Bond - Project 311 - Sewer Manhole Surface Repair Program RECEIVED
NOV 2 3 2015
VERIFY YOUR BOND—MODEL INQUIRY C�SIA MESH SANiiAB)�I$)�ilid
fond Authenticity Inauiry
To: Name and Address of Surety:
SureTec Insurance Company, 3033 51h Avenue,Suite 300, San Diego,CA 92103
This bond or bonds described below have been presented to us.Please acknowledge that these bonds have been provided by your
company.
A copy of the bond(s)may be submitted in lieu of providing the information marked with an asterisk(*)
*Bond Number(if any): 4400966—Faithful Performance Bond; Labor and Material Bond
*Name and Address of Principal on the Bond(If Principal is a Joint Venture,include Name of all Parties):
FB5 General Fngineering, Inc. 1320 E. Sixth Street.Suite 100. Corona.CA 92879
*Name and Address of Obligee:
Costa Mesa Sanitary District. 678 W. 19th Street. Costa Mesa CA 92677
*Amount of Performance Bond: $47,420.00
*Amount of Payment Bond: $47,420.00
*Date Bond Executed: October 28,2015
*Name of Person Signing Bond for Surety: Charles L. Flake
*Brief Description of the Project: Sewer Manhole Surface Repair Program—Phase lh
Project No.311
Please Send Confirmation to Name and Address:
Dyana Bojarski,Management Analyst, Costa Mesa Sanitary District,628 W. 191h Street,
Costa Mesa. CA 92627
Validity Confirmed:
Company Name: This is an active/ valid bond.
Signed By: ! _ SureTec Insurance Company
(Print or Type Name) Jessica Donaghe, Contract Underwriting Assistant
Executed in Three Counterparts
FAITHFUL PERFORMANCE BOND
PAGE 1
Bond No. 440966
Premium: $683
COSTA MESA SANITARY DISTRICT
FAITHFUL PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT, WHEREAS, COSTA MESA SANITARY DISTRICT (DISTRICT), a California
Sanitary District, has on t 's4,vy\\e,1g. )2j awarded to
(Name and Address of Contractor)
EBS General Engineering, Inc.
1320 E. Sixth Street, Suite 100, Corona, CA 92879
hereinafter designated as the "PRINCIPAL," an AGREEMENT for the work described as follows:
Sewer Manhole Surface Repair Program — Phase II, Project No. 311_ Said
AGREEMENT is fully incorporated herein by reference.
WHEREAS, the said PRINCIPAL is required under the terms of said AGREEMENT to
furnish a bond for the faithful performance of said AGREEMENT.
NOW, THEREFORE, WE, the undersigned CONTRACTOR, as PRINCIPAL, and
(Name and Address of Surety)
Suretec Insurance Company
3033 5th Avenue, Suite 300, San Diego, CA 92103
hereinafter designated as the "SURETY," duly authorized to transact business under the laws of
the State of California, as SURETY, are held and firmly bound unto the Costa Mesa Sanitary
District., in the penal sum of: _forty-seven thousand four hundred twenty_ ($_47,420.00J,
said sum being not less than one hundred percent (100%) of the estimated amount payable
under the terms of the AGREEMENT for which payment well and truly be made, we bind
ourselves and our heirs, executors and administrators, successors and assigns, jointly and
severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that, if the above burdened
PRINCIPAL, his/her/its heirs, executors, administrators, successors, or assigns, shall in all
things stand to and abide by, and well and truly keep and perform all the undertakings, terms,
covenants, conditions, and agreements in the said AGREEMENT and any alteration thereof
made as therein provided, on his or their part, to be kept and performed, at the time and in the
manner therein specified, and in all respects according to their true intent and meaning, and
shall indemnify and save harmless the Costa Mesa Sanitary District, its officers, and its agents,
as therein stipulated, then this obligation shall become null and void, otherwise it shall be and
remain in full force and virtue.
FAITHFUL PERFORMANCE BOND
PAGE 2
Bond No. 4400966
In case suit is brought upon this bond, SURETY further agrees to pay all court costs and
reasonable attorney's fees as fixed by the court
And the said SURETY, for value received, hereby stipulates and agrees that no change,
extension of time, alteration, or addition to the terms of the AGREEMENT or to the work to be
performed thereunder or the specifications accompanying the same shall in any way affect its
obligations on this bond, and it does hereby waive notice of any such change, extension of time,
alteration, or addition to the terms of the AGREEMENT or to the work or to the specifications.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this 28'"
day of October , 2015_
CONTRACTOR
EBS General Engineering, Inc.
1320 E. Sixth Street, Suite 100, Corona, CA 92879
(ADDRESS)
PRINCIPAL
By: /�
Company R presentative
Jcre n R. Nmc., 12rz;.de,*
In accordance with the AGREEMENT, all bonds shall have been issued by an admitted
surety insurer, and the DISTRICT reserves the right to object to any such surety, in accordance
with Code of Civil Procedure Section 995.660.
By signing below, SURETY certifies that the bonds are issued by admitted surety.
SURETY
Suretec Insurance Company
3033 5th •PAP_At
- e, Suite 300, San Diego, CA 92103
By: _
op
m
Coe:w-sWtative
Charles L. Flake, Attorney-In-Fact
APPROVED AS TO FORM:
District Counsel
Costa Mesa Sanitary District
By /s/
1
•
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
1 County of Orange ••
I On 10/28/15 before me, Lexie Sherwood Notary Public, 1
Dara igen Name of Notary exactly as it appears on the official seal '.
personally appeared Charles L. Flake •
N mel)or Signe")
-- 1
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(ies), '1
and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) I
LEXISromnr ttSHER2oanWOODaz acted, executed the instrument.
0i I o k7,--Jock 0cnuwemA '6 I certify under PENALTY OF PERJURY under the laws of 1,
y ()NOL.
NCE courvTv the State of California that the foregoing paragraph is true
JULY 27,2017 and correct. I j
Witness my hand and ocial seal
Signature e�- �'////�GCIC F D�
Place Notary Seal Above Signature ofNewry Public Lexie Sherwood
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of the form to another document.
Description of Attached Document
i Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above: _ 1 '
Capacity(ies) Claimed by Signer(s)
' Signer's Name. _ _ Signer's Name:
❑ Individual ❑ Individual
❑ Corporate Officer Tille(s): ❑ Corporate Officer —Title(s):
❑ Partner ❑Limited (General ❑ Partner ❑Limited ❑ General
❑ Attorney in Fact RIGHT THUMBPRINT ❑ Attorney in Fact RIGHT THUMBPRINT
❑ Trustee OF SIGNER ❑ Trustee OF SIGNER
O Guardian or Conservator Top of thumb here ❑ Guardian or Conservator Top of thumb here
❑ Other: ❑ Other: 1.
Signer is Representing: Signer is Representing:
__ ___ — - ___ _..__ _. _ _ JI
FOA e: 510123
SureTec Insurance Company
LIMITED POWER OF ATTORNEY
Know AU Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and
existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents
make,constitute and appoint
Charles L. Flake, David L.Culbertson, Richard A.Coon, Spencer Flake
its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name,place and stead,to execute, acknowledge
and deliver any and all bonds,recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the
conditions of contracts and consents of surety for:
Five Million and 00/100 Dollars($5,000,000.00)
and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President, sealed with the corporate
seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney-in-Fact may do in the
premises. Said appointment shall continue in force until 1O131/201e and is made under and by authority of the following
resolutions of the Board of Directors of the SureTec Insurance Company:
Be it Resolved, that the President, any Vice-President, any Assistant Vice.President, any Secretary or any Assistant Secretary shall be and is
hereby vested with hill power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on
behalf of the Company subject to the following provisions:
Attorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company,to execute, acknowledge and
deliver, any and all bonds,recognizances, contracts,agreements or indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be it Resolved that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or
any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid
and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adapted at a meeting held on 20th of April.
1999.)
In Witness Whereof SURETEC INSURANCE COMPANY has caused these presents to be signed by its President,and its corporate seal
to be hereto affixed this 18th day of May A.D. 2015
,,.....,,„, SURETEC INSURANCE COMPANY
SUPANCF A er
�,,.......,o�
,_y' X/q '.LL By:
a .* n John rox Jr: 'resident
State of Texas ss'. 9s+.. 1
County of Harris
„✓
On this ion day of May ,A.D. and before me personally came John Knox Jr.,to me known,who,being by me duly sworn,did depose and say,that he
resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above
instrument;that he knows the seal of said Company;that the seal affixed to said instrument is such corporate seal;that it was so affixed by order of the
Board of Directors of said Company;and that he signed his name thereto by like order.
wq„ JA000ELYN MAIDONADO
/ry NonaryPuhLc n �\�\l
State Exp 5i1s
\O� My comm.EV snarson Jacq elyn Maldonado,Notary Public
I o. My commission expires May 18,2017
I,M.Brent Beaty,Assistant Secretary of SURETEC INSURANCE COMPANY,do hereby certify that the above and foregoing is a true and correct copy
of a Power of Attorney,executed by said Company,which is still in full force and effect;and furthermore,the resolutions of the Board of Directors, set
out in the Power of Attorney are in full force and effect.
Given under my hand and the seal of said Company at Houston, Texas this 28TH day ofOCTOBER _2015 ,A.D.
• /u/i
. Bre.t Beaty,Assistant ecretary
Any Instrument issued In excess of the penalty stated above is totally void and without any validity.
For verification of the authority of this power you may call 713)812-0800 any business day between 8:00 am and 5:00 pm CST.
_- i
California All-Purpose Acknowledgement
State of California}
County of Orange
On ('2-•\S before me, William E. Ellis, Jr. ,a Notary Public
personally appeared_ Joseph A. Nandi
who proved to me on the basis of satisfactory evidence
to be the personO whose nameXis/arc subscribed to
the within instrument and acknowledged to me that he/
she/thcy executed the same in hisN,.,l/th,,:r authorized
,��.�a�•._`s WILLIAM E ELLIS Jq. capacity(tea}, and that by histhcihheir signaturets) on
9�¢;�a Commission #2127998 the instrument the person(s), or the entity upon behalf
r
"' 7 Notary Public -California i of which the person)acted,executed the instrument.
'.,,7 Orange County '_ I certify under PENALTY OF PERJURY under the laws
A Comm.Ex ires Oct 23,2079 of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
GUt aegat.t `e reJ2S2/2
Notary Public Seal Notary Public Signature
OPTIONAL
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s)Other than Named Above:
Capacity(ies) Claimed by Signer(s)
Thumbprint of Signer t 0 Individual ❑Individual
p g ❑Corporate Officer: Thumbprint of Signer2 ❑Corporate Officer:
❑Partner- O Limited O General ❑Partner- ❑Limited O General
❑Attorney-in-Fact ❑Attorney-in-Fact
❑Trustee 0 Trustee
❑Guardian or Conservator ❑Guardian or Conservator
❑Other: ❑Other:
Signer is Representing: Signer is Representing:
Executed in Three Counterparts
PAYMENT BOND
PAGE 1
Bond No. 440966
Premium: Included in Performance Bond
COSTA MESA SANITARY DISTRICT
PAYMENT BOND
(LABOR AND MATERIAL BOND)
KNOW ALL MEN BY THESE PRESENTS:
THAT, WHEREA , COSTA MESA SANITARY DISTRICT (DISTRICT), a California
sanitary district, has on h 4Q,rYlv1pf(2. 33, 2p-01c-
warded to
(Name and Address of Contractor)
EBS General Engineering, Inc.
1320 E. Sixth Street, Suite 100, Corona, CA 92879
hereinafter designated as the "PRINCIPAL," an AGREEMENT for the work described as follows:
Sewer Manhole Surface Repair Program — Phase II', Project No. 311_ Said
AGREEMENT is fully incorporated herein by reference.
WHEREAS, said PRINCIPAL is required by the provisions of said AGREEMENT and of
the Civil Code to furnish a bond in connection with said AGREEMENT, as hereinafter set forth.
NOW, THEREFORE, WE, the undersigned CONTRACTOR, as PRINCIPAL, and
(Name and Address of Surety)
Suretec Insurance Company
3033 51h Avenue, Suite 300, San Diego, CA 92103
hereinafter designated as the "SURETY," duly authorized to transact business under the laws of
the State of California, as SURETY, are held and firmly bound unto the Costa Mesa Sanitary
District, in the penal sum of: _forty-seven thousand four hundred twenty _ ($217,420.00 ),
said sum being not less than one hundred percent (100%) of the estimated amount payable
under the terms of the AGREEMENT for which payment well and truly be made, we bind
ourselves and our heirs, executors and administrators, and successors and assigns, jointly and
severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that, if said PRINCIPAL or his/her/its
subcontractors, or the heirs, executors, administrators, successors, or assigns thereof, shall fail
to pay any of the persons named in Section 3181 of the Civil Code of the State of California for
any materials, provisions, provender, or other supplies used in, upon, for, or about the
performance of the work contracted to be done, or for any work or labor performed by any such
claimant or any amounts required deducted, withheld, and paid over to the Franchise Tax Board
from the wages of employees of the CONTRACTOR and his subcontractors pursuant to Section
18806 of the Revenue and Taxation Code, with respect to such work and labor, then said
SURETY will pay for the same, in an amount not exceeding the sum set forth hereinabove, and
in addition, in case suit is brought upon the bond, will pay a reasonable attorney's fee to be fixed
by the court. This bond shall inure to the benefit of any and all persons named in the aforesaid
Civil Code Section 3181 so as to give a right of action to them or their assigns in any suit
brought upon the bond.
PAYMENT BOND
PAGE 2
Bond No. 440966
Further, the said SURETY, for value received, hereby stipulates and agrees that no
change, extension of time, alteration, or modification of the CONTRACT DOCUMENTS or of the
work to be performed thereunder shall in any way affect its obligation on this bond, and it hereby
waives notice of any and all such changes, extensions of time, and alterations or modifications
of the CONTRACT DOCUMENTS and/or of the work to be performed thereunder.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this 28'"
day of October , 2015_
CONTRACTOR
EBS General Engineering, Inc.
1320 E. Sixth Street, Suite 100, Corona, CA 92879
(ADDRESS)
PRINCIPAL
By. /" 1
Company Representative
3netc, A. NNt." "V< eirk-
Inn accordance with the AGREEMENT, all bonds shah have been issued by an admitted
surety insurer, and the DISTRICT reserves the right to object to any such surety in accordance
with Code of Civil Procedure Section 995.660.
By signing below, SURETY certifies that the bonds are issued by an admitted surety.
SURETY
Suretec Insurance Company
3033 51" Ave- , Suite 300, San Dies o, CA 92103
By: iSArr .
_
Comp:n 'epre entre
Charles L. Flake, Attorney-In-Fact
APPROVED AS TO FORM:
District Counsel
Costa Mesa Sanitary District
By/s/
1
I ' CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT I l
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. I
STATE OF CALIFORNIA•
lj •
•
• CountY o
9
f Oran e J
iI
'I On 10/28/15 before me, Lexie Sherwood , Notary Public,
Date Insect Name of Notary exactly as it appears on the official seal
personally appeared Charles L. Flake 111 "
mama(:)ofSgoerts7
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name(s) is/are subscribed to the 1,
within instrument and acknowledged to me that he/she/they l '
executed the same in his/her/their authorized capacity(ies), 1 .
• .,,�,..," and that by his/her/their signature(s) on the instrument the 1 .
LEXIE SHERWOOD person(s), or the entity upon behalf of which the person(s)
" Con;tis 031722 acted, executed the instrument.
0 ffict. 1 NOTARY, CALIFORNIA L
ffin s uta r nousv I certify under PENALTY OF PERJURY under the laws of
Comm Exp JULY zT.zov the State of California that the foregoing paragraph is true
and correct.
Witness my hand andgfficial,seal.
IH
Signature 1�, i/pwz�-gp�
Place Notary Seal Above Sienatereo I. Public Lexie SSSnerwood
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of the form to another document.
Description of Attached Document
Title or Type of Document:
Document Date: _ _ Number of Pages:
Signer(s)Other Than Named Above:
•
Capacity(ies) Claimed by Signer(s) I
Signer's Name: Signer's Name: i i,
❑ Individual ❑ Individual '•.
❑ Corporate Officer—Title(s): C Corporate Officer --Title(s):
U Partner 0 Limited U General U Partner U Limited U General
i U Attorney in Fact RIGHT THUMBPRINT U Attorney in Fact RIGHTTHUMBPRINT
❑ Trustee OF SIGNER U Trustee OF SIGNER l
U Guardian or Conservator Top of thumb here U Guardian or Conservator Top of thumb here
U Other: U Other:
I
Signer is Representing. Signer is Representing:
POA a: 510123
SureTec Insurance Company
LIMITED POWER OF ATTORNEY
Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and
existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents
make,constitute and appoint
Charles L.Flake, David L. Culbertson, Richard A.Coon,Spencer Flake
its true and lawful Attorney-in-fact, with full power and authority hereby conferred in its name,place and stead,to execute, acknowledge
and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the
conditions of contracts and consents of surety for:
Five Million and 00/100 Dollars($5,000,000 00)
and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President, sealed with the corporate
seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney-in-Fact may do in the
premises. Said appointment shall continue in force until 10/3112016 and is made under and by authority of the following
resolutions of the Board of Directors of the SureTec Insurance Company:
Be it Resolved, that the President,any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is
hereby vested with full power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for and on
behalf of the Company subject to the following provisions:
Attorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company,to execute, acknowledge and
deliver,any and all bonds,recognizances,contracts,agreements or indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or
any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid
and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held art 20'"of April,
1999.)
In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its President,and its corporate seal
to be hereto affixed this 18th day of May A.D. 2015
SURETEC INSURANCE COMPANY
SURA/
F! 06 9i By:
1w�I n: Jahn ox Jr.. resident
Staa''. /a e ;zl
Coue nty Texas ss: 9m., t �j
County of Harris
On this 18th day of May A.D. 2018 before mepersonallycame John Knox Jr.,to me known,who,being by me duly sworn,did depose and say,that he
resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above
instrument;that be knows the seal of said Company;that the seal affixed to said instrument is such corporate seal;that it was so affixed by order of the
Board of Directors of said Company;and that he signed his name thereto by like order.
v U
&s t 3A000ELYNNmaryMALbONAnOvuhuc
State of Taros
‘33W8-4' My Conn En.sr31mn Jacq elyn Maldonado,Notary Public
My commission expires May 18,2017
I,M.Brent Beaty,Assistant Secretary of SURETEC INSURANCE COMPANY,do hereby certify that the above and foregoing is a true and correct copy
of a Power of Attorney,executed by said Company,which is still in MI force and effect;and furthermore,the resolutions of the Board of Directors,set
out in the Power of Attorney are in full force and effect.
Given under my hand and the seal of said Company at Houston, Texas this 28TH day of OCTOBER 2015 _ , A.D.
•
lW -
-
. Bre,t Beaty,Assistant ecretary
Any instrument Issued in excess of the penalty stated above is totally void and without any validity.
For verification of the authority of this power you may call(713)812-0800 any business day between 8:00 am and 5:00 pm CST.
California All-Purpose Acknowledgement
State of California }
County of Orange
On 1 ( •2•\ S before me, William E. Ellis, Jr. ,a Notary Public
personally appeared Joseph A. Nanci
who proved to me on the basis of satisfactory evidence
to be the persons) whose nameXis/arc subscribed to
the within instrument and acknowledged to me that he/
she/they executed the same in his/LA/tin-ix authorized
capacity(ies , and that by his/fm/Hreit signature's),on
the instrument the personN or the entity upon behalf
+o. WILLIAM E EL118 Ja, of which the person)acted,executed the instrument.
3 s, Commission x 2127998 I certify under PENALTY OF PERJURY under the laws
7� NotaryPublic- California i of the State of California that the foregoing paragraph
?� Orange County a
M Comm.Ex fres Oct 23,2019 is true and correct.
WITNESS my hand and official seal.
or
Notary Public Seal Notary Public Signature
OPTIONAL
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s)Other than Named Above:
Capacity(ies) Claimed by Signer(s)
Thumbprint of Signor I ❑Individual ❑Individual
p 9Thumbprint of Signer 2
❑Corporate Officer: ❑Corporate Officer:
❑Partner- ❑Limited O General ❑Partner- ❑Limited O General
❑Attorney-in-Fact ❑Attorney-in-Fact
❑Trustee 0 Trustee
❑Guardian or Conservator ❑Guardian or Conservator
❑Other: ❑Other:
Signer is Representing: Signer is Representing:
Executed in Three Counterparts
SURETEC INSURANCE COMPANY
1330 Post Oak Blvd., Suite 1100 Houston, TX 77056
CHANGE RIDER
Date: November 10, 2015
To be attached to and form a part of:
Bond Number: 440966
Principal: EBS General Engineering, Inc.
Obligee: Costa Mesa Sanitary District
Said bond, issued by SureTec Insurance Company, as Surety, is hereby amended as follows:
Change Bond no. from: 440966
To: 4400966.
Effective date of rider: October 28 2015
All other terms and conditions shall remain the same.
Signed and sealed this tenth day of November, 2015.
SureTec Insurance Company
Surety
By: . .,dile
Sp-neer Flake, Attorney-in-fact
Change Rider doc rev. 1.1.06
1
CALIFORNIAALL-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 11/10/15 before me, Lexie Sherwood , Notary Public,
Dale Insert Narne 0Notary exactly as R appears on the official seal
personally appeared Spencer Flake '
Namels)of Signer(s)
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name(s) is/are subscribed to the i.
within instrument and acknowledged to me that he/she/they 1 .
executed the same in his/her/their authorized capacity(ies),
LE SI ILRWOOD and that by his/her/their signature(s) on the instrument the
d''t-' r co- t a2031782 person(=), or the entity upon behalf of which the person(=) •
It* Otttj oy f n C.CALIFORNIA acted, executed the instrument.
`ys _ : onr.;ccouury
.,,;� , comm Fm JULY zn 2017 I certifya under PENALTY PERJURY under the laws of
the State of California thatt the foregoing paragraph is true I
and correct.
Witness my hand and official seal.
•
Signature
.__a. r_-..
nota Notary Seal Above Signature or .fa . Public exie erwoo.
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of the form to another document.
Description of Attached Document
Title or Type of Document -
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s) I
Signer's Name: Signer's Name:
❑ Individual ❑ Individual
❑ Corporate Officer—Title(s): _ ❑ Corporate Officer —Title(s):
❑ Partner L7 Limited LI General ❑ Partner ❑Limited❑ General
❑ Attorney in Fact RIGHTTHUNrEPRINT ❑ Attorney in Fact RIGHT THUMBPRINT
❑ Trustee OF SIGNER ❑ Trustee OF SIGNER
❑ Guardian or Conservator Top of thumb here ❑ Guardian or Conservator Top of thumb here
H Other. 9 Other.
Signer is Representing: Signer is Representing:
I
Pont 510123
SureTec Insurance Company
LIMITED POWER OF ATTORNEY
Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and
existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents
make,constitute and appoint
Charles L. Flake, David L. Culbertson,Richard A.Coon,Spencer Flake
its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name,place and stead,to execute,acknowledge
and deliver any and all bonds, recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the
conditions of contracts and consents of surety for:
. Five Million and 00/100 Dollars($5,000,000.00)
and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President, sealed with the corporate
seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attomey-in-Fact may do in the
premises. Said appointment shall continue in force until 10/31/2016 _ and is made under and by authority of the following
resolutions of the Board ofDirectors of the SureTec Insurance Company:
Be it Resolved, that the President,any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is
hereby vested with full power and authority to appoint any one or more suitable persons as Attamey(s)-in-Fact to represent and act for and on
behalf of the Company subject to the following provisions:
Attorneyin-Fact may be given full power and authority for and in the name of and of behalf of the Company,to execute,acknowledge and
deliver,any and all bonds,recognizanecs,contracts,agreements or indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminaling the Company's liability thereunder, and any such instruments so executed by any such
Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be it Resolved that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attomey or
any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid
and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 20°of April,
1999.)
In Witness Whereof,SURETEC INSURANCE COMPANY has caused these presents to be signed by its President,and its corporate seal
to be hereto affixed this 18th day of May A.D. 2015
SURETEC INSURANCE COMPANY
w! x19 .o;ti By: 14 Of
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/co 2. John sox Jr. 'resident
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State of Texas ss: 9f`., 1 //
County of Harris "
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On this 1815 day of May ,A.D. 2015 before me personally came John Knox Jr.,to me known,who,being by me duly sworn,did depose and say,that he
resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above
instrument;that he knows the seal of said Company;that the seal affixed to said instrument is such corporate seal;that it was so affixed by order of the
Board of Directors of said Company;and that he signed his name thereto by like order.
s�y� JACQUELYN MA0118 O
',j.• Nate oP Texas
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W mm. oft, 5az 1 I
Co., My Comm.Exit, si eimn Jacq elyn Maldonado,Notary Public
My commission expires May 18,2017
I,M.Brent Beaty,Assistant Secretary of SIJRETEC INSURANCE COMPANY,do hereby certify that the above and foregoing is a true and correct copy
of a Power of Attorney,executed by said Company,which is still in full force and effect;and furthermore,the resolutions of the Board of Directors,set
out in the Power of Attorney are in full force and effect.
Given under my hand and the seal of said Company at Houston, Texas this l OTll day of NOVEMBER 2015 A.D.
IF
.Bre't Beaty,Assistant ecretary
Any Instrument issued in excess of the penalty stated above Is totally void and without any validity.
For verification of the authority of this power you may call(713)812-0800 any business day between 8:00 am and 5:00 pm CST.