36791 SDP2014-1005 In-N-Out BurgerMarch 30, 2016
Loida Rebong
In -N -Out Burger
13502 Hamburger Lane
Baldwin Park, CA 91706
Re: SDP 2014-1005
Dear Loida Rebong:
Per authorization from the Public Works Department, the City Clerk's office hereby
releases Grading Bond No. CMS287133 in the amount of $58,300.
If you have any questions, please call me at (760) 777-7103.
Sincerely,
C�L�
Pam Nieto
Deputy City Clerk
c: Tim Jonasson, Design & Development Director/City Engineer
RLI Insurance Company
File
78-495 Calle Tampico I La Quinta I California 92253 1 760.777.7000 1 www.La-Quinta_org
BOND NO. CMS287133
FAITHFUL PERFORMANCE BOND PREMIUM $583.00
(LQMC 8.02.01 & CBC 3311)
Grading Bond
WHEREAS, the City of La Quinta, California, is prepared to issue Encroachment Permit #
PG2015-0006 in accordance with the La Quinta Municipal Code, and the California Building Code which is
adopted by reference, to IN -N -i UT 13URGFIRS ' as Principal,
whereby Principal will be authorized to perform certain grading improvements identified in the permit, and as
further detailed on the grading plans referenced_ therein, to privately -owned property generally known to the
City and others as in N: ULaJ3urzer; 7 l 1 'Eiighivay i:i i_ ; and
La Quinta, CA 92253
WHEREAS, Said Principal is required under the terms of the permit to furnish a bond for the
faithful performance of the grading work in accordance with the approved plans, specifications, and permit
requirements; or, if the work is abandoned (not completed as required), Principal shall correct or eliminate any
hazardous conditions that may exist.
NOW, therefore, we the Principal and RLI INSMANCE COMrANV as
Surety, are held and firmly Found unto the City of La Quinta, as Obligee, in the penal sum of
IlFT]icitT�y(iUs1�!}77tii�lE:rIVM1URf C3Qari:ua. .Dollars
(s &366:00 } lawful money of the United States, for the payment of which sum well and truly to be
made, we bind ourselves, our heirs, successors, executors and administrators, jointly and severally, firmly by
these presents_
The condition of this obligation is such that if the above bonded Principal, 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 provisions in the said permit and any alteration thereof made as therein
provided, on his ortheir part, to be kept and performed at the time and in the manner therein specified, and in
all respects according to theirtrue intent and meaning, and shall indemnify and save harmless the Obligee, its
officers, agents and employees, as therein stipulated, then this obligation shall become null and void;
otherwise, it shall be and remain in full force and effect.
As a part of the obligation secured hereby and in addition to the face amount specified therefore, there shall be
included costs and reasonable expenses and fees, including reasonable attorney's fees, incurred by the
Obligee in successfully enforcing such obligation, all to be taxed as costs and included in any judgment
rendered.
The surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms
of the permit or to the work to be performed there under or the specifications accompanying the same shall in
anywise affect its obligations on this bond, and it does hereby waive notice of any such change, extension of
time, alteration or addition to the terms of the permit or to the work or to the specifications-.
Page 1 of 2
T Drive/Checklists — Forms & Applications/Standard Grading Bond Form
Standard Grading Bond Form { s�
Encroachment Permit #P62.1X75 �46'!
Page 2 of 2
In witness whereof, this instrument has been duly executed by the Principal and Surety above
named, on,A G !.5T6- - 20 1$:
TWNM OUT
Pring al
(Seal)
Signature of Principal
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Title of Signatory
itl.l INS.. NO E0%,' P NY
Surety'
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Signa rc y
NNATHAN VARNOLD. ATTORi 41EYIN FACT
Title of Signatory
4025 North Liiidbggh i 1rmk�
NAr in. IL6V615
Address of Surety
�l aeGaur-,21H1
Phone # of Surety
yATHAN VARNOLD
Contact Person for Surety
T Drive/Checklists — Forms & Applications/Standard Grading Bond Form
CALIFORNIA 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 California
County of San Francisco
AUG 0 6 2015
On before me, Dara_yy_Mady, NotgU Public, personally appeared
Nathan Varnold who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) isle subscribed to the within instrument and acknowledged to me that he/sey
executed the same in his�'ie�� authorized capacity(ies), and that by his/keeisignature(s)
on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed
the instrument.
� DARAVY MAf1Y
` COMM. #2013320 z
cccc a� ' y Notary Public - California o
Z ' f Los Angeles County
Comm. Expires Mar. 18, 2017
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.
Signature j.'iJ
Daravy Mady, Signatti
otary Public
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
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 California )
County of 11 L� ) ,.w
On �� tav 11, 2015 before me, _ X01 aQ Rtbc"A , M -�"� WW110.
Date n ,, , , ,I Here Insert Name and Title v the Officer
lAAlf
personally appeared 1 DA �m+
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the persor4)-whose name(s} isle -s
subscribed to the within instrument and acknowledged to me that heAs4e.44Qy executed the same in
his!4& ;e:: -authorized capacity(iee} and that by hisAheFAheir signature(oon the instrument the person(s),
or the entity upon behalf of which the personfs} acted, executed the instrument.
Imm�l
LbIDA REBONG
Commission #t 2102012 x
Notary Public - Caldornia i
Los Anpeles County
16M,Comm. E kes Mar 31, 2019
Place Notary Seal Above
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.
Signature ljb�- W7nn�
Signature of Notary Pub '
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document ii
Title or Type of Document: Y(XAk, BWA Document Date: S 20t5
Number of Pages: 4 Signer(s) ther Than Named Above:
Capacity(ies) C i e y Si ger[s
Signer's Name: l Signer's Name:
$ Corporate Officer — Title(s): Vltrl ElCorporate Officer — Title(s):
❑ Partner — El Limited El General N '❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator ❑ Trustee ❑ Guardian or Conservator
❑ Other:. ❑ Other:
Signer Is Representing: - VI Signer Is Representing:
02014 National Notary Association • www.NationaiNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907
L I
an RLI Company
P.O. Box 3967 1 Peoria, IL 61612-3967
Phone: (800)645-2402 1 Fax: (309)689-2036
Know All Men by These Presents:
POWER OF ATTORNEY
RLI Insurance Company
Contractors Bonding and Insurance Company
That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the
approving officer if desired.
That this Power of Attorney may be effective and given to either or both of RLI Insurance Company and Contractors Bonding and
Insurance Company, required for the applicable bond.
That RLI Insurance Company, a Illinois corporation, and/or Contractors Bonding and Insurance Company, a Washington
corporation (as applicable), each authorized and licensed to do business in all states and the District of Columbia do hereby make,
constitute and appoint:
Richard S. Svec, James W. Untiedt, Michael E. Sheahan, Julia Pitta Jeanette Conley, Patrick T Maughan, iaintly or severally
in the City of San Jose State of California , as Attorney in Fact, with full power and authority hereby
conferred upon him/her to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds,
undertakings, and recognizances in an amount not to exceed Ten Million Dollars
$10,000,000.00 ) for any single obligation.
The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon this Company as if such bond had
been executed and acknowledged by the regularly elected officers of this Company.
RLI Insurance Company and Contractors Bonding and Insurance Company, as applicable, have each further certified that the
following is a true and exact copy of the Resolution adopted by the Board of Directors of each such corporation, and now in force, to -wit:
"All bonds, policies, undertakings, Powers of Attorney or other obligations of the Corporation shall be executed in the
corporate name of the Corporation 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 Corporation. 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 or other electronic image."
IN WITNESS WHEREOF, RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have
caused these presents to be executed by its respective Vice President with its corporate seal affixed this 13th day of January, 2014.
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RLI Insurance Company
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Contractors Bonding and Insurance Company
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.SEAL
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State of Illinois l ••.•
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Roy C. Die Vice President
•,,.••
SS �ASHINGSON �•`�,'
iiH
)} L0i�'91}•'`',r`
County of Peoria ''111i+iiia oll,
CERTIFICATE
On this 13th Clay of January 2014,
I, the undersigned officer of RLI Insurance Company, a stock
before me, a Notary Public, personally appeared _Roy C. Die _, who
being by me duly sworn, acknowledged that he signed the above Power of
corporation of the State of Illinois, and/o X tractors Bonding and
Insurance Company, a Washing %81T"" f,,Oo hereby certify
Attorney as the aforesaid officer of the RLI Insurance Company and/or
that the attached Dower of Atio�$. tre'a�jd effect and is
Contractors Bonding and Insurance Company, and acknowledged said
• •
irrevocable; and furthermore, tbh �.Resolution•p jh°e. Company as
instrument to be tate voluntary act and deed of said corporation.
set forth in the Power of Ai�x;�e)r, i fdr q;An testimony
I have 'my
whereof, hereunto 1saKd and tl}g spaP Of the RLI
Insurance Company and/otractusbonding:a7t(Vinsurance
Company this , da3co :.Z
O -1 ` y
5•,
fix_
Jacqu i M. $ackler Notary Public
RLI Insurance Company `.. � qm:
Contractors Bonding and In a
+ear ne+<sa4r�
"OFFICIAL SEAL”
RoyC. Die Vice President
swEor JACQUELINE M. BOCKLER
COMMISSION EXPIRES 03/19/14
0475962020212
A0059913
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To: Susan Maysels, City Clerk
From:. ryan McKinney, Principal Engineer
Via: C0- imothy R. Jonasson, P.E., Design & Development Director/ City Engineer
Date: March 29, 2016
'CQM 1)41�l ��Pm a,014 - IONS
Re: Release of Grading Bond for SDP 2014-1005, In -N -Out Burger
Please release the following grading bond held in your files for the above referenced
tract. All grading work for this project has been completed.
The grading bond amount and the address to the developer and surety company
are as follows:
SDP 2014-1005
Bond Description Bond No. Bond Amount
Grading CMS287133 $58,300
Developer: Loida Rebong
In -N -Out Burger - New Construction
13502 Hamburger Lane
Baldwin Park, CA 91706
Surety Company: RLI Insurance Company
9025 North Lindbergh Drive
Peoria, -IL 61615
(213) 630-3200
Attn: Nathan Varnold
Cc: Project File I, SDP 2014-1005
OUTSTANDING BOND REPORT
Name: IN -N -OUT BURGER
Tract Map or Case No. SDP 2014-1005
Date of Contract (if applicable): 2015
Required Bond Amounts:
ENTER
Bond Company: RLI Insurance Company
Outstanding Bonds:
Amount: Bond No. Date Replaced or Releas d:
3
`�
2
$ 58,300. Grading CMS !7133
a0 S aT
OF
TO: Susan Maysels, City Clerk
FROM: Amy Yu, Associate Engineer 1.
VIA: Timothy R. Jonasson, P.E., Public Works Director/City Engineer 'i�rw
DATE: August 21, 2015
RE: Grading Bond for SDP2014-1005, In -N -Out Burgers
The developer is posting a grading bond for the above referenced project.
Grading Bond
Performance = $ 58,300
Bond No. CMS287133
Surety: RLI Insurance Company
9025 North Lindbergh Drive
Peoria, IL 61615
(213) 6.30-3200
Attn: Nathan Varnold
If you have any questions, please contact me at extension 7047.
Thank You.