15-0804_CHARLES KING COMPANY, INC._Preliminary NoticeLIBERTY MUTUAL SURETY
PO BOX 11053
ORANGE, CA92856-9926
Date of Request: 8/31/2015
CITY OF SAN JUAN CAPISTRANO
32400 PASEO ADELANTO
SAN JUAN CAPISTRAN, CA 9267 5
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SURETY
Offrce: [,os Angeles
Phone: 800-763-9268
Fax: 855-318-1836
Email : StatusQuery@LibertyMutual.com
005642
ContractBond
Status Query
In order to allow us to monitor the progress of our contractor, please complete and return this form. Your response will not prejudice
your rights or affect our liability under our bond(s) referred to below. We enclose a prepaid return envelope for your use.
BondNumber:024047208 ContractPrice: $1,695,422.00 InceptionDate: I/4/20I3
Cross Reference Bond Number:
Contract Description: Improvement plans for I-5 & Ortega Highway Interchange Pipeline Relocation Project (CIP No
Our Bond On Behalf Of: Charles King Company,Inc.
Bond Executed In The
Following Company: The Ohio Casualty Insurance Company
Signed
Tim Mikolajewski
President - Liberty Mutual Surety
1. HAS CONTRACT BEEN COMPLETED?
2. IF COMPLETED PLEASE STATE:
a. Date ofacceptance
b. Total amount of completed conkact
3. IF NOT COMPLETED PLEASE STATE:
a. Probable completion date
b. Amount paid contractor to date
c. Amount withheld as retained percentage
4. HAS WORK PROGRESSED SATISFACTORILY?
5. ARE THERE ANY UNSATIS}-IED CLAIMS OR LIENS ON FILE?
.-D-
REMARKS:
Signed
Name
Title
Dated:
Phone: Fax: