QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT
CIP 23-08
APPENDIX 4
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QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT
CIP 23-08
CONTRACTOR'S CERTIFICATION OF COMPLETION
DATE: 5/30/2024
TO: City of Menifee
29844 Haun Rd
Menifee, California 92586
FROM: MC ELECTRIC
(Firm or Corporation)
PROJECT: QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT - CIP 23-08 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. gnature of Prime Contrac Signature of Prime Contractor
Andrew Chavez, COO & Secretary Mario Chavez, Vice President Print name and title
Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-2
QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT
CIP 23-08
CONTRACTOR'S AFFIDAVIT OF DISPOSAL
WHEREAS, on the 30th day of May → 20 24 _ the undersigned entered into and executed a contract with City of Menifee for QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT as particularly described in said contract and identified as CIP 23-08, 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 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 locations):
Miscellaneous frash debais.,
Type of material disposed of Type of material disposed of Cita of Ontari (Yard Bin
Name of disposal site
Name of disposal site
1222 E Holt, Suite B, Ontaio, (A
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
hereby certified and swear under penalty of perjury under the laws of the state of California that the By signing and submitting this form to the City of Menifee on this 30 day of Man aforementioned information is true and correct without omission, error or misrepresentation.
Clim 5/30/24 5/38/24
Signature of Prime Contractor
Mario Chavez, Vice President
Andrew Chavez, COO & Secretary
Print name and title
Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-3
QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT
CIP 23-08
Bond #10081147
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: American Contractors Indemnity Company Eighty-Nine Thousand
on the Payment Bond in the amount of _ Five Hundred and 00/100 _Dollars, MC Electric da:
of the following named Contractor:_ MC Contracting
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 31st. day of May , 2024
Sie hatre of Afthorized Surey Representative
Title Attorney-in-Fact
(CORPORATE SEAL
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TOKIO MARINE
HC C
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint,
GABRIEL HILL
its true and lawful Attorney-in-Fact, with full authority to execute on its behalf bond number 100846404 issued in the course of its business and to bind the Company thereby, - in to exceed an amount not
Three million and 00/100 $3,000,000.00
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 1s' day of September, 2011.
*Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions:
Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings. including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney-in-Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney-in-Fact is or is not an appointed agent of the Company.
Present on thie ay. April, an Contraciors Indermily, Company has caused is seal lo be afixed hereto and executed by is. President on this 18th day of April, 2022.
AMERICAN CONTRACTORS INDEMNITY COMPANY
NOORPORATED
SEPT. 25. 1990 By: милід
Adam S. Pessin, President
CALIFCANIA
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 Caiifornia
County of Los Angeles
On this 1gih day of April, 2022, before me, Sonia O. Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person 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, SONIA O. CARREJO
Notary Public • California
ChanCesto Los Angeles County
Signature (seal) Commission # 2398710
My Comm. Expires Apr 23. 2026
1, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect.
N WITNESS WHEREOF, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this 31st._day of_ May 2024
CONTACTOR NOT
Bond No. 100846404
soro
Agency No. 18488 Kio Lo, Assistaht Secretary
Visit tmhcc.com/surety for more information CALIFORNA
HCCSOZZPOAACIC07:2023
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 locument to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document State of California
County of Orange
On May 31, 2024 before me, - Robert Laurence Johnson, Notarn Public Date tere Insert Name and Title of the Office
personally appeared Gabriel Hill
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) sare subscribed to the within instrument and acknowledged to me thatcne/she/they executed the same in dis her/their authorized capacity(ies), and that bymis/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 paragraph is true and correct.
ROBERT LAURENCE JOHNSON WITNESS my hand and official seal.
Notary Public - California
Orange County
Commission # 2457311
My Comm. Expires Aug 3, 2027 Signature Teto laurena
Signature of Notary Publ
Place Notary Seal Above
— OPTIONAL -
Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an nintended document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) 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 - O Limited • General • Partner - • Limited • General • Individual • Attorney in Fact • Individual
• Attorney in Fact
• Trustee • Guardian or Conservator • Trustee • Guardian or Conservator ] Other: • Other:
Signer Is Representing: Signer Is Representing:
©2015 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907
QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT
CIP 23-08
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 QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT - CIP 23-08, under a contract dated the 30th day of May _ 20_24, in the City of Menifee, County of Riverside, State of California, of which City of Menifee is the Owner. 30th day of May _ 2024 the
NOW, THEREFORE, this
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.)
ChOa 5/30/24 5/30/24
Signature of Prime Contractor Date
Signature of Prime Contractor Date
Mario Chavez, Vice President
Andrew Chavez, COO & Secretary
Print name and title Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-5
QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT
CIP 23-08
GUARANTEE AGREEMENT
We hereby guarantee that QUAIL VALLEY GRID AREA STREET LIGHTING PROJECT - CIP 23-08, 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.
13619 12th St., Suite B, Chino, CA 91710
MC Electric
Address
Firm name
eat to or sit contaco Signature of Prime Contractor or Sub-Contractor Signature ot
Andrew Chavez, COO & Secretary Mario Chavez, Vice President Print name and title
Print name and title
Countersigned (required by Prime Contractor if this Guarantee Agreement is for a Sub-Contractor):
Address
Firm name
Signature of Prime Contractor
Signature of Prime Contractor
Print name and title Print name and title
Contact for Service:
Andrew Chavez
Name
13619 12th St., Suite B, Chino, CA 91710
Address
909-464-9400, [email protected]
Telephone number and email address
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