Bradley Rd/Paloma HS Entrance (CIP No. 23-03)
CONTRACTOR'S CERTIFICATION OF COMPLETION
DATE: 8/29/2024
TO: City of Menifee
29844 Haun Rd
Menifee, California 92586
FROM: Wheeler Paving Inc.
(Firm or Corporation)
PROJECT: Bradley Rd/Paloma HS Entrance - CIP No. 23-03
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 Richard Wheeler - President Douglas Rash - Operations Manager Print name and title Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-2
Bradley Rd/Paloma HS Entrance (CIP No. 23-03)
CONTRACTOR'S AFFIDAVIT OF DISPOSAL
WHEREAS, on the 15th _day of May _ 2024 _ the undersigned entered into and executed a contract with City of Menifee for Bradley Rd/Paloma HS Entrance as particularly described in said contract and identified as CIP No. 23-03, 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):
Dirt Asphalt
Type of material disposed of Type of material disposed of Maitri Road Recycling Ewles Materials
Name of disposal site Name of disposal site
24980 Maitri Rd, Corona, CA 26160 Adams Ave, Murrieta, CA Address of disposal site Address of disposal site
Asphalt
Type of material disposed of Type of material disposed of Green Rock Materials
Name of disposal site Name of disposal site
1420 Nandina Ave, Perris, CA
Address of disposal site Address of disposal site
By signing and submitting this form to the City of Menifee on this 5th day of September, 2024 (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.
10.15.24 10.15:24
Signature of Prime Contractor Date Signature of Rime Contractor Date Richard Wheeler - President Douglas Rash - Operations Manager Print name and title Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-4
Bradley Rd/Paloma HS Entrance (CIP No. 23-03)
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 Bradley Rd/Paloma HS Entrance, CIP No. 23-03, under a contract dated the day of , 20 in the City of Menifee, County of Riverside, State of California, of which City of Menifee is the Owner.
NOW, THEREFORE, this day of → 20_ 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.)
10.15-24 10-15.24
Signature of Prime Contractor Date Signature of Prime Contractor Date Richard Wheeler, President Douglas Rash, Operations.
Print name and title Print name and title
(If the Prime Contractor is a corporation two signatures of corporate officers are required.) 4-6
Bradley Rd/Paloma HS Entrance (CIP No. 23-03)
GUARANTEE AGREEMENT
We hereby guarantee that Bradley Rd/Paloma HS Entrance, CIP No. 23-03, 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.
Wheeler Paving Inc. 2734 Avalon St, Riverside, CA 92509 Firm name Address
Signature of Prime Contractor or Sub-Contractor Signature of Prime Contractor or Sub-Contractor Richard Wheeler - President Douglas Rash - Operations Manager 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:
Douglas Rash
Name
2734 Avalon St, Riverside, CA 92509
Address
(951) 685-7283, [email protected]
Telephone number and email address
4-7
Bradley Rd/Paloma HS Entrance (CIP No. 23-03)
GUARANTEE AGREEMENT
We hereby guarantee that Bradley Rd/Paloma HS Entrance, CIP No. 23-03, 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.
Interstate striping, Inc 9784 Poplar Aue, Fontana, CA 92335 Firm name Address
Signature of Prime Contractor or Sub-Contractor Signature of Prime Contractor or Sub-Contractor Stephanie Acosta president Andrew Acosta Officer
Print name and title Print name and title
Countersigned (required by Prime Contractor if this Guarantee Agreement is for a Sub-Contractor):
Wheeler Paving, Inc 1134 Avalon St. Riverside
Firm name Address
Signature of Prime Contractor Signature of Prime Contractor Richard wheeler, President Douglas kash, operations
Print name and title Print name and title
Contact for Service: manager
Name
Address
Telephone number and email address
4-7
ORIGINAL
ISSUED IN THREE ORIGINAL COUNTERPARTS BOND NO. PPD0102213
COUNTERPART NO OF
Bradley Rd/Paloma HS Entrance (CIP No. 23-03)
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: Developers Surety and Indemnity Company on the Payment Bond in the amount of (S2-,y000d Fory-Nine Thousand Seven Hundred and 00/100'3 _Dollars, of the following named Contractor: Wheeler Paving, 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 30th day of August _2024
Dovelopers Seto Developers Surety and Indemnity Company Signature of Ausprized Surety Representative
Julia B. Bales, Attorney-in-Fact
Title
(CORPORATE SEAL)
4-5
No. 4606-0
STATE OF CALIFORNIA
DEPARTMENT OF INSURANCE
SAN FRANCISCO
Amended
Certificate of Authority
THIS IS TO CERTIFY that, pursuant to the Insurance Code of the State of California, Developers Surety and Indemnity Company
of California, organized under the laws of California, 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, Workers' Compensation, Common Carrier Liability, Boiler and Machinery, Burglary, Credit, Sprinkler, Team and Vehicle, Automobile, Aircraft, Legal, and Miscellaneous 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 WHEREOF, effective as of the I" day of November, 2017, I have set my hand and caused my official seal to be affixed this 1" day of November, 2017.
ave Jone
surance Commission
ValiAnt
By Valerie Sarfaty
for Joel Laucher
Chief Deputy
NOTICE:
Qualification with the Secretary of State must be accomplished as required by the California Corporations Code promptly after ssuance of this Certificate of Authority. Failure to do so will be a violation of Insurance Code section 701 and will be grounds fo evoking this Certificate of Authority pursuant to the covenants made in the application therefor and the conditions containe herein.
POWER OF ATTORNEY FOR
COREPOINTE INSURANCE COMPANY
DEVELOPERS SURETY AND INDEMNITY COMPANY
59 Maiden Lane, 43rd Floor, New York, NY 10038
(212) 220-7120
KNOW ALL BY THESE PRESENTS that, except as expressly limited herein, COREPOINTE INSURANCE COMPANY and DEVELOPERS SURETY AND INDEMNITY COMPANY, do hereby make, constitute and appoint:
Julia B. Bales and Kenneth A. Coate ., of Riverside, CA as its true and lawful Attomey-in-Fact, to make, execute, deliver and acknowledge, for and on behalf of said companies, as sureties, bonds, undertakings and contracts of suretyship giving and granting unto said Attomey-in-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said company could do, but reserving to each of said company full power of substitution and revocation, and all of the acts of said Attorney-in-Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is effective August 30, 2024 and shall expire on December 31, 2025.
This Power of Attorney is granted and is signed under and by authority of the following resolutions adopted by the Board of Directors of COREPOINTE INSURANCE COMPANY and DEVELOPERS SURETY AND INDEMNITY COMPANY (collectively, "Company") on February 10, 2023.
RESOLVED, that Sam Zaza, President, Surety Underwriting, James Bell, Vice President, Surety Underwriting, and Craig Dawson, Executive Underwriter.
Surety, each an employee of Am Trust North America, Inc., an affiliate of the Company (the "Authorized Signors"), are hereby authorized to execute a Power of Attorney, qualifying attorney(s)-in-fact named in the Power of Attorney to execute, on behalf of the Company, bonds, undertakings and contracts of suretyship, or other suretyship obligations; and that the Secretary or any Assistant Secretary of the Company be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney.
RESOLVED, that the signature of any one of the Authorized Signors and the Secretary or any Assistant Secretary of the Company, and the seal of the Company must be affixed to any such Power of Attorney, and any such signature or seal may be affixed by facsimile, and such Power of Attorney shall be valid and binding upon the Company when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached.
IN WITNESS WHEREOF, COREPOINTE INSURANCE COMPANY and DEVELOPERS SURETY AND INDEMNITY COMPANY have caused these presents to be signed by the Authorized Signor and attested by their Secretary or Assistant Secretary this March 27, 2023 NSUR
By: _ Santo SETY AND
RPORA CORPORA
Printed Nai
Title: President, Surety Underwriting ¡SEAL 3 1936
ELAWARE CALIFORN
ACKNOWLEDGEMENT:
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 this 27_ day of March, 2023. before me, Hoang-Quen Phu Pham _ personally appeared Sam Zaza ho proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to within the instrument and acknowledged to me that they execut le same in their authorized capacity, and that by the signature on the instrument the entities upon behalf which the person acted, executed this instrume 1 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.
HOANG-QUYEN P. PHAM
Notary Public - California
Orange County
Commission # 2432970
My Comm. Expires Dec 31, 2026
CORPORATE CERTIFICATION
The undersigned, the Secretary or Assistant Secretary of COREPOINTE INSURANCE COMPANY and DEVELOPERS SURETY AND INDEMNITY COMPANY, does hereby certify that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in this Power of Attorney are in force as of the date of this Certification.
This Certification is executed in the City of Cleveland, Ohio, this March 19, 2023. - DocuSigned by:
By: Barry W. Moses Barry W. Moses, Assistant Secretary POA No. N/A •6B6415E7ADE548C...
• DocuSignEnvelopeID:3352BFD6-5E9D-4796-837E-C1E455E6530F Ed. 0323 CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189
8489898888888489808:8:888:8888880888389848:80888888888088808989888888888818888898888:81888088888888888818888988888898881888080888888888884898088898881818 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_Riverside
AUG 3 0 2024 Mariah Giselle Barela, Notary Public
On before me,
Date Here Insert Name and Title of the Officer
personally appeared Julia B. Bales
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the personts) whose namefs) is/are-subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/the+f authorized capacitylies), and that by his/her/theit 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
MARIAH GISELLE BARELA E paragraph is true and correct.
COMM. #2417169
NOTARY PUBLIC - CALIFORNIA
RIVERSIDE COUNTY WITNESS my hand and official seal.
My Comm. Expires Sept. 20, 2026
Signature
Place Notary Seal and/or Stamp Above Signature of Notary Public
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:.
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 - • 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:
8888888888888888888888888880848488888:8380808 8080333 838080808083808083838083308033308380838083898889 0808088888081 ©2019 National Notary Association