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2100 - PTM General Engineering Services Inc. - Traffic Signal Improvement Project - Valley at Ivar (C19601) o A This page is part of your document- DO NOT DISCARD 20191358687 CAlTFOI-0' 12/09/19 AT 09:44AM FEES: 0.00 TAXES: 0.00 OTHER: 0.00 CITY ROE:ETVIEAD PAID DEC ae 2019 0.00 ortCLERK,...4r6 lin Mill HINER LEA SHEET III�I I I IIIII III IIS 1 1 1 III I �A vi 1 1 1 III IIII I ii ii 20 9120 3 40010 001 6 8027 11 10111[1311419 14111 1 IN 01 II I IIII IiII I II liii I I III I I 11111 DII 111111 I ID 0 - IIiIIIIIflIIIVIII�IIBIIIIIIIIIIlE111911111N11111 RECORDING REQUESTED BY 1210912019 1� CITY OF ROSEMEAD 111111111 1,, AND WHEN RECORDED MAIL TO: *211191358687` Name City of Rosemead \L__-- 8838 E.Valley Blvd. Street Rosemead, CA 91770 Address City& ATTN: CITY CLERK State SPACE ABOVE THIS LINE FOR RECORDER'S USE Notice of Completion Notice is hereby given that: 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full name of the undersigned is: City of Rosemead 3. The full address of the undersigned is: 8838 E.Valley Blvd., Rosemead, CA 91770 4. The nature of the title of the underground is: In fee (If other than fee,strike"In fee"and insert,for example,"purchaser under contract of purchase,"or"lessee".) 5. The full names and full addresses of all persons, if any,who hold title with the undersigned are: Names Addresses N/A N/A 6. The names of the predecessors in interest of the undersigned, if the property was transferred subsequent to the commencement of the work of improvement herein referred to: Names Addresses N/A N/A (If no transfer made,insert,"none".) 7. A work of improvement on the property hereinafter described was completed on: October 11 . 2019 8. The name of the contractor, if any,for such work of improvement was: PTM General Engineering Services, Inc. 9. The property on which said work of improvement was completed is in the City of Rosemead County of Los Angeles .State of California, and,is described as follows: Traffic Signal Improvement Project - Valley Boulevard at Ivar Avenue 10. The street address of said property is: as listed in No.9 (If no street address has been officially assigned,insert"none".) Signature of owner named Dated: / / in paragrapgh 2 s Da Director of Public Works By City of Rosemead • I certify(or declare) under penalty of perjury that the foregoing is true and correct. Date / z/ Q// Chris Das4--- (2Z Director of Public Works City of Rosemead, California Rosemead, CA Place of Execution CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies onlythe 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 th ► fig 1 r On plZ,V./1V1 C I 2 \before me, I t b vw ol% ( lo '& C , Date Here Insert Name and Title of t e 0 icer c p 1)(1/41k-4,1 personally appeared r. Name of Signer who proved to me on the basis of satisfactory evidence to be the person,,whose name(,is, -subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/hcr/thcir authorized capacityjj )), and that by his/I ICI tt1icii,signatureV on the instrument the personc%or the entity upon behalf of which the person(4acted, executed the instrument. I certify under PENALTY OF PERJURY under the NATALIE HAWORTH laws of the State of California that the foregoing . c•`�'� Notary Public-California Los Angeles County paragraph is true and correct. Z : f Commission B 2272060 My Comm.Expires Dec 20,2022 WITNESS my hand and official seal. wili. Signature )k ,a 11 Place Notary Seal and/or Stamp Above Signature of NA.ry Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Docu ent, Title or Type of Document: _'! i 1_ 1 I k,t.-n) t`dit Document Date: l`-ICII 101 Number of Pages: Signer(s) Other Than Named Above: 1v F Capacity(ies) CI ed by Signer(s) • Name: J(* �ti Signer's Name: ❑ Corporate Officer—Title(s): 0 Corporate Officer—Title(s): ❑ Partner— 0 Limited 0 General 0 Partner— 0 Limited 0 General ❑ Individual 0 Attorney in Fact 0 Individual 0 Attorney in Fact ❑ Trustee 0 Guardian of Conservator 0 Trustee 0 Guardian of Conservator ❑ Other: 0 Other: Signer is Representing: Signer is Representing: ©2017 National Notary Association i i EMSf Y‘,...: l lrciv,c plopsJ NC�PORATED'nv ' CITY OF ROSEMEAD, CALIFORNBA Public Works/Engineering: 8838 East Valley Boulevard, Rosemead,California 91770 (626)569-2150 FAX:(626)307-9218 CONTRACT CHANGE ORDER Date: March 7, 2019 Contract Number: C19601 Project: Traffic Signal Improvement Project—Valley Boulevard Change Order Number: 1 at Ivar Avenue To: PTM General Engineering Service, Inc. ' 5942 Acorn Street Riverside, CA 92504 Contractor Telephone: (951) 710-1000 Attention: Mr. Brian Mendoza Contractor Fax: (951) 710-1006 Description of Change (additional sheet attached) ZI CO#1 - Due to the obstruction of an existing business awning, the northeast corner pole had to be relocated to the northwest corner and a different type of pole is needed. Please see attachment: $ 5,496.28 Total Contract Change Order No. 1: $ 5,49628 Reason for Change(additional sheets attached) /1 The above-described changes are outside of the original scope of work. Distribution Contractor ® Consultant ❑ Division ® Project Manager ® Project File ® Other: 0 Form PWE(Revised 5/09) Page 1 of 2 CITY OF ROSEiMIEAD • CONTRACT CHANGE ORDER The change results in the following adjustment of Contract Price and/or Time: Description Amount %Change Original Contract Price $ 97,079.00 Net Change by Previously Authorized Change Orders/Contract Amendment $ 0.00 This Change Order $ 5,496.28 Total Change Order Amount including this Change Order $ 5,496.28 Contract Price after Change Order(s) $ 102,575.28 Account/Program Numbers 225-6005-5395-27005-3014 $ 5,496.28 Contract Time prior to Change Order N/A Net Increase in Days Authorized by this Change Order N/A Current Contract Time including this Change Order N/A Project Completion Date Including Net Increase in Days by Change Order__. Contractor is hereby directed to make the herein-described changes and/or perform said herein-described work in connection with above reference project. All new work shall conform to the applicable provisions of the plans and specifications, except as specifically modified by the Contract Change Order. This Change Order No. 1 to Contract No. C19601 constitutes full and complete compensation for all costs associated with the above changes inclusive of insurance, contractors profit, direct and indirect overhead, extended office overhead, bonds, supervision, labor, materials and equipment. All other costs are non-compensable. All other provisions, requirements, terms and conditions contained in the above referenced Agreement remain in full force and effect. This Change Order is not valid until signed by both City and Contractor. Attachments: (List attached documents that support Change Order) Attached is Change Order#1 City of Rosemead Contractor/Consultant Prepared/Approved By: Accepted By: /// PTM General Engineering Services, Inc. Rey Alfonso,P.E., Director of Public Works Date Name of Contractor to City Engineer Date Contractor Representative Signature Date Additional City Approvals: i1i Voram + Q()(110& i.AIO1LPA) Printed Name, Title Title Date Title Date Form PWE(Revised 5/09) Page 2 of 2 PTM General Engineering Service Inco P. 0. Box 7745 Riverside, Ca. 92513-7745 Contractor's License # 947817 Class A; C-10; C-31; Via E-mail December 11, 2018 City of Rosemead 8838 East Valley Blvd. Rosemead, Ca. 91770 Attention: Rafael Fajardo,Engineer Reference: Traffic Signal Improvement Ivar and Valley (Project#27005) PTM Project#18.22 Subject: Change Order Request#01 Mr.Fajardo, Mentioned below is the additional cost related to the following changes: *Pole change LS $5,496.28 *Pole Change During the field review it was determined that the proposed Pole E Type 19.3.100 located on the NEC was unable to be installed due to existing building canopy, therefore pole was relocated to the NWC and replaced with a Type 24.4.100.Additional time may be required for procurement of materials. Additional Cost Request: $5,496.28 Please free to contact me at 951.710.1000 or 951.722.5755 Thank You, PTM General Engineering Brian Mendoza,Project Manager CZqfROSMea Tub& 410 ;Department Er,(y"ineermgC Division Received �t mate: 3. (1( Approved Denied: r Phone: 951.710.1000 Fax: 951.710.1006 DAILY EXTRA WORK REPORT City Of Rosemead Contract: 27005 Change Order 001 Contractor Job: P18-22-City Of Rosemead-Valley&Ivar TS Billing Number 1.0 Work Performed By: PTM General Engineering Services,Inc. Report Date 12/04/2018 Description of Work: Installation Of 24.4.100/35/SMA 12'LMA On The NW-Vally&Ivar TS Perform Date 12/03/2018 Labor Charges Labor Charges Craft ID Employee Name RT Hrs OT Firs Subs Units RT Rate OT Rate Subs Rate Extended RT Labor 541.44 Loi ELC J A Briseno 3.00 73.020 219.06 SC 11.00% 59.56 um LBR G1 J Felix 3.00 53.730 161.19 OT Labor 0.00 Loa LBR G1 I Felix 3.00 53.730 161.19 Equipment Charges Subtotal Labor 601.00 Equipment ID Class Make Model Al A2 RT Hrs OT Hrs RT Rate OT Rate Delay Factor Extended Subsistence 0.00 Eat 159A HCETD MANX 4985 3.00 70.420 211.26 Other Expenses 0.00 E02 IZUSU TRUCK T&TT 20-28 3.00 34.490 103.47 Mu 24.00% 144.24 E03 001.3 TRUCK T&TT 20-28 3.00 34.490 103.47 Labor Total 745.24 04 001.4 HYLFT BOOM 25-49 3.00 32.400 97.20 Material/Specialist Work/Lump Sum or Unit Price Payment Equipment Charges Number Date Vendor Name and Description Units Unit Price Extended Subtotal 515.40 Mot Walters Wholesale/Pole Change-Tax 8.75% 1.000 LS 3,615.94000 3,615.94 MU 15.00% 77.31 Contractor Comments Equipment Total 592.71 Material Charges Installation of 24.4.100/357SMA 12'LMA on the NW Corner of Ivar and Valley,instead of 19.3.100/25SMA/12'LMA on the NE Corner Subtotal 3,615.94 MU 15.00% 542.39 Material Total 4,158.33 Activity Total 5,496.28 • Work Total 5,496.28 Bill Subtotal 5,496.28 For Owner/Resident Engineer's Use Only Accepted: ❑New Bill ❑Approved for Payment Date of Action: Customer: Date: ❑Resubmittal ❑Returned for Correction Date Received: Contractor: Dale: Bill Total + 5,496.28 NTS Universal Bill Form Page 1 www.ewbills.com From: Ryan Thibault To: Brian Mendoza(briant otm-ena.com);"Jade" Cc: Ryan Thibault Subject: Fw:City of Rosemead-Valley&Ivar Traffic Signal Modification Date: Friday,December 07,2018 1:11:46 PM Attachments: Traffic Signal Valley and Ivar-Rev 1.pdf Brian, This change can be made still. The adder will be$3,325.00 to change the pole. Thank you, Ryan Thibault Walters Wholesale 714-784-1820 From:Jade [mailto:jade@ptm-eng.com] Sent: Monday, December 3, 2018 9:35 AM To: Ryan Thibault<Ryan.T hibault@walterswholesale.com> Cc: 'Brian Mendoza'<brian@ptm-eng.com>;jade@ptm-eng.com Subject: FW: City of Rosemead-Valley& Ivar Traffic Signal Modification Hi Ryan: Please see attached plan sheet for City of Rosemead project and advise what the cost change would be. Thank you, Ja Se'lit e,44,c o-zao PTM General Engineering T: 951.710.1000 From: Brian Mendoza<brian@ptm-eng.com> Sent: Monday, December 03, 2018 8:50 AM To:jadePptm-eng.com Subject: FW: City of Rosemead-Valley& Ivar Traffic Signal Modification Thanks: Brian Mendoza 951.710.1000 Office From: elie farah<efarahPeliefarahinc.com> Sent:Thursday, November 15, 2018 6:45 AM To:peterPptm-eng.com; 'Rafael Fajardo'<rfajardo(lcityofrosemead.org> Cc: sean.bestPmerrelljohnson.com; brianc ptm-eng.com