20-101386-Bond Information Worksheet-4-13-2022-V1Agreement & Performance/Maintenance Bond Information Sheet
Rev. xx/xx Page 1 of 2
Public Works Department
AAGGRREEEEMMEENNTT && PPEERRFFOORRMMAANNCCEE//MMAAIINNTTEENNAANNCCEE BBOONNDD
IINNFFOORRMMAATTIIOONN SSHHEEEETT
PROJECT INFORMATION
Project Name: Bond No.:
Address:
(Street) (City) (State) (ZIP)
Development Review Engineer: Permit No.:
Description of Work: The Principal has entered into an Agreement with the City for the civil
infrastructure required as part of the subject development which includes:
Curb & Gutter Sidewalk
Erosion Control Streetlights
Utility Work Signalization
Channelization Drainage
Planter Strip with Street Trees Paving
Other Required Information:
Full Legal Description Abbreviated Legal Description Parcel Number(s)
BOND PRINCIPAL INFORMATION
Person(s) entering into the agreement with the City.
Bond Principal:
State of Incorporation: (If applicable)
Nature of Principal’s Entity:
(i.e. Corporation, General Partnership, Limited Partnership, Individual, etc.)
Individual Signing on Behalf of Principal:
(Name) (Title)
Mailing Address:
(Street) (City) (State) (ZIP)
Phone: Fax Number:
Attach Signature Authority1 (except for Individual Entity)
1 This is an official document that has been submitted to the State showing who has au thority to sign legal
documents on behalf of the company. (i.e. Corporate Resolution, Company By-Laws, or State License showing
Corporate Officers)
Agreement & Performance/Maintenance Bond Information Sheet
Rev. xx/xx Page 2 of 2
PROPERTY OWNERS INFORMATION
Property Owner’s Name if Individual:
Spouse:
Property Owner’s Name if Proprietary Then:
Mailing Address:
(Street) (City) (State) (ZIP)
Phone:
BOND COMPANY (SURETY) INFORMATION
Company Name:
Mailing Address:
(Street) (City) (State) (ZIP)
Phone: Fax Number:
Nature of Bond Company’s Entity:
(i.e. Corporation, General Partnership, Limited Partnership, Individual, etc.)
State of Incorporation:
APPLICANT INFORMATION (If different from Bond Principal or Property Owner)
Applicant’s Name:
Title of Person Signing on Behalf of Applicant:
Applicant’s Address:
(Street) (City) (State) (ZIP)
Applicant’s Phone:
K:\DEVELOPMENT SERVICES\DEVELOPMENT STANDARDS\2008 Development Standards-DRAFT\Checklists\Bond Information Worksheet.doc
FOR CITY USE ONLY
Bond Amount: $_____ Administrative Deposit: $