Common use of Required Form Clause in Contracts

Required Form. Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in California Insurance Code section 105, and if the work or project is financed, in whole or in part, with federal, grant or loan funds, Surety’s name must also appear on the Treasury Department’s most current list (Circular 570 as amended). Any claims under this bond may be addressed to: (Name and Address of Surety) (Name and Address of agent or representative for service for service of process in California) Telephone: Telephone: A notary public or other office 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 ) ) ss. COUNTY OF ) On ____________________________, before me, _________________________, personally appeared _______________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) as the Attorney-in-Fact of ____________________________ (Surety) and acknowledged to me that by his/her/their signature(s) their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) executed the instrument. 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. Notary Public in and for said State Commission expires: (SEAL)

Required Form. Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in California Insurance Code section 105, and if the work or project is financed, in whole or in part, with federal, grant or loan funds, Surety’s name must also appear on the Treasury Department’s most current list (Circular 570 as amended). Any claims under this bond may be addressed to: (Name and Address of Surety) (Name and Address of agent Agent or representative Representative for service of process in California, if different from above) (Telephone number of Surety and Agent or Representative for service of process in California) Telephone: Telephone: Notary Acknowledgment A notary public or other office 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 ) ) ss. COUNTY OF ) On ____________________________, 20 , before me, _________________________, Notary Public, personally appeared _______________________________, who proved to me on the basis of satisfactory Name(s) of Signer(s) evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) as the Attorney-in-Fact of ____________________________ (Surety) ), and acknowledged to me that by his/her/their signature(s) their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. 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 of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT Individual Corporate Officer Title(s) Partner(s) Limited General Attorney-In-Fact Trustee(s) Guardian/Conservator Other: Signer is representing: Name Of Person(s) Or Entity(ies) Title or Type of Document Date of Document Signer(s) Other Than Named Above With respect to the Contract dated 20 by and between the PERRIS ELEMENTARY SCHOOL DISTRICT ("the District") and ("Contractor") Contractor hereby certifies to the District's governing board that it has completed the criminal background check requirements of Education Code section 45125.1 and that none of its employees that may come in contact with the District 's pupils have been convicted of a violent felony listed in Penal Code section 667.5(c) or a serious felony listed in Penal Code section 1192.7(c). Contractor's Representative Date: Pursuant to Education Code sections 45125.1 and 45125.2, the PERRIS ELEMENTARY SCHOOL DISTRICT School District ("the District") has determined that ("Contractor") is exempt from the criminal background check certification requirements for said the contract dated 20 by and between the District and Contractor ("Contract") because: The Contractor's employees will have limited contact with the District students during the course of the Contract; Emergency or exceptional circumstances exist; or With respect to Contractors constructing, reconstructing, rehabilitating or repairing a school facility, as provided in Section 45125.2, the Contractor has agreed to ensure the safety of pupils at the school facility by the following method(s) specified in Section 45125.2: School the District Official: Date: The PERRIS ELEMENTARY SCHOOL DISTRICT School District ("the District") entered into a contract for services with ("Contractor") on or about , 20 ("Contract"). This certification is submitted by Subcontractor's Representative: Date: The PERRIS ELEMENTARY SCHOOL DISTRICT School District ("the District") entered into a contract for services with ("Contractor") on or about ("Contract"). Pursuant to Education Code sections 45125.1 and 45125.2, the District has determined that The Subcontractor's employees will have limited contact with the District students during the course of the Contract; Emergency or exceptional circumstances exist; or With respect to Contractors constructing, reconstructing, rehabilitating or repairing a school facility, as provided in Section 45125.2, the Contractor and/or Subcontractor have agreed to ensure the safety of pupils at the school facility by the following method(s) specified in Section 45125.2: School the District Official: Date Labor Code section 3700 in relevant part provides: Every employer except the State Commission expires: (SEAL)shall secure the payment of compensation in one or more of the following ways: