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COPP Contracting Inc. - Patio Home Street ResurfacingFile #: 635 [CA][PUBLIC][COPY:NOEST] Customer: Roy Allan Slurry Seal Inc Recording Requested by and Return to: P.O. #: Chandler Aggregates Inc Project: Patio Homes Neighborhood Street Resur I Rec ID: 04D6BCF7-32E0-4D75-B751-128630741469 P O Box 78450 Job #: 3264 Corona, CA 92877-0148 1 Cert No.: CALIFORNIA PRELIMINARY NOTICE - PUBLIC WORKS (THIS NOTICE IS GIVEN PURSUANT TO CALIFORNIA CIVIL CODE §§ 8034(B), 8102, 8106-8118, 8200 et seq., 8612, 9300 et Seq.) >> TO THE PUBLIC ENTITY OR REPUTED City Of Menifee 29683 New Hub Drive Ste C Menifee, CA 92586 >> TO DIRECT OR REPUTED CONTRACTOR Copp Contracting Inc 6751 Stanton Ave Buena Park, CA 90621 Contract Number 1500 >> TO LENDER, SURETY OR BONDING CO. OR >> REPUTED LENDER, SURETY, BONDING CO None The following is a general description of the labor, service, equipment or materials furnished or to be furnished by the undersigned: Aggregate Materials 2. The estimated amount of the work provided or to be provided is $########## 3. The name of the person who furnished that labor, service, equipment or materials is: Chandler Aggregates Inc P O Box 78450 Corona, CA 92877-0148 Relationship to Parties: 4. The name of the person who contracted for purchase of that labor, service, equipment or material is: Roy Allan Slurry Seal Inc 11922 Bloomfield Ave SANTA FE SPRINGS, CA 90670 5. The description of the jobsite is: Patio Homes Neighborhood Street Resurfacing Pavement Management Project No 16-03 Rouse rd at the end Menifee Contract # 1500 Menifee, CA County of Riverside REQUEST FOR COPY OF PAYMENT BOND AND NAME OF SURETY COMPANY TO CONTRACTING BODY: City Of Menifee or State Comptroller The undersigned Claimant hereby declares that he has supplied or will supply labor or materials as described above, that payment has not yet been made therefore; and that he hereby requests that the contracting body furnish a certified copy of the Payment Bond, if any, to the Claimant, at the address listed above, and the current address of the contracting public entity. I declare that I am authorized to file this claim on behalf of the Claimant. I have read the foregoing document and know the contents thereof; the same is true of my own knowledge. I declare under penalty of perj ry that the foregoing is true and correct. Executed at Corona, California on 11/30/2016 for CH D R AGGREGA ES C. Prepared by: Sandi Lawson, Cr d t Manager Phone: (9 -3900 Fax: (951) 277-3339 PROOF OF SERVICE BY MAIL AFFIDAVIT I declare that I served the Preliminary Notice, and any related documents, by certified or registered mail, posta e prepaid, or other certified delivery, addressed to the above named parties, at the addre es listed abo , on 11/30/2016. I declare under penalty of perjury that the foregoing is true n correct. E ed at Corona, California on 11/30/2016. Prepared by: Sandi Lawson, Cr dit a ager