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HomeMy WebLinkAboutC28800E Free Right-turn Lane at Fred Waring x Hwy 111 658-08Contract No. C28800E CITY OF PALM DESERT PUBLIC WORKS DEPARTMENT STAFF REPORT REQUEST: AWARD CONTRACT NO. C28800E FOR CONSTRUCTION OF THE FREE RIGHT TURN LANE AT FRED WARING DRIVE AND HIGHWAY 111 PROJECT TO ALL AMERICAN ASPHALT OF CORONA, CALIFORNIA, IN THE AMOUNT OF $313,765 (PROJECT NO. 658-08) SUBMITTED BY: Mark Greenwood, P.E., Director of Public Works CONTRACTOR: All American Asphalt 400 East Sixth Street, Corona, CA 92879 DATE: March 10, 2016 CONTENTS: Contract Agreement and Bonds Contractor's Proposal Vicinity Map Recommendation By Minute Motion: 1. Award Contract No. C28800E for construction of the Free Right Turn Lane at Fred Waring Drive and Highway 111 Project to All American Asphalt of Corona, California, in the amount of $313,765 (Project No. 658-08); 2. Authorize the Director of Finance to set aside a 10 percent contingency in the amount of $31,376; and 3. Authorize the Mayor to execute the agreement. Funding is available for this project in Account No. 2134384-4400100, Measure "A" Fund. Background In March 2008, the City was awarded federal Congestion Mitigation and Air Quality (CMAQ) grants for eight projects. The Regional Transportation Improvement Program was approved, which allows the City to proceed with the development of the projects. One of these projects is the reconfiguration of the right turn lanes from westbound Fred Waring Drive to northbound Highway 111. This project will eliminate the dual right turn lanes and replace them with a single, unrestricted free right turn lane. Staff Report Award Contract C28800E to All American Asphalt, Inc. (Project 658-08) Page 2 of 2 March 10, 2016 In December 2012, the City Council approved the appraisals and set just compensation for the property acquisition required to construct the free right turn. In September 2015, Caltrans authorized the construction phase of the project. Staff did not want to construct during the winter season and opted to wait until summer of 2016. A call for bids for the project was advertised, and on February 29, 2016, sealed bids were opened and read aloud. The following is a summary of the bids received: Contractor Location Bid Amount All American Asphalt Corona, CA $313,765 Granite Construction Indio, CA $338,338 Atom Engineering Hemet, CA $374,962 Bids were verified and All American Asphalt submitted the lowest responsive bid. Fiscal Analvsis This project is primarily funded using a CMAQ grant. The CMAQ grant reimbursed the City 88.0 percent of the design costs and 88.8 percent of the right-of-way acquisition and acquisition services. Caltrans will reimburse the City up to 100 percent of the construction costs. The City will utilize Local Measure A funds to contribute the City's share of this project. Prepared By: ,) el Kdontalvo, P.E, Senior Engineer Pa S. Gibson, Director of Finance • 7"W- JgiKrf M. Wohlmuth, City Manager DeZw Ma,.. Directorof P blic Works CONTRACT NO. C28800E AGREEMENT THIS AGREEMENT is made and entered into this 10th day of March, 2016, by and between City of Palm Desert, California, hereafter called "CITY" and All American Asphalt hereinafter called "CONTRACTOR". WITNESSETH RECITALS: CONTRACTOR has submitted to CITY its Contractor's Bid for the construction of CITY Project, 1. FREE RIGHT TURN LANE AT FRED WARING DRIVE AND HIGHWAY 111, CITY CONTRACT NO. C28800E, CITY PROJECT NO. 658-08, FEDERAL PROJECT NO. CML 5414(008), in strict accordance with the Contract Documents identified below, CITY has accepted said Bid. 2. CONTRACTOR states that it has re-examined its CONTRACTOR'S Bid and found it to be correct, has ascertained that its Subcontractors are properly licensed and possess the requisite skill and forces, has examined the site and Contract in accordance with the Contract Documents for the money set forth in its Bid to be paid as provided in the Contract Documents. AGREEMENT: IT IS AGREED BY THE PARTIES AS FOLLOWS: 1. Contract Documents: The entire contract consists of the following: (a) The Agreement; (b) The Notice Inviting Bids; (c) The Instruction to Bidders; (d) The Contractor's Bid; (e) The Bidder's Bond; (f) The Performance Bond; (g) The Payment Bond; (h) The General Specifications; (i) The Special Provisions; 0) The Standard Specifications as modified in other portions of the Contract Documents; (k) The Plans; (1) Any Change Orders issued; (m) Any additional or supplemental specifications, notices, instructions and drawings issued in accordance with the provisions of the Contract Documents (n) The Determination of Prevailing Wage Rates for Public Work,(o) Disadvantaged Business Enterprise Documents, (p) Federal Requirements for Federal Aid Construction Projects (q) Addenda No(s) 1. All of said Documents presently in existence are by this reference incorporated herein as if here set forth in full and upon the proper issuance of their documents they shall likewise be deemed incorporated. 2. Contractor shall commence the work within ten calendar days after the date of the Notice to Proceed and will do all things necessary to construct the work generally described in Recital No. 1 in accordance with the Contract Documents CONTRACT NO. C28800E and will complete said work within 45 Calendar Days from the Notice to Proceed date to the satisfaction of the Engineer. 3. Contractor agrees to indemnify, defend and save CITY and its officers, agents and employees, and the Engineer harmless from: a. Any and all liability, claims, damages, losses or injuries to any person or other entity, including injury to Contractor's employees, and all claims which arise from or are connected with the negligent performance of or failure to perform the work or other obligations of this Agreement, or which are caused or which are claimed to be caused by the negligent or intentional acts or omissions of Contractor, its subcontractors, its agents or employees, and, all expenses of investigating and defending against same, b. Any and all liability, claims, damages, losses or injuries to any and all contractors, subcontractors, material -men, laborers, or any other person, firm or corporation furnishing or supplying work, services, materials or supplies in connection with the performance of the Agreement. C. Attention is directed to the General Specifications - Claims, Liability, and Indemnity Agreement/Hold Harmless sections, which specifications are made part of this Agreement as set forth in Agreement paragraph 1, above. d. Attention is directed to Section 6-9, "Liquidated Damages" of the Standard Specifications and is hereby amended to substitute the "City of Palm Desert" in place of "Agency." Liquidated damages shall be $1,900 per calendar day of delay. 4. Should any litigation or arbitration be commenced between the parties concerning the works of improvements as referenced herein, the prevailing party in any such litigation, being the CITY or the Contractor, should be entitled to a reasonable sum for attorney's fees incurred in any such litigation relating to this Contract. 5. This Agreement shall be binding upon all parties hereto and their respective heirs, executors, administrators, successors, and assigns. 6. Contractor shall be paid in the manner set forth in the Contract Documents the amount of its Bid as accepted by CITY, subject to such additions and deductions as may be made pursuant to the Contact Documents and applicable law. Satisfactory Performance: The prime Contractor agrees to pay each Subcontractor under this prime contract for satisfactory performance of its contract no later than 10 days from the receipt of each payment the prime Contractor receives from City of Palm Desert. Any delay or postponement of CONTRACT NO. C28800E payment from the above referenced time frame may occur only for good cause following written approval of the City of Palm Desert. Release of Retention: The prime Contractor agrees further to release retention payments to each Subcontractor within 30 days after the Subcontractor's work is satisfactorily completed. Any delay or postponement of payment from the above referenced time frame may occur only for good cause following written approval of the City of Palm Desert. 7. Execution of the Agreement by the parties constitutes their agreement to abide by all applicable provisions of the California Labor Code; constitutes contractor's certification that he is aware of the provisions of said Code and will comply with them; and further constitutes Contractor's certification as follows: 1 am aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for workers' compensation or to undertake self insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the work of this contract." IN WITNESS WHEREOF the parties hereto have executed or caused to be executed by their duly authorized officials, this Agreement which shall be deemed an original on the date first above written. CONTRACTOR: All American Asphalt Signature to be notarized TITLE: CITY: TITLE: Mavor of Palm Desert, CA APPROVED AS TO CONTENT: MARK GREENWOOD, P.E. DIRECTOR OF PUBLIC WORKS ATTEST BY: TITLE: ATTEST BY: TITLE: City Clerk of Palm Desert, CA APPROVED AS TO FORM: ROBERT W. HARGREAVES CITY ATTORNEY CONTRACT NO. C28800E CONTRACTOR 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 ) ) SS. County of On , 20 , before me, , a Notary Public, personally appeared , 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), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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 CONTRACT NO. C28800E PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: awarded to designated as the "Principal", a contract for: That whereas the City of Palm Desert has hereinafter FREE RIGHT TURN LANE AT FRED WARING DRIVE AND HIGHWAY 111 PROJECT CITY PROJECT NO. 658-08 CITY CONTRACT NO. C28800E FEDERAL AID PROJECT NO. CML 5414 (008) WHEREAS, said Principal is required under the terms of said contract to furnish a good and sufficient bond for the performance of said contract: NOW THEREFORE, WE, All American Asphalt the Principal, and as Surety, are held and firmly bound unto the City of Palm Desert hereinafter called the City, in the penal sum of Three Hundred Thirteen Thousand Seven Hundred Sixtv-five and 00/100 Dollars ($313.765.00), being 100% of the contract amount in lawful money of the United States of America for the payment of which sum well and truly to be made, we hereby bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the above bounded Principal, his executors, heirs, administrators, and successors, or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants and agreements in the said contract and any alterations 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 City, its officers and agents, as therein stipulated, then this obligation shall become null and void; otherwise, it shall be and remain in full force and virtue. And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to terms of the contract or to the work to be performed thereunder or the specifications accompanying the same shall in any wise affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alterations or additions to the terms of the contract or to the work or the specifications. Should it become necessary for the City to institute a lawsuit or any other legal proceeding to enforce the terms and conditions of this bond, then all costs of said proceeding, including attorneys' fees, shall be awarded to the prevailing party. CONTRACT NO. C28800E IN WITNESS WHEREOF, identical counterparts of this instrument, each of which shall for all purposes be deemed an original thereof, have been duly executed by the Principal and Surety above named, on this day of , 20 SURETY (Signature must be notarized) INSURANCE COMPANY and/or AGENT ADDRESS TELEPHONE NUMBER SURETY ACKNOWLEDGEMENT PRINCIPAL (Signature must be notarized) 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 On before me, personally appeared , 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), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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 CONTRACT NO. C28800E PRINCIPAL ACKNOWLEDGEMENT 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 �� before me, personally appeared 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), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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 CONTRACT NO. C28800E PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: THAT WHEREAS, the City of Palm Desert (sometimes referred to hereinafter as "Obligee") has awarded to All American Asphalt (hereinafter designated as the "CONTRACTOR"), an agreement dated March 10. 2016 described as follows: FREE RIGHT TURN LANE AT FRED WARING DR. AND HIGHWAY 111, CITY PROJECT NO. 658-08, CITY CONTRACT NO. C28800E, FEDERAL PROJECT NO. CIVIL 5414(008), (hereinafter referred to as the "Contract"); and WHEREAS, said CONTRACTOR is required to furnish a bond in connection with said Contract, and pursuant to Section 9100 of the California Civil Code; NOW, THEREFORE, we, All American Asphalt, the undersigned CONTRACTOR, as Principal, and a corporation organized and existing under the laws of the State of , and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the City of Palm Desert and to any and all persons, companies or corporations entitled to file stop payment notices under Section 9100 of the California Civil Code, in the sum of Three Hundred Thirteen Thousand Seven Hundred Sixtv-five and 00/100 Dollars ($313,765.00), said sum being not less than one hundred percent (100%) of the total amount payable by the said Obligee under the terms of the said Contract, for which payment well and truly to be made, we bind ourselves, our heirs, executors and administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that, if said CONTRACTOR, his or its heirs, executors, administrators, successors or assigns, or Subcontractors, shall fail to pay for any materials, provisions or other supplies, implements, machinery or power used in, upon, for or about the performance of the Public Work contracted to be done, or to pay any person for any work or labor of any kind, or for bestowing skills or other necessary services thereon, or for amounts due under the Unemployment Insurance Code with respect to such work or labor, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of said CONTRACTOR and his or its Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect to such work and labor as required by the provisions of Section 9100 et seq. of the Civil Code, or for any amounts required to be deducted, withheld, and paid over to the Franchise Tax Board or Internal Revenue Service from the wages of employees of the CONTRACTOR or his or its Subcontractors, the Surety or Sureties hereon will pay for the same in an amount not exceeding the sum specified in this bond, otherwise the above obligation shall be void. In addition to the provisions herein above, it is agreed that this bond will inure to the benefit of any and all persons, companies and corporations entitled to serve stop payment notices under Section 9100 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this bond. CONTRACT NO. C28800E The Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the said Contract 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 Contract or to the Specifications. No final settlement between the Obligee and the CONTRACTOR hereunder shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. CONTRACTOR and Surety agree that if the Obligee is required to engage the services of an attorney in connection with the enforcement of the bond, each shall pay Obligee's reasonable attorney's fees incurred, with or without suit, in addition to the above sum. IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of 20 PRINCIPAL/CONTRACTOR: (Typed Name of CONTRACTOR) By: (Signature) (Typed Name and Title) (Signature must be notarized) The rate of premium on this bond is $ SURETY: (Typed Name of Surety) By: (Signature of Attorney -in -Fact) (Typed Name of Attorney -in -Fact) (Signature must be notarized) The total amount of premium charged: $ (the above must be filled in by corporate surety). per thousand. IMPORTANT: Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in Section 105 of the California Insurance Code, and if the work or project is financed, in whole or in part, with federal, grant or loan funds, it must also appear on the Treasury Department's most current list (Circular 570 as amended). THIS IS A REQUIRED FORM. Any claims under this bond may be addressed to: (Name, Address and Telephone No. of Surety) (Name, Address and Telephone No. of agent or representative for service of process in California if different from above) CONTRACT NO. C28800E SURETY 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 ) On before me, personally appeared 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), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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 CONTRACT NO. C28800E PRINCIPAL 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 On before me, personally appeared 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), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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 C - CONTRACTOR'S BID FREE RIGHT TURN LANE AT FRED WARING DRIVE AND HIGHWAY 111 PROJECT PROJECT NO.658-08 CONTRACT NO. C28800E FEDERAL AID PROJECT NO. CML 5414(008) TO: CITY OF PALM DESERT, "CITY" DATE: Z I Z(a /,Zo1 BIDDER: A\1 Nr of an Nt a `I "CONTRACTOR" The UNDERSIGNED, "CONTRACTOR", having carefully examined the site and the Contract Documents for the construction of, FREE RIGHT TURN LANE AT FRED WARING DR. AND HIGHWAY 111, CITY PROJECT NO. 658-08, CONTRACT NO. C28800E, FEDERAL PROJECT NO. CML 5414(008), hereby proposes to construct the work in accordance with the Contract Documents, including Addenda No(s). for the amount stated in this Bid. By submitting this Bid, CONTRACTOR agrees with CITY: 1. That unless withdrawn in person by CONTRACTOR or some person authorized in writing by CONTRACTOR before the time specified in the Notice Inviting Bids for the public opening of bids, this Bid constitutes an irrevocable offer for 60 calendar days after that date. 2. The CITY has the right to reject any or all Bids and to waive any irregularities or informalities contained in a Bid. 3. That the contract shall be awarded only by the governing body of CITY. Said contract shall only be deemed awarded after the CONTRACTOR'S complete submission of all contract documents, bonds, insurance documentation, and the CITY shall obtain all necessary signatures of the governing body, at which time the contract shall be deemed awarded. 4. To submit to CITY such information as CITY may require to determine the Bidder's financial standing experience and to perform the work. 5. That the accompanying certified or cashier's check or Bid Bond constitutes a guarantee that if awarded the contract, CONTRACTOR will execute the Agreement and deliver the required bonds and certificates of insurance within 10 days after notice of award. If CONTRACTOR fails to execute and deliver said documents, the check or bond is to be charged with the costs of the resultant damages to CITY, including but not limited to publication costs, the difference in money between the amount bid and the amount in excess of the bid which costs CITY to do or cause to be done the work involved, lease and rental costs, Page C-1 i additional salaries and overhead, increased interest and costs of funding the ` project, attorney expense, additional engineering and architectural expense and cost of maintaining or construction alternate facilities occasioned by the failure to execute and deliver said documents. It is understood that the quantities shown hereon, except for those quantities marked "Lump Sum", are estimates and the final payment will be based upon the actual work performed, subject to such adjustment and alterations as elsewhere provided herein. ITEM' , r �.. _ •, At NQ. t I EM DESCRI&10� UNIT' . QTY • . ,UNIT POST TOTAL .� • ,� 1 Mobilization 2 Traffic Control 3 Clearing and Grubbing 4 Remove and Dispose of Tree 5 Remove Base and Surfacing 1 6 Cold Mill Asphalt Concrete Pavement 7 Remove Concrete Curb / Curb and Gutter 8 Remove Concrete 9 Unclassified Excavation (F) 10 Relocate Monument Sign 11 Landscape and Irrigation System Modifications _ 12 Aagre ate Base 13 Asphalt Concrete Pavement Surface Course 14 Asphalt Concrete Pavement Base Course is Asphalt Concrete Pavement Slot Paving 16 Concrete Curb and Gutter (Type 1) 17 Concrete Median Curb (Type 11) 18 Concrete Sidewalk and Median Hardscape 19 Concrete Curb Ramp 20 Truncated Domes 21 Pedestrian Barricades LS LS LS EA SF SF 1 $ UGC) 1 $ 00007 8 $ 100 2,700 $ 10 — 9,300 $ q b LF 285 SF 2,550 LS 1 EA 1 LS 1 CY 140 TON 180 TON 115 TON 8 Page C-2 LF 280 LF 165 SF 2,150 EA 1 SF 48 EA 2 $ 1' $ 2,w $ 10OU6- $ U)t,0 $100-" $ $13CO , $ 4 SS- $LG-oOu- $ 1C060- $ 1COW - $ 5��v $2']v6o- o5- $ 5-u 10 $ !C 60C — $ Woo - $ '�VdU-- $ I 1 WO - U-w - $ $ 121.cl0 O - $1,4-ZC - $fq_ $I — $ ` 000 t i 1T�11`D`E,SCRIRT,.ION�- (1 22 Traffic Signals (S) and Safety Li htin (S) 23 Signing and Striping TOTAL BID PIRCE C TY - } 'UNIT -COST TOTAL.' {UNIT^," LS 1 �vco LS $ XbNC - $ UGC.) $ J I 1 V .✓ I u V The costs of any work shown or required in the Plans and Specifications, but not specifically identified as a Pay Item are included in the related Pay Item(s), and no additional compensation shall be due CONTRACTOR by virtue of CONTRACTOR'S compliance with the Plans and Specifications. I r TOTAL AMOUNT BASE BID IN FIGURES $ TOTAL AMOUNT BASE BID IN WORDS AA)f-eP -NWSanr� q�Qn �%064-d R\,�,f'4 PW f)d tO V 5 - IN WITNESS WHEREOF CONTRACTOR executed this Bid as of date set forth on Page C-1. SignatureLaw„ j S lSfl�lv`,t,� `�-nCS�C Yt Title: k\\ fie, tcoln�- CONTRACTOR 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 2AVQtS(A;;r Subscribed and sworn to (Q� before me on this Z� day of kAlew (month), 7-01 G (year), by eJbW4!L 1 CA-R LSo1V proved to me on the basis of satisfactory evidence to be the person( who appeared before me. Signature of Notary ti.q-x Page C-3 S. ROYSTER Commission 12083832 w Notary Pope - California Riverside Counttr Mir Comm. Expires Oct 26. 20tiB D - INFORMATION REQUIRED OF BIDDER TO ACCOMPANY BID The bidder is required to supply the following information. Additional sheets may be attached if necessary. (1) Company Name pm Fref iavn t� T (2) Address `��U F�S SAX �j—��(�Q� umrQll CA 9Zei� (3) Telephone No. CQS (4) Type of Firm (Individual, Partnership or Corporation)(,o� (5) Corporation organized under the laws of the State of l Lei 1� (6) Contractor's License No.Exp. Date } 13� III i (7) Department of Industrial Relations Contractor Registration number: IDODXii� (8) List the names and addresses of all owners of the firm or names and titles of all officers of the corporation: ft\\ - wtv-" �ce�140-�� T►0. �22Za Corona► CA 92--&-Hr &L2VA 7� C.DiL-�,\+c 1?resje0- ZZ1q %,mr,�, (-A 9Z�8 rkc,�� r�S, �P«Ar . U�DX 222et C-oran0., CA 9 ,Mr (9) Number of years' experience as a Contractor in construction work '7 7 U-6rS J (10) List at least three similar projects completed recently: Contract Amount Class of Work Date Completed Name, Address & Telephone No. of Owner 2. 3. Page D-1 442015„ PAST WORK REFERENCES City of Hawthorne Hawthrone Blvd Reconstruction 4455 W. 162"`' Street Contract Amount: $12,579,000.00 Hawthorne, CA 90250 Start: 4/2014 Contact: Heecheol Kwon, (310) 349-2980 Completed: 5/2015 City of Inglewood One Manchester Blvd, 31d Floor Inglewood, CA 90301 Contact: Hunter Nguyen, (310) 412-4252 County of Ventura 800 S. Victoria Ave Ventura, CA 93009 Contact: Jeewoong Kim, (805) 654-3987 City of Montclair 5111 Benito Street Montclair, CA 91763 Contact: Steve Stanton, (909) 625-9444 Florence Ave Contract Amount: $2,639,000.00 Start: 4/2015 Completed: 10/2015 Pavement Resurfacing, Phase II Contract Amount: $2,401,970.00 Start: 4/2015 Completed: 10/2015 Northeast Montclair Street Rehabilitation Contract Amount: $514,150.00 Start: 4/2015 Completed: 7/2015 Riverside County Transportation Commission Route 74 Widening 4080 Lemon Street, 31 Floor Contract: $1,970,004.00 Riverside, CA 92501 Start: 4/2014 Contact: Bill Seitz, (949) 300-9132 Completed: 7/2015 City of Riverside 3900 Main Street Riverside, CA 92501 Contact: Steve Howard, (951) 826-5708 Long Beach Unified School District 2201 E. Market Street Long Beach, CA 92805 Contact: Nancy Chinchilla, (562) 997-7513 2014/15 Arterial Streets Contract Amount: $1,683,076.00 Start: 4/2015 Completed: 9/2015 Garfield Elementary School Pavement Contract Amount: $1,976,508.00 Start: 6/2015 Completed: 11/2015 (11) Pursuant to California Public Contracting Code, Section 4100 et. Seq., the following list gives the name business address, and portion of work (description of work to be done) for each subcontractor that will be used in the work if the bidder is awarded the Contract, (Additional supporting data may be attached to this page. Each page shall be sequentially numbered, and headed "Proposed Contractors" and shall be signed.) The Bidder shall list all subcontractors who will perform work or labor or render service to the prime contractor in excess of one-half of one percent of the prime's bid. Failure to include the subcontractor's DIR registration number may result in the bid being rejected as non -responsive. Subcontractor's Name: \1 (A t,'� ''ON, ',�-UIII M License Number: 09 ' 00 DIR Contractor Registration No. f q3w Business Address: Pn Gq �)ZS-c OYC(MC CCI 9Zs(P�;- Telephone: -114 Qq`I OR 03 / Work Description: IV_e-e f2jp�1Y1rniGt 2 Percent of Work: Subcontractor's Nammee:�OOj 9 License Number:_UY / 9 1 DIR Contractor Registration No. l 0000a)oo Business Address: '2440 G S I#*e k I atW 0 c q2/3_2_11 Telephone: QO�q ;-,,x4 11-7 0 0 Work Description: &M 19)h Percent of Work: "L'�'ll-0 0 Subcontractor's Name: wow Oe����. � O � gy""'2 ' License Number: (7091 DIR Contractor Registration No. 1 Ood Zzq-_-�! Business Address: VO J�rik ) OU ( NCJ h 16iY) d C Q 7� Telephone: a09 Ucr� 3j10 Work Description: OA CCA-P Percent of Work: � '"q �,, (12) List ttAnpe o the p�rsQ�n wt nspec ed the site of the proposed work for your firm k-zO aW U1L ,� e � (13) A financial statement or other information and references sufficiently comprehensive to permit an appraisal of your current financial condition may be required by the City. (14) Contractor hereby swears under penalty of perjury that this information provided is true and correct, By: //��XTitle: l,.f��fn Signature Contractor Page D-2 (11) Pursuant to California Public Contracting Code, Section 4100 et. Seq., the following list gives the name business address, and portion of work (description of work to be done) for each subcontractor that will be used in the work if the bidder is awarded the Contract, (Additional supporting data may be attached to this page. Each page shall be sequentially numbered, and headed "Proposed Contractors" and shall be signed.) The Bidder shall list all subcontractors who will perform work or labor or render service to the prime contractor in excess of one-half of one percent of the prime's bid. Failure to include the VA subcontractor's DIR registration number may result in the bid being reiected as non -responsive. Subcontractor's Name: C1. Sevuw License Number: ins . 1 DIR Contractor Registration No. Business Address: fbfi �cmd " C�M67 f:. Telephone: 109 4�4 4Wd Work Description: �P,117,tI�1/�.( Percent of Work: 6%1-)7v Subcontractor's Name: License Number: DIR Contractor Registration No. r Business Address: a Telephone: Work Description: Percent of Work: Subcontractor's Name: License Number: DIR Contractor Registration No. Business Address: _ Telephone: Work Description: Percent of Work: (12) List t( n me o the person wtlVnspec ed the site of the proposed work for your firm �,JNIUk _0; Q( r 1�� J (13) A financial statement or other information and references sufficiently comprehensive to permit an appraisal of your current financial condition may be required by the City. (14) Contractor hereby swears under penalty of perjury that this information provided is true and correct. By: '0� - TitIe:Z,i�7a� � n�t Ice ?rfs8w� Si nature Contractor Page D-2 E - NONCOLLUSION DECLARATION To be Executed by Bidder and Submitted with Bid The undersigned declares: I am the \C. ?0!5&V1V of the party making the foregoing bid. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed n \ n i tt� ? Ylclf�i 2�v , 2g�, at �lrt?� , l . City State By: Signature Title: &QJ CONTRACTOR Page E-1 a C2&n*0' eo� CALIFORNIA JURAT OOV CODE § 8202 A notary public or other officer completing this certificate verifies on I) 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 Riverside 0 ROYSTER 7 Commission #I 2083832 i Notary Public - California = Riverside County IMy Comm. Wires Oct 26, 2018 Place Notary Seal Above Subscribed and sworn to (or affirmed) before me on this 26th day of February t 2016. Date Month By (1) Edward J. Carlson Name of Signer Proved to me on the basis of satisfactory evidence be the person who appeared before me (.) (,) Name of Signer Prov to me on the basis of satisfactory evidence be he person who appeared before me.) 11 Signature Ignature of tary Public OPTIONAL Though the information below Is not required by law. 4 may prove valuable to person relying on the document and could prevent fraudulent removal and reattachment of this form to another document Further Description of Any Attached Document Title or Type of Document Nonco'lusion Declaration Document Date. 2-26-16 Number of Pages 1 Signer(s) Other Than Named Above None Top of rumb here Top of thumb here BID BOND NUMBER 08597423 F — BIDDER'S BOND To Accompany Bid KNOW ALL MEN BY THESE PRESENTS, That we, A I American Asphalt as principal, and Fidelity and Deposit Company of Maryland as surety, are held and firmly bound unto the City of Palm Desert in the sum of $ Ten Percent ofTotar (10% of bid) to be paid to the said City or its certain attorney, its successors and assigns; for which payment, well and truly to be made, we bind ourselves, our heirs, executors and administrators, successors or assigns, jointly and severally, firmly by these presents. *Amount Bid THE CONDITION OF THIS OBLIGATION IS SUCH, that if the certain bid of the above bounden principal to perform certain work described as follows: FREE RIGHT TURN LANE AT FRED WARING DRIVE AND HIGHWAY 111 PROJECT CITY PROJECT NO.658-08 CONTRACT NO..C28800E FEDERAL AID PROJECT NO. CML 5414 (008) The general items of work to be done hereunder consist of mobilization; removal of existing improvements; roadway construction including curb and gutter, sidewalk pavement and traffic signal modifications and other improvements as shown on the plans and per these specifications and dated February 29, 2016 is accepted by the City of Palm Desert, and if the above bounden principal All American Asphalt shall duly enter into and execute a contract for such construction, and shall execute and deliver the Performance Bond and Payment Bond and insurance certificates as required by said contract, then this obligation shall become null and void; otherwise it shall be and remain in full force and effect. Should it become necessary for the City to institute a lawsuit, or any other legal proceeding to enforce the terms and conditions of this bond, then all costs of said proceeding, including attorneys fees, shall be awarded to the prevailing party. [Remainder of this page has intentionally been left blank. Signature blocks are contained on the next page] Page F-1 IN WITNESS WHEREOF, We hereunto set our Hands and Seals this 25th day of February 2016 Contractor's Name: All American Asphalt / Contractor's Signature: I `` I Mudt be Notarized Title:�-A DAS1 nlx-a W-Ae& Address: 400 East Sixth Street, Corona, CA 92879 Telephone: (951)736-7600 Surety's Name: Fidelity and Deposit Company of Maryland Surety's Signature: �t ._.w C-2j +ctcl Must be Notarized Title: Rebecca Haas -Bates, Attorney -in -Fact Address: 777 S. Figueroa Street, Suite 3900, Los Angeles, CA 90017 Telephone: (213)270-0600 Page F-2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT 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 Chic eertiffcate is attached anti not the tntthfttlncsc, arrurne%. nr validity orthat document State of California County of Riverside On February 26. 2016 before me, B. Rooster. Notary Public Date Here Insert name and Us of the Officer personally appeared Edward J. Carlson Neme!ilMerSipnsr!� who proved to me on the basis of satisfactory evidence to be the B. ROYSTER person(s) whose name(s) is/are subscribed to the within instrument _ MK7omrntssion #I 2063632 and acknowledged to me that he/sbe 4ey executed the same in Notary Public - Celltornfa his/her;4heir authorized capacity(ies), and that by his/hefAheif Z 0Rlversitte County signature(s) on the instrument the person(s), or the entity upon behalf My Comm. Expires Oct 26, 2018 of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the forgoing paragraph is true and correct. WITNESS my hart - nd off seal. 11 � Signature J� Place Notary Seal Above 1pn n► of 4,.ybat OPTIONAL Though the information below is not required by law, it may prove valuable to person relying on the document and could prevent fraudulent removal and reattachment of this form to another document Description of Attached Document Title or Type of Document Bidder's Bond — City of Palm Desert Document Date. February 25. 2016 Number of Pages: Signer(s) Other Than Named Above Rebecca Haas -Bates, Attornev-in-Fact Capacity(ies) Claimed by Signer(s) Signer's Name- Edward J. Carlson _ Individual X Corporate Officer — Title(&): Vice President Partner Limited r. General Attorney in Fact Trustee Top of th..mb hors Other - Signer is Representing: All American Asphalt Signer's Name: r. Individual c Corporate Officer — Title(s)- c Partner _j Limited o Gen c Attorney in Fad Trustee Other: Signer is Representing: 9 Top of Vk nb here CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 J.. Y.i..-11 .. II..I .... ­i .la:I..J1., 11.'1.. II...I Yi.l. 11..1 4.i­J1.101.r1�.i.11..0...11 .i J..:Jl.i 1... II.1,91..A.. 11 ..II.. 11.. 11. J1.i 11 A notary public or other officer completing this certificate verifies only the identify 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 02/25/2016 before me, R. Panuno, Notary Public Date Here Insert Name and Title of the Officer personally appeared Rebecca Haas -Bates Name(*of Signerr* 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 Wshe/thew executed the same in hWber/th►eir authorized capacity(iec), and that by hic(her/their signature4on the instrument the person(* or the entity upon behalf of which the person(s4 acted, executed the Instrument. P. PMMO Commission # 2035ON Notary Public - CalllOmla Orange County Mr Comm. Empires Aunt S. 2017 1 Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of Califomia that the foregoing paragraph is tru I ESS my hand a d offici s 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 Document Title or Type of Document: Bid Bond Document Date: 02/25/2016 Number of Pages: Two(2) Signer(s) Other Than Named Above: All American Asphalt Capacity(ies) Claimed by Signer(s) Signer's Name: Rebecca Haas -Rates C1 Corporate Officer — Title(s): 0 Partner — 0 Limited O General n Individual 2Attomey In Fact 0 Trustee O Guardian or Conservator ❑ Other. Signer Is Representing: Fidelilv and Deposit Companv orMaryland Signer's Name: D Corporate Officer -- Title(s): O Partner — O Limited O General 0 Individual 0 Attomey in Fact O Trustee O Guardian or Conservator f] Other. Signer Is Representing: ... •111, 19, 0 1•,III..II. 11.•11.. 11010.• II.r Y I— I., 11..1 .r 11.• II.. 111.11 Lr 11.. 11.. W 1.. 11 . .10 ;"Nl IIw 11 6-.1 ✓ 1/-1.1.1.I...;.11.. 11 A1"11., 1 .. it"01. i M.,;I 1Y.I..1 +A . 1 02014 National Notary Association - www.NabonaiNotary.org -1-800-US NOTARY (1-800-818-8827) ltam if5907 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V. Section 8. Attomevs-in-Fact. The Chief Executive Officer. the President, or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies, recognizances. stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney -in -fact to affix the corporate seal thereto: and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE 1, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate: and 1 do further certify that Article V. Section 8, of the By -Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Scat of the Company may he affixed by facsimile on any Power of Attorney. -Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may he signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the I0th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President. Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTINIOIJY WHEREOF, I have h eunto subscribed my name and affixed the corporate seals of the said Companies. this q,day of p1"T 20J. UV .•° n'°'�. �F�� ow s itAL '� Michael Bond, Vice President ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by THOMAS O. MCCLELLAN, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint William SYRKIN, Rebecca HAAS-BATES, Sergio D. BECHARA tied Richard ADAIR, all of Irvine, California, EACH its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duty executed and acknowledged by rive regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland.. and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons, The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V. Section 8, of the By -Laws of said Companies, and is now in force. IN WITNESS WHEREOF. the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of tlx: said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 5th day of August. A.D. 2015. ATTEST: W. 4t, e)-, All� Secretary Eric D. Banres ZURICH AMERICAN INSURANCE COMPANY COLONIAL. AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND Vice President Thonmas O. McClellan Stale of Maryland County of Baltimore On this 51h day of August. A.D 2015. before the subscriber, a Notary Public of the State of Maryland, duty commissioned and qualified, THOMAS O. NICCLEI.LAN, Vice President, and ERIC D. BARNES, Secretary, of the Companies, to me personalty known to be the individunls and oflces described in and who executed the preceding instrutrimt, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that hclslx: is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrurtwnt are the Corporate Seals of said Companies, and that the said Corporate Seats and the signature as such officer were duly affixed and subscribed to the said Instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written Constance A. Dunn, Notary Public My Commission Expires- July 9, 2019 POA-F 012-0033D 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 I On before me, personally appeared who proved to me on t basis of satisfactory evidence to be the person(s) whose name(s) is/bbbed to a within instrument and acknowledged to me that he/she/they execuame n his/her/their authorized capacity(ies), and that by his/her/their signatures)u ent the person(s), or the entity upon behalf of which the person(s) acted, executeent.I certify under PENALTY OF PERJURY under the State of California that the foregoing paragraph is true and correct. WITHd and official seal. Signature Acknowledgment k�A441mev J A Notary Public or other officer ompleting this certificate verifies only the identity of the individual who signed the document, to whit his certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of / ) On before me, persona appeared who proved to me on the basis of satisfactory evid ce to be the person(s) whose name(s) is/are subscribed to the within instrument and ac owledged to me that he/she/they executed the same in his/her/thelr authorized pacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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. Signature WITNESS my hand and official seal. Page F-3 t gage J�Ai Man=17-0 Local,laistntaftKa res]tmul Dtsadsiata=ed Bastwu Entayrises OBE) CeRdcstion 5tstas Claasp Foam CP-CEhl 2403(F) (N9W 1099) DISADVANTAGED BUSLNESS EN WRISES (DBE) CHANGE LV CERTMCATION STATUS REPORT The top of the form mgmm -�peabc mfium um regudsag the cow-bucbon project Cotmact N mba. Co-ty. Rrnrt.. Post Miles, the Adrauzeaa><Apamy, the Commel Cauwletron Date, and the Emmzted Co nrxi Amato b ceq=m the Pttme Con=ctm's craze sad Btrmen AA&w.% The foca; of the farm u to-u%=Wte =Acetify the achnl DBE dollar ammw paid to cows an federaRy funded project: dhu had a chatted m Cafifscaboo :taros ios,a= the comae of the ctetaplmoa a6thr aorrfsact The two sttuaacon: that are bang adr..ed bjr CP{Et+f 2403M art, tf a fiaa cutiW as a DBE and doing vmk ca the contract dutmg the worse of the ptajed become: DrmmSed, and tf a non -DBE firm dotmg work on the contract &zing the com-s of the project bwau m Caxa6ovai uaDBE The fu= has a cuh=m m — the Contact Item No (or Iteaa :Jac) a: weU as a calm= fz the Subcocrnctm " Name, Busme:s A&bw— Bets: Phmc and coatractoc : CerhUltaon D7®ber The cab==mtttl#A Ataatmt Paid %lils CvmW wM be mad to mter the acne! do$u vaine of the wmk pafotmed by thox cwuacros who meet the cot doom a andmed abort drama the tame period then• as Certified as a DBE. ThL- cohtmn an tha CR4MJ-2403(F) -should oak ml6d the dollar she of work performed wlale the firm %%a Camfied a: a DBE The coh== cAned Ccu&ztoa'Daoaftfitat m Date (Letts atmchod) call relied eeha the dm of the Decutdcanoa Lettm:, t ot3 by tkt Ct%-d Right Program or the date of the Cw"cm= Certificate mailed art by the Cnil Rights Program Then n a boa to ched-- that support dacvmentatioa r. attached to the CP-MI--2403 (F) foray There " a Comae= section for any addummW a &=wtsoa that enay need to be Mculad reps mg say of the abate urn: cu ms The CEhi-2403 (F) bar m area at the bottom where the Coatradar and die Re tdtat Ettp per saga and date that the mformatton pvnided n co=p!ete and torrid c- i There c a Cc sae - :wtwn for way addraoml taiotmatloo that may need to be pranded re2edimg any of the abate tray.-aenom The OU61.2403 (F) ha- an area at the bottomwhem the Co motor sad the Resdmt Er4=&,W saga and date that the mformatwn psm-uW as cm q lore sad correct Page17-U "IT A 290d Page J-12 EPP K43 E33EWT 17-F local Atsistaare Freced ms llaaaai final Aeprt-L:tAzs fan efl kindrantaged Buns Eeleryrtes Mfg, Fast-71ar 9abcessnftn f1NAL RMKM - UTM17ATIO` OF DL4ADVAt`UGM BUSLESS LN-Mp MS (DM:} FI&ST-TM?. MMCON-rRA.CTOR.S CDt 240_-'(F) (tier 02 2008) Tba fmaa requsm specific n1f nmu tou rtgatdm, the camtractsonpraject Corm==- timber, Catmty, RDGte, Pwt Maw. Fa fetal -aid Project No, the Admmatrsatd Agency. the Contract Complai= Date and the F--tmneed Contract Amount It ngmw. the ptmy! contractor name and bu:me- add<r Tl a fogs: of the fotm L to dezcrtbe ttho dsd what by taami tact stem minbar and desasptum:, xkmg for spemrk &Mv values of ties wok conVIeW Wall down by ,sbconractoc who perfomoed the ttolk bout DBE and am -OBE wo* fosters rM prime contractors are nKturtd to A as the lope of work pufuemed by thaw mm fivr . along wak the aotyeqp=d=g dollar talw of wmi The fbrw has a column to enter the Cotrnct Item No. (or Item Nos) and drcaspuan cf wink performed a macedah pronded. as wtO as a c oh= for the mbcontraetor tome and but wz addrt:s For those firms who are DBE, that is a column to enter thew DBE Ca tficanaaNlm6w The 178E *anldpmsadr their caettficatum numberto the contractor and notify the contacta to wntmg with the date of the decer2L6 catetsa of rhea swu: ;b=W change dnnng the coarse of the pro1ect- Tbe form has a col;jn= 6u the dolLir %-2ke to be ertaed for the am tarok pwformed by the subcontractor. The Non -DBE coiutm is used to enterr the d*Uv %alne of work perfarrsed for fun: « ba are aot ce ai&d ` DBE The dect--a f wrbich col,— to be used fist ease m the DBE dollar vAm n Erased an what progom(S) xatu: the firm" cwuf3ad 'I11: program statsz is detamcsdby the CaMorcia UaXwA Cand6cation Program by etltmcay, pander, normship, and collad =—.0 : at me of cettifiedu= To confirm the ceAt5cation starter and program status, access the Department of Traasparbs n Cird RtAbb web site at- hdp .'.turww dot cxt:os'•'M bcw or by cuing (916) 324-1700 as the toll five number at (888) 810a346 Based on thss DBE Program stasns, the follou'mg table depot u+wh colt= to be need i DBE Program Stattn I Column to be avid r If prapain stag -how: DBE anZy I:U no other tAo�: h=tcd DBE If a contractor pc-fmmmng rank as a DBE on the project becomr. dwern&d and :till per6oam: walk after then deeavliritian data, enter the total daily ralivr padotmed by thz: cflmracbor tender the appeap:iate DBE ideanIIutson cohnun If a csmlra�r perfm�g tsaric a: a turn DBE on the protect bey catufied a: a DHE enter the d-n tahte of all ' work perfotvted after certification as a DBE under the appropriate i—9-tion cola= Eater the total of nch of the SM colutms to FormC M-2;02M Amy A—sw tD DBE cenfu—tion moat also be smbtmimtd on Fwmk-al 2403CF). Eats the Date Waudk Cmapieted a: uaell a: the Date of Fun) Pa%ment (the date tcben the pane canZaetor made the `final pr me7 ' to the nAxodra ctor for &a yortmn of wu& Lamed a: bung c ouplettad) The cantractnr and the nrademt imgm er ssgo and daft the fimmt stsdsabag that the =fiv==on prwided c compIete gad correct pw 17-22 Jew 1, 201) Page J-14 UT 0"I Page J-15 - $ kk2 % 222 2 e 7 « bo » « DIa « gO � ■ /$ \ k )$ ■ � ®E � Jf asa ■■! ��_a_ ■'i }}-ate �$! }I=-- � 2 RR &�■aa f■�3ƒ fai�k a}{/\ { |D ^ 2:130p :1313:�D 7 }2 }� � �- � 2 $_ ■/ a a2� } $� Big _| ±�Z f q # ■ . Page J-15 Page J-16 (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMENT AND EXECUTION OF THOSE CERTIFICATIONS WHICH AREA PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The bidder P A r'`w zx \01% f -44 t- , proposed subcontractor hereby certifies that he has 41 has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. Page K-19 DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49, CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: • is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency; • has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years; • does not have a proposed debarment pending; and • has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. Page K-20 NONLOBBYING CERTIFICATION FOR FEDERAL -AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. Page K-21 DISCLOSURE OF LOBBYING ACTIVITIES MCLOSURE OF LOWYOG ACai'III U testa tm ro:sf To n3aam i .,e m i! r, t c tssz 1. 7s pe of Federal Action • Status of Fed" Action: 3. Report Type: a corn O a tides v.rcA6= ma, ttanal b pm b itsitlal wzd b an osW ohms � c posiaw�d d ltifltabritt CLUP f Lom � � d�quo, 4 NAM and Add of Repotting Ewale 5 URaptffttag ERWy mNw 1 it u Edv Nana and Ad&= of Pnai � SaCas�..ae Tla . disown Coagmtoaa! Ditbi c k dkza" conowsin" Dc • Federal Departae ACtacr 7 Ftdacal Pfw= CFAI K dapFLicaCk 8 Fedval Action Naafba. d lmomw 9. Award • tC�eaa Lo a Bane aad Address ofL.obbf Eab[y b Petfe7nmgS<retca (ta sabcp (If LaditidaL. Wt cscae, fnsi zmna. 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