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DocuSign Envelope ID:EA873EC6-CBA7-428B-95D8-409AOA295974 <br /> _ City of Tracy Agreement Routing <br /> TRACY <br /> �f Please fill out form completely& write N/A if not applicable. <br /> - A CONTRACTORJCOMPANY INFORMATION <br /> Contractor/Company: Woodside 05N, LP/Surland Communities, LL( Email: Michael LaFortune <Michael.LaFortu <br /> Contact Person: Phone: <br /> Michael LaFortune 916.790.7121 <br /> ?-EWfi6XWrr.CITY DEPARTMENT <br /> Department: DS-Engineering KeaTc.+.K., Phone: x6438 <br /> Project Manager: Al Gali 7A9E694E49WEE... Admin: Michelle Hart <br /> Contract Type: PSA❑ GSA ❑ Amendment❑ Public Proj. ❑ SIA❑ 1 OIA 21 1 Other❑ <br /> To be signed by: Mayor 0 City Manager❑ City Attorney r❑ Department Head ❑ <br /> Per signature authority: I TMC§2.20.080 TMC§2.20.090 TMC§2.20:095 TMC§2.20.100 <br /> CONTRACT DESCRIPTIONJINFORMATION <br /> Project Name: OFF-SITE IMPROVEMENT AGREEMENT FOR OFF-SITE DETENTION BASIN 3A PUBLIC IMPROVEMENTS <br /> Approved by/Reso No.&Date Amount Term Total Amount <br /> Original CITY COUNCIL,2022-194, 12/6/22 <br /> Amendment No. 1/Task Order <br /> Amendment No.2 <br /> Z Previously reviewed by City Attorney's Office. Document Review No.22-163 <br /> ❑ Exhibits A through C attached. 21 Signed by other Party&confirmed corporate,LLC or LP status,if applicable. <br /> To confirm Corp., LLC or LP status,please visit https:Hbusinesssearch.sos.ca.gov/ <br /> ❑ Check if two originals are attached. The Clerk's Office will keep one original. <br /> ❑ Check if document will need to be notarized. <br /> ❑ Check if document will be recorded&list who will record the agreement: <br /> INSURANCE REQUIREMENTS <br /> All Insurance Certificates must include the corresponding Contract Name <br /> 0 Insurance Certificate is attached. ❑This is an Amendment or Task Order. Insurance Certificate is on file&current. <br /> ❑� Is Endorsement included? ❑ Is Waiver of Subrogation attached? Risk Manager Initials: <br /> ❑ Check if any modifications to insurance requirements&include email from Risk Manager approving modification. <br /> FINANCE&BUSINESS LICENSE INFORMATION <br /> To locate the business license number and status,please visit https://tracy.hdIgov.com/Search/Index/BusinessLicense <br /> City Account# 206-4542-R6322 Business License# 06000793 <br /> Funds are budgeted& <br /> available <br /> NOTESJSPECIAL INSTRUCTIONS <br /> CONTRACT CERTIFICATION&APPROVA S <br /> 1.Department Head Dat 4.City Attorney Date <br /> Ai^ /10/2023 1 6:0 P PST 23 <br /> 2. Risk 9 4 4 D.Date 1/11/2023 1 8: 2 A RS"City Clerk Date <br /> 3. Finance 918B5 F9Al2C40E.. Date 1/11/2023 18:4 2 A A PSTAhtAS <br /> Contract que ' 947CAW9 W01y Attorney's office(209)831-6130. Insurance questions?Conta ' Manager(209)831-6169. <br /> Finance questions?Contact Finance Department(209)831-6822. Business License Questions? Contact HDL(209)826-1827 or request@hdlgov.com. <br />