CONTRACTOR'S CERTIFICATION OF COMPLETION
DATE: 11/06/23
TO: City of Menifee
29844 Haun Rd
Menifee, California 92586
FROM: Roadway Engineering & Contracting Inc.
(Firm or Corporation)
PROJECT: Menifee Road and Garbani Road Traffic Signal Improvement Project - CIP No. 21-11 This is to certify that I, acting as an authorized official of the above stated firm or corporation, have been properly authorized by said firm or corporation to sign the following statements pertaining to the subject contract:
1. I know, of my own personal knowledge, and do hereby certify, that the work of the contract described above has been performed, and materials used and installed in every particular, in accordance with, and in conformity to, the contract drawings and specifications.
2. The contract work is now complete in all parts and requirements, and ready for your final inspection.
3. I understand and agree that neither the determination by the Owner that the work is complete, nor the acceptance thereof by the Owner, shall operate as a bar to claim against the Contractor under the terms of the guarantee provisions of the contract documents.
Signature of Pring Contractor Signature of Prime Contractor Eric Alvarez - President / Secretary / Treasurer
Print name and title Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-2
CONTRACTOR'S AFFIDAVIT OF DISPOSAL
WHEREAS, on the 15 _ day of Decembor _ 20_ZL, the undersigned entered into and executed a contract with City of Menifee for Menifee Road and Garbani Road Traffic Signal Improvement Project, as particularly described in said contract and identified as CIP No. 21-11, and WHEREAS, the specifications of said contract requires the Contractor to affirm that "all brush, trash, debris, and surplus materials resulting from this project have been disposed of in a legal manner" and that all designated recyclable materials are properly recycled in compliance with the City of Menifee Ordinances.
WHEREAS, said contract has been completed, all surplus materials disposed of, and proof of compliance with the City of Menifee Municipal Code has been furnished.
NOW, THEREFORE, in consideration of the final payment by the City of Menifee to said Contractor under the terms of said contract, the undersigned Contractor, hereby certifies and affirms under penalty of perjury that all surplus materials as described in said contract have been disposed of at the following location(s):
Asphalt and Concrete Debris
Type of material disposed of Type of material disposed of GreenRock Materials Inc
Name of disposal site Name of disposal site
1420 Nandina Ave, Perris, CA 92571
Address of disposal site Address of disposal site
Type of material disposed of Type of material disposed of Name of disposal site Name of disposal site
Address of disposal site Address of disposal site
By signing and submitting this form to the City of Menifee on this_06_day of November, 2023, I (we) hereby certified and swear under penalty of perjury under the laws of the State of California that the aforementioned information is true and correct without omission, error or misrepresentation. 11/6/23
Signaty or phime contractor Signature of Prime Contractor Date Eric Alvarez - President
Print name and title Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-3
CONSENT OF SURETY FOR FINAL PAYMENT
In accordance with the provisions of the contract between the Owner and the Contractor, and the following named Surety: Nationwide Mutual Insurance Company on the Payment Bond in the amount of $1,178,547.76 Dollars, of the following named Contractor:_Roadway Engineering & Contracting Inc. hereby approves of final payment to the Contractor, and further agrees that said final payment to the Contractor shall not relieve the Surety named herein of any of its obligations to the Owner, as set forth in said Surety company's bond.
IN WITNESS WHEREOF, the Surety Company has hereunto set its hand and seal this 7th _day of November , 2023
Adriana Valenzuela, Attorney-In-Fact
Title
(CORPORATE SEAL)
4-4
Power of Attorney
KNOW ALL MEN BY THESE PRESENTS THAT:
Nationwide Mutual Insurance Company, an Ohio corporation hereinafter referred to severally as the "Company" and collectively as "the Companies" does hereby make, constitute and appoint:
ADRIANA VALENZUELA; CHRISTINA MOUNTZ; CYNTHIA J YOUNG; JAY P FREEMAN; each in their individual capacity, its true and lawful attorney-in-fact, with full power and authority to sign, seal, and execute on its behalf any and all bonds and undertakings, and other obligatory instruments of similar nature, in penalties not exceeding the sum of
UNLIMITED
and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company; and all acts of said Attorney pursuant to the authority given are hereby ratified and confirmed.
This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company:
"RESOLVED, that the president, or any vice president be, and each hereby is, authorized and empowered to appoint attorneys-in-fact of the Company, and to authorize them to execute and deliver on behalf of the Company any and all bonds, forms, applications, memorandums, undertakings, recognizances, transfers, contracts of indemnity, policies, contracts guaranteeing the fidelity of persons holding positions of public or private trust, and other writings obligatory in nature that the business of the Company may require; and to modify or revoke, with or without cause, any such appointment or authority; provided, however, that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company."
"RESOLVED FURTHER, that such attorneys-in-fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company subject to the terms and limitations of the power of attorney issued to them, and to affix the seal of the Company thereto; provided, however, that said seal shall not be necessary for the validity of any such documents." This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company.
Execution of Instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved documents, instruments, contracts, or other papers in connection with the operation of the business of the company in addition to the chairman of the board, the chief executive officer, president, treasurer or secretary; provided, however, the signature of any of them may be printed, engraved, or stamped on any approved document, contract, instrument, or other papers of the Company.
IN WITNESS WHEREOF, the Company has caused this instrument to be sealed and duly attested by the signature of its officer the 20th day of August, 2021.
Antonio C. Albanese, Vice President of Nationwide Mutual Insurance Company
ACKNOWLEDGMENT
STATE OF NEW YORK COUNTY OF NEW YORK: ss
On this 20th day of August, 2021, before me came the above-named officer for the Company aforesaid, to me personally known to be the officer described in and who executed the preceding SEAL instrument, and he acknowledged the execution of the same, and being by me duly WeT SEDA sworn, deposes and says, that he is the officer of the Company aforesaid, that the seal affixed COLLA hereto is the corporate seal of said Company, and the said corporate seal and his signature were duly affixed and subscribed to said instrument by the authority and direction of said Company.
Stephanie Rubino McArthur
Notary Public, State of New York
No. 02MC6270117
Qualified in New York County Notary Public
Commission Expires October 19, 2024 My Commission Expires October 19, 2024
CERTIFICATE
1, Laura B. Guy, Assistant Secretary of the Company, do hereby certify that the foregoing is a full, true and correct copy of the original power of attorney issued by the Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked or amended in any manner; that said Antonio C. Albanese was on the date. of the execution of the foregoing power of attorney the duly elected officer of the Company, and the corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors; and the foregoing power of attomey is still in full force and effect. overn WHERE2023 ve hereunto subscribed my name as Assistant Secretary, and affixed the corporate seal of said Company this Ith day of 2023 Kaura B. Guy
Assistant Secretary
BDJ 1(08-21)00
NL-33
N° 3201
STATE OF CALIFORNIA
DEPARTMENT OF INSURANCE
SAN FRANCISCO
AMENDED
Certificate of Authority
THIS Is TO CERTIPY, That, pursuant to the Insurance Code of the State of Callfornia,
NATIONWIDE MUTUAL INSURANCE COMPANY
of COLUMBUS, OHIO , organized under the
laws of OHIO , subject to its Articles of Incorporation or other fundamental organizational documents, is hereby authorized to transact within this State, subject to all provisions of this Certificate, the following classes of insurance: FIRE, MARINE,
SURETY, DISABILITY, PLATE GLASS, LIABILITY, WORKMEN'S COMPENSATION,
COMMON CARRIER LIABILITY, BOILER AND MACHINERY, BURCLARY, SPRINKLER, TEAM AND VEHICLE, AUTOMOBILE, AIRCRAFT and MISCELLANEOUS Insurance, as such classes are now or may hereafter be defined in the Insurance Laws of the State of California.
THIS CErTIFICATE is expressly conditioned upon the holder hereof now and hereafter being in full compliance with all, and not in violation of any, of the applicable laws and lawful requirements made under authority of the laws of the State of California as long as such laws or requirements are in effect and applicable, and as such laws and requirements now are, or may hereafter be changed or amended.
IN WITNESS WHEREOr, effective as of the. 18TH ...day
of... APRIL _ 1972, I have hereunto set
my hand and caused my official seal to be affixed ths... 18TH day of - APRIL -19.72.
RICHARDS D. BARGE:
ce Commissiona
eli, Fater
By JOHN J. FABER Deputy
therefor and the conditions contained herein.
FORM CB.3 41021.505 X-70 900 DUr ® oar
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE 1189
AYAWANNANNYNNNNM
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 Bernardino
On_ NOV 0 7.2023 before me, Vanessa Copeland , Notary Public, personally appeared Adriana Valenzuela
Name(s) of Signer(s)
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), and that by his/her/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
VANESSA COPELAND paragraph is true and correct.
Notary Public - California
Orange County
Commission # 2424393 WITNESS my l hand and official seal.
My Cornm. Expires Oct 31, 2026
Signature:
Place Notary Seal Above
- OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document and could present fraudulent and reattachment of this form to another document.
Description of Attached Document
Type or Title of Document:
Document Date: Number of Pages:
Signers) Other Than Named Above:
Capacity(ies) Claimed by Signer(s) Capacity(ies) Claimed by Signer(s) Signer's Name: Adriana Valenzuela Signer's Name:
• Individual • Individual
Corporate Officer - Title(s): Corporate Officer - Title(s):
Partner: •Limited • General Partner: •Limited • General Attorney in Fact Attorney in Fact
Trustee Trustee
Guardian or Conservator Guardian or Conservator
Other: • Other:
Signer Is Representing: Signer Is Representing:
MANNYMANA
Rev. 1-15
CONTRACTOR'S AFFIDAVIT OF PAYMENT
- To All Whom It May Concern:
WHEREAS, the undersigned has been contracted by the City of Menifee to furnish labor and materials for Menifee Road and Garbani Road Traffic Signal Improvement Project, CIP No. 21-11, under a contract dated the |S_ day of December _ 2021, in the City of Menifee, County of San Diego, State of California, of which City of Menifee is the Owner.
NOW, THEREFORE, this day of Novembor 2023 the
undersigned, as the Contractor for the above-named Contract pursuant to the Conditions of the Contract hereby certifies that, except as listed below, he has paid in full or has otherwise satisfied all obligations for all materials and equipment furnished, for all work, labor, and services performed, and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract referenced above for which the Owner or his property might in anyway be held responsible.
EXCEPTIONS: (If none, write "None" '. If required by the Owner, the Contractor shall furnish bond satisfactory to the Owner for each exception.)
-
1 6 27
Jate Signature of Prime Contractor Date
Eric Alvarez - President / Secretary/ Treasurer
Print name and title Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-5
GUARANTEE AGREEMENT
We hereby guarantee that Menifee Road and Garbani Road Traffic Signal Improvement Project, CIP No. 21-11, has been installed in accordance with the drawings and specifications and that the work as installed will fulfill the requirements included in the specifications. The undersigned agrees to promptly repair or replace, in a manner satisfactory to the Engineer, any or all of such work, together with any other adjacent work which may be displaced in connection with such repair or replacement, that may prove to be defective in workmanship or material within a period of one (1) year from the date of acceptance of the above referenced project by City of Menifee, ordinary wear and tear and unusual abuse or neglect excepted.
The Contractor also agrees to indemnify and hold City of Menifee harmless from claims of any kind arising from damage due to said defects in the work constructed under the Contract.
In the event that the undersigned fails to comply with the abovementioned conditions within a reasonable period of time, as determined by City of Menifee, the undersigned hereby authorizes the City of Menifee to proceed with the repair of said defects and the Contractor and his/her surety shall be liable to the City of Menifee for the cost thereof.
Roadway Engineering & Contracting Inc. 3121 Indian Ave., Perris, CA 92571 Firm name Address
Signature of Prime Contractor or Sub-Contractor Signature of Prime Contractor or Sub-Contractor Eric Alvarez - President
Print name and title Print name and title
Countersigned (required by Prime Contractor if this Guarantee Agreement is for a Sub-Contractor):
Firm name Address
Signature of Prime Contractor Signature of Prime Contractor Print name and title Print name and title
Contact for Service:
Eric Alvarez
Name
3121 Indian Ave., Perris, CA 92571
Address
951-940-0045 [email protected]
Telephone number and email address
4-6