HomeMy WebLinkAboutC32630 - Trffc Sgnl LED Indication Rplcmnt 586-13 Contract No. C32630
CITY OF PALM DESERT
PUBLIC WORKS DEPARTMENT
STAFF REPORT
REQUEST: AWARD CONTRACT NO. C32630 FOR THE TRAFFIC SIGNAL
LED INDICATION REPLACEMENT PROJECT TO SIEMENS
INDUSTRY, INC., OF ANAHEIM, CALIFORNIA, IN THE AMOUNT
OF $52,700 (PROJECT NO. 586-13)
SUBMITTED BY: Mark Greenwood, P.E., Director of Public Works
CONTRACTOR: Siemens Industry, Inc.
1266 No. La Loma Circle
Anaheim, CA 92806
DATE: March 14, 2013
CONTENTS: Contract Agreement and Bonds
Contractor's Proposal
List of Locations
Location Map
Recommendation
By Minute Motion:
1. Award Contract No. C32630 for the Traffic Signal LED Indication
Replacement Project to Siemens Industry, Inc., of Anaheim,
California, in the amount of$52,700 (Project No. 586-13);
2. Authorize the Director of Finance to set aside a 10 percent contingency
in the amount of $5,270; and
3. Authorize the Mayor to execute the subject agreement.
Funding is available for this project in the Traffic Signal Reserve Account: 440-4250-
422-4001.
Backqround
The LED Indication Replacement Project will replace all of the vehicle indications at 19
signalized intersections. Project locations are noted on the attached list and shown
graphically on the attached Location Map.
Staff Report
Award Contract C32630 to Siemens Industry, Inc. (Project 586-13)
March 14, 2013
Page 2 of 2
The project was advertised and contractors were encouraged to submit bids. Six
contractors submitted bids at the February 21, 2013, bid opening. The results are as
follows
Contractor Location Bid Amount
Siemens Industry, Inc. Anaheim, CA $ 52,700
Steiny & Company Baldwin Park, CA $ 61,145
Traffic Development Services Moorpark, CA $ 69,447
PTM General Engineering Riverside, CA $ 75,407
Aegis ITS Anaheim, CA $ 79,378
JFL Electric Los Angeles, CA $116,424
Siemens Industry, Inc., submitted the lowest responsive bid. Siemens' bid was
approximately 30 percent lower than the $75,000 programmed for this project in the FY
2012-2013 budget.
Fiscal Analvsis
This project is being done as a part of the City's annual LED Indication Replacement
Program. There is no fiscal impact beyond the contract amount.
Prepared By: Department Head:
� P
c
Mar S. Diercks, P.E. Mark Gr wood, P.E.
Transportation Engineer CT�'.1'�iQ�iE�Altl��rks
� APPROVED `� nErrri�n
RECEIVED OTHER
I S. Gibson, Director of Finance MEET G D l3
AYESa / m
Approval: NOES:
.-� ABSENT:
ABSTAIN:
, VERIFIED BYs
J n M. Wohlmuth, City Manager Original on Filewith City erk's Office
Contract No. C32630
AGREEMENT
THIS AGREEMENT is made and entered into this 14 day of March, 2013, by and
between City of Palm Desert, California, hereafter called "CITY" and Siemens Industry,
Inc. hereinafter called "CONTRACTOR".
WITNESSETH
RECITALS:
CONTRACTOR has submitted to CITY its Contractor's Bid for the construction of CITY
Project,
1. TRAFFIC SIGNAL LED INDICATIONS REPLACEMENT PROJECT, PROJECT
NO. 586-13; Contract No. C32630 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; (j)
The Standard Specifications as modified in other portions of the Contract
Documents; (k) The Plans; (I) 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 30 Calendar Days from the Notice to Proceed
date to the satisfaction of the Engineer.
1
Contract No. C32630
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 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
payment from the above referenced time frame may occur only for good cause
following written approval of the City of Palm Desert.
2
Contract No. C32630
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.
Siemens Industry, Inc.
BY: ATTEST BY:
Signature to be notarized
TITLE: TITLE:
CITY:
BY: ATTEST BY:
Signature to be notarized
TITLE: Mayor of Palm Desert, California TITLE: City Clerk of Palm Desert, CA
APPROVED AS TO CONTENT: APPROVED AS TO FORM:
MARK GREENWOOD, P.E. DAVID J. ERWIN
DIRECTOR OF PUBLIC WORKS CITY ATTORNEY
3
Contract No. C32630
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 (seal)
CITY ACKNOWLEDGMENT
State of California )
) SS.
County of Riverside )
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)
Contract No. C32630
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS: That whereas the City of Palm Desert has
awarded to Siemens Industry, Inc. hereinafter designated as the "Principal", a contract
for:
TRAFFIC SIGNAL LED INDICATION REPLACEMENT PROJECT
PROJECT 586-13
CONTRACT NO. C32630
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, Siemens Industry, Inc.
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
Fifty Two Thousand Seven Hundred and no/00 Dollars ($52,700.00), 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.
Page 1
Contract No. C32630
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 PRINCIPAL
BY: BY:
INSURANCE COMPANY and/or AGENT
ADDRESS
TELEPHONE NUMBER
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 2
Contract No. C32630
PAYMENT BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT WHEREAS, the City of Palm Desert (sometimes referred to hereinafter as
"Obligee") has awarded to Siemens Industry, Inc. (hereinafter designated as the
"CONTRACTOR"), an agreement dated March 14, 2013 described as follows:
TRAFFIC SIGNAL LED INDICATION REPLACEMENT PROJECT
PROJECT 586-13
CONTRACT NO. C32630
(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, , 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 Fiftv Two Thousand Seven Hundred and no/00
Dollars ($52,700.00), 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
Page 1
Contract No. C32630
benefit of any and all persons, companies and corporations entitled to serve stop
payment 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.
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: SURETY:
Siemens Industry, Inc. (Typed Name of Surety)
By: By:
(Signature) (Signature of Attorney-in-Fact)
(Typed Name and Title) (Typed Name of Attorney-in-Fact)
The rate of premium on this bond is $ per thousand.
The total amount of premium charged: $
(the above must be filled in by corporate surety).
Page 2
Contract No. C32630
IMPORTANT: Surety companies executing bonds must possess a certificate of
authority from the California lnsurance Commissioner authorizing them to write surety
insurance defined in Section 105 of the California lnsurance 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)
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 BID
TRAFFIC SlGNAL LED INDICATION REPLACEMENT PROJECT
PROJECT NO. 586-13
TO: CITY OF PALM DESERT, "CITY"
DATE:
BIDDER: �C, "CONTRACT(�R"
The UNDERSIGNED, "CONTRACTOR", havmg carefully examined the site and the
Contract Documents for the construction of, TRAFFIC SIGNAL LED INDICATION
REPLACEMENT PROJECT, PROJECT 586-13, hereby proposes to co ct the wortc
in accordance with the Contract Documents, including Addenda No(s). for the
amount stated in this Bid. 1� ����� '
By submitting this Bid, CONTRACTOR agrees with CfTY:
1. That unless withdrawn in person by CONTRACTOR or some person authorized
in writing by CONTRACTOR — not by telephone or telegram — before the time
specifed in the Notice Inviting Bids for the pubiic 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 goveming body of CITY. Said
contract shall only be deemed awarded after the CONTRACTOR'S complete
submission of ali contract documents, bonds, insurance documerrtation, and the
CITY shall obtain all necessary signatures of the goveming body, at which time
the contract shall be deemed awarcled.
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 certif�ed or cashiers check or Bid Bond constitutes a
guarantee tha# if awarded the contract, CONTRACTOR wili execute the
Agreement and deliver the required bonds and cert�cates of insurance within 10
days after notice of award. If CONTRACTOR fails to execute and deliver said
d�cuments, the check or bond is to be charged with the c�sts of the resuitant
damages to CITY, inciuding but not iimited to publication costs, the dtfference 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 invoived, lease and rental costs,
additional salaries and overhead, increased interest and costs of funding the
project, attomey expense, add{tional engineering and architectural expense and
cost of main#aining or construction al#emate facilities occasioned by the failure to
execute and deliver sa+d documents.
Page C-1
it is understood that the quantities shown hereon, except for those quantities marked
"Lump Sum", are estimates and the final payment wiil be based upon the actual work
performed, subject to such adjustment and alterations as elsewhere provided herein.
ETEM NO. PROJECT LOCA710N UNITS QUANTI'T'Y UNIT TOTAL
COST
1 EI Paseo (c� San Pabio Ave. EA 1 �(�� ��?
2 EI Paseo (d1 l.arkspur � � ��=-- �����'J
3 EI Paseo (� San Lu(s Rey Ave.
EA 1 �-►��':l ��
4 EI Paseo � Portola Ave. �A 1 � �
��____
5 Portola FA 1
Ave C� Shadow Mountain 2�-� ,a �°�..
6 Hvry 74 (c� EI Paseo
� 1 31o�p lOc�—`
7 Hwy 74 Q Shadow Mountain � � °°
�+C�'�-� �►�
8 Hwy 74 � Haystack � �
2�r ����
9 Hwy 111 Q Hospitality Row � � ��� ���=�'
10 Hvvy 111 � Deep Canyon Rd. � � °� �
o�
3, " 3,rt�
11 Hwy 111 Q EI Paseo/Cabrilio � � ��°� 2 c-���s-
EA 1 .,, �t � ,o„
12 Hwy 111 � San Luis Rey Ave. 2r`�C� 2,`3�T
13 Hwy 111 Q Portola Ave. � �
3,��- 3 ��"
14 Hwy 111 � San Pablo Ave. � � ��'= 3��=-
15 Hwy 111 � Hwy 7M Monterey � � d°
�•yw�— 2 �a.�
M•� J
16 Flvvy 111 � Town Cenfer WylEl Paseo � � �-"O �'-=
� 3,
17 Hwy 111 (a� Desert Crossing � � p�;p 3 (���
�
18 Hwy 111 � Fred Waring Dr. � � 3��= 3��1�'�
19 Hwy 111 Park View Dr./ Painter's EA 1 » �
� Path 3,�� 3�p��-
Totat Bid Price s �.,Z��=�
Page G2
The costs of any work shown or required in the Plans and Specifications, but not
specifically identified as a Pay Item are inciuded 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.
TOTAL AMOUNT BASE BID IN FIGURES $ ��,�t,JLJ�
TOTAL AMOUNT BASE BID IN WORDS ' W
V �
IN WITNESS WHEREOF CONTRACTOR executed this Bid as of date set forth on
Page C-1: _
By:
Signature
Title: " 1r
CONTRACTOR
State of Califomia )
)
County of ) �
Subscribed and swom to (or � n this day of
(month), , y
, pro e e basis of satisfactory evidence to be the person(s)
who appeared befo .
' nature of Notary (Seal of Notary)
Page G3
CALIFO1zNIA ALL-PURPOSE
CERTIFICATE OF ACKNOWLEDGMENT
State of Catifornia
County of ,.�1 IQe
On � �Al� beforeme, �GQI��II�It, J�I� , � (�y i'U���L
(Here insert name and tide of the o �cer)
personally appear�d C�I��S �s
who proved to me on the basis of satisfactory evidence to be the person(y0J whose name{�ij is/ix�subscri!�e� to
the within instrument and acknowledged to me that he/�/t�er�executed the same in his/p�/�a�,t;�c��;ze '
capacity�),and that by his/3�rI�signature�on the instrument the person�j,or the entity upon nel�_. t'�`'
which the person�acted,executed the instrument.
I certify under PENALTY OF PER,IURY under the laws of the State of Catifornia that the foregoing para�+• ��'�
is true and correct. �„�
JACOUELINE SOLIS
� Commis:foe� t945548
-+ Notary PuWic-C�IBo►nia
TNESS my hand and o �cial s al. , oran9e coumy �
M Comm.Ex :Jut 25 2015
f Notary Pub ic (NoWry Seal)
ADDITIONAL OPTIONAL INFORMATION
tNSTRUCTIONS FOR COMPLETING THtS FORM
Aey acb�owkdgxrenr rnaipleled in Col�rnfa must conloin �Kr6raye e.enc:� ..
DESCRIPT[ON OF TI-�ATTACHED DOCUMENT appecra obore/n�lx no�ory nulon or a sepamte ocknmakdgmr�rr jarnr�nrr��hc
properly comp/e�ed mAd anached to dm�docrrnxat The only escrprfou ::s ±1�..
docwnent is ro be recorded oulside of Cal�(ornia.In aech tns�anres,n�i� ulrcru�,- „•
(Titte or description of aueched documait) ���'kdg�nen�verbla�e as smy be prin�ed on axch a docunrent so Inug ra ;'
verbioge doea not nqulrr the�ary lo do sonrethtrog Ilrat is!!lega!rn,•n r:�..�
Ca!{/'ornfo(t.e. cert(Jptng tlle au�horlud copacuy ojrlre stgner). Pleuse d�r�-1: �.•.
(Title or description of spached daCummt C�ttnued) docrm�ent careft�!!y for proper norarial svaYling muf atrach�his fornt ijrnyuir�d.
Numbd'Of PBgeS DoCument DBte • 5tate and Counry infortnatan must be the State and County�vhere tM:do���. r��
signer(s)personally appearcd beForo ihe nomry public for edcnowledcr� :��
• Date of�mtsrizetion must be the date thet the signer(s)personally ap�carr'»� '
must also be the seme date the acktwwlalgment is completed.
(Additionel infmmation) • The notery public must print his or her neme as it appeats��i;:��i� hi, �, �
commission followed by a comma and then your title(notery publ ic i
• Print the name(s)of docummt signet(s)who personally appear ut th� ��,;
�awrizatioo.
CAPACITY CLAIMED BY THE SIGNER • �nd�cate the coaect singular or plural forms by crossing oflincorc�ce fon l
❑ L1diVidua�(S) ����/�)or ciroling the cortect forms.Feilure to correctl+ �ndi•...,�:
❑ Co te OfflCer • infom�ation may lead to rejection of document rccording.
� The rwtnty seal imprtssion must bo clear and photogrephically r;pro,:�r!
Impression must not rnver�xt or lines.tf seat�mpression smudgcs.;�•sc:: : �
(fitle) su�cieM area pennits,otherwise complete a dift'erent�knowledgmcnt Cu; .
❑ Pet'q1eC(S) • Signeture ofthe notary public must match the signawre on file w�d�the o;'icc af
thc counry clerk.
O Atbomey-ilt-F�t d� Additiotml information is not requircd but could help in ens�in th��
O TTUStCC(s) ackrowledgment is not misuad or etmetud to a ditfbreni,t�cu� crn
❑ �a 4 tndicete title or rype of�tached docwnent,nunber of pagea and d�ir
� Indicate the capacity claimed by the signe�.If the claimcd canacr� ,
corporate offica,indicate the tiUe(i.e.CEO,CfO,Secrctary)
• Secwely attach this document w the signed document
2008 Version CAPA v12.10.07 800-873-9865 www.NcrmryClesses,com
D — fNFORMATION REQUtRED OF BIDDER
The bidder is required to supply #he following information. Additional sheets may be
attached if necessary.
(1) Address ��-�t�Q �• �.� �.� a�t�P,����_lni n'�� �t�3��
(2) Telephone No. __1�,�� �Q���� 1
(3) Type of Firm (Individual, Partnership or Corporation� 1�����
(4) Corporation organized under the laws of the State of ����
(5) Contractor's License No.J('���1� Exp. Date �2`L���1�J
Contractor hereby swe rs under penalty of perjury that this information provided is true
and correct. �
---,x`,
By. __._ Title.�r�S�1���� � � �
- re Contractor �
(6} List the names and addresses of all owners of the firm or names and titles of all
officers of the corporation:
�Y��. �s �S�' i�r �-r� '( '�. v�
_ �
IY - Y�e '(lC� ' '11�� ���D-�t�
(7) Number of years' experience as a Contractor in construction work �
(8) List at feast three similar projects completed recently:
Contract Amour�t Class of Work Date Compieted Name,Address 8�
Tele hone No. of Owner
1. 2,H17,D(��' l,Eb Lk�im r�`t ^ t.:c� �e1es
VQ� ��1'� o�s. r�rem�t►�ve.►�IYY�mVI+ro►a �03
70tC�
2 I 2�c�,a`�� �� �tt� �co K-�r�c�t r�e:
� �f- t�'fl`s ��o,r�err�. ac�i
P�t�-Fx+�ner - -� _
s. It�1,2'-��" �lo�t� � �� 1�11 ►��c C� p�a�T�n ���
��� � � Ca`i9 �'] ��g�
V
Page D-9
(9) Pursuant to Califomia Public Contracting Code, SeCtion 41 QO et. Seq., the
following list gives the name business address, and portion of work {desc�iption
of work to be done) for each subcontractor that will be used in the wo�ic if the
bidder is awarded the Corrtrac#, (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 shali list all subcorrtractors who
wiil perForm work or labor or render service to the prime contractor in excess of
one-half of one percent of the prime's bid. �
Subcontractor's Name: �_��_.1._.�
License Number.
Business Address:
Telephone:
Work Description: Percent of Wo�lc:
Subcontractor's Name:��'�-
License Number:
Business Address:
Telephone:
Work Description: Percent of Work:
Subcontractor's Name:�,
License Number.
Business Address:
Telephone:
Work Description: Per+cent of Work:
�-�
Name of Bidder (`��� �t7� � Signature of der �-
(10) List the n e of�e rson i�ect�edY�of the proposed work for your
f�, ��,�� .S�n�n- ��t�����- ��
(11) A financial statement or other ir�formation and references suffictently
comprehens'nre to permit an appraisal of your curnent financial condition may be
required by#he City. '
Page�-2
E — NONCOLLUSION DECLARATI�N
To be Executed by Bidder and Submitted with Bid
The undersigned declares:
I am the���i�,�•'�,`�� of � S the
party making the foregoing bid. The bid i ot made in the interest of, r behalf of,
. any undisclosed person, partnership, company, association, org ization, 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 indirectiy coiluded, 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 indirectiy, sought by agreement� communication, or
conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any
ovefiead, proflt, or cost element of the bid price, or of #hat of any other bidder. All
statements contained in the bid are true. The bidder has not, directly or indirectiy,
submitted his or her bid price or any breakdown thereof, or the contents thereof, or
diwlged inforrnation 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, joir�t venture, limited liability company, limited liability partnership, or any
other entity, hereby represents that he or she has fuli power to execute� and does
execute� this declaration on behalf of the bidder.
I deciare under penalty of perjury under the laws of the State of Califomia that
the foregoing is true and correct and that this declaration is executed on
� �'„Z_, 20.l.�, at �11'1Ll�t.�H'Y) , ��f�t�0�---
c�► st�e
By: �.�_
Signature
Title
CONTRACTOR
Page E-1
������- ��� �,��,� ,�
F - BIDDER'S BOND
To Accompany Bid
KNOW ALL MEN BY THESE PRESENTS,
That we, as principai,
and 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 attomey, 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.
THE CONDITI4N OF THIS OBLIGATION IS SUCH, that if the certain bid of the above
bounden principal to perform certain work described as foliows:
TRAFFIC SIGNAL LED INDICATION REPLACEMENT PROJECT
Project No.586-13
The general items of work to be done hereunder consist of: replacing tra�c signal LED
modules and dated is accepted by the City of Palm
Desert, and if the above bounden principal
shall duly enter into and execute a contract for such construction, and shall execute and
deliver the PerFormance Bond and Paymen#Bond and insurance certificates as required
by said contract, then this obligation shali become nuil and void; otherwise it shall be
and remain in full force and effect.
Should it become necessary for the City to institute a lawsui�, or any other legal
proceeding to enforce the terms and conditions of this bond, then all costs of said
proceeding, including attomey's fees, shall be awarded to the prevailing party.
�Remainder of thls page has intentionally been lef�btank.
Signature blocks are contained on the next page]
Page F-1
tN WtTNESS WHEREDF, We hereunto set our Hands and Seals this day
� of 20 .
Contractor's Name:
Contractor's Signature:
Title:
Address:
Telephone:
Surety's Name•
Surety's Signature:
Title:
Address:
Telephone:
Acknowledgment
State of Califomia }
)
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) fs/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 hislher/their signature(s) on the instrument the
person(s), or the entity upon behaif of which the person(s) acted� executed the
instrument.
I certify under PENALTY OF PERJURY under the laws of the State of Calffomia that the
foregoing paragraph is true and correc#.
WITNESS my hand and officiai seal.
Signature (Seal)
Page F-2
CERTIFICATION OF SlGNATURE AUTHORIZATiQN
SIEMENS INDUSTRY, INC.
I, Daniei W.Hislip,the undersigned Secretary,do hereby certify thaG
DARYL D.DUL4NEY President$CEO
NELMUTH IUDWIG Executive Vice President
AXEL MEIER Executive Vlc,�e Prestdent�
Chief Financiai Officer and
T�easurer
DANIEL W.HtSLIP Vice President,
General Counsel8 Secretary
of SIEMENS INDUSTRY, INC.(the"Corporation'),a corporation duly organized and exisbng
under the State of Delaware,are duly authorized to execute any and all Agreements without
limihatian regardtng the amaunt,subject to the requiremerrt of dual signature authorizatlon.
1 further certify that the above named Officers are authorized to execute on behatf of the
Corporation,without regard to amount,bids,proposals,r�equests for proposals or quota�ons,bid
bonds, payment bonds,petformance bonds,maintenance bonds,change orders,Technlcat
SuPport program Agreements,ar�d woric orders and their signatures o�these documents are
binding on the Corporatfon.
IN WITNESS WHEREOF, f have hereunto subscribed my name and affixed the corporate
seal of the Corporation,on this 1st day of October 2011.
�
1
1
� � `
.
Daniet W.Hislip f
V�ice President� `
General Counsel&Secretary
Siemens Industry�tnc.
Signe before me this 1st day of October 2011.
�2. I�r �,,,�����►,,,,
�a � Mco ��,
No Public `.``,��� � '���
2 ���•�:�`�o��
= � '� � -
—i ,e",� — i.�—
.—''.�i y91��+ �Q�
IiO�'R�Ye '�i�'f ��
�,FF �....c.r Gt�•���
�����Ca tK�(```���
ACKNOWLEDGEMENT O�APPOINTED SIGNATURE AUTHORITY FROM
PRESIDEN7 AND CHIEF EXECUTIVE OF�ICER DARYL DULANEY
AND CHIEF FINANCIAL OFFlCER AXEL MEIER
OF THE INFRASTRUCTURE&CiTIES SECTOR OF
SIEMENS INDUSTRY, INC.
A. We, the undersigned. Daryl Dulaney, Pres�ent and Chief Executive �fficer and, Axel Meier, Chief
Financial Officer oi the infrastructure 8 Cities Sector of 5iemens Industry, lnc.(the'Corporatton7
a aorporation duly organized and exis�ng under the laws of the State of Delaware,by virtue oP the
authotity vested by the Board of Directors of Slemens lndustry, lnc.and in accordance with the ey-
laws of the CorporaCbn and the laws of said State, do hereby acknowledge that the foilowing
individuals: (1) have been appointed to their respective offices as set out herein beiow in
accordance with the By-laws of the Corporation; and (2) are hereby authorized to sign or
countersign and otherwise execute in the name, or on behalf of thelr respedhre Divisions or
Business Units of the Corporation, any bids, proposals. bonds, reteases and waivers of liens, and
any certiticates, affidavits, or anciliary documents in connectton therewith; any Ikenstng
qualification or registraGon fclings, retums, certifica6ons or questionnaires; any oontracts, leases,
agreements, guarantees and any certificates, affidavits, or ancillary dxuments in connectbn
therewith, up to and including a transactlonal limit of 510,000,000.00; and any releases,
compromises or settlements in connection with claims or disputes arising out of any such
transactlon.
� Authorized Slgnatories
Business Operations Finance/Central Support�unction
(Name/O�ce) jName/Office)
Matthias Rebellius Mark Evans
President, Building Technotogies Division Vfce President,Finance and Business
Administration, Building Technologies
Dtvision
Kevin Yates qnton�uvell
j President,Low and M�dium Voltage Division V'�ce Prestdent,Finance and Business
Administration,Low and Medium Voltage
i
DIViS�0�1
Terry Heath Martin Schul�
President, Mobility and Logistics Dlvision Vice President,Finance and Business
AdminisbaGon,Mobiliry and Logisacs
Division
Thierry Godan Mactin Schultz
President, Smart Grid Division Vice Presiden� Finance and Business
Administratlon Smart Grid Division
Michael CahU! Christopher Hatleus
President, Ra�1 Systems Division Vice President, Fnance and Business
Administration Rail S stems Division
Tom Kopanslci Steve Monetta
Sr.Vice President, tndustry Sales vice PresidenE, Finance and Business
Admtni5twation Indust Sales
Atex Stuebler Mitch Flanagan
Vice President,Stra Vice Preslden Co rate Controller
8. We funher ackaowledge that each of the signatures of the persons refeRed to in paragraph A is
binding upon the Corporation.
C. We further acknorMedge that any document shal! require the signature of 1wo j2j of the abcve
Authorized Signatories,one each from Business Opecations and FinancelCentral Support Function,
whom shall have the requisite slgnature authority lo be legally bind'mg upon the Corporation.
;o�2
D. We further acknowledge that each of ihe persons reterred to heretn Is authorized to delegate such
pe�son's sutharity hereunder to addkional membere of hts or her management team up tn the Iimit
of such petson's detegetion of euthorily,provided that stx:h delega�on la in wriiten fvnn stgned by
the�legabr and filed wlth ihe Legal Departmer�t,
E. We turthar ackncwledge that the Secretary or an Assistant Secreiary ot the Corporaaon ls
authorized 6� issue �cetlons att�snng oo ma u�umbency, auttwrtty and status of any ot the
persons referred to in thls resolution.
W WITrtES8 WHEREOF,we have hereunto subacn'bed our names and affbced the corporate seal
of the said Corpo�atfon,on this 1 a day of June,2012,
Datyi Dulaney
PresideM&CE
Siemena Indus , c.
A�te{ ter
Executhre VP,CFO
5lemens Industry.Inc.
2 of 2
DELEGATION OF APPROVAL AUTHORITY FROM
PRESIDENT TERRY HEATH
AND VICE PRESIDENT FINANCf 8 BUSINESS ADMINISTRATION MARTIN SCHULTZ
SIEMENS INDUSTRY�INC.—MQBILITY AND LOGISTICS DMSION
IL We,the undersigned,Terry Heath�Prostdent and Martln Schultz�Vica prasider�t�p�nance and
Business Administratton of the Mobility and Logistics Division of Siemens Ir►dustry,Inc.(the
'C��poradon��a cocporation duly organized and existing under the laws of the State of Delaware, by
virtue of the auMority veated in us as Pre.�ident snd V'�ce President Finance g gusiness
AdminisVation to sign or courttersign and otherwise execute in the n�ne,or on behalf of the
Corpcxaaon,any bids,projects,contracts�agreeme�s and any certificates,affida�vits or ancAlary
dxuments in connection the�ewilh for and on behalf of the Corporation�do hereby dele�ate to and
acknowledge that the followinp Person(s)maY exercise such authorily for and on our behalf up to S2
million.
U R SI OR S
Bustness Ooerations , Finance/Central Su000rt Ft�nction
Dana Resmussen �
Dirk Giaser
Service ment Head Fgq
Neway Redia
&ervice ment FBA
B. We iurther adu►owledpe that the follawing individuals ar�e h�eby authorized to sign or countersign
and Mheiwise axecute in the name.or on behalt of the Corporatior►.the same documents as
refisrenced in para�raPh q�up to and induding a trensactional limit of s500.000. Any such delegation
n Pxtends b but is limited to tt�same soope.dxumen�and subject matter as rcierenced�d granted
9raPh A.Umited to the monetary�nount stated in th�Paragraph.
AUTHORIZED SIGNATORIES
i � Financel�Centra!Su�oort Function
Nam kio N P i n
And�+ew Posber �ef�y Enge!
�� r FBA
Chris Reyes Tara Inbon'boon
Area M �
Jii Pe�rie
tfons mana
Tim Carter
�s er
Mdrew Rist
erations �
Christopher Romeo
s ma er
Steven Tesl
O �ions mana r
C. We further acknowledge that each af the signatures of the persons refeRed to in Pe�a9raphs A and B
are bind'm4 uoon th�Corporation.
D. We further adcnowledge that any docurnent shaa r�equire tt�e signature of two(2)of the above
A�thorized Signatories,one ead�from B�sin�s pperepons and from Fnance/Centtal Support
Functlons,whom shaM have the requisite aignature authority to be legally binding upon the
Corporatio�.
E. We further adcnowkdge that each of the persons referred to herein k authorized�o delepate such
Person's�uthority hereunder to additionai m�nbers of his a her management te�rn up to the limit of
��Pe�$delegation of authority,provided that such delegation is in written form signed py the
delegatw and filed with the Legal Departrnent,
F. We furtAer acknowiedge that the Secretary or sn qss�ant Secretary of the Corporation is authorized
to issue certificatjpns attesting to!he inc:umben�y,authoriry and status of any of the persons referred
to in this resolution.
IN WtTNESS WHEREQF.we have hereunto subscribed a�r names and affixed!he corporate seal of
the said Caiperation.as of the 1si day of October,2012.
l `
Terry Heath
President
Skmens Industry,lnc.
MobiNly and Logistic�s pivision
, r��.
��r
Marti ultx
Vice President,Finence and Business Adminlstretion
Siemens Indusiry�inc.
AAobliiy and LoQistks Division
2
�. •�
• ' • • . .
F— BlDDER'S BQND
� To Accompany Bid -
KNUW AI.L MEM BY THESE PRESENTS� �
That we, s� �. �• as p�nclpai�
and Fe�al �um�ce c�m�e�ny as aurety� are heid end
' flrmly bound unto the Clty of Palrn Desert in the sum of$T�� � # (10°� of bid)
' to be pald ta i�he sald City or Its certaln attomey� tts successors and asslgns; far wh�h
payment, wett and truly to be made. we bind oursetves� our helrs� executors aru!
admtntstretots� successors or assigns,jolnfh►and se�raily�flrmly by these presents.
THE CONDITION OF THlS OBLtGAT14N iS SUCH� that if the certaln bid of the above .
bounden principal to perForm certatn work descrtbed as follows:
TRAFFtC SIGNAL LED INDICATION REPLACEMENT PROJECT
• Project No.586-13
The generai Items of vu�oric fia be done hereunder consist of: replacfng trafflc signal E.ED
• modules and dated Fe�� �� �� fs accepted by the City of Palm
Desert,�nd ff fhe above bounden princlpai s�r,s �y, �.
shaU duly entsr tr�to and execute a contract for such construcflon, ar�d �aN execx�te end
deliver the PerFom�ance Bond and Payment Bond and insuranoe cartl�c:afes as required !
by said oor�tract, then this obfiga�on shall become nuli and vold; otherwise i� shall be �
and remaln In futl force and effect. �
ShaWd it become necessa for the C fo Institube a lawsu�, or a otNer af I
rY �Y nY � �
praceeding to enforrs the terms and condlfions of thls lxmd. then eii cosfis of sald `
proceeding, Indudtng attome�'s i�es�shall be awarded 6�the prevaltir�g Party. I
' ' f
. �
i
jRematnder of th/s p�ge has lnter►t��nally been leR blanlG �
• SiBnafuna bibcke are vontafied on fhe next pageJ
. . . �
. ,
• � �
* �mamt �d ' �
. ;
. • �
. �
�
,
. - �
Page F-1
;
IN WITNESS WHEREaF,We hereur�to set o�r Hands and Seats thls � day
• Of F�' 2� 13 .
J
' Cortitractor's Name: � �, �• r
�
Contractor's Slgnature: -
Ti�e. � �
Address: i�t' No��' Ia�'°ma , A�t'e�m, C�' 92806
Telephone: �,,,�����D�"���1.�
�..�.._..__�
Surety's Name: �
. ____
Sure#y's Signature: �____ .
Tl�e: S� � , IirF'act
Address: 15 Mwnrain View Road, t�rr�, xT o7a99 ----
Telephone: �`�� `� ' �'`�
Acknowtedgment
. ,
State of Callfomta )
� - �
CouMy of, ) �
�
�
�
On be�are me�
personally appeared ' �
, wno proved to me on the ba�s of
sa�sfactory evtdence to be the person(s)whose name(s}Is/are subsctibsd to the wfthtn
lnstrument and acknowledged to me that helshe/they executed the same in hiaJher/their �
authorized capaclty(les)� and that by his/herlthetr sigrtature(s) on the insfrument the �.
persan(s)� or the en�ty upan behaif of which ths person(s) ected, executed the �
insfrumen� •
I cer�fy under PENALTY OF PERJURY under the laws of the State of Caltfomia that the �
foregoMg paragraph!s true and comact.
WlTNESS my hand and ofFl�ai seal.
Signature (S�� . '
Page F 2
ACKNOWLEDGEMENT OF SURETY
STATE OF Connecticut
COiJNTY OF Hartford
On this 21st day of February,2013,before me personally came Stacy Rivera,to me
known,who,by me duly sworn,did depose and say that she is the attorney-in-fact of the
Federal Insurance Company,that she knows the seal of the corporarian;that the seal
affixed to the said instrument is such company seal;that it was so affixed by order of the
Board of Directors of said company and�she signed her name thereto by Iike order.
��
;
, �
.�__.. _
ry Public,Jul' erry f
'� y Commission xpires: �31/20I5
� Chubb ��R F��Insurance Company Attn: Sur+ety Department
0� Vigilant Insurance Compairy 15 Mountsin View Road
Surety ATTORNEY pad�C Indemnrty Company WaRen,NJ 07059
OF1N�i
Knaw All by These Preser�ts, That FEDERAL INSURANCE CO�APANY, an Indiana corpora6on, VIGILANT iNSURANCE
COMPANY, a New Yoric oorporation,and PACIFlC INDEMNITY COMPANY,a Wisconsin oorporation,do each hereby constitute and
appoint Aiza Lopez,Jeannette Porrini and Stacy Rivera of Hartford,Connecticut
each as Mar tnu and law�i�l AtEorneY-er Pad to e�ecule w�der weh deMpna�On in M�eir names�e to aMbc tl�ir oorporaee aesis to and detiver far and on tlxir betWf as suroy
therBon Or oplsiwiss.6onds and undertalangs end Otllalr urtiGl�gS obRpido�y in Ute n�ure lhere0f(o01et tharl bal bOflds)0��Ot lorocu6ed in the Coutse of buskMas�etb anY
wwmems amending or a�a�tp th.sams�and�to a+e nqdfficstlon or aRera�on a any ins+n,merd rsiened 6o in sew eonds w oaqauovn.
In Wlbwss WhMof,said PEDERAt.INSURANCE COMPANY,YIti1LAM INSURANCE COMPANY.and PACIFIC INDEMNI'iY COYPANY hwe esrh�d r�d albe�ed
meae p�and artboea aie�r'oorpoiaoe eea�s on o►�s Stfi day m October,2011.
v_ ;�� � f t
�.071�1�����w_�/w� 8.Naiis�Jr.�Vice PreeidaM
STATE OF NEW JERSEY
ss.
CourUp of Sot�rset
a,nrs Sth aay or October,2011 asrwe me,a No�ry P►,a�or New.iener.ve�h�w�Kennea�c.wenaei.m�
known q be Assiqant Secrefiry of FEDERAL INSURANCE C�iIPANY,VIGNANT iNSURANCE COMPANY.and PACIFIC INDEMNITY COMP/WY.the eomptni9c whbh
sxeeu�d Ihe b�epoi�p Powa ot At�omey,rb 1he sad Karw�dh C.VVendel�beinD bY me duy swom�did depoYe end aay ihat he i�A�(�ent SeasLry af FEDERHt
IMSURANCE COMPANY,VI(iIUWT INSURANCE COMPANY.and PACIFIC MDEI�I'Y COMPANY arb knowa the ootporaoe seala tl�eof.tlnt tl�e aaals ai�oad to tlro
taepoin0 Powsr O(AtEomey ere sudt oaporate ssilt and Wers ihero�D sl�aed by suqardy of tlu 8y-L.aws oF said Cortpanies�and Met he signed sWd Powet d Attomey at
AssiataiR S�r d seid ComPanks M�ce aWhoriy,and that he it acquainler!wilh Oavid 8.Nortb.Jr..and kiwrrs him to be 1Ra P�idaK d saW CompaNas;and that ths
siDnatwe of Davki B.Nortis.Jr..arbscxibed bo said Power of Atto►ney is in tlie genuine handwrN4p of Oavid B.Naais,Jr.,and was tl�nato subaaibed by autlwrily of wid 9Y-
Laws end in daponanYs pr�ence.
"°���'' KATHERINE.!�
' NOTARY PUBlJC�NEW JERSFI G�%l.� /r
�OtAR N�►.Z316ba5
�" Ca^Mbdoi►E�pYw,1Y1!►lb�TA11
pUBLIG f Nofary PubNc
��►JERS�� CERTIFICATION
Extrad(rom Uie�r-laws af FEDERAL INSURILNCE COMPANY.VKsitANT INSURANCE COMPANY.and PACIFIC INDEMNITY COMPANY:
"AN pqweis of aleomsy for and on behaM d Ih�Company msy and ahsl be txed�bed G11hs neme ard on beAelf d tl1e Cotnpany�eilhe�by the CFwkrnfn or the
Pre�ideiu or a Vbe Proqdeirt a m AselataM V�e P►esldant.lo�ty w�h the Sea�lary ar an AasistanR Seaehry.under Me'v rerpx.dve desip�tAiona.71fe
sip�atwe d wfi ofiaB mey 6a er�aved.P��d or rtl�o�aPhsd.The afpnahr��esch ot Me foNow�g ailic�►a:t�akman.ProsidenR�Vlcs Prs�Wxit airy
Atsi�t Vke Proeident,anY Se�ry,anY Assi�t Swefary and tl�a ae�l of the CompaM maY be atroaed by�e�anY Powar ot allorney or b wny
ceNficste�Itng M�appokHinp Asdster�SaxamAes a A16orneys-M-Fact for purposes oNy d�and atlestlng baids and undatakYqs and omer
w�np.owp.mry k►r,s na�ua n�rsof�ana u,y sucn paa�a auomay or oetBfic�e 6�r�sucn taaknNe sfpns0xe or aaNnAe.s�l aw De v�Na and eindinp
�on tlie Comprn�r and airy auch pawer so sxeqd�d and aadsed bY wch taaimib algnaWre and facsimNe seal shel be vaNd and Wnding upon the Comp�ny
wiM rs�pect�aig�boM or�xidataldrp bo�whfd�it is 1asd�ad.'
t,K�nnaC�C.Wendsi,AssislaM Seae�ry af FEDERAL iNSURANCE COA�PANY,V161tANT IMSURANCE COMPANY,and PAC�IC INDEMNRY COA�ANY
phe'companies�ao neraeY oerlih n�et
(� tha totepoitlp a�ctract d t�e By-laws o(Ihe Compar�a is bus and consct,
0� Ihs Car�SrYse ais dttly Ncaa�d and autllo�ised to tren6ad w►�ly businses in ap 50 of the UniEsd StaEet af Arnerica end ths Disbid ot Calumbis and aie
�by!he U.S.TreaeuY��C fiutlbr.Federal and 1RgNaM are Nanaed h Pua1D Rioo end tl1e U.S.Ykgk►Islanda.and Federal le ikeMsO in
Atneriran Sartq�.Gudn,end earh af tl�e PrO�rinces of CY�da e�aoept Prinee EdNrerd lshnd:81d
(f� the Tonepdng Power of Aaomey is true.�s�3 and in fu8 face and e1fBd
G'wen uiWer my hmid end.���rsaw com��a�werre�,NJ fhis 21st �y m Febntaz9. 2013
��� � �
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IN THE EVENT YOU W1SH TO NOTiFY US OF A CLAtM,VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY U8 OF ANY OTFIER
MATTER,PLEASE CONTACT LS AT ADDRESS LISTED ABOVE,OR BY Tslephone(908}903-34�3 Fax(908}9D3-3666
e-mail: chubb.com
Form 15-t 0-0225&U (Ed.5-03) CONSENT
.,
FEDERAL INSURANCE COMPANY
STATEMENT OF ASSETS,UABILlTIES AND SURPLUS TO POUCYHOLDERS
Statutory Basis
DECEMBER 31,2011
(in thousands of dol�rs)
LlABILITIES
AND
ASSETS SURPLUS TO POLICYHOLDERS
Cash and Short Term Investments................ $ 151.942 Outstend'mg Losses and Loss Expenses..... $ 12,300.432
Unitad States Govemment,State and Uneamed Premiums..................................... 3,395,082
Municipal Bonds......................................... 10,312,572 Ceded Reinsurance Premiums Payable....... 320.332
Other Bonds.................................................. 4,146�378 Provisfon for Reinsurance............................ 80,930
Stocks........................................................... 779,367 Other Liabilities............................................. 922,290
Other invested Asse�s................................... 1,924,895
TOTALINVESI'IVIENTS............................... 17,315,154 TOTALUABILi'ftES.................................... 17,019,066
Investments in Affiliates: Special Surplus Funds................................. 222,832
Chubb Investm�t Holdings,Inc................ 3,212,072 Capfta!Stock................................................ 20,980
Pacific Indemnity Company........................ 2,440,763 Paid-In Surplus............................................. 3,106,808
Chubb Ir�surarx�Irnesvr�ent Hold'mgs Ltd.... 1237,556 Unassigned Funds....................................... 10�356,926
Executive Risk Ind�nnity lnc...................... 1,076,901
CC Canada Hold'mgs Ltd............................ 747,660
Great Northern kisurance Company.......... 436,665 SURPLUS TO POUCYHOLDERS.............. 13,707,546
Chubb Insurance Company of Australia Limited 404,315
Cfitibb European Investrnent Hddmgs SLP.. 251,756
Vgilant Insurance Company...•-••••.............. 233.6d4
Other Afflliates............................................ 4Q9.535
Premiums Receivable................................... 1,470�010
Other Assets................................................. 1,490,621 TOTAL LIABtUT1ES AND SURPLUS
70 POUCYHOLDERS............................. S 30,726,612
TOTAL ADMITT�ASSEi'S...................... $ 30,726,612
lnve.sbnents are valued��rdance wfth requfrements of the NaHonal Associetbn of Msurance Commissioners.
InvestmeMs with a carrying value of$431,309,571 are deposited with govemmerrt suthoritles as requireci by!aw
Sffite,County&City of New York, — ss:
Yvonne Beker,AsSistant Secretary of the Federal Msurance Company
being duly swom,deposes and says tl�at the forego&�g Sffitem�t of Assets,E�abilities and Surplus to Pdicyhold�s of said
Federal lnsw'ance Compeny on December 31,2011 �true and correct and is a true abatrad of the Annual Statemerrt of sald
Company as filed with the Secretery of the Treasury of the United States for the 12 montl�s ending Decemb�31,2011.
Subscxibed and swom ta before me
this Merch 31,20i2 ^�
�� ��
�,ro DOROTHY M.BAKER ��re�Y
Notary PubNc,State of New York
Notary Publ'ic No.31-4804994
�ualified b�New Yark County
Commission Se .14,2013
w�,is�am���.sn�
��
CALIFORNIA ALL-PURPOSE �
;
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County of O l, �
y� , �
On����� ����3 before me, �cqueline 5���S� �� !'Ub��� _
{Flerc insert name and title ofthe o icer)
(�f50118j�Y AppCBfCt� I J _____. -
who pmved to me on the basis of satisfactory evidence to be the person�whose name� is/�subscribn�:: �
the within instrument and acknowledged to me that he/�h@/�h6j� executed the same in his/�auti�or;��u
capacity�ip�,and that by his/F�b�lt�iPsignature�llj on the instrument the person�J,or the entity upon behalf� .'
which the person�acted,executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paj•n ••�,
is tcue and correct.
���JA�UE E SOLIS
Commissioe� 19�5548
W ESS my hand and �cial l. w•< Notery PubUc•Ca�NornN
_ . Onnqe County
ConMn. et Jul 25 20/5
Si o Public (No�ary Seal)
ADDITIONAL OPTIONAL INFORMATION
INSTRUCT[ONS FOR COMPLETMG TH1S FORM
Airy aclurmekdgme»r eompkad In Ca/iJ'ornia must ca�tain rerbiage c.cn r1� ,,
DESCRIPTION OF Tl�ATTACHED DOCUMENT apptars obove in ths�rokuy secdon or u sepamte acbwmledgx�cur Jvr�»n::rs, h�
properly compkted w�d artached to rhar docrm►enl. The onh� esc��tio,. �t ;�
doca►xent is to be ncav�ded oalside ojCaljfonda./n such insrances.aeir aher•,,.ir,�
(Title or descri�ion of attached document) ��'tedgaun�verbiage as�vy be prfnted a►such a documenr so lnns<
verWage does►ro►nqnin�he►atary to do sa►ie�hfng lha�Is J/lega!jor u�m.n+� r�
Calj�ornia(l.e. cert�'ylilg tht authorced capaclly of 11x slgner). Please ch,cti i r;
(Tide or desuiption of apaclxd document continued) docwnenr canju!!y jor proper notarial�nordfng and attach�fiis jornl rf�•eqlri�.'.
Number of P s Doeument Date • State and Counry information m�t be the Statc and County�vherc tl,r ' -i..u� •
� S�6^�K$)P����Y ePP���fnre the nWary public for ackno���•demrm
• Date of notarization mu�t be the date that the signa(s}personally a�penrr��.i, •
must also be the same date the�knowledgmc�is completed.
(Additio�rel information) • The notary public must print his or her name os it appears��iihm his or I �
commission followed by a comma and then your title(notary publi:).
• Print the name(s)of document signer(s)who personally appear at thc[ime �
notari7ation.
CAPACITY CLAIMED BY THE SIGNER • lndicate the correct singulaz or plural forms by crossing off mcorreci fur:,s �
O Individual(s) �/sh�/thy;-is/a►e)or circling the correct forms.Pailure ro correcAy md�c:•..
infortnation may kad M tejection of documeN rccording
D Corporate Officer • The notary seal imprcssion must be cleer and photographically reproc:.:c b!e
tmpression must not cover text or lines.!f seal im{�ession smudgcs.re-sra r
(Titk) su�cient erea permits,othenvise complete a differom acknowtedg�r,rnt lo:m
❑ Pstttlel'(S) • Signaturc ofthe notary puaic must metch the signatiae on file with�:ic o:.'
the co�ty ckrk.
❑ AttOi[ley-in-FBCt 4 Add'Nional infonnation is not requircd but could help to en,�..c �li�,
� Trustee(S) �knowledgment is na misused or attached to a differmt documen!.
� ��. .► (ndicate title or rype of atmched document,number of peges ar�d u..._
O Ind'tcale the cepAcity cleimed by the signer.lf the clmrtted can�c�t� �,..
corporote officu,indicate the title(i.e.CEO,CFO,Secretar�)
• Securely aUach this document to the signed document
2008 V�sion CAPA v12.10.07 800-873-9865 www.NotaryClasxs.com
PROJECT LOCATIONS LIST
TRAFFIC SIGNAL LED INDICATION REPLACEMENT PROJECT
PROJECT NO. 586-13
12" 3- 12" 3- 12" 4- 8" 3-
No. Project Location Section Section Section Section
Heads All Arrow Heads Heads
1 EI Paseo @ San Pablo Ave. 7 3 4
2 EI Paseo @ Larkspur 10 4
3 EI Paseo @ San Luis Rey Ave. 4 4 8
4 EI Paseo @ Portola Ave. 8 8
5 Aor�tola p� Shadow Mountain 10 4
6 Hwy 74 @ EI Paseo 9 8 3
7 Hwy 74 @ Shadow Mountain 14 4
8 Hwy 74 @ Haystack 13 4
9 Hwy 111 @ Hospitality Row 6 4 6
10 Hwy 111 @ Deep Canyon Rd. 12 8
11 Hwy 111 @ EI Paseo/Cabrillo 12 4
12 Hwy 111 @ San Luis Rey Ave. 14 4
13 Hwy 111 @ Portola Ave. 11 8
14 Hwy 111 @ San Pablo Ave. 12 8
15 Hwy 111 @ Hwy 74/ Monterey 12 8
16 Hwy 111 @ Town Center Wy/EI Paseo 12 8
17 Hwy 111 @ Desert Crossing 10 6 2
18 Hwy 111 @ Fred Waring Dr. 12 8
19 Hwy 111 p� Park View Dr./Painter's 15 4
Path
Total LED Signal Heads 203 109 2 21
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