CONTRACT 5196A Other CLOSED Agreement No. 5196A
Change Order
City of El Segundo, Public Works Department
Permit No.:N/A Plan No.(S): Project Number: Change Order No.: 3
PW 15-18
Contractor Name: Danny Letner Inc. / Project Manager Name: Cheryl Ebert
Letner Roofing Co. Project Manager Phone: 310-524-2321
Contractor Address:
1490 N.Glassell Street
Orange,CA 92867
Contractor Phone: (714)633-0030
Contract No.: File Reference: Inspector Name:Cheryl Ebert
NA NA Phone: (310)524-2321
Contract Name:PW 15-18: Fire Station Roof Replacement Project
Description of Changes:
Add Police Department Roof Replacement project from scope of work. ($533,000), including:
- $482,000 Letner Roofing Co.May 26 quote per city directed revisions.
- $51,000 as-needed revisions and repairs,pending site verification,independent testing and mutual agreement.
Method of Payment(May Be Combination):
® Contract Unit Prices ® Contractor's Quote (see attached) [ Time & Materials (Estimated)*
REVISED CONTRACT COSTS: REVISED CONTRACT TIMELINE:
Original Contract Cost: $806,000.00 Original Start Date: N/A
Previous Changes: $491,120 Original Working Days(Fri-Sun): 40
Additions to $0 Previous Work Days Changes: 0
Bid Items Per this CO: $533,000.00 Current CO Work Days Change: 0
New Contract Cost: $847,880.00 New Total Working Days: 40
%Above Original Contract Cost: 5.2% New Completion Date: Start date+
Working Days
CITY OF EL SEGUNDO
Approved By: Date:
Note:This Change Order is Effective on the date signed by the City Representative. Notify the Project Engineer immediately
if there is any disagreement.The Change Order costs indicated on this form represent the complete cost to perform the
noted work. No other incidental or related costs are due or will be claimed by the contractor for this item of work without
the express written approval from the City.
Received:
Dennis Olson, President Sianature
Agreement No. 5196A
Executed in Two (2) Originals
Premium: $4 ,624'00
GENERAL PURPOSE RIDER
To be attached to and form part of Bond Number 58738864 effective issued by the
Western Surety Compan as Surety in the amount of Two Hundred Eighty-Eight'T. housand Three
Hundred and No/00 DOLLARS ($288,300.00), on behalf of Danny Letner, Inc. dba Letner Roofin
Corngany as Principal and in favor of City of El Segundo as Obligee.
Now, Therefore, itiaagreed that:
Performance Bond No. 58738864 and Payment Bond No. 58738864 shall each be increased by Five
Hundred Fifty-Nine Thousand Five Hundred Eighty and No/00 Dollars ($559,580.00) reflecting Chage
Order No. 8 dated July 17, 2017
Performance Bond No. 58738804and Payment Bond No. 587388O4shall each beincreased:
From: Two Hundred Eighty-Eight Thousand Three Hundred and No/00 Dollars ($288,300.00)
To: Eight Hundred Forty-Seven Thousand Eight Hundred Eighty and No/00 Dollars ($847,880.00)
It is further understood and agreed that all other terms and conditions of this bond shall remain
unchanged.
This rider toboeffective the 17m day ofJUl . 2{y17.
'
Signed, sealed and dated this 17m day ofJuly, 2D17.
Agreement No. 5196A
Cer0ficate pursuant to aCivilProcedure .
tM " C�C.0 �� W C Ou my Clerk of the Coin
Of to of California,in and for said County
DO HEREBY CERTIFYTHAT
tn �rtntn�t t utt� pty � ntn Ott d nar ty ns � t1w6 c.5fow�rnG
Insurance Caau mu ssiouner authorizing the insurer to transact surety insurance in
the State of California,and that based on the records shown uuu the Department of
Insurance ebsute,that authority has unot been surrendered,revoked,canceled,
rnn0ed,or suspsended.
to t" vu�n toy roof, I d n a �hereunto t my hand and armed the p of
saitd ounl urn
� _ a COUNTY CLE
RK
.. .
M ... Deputy o unty
By 12-
E. PIGGUE
Agreement No. 5196A
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 )
ss.
County of Los Angeles )
On Jul, 17, 20.17, _ _before me, Gisel a� Soto Notary Public personally appeared
Martha J. Chase who proved to me on the basis of satisfactory evidence to be the person(s)
whose name(s) is/ate subscribed to the within instrument and acknowledged to me that
Ire/she/trey executed the same in 13i-s/herfthe4-- authorized capacity(ies), and that by hi-s/her/their
signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s)
acted, executed the instrument.
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
CIt3ELLA 9OTO paragraph is true and correct.
Commission#►2090504
Notary Public-California
Los Angeles County WITNESS my hand and official seal.
M Comm.E Ires Dec tib,2018
Signature �
x1o,
Gisellotary Public
Agreement No. 5196A
CALIFOR IALL, PURPOSE
CERTIFICATE ATIE OF 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 7/18/17 before me, R. Zazueta, Notary Public ,
(tiers rose name am lue in frie FEW
personally appeared Dennis Olson
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s re subscribed to the within instrument and acknowledged to me that
the/they executed the same in is er/their authorized capacity(ies), and that by
is er/their signature(s) on the instrument the person(e), or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that
the foregoing paragraph is true and correct.
WITNESS my hand and official seal,
R.2U ETA
COMM.#2041125
NOTARY PUBLIC-CALIFORNIA
ORANGE COUNTY
My Comm.Expires Sept.12,2017
IVbtary � c 16ture (Notary Public Seal) "
ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM
This form complies with current California statutes regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded,should be completed and attached to the document.Acknowledgments
from other slates may be completed for documents being sent to that state so long
General Purpose Rideras
the wording does not require the California notary to violate California notary
(Title or description of attached document) • State and County information must be the State and County where the document
signer(s)personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s)personally appeared which
(Title or description of attached document continued) must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
Number of Pages Document Date 7/17/1 commission followed by a comma and then your title(notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e.
he/she/the}--is/are)or circling the correct forms.Failure to correctly indicate this
❑ Individual (s) information may lead to rejection of document recording.
El Corporate Officer • The notary seal impression must be clear and photographically reproducible.
President Impression must not cover text or lines. If seal impression smudges,re-seal if a
(Title sufficient area permits,otherwise complete a different acknowledgment form.
[I Partner(s) • Signature of the notary public must match the signature on file with the office of
the county clerk.
❑ Attorney-in-Fact : Additional information is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document.
Other Indicate title or type of attached document,number of pages and date.
E] 46 Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(i.e.CEO,CFO,Secretary).
2015 Version www.NotaryClasses.com 800-873-9865 • Securely attach this document to the signed document with a staple.
Agreement No. 5196A
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation
having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby
make,constitute and appoint
Martha J.Chase, Individually
of its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds,undertakings
and other obligatory instruments of similar nature
-In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 9th day of June,2015.
Ur
WESTERN SURETY COMPANY
�a/0' 1
/10
aul"f'.Bruflat,Vice President
State of South Dakota
ss
County of Minnehaha
On this 9th day of June,2015,before me personally came Paul T. Bruflat,to me known,who,being by me duly sworn,did depose and say: that he
resides in the City of Sioux Falls,State of South Dakota;that he is the Vice President of WESTERN SURETY COMPANY described in and which executed
the above instrument;that he knows the seal of said corporation;that the seal affixed to the said instrument is such corporate seal;that it was so affixed
pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority,and acknowledges
same to be the act and deed of said corporation.
My commission expires
S. EICH
Februaryrebruary 12 202.1 NOTARY PUNX
JaSOUTH Drwt to S
S.Eich,Notary Public
CERTIFICATE
I, L.Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 17th day of i ti] y 2017
.
9"
�t � WESTERN SURETY COMPANY
I tA*v
L.Nelson„Assistant Secretary
Form F4280-7-2012
Agreement No. 5196A
Authorizing By-Law
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the shareholders
of the Company.
Section 7. All bonds, policies, under-takings, Powers of Attorney, or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other
officers as the Board of Directors may authorize. The President, any Vice President,'Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds,policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity ofanybonds, policies, undertakings, Powers of Attomey or other obligations of the
corporation. The signature of any such officer and the corporate seal may be-printed by facsimile.