City of Merced
Statement of Services
Robby Jeppesen
Name of City Conta ct
Descr iption of Services to be Provided:
Dept. Head Sig.:-+-.wa=-c=----i--==--
Due Date: ________ _
Return to: ---------
(20) 385-6800
Phone Ext.
Official Use Only
( CHANGE ORDER ) Contractor to pressure wash and air lift well casing at well stte #18. Replace 30 ten foot sectio ns of 12" coated colum n pipe and install a new 14" five stage bowl assembly . flush and run to waste once completed .
Check Box If Applicab le To Project:
I ✓ I License ( 1 )* Type 0 -21 1 c-61
! ✓ I insurance ( 13)*
[Z] Business License (2)* I ✓ I
[Z] Workers' Compensation (14)* l ✓ I
* Numbers corres
Consultant: Proposal /Quote
I . (See Attach ed Quote)
2. Phase I Quote # 230793 15,200.00
3. Phase II Quote # 231072 196,348.84
Total Amount$ 211,548.84
- --- ----------
Bonds (6)*
Prevailing Wages (15)*
By completing and executing this document, Consultant agrees to be bound to the Term s and Conditions attached hereto and incorporated by reference, any additional term s and conditions found on the Purchase Order, and any other terms and conditions imposed by the City and attached hereto or in the Merced Municipal Code, and makes the City an offer for the above-mentioned services at the above-mentioned price. This agreement is not binding on the City until executed by the City Manager, or his/her designee, and a Purchase Order is issued to Consultant. Any terms and conditions proposed by Consultant shall not be binding upon the City unless expressl y agreed to in writing by the designated representative of the City.
The individuals executing this contract repr esent and warrant that they have the legal capacity and authority to do so on behalf of their respectiv e legal entiti es.
Consultants
!~l-li%-•r+r~
Name of Business E ntity
ense N
Registra .. ---lu.L~ ~'---i l..L....L...j'---1----
Official Use Only
C:\Users\lawrie t\Desktop\Statement of Serv ices Fo
SHANNON PUMP COMPANY
275 S. Highway 59
P.O. Box 686
Merced, CA 95340
Phn: (209) 723-3904
Fax: (209) 723-5865
CONT. LIC. #279578
CUSTOMER
CIT206
1 30
CITY OF MERCED
678 W. 18TH ST.
MERCED, CA 95340
DATE
09/12/2023
1.000 L22-100
"Under the Mechanics Lien Law {California Code of
Civil Procedure. Section 1181 et seq.) any contractor,
subcontractor , laborer, supplier or other person who
helps to improve your property but is not paid for his
work or supplies, has a right to enforce a claim against your property. This means that after a court hearing,
your property could be sold by a court officer and the
proceeds of the sale used to satisfy the indebtedness.
This can happen even if your have paid our own
contractor in full, if the sub-contractor, laborer, or
supplier remains unpaid."
TERMS
NET 10th
DESCRIPTION
CITY WELL SITE NO: 18
REPAIRS
AIR LIFT WELL , PRESSURE WASH
AND FISH OUT SOUNDER CABLE
•••••••• PUMP REAIRS•••••••
12" X 1-11/16" X 9' 11-1/4
COLUMN ASSY
PER CITY SPEC
14" 5 STAGE BOWL ASSY.
HEAD SHAFT NUT, KEY
AND REPAIR PACKING GLAND
SHOP LABOR
READY PUMP FOR INSTALL
INSTALL TURBINE
BOND
Quote subtotal
Quote
Quote No.: 231072
All Accounts are due and payable on the
10th of following month after purchase. A
FINANCE CHARGE of 1.6% based on an
ANNUAL RATE of 19.2% will be added to all
DELINQUENT ACCOUNT S. Closing date
25th of each month.
CONTACT
pam 385-683 3
Sales tax @ 8.25000%
185614.40
10734.44
Quote total 196348.84
Authorized Signature
Date l~r/i3
Thank You
NationwidEi) Mutual Insurance Company
1100 Locust St., Dept 2006
Des Moines, IA 50391-2006
(Premium included in Faithful Performance Bond)
KNOW ALL MEN BY THESE PRESENTS:
State of California
Payment Bond - Public Works
(Section 3247-3252 inclusive California Civil Code)
Bond No. Bd 7901157329
That, Whereas, City of Merced has awarded to Shannon Pump Company Inc. as Contractor, a contract for the work described as follows:
Pressure wash and air lift well casing at well site #18. Replace 30 ten foot sections of 12" coated column pipe and install new 14" five stage bowl assembly. Flush and run to waste once completed; and AND WHEREAS, Said Contractor is required to furnish a bond in connection with said contract, to secure the payment of claims of laborers, mechanics, material men, and other persons as provided by law; NOW, THEREFORE, We the undersigned Contractor and Surety are held and firmly bound unto the City of Merced in the amount required by law, the sum of Two Hundred Eleven Thousand Five Hundred Forty Eight and 84/100 Dollars Dollars ($211.548.84) for which payment well and truly to be made we bind ourselves, our heirs, executors and administrators , successors and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THE OBLIGATION IS SUCH,
That if said Contractor, his or its heirs, executors, administrators , successors or assigns , or subcontractors, shall fail to pay any of the persons named in Civil Code Section 3181, or amounts due under the Unemployment's Insurance Act with respect to work or labor performed by any such claimant, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the contractor and his subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to such work and labor , that the Surety or Sureti es herein will pay for the same in the amount not exceeding the sum specified in this bond, otherwise the above obliga tion shall be void. In case suit is brought upon this bond, the said Surety will pay a reasonable attorney 's fee to be fixed by the court .
This bond shall inure to the benefit of any of the persons named in Civil Code Section 3181 as to give a right to action to such persons or their assigns in any suit brought upon this bond.
In Witness Whereof, We have hereunto set our hands and seals this 22nd day of September, 2023.
Shan
(Principal)
Nationwide Mutual Insurance Compan y
(Surety)
By: , 21/JJ/J-I' R ;(e,tuY'
Teresa R. Liles, Attorney -in-Fact
..
Power of Attorney 0000057716
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:
GEORG IA L DOZIER ; MICHAEL J CARPENTER; RUTH B HALSTEAD ; SHERRYL YORKS ; TERESA R LILES; 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 SEVEN HUNDRED FIFTY THOUSAND AND NO/100 DOLLARS ($750,000.00) 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 pursuan t 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 :
"RESOLV ED, 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, recognizanc es, 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 documen ts 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 docume nts." 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
ACKNOWL EDGM ENT
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 aforesa id, to me personally known to be the officer described in and who executed the preceding instrument, and he acknowledge d the execution of the same, and being by me duly sworn, deposes and says, that he is the officer of the Compa ny aforesaid , that the seal affixed 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 Yori<
No. 02MC6270117
Oua~lied in New YO<I< County
Commission Exoires October 19 2024
CERTIFICATE
~ ~"111 ~
Nolar;P.-
My Commis-Expires
~19,202 4
I, Laura B. Guy, Assistant Secretary of the Company, do hereby certify that the foregoi ng 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 foregoi ng 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 attorney is still in full force and effect.
IN WITNESS WHEREOF, I have hereunto subscribed my name as Assistant Secretary , and affixed the corporate seal of said Company this 11._ day of Septe mbe r . 2023. c?(~ 8- 6-v'd-
Assistant Secretary
BDJ 1 (08-21 )00
This document Is l.'Oi<l ~ VOIO appears In the BLUE line on the nght, the Nationwide watermark Is missing from the center of the page and/or the red consecutl\/8 number Is mIssmg from the upper nght-hand corner. Contact us at 212-329-6900 1I this document Is vo,d or 11 vou have anv ouestInns
ACKNOWLEDGMENT
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
va'lldity of that document.
State of California
County of Merc e d
On September 22. 2023 before me, Yolanda R. Ochoa , Notary Public (insert name and title of the officer)
personally appeared Te r e s a R . Liles
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(les), 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 PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
(Seal)