Slurry Seal Project (PMP No. 23-01)
APPENDIX 4
CLOSE-OUT DOCUMENTS
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Slurry Seal Project (PMP No. 23-01)
CONTRACTOR'S CERTIFICATION OF COMPLETION
DATE: December 21st, 2023
TO: City of Menifee
29844 Haun Rd
Menifee, California 92586
FROM: Pavement Coatings Co.
(Firm or Corporation)
PROJECT: Slurry Seal Project - PMP No. 23-01
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 Prime Contractor Signature of Prime Contractor James Wu. Vice President Tom Mucenski, Secretary
Print name and title Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-2
Slurry Seal Project (PMP No. 23-01)
LAND SURVEYORS' CERTIFICATION OF COMPLETION
TO: City of Menifee
29844 Haun Rd
Menifee, California 92586
FROM: Pavement Coatings Co.
(Firm or Corporation)
PROJECT: Slurry Seal Project PMP No. 23-01
Work of contract: Perform field survey and locate all Survey Monuments including centerline and property corners or references to them including centerline ties within area of disturbance from construction activities for his project. Prepare and File a corner record referencing survey monument and/or ties subject to disturbance in the office of the Riverside County Surveyor prior to NTP.
Reset monuments and/or references to them and file post construction corner records.
The corner records shall be delivered to the Engineer prior to the commencement of work and at prior to completion of work.
This is to certify that I, the land surveyor of record 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. (initials)I know, of my own personal knowledge, and do hereby certify, that the work of the contract described above has been performed and survey monuments within area of disturbance have been located and Corner records filed prior to construction and reset with Corner records filed post construction in every particular, in accordance with, and in conformity to business and profession code 87771
(initials)I know, of my own personal knowledge, and do hereby certify, that the work of the contrart described above has been pertormed and NO survey monuments and/or reterences were found within area of disturbance in every particular, in accordance with, and in conformity to business and
2. The contract work is now complete in all parts and requirements.
PLS SEAL & SIGNATURE
PLS#_ Date Signature of Prime Contractor
James Wa, Vice President
Print name and title Print name and title
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Slurry Seal Project (PMP No. 23-01)
CONTRACTOR'S AFFIDAVIT OF DISPOSAL
WHEREAS, on the _21st day of June _ 20_23 _ the undersigned entered into and executed a contract with City of Menifee for Slurry Seal Project as particularly described in said contract and identified as PMP No. 23-01, 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):
STRIPE REMOVAL GRINDINGS
Type of material disposed of Type of material disposed of
ZATARAIN DUMPINGS
Name of disposal site Name of disposal site
1B12 COPPER RD., CORONA, CA 92881
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 21st day of December, 2023, 1 (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. 12/21/2023 16-66 12-21-23
Signature of Prime Contractor Date Signature of Prime Contractor Date James Wu, Vice President Tom Mucenski, Secretary
Print hame and title Print name and title
uf the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-4
Bond # 024268941
Slurry Seal Project (PMP No. 23-01)
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: The Ohio Casualty Insurance Company Four Hundred Nine Thousand Seven Hundred
on the Payment Bond in the amount of Three Dollars and Fifteen Cents _Dollars, of the following named Contractor: Pavement Coatings Co. 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 _11th day of December 20 23
Signature of Authorized Surety Representative
Evett Lam, Attorney-in-Fact ::
Title 1!:
==
(CORPORATE SEAL)
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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 _Orange )
On _December 11, 2023 before me, Brigid Lopez, Notary Public Date Here Insert Name and Title of the Officer
personally appeared_Evett Lam
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/axe subscribed to the within instrument and acknowledged to me that he/she/they executed the same ir ks/her/their authorized capacity(ies), and that by his/her/teir 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.
BRIGID LOPEZ WITNESS my hand and official seal.
Notary Public - California
Orange County
Commission # 2444630
My Comm. Expires May 2, 2027 Signature Binged legro
Place Notary Seal Above
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
Title or Type of Document: _ Document Date:
Number of Pages: Signers) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
• Corporate Officer - Title(s): • Corporate Officer - Title(s):
• Partner - • Limited • General • Partner - • Limited • General Ü Individual • Attorney in Fact • Individual • Attorney in Fact • Trustee • Guardian or Conservator • Trustee • Guardian or Conservator L Other: • Other:
Signer Is Representing: Signer Is Representing:
©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated.
Liberty Liberty Mutual Insurance Company
Mutuál. The Ohio Casualty Insurance Company Certificate No: 8208193-971991 West American Insurance Company
SURETY
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Brian A.
McGoldrick, Brigid Lopez, Evett Lam, Marisella Rivera
all of the city of Placentia state of CA each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own prope persons.
IN WITNESS WHEREOF, this Power of Attomey has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 21st day of June 2022
Liberty Mutual Insurance Company
INSUR INSURAN The Ohio Casualty Insurance Company
CORPORATE ANCE CASUAL West American Insurance Company
1912 8 1919 1991
OHI Hail Cary
guarantees -SEM By: inquiries,
David M. Carey, Assistant Secretary
State of PENNSYLVANIA
credit, County of MONTGOMERY
On this 21st day of June 2022 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance of Company, The Ohio Casually Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes letter therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. loan, RESA PASTELLA
interest rate or residual value Commonwealth of Pennsylvania - Notary Seal Teresa Pastella, Notary Public
Montgomery County Pastella
note, My commission expiros March 28, 2025 Mess
By:
Commission number 1126044
Member, Pennsylvania Association of Notaries Teresa Pastella, Notary Public PUBLIC
mortgage, This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual ower 0-832-8240 Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV - OFFICERS: Section 12. Power of Attorney. lor Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the currency rate, President may prescribe, shall appoint such attoreys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety Not valid for
have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings bonds, recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary.
Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys-in- fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations.
Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attomey issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed.
1, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and *has cal been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 11th day of December 2023
HUTUAL -CORPORA, GASUALTY CORPORATE INSURANCE ERICAN CORPORATE 1912 1919 1991 Ranitely
By:
ANTAMOD NOIANA ANYO Renee C. Llewellyn, Assistant Secretary LMŞ-12873 LMIC CCIC WAIC Multi Co 02/21
Slurry Seal Project (PMP No. 23-01)
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 Slurry Seal Project, under a contract dated the 21st_day of June , 2023, in the City of Menifee, County of Riverside, State of California, of which City of Menifee is the Owner.
NOW, THEREFORE, this 21st day of December _ 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.)
12-23-2023 12-21-23
Signature of Prime Contractor Date Signature of Prime Contractor Date James Wu, Vice President Tom Mucenski, Secretary
Ptint name and title Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-6
Slurry Seal Project (PMP No. 23-01)
GUARANTEE AGREEMENT
We hereby guarantee that Slurry Seal Project, PMP No. 23-01, 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.
Pavement Coatings Co 10240 San Sevaine Way, Jurupa Valley, CA 91752 Firm name Address
Signature of Prime Contractor or Sub-Contractor Signature of Prime Contractor or Sub-Contractor James Wu, Vice President Tom Mucenski, Secretary
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:
Jason Shelton
Name
10240 San Sevaine Way, Jurupa Valley, CA 91752
Address
951-941-9080/[email protected]
Telephone number and email address
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