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C31670 - Accessible Pedestrian Signal Project 562-12
Contract No. C31670 CITY OF PALM DESERT PUBLIC WORKS DEPARTMENT STAFF REPORT REQUEST: AWARD CONTRACT NO. C31670 FOR THE ACCESSIBLE PEDESTRIAN SIGNAL PROJECT TO PTM GENERAL ENGINEERING SERVICE, INC., OF RIVERSIDE, CALIFORNIA, IN THE AMOUNT OF $144,944.00 (PROJECT NO. 562-12) SUBMITTED BY: Mark Greenwood, P.E., Director of Public Works CONTRACTOR: PTM General Engineering Service, Inc. 5942 Acorn Street Riverside, California 92504 DATE: June 28, 2012 CONTENTS: Agreement Performance Bond Payment Bond Contractor's Proposal Location List Recommendation By Minute Motion: 1. Award Contract No. C31670 for the Accessible Pedestrian Signal Project (562-12) to PTM General Engineering Service, Inc., of Riverside, California, in the amount of $144,944.00; 2. Authorize the Director of Finance to set aside a 10 percent contingency in the amount of $14,494.40; and 3. Authorize the Mayor to execute the same. Funds are available in Account No. 440-4565-422-4001, Capital Project Signalization and 220-4565-422-4001, Community Development Block Grant. No General Fund money is being used for this expenditure. Background On April 18, 3012, staff advertized a Notice Inviting Bids for the Accessible Pedestrian Signal Project. This is the first year of an annual program to bring our traffic signals into State and Federal compliance. The Accessible Pedestrian Signal (APS) will have both Staff Report Award Contract No. C31670 Accessible Pedestrian Signal Project. June 28, 2.012 Page 2 of 2 a visual countdown indicator and a street name audio feature. Staff has identified and prioritized locations within the City for the installation of these APS. On June 18, 2012, the bids were opened and read aloud. The results are as follows: Contractor Location Amount PTM General Engineering Services Inc. Riverside, California $144,944.00 B W Simmons, Inc. Calimesa, California $210,000.00 DBX, Inc. Temecula, California $216,953.00 A Community Development Block Grant will fund $104,781.00 of this project. The remaining contract amount and contingency will be funded through the Capital Project Signalization account. Fiscal Analysis There is no fiscal impact outside the contract and contingency amounts associated with this action. Prepared By: s %— Marlys. Diercks, P.E. Transportation Engineer Frankie Riddfe' Director of Special Programs Approval: M. Wohlmuth, City Manager ead: Mark Gr nwood, P E., Director Public W rk; / I //�� Paul S. Gibson, Director of Finance CITY COUNCILA�L'1'ION APPROVED ✓✓ DENiED RECEIVED OTHER MEETING DAB n� 5 AYES: ^ j� NOES: ABSENT: 1 _..__........ ABSTAIN: --.�— VERIFIED BY: Original on File with C114,eiews Office Contract No. C31670 AGREEMENT THIS AGREEMENT is made and entered into this 28 day of June, 2012, by and between City of Palm Desert, California, hereafter called "CITY" and PTM General Engineering Service Inc. hereinafter called "CONTRACTOR". W ITNESSETH RECITALS: CONTRACTOR has submitted to CITY its Contractor's Proposal for the construction of CITY Project, ACCESSIBLE PEDESTRIAN SIGNAL PROJECT, PROJECT NO. 562-12, CONTRACT NO. C31670, in strict accordance with the Contract Documents identified below, CITY has accepted said Proposal. 2. CONTRACTOR states that it has re-examined its CONTRACTOR'S Proposal 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 Proposal 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 Proposal; (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) Addenda Nos. -0-; (m) The Determination of Prevailing Wage Rates for Public Work; (n) Any Change Orders issued; (o) Any additional or supplemental specifications, notices, instructions and drawings issued in accordance with the provisions of the Contract Documents. 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 and will complete said work within Error! Use the Home tab to apply Length to the text that you want to appear here. from the Notice to Proceed date to the satisfaction of the Engineer. Page 1 Contract No. C31670 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 $500.00 dollars 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 Proposal 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 payment from the above referenced time frame may occur only for good cause following written approval of the City of Palm Desert. Page 2 Contract No..C31670 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: "I am aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for worker's 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: BY: Signature to be notarized TITLE: CITY: BY: Signature to be notarized TITLE: Mayor of Palm Desert, CA APPROVED AS TO CONTENT: MARK GREENWOOD, P.E. DIRECTOR OF PUBLIC WORKS State of California ) County of ) ATTEST BY: TITLE: ATTEST BY: TITLE: City Clerk of Palm Desert, CA APPROVED AS TO FORM: DAVID J. ERWIN CITY ATTORNEY Page 3 Contract No. C31670 CONTRACTOR ACKNOWLEDGMENT 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 CITY ACKNOWLEDGMENT State of California ) ) SS. County of Riverside ) (seal) 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 _ (seal Page 4 PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: That whereas the City of Palm Desert has awarded to PTM General Ennineerina Service, Inc hereinafter designated as the "Principal", a contract for: ACCESSIBLE PEDESTRIAN SIGNAL PROJECT PROJECT NO. 562-12 CONTRACT NO. C31670 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, 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 One Hundred Forty -Four Thousand Nine Hundred Forty -Four and no/00 Dollars ($144,944.00), 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. 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 INSURANCE COMPANY and/or AGENT ADDRESS TELEPHONE NUMBER State of California ) County of ) On personally appeared before me, PRINCIPAL , 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 (Seal) PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: THAT WHEREAS, the City of Palm Desert (sometimes referred to hereinafter as "Obligee") has awarded to PTM General Engineering Service, Inc. (hereinafter designated as the "CONTRACTOR"), an agreement dated June 28, 2012 described as follows: ACCESSIBLE PEDESTRIAN SIGNAL PROJECT, PROJECT NO. 562-12, CONTRACT NO. C31670, (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 3247 of the California Civil Code; NOW, THEREFORE, we, 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 notices under Section 3181 of the California Civil Code, in the sum of $One Hundred Forty -Four Thousand Nine Hundred Forty -Four and no/00 Dollars ($144,944.00), 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 3247 through 3252 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 notices under Section 3181 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this bond. Page 1 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 PRINCIPAUCONTRACTOR: PTM General Engineering Service Inc. in (Signature) (Typed Name and Title) 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) 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) Page 2 Acknowledgment 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 (Seal) Page 3 C - CONTRACTOR'S PROPOSAL ACCESSIBLE PEDESTRIAN SIGNAL PROJECT PROJECT NO. 562-12 CONTRACT NO. C31670 i TO: CITY OF PALM DESERT, "CITY" is DATE: 6/ 15/ 12 BIDDER: PTM General Engineering Service Inc. "CONTRACTOR" The UNDERSIGNED, "CONTRACTOR", having carefully examined the site and the Contract Documents for the construction of, ACCESSIBLE PEDESTRIAN SIGNAL PROJECT, PROJECT NO. 562-12, CONTRACT NO. C31670, hereby proposes to construct the work in accordance with the Contract Documents, including Addenda No(s). 0 for the amount stated in this Proposal. (per Bertha Gonzaez on 6/15/12 at 10:22am) F - By submitting this Proposal, CONTRACTOR agrees with CITY: i 1. That unless withdrawn in person by CONTRACTOR or some person authorized in writing by CONTRACTOR — not by telephone or telegram — before the time specified in the Notice Inviting Bids for the public opening of bids, this Proposal ( constitutes an irrevocable offer for 60 calendar days after that date. 2. The CITY has the right to reject any or all Proposals and to waive any irregularities or informalities contained in a Proposal. 3. That the contract shall be awarded only by the governing body of CITY. Said I . contract shall only be deemed awarded after the CONTRACTOR'S complete submission of all contract documents, bonds, insurance documentation, and the t ' CITY shall obtain all necessary signatures of the governing body, at which time the contract shall be deemed awarded. E 4. To submit to CITY such information as CITY may require to determine the Bidder's financial standing experience and to perform the work. y 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 i 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, additional salaries and overhead, increased interest and costs of funding the I_. project, attorney expense, additional engineering and architectural expense and Page C-1 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. FURNISH AND INSTALL ASSESSABLE PEDESTRIAN 1 SIGNALS AND LED PED HEAD MODULES AT LOCATIONS DESIGNATED IN APPENDIX "A" LS 1 I S MP I $ ILI�ciL(_ TOTAL BID PRICE $ , j q q,4 q — 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 Q{ TOTAL AMOUNT BASE BID 1N FIGURES $ Ll L `I `lei TOTAL AMOUNT BASE BID IN WORDS (�tiv,�ve vs cic�cs�1 IN WITNESS WHEREOF CONTRACTOR executed this proposal as of date set forth on Page C-1: a By: Brian Mendoza Signat Title: Vice President/Secretary CONTRACTOR State of California ) County of Riverside ) Subscribed and sworn to (or affirmed) before me on this 15th day of June .(month), 2012 (year), by proved itome on the basis of satisfactory evidence to be the person(s) who appeared before --Signature of Notary(Sea( of Notary) Page C-2 •-------�------ ELiZABETH H. M MCRAE Comm. # 1914816 rn NOTAR YE RY SIDE COUNT�RNIA =' tAv Couu. Exp. Ocr. 29, ?D14 "� All Purpose Acknowledgement State of California COX" Of Riverside Ongy , before me, Elizabeth H. M. McRae (date) (notary) personally appeared, Brian Mendoza (signers) ❑ personally known to me — OR -- [2[ ELIZABEi—7HM. RAE NOTARY �PUBLIC BALIgORNIA RIVERSIDE COUNTY MY COW EXP. OCT. 29, 2BI� (seal) proved to me on the basis of satisfactory evidence to be the person(x) whose name(4iskDa<subscribed to the within instrument and acknowledged to me that he/sbdQ" executed the same in his/hw*b2�T authorized capacity0r,4,kand that by his/WCAO& signature( on the instrument the person(p) or the entity upon behalf of which the person(s) acted, executed the instrument ESS my hand and official seal (notary signature) OPTIONAL INFORMATION The information below is not required by law. However, it could prevent fraudulent attachment of this acknowledgement to an unauthorized document. CAPACITY CLAIMED BY SIGNER (PRINCIPAL) ❑ Individual ❑ Corporation Officer title(s) ❑ Partner(s) ❑ Attorney -In -Fact ❑ Trustee(s) ❑ Guardian/Conservator ❑ Other: SIGNER IS REPRESENTING: Name of Person(s) OR Entity(ies) DESCRIPTION OF ATTACHED DOCUMENT Title or Type of Document Number of Pages Date of Document Other Right Thumbprint of Signer (if required) .L D — INFORMATION REQUIRED OF BIDDER The bidder is required to supply the following information. Additional sheets may be attached if necessary. (1) Address 594? Acorn Sheet, Riverside. CA 92504 (2) Telephone No. 951-710-1000 (3) Type of Firm (Individual, Partnership or Corporation) __ CoWoration (4) Corporation organized under the laws of the State of _C aHfnrn;a (5) Contractor's License No. 891265 Exp. Date 2/2013 Contractor hereby swears under penalty of perjury that this information provided is true and correct. By: Brian Mendoza Title: Vice President/Secroary Ignature Contractor (6) List the names and addresses of all owners of the firm or names and titles of all officers of the corporation: Elizabeth McRae, President/CFO, 595 S. Los Coyotes Dr. Anaheim Hills, CA 92807 Tel: 951-722-5678 Brian Mendoza, Vice President/Secretary, 11080 Kay Jay St., Riverside, CA 92504 Tel: 951-722-5755 (7) Number of years' experience as.a Contractor in construction work 23 years (8) List at least three similar projects completed recently: Contract Amount Class of Work Date Completed Name, Address & Telephone No. of Owner 1. $318,318.00 Pioneer Park SCCUrit Lt-. City of Anaheim ADA Access & Play round 6/2010 200 S. Anaheim Blvd., Anaheim, CA9 Mr Heinibereer, TeL: 714-765-5176 2. Mitchell Ave/UTT City of Tustin $72,070.00 Dr. Pedestrian 300 Centennial Way, Tustin,CA 92780 l 1/201 l Enhancement Mr. Eric Johnson Tel: 714-573-3320 3• $124,400.00 T/S Mod on Hawtho ne City of Hawthorne Blvd. between 120th 80i2008 4455 W. 126th St., Hawthorne, CA 90- & Broadway M.r Alan Leung Tel: 310-349-2997 Page D-1 M7 �0 Irian Mendoza PA l ex 774Wordik CA 9261.11-7745 ZMAitt brtanlaptoong-com a COD 961.722,6785 Chief Estimator and Supervisor of Outside Operations Supe+rvlsor of outside open oms with over I years of experienoo, Bloclriolan with over 20 years of experiM0e, An effective a mrarnieator and team leader; largo aW t�peoed prOjerte. exporiettced in conriilnsting and exerting CAME.NPRRil NCE Freeway ElectrleM General Englneering•Services, be, Riverside, CA, 0612006 to Date Chief Estimator/Supervisor of Outside Operations Tn charge of managing the estimating deput=t and finalizing bid packages; coordInating the beginning phase of an awarded project between the company and agency, project submittals, contmot review, Coordinated and managed crows CalMmla region; handled various sized Projects ranging in size froze $1,000 th $4.5 million dealing with dry utilities, wet utilities, traffic signals, and road improvements, Maintained coordination Freeway Fleetrio)PTM General Engineering and subcontractor, and project owners. In charge of handling project's administrative work; monthly gross estimates, project progress schedule, materials requisitions, contract change order negotiations and egOPMentpurchase and rentals. Higf: "ght Electric Ine,/Pete & Son$ Construction inn Riverside, CA 10196 to 0612006 Ctefef Eeiimatcr In 'huge' of managing the estimating deparhmt and iirrdtizing bid packages. Coordinating the beginning phase of an awarded project betwom the company and agency or prime contractor; project submittals, contract review, SuW.ssf Y bid on projects totaling $12 million with an average spread 6%. Ares guperviser Coordinated -and managed 40 crews Comb* of 6 monabere per team in the southexu California region; handled various sized prgjeots ranging In size JIM $i,000 to $4.5 m llon dealing witty dry utilities, wet utilities, ttfflo signals, and road improvements, Maintained coordination between High Light Blochic Im and Wboontraotor, Smoral contractor and project owners, in charge of handling projec's adminlstmtive w MOWWy gross estimates, pm jeot props# schedule, materials Mqubidans, Contract Change order nerdadoas and egwipment purchase and metals, Continued,,, BRl'A111 MENDOZA • Pop x CARUR AXPUMNCv COivrWO MBE lU00rlc Tno, In Rlver3 4 CA 1011998MX011996 YIN Proeldeut and Read of Outside Oporations Managed outside operations for all pg0ots ranging in size from'$1 to $2.5 million Headed an around tho clock plsctrio crew and. coordinated with CC Mayes to repair the I-10 Santa Monioa Freeway after it collapsed during the 1994 Northridge Batihquake to complete the fast paced Project in 6ti days. Maintain, coordinatlon botwean MBB Blechic and subcontraotors, general contractor and project owners; rmpler6ted and onforoad safety guidelines. Handled administrative wok monUy progress estimates, material requisitions, contract change order negotiations. Vascc Corp era tton in san Fernando, CA 1011997-0611998 Foreman (Part Time) Managed day to day operations of work crews and, various projects ranging in size from $1, 000 to $5,000 in pastern Los Angeles County; traffic signals, street fighting, signsl intereonnect. Rayinor L7lecWe in Raeemessd, CA 0611986.1011987 Crew Leader (Part Time) In charge of work crew on projects ranging from $25,000 to $250.000 through out Los Angeles County. WORK SIML9 • Capable of operafln bWvY equlptaeW such as ekip loadeus, wands, and baekhoes; Hands-on expad=Q with hand tools and power tools; s Capable of ovorsW4 that -Paced and high profile pmjeots; a An Offi6 vo aoabmtoelor sad leader; EDUCATION a Intornatloual Brothmihood oiNeotrloal Wo*en Completed taWq course (19ti8.1989) hi stroot lighting and tmflfc e1gal taetailatlons, code 40oWWftt and blue At tom, South Oslo 88b school R004YOd High B4001 diploma In 1988 -OMAN MENDOZA • Page 3 CARIBR EXPRRMCI COM'MID PROMSIONALMDWORMS + Intm4donal Brotherhood of Bleotdool Workers (MW • National Bleotrlaal Contractors A:ssooiadon (NMCA) ACCREDITATION • iBBW Journeyman Wireman; CSLB-Bleotdoal Contractors; Certifled Trench Safety Coordinator. LANGUAGES • English (Native) . • Spanish (Fluent) AWARD RECEIVED • Recipient of the U.S. Small Business "Young Entrepreneur of the Yee, Award in. 1996, nationally. • Recipient of the Certificate of Recognition by the City of Los Angeles for "Small Business" in 1997. • Recipient of the Certificate of Recognition by the City of Riverside for llsmaU Business" in 1997. • Recipient of the Certificate of Reoognition by the State Assembly, Assemblyman Mr. Rod Pacheco, for the"iop 500 IWand Empire Small Business" in 1997. • Ranked among the "Top Soo Inland Empire Hispanio Owned Companies" since 1997. • Certification ofAppreolatiou for ourpardoipation and ma hnization in the "Ceutury Freeway Aiinzstive Aotion" by CFAAC. PROIH'ESSIONA.L AND PERSONAL RItFERENCES Capra project #07M12204 (Eleotdool oontraot amount $4.5 million) Fr. JM completed b 2005 DesMpdon ofprojeot; lnstall4don of tratBo signals, ramps matnrhtg, sign illumination, Highway llghdug, i56ar opdo oommunloadon, and eleotdoai iMgatlon along the I.10 Freeway in Dos Angeles County. • Doug 1)Wason•Projaot Manager Ibr Prime oorttraotor, Bailout Beatty COD (949)232-3276 ad Me (909)397-8040 • Patty Clalvan - Reddant Snow, Offloe (909)594.4270 4 Veror&4 Roes-Eleotxioal Wpootor, Cell (714)6" 11 ,BRiAN WNDQ7AA • page 4 CAMItll-VERMNCZ CO.NnNUED City of Rediauds Contract #108300.72304/41008 (Blectrloal contract amount is $218,800) Project oompteted in 2003 Description ofprojectt Installation of traffic signals, modification of ramp metming, lighting and sign illumination, • Bill Hensley -Senor Civil Engineer. Office (909)798-7586 ext 2 ' luan Olvera pmjeot Manager for general contractor, H&H Conshuctlon- Celt (951)453-7712 and Office (909)473-7331. Caltrans projcct#Q8.4567V4) Electrical contract amount 18 $938,238) Prof ect completed in 2005 Description ofprojech Installation of lighting aystem along the 1-5 Freeway in San Bernardino County, • "Clary Vogel -Project Manager farm prime contractor, C3ranite Construction Cell; (661)549-3953 and Office (661)726-4447 Sanbag Projects' Segmentl, 2, 3, early segment 9, segment 9, and alder Ave. ('Total electrical contract amount was $3.2 million) project completed in 2004. Description ofprojects: Installation of traMc signals, ramp metering, sign illumination,' 14hway llghtin& fiber optic con munlcation, and electrical nrlgatlon along the I.10 Freeway In Son Bernardino County. .. Harold Lentil-Sanbag Contract Manager- Cell (760)802-7730 and Office . (909)875.8029 art 213, Tim Hanable-Caltrans Jnspector- Cell (951)712-0021 Al O,ttega- Project Manager for prime contractor, Yeager Shanska- Cell (714)240- 5333. City of bdlo Projeet#M137 (Electrioal contract amount was $1.4 million) Project eotnpleted in 2005 Deemtdon of project;-butdiation of street. lightingng system, traffic signals$ electrioal inigatlon, ead dry unities. • Gff� Baxter-Area.Maaagear for prime contractor, Yeager Shanska Construodon- Cell (909).721.9749 and Qffioo (760)343-5472 • Tommy Young-Ptojeot Manager for prime contMotor- Ce11 (951)232.6618 and Offb (760)343-5472 • Matins Bopehri-aty BngineN, Con (760)250 2201 Addidonsi krofesdo W References: • fiate�rils-Caltraps ,Cnepeotori CaT1(951�t89.0047 • Ray RAW-Cahrane area supervisor• COD (909)799.0646 (9) List the names and addresses of each Subcontractor who will perform work in or about the work improvement, and indicate what portion of the work will be done by each Subcontractor: Subcontractor's Name: License Number: Address: Telephone: Work to be performed:_ Subcontractor's Name: License Number: Address: Telephone: Work to be performed: Subcontractor's Name: License Number: Address: Telephone: Work to be performed: (10) List the name of the person who inspected the site of the proposed work for your firm Brian Mendoza (11) 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. Page D-2 E - NONCOLLUSION DECLARATION To be Executed by Bidder and Submitted with Bid The undersigned declares: F I am the Vicc Presdient of PTNI General Engineering Service Inca the f 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, ;y 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. T 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 t ' the foregoing is true and correct and that this declaration is executed on ie June 15, , 20 12, at Riverside California t ' City State t ' By: Brian Mendoza t iy Signature Title: Vice President/Secretary l to CONTRACTOR i i r Page E-1 F- BIDDER'S BOND To Accompany Proposal KNOW ALL MEN BY THESE PRESENTS, That we,PTM GENERAL ENGINEERING SERVICES, INC. as principal, and INTERNATIONAL FIDELITY INSURANCE COMPANY as surety, are held and firmly bound unto the City of Palm Desert in the sum of $ ** (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. ** TEN PERCENT OF AMOUNT BID 10% THE CONDITION OF THIS OBLIGATION IS SUCH, that if the certain proposal of the above bounden principal to perform certain work described as follows: The general items of work to be done hereunder consist of removals of existing striping; fog seal; and installation of striping, pavement markings and pavement markers; and providing of temporary traffic control as required during construction of the improvements and all appurtenant work, as required by the specifications and appendices, and dated kt. 11, 11, z is accepted by the City of Palm Desert, and if the abov bounden principal PTM GENERAL ENGINEERING SERVICES, INC. Shall duly enter o 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 attorney's 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 15TH day ofJUNE 2012 Contractor's Name: PTM GENERAL ENGINEERING SERVICES, INC. Contractor's Signature Title: /t6 � �G'l141* Address: 5942 ACORN ST. RIVERSIDE, CA 92504 Telephone: 951-710-1000 Surety's Name: INTERNA Surety's Signature: Title: PHILIP VEGA, ATTO Address:534 E. BADILLO ST Telephone: 626-859-1000 FIDELITY INSURANCE COMPANY FACT NA, CA 91723 Page F-2 Tel (97 ) 624-7200 POWER OF ATTORNEY INTERNATIONAL FIDELITY INSURANCE COMPANY ALLEGHENY CASUALTY COMPANY ONE NEWARK CENTER, 20TH FLOOR NEWARK, NEW JERSEY 07102-5207 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY , a corporation 0r93ni_ed and uniie the lac -vs of the Stale of New ,lersev. and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under tile, I,':,vc of the jt:lie. of Pennnysylvania, having their principal office in the City of Ne�-vark, Nev,, Jersey, do hereby constitule and appoint KEVIN E. VEGA, BRITTON CHRISTIANSEN, Ivl)'RNA SMITH, PHILIP E. VEGA Covina, CA. their true and lawful allorney(s)-in-fact to execute, seal and deliver for and on its behalf as surely, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, Contract or olhenvise, and the execution of such instrumenl(s) inCursuance of these presents, shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY OMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and ma be revoked, pursuant to and by authority of the By -Laws of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution aclopled by the. Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting du� held on the 201h day of July, 2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY at a meeting duly held on the 151h day of August, 4000: "RESOLVED, that (1) the President, Vice President, or Secretary of the Corporation shall have the power, to appoint, and to revoke the appointments of, Allomeys-in-Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporalion and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related Lherelo; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and f9) the signature nf• any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whelhc>.r herelofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the orirlinal seal of tile. Corporation, In he v,alirl ,pnd binding uprnrtile Corporation with the same force and effect as Ihnuma nually anually affixed." IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each exr;r..r.ilerl an nllesled Ihese presents on this '121h clay of March, 2012. STATE OF NEW ,IERSEY County of Essex /! Yn 7G V P it ry ar': SEAL "' 1936 T GI _ It ROBERT W. MINSTER 'pf'h?JSYLf Executive•. Vice President/Chief O(aeralin OI(ir„r..r (International Fidelity Insur,-ancr. C nrcrpanY and President (Allegheny Casually Company) On this 121h clay of March 2012, before me came the individual who executed the preceding instrument, to me personally known, and, being by 111e duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLCGHENY CASt_JAI_TY COMPANY ; that the seats affixed to said in, Irumerd are the Corporate Seals of said Companies that the said Corporate Scals and his sir.lnalun: we rr; (.tiny aflixr.-d by order of the Boards of Directors of said Companies. IN TESTIMONY WHEREOF, I have hereunto set illy Hand affixr_•dIn1y C)flici.�l r:al, • ,,, `+, at the City of Newark, New ,)errsey Iha clay nild yrnr firsl :above written. \\y`+�,,, ` St C, B�-�� �,4' A NOTARY PUBLIC OF 1,I11W JERSEY OrPILld stc� ", ,` My Commission Expire<; Mrcr. 27, 20'1/1 c"""""" CERTIFICATION I, Iho urufrr.;igricd officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hoof ly cerlify Iti:rl I Ip�cvr: cornpN,red the (oregoing copy of the Power of Attorney and affidavit, and Ilpe copy of file; Sections of the By -Laws of ;:,id Companies as set faith in s,,;iica Power of Attorney, with the originals on file in the home office of said rornpanies, and that the same are correct Iranr.;cripls lherer)f, and of Ilcr; vdtioir, Of lily 20id originals, and that the said Power of Attorney has not be,r•n revoked and is now in full force and effe ri. Ild fE"STnJrr)fdY WHEREOF, I have hereunto set my hand INN 15TH day Of JUNE, 2012 MARIA BRANC0, A,srslanl Secretary CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Los Angeles On JUN 14 2012 before me, Monica Blaisdell, Notary Public Date Here Insert Name and Title of the Officer personally appeared Philip Vega Names) of Signers) who proved to me on the basis of satisfactory evidence to be the person() whose name(g) is/grg subscribed to the within instrument and acknowledged to me that he4l,t3ftiepexecuted the same in his6kr .fte6outhorized capacityjiR*, and that by hig(krNbeir signature(s) on the rA MONICA BLAISDELL instrument the person), or the entity upon behalf of Commission # 1970845 K which the person) acted, executed the instrument. Notary Public - California z z Orange County I certify under PENALTY OF PERJURY under the laws My Comm. Expires Mar 26, 2016 of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Place Notary Seal Above Signature ttV Signature of Notary Public All Purpose Acknowledgement Stateof California Co.intyof Riverside On U&I1?' ,before me, Elizabeth H. M. McRae -''(date) (notary) personally appeared, Brian Mendoza (signers) ❑ personally known to me -- OR proved to me on the basis of satisfactory evidence to be the person(io whose name(4iskDazubscribed to the within instrument and acknowledged to me that he/sheA" executed the same in his/hoftek authorized ........� capacity(c and that by his/IYOCAWc signature( on the EUZABETH H. M. MCRAE instr ent the person(s) or the entity upon behalf of ►�nn Comm. # 1910816 whi h the person( acted, executed the instrument yl NOTARYFUBLIC•CALIFORNIA COUNT My COMM, ExrEOCT. 29, 201 WI SS my hand and official seal (seal) (notary signature) OPTIONAL INFORMATION The information below is not required by law. However, it could prevent fraudulent attachment of this acknowledgement to an unauthorized document. CAPACITY CLAIMED BY SIGNER (PRINCIPAL) DESCRIPTION OF ATTACHED DOCUMENT ❑ Individual ❑ Corporation Officer Title or Type of Document title(s) ❑ Partner(s) Number of Pages ❑ Attorney -In -Fact ❑ Trustee(s) ❑ Date of Document Guardian/Conservator ❑ Other: SIGNER IS REPRESENTING: Name of Person(s) OR Entity(ies) Other Right Thumbprint of Signer (if required) CERTIFICATE OF CORPORATE RESOLUTION I, Brian Mendoza , Secretary of PTM General Engineering Services Inc. (Corporation) do hereby certify that at a duly constitutes( meeting of the Stockholders and Directors of the Corporation held at the office of the Corporation on December 30 , 2 0 0 7 (year), it was upon motion duly made and seconded, that it be VOTED: Elizabeth H. Mendoza de McRae, President/CFO ..... OR.... Brian Mendoza, Vice President/Secretary Authorized to sign & execute contracts and submit bids with either one of the corporate officer's signatures. It was upon further motion made and seconded that it be further VOTED: That Elizabeth H. Mendoza de McRae, President/CFO ..... OR .... Brian Mendoza, Vice President/Secretary in the capacity as of the Corporation is empowered, authorized and directed to execute, deliver and accept any and all documents and undertake all acts reasonably required or incidental to accomplish the foregoing vote, all on such terms and conditions as he in his discretion deems to be in the best interests of the Corporation. I further certify that the foregoing votes are in full force this date without rescission, modification or amendment. Signed this day of , -10, (v (year). A TRUE RECORD ATTEST Brian Mendoza Se/Clerk Vice President/Secretary (Corporate Seal) 53 EXHIBIT B-CERTIFICATION OF BIDDER REGARDING SEGREATED FACILITIES CERTIFICATION OF BIDDER REGARDING SEGREGATED FACILITIES PTM General Engineering Service Inc. Prime Contractor Brian Mendoza Project Number 562-12 Accessible Pedestrian Signal project Project Name The undersigned hereby certifies that no Segregated Facilities will be maintained Name of Signer (Print or Type) Signature Page 79 Vice President/Secretary Title 6/i5/l2 Date I EXHIBIT C-EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CERTIFICATION OF BIDDER REGARDING EQUAL EMPLOYMENT OPPORTUNITY INSTRUCTIONS This certification is required pursuant to Executive Order 11246 (30 F.R. 12319-25). The implementing rules and regulations provide that any bidder or prospective contractor, or any of their proposed sub -contractors, shall state as an initial part of the bid or negotiations of the contract whether it has participated in any previous contract or subcontract subject to the equal opportunity clause; and, if so, whether it has filed all compliance reports due under applicable instructions. Where the certification indicates the bidder has not filed a compliance report due under applicable instructions, such bidder shall be required to submit a compliance report within seven calendar days after bid opening. No contract shall be awarded unless such re ort is submitted. CERTIFICATION BY BIDDER NAME AND ADDRESS OF BIDDER (INCLUDE ZIP CODE) PTM Gencral Engineering Sen ice Inc. 5942 Acorn Street Riverside, CA 92504 1. Bidder has participated in a previous contract or subcontract subject or the Equal Opportunity Clause. EK Yes ❑ No . 2. Compliance reports were required to be filed in connection with such contract or subcontract. Ia Yes ❑ No 3. Bidder has filed all compliance reports due under applicable instruction, including SF-100. [I Yes 0 No ❑ None required 4. Have you ever been or are you being considered for action due to violation of Executive Order 11248, as amended? _ C Yes E • No NAME AND TITLE OF SIGNER (PRINT OR TYPE) Brian Nlendoza, Vice President,'Scerctary SIGNATURE DATE 6/15/12 Page 80 t: EXHIBIT D-CONTRACTOR(S) CERTIFICFATION CONTRACTOR (S) CERIFICATION ON FEDERAL CONTRACT REQUIRMENTS I hereby certify that I have reviewed the diversified Federal Construction Contract related requirements imposed on the Contractor(s) of HUD funded construction projects, and fully understand all my obligations if the project is awarded to me. 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CSLB complaint disclosure is restricted by law (B&P 7124.6) If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear below. Click on the link or button to obtain complaint and/or legal action information. Per B&P 7071.17 , only construction related civil judgments reported to the CSLB are disclosed. Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. Due to workload, there may be relevant information that has not yet been entered onto the Board's license database. License Number 891265 Extract Date 6/18/2012 P T M GENERAL ENGINEERING SERVICES INC Business Information Business Phone Number: (951) 710-1000 P O BOX 7745 RIVERSIDE, CA 92513 Entity Corporation Issue Date 02/20/2007 Expire Date 02/28/2013 ACTIVE License Status This license is current and active. All information below should be reviewed. CLASS DESCRIPTION A GENERAL ENGINEERING CONTRACTOR C10 ELECTRICAL C31 CONSTRUCTION ZONE TRAFFIC CONTROL C27 LANDSCAPING Classifications C32 PARKING AND HIGHWAY IMPROVEMENT B GENERAL BUILDING CONTRACTOR D42 SIGN INSTALLATION C-7 LOW VOLTAGE SYSTEMS C13 FENCING D09 DRILLING BLASTING AND OIL FIELD WORK CERT DESCRIPTION Certifications HAZ HAZARDOUS SUBSTANCES REMOVAL Bonding CONTRACTOR'S BOND https://www2. eslb. ca. gov/OnlineS ervices/CheckLicenseII/LicenseDetail. aspx?LicNum=89... 6/ 18/2012 Check a License - License Detail - Contractors State License Board Page 2 of 2 This license filed a Contractor's Bond with INTERNATIONAL FIDELITY INSURANCE COMPANY. Bond Number: 0568087 Bond Amount: $12,500 Effective Date: 10/11/2011 Contractor's Bond History BOND OF QUALIFYING INDIVIDUAL 1. The Responsible Managing Officer (RMO) MC RAE ELIZABETH HERNANDEZ certified that he/she owns 10 percent or more of the voting stock/equity of the corporation. A bond of qualifying individual is not required. Effective Date: 08/01/2011 BQI's Bond History 2. The Responsible Managing Officer (RMO) MENDOZA BRIAN HERNANDEZ certified that he/she owns 10 percent or more of the voting stock/equity of the corporation. A bond of qualifying individual is not required. Effective Date: 04113/2012 BQI's Bond History WORKERS' COMPENSATION An employee service group holds the workers compensation insurance. Policy Number: 2246 Workers' Compensation Effective Date: 11/19/2007 Expire Date: None Workers' Compensation History Personnel listed on this license (current or disassociated) are listed on other licenses. Personnel List Other License Conditions of Use I Privacy Policy Copyright © 2010 State of California https://www2.cslb. ca.gov/OnlineServicesICheckLicenseIIlLicenseDetail. aspx?LicNum=89... 6/ 18/2012 Company Profile Page 1 of 2 Company Profile Company Search Company Search Results Company Information Old Company Names Agent for Service Reference Information NAIC Group List Lines of Business Workers' Compensation Complaint and Request for Action/Appeals Contact Information Financial Statements PDF's Annual Statements Quarterly Statements Company Complaint Company Performance & Comparison Data Company Enforcement Action Composite Complaints Studies Additional Info Find A Company Representative In Your Area View Financial Disclaimer COMPANY PROFILE Company Information INTERNATIONAL FIDELITY INSURANCE COMPANY ONE NEWARK CENTER 20TH FL NEWARK, NJ 07102-S207 Old Company Names Effective Date Agent For Service DOROTHY O'CONNOR-MANSON 2999 OAK ROAD SUITE 820 WALNUT CREEK CA 94597 Reference Information NAIC #: 11592 California Company ID #: —� 4341-4 Date Authorized in California: 02/09/1996 License Status: UNLIMITED -NORMAL Company Type: Property & Casualty te of Domicile: NEW JE StaRSEY back to top NAIC Group List NAIC Group #: 4705 AIA Holdings Inc Grp Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. SURETY back to top Workers' Compensation Complaint and Requests for Action Contact Information Part 1: Complaints and Requests for Action (CRA) If you are seeking information about your workers' compensation insurance policy, you must first submit a Complaint and Request for Action (CRA) to the workers' compensation insurance company using the address below. Phone Number: Ext. FAX: E-Mail: WEB Address: http://interactive.web.insurance. ca.govlcompanyprofilelcompanyprofile?event=companyPr... 6/ 18/2012 Company Profile Page 2 of 2 Mailing Address: Department Name: Contact Notes: 11 Part 2: Appeals to the Department of Insurance You may contact the department if you disagree with your workers' compensation insurance company's written decision on your CRA. You also must mail a copy of what you send us to your workers' compensation insurance company using the address below. Phone Number: Ext: FAX: E-Mail: WEB Address: Mailing Address: Department Name: Appeals Notes: back to top © 2008 California Department of Insurance http://interactive. web. insurance. ca. gov/companypro file/companypro file?event=companyPr... 6/ 18/2012 F W N X cm® O � D _0 _0 m� p'O'D m�� -nm Z m -0 Z A D Z �00 o�= _ mC) �c o rm O � mN CD mzcn 00 o rDm o Zrn cmrm X ZO2 z m C7 c- m C) = D mr D rnC7r M O D� r r r C O pr a Z M i C n � O 0 T C I n O_0 C D M O O �C ��Cn ITl ! rn OC 7 m Z O C7 N a D 0 Op 0- z Crnrn Dm -� D O Z O Z r-o r- coo i ZNm -iD O� map N �mrN y T1 O N D Z� r Z O p t 70 Z rn PAINTERS PATH -D z m OWN CENTER WY O m CD iit O O � L4 � o PLAZA z cn o H.� MONTEREY AVENUE z m N n m o � SA N 0 Dr- n a � N SANJPABLO AVE m �SN p m AR SPUR !y a ASCUAL C m D r m cn 0 L � o m >< cn C)Z= n i/) � O Z UDCA o n D D rL. m � z D 'T O -0n Z PLLLLIZ n IT PHYLLIS JA N rn �° O m Z D O ' m rn m o N m rn � m I N C o 70 z n U) C7 D N = r m m z 0 NOT TO SCALE l 1-