is added to 4.a. of Other Insurance of Section IV - Commercial General Liability Conditions: If required in a written contract, your policy is primary and noncontributory in the event of an occurrence caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf that occurs while performing ongoing operations for the additional insured at the location(s) designated in the Schedule. All other terms and conditions of this policy remain unchanged. Endorsement #CG5585-77 L803 (06/07) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Progressive P.O. Box 94739 Cleveland, OH 44101 1-800-895-2886 Certificate of Insurance Certificate Holder Additional Insured CITY OF PALM SPRINGS 3200 E TAHQUITZ CANYON WAY PALM SPRINGS, CA 92262 Insured ........................................ ECOSENSE CONSTRUCTION CORP PO BOX 734 MORONGO VALLEY, CA 92256 PROGREl 11F COMMERCIAL Policy number: 03342925-0 Underwritten by: Progressive Express Ins March 10, 2021 Page 1 of 1 Agent/Surplus Lines Broker ................................. PROG COMMERCIAL PO BOX 94739 CLEVE LAND, OH 44101 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. _._.......................................................................................................................... Policy Effective Date: Mar 5, 2021 Insurance coveragets) Bodily Injury/Property Damage Description of LocationNehicles/Special Items Scheduled autos only ................................................................ 2008 SUBARU LEGACY 4S3BL616687226097 Policy Expiration Date: Sep 5, 2021 Limits ................................................... $1,000,000 Combined Single Limit WE WILL ENDEAVOR TO PROVIDE 30 DAYS NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES Certificate number 06921A13925 Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. Form 5241 (10/02) Additional insured endorsement Name of person or Organization CITY OF PALM SPRINGS C/O ENGINEERING SERVICES DEPARTMENT 3200 E TAHQUITZ CANYON WAY PALM SPRINGS, CA 92262 PR99RFJT1YE' COMWERCIAL Policy number. 03342925-0 Underwritten by Progressive Express Insurance Co. insured. ECOSENSE CONSTRUCTION March 5, 2021 Policy Period: 03/05y2021 — 091!05;`2021 Mailing Address Progressive Express Insurance Co. PO Boy, 94739 Cleve;and, OH 44101 1-800-"4-4487 For customer service, 24 hours a day, 7 days a week The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for an; power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury each person/ each accident Property Damage each accident Combined liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 03342925-0 Issued to (Name of Insured) ECOSENSE CONSTRUCTION Effective date of endorsement: 03/05/,2021 Policy expiration date: 09%05j202'I Form 1198 (01/04) M CL USA CONTRACTORS STATE LICENSE BOARD STATE OF CALIFORNIA V� 9821 Business Park Drive, Sacramento, California 95827 Governor Gavin Newsom Mailing Address: P.O. Box 26000, Sacramento, CA 95826 • • ® 800.321.CSLB (2752) 1 www.cs/b.ca.gov I CheckTheLicenseFirst.com Exemption from Workers' Compensation Insurance Before the Contractors State License Board (CSLB) can issue a new license or reinstate, reactivate, or renew an existing license, the applicant or licensee must have on file a Certificate of Workers Compensation Insurance or Certificate of Self -Insurance issued by the Director of Industrial Relations, or meet the criteria for an exemption from this requirement. Holders of an inactive license are not subject to the workers compensation insurance requirements. To demonstrate exemption from the workers compensation insurance requirement, an applicant or licensee must submit this form to CSLB, certifying under penalty of perjury that he or she does not employ anyone in a manner subject to the workers compensation laws of California, is not otherwise required to provide for workers compensation insurance coverage under California law, or does not hold a C-39 (Roofing) license. (See Business and Professions Code (B&P) section 7125.) YOU ARE NOT ELIGIBLE FOR AN EXEMPTION IF: • You have employees, including Home Improvement Salespersons (HIS) or a qualifier who is a Responsible Managing Employee (RME). • You have a workers compensation policy in California. • You hold a C-39 Roofing classification all contractors with a C-39 Roofing classification are required by B&P Section 7125 to have a Certificate of Workers Compensation Insurance or a Certificate of Self -Insurance on file with CSLB. If you are submitting this form manually, please print legibly in black or dark blue ink THE FOLLOWING INFORMATION IS REQUIRED 1. License or Application Fee Number: 20190100516 2. Full Name of Licensee or Applicant (as it appears on CSLB records): Last: RAMIREZ First: ANDREA Middle: LORENA SFX: 3. Select the statement that is true: ® 1 am an owner, partner, officer, member or manager of the above License or Application and I do not employ any person in any manner so as to become subject to the workers compensation laws of California, and am not otherwise required to provide for workers compensation insurance coverage under California law. ❑ 1 am an owner, partner, officer, member or manager of the above License or Application and I do employ persons in connection with my California contractor license in a manner that invokes the workers compensation laws of a state other than California and have attached a certificate of insurance from said state. NOTICE: Upon employing anyone in a manner subject to the workers compensation laws of the State of California, the claim of exemption executed under this form will no longer be valid. As soon as a licensee employs anyone subject to the California workers compensation laws, the licensee must obtain a Certificate of Workers Compensation Insurance or a Certificate of Self -Insurance, and submit this certificate of coverage or self-insurance to CSLB within 90 days of its effective date, and continuously maintain the certificate while acting as a contractor in accordance with the law. Failure to comply with this requirement is grounds for disciplinary action. B&P section 7125(d)(3): Willful or deliberate disregard and violation of workers compensation insurance laws constitutes a cause for disciplinary action by the registrar against the licensee. I certify under penalty of perjury under the laws of the State of California that the information provided on this exemption statement is true and correct. Ida%. Date: 12/21/2019 Signature: Submitted Collection of Personal Information CSLB collects the personal information requested on this form as authorized by B&P sections 7125 and 7125.2. CSLB makes every effort to protect the personal information you provide; however, it may be disclosed in response to a Public Records Act request as allowed by the Information Practices Act; to another government agency as required by state or federal law, or as provided in Civil Code section 1798.24; or to a court or administrative order, a subpoena, or a search warrant. III III IIII III III IIIIIII IIIIII III II IIIII II IIII I IIIIII IIIII IIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII I IIIIIIIIIII �Q I II III IIIII IIII I II III IIIII IIIII Ildl IIII IIII WC -EXEMPT 20190100516 12/21/2019 FOR CSLB USE ONLY v1.0 WORKER'S COMPENSATION CERTIFICATE (AS REQUIRED BY SECTION 1861 OF THE CALIFORNIA LABOR CODE) I am aware of the provisions of Section 3700 of the California Labor Code, which require every employer to be insured against liability for worker's compensation, or to undertake self-insurance in accordance with the provisions of said Code, and I will comply with such provisions before commencing the performance of the Work of this Contract. Contractor r °SQ nj -Q- CGons By A nAmo,,- �Zc`rrisy .Z Title ls�« S Uz�N- �,a SUNRISE PARK RESTROOM CITY PROJECT NO. 19-13 WORKER'S COMPENSATION CERTIFICATE DECEMBER 2020 AGREEMENT AND BONDS - PAGE 7 r Q v ;wa �UUW�v Q -wAS. azap _.... N cu �o M rA v Q Home A CONTRACTORS STATE LICENSE BARD 0 QContractor's License Detail for License # 1061632 DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. CSLB complaint diulosure ie testriCted bylaw (S&P 7124.6) If this entity is subject to public complaint disclosure click on link that will appear below for more information. Click here for a definition of dimlosable actions. s Only construction related civil judgments reported to CSLB are disclosed(B&P7071.17). Arbitrations are not listed unless the contractor fails to comply with the terms. Due to workload, there may be relevant information that has not yet been entered into the board's license database. Data current as of 3/16/20219:25:03 AM i3usnees litfDrrr?;tiu:f ECOSENSE CONSTRUCTION CORP 200 E FRANCIS DR UNIT 240 PALM SPRINGS, CA 92262 Business Phone Number:(9S4) 598-5946 Entity Corporation Issue Date 12/23/2019 Expire Date 12/31/2021 License Status This license is current and active. All information below should be reviewed. Cia85i 03IOns B - GENERAL BUILDING CONTRACTOR orl Contractor's Bond This license filed a Contractor's Bond with BUSINESS ALLIANCE INSURANCE COMPANY. Bond Number: G101005383832 Bond Amount: S15,000 Effective Date: 10/09/2020 Contractor's Bond History Bond of Qualifying Individual The qualifying individual ANDREA LORENA RAMIREZ certified that he/she owns 10 percent or more of the voting stock/membership interest of this company; therefore, the Bond of Qualifying Individual is not required. Effective Date: 12/23/2019 ji orkl,,S` C0glr;e'9S1, is This license is exempt from having workers compensation insurance; they certified that they have no employees at this time. Effective Date:12/21/2019 Expire Date: None Back t0'Top Conditions of Use Privacy Policy Accessibility Accessibility Certification Copyright © 2021 State of California StateFarrf► STATE FARM PO Box 2368 Bloomington IC 61702-2368 58A AT1 12 000601 0093 CITY OF PALM SPRINGS 3200 E TAHQUITZ CANYON WAY L PALM SPRINGS CA 92262-6959 II..III'I�"'II�I�II�I��IIIIIII���'lll��l�ll"��I'll�l���ll"II" DATE OF NOTICE: NOV 03 2022 CODE: AgvQZ NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 0388-FA41-A NAMED INSURED: POLICY NO: 609 5091-D15-55A COVERAGE: WHITE'S STEEL INC. YR'MAKE MODEL: 2005 FORD UTIL TRK BI AND PC LIABILITY PO BOX 846 VINICAMPER: 1 FTRF12W25NB86535 $1 MIL $1000DED.COMP. THERMAL CA92274.0846 AGENT NAME: GUILLERMO MOLINA INS AGCY INC $1000 DED. COLL. AGENT PHONE: (760)347-5700 ENDORSEMENT NO: 8028BU POLICY EFFECTIVE OCT 31 2022 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 6095091-55. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the Insurance provided and subject to all policy provisions. The additional Insured will be given 20 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. RECEIVED v ,i 14 2022 FRT City Hall Recection Desk PROGRESSIVE PO BOX 94739 CLEVELAND, OH 44101 ECOSENSE CONSTRUCTION CORP PO BOX 734 MORONGO VALLEY. CA 92256 Cancellation Notice A4yz PR96Rf1f1YF COMMERCIAL ECOSENSE CO NSTRUCTION Policy Number. 033429254 Underwritten by: Progressive Express Ins Date of Mailing: April 12, 2021 Policy Period: Mar 5, 2021 - Sep 5, 2021 Pagel of 2 Online Service progressive.com Customer Service 1-800-895-2886 Unfortunately, we didn't receive your payment and, as a result, your policy will be canceled at 12:01 a.m. on May 3, 2021. Please know that this means you will no longer have insurance coverage. We value you as a customer and want to continue being your insurance provider. To avoid cancellation, please send us your payment by check or money order so that it is received or postmarked by 12:01 a.m. on May 3, 2021. This way, there will be no lapse in your coverage. If you've already sent your payment, thank you. Your next regular payment will be due on May 5, 2021, You can also pay online or over the phone using a credit card or authorizing a withdrawal from your bank account. We'll credit your payment right away so your insurance coverage will continue. We sincerely appreciate your attention to this matter and thank you for your business. Please see the reverse side. continued on back ......................................................................................................................... Payment Coupon ................................................ Minimum amount due .......................................... Due date ................. I... I...... I................... Amount enclosed ................................................ .............................................. $205.15 May 3, 2021 ........................... I ...... ........ ... S .............................................. To maintain continuous coverage, your payment must be received or postmarked by 12:01 a.m. on May 3, 2021. ��,IIIIII''ll'1111111111II'IIIIII'I"'11'11'11IIII""'II'I'lllll PROGRESSIVE DEPT 0561 CAROL STREAM IL 60132-0561 Policy Number: 03342925-0 ECOSENSE CO NSTRUCHON For immediate payment, please go to progressive.com or call 1-800-249-2832. If you pay by check, please allow five to seven days for your payment to reach us. Write your policy number on the check and make it payable to Progressive Express Ins. Do nor mire Wow this seaion of coupon. He 86020 Form 6268 (10/10) 056103342925 04411 0020515 0080260 5000535 1169249 000003052107 Policy Number: 03342925-0 ECOSENSE CO NSTRUCTION Page 2 of 2 ................................................................................................ Remaining balance $802.60 .......................... ...... _.............................. Payments remaining 3 .......................... __ _. ..__. .....................I... Minimum amount due $205.15 Due date May 3, 2021 Billing detail for March 21, 2021 - April 12, 2021 Minimum amount due.............................$205.15 Payments received after April 12, 2021 will appear on your next bill. You may call Customer Service or check progressive.com to make sure we received your payment. PROGRESSIVE PO BOX 94739 CLEVEIAND, OH 44101-4739 657443 24242 1 AB 0.428 PPACS011067 024242 CITY OF PALM SPRING 3200 E TAHQUITZ PALM SPRINGS CA 92262 II"III'IIPJI''IIId��Jl�l�l�l���dllll"'III"'III1111'IIILI PROGREII/UE COMMERCIAL RECEIVED CITY OF P"LH SPRINGS 2021 APR 19 AN 9: 53 OFFICE OF THE- CITY CLE:G PROGRESSIVE PO BOX 94739 CLEVELAND, OH 44101 ECOSENSE CONSTRUCTION CORP PO BOX 734 MORONGO VALLEY, CA 92256 Final Bill Please note that you no longer have insurance with us, effective April 13, 2021. PROGRMIff COMMERC/AL ECOSENSE CO NSTRUCIION Policy Number: 03342925-0 Underwritten by: Progressive Express Ins Date of Mailing: April 13, 2021 Policy Period: Mar 5, 2021 - Sep 5, 2021 Page 1 of 1 Online Service progressive.com Customer Service 1-800-895-2886 Your policy was canceled at your request. Please see your payment summary below for more information. If you've scheduled a payment, we've canceled it; please pay the amount due (if any). If you have questions about your cancellation, or would like to learn how to keep this policy or purchase a new one, please call us. ........... .......1.. Policy premium for coverage until April 13, 2021 $241.00 Installment fee 6.00 Otherfees 15.88 Total $262.88 Total amount paid 357.28 ........................refund am.....................................................................................40..... Total ount $94. form 6269 (10110) PROGRESSIVE PO BOX 94739 CLEVELAND. OR 441014739 PR URF111YE COMMERCIAL 657W 25210 1 AB 0.428 PPACS01 K 068 025210 CITY OF PALM SPRING 3200 E TAHQUITZ PALM SPRINGS CA 92262 IIIIII�II„1111,IIII'IIIIIII'�"I1111,1„'III,��IIIIIJ�II�I„III ill i 1 SU RECEIVED CITY OF PALM SPRINGS 2021 APR 19 AM 9: 53 OFFICE OF THE CITY CLEF:'+ StateFarm STATE FARM® A. PO Box 853922 Richardson, TX 75085-3922 A &/9v DATE O OTICE: APR 12 2021 CODE: 28A AT1 12 000511 W93 CITY OF PALM SPRINGS PO BOX 2743 PALM SPRINGS CA 92263-2743 III'III'lllllllllll'lllll'IIIIII'III11'IIIIIIII'I'IIII'lllllllll ,ITY OFEPAILM SDPRI48 TE: PLEASE NOTIFY STATE FARM AT THE /,ADDRESS LISTED AT THE TOP, LEFT CORNER 2021 APR 19 AM 9: 54DF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. :)FFICE OF THE CITY CLi_ ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 1498-FA41-A NAMED INSURED: POLICY NO: 456 1284C15.55G COVERAGE: PALM SPRINGS WELDING, INC YR/MAKEIMODEL: 2020 CHEVROLET PICKUP BI AND PD LIABILITY 1189 N VALDIVIA WAY VINICAMPER: 1 GC3WRE72LF218920 $ t MILE 1 MILE 1 MIL $1000 DED. COMP. PALM SPRINGS CA 92262-5426 AGENT NAME: JOHN FORD $1000 DED. COLL. AGENT PHONE: (760)564-0011 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE c FEB 01 2021 UNTIL TERMINATED m POLICY MESSAGES: This policy shown above supersedes policy# 4561284-55F. A The policy includes a loss payable clause protecting the additional insureds Interest in the described car to the extent of the insurance b provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice m is provided, it shalt be presumed that the required renewal premiums have been paid. The additional Insured must notify us within 10 days of 8 any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. N FRT State Farm General Insurance Company PO Box 853925 Richardson, TX 75085-3925 12 ;033 AT1 003618 1005 01 NADINE T FIEGER CODE COMPLIANCE CITY OF PALM SPRINGS PO BOX 2743 PALM SPRINGS CA 92253-2743 �s �1�I11I.11'jj11�1111�1'�'IIIII'�I��I'ICI"�Illl1'jljj'j11111111j1 �o Notice of Reinstatement Businessowners Reinstatement date: March 21, 2021, 12:01 a.m. Standard Time Date processed: April 6, 2021 Amount paid: $325.00 Please keep for your records .. StateFarm State Farm General Insurance Company Policy number: 90-XL-0330-2 Your State Farm Agent Cindy Pieper Cynthia L Pieper Ins Agcy Inc 201 E. Ramon Rd Palm Springs, CA 92264-741D Bus:760-416-3006 Email: cindy.pieper.hibq@statefarm.com We are pleased to acknowledge receipt of the premium due on this policy. This policy will be continued in force subject to Its printed terms and conditions upon the payment check clearing through your bank. Insured: ADVENTURE MEDIA INC 1462 S SAGEBRUSH RD PALM SPRINGS CA 92264-8542 Policy Number. 90-XL 0330-2 Prepared. April 06. 2021 u-v Location: 1462 S SAGEBRUSH RD PALM SPRINGS CA 92264-8542 Page 1 of 1 100E 20M 152E32 20D DOIN-2017 00361E