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25078122 - Notice of Acceptance of Completion - Fuel Station Secondary Containment Components Repair Project No. 21-PW-264 - Balch Petroleum Contractors & Builders - Recorded 08/25/2021RECORDING REQUESTED BY: City of Gilroy WHEN RECORDED, MAIL TO: City Clerk's Office City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 25078122 Regina Alcomendras Santa Clara County - Clerk -Recorder 08/25/2021 03:14 PM Titles: 1 Fees: $0.00 Taxes: 0 Total: 0.00 Pages: 3 1111 Eirdj'T h1LSiih•''ll Wily),11111 (SPACE ABOVE THIS LINE FOR RECORDER'S USE) RECORD WITHOUT FEE UNDER SECTION 27383 GOVERNMENT CODE OF STATE OF CALIFORNIA Notice of Acceptance of Completion Fuel Station Secondary Containment Components Repair Project Project No. 21-PW-264 Balch Petroleum Contractors & Builders, Inc. 181920 Ock I P 6 4 4atz-evni-6 A,LIL-814-6 SEPARATE PAGE PURSUANT TO GOVT. CODE 27361.6 NOTICE OF ACCEPTANCE OF COMPLETION NOTICE IS HEREBY GIVEN that, as of the 16th day of August, 2021, the City of Gilroy, California ("City") has accepted as completed the work required to be performed under the following agreement ("Agreement") by and between Balch Petroleum Contractors & Builders, Inc. ("Contractor") and City: Fuel Station Secondary Containment Components Repair Project Project No. 21-PW-264 Balch Petroleum Contractors & Builders, Inc. Project No.: 21-PW-264 Contractor Name: Balch Petroleum Contractors & Builders, Inc. Contractor Address: 930 Ames Avenue, Milpitas, CA 95035 Surety on Contract: American Contractors Indemnity Company Location of Project: Gilroy, California Description of Work: This project includes the removal, disposal, and replacement of two existing suction system fuel dispensers and all associated equipment, fittings and accessories, including replacement of concrete island and slab, and installation of a new accessible card reader unit at the City Corporation Yard. Interest of City: Owner in Fee Vendee under Agreement to Purchase Lessee Owner of Easements X Holder of License Owner of Streets Owner of Utilities, Water, Sewer, Storm Systems Owner's Name/Address: City of Gilroy, 7351 Rosanna Street, Gilroy, CA 95020 Work Done: See above, Description of Work This notice is given in accordance with the provisions of Section 3093 of the Civil Code of the State of California. The undersigned, being duly sworn, deposes and say: That I am an officer of the City of Gilroy, that I have read the foregoing Notice of Acceptance of Completion and know the contents thereof; and that the same is true of my own knowledge, except as to those matters that I believe to be true. I certify under penalty of perjury that the foregoing is true and correct. Executed at the City of Gilroy, County of Santa Clara, State of California, on J 1,y z .Zv c—/ CITY OF GILROY BY: Gary Heap TITLE: City Engineer ©ALIFORNI1JlA ALL-PURPOSE /,1©I N®W'JLEDONERIT ��:„=t.`�7=�^-."�-c':,r�4=.�`,2�r'.s�^���.Fa•r'`�(�^t=�r•.��t'�:�'��-rc�Y..�.�f'a-'^a'�� CIVIL CODE § 1189 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 CjC--tf1 \CiCCI On ,73-R Z 202_1 before me, SCh(Id 9VC.Ii)+11 , Date personally appeared Here Insert Name and Title of the Officer % I t f V \Aect Nanie(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the persons) whose name() is/are subscribed to the within instrument and acknowledged to me that he/the//h‘y executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature() on the instrument the personK, or the entity upon behalf of which the person) 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. Signature ,St?✓rti Signature of (Votary Public SANDRA E. NAVA Notary Public - California Santa Clara County Commission # 2262752 My Comm. Expires Nov 11, 2022 Place Notary Seal Above �=S,..� - - OITO®NAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description ofi Attached Document )�- a `1 Title or Type of Document: t-i-e v� A«-ep1u ace c-( ��' F Document Date: J v l) 2'1 2- a Number of Pages: Signer(s) Other Than Named Above: Capaclty(Ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Representing: Signer Is Representing: Signer's Name: 'v„-.""'v8-::-'%Gti-.i.=i.��_%cr.'!T�'F:T-•�.- ':.Fla'-:::c'.,rf.v,7'''-vh..--w.v'=.'.""`."_..., v_ - - av`GC.'C:��'a;• ©2014 National Notary Association ' www.NlationalNotary.org ^ 1-800-US NOTARY (1-800-876-6827) Item #5907 RECORDING REQUESTED BY: City of Gilroy WHEN RECORDED, MAIL TO: City Clerk's Office City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 25078122 Regina Alcomendras Santa Clara County - Clerk -Recorder 08/25/2021 03:14 PM CONFORMED COPY Copy of document recorded. Has not been compared with original. (SPACE ABOVE THIS LINE FOR RECORDER'S USE) RECORD WITHOUT FEE UNDER SECTION 27383 GOVERNMENT CODE OF STATE OF CALIFORNIA Notice of Acceptance of Completion Fuel Station Secondary Containment Components Repair Project Project No. 21-PW-264 Balch Petroleum Contractors & Builders, Inc. SEPARATE PAGE PURSUANT TO GOVT. CODE 27361.6 NOTICE OF ACCEPTANCE OF COMPLETION NOTICE IS HEREBY GIVEN that, as of the 16th day of August, 2021, the City of Gilroy, California ("City") has accepted as completed the work required to be performed under the following agreement ("Agreement") by and between Balch Petroleum Contractors & Builders, Inc. ("Contractor") and City: Fuel Station Secondary Containment Components Repair Project Project No. 21-PW-264 Balch Petroleum Contractors & Builders, Inc. Project No.: 21-PW-264 Contractor Name: Balch Petroleum Contractors & Builders, Inc. Contractor Address: 930 Ames Avenue, Milpitas, CA 95035 Surety on Contract: American Contractors Indemnity Company Location of Project: Gilroy, California Description of Work: This project includes the removal, disposal, and replacement of two existing suction system fuel dispensers and all associated equipment, fittings and accessories. including replacement of concrete island and slab, and installation of a new accessible card reader unit at the City Corporation Yard. Interest of City: Owner in Fee Vendee under Agreement to Purchase Lessee Owner of Easements X Holder of License Owner of Streets Owner of Utilities, Water, Sewer, Storm Systems Owner's Name/Address: City of Gilroy, 7351 Rosanna Street. Gilroy, CA 95020 Work Done: See above, Description of Work This notice is given in accordance with the provisions of Section 3093 of the Civil Code of the State of California. The undersigned, being duly sworn, deposes and say: That I am an officer of the City of Gilroy, that I have read the foregoing Notice of Acceptance of Completion and know the contents thereof; and that the same is true of my own knowledge, except as to those matters that I believe to be true. I certify under penalty of perjury that the foregoing is true and correct. Executed at the City of Gilroy, County of Santa Clara, State of California, on/y z-5j 2 _—/ CITY OF GILROY BY: Gary Heap TITLE: City Engineer ©ALRfP©L MA ALL-PURPOSE AC NO LE ONELTT CIVIL CODE § 1189 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 Santa C 1 FCA On - 4 � Z`i 2021 before me, 5 GI$`ACA E. MNct� l�iSiu (tA Date Here Insert Name and Title of the Offfcer Nan<(e(s) of Signer(s) personally appeared who proved to me on the basis of satisfactory evidence to be the personJ,sJ whose name,( is/are subscribed to the within instrument and acknowledged to me that he/ h / h y executed the same in his/jxer/t} it authorized capacity(ie's), and that by his/t7er/ter signature(8) on the instrument the persons, or the entity upon behalf of which the person) acted, executed the instrument. SANDRA E. NAVA Notary Public - California Santa Clara County Commission # 2262752 My Comm. Expires Nov 11, 2022 Place Notary Seal Above 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. Signatures • 1 ��- Signature of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description off Attached Document y-} i c 0 Title or Type of Document: K Dl-i e v-( Acc-e Onnce c± r Document Date: Number of Pages: Signer(s) Other Than Named Above: Capaciily(ies) Ciaiimec1 by Signer'js) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: v l JJ 2`1 -2- J Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator El Other: Signer Is Representing: C:_Y.'i:.r."=.•ti=:v-�T^.i{_=-°.:°�`vyn;=�Y.'Jcv.`.mot"�;aiv.."z^'�`�:5.4`_v3;�vC-::'_1.:4�'v`'"•iv:.'•i�-n:'":�-�-.v ©2014 National Notary Association ° www.NationalNotary.org , 1-800-US NOTARY (1-800-876-6827) Item #5907 City of Gilroy City Clerk's Office City Hall 7351 Rosanna Street Gilroy, California 95020-6197 Clerk -Recorder, Santa Clara County ATTN: Recording Division 70 West Hedding Street 1st Floor, East Wing San Jose, CA 95110 City Clerk's Office CityClerk(a cityofgilroy.org Telephone (408) 846-0204 www.cityof gilroy.org August 20, 2021 SUBJECT: (1) Notice of Acceptance of Completion Project No. 21-PW-264 Fuel Station Secondary Containment Components Repair Project Item 1 is recorded without fee per California Government Code Section 27383 as it is for the benefit of the City of Gilroy. Sincerely, LeeAnn McPhillips Interim City Clerk By: e�/�%" Anne Bybee, Chief Deputy Clerk Enclosure RECORDING REQUESTED BY: City of Gilroy WHEN RECORDED, MAIL TO: City Clerk's Office City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 (SPACE ABOVE THIS LINE FOR RECORDER'S USE) RECORD WITHOUT FEE UNDER SECTION 27383 GOVERNMENT CODE OF STATE OF CALIFORNIA Notice of Acceptance of Completion Fuel Station Secondary Containment Components Repair Project Project No. 21-PW-264 Balch Petroleum Contractors & Builders, Inc. SEPARATE PAGE PURSUANT TO GOVT. CODE 27361.6 NOTICE OF ACCEPTANCE OF COMPLETION NOTICE IS HEREBY GIVEN that, as of the l6th day of August, 2021, the City of Gilroy, California ("City") has accepted as completed the work required to be performed under the following agreement ("Agreement") by and between Balch Petroleum Contractors & Builders, Inc. ("Contractor") and City: Fuel Station Secondary Containment Components Repair Project Project No. 21-PW-264 Balch Petroleum Contractors & Builders, Inc. Project No.: 21-PW-264 Contractor Name: Balch Petroleum Contractors & Builders, Inc. Contractor Address: 930 Ames Avenue, Milpitas, CA 95035 Surety on Contract: American Contractors Indemnity Company Location of Project: Gilroy, California Description of Work: This project includes the removal, disposal, and replacement of two existing suction system fuel dispensers and all associated equipment. fittings and accessories, including replacement of concrete island and slab, and installation of a new accessible card reader unit at the City Corporation Yard. Interest of City: Owner in Fee Vendee under Agreement to Purchase Lessee Owner of Easements X Holder of License Owner of Streets Owner of Utilities, Water, Sewer, Storm Systems Owner's Name/Address: City of Gilroy, 7351 Rosanna Street. Gilroy. CA 95020 Work Done: See above, Description of Work This notice is given in accordance with the provisions of Section 3093 of the Civil Code of the State of California. The undersigned, being duly sworn, deposes and say: That I am an officer of the City of Gilroy, that I have read the foregoing Notice of Acceptance of Completion and know the contents thereof; and that the same is true of my own knowledge, except as to those matters that I believe to be true. I certify under penalty of perjury that the foregoing is true and correct. Executed at the City of Gilroy, County of Santa Clara, State of California, on J,f y zy .c..? CITY OF GILROY BY: Gary Heap TITLE: City Engineer ©ALUIlIDRM ALL-PURPOSE ACKNO JLEOCNEAT COM CODE § 1189 • 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 3cciltq ()al CA On -`JT�� ?A 2-02l before me, ,0tod iA oVct> cy'ra L1 K1\ Its, Date / Here Insert Name and Title of the Officer t s Gl i l/ ec Narrie(s) of Signer(s) personally appeared who proved to me on the basis of satisfactory evidence to be the personcsi whose name,() is/arg subscribed to the within instrument and acknowledged to me that he/9h6/they executed the same in his/-rer/their authorized capacity(0), and that by his/her/ter signature(8) on the instrument the person(), or the entity upon behalf of which the persons) acted, executed the instrument. SANDRA E. NAVA Notary Public - California Santa Clara County Commission # 2262752 My Comm. Expires Nov 11, 2022 Place Notary Seal Above 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. Signature rZ 2 , 11'`- Signature of Notary Public OPTIONAL. Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached aclhedl Document (bM )� i c Ili Title or Type of Document: tk ice c( Acc.e p±z nce c-� P Document Date: Number of Pages: Signer(s) Other Than Named Above: capacily(ies) Claimed by Signers) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer Is Representing: -71 \A kA 2i zaZl J Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: �.�..,,�.�F.•,;..-�. L ^c-r--^--c--�--,. _ :max .�.:�....v---� .L �•ycv.,�ti.•^`--a-�.�?.cz�`:��Y.� - _-�r��i-2 �4� _��i.-� ��.s..:;,�c.,a•—Y-v j;`4. �._^.;""� `-v'.�.�:--s.- �cv..:: v���-sn:�ti`5..�.'-4�-�.- ©2014 National Notary Association ^ www.NationalNotary.org 1-800-US NOTARY (1-800-876-6827) Item #5907