HomeMy WebLinkAboutCP1122 Revised Bid Proposal Package Addendum 2.pdf
2012 WSDOT
CITY OF AUBURN
KING AND PIERCE COUNTIES ,
WASHINGTON
BID PROPOSAL PACKAGE
for
Project Number CP1122
30TH STREET NE AREA FLOODING – PHASE 1
Contract No. 14-08
Bid Opening Date: July 15, 2014
11:00 AM PDT
City of Auburn
Engineering Division
Community Development & Public Works Department
25 West Main St.
Auburn, WA 98001-4998
(253) 931-3010
FAX (253) 931-3053
BIDDER’S CHECKLIST
Bidder must execute and return with submittal:
1. PROPOSAL FORM
The unit prices bid must be shown in the space provided. The proposal shall be filled in and
signed by the bidder.
2. RESPONSIBLE BIDDER INFORMATION
To show contractor’s ability to perform jobs of a similar nature.
3. PROPOSED EQUIPMENT AND MANPOWER SCHEDULE
Provide a complete list of equipment and manpower to be used on project.
4. LOCAL AGENCY SUBCONTRACTOR LIST (Required on $1,000,000 or larger projects) List
all subcontractors who are proposed to perform the work of heating, ventilation and air
conditioning, plumbing, and electrical. Failure to submit this with the bid shall render the bid
nonresponsive. (Form 271-015 included for this purpose). See Section 1-02.6 (Preparation of
Proposal).
5. BID BOND
This form is to be executed by the bidder and the Surety Company unless cash, cashier’s check or
a certified check in the amount of 5% of the total bid accompanies bid. The amount of this bond
shall be not less than five percent (5%) of the total amount bid and may be shown in dollars or on
a percentage basis.
After the Contract is awarded, execute:
1. CONTRACT
To be executed by the successful bidder in triplicate.
2. CONTRACT BOND
To be executed by the successful bidder and his surety company in triplicate.
3. POWER OF ATTORNEY
To be submitted in triplicate.
4. EVIDENCE OF INSURANCE
To be submitted in triplicate.
5. PRELIMINARY CONSTRUCTION PROGRESS SCHEDULE
Submitted in duplicate, showing the first 30 working days, to the Engineer one (1) working day
prior to the date of the Pre-construction Conference. To be provided in conformance with Section
1-08.3 (Progress Schedule) of the Standard Specifications.
6. REQUEST TO SUBLET WORK
One copy for each subcontractor and lower tier subcontractor shall be submitted and approved by
the City, prior to the subcontractor entering the project work site(s) to perform work. (Sample
form is included).
P R O P O S A L F O R M Page 1
CITY OF AUBURN
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Bid Opening: July 15, 2014
Bids received after this time will be returned to sender unopened in accordance with
Section 1-02.9 (Preparation of Proposal) of the Specifications.
The undersigned hereby certifies that:
1. The project site has been inspected.
2. The Bid Documents governing the work have been read and are thoroughly understood.
3. The bidder is willing and able to execute the Contract, provide a Contract Bond and
Evidence of Insurance within 7 calendar days following the receipt of the dated “Notice
of Award”.
4. The “Responsible Bidder Information” and “Proposed Equipment and Manpower
Schedule” forms have been completed and are enclosed with this Bid Proposal.
5. A “Local Agency Subcontractor List” per Section 1-02.6 (Preparation of Proposal) of the
specifications has been completed and is enclosed with this Bid Proposal if applicable. .
6. A 5% Bid Deposit has been enclosed with this Bid Proposal.
7. All addendums have been acknowledged in the space provided in this Bid Proposal.
8. The bidder will promptly undertake the work upon receipt of the dated “Notice to
Proceed” that will be issued within 5 working days of the contract execution date and
complete the work embraced in this improvement in accordance with the Contract
Documents at the following schedule of rates and prices, and it is understood that failure
to complete the work within the time stated in Section 1-08.5 (Time for Completion) of
the Specifications will be cause for assessment of liquidated damages in accordance with
Section 1-08.9 (Liquidated Damages) of the Specifications.
9. The City may choose to include additive and/or alternate bid items on the Proposal Form
and, if included, the City has the right to select any or all of the additive and/or alternate
bid items. The additive and/or alternate bid items selected shall be added to the basic
bid and the Contract award will be made based on the lowest and most acceptable total
bid including selected additives and/or alternates.
10. The method of payment will be made only on the unit prices for items appearing on this
Bid Proposal form.
11. The bidders must bid all items in the bid proposal. If any items are left blank or
represent $0.00, the bid may be disqualified.
NOTE: Unit prices for all items, all extensions and the total amount of bid must be shown.
All proposals shall be typed or written in ink.
FIRM NAME
P R O P O S A L F O R M Page 2
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Schedule A: Street Improvements
Bid
Item
Sec.
No.Description Quantity Unit Unit Price Total Price
1 1-04 Minor Changes 1
EQ.
ADJ.EQ. ADJ.$5,000.00
2 1-05 Record Drawings (Min. Bid $1000)1 LS LS $
3 1-09 Construction Site Sign(s)1 EA $$
4 1-09 Mobilization 1 LS LS $
5 1-10 Trafic Control Supervisor 1 LS LS $
6 1-10
Traffic Control Labor (Min. Bid
$38.00 per hour)480 HR $$
7 1-10 Sequential Arrow Sign 15 DAY $$
8 1-10 Portable Changeable Message Sign 15 DAY $$
9 1-10
Outside Agency Uniformed Police
Flagging Labor 1
EQ.
ADJ.EQ. ADJ.$5,000.00
10 5-04
HMA Cl. 1/2-inch PG 64-22 (Class
B)1,580 TON $$
11 5-04 Planing Bituminous Pavement 11,570 SY $$
12 7-05 Adjust Manhole 14 EA $$
13 7-05 Adjust Catch Basin 18 EA $$
14 7-12 Adjust Valve Box 23 EA $$
15 8-01
Temporary Water Pollution/Erosion
Control 1
EQ.
ADJ.EQ. ADJ.$2,500.00
16 8-09 Raised Pavement Marker Type 2 130 EA $$
17 8-14 Cement Concrete Sidewalk 100 SY $$
18 8-14
Cement Concrete Curb Ramp Type
Perpendiular A 1 EA $$
19 8-14
Cement Concrete Curb Ramp Type
Parallel A 2 EA $$
20 8-20 Induction Loop Vehicle Detector 8 EA $$
FIRM NAME
P R O P O S A L F O R M Page 3
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Schedule A: Street Improvements Continued
Bid
Item
Sec.
No.Description Quantity Unit Unit Price Total Price
21 8-20 Induction Loop Bicycle Detector 1 EA $$
22 8-20
Pedestrain Traffic Signal
Modications, Complete 1 LS LS $
23 8-20
Install and Remove Temporary Video
Detection System 1 LS LS $
24 8-20 Adjust Existing Junction Box 1 EA $$
25 8-21 Permanent Signing 1 LS LS $
26 8-22 Paint Line 4,210 LF $$
27 8-22 Plastic Wide Line 4,700 LF $$
28 8-22
Plastic Crosswalk Stripe and Stop
Bar (24 inch wide)135 LF $$
29 8-22 Plastic Traffic Arrow 20 EA $$
30 8-22 Plastic Bicycle Lane Symbol 16 EA $$
31 8-22 Plastic Traffic Letter 12 EA $$
32 8-22 Removing Plastic Crosswalk Line 550 SF $$
33 8-23 Temporary Pavement Markings 5,000 LF $$
Subtotal Schedule A $
FIRM NAME
P R O P O S A L F O R M Page 4
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Schedule B: Storm Utility Improvements and Street Restoration
Bid
Item
Sec.
No.Description Quantity Unit Unit Price Total Price
34 1-04 Minor Changes 1
EQ.
ADJ.EQ. ADJ $25,000.00
35 1-07 SPCC Plan 1 LS LS $
36 1-07 Utility Potholing 6 EA $$
37 1-05 Record Drawings (Min. Bid $1000)1 LS LS $
38 1-09 Construction Site Sign(s)2 EA $$
39 1-09 Mobilization 1 LS LS $
40 1-10 Trafic Control Supervisor 1 LS LS $
41 1-10
Traffic Control Labor (Min. Bid
$38.00 per hour)1,280 HR $$
42 1-10 Sequential Arrow Sign 30 DAY $$
43 1-10 Portable Changeable Message Sign 30 DAY $$
44 1-10
Outside Agency Uniformed Police
Flagging Labor 1
EQ.
ADJ.EQ. ADJ $10,000.00
45 2-01 Clearing and Grubbing 1 LS LS $
46 2-02
Removal of Structures and
Obstructions 1 LS LS $
47 2-02 Remove and Reset Fence 16 LF $$
48 2-02 Remove and Reset Bench 1 EA $$
49 2-02
Removal of Concrete or Asphalt
Pavement 5,360 SY $$
50 2-02 Remove Cement Concrete Flat Work 580 SY $$
51 2-02 Removal of Curb and Gutter 550 LF $$
52 2-03
Unsuitable Foundation Excavation
Incl. Haul 800 CY $$
53 4-02 Gravel Base 3,260 TON $$
FIRM NAME
P R O P O S A L F O R M Page 5
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Schedule B: Storm Utility Improvements and Street Restoration Continued
Bid
Item
Sec.
No.Description Quantity Unit Unit Price Total Price
54 4-04 Crushed Surfacing Top Course 180 TON $$
55 5-04
HMA Cl. 1/2-inch PG 64-22 (Class
B)810 TON $$
56 5-04 HMA Cl. 1-inch PG 64-22 (Class E)2,430 TON $$
57 5-04 Asphalt Cold Patch 250 TON $$
58 7-04
Solid Wall Polyvinyl Chloride (PVC)
Storm Pipe, SDR-35, 4-Inch Diam.165 LF $$
59 7-04
Solid Wall Polyvinyl Chloride (PVC)
Storm Pipe, SDR-35, 6-Inch Diam.229 LF $$
60 7-04
Solid Wall Polyvinyl Chloride (PVC)
Storm Pipe, SDR-21, 8-Inch Diam.55 LF $$
61 7-04
Solid Wall Polyvinyl Chloride (PVC)
Storm Pipe, SDR-21, 12-Inch Diam.67 LF $$
62 7-04
Solid Wall Polyvinyl Chloride (PVC)
Storm Pipe, SDR-35, 12-Inch Diam.251 LF $$
63 7-04
Solid Wall Polyvinyl Chloride (PVC)
Storm Pipe, PS46, 18-Inch Diam.112 LF $$
64 7-04
Solid Wall Polyvinyl Chloride (PVC)
Storm Pipe, PS46, 30-Inch Diam.23 LF $$
65 7-04
Solid Wall Polyvinyl Chloride (PVC)
Storm Pipe, PS46, 42-Inch Diam.3,386 LF $$
66 7-04
42-Inch Diam. Storm Pipe
Installation, Sta. 34+50 to Sta. 39+50,
Complete 1 LS LS $
67 7-04 Storm Sewer Television Inspection 4,790 LF $$
68 7-04
Special Class 50 Ductile Iron Pipe for
Storm Pipe, 12-Inch Diam.36 LF $$
69 7-05 Catch Basin Type 1 5 EA $$
70 7-05 Catch Basin Type 2, 48-Inch Diam.3 EA $$
71 7-05 Catch Basin Type 2, 72-Inch Diam.3 EA $$
72 7-05 Manhole 72-Inch Diam., Type 3 22 EA $$
73 7-05 Manhole 96-Inch Diam., Type 3 4 EA $$
74 7-05 Connect to Drainage Structure 15 EA $$ FIRM NAME Addendum #2
P R O P O S A L F O R M Page 6
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Schedule B: Storm Utility Improvements and Street Restoration Continued
Bid
Item
Sec.
No.Description Quantity Unit Unit Price Total Price
75 7-05 Abandon Existing Manhole 4 EA $$
76 7-08 Pipe Foundation Material 2,500 TON $$
77 7-08 Imported Pipe Bedding 7,000 TON $$
78 7-08 Imported Pipe Trench Backfill 15,000 TON $$
79 7-08 Select Pipe Trench Backfill 400 TON $$
80 7-08
Controlled Density Fill (CDF) for
Filling Pipe 750 CY $$
81 7-08 Trench Shoring System 36,500 SF $$
82 7-09 Connect to Existing Water Main 20 EA $$
83 7-09
Special Class 52 Ductile Iron Pipe for
Water Main, 8-Inch Diam.40 LF $$
84 7-09
Special Class 52 Ductile Iron Pipe for
Water Main, 12-Inch Diam.410 LF $$
85 7-09 Blowoff Assembly, 2-inch 3 EA $$
86 7-12 Gate Valve, 12-Inch Diam.1 EA $$
87 7-12
Combination Air Release/Air Vacuum
Valve Assembly 1 EA $$
88 7-14 Hydrant Assembly 1 EA $$
89 7-15 Water Service Connection Renewal 2 EA $$
90 7-17
8-inch Sanitary Sewer Crossing
(through New Storm Structure)34 LF $$
91 7-17
12-inch Sanitary Sewer Crossing
(through New Storm Structure)23 LF $$
92 7-18
6-Inch Diam. PVC Side Sewer with 6-
Inch Diam. PVC Cleanout 250 LF $$
93 7-21 Removing Steel Casing Obstructions 1
EQ.
ADJ.EQ. ADJ.$5,000.00
94 8-01
General Permit Documentation
Compliance 1 LS LS $
95 8-01
Temporary Water Pollution/Erosion
Control 1
EQ.
ADJ.EQ. ADJ.$5,000.00
FIRM NAME
P R O P O S A L F O R M Page 7
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Schedule B: Storm Utility Improvements and Street Restoration Continued
Bid
Item
Sec.
No.Description Quantity Unit Unit Price Total Price
96 8-01 ECS Lead 60 DAY $$
97 8-01 Silt Fence Installation and Removal 1,120 LF $$
98 8-01
High Visibility Fencing Installation
and Removal 950 LF $$
99 8-01 Wattle 1,460 LF $$
100 8-01 Inlet Protection 29 EA $$
101 8-02 Topsoil Type A 340 CY $$
102 8-02 Lawn Sod 2,010 SY $$
103 8-02
PSIPE Red Sunset Maple (Acre
Rubrum), 2-inch Caliper 1 EA $$
104 8-02
PSIPE Douglas Fir (Pseudotsuga
Menziesii), 7-foot Height 3 EA $$
105 8-03 Irrigation System Repair 1
EQ.
ADJ.EQ. ADJ.$5,000.00
106 8-04
Cement Concrete Traffic Curb and
Gutter 550 LF $$
107 8-04 Cement Concrete Pedestrian Curb 80 LF $$
108 8-05 Dewatering System 5,600 LF $$
109 8-06
Industrial and Commercial Driveway
Apron 30 SY $$
110 8-09 Raised Pavement Marker Type 2 30 EA $$
111 8-12
Temporary Security (Chain Link)
Fence 920 LF $$
112 8-12 Remove and Replace Outfield Fence 120 LF $$
113 8-13 Monument Type B (Modified)3 EA $$
114 8-14 Cement Concrete Sidewalk 460 SY $$
115 8-14
Cement Concrete Curb Ramp Type
Perpendiular A 1 EA $$
116 8-14
Cement Concrete Curb Ramp Type
Parallel A 2 EA $$
FIRM NAME
P R O P O S A L F O R M Page 8
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Schedule B: Storm Utility Improvements and Street Restoration Continued
Bid
Item
Sec.
No.Description Quantity Unit Unit Price Total Price
117 8-22 Paint Line 575 LF $$
118 8-22 Plastic Wide Line 900 LF $$
119 8-22
Plastic Crosswalk Stripe and Stop
Bar (24 inch wide)420 LF $$
120 8-22 Plastic Traffic Arrow 2 EA $$
121 8-22 Plastic Bicycle Lane Symbol 3 EA $$
122 8-22 Plastic Traffic Letter 4 EA $$
123 8-22 Removing Plastic Crosswalk Line 1,850 SF $$
124 8-23 Temporary Pavement Markings 1,200 LF $$
125 8-30 Joint Utility Trench 250 LF $$
Subtotal Schedule B $
FIRM NAME
P R O P O S A L F O R M Page 9
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Bid Summary:
Subtotal Schedule A: Street Improvements $
WSST Not Applicable for Schedule A
Subtotal Schedule B: Storm Utility Improvements and Street Restoration $
Washington State Sale Tax Schedule B (9.5%) $
Total Basic Bid $
Total Gross Bid (basic bid plus sales tax) $
If sales tax is shown for a schedule above sales tax should not be included in each bid item
price (Rule 170).
RECEIPT OF ADDENDA. I certify and acknowledge receipt of the following Addenda to
the Bid Documents and that due consideration thereof has been used in preparing and
submitting this Bid Proposal.
Addendum
No.
Date of Receipt
of Addendum
Signed
Acknowledgment
1
2
3
4
(NOTE: Failure to herein acknowledge receipt of the addenda may be considered an
irregularity in this proposal.)
FIRM NAME Addendum #2
P R O P O S A L F O R M Page 10
30th Street NE Area Flooding – Phase 1
Contract No. 14-08 Project No. CP1122
Submitted by:
I certify under penalty of perjury under the laws of the State of Washington that I am the
official authorized to submit this Bid Proposal on behalf of:
FIRM NAME:
Address:
Phone #: FAX #: Email:
Authorized Official: Title:
(Please print name)
Date:
(Signature)
Authorized Official: Title:
(Please print name)
Date:
(Signature)
Place of Execution:
City and State
NOTE: 1. Bidder is a(n): [ ] Corporation [ ] Individual [ ] Partnership
[ ] Joint Venture [ ] Other
2. If the bidder is a corporation, its duly authorized officials must execute this
proposal. Incorporated in the State of
.
State Contractor State Contractor
License #: License Expiration Date:
State Unified Business Employment Security
Identifier (UBI) #: Department #:
State Excise
Tax Registration #: Federal Tax ID #:
Construction Contractors: Please use the following City of Auburn Tax Code Numbers on
retail sales where the labor and services are primarily performed in Auburn;
1. Number 1702 when the work is performed in King County
2. Number 2724 when the work is performed in Pierce County
Submit Bid Proposal to: Office of City Clerk
City of Auburn
25 West Main Street
Auburn, WA. 98001-4998
RESPONSIBLE BIDDER INFORMATION
Bidder has been in business continuously from (year).
Bank Reference:
Bank Name Account Officer Phone No.
Number of regular full-time employees:
Number of projects in the past 5 years completed:
ahead of schedule on schedule behind schedule
Bidder has had experience in work comparable to that required for this Project:
As a prime contractor for years. As a subcontractor for years.
List the supervisory personnel to be employed by the Bidder and available for work on this
project (Project manager, Foreman, Site Superintendent, Engineer, etc.):
Name Title Years with firm
List below, non City of Auburn construction work successfully completed by the bidder
within the past five years which was similar in size, scope, and difficulty to the work herein
being bid upon.
Year Contract
Project Name Completed Amount Owner/Reference Name & Phone
List all projects undertaken in the last 5 years which have resulted in partial or final
settlement of the contract by arbitration or litigation in the courts:
Name of Client & Project
Contract
Amount
Total Claims Arbitrated
or Litigated
Amount of
Settlement
of Claims
FIRM NAME
RESPONSIBLE BIDDER INFORMATION (continued)
Has Bidder, or any representative or partner, ever failed to complete a contract?
[ ] No [ ] Yes If yes, give details:
Has Bidder ever had any Payment/Performance Bonds called as a result of its work?
[ ] No [ ] Yes If yes, please state:
Project Name Contracting Party Bond Amount
Has Bidder changed bonding companies in the last 3 years?
[ ] No [ ] Yes If yes, give details:
Has Bidder ever been found guilty of violating any State or Federal employment laws?
[ ] No [ ] Yes If yes, give details:
Has Bidder ever filed for protection under any provision of the federal bankruptcy laws or
state insolvency laws?
[ ] No [ ] Yes If yes, give details:
Has Bidder or any of its employees filed any claims with Washington State Workman’s
Compensation or other insurance company for accidents resulting in fatal injury or
dismemberment in the past 5 years? [ ] No [ ] Yes If yes, please state:
Date Type of Injury Agency Receiving Claim
Will you, upon request from the City, fill out a detailed financial statement and furnish any
other information that may be required by the City? [ ] No [ ] Yes
The Bid Proposal signature warrants under penalty of perjury that the foregoing information
is true and accurate to the best of his/her knowledge. The Bid Proposal signature authorizes
the City of Auburn to verify all information contained herein.
FIRM NAME
PROPOSED EQUIPMENT AND MANPOWER SCHEDULE
(Use additional sheets, if required)
Equipment to be used:
DESCRIPTION/TYPE YEAR CONDITION OWN/RENT
Manpower schedule:
FIRM NAME
Project CP1122 - 30th Street NE Area Flooding – Phase 1
Failure to list subcontractors who are proposed to perform the work of HVAC (heating, ventilation and
air conditioning), plumbing, as described in Chapter 18.106 RCW, and electrical as described in
Chapter 19.28 RCW, or naming more than one subcontractor to perform the same work will result in
your bid being non-responsive and therefore void.
Subcontractor(s) that are proposed to perform the work of Heating, ventilation and air conditioning,
plumbing, as described in chapter 18.106 RCW, and electrical as described in chapter 19.28 RCW must be
listed below. The work to be performed is to be listed below the subcontractor(s) name. The requirement to
name the prime contract bidder’s proposed HVAC, Plumbing and electrical subcontractors applies only to
proposed HVAC, plumbing, and electrical subcontractors who will contract directly with the prime contract
bidder submitted the bid to the public entity.
If no subcontractor is listed below, the bidder acknowledges that it does not intend to use any subcontractor to
perform those items of work.
Subcontractor Name
Work to be Performed
Subcontractor Name
Work to be Performed
Subcontractor Name
Work to be Performed
Subcontractor Name
Work to be Performed
Subcontractor Name
Work to be Performed
Bidder’s are notified that in the opinion of the enforcement agency PVC or metal conduit, junction boxes, etc.
are considered electrical equipment and must be installed by a licensed electrical contractor, even if the
installation is for future use and no wiring or electrical current is connected during the project.
A licensed electrical contractor must be listed to perform the work.
FIRM NAME
DOT Form 271-015A EF Rev. 07/2011
Local Agency Name Local Agency Subcontractor List
CITY OF AUBURN Prepared in compliance with RCW 39.30.060 as amended
Local Agency Address
25 W. Main Street, Auburn, WA 98001 To Be Submitted with the Bid Proposal
BID BOND
BOND NO. ________________
KNOW ALL MEN BY THESE PRESENTS:
That we, _______________________________________________________, as Principal,
(hereinafter called the “Principal”), and
______________________________________________, a corporation duly organized
under the laws of the ___________________________ as Surety, (hereinafter called the
“Surety”), are held and firmly bound unto the CITY OF AUBURN, Washington, as Obligee,
(hereinafter called the “Obligee”), in the sum of FIVE PERCENT (5%) OF TOTAL
AMOUNT BID not to exceed _____________________________________________
dollars ($_____________), for the payment of which sum well and truly to be made, the said
Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors
and assigns, jointly and severally, firmly by these presents.
WHEREAS, the Principal has submitted a bid for 30TH STREET NE AREA FLOODING
– PHASE 1, CP1122, 14-08
NOW THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal
shall enter into a contract with the Obligee in accordance with the terms of such bid and give
such bond or bonds as may be specified in the bidding or contract documents with good and
sufficient surety for the faithful performance of such contract and for the proper payment of
labor and material in the prosecution thereof, or in the event of the failure of the Pri ncipal to
enter into such contract and give such bond or bonds, if the Principal shall pay to the Obligee
the difference not to exceed the penalty hereof between the amount specified in said bid and
such larger amount for which the Obligee may in good faith contract with another party to
perform the work covered by said bid, then this obligation shall be null and void, otherwise
to remain in full force and effect.
SIGNED, SEALED AND DATED THIS DAY OF , 20 .
Name of Contractor
Signed by Principal
Surety Name
Signed by Surety