HomeMy WebLinkAboutVIDO SAMARZICH, INC. (5) 3Lb
Recording Requested By, Recorded in Official Records, Orange County
And When Recorded Mail To: Hugh Nguyen, Clerk-Recorder
City of Santa Ana,Public Works Agency M22 II III I II II I III IIIII I �� I I III I III NO F E E
20 Civic Center Plaza,P.O.Box 1988 * R 0 0 1 2 7 1 5 9 1 2 g
Santa Ana,CA 92702 202100024538311:17 am 04112121
340 414A N 12 1
0.00 0.00 0.00 0.00 0.00 0.00 0.000.000.00 0.00
THIS SPACE FOR COUNTY RECORDERS USE ONLY
NOTICE OF COMPLETION
NOTICE IS HEREBY GIVEN that the undersigned City of Santa Ana, California, a
municipal corporation, with the address of City Hall, 20 Civic Center Plaza, Santa Ana,
California, 92701, is the owner of the property hereinafter described, that said owner has caused
construction of LOCAL STREET CURB RAMP IMPROVEMENTS (PHASE IIl under contract
U 00 entered into on MAY 5, 2020, with VIDO SAMARZICH INC., on which contract FIDELITY
x AND DEPOSIT OF MARYLAND is surety. The property on which such work improvement
o was placed is in the City of Santa Ana, County of Orange, State of California, and described as
o Project No. 20-7535 (20-7548) located at: VARIOUS LOCATIONS. The work improvement on
said property was accepted as completed on DECEMBER 11 2020.
ow
CITY OF SANTA ANA, A MUNICIPAL CORPORATION
o
F bycrw
-
zQ Dated: Principal Civil Engineer Jason Gabriel
a TITLE
-------------------------------------------------------------------------------------------
VERIFICATION
I, the undersigned, say: I am the City Engineer— Edwin "William" Galvez of the City of Santa
Ana, California; I executed the foregoing Notice of Completion acting on behalf of the owner of
the property therein described; I make this verification on behalf of said corporation by
authorization of the City Council of the City of Santa Ana; I have read said notice and know the
contents thereof; and�I declare under penalty of perjury that the facts therein stated are true.
Executed on � , at Santa Ana, Cali
(Signature of individual swearing that the
contents of Notice of Completion are true.)
THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION
INSURANCE NOT ON FILE
WORK MAY NOT PROCEED CITY OF SANTA ANA
CLERK OF COUNCIL CONSTRUCTION CONTRACT
t gel D�5E: PROJECT 20-7535
1JJLOCAL STREET CURB RAMP IMPROVEMENTS (PHASE II) PROJECT
This CONSTRUCTION CONTRACT is made and entered into this 5"' day of May, 2020 by and
between the City of Santa Ana, California, a charter city and municipal corporation organized and
existing under the Constitution and laws of the State of California (hereinafter "CITY"), and Vido
Samarzich, Inc. (hereinafter "CONTRACTOR").
WITNESSETH:
The CITY and the CONTRACTOR, for the consideration hereinafter named, mut.tally agree as follows:
I_ CONTRACTOR agrees to perform all the work and furnish all the materials at its own cost and
expense necessary to construct and complete in a good and workmanlike manner and to the
satisfaction of the City Engineer of the CITY, the Local Street Curb Ramp Improvements (Phase II)
Project (hereinafter referred to as the "WORK OF IMPROVEMENT") identified in and in
accordance with the Contract Documents prepared by the City's Public Works Agency and approved
by the City Council.
2. The complete Construction Contract consists of the "Contract Documents" as defined by the
Standard Specifications for Public Works Construction and which include the following:
• Notice Inviting Bids
• Information to Bidders
• Bid Proposal
• Bid Bond
• Contract Form
• Contract Bonds
• General Provisions
• Special Provisions
• Technical Provisions and Project Plans
• Community Workforce Agreement
• Appendices
In case of conflict between the Contract Documents, the precedence of documents shall be as
established in the Standard Specifications for Public Works Construction.
3. CITY agrees to pay and CONTRACTOR agrees to accept in full payment to complete the WORK
OF IMPROVEMENT the sum total amount not to exceed Three Hundred Ninety-eight Thousand
Seven Hundred Dollars and No Cents- ($39.&70ti:00), as set forth and -dentified in the BID
PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A."
The BID PROPOSAL contains a schedule of unit price(s) or lump sum(s) based on approximate
quantities only, and the City does not expressly or by implication agree tha. the actual amount of
work will correspond therewith, but reserves the right to increase or decrease the amount of any
class or portion of the work or to omit portions of the work as may be deemed necessary or
advisable.
rev. 09/01n017 Page] of3
4. CONTRACTOR agrees to complete the WORD OF IMPROVEMENT within the time specified in
the Time for ConrpletIon of improvements section of the BID PROPOSAL (Exhibit "A") including
commencing construction within the timeframe therein specified after issuance of a- Notice to
Proceed.
5. The CONTRACTOR will pay, and will require all subcontractors to pay, all employees on the
WORK OF IMPROVEMENT a salary or wage at least equal to the prevailing salary or wage
established for such work as set forth in the wage detortnipations for this work in accordance with.
applicable State and Federal law,
6. If applicable, the CONTRACTOR shall adhere to the CITY'S "Community Workforce Agreement
(CWA), a pre-hire.collcotivc bargaining agreement, which establishes the labor relations policies and
procedures for CONTRACTOR to follow in the crafts persons employed to complete the WORK OF
IMPROVEMENT as more fully described in the CWA.. The CWA may be found on the City's
webshe at:
http://www.saiita-aii,i.org/pwaldoctiments/CWA.i)df
7. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the CITY,
one in the amount of One Hundred Percent (100%) of the Contract price, to guarantee the faithful
performance of the work (Performance Bond),and one in the amount of O.ne Hundred Percent
(100%) of the Contract price to guarantee payment of all claims for labor and materials furnished
(Payment Bond), This Contract shall not become effective until such bonds are supplied to and
approved by the CITY.
3. CONTRACTOR shall, prior to the release of the performance and payment bonds or the retention
payment, furnish a warranty performance and payment bond (Warranty Bond). Said Warranty Bond
shall also be required as a 'condition of project aoeeptance. For projects tip to Five Hundred
Thousand Dollars ($500,000), the Warranty Bond amount shall be the greater of Ten Thousand
Dollars ($10,000) or Twenty Percent (20%n) of the final contract price. For projects above hive
Hundred Thousand_ Dollars ($500,000); the Warranty Bond amount shall be the greater of One
Hundred Thousand Dollars ($100,000) or Ten Percent (I0°fo0 of the final contract price,
9. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and
Worker's Compensation Insurance as outlined in the General Provisions, to be approved by the
CITY.
it
Page 2 of 3
IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and
year first above written.
ATTEST:
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By: %'. �.� -4 .
J N FUNK
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
NABIL SABA, PE
Acting Executive Director
Public Works Agency
CITY OF SANTA ANA
KRISTINE RIDGE
City Manager
CONTRACTOR:
Vido Samarzich, Inc.
I A
NAME:
TITLE: ViDD L SA^IAZ►CH
VICE PAL- g IoBro'r
Page 3 of 3
CITY OF SANTA ANA ADDENDUMNO.ONE
PROPOSAL
PROJ ECT NU,: 20-'75 35'
LOGAL STREET CURB RAMP IMPROVEMENTS (PHASE 11)
BID PROPOSAL
TO: CITY COUNCIL OF THE CITY OF SANTA ANA
FROM,, Vida Samarzich, Inc;
REQUIREMENT::
The undersigned kidder declares that they have carefully examined the location of the proposed
work, that they have examined the Contract Documents in Its entirety and hereby proposes to
furnish all material and do all the work required to complete the said work In accordance with
said plans (if any) and the specifications for the unit price(s) or lump sum(g) set forth in the
following schedule:
Item
Description
Qty
Unit
Unit flco
Amount
1
ove and Caitstruct PCC Curb
Ra m p
16,800
SF
I 3 o
$
3 t7y 00,00
2
Reinvve and Cansnvct i CC Sidewalk
(t 4') `
t,t00
SF
$ Il. o�
$ 12� I Go Qt7
3
Remove and Construct PCC Curti &
Gutter (A-2-b)
700
LF
$ 90. oo
y y dap. asa
t
4
LaborAgieementOversipla
t
LS
$i0;000
$10,000
TOTAL BASF'E, BiI7
R *3 R �'7 � 40�0• DC%
The lowest responsible bidder shall be selected based on the total base bid. The City reserves the
right to award the Base Bid, and any, all, or none of the add -alternate bid items (if any).
FOR COMPLETION OP IMPROVEMENTS AND LIQUIDATED DAMAGES
The undersigned bidder hereby proposes to complete the Work for the total 'base bid amount
shown above, within ei I (80)-wgrkjng days after the commencement date stated in the Notice
to :Proceed.. .
The liquidated damages amount, in liou of the amount specified in Subsection 6-9 of the
Standard Specifications, shall be $500 per calendar day.
Name ofFirm
Signature of Bi]
Title Vice President
(If an individual, so state. If a firm or co -partnership, state the firm name and give the names of
all individual co-partners composing the firm. If a corporation, state legal name of corporation,
and names of President, Secretary, Treasurer and Manager, thereof.)
Corporation: Vido Samarzich, Inc
President: Vido Samarzich Vice President: Vido L. Samarzich Secretary: Monika Samarzich
P-I ofP-16
CITY OF SANTAANA ADDENDUMNO.ONE
KIDDER'S STATEMENT
BIDDER understands and agrees that this Kid Proposal, Contract Documents and subsequent
Construction Contract Agreement shall constitute the entire agreement between BIDDER and the
AGENCY only after it hasbeen accepted by the City Council, endorsed by the Clerk of the
Council with her signatureandofficial seal noting hereon the action of approval of the Council,,
signed by the Public Works Agency Executive Director or his/her duly authorized agent, and
signed by the City Attorney, denoting his approval of the form of this document, and its
execution, and when It.or an exact copy of it has been eitherdeliveredto BIDDER or deposited
with the United States Postal Service properly addressed to the BIDDER with the correct postage
affixed thereto.
BIDDER further agrees that upon delivery (as defined above) of the accepted agreement lie/she
will furnish AGENCY all required bonds and certificate of liability insurance within ten (10)
business days or the funds; check, draft, or BIDDERS bond substituted in lieu thereof
accompanying this proposal shall become the property of the AGENCY and shall be considered
as payment of damages due to the delay and other causes suffered by AGENCY because of the
failure to furnish the necessary bonds and because it is distinctly agreed that the proof of
damages actually suffered is difficult to ascertain; otherwise said funds, check, drafts, or
BIDDER'S bond substituted in lieu thereof shall be returned to the undersigned.
BIDDER understands that a bid is required for the entire work, the estimated quantities set forth
in the bid schedule are solely for the purpose of comparing bids, and that final .compensation
under the contract will be based upon the actual quantities of work satisfactorily completed. The
BIDDER also certifies that the bid is abalanced bl:d.
In accordance with Section 7028.15 of the California Business and Professions Code, the
undersigned certifies under penalty ofpetjury that the foregoing is true and correct.
Name of Firm.
Signature ofBli
Title Vice President
(If an individual, so state. If a firm or co -partnership, state the firm name and givethenames of
all individual co-partners composing the firm. If a corporation, state legal name of corporation,
and names of President, Secretary, Treasurer and Manager, thereof,)
Corporation:: Vido Samarzich, Inc.
President: Vido Samarzich
Vice President: Vido L. Samarzich
Secretary: Monika Samarzich
P-2 of P-16
CITY Oc SANTA ANA ADDENDUMNO.ONE
PROPOSAL,
PROJECT NO,:20-7S3S
LOCAL STREET CUR13 RAMP IMPROVEMENTS (PHASE 11)
CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT"
The undersigned contractor, or corporate officer, declares under penalty of perjury that he/she
and all his/her subcontractors are registered with the State of CaliforniaDeparmment of Industrial.
Relations (DIR), and that the following is true and correct.
Contractor's Name: Vido Samaraich, Inc.
Husiness Address: 6629 Billings Place, Rancho Cucamonga CA 91701
Business E-Mail Address: vidosam@yahoo:eom
Telephone: (909) 967-6377
State Contractor's License No. and Class; 433210 Class A
License Expiration_ Date: 12/31 /2020
State Dept, of Industrial Relations (DI, )
Registration No.: 1000013213
State Dept. of In ustrhd Relations (DIR)
Registration Ex atioIj
Date: 06/30/2020
Signed: ,
Title, Vice President
P-3 of P-16
CITY OI+ SANTA ANA ADDEN UM N e ONE
PROPOSAL
PROJECT NO,: 20-7535
LOCAL STREET CURB RAMP IMPROVEMENTS (PHASE 10
PREVAILING WAGE COMPLIANCE AND MONITORING STATEMENT
Contractor is aware of the requirements of California Labor Code Section 1720, et seq., as well
as California Coale of Regulations, Title 8, Section 16,000, ct seq„ ("Prevailing Wage Laws"),
which require the payment of prevailing wage rates and the performance of other requirements
on "public works" and "maintenance" projects. Since the services are being performed as part of
an applicable "public works" or "maintenance" project, as, defined by the Prevailing Wage Laws,
and since the total compensation is $1,000 or more, Contractor agrees to fully comply with such
Prevailing Wage Laws;
City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at
the commencement of this Agreement, Contractor shall snake copies of the prevailing rates of
per diem wages for each craft, Classification or type of worker needed to execute the services
avallable to interested parties upon request, and shall post copies at the Contractor's principal
place of business and at the project site.
Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees
and agents free and barmless from any claim of liability arising out of any failure or alleged
failure to comply with the Prevailing Wage Laws.
The undersignet( certifies that the foregoing is true and correct.
Name of Firm
Signature of Bill
Title Vice President
(if an individual, so state)
P-4 of P-16
CITY OF SANTA ANA ADDENDUM NO. ONE
PROPOSAL
PROJECT NO.: 20-7535
LOCAL URB RAMP IMPROVEMENTS (PHASE II}
OWNERSHIP AFFIDAVIT
STATE 0I7 CAI.IVORNIA )
COUNTY OF ORANGE, ) SS:
CITY OF SANTA ANA
Vido L. Samar aiGti being duly sworn, deposes and suys4
INDIVIDUAL That he/she Is dra party making the foregoing, proposal:
tI PAW17NERSUIP That he/she is a inentbor of the co -partnership Ann designuedas:-
slid who hasJaeen and is duly vested with die authority to inalco end execute instiilluents
for the co-purfnetship by:
who constitute the other members ofthe co -partnership.
2CORPORATION That he Is of; VJdO S&iT1�rZIOh,.LC ,_,_,_
a corporation whiolt isauaking theforegaing proposal:
El JOINT VENTURE That he is off,.
one of the parties making the 11m%oing -propose[ its a joint venture, and the he/she has
been unit Is duly vested with the authority to execute instruments for an on behalf of the
parties making said hid who arc:
that such a bid Is genuine and not collusive or share, and has not in any manner sought by
collusion to secure any advantage against the City of Santa Ana or any person interested in the
propose nt c for himself or any other person.
Signature o der
Subscribed and sworn to before me this day of 20
s'%7
Signature of officer Administering Oath (Notary Public)
P-5 of P-16
Ni
notary public or other officer completing thls-
Irtificate verifies only the identity of the individual
io signed the document to which this certificate
attached, and not the truthfulness, accuracy, or
State of California
County of LOS ANGELES
Subscribed and sworn to (or affirmed) before me on this ;24TH
day of MARCH _—, 20 20, by VIDO L. SAMARZIGH
proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me.
NNNM AXYWwwgNNptlIINNIIIIII1NIXl1111111111111111111
OBBMORC 0. WARREN
COMM. #2100634
Notary Public- California
Rivenlide County
MYCoIOm.-ExPirus Apr. 9, 2021
XNI{II. NNtlX1111%IXI@IIIINIipllllllllllllllllllrlllllXlllll
(Seal) Slgnature
CITY OF SANTA ANA ADDENDUM ONE
PROPOSAL
PROJECT NO.: 20-7533
RESIDENTIAL STREET REPAIR PROGRAM FY 19/20
HENINGER PARK NEIGHBORHOOD
OWNERSHIP AFFIDAVIT
STATE OF CALIFORNIA
)
COUNTY OF ORANGE
) SS:
CITY OF SANTA ANA
)
Vido L. Samarzich
being duly sworn, deposes and says:
❑ INDIVIDUAL
That he/she is the party making the foregoing proposal:
❑ PARTNERSHIP
That he/she is a member of the co -partnership firm designated as:
and who has been and is duly vested with the authority to make and execute instruments
for the co -partnership by:
who consbtute the other members of the co -partnership.
CORPORATION
That he is of:
Vido Samarzich, Inc.
a corporation which is making the foregoing proposal:
❑ JOINT VENTURE
That he is of..
one of the parties making the foregoing proposal as ajoint venture, and the he/she has been
and is duly vested with the authority to execute instruments for an on behalf of the parties
making said bid who are:
that such a bid is genuine and not collusive or sham, and has not in any manner sought by collusion
to secure any advantage against the City of Santa Ana or any person interested in the proposed
contract/ Qoii
If or any other person.
Signaturr
Subscribed and sworn to before me this day of
Signature of officer Administering Oath (Notary Public)
20
P-6 of P-17
Bond No.: VIDSA-2085
0
M
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.: 20-7533
RESIDENTIAL STREET REPAIR PROGRAM FY 19/20
HENINGER PARK NEIGHBORHOOD
KNOW ALL PRESENT that,
Vido Samarzich. Inc , as BIDDER, and
Fidelity and Dom. o it , of Maryland , as SURETY,
are held and firmly bound unto the CIy TY OF SANTA ANA, as AGENCY, in the penal sum of
Ten Percent of the Total Amount BlcDollars ($ 1O% of the Rid ), which is ten percent (10%)
of the total amount bid by BIDDER to AGENCY for the above -stated project, for the payment of
which sum, BIDDER and SURETY agree to be bound, jointly and severally, firmly by these
presents.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas BIDDER is about to
submit a bid to AGENCY for the above -stated project, if said bid is rejected, or if said bid is
accepted and a contract is awarded and entered into by BIDDER in the manner and time specified,
then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor
of AGENCY.
IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this
24th day of March , 2020.
BIDDER*
6829 Billings Place
Rancho Cucamonaa. CA 91701
SURETY* Los Angeles, CA 90017
Matthew! R. Dohyns / Attorney -in -Fact, 1633 E. 4th St., #228, Santa Ana, CA 92701, tel: 1(714) 541-4700
Subscribed and swom to before me this day of
0
J.S. V,i• t,/.S,
Signature: i
*V'
Notary Public in and for the County of
, State of
* Provide BIDDER/ SURETY name, address, and telephone number and the name, title, address,
and telephone number of authorized representative.
P-7 of P-16
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
IWOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by
Robert D. Murray, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are
set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute,
and appoint Randy SPOHN, Ashley M. SPOHN, Matthew R. DOBYNS and Hamilton KENNEY, all of Santa Ann, California, EACH,
its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any
and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon
said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected
officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings. Mills, Maryland., and the regularly elected
officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper
persons.
The said Vice President does hereby certify that the extract set forth oil the reverse side hereof is a true copy of Article V, Section 8, of
the By -Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of file said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 20th day of September, A.D. 2019,
r.RR
r ut��r g tw�l BNA �
1 )NN
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By: Robert. D. Mtrray
Vice President
r�tx4VrL �
By: Dawn Dawn E. Brown
Secretary
State of Maryland
County of Baltimore
On this 20fh day of September, A.D. 2019, before the subscriber, a Notary Public of the State of Maryland, duty commissioned and qualified,
Hubert D. Murray, Vice President and Dawn E. Brown, Secretary of the Companies, to me personally known to be the individuals and officers
described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that
he/she is the said officer of the Company aforesaid, and that the suits affixed to the preceding instrument are the Corporate Seals of said Companies, and
that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the
said Corporations.
IN TESTIMONY WHEREOF, I have hereunto set my hand end affixed my Official Seal the day and year first above written.
oSb1N'y.,r
�y-
Constance A. Dunn, Notary Public
My Commission Expares: July 9, 2023
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attorneys -in -Pact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attorneys -in -fact with authority to execute bonds, policies,
reeognizanees, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize ally officer or any such
attorney -in -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of
the By -Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile oil any Power of Attorney ... Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the I Oth day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 24th day of March 2020.
3
Brian M. Hodges, Vice President
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT A COMPLETE DESCRIPTION
OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND, THE BOND NUMBER, AND YOUR CONTACT
INFORMATION TO:
Zurich Surety Claims
1299 Zurich Way
Schaumburg, IL 60196-1056
www.repoTtsfc[aims@zurichiia.com
800-626-4577
CALIFORNIA ALL-PURPOSE 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 validity of that document.
State of CALIFORNIA
County of ORANGE
L l
77
On l before me, ERIKA GUIDO, NOTARY PUBLIC,
personally appeared MATTHEW R. DOBYNS
❑ who proved to me on the basis of satisfactory evidence to be the Derson(s)
whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/he
authorized capacity (-ies), and that by his/her/them signatures) on the
instrument the personH, or the entity upon behalf of which the persons)
acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of
ERIKA GLADO ` California that the foregoing paragraph is true and correct.
COMM. # 2190052 e
NOTARY PUBLIC CALIFORNIA WITNESS my .and and official seal.
ORANGE COUNTY " ,'
3 2021
�I My comm. ex ies May 5, �I
if
ll
Signature of N to
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and
could prevent fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
❑ INDIVIDUAL
❑ CORPORATE OFFICER
❑ PARTNER(S) ❑ LIMITED
® ATTORNEY -IN -FACT
❑ TRUSTEE(S)
❑ GUARDIAN/CONSERVATOR
❑ OTHER:
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
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 LOS ANGELES
Subscribed and sworn to (or affirmed) before me on this 2ND
day of APRIL 20 20, by VIDO L. SAMARZICH
proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me.
MMMeMMMMMDESMONDG. WARREN
M
DESMOND G. WARREN
COMM. #2190534
e =m Notary Public- California 'o
Riverside County
'c My Comm. Expires Apr. 9, 2021
inxnnni mm11nnnneM atunnnnnnnonnennnnni'c
(Seal) Signature
CITY OF SANTA ANA. ADDENDUMNO.ONE
PROPOSAL
PROJECT NO.: 20-7535
LOCAL STREET CURB RAMP IMPROVEMENTS (PHASE 11)
LIST OF SUB-CONTRACTOi2S
Section 41.00 et. seq. of the Public Contract Code requires listing of all subcontractors with the bid for all
subcontract work exceeding the following amount:
o Streets, highways including bridge projects: ''i4% ofthe bid or $1Q,000, whichever is greater
0 Buildings, parks, ai. other projects: V2% of the bid
Section 1725.5 of the Public Contract. Code requires all Subcontractors be registered with the State
Department of Industrial Relations (DIR).
BIDDER proposes to subcontract certain portions of the work to the firms listed below;
Name
License
#/Exp.
DRR* � *
l'Reg, #lEap.
Location
Phone _
Type Of Work
Amount $
Name
License #/Exp.
License #
Location
"Phone _
Typo Of Work
.Amount $
Name
License #/Exp.
DIR Reg. #/Exp.
License # `-
Location
Phone
Type Of Work
Amount $
Signature of Bodki
Name
License #/Exp.
DIR Reg. #/Flop.
Location
Phone
Typo Of Work _
Amount $
Name
License #/Exp.
DIR Reg. #/Exp.
License #
Location
Phone
Type Of V1ork
Amount$
Name
License #/Exp,
DIR Reg: #/Exp.
License f#
Location
Phone
Type Of Work
Amount $
P-7 of P-16
CITY OF SANTA ANA ADDENDUM NO. ONE
PROPOSAL
PROIECT NO,: 20-7535
LOCAL S* ET CURB RAMP IMPROVEMENTS (PHASE 11)
The fbllowing are the names, address", and telephone numbers for THREE public agencies for
which the BIDDER has performed similar work within the pastthree years,
i, SEE ATTACHED INFORMATInN
2,
Name and Telephone Number of person familiar with project,
Contract Amount Type of Work Date -Completed
Name and Telephone Number of person familiar with project.
Contract Amount
3. SEEATTACHED 1Nf
Name and Address of owr
Type Of Work Date Completed
Name and Telephone Number of person familiar with - project.
Contract Amount Type of Work
Date Completed
The following are the names, addresses, and telephone numbers of all brokers and sureties from
whom BIDDER Intends to procure insurance and bonds,
Surely = Zurich - Fidelity Deposit Company of Maryland
777 8, F
Broker = R S Bonding & Insurance Agency, Inc.
1633.E. 4th Ave, Ste. 228, Santa Ana, CA 92701 - (714) 541-4700
P-8 of P-1 6
CCTV OF SANTA ANA ADDENDUM NO.ONE
PROPOSAL,
PROJECT NO,.: 20-7535
LOCAL STREET CURB RAMP IMPROVEMENTS (PHASE 11)
A Q11IONAL REFI-RF.,N�J!a
The following are the names,- addresses, and telephone numbers for n1REE public agencies for
which the BIDDER or SnbcontracCar has performed similar work in the past five years,
t. SEE ATTACHED INFORMATION
19
a
Name
Narrre and Telephone Number of person AmiUar with project.
Contract Amount
and Address of owner.
Type of Work Date Completed
Name and Telephone Number of person familiar with project.
Contract Amount
of owner.
Type of Work Date Completed
Name and Telephone Number of person familiar with project.
Contract Amount
Type of Work Rate Completed
The following are the names addresses, and telephone numbers of all brokers and sureties from
whom BIDDER intends to procure insurance and boards.
Surety = Zurich - Fidelity Deposit Company of Maryland
777 S�Streek suite 3900 Los Angeles CA - (619) 236-1388
Broker = R S Bonding & Insurance Agency Inc.
1633 E. 4th Ave, Ste 228, Santa Ana, CA 92701 � 641-4700
P-9 ofP-16
VIDO SAMARZICH, INC.
General Engine Contractor No. 4a3214 A
6829 BILLINGS PLACE, RANCHO CUCAMONQA, CALIFORNIA 91701 TELEPHONE 909-987-6377
FAX 909487-8988
COMPLETED CONSTRUCTION
PROJECT REFERENCES
1. Project Name: Local Street Curb Ramplmpr9vementa
Owner: City of Santa Ana
Phone ]Number: (714) 552-53.36
Engineer/Contact: Mr, Gerardo Leclinga
Contract Amount: $495,000,00
Date of Completion: 2019
2. Project Name: P Ave Pavement Rehabilitation and Water Improvements
Owner: City of Upland
Phone Number: (909) 291.2946
Engineer/Contact Mr. Bob Critchfield
Contract Amount: $2,800,000,00
Dote of Completion: 2019
3. Project Name: 0' Street Pavement Rehabilitation and Waterhuprovements
Owner: City of Upland
Phone Number: (909) 291-2946
Engineer/Contact: Mr. Bob Critchfield
Contract Amount: $2,600,000,00
Date of Completion: 2019
4. Project Name: La Palma Ave Sidewallc improvements
Owner. City of Anaheim
Phone Number: (714) 765.5052
Pugincer/Coutact: Mr, Joel Jordan
Contract Amount: $479,000,00
Bate of Completion: 2019
5. Project Name: Wilshire Avenue Bicycle Blvdlmprovements
Owner: City of Fullerton
Phone Number: (714) 738-6853
Engineer/Contact: Mr. David Grantham
Contract Amount: $2,100,000.00
Date of Completion: 2019
Pate 1 of 6
VIDO SAMARZICI, INC.
- General En&eering Contractor No..433210 A
6a29 BILLINGS PLACE, RANCHO CUCAMONGA, CALIFORNIA 91701 TELEPHONE 909-987-077
FAX 909-987-8988
6. Project Name: FY 17-18 ADA Aocess Ramp Improvements at Various Locations
Owner: City of Raacho Cucamonga
Phone Number: (909) 7744070
I ngineer/Contact: Mr. Romeo David
Contract Amount: $975,000.00
Date of Completiow 2018
7. Project Name: Wilshire Avenue Waterand Sewer Improvement Project
Owner: City of Fullerton
Phone Number: (714) 738.6895
Engineer/Contact: Mr, Gar Pinang
Contract Amount: $550,000,00
Date of Completion: 2018
R. Project Name: Elm/Malden Area Street, Sewer and Water Improvements
Owner: City of Fullerton
Phone Number: (714) 773-0049
Enginrcer/Contact: Mr, Joseph Hernandez
Contract Amount $2,200,000.00
Date of Completions 2018
9. Project Name: Anaheim Hills Road Water.Main Replacement
Owner: City of Anaheim
Phone Numbers (714) 863-8020
Engineer/Contact: Mr. Luis Tapia
Contract Amount: $600,000.00
Date of Completion: 2018
10. Project Name: CDBG ADA Wheelchair Access Ramp Replacement at Various Locations
Owner: City of Orange
Phone Number, (714) 744-5566
Engineer/Contact: Mr, Matthew Lorenzen
Contract Amount: $204,300.00
Date of Completion: 2018
11. Project Name: 2017 Citywide Curb Ramp Improvements
Owner: City of Laguna Beach
Phone Number: (949) 497-0741
Engineer/Contact: Mr. Tri Nguyen
Contract Amount: $285,000.00
Completion Date: 2017
Page 2 of 6
VIDO SAMAR.ZICII, INC,
General Engineering Contractor No. 433210-A
6829 61177 PLACE, RANCHO CUCAMONGA, CALIFORNIA 91701 7TEPI-IONE 909-987-6377
FAX 909-987-8988
12. Project Name: Safe Routes to School iriiprovernems, Phase 3
Owner: City of Glendale
Phone Number: (818) 402-0225
Engineer/Contact: Mr, Crary Edsall
Contract Amount: $908,000,00
Date of Completion 2017
11 Project Name- Heim Ave at Canal 8t $term L)rahi Improvements
Owner: City of Orange
Phone Number: (7.44) 744-5566
Engineer/Contact: Mr. Matthew Lorenzen
Contract Amount: $99,000 00
Date of Completion: 2017
14, Project Name: Citywide Sidewalk Repair Project FY 15-16
(Owner; City of Santa Monica
Phone Number; (951) 522-4505
Engineer/Contact: Mr. Craig Wheeler
Contract Amount: $878,000.00
Date of Completion: 2017
15, Project Name: FY 16/17 Curb Access Ramp Installation Project
Owner: City of Huntiogton $each
Phone Number: (714) 536-5259
Engineer/Contact: Mr. Joe Fuentes
Contract Amount: $679,000.00
Date of Completion: 2017
16. Project Name: Comstock Avenue Water Main Improvements
Owner: City of Whittier
'hone Number: (562) 567-9302
Engineer/Contact: Mr: Carl Hassel
Contract Amount: $578,000.00
Date of Completion: 2017
17. Project Name: Monterey Road Street .Improvements
Owner: City of South Pasadena
Phone Number: (626) 590-0570
Engineer/Contact: Mr. Alex Chou
Contract Amount: $1,550,000.00
Date of Completion: 2017
Page 3 of 6
VIDO SAMARZICH INC,
General Engineering Contractor Na. 483210 A
6829 BILLINGS PLACE, RANCHO CUCAMONGA, CALIFORNIA 91701 7 7PHONE 909-987-6377
FAX 909-987-8988
18� Project Name: Fletcher Avenue Reconstruction
Owner; City of South Pasadena
Pbone;Number: (702) 2044W5
Engincer/Contaet; Mr, Mark'Peterson
Contract Amount: $878,000,00
Date of Completion: 2016
19, Project Name: Patterson Street Reconstruction
Owner: City of Fullerton
Phone Number: (714) 732-9060
Engineer/Contact: Mr. Pete Acosta
Contract Amount: $675,000.00
Date of Completion; 2016
20. Project Name: Magnolia/Bolsa Intersection Widening
Owner: City of Westminster
Phone Number: (714) 548-3464
;Engineer/Contact; Ms. Theresa Tran
Contract Amount. $97$,000,00
Date of Completion: 2016
21. Project Name., 2015 Water Main Improvements
Owner: City of Westminster
Phone Number: (714) 548-3456
Engineer/Contact: Mr, Tuan Pham
Contract Amount; $1,100,000.00
Date of Completion: 2016
22. Project Name: tied 1-till Lake Modernization
Owner: City of Rancho Cucamonga
Phone Number: (909) 477-2740
l ngincer/Contact: Mr. Romeo David
Contract Amount: $300,000,00
Date of Completion: 2016
23. Project Name: 2015 Concrete Improvements
Owner: City of Inglewood
Phone Number: (714) 468-7319
Engineer/Contact: Mr. HunterNguyen
Contract Amount: $425,000.00
Date of Completion; 2015
Page 4 of 6
VIDO SAMAR.ZICI-I, INC.
General )engineering Contractor No, 433210 A
6829 BILLINGS PLACE, RANCHO CUCAMONGA, CALIFORNIA 91 701 TELEPHONE 909-987-6377
FAX 909-987-8988
24. Project Name:11 Centro Avenue Rehabilitation
Owner: City of South Pasadena
Phone Number: (626) 590-0570
Engineer/Contact: Mr. Alex Chou
Contract Amount: $1,100,000.00
Date of Completion: 2015
25. Project Name: Concrete Bus Pads
Owner: City of Rancho Cucamonga
Phone.Number: (714) 548-3456
Englnecr/Contact: Curt Billings
Contract Amount $175,000,00
Date of Completion: 2015
26. Project Name: ADA Wheelchair Ramps
Owner: City of Orange
Phone Number: (714) 744-5566
Eugineer(Contact: Mr. Matthew Lorenzen
Contract Amount: $275,000.00
Date of Completion: 2015
27. Project Name; 2014 Water Improvement
Owner: City of Westminster
Phone Number: (714) 548-3456
Engineer/Contact; Mr. '1 uan Pharr
Contract Amount: $1,100,000.00
Date of Completion: 2015
28. Project Name: ADA Sidewalk improvement
Owner: City of Artesia
Phone Number: (951)314-6954
Engineer/Contact: Mr, Chuck Burkhardt
Contract Amount: $200,000.00
Date of Completion: 2014
29. Project Name: YLHS Park Bryant Cross Feeder Pipeline
(owner: Yorba Linda Water District
Phone Number: (714) 701.3104
Engineer/Contact: Mr. Joe Polimino
Contract Amount; $675,000.00
Date of Completion: 201.3
Page 5 of 6
VIDO SAMARZICH, INC.
General Engineering Contractor No, AM210A
682.9 BILLINGS PLACE, RANCHO CUCAMONGA, CALIFORNIA 91701 TELEPHONE 909-987-6377
FAX 909-987-8988
30. Project Name: County Road Storm Drain
Owner; City of Pomona
Phone Number: (909) 322-7471
Engineer/Contact: Mr, Dave Barron
Contract Amount: $570,000.00
Date of Completion: 2013
3i, Project Name: Adams Square Park
Owner:. City of Glendale
Phone Number: (818) 548-2864
Engineer/Contact: Mr, Hagop Kassabian
Contract Amount: $1,100,000M
Pate of Completion: 2010
32. Project Name: Various Public Work Purchase Orders and Contracts 2000-2013
Owner: City of Pasadena
Phone Number: (626) 484-5640
Engineer/Contaett Mr, .Dale Torstenbo - dtorstenbo rz cityofpasadena.net
Contract Amount:. $2,500,000.00
Bate of Completions 2000-2013
33, Project Name: Mise Park Improvements From 2000-2010
Owner: City of Glendale
Engincer/Contact: George Baheria— (951) 201-2710
Peter Vierheilig — pvierlieilig@oi.gieudale.ca,us
Contract Amount: $3,500,000.00
Date of Completion: 2000-2010
Page 6 of 6
CITY OF SANTA ANA ADD NDUM O ONE
PROPOSAL
PROTECT NO,: 20-7535
LOCAL STREET CURB RAMP IMPROVEMENTS (PHASE I1)
NO-_C0LLUjONAFFID&VIT"
(Title 23 United States Code Section 112 and Public Contract Code Section 7106)
In conformance with Title 21 United States Code Section 112 and Public Contract Code 7106 the
BIDDER declares that the bail is not made in the interest of, or on behalf of, any undisclosed
person, partnership, company, association, organization, or corporation; that the bid is genuine
and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited
any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded,
conspired, connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that
anyone shall refrain from bidding; that the BIDDER has not li any manner, directly or indirectly;
sought by agreement, communication, or conference with anyone to fix the bid price or the
BIDDER or any other BIDDER, or to fix any overhead, profit, or cost element of the bid price,
or of that of any other BIDDER, or to secure any advantage against the public body awarding the
contract of anyone interested in the proposed contract; that all,statements contained in the bid are
true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price
or any breakdown thereof, or the contents thereof, or divulged information or data relative
thereto, or paid, and will not pay, any fee to any corporation, partnership, company association,
organization, bid depository; or to any member or agent thereof to effectuate a collusive or sham
bid.
Note: The above Non-eollusion Affidavit is part of the Proposal. BIDDERS are
cau�oned,that snaking a false certification may subject the certifier to criminal
MWJINM
State of California
County of
Subscribed and sworn to (or affirmed) before me on this day of , 20_ by
proved to me on the basis of satisfactory evidence to be "the
person(s) who appeared before me
_#
Notary Public Signature Notary Public Seal
P40 of P-I 6
certificate verifies only the identity of the individua
who signed the document to which this certificate
Is attached, and not the truthfulness, accuracy, or
State of California
County of LOS ANGELES
Subscribed and sworn to (or affirmed) before me on this 24TH
day of MARCH 20 20, by VIDO L SAMARZICH
proved to me on the basis of satisfactory evidence to be the
person(s) who appeared before me.
Mwrwde romnly
2021
L I W01M AW .4m: zz-.4. :,r,. , 191111111110 1
(Seal) Signature
CITY OF SANTA ANA ADDENDUM DUM NO. ONE
PROPOSAL
PROJECT NO.: 20-7535
LOCAL STREET CURB RAMP IMPROVEMENTS (PRASE 11)
NONDTSCIIIMINATION CEl2TIFI;CM'
The undersigned contractor or corporate officer, during the performance of this contract, certifies
as fellows:
1. The Contractor shall not discriminate against any employee or Applicant for employment
because of race, color; religion, sex, or national origin. The. Contractor shall take affirmative'
action to ensure that applicants are employed, and that employees are treated during
employment without, regard to their race, color; religion, sex, or national origin. Such action
shall include, but not be limited to, the following; employment, upgrading, demotion, or
transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other'
forms of compensation; acid selection for training, including apprenticeship, The Contractor
agrees to post in conspicuous places, available to employees and applicants for` employment,
notices to be provided setting forth the provisions of this nondiscriiimination clause,
2. The Contractor shall, in all solicitations or advertisements for employees placed by or on
behalf of the Contractor; state that all qualified applicants will receive consideration for
employment without regard to race, color, religion, sex, or national origin.
1. The Contractor shall send to each labor union or representative of workers with which he/she
has a collective 'bargaining agreement or other contract or understanding, a notice to be
provided advising the said labor union or workers' representatives of the Contractor's
commitments under this section, and shall post. copies of the notice in conspicuous places
Available, to employees and applicants for employment.
4. The Contractor shall comply with all provisions of Executive Order 11246 of$eptcmbcr:24,
1965, and of the rules, regulations, and relevant orders of the Secretary of Labor,
5. The Contractor shall furnish all information and reports required by Executive Order 11246
of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or
pursuant thereto; and will permit access to his/her books, records, and accounts by the
administering agency and the Secretary of Labor for purposes of investigation, to ascertain
compliance with such rules, regulations, and orders.
6. In the event of the Contractor's non-compliance with the nondiscrimination clauses of this
contract or with any of the said rules; regulations, or orders, the contract may be canceled,
terminated, or suspended in whole or in part and the Contractor may be declared ineligible
for further Government contracts or federally assisted construction contracts in accordance
with procedures authorized in Execution Order 11246 of September 24, 1965, and such other
sanctions may he Imposed and remedies invoked as provided in Executive Order 11246 of
September 24, 1965, or by rule, regulations; or order of the Secretary of Labor, or as
otherwise provided by law.
P-11 of P-16
CITY Or' SANTA ANA
PROPOSAL
PROJWCT NO.: 20-7535
ADDENDUM NO. ONE
LOCAL STREET C1JR2 RAMP IMPROVEMENTS (PHASE 11)
The Contractor shall include the portion of the sentence immediately preceding paragraph (1)
and the provisions of paragraphs (1) through (1) in every subcontract or purchase order
unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to
Section 204 of Excemlvo Order 11246 of September 24,1965, so that such provisions will be
binding upon each subcontract or purchase order as the administering agency may direct as
means of enforcing such provisions, including sanctions for noncompliance; provided,
however, that itt the event the Contractor becomes involved in, or is threatened with,
litigation with a subcontractor or vendor as a. result of such direction by the administering
agency, the Contractor may request that the United States entcr into such litigation to protect
the interests of the United States,
S. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as
amended, no discrimination shall be made in the employment of persons upon public works
because of race, religious creed, color, national origin, ancestry, physical handicaps, mental
condition, marital ,status, or sex of such persons, except as provided in Section 1420, and any
contractor of public works violating this Section is subject to all the penalties imposed for a
violation of.the apt
Signed; t/ t, 1 :.mod rah
Title: Vice President
Firm: Vido Samarzith, Inc.
Date:. 03/23/2020
P-12 ofP•16
CITY O SANTA ANA ADDENDUMNO.ONE
PROPOSAL
PROJECT NO.: 20.7535
LOCAL :iET CURB RAMP IMPROVEMENTS (PRASE Ii)
STATEMENT REGARDINGAPPRPNTIC"PSI-IIP REQ_UJ9-MENTS
The undersigned; BIDDER is familiar with the requirements of Section 1777,5' of the State Labor
Code regarding employment of apprentices, and understands that contractors on contracts
exceeding $M,000 or 20 working days shall
1. Apply to the joint apprenticeship committee administering the apprenticeship standards of
the 'craft or trade in the area of the site of the public work for a certificate approving the
contractor under the apprenticeship standards for the employment and training of apprentices
in the area or industry affected.
1 Employ the number of apprentices or tire ratio of apprentices to journeyman stipulated in the
apprenticeship standards.
3. Contribute to the land or funds in each craft or trade in which he/she ernploycjourneymen or
apprentices on the public work, in the same amount or upon the same basis and in the -same
manner as the .o rer contractors, except contractors not signatory to. the trust agreement shall
pay a like amj
totle- aliforniaApprenticeshipCouncil,
Signed; Ili°a 4 A..rt keel
Title: Vice President
Finn; Vido Samarzich, Inc.
Date: 03/23/2020
P-13 of P-16
CITY OF SANTA ANA ADDENDUMN0.0NE
PROPOSAL
PROJECT NO,: 20-7535
LOCAL STREET CURB RAMP IMPROVEMENTS (PHASE II)
STATEMENT RECAR)INS_ REGARDING-T1CILI3ACI<"R,�ilIRt�MENTS
The undersigned is submitting this proposal for performing by contract the work required by
these bid documents, agrees to comply with the Copeland "Anti -Kickback" Act (18 USC 74) as
supplemented in the Department of Labor regulations (20 CPR, Part 3), This act provides that
each contractor of subcontractor shall be, prohibited from .inducing, by any means, any person
employed in the construction or repair Of`pub lic work, to give up any part of the compensation to,
which he/she is 10(rwiso nftled,
Signed: UJV L.A�n�ittc r
Title: Vice President
Firm: Vido Samarzich Inc.
Bate; 03/2312020
P-14 ofP-16
CITY OF SANTA ANA
PROPOSAL
PROJECT NO.:20-7535
LOCAL STREET CURB RAMP IMPROVEMENTS (PHASE 11)
'PUBLIC CONTRACT CODE SECTION 0! Z UEST,�ONNATRE
In conformance with Public Contract Code Section 10162, the BIDDER shall complete,
under penalty of perjury, the following questionnaire:
Has the BIDDER, any off= of the BIDDER, or any employee of the BIDDER who has a
proprietaryy, interest, in the BIDDER, ever been disqualified, removed, or otherwise prevented
from bidding on, or completing a federal, state, or local government project because of a
violation of law orasafety regulation)
Yes No V
If the answer is yes, explain the circumstances in the following space.
P-15 ofP-15
CITY OF SANTA ANA ADDENDUMN0,0NE
PROPOSAL,
PROJECT NO.: 20-7535
LOCAL4 CUR13 RAMP IMPROVEMENTS (PHASE II)
STATEMENT RE(3ARDiNG COMMMT) W(7ttT{FORCE ACRMMENT (CM A)
REQUIREMENTS
This is to certify that the undersigned BIDDER, and subcontractors, have read and
understood the CWA entered into by and between the City of Santa Ana, the Los
Angeles/Orange Counties Building and Construction Trades Council, and the signatory
Craft Councils and Local Unions, effective as of September 1 `, 2017, Thy CWA is
available at http://www.santaa-ana.org/pwa/documents/CWA,pdf, The undersigned BIDDER
"hereby agrees to comply with all terms and conditions of the CWA, and is capable of
completing construction of the project continuously, and without interruptions or delays; If
awarded any work covered by the, CWA, BIDDER will also be required to sign the Letter of
Assent that appears as Attachment to the CWA.
Signed: — On L. S tLy�___,,,,,
Title: Vit e President
Title: Vido Samarzich, Inc,
Date: 03/23/2020
P-16 of P-16
ORANGE COUNTY REGISTER This space for gong stamp only
2190 TOWNE CENTER PL, ANAHEIM, CA 92006
Tolophone (714) 796-7000 1 Fax (714) 796r,6069
CNS#: 3350309
PROOF OF PUBLICATION
(2015.6 C.C,P.)
State of Californla )
County of ORANGE ) ss
Notice Type: BID - NOTICE INVITING BIDS
Ad Description:
20-7635 LOCAL STREET CURB RAMP IMPROVEMENTS (PHASE II)
I am a citizen of the United States and a resident of the State of California; I am
over the age of eighteen years, and not a party to or Interested in the above
entitled matter. I am the principal clerk of the printer and publisher of the
ORANGE COUNTY REGISTER, a newspaper published In the English
language In the city of SANTA ANA, county of ORANGE, and adjudged a
newspaper of general circulation as defined by the laws of the State of
California by the Superior Court of the County of ORANGE, State of California,
under date 1111911905, Case No. A21046. That the notice, of which the
annexed Is a printed copy, has been published in oath regular and entire Issue
of said newspaper and not in any supplemont thereof on the following dates,
to -wit:
03/0612020, 03/13/2020
Executed on: 03/13/2020
At SANTA ANA ,CA
I certify (or declare) under penalty of perjury that the foregoing Is true and
correct.
I IIII II (Signature
Smell IIIIIIIII �tlI�� I��II II0
Il5
II I3
IIII 3II 0
�I I3III �1
same
The
the
bid
be
THE FINAL PREMIUM IS Bond No.: 08712177
PREDICATED ON THE (One of Two Originals)
FINAL CONTRACT PRICE CITY OF SANTA ANA
BONDS
PROJECT NO.: 20-7535
LOCAL STREET CURB RAMP IMPROVEMENTS (PHASE 11)
FAITHFUL PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS that
Inc.
as CONTRACTOR, and Fidelity and Deposit Company of Maryland ,
a corporation, organized and existing under the laws of the State, and duly authorized to transact
business under the laws of the State of California, as SURETY, are held and firmly bound unto
the City of Santa Ana, as AGENCY, in the penal sum of Three Hundred Ninety Eight Thousand
Seven Hundred and 00/100 Dollars
($ 398,700.00 ), which is 100 percent of the total contract amount for the above stated
project, for the payment of wt ich sum, CONTRACTOR and SURETY agree to be bound, jointly
and severally, firmly by these presents.
THE CONDITIONS OF THLS OBLIGATION ARE SUCH that, whereas CONTRACTOR has
been awarded and is about to anter into the annexed Contract Agreement with AGENCY dated
May 5th, 2020 fop Project No. 20-7535 Local Street Curb Ramp Improvements (Phase II)
if CONTRACTOR faithfully -jerforms and fulfills all obligations in the performance of the Work
of Improvement to be done under said Contract Agreement in the manner and time specified
therein, then this obligation shall be null and void, otherwise it shall remain in full force and
effect in favor of AGENC` provided that any alterations in the obligations or time for
completion made pursuant to the terns of the contract documents shall not in any way release
either CONTRACTOR or SURETY, and notice of such alterations is hereby waived by
SURETY.
IN WITNESS WHEREOF the
14th day of May
A
CONTRACTOR*
SURETY*
Matthew R. Dobync , Attorr
Subscribed and sworn to before me,
20,.
Signature:
hereto have set their names, titles, hands, and seal this
2020 .
6829 Billings Place
Rancho Cucamonaa. CA 91701
Telephone: (909) 987-8377
777 S. Figueroa Street, Suite 3900
Los Angeles. CA 90017
Telephone: (619) 235-1388
this day of
Notary Public in and for the County of , State of
Rate of premium on this bond is $ 15.31 per thousand.
Total amount of premium charge is $ 6,104.00 To be oiled In by Surety
*Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the
name, title, address, and telephone number ofauthorized representative.
I of 3
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: "hat the ZURICH AMERICAN INSURANCE COMPANY, a. corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the Stale of Illinois (heroin collectively called the "Companies"), by
Robert D. Murray, Vice President, in pursuance of authority granted by Article V, Section 8,of the By -Laws of said Companies, which are
set forth on the reverse side hereof and ore heseby certified to be In full force and effect on the date hereof; do hereby nominate, constitute,
and appoint Randy SPORN, Ashley M. SPOBN, Matthew R. DOBYNS and Hamilton KENNEY, all of Santa Ann, California, EACH,
its true and lawful agent and Attorney -in -Fact, .o make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any
and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon
said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected
officers of the ZURICH AMERICAN INSURANCE COMPANY at itsoffice in New York, New York., the regularly elected officers of the
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maylntrd., and the regularly elected
officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper
persona.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By -Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her mmraes and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 201hday of September, A.D. 2019.
��s'r"W �Hrr4
a:
ATTEST;
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL. AMERICAN CASUALTY AND SURVIT COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By: Robert D. Murry
Fire President
By: Down E. Brown
5ecreltuy
State of Maryland
County of Baltimore
On this 20111 day of September, A.D. 2019, before the subscriber, a Nolary Public of the State of Maryland, duly commissioned and qualified,
Robert D. Murray, Vice President and Dawn E. Drown, Secretary of the Companies, to ale personally known to be the individuals and officers
described in and who executed the preceding instrument, laid acknowledged the execution of same, and being by me duly sworn, deposeth and sailh, that
hdshe is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and
that the said Corporate Seals and the signature as suA officer were duly affixed and subscribed to the said instrument by file authority and direction of the
said Corporations.
IN TESTIMONY WHEREOF, I have hereanlcset my hand and affixed my Official Seal the day and year first above written.
j\q t
Y ; Pnel.'�fi:
wl'11 1YiiiXti
Constance A. Dann, Notary Public
,`
q„[ja
My Commission Expires: July 9, 2023
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attorneys -in Pact. Tile
allay, by written instr Chief Executive Officer, the President; or any Executive Vice President or Vice President
trument under the attested corporate seal, appoint attorneys -in -fact with authority to execute bonds, policies,
reengnizances, stipulations, undertakings, or ether like Instruments on behalf of the Company, and may authorize any officer or any auch
attorney -in -fact to affix the corporate seal tha+..top and may With o
limo." r without cause inodifyof revoke any such appointment or authority at any
CERTIFICATE
1, the undersigned, Vice Presidomt Of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
f ,going Power onf Attorney is COMPANY,
Plfull fo e and effecct on the dOrd tile FIDELITY ate of this DEPOSIT ert COMPANY mid dFfurthe certify tthatohereby Artic a V,Seat Section that
tiof
the By -Laws of the Companies is still in ford
71ris Power of Attomey and Certificate n ay be signed by facsimile under and by authority of the following resolution of the Board of
Directors of theZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and hold on the 15th day of December 1998.
RESOLVED: "That the signature of the Fresidcut or a Vico President and rho attesting signahrra Ofa Secretary or an Assistant Secretary
and the Seal of the Conrpony may be affixed In facsimile oil any Power of Attorney... Any such Power or ally cert
facsimile signature and seal shall be valid and ;tiding on the Company." ificate thereof bearing such
This Power of Attorney and Certificate nay be signed by facsimile under and by authorhy of the following resolution of tine Board of
Directors of the COLONIAL AMERICAN C, SUALTY AND SURETY COMPANY at a meeting duly called and held oil the Sth day of
May, 1994, and the tbilowing resolution of tlE Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
mecting duly called and held on the I Oth day o.'May,1990,
RESOLVED; "That the facshile or mechaaically reproduced seal of the company and fac
ry, or Assistant iecratary of rho Csimile or mechanically reproduced signature
of any Vice-president, Secretaompany, whether made heretofore or hereafter, wherever appearing upon a
certified copy of nay power of attorney issued 6y the Company, sholl be valid and binding upon the Company with the same force and effect
as thought ma»aally affixed,
IN TESTIMONY WHEREOF, I have hermrnto subscribed my name and affixed the corporate seats of the said Companies,
A4th ' dayof Mav 202I1,
Tom
im Sao
IlMlul 00
Brian M• Hodges, Vice president
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT A COMPLETE DESCRI
IPTION
OFTHE CLAIM INCLUDING THE PRINCIPAL ON THE BOND, THE BOND NUMBER, AND YOUR CONTACT
NFORMATION TO;
Zurich Surety Claims
1299 Zurich Way
Schaumburg, IL 60196-1056
R".rollgrwf ims zu fill.c n
800-626-4577
CALIFORNIA ALL-PURPOSE 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 validity of that document.
State of CALIFORNIA
County of ORANGE
On May 14th, 2020 before me, ASHLEY MARIE SPOHN NOTARY PUBLIC
personally appeared MATTHEW R DOBYNIS
J
® 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
autiorized capacity oes), and that by his/her/their signature(s) on the
instrument the person(, or the entity upon behalf of which the person(s)
MARIESPOHN acted, executed the instrument.
A@ASHLEY
COMM. # 2188665
NDTARY PUBLIC CALIFORNIA
ORANGECOUNTY 3 I certify under PENALTY OF PERJURY under the laws of the State of
� MyCOM ,ZresM�7�2021 California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Notary
Though the data below is not required by law, it may prove valuable to persons relying on the document and
could prevent fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER
❑ INDIVIDUAL
❑ CORPORATE OFFICER
❑ PARTNER S
() El LIMITED
® ATTORNEY -IN -FACT
❑ TRUSTEE(S)
❑ GUARDIAN/CONSERVATOR
❑ OTHER: _
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
DESCRIPTION OF ATTACHED DOCUMENT
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 truthfLlness, accuracy, or
validi of that document.
State of California
County of LOS ANGELES
On MAY 18, 2020 before me, DESMOND G. WARREN, NOTARY PUBLIC
(insert name and title of the officer)
Personally appeared VIDO L. SAMARZICH
who proved to me on the basis of satisfactory evidence to be the personKwhose nameysj is/gr6
subscribed to the within instrunent and acknowledged to me that he/sp�/jpey executed the same in
his ((�eir authorized capacitypW, and that by his/Ile Uieii'signaturefs) on the instrument the
person(sj, or the entity upon behalf of which the personW 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. CSAMNDomm. 9% REN
r� cob+b�. nee
Nctary Public• celNomla
MY CaOim E C County
gNNu glggql1111N11ryryIXWjIqI�q,11N�gg112. 2021
Signature (Seal)
Bond No.:08712177
CITY OF SANTA ANA (One of Two Originals)
BONDS
PROJECT NO.: 20-7535
LOCAL STILET CURB RAMP IMPROVEMENTS (PHASE II)
PAYMENT BOND
KNOW ALL MEN BY THESE PRESENTS that Vido Samarzich, Inc.
as CONTRACTOR, and Fid=_lity and Deposit Company of Maryland
a corporation, organized and existing under the laws of the State, and duly authorized to transact
business under the laws of thzState of California, as SURETY, are held and firmly bound unto
the City of Santa Ana, as AGENCY, in the penal sum of Three Hundred Ninety Eight Thousand Seven
Hundred and 00/100
($ 398,700.0owhic Dollars
project, for the payment of which sum, CONTRACTOR and SURETY a0 percent of the total contract u eent f to be bouor the nd jointly
and severally, firmly by these presents. g y
THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas CONTRACTOR has
been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated
May 5th 2020 for Project No. 20-7535 Local Street Curb Ramp Improvements (Phase II)
if CONTRACTOR or any subcontractor fails to pay for any labor or material of any kind used ill
the performance of the Work of Improvement to be done under said Contract Agreement, or fails
to submit amounts due under the State Unemployment Insurance Act with respect to said labor,
SURETY will pay for the same in an amount not exceeding the sum set forth above, which
amount shall insure to the benefit of all persons entitled to file claims under the State Code of
Civil Procedures; provided Mal! any alterations in the work to be done, materials to be furnished,
or time for completion made pursuant to the terms of the contract documents shall not in any
way release either CONTRACTOR or SURETY, and notice of said alterations is hereby waived
by SURETY.
IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this
14th day of May , 20 20 .
CONTRACTOR* Vjdo>5�}r c Inc.
By:
SURETY*
_ t
Matthew R. Dobyns , Anorn
8fibscribed and sworn to beforeme,
_ 20
of
6829 Billings Place
Rancho Cucamonga CA 91701
Telephone: (909) 987-6377
777 S. Figueroa Street, Suite 3900
Los Angeles CA 90017
Telephone: (619) 235-1388
,this day of
Signature:
Notary Public in and for the Co� my of , State of
Rate of premium on this bond is $ included in the performance bond per thousand.
Total amount of premium charge is $ included in the performance bond , To be filled in by Surety
*Provide CONTRACTOR I ADMITTED SURETY name, address, and telephone number and the
name, title, address, and telephone number of authorized representative.
2 of 3
to
- - - ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY Or MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, 0 corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois,slid the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (heroin collectively called the "Cornponics, I, by
Robert D. Murray, Vice President, it' pursuaice of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are
set forth on the reverse side hereof slid are hereby certified to be in fit]] force and effect on the (late hereof, do hereby nominate, constitute,
and appoint Randy SPOHN, Ashley M. SPOAN, Muttlnew R. DODYNS and Hamilton KENNEY, all of Santa Ana, California, EACH,
its true and lawful agent and Attorney -in -Fact, :o make, execute, seal and deliver, for, and oil its behalf as surety, and as its act and deed: tiny
and all bonds and undertakings, and the execution of such bonds or undertakings in pursuonce of these presents, shall be as binding upon
sold Coapanies, its fully and amply, to all inti nts and purposes, as if they had been duly executed and acknowledged by the regularly elected
officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,. Now York., the regularly elected officers of the
COLONIAL AMERICAN CASUALTY ANC SURETY COMPANY at its office in Owings Mills, Maryland., -and tilt regularly elected
officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper
persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By -Laws of said Companies, and is now in 'orcc.
IN WITNESS WHEREOF, the sold Vice President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, tied FIDELITY AND DEPOSIT COMPANY OF:MARYLAND, this 20th day of September, A.D. 2019,
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL, AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By: Bobel'ID. Manny
Vice Plwsldent
COY;—)a44,rt, 4 ldmw.
By: Dawn B. Btnwn —
Secretary
State of Maryland
County of Baltimore
On this. 201h day of September, A.D. 201% befibie the subscriber, a Notary Public Of the Slate of Maryland, duly cmnmissionerl and qualified,
Robert D. Murray, Vice President and Down E. Brown, Secretary of the Companies, to ale personally known to be the Individuals and oMeors
described in and who executed the preceding instrument, and acknowledged the execration of snnne, and being by me duly sworn, deposeth and with, that
he/she is lie said officer of the Company aforesaid, and this the seats affixed to the preceding instrument are the CorPonac Seals Of said Companies, and
that the said Commit: Seals and the signature as such oll'icer were duly affixed and subscribed to the said instrument by the authority and dirc6lion of the
said Corpomtimns.
IN TESTIMONY WHEREOF, I have hereunto set my hand and aRfxed my Official Seal the day and year first above written
�`+`',,,nop or& itliA,'+
�/,1�y '
fit:
vsr ally ntleti ��^'
Constance A. Dune, Numry Puhlic
er�,n iii,f .``
My Coamnission Expires: July 9,2023
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attorneys -in -Fact The Chlef Executive Officer, the President, or any Executive Vic, President or Vice President
may, by written instrument under the atosted corporate seal, Appoint attorneys -Ill -fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or ether like instruments on behalf of the Company, and may authorize any officer or any such
attorney -In -Fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President cf the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, Lrd the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do Itoreby corlify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of
the By -Laws of the Companies is still in forme,
This Power of Attorney And Certificate tay be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at it meeting duly called And held oil the 15111 clay of December 1998,
RESOLVED: "That the signature ofthel-resident or a Vice President end theallesting signature of a Secretary o• an Assistant Secretary
and the Seal of the Company may be affixed b•-, facsimile on any Power of Attoney... Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate nay be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the Slit day of
May, 1994, and file following resolution of tv Board of Directors of tite FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the I oth day c; Muy, 1990.
RESOLVED: "That the facsimile or mee:10nically reproduced seal of the company and facsimile or mechanically reproduced signature
Of any Vice -President, Secretary, or Assistant. 3eoretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
As though manually affixed.
IN TESTIMONY WHEREOF, f have heramto subscribed my name and affixed the corporate seals of tiro said Companies, this:444th cl'ayof May 2020
�r
W411111,"
Brian M. Hodges, Vice President
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT A COMPLETE DESCRIPTION
OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND, THE BOND NUMBER, AND YOUR CONTACT
INFORMATION TO:
Zurich Surety Claims
1299 Zurich Way
Schaumburg, IL 60196-1056
ANY w 1'0bO,tsfQlaims@zul.iclllla.com
800-626-4577
CALIFORNIA ALL-PURPOSE 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 validity of that document.
Sate of CALIFORNIA
County of ORANGE
On May 14th, 2020 before me, ASHLEY MARIE SPOHN, NOTARY PUBLIC,
personally appeared MATTHEW R. DOSYNS
® who proved to me on the basis of satisfactory evidence to be the person(s)'
whose name(6) 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 signatures) on the
instrument the person(s), or the entity upon behalf of which the persons)
ASHLEY MARIE SPOHN acted, executed the instrument.
o COMM. # 2188665 f
g NOTARY PUBLIC CALIFORNIA 3
3 ORANGE COUNTY I certify under PENALTY OF PERJURY under the laws of the State of
1� MyCOMM, axptea Mar. 27,2021 California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
of Notary
Though the data below is not required by law, it may prove valuable to persons relying on the document and
could prevent fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER
❑ INDIVIDUAL
❑ CORPORATE OFFICER
❑ PARTNER(S) ❑ LIMITED
® ATTORNEY -IN -FACT
❑ TRUSTEE(S)
❑ GUARDIAN/CONSERVATOR
❑ OTHER:
S=GNERIS REPRESENTING:
NILME OF PERSON(S) OR ENTITY(IES)
DESCRIPTION OF ATTACHED DOCUMENT
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
validity of that document.
State of California
County of LOS ANGELES
On MAY 18, 2020 before me, DESMOND G. WARREN, NOTARY PUBLIC
(insert name and title of the officer)
personally appeared VIDO L. SAMARZICH
who proved to me on the basis of satisfactory evidence to be the personfls)'whose nam%is/pw
subscribed to the within instrument and acknowledged to me that he/5he/yaepexecuted the same in
his/be rttbeR authorized capac typo, and that by his/4erf)peir signature*on the instrument the
personX, or the entity upon tehalf of which the personX 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.
M ININININNNN�IIMNNNINgINNNNNN
bEEMOND 6. WMREN
WITNESS my hand and official seal. COMM. M00534
. NouxyPuMk-cMHmnli
RMrNitle county
Mr COIpNI: ENprNNApr, B, E021
NNN pNNXNYNN NNIIINI III.
Signature (Seal)