2017-090 CONTRACTOR AGREEMENT
THIS AGREEMENT, made and entered into this )CA day of Ja( 2017,
A.D., by and between the City.of Clermont, 685 W. Montrose Street, Clerm nt, Florida
(hereinafter referred to as "OWNER"), and DERELLE, INC., 11520 Nellie Oaks Bend,
Clermont, FL 34711 (hereinafter referred to as "CONTRACTOR").
WITNESSETH: That the parties hereto, for the consideration hereinafter set forth,
mutually agree as follows:
SECTION I - SCOPE OF WORK
The CONTRACTOR shall furnish all labor, materials, equipment, machinery, tools,
apparatus•and transportation and perform all of the work described in the specifications
entitled:
RFB No. 17-015,Titled: Hancock Park Renovations
as prepared by OWNER and its agents shall do everything required by this Contract and
the other Contract Documents contained in the specifications, which are a part of these
Documents.
SECTION II -THE CONTRACT SUM
The OWNER shall pay_ to the CONTRACTOR, for the faithful performance of the
Contract, in lawful tender of the United States, and subject to addition and deductions as
provided in the Contract Documents, the Price Schedule, attached hereto and incorporated
herein as Exhibit "A". The total ;contract lump sumprice shall not exceed THREE
HUNDRED SIXTY-FOUR THOUSAND, SEVEN HUNDRED DOLLARS AND 00/100
CENTS ($364,700.00).
SECTION III - COMMENCEMENT AND COMPLETION OF WORK
1) The CONTRACTOR shall commence work within 10,calendar days after receipt
of(i) Notice to Proceed, and (ii) receipt of all permits required to perform the work, and
the CONTRACTOR will complete the same by February 19, 2017, unless the period for
completion is extended otherwise by the CONTRACT DOCUMENTS.
2) The CONTRACTOR shall prosecute the work with faithfulness and diligence.
3) The CONTRACTOR further declares he has examined the project site and that
from personal knowledge and experience has made sufficient investigations to fully satisfy
himself that such site is correct and suitable for the work and he assumes'full responsibility
therefore. The provisions of this Contract shall control any inconsistent provisions
contained in the specifications. All Drawings and Specifications have been read and
carefully considered by the CONTRACTOR,who understands the same and agrees to their
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sufficiency for the work to be done. It is expressly agreed that under no circumstances,
conditions or situations shall this Contract be more strongly construed against the OWNER
than against the CONTRACTOR and his Surety.
Any ambiguity or uncertainty in the Plans, Drawings or Specifications shall be interpreted
and construed by the OWNER's designated Project Manager after consultation with the
Project Architect,and:the OWNER's;Project Manager's decision shall be final and binding
upon all parties, provided the OWNER agrees.
It is distinctly understood and agreed that the passing, approval and/or acceptance of any
part of the work or material by the OWNER or by any agent or representative as in
compliance with the terms of this Contract and/or of the Drawings, Plans and
Specifications covering said work shall not operate as a waiver by the OWNER of strict
compliance with the terms of this Contract and/or the Drawings and Specifications
covering said work; and the OWNER may require the CONTRACTOR;and/or his Surety
to repair,replace,restore and/or make to comply strictly and in all things with this Contract
and the Drawings andi Specifications any all of said work and/or materials which within
a period of one year fromand after-the date of the passing; approval, and or acceptance of
any such work or material,are found to be defective or to fail and in any way to comply
with this.Contract or with the Drawings and-Specifications. This provision shall not apply
to materials or equipment normally expected to deteriorate or wear out and become subject
to normal repair and replacement before their condition is discovered. The
CONTRACTOR shall riot be required to do normal maintenance work under the guarantee
provisions. Failure on the part of the,CONTRACTOR and/or his Surety,immediately after
Notice to either,to repair or replace any such defective materials and workmanship shall
entitle the OWNER,if it sees fit, to replace or repair the same and recover the reasonable
cost of such replacement and/or repair from the CONTRACTOR and/or his Surety, who
shall in any event be.jointly and severally liable to the OWNER for all damages, loss and
expense caused to the OWNER by reason of the CONTRACTOR'S breach of this Contract
and/or his failure to comply strictly and in all things with this Contract and/or his failure to
comply strictly and in all things with this Contract and with the Drawings and
Specifications.
4) As-built drawings, warranties acceptable to OWNER must be submitted to the
OWNER before final payment will bemade to the CONTRACTOR.
SECTION IV - AUTHORIZED REPRESENTATIVES
1) Before starting work, CONTRACTOR shall designate a competent, authorized
representative acceptable to OWNER to represent and act for CONTRACTOR and shall
inform OWNER in writing,,of*naine'arid address of such representative together with a
clear definition of the Scope of his authority to represent and act for CONTRACTOR and
shall specify any and-all limitations of such authority. At the Pre-construction Conference,
CONTRACTOR shall provide resumes of key personnel for OWNER's approval.
CONTRACTOR shall keep OWNER informed in writing pursuant to the notice
requirements provided herein of any subsequent changes in the foregoing. Such
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representative shall be present or duly represented at the site of work at all times when
work is actually in progress.
2) From the time of execution of the Contract, the OWNER shall have the right to
remove the CONTRACTOR's representative from the project for inappropriate behavior
including, but not limited to, lack of concern for residents, or acting in an unprofessional
manner(i.e. argumentative with residents or OWNER's representative and the use of foul
language).
3) All notices, determinations, instructions and other communications given to the
authorized representatives of the CONTRACTOR shall be binding upon CONTRACTOR.
Nothing contained herein shall be construed as modifying the CONTRACTOR's duty of
supervision and fiscal management as provided for by Florida law.
4) The OWNER shall designate a Project Manager who will have limited authority to
act for the OWNER. The OWNER will notify the CONTRACTOR in writing of the name
of such representative(s). Any other City employees are not authorized OWNER
representatives and any work performed by the CONTRACTOR without proper written
authorization from the Project Manager as approved by OWNER, is performed at the
CONTRACTOR's risk, and the City shall have no obligation to compensate the
CONTRACTOR for such work.
SECTION V - LAWS AND REGULATIONS
1) CONTRACTOR and its employees and representatives shall at all times comply
with all applicable laws, codes, ordinances, statutes, rules or regulations in effect at the
time work is performed under this Contract.
2) If, during the term of this Contract, there are any changed or new laws, ordinances
or regulations not known or foreseeable at the time of signing this Contract which become
effective and which affect the cost or time of performance of the Contract,CONTRACTOR
shall immediately notify OWNER in writing and submit detailed documentation of such
effect in terms of both time and cost of performing the Contract. Upon concurrence by
OWNER as to the effect of such changes, an adjustment in the compensation and/or time
of performance will be made, if applicable.
3) If any discrepancy or inconsistency should be discovered between the Contract and
any law, ordinance, regulation, order or decree, CONTRACTOR shall immediately report
the same in writing to OWNER who will issue such instructions as may be necessary.
However,it shall not be grounds for a Change Order that the CONTRACTOR was unaware
of or failed to investigate the rules, codes, regulations, statutes, and all ordinances of all
applicable governmental agencies having jurisdiction over the Project or the work.
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SECTION VI - CODE RELATED INSPECTIONS
The CONTRACTOR recognizes that the City of Clermont is the governing jurisdiction
charged with the inspection of improvements to real property for code compliance and the
improvements to be made by the CONTRACTOR pursuant to this contract may be subject
to inspection by City of Clermont or its agents. The CONTRACTOR agrees that it will
not assert, as a City-caused delay or as a defense of any delay on the part of the
CONTRACTOR, any good faith action or series of actions on the part of the City or its
agents with regard to inspections, including, but not limited to the refusal to accept any
portion of the CONTRACTOR's work.
SECTION VII - PARTIAL AND FINAL PAYMENTS
In accordance with the provisions fully set forth in the Bid Documents and General
Conditions,and subject to additions and deductions as provided,the OWNER shall pay the
CONTRACTOR as follows:
1) CONTRACTOR shall submit a progress payment request by the twentieth(20th)day
of each calendar month for work performed during the current calendar month,
projected through the 25th. At any time, the OWNER shall have the right as a
condition of making a partial payment hereunder, to require CONTRACTOR to
submit evidence satisfactory to the OWNER that all payrolls,material bills and other
costs incurred by the CONTRACTOR in connection with the subject progress
payment request have been paid in full. Upon OWNER's signature accepting the
PARTIAL PAYMENT AUTHORIZATION, the OWNER shall make a partial
payment to the CONTRACTOR, within thirty (30) calendar days, on the basis of a
duly certified and approved estimate by the OWNER and the Architect, for work
performed during the preceding calendar month under the Contract. To insure proper
performance of the Contract, the OWNER shall retain ten percent (10%) of the
amount of each estimate until final completion and acceptance of all work covered
by the Contract.
2) Upon submission by the CONTRACTOR of evidence satisfactory to the OWNER
that all payrolls, material bills and other costs incurred by the CONTRACTOR in
connection with the construction of the work have been paid in full, and also, after
all guarantees that may be required in the Specifications have been furnished and
are found acceptable by the OWNER, final payment on account of this Agreement
shall be made within thirty(30) calendar days after completion of all work by the
CONTRACTOR covered by this Agreement and acceptance of such work by the
OWNER.
ARTICLE VIII - LIQUIDATED DAMAGES
1) It is mutually agreed that time is of the essence in regard to this Agreement.
Therefore, notwithstanding any other provision contained in the Contract
Documents, should the CONTRACTOR fail to complete the work within the
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specified time as set by the Notice to Proceed, or any authorized extension thereof,
CONTRACTOR shall pay to OWNER the sum of ONE HUNDRED FIFTY
DOLLARS($150.00)per calendar day as fixed, agreed and liquidated damages for
each calendar day elapsing beyond the specified time date for beneficial occupancy
(substantial completion) and/or final completion; which sum shall represent the
damages sustained by the OWNER, and shall be considered not as a penalty,but in
liquidation of damages sustained. Contractor shall pay the liquidated damages
amount contained herein. 'NOTE: Not necessary, this would come out of contract
balance. Contractors pay applications would be reduced to cover anticipated
liquidated damages.
SECTION IX- ADDITIONAL BONDS
It is further mutually agreed between the parties hereto that if, at any time after the
execution of this Agreement and the Surety Bonds hereto attached for its faithful
performance and payment of labor and materials, the OWNER shall deem the Surety or
Sureties upon such bonds to be unsatisfactory,or if, for any reason, such bonds cease to be
adequate to cover the performance and payments of the work, the CONTRACTOR shall,
at his expense, and within seven (7) days after receipt of Notice from the OWNER to do
so, furnish additional bonds, in such form and amounts, and with such Sureties as shall be
satisfactory to the.OWNER. In such event, no further payment to the CONTRACTOR
shall be deemed due under this Agreement until such new or additional security for the
faithful performance and for payment of labor and materials of the work shall be furnished
in manner and form satisfactory to the OWNER.
SECTION X—DISPUTE RESOLUTION - MEDIATION
1) Any claim, dispute or other matter in question arising out of or related to this
Agreement shall be subject to mediation as a condition precedent to voluntary arbitration
or the institution of legal or equitable proceedings by either party.
2) The OWNER and CONTRACTOR shall endeavor to resolve claims, disputes and
other matters in question between them by mediation.
3) The parties shall share the mediator's fee and any filing fees equally. The mediation shall
be held in the place where:the Project is located,unless another location is mutually agreed
upon. Agreements reached in mediation shall be enforceable as settlement agreements in
any court having jurisdiction thereof.
SECTION XI—INSURANCE AND INDEMNIFICATION RIDER
1) Worker's Compensation Insurance - The CONTRACTOR shall take out and
maintain during the life of this Agreement Worker's Compensation Insurance for all his
employees connected with the work of this Project and, in case any work is sublet, the
CONTRACTOR shall require the subcontractor similarly to provide Worker's
Compensation Insurance for all of the latter's employees unless such employees are
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covered by the protection afforded by the CONTRACTOR. Such insurance shall comply
with the Florida Worker's Compensation Law. In case any class of employees engaged in
hazardous work under this contract at the site of the Project is not protected under the
Worker's Compensation statute, the CONTRACTOR shall provide adequate insurance,
satisfactory to the OWNER, for the protection of employees not otherwise protected.
2) Contractor's Public Liability and Property Damage Insurance-The Contactor shall
take out and maintain during the life of this Agreement Comprehensive General Liability
and Comprehensive Automobile Liability Insurance as shall protect it from claims for
damage for personal injury, including accidental death, as well as claims for property
damages which may arise from operating under this Agreement whether such operations
are by itself or by anyone directly or indirectly employed by it, and the amount of such
insurance shall be minimum limits as follows:
(a) Contractor's Comprehensive General, $1,000,000 Each
($2,000,000 aggregate)
Liability Coverages, Bodily Injury Occurrence, & Property Damage
Combined Single Limit
(b) Automobile Liability Coverages, $500,000 Each
Bodily Injury& Property Damage Occurrence,
Combined Single Limit
(c) Workers Compensation and Employer's Liability$500,000
Each Occurrence, Combined Single Limit
3) Subcontractor's Public Liability and Property Damage Insurance - The
CONTRACTOR shall require each of his subcontractors to procure and maintain during
the life of this subcontract, insurance of the type specified above or insure the activities of
his subcontractors in his policy, as specified above.
4) "XCU" (Explosion, Collapse, Underground Damage) - The CONTRACTOR's
Liability Policy shall provide "XCU" coverage for those classifications in which they are
excluded.
5) Broad Form Property Damage Coverage, Products & Completed Operations
Coverages - The CONTRACTOR's Liability Policy shall include Broad Form Property
Damage Coverage, Products and Completed Operations Coverage.
6) Contractual Liability Work Contracts - The Constractor's Liability Policy shall
include Contractual Liability Coverage designed to protect the CONTRACTOR for
contractual liabilities assumed by the CONTRACTOR in the performance of this
Agreement.
7) Indemnification Rider
(a) To cover to the fullest extent permitted by law, the CONTRACTOR shall
indemnify and hold harmless the OWNER, ADG and Ajax Building
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Corporation and its agents and employees from and against all claims,damages,
losses and expenses, including but not limited to attorney's fees, arising out of
or resulting from the performance of the Work, provided that any such claim,
damage, loss or expense (1)is attributable to bodily injury, sickness, disease or
death, or to injury to or destruction of tangible property (other than the Work
itself) , and(2) is caused in whole or in part by any negligent act or omission of
the CONTRACTOR,any subcontractor,anyone directly or indirectly employed
by any of them or anyone for whose acts any of them may be liable. Such
obligation shall not be construed to negate, abridge, or otherwise reduce any
other right to obligation of indemnity which would otherwise exist as to any
party or person described in this Section.
(b) In any and all claims against the OWNER, • ` _ - • '. ' -• •• . ; . •• •
or any of its agents or employees by any employee of the CONTRACTOR, any
subcontractor, anyone directly or indirectly employed by any of them or anyone
for whose acts any of them may be liable,the indemnification obligations under
this Paragraph shall not be limited in any way by any limitation on the amount
or type of damages, compensation or benefits payable by or for the
CONTRACTOR or any subcontractor under workers' or workmen's
compensation acts, disability benefit acts or other employee benefit acts.
(c) The CONTRACTOR hereby acknowledges receipt of ten dollars and other
good and valuable consideration from the OWNER for the indemnification
provided herein.
SECTION XII - TAXES
1) CONTRACTOR shall pay all taxes, levies, duties and assessments of every nature
that may be applicable to any work under this Contract. The Contract Sum and any agreed
variations thereof shall include all taxes imposed by law. CONTRACTOR shall make any
and all payroll deductions required by law. CONTRACTOR herein indemnifies and holds
the OWNER harmless from any liability on account of any and all such taxes,levies,duties,
assessments and deductions. Such indemnification shall be in accordance with the terms
and conditions of the Indemnification provisions provided herein.
2) OWNER and CONTRACTOR hereby acknowledge that OWNER is a tax-exempt
entity. Where applicable, and so directed by the OWNER, the OWNER reserves the right
to implement, at its convenience, a tax exemption program to buy selected materials and
place the tax savings in line item contingency.
SECTION XIII - SUCCESSORS, ASSIGNS AND ASSIGNMENT
The OWNER and the CONTRACTOR each bind itself, its officers, directors, qualifying
agents,partners, successors, assigns and legal representatives to the other party hereto and
to the partners, successors, assigns and legal representatives of such other party in respect
to all covenants,agreements and obligations contained in the Contract. It is agreed that the
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CONTRACTOR shall not assign, transfer, convey or otherwise dispose of the contract or
its right, title or interest in or to the same or any part thereof, or allow legal action to be
brought in its name for the benefit of others, without previous consent of the OWNER and
concurred to by the sureties.
SECTION XIV -NOTICES
All notices shall be in writing and sent by United States mail, certified or registered, with
return receipt requested and postage prepaid,or by nationally recognized overnight courier
service to the address of the party set forth below. Any such notice shall be deemed given
when received by the party to whom it is intended.
CONTRACTOR: Derelle, Inc.
11520 Nellie Oaks Bend
Clermont, FL 34711
Attn: Scott Clark, President
OWNER: City of Clermont
Attn: City Manager
685 W. Montrose Street
Clermont, FL 34711
SECTION XV—OPTIONAL TERMINATION
1) OWNER may, at its option,terminate the Contract, in whole or in part, at any time
by written notice thereof to CONTRACTOR,whether or not CONTRACTOR is in default.
Upon any such termination, CONTRACTOR hereby waives any claims for damages from
the optional termination, including loss of anticipated profits, on account thereof, but as
the sole right and remedy of CONTRACTOR, OWNER shall pay CONTRACTOR in
accordance with Subparagraphs below, provided, however, that those provisions of the
Contract which by their very nature survive final acceptance under the Contract shall
remain in full force and effect after such termination.
2) Upon receipt of any such notice, CONTRACTOR and its Surety shall, unless the
notice requires otherwise:
(a) Immediately discontinue work on the date and to the extent specified in the
notice;
(b) Place no further orders or subcontracts for materials,services,or facilities,other
than as may be necessary or required for completion of such portion of work
under the Contract that is not terminated;
(c) Promptly make every reasonable effort to obtain cancellation upon terms
satisfactory to OWNER of all orders and subcontracts to the extent they relate
to the performance of work terminated or assign to OWNER those orders and
subcontracts and revoke agreements specified in such notice;
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(d) Assign all Subcontracts required for performance of this Contract to the
OWNER. In anticipation of such a remedy, the CONTRACTOR shall include
in all Subcontracts, equipment leases and purchase order, a provision requiring
the subcontractor, equipment lessor or supplier,to consent to the assignment of
their Subcontract to the OWNER and to agree to the greatest extent possible to
cooperate with the OWNER;
(e) Assist OWNER, as specifically requested in writing, in the maintenance,
protection and disposition of property acquired by OWNER under the Contract;
and
(f) Complete performance of any work that is not terminated.
3) Upon any such termination, OWNER will pay to CONTRACTOR an amount
determined in accordance with the following(without duplication of any item):
(a) All amounts due and not previously paid to CONTRACTOR for work
completed and accepted in accordance with the Contract prior to such notice,
and for work thereafter completed as specified in such notice.
(b) The reasonable cost of settling and paying claims arising out of the termination
of work under subcontracts or orders as provided above.
(c) The verifiable costs incurred as set forth above.
(d) Any other reasonable costs which can be verified to be incidental to such
termination.
4) The foregoing amounts will include a reasonable sum, under all of the
circumstances, as profit for all work satisfactorily performed by CONTRACTOR.
5) CONTRACTOR shall submit within thirty (30) days after receipt of notice of
termination, a proposal,for an adjustment to the contract price including all incurred costs
described herein. OWNER shall review, analyze, and verify such proposal, and negotiate
an equitable adjustment, and the Contract shall be amended in writing accordingly.
SECTION XVI—MISCELLANEOUS
1) Attorneys' Fees. In the event a suit or action is instituted to enforce or interpret any
provision of this agreement, each party shall bear its own attorney fees.
2) Waiver. The waiver by OWNER of breach of any provision of this agreement shall
not be construed or operate as a waiver of any subsequent breach of such provision
or of such provision:itself and shall in no way affect the enforcement of any other
provisions of this agreement.
3) Severability. If any provision of this agreement or the application thereof to any
person or circumstance is to any extent invalid or unenforceable, such provision,or
part thereof,shall be deleted or modified in such a manner as to make the agreement
valid and enforceable under applicable law, the remainder of this agreement and
the application of such a provision to other persons or circumstances shall be
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unaffected, and this agreement shall be valid and enforceable to the fullest extent
permitted by applicable law.
4) Amendment. Except for as otherwise provided herein, this agreement may not be
modified or amended except by an agreement in writing signed by both parties.
5) Entire Agreement. This agreement including the documents incorporated by
reference contains the entire understanding of the parties hereto and supersedes all
prior and contemporaneous;agreements between the parties with respect to the
performance of services by CONTRACTOR.
6) Assignment. This agreement is personal to the parties hereto and may not be
assigned by CONTRACTOR, in whole or in part,without the prior written consent
of city.
7) Venue. The parties agree that the sole and exclusive venue for any cause of action
arising out of this agreement shall be Lake County, Florida.
8) Applicable Law. This agreement and any amendments hereto are executed and
delivered in the.State of Florida and shall be governed, interpreted, construed and
enforced in accordance with the laws of the State of.Florida.
9) Public Records. Contractor expressly understands records associated with this
project are public records and agrees to comply with Florida's Public Records law,
to include, to:
(a) Keep and maintain public records that ordinarily and necessarily would be
required by the CITY in order to perform the services contemplated herein.
(b) Provide the public with access to public records on the same terms and
conditions that the CITY would provide the records and at a cost that does
not exceed the cost provided in this Florida's Public Records law or as
otherwise provided by law.
(c) Ensure that public records that are exempt or confidential and exempt from
public records disclosure requirements are not disclosed except as
authorized by law.
(d) Meet all requirements for retaining public records and transfer, at no cost,
to the"CITY all public records in possession of CONSULTANT upon
termination of the contract and destroy any duplicate public records that are
exempt or confidential and exempt from public records disclosure
requirements. All records stored electronically must be provided to the
CITY in a format that is compatible with the information technology
systems of the CITY.
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(e) IF CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS CONTRACT, CONTRACTOR SHALL
CONTACT THE CITY'S CUSTODIAN OF PUBLIC RECORDS AT
CITY CLERK'S OFFICE, (352) 241-7331.
SECTION XVII - CONTRACT DOCUMENTS
The Contract Documents, as stated in the Instructions to Bidders and herein made a part,
are as fully a part of this Contract as if herein repeated.
Document Precedence:
1) Contract Agreement
2) Specifications for RFB 17-015, Hancock Park Renovation, including all addenda.
3) All documents contained in RFB No. 17-015, Hancock Park Renovations and
CONTRACTOR's response thereto including, the Instructions to Bidders and proposal
guarantee, if any.
IN WITNESS WHEREOF,the parties hereto have executed this Agreement on this b_
day of ci Oul llCt,fA,_ 2017.
City of Clermont
Gail L. Ash., Mayor
Attest
Tracy Ackroyd Howe, City Clerk
`" •
v
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Derelle, Inc.
By:
Scott Clark, President
If a corporation, affix corporate
seal and have corporate secretary
attest. Attest:
Corporate Sec ary
(Nam: 'rinted or Typed)
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EXHIBIT A
SECTION—C
PRICE SCHEDULE
NOTE: Payment shall be for the units ordered,placed,and accepted by the City. By signing this
form, the respondent fully acknowledges that there will be no additional compensation (no
overhead, no anticipated profits, etc.) other than the unit price of the items times the number of
items authorized, ordered, placed,and accepted by the City.
L.N. Description Lump Sum Price
1 Restroom Renovation
2 Concession Stand Building Renovation f . 6, ; c
3 Concrete Pad and Brick Pavers tj (P t o 0 0`
4 Fence Removal and Installation ! I • 16o.r�
Total Lump Sum Price 13 0,4+4)
C)0
Price per linear feet for rotted roof boards: $
AN-work The work including fence removal and installation, netting removal and
installation, concrete pads and pavers shall begin January 16, 2017 and shall be
completed by February 19, 2017. Some work could take place prior to January 16,
2017 depending on schedule.
Renovations to concession building and both restrooms shall begin in April. The
specific starting time will be scheduled between the successful contractor and the
City's Project Manager.
RFB No:17-015
Page 19 of 39
SECTION-C
PRICE SCHEDULE
By signing below, the respondent agrees to all terms, conditions, and specifications as stated in this
solicitation,and is acting in an authorized capacity to execute this response. The respondent also certifies
that it can and will provide and make available,at a minimum,the items set forth in this solicitation.
Respondent Information and Signature
Company Name(print): O L(€i \f2 A 1,
Street Address: \\523 -Nen te, 0oAK6 t`,.r\At C ecrYCCf' ) cL (-1-)I�
Mailing Address(if different):
Telephone: n.L RQ L163 Fax: 6661
Email: 6,efe1`( "C ( hoc
COM Payment Terms: % ! ys,net
FEIN: ')() - (-169 Ll q Professional.License No.: C& 01I co�S)C19
Signature: yl�- Date: kg - (L'
Print Name: C CO-( Cod' rue: ?Ce 5\62n-4.
Does the respondent accept payment using the City's MASTERCARD? 0 Yes pd No
END OF SECTION-C
RFB No: 17-015
Page 20 of 39